The AAO Journal, 2025/12, 35(4):14–24. doi: 10.53702/i2375-5717-35.4.14, type of study: ,ppt,

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/4/article-p14.xml)

Keywords:

autonomic nervous system [154]
cardiovagal tone [1]
cervical spine [319]
heart rate variability [69]
MET [640]
muscle energy technique [180]
pretest posttest design [240]

Abstract:

Introduction: Autonomic rehabilitation aims to rewire chronic disease states, like chronic pain sensitization, through passively stimulating parasympathetic tone. Informed treatment decisions that include the use of osteopathic manipulative treatment (OMT) may provide a noninvasive and nonpharmacologic modality to temporarily reset the autonomic nervous system (ANS). Heart Rate Variability (HRV) could provide quantifiable evidence for the impact of OMT on autonomic rehabilitation. Reduced HRV is associated with stress, pain, and chronic conditions, making it an important indicator of autonomic function. Objectives: Analyze the impact of post-isometric muscle energy technique (MET) to the upper cervical spine on parasympathetic tone measured through HRV. Design: Within-subject design with 5-minute HRV measurement pre- and post-OMT treatment. Setting: Clinical examination suites. Participants: Thirty-three healthy osteopathic medical school students, faculty, and staff. Interventions: MET treating somatic dysfunction by osteopathic physicians board-certified in neuromusculoskeletal medicine and osteopathic manipulative medicine. Main Outcome Measures: HRV variables related to parasympathetic activity including root mean square of successive differences (RMSSD), percentage of successive normal sinus RR intervals more than 50ms (pNN50), and high frequency (HF). Repeated measures t-test analyzed the difference in mean HRV values after OMT. Results: There were statistically significant increases in most of the HRV measures after OMT. Participants’ mean (95% confidence interval) RMSSD increased from 56.2ms (44.2, 68.2) at baseline to 60.14 (47.8, 72.5, p=0.001) post-OMT. pNN50 increased from 28.8% (21.5, 36.0) to 31.9% (24.5, 39.2, p=0.003) at post-OMT. HF increased from 1237.6ms2 (756.1, 1719.1, n=32) at baseline to 1456.8ms2 (875.6, 2037.9) but was not statistically significant (p=0.107) post-OMT. All somatic dysfunctions at spine levels OA, AA, and C2 were either resolved or improved after OMT. Conclusions: MET may provide clinical benefit through increased parasympathetic tone, leading to reestablished autonomic balance, which can supplement rehabilitation practices for those with dysautonomia stemming from persistent sympathetic activation.