Manual Therapy Through a Pain Science Lens: What's Really Happening with Damian Keter PT, DPT, PhD

What actually happens in a patient's brain and body when you perform manual therapy? The answer may surprise you and change how you practice. In this episode, Joe Tatta, PT, DPT, sits down with Damian Keter, PT, DPT, PhD, a researcher whose clinical career led him to question the foundational explanations behind one of physical therapy's most widely used interventions. Damian breaks down what a "treatment mechanism" actually means, a term frequently misused in the literature, and shares findings from his systematic review on the mechanisms associated with manual therapy. The evidence reveals significant gaps: low-quality research, poor translational understanding, and the persistent influence of contextual factors that have nothing to do with the technique itself. Perhaps most provocatively, Damian addresses whether clinicians truly understand that manual therapy is no longer doing what we once thought,-realigning spines, correcting tissue abnormalities, or fixing structural problems. With wide variability across professions, training backgrounds, and regions, false ideologies continue to circulate and undermine the credibility of evidence-based practitioners. The good news? Understanding manual therapy through a mechanistic lens opens the door to smarter, more patient-centered practice. One where expectations, context, and the individual in front of you matter more than the technique you choose. Visit integrativepainscienceinstitute.com for CEU training in integrative, psychologically informed care for physical therapists and other practitioners. Thank you for listening, Joe Tatta, PT, DPT