An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments

Neil Tuttle, Charles Hazle

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Most literature on decision processes within physiotherapy relates to “reasoning that results in action”–decisions based on information including assessments that are gathered prior to treatment decisions. A process of “reasoning in interaction” that is often used, particularly by expert clinicians, has received less attention. Objective:  To provide a theoretical and practical approach to applying reasoning in interaction in a musculoskeletal setting. Methods: The theory is: If an impairment that can be directly targeted by treatment (i.e. pain or limitation of passive movement) is related to patient’s active impairments and functional limitations, then moment-to-moment changes in the targeted impairment can be used as feedback to guide real-time treatment modification before formal reassessment of functional limitations and other impairments. Results: Applying the theory to manual therapy results in parameters of techniques such as force, speed, direction and duration no longer being pre-determined, but rather being continually adjusted in real-time according to feedback from the patient through both therapist perception (changes in movement quantity or quality) and patient verbal responses. Conclusion: A process of continuous decision-making is described that the authors believe is used by many experienced clinicians but has not previously been adequately described in the literature. .

Original languageEnglish
Pages (from-to)775-786
Number of pages12
JournalPhysiotherapy Theory and Practice
Issue number7
StatePublished - 2021

Bibliographical note

Publisher Copyright:
© 2021 Taylor & Francis Group, LLC.


  • Clinical reasoning
  • clinical prediction rules
  • individualized patient care
  • spinal mobilization

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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