One of the beliefs I carry into my work is the belief that the bodywork done is a conversation between the practitioners hands, the patient’s nervous system, and the patients verbal feedback. I think of it as a three way conversation.
Sometimes those conversations lead to questions that challenge the way we understand the body.
Recently, I was working with a patient recovering from a concussion. We started discussing a fascinating new study that explored how applying controlled mechanical compression to the tibia, or shinbone, appeared to help animals recover from traumatic brain injuries.
Researchers applied mechanical pressure to a bone in the leg and observed improvements in recovery from injuries involving the brain.
The study, published in Nature Neuroscience in September 2026, explored how specialized cells within our bones respond to mechanical forces and how those responses may influence the brain.
As we talked about the research, my patient asked me a question that took our conversation in an interesting direction.
"Why do you think they chose the tibia?"
I was grateful for that question because it immediately got my clinical brain thinking about anatomy.
If you run your fingers down the front of your shin, you'll notice something different compared to most other areas of the body.
There's very little muscle covering that portion of the tibia. In some areas zero muscle lays over the bone.
Beneath the skin and its connective tissue layers, we have the periosteum, a thin but incredibly important membrane that covers most of the outer surface of bone.
My initial thought was that this accessibility might make the tibia a particularly interesting place to apply mechanical forces.
It reminded me of some of the work we do around the cranium.
In certain regions of the skull, we also have relatively thin layers of soft tissue covering bone. The epicranial aponeurosis, surrounding connective tissues, and periosteum all contribute to the anatomy we're working through.
Of course, the skull and tibia are very different structures, and we can't assume pressure applied to one creates the same biological response as pressure applied to the other.
But the comparison led us to something else worth discussing.
Bones aren't just hard structures holding us together. They're living, responsive tissues.
And I think that's something we tend to forget.
When most people imagine a skeleton, they picture the dry bones we see in anatomy classrooms or museums or on a wildness hike.
But that's not what our bones are like inside our bodies.
Bones are alive.
They're supplied with blood vessels and nerves. They contain cells that constantly maintain, remodel, and respond to the demands placed on them.
Even the periosteum, that thin membrane covering the outer bone, is rich in sensory nerves and blood vessels. It's one reason direct pressure or injury involving the bone surface can be so sensitive.
And inside the bone are specialized cells called osteocytes.
These cells help monitor the mechanical environment of our skeleton.
Every time we walk, run, jump, or place weight through our bodies, mechanical forces travel through our bones.
Those forces can be translated into biological signals.
This process is called
It's a complicated word for a relatively simple concept.
Mechanical force becomes biological information.
And that's exactly what made this study so fascinating.
The researchers identified a mechanosensitive protein called PIEZO1 within the osteocytes. Think of it as part of the cells' ability to recognize mechanical changes.
When researchers applied controlled compression to the tibia, they activated a biological signaling process that appeared to support recovery from brain injury in their animal models.
The study suggests that signals released by bone cells can influence inflammation and nerve-cell survival.
When the researchers experimentally disrupted PIEZO1 in osteocytes, the beneficial effects of compression were lost.
This suggested that bone wasn't simply receiving pressure. The bone cells were actively participating in a response that could influence tissues elsewhere in the body.
Researchers described this relationship as part of a
Now, I want to be careful here.
This research was performed in animals using controlled mechanical loading. It is very early in research and shouldn’t be taken as if this means that pressing on someone's shin will treat a concussion, and it certainly doesn't mean we've discovered a new manual therapy protocol for traumatic brain injuries.
But what it does demonstrate is that our bones may participate in biological communication with the brain in ways we're only beginning to understand.
And that brings me back to the conversation with my patient.
As we continued talking about the tibia, the periosteum, and the surrounding tissues, I started thinking about how these structures are connected.
Our bones don't exist independently from everything else.
They interact with fascia, tendons, ligaments, muscles, blood vessels, and nerves.
When we apply a mechanical force to the body, that force interacts with multiple tissues, each with its own mechanical and sensory properties.
This is why weighted blankets can be extremely therapeutic for some.
And all of this is something I think about regularly in my clinical work.
How this are connected.
