Heart failure is a condition that develops when there are issues with the heart that impede its ability to efficiently pump blood around the body. There are a variety of causes that initiate the development of this condition, but most often heart failure is caused by another medical condition that impacts your heart – things like coronary heart disease, heart inflammation, high blood pressure (etc). Heart Failure can develop suddenly or over time and symptoms may not appear right away. It has many complications associated with it including pulmonary hypertension, liver and kidney damage.
While there are no substantial chiropractic studies relating directly to heart failure, a recent paper looking at osteopathic manipulative treatment on vascular function and the autonomic nervous system may have strong implications for chiropractic care.
While the causes of heart failure is a topic all of its own, when we look behind this we see some shared pathophysiological characteristics – things like autonomic nervous system dysregulation (which governs the beating of the heart) and endothelial dysfunction (which is a type of coronary arterial disease in which there are no artery blockages). The changes in the Autonomic Nervous System related to heart failure play an important role not only in the symptoms of limited aerobic capacity (exercise) but also in the prognosis for patients suffering from Heart Failure. As there is no cure for the condition currently, treatments geared toward modulating the vascular and autonomic function have great potential in improving the lives of patients. But there is a lot of research required to put parameters around this potential.
That’s what makes this study so interesting. While osteopathic manual therapy (OMT) and chiropractic are quite different when it comes to the overarching focuses and specific manoeuvres of each modality, they are related in that they target dysfunction in the body and can influence nervous system function through manual therapy.
This study states that ‘in theory, the effect of OMT on vascular function is believed to follow an autonomic change [2].’ Numerous studies have indicated that chiropractic care impacts the autonomic nervous system, and we also have evidence (through heart rate variability and blood pressure studies) that the vascular system can also be impacted by chiropractic care.
The study:
In the current study, researchers took twenty patients with heart failure (HF) aged between 50-60 years and split them into two groups. In the blinded study, the first group received a single session of osteopathic manipulative treatment (OMT) and the second group received a sham intervention. Researchers measured three key metrics: flow-mediated dilatation (FMD) at the brachial artery, hemodynamic measures, and heart rate variability. These assessments were done at baseline (before the intervention), immediately after intervention, and 15 minutes after intervention)
Researchers used high-velocity low-amplitude thrusts (commonly used in chiropractic care) at the base of the skull and cervical spine (upper neck). They also used soft tissue techniques at the base of the skull and in the retro-maxillary region (near the jaw/throat), visceral techniques for the heart and lungs, and hemodynamic pumping of the thoracic duct.
The sham group involved use of a chiropractic activator with no load at the same points used by the intervention group. A doctor of osteopathy with 10 year’s experience applied both interventions. The authors of the study stated that, “The hypothesis of the present study was that blood redistribution and autonomic modulation would occur immediately after OMT in patients with heart failure [2].”
While the study looked at just one session, and only measured findings up to fifteen minutes post-intervention, the results were still quite interesting.
- The intervention group had greater Flow-mediated dilation at both immediate and 15 min assessments compared to the sham group.
- The intervention group showed some heart rate variability modulation at 15 min assessment
- These two findings indicated both acute and time-course vascular effects from OMT, and time-course Autonomic nervous system modulation after OMT.
- OMT appeared to be effective at increasing brachial blood flow and stimulating the vagal system in patients with heart failure.
The researchers noted that “Vascular changes seem to precede the autonomic modulation.” They elaborated on this statement by explaining “The present randomized clinical trial showed that the OMT acutely increases the flow-mediated dilatation and the brachial artery diameter, independently to the ANS modulation, which seems to occur particularly later [2].”The inclusion of the note about the vagal system is interesting, as certain chiropractic adjustments are known to stimulate vagal tone.
This appears to be a preliminary study, and further research is required to expand the time-related findings, or the impact of multiple sessions on longer term function in heart failure patients. We also lack in-depth biomechanical rationale into why there was an effect. However, the core of this study seemed to be looking at whether high-velocity, low-amplitude manual therapy could modulate the way the vascular system, the vagal system and the autonomic nervous system behaved in heart failure patients.
Yet again, it is bringing balance back to the nervous system, and seeing the potential positive impacts patients who suffer from heart failure. More research is required to show us how far this improvement can go, but it’s a positive indicator indeed.
References:
- Heart Failure. NHLBI, NIH. 2021. Available from: https://www.nhlbi.nih.gov/health-topics/heart-failure
- Amatuzzi F, Gervazoni Balbuena de Lima AC, Da Silva ML, Cipriano GFB, Catai AM, Cahalin LP, et al. Acute and Time-Course Effects of Osteopathic Manipulative Treatment on Vascular and Autonomic Function in Patients With Heart Failure: A Randomized Trial. J Manip Physiol Ther. 2021. 44(6):455–66.
- Haas A, Russell D (2018), “Sustained improvement of heart rate variability in patients undergoing a program of chiropractic care: a retrospective case series,” Chiropractic Journal of Australia, Volume 45, Number 4, pp. 339-358
