In this episode of The Evidence‑Based Chiropractor, Dr. Jeff Langmaid reviews a newly published narrative review titled Mechanoresponsiveness of Neuroimmune Crosstalk in Bone and Joints: A Narrative Review with Implications for Force‑Based Manipulations. He explains that bone is not merely a static scaffold but an active participant in a complex communication network linking the nervous system, immune system, and endocrine signals. The review highlights how sensory and sympathetic innervation of bone releases neurotransmitters (e.g., CGRP, substance P) that regulate osteoblast and osteoclast activity, and how pro‑inflammatory cytokines (IL‑1, TNF‑α, IL‑6) promote bone resorption while anti‑inflammatory cytokines (IL‑10) support formation. Balance between sympathetic and parasympathetic tone, and between pro‑ and anti‑inflammatory signaling, is crucial; chronic stress, high cortisol, poor sleep, and persistent inflammation shift the system toward bone loss and joint degeneration. Exercise improves neuroimmune balance, increasing bone density and reducing inflammation. Manual therapies, including chiropractic adjustments, show early evidence of influencing neuroimmune markers (e.g., osteocalcin) and may modulate nerve‑derived peptides that affect bone remodeling. Dr. Langmaid translates these findings into clinical pearls: explain to patients that adjustments influence more than pain— they affect systemic healing, inflammation, and bone health; emphasize stress‑reduction, sleep, nutrition, and movement as part of a comprehensive plan; and use the neuroimmune framework to differentiate chiropractic value and grow the practice. The episode also includes sponsor messages for Leander Tables, Shockwave Centers of America, NovoPulse OA Recovery Program, and the Diabetes Reversal Group.
Welcome to The Evidence Based Chiropractor, where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.
Hello and welcome to The Evidence-Based Chiropractor. I am your host, Dr. Jeff Langmaid. On today's episode, we are back with research, a brand new one and another good one. This is all about neuroimmune control of bone and why it changes everything for chiropractors. Brand new study we're gonna highlight on today's episode, pull out some clinical pearls. What did they find? What are the next questions to be asked? As well as how does this matter for your practice? Gonna dive into that and much more on today's episode. Before we get started, a few big shoutouts to our partners. One of them, Leander Tables. You can still save $1,000 off their Series 950 using the code EBC2026 or visiting their page, having a conversation, letting them know you listen to this podcast. You'll save $1,000 on the Series 950. And Shockwave Centers of America, $500 off one of their Shockwave units and a free cart. $1,500 in savings right there alone. We have more sponsors and partners at the end of this podcast. Big savings for being a listener. Thank you so much for tuning in. But as I said at the top, today's episode all about research and the title of the study. I'll drop a link in the show notes. As you could expect, it is titled Mechanoresponsiveness of Neuroimmune Crosstalk in Bone and Joints: A Narrative Review with Implications for Forced based manipulations. Brand, brand, brand new study that came out in Musculoskeletal Science and Practice, and we're gonna dive into it on today's episode. So I know I have had this thought. So if you've ever had the thought about your adjustment or even just a simple movement, how's that actually affecting a patient's immune system and their bone health? And at the same time or not? Well, that's what we're gonna dive into. That's really what this study was all about. Interestingly, there's a growing body of research showing that bone is not just structural. It's actually part of an incredibly complex system involving the nervous system, the immune system, and hormones, which are basically all in communication with each other constantly. Probably no news to you as far as that's concerned, but the depth and breadth and complexity of this system we're just starting to scratch the surface. So the kicker is this system, the complex system that I mentioned, it responds to pretty much everything, you know, movement, stress, exercise, and touch. So today we're gonna break down this brand new important review on neuroimmune crosstalk in bone and joints. And again, what this means for your practice, how to explain it to patients, and how it might shift how people perceive the value of care. So this paper is a narrative review, and it was looking at something called the neuroimmune crosstalk in bone and joints. So what does that actually mean? Well, it's exploring how the nervous system, the immune system, and the skeletal system— or for the, uh, international docs, the skeletal system, but I'll say the skeletal system— are constantly interacting and influencing each other. So historically, you know, I think many people in healthcare have thought of bone health in pretty simple terms: mechanical loading, hormones, and nutrition. But this research really expands that idea to a pretty significant amount. It shows that bone is actually part of that dynamic communication network involving brain signaling, inflammatory responses, neurotransmitters, and hormones. And all of this is happening in an incredibly complex, nonlinear, interconnected system where basically everything affects everything else. And this is, I'm gonna say, the beauty of the human body, of our life experience, of the dynamics, and of the chiropractic adjustment and how far-reaching it is, but also makes research