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Understanding Pain Gate Theory: A Key to Physiotherapy Practice.

Hello, wonderful readers! Today, we're diving into the fascinating world of pain and how understanding it can transform physiotherapy practice. If you've ever wondered how physiotherapists work their magic to alleviate pain, then you're in for a treat. Let's explore Pain Gate Theory and its significant role in physiotherapy.

What is Pain Gate Theory?

Pain Gate Theory, first proposed by Ronald Melzack and Patrick Wall in 1965, revolutionised our understanding of pain mechanisms. Before this theory, pain was considered a straightforward response to injury or damage. However, Melzack and Wall suggested that our spinal cord contains a neurological "gate" that either blocks pain signals or allows them to pass to the brain [1].

Imagine a gatekeeper in your spinal cord who decides whether to let pain signals through or not. When the gate is open, pain signals travel to the brain, and we feel pain. When it's closed, these signals are blocked, and we don't experience pain as intensely.

How Does This Relate to Physiotherapy?

Physiotherapists are like master gatekeepers. They use various techniques to influence this gate, helping patients manage and reduce pain. Let's break down a few ways this works:

1. Manual Therapy: Techniques such as massage and joint mobilisation can stimulate non-painful nerve fibres. This stimulation can help "close the gate" to painful signals, reducing the sensation of pain [2].

2. Exercise Therapy: Regular physical activity can increase the production of endorphins, the body's natural painkillers. Endorphins interact with receptors in the brain to reduce our perception of pain, effectively "closing the gate"[3].

3. Electrotherapy: Treatments like Transcutaneous Electrical Nerve Stimulation (TENS) apply electrical currents to the skin. These currents can disrupt pain signals travelling to the brain, helping to manage pain by keeping the gate closed [4].

4. Education and Psychological Approaches: Understanding pain and its mechanisms can empower patients. Cognitive-behavioural therapy and mindfulness can reduce the emotional response to pain, which in turn can influence the gating mechanism [5].

Academic Insights

Recent research continues to support and expand on Pain Gate Theory. Studies have shown that the central nervous system is incredibly complex and that psychological factors, such as stress and anxiety, can impact the pain experience [6]. This highlights the importance of a holistic approach in physiotherapy, where addressing the mind is as crucial as treating the body.

Moreover, advancements in neuro-imaging have provided visual evidence of how pain is processed in the brain. Functional MRI studies have shown that certain brain regions are less active when the "gate" is closed, confirming Melzack and Wall's groundbreaking hypothesis [7].

Practical Applications

In practical terms, physiotherapists tailor their treatments based on the principles of Pain Gate Theory. For example, a patient with chronic lower back pain might receive a combination of manual therapy to provide immediate relief, exercise programmes to build long-term resilience, and education sessions to manage stress and anxiety. By understanding and manipulating the gate control mechanism, physiotherapists can offer more effective, personalised treatment plans. This not only alleviates pain but also improves overall quality of life for patients.


Pain Gate Theory has profoundly influenced physiotherapy, providing a robust framework for understanding and managing pain. By incorporating techniques that manipulate the pain gate, physiotherapists can offer targeted, effective treatments. As research evolves, so does our ability to fine-tune these approaches, promising even better outcomes for those suffering from pain.

So next time you visit your physiotherapist, remember – they're not just treating your symptoms. They're masterfully guiding the gatekeeper in your spinal cord, helping you find relief and regain control over your pain. Until next time, stay curious and take care of your body and mind!

Our Barnet, Cockfosters & Enfield Physio's have tons of experience in dealing with all types of pain. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.

Blog By: Emre Oz (Musculoskeletal Physiotherapist at Crouch Physio).


1. Cervero, Fernando, and John N. Wood. A history of pain research. Oxford: Oxford University Press, 2020

2. Wang, Si-Qi, Ai-Yun Jiang, and Qi Gao. "Effect of manual soft tissue therapy on the pain in patients with chronic neck pain: A systematic review and meta-analysis." Complementary Therapies in Clinical Practice 49 (2022): 101619.

3. Borisovskaya, Anna, Elizabeth Chmelik, and Ashwin Karnik. "Exercise and chronic pain." Physical Exercise for Human Health (2020): 233-253.

4. Vance, Carol GT, et al. "Using TENS for pain control: update on the state of the evidence." Medicina 58.10 (2022): 1332.

5. Rognsvåg, Turid, et al. "Development of an internet-delivered cognitive behavioral therapy program for use in combination with exercise therapy and education by patients at increased risk of chronic pain following total knee arthroplasty." BMC Health Services Research 21 (2021): 1-14.

6. Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgrad Med. 2019;131(7):438-444. doi:10.1080/00325481.2019.1663705

7. Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain. 2005;9(4):463-484. doi:10.1016/j.ejpain.2004.11.001

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