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Cook AC, Egli AE, Cohen NE, Bernardi K, Chae MY, Kapalko BA, Coyne SA, Scott R. The Neurophysiological Effects of Craniosacral Treatment on Heart Rate Variability: A Systematic Review of Literature and Meta-Analysis. Cureus 2024; 16:e64807. [PMID: 39156412 PMCID: PMC11329942 DOI: 10.7759/cureus.64807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Craniosacral treatment (CST) is an osteopathic technique grounded in the assumption that there is an intrinsic, fine movement of the cerebrospinal fluid. This rhythmic movement can be utilized for diagnostic and therapeutic purposes by palpation and manipulation of the skull, spine, and associated connective tissues. Therapeutic benefit is likely due to action on the autonomic nervous system (ANS), specifically through the vagus nerve. Current literature on the neurophysiological effects of CST is limited, which has contributed to controversy regarding its effectiveness. Heart rate variability (HRV) as a measure of cardiovascular stress and autonomic system activity is thus proposed as a tool to evaluate the neurophysiologic effects of CST. HRV can be analyzed in two different bands, high-frequency (HF) and low-frequency (LF) power associated with a parasympathetic and sympathetic response. In this meta-analysis, we provide a brief introduction to CST, analyze three primary studies, and summarize the therapeutic benefits and pitfalls of this alternative treatment on the ANS. A significant negative HF standardized mean difference after CST was observed; standardized mean difference = -0.46; 95% CI (-0.79,-0.14). No significant effect on LF power was observed. We conclude that CST does provide a moderate short-term increase in parasympathetic activity. These findings suggest that CST may be used to treat patients with an overactive sympathetic state. Further studies should be conducted for comparison against a control group to eliminate the possibility of a placebo effect and to elucidate long-term effects.
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Affiliation(s)
- Andrew C Cook
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine - Bradenton, Jacksonville, USA
| | - Anna E Egli
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine - Bradenton, St. Augustine, USA
| | - Nathan E Cohen
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine - Bradenton, Jacksonville, USA
| | - Kyrie Bernardi
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine - Bradenton, Jacksonville, USA
| | - Min Y Chae
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine - Bradenton, Jacksonville, USA
| | - Brandon A Kapalko
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine - Bradenton, St. Augustine, USA
| | - Sunni A Coyne
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine - Bradenton, Daytona Beach, USA
| | - Randy Scott
- Regional Dean, Lake Erie College of Osteopathic Medicine - Bradenton, Jacksonville, USA
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Liem T, Bohlen L, Jung AM, Hitsch S, Schmidt T. Does Osteopathic Heart-Focused Palpation Modify Heart Rate Variability in Stressed Participants with Musculoskeletal Pain? A Randomised Controlled Pilot Study. Healthcare (Basel) 2024; 12:138. [PMID: 38255026 PMCID: PMC10815744 DOI: 10.3390/healthcare12020138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Heart rate variability (HRV) describes fluctuations in time intervals between heartbeats and reflects autonomic activity. HRV is reduced in stressed patients with musculoskeletal pain and improved after osteopathic manipulative treatment and mind-body interventions. Heart-focused palpation (HFP) combines manual and mind-body approaches to facilitate relaxation. This randomised controlled pilot study investigated the feasibility and sample size for a future randomised controlled trial and the effect of a single treatment with HFP or sham HFP (SHAM) on short-term HRV. A total of Thirty-three adults (47.7 ± 13.5 years old) with stress and musculoskeletal pain completed the trial with acceptable rates of recruitment (8.25 subjects per site/month), retention (100%), adherence (100%), and adverse events (0%). HFP (n = 18), but not SHAM (n = 15), significantly increased the root mean square of successive RR interval differences (p = 0.036), standard deviation of the NN intervals (p = 0.009), and ratio of the low-frequency to high-frequency power band (p = 0.026). HFP and SHAM significantly decreased the heart rate (p < 0.001, p = 0.009) but not the stress index and ratio of the Poincaré plot standard deviation along and perpendicular to the line of identity (p > 0.05). A power analysis calculated 72 participants. Taken together, the study was feasible and HFP improved HRV in stressed subjects with musculoskeletal pain, suggesting a parasympathetic effect.
