Physiotherapy Sessions Could Double as Real-World Mindfulness Labs, Study Argues

Every day, millions of people around the world lie on a treatment table while a physiotherapist places trained hands on a painful back, a stiff shoulder, or a healing knee. These encounters are so routine that they rarely attract attention from researchers interested in the science of the mind. Yet a new correspondence published in the journal Mindfulness argues that this everyday clinical ritual may represent one of the most underused resources in public health: a natural laboratory in which mindfulness, therapeutic presence, and the biology of touch converge in real time, outside the artificial constraints of a meditation trial.

The piece, written by Roberto Tedeschi, an independent researcher based in Bologna, and Sara Di Serio of the Department of Clinical Science and Translational Medicine at the University of Rome Tor Vergata, does not report new experimental data. Instead, it is a conceptual argument, a deliberate provocation aimed at both the mindfulness research community and the rehabilitation sciences. The authors state that no datasets were generated or analysed, and the article carries no ethics approvals, consistent with its nature as a theoretical correspondence. What it offers is a framework: the proposal that the physiotherapist–patient encounter should be understood as a recurring, real-world setting where the psychological and neurobiological ingredients of mindfulness-based care are already in play, whether or not anyone labels them as such.

The argument begins with a paradox. Mindfulness has travelled an extraordinary distance from its origins in contemplative traditions to its current status as a mainstream public health intervention. Since Jon Kabat-Zinn’s landmark 1982 outpatient programme for chronic pain patients, which introduced mindfulness meditation into behavioural medicine, the field has grown into a global enterprise. Recent critical analyses in Mindfulness itself, including Oman’s 2025 agenda for mindfulness in global public health and Sutton’s organisational-psychology perspective on cultivating global health, signal an ambitious push to embed mindfulness at the population level. And yet, the authors contend, this push has concentrated on formal programmes and structured courses, while overlooking the places where embodied awareness is most frequently practised: clinical encounters involving the body itself.

Physiotherapy, the authors argue, is uniquely positioned in this respect. Unlike many medical consultations, physiotherapy is built on sustained physical contact, manual skills, guided movement, and an extended temporal relationship between practitioner and patient. Treatment sessions unfold over weeks or months, giving the therapeutic relationship time to deepen. Scoping reviews of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy, such as the 2017 analysis by Babatunde and colleagues published in BMC Health Services Research, have documented that the quality of this alliance is not a peripheral nicety but a core component of practice that shapes engagement, adherence, and outcomes. In other words, the relational dimension of physiotherapy is not an optional extra layered onto exercise prescription; it is woven into the delivery of care itself.

The concept at the heart of the correspondence is therapeutic presence, a construct developed most prominently by Geller and Greenberg in their 2012 book Therapeutic Presence: A Mindful Approach to Effective Therapy, and operationalised in a 2010 measurement study by Geller, Greenberg, and Watson in Psychotherapy Research. Therapeutic presence describes a clinician’s state of being fully attentive, receptive, and embodied in the encounter with a patient—listening not only with the ears but with the whole nervous system. Presence, in this account, is not a vague bedside manner but a trainable, mindful capacity with measurable correlates in both therapist and client perception. The authors of the correspondence propose that physiotherapists, whose work demands continuous attention to bodily cues, are natural practitioners of presence, even if the term never appears in their training curriculum.

Why should this matter for outcomes? One strand of evidence comes from the science of contextual factors. In 2023, an international group led by Cook and colleagues, publishing in Frontiers in Psychology, reached a consensus definition for contextual factors: the elements of the therapeutic encounter—expectations, the clinician’s manner, the setting, the ritual of treatment—that modulate outcomes independently of the specific technique delivered. This line of research, closely tied to placebo and nocebo science, has made it increasingly difficult to dismiss the relational and cognitive environment of care as noise. In physiotherapy specifically, systematic reviews of attentional focus instructions, including the 2018 review by Piccoli and colleagues in the Journal of Functional Morphology and Kinesiology, show that the way a clinician directs a patient’s attention changes motor learning and performance in both central nervous system and musculoskeletal disorders. Attention, in other words, is a clinical variable, and a mindful clinician is one who manages it deliberately.

