Does Manual Therapy Reduce Fear of Movement and Pain Catastrophizing?

Fear of movement and fear of future pain can decrease physical activity and quality of life, increase pain intensity and work absenteeism, and cause higher levels of disability. Fear is a powerful motivator. It can create a perpetual negative feedback loop that is difficult to escape. Fear and catastrophic thoughts may cause an over-reaction to pain or potential threats of pain or injury, leading to avoidance behavior.

Manual therapy, such as massage and joint manipulation, can provide short term reductions in the pain experience. But can manual therapy improve fear-avoidance, kinesiophobia, and pain catastrophizing in individuals with chronic musculoskeletal pain?

A recent research review concluded manual therapy was no better than no treatment or other treatments on reducing fear-avoidance, kinesiophobia, and pain catastrophizing. This is not to say manual therapy is useless, but it should not be used to target fear-avoidance, kinesiophobia, or pain catastrophizing.