When I'm performing manual therapy, I'm not simply trying to push on a tight muscle until it relaxes.
I'm introducing a stimulus.
That stimulus might be compression, shear, tension, or movement.
And the body responds through a combination of sensory input, neurological processing, and biological signaling.
Not every technique produces the same response, and we can't assume we're activating the exact pathways described in this study.
But we're working with the same broader principle.
Our tissues are constantly responding to the environment we place them in.
That idea brought another thought to mind.
Why do certain people feel more comfortable resting on a firm surface?
Some cultures and traditional practices have long encouraged sleeping on firmer surfaces for physical support.
Could that preference have something to do with how our nervous system interprets pressure, support, and stability?
We know our nervous system constantly gathers information about the position and condition of our body.
Whether we're standing, walking, lying down, or being touched, sensory information helps our brain understand what's happening around us.
Sometimes a predictable, supportive surface can feel reassuring.
Other times, that same surface might create discomfort.
And that's an important distinction.
A firmer mattress isn't automatically better, and there isn't evidence that sleeping on a hard surface activates the bone–brain pathway identified in this study. Research on back pain has often found medium-firm mattresses more helpful than very firm ones.
But the broader question still interests me.
How does the physical environment influence whether our nervous system feels supported, threatened, or comfortable enough to reduce its protective responses?
Because I believe this question is central to the work we do in manual therapy.
Another connection that crossed my mind was the relationship between the tibia and traditional acupuncture meridians.
Several meridians described in traditional Chinese medicine travel through regions surrounding the shinbone.
Research has explored whether some acupuncture points and meridian pathways correspond with connective tissue planes.
That doesn't establish that meridians are anatomical structures or that they played any role in this new study.
But I find the overlap interesting enough to ask questions.
Could certain traditional observations about the body eventually be explained through measurable relationships between connective tissue, mechanical forces, and cellular signaling?
Possibly.
Or perhaps future research will show us that these are completely different mechanisms.
Either way, I think there's value in remaining curious without becoming attached to an explanation simply because it sounds appealing.
I've always tried to challenge my understanding of the body rather than protect it.
And that's part of what made this conversation with my patient so meaningful.
We started by talking about a concussion.
Then a bone in the leg.
Then the periosteum, fascia, mechanotransduction, and the possibility that mechanical forces in one region of the body could influence biological processes somewhere else.
And by the end of our conversation, I found myself returning to the same principle that has shaped so much of my approach to treatment.
The body is constantly adapting.
It adapts to mechanical stress, psychological stress, injury, repetitive movements, and the environments we're exposed to.
Sometimes those adaptations are necessary.
They help us protect injured tissues, maintain stability, and navigate difficult circumstances.
But sometimes those protective responses persist longer than they're useful.
And this is where I believe manual therapy has an important role.
Not because we can force the nervous system to relax.
Not because we can manually correct every dysfunction.
And certainly not because a single technique can solve every problem.
But because we can influence the environment.
Through touch, compression, movement, and carefully applied mechanical forces, we provide sensory information that the body can respond to.
We can then reassess.
Did movement improve?
Did pain decrease?
Can the patient produce force more comfortably?
Is the body responding differently than it was before?
These are some of the questions that guide my clinical work.
And while we may not always know the exact cellular mechanisms responsible for those changes, we can still observe and measure meaningful responses.
To me, that's the larger lesson from this study.
The researchers weren't simply showing that pressure on a shinbone might help an injured brain recover in animals.
They were helping reveal another biological pathway through which our bodies communicate and adapt.
And it reminds me that sometimes the most interesting discoveries come from questioning things we've grown accustomed to overlooking.
Like the fact that our bones are alive.
Or that a physical force applied in one part of the body might influence processes somewhere completely different.
Or that a simple question from a patient can open the door to a much bigger discussion.
"Why do you think they chose the tibia?"
It's a question I'm glad she asked.
Because it reminded me that the goal of manual therapy isn't necessarily to force change.
It's to understand what the body is responding to and whether we can help create the conditions for a different response.
Ultimately, that's what I'm trying to do with every patient.
Create an environment where the nervous system has less reason to protect and more opportunity to adapt.
