What if context—patient beliefs, provider expectations, and the therapeutic relationship—drives a meaningful share of spinal manipulation outcomes? In this HANDS ON HANDS OFF episode, we break down a single-arm intervention study funded by the Paris Family Foundation via the Foundation for OMPT, why the current mechanisms model zeroes in on the “context zone,” and how to practically weave guidelines + shared decision-making into outpatient practice.Top takeaways* Outcomes vary—and context might be part of the mechanism* Study design links individual providers ↔ individual patients for cleaner signals* Implementation: use shared decision-making to operationalize guidelines* Career notes: pick mentors early, build long-term collaborators, include patient partners