Heart Rate Variability Modulation Following a Manipulation in Pain Free Patients Versus Patients in Pain
Condition: Low Back Pain
MeSH terms: Low Back Pain
Study type: Interventional

Summary: 
      Background

      The purpose of this study was to examine the heart rate variability (HRV) in the presence or
      the absence of pain in the lower back (L5), while receiving chiropractic care.

      Methods

      A total of 53 healthy participants were randomly assigned to a control, 2 treatment or 2 sham
      groups (n = 10 per group). Participants underwent an eight-minute acclimatizing period. The
      HRV tachygram (RR interval) data were recorded directly into a Suunto watch (model T6). The
      investigators analyzed the five minute pre-treatment and post treatments intervals. The
      spectral analysis of the tachygram was performed with the Kubios Software (University of
      Kuopio, Finland).
    

Detailed description: 
      Background The chiropractic profession has in the past utilized research results from other
      fields of and extrapolated them into their science and clinical interpretation 1-4. More
      recently, chiropractic researchers looked into autonomic nervous system (ANS) adaptations in
      an animal model following a mechanical stress to the spinal column 5, a noxious mechanical
      stimulation 6 or a spinal manipulation 7.

      In the human model, several investigations have been done to measure modifications of the
      heart rate variability (HRV) following cervical 8 and thoracic manipulations 9 or in a
      multisite clinical study 10 where details of the manipulation site were not provided. The
      site of interest for the chiropractic intervention was defined at the level of the lumbar
      spine, left and right L-5. This site was selected because most studies 8-10 measuring HRV
      have used the cervical or thoracic component of the spine. The effect of the lumbar
      parasympathetic nervous system has not been evaluated. In these studies 8-10, changes were
      observed in various HRV variables, while in two of those studies 8, 9, where sham groups were
      included, the sham conditions did not demonstrate any changes in the reported HRV parameters.
      There are strong indications that HRV is a good marker of ANS activity 19-24. Thus, in the
      three above mentioned studies, it appears that chiropractic interventions have an effect on
      the ANS.

      At present, however, no studies to evaluate whether a lumbar spinal manipulation would
      produce a change in the HRV have been reported. Thus, the present study seeks to measure the
      effect of a lumbar adjustment, with a manually assisted mechanical force, producing a
      chiropractic adjustment, in participants without lumbar pain and a traditional adjustment in
      participants with lumbar pain on HRV. The hypothesis being that a lumbar intervention would
      have an acute effect on the ANS as demonstrated by the modulation of HRV variables.
    

Intervention name(s): Activator methods technique; Traditional chiropractic adjustment
Intervention type(s): Procedure; Procedure
Intervention description(s): Chiropractic adjustment by a manually assisted mechanical force; Lumbar roll according to the Diversified technique of chiropractic adjusting
Other intervention name(s): Activator methods; Lumbar roll
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: HRV; Activator; Chiropractic; VLF; HF; LF; LF/HF