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Affiliation(s)
- Torsten Liem
- Osteopathic Research Institute, 22297 Hamburg, Germany
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Lucas Bohlen
- Osteopathic Research Institute, 22297 Hamburg, Germany
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Anna-Moyra Jung
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
- Department of Healthcare, Dresden International University, 01067 Dresden, Germany
| | - Samira Hitsch
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
- Department of Healthcare, Dresden International University, 01067 Dresden, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, 22297 Hamburg, Germany
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
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Abenavoli A, Badi F, Barbieri M, Bianchi M, Biglione G, Dealessi C, Grandini M, Lavazza C, Mapelli L, Milano V, Monti L, Seppia S, Tresoldi M, Maggiani A. Cranial osteopathic treatment and stress-related effects on autonomic nervous system measured by salivary markers: A pilot study. J Bodyw Mov Ther 2020; 24:215-221. [PMID: 33218514 DOI: 10.1016/j.jbmt.2020.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Variations in the concentration of salivary alpha amylase (sAA) may indicate a change in the autonomic nervous system functionality. In osteopathic medicine it has long been stated that the osteopathic manipulative treatment (OMT) can modulate the autonomic nervous system. Studies carried out on the compression of the fourth ventricle (CV4) have shown a positive effect in reducing the sympathetic tone. The goal of this pilot study is measuring the physiological response of the sAA levels after CV4 technique. METHODS 90 subjects were randomly assigned to a sham, a control or a CV4 group. Randomization accounted for sex and score in the STAI-2 (form Y) questionnaire. Each subject completed the STAI-1 (form Y) questionnaire to evaluate the anxiety of the moment. sAA activity and saliva flow rate were measured. Saliva was collected before, immediately after and 30 min after treatment. RESULTS Within group analysis revealed that sAA activity increased significantly immediately after the technique application only in the CV4 group (p = 0,05). Between groups analysis show a significant difference of the sAA activity in the CV4 group respect the control group (p < 0,05), but no significant difference between CV4 and sham group (p > 0,05). The effect in the CV4 group after the intervention is highly variable and appeared to be related to the level of stress measured with the STAI-Y1 questionnaire (p = 0,002). CONCLUSIONS This study shows a positive effect of the CV4 procedure on sAA activity even if not significantly different from the sham procedure, probably due to the confounding effect of stress variability between groups.
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Affiliation(s)
- A Abenavoli
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy.
| | - F Badi
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - M Barbieri
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - M Bianchi
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - G Biglione
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - C Dealessi
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - M Grandini
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - C Lavazza
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - L Mapelli
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - V Milano
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - L Monti
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - S Seppia
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - M Tresoldi
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
| | - A Maggiani
- AIMO Accademia Italiana di Medicina Osteopatica, Piazzale del Santuario 7, 21047, Saronno, (VA), Italy
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Arienti C, Farinola F, Ratti S, Daccò S, Fasulo L. Variations of HRV and skin conductance reveal the influence of CV4 and Rib Raising techniques on autonomic balance: A randomized controlled clinical trial. J Bodyw Mov Ther 2020; 24:395-401. [PMID: 33218540 DOI: 10.1016/j.jbmt.2020.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 06/28/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of the present study was to evaluate whether Fourth Ventricle Compression Technique (CV4) and Rib Raising (RR) osteopathic techniques influence Autonomic Nervous System (ANS) activity, as measured by Heart Rate Variability (HRV) and Skin Conductance (SC). METHOD A randomized-controlled clinical trial has been performed from June 2010 to January 2011. 32 healthy adults (33.9 ± 14 years, and 72% female) were selected. Subjects were randomized in three groups: CV4 group, RR group and Placebo group. Each subject of each group underwent respective technique only once. HRV and SC were continuously recorded during the session. All data analysis was performed using SPSS statistical software (version 21.0) and the significance level was considered at p ≤ 0.05. RESULTS RR technique intra-group subject analysis showed a significant decrease in LF/HF ratio (F = 25.18; p < 0.001), a statistically significant decrease of LF (F = 27.09; p < 0.001), and increase of HF, both at the end of treatment (F = 27.09; p < 0.001). CV4 technique intra-group subject analysis showed a significant reduction of the LF/HF ratio (F = 81.15; p < 0.001), a significant decrease in LF (F = 38.29; p < 0.001) and a significant increase of HF, at the end of treatment (F = 38.28; p < 0.001). Between-group analysis showed only a significant difference in LF/HF ratio between CV4 and PL groups (F = 3.44; p = 0.042). DISCUSSION Our results suggest that the application of CV4 and RR techniques favors a shift in the autonomic balance towards a parasympathetic predominant state. Thus, their use within OMT protocol, as holistic approach, might improve the outcome of the treatment of clinical neuro-vegetative conditions.
