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The Effect of Spinal Adjustment / Manipulation on Immunity and the Immune System: A Rapid Review of Relevant Literature. World Federation of Chiropractic.

Authors:

Abstract

This rapid review considers materials the WFC is aware have been cited in support of claims of effectiveness for spinal adjustment / manipulation in conferring or enhancing immunity.
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The Effect of Spinal Adjustment /
Manipulation on Immunity and the
Immune System: A Rapid Review of
Relevant Literature.
World Federation of Chiropractic.
March 19, 2020
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The Effect of Spinal Adjustment / Manipulation on Immunity and the Immune
System: A Rapid Review of the Relevant Literature
World Federation of Chiropractic.
March 19, 2020
Introduction
The world is currently in the midst of a global health crisis due to the spread of Coronavirus Disease 2019
(COVID-19). The World Health Organization (WHO) has declared COVID-19 a pandemic, meaning that it is
being spread uncontrolled across country borders. At the time of writing, COVID-19 is affecting some 143
countries worldwide and there have been over 200,000 reported cases. As testing for COVID-19 has been
limited, it is estimated that the true prevalence of COVID-19 is far greater than the situation reports have
stated.
WHO has issued information and guidance with a view to reducing the spread of COVID-19 and controlling
the pandemic. This information has included correcting misinformation about COVID-19.
The World Federation of Chiropractic (WFC) has supported WHO in its advice and recommendations and
on March 17, 2020 issued an advice note to the worldwide chiropractic profession.
One of the key messages contained in the WFC advice note highlighted the lack of credible, scientific
evidence supporting claims of effectiveness of spinal adjustment / manipulation in boosting immunity and
strengthening the immune system. Immunity is defined as the ability of an organism to resist disease, either
through the activities of specialized blood cells or antibodies produced by them in response to natural
exposure or inoculation, or by the injection of antiserum, or the transfer of antibodies from a mother to her
baby via the placenta or breast milk.
This rapid review considers materials the WFC is aware have been cited in support of claims of
effectiveness for spinal adjustment / manipulation in conferring or enhancing immunity.
1. Pero R, Flesia J, (1986) University of Lund, Sweden
Citation: None available.
Overview: It has been reported that in 1986 Dr Ronald Pero, a Professor of Medicine in Environmental
Health at New York State University, collaborated with Dr Joseph Flesia, a basic science researcher and
chiropractor. Reports state that subjects receiving chiropractic care (n=107) had a 200% greater immune
competence than those who had not received chiropractic care and a 400% greater immune system
competence than those with cancer or other serious disease.
Response: Numerous attempts have failed to retrieve this study. Without the original study to review, no
scientific assessment of its claims can be made. Therefore, the "Pero and Flesia" study does not constitute
credible, scientific evidence that spinal adjustment / manipulation enhances or confers immunity nor should
it be used as a basis to provide care.
2. Enhanced phagocytic cell respiratory burst
Citation: Brennan PC, Kokjohn K, Kaltinger CJ, Lohr GE, Glendening C, Hondras MA, McGregor M, Triano
JJ. Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P.
J Manipulative Physiol Ther. 1991 Sep;14(7):399-408. PMID:1719112.
https://www.ncbi.nlm.nih.gov/pubmed/1719112
Overview: This study examined the effect of spinal manipulation on the respiratory burst of
polymorphonuclear neutrophils (PMN) and monocytes in asymptomatic adults. The investigators found
changes in levels of substance P in subjects who underwent spinal manipulation but not in subjects who
underwent sham manipulation.
Response: The clinical meaning of the study?s results regarding cellular activity is not known. No clinical
research has been performed in this area. Therefore, it is not known if these observations have any effect
on human health. This report does not constitute credible, scientific evidence that spinal adjustment /
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manipulation enhances or confers immunity.
3. Enhanced in-vitro interleukin-2 production following spinal manipulation
Citation: Teodorczyk-Injeyan JA, Injeyan HS, McGregor M, Harris GM, Ruegg R. Enhancement of in vitro
interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropr
Osteopat. 2008 May 28;16:5. doi: 10.1186/1746-1340-16-5. PMID: 18507834; PMCID:
PMC2423359.https://www.ncbi.nlm.nih.gov/pubmed/18507834
Overview: The purpose of this study was to report on spinal manipulation-related changes in the production
of the immunoregulatory cytokine interleukin 2 (IL-2) in asymptomatic adults. This study found a short-term
increase in IL-2 with spinal manipulative intervention, with or without cavitation.
