Key result
Spinal manipulation fails to alter autonomic nervous system measures versus sham or control.
Why the study?
Spinal manipulation has been hypothesized to influence the autonomic nervous system, with effects possibly varying by the segment manipulated.
Does spinal manipulation influence the autonomic nervous system in healthy and/or symptomatic populations?
Meta-Analysis (n=618)
Does spinal manipulation influence the autonomic nervous system in healthy and/or symptomatic populations?
Spinal manipulation does not appear to significantly alter autonomic nervous system function compared to control or sham interventions, though current evidence quality is low.
Discourages the clinical use of spinal manipulation to modulate autonomic tone; leaves open whether targeted cervical.
BACKGROUND: Spinal manipulation (SM) has been hypothesized to influence the autonomic nervous system (ANS). Further, it has been proposed that the effects may vary depending on the segment manipulated. The aim of this systematic review was to synthesize the current level of evidence for SM in influencing the ANS in healthy and/or symptomatic population. METHODS: = 618 participants) were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. The data were synthesized using standard mean differences and meta-analysis for the primary outcome measures. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest. RESULTS: Overall, there was low quality evidence that SM did not influence any measure of ANS including heart rate variability (HRV), oxy-hemoglobin, blood pressure, epinephrine and nor-epinephrine. However, there was low quality evidence that cervical spine manipulation may influence high frequency parameter of HRV, indicating its influence on the parasympathetic nervous system. CONCLUSION: When compared with control or sham interventions, SM did not alter the ANS. Due to invalid methodologies and the low quality of included studies, findings must be interpreted with great caution. Future studies are needed which employ rigorous data collection processes to verify the true physiological implications of SM on ANS.
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Sampath et al. (2023) conducted a meta-analysis in Healthy and/or symptomatic population (n=618). Spinal manipulation vs. Control or sham interventions was evaluated on Measures of autonomic nervous system (ANS) including heart rate variability, oxy-hemoglobin, blood pressure, epinephrine and nor-epinephrine. Spinal manipulation did not alter any measure of the autonomic nervous system compared with control or sham interventions, though cervical manipulation may influence high frequency HRV.
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