Spinal Manipulation Improves Cardiac Autonomic Control

Publication: SPINE. 46(14):915-922, July 15, 2021. Original Authors: Rodrigues, Pedro Teixeira Vidinha; Corrêa, Leticia Amaral; Reis, Felipe José Jandre; More

Conclusion Summary

Spinal manipulation of the upper thoracic spine led to an immediate enhancement of resting cardiac autonomic control in patients with musculoskeletal pain, without negatively affecting blood pressure.

Abstract:

Objective

The study aimed to compare the immediate effects of manual therapy on cardiovascular autonomic control in patients with musculoskeletal pain, specifically focusing on spinal manipulation and myofascial manipulation.

Background

Musculoskeletal pain is associated with an increased risk of cardiovascular events. Manual therapy applied to the upper thoracic region may enhance cardiac autonomic control.

Study Design

This research was conducted as a three-arm, parallel, randomized, placebo-controlled, assessor-blinded trial.

Methods

The study included 59 patients with musculoskeletal pain recruited from an outpatient clinic. Participants were randomly assigned to one of three groups: spinal manipulation (n=19), myofascial manipulation (n=20), or placebo (n=20), all targeting the upper thoracic region. Resting heart rate variability was used to assess cardiac autonomic control, while the blood pressure response to the cold pressor test served as an indicator of sympathetic responsiveness to stress.

Results

Baseline characteristics of the groups were similar, except for blood pressure. Two-way repeated-measures ANCOVA analysis revealed that only spinal manipulation resulted in a significant increase in the square root of the mean squared differences of successive RR intervals (RMSSD), indicating improved parasympathetic activity. Additionally, there was a decrease in normalized units of low-frequency power (LF) and the LF/HF ratio after spinal manipulation, suggesting reduced sympathetic activity. There were no significant differences in blood pressure responses among treatment groups, and no adverse events were reported.

Conclusion

Spinal manipulation of the upper thoracic spine led to an immediate enhancement of resting cardiac autonomic control in patients with musculoskeletal pain, without affecting blood pressure responsiveness to stress. Neither myofascial manipulation nor placebo treatments demonstrated any changes in cardiovascular autonomic control.



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