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The Effects Induced by Spinal Manipulative Therapy on the Immune and Endocrine Systems

Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto, 2 17100 Savona, Italy
Author to whom correspondence should be addressed.
Medicina 2019, 55(8), 448;
Received: 10 June 2019 / Revised: 27 July 2019 / Accepted: 2 August 2019 / Published: 7 August 2019
PDF [337 KB, uploaded 15 August 2019]


Background and Objectives: Spinal manipulations are interventions widely used by different healthcare professionals for the management of musculoskeletal (MSK) disorders. While previous theoretical principles focused predominantly on biomechanical accounts, recent models propose that the observed pain modulatory effects of this form of manual therapy may be the result of more complex mechanisms. It has been suggested that other phenomena like neurophysiological responses and the activation of the immune-endocrine system may explain variability in pain inhibition after the administration of spinal manipulative therapy (SMT). The aim of this paper is to provide an overview of the available evidence supporting the biological plausibility of high-velocity, low-amplitude thrust (HVLAT) on the immune-endocrine system. Materials and Methods: Narrative critical review. An electronic search on MEDLINE, ProQUEST, and Google Scholar followed by a hand and “snowballing” search were conducted to find relevant articles. Studies were included if they evaluated the effects of HVLAT on participants’ biomarkers. Results: The electronic search retrieved 13 relevant articles and two themes of discussion were developed. Nine studies investigated the effects of SMT on cortisol levels and five of them were conducted on symptomatic populations. Four studies examined the effects of SMT on the immune system and all of them were conducted on healthy individuals. Conclusions: Although spinal manipulations seem to trigger the activation of the neuroimmunoendocrine system, the evidence supporting a biological account for the application of HVLAT in clinical practice is mixed and conflicting. Further research on subjects with spinal MSK conditions with larger sample sizes are needed to obtain more insights about the biological effects of spinal manipulative therapy. View Full-Text
Keywords: spinal manipulative therapy; immune system; endocrine system; back pain; neck pain; physiotherapy spinal manipulative therapy; immune system; endocrine system; back pain; neck pain; physiotherapy
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Colombi, A.; Testa, M. The Effects Induced by Spinal Manipulative Therapy on the Immune and Endocrine Systems. Medicina 2019, 55, 448.

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