Prediction, pain, and the power of context: toward a contemporary identity for the chiropractic profession

Musculoskeletal (MSK) pain is a leading cause of disability worldwide, with low back and neck pain among the largest contributors to years lived with disability. For many people with persistent pain, mechanisms are increasingly understood as arising from altered regulation at multiple loci rather than simple ongoing tissue injury. This challenges chiropractic's long-standing reliance on body focused explanatory models centred on correcting structural lesions or dysfunction.

Active Inference (AIF) provides a contemporary framework for understanding pain perception as an embodied, context-sensitive process of sense-making. Here, inferences concerning threat or safety are informed by information generated across multiple interacting levels (neural, physiological, psychological, behavioural, and socio-cultural), and pain emerges when threat-related inferences remain persistently weighted as trustworthy. From this perspective, manual therapy may be understood as a coherent ensemble of interacting sensory, affective, interpersonal, and contextual cues that together reshape expectations, meaning, and action. We revisit the concept of Contextually Aided Recovery (CARe), a lens that sees the therapeutic encounter as a rich space of potential contextual modulation and affordances and argue that chiropractic's distinctive contribution lies in combining skilled manual contact with the deliberate shaping of context to support adaptive regulation.

We propose that integrating AIF and CARe offers the chiropractic profession a coherent, evidence-aligned route toward a more contemporary identity, with implications for practice and education.