Please see our entire May e-newsletter, Reversing Heart Disease, here.
As most of my patients know I am currently knee deep in my research to complete my thesis for the Canadian College of Osteopathy, the last step in my osteopathic education. I am working with researchers from Queens University, the Cardiac Rehabilitation Program at Hotel Dieu Hospital and Cardiologist Dr. Stephen LaHaye, to determine if osteopathy can improve the ability to exercise for people diagnosed with heart disease.
Osteopathy has been shown to benefit patients with a wide variety of cardiovascular diseases. Early osteopaths found that osteopathic manual therapy normalized abnormal blood pressure which was presumed to be achieved by improving cardiovascular circulation and relaxing the musculoskeletal system (Spiegal et al, 2003). Later it was discovered that osteopathy improves blood pressure mainly with cranial manipulation. Cranial therapy was also thought to influence the cardio-respiratory centres of the brain (Spiegal et al, 2003).
Research has also shown a correlation between musculoskeletal changes and coronary artery disease. Cox et al. (1983) found a high correlation between coronary artery disease and abnormalities in range of motion and soft tissue texture changes in the mid-back. Further studies revealed muscle tension in the mid-back and a reduction in motion in seventy six percent of the subjects diagnosed with cardiovascular disease (Beal, 1983). Currently, management of the disease includes drug intervention and lifestyle modification, including exercise training. It has been well documented that being physically active plays a critical role in the management of cardiovascular disease. Unfortunately, exercise intolerance or feeling breathless and fatigued is one the most reported and disabling symptoms of heart disease.
Traditionally it was thought that the exercise intolerance was due to physiological changes to the heart. More recent evidence has begun to accumulate that the decrease in cardiac function along with changes (constriction) in the peripheral arteries causes a decrease in blood flow to skeletal and respiratory muscles which then leads to changes in the muscles’ metabolism. These changes in metabolism lead to an increased sensitivity of nerves in the muscle tissue which then leads to an increase in the sensitivity of the patients’ sympathetic (fight or flight) nervous system. All these changes cause an increased response to exercise, such that physical activity feels much worse. Reports suggest that 25% of patients are limited by skeletal muscle abnormalities rather than cardiac function.
Osteopathic manual therapy has been proposed to normalize the increased sympathetic nervous system response by treating dysfunctions in the associated musculoskeletal areas. Proposed improvements include increasing the available space for the heart to expand and function thereby improving blood flow. This improvement will theoretically lead to a decrease in stimulation of the nerves in skeletal muscle which contribute to an exaggerated response of breathlessness and fatigue during activity in this population. A decrease in this exaggerated response will potentially allow greater improvements in fitness thus improving the health outcomes of this population and play a role in the management of their disease.
Once my study is complete, I will be sure to write a follow up article to inform everyone of the results.
Beal, Myron C. DO (1983). Palpatory testing for somatic dysfunction in patients with cardiovascular disease, J Am Osteopath Assoc 82(11):822-31.
Cox, John M. DO, Gorbis, Sherman DO, Dick, Lorane M. DO, Rogers, Joseph C. DO & Rogers, Felix J. DO (1983). Palpable musculoskeletal findings in coronary artery disease: Results of a double-blind study, J Am Osteopath Assoc 82(11):832-6.
Speigal, Adam J. DO, Capobianco, John D. DO, Kruger, Adam DO, Spinner, Warren D. DO, (2003). Osteopathic Manipulative Medicine in the treatment of Hypertension: An Alternative, Conventional Approach, Heart Disease, A Journal of Cardiovascular Medicine, Vol 5(4), p272.