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Affiliation(s)
| | - Federica Farinola
- Division of Research, Istituto Superiore di Osteopatia, Milan, Italy
| | - Silvia Ratti
- Division of Research, Istituto Superiore di Osteopatia, Milan, Italy
| | - Silvia Daccò
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, 22032 Albese con Cassano, Como, Italy
| | - Luigi Fasulo
- Osteopathic Clinic, ASP nr 9 of Mazara del Vallo, Trapani, Italy
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Rechberger V, Biberschick M, Porthun J. Effectiveness of an osteopathic treatment on the autonomic nervous system: a systematic review of the literature. Eur J Med Res 2019; 24:36. [PMID: 31653268 PMCID: PMC6814098 DOI: 10.1186/s40001-019-0394-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/15/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The objective of this systematic review was to evaluate the effectiveness of an osteopathic treatment on the autonomic nervous system (ANS). For this purpose, published primary studies were analysed and critically evaluated. METHOD To generate this review, 15 electronic databases were systematically searched for studies. Randomized clinical controlled trials (RCT) and clinical controlled trials (CCT) are included in the review and evaluated with appropriate assessment tools (Downs and Black Checklist and the checklist from Kienle and Kiene). RESULTS 23 published studies (10 RCT, 1 clinic multi-centre study, 1 CCT, 5 randomized cross-over studies, 5 randomized pilot studies and 1 single case study) are included in this review. The studies were evaluated with the assessment tools according to their quality. 3 studies are graded as high quality, 11 as moderate and 8 as low-quality studies. CONCLUSION The included published studies represent a good level of evidence. Due to a small number of subjects and no follow-ups, the methodological quality is rated as moderate. A significant change on the ANS was shown in studies including High-Velocity Low-Amplitude Techniques (HVLAT). No statement could be drawn in studies in which they used cranial osteopathic techniques due to the lack of methodological quality. A significant change on the ANS is shown in the treatment of the suboccipital region. In studies which evaluated the effectiveness of mobilization in the cervical and thoracic region, no statement could be displayed due to a low level of evidence. None of the findings in these studies have given statements if ANS activation takes place in the sympathetic or parasympathetic system.
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Affiliation(s)
- Verena Rechberger
- Vienna School of Osteopathy, Donau University Krems, Vienna, Austria
| | | | - Jan Porthun
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
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Bayo-Tallón V, Esquirol-Caussa J, Pàmias-Massana M, Planells-Keller K, Palao-Vidal DJ. Effects of manual cranial therapy on heart rate variability in children without associated disorders: Translation to clinical practice. Complement Ther Clin Pract 2019; 36:125-141. [PMID: 31383430 DOI: 10.1016/j.ctcp.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 06/11/2019] [Accepted: 06/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND and purpose: Heart rate variability (HRV) represents a marker of autonomic activity, self-regulation and psychiatric illness. Few studies of manual therapy have investigated the neurophysiological effects of manual cranial therapy (MC-t). This study assessed the neurophysiological short/medium-term effects of two manual therapy interventions: massage therapy (Mss-t) and MC-t. MATERIALS AND METHODS A double-blind clinical trial was conducted with 50 healthy children, randomized into two groups who received a Mss-t intervention or MC-t. The variables analysed included vital signs (temperature, respiratory rate, heart rate, blood pressure) and HRV components, including the root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF) and LF/HF ratio. RESULTS Both interventions produced short-term parasympathetic effects, although the effects of MC-t were more persistent. CONCLUSION The persistence of the MC-t intervention suggested a prominent vagal control and better self-regulation. Autonomic imbalances in mental pathologies may benefit from the neurophysiological effects of MC-t.