Response: The clinical meaning of these in vitro observations of cellular activity on human health is not
known. No clinical research has subsequently been performed in this area.
4. Interleukin-2-regulated in vitro antibody production following single spinal manipulative
treatment.
Citation: Teodorczyk-Injeyan JA, McGregor M, Ruegg R, Injeyan HS. Interleukin 2-regulated in vitro
antibody production following a single spinal manipulative treatment in normal subjects. Chiropr Osteopat.
2010 Sep 8;18:26. doi: 10.1186/1746-1340-18-26. PMID: 20825650; Central PMCID:
PMC2945351.https://www.ncbi.nlm.nih.gov/pubmed/20825650
Overview: The purpose of this study was to determine if spinal manipulation-related augmentation of in
vitro interleukin-2 synthesis in asymptomatic adults is associated with the modulation of interleukin
2-dependent and/or interleukin-2-induced humoral immune response. While the augmentation of IL-2
induced IgG or IgM synthesis in subjects receiving spinal manipulation, the amount did not exceed the
physiological range of normal human response.
Response: The clinical meaning of these in vitro observations of cellular activity on human health is not
known. No clinical research has been performed in this area. Further, the authors state "The clinical
significance of the elevated responsiveness to IL-2 demonstrated in this in vitro study is presently unclear."
5. Effects of specific upper cervical adjustments on CD4 counts in HIV positive patients.
Citation: Hightower BC, Pfleger B, Selano J. The Effects of Specific Upper Cervical Adjustments on the
CD4 Counts of HIV Positive Patients. Chiropractic Research Journal 1994 ;3(1):32-39. No PubMed ID
available ? this publication is not indexed by PubMed
https://www.chiroindex.org/?search_page=articles&action=&articleId=5619
Overview: This project sought to demonstrate if upper cervical specific adjustments have a profound effect
on the physiology, serology and immunology of HIV positive individuals. No statistically significant
differences between the treatment and control group were found.
Response: With only 5 subjects in the experimental treatment group, no description of how the study was
conducted or analyzed, and no reporting of absolute change in CD4 values, these results are highly
questionable. Further, the authors state "...it must be noted that we cannot generalize our findings to the
general population." The clinical meaning of these in vitro observations of cellular activity on human health
is not known.
6. Reports of decreased mortality in chiropractic/osteopathic patients during flu epidemics.
Citation: None
Overview: It is claimed that the treatment of patients by chiropractors during the influenza pandemic of
1918 resulted in fewer deaths than those treated by medical doctors.
Response: These narrative reports of historical events do not equate to scientific studies. Their lack of
methodological structure or data analysis is likely to have resulted in incomplete information and a high
likelihood of bias. We note that even those who have written about these events in a positive light
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(https://doi.org/10.7556/jaoa.2013.036) concede that there is no way to tell if these observations can be
attributed to manual medicine and care philosophy or ?statistical issues of reporting?. These various reports do
not provide the necessary evidence to justify the use of spinal adjustment / manipulation for infectious
diseases.
7. Effects induced by spinal manipulative therapy on the immune and endocrine system
Citation: Colombi A, Testa M. The effects induced by spinal manipulative therapy on the immune and
endocrine systems. Medicina 2019; 53:448. doi 10.3390/medicina55080448.
Overview: This was a narrative review of the available literature that aimed to provide an overview of the
available evidence supporting the biological plausibility of high-velocity, low-amplitude thrust on the
immune-endocrine system. Following a search, 4 studies were retrieved studying the effect of spinal
manipulation on the immune system.
Response: The authors concluded that "While spinal manipulation may stimulate the neuroimmunoendocrine
system, the evidence supporting a biological account for the application of high-velocity, low-amplitude thrust
manipulation in clinical practice is mixed and conflicting." It also concluded that the clinical relevance of most
of the studies remained unanswered as they were conducted on healthy subjects. This study supports that
there is no current basis for which to provide spinal adjustment / manipulation for the purpose of conferring or
enhancing immunity.
Conclusion
No credible, scientific evidence that spinal adjustment / manipulation has any clinically relevant effect on the
immune system was found. Available studies have small sample sizes and a lack of symptomatic subjects.
