18/07/2026
"A bit of exercise and a bit of manual therapy."
That's the phrase Jeremy Lewis, Paul Mintken and Amy McDevitt talk about in their 2025 editorial in the Journal of Manual & Manipulative Therapy.
Their point isn't that exercise and manual therapy don't work. It's that we've built a profession around two interventions with modest effect sizes, and then justified them with mechanistic stories the evidence doesn't support.
Meanwhile, MSK pain accounts for more years lived with disability than any other group of health conditions on the planet.
What the authors propose is a shift in scope:
→ From "I can fix you" to "I can work with you"
→ From technique-centred practice to person-centred, lifestyle-informed care
→ From passive recipient to active partner in shared decision making
The clinician of the future, they argue, is an expert in assessing lifestyle factors — sleep, physical activity, diet, smoking, stress — able to discuss those findings sensitively, and skilled in supporting behavioural change.
This sits right at the heart of what we teach at MTE. Hands-on skills matter. So does honest communication about what they can and can't do. The two aren't in conflict.
📄 Lewis J, Mintken PE, McDevitt AW (2025). Treating musculoskeletal conditions with a bit of exercise and manual therapy: are you kidding me? It's time for us to evolve again. J Man Manip Ther 33(3):167–172.
What do you think — are we ready for this evolution?