Correlation between mobilization of occipitomastoid suture and a change in the PQ-time in the electrocardiogram. | The International Academy of Osteopathy IAO

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Correlation between mobilization of occipitomastoid suture and a change in the PQ-time in the electrocardiogram.


Author: Frank Eder
Supervisor: Peter Schorpp MSc. Ost.

Introduction: Disorders of the cranial nerves often cause clinically nonspecific symptoms — so-called "soft neurological signs" — and present a common clinical picture in the everyday practice of osteopathy. Due to the anatomical conditions, the skull and cranial sutures are mobilized mechanically in osteopathic treatments to counteract possible blockages and any adverse effects on the cranial nerves. Until now, such treatments remain theoretical, and clinically validated studies are virtually non-

Leading question: Can the mechanical mobilization of the left occipitomastoid suture lead to the stimulation of the vagus nerve, passing through the jugular foramen, and thus to a detectable change in the PQ-time and heart rate in an EKG?

Hypothesis: In comparison to a placebo treatment, which does not involve mobilization of the left occipitomastoid suture, the mobilization of the left occipitomastoid suture results in a measurable prolongation of PQ-time in the EKG through stimulation the vagus nerve. The same technique also leads to a verifiable decrease in the heart rate.

Intention: There is so far little evidence that shape and tension changes in the skull lead to intraforaminal compressions of cranial nerves and blood vessels and that these can be treated by osteopathic manual techniques. The primary objective of this study is therefore proving the effectiveness of a mechanical, manually executed mobilization or expansion of a cranial suture. For this purpose, the effect should be captured electrocardiographically via the electrophysiological influence on the tenth cranial nerve and the resulting change in the target organ heart.

Methods: Randomized controlled survey study, in which (N = 66) subjects the change in the PQ-time and heart rate was recorded in the electrocardiogram after a mobilization of a skull seam and compared to placebo. The measurements collected were evaluated for measurement differences by means of statistical variance analysis to compare the treatment effect.

Results: In general comparison of the PQ-time, a significant main effect was p = .010 observed between all three measurements in both the experimental and control groups. Thus, a general change in the PQ-time was present in experimental and control groups at the three measurement times. However, no significant interaction between experimental and control groups according to treatment technology could be found. Experimental and control groups did not differ significantly in the development of the PQ-time over the three time points p = .511. When comparing the heart rate, a significant main effect of the measurement time point p = .001 could be observed, just as in the case of PQ-time. However, no significant interaction according to treatment technique could be detected. The experimental and control groups did not show any significant difference in the performance of the heart rate over the three points of measurement p = .991.

Discussion: Despite the lack of significant results, it is still unclear whether a mechanical mobilization of a skull seam can have an impact on the cranial nerves. No data were available until the present study, therefore this should be considered only as first attempt to examine how applicable osteopathic manual techniques are. A more extensive number of cases and the adaptation of the experimental setup could provide more information. Furthermore studies with pathological subjects are necessary because it does not seem to be clear whether a reaction can be observed only in subjects with existing pathologies. Due to the lack of clinical evidence in osteopathy, there should be a clear selection of the pathologies used for the research. Only then we can further investigate the role of the mobilization of the human cranial sutures leading to movements and their influence on the cranial nerves. Now we can only speculate on the mechanisms. In order to prove them in the future, an integrative interdisciplinary cooperation of the different branches of medicine is required.