Osteopathic Manipulative Treatment and Cardiovascular Autonomic Parameters in Rugby Players

Participants

• Number: 23 people (mean age 24.1 years)
• Criteria of inclusion: professional rugby players, volunteers, adults (age ≥ 18 years), in good health and without injuries, all of white ethnic background to avoid possible confounding factors on the HRV depending on the ethnic background, regular participation in championship matches, regular training for an average time of 6 hours a week during the previous 4 weeks
• Criteria of exclusion: a history of cardiovascular diseases or concussion, chronic pharmacological treatment, consumption of medicines of any type in the last week, having received OMT in the past
• Group of study: 4 groups obtained by randomization
  • Group 1: 7 people, administered in the following order with
    • sham treatment after resting
    • OMT after resting
    • sham treatment after match
    • 1 person dropped out
  • Group 2: 6 people, administered in the following order with
    • sham treatment after match
    • OMT after resting
    • OMT after match
    • 1 person dropped out
    • sham treatment after resting
  • Group 3: 6 people, administered in the following order with
    • OMT after resting
    • sham treatment after match
    •  sham treatment after resting
    • OMT after match

  • Group 4: 6 people, administered in the following order with

    •  

      sham treatment after resting

    • OMT after match
    • 1 person dropped out
    • sham treatment after match

    • OMT after resting

Interventions and evaluations

• Each participant was treated and evaluated 4 times according to all possible conditions, scheduled one week apart from one another
• The basic conditions were:
  • 18-20 hours after a championship match in with at least 60 minutes were played
  • the day following a resting day (no match or heavy training)
• The participant received, for each basic condition, OMT once and sham treatment also once
• Evaluation of the heart rate during and after a 250Hz head-up tilt test using ECG, before and immediately after the intervention
  from the heart rate were derived the values of RMSSD and HF related to HRV, in particular, the influence of vagal activity on the autonomic control of the cardiovascular system
• The logarithmic values of RMSSD and HF were evaluated in the analysis
• Evaluation before and immediately after the intervention of diastolic and systolic blood pressure by sphygmomanometer
  from diastolic and systolic blood pressure the average blood pressure was calculated
• 1 20-minute session of OMT or sham treatment, preceded by a 10-minutes structural evaluation of the pelvis, abdomen, cervical, dorsal and lumbar spine, sacrum and upper and lower extremities to find any somatic dysfunctions in accordance with the TART parameters
• OMT: treatment based on the somatic dysfunctions found aiming at improving the physiological function
• Sham treatment: light touch through hand contact for 2-3 minutes on different areas following a specific sequence (pelvis, abdomen, cervical, dorsal and lumbar rachis, sacrum and upper and lower extremities), without applying any therapeutic technique
• OMT and sham treatment performed by 2 osteopaths with the same educational training
  • for the sham treatment, the 2 osteopaths followed a 4-hour training
• Participants were required to abstain from any physical exercise, caffeine or alcohol consumption and smoking on the day of the treatment and evaluation

Results

• Primary outcomes: the day after a match, the participants showed some of the heart rate values and the average blood pressure higher than the day after resting, in a statistically significant manner. In the same way, RMSSD and HF values were lower.
  OMT favored a statistically significant reduction in average blood pressure and increase in RMSSD and HF, compared to sham treatment in both conditions (after the match or after a resting day).
  As for the heart rate, this dropped statistically significantly after both treatments, especially after match
• Secondary outcomes: while during the tilt test the heart rate increased under all conditions, the RMSSD and HF values decreased more when the participants received OMT compared to when they received the sham treatment and in a statistically significant manner.
• Rurther analyses: no adverse effect emerged.

Discussion

A single session of OMT seems to have favored a greater recovery of the cardiovascular function following a rugby match – lower heart rate and blood pressure, and greater vagal control – just as it seems to have made the cardiovascular system ready to face new stressors (greater reactivity of HRV values during the tilt test).
In fact, a day after a rugby match, the cardiovascular system had not yet recovered its autonomic balance as the vagal parameters were reduced, while the heart rate and blood pressure were higher. The consequence of such a situation can be a sense of prolonged fatigue that, over time, can affect performance and health, especially considering the intensity of physical effort that rugby requires.

HRV values linked to vagal influence are in fact negatively correlated with pain and inflammation levels (in practice: increased pain and inflammation, lower RMSSD and HF values).
An intervention that can therefore favor autonomic balance becomes important in these athletes, considering that, potentially, the OMT could have acted both indirectly, reducing the circulation of inflammatory cytokines at the base of any pain, and directly through the C-tactile fibers involved in autonomic regulation.

Further and larger studies are needed to evaluate other parameters, both subjective (eg, level of pain and fatigue) and objective (eg, pH levels, lactate), to better understand the incidence and mechanisms of OMT action. In addition, it would be good to check whether participants can recognize the treatment they receive so as to analyze possible placebo effects.