BackgroundMechanisms reflect the steps or processes through which an intervention unfolds and produces change in a specified outcome variable. Mechanisms are responsible for determining “how treatments work” which has emerged as a critical question for both developing theory and enhancing treatment efficacy. Studies that evaluate “how” treatments work, not just “if” treatments work are of considerable importance.DiscussionSpecific and shared mechanisms research is a promising approach which aims to improve patient outcomes by tailoring treatments to the specific needs of each patient. Mechanisms research is an underexplored area of research requiring a unique research design.ConclusionAlthough mechanisms research is still in its infancy, prioritizing the study of the mechanisms behind manual therapy interventions can provide valuable insight into optimizing patient outcomes.