Sacro-Occipital Technique and Chiropractic Manipulative Reflex Technique Effects on Heart Rate Variability Jennifer Oliver, B.S.; Rebecca Evans, B.S.; Dale Thompson, DC, Logan College of Chiropractic Logan College of Chiropractic 1851 Schoettler Road Chesterfield, MO 63006-1065 © August 2003,Abstract: There are seven aspects of SOT including Occipital Fibers/Chiropractic Manipulative Reflex Technique (CMRT). The nervous system branches and is measured at two frequencies: the sympathetic division is measured at a low frequency whereas the parasympathetic at high frequency. Heart rate variability is one method to detect the effects of the nervous system which was monitored by BioCom Version 2.0. Various students attending Logan College of Chiropractic were divided in two groups to see the results SOT/CMRT has on the nervous system. The treatment group, who received SOT/CMRT adjustments, consisted of 10 subjects, The comparison group contained 17 students, who received adjustments outside this study. One factor influencing our study ‘was National Board Examinations during the later part of this study, Results include the treatment group with a significant difference in high frequency range at p=.026, whereas the comparison group displayed an insignificant difference at p=.387, Based on results, SOT in combination with CMRT may affect the nervous system by stastically increasing the parasympathetic tone as evidenced by heart rate variability.Introduction Sacro-Occipital Technique (SOT) is a chiropractic approach to diagnosis, ‘treatment, and re-evaluation based on an indicator system founded by Dr. Major Bertrand DeJarnette, D.C. These indicators guide the practitioner in the diagnosis of dysfunction within the somatic and visceral components of the body. Chiropractic Manipulative Reflex Technique (CMRT) is a technique designed to affect the visceral-somatic relationship and balance the autonomic nervous system. Stress affects the body through physiological responses from the autonomic nervous system. In this study, heart rate variability (HRV) was monitored to determine the nervous system’s response to every stress and SOT treatment. Background There are seven aspects involved in SOT: Category I, Category II, Category Ill, Cranial Technique, Extremity Technique, Trapezius Fibers, and Occipital Fibers/Chiropractic Manipulative Reflex Technique (CMRT). By having a category system, there are specific procedures to be preformed within each category treatment. See Table 1. The Category system is based on the pelvis, specifically the sacroiliac (SI) joint. The SI Joint is divided into two parts: Part one is called the boot mechanism, and controls the primary sacral respiratory mechanism and the tension of the dura mater. This is a synovial joint and has reciprocal motion coordination with respiration. Part two is the weight bearing part and is a hyaline cartilage joint. Its immovable articulation is due to the age of epiphyseal closure. In addition, part two is dense with proprioceptivefibers 7, Since the SI joint supports the sacrum and the sacrum is the base of the whole vertebral column, most problems involving the vertebral column can be associated with SI joint dysfunction, When trying to determine patient’s category, a postural analysis is performed. This involves looking for increased sway patterns, checking first rib head tenderness and mobility, tendemess of the styloid process or C3/C4 lamina, Sacral Base +/-, dollar and crest signs, heel tension, and vasomotor involvement. Category I: This category involves part one of the SI joint, the boot mechanism. Because the boot mechanism controls the tension of the dura mater, it involves the neurology, physiology, and reflex arcs of the nervous system. On standing analysis, the patient will have increased anterior to posterior sway and will have bilateral rib head tenderness. The pull on the dura will cause there to be heel tension. Heel tension is a tendon guard reflex ', Dollar and crest signs are checked after 3 minutes of blocking. Crest signs indicate function of all skeletal muscles, and dollar signs are neurological monitors of the total nervous system except proprioceptors !. Category II: This category involves part two of the SI joint. It isa sprain of the ligaments holding the joint together. On the standing analysis, there will be increased lateral sway, and unilateral rib head motion in excess of normal. The C4 lamina on the left will be tender to palpation. In