really, really complex. So instead of thinking that bone responds to force, just direct mechanical loading, we should be thinking of bone responds to a full-body communication network. So if we pull out some of the most important key findings, bone is deeply connected to the nervous system. Bone tissue is richly innervated with sensory and sympathetic nerves, and these nerves release neurotransmitters that directly affect a variety of things. Bone formation, one of them. Bone breakdown, another one. The healing process, a third one. So really, really important. And the immune system plays, probably no surprise to you, a massive role in overall bone health. So pro-inflammatory cytokines like IL-1, TNF-alpha, IL-6, we talk about these week in and week out on this podcast, but they can actually increase bone breakdown. Breakdown. So osteoclast activity. Now anti-inflammatory cytokines, probably already know what this one's going to be, IL-10. They can promote bone formation and repair. So this is massively impactful because we've highlighted multitudes of other research studies talking about how what we do as chiropractors can influence cytokines. So it's not only brain-based, it's not only regional, it's not only segmental. This can really— has the potential, I should say, to really influence all the way down to bone matrix level. So before we get there, important to also know, you know, balance is everything. We know that throughout life, but we also see that in studies like this. So bone health depends on a really, really fine balance between sympathetic versus parasympathetic activity. A fine balance between pro-inflammatory versus anti-inflammatory signaling. And if that balance gets disrupted, it can result in a host of things that are not exactly what we want: bone loss, joint degenerative— degeneration, and poor healing mechanisms over time. Now, exercise, very strong evidence for improving this system, increases bone density and formation, some of that due to load, some of that due to what we're learning today, reduces inflammation, exercise that is, and improves neuroimmune signaling. So that's, that's well documented. Now let's talk about manual therapies, including what we do. Manual therapies show early but really promising effect. Some studies show increases in osteocalcin, in bone formation markers, but the evidence is pretty— is still pretty limited for what we'll say is direct bone changes. But there are measurable effects on neuroimmune markers. So if we unpack what's happening under the surface, you know, nerves directly influence bone. You know, sensory nerves release things like, uh, calcitonin gene-related peptide, CGRP. What does that do? A couple really nice things. Promotes bone formation, it inhibits bone breakdown. There's also substance P, plays a role in healing and inflammation, help regulating bone repair. So when mechanical loading happens, those nerves tend to become activated, they release signaling molecules, and bone remodeling is triggered. These are all really important things. And you probably saw the, the P word there, right? Peptide. In terms of that CGRP, I know there's a lot of topics around that. We won't dive into the peptide world today, but I thought I'd just point it out. We also can talk about that sympathetic versus parasympathetic balance. And this is where things get clinically relevant. Sympathetic stress response, right? Increases bone breakdown. Parasympathetic recovery mode promotes bone formation. Kind of oversimplifying, but that's the gist of it. So if your patient is stressed, inflamed, poor sleep patterns, high cortisol, a.k.a. 90% of what's walking through your door every day, their body is literally shifting towards bone loss. I can guarantee you almost nobody knows that. It's like, well, I'm— I have osteo. I have osteoporosis, I need to— And I'm not saying, I'm not talking about treatment right now, but what I am saying is many people who have that, it's like, "Okay, well, I need to work out and take calcium." It's like, well, are you stressed? Have you been stressed for 50 years? Have you been inflamed, poor sleep habits, and high cortisol for 50 years? It might not just be that your body has not enough calcium and you are not exercising enough. No, you know, having enough calcium and exercising enough are really good ideas. But there could be some really other— well, to say, critically important aspects of this that are chronically overlooked pretty much every single place. We can also highlight, you know, inflammation. It basically equals bone breakdown. Chronic inflammation drives osteoclast activity. We know that it drives cartilage damage. It drives things like joint degenerative changes. So rheumatoid arthritis, osteoarthritis, walk through your door again each and every day. These conditions are driven by persistent inflammatory signaling, and it doesn't just stop at the inflammatory component. It can really get down to how the bone density, the bone, you know, strength, so to speak, of each individual. And stress, it matters more than you think. We know stress matters with chronic disease, but I've never heard stress really talked about personally in terms of bone, right? And in terms of mechanical responsiveness of bone. So chronic stress actually activates the HPA axis. It can increase cortisol levels. It can suppress bone formation, and it actually increases the fracture risk. So this is a really, really big deal. Stress isn't just this mental thing. It actually affects us structurally. And for us, this is where everything comes together, because as chiropractors, what do we do every day? We influence