Manual therapy and exercise effects on inflammatory cytokines: a narrative overview.

This was a narrative overview, not a systematic review, so the authors did not use a comprehensive automated search or rate risk of bias. The included studies mixed animal work, healthy people, and people with conditions, so findings may not apply to patients with musculoskeletal pain. Exercise and manual therapy doses, techniques, timing, and cytokine measurement methods varied widely, so consistent conclusions are difficult. Many manual therapy studies showed mixed or no effect, and the authors state there is insufficient evidence to draw conclusions. Cytokines interact with each other and with nervous and endocrine systems, so changes in one marker may not mean a clinically useful effect. Many manual therapy studies had poorly described subjects, so it is unclear how patient condition affected cytokine responses.

The study received NIH support through the Force-Based Manipulation network. The authors state the funders had no role in design, data collection, analysis, publication decisions, or manuscript preparation.

Do not conclude that manual therapy or exercise changes cytokines in a clinically useful way for musculoskeletal pain. The review found mixed manual therapy evidence and insufficient evidence for firm conclusions, and many studies were preclinical or did not focus on patients with musculoskeletal pain.