Beyond Pain, Toward Healing: A Narrative Review of Therapeutic Communication, Patient Engagement, and the Changing Role of Physiotherapy in Chronic Musculoskeletal Conditions

Chronic musculoskeletal conditions are major contributors to pain, reduced physical function, limitations in daily activities and work participation, and diminished psychosocial well-being. Physiotherapy was historically framed largely within a biomedical orientation directed at correcting impairment and reducing symptoms. Contemporary evidence, however, indicates that chronic pain and disability cannot be understood through biological processes alone: psychological, social, behavioural, and contextual influences also shape the course of rehabilitation. This narrative review examines the changing role of physiotherapy in chronic musculoskeletal care through the interconnected lenses of therapeutic communication, therapeutic alliance, person-centred care, shared decision-making, and patient engagement. The review argues that listening to the patient narrative, communicating in accessible and non-threatening language, negotiating meaningful goals, and supporting autonomy are not ancillary interpersonal accomplishments; they are integral to sound clinical practice. It also considers the ethical dimensions of touch, the contribution of health literacy and pain education, and the challenges posed by digitally mediated rehabilitation. The most clinically coherent model is one in which evidence-informed physical interventions are embedded within a collaborative therapeutic relationship that recognises the person's values, lived experience, and capacity for action. This expanded review further situates these relational dimensions within the biopsychosocial understanding of persistent pain, emphasising that physiotherapy outcomes are shaped not only by the selection of an intervention but also by the way symptoms, prognosis, movement, and self-management are explained. It examines how fear-avoidance, treatment beliefs, health literacy, contextual effects, and the ethical use of touch can alter participation in rehabilitation. The review also distinguishes patient engagement from passive adherence and considers motivational interviewing and autonomy-supportive communication as methods for strengthening sustained behaviour change. Across these domains, the central argument is that technical and relational competence are not competing models of practice. Effective physiotherapy requires accurate assessment, evidence-informed physical intervention, and a communicative process through which the patient can understand the problem, participate in decisions, and progressively recover confidence in movement and everyday function. Digital rehabilitation is considered within the same framework: technology can extend access and monitoring, but it should preserve opportunities for dialogue, interpretation, and collaborative adjustment. The review concludes that person-centred physiotherapy is most coherent when clinical evidence, professional judgement, and the patient's lived expertise are integrated in a transparent therapeutic partnership.