How Manual Therapy Influences Pain: The Neuroscience Behind Hands-On Treatment

Manual therapy has come a long way from the idea of “fixing tissues.”Modern pain science shows that hands-on treatment affects the nervous system, immune system, and brain, often producing benefits far beyond mechanical effects.

At The Flow Clinic, our approach blends manual therapy, pain science education, and movement retraining.This blog explains the actual physiological mechanisms behind manual therapy — and why touch remains such a powerful tool in supporting people with pain.

🧠 Pain Is Not Just About Injury — It's About Processing

Pain happens when the brain judges something as threatening.The more sensitised the system becomes — due to inflammation, stress, low sleep, fear, or previous pain — the more likely it is to react strongly.

This is why manual therapy isn’t just about “loosening tight muscles.”It can modulate the entire neuroaxis, from local tissues to spinal cord pathways to higher brain centres involved in emotion and expectation. (Smith & Muralidharan, 2014; Ossipov, 2010)

🖐️ How Manual Therapy Calms the Nervous System

Manual therapy influences pain through several well-researched mechanisms:

1️⃣ Pain Gating at the Spinal Cord

Gentle soft-tissue work activates A-beta fibres, which can “gate” pain by reducing C-fibre input.

This is why light pressure or stroking often gives immediate relief.

(Vigotsky & Bruhns, 2015)

2️⃣ Conditioned Pain Modulation (CPM)

Deeper, slightly uncomfortable but safe techniques can activate the brainstem’s PAG–RVM pathway, which releases natural painkillers like serotonin and noradrenaline.

This reduces pain both locally and at distant areas.

(Vigotsky & Bruhns, 2015; Voogt et al., 2015)

3️⃣ Changes in Pressure Pain Threshold (PPT)

Joint articulation and mobilisation reduce local afferent noise and improve joint mechanics.

Research shows cervical articulation can increase PPT across the entire upper quarter — not just locally.

(Voogt et al., 2015)

4️⃣ Widespread Analgesia from Spinal Manipulation (SMT)

High-velocity or low-velocity thrust techniques cause immediate reductions in:

• secondary hyperalgesia

• allodynia

• pain rating scores

Changes are seen both sides of the body and even into the extremities.

(Onifer et al., 2015; Grayson et al., 2010)

⚖️ Manual Therapy and the Autonomic Nervous System

Manual therapy affects the balance between sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) activity.

🔺 High-velocity thrusts (HVT)

Increase sympathetic activity (e.g., heart rate, skin conductance).

(Perry et al., 2015; Budgell & Hirano, 2001)

🔻 Gentle techniques (craniosacral, BLT, light touch)

Increase parasympathetic activity and vagal tone.

(Ruffini et al., 2015)

This shows different techniques can be used intentionally to either stimulate or soothe a system depending on the client’s state.

🤲 The Power of Gentle Touch

Human touch activates C-tactile (CT) fibres — specialised nerves that project to the insular cortex (the brain’s emotional and interoceptive centre).

CT activation releases:

• Oxytocin

• Endogenous opioids

• Parasympathetic calming responses

This is why gentle touch can produce feelings of safety, connection, and emotional ease — and directly reduce pain.

(McGlone et al., 2016)

🧩 Summary: What Manual Therapy Actually Does

Bottom-Up Effects (Body → Brain)

✔ Reduces local inflammatory signalling

✔ Provides safe sensory input

✔ Activates inhibitory brainstem pathways

✔ Stimulates CT fibres for emotional soothing

✔ Improves movement and proprioception

(Van Griensven et al., 2014)

Top-Down Effects (Mind → Body)

✔ Distraction — reduces threat perception

✔ Habituation — the system learns stimuli aren’t dangerous

✔ Rewiring painful movement memories

✔ Education — reduces fear and catastrophising

(van Griensven et al.; Bishop et al., 2015)

Manual therapy is neurophysiology first — mechanics second.

🧘‍♀️ Education and Reassurance: Small Changes, Big Effects

Even a single conversation can change pain.Education reduces fear, shifts perspectives, and improves recovery outcomes.

• Psycho-educational videos reduce whiplash pain(Oliveira et al., 2006)

• Changing beliefs about pain reduces disability(Moseley et al., 2004)

• Reframing angina pain reduces symptom severity(McGillion et al., 2007)

Words can genuinely change physiology.

💫 Why This Matters at The Flow Clinic

Our neuro-informed manual therapy approach integrates:

✔ Hands-on treatment

To modulate pain, calm the system, and restore movement

✔ Pain neuroscience education

To reduce fear and build confidence

✔ Movement retraining

To rewire the nervous system through graded exposure and exploration

✔ Breathwork and down-regulation

To shift from survival mode → safety mode

When combined, these create a powerful environment for healing.

📚 References

• Bialosky et al. (2009). Mechanisms of Manual Therapy.

• Bishop et al. (2015). Effect of manual therapy on pain experience.

• Budgell & Hirano (2001). Mechanical stimulation and HRV.

• Coppieters et al. (2003). Cervical lateral glide research.

• Giles et al. (2013). Suboccipital decompression and HRV.

• Glinski & Page (2010). Cognitive behavioural therapy and personality traits.

• Grayson et al. (2010). Rapid analgesia in rodent models.

• McGlone et al. (2016). Gentle touch and CT afferents.

• McGillion et al. (2007). Angina pain perception.

• Moseley et al. (2004). Pain education trial.

• Nijs et al. (2015). Exercise therapy and pain memories.

• Onifer et al. (2015). Analgesic effects of SMT.

• Oliveira et al. (2006). Pain education in ED.

• Perry et al. (2015). Autonomic effects of manual therapy.

• Reed et al. (2014). SMT and thalamic neurons.

• Rio et al. (2016). Tendon neuroplastic training.

• Ruffini et al. (2015). Parasympathetic changes after OMT.

• Schmid et al. (2008). Cervical mobilisation and CNS effects.

• Skyba et al. (2003). Joint manipulation & monoamine receptors.

• Vigotsky & Bruhns (2015). Descending modulation in manual therapy.

• Voogt et al. (2015). Systematic review of manual therapy analgesia.

• Van Griensven et al. (2014). Pain textbook.

• Zusman (2004). Mechanisms of physiotherapy.

✨ Takeaway

Manual therapy influences far more than muscles and joints.It communicates with the nervous system, rewrites pain pathways, and helps the body shift from protection to safety.

Pain is changeable — and your nervous system is capable of profound adaptation.

👉 Learn more or book at: www.theflowclinic.co.uk