Exploring the Effects of Osteopathic Manipulative Treatment on Autonomic Function Through the Lens of Heart Rate Variability

Abstract

The osteopathic community has long hypothesized that the autonomic nervous system (ANS) represents one of the putative substrates through which osteopathic manipulative treatment (OMT) can improve body functions that have been altered by musculoskeletal alterations. Heart rate variability (HRV) is an important physiological measure of cardiac ANS activity. Emerging evidence suggests that OMT is associated with HRV changes that (i) are indicative of a larger cardiac vagal modulation, (ii) are independent from the part of the body needing treatment, (iii) occur even in the absence of musculoskeletal alterations. Yet, many questions remain unanswered, the duration of these effects and the specificity of HRV responses to different OMT techniques being perhaps the most critical. Therefore, this paper discusses prospects for future applications of HRV for the study of the influence of OMT on ANS function. Moreover, based on existing studies and preliminary data on the effects of OMT on HRV in specific pathological (hypertension) and physiological (stress exposure and recovery from sport competition) conditions that are commonly associated with increased sympathetic and/or decreased vagal activity, we propose that HRV analysis could be exploited to evaluate the effectiveness of OMT as a preventive or complementary strategy in clinical and non-clinical conditions characterized by ANS imbalance.

Do manual therapies have a specific autonomic effect? An overview of systematic reviews

“…Up to now, scientific literature has described only the short-term effects of MT [ 63 ], so exploring the sustained effects through sessions is crucial. Nevertheless, it has been argued that short-term effects might not have a predictive value over time [ 25 ], implying the need for assessing both short- and long-term effects [ 50 ].…”

“…hypertension) and physiological conditions (e.g. recovering from sports competition) [ 50 ]. Therefore investigating the impact of MT on the autonomic indices enrolling patients with pain or other clinical conditions, including dysautonomic syndromes, is paramount.…”

“…This gentle solicitation selectively activates low mechanical threshold C fibres [named C-tactile fibres or CTs] [ 35 – 39 ], which produce a specific activation of autonomic supraspinal nuclei as well as brain areas regulating emotions and interoception [ 36 , 37 , 39 , 40 ]. Initial evidence suggests that MT interventions cause changes in different autonomic markers [ 41 – 49 ] and a recent paper has introduced the potential preventive role of MT in ANS imbalance [ 50 ]. However, the precise mechanisms by which MT interventions activate the autonomic response are still under exploration [ 50 ].…”

“…Initial evidence suggests that MT interventions cause changes in different autonomic markers [ 41 – 49 ] and a recent paper has introduced the potential preventive role of MT in ANS imbalance [ 50 ]. However, the precise mechanisms by which MT interventions activate the autonomic response are still under exploration [ 50 ].…”

“…It is well-known that a balanced ANS function is generally associated with health [ 50 ], while impairments in autonomic regulation have been considered a risk factor for physical and psychological morbidities and pathologies (e.g., hypertension, persistent generalising pain disorders, rheumatic diseases, diabetes or depression) [ 34 , 51 , 52 ]. It is worth noting that these clinical conditions are classified as dysautonomic, which means that they are generally associated with an increased sympathetic or decreased parasympathetic vagal activity.…”