Send us a text We question whether it is ethical to cause pain during manual therapy and unpack what nociception, tissue insult, and consent truly mean. We challenge heuristics like no pain, no gain and ground decision-making in evidence, context, and patient autonomy. • defining pain and nociception as signals of actual or potential tissue damage • challenging bruising and discomfort as therapeutic proof • critiquing hurt does not equal harm as a blanket rule • considering acute movement wit...