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Pain isn't always just a physical symptom. It can also be personal, emotional, and sometimes overwhelming. For the millions of people living with chronic low back pain, the struggle often goes far beyond sore muscles or aching joints, as it can significantly impact mood, sleep quality, daily joy, and even how they perceive their pain.

Research consistently shows that people suffering from chronic pain are three times more likely to develop depression than those without pain. This is a startling reality that highlights a double–edged sword: pain impacts both body and mind, creating a complex cycle that makes recovery difficult if only one of these areas is treated. Understanding how these physical and psychological factors interact is critical in designing effective treatment for chronic conditions like lumbar disc herniation.

Lumbar disc herniation: More than just a backache

Your spine, a complex column of bones (vertebrae), is cushioned by small, gel–like discs called intervertebral discs. These discs act as shock absorbers that help you move and bend your spine comfortably. Lumbar disc herniation occurs when the soft, gel–like center of one of these discs in the lower back (lumbar region) slips out through its tough outer shell. One way to visualize this is a jelly donut with the filling oozing out the side. This protrusion can press on nearby nerves and cause symptoms like:

• Severe back pain that can radiate down the leg (sciatica)


• Numbness or tingling sensations in the lower extremities


• Muscle weakness or difficulty moving certain muscles

For most patients with these symptoms, many everyday activities–like walking, sitting, and sleeping–start to come with restrictions, which can severely diminish one's quality of life in the process. But lumbar disc herniation doesn't just stop there with physical discomfort. Many patients also experience kinesiophobia, which is a fear of movement stemming from anxiety that physical activity will worsen their pain or cause harm. Others develop depression or catastrophize their pain, meaning they have an overwhelming fear or belief that their pain will continue to get worse.

Manual therapy eases patients' concerns about their pain

Researchers noticed that most treatments for lumbar disc herniation focus on the physical aspects of the condition–pain, mobility, and function. But since pain and mental health are so closely linked, they wanted to know if manual–or hands–on–therapy, a technique that uses skilled hand movements to mobilize joints, could help with the mental side of recovery.

The study group consisted of 32 patients with lumbar disc herniation and pain lasting at least 8 weeks who hadn't had therapy in the last 6 months. These participants were then randomly split into one of the following two groups:

Manual therapy group

• Participants in this group underwent stabilization exercises (core–strengthening moves to support the spine) and three spinal mobilization techniques from the therapist:
  
  
  • Anterior–posterior pushes (gentle downward pressure on the spine)
  
  
  • Rotational mobilization (twisting motions)
  
  
  • Joint mobilization in a flexed position (nudging vertebrae while the spine is bent)
  
  
  
  

Exercise group

• These participants received the same stabilization exercises along with sham mobilization, meaning the therapist's hands were placed on the spine, but no actual force was applied

Timeline

• Participants completed 2 sessions per week for 5 weeks (10 sessions total) and were assessed before treatment, after treatment, and 3 months later with tools that measured the following:
  
  
  • Pain intensity and type
  
  
  • Anxiety and depression levels
  
  
  • Kinesiophobia (fear of movement)
  
  
  • Pain catastrophizing (exaggerated negative thoughts about pain)
  
  
  • Quality of life
  
  
  
  

Results showed that participants in the manual therapy group experienced significant reductions in anxiety, depression, and kinesiophobia after treatment, and these effects persisted at the three–month follow–up. Although both groups experienced decreased pain levels and improvements in quality–of–life measures, only the manual therapy group demonstrated substantial benefits in the psychological measures. This suggests that manual therapy does more than alleviate physical discomfort. It also appears to reduce the mental distress that amplifies the perception of pain.

Why should physical therapists consider the mind–body connection?

Manual therapy–which involves hands–on techniques intended to relieve pain and restore mobility–is believed to indirectly influence psychological factors by stimulating mechanoreceptors in joints that activate the gate control mechanism. This means it essentially “closes the gate” on pain signals sent to the brain, thereby reducing the physical sensation of pain. By effectively lowering pain intensity, manual therapy reduces fear and avoidance behaviors (kinesiophobia), allowing patients to regain function and confidence in the process. Reduced pain and increased mobility also improve mood and decrease anxiety and depression, breaking the vicious cycle of chronic pain and psychological distress.

Physical therapists have traditionally prioritized physical structures (e.g., muscles, joints, and nerves), but we now recognize that pain is not just a sensory experience; it is deeply connected to emotions and cognition as well. The pain experience is shaped by psychological states like fear, anxiety, and depression, and psychological distress can increase the perception of pain, decrease pain tolerance, and interfere with participation in therapy. That's why addressing psychological factors along with physical symptoms may be necessary for a complete recovery from lumbar disc herniation and other chronic conditions.

With this in mind, many physical therapists now consider not only patients' physical condition, but their emotional state as well. While therapists are not certified mental health professionals, they can do the following:

• Ask patients to share their feelings regarding the psychological component of their pain (like fear, anxiety, and fear of movement)


• Address these issues with interventions like manual therapy


• If necessary, refer the patient to a mental health specialist for further treatment

Treating chronic pain with this type of approach is more likely to produce positive long–term outcomes in which patients have a better understanding of their chronic pain and how to manage both its physical and psychological components.

Call us today to start taking better control of your chronic pain

Is lower back pain, sciatica, or any other chronic pain holding you back? Don't let it dim your days. Our team is armed with tools like manual therapy to tackle your pain and boost your spirit. This study shows what's possible–check it out here.