Espejo, José Andrés, García-Escudero, María, Oltra, Elisa · International journal of molecular sciences · 2018 · DOI
This review examines how manual therapy—such as massage and physical manipulation—might help people with fibromyalgia and ME/CFS by studying what happens at the cellular and molecular level. The authors argue that manual therapy could work by triggering the body's natural healing responses, and they suggest it might be particularly helpful for ME/CFS patients because it can gently condition muscles without requiring strenuous exercise that typically worsens symptoms.
This work addresses a critical gap for ME/CFS patients by proposing a scientific framework to explain how manual therapy might provide benefits without triggering post-exertional malaise (PEM)—a key concern for this population. Understanding the molecular mechanisms could help researchers and clinicians design safer, evidence-based therapeutic protocols tailored to ME/CFS pathophysiology.
This review does not establish that manual therapy definitively treats ME/CFS or fibromyalgia; it proposes a research framework and mechanism but presents no new clinical trial data. The authors do not prove causation between proposed molecular changes and clinical improvements. Importantly, it does not address individual patient variability or demonstrate that benefits outweigh risks for all ME/CFS patients.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Espejo, José Andrés, García-Escudero, María, & Oltra, Elisa (2018). Unraveling the Molecular Determinants of Manual Therapy: An Approach to Integrative Therapeutics for the Treatment of Fibromyalgia and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.. International journal of molecular sciences. https://doi.org/10.3390/ijms19092673
BibTeX
@article{mecfsatlas-espejo-2018-unraveling-molecular,
author = {Espejo, José Andrés and García-Escudero, María and Oltra, Elisa},
title = {Unraveling the Molecular Determinants of Manual Therapy: An Approach to Integrative Therapeutics for the Treatment of Fibromyalgia and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.},
journal = {International journal of molecular sciences},
year = {2018},
doi = {10.3390/ijms19092673},
note = {PubMed: 30205597},
url = {https://www.mecfsatlas.com/evidence/espejo-2018-unraveling-molecular},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/espejo-2018-unraveling-molecular
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