A 2025 single-blind RCT examined the distant effects of myofascial release applied to the thoracolumbar fascia together with exercise training on balance, lower-extremity flexibility, and muscular endurance in 36 healthy young adults. The 3 treatment groups were: 1) myofascial release and exercise; 2) exercise only; and 3) no treatment (control). Treatment was 3x/week for 4 weeks. Myofascial release was self-applied vias foam roller; exercises addressed endurance, balance and stretching. Flexibility was assessed with sit and reach test, muscular endurance with the 1-minute sit to stand test, and balance with star excursion balance test before the intervention and at the end of the fourth week. Results indicated significant improvement in all outcomes for groups 1 and 2 but not 3. Group 1 improved significantly more than Group 2 in all outcomes. The authors concluded that the effect of distant myofascial release and exercise on flexibility, muscular endurance, and dynamic balance was greater than that of exercise alone. ABSTRACT

A 2025 parallel-group, pragmatic RCT with 106 patients aged 20-60 with subclinical spinal pain evaluated the effects of chiropractic care on physiological biomarkers, including brain-derived neurotrophic factor (BDNF), cortisol (saliva, blood, hair), inflammatory cytokines [interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), C-reactive protein (CRP), B-lymphocytes (CD19), T-helper cells (CD4), cytotoxic T cells (CD8), and natural killer cells (CD56)]. Either spinal manipulation (SM) or sham manipulation (sham) was provided over 12 weeks and followed up at 16 weeks. Significantly higher salivary cortisol and blood BDNF levels were found in the SM group at 12 weeks.. At the 16-week follow-up, blood cortisol and TNF-α levels increased in the sham group. The authors concluded that 12 weeks of spinal manipulation modulates biomarkers linked to neuroplasticity, inflammation and stress. Increases in BDNF and interleukin-6 suggest enhanced neuroplasticity and inflammatory responses, while decreases in tumor necrosis factor-alpha indicate a regulatory effect on systemic inflammation. These findings support the notion that chiropractic care modulates physiological systemic biomarkers, which may underscore its benefits on clinical outcomes. FREE FULL TEXT

A 2025 placebo-controlled RCT assessed the effect of CM on HRV in 64 participants aged 18-60 with musculoskeletal pain. The intervention group received a single high-velocity, low-amplitude impulse on the bilateral transverse processes of C1, while the control group (CG) received a placebo. HRV was recorded both pre- and post-intervention. Results indicated that both interventions induced HRV changes without significant intergroup differences, suggesting uncontrolled factors may influence the autonomic response. The authors concluded that instrument-assisted chiropractic manipulation of C1 did not significantly change HRV vs. placebo, indicating the need for further studies on external variables. ABSTRACT

A 2025 systematic review and meta-analysis assessed the effects of thoracic mobilization/manipulation on autonomic nervous system responses. 20 studies with 863 participants were included in the analysis and 15 in the meta-analysis. 4 studies had a high risk of bias. Meta-analyses indicated no statistically significant effect of mobilization or manipulation on markers of the ANS. The ratio of low-frequency-to-high-frequency power did not significantly decrease after thoracic mobilization/manipulation compared to any type of control intervention. Skin conductance did not significantly increase after thoracic mobilization/manipulation. Subgroup and sensitivity-analyses indicated no significant effects. Due to methodological limitations and heterogeneity in reported outcomes, definitive conclusions were not possible. FREE FULL TEXT

A 2025 systematic review and meta-analysis evaluated the effect of osteopathic and related manual interventions on adult mental health (depression, anxiety, stress) and psychophysiological measures (such as heart rate variability, skin conductance). 20 RCTs were included. Osteopathic interventions reduced depression and increased skin conductance. Depression improvements were greater in pain populations. However, wide prediction intervals and moderate heterogeneity indicate uncertainty in true effect sizes, and limited studies and sample sizes restrict assessment of publication bias. The authors concluded that osteopathic and related manual therapies may reduce depression and influence certain psychophysiological markers, particularly in pain populations, but more rigorous, larger, and longitudinal RCTs are needed. FREE FULL TEXT

