Objective measures of physiologic change from osteopathic manipulative treatment (OMT) have included blood pressure and heart rate variability, cannabimimetic effects, electroencephalographic change, radiographic evidence, skin-resistance testing, and sympathetic nerve activity. The authors report on the effect of a cranial OMT procedure called compression of the fourth [cerebral] ventricle, or CV-4, on low-frequency oscillations in cutaneous blood flow velocity as measured by transcutaneous laser Doppler flowmetry (LDF). Each biologic process has its own biorhythm or rhythmic fluctuation. The oscillations of these biorhythms can be measured by various devices, including LDF. Computer software and LDF technology allow researchers to discern various frequencies of body rhythms (ie, other than the directly measured cutaneous blood flow) that may be affected by OMT. The CV-4 procedure has previously been shown to affect the low-frequency component of blood flow velocity measurements, but not the higher frequency components (eg, respiratory or cardiac fluctuations). In other unrelated studies, CV-4 has also been shown to decrease sleep latency (brain electronic rhythmic fluctuations) and sympathetic nerve activity (sympathetic nerve rhythmic fluctuations).
This study was conducted at the annual American Academy of Osteopathy Convocation in Colorado Springs, Colo, March 18 to 19, 2004. Twenty-eight DOs and 26 healthy adult subjects participated. The LDF consists of a fiber optic probe that rests on the skin surface of subjects' foreheads. The probe has two optic fibers, one that sends laser light into the subcutaneous capillaries while the other transfers the reflected light from passing hemoglobin molecules to a photo detector for electronic processing. The Doppler effect is used to calculate blood flow velocity and display this number on a standard scale. Physicians were asked to verbally cue investigators when initiating the CV-4 procedure, when the subject's inherent motion was palpably minimized (ie, the still point was achieved), and again when that motion had resumed. The LDF measurements were compared with resting measures in both pretreatment “control” and posttreatment response. Sham treatment was not used.
The mean (SD) length of treatment was 4.43 (2.22) minutes. The most consistent and significant change in blood flow velocity oscillations was at the 0.1 Hz frequency (ie, the baro or Traube-Hering wave). These low-frequency oscillations are manifestations of autonomic vascular regulation. An analysis of variance established significant differences between groups (ie, pretreatment, during CV-4, and posttreatment) at both the 0.08 Hz (P=.041) and 0.1 Hz (P=.000) low frequencies, but not at the higher, cardiac cycle–related frequencies or at very low temperature regulation–related frequencies (0.02 Hz). Amplitude of the 0.1 Hz frequency decreased during CV-4 and was dampened or eliminated at the still point. Posttreatment measures of the 0.1 Hz oscillation were significantly amplified (P=.011) when compared with pretreatment control and CV-4 measures.
The authors conclude that CV-4 has quantifiable physiologic effects on low-frequency oscillations of blood flow velocity as measured by the transcutaneous LDF. This research model enables researchers to objectively ascertain when the procedure was in use, whether a still point was reached, and whether a physiologic effect was obtained. The potential health benefit of these physiologic changes induced by CV-4 has yet to be investigated. —M.A.S.
Nelson K, Sergueef N, Glonek T. The effect of an alternative medical procedure upon low-frequency oscillations in cutaneous blood flow velocity. J Manipulative Physiol Ther. 2006;29:626 –636.