Treatment Mechanisms Associated With Directional Preference and Repeated Movements: A Scoping Review

OBJECTIVE: To synthesize the evidence for treatment mechanisms underlying repeated movements and sustained positioning, especially when matched to one's directional preference. DESIGN: Scoping review LITERATURE SEARCH: Five electronic databases were searched in November 2025 (PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and SPORTDiscus). The review was registered a priori on Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/SX5H7). STUDY SELECTION CRITERIA: Included studies investigated adults with any form of musculoskeletal pain who completed repeated movements or sustained positioning as an intervention. The outcomes must have included a physiological proxy measure for a treatment mechanism pre- and during/post-intervention. DATA SYNTHESIS: Narrative and descriptive data were categorized by mechanistic domains and treatment fidelity. RESULTS: Thirty-six (36) articles were identified, which included treatment mechanisms from 5 domains: biomechanical domain (n=11; 31%), neurological domain (n=10; 28%), neuromuscular domain (n=11; 31%), neuroimmune domain (n=2; 6%), and neurovascular domain (n=2; 6%). Most studies were categorized with lower treatment fidelity of directional preference. CONCLUSION: We found preliminary evidence for a multisystem mechanistic response following the application of repeated movements and/or sustained positioning interventions in adults with musculoskeletal pain.