Manual therapy practitioners frequently work with clients experiencing chronic or persistent pain, yet many commonly held assumptions about pain can unintentionally limit clinical reasoning and outcomes. These misunderstandings are rarely due to lack of training; rather, they reflect the persistence of outdated pain models that remain influential in everyday practice.

Recognising these misconceptions is an important step in improving both practitioner confidence and client understanding.

Pain Always Reflects Ongoing Tissue Damage

One of the most enduring misconceptions is that persistent pain must indicate ongoing tissue injury or structural dysfunction. While tissue damage is relevant in acute presentations, pain that continues beyond expected healing timeframes often cannot be explained by tissue pathology alone.

When pain is viewed solely through a structural lens, treatment may become overly focused on repeatedly “fixing” tissues that are no longer the primary driver of symptoms.

Stronger or More Frequent Treatment Produces Better Results

Another common belief is that increasing treatment intensity or frequency will eventually resolve persistent pain. In reality, some clients experience increased sensitivity or symptom flare-ups with repeated or aggressive intervention.

This misconception can contribute to treatment plateaus, practitioner frustration, and clients feeling as though their body is “not responding properly,” rather than recognising a need to reassess the overall approach.

Pain Severity Matches Tissue Severity

Many practitioners are taught, implicitly or explicitly, that higher pain levels reflect greater tissue damage. In persistent pain presentations, this relationship is often inconsistent. Clients may report significant pain despite minimal objective findings, or experience fluctuating symptoms unrelated to mechanical load.

Failing to recognise this disconnect can make pain feel confusing or invalidating for clients, particularly when explanations rely heavily on imaging or structural findings.

Pain Is Primarily a Local Problem

Chronic pain is frequently approached as a local issue, targeting the site of symptoms while overlooking broader contributors such as nervous system sensitivity, stress, sleep disruption, and cumulative load. When pain is framed purely as a local problem, opportunities for more effective education and expectation management may be missed.

Why These Misconceptions Persist

These beliefs persist because they are deeply embedded in traditional musculoskeletal education and reinforced by early clinical experiences. They are not the result of poor practice, but of models that do not fully account for the complexity of persistent pain.

Moving Beyond Outdated Pain Models

Challenging these misconceptions allows manual therapy practitioners to refine clinical reasoning, improve communication with clients, and reduce frustration when progress is slow or unpredictable. Understanding pain as a multifactorial experience supports more realistic expectations and more sustainable care strategies.

Our CPD courses are designed to help practitioners move beyond outdated pain models and develop greater confidence when managing complex and persistent pain presentations.