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 low-frequency vasomotor oscillations (~0.1 Hz) within angiosomes, when exhibiting optimal fractal complexity and multiscale organisation, may serve as a candidate biophysical substrate capable of structuring ascending interoceptive signals. When this complexity is disrupted — shifting microvascular dynamics towards either rigid periodicity or stochastic noise — the resulting afferent stream may become ambiguous and contribute to interoceptive prediction error. Chronic somatic dysfunction can then be understood as a maladaptive attractor state — 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. If supported, the model offers a mechanistically grounded account of the frequently observed discrepancy between the modest mechanical effects of manual intervention and the substantial clinical outcomes that follow.