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Affiliation(s)
- Vanessa Bayo-Tallón
- Universitary Research Service of Physical Therapy, Servei Universitari de Recerca en Fisioteràpia -S.U.R.F, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
| | - Jordi Esquirol-Caussa
- Universitary Research Service of Physical Therapy, Servei Universitari de Recerca en Fisioteràpia -S.U.R.F, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
| | - Montserrat Pàmias-Massana
- Executive Direction of Adult, Child and Juvenile Mental Health Area at Corporación Sanitaria y Universitaria Parc Taulí (Neurosciences) (Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Kalia Planells-Keller
- Executive Direction of Adult, Child and Juvenile Mental Health Area at Corporación Sanitaria y Universitaria Parc Taulí (Neurosciences) (Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Diego J Palao-Vidal
- Executive Direction of Adult, Child and Juvenile Mental Health Area at Corporación Sanitaria y Universitaria Parc Taulí (Neurosciences) (Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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Wójcik M, Dziembowska I, Izdebski P, Żekanowska E. Pilot randomized single-blind clinical trial, craniosacral therapy vs control on physiological reaction to math task in male athletes. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Curi ACC, Maior Alves AS, Silva JG. Cardiac autonomic response after cranial technique of the fourth ventricle (cv4) compression in systemic hypertensive subjects. J Bodyw Mov Ther 2018; 22:666-672. [PMID: 30100295 DOI: 10.1016/j.jbmt.2017.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/18/2017] [Accepted: 11/21/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare blood pressure (BP) behavior and heart rate variability (HRV) among hypertensive stage I and normotensive individuals who were submitted to the cranial technique of the 4th ventricle compression (CV4), an osteopathic technique. METHODS In this experimental controlled study, thirty men between 40 and 60 years old were evaluated and divided into two groups: normotensive (NT) and hypertensive (HT). The CV4 maneuver was applied in both groups and BP was measured at 5 (five) different stages: pre and post-intervention, 5, 10 and 15min after technique. Time-frequency parameters were obtained from measurements of RR intervals. Data were analyzed using an ANOVA two-way for analysis of the condition factor (NT and HT) and times with p-value ≤ .05. RESULTS There was a reduction in the BP of the HT group. A significant intergroup difference (p = .01) was noticed, with respect to the standard deviation of successive normal R-R intervals (SDNN) values, mainly between pre-intervention and 15min stages. Concerning root mean square of the mean squared differences (RNSSD) values, the highlights were differences between pre-intervention and 10min (p = .01) only in the NT group. There was an increase in high frequencies (HF) values and a low frequencies (LF) attenuation in both groups at all different stages. CONCLUSION The data showed a BP reduction in the HT group in pre-intervention/15min and an increase in parasympathetic activity and decreased sympathetic activity in both groups. This suggests a change in the sympathetic-vagal balance. However, further studies are needed to elucidate the data on BP reduction mechanisms with CV4.
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Affiliation(s)
| | - Alex Souto Maior Alves
- Rehabilitation Science at UNISUAM (Centro Universitário Augusto Motta), Rio de Janeiro, RJ, Brazil
| | - Julio Guilherme Silva
- Rehabilitation Science at UNISUAM (Centro Universitário Augusto Motta), Brazil; Department of Physical Therapy - UFRJ [Universidade Federal do Rio de Janeiro], Brazil.
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Compression of the Fourth Ventricle Using a Craniosacral Osteopathic Technique: A Systematic Review of the Clinical Evidence. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:2974962. [PMID: 29234380 PMCID: PMC5664229 DOI: 10.1155/2017/2974962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/29/2017] [Accepted: 09/18/2017] [Indexed: 02/07/2023]
Abstract
Compression of the fourth ventricle (CV4) is a well-known osteopathic procedure, utilized by osteopaths, osteopathic physicians, craniosacral therapists, physical therapists, and manual therapists as part of their healthcare practice based on some evidence suggesting impact on nervous system functions. The main objective of the study was to identify randomized controlled trials (RCTs) assessing the clinical benefits of CV4 and to show the evidence supporting clinical prescriptions, guides, and advice in treating. A computerized search of the PubMed, CINAHL Complete, Scopus, Web of Science, and ScienceDirect databases was performed. Two filters were used (article type: RCTs; species: humans). The methodological quality of the trials was assessed using the Downs and Black quality checklist for healthcare intervention studies. Only six studies met the inclusion criteria, of which four were RCTs and two were observational studies. The Downs and Black score ranged from 17 to 24 points out of a maximum of 27 points. The present review revealed the paucity of CV4 research in patients with different clinical problems, as five out of six included studies investigated healthy adults. According to the results of the included studies, CV4 may be beneficial for patients with different functional problems.
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Kovanur Sampath K, Roy DE. Management of mood disorders by osteopaths in New Zealand: A survey of current clinical practice. INT J OSTEOPATH MED 2015. [DOI: 10.1016/j.ijosm.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Work-related risk factors for low back pain in firefighters. Is exercise helpful? SPORT SCIENCES FOR HEALTH 2014. [DOI: 10.1007/s11332-013-0167-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hamm D. A hypothesis to explain the palpatory experience and therapeutic claims in the practice of osteopathy in the cranial field. INT J OSTEOPATH MED 2011. [DOI: 10.1016/j.ijosm.2011.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Saíz-Llamosas JR, Fernández-Pérez AM, Fajardo-Rodríguez MF, Pilat A, Valenza-Demet G, Fernández-de-las-Peñas C. Changes in Neck Mobility and Pressure Pain Threshold Levels Following a Cervical Myofascial Induction Technique in Pain-Free Healthy Subjects. J Manipulative Physiol Ther 2009; 32:352-7. [DOI: 10.1016/j.jmpt.2009.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/07/2009] [Accepted: 01/13/2009] [Indexed: 10/20/2022]
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