What I’m reading: Neuroimmune interactions in musculoskeletal conditions
Your pain and your body are having a conversation and it's sooo cool.
I've been reading a review article and I genuinely can not stop thinking about it. I keep bringing it up in treatments. It's on neuroimmune interactions in musculoskeletal conditions, which sounds super dry, I know, but I’m a nerd and it is soo juicy!
There are sooo many nuggets that make me run out of my office to share with anyone who will listen!
“Neuroimmune interactions in musculoskeletal conditions. An introduction for clinicians.”
Schipholt, Ivo J. Lutke, et al.
Musculoskeletal Science and Practice 81 (2026): 103469.
https://doi.org/10.1016/j.msksp.2025.103469”
Not to mention that this article reminded me of so many cool little tid bits about our bodies. LIKE → did you know that the nervous system has non nervous cells, and cells that make hormones. (that could be its own blog “where the f*** do hormones come from????”)
THE ONE THING
Except it’s 3 things, or 4.
Neurogenic Neuroinflammation (1st off that’s a ridiculous name)
It means that nerves at your skin, or fingers, or glutes, - peripheral nerves - can start inflammation in YOUR SPINAL CORD!!!! (Xanthos and Sandkühler, 2014). This means that even a “small” injury could lead to big responses, and full body adaptations. The size of the injury does not necessarily relate to our pain response.
Ongoing inflammation can lead to higher nerve sensitivity and can show up as chronic pain or pain and dysfunction that spreads throughout the body. (Chapman and Tucker, 2008).
Let’s break this one down. Higher nerve sensitivity means your nerve will send a signal to your brain with less sensation. So normally a feather is light touch, but with increased sensitivity your nerves could read that as pain. AKA your body is like guys something happened, it might happen again!
This is why osteopathic manual therapy treatments focus on circulation! To lower the nerves threshold to pain. This mechanism is actually fundamental to osteopathic treatment, that without proper circulation or drainage nerves get more sensitive, increasing our pain levels. It's cool to see that this idea is slowly becoming more mainstream.
An unaffected nerve can pick up on a nearby nerve-immune response and spread the immune response to other nerves (aka other parts of the body)
This is referring to nearby nerve cells in the spinal cord. When we look at anatomy this makes sense because we have “interneurons” which communicate short distances up and down the spine.
BUT, what this means for pain is that the pain is not necessarily the site of injury. Or, the pain could be at the site of injury plus at other spots. I read this as pain that moves, pain that might be hard to pin point, or pain that is diffuse.
In people who recover the best, inflammation markers are high when an injury first occurs, then go back to base levels as the injury heals (Klyne, Barbe et al., 2018)
In some instances, high inflammation levels are good. Conversely, chronic low-grade inflammation markers could be medical proof of persistent pain (Lutke Schipholt, Scholten-Peeters et al., 2022), (Lutke Schipholt et al., 2024a)
Here is a great quote from the article, “This may partly explain why the use of anti-inflammatory medications in people with acute back pain is associated with an increased risk of developing ongoing, chronic pain (Parisien, Lima et al., 2022).”
I’m an anatomy nerd, so that is what I took from the article, but there are so many other layers. They also discuss the stress response and other neurological influences to the nervous system. They also talk about lifestyle modifications. Which really comes down to the things we already know: Eat well, move well, sleep well, and manage stress.
WHY DOES THIS MATTER?
Other than it is so cool to understand our bodies, this matters because it gives pain context, and it gives manual therapy context. What I take away from this article is that our bodies are really one dynamic unit of function. Like for real. There is no “immune system” without the “nervous system”.
It really reinforces for me why I never look at the structure in front of me in isolation without also considering what else is going on for you.
I was relaying one of these tidbits to a patient, and they commented that it sounded terrible, more opportunity for inflammation. But these processes are actually crazy helpful. These mechanisms allow for incredibly fine tuned responses to actual and perceived tissue damage This helps your body reach its goal of protection and healing you.
WHAT THIS HAS ADDED TO MY PRACTICE
I (like everyone) look for confirmation to my biases. And I see this as a call for working with the nervous system in treatment, not as secondary consideration, but as important, front and centre. I remember one of my teachers saying “treat the body like a very sensitive nervous system, because it is” and this article feels like its saying the same thing. In science language.
This article made me want to double down on the gentle work that I do. It feels like it has given me the academic/ scientific explanation to back up my treatment philosophies.
If this got you thinking about your own pain and your own responses to stress, I'd love to hear it. You can always reach me through the contact page, or we can chat about it at our next session. LMK.
