More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain—a qualitative study

Kesava Kovanur Sampath; Prashant Mishra; Tep Mills; Gary Fryer; Rebecca Mowat; Oliver P Thomson; Jerry Draper-Rodi; Brett Vaughan

doi:10.1136/bmjopen-2025-113886

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More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain—a qualitative study

Kesava Kovanur Sampath, Prashant Mishra, Tep Mills, Gary Fryer, Rebecca Mowat, Oliver P Thomson, Jerry Draper-Rodi and Brett Vaughan

BMJ Open, Vol.16(6), pp.1-12

2026

DOI: https://doi.org/10.1136/bmjopen-2025-113886

PMID: 42373186

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Abstract

Objective: To explore how physiotherapists and osteopaths who use manual therapy in New Zealand conceptualise, reason about and manage upper back pain (UBP), a clinically relevant but inconsistently defined musculoskeletal presentation. Design: Qualitative study using semistructured interviews and reflexive thematic analysis. The study was conducted and reported in accordance with best-practice qualitative guidance, including Consolidated Criteria for Reporting Qualitative Studies. Setting: Private and public musculoskeletal practice settings across New Zealand. Participants: 17 physiotherapists and osteopaths with a minimum of 2 years’ clinical experience, recruited through national professional networks. Results: Data analysis resulted in the generation of four themes: (1) a fuzzy construct; (2) more than biomechanics; (3) hands-on leads to facilitate active care and (4) towards patient-centred care. The analysis revealed an interconnected progression across the key themes, which reflects not only the evolution of clinical practice but also the integration of contemporary evidence, highlighting a shift from intervention-focused to relationship-focused and collaborative care. Conclusion: Clinicians conceptualise UBP as a complex and multifaceted condition, increasingly managed through biopsychosocial reasoning, self-management strategies and patient-centred care. However, definitional ambiguity between UBP and thoracic spine pain, combined with profession-specific patterns, demonstrates the need for clearer terminology and greater interprofessional alignment. Further research incorporating patient perspectives is required to inform guideline development and promote coherent, evidence-informed care for UBP.

Details

Title: More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain—a qualitative study
Authors: Kesava Kovanur Sampath (Corresponding Author) - RMIT University
Prashant Mishra - Waikato Institute of Technology
Tep Mills - Waikato Institute of Technology
Gary Fryer - Victoria University
Rebecca Mowat - Auckland University of Technology
Oliver P Thomson - Health Sciences University
Jerry Draper-Rodi - Health Sciences University
Brett Vaughan - The University of Melbourne
Publication details: BMJ Open, Vol.16(6), pp.1-12
Publisher: BMJ Group
Date published: 2026
DOI: 10.1136/bmjopen-2025-113886
ISSN: 2044-6055
PMID: 42373186
Copyright note: © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
Data Availability: Data are available upon reasonable request. De-identified data that support the findings of this study are available from the corresponding author upon reasonable request. Requests will be considered in accordance with participant consent, ethical requirements and the need to protect participant confidentiality.
Organisation Unit: Healthy Ageing Research Cluster; School of Health - Nursing
Language: English
Record Identifier: 991243698402621
Output Type: Journal article

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Web Of Science research areas: Rehabilitation

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