At the time of writing, there exists no credible, scientific evidence that would permit claims of effectiveness for
conferring or enhancing immunity through spinal adjustment / manipulation to be made in communications by
chiropractors.
In the event that new scientific evidence emerges, it will be critically appraised using scientific methods of
analysis.
Acknowledgments
The WFC is grateful to the Research Committee for its work in compiling this rapid review:
Greg Kawchuk DC, PhD (Chair)
Christine Goertz DC, PhD (Vice-Chair)
Iben Axén DC, PhD
Martin Descarreaux DC, PhD
Simon French B.App.Sci (Chiro), MPH, PhD
Mitch Haas MA, DC
Jan Hartvigsen DC, PhD
Carolina Kolberg BSc (Chiro), PhD
Michele Maiers DC, MPH, PhD
... Despite these trying times, we appreciate and are encouraged by the initiative and collaborative spirit of the chiropractic profession. Chiropractic institutions have ensured the availability of quality education in an online format [2], associations have supported and advocated for their members [3], and researchers have appraised literature to assist with knowledge translation [4]. ...
... Shortly after the World Health Organization (WHO) declared COVID-19 a pandemic [6], the World Federation of Chiropractic (WFC), which supports the WHO on this matter, released a rapid review on March 19th, 2020 [4]. The review, which examined cited material claiming support for the effectiveness of SMT and immunity enhancement, concluded that "[there is] no credible, scientific evidence that spinal adjustment/manipulation has any clinically relevant effect on the immune system …" [4]. ...
... Shortly after the World Health Organization (WHO) declared COVID-19 a pandemic [6], the World Federation of Chiropractic (WFC), which supports the WHO on this matter, released a rapid review on March 19th, 2020 [4]. The review, which examined cited material claiming support for the effectiveness of SMT and immunity enhancement, concluded that "[there is] no credible, scientific evidence that spinal adjustment/manipulation has any clinically relevant effect on the immune system …" [4]. As students, we are not only encouraged by the WFC's response, but support their strong and swift action in exposing unsubstantiated claims contradicting official public health policy. ...
Article
Full-text available
Background The 2019 coronavirus pandemic is a current global health crisis. Many chiropractic institutions, associations, and researchers have stepped up at a time of need. However, a subset of the chiropractic profession has claimed that spinal manipulative therapy (SMT) is clinically effective in improving one’s immunity, despite the lack of supporting scientific evidence. These unsubstantiated claims contradict official public health policy reflecting poorly on the profession. The aim of this commentary is to provide our perspective on the claims regarding SMT and clinically relevant immunity enhancement, drawing attention to the damaging ramifications these claims might have on our profession’s reputation. Main text The World Federation of Chiropractic released a rapid review demonstrating the lack of clinically relevant evidence regarding SMT and immunity enhancement. The current claims contradicting this review carry significant potential risk to patients. Furthermore, as a result of these misleading claims, significant media attention and public critiques of the profession are being made. We believe inaction by regulatory bodies will lead to confusion among the public and other healthcare providers, unfortunately damaging the profession’s reputation. The resulting effect on the reputation of the profession is greatly concerning to us, as students. Conclusion It is our hope that all regulatory bodies will protect the public by taking appropriate action against chiropractors making unfounded claims contradicting public health policy. We believe it is the responsibility of all stakeholders in the chiropractic profession to ensure this is carried out and the standard of care is raised. We call on current chiropractors to ensure a viable profession exists moving forward.
... Although manipulation of the skeleton has been shown not to influence the immune system, its ability to act as a fulcrum or motion, to allow flow of effector cells through lymph and its internal microenvironment, for immune development points to the importance of a full osteopathic structural examination in patients with PIDs [22]. We have described the first concise osteopathic examination of an immunodeficient patient with a PIK3R1 mutation and a review of musculoskeletal abnormalities found in more common PIDs. ...
