Mechano responsiveness of neuroimmune cross-talk in bone and joints: A narrative review with implications for force-based manipulations.

Researchers reviewed how the nervous and immune systems work together to maintain healthy bones and joints, and whether hands-on therapies like acupuncture might influence this process. Our bodies have a complex communication network where the brain, nerves, immune cells, and hormones all send signals that affect bone strength and joint health. This system helps control inflammation, bone building, and bone breakdown.

The study found strong evidence that physical activity positively affects bones and this nerve-immune communication system. However, researchers discovered very little scientific evidence showing whether force-based treatments—including acupuncture, massage, manual therapy, and spinal manipulation—actually change bone tissue itself. Despite this gap, some early studies have found that these hands-on therapies may influence the immune and nervous system responses related to bone health.

For patients considering acupuncture or other manual therapies for bone and joint conditions, this means the research is still emerging. While these treatments may affect the body's neuroimmune responses, more studies are needed to understand exactly how they work and which patients benefit most. The review suggests that clinicians should customize treatment plans based on individual factors like age, hormone levels, and other health conditions, since these affect how your nervous and immune systems respond.

The most important takeaway is that while physical activity has proven benefits for bone health, the scientific understanding of how acupuncture and similar therapies affect bones is still developing. If considering acupuncture for bone or joint health, seek treatment from a qualified, licensed acupuncture practitioner.

This narrative review examines neuroimmune mechanisms in bone and joint health and evaluates whether force-based manipulations influence these systems. The authors describe a complex nonlinear network involving sympathetic/parasympathetic signaling, pro- and anti-inflammatory cytokines, cortisol, hormones, and growth factors that regulate bone cell function, with the brain serving as central coordinator. While substantial evidence supports physical activity's effects on bone-related neuroimmune responses, the review identifies a significant evidence gap regarding actual bone changes induced by force-based manipulations including acupuncture, massage therapy, manual therapy, and spinal manipulation. However, preliminary studies suggest these interventions may exert neuroimmune modulatory effects. No specific sample sizes or effect sizes were reported as this was a narrative review rather than a systematic review or meta-analysis. Clinical implication: Practitioners should individualize physical activity, manual therapy, and exercise interventions based on patient-specific factors (age, hormonal status, comorbidities) that influence neuroimmune responses and bone health, while recognizing current evidence limitations for force-based approaches.