Abstract
BackgroundThis study aimed to quantify the effect of spinal manipulative treatment (SMT) from an analysis of baroreflex, systolic blood pressure and heart rate variability (HRV) on patients with acute back pain. It was hypothesized that SMT would increase the parasympathetic cardiovascular autonomic control.MethodsTwenty-two patients with acute back pain were randomly divided into two groups: one receiving sham treatment (Sham) and the other receiving SMT. Recordings were completed during the first day and the seventh day, immediately before and after treatment on both days. ECG and systolic blood pressure were continuously recorded to compute cardiovascular variability and baroreflex sensitivity components. The perceived level of pain was measured with the numeric pain scale (NPS) 48 h before, just before and just after each treatment. The NPS ranged from 0 to 100% (peak of pain before treatment). ECG and systolic blood pressure recordings were analyzed in time frequency domain using the Smoothed pseudo Wigner-Ville distribution.ResultsRoot mean square of the successive differences, high frequency power of the heart rate variability, and high frequency baroreflex sensitivity differences between post and pre tests were higher in the SMT group than in the Sham group (p < 0.01), whereas no differences were observed with the other heart rate variability components. Also, no differences were observed with the systolic blood pressure components. Although the estimated pain scale values decreased over time, no difference was observed between the SMT and Sham groups.ConclusionsThis seems to be the first study to assess the effect of SMT on both heart rate variability and baroreflex sensitivity in patients with acute back pain. SMT can be seen to provoke an increase in parasympathetic control known to relate to a person’s healthy state. Thus, cardiovascular variability analysis may be a useful tool for clinicians to quantify and objectify the beneficial effects of spinal manipulation treatment.
Highlights
This study aimed to quantify the effect of spinal manipulative treatment (SMT) from an analysis of baroreflex, systolic blood pressure and heart rate variability (HRV) on patients with acute back pain
There is no significant difference between groups (SMT vs. SHAM) SMT spinal manipulative treatment, RMSSD root mean square of the successive differences, LF low frequency, HF high frequency, SBP systolic blood pressure, BRS baroreflex sensitivity
The main results of this study were that the components of cardiovascular variability linked to the vagal modulation of heart rate (RMSSD, HF-RR and HF of baroreflex sensitivity) were significantly higher with SMT than sham treatment (Sham) intervention (Fig. 2)
Summary
This study aimed to quantify the effect of spinal manipulative treatment (SMT) from an analysis of baroreflex, systolic blood pressure and heart rate variability (HRV) on patients with acute back pain. The effect of SMT on both HRV and baroreflex sensitivity has not previously been studied. This is relevant, as they may be relevant additional indices in quantifying the physiologic effects of SMT. The HRV and baroreflex sensitivity can be analyzed in such a way as to provide several indices of cardiovascular autonomic control [9]. Pathological and stress states shift the sympathovagal balance towards an increase in sympathetic cardiac control. [10], whereas healthy cardiovascular states shift the sympathovagal balance towards an increase in parasympathetic cardiac control. A decrease in baroreflex sensitivity has been associated with pathological states such as chronic heart failure. [12], hypertension. [13], and other human pathophysiological states [12, 13]
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