the supine position, there needs to be congruency of the Category Il indicators. The inguinal ligament is divided into two sections bilaterally, an upper fossa and lower fossa. On the short leg side, there should be medial knee tenderness and upper inguinal fossa tendemess. On the long leg side, there should belateral knee tenderness and lower inguinal fossa tendemess, One or the other of these possibilities must be present to block as a category IT! Category III: This category involves the cartilage system of the body, most commonly the intervertebral discs. On standing analysis, there will be antalgic posture, with no sway or first rib head tenderness, and there will be tenderness of at least one of the styloid processes ! Trapezius Fibers are an indicator of pedicle involvement in the thoracic and lumbar spine. Within the trapezius there are Ruffini spray endings, which respond to changes in temperature due to congestion of blood and lymph at the pedicle when there is restriction of the vertebrae *, When these fibers contract, they are tender, There are 7 fibers running across each trapezius muscle from the acromioclavicular notch to the transverse process of TI, These fibers correlate with specific vertebrae as shown in Table 2. The patient will experience pain upon palpation of the spinolaminar junction of the vertebra '. Occipital fibers are located in the occipital muscles from the occipital-mastoid V to the External Occipital Protuberance '. They are the Golgi tendon apparatus between the tendon and muscle of the stemmocleidomastoid and trapezius muscles as they insert onto the occiput”. There are 7 fibers located bilaterally. These fibers are the defense of the visceral system. When the organ demonstrates dysfunction, the intrinsic spinal muscles are affected at the level of that organ. This changes the gravitational pull into the occiput, and the occipital fiber forms to maintain the human righting reflex ?. Each fiber has 3 lines. Line 1 involves the cerebrospinal fluid flow and the basic dural membranes. It is associated with a spasm of the interspinous muscles. A line 2 fiberindicates that an organ is under physiological changes and bordering on pathological states of function. The rotatory muscles are involved at this level. When a line 3 is present, the organ dysfunction has progressed to a pathological state. The interspinous, rotatory and intertransversarii muscles are all ihvolved with producing this line 3'. Table 2 shows the relationships between the occipital fibers and vertebrae. Chiropractic Manipulative Reflex Technique addresses the viscera of the body and is a complement to the structural aspect of chiropractic 2, DeJamette believed the organs themselves contributed to decreased function by decreased mobility. ‘When an organ has decreased mobility, there is an increase in stress to the body, leading to an altered response of autonomic nervous system. This technique utilizes neurological reflexes, such as the scleratomes, to affect thé autonomic nervous system by various skin receptors on the body. These receptors are usually nodular, sometimes tender, and each corresponds with has a specific organ. Various methods are used to increase mobility and reduce the tone and tenderness of the skin receptors. In order for MRT to be performed, one must have an active line two occipital fiber or other physiological responses involving the lymph and skin receptors *, ‘The autonomic nervous system regulates a plethora of physiological functions such as breathing, digestion, and heart rate. This nervous system branches into parasympathetic and sympathetic divisions. The parasympathetic system is responsible for physiologic responses while the body is relaxed. This includes resting heart rate, digestion, and dilation of blood vessels. The sympathetic system responds when the body is under stress commonly called the “fight or flight” response. This response increases heart rate, decreases digestion and constricts blood vessels. *Measuring heart rate variability is a simplistic, reliable method to interpret the function and effects of the autonomic nervous system. **” An electrocardiogram, EKG, is the one instrument responsible for measuring heart rate, When the heart contracts and relaxes, certain waves are produced and recorded. In this study, interpretations were based on the distance between two waves, R’-R’, when the ventricles of the heart contract. Electrodes are attached to the body while the computer