Osteopathic Manipulation as a Method of Cortisol Modification: A Systematic Review

Abstract

The effectiveness of osteopathic manipulative treatment (OMT) in the modification of various hormones has been studied; however, there is still a need for quantitative measurements to determine how large of an influence exists. The goal of this meta-analysis is to investigate the implications OMT has on cortisol levels. A systematic literature search restricted to English was performed from October 2022 to November 2022 using Google Scholar, OSTMED.DR, and PubMed and included articles from 2000 onward. Articles were excluded if they did not include a measurement for the control group in their study. We identified 4120 studies for potential inclusion. Of these, a total of four studies met the inclusion criteria, with a total of 135 participants (N= 68 OMT, N= 67 control). Out of the 135 participants, 126 participants (N= 62 OMT, N= 64 control) made up the salivary cortisol studies, and the remaining nine participants made up the serum cortisol studies (OMT N= 6, control N= 3). The National Institutes of Health (NIH) bias assessment tool was utilized to measure the risk of bias. Standard mean differences were calculated for effect size. A mean difference in cortisol of 0.10μg/dl (-10μg/dl, 95%CI -0.15, -0.04) was found when comparing all pre-versus post-cortisol levels with OMT versus sham control groups. OMT demonstrated a 0.10μg/dl larger decrease in cortisol than sham control treatments. The standard mean difference was found to be -0.46 (95%CI -1.40, 0.48) making this finding a medium effect size without significance. Heterogeneity for the salivary analysis measured by I 2 was 0% indicating no significant heterogeneity across studies. When serum cortisol was included, heterogeneity stayed at 0%. A larger number of high-quality studies, especially those specific to serum cortisol, are recommended, to elucidate the relationship between OMT and cortisol. This research suggests OMT reduces cortisol more than sham treatment before versus after OMT treatment, and though the change is small when comparing after one treatment, it may have clinical usage if multiple OMT sessions are performed.

The Effect of Craniosacral Therapy on Blood Levels of Stress Hormones in Male Firefighter Cadets: A Randomized Clinical Trial

“…Inclusion criteria were male gender and being a fire academy cadet. The exclusion criteria were daily cigarette smoking, alcohol abuse, caffeine use (>300 mg/day), medication, drug use, reported medical illness, and the following types of disorders: endocrine, cardiovascular disease, and psychiatric, physiotherapeutic or osteopathic therapy applied now or in the past, because therapeutic intervention involving, for example, spinal manipulation increases cortisol levels in the body [16,17]. In this study, we were keen to exclude factors that may affect stress hormones.…”

Does Osteopathic Heart-Focused Palpation Modify Heart Rate Variability in Stressed Participants with Musculoskeletal Pain? A Randomised Controlled Pilot Study

“…Similarly, MBIs were shown to improve HRV by decreasing LF and LF/HF and increasing HF, SDNN, and RMSSD in some reviews (after mindfulness, yoga, and/or tai chi) [54,56], while others showed no changes in LF, HF, LF/HF, RMSSD, and SDNN (after mindfulness) [57]. Nonetheless, the literature on the effect of OMT and MBI on stress and cortisol levels as well as autonomic activity and HRV remains partially limited and heterogenous, and future research is needed [35,36,54,58]. Taken together, OMT and MBI were shown to reduce stress (by means of decreased cortisol levels) and enhance autonomic activity (by means of increased HRV) [35,37,54,58].…”

“…On the one hand, OMT was shown to improve stress and cortisol levels in some studies [30,31] but not others [32][33][34]. A recent systematic review concluded that OMT decreases cortisol levels with a medium effect [35]. Similarly, reviews have shown that OMT improves autonomic activity [36,37] and HRV [38,39].…”

“…Nonetheless, the literature on the effect of OMT and MBI on stress and cortisol levels as well as autonomic activity and HRV remains partially limited and heterogenous, and future research is needed [35,36,54,58]. Taken together, OMT and MBI were shown to reduce stress (by means of decreased cortisol levels) and enhance autonomic activity (by means of increased HRV) [35,37,54,58].…”