Article
Full-text available
Structural skeletal abnormalities are associated with primary immunodeficient (PID) patients. These abnormalities have not been well studied in PID with reference to osteopathic medicine tenets. Osteopathic structural examinations of PID patients with respect to these tenets and the diagnosis of somatic dysfunctions preventing the free flow of lymph fluids back into the circulation and the disruption of the skeletal microenvironment may have an impact on the status of the immune system in patients with a PID. A standardized evaluation was conducted in a patient with a phosphatidylinositol 3-kinase regulatory subunit 1 (PIK3R1) mutation who presented with skeletal abnormalities. A literature review was also conducted to determine the breadth of other PIDs with structural irregularities. Osteopathic structural clinical examinations (OSCEs) were performed by an osteopathic medical student, fellow, and attending after receiving informed consent from the patient. The findings were collected regionally noting severity, tissue texture changes, asymmetry, altered range of motion (ROM), and tenderness according to DO-Touch.NET physical examination and treatment form. A literature review was conducted utilizing various search engines and the textbook, Stiehm’s Immune Deficiencies, 4th edition. The significant findings found from the patient were right sidebending rotation cranial strain pattern with decreased left temporal bone motion, temporomandibular joint crepitus, and right deviation upon mandibular opening. The thoracolumbar region revealed tissue tenderness and restricted psoas ROM. Bilateral sacroiliac joint tenderness, right superior sheering, and anterior innominate rotation, along with left-on-left sacral flexion, were associated with valgus knees. The literature search showed multiple other PIDs outside of PIK3R1 that have associated skeletal and structural abnormalities. Irregular skeletal features found in immunodeficient patients may have an additive defect on the immunological responses due to somatic dysfunction impinging on the lymphatic flow to the central circulation. Other different immunodeficient patients suffer from boney structural abnormalities, which may lead to further immune hindrance caused by impingement of flow as well as bone marrow microenvironment impact on the peripheral immunological output. We present the first osteopathic examination with detailed findings of somatic dysfunction in a patient with PID. Future studies on PID patients should require more attention to structure and function, as found by a thorough osteopathic examination in order to unrestrict preformed cellular and humoral components back into the peripheral circulation.
... This includes assertions by researchers within the chiropractic profession that there is no credible evidence supporting claims of effectiveness of spinal adjustment and/or manipulation in boosting or strengthening the immune system and that there is no credible, scientific evidence that spinal adjustment and/or manipulation has any clinically relevant effect on the immune system. 5 As a result of the assertions by these researchers, some chiropractic regulatory boards, chiropractic trade organizations and chiropractic educational institutions from around the world are claiming that there exists no credible, scientific evidence that would permit claims of effectiveness for conferring or enhancing immunity through spinal adjustment and/or manipulation to be made in communications by chiropractors. 6 Essentially, chiropractors have been effectively muzzled and banned from discussing any connection between the nervous and immune systems. ...
Article
Objective: To discuss the existing literature on chiropractic, vertebral subluxation and immune function in order to inform the development of an integrative review of the literature, a review of immune biomarkers in relation to chiropractic, development of a research protocol, the implementation of future studies and the development of related policy. Methods/Results: We conducted a scoping review of existing literature available to the authors and conducted further searches and gathering of documents based on that available literature. 125 papers were gathered and included in this review. Conclusions: This is a scoping review of the literature regarding chiropractic and its relationship to neuroimmunology. It is intended to inform a larger project and give that team as much background as possible in a short period of time. The results of the already available research demands that we further explore the neuro-immuno-regulatory effects of chiropractic, adjustment and spinal manipulation and it provides a starting point for doing so. While adjustments reduce pain and inflammation, they also improve immune-regulatory function. How and to what extent is the subject of this current multi-pronged project. Key Words: Chiropractic, immunity, neuroimmunity, neuroimmunology, psychoneuroimmunology, neuroimmunoendocrine system, immune biomarkers, supersystem, vertebral subluxation, adjustment, spinal manipulation
... This includes assertions by researchers within the chiropractic profession that there is no credible evidence supporting claims of effectiveness of spinal adjustment and/or manipulation in boosting or strengthening the immune system and that there is no credible, scientific evidence that spinal adjustment and/or manipulation has any clinically relevant effect on the immune system. 5 As a result of the assertions by these researchers, some chiropractic regulatory boards, chiropractic trade organizations and chiropractic educational institutions from around the world are claiming that there exists no credible, scientific evidence that would permit claims of effectiveness for conferring or enhancing immunity through spinal adjustment and/or manipulation to be made in communications by chiropractors. 6 Essentially, chiropractors have been effectively muzzled and banned from discussing any connection between the nervous and immune systems. ...
