Introduction: Spinal pain is one of the leading reasons for the absence from work, which is a major socio-economic problem. There are several reasons which vary from person to person. The main factors are individual characteristics, occupation and leisure time activities; a fairly low share are those with cancer and fractures. Treatment differs among therapists, but the most effective is the presnted multidisciplinary approach. This approach includes exercise, education, instrumental therapy and manual techniques. The latter not only affect the muscular skeletal structures but also the nervous system. According to the authors, the manipulation prevents the pain to transfer and thus significantly improves the function, whereby the sympathetic nervous system participates. Purpose: The aim was to research and present state-of-the-art literature and research in the field of the impact of manual therapy on the sympathetic nervous system. Methods: We have selected seven suitable studies in the online available databases, which have studied the activity of the sympathetic nervous system when manual techniques are applied. The studies needed to use randomized controlled experiments on subjects and should not have been older than 2010. Results: All of the studies have confirmed a response of the sympathetic nervous system response during manual therapy, but did not demonstrate greater efficacy than placebo. Two of seven studies have compared the Maitland and McKenzie approach and in both the latter achieved worse results by half. The second study, which performed therapy on individuals with symptoms, achieved a better response of the sympathetic nervous system. Discussion and conclusion: Depending on the change in skin irritation in placebo groups, the touch itself can lead to a sympathetic response, but less than in intervention groups. Studies using oscillation approaches have achieved better results than those without. Within the chosen studies, the most effective was the Maitland approach in subjects with back pain and the lowest score was when mobilizing the III stage in the area of the cervical spine. Three out of four studies have shown that the response to stimulus is specific to the side of the body, as the response of the sympathetic nervous system was expressed twice more on the side of the mobilization.