records and interprets frequency and statistical data. ° The nervous system produces a specific frequency and consists of one of the following: high, low or very low frequency. The parasympathetic division measures 0.15-0.40 Hz, high frequency (HF) contrasting the sympathetic, which is low frequency, (LF) 0.04-0.15 Hz. Very low frequency was not interpreted in this, study, 567 Hypothesis Through measurement of heart rate variability, we hypothesize that SOT/CMRT adjustments will statistically increase the parasympathetic tone. SPSS (Statistical Package for the Social Sciences, SPSS, Chicago, IL) was used to calculate Pearson 2 tailed T test with a significance set at p<0.05. Materials and Methods All subjects signed a consent form, which included a review of systems, medical/supplemental information, history of accidents/surgeries and pregnancies Subjects were restricted to the ages of 18-65. This study excluded any subjects with cancer, spinal surgery, herbal/pharmaceutical medications directly affecting the nervous system, and fracture within the last twelve months. Subjects agreed to refrain from smoking, eating, or drinking caffeinated beverages within two hours of recording heartrate variability. Groups were non-randomized and non-blinded to treatment of SOT/CMRT. The treatment group, Group 1, consisted of 10 chiropractic students: 6 men and 4 women, between ages of 22-49. Dr, Dale Thompson, a graduate from Logan College of Chiropractic in 2002, adjusted each subject using SOT/CMRT protocols. ‘The comparison group, Group 2, consisted of 17 chiropractic students, including 12 men and 5 women ranging from ages 22-38. For treatment protocols, see DeJamette’s 1984 SOT manual, BioCom Version 2.0 (BioCom, Poulsbo, WA) monitored heart rates of both groups. For five minutes, the computer recorded heart rate variability. Three electrodes were placed on the ventral aspects of the arms and legs to monitor heart rate. One electrode was placed on the right arm and second on the left arm, between the proximal and distal radius/ulna. The third electrode was placed on the left leg, between the proximal and distal tibia/fibula, Three baseline readings were taken one week prior to ‘treatment in Group 1. As the study continued, readings were performed once a week for 5 weeks before each treatment. Group 2 was only evaluated at the time scheduled and was not dependent on treatment, The final SOT/CMRT adjustments were performed by Dr. Thompson 5 weeks after initial readings. The final post-treatment readings were recorded on separate days in Groups 1 and 2 a week after National Boards to establish an end line average, Data/Results The comparison group was adjusted outside the study by the following techniques: HVLA (Gonstead, Thompson, Diversified), Activator, and Logan Basic.Students performed most of the adjustments with licensed D.C. supervision at Logan College of Chiropractic. Treatments averaged 6.13 times per subject during the course of this study. All subjects in the comparison group took National Boards The treatment group was only adjusted using SOT/CMRT performed by Dr. ‘Thompson. Each subject averaged 5.4 adjustments and two subjects did not take National Boards. Neurological reflexes along the cranial suture lines and a Cl diversified adjustment were the only two treatments outside the descriptions of basic SOT/CMRT in this study performed by Dr. Thompson. The following additional adjustments outside this study were noted: 4 SOT, 4 Diversified, 4 Basic, and 3 Activator. Dr. Thompson did not perform these additional treatments. Treatments terminated prior to National Boards and the end line readings were taken the week following National Boards. In Table 4, the treatment group displayed a significant difference in high frequency range at p=.026, whereas the comparison group in Table 3 displayed an insignificant difference at p=.387. The low frequency range was not significant in this study, ‘Two subjects inthe comparison group did not complete this study, and two subjects in the treatment groups did not take National Board. By removing the two subjects who did not take National Boards, significance was lost in the baseline to endline readings (p=.026 to p=.057) with a trend toward significance. However, 015 to significance was maintained from the last treatment to endline readings p=010).Discussion SOT treatments with CMRT affected the high frequency range in heart rate variability thus affecting the parasympathetic nervous