Article
Objective: To perform a scoping review of the existing literature on salivary tests for immunoglobulin A (IgA), cortisol and C-reactive protein (CRP) to inform researchers in regards to their use as measurements of immune biomarkers following chiropractic intervention. Methods/Results: We conducted a scoping review of existing literature available to the authors and conducted further searches and gathering of documents based on that available literature. 46 papers were gathered and included in this scoping review. Conclusions: This is a scoping review of the existing literature on salivary tests for immunoglobulin A, cortisol and C-reactive protein. Its purpose is to inform researchers on the existing science in order to inform their use as measurements of immune biomarkers following chiropractic intervention. It is intended to inform larger projects and give that team as much background as possible in a short period of time. The results of this scoping review reveal the potential use and utility of salivary tests as measurements of immune biomarkers to explore the neuro-immuno-regulatory effects of chiropractic, adjustment and spinal manipulation. Key Words: Chiropractic, immunity, neuroimmunity, neuroimmunology, psychoneuroimmunology, neuroimmunoendocrine system, immune biomarkers, supersystem, vertebral subluxation, adjustment, spinal manipulation, Immunoglobulin A, C-Reactive Protein, cortisol, salivary tests
... Within the chiropractic profession, broad stroke assertions by researchers to the effect that no "credible" published scientific evidence supports claims of clinically relevant effectiveness of spinal adjustment and/or manipulation in boosting or strengthening the immune system. 5 As a consequence of the assertions of the small cadre of researchers, certain chiropractic regulatory boards, chiropractic trade organizations and chiropractic educational institutions from around the world are claiming that there exists no credible, scientific evidence that would permit claims of effectiveness for conferring or enhancing immunity through spinal adjustment and/or manipulation to be made in communications by chiropractors. 6 Essentially, chiropractors have been effectively muzzled and throttled from discussing any connection between the nervous and immune systems. ...
Article
Full-text available
A growing body of evidence supports our understanding of the role of the nervous system in immune system function. Basic science studies and clinical reports in the scientific literature provide supportive evidence of the beneficial effects of chiropractic care in improving function, including immune system function and quality of life. These guidelines support chiropractic practice in an evidence-informed, patient centered model. Evidence-informed practice involves the integration of the knowledge and experience of the chiropractor, the best available research evidence, and the needs and preferences of individual patients. Furthermore, chiropractors must be free to discuss, publish, and otherwise disseminate the best available evidence, and in practice, apply it to the needs of individual patients.
... Most chiropractors in our study identified recognised government agencies and professional bodies as their most trusted sources when seeking COVID-19 public health information. However, a smaller number of chiropractors have made claims on social media that chiropractic spinal manipulation reduces the adverse impact of COVID-19 [11,12,14], claims that appear to conflict with current clinical research evidence [51,52]. In response, leaders of the chiropractic research community [53], chiropractic regulatory bodies [15,16] and chiropractic professional associations [54][55][56][57] have made efforts to redress such claims within the profession. ...
Article
Full-text available
Background The unprecedented impact of COVID-19 on healthcare professionals has implications for healthcare delivery, including the public health guidance provided to patients. This study aims to assess the response and impact of COVID-19 on chiropractors internationally, and examines the public health response of chiropractors to the COVID-19 pandemic practising under a musculoskeletal spine-care versus subluxation-based care paradigm. Methods A survey was distributed to chiropractors in Australia, Canada, Denmark, Hong Kong, United Kingdom and United States (Oct. 2nd–Dec. 22nd, 2020) via professional bodies/publications, and social media. Questions were categorised into three domains: socio-demographic, public health response and business/financial impact. Multivariable logistic regression explored survey items associated with chiropractors practising under different self-reported paradigms. Results A total of 2061 chiropractors representing four global regions completed the survey. Our recruitment method did not allow the calculation of an accurate response rate. The vast majority initiated COVID-19 infection control changes within their practice setting, including increased disinfecting of treatment equipment (95%), frequent contact areas (94%) and increased hand hygiene (94%). While findings varied by region, most chiropractors (85%) indicated that they had implemented regulator advice on the use of personal protective equipment (PPE). Suspension of face-to-face patient care during the peak of the pandemic was reported by 49% of the participants with 26% implementing telehealth since the pandemic began. Chiropractors practising under a musculoskeletal spine-care paradigm were more likely to implement some/all regulator advice on patient PPE use (odds ratio [OR] = 3.25; 95% confidence interval [CI]: 1.57, 6.74) and practitioner PPE use (OR = 2.59; 95% CI 1.32, 5.08); trust COVID-19 public health information provided by government/World Health Organisation/chiropractic bodies (OR = 2.47; 95% CI 1.49, 4.10), and initiate patient telehealth in response to COVID-19 (OR = 1.46; 95% CI 1.02, 2.08) compared to those practising under a subluxation-based paradigm. Conclusions Chiropractors who responded to our survey made substantial infectious control changes in response to COVID-19. However, there was regional variation in the implementation of the advised practitioner and patient use of PPE and limited overall use of telehealth consultations by chiropractors during COVID-19. Musculoskeletal spine-care chiropractors were more adaptive to certain COVID-19 public health changes within their practice setting than subluxation-based chiropractors.
