The musculoskeletal (MSK) system is the focus of attention in many of our practices, with pain and function being the focal point of attention. I would love to broaden this scope of thinking to include the concept of immune health and inflammation, and how they are influenced by the MSK system. Part of the reason I’m shining a light on this topic is that in recent decades, the focus has narrowed on just pain and function, but there is so much more to these intricately linked systems.

This really struck home when I was discussing spinal health with one of our newest doctors who had just graduated the year before. I mentioned that adjusting the mid lumbar can give wonderful relief for menstrual cramps, and that adjusting T6 has a dramatic effect on reflux in infants or heartburn in adults. I was giving several more examples such as this, and he gave me a bemused smile and said, “Doc, that’s so old school!” Yes, I think it’s time for some more old-school underpinning with well-done research. 

For instance, a quick review of current research shows that manipulation treatment reduces a patient's length of hospital stay, duration of IV antibiotics, and incidence of respiratory failure or death.1 Another recent study found that adjustments to T9 T10 (innervation adrenals) impacted cortisol numbers to such a degree that it affects even “far removed” conditions such as tonsilitis.2 Over the years I have repeatedly seen evidence, both in my clinic and in studies, of the effect of spinal health on overall immunity, including outcomes in flu epidemics.3


One of the key elements that must be addressed for all MSK conditions is inflammation, whether it’s acute or chronic or both. I consider it the emperor of almost all maladies and waste no time teaching patients about it. I make sure patients understand the basic mechanisms, its effect on recovery, and ability to maintain optimum MSK health, including proper muscle tone, proper strength and elasticity of ligaments and tendons, as well as proper synovial fluid productivity, cartilage health, and proper bone density. 

Managing Acute Inflammation

It is so easy to overwhelm a patient with all this, so keep it simple. It’s a three-stage process: first, get the patient out of pain and loss of function, then complete the healing cycle so this condition doesn’t return, and finally optimize health on all fronts. The healthy MSK system then rewards the patient by allowing freedom for a variety of exercise with all its benefits, proper neurological input to all other systems, and reduction of injuries. 

To achieve these objectives, we use both downstream and upstream medicine. We adjust, use rehab modalities, and employ dietary changes to get results quickly. The Anti-Inflammatory Food Plan (AIFP) often gets utilized, especially for chronic inflammation, as well as nutraceuticals. 

It doesn’t have to be complicated. For acute pain/inflammation, we use a proprietary pack of nutraceuticals that contains curcumin, proteolytic enzymes, flavonoids, GABA and glycine for pain and spasms. When appropriate, we use collagen in the proprietary form of FORTIGEL®, whose benefits have been demonstrated by studies led by Harvard Medical School and Tufts Medical Center.4

This collagen blend also includes a patented form of hyaluronic acid (Mobilee®), which has a long track record in the orthopedic world. Last but not least, type I collagen is also included to rebuild, stretch, bend, flex and boost resilience.5

Managing Chronic Inflammation

Chronic inflammation is a 21st century disease and is often the root cause of MSK disorders such as osteopenia/osteoporosis, loss of flexibility in tendons/ligaments and cartilage destruction. Addressing this issue effectively will not only greatly improve recovery time and ultimately outcome, but also facilitates other positive outcomes as a trickle-down effect. 

The one commonality in almost all cases of chronic inflammation is gut health. It is now widely accepted that the gut is responsible for at least 70% of our immunity. We have come a long way since I authored an article in 1987 titled, “RA and the link to leaky gut syndrome.” 

For chronic inflammation cases, the patient must be guided and supported in making lifestyle changes including AIFP, exercise, sleep, proper stress processing, and nutraceuticals. 

Turmeric is commonly used in my practice, and when it is delivered in the whole-root form (not just curcuminoids), you get the additional benefit of healing and feeding the gut microbiome. Proteolytic enzymes such as bromelain are also employed, as well as flavonoids such as quercetin.  

Besides collagen, if joint destruction is extensive, glucosamine sulfate needs to be employed to further enhance cartilage health. 

Rebuilding bone health through weight bearing exercise and providing the body with ammunition to reverse bone loss is critical as well. Clinical evidence and outcome can be provided by prescribing calcium in the form of citrate/maleate as well as ipriflavone, magnesium and vitamins K1 and K2. 

The Bottom Line

It is not uncommon in our practice to see bone loss reversal of 4-6% annually, even in the elderly. Once the patient’s MSK health has been optimized, continued guidance in overall health is critical for continued wellbeing. For maintenance, I usually recommend EPA/DHA at up to 3 g/day, a multivitamin for filling nutritional gaps, calcium and vitamin D3 when appropriate, and probiotics for continued gut support. 

Put these steps in place, and your practice will become the go-to MSK center in your community! 

For further discussion on some of the topics mentioned in this post, see these previously published blogs: 


  1. Yao S. et al. Osteopathic manipulative treatment as a useful adjunctive tool for pneumonia. J. Vis Etp, 2014; (87): 50687 
  2. Luceno-Mardones A, et al. Effects of osteopathic T9 T10 vertebral manipulation in tonsilitis, a randomized clinical trial. Healthcare, 2021; q:394 
  3. Mueller DM. The 2012-2013 influenza epidemic and the role of OMT. J. Osteopath. Med., 2013; 113(9): 703-707. 
  4. McAlindon TE, Nuite M, Krishnan N, Ruthazer R, et al. Changes in knee osteoarthritis detected by delayed gadolinium enhanced magnetic resonance imaging follows treatment with collagen hydrolysate: a pilot randomized controlled trial. Osteoarthritis and Cartilage 19 (2011) 399e405 
  5. Nadal et al. Effectiveness of treatment of tendinitis and plantar fasciitis by Tendoactive. Osteoarthritis and Cartilage 2009; 17(1):S253.

Adrian den Boer, ND, NC Headshot

Adrian den Boer, ND, NC Headshot

Adrian den Boer, ND, DC, IFMCP

Educated in both the Netherlands and the United States, Dr. Adrian den Boer is a board-certified and licensed Naturopathic and Chiropractic physician. In addition, Dr. den Boer is fully certified as a functional medicine doctor. Dr. den Boer has treated over 10,000 patients successfully by utilizing multiple resources to manage patient care. Most recently, he joined Lifestyle Matrix Resource Center as the Clinical Expert serving the MSK Solutions Pain Recovery Program.