A second strand comes from pain neuroscience. Bushnell, Čeko, and Low’s influential 2013 review in Nature Reviews Neuroscience mapped how cognitive and emotional processes modulate pain and how these regulatory systems become disrupted in chronic pain. Pain is not a simple readout of tissue damage; it is constructed through an interaction of sensory input, attention, expectation, and affect. This is precisely why the mental state of the clinician may matter. A distracted, hurried practitioner may inadvertently amplify threat appraisals, while a present, calm one may foster the sense of safety that allows descending pain-modulatory systems to work in the patient’s favour. The correspondence frames the physiotherapy room as a place where these mechanisms can be observed, refined, and taught—not as abstract theory but as lived clinical practice.

The authors also draw on the phenomenology of body awareness. Mehling and colleagues’ 2011 inquiry into body awareness as the common ground of mind-body therapies, published in Philosophy, Ethics, and Humanities in Medicine, positioned interoception—the perception of internal bodily signals—as the shared substrate of practices ranging from meditation to massage. Price and Hooven’s 2018 work on interoceptive awareness skills for emotion regulation, through the mindful awareness in body-oriented therapy approach, translated that substrate into teachable clinical skills. More recently, Parma and colleagues’ 2024 overview in Brain Sciences charted progress on bodily awareness and interoception in neurorehabilitation research. Clinical perspectives on the notion of presence, gathered by Malet, Bioy, and Santarpia in Frontiers in Psychology in 2022, add a cross-disciplinary frame. Seen through this converging literature, the physiotherapist’s hands are not merely applying technique; they are participating in a bidirectional channel of interoceptive and proprioceptive information, one that mindfulness research has rarely examined in situ.

The public health implications of the argument are what give it its edge. If mindfulness is to fulfil the population-level ambitions set out in recent global health agendas, the authors suggest, it cannot rely solely on scaling formal eight-week courses, which carry costs, access barriers, and adherence challenges. Embedding mindful presence into existing, universally used services—rehabilitation being one of the most widely delivered—offers a complementary route. Every physiotherapy encounter becomes, in their phrase, a natural laboratory: a setting where presence, attention, touch, and body awareness interact without the artificiality of a lab-based attention task or a self-report questionnaire administered in isolation. Training physiotherapists explicitly in mindfulness and presence, the correspondence implies, could turn an enormous segment of routine healthcare into an informal delivery channel for skills already known to support emotion regulation, pain modulation, and motor learning.

The correspondence is careful in its limits. It proposes no trials, reports no measurements, and acknowledges its status as a conceptual intervention rather than an empirical one. But that is part of its strategic function. By naming the physiotherapist–patient encounter as a natural laboratory, the authors issue an invitation: to design studies that measure presence in rehabilitation settings, to test whether mindfulness training for physiotherapists alters patient outcomes, and to integrate the constructs of psychotherapy research with the biomechanics of manual therapy. If the invitation is taken up, the humble treatment table—arguably one of the most intimate interfaces in modern medicine—could become one of the most informative sites in the science of mind-body health. The next phase belongs to researchers willing to walk into the clinic and watch closely.

Subject of Research: Therapeutic presence and mindfulness in physiotherapist–patient encounters as a natural laboratory for public health practice

Article Title: Mindfulness in Public Health Practice: The Physiotherapist–Patient Encounter as a Natural Laboratory for Therapeutic Presence

Article References: Tedeschi, R., & Di Serio, S. (2026). Mindfulness in Public Health Practice: The Physiotherapist–Patient Encounter as a Natural Laboratory for Therapeutic Presence. Mindfulness. https://doi.org/10.1007/s12671-026-02991-8

Image Credits: AI Generated

DOI: 10.1007/s12671-026-02991-8

Keywords: mindfulness, public health, physiotherapy, therapeutic presence, therapeutic alliance, contextual factors, interoception, body awareness, chronic pain, rehabilitation, motor learning, patient encounter