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Pain Research and Treatment
Volume 2015 (2015), Article ID 292805, 11 pages
Review Article

The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review

1Kinesiology Program, Arizona State University, Phoenix, AZ 85004, USA
2College of Medicine, University of Arizona, Tucson, AZ 85724, USA

Received 3 July 2015; Revised 15 November 2015; Accepted 29 November 2015

Academic Editor: Bjorn Meyerson

Copyright © 2015 Andrew D. Vigotsky and Ryan P. Bruhns. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Manual therapy has long been a component of physical rehabilitation programs, especially to treat those in pain. The mechanisms of manual therapy, however, are not fully understood, and it has been suggested that its pain modulatory effects are of neurophysiological origin and may be mediated by the descending modulatory circuit. Therefore, the purpose of this review is to examine the neurophysiological response to different types of manual therapy, in order to better understand the neurophysiological mechanisms behind each therapy’s analgesic effects. It is concluded that different forms of manual therapy elicit analgesic effects via different mechanisms, and nearly all therapies appear to be at least partially mediated by descending modulation. Additionally, future avenues of mechanistic research pertaining to manual therapy are discussed.