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Impact of Suboccipital Release Osteopathic Manipulative Treatment on Cardiac Control in Healthy Adults

Journal: Journal of Osteopathic Medicine Date: 2024/12, 124(12):Pages: A48-A49. doi: Subito , type of study: pretest posttest design

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2024-2000/html)

Keywords:

autonomic nervous system [145]
cardiac control [1]
pretest posttest design [221]
suboccipital release [6]

Abstract:

Context: Suboccipital release (SOR) is a long-practiced osteopathic manipulative technique directed towards the fascia, connective tissue, and muscles of the suboccipital area. SOR targets the autonomic nervous system (ANS) via relieving compression of the vagus nerve. [1] The ANS, along with physiologic influence, affects the sinus node through neuromuscular stimulation. In particular, the ANS is responsible for modulating the QT interval, representing the time needed for the onset of electrical activity and its subsequent recovery in the myocardium. Variabilities in the QT interval have been associated with changes in ANS activity, and specifically parasympathetic nervous system tone. [2] Objective: To examine how SOR impacts cardiac control, using QT variability as a surrogate measure. Methods: A prospective, single-blinded, crossover study was utilized using a total of 24 healthy adults. Subjects were first and second year medical students at Lake Erie College of Osteopathic Medicine (LECOM) at Elmira, who were recruited with an approved poster. Interested students ages 21-35 years old were screened to determine if any exclusion criteria were met prior to obtaining consent, including a history of conditions or medications that may affect their cardiovascular or ANS function,. Each subject received three interventions: a control treatment with no physical contact, sham treatment, and SOR. Control treatment was utilized to establish a baseline for each subject before any potential therapeutic effects from touch were introduced. Sham treatment consisted of investigator finger placement near the subject’s occipital condyles without any tension to evaluate the effect of touch alone. [3] Data from 12-lead electrocardiograms (EKG) were taken with intervals for QRS, QT, QTcb, JT, QTa, and QTend, along with associated dispersion and index changes. Repeated measure analysis of variance (ANOVA) was employed with each subject serving as their own control. Post-hoc comparisons of the three treatment groups were adjusted using Bonferroni’s method for multiple comparisons. Bland-Altman limits of agreement were calculated to assess the agreement between the QTend values in the control and sham treatment groups. Results: The final analysis consisted of 21 participants (11 female, 10 male), excluding 3 participants due to abnormal EKG results obtained during the baseline recording. A normality revealed no significant differences among the QTa intervals in the V2 (maximum) and aVF (minimum) leads [F(1.705, 34.11) = 1.294, P = 0.06]. The Mean ± SEM (msec) calculated QT variables for the SOR treatment (89.48 ± 4.62) were significantly lower than that of the control (96.29 ± 4.37) and sham (97.14 ± 5.85) treatments [F (1.705, 34.11) = 1.294, P = 0.05]. The variability in QTcb was significantly lower in the SOR group [F (1.410, 28.19) = 0.4429, P=0 .051]. A significant decrease in the ratio of QTend to either QT or QTc was observed in the SOR group compared to the control and sham treatments [F (2,60) = 10.35 = P=0.03]. The calculated Bias or Bland-Altman index of agreement was -0.86. Conclusion: SOR treatment resulted in variations of QT intervals and shortening of QTend intervals. The decreased QTend/QTcb ratio observed in the SOR group is likely due to an increase in parasympathetic activity, via SOR-induced vagus nerve stimulation. This ratio provides a more accurate measurement of relative variation compared to QTend alone. The calculated Bland-Altman index of -0.86 indicates there was minimal difference between the QTend of the control and sham treatments, suggesting that the significant differences observed in the QTend of the SOR group were caused by the SOR treatment itself and not influenced by touch or other variables. Shortened QTend intervals can promote cardiac stability by preventing QT dispersion. This study, while small and preliminary, has provided initial evidence of a relationship between SOR manipulative treatment and QTend shortening in healthy adults. Further research with a larger sample size and more diverse population would help to confirm and expand our results to fully understand the observed relationship between SOR and QTend shortening, and its potential benefits on cardiac function in a clinical setting.


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