From Vasomotion to Interoception: The PULSE-V Hypothesis of Predictive Tissue Regulation in Manual Medicine

Manual medicine has long outgrown explanations that rest solely on structural-biomechanical correction. While the techniques reliably alleviate musculoskeletal pain and functional complaints, the evidence suggests that durable benefit depends far less on lasting mechanical realignment than on a distributed set of neurophysiological, autonomic, interoceptive and contextual processes. A persistent translational gap nevertheless remains between these abstract predictive models of bodily regulation and the tangible, regional tissue dynamics that clinicians encounter in practice. We propose PULSE-V (Predictive Updating of Local Somatic Errors via Vasomotion) as a hypothesis-generating framework that seeks to narrow that gap. The central suggestion is that coherent low-frequency vasomotor oscillations (~0.1 Hz) within angiosomes may serve as a candidate biophysical substrate capable of organising ascending interoceptive signals. When coherence is disrupted, the resulting noisy afferent stream may contribute to interoceptive prediction error. Chronic somatic dysfunction can then be understood as a form of allostatic interoceptive overload — a self-stabilising loop in which ambiguous peripheral input, impaired sensory attenuation and entrenched top-down priors reinforce one another. PULSE-V is offered as a deliberately falsifiable programme rather than a settled theory. It generates testable predictions concerning regional vasomotor patterns, multimodal biomarker signatures and the differential contributions of vasomotor, affective-touch and relational elements in treatment. Should the evidence support it, the model may help account for the frequently observed discrepancy between the modest mechanical effects of manual intervention and the substantial clinical outcomes that follow.