movement. We influence nervous system function, mechanical chemical load, stress levels, and recovery. And all of those, literally every single one of those, feed directly into this neuroimmune system. So it's really not just about affecting joints. It's— what you're doing is influencing and affecting inflammation, hormone balance, neural signaling, healing capacity, all of these things. And this can really help, I'm going to say, shift some of your positioning It's, you know, can we help with pain? Absolutely. You know, for many neuromusculoskeletal challenges, a couple adjustments, people are feeling better, but that doesn't mean they are well. So instead of, I can help with pain, okay, a couple adjustments and you're out, it's really about, I can help regulate the systems that control things like healing, inflammation, and tissue health. You don't need to overstate it, but you also should be confident and clear. And that's really important because people have no clue that their bones and joints aren't just structural. They're actually controlled and influenced by the nervous and immune system. So if they're coming in and you're making influence on that within your practice, you're helping them in that way. And when many people, again, no clue that when their body's under stress and inflammation, especially chronic, it actually shifts towards breakdown instead of healing. So everything you're doing in your practice, whatever modalities they might be, whatever treatment protocols you're doing, you know, the goal is to move the body back towards a healing state, getting rid of pain. Pain is the last thing to come and the first thing to go. We all know that, Are you describing that efficiently and effectively to everybody that comes in your front door? And also that movement and the care that you provide, it's not just about feeling better. It's about helping the body rebuild and stay strong over time. And chances are that's not gonna happen in 1 or 2 adjustments. Has there been habit change? Have they actually built muscle? Have they shifted habits? All of these things are really, really important. Again, highlighting aspects of this during a report of findings, in reactivation campaigns, talking about it when you're integrating exercise, in prescribing movement for bone health, immune support, nervous system regulation, not just getting stronger, not just rehab, really important conversation, as well as stress conversations. This ties into everything. I mean, sleep, stress, recovery, you know, these are neuromusculoskeletal drivers. So while they're, you know, everybody out there, many chiropractors, pain, structure, pain, structure, you have the opportunity to talk about systems and adaptation and long-term health because bone health is not just structure. It's not just load and force. It's actual communication between the brain, the immune system, hormones, and the musculoskeletal system. And all of that is influenced by things like movement, stress, inflammation, and even touch— what you do in your practice. So I'm a big fan of research just like this because, again, it continues to highlight the breadth and depth of what we do. And it highlights that this is really about the holistic experience that, that patient is having. And this paper highlights the breadth and depth of what we do, the breadth and depth of the nervous system and its influence, and that ultimately being able to have accurate, clear communications is a really, really good way to help build a practice, to help build a community of people who understand what's going on at a higher level. And ultimately, as a result of that, your business grows. And your business grows not by quote unquote taking advantage of people or keeping people in your practice too long. It grows by helping people understand the truth, which is that every process takes time. The fact that they're in your practice and they might be 35, 45, 55, 65 years old, and if they've never been to a chiropractor before, They have that many decades of stress, of habits, of past injuries. And yes, you can help get them feeling better quickly, but chances are they're actually there for more than that. And it's not just about feeling better quickly. It's about ensuring that they have the best opportunity to feel their best for the longest amount of time. And for every person, that will be a little bit different. But that's a conversation that is often overlooked. Now, as we wrap up today's episode, big shout out to the NovoPulse OA Recovery Program. Osteoarthritis right right there. Do you have a program for your practice? If not, NovoPulse is a fantastic one to implement. Hardware, software, make it super easy. A lot of people walking in with that already. You can click the link down below, connect with the NovoPulse team and see what they have to offer, as well the Diabetes Reversal Group. Massive, massive opportunity here. I'm going to drop a link down below. You can watch their video, connect with their team, and learn more. It is a turnkey system. No selling on your behalf, nothing to buy. It is really about being able to help those individuals with type 2 diabetes. So whether this is your first episode or 530-some-odd episode listening, thank you so much for tuning in. If you would do me a solid and please click how many stars if you're listening on a podcast app, leave a line or two of feedback, super, super helpful in getting this podcast out to as many people as possible. Thank you so much for being a chiropractor. Have a fantastic week in practice, and I will talk to you soon.
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