alleviate the musculoskeletal disorders associated with everyday stress, physical manifestation of mental distress, muscular overuse and many persistent pain syndromes continues to grow, understanding the basic science behind what we do enable us to apply this work to a number of conditions. Treatment approaches in Massage Therapy may vary, but each therapeutic encounter involves some overlapping principles. This book will conceptualize the main domains of an evidence-based framework for Massage Therapy using recent scientific research. Massage Therapy for People with Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, affecting an estimated 302 million people worldwide, this is a condition characterized by cartilage degradation and bone remodeling which in some cases can lead to pain, stiffness, swelling, and loss of normal joint function (Kolasinski et al., 2020). Pathophysiology Osteoarthritis is a common finding in the general population, and most commonly will affect knees, hips, hands, and the spine. In addition to tissue degeneration this condition involves sensitization of the nervous system, which may result in patients with osteoarthritis perceiving relatively low level stimuli as being overtly painful (Hunter & Bierma-Zeinstra, 2019). Examination A thorough health history intake can be done to gather information about patients’ limitations, course of pain, and prognostic factors for delayed recovery (e.g. low self-efficacy, fear of movement, ineffective coping strategies, fearavoidance, pain catastrophizing) and answers to health-related questions. Screen patients to identify those with a higher likelihood of serious pathology/red flag conditions. Then undertake a physical examination: neurological screening test, assess mobility and/or muscle strength. Incorporate one or more of the following outcome measurements when assessing and monitoring patient progress: • Patient Global Impression Change • Pain Self Efficacy Scale • Self-Rated Recovery Question • Patient Specific Functional Scale • Brief Pain Inventory (BPI) • Numeric Pain Rating Scale (NPRS) • Visual Analogue Scale (VAS) • McGill Pain Questionnaire (MPQ) or The Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) • Multidimensional Pain Inventory • Short Musculoskeletal Function Assessment (SMFA) • Knee Injury and Osteoarthritis Outcome Score (KOOS) • The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Treatment Skills-based capability framework for health professionals providing care for people with osteoarthritis There are a number of rehabilitation strategies for osteoarthritis based on patient-specific assessment findings including, but not limited to self-management and education, exercise, and manual therapy. A skills-based capability framework helps to facilitate individualized treatment decisions regarding the management of osteoarthritis (Hinman et al., 2020), this includes but is not limited to: 1. communication 2. person-centred care; 3. history-taking; 4. physical assessment; 5. investigations and diagnosis; 6. interventions and care planning; 7. prevention and lifestyle interventions; 8. self-management and behaviour change; 9. rehabilitative interventions; 10. pharmacotherapy; 11. surgical interventions; 12. referrals and collaborative working; 13. evidence-based practice and service development Education Provide reassurance and patient education on condition and management options and encourage the use of active approaches (lifestyle, physical activity) to help manage symptoms. Manual Therapy A number of clinical practice guidelines and randomized controlled trials recommend the use of manual therapy as part of a multi-modal approach for patients with osteoarthritis related pain (Busse et al., 2017; Kolasinski et al., 2020; Skelly et al., 2020). Two recent randomized clinical trials have highlighted the effect of conservative treatment options for patients suffering from osteoarthritis related knee pain. In one randomized clinical trial published in the Journal of General Internal Medicine massage therapy was shown to improve function in patients who suffer from osteoarthritis related knee pain (Perlman et al., 2019). In addition a randomized trial published in The New England journal of medicine demonstrated the benefits of a conservative multimodal approach (manual therapy + exercise) for patients with symptomatic osteoarthritis of the knee (Deyle et al., 2020). 268 | OSTEOARTHRITIS It is not suggested that massage therapy alone can control symptoms but can be utilized to help relieve pain & reduce anxiety when integrated with standard care. Ascribing a patient’s pain solely to a tissue-driven pain problem is often an oversimplification of a complex process. This insight provides us with an opportunity to re-frame our clinical models. Massage therapy is a form of peripheral somatosensory stimulation that can modulate the activity of neuro-immune (peripheral, cortical, subcortical) processes correlated with the experience of pain (Bialosky et al., 2018). By activating ascending and descending inhibitory systems, massage therapy may be able to mitigate the transition, amplification and development of chronic pain. Exercise People with lower-extremity osteoarthritis should be encouraged to engage in physical activity,