A 2025 longitudinal retrospective cohort study of data from 53,412 veterans with chronic pain assessed effects of use of Whole Health Services compared to non-users on downstream use of IPT. Whole Health emphasizes non-pharmacological approaches to chronic pain, including chiropractic, acupuncture, massage therapy, yoga, Tai Chi and meditation. Rates of IPT were estimated over 18 months. Results indicated that Whole Health use was associated with 42% lower utilization of IPT at 3 months but differences were minimal by 18 months (1%). The authors concluded that emphasizing non-drug approaches, such as Whole Health, may help patients interrupt patterns of escalating invasive pain management. FREE FULL TEXT

A 2025 umbrella review of meta-analyses investigated the evidence for treatment and prevention of CAI. 37 studies were included. Results found strong evidence that lower weight and body mass index significantly reduce the risk of CAI. Strong evidence supports the treatment of CAI with exercise and moderate evidence supports manual therapy, acupuncture and surgery. ABSTRACT

A 2025 systematic review and meta-analysis investigated the effects of exercise training including balance training and aerobic training on fear of falling (FOF) and number of falls (NoF). 14 RCTs were included. There was a generally high risk of bias reported with selective reporting of results. Results of the meta-analysis indicated that exercise training reduced FOF and fall incidence in older patients with osteoporosis or osteopenia. The authors recommend inclusion of tailored exercises for fall prevention. ABSTRACT

A 2025 systematic review and meta-analysis evaluated the effect of osteopathic and related manual interventions on adult mental health (depression, anxiety, stress) and psychophysiological measures (such as heart rate variability, skin conductance). 20 RCTs were included. Osteopathic interventions reduced depression and increased skin conductance. Depression improvements were greater in pain populations. However, wide prediction intervals and moderate heterogeneity indicate uncertainty in true effect sizes, and limited studies and sample sizes restrict assessment of publication bias. The authors concluded that osteopathic and related manual therapies may reduce depression and influence certain psychophysiological markers, particularly in pain populations, but more rigorous, larger, and longitudinal RCTs are needed. FREE FULL TEXT

A 2025 longitudinal retrospective cohort study of data from 53,412 veterans with chronic pain assessed effects of use of Whole Health Services compared to non-users on downstream use of IPT. Whole Health emphasizes non-pharmacological approaches to chronic pain, including chiropractic, acupuncture, massage therapy, yoga, Tai Chi and meditation. Rates of IPT were estimated over 18 months. Results indicated that Whole Health use was associated with 42% lower utilization of IPT at 3 months but differences were minimal by 18 months (1%). The authors concluded that emphasizing non-drug approaches, such as Whole Health, may help patients interrupt patterns of escalating invasive pain management. FREE FULL TEXT

A 2025 umbrella review of meta-analyses investigated the evidence for treatment and prevention of CAI. 37 studies were included. Results found strong evidence that lower weight and body mass index significantly reduce the risk of CAI. Strong evidence supports the treatment of CAI with exercise and moderate evidence supports manual therapy, acupuncture and surgery. ABSTRACT

A 2025 systematic review and meta-analysis investigated the effects of exercise training including balance training and aerobic training on fear of falling (FOF) and number of falls (NoF). 14 RCTs were included. There was a generally high risk of bias reported with selective reporting of results. Results of the meta-analysis indicated that exercise training reduced FOF and fall incidence in older patients with osteoporosis or osteopenia. The authors recommend inclusion of tailored exercises for fall prevention. ABSTRACT

A 2024 systematic review assessed temporal and mechanical parameters of vibration that modulate balance to identify the short- and long-term effects of vibration on balance when applied to the lower limbs of older adults. 10 randomized controlled trials and 43 laboratory-based studies were included in the analysis. Vibration frequencies used in most studies (n=41) were ≤100 Hz. Amplitude in most studies was ≤1 mm. Short-term suprathreshold perceived muscle/tendon vibration had a large destabilizing effect size on balance in healthy older adults but little or no effect on older fallers. Short-term subthreshold vibration to the soles of the feet had a small stabilizing effect size. Suprathreshold muscle, tendon, or sole vibration applied for 10-30 min over days to weeks improved balance measures, but most (8 of 10) studies had an increased risk of bias. The authors concluded that these results suggest that the application of local vibration to the lower limbs of older adults can modulate balance in the short- and long-term. FREE FULL TEXT

