Effects of Suboccipital Release Osteopathic Manipulation on Autonomic Nervous System: Insights from Short-Term QT Interval Measurements in Healthy Young Adults

Author(s): Ryan Witczak, Jennifer Kachelmeyer, Kristina Cummings, Maxim Crasta


Osteopathic physicians employ the Sub Occipital Release (SOR) manipulation technique to promote wellness and modulate the Autonomic Nervous System (ANS). It has been found that this technique promotes relaxation and balance throughout the body. The principle behind SOR involves targeting mechanoreceptors found within the deep fascia, connective tissue, and muscles of the sub occipital area. By effectively balancing the ANS, SOR techniques are believed to alleviate stress and improve blood flow in the suboccipital region. This could potentially relieve any potential compression on the vagus nerve, enhancing vagal activity in cardiac myocytes. The primary objective of this research is to examine how SOR impacts cardiac control, specifically using QT variability as a surrogate measure.


A crossover design was incorporated with three interventions: a control group with no physical contact, sham treatment, and a SOR group. Data was collected using 12-lead EKG recordings, with intervals for QRS, QT, QTcB, JT, QTa, and QTend. The index of cardiac electrophysiological balance (iCEB) was determined by measuring QTcB and QRS duration.


The multiple comparisons showed that there was no significant difference in the QTa measurements between the V2 and aVF leads, as these two leads record the maximum and minimum QTa intervals [F (1.705, 34.11) = 1.294, P = 0.06]. The The mean values (Mean±SEM) for the control, sham, and SOR groups (96.29 ± 4.37msec ,97.14 ± 5.85 msec, and 89.48 ± 4.62msec respectively. This was significantly lower for the SOR group [F (1.705, 34.11) = 1.294, P = 0.05]. The variability in the QTcb was also found to be statistically significant [F (1.410, 28.19) = 0.4429, P=0 .051]. To get a more accurate measurement of relative variation compared to just using QTend alone, we looked at the ratio of QTend to either QT or QTc interval. The mean ratio values (Mean±SEM) for the control, sham, and SOR groups were 0 .26±0 .01, 0.25±0 .01, and O .19±O.01 respectively. A significant decrease was observed in the SOR group when compared to the other two groups.


The effects of SOR on QT metrics were diverse, resulting in a moderate increase in both QT and QTcB length. Additionally, there was a decoupling of the QTend and JT intervals, leading to shortened QTend intervals potentially due to increased vagal activity. This could be a result of alterations in repolarization or a temporary decrease in heart rate due to vagal stimulation. This, along with a moderate increase in QTcB, suggests that SOR may improve cardiac function by prolonging the effective refractory period enhancing ventricular relaxation.

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