More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain—a qualitative study

Objective To explore how physiotherapists and osteopaths who use manual therapy in New Zealand conceptualise, reason about and manage upper back pain (UBP), a clinically relevant but inconsistently defined musculoskeletal presentation. Design Qualitative study using semistructured interviews and reflexive thematic analysis. The study was conducted and reported in accordance with best-practice qualitative guidance, including Consolidated Criteria for Reporting Qualitative Studies. Setting Private and public musculoskeletal practice settings across New Zealand. Participants 17 physiotherapists and osteopaths with a minimum of 2 years’ clinical experience, recruited through national professional networks. Results Data analysis resulted in the generation of four themes: (1) a fuzzy construct; (2) more than biomechanics; (3) hands-on leads to facilitate active care and (4) towards patient-centred care. The analysis revealed an interconnected progression across the key themes, which reflects not only the evolution of clinical practice but also the integration of contemporary evidence, highlighting a shift from intervention-focused to relationship-focused and collaborative care. Conclusion Clinicians conceptualise UBP as a complex and multifaceted condition, increasingly managed through biopsychosocial reasoning, self-management strategies and patient-centred care. However, definitional ambiguity between UBP and thoracic spine pain, combined with profession-specific patterns, demonstrates the need for clearer terminology and greater interprofessional alignment. Further research incorporating patient perspectives is required to inform guideline development and promote coherent, evidence-informed care for UBP.