Balancing "hands-on" with "hands-off" physical therapy interventions for the treatment of central sensitization pain in osteoarthritis

Man Ther. 2015 Apr;20(2):349-52. doi: 10.1016/j.math.2014.07.017. Epub 2014 Aug 14.


Traditional understanding of osteoarthritis-related pain has recently been challenged in light of evidence supporting a key role of central sensitization in a subgroup of this population. This fact may erroneously lead musculoskeletal therapists to conclude that hands-on interventions have no place in OA management, and that hands-off interventions must be applied exclusively. The aim of this paper is to encourage clinicians in finding an equilibrium between hands-on and hands-off interventions in patients with osteoarthritis-related pain dominated by central sensitization. The theoretical rationale for simultaneous application of manual therapy and pain neuroscience education is presented. Practical problems when combining these interventions are also addressed. Future studies should explore the combined effects of these treatment strategies to examine whether they increase therapeutic outcomes against current approaches for chronic osteoarthritis-related pain.

Keywords: Central nervous system sensitization; Musculoskeletal manipulations; Osteoarthritis; Pain.

Publication types

  • Review

MeSH terms

  • Central Nervous System Sensitization*
  • Combined Modality Therapy
  • Female
  • Hand / physiology
  • Humans
  • Male
  • Musculoskeletal Manipulations / methods*
  • Musculoskeletal Pain / etiology
  • Musculoskeletal Pain / physiopathology
  • Musculoskeletal Pain / therapy*
  • Neurosciences / education
  • Osteoarthritis / complications
  • Osteoarthritis / diagnosis
  • Osteoarthritis / therapy*
  • Pain Management / methods*
  • Pain Threshold
  • Physical Therapy Modalities
  • Practice Guidelines as Topic
  • Severity of Illness Index