Manual Therapies

Conference on the Biology of Manual Therapies
Conference Recommendations

June 9-10, 2005

Natcher Conference Center,
National Institutes of Health,
Bethesda, Maryland

General Questions Relating To Mechanisms of Action for Manual Therapy

Determine the effects of manual therapy in normal experimental animals and in animal models of tissue injury, including:

Does applying very superficial "manual therapies, such a light massage, that mainly activate skin afferents produce different effects on the nervous system, immune system, and endocrine system compared with manual therapies that also involve activation of muscle afferents?

Does paraspinal tissue have any unique physiology compared to appendicular tissues? Is this related to the reported clinical efficacy of manual therapies?

Do manual therapies produce long-lasting changes in the biomechanics of the spinal, torso, or limbs? Are these changes associated with altered activity in the nervous system? Immune system? Endocrine system?

Identify valid, reliable biomechanical measures (e.g. posture, kinematics, kinetics, functional imaging) that can be used to:

Develop imaging techniques that can be used to capture dynamic in vivo responses to biomechanical signals in healthy and non-healthy tissues.

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Questions Relating To Peripheral Mechanisms of Action for Manual Therapy

Determine and compare the discharge characteristics (i.e. the pattern or frequency of action potentials) of primary sensory neurons in response to various types of manual therapies (e.g., high velocity loading compared with slower loading rates). Is there any correlation with reported efficacy?

How do various manual therapies affect peripheral nerve biomechanics?

What path of mechanical load transmission do various manual therapies take through the body?

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Questions Relating To Central Mechanisms of Action for Manual Therapy

Determine how different types of manual therapies affect the signaling properties of neurons in the central nervous system or autonomic nervous system. I.e., do they produce long-lasting changes?

Do different types of manual therapies evoke different patterns of neural activity in the central nervous system or autonomic nervous system?

Determine effects of peripheral mechanical stimuli (e.g., manual therapies) on spinal cord gating mechanisms and synaptic plasticity.

Develop and use human models of experimental pain to determine the role of the nervous system, if any, in explaining how manual therapies work. Specific areas of investigation could include: Non-neural outcomes might include:

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