Effect of Chiropractic Care on Heart Rate Variability and Pain in a Mult-isite

Clinical Study
Zhang J, Dean D, Nosco D, Strathopulos D & Floros M, Journal of Manipulative and
Physiological Therapeutics, 2006; 29(4):267-274.
Review by
Christopher Notley
Study
The purpose of this study was to look at the effect of chiropractic care on
sympathetic and parasympathetic nervous system using heart rate variability analysis.
Heart rate variability (HRV) analysis determines the balance between the
parasympathetic (PNS) and sympathetic activity (SNS). It is measured by beat to beat
variation of heart beats (R-R interval). Studies have shown that HRV is lower in patients
with acute MI.
Also measured within this analysis was the standard deviation of normal-tonormal (SDNN) and the square root of mean squared difference (RMS-SD) both of which
are associated with fast parasympathetic variability. High frequency measures (measures
PNS activity), low frequency measures (SNS and PNS tone) were also measured. Lower
low frequency measures indicate a change SNS and PNS balance. The ratio between low
and high frequency is used to measure balance between the two. An increase in this score
would indicate a decrease in PNS or increase in SNS.
The study took 10 subjects. Eight of the subjects were monitored before and after
an adjustment. The other two subjects were followed over a four week period. 2 HRV
recordings were done per week. A control group consisted of 157 college students.
Chiropractic Theory
The theory that this study is working under is the somatoautonomic reflex theory.
The theory is that a segmental of region dysfunction will cause a somatoautonomic
dysfunction. This leads to changes in sympathetic or parasympathetic activity
(somatoautonomic imbalance).i
We see the positive application of this theory in the results of the study. There
was an increase or improvement in heart rate variability (better balance between the
systems). After adjustments the heart rate was reduced from 76 to 74 beats a minute.
SDNN increased indicating increase in fast parasympathetic activity. High frequency
measurement increased along with the low frequency measurement. This would indicate
an increase in PNS. Based on this information chiropractic care has an effect on the
parasympathetic system leading to an increase in activity. An increase in
parasympathetic activity would be a reason for a decrease in heart rate.
The authors point out that their results were similar to the effects of exercise on
HR after an 8 week training program. They also note that the changes in HRV were
similar to those in their study which was only 4 weeks versus 8 weeks.
Relevance to My Understanding of Chiropractic
We are told that there is a connection between structure and function. If the
structure of the spine is affected it can affect the function of the body. This effect may be

through the balance of the sympathetic and parasympathetic systems. There is skepticism
by the general public and scientists that there is no connection. By reading this article it
adds to the likelihood that chiropractic has more effects on the body other than on the
musculoskeletal system. The article shows that chiropractic can affect the balance
between the sympathetic and parasympathetic system. This may be the start of a better
understanding and measurable proof of the effects of chiropractic and on the sympathetic
and parasympathetic systems.

Leach RA. The Chiropractic Theories: A textbook of scientific research 4th ed. Philadelphia: Lippincott Williams &
Wilkins, 2004.