system. We can not be sure what Part of the treatment made the greatest change; therefore further study could be done to ‘ease out the variables associated with cranial, CMRT, or blocking. In addition, the subjects of this study were generally in good health, Further studies on subjects with known pathology would expand knowledge of how CMRT affects organ function and mobility. The limitations of this study include the following. The treatment group consisted of individuals familiar with the SOT technique; therefore this study was not blinded nor randomized. Subjects were divided into groups based on schedule availability and the treatment group consisted of only ten subjects thus not producing enough data to tion of subjects would improve tepresent a large portion of the population. Randomi this study, In addition, National Boards were taken during the last third of this study, However 2 subjects in the treatment group did not take Boards, Both the National Boards and the 2 students not taking boards are variables, which affected the outcome of this, study, Improvements to enhance this study include increasing the treatment group size, period of this study, and excluding National Boards Conclusion Based on the results, SOT in combination with CMRT may affect the nervous system by increasing the parasympathetic division as evidenced by heart rate variability.Table 1 Indicators for Category Identification Category I i Category I Category | Increased Sway ‘Anterior-Posterior Lateral None Rib Tenderness =, Bilateral | __+, Unilateral None Rib hyper mobility + : 5 Styloid process - = tenderness Heel tension Present on short leg = : side | C3/C4 lamina - Present on the left > tendemess SB +/-, neutral + May or may not be | May or may not be ie present present Dollar and Crest + : E ‘Vasomotor | + : = Table 2 Line One Occipital Fibers and Trapezius Fibers Occipital eee eee 3 4 5 6 | 7 fiber | Cervical [1 2 3 + 3 6 7 Thoracic |" 12,10 [31112 | _45 6 7 8 9 | | Lumbar 1 2 13 4 [sj Line Two Oceipital Fibers Occipital 1 2 Bi 4 5 6 7] | fiber | Thoracic | 1,2,9,10 | 311,12 | 45 6 a 8 9 | [Lumbar 1 2 3 4 3 Sacral 1 2 4 ] | Line Three Occipital Fibers | Occipital [1 2 3 4 3 6 7 fiber : eUnoeaoie®| Bi 7;1206t/ ame 2!T Tee |ea3'101eE | aan) 38 67 Lumbar 5 4 3 2 i (Cervical [1-2 12 12 12 1-2 12 12 @Sacro Occipital Research Society International, Leawood, KS 10‘Table 3 Comparison Group Results Group 2, Comparison Mean ‘Standard Pearson 2 iB (n=15) Deviation __| Tailed T Test |” Pre 68.7278 49.0817 Heart Rate 425 (bpm) Post 70.2374 10.7931 Tow Pre 1024.8798 £851,7846 Frequency 749 (ims’) Post 1073.1499 916.3108 High Pre 397.6554 £310.4948 Frequency 387 (ms*) Post 345.1962, £292.9229 High Pre 28.0096 #113831 Frequency 988 Norm (mu) Post 29,5963 12.2768 Low Pre 71,9904 ~E113831 Frequency 988 Norm (nu) Post 70.4037 £12.2768 Ratio Pre 3.6359 [#21671 Low/High | : 323 Frequency Post 3.5738 22.0260 MLTable 4 Treatment Group Results Group 1,Treatment ] Mean ‘Standard Pearson 2 (n=10) Deviation _| Tailed T Test Pre 76.0520 10.1388 Heart Rate 129 (bpm) Post 73.6911 29.4946 Low Pre 793.7306 £493.0187 Frequency 694 (ms*) Post 811.6713 £463.7415 High Pre B1277D $325 5403 Frequency _ 026 | (as?) Post 344.8887 2385.6438 High Pre 26.1852 F118 Frequency 188 Norm (nu) Post 34.0987 =15.0961 Low Pre BRB 1.5822, Frequency 188 Norm (nu) Post 65.5013 15.0961 Ratio Pre 41896 226018 Low/High 195 Frequency Post 29049 215036 | 12Works Cited - Delamette, Major Bertrand; Sacro Occipital Technic 1984; Sacro Occipital Research Society International, 2000. - Howat, Jonathan; Chiropractic: Anatomy and Physiology of Sacro Occipital Technique; Cranial Communication System, Oxford, 1999. . DeJamette, Major Bertrand; Line Two Occipital Fiber Technique with Advanced CMRT Methods; Sacro Occipital Research Society Intemational, 1993, } Fox, Stuart Ira; Human Physiology; Wm. C, Brown Publishers, Dubuque, IA, 1996, . Zhang, John, 2000. Short-Term Power Spectrum Analysis of Heart Rate Variability of Chiropractic Students in College. Chiro Res Journal 7(2): 70-77. Eingor, Am, Mubs, GJ, 1999. Rationale for Assessing the Effects of Manipulative Therapy on Autonomic Tone by Analysis of Heart Rate Variability. J Manipulative Physiol Ther 22(3): 161-165. - Budgell, B, Hirano, F, 2001. Auton Neurosci: Basie and Clinical 91; (2001): 96- 99. . Heart Rate Variability: Standards of Measurement, Physiological Interpretation and Clinical Use. Circulation, March 1, 1996; 93(5): 1043-1065. 1B