A 2024 systematic review and meta-analysis evaluated the effect of balance training on chronic ankle instability (CAI). 9 randomized controlled trials involving 341 patients were included in the analysis. Results indicated that balance training, when compared to controls, significantly improved CAI. Balance training enhances daily activity capability, motor function, and dynamic balance, and it can be utilized to reduce the risk of a recurring sprain. However, there was no difference in outcomes when compared to strength training. FREE FULL TEXT

A 2023 multi-center double-blinded RCT with 200 healthy participants (mean age=22) analyzed short-term changes in dynamic and static balance after a manual therapy (MT) protocol in healthy participants and analyzed effects on mood and perception of change. The MT protocol included spinal high-velocity, low-amplitude manipulation of the lumbar spine and lower extremity and soft tissue techniques to the lower extremity. The results suggest the MT intervention was effective on dynamic balance in post-intervention in healthy participants, and some of the directions maintained the results at the 1-week follow-up. Perception of change in post-treatment and 1-week follow-up also significantly improved. The protocol did not show changes in static balance and mood states. FREE FULL TEXT

A 2023 commentary discusses a rationale for including chiropractors in prevention-focused care as Hong Kong’s healthcare system moves toward a preventive and primary care focus. Chiropractic professionals are in an advantageous position to support a prevention-focused strategy by identifying musculoskeletal problems early, reducing risks, and promoting healthy lifestyles. This article examines how the involvement of chiropractors in public health programs could improve population health in Hong Kong and boost primary care. The inclusion of chiropractors in district health centers and other initiatives would offer safer and more cost-effective choices for treating functional problems and chronic pain. FREE FULL TEXT

A 2023 commentary explores the role of chiropractic care in the sports industry in China and Hong Kong. As a component of sports medicine, chiropractic care can enhance athletic performance, health, and competitiveness by addressing biomechanical imbalances and optimizing neuromuscular function. The potential impact of chiropractic care on the sports industry includes attracting international events and investments, leading to increased economic opportunities and the overall growth of the industry. Key strategies for promoting chiropractic care in the sports industry encompass developing a robust chiropractic care infrastructure, raising public awareness through targeted campaigns, and implementing supportive policies by governments and sports organizations. FREE FULL TEXT

A 2023 systematic review and meta-analysis investigated the effect of non-pharmacological sleep interventions for improving inpatient sleep, with the primary outcome being sleep quality. 76 studies (5375 participants) comparing 85 interventions were included. Interventions comprised physical sleep aids, relaxation, manual therapy, music, psychological therapy, light therapy, sleep protocols, milk and honey, exercise, and nursing care. The meta-analysis found medium to large improvements in sleep quality for sleep aids, relaxation, music, and manual therapies. Manual therapies showed a large improvement in sleep quality compared with controls. FREE FULL TEXT

A 2023 systematic review evaluated the immediate effect of manual therapy (MT) on heart rate variability (HRV), a measure of the autonomic nervous system, in adults with chronic neck pain. 3 RCTs were included, with a total of 112 patients. MT techniques statistically significantly improved HRV in people with chronic neck pain. The authors concluded that results support the use of MT for an acute reduction in HRV, which is consistent with decreased sympathetic tone and subjective pain. ABSTRACT

A 2023 systematic review and meta-analysis investigated the effect of spinal manual therapy (SMT) compared with sham or no intervention on local or remote (segmental or non-segmental) pressure pain thresholds (PPTs) in patients with chronic musculoskeletal conditions and pain-free patients. 22 RCTs were included. There was no significant immediate effect of SMT on local, remote (segmental), and remote (non-segmental) PPTs in patients with chronic pain or in people who were pain-free. A small but statistically significant effect was observed on remote (non-segmental) PPTs in pain-free people, but the authors did not consider it clinically meaningful. The authors concluded that no immediate, consistent, or meaningful hypoalgesic effect of SMT was shown on PPTs in various body areas. Involvement of spinal or supraspinal underlying mechanisms were, therefore, not confirmed via PPTs but should still be investigated using methods designed to assess central nervous pain processing. ABSTRACT