“…It is important to realise that, while basic or primary experimental research may support the plausibility of a variety of mechanisms that produce changes to the tissues or nervous system, there remains a lack of clinical evidence that establishes these changes as relevant and meaningful to clinical outcomes in patients. Some of these plausible, but speculative, therapeutic mechanisms affecting the tissues include drainage of tissue fluids and pro-inflammatory metabolites from injured joints and tissues [21][22][23], short-term changes in joint pressure and motion due to joint tribonucleation and cavitation [24,25], manipulation of extrapped zygapophyseal meniscoid folds [24,26], promotion of tissue healing and collagen remodelling following injury [27][28][29], reduced thickness (densification) and improved viscosity of the loose connective tissue layer in deep fascia [30,31], mechanotransduction 5 and anti-inflammatory cellular responses of fibroblasts [32][33][34][35][36], improvement in sensory motor integration [37][38][39] and proprioception [40][41][42][43], parasympathetic responses following gentle techniques to the neck and head [44][45][46], and increased lymph flux, circulating lymphocytes, and immunity from abdominal lymphatic pump techniques [47][48][49][50].…”