Manual therapy practitioners often work with clients experiencing complex pain or persistent fatigue that does not follow predictable biomechanical patterns. One of the greatest clinical challenges is explaining these conditions clearly and honestly, without making clients feel dismissed, blamed, or misunderstood.

Effective communication is not about simplifying the condition to the point of inaccuracy, nor overwhelming clients with technical detail. It is about providing explanations that validate the client’s experience while expanding their understanding of what may be contributing to their symptoms.

Why These Conversations Are Challenging

Clients with chronic pain or fatigue are often searching for certainty. Many have seen multiple practitioners and may feel frustrated, confused, or fearful about the meaning of their symptoms. When explanations focus too heavily on “nothing being wrong” or lack clear rationale, clients may interpret this as disbelief or minimisation.

At the same time, over-emphasising structural damage or permanent dysfunction can unintentionally reinforce fear and dependency.

Common Phrases Practitioners Struggle With

Manual therapy practitioners frequently hesitate around phrases such as:

• “Your scans are normal”

• “There’s no tissue damage”

• “Stress may be contributing”

• “Your nervous system is involved”

Without context, these statements can sound dismissive or imply that symptoms are imagined, even when that is not the intention.

Reframing Explanations Without Invalidating Symptoms

Reframing involves shifting from a damage-based explanation to a function-based understanding, while clearly stating that the pain or fatigue is real.

Helpful approaches include:

• Emphasising that symptoms are protective responses, not failures

• Explaining that the body can remain sensitive even after tissues have healed

• Normalising variability and flare-ups without implying weakness

This allows clients to understand their condition without feeling blamed or dismissed.

Reducing Fear-Based Language

Language matters. Descriptions that focus on degeneration, instability, or permanent damage may increase fear and reduce confidence in movement. Clear, neutral explanations help clients feel safer and more engaged in their care.

Reducing fear does not mean offering false reassurance; it means choosing language that supports understanding rather than alarm.

Building Trust Through Clear Communication

When clients feel heard and understood, they are more likely to engage with management strategies and maintain realistic expectations. Strong communication supports therapeutic alliance, reduces frustration for both practitioner and client, and improves long-term outcomes.

Several of our CPD courses focus on improving practitioner confidence in these conversations, particularly when working with complex pain and fatigue presentations.