... (62) A critical analysis of the biomedical approach promoted by the WFC suggests flaws in its basic understanding of clinical chiropractic practice by applying the standards of medical care to a patient under chiropractic care. (63) The inability to understand this distinction seems to underpin the WFC's position in another matter (64) and I make this point here as it appears the contemporary divided professional identity can be resolved to being 1 of 2 interpretations of clinical practice as a chiropractor. These are either a conventional view through a chiropractic lens or a concessional view through a medical lens. ...
Research
Full-text available
Objective: To discuss the professional identify of chiropractic as evident in the profession's literature. Methods: Structured literature review followed by a pragmatic historical narrative of found artefacts. Results: The literature appears vague regarding chiropractic's identity. Discussion: The literature does allow a broad determination that the identity of chiropractic is uni-modal gathered around the founding premise of DD Palmer with an informed prediction of a left-skewed, negative distribution of concessional chiropractors representing no more than 30% of all. It appears this minority becomes more dogmatic as it concedes elements of conventional identity and adopts extreme evidence-based musculoskeletal medicine to become a sect of about 0.2% of all. About 70% of chiropractors identify with subluxation in an evidence-informed context and I call this representation the conventional chiropractic identity. Conclusion: The identity of chiropractic may now be described as conventional when its practitioners adhere to the profession's founding precepts, or concessional when it modifies or ignores these. The majority of the profession can be considered conventional. (J Contemporary Chiropr 2020;3:111-126)
... has not yet been done that shows that HVLA controlled vertebral thrusts enhance immune function [301]. This is important for all manual therapists to know when promoting the potential benefits of HVLA controlled vertebral thrusts or when sharing information related to HVLA controlled vertebral thrusts and immunity or the COVID-19 pandemic. ...
Article
Full-text available
The current COVID-19 pandemic has necessitated the need to find healthcare solutions that boost or support immunity. There is some evidence that high-velocity, low-amplitude (HVLA) controlled vertebral thrusts have the potential to modulate immune mediators. However, the mechanisms of the link between HVLA controlled vertebral thrusts and neuroimmune function and the associated potential clinical implications are less clear. This review aims to elucidate the underlying mechanisms that can explain the HVLA controlled vertebral thrust--neuroimmune link and discuss what this link implies for clinical practice and future research needs. A search for relevant articles published up until April 2021 was undertaken. Twenty-three published papers were found that explored the impact of HVLA controlled vertebral thrusts on neuroimmune markers, of which eighteen found a significant effect. These basic science studies show that HVLA controlled vertebral thrust influence the levels of immune mediators in the body, including neuropeptides, inflammatory markers, and endocrine markers. This narravtive review discusses the most likely mechanisms for how HVLA controlled vertebral thrusts could impact these immune markers. The mechanisms are most likely due to the known changes in proprioceptive processing that occur within the central nervous system (CNS), in particular within the prefrontal cortex, following HVLA spinal thrusts. The prefrontal cortex is involved in the regulation of the autonomic nervous system, the hypothalamic–pituitary–adrenal axis and the immune system. Bi-directional neuro-immune interactions are affected by emotional or pain-related stress. Stress-induced sympathetic nervous system activity also alters vertebral motor control. Therefore, there are biologically plausible direct and indirect mechanisms that link HVLA controlled vertebral thrusts to the immune system, suggesting HVLA controlled vertebral thrusts have the potential to modulate immune function. However, it is not yet known whether HVLA controlled vertebral thrusts have a clinically relevant impact on immunity. Further research is needed to explore the clinical impact of HVLA controlled vertebral thrusts on immune function.
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