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Recommendations From the Conference on the Biology of Manual Therapies

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:

  • Behavioral responses to painful stimuli
  • Fibroblast response
  • Gene expression

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:

  • Distinguish between healthy and non-healthy tissues
  • Subcategorize patients/clients with musculoskeletal disorders

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:

  • The effects of temporal summation
  • The effect of manual therapies on windup
  • Quantitative sensory testing.

Non-neural outcomes might include:

  • Heart rate and heart rate variability
  • Laser Doppler blood flow and blood pressure changes
  • Respiratory frequency
  • CO2 levels
  • Catecholamine levels
  • Circulating cells (numbers/subsets/response)
  • Cytokines
  • Vaccine response (Ig response)
  • Contact hypersensitivity/DTH
  • High sensitivity C-reactive protein
  • Lymphatic flow

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