Pain & Manual Therapy

Understanding Manual Therapy and Its Impact on the Pain System


Pain is a complex and multifaceted phenomenon, deeply rooted in both physiological and psychological dimensions. In the quest to manage and alleviate pain, manual therapy has emerged as a cornerstone approach, offering tangible relief to countless individuals. This blog delves into the evidence-based mechanisms by which manual therapy influences the pain system, highlighting its efficacy and potential benefits.

What is Manual Therapy?

Manual therapy encompasses various hands-on techniques to manipulate muscles, joints, and connective tissues. Techniques such as massage, mobilization, and manipulation are commonly used to enhance mobility, reduce pain, and improve overall function. Practitioners, including massage therapists and physiotherapists, tailor these techniques to meet individual patient needs, particularly for those suffering from chronic pain, post-surgical discomfort, and repetitive strain injuries.

The Pain System: A Brief Overview

Understanding how manual therapy affects pain requires a basic grasp of the pain system. Pain perception involves a complex interplay between peripheral and central nervous systems. Key components include:

  • Nociceptors: Sensory receptors that respond to potentially damaging stimuli.
  • Peripheral Nerves: Transmit pain signals from nociceptors to the spinal cord.
  • Spinal Cord: Acts as a relay station, modulating pain signals before reaching the brain.
  • Brain: Interprets pain signals, leading to the conscious experience of pain.

Mechanisms of Pain Modulation through Manual Therapy

  1. Neuromodulation

    Manual therapy can modulate pain through several neurophysiological pathways. The stimulation of mechanoreceptors in the skin and muscles during manual therapy can inhibit nociceptive signals through a process known as the "gate control theory" of pain. Manual therapy essentially "closes the gate" to smaller, slower pain fibres by activating larger, faster-conducting nerve fibres, thereby reducing pain perception.

  2. Endogenous Opioid Release

    Research has shown that manual therapy can stimulate the release of endogenous opioids, such as endorphins and enkephalins. These natural pain-relieving chemicals bind to opioid receptors in the nervous system, providing analgesic effects similar to those of opioid medications but without the associated risks and side effects.

  3. Reduction of Muscle Tension and Spasm

    Chronic pain is often accompanied by muscle tension and spasms, which can exacerbate discomfort and limit mobility. Manual therapy techniques, particularly massage, can help relax tense muscles, reduce spasms, and break the pain and muscle tension cycle. This not only alleviates pain but also improves functional outcomes.

  4. Improved Blood Flow and Tissue Healing

    Manual therapy enhances blood circulation, which is crucial for tissue health and repair. Increased blood flow delivers essential nutrients and oxygen to damaged tissues while removing metabolic waste products. This promotes healing and can reduce inflammation, a common source of pain.

  5. Psychological Benefits

    The psychological aspects of pain are significant, with factors such as stress, anxiety, and depression often exacerbating the pain experience. Manual therapy provides a therapeutic touch and can foster a sense of relaxation and well-being. The positive therapeutic relationship between the therapist and patient also plays a critical role in pain management, contributing to a holistic approach to treatment.

Evidence Supporting Manual Therapy

A growing body of research supports the efficacy of manual therapy in pain management. For instance, a systematic review published in the Journal of Pain Research highlighted the benefits of manual therapy for chronic low back pain, demonstrating significant pain reduction and improved functional outcomes. Similarly, a meta-analysis in the British Journal of Sports Medicine confirmed the effectiveness of manual therapy in treating musculoskeletal pain, emphasizing its role in enhancing quality of life.


Manual therapy stands as a powerful tool in the management of pain, leveraging both physiological and psychological mechanisms to provide relief. Its ability to modulate pain through neuromodulation, endogenous opioid release, muscle relaxation, improved blood flow, and psychological support underscores its multifaceted benefits. As research continues to evolve, the integration of manual therapy into pain management protocols promises to offer even greater insights and therapeutic potential for those in need.

By embracing evidence-informed practices, practitioners can ensure that their interventions are not only effective but also grounded in scientific rigour, ultimately enhancing patient outcomes and quality of life.


For more pain management and manual therapy information, book a treatment and see how massage therapy can benefit you.