Why Manual Therapy Helps Our Clients: The Science Behind Real Relief

I have just returned from several days of teaching dry needling to groups of health professionals, Physios, GPs, OTs and chiros, and one thing that keeps coming back to me on these courses is how we undervalue the benefit of touch and the skill of palpation. Palpation is what I call 'clinical touch'. That is, we are specifically aiming to locate and then feel how tissue responds to our application of mechanical force. We use other forms of touch to greet (handshake), guide (hand on the shoulder or hip), or convey empathy and support (rub back, hand on the knee) and treat (massage)

As a manual therapist, I confess to a strong bias toward the benefits of skilful touch. This pre-print article indicates the role oxytocin may play, not at a cortical level but at a spinal level, resulting in faster pain modulation and mood improvement, emphasising the importance of this time-honoured method of treatment.

Core benefits supported by this paper

• Reduced pain intensity
• Reduced pain unpleasantness (affective pain)
• Improved mood and emotional state
• Increased tolerance to uncomfortable stimuli
• Enhanced reward value of gentle touch
• Stress reduction (↓ cortisol, ↓ heart rate)

Crucially, these benefits arise early in sensory processing (in the spinal cord) — not only in the brain.

The Main Pathway: How Massage Actually Works1. Massage → Oxytocin Release

• Gentle, skin-to-skin massage reliably increases endogenous oxytocin in humans.
• This correlates with:
  • Improved mood
  • Reduced negative affect
  • Reduced discomfort from otherwise unpleasant stimuli

Clinical takeaway:
Massage changes the internal chemical state of the nervous system, not just tissues mechanically

2. Oxytocin Acts Directly in the Spinal Cord

Traditionally, affective touch and pain modulation were thought to be "brain-only" processes. This paper shows otherwise.

• Oxytocin neurons in the hypothalamus send descending projections directly to the spinal dorsal horn
• Oxytocin receptors (OTRs) are densely expressed in:
  • Lamina I
  • Lamina II (outer and inner)
• These layers process:
  • Pain (e.g., A delta, C fiber)
  • Gentle touch
  • Affective (emotional) valence of sensation

Clinical takeaway:
Manual therapy can modify pain and comfort before signals ever reach the brain.

3. Dual Modulation: Less Pain, More Reward

Oxytocin reshapes spinal processing by rebalancing excitation and inhibition.

For pain pathways:

• Enhances inhibitory interneuron activity
• Suppresses output from pain-aversive projection neurons (TACR1+)
• Reduces both:
  • Pain intensity
  • Pain unpleasantness

For touch pathways:

• Enhances output from reward-associated projection neurons (GPR83+)
• Makes gentle touch feel more pleasant and more rewarding
• Reinforces approach behaviours and relaxation

Clinical takeaway:
Massage simultaneously:

• Turns down "threat"
• Turns up "safety and reward"

Why This Matters for Manual Therapists1. Explains Why Gentle Techniques Work

You don't need aggressive force to influence pain:

• Light pressure
• Slow, rhythmic strokes
• Skin-focused techniques can be neurobiologically powerful.

This supports:

• Massage
• Myofascial techniques
• Cranial/manual therapy
• Comfort-based and trauma-informed approaches

2. Separates Pain Intensity From Pain Experience

The study shows pain has two separable components:

• Sensory-discriminative (how strong it is)
• Affective-motivational (how bad it feels)

Massage strongly influences the affective component, which:

• Improves patient tolerance
• Reduces fear and avoidance
• Supports engagement in rehab

Clinical language upgrade:
"I'm not just reducing pain — I'm changing how threatening the pain feels."

3. Supports Manual Therapy as a Nervous System Intervention

This paper reframes massage as:

• A descending neuromodulatory intervention
• A way to influence spinal gating mechanisms
• A method to promote safety, bonding, and recovery

That matters when:

• Treating chronic pain
• Working with sensitised patients
• Managing high anxiety or stress
• Explaining value to patients or supervisors

Practical Clinical Applications

For early-career clinicians, this research supports:

• Using gentle, reassuring touch
• Using massage to:
  • Down-regulate pain before exercise or perhaps dry needling
  • Improve tolerance to manual or active treatment
• Framing manual therapy as:
  • Nervous system regulation
  • Not just mechanical input,