Table 1.

Physical therapy interventions for chronic pain and targeted neurophysiologic mechanisms.

Physical therapy intervention	Neurophysiologic mechanism
Active interventions
Promote quality sleep	Disturbed sleep can result in impaired pain inhibition
Aerobic exercise	Promotes descending inhibition of pain
Isometric exercise	Systemic and local inhibitory mechanisms
25% MVC* until task failure
Brief MVC* (3 s duration/1 min apart)
Educational – Cognitive interventions
Pain science education	Diminishes psychological (top down) drivers of pain
Graded approach to increased functional activity	Promotes pain relief and well-being without triggering inflammatory flare thought to occur via neurogenic inflammation
Passive interventions
Manual Therapy	Decreases central sensitization
	Promotes descending inhibition of pain
TENS	Promotes descending inhibition of pain
Noxious electrical stimulation	Promotes descending inhibition of pain

Note: *MVC: Maximum voluntary contraction.