Effect of spinal manipulative treatment on cardiovascular autonomic control in patients with acute low back pain

Abstract

BackgroundThis study aimed to quantify the effect of spinal manipulative treatment (SMT) from an analysis of baroreflex, systolic blood pressure and heart rate variability (HRV) on patients with acute back pain. It was hypothesized that SMT would increase the parasympathetic cardiovascular autonomic control.MethodsTwenty-two patients with acute back pain were randomly divided into two groups: one receiving sham treatment (Sham) and the other receiving SMT. Recordings were completed during the first day and the seventh day, immediately before and after treatment on both days. ECG and systolic blood pressure were continuously recorded to compute cardiovascular variability and baroreflex sensitivity components. The perceived level of pain was measured with the numeric pain scale (NPS) 48 h before, just before and just after each treatment. The NPS ranged from 0 to 100% (peak of pain before treatment). ECG and systolic blood pressure recordings were analyzed in time frequency domain using the Smoothed pseudo Wigner-Ville distribution.ResultsRoot mean square of the successive differences, high frequency power of the heart rate variability, and high frequency baroreflex sensitivity differences between post and pre tests were higher in the SMT group than in the Sham group (p < 0.01), whereas no differences were observed with the other heart rate variability components. Also, no differences were observed with the systolic blood pressure components. Although the estimated pain scale values decreased over time, no difference was observed between the SMT and Sham groups.ConclusionsThis seems to be the first study to assess the effect of SMT on both heart rate variability and baroreflex sensitivity in patients with acute back pain. SMT can be seen to provoke an increase in parasympathetic control known to relate to a person’s healthy state. Thus, cardiovascular variability analysis may be a useful tool for clinicians to quantify and objectify the beneficial effects of spinal manipulation treatment.

Effectiveness of an osteopathic treatment on the autonomic nervous system: a systematic review of the literature

“…15 of the 23 studies were dealing with a healthy population. In the other articles, the included subjects were dealing with craniofascial pain and temporomandibular dysfunction (TMD) [19], hypertensive and normotensive blood pressure [8], lumbar pain vs. pain free [20], acute cervical pain vs. pain free [21], lumbar pain, cervical pain or headache [22], acute back pain [23], cervical pain and stiffness [24] and certain symptomatic region [25].…”

“…Globally, a wide range of techniques was used. The following treatment techniques were investigated: mobilization of the cervical spine [19–21], posterior/anterior mobilization of the thoracic spine [28], mobilization of the lumbar spine [23], soft tissue techniques in the cervical spine region [24, 25], HVLAT techniques in the thoracic spine [6, 15, 26], HVLAT techniques in the lumbar spine [23, 26–28], HVLAT techniques in the cervical spine [6, 26, 28–32] and a rib raise technique [7].…”

“…cross-over design16ModerateScoppa et al [15]Rand. pilot study10LimitedWin et al [21]RCT21StrongWelch and Boone [6]CCT10LimitedYounes et al [23]RCT20ModerateZhang et al [27]Clin. multi-centre study15Moderate…”

“…The studied population ranged in size from 1 in the single case study [25] and 10 in a pilot study [16] to 539 in a clinical multi-centre study [22]. Treatment duration ranged from 3 times 1 min [26] to 45 min [23]. The length of treatment period differed, ranging from single treatments to regularly treatments in a period of 5 weeks.…”

The effect of a single spinal manipulation on cardiovascular autonomic activity and the relationship to pressure pain threshold: a randomized, cross-over, sham-controlled trial

“…The beat-to-beat variation in systolic blood pressure was resampled to obtain a smoother trace and to permit further spectral analysis (using fast Fourier transformation) of systolic blood pressure variability in the low frequency band (0.04-0.15 Hz) in LabChart. The low frequency oscillations in systolic blood pressure (LF-SBP) are proposed as a marker of the sympathetic activity to the alphaadrenergic receptor of vasculature [17] and was used in a previous study on spinal manipulative therapies [46].…”