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Inhibitory Rib-Raising With Direct Sympathetic Nervous System Measurement
Kinzler, D. W. [1]
Siu, J. [3]
Smith, M. [15]

Journal: The Journal of the American Osteopathic Association Date: 2006/08, 106(8):Pages: 476. doi: Subito , type of study: pretest posttest design

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2006.106.8.471/html)

Keywords:

nervous system [243]
pretest posttest design [225]
rib raising [21]

Abstract:

The systematic evaluation of osteopathic manipulative therapy (OMT) on sympathetic neural activity (SNA) is limited. A specific OMT technique (inhibitory sympathetic rib-raising) has been theorized to regulate autonomic imbalance by applying direct pressure to the head of the rib near the sympathetic ganglion. This technique has historically been described to initially produce sympathoexcitation followed by a sympatholysis, yet no work has been published documenting this effect. An initial study in our lab found no change in SNA in healthy individuals who had low basal SNA. We hypothesized that rib-raising applied while SNA is elevated will effectively modulate SNA. Methods: We used a cold stimulus to produce a pain-mediated elevation of the SNA which allowed us to determine whether OMT can directly reduce a state of elevated SNA. Fifteen healthy subjects by history and physical examination who were naïve to OMT techniques and proposed effects were recruited. IRB approval was obtained. SNA was assessed using standard microneurography. Data were recorded continuously on a computer analysis system. After instrumentation and an initial 20 min period of rest, subjects were exposed to a two-minute cold stimulus (CS) by submersion of the hand in water randomized at 2°C, 10°C and 18°C. During each stimulus sustained inhibitory rib-raising or sham OMT was applied. The sustained inhibitory rib-raising OMT was performed for 2 min in an attempt to affect the thoracic sympathetic chain ganglia. Sham OMT was performed by placing the hands in the same position without the concurrent anterolateral force. Data recording began two-minutes prior to the stimulus, during the stimulus and for a four-minute recovery period. All data were reduced post hoc via a customized digital data acquisition system. Results and Conclusions: There was no significant difference between the treatment groups (P>0.05) suggesting that the OMT did not directly affect sympathetic nervous system activity. However, there was a trend towards an initial sympathoexcitation (P<0.11) during the 10° cold-pressor stimulus. Additional subject recruitment to complete the study is currently ongoing and will achieve appropriate statistical power.

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