Osteopathic manipulative therapy (OMT) produces beneficial changes in cardiovascular autonomic parameters in rugby players
Osteopathic Manipulative Therapy

Osteopathic manipulative therapy (OMT) produces beneficial changes in cardiovascular autonomic parameters in rugby players

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A recent study investigated the effects of a single OMT session on mean arterial pressure, heart rate (HR) and heart rate variability (HRV) in rugby players (Carnevali et al. 2021).

During physical stress, e.g. during training, the autonomic nervous system (ANS) has to cope with many demands of the body at the same time. For example, the muscles being used compete with the thermoregulatory need for sufficient blood flow to the skin, the maintenance of a stable blood pressure and good blood flow to the internal organs (Michael et al. 2017). All of this is controlled autonomously outside of our awareness until exercise is stopped and there is an onset of cardiac autonomic recovery (Coote 2010). Full recovery occurs when all stressed systems return to normal resting levels (Terziotti et al. 2001). Particularly high training intensities correlate with a slower recovery of heart rate and heart rate variability (Peçanha et al. 2014, Pecanha et al. 2013, Seiler et al. 2007, Terziotti et al. 2001). Additional psychological stress, as is the case in a competition, amplifies this effect (Barbero-Álvarez et al. 2012, Póvoas et al. 2012). Surveys have found increased HR and HRV values up to 24 hours after a competition in athletes. In addition, orthostatic dysregulation of the ANS has been observed in rugby players the day after a competition (Edmonds et al. 2013). These altered resting and reactivity parameters in elite athletes with incomplete cardiac autonomic recovery have potentially adverse health consequences and lead to reduced performance in training and competition.

Osteopathic manipulative therapy influences the work of the autonomic nervous system by contributing to simultaneous vasodilation, smooth muscle relaxation and increased blood flow. Studies have also shown that OMT leads to an increase in heart rate variability at rest and counteracts a stress-induced decrease in HRV (Fornari et al. 2017, Giles et al. 2013, Henley et al. 2008). OMT is thus able to promote cardiac autonomic homeostasis.


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In the present study, a randomised, double-blind, sham-controlled crossover design was used and resting and reactivity measurements (blood pressure, heart rate, heart rate variability) were taken. A total of 23 male rugby players participated in the study. Each player was tested four times under two different conditions (after a match vs. no match). Subjects were randomly assigned to either OMT or sham treatment.


18 to 20 hours after a match, an increase in blood pressure and heart rate was observed, as well as a decreased HRV compared to a day without training.

The single OMT session resulted in a significant increase in HRV and a significant decrease in blood pressure, regardless of exercise level.

Thus, this study shows a clear benefit of a single OMT session for elite athletes in terms of cardiovascular autonomic parameters.


Barbero-Álvarez J, Boullosa DA, Nakamura FY, et al. Physical and physiological demands of field and assistant soccer referees during America's cup. J Strength Cond Res. 2012;26(5):1383-1388

Carnevali L, Cerritelli F, Guolo F, et al. Osteopathic Manipulative Treatment and Cardiovascular Autonomic Parameters in Rugby Players: A Randomized, Sham-Controlled Trial. J Manipulative Physiol Ther. 2021;44(4):319-329

Coote JH. Recovery of heart rate following intense dynamic exercise. Exp Physiol. 2010;95(3):431-440

Edmonds RC, Sinclair WH, Leicht AS. Effect of a training week on heart rate variability in elite youth rugby league players. Int J Sports Med. 2013;34(12):1087-1092

Fornari M, Carnevali L, Sgoifo A. Single osteopathic manipulative therapy session dampens acute autonomic and neuroendocrine responses to mental stress in healthy male participants. J Osteopath Med. 2017;117(9):559-567

Giles PD, Hensel KL, Pacchia CF, et al. Suboccipital decompression enhances heart rate variability indices of cardiac control in healthy subjects. J Altern Complement Med. 2013;19(2):92-96

Henley CE, Ivins D, Mills M, et al.Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: a repeated measures study. Osteopath Med Prim Care. 2008;2(1):1-8

Michael S, Graham KS, Davis GM. Cardiac autonomic responses during exercise and post-exercise recovery using heart rate variability and systolic time intervals-a review. Front Physiol. 2017;8:301

Peçanha T, Prodel E, Bartels R, et al. 24-h cardiac autonomic profile after exercise in sedentary subjects. Int J Sports Med. 2014;35(03):245-252

Pecanha T, Paula-Ribeiro M de, Nasario-Junior O, et al. Post-exercise heart rate variability recovery: a time-frequency analysis. Acta Cardiol. 2013;68(6):607-613

Póvoas SCA, Seabra AFT, Ascensão AAMR, et al. Physical and physiological demands of elite team handball. J Strength Cond Res. 2012;26(12):3365-3375

Seiler S, Haugen O, Kuffel E, Autonomic recovery after exercise in trained athletes: intensity and duration effects. Med Sci Sport Exerc. 2007;39(8):1366-1373

Terziotti P, Schena F, Gulli G, et al. Post-exercise recovery of autonomic cardiovascular control: a study by spectrum and cross-spectrum analysis in humans. Eur J Appl Physiol. 2001;84(3):187-194