The clinical implications of this altered brain state in individuals with chronic low back pain are not completely known yet. However, the authors make three interesting observations for clinical practice. Firstly, a number of manual therapies focus on an analgesic effect via descending pathways that inhibit pain, while these pathways are disrupted in this population. Secondly, psychological and cognitive deficits are involved in the problem of chronic low back pain. Thirdly, the changed cortical representation will disrupt the body perception of the individuals, another possible target for treatment.