Hypothetical Link Between Osteopathic Suboccipital Decompression and Neuroimmunomodulation

Abstract

Emerging evidence has begun to depict the molecular mechanisms by which inflammation is regulated via the vagus nerve. Specifically, inflammation can be controlled by neuroimmunologic circuitry, dependent upon vagal afferent and efferent fibers, operating in a reflexive continuum. This neuro-immune reflex, known as the inflammatory reflex arc, has some control on serum concentrations of numerous molecular mediators of inflammation such as C-reactive protein and interleukin-6. Importantly, both of these inflammatory proteins are elevated in acute ST-elevation myocardial infarction and are associated with worse cardiac sequelae. Suboccipital decompression by osteopathic manual treatment has been demonstrated to enhance vagal output to the heart, as measured by increased high frequency spectral power of heart rate variability, in a statistically significant manner further supported by a significant decrease in the low-/high frequency spectral power ratio among healthy adults compared to sham treatment and time control. Considering this association, we postulate that suboccipital decompression may stimulate the efferent branch of this vagal-mediated reflex, the cholinergic antiinflammatory pathway, thereby suppressing C-reactive protein and interleukin-6 levels post-ST-elevation myocardial infarction. Furthermore, we provide a detailed clinical study that can determine the validity of our hypothesis.

Nociception, pain, neuroplasticity and the practice of Osteopathic Manipulative Medicine

“…As studies of subjects with chronic pain suggest that parasympathetic activity is heightened, OMM should focus on interventions to increase parasympathetic activation. (8) OMT of the upper cervical region may impact vagal nerve function and influence the neuroendocrine reflex arc to attenuate the serum levels of molecular inflammatory mediators [206]. This hypothesis is presently under study [206].…”

Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System

“…The precise neuroanatomical means by which chiropractic care, and VS, may exert neuromodulatory effects on HRV have yet to be elucidated and may include indirect effects via modulation of sympatho-excitatory response [55] or alteration of somatosensory input to the CNS from the upper cervical spine [220], or perhaps via modulation of vagal (SNS/PNS) input within the hierarchy of Thayer's NVI model [249]. Interestingly, "innocuous stimulation" to the upper cervical spine evokes HRV changes [98], and osteopathic suboccipital decompression enhances HRV indices in healthy subjects [266,267] supporting the hypothesis that somatosensory efferent input from the upper cervical spine, or dysfunction thereof via VS, may influence HRV. The emerging field of research exploring the impact of chiropractic care on HRV contains both clues and opportunities for the broaderreaching effects of chiropractic care to be discovered and understood.…”