Movement within a therapeutic field as a framework for multimodal neuromodulation in musculoskeletal pain rehabilitation

Musculoskeletal (MSK) pain remains a major clinical challenge, shaped by complex interactions among peripheral tissues, neuromuscular function, and central pain processing mechanisms. Electrophysical agents have traditionally been viewed as passive therapeutic modalities acting primarily through local tissue effects. However, contemporary pain neuroscience suggests that their clinical effects are more plausibly mediated not only by local tissue responses, but also through modulation of sensory input and nociceptive processing at peripheral, spinal, and supraspinal levels. Evidence from electrical stimulation research indicates that analgesic effects may involve segmental inhibition, endogenous opioid activation, descending inhibitory control, and stimulation-dependent recruitment of overlapping neuromodulatory mechanisms. Building on this perspective, emerging clinical findings suggest that the simultaneous application of electrophysical agents with manual therapy or movement-based interventions may be associated with improved clinical outcomes compared with monotherapies. Recent randomized clinical trials involving functional magnetic stimulation, TECAR therapy, and electro-assisted manual techniques provide preliminary support for the hypothesis that concurrent delivery of mechanical and electrophysical stimuli may create a distinct multimodal sensory condition with potential neuromodulatory relevance. This conceptual review proposes the concept of “movement within a therapeutic field” to describe the integration of electrophysical stimulation with mechanical and sensorimotor input within the same therapeutic context. This framework repositions electrophysical agents as active components of a dynamic rehabilitation strategy rather than isolated passive adjuncts. Although current evidence remains preliminary and mechanistic pathways are not yet fully established, a better understanding of this interaction may support the development of more effective multimodal interventions, guide future mechanistic research, and inform innovative approaches to MSK pain rehabilitation.