“The experts in pain are the patients.” This quote from chiropractor and lecturer Dr. Michael Vianin encapsulates the patient-centered spirit of the dispositionalism model of musculoskeletal care outlined in his recent book, Dispositionalism in Musculoskeletal Care. This model provides practical tools for clinicians managing patients with musculoskeletal disorders and chronic pain syndromes.

In this blog post, we will explore the key components of this model and how they can be implemented in clinical practice.

Understanding Dispositionalism

The dispositionalism model views pain and dysfunction as resulting not solely from structural or tissue abnormalities but also from an interplay of biological, psychological, and social factors unique to each patient. This biopsychosocial framework considers how things like thoughts, emotions, lifestyle, and environment influence the disorder.

Dr. Vianin introduces the idea of “predictive processing” as a way patients subconsciously detect and respond to internal and external stimuli based on prior experiences. By understanding these predictive patterns in patients, clinicians can better empathize and collaborate on treatment plans.

Tools for the Clinical Encounter

A dispositionalist assessment starts by asking patients to share their “pain narrative.” This involves prompting them to describe when their pain started, daily fluctuations, relieving/exacerbating factors, and effects on function, goals, and priorities.

Clinicians should adopt active listening skills, asking exploratory questions without judgment. Identifying maladaptive thought and behavior patterns is key to supporting the development of self-management skills. Providing validation and reassurance throughout the encounter further builds trust and rapport.

Addressing the “Self”

The dispositionalism model greatly emphasizes understanding patients’ sense of self and how this shapes their pain perception and healing capabilities. Clinicians can nurture a positive self-concept by:

  • Helping patients identify valued aspects of self not defined by pain
  • Guiding patients to set meaningful, achievable goals
  • Encouraging maintenance of roles, relationships, or activities that promote self-worth

Considering Social Determinants

Social determinants of health like socioeconomic status, education, employment, social support, access to care, and environment interact to influence health outcomes. Clinicians should evaluate how these factors may enable or impede healing and recovery for individual patients.

Asking screening questions about housing, food/income security, transportation barriers, and other potential needs allows for appropriate referrals and resources to be provided.

Fostering Self-Efficacy

Self-efficacy refers to one’s belief in their ability to succeed and persevere through challenges to reach goals. Clinicians can promote self-efficacy through the following:

  • Establishing reasonable, incremental goals
  • Checking in on progress and providing encouragement
  • Identifying and addressing obstacles proactively
  • Emphasizing and celebrating wins, no matter how small


The dispositionalism model outlined in Dr. Vianin’s book ‘Dispositionalism in Musculoskeletal Care’ equips clinicians with practical tools to address the multiple interacting factors influencing each patient’s unique pain experience. This biopsychosocial approach centered on understanding the whole person can transform clinical encounters and improve outcomes. Centering patient perspectives and goals, validating their experiences, and meeting them where they are represents the primary approach of the dispositionalism model.

Grab your copy of Dispositionalism in Musculoskeletal Care today!