How Osteopathic Manipulation May Be Able to Lower Blood Pressure

Rheumatology Consultation, Doctor Examining back

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Just as it controls many bodily functions that we aren't even aware of, the sympathetic nervous system can exert a direct effect on blood pressure. Known as neurogenic hypertension, high blood pressure that's due to a problem in the sympathetic nervous system is caused by an increased amount of stress hormones circulating in the body. These hormones increase the amount of blood pumped out by the heart while simultaneously constricting arteries. The result is a build-up of pressure as more blood tries to flow through less space.

Many doctors of osteopathic medicine (DOs), commonly known as osteopathic physicians, believe that out of balance spinal mechanics, particularly related to the spinal column, can directly affect blood pressure. DOs are trained to examine the spine and look for abnormalities in your spinal mechanics. By getting your spinal and body mechanics back "in-line," many DOs believe neurogenic blood pressure can be managed.

However, a word of caution: While spinal manipulation has been reported to be a means of controlling hypertension, many researchers believe the evidence supporting this possibility is biased and more studies are needed to confirm spinal manipulation as a treatment for hypertension. is currently a lack of low bias evidence to support the use of SMT as a therapy for the treatment of HTN. Future investigations may clarify if SMT is effective for treating HTN, either by itself or as an adjunctive therapy, and by which physiologic mechanism this occurs.

How Spinal Manipulation May Control Blood Pressure

Understand that your spinal column is a big-time nerve center of your body. The nervous system is in effect a balance of nerves that control how your body relaxes (the parasympathetic response) compared to the sympathetic nervous system, which controls the body's "fight or flight response." When the middle part of your back (the thoracic spine) or the lumbar aspect of your back is out of alignment, this can have a direct effect on increasing the activity of the sympathetic nervous system. This is where osteopathic manipulative treatment (OMT) may be helpful.

In one clinical study, thirty-one patients who received OMT in addition to standard medical therapy showed an improvement in systolic blood pressure and improved functioning of the vascular system compared to those subjects who did not.

How can the use of osteopathic manipulation improve blood pressure? There are several possibilities: 

By improving body mechanics of the thoracic and lumbar spines, it may normalize any stimulus that could "irritate" the nerves and decrease sympathetic tone.

It may help in the treatment of chronic pain. Any type of chronic pain, especially low back pain can affect spinal mechanics. Pain is also a direct stimulus to the sympathetic nervous system. When you are in pain, your blood pressure will be elevated compared to your baseline. Osteopathic manipulation is effective in the treatment of chronic pain.

In one clinical study, osteopathic manipulation was administered to patients who had diabetes as well as chronic low back pain. The authors noted that this set of patients noted a significant improvement in their back pain after a period of three weeks. The authors also noted in this study that those with diabetes had more back and muscular dysfunction compared to those who didn't have diabetes.

In the setting of chronic back pain, for example, it is not just the vertebrae that are affected, but also the nerves and muscles as well. The muscles can be tight, boggy, or in spasm as a result of a back injury. The presence of chronic illness or chronic medical conditions, like diabetes, can sometimes worsen the underlying pain and it may take longer to recover.

3) Osteopathic manipulation may help dissipate tension and reduce stress. When many people think of OMT, the main thing that comes to mind is that their backs are going to "get cracked." There is more to OMT than the cracking of backs. In addition to performing a structural examination, the first aspect of treatment is paying attention to the fascia and the muscles. Many people "wear their stress" in their muscles and we find that their muscles can be tight and in spasm. Strained muscles can be boggy or "rope-like." The characteristic of the muscle will determine the type of treatment. For example, for someone with a muscle strain or with fibromyalgia, deep myofascial techniques may cause more pain and discomfort. A more shallow, less intense myofascial release technique is needed. 

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