Influence of an osteopathic manipulative intervention on cerebral blood velocity changes: do we have the whole story to appropriately interpret the data?
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Audrey Drapeau
,
Sarah Imhoff
and
Patrice Brassard
We read with interest the article by Roberts et al. that was recently published in this journal [1]. The authors performed a randomized, single-blinded, two-period, two-treatment crossover study to evaluate the impact of the occipitoatlantal decompression, compared to a sham manipulation, on intracranial and extracranial blood velocity responses in young healthy participants. The authors [1] reported increased end-diastolic velocity in the internal carotid artery (ICA), vertebral artery (VA), and middle cerebral artery (MCA) following the intervention but not after the sham treatment.
Several mechanisms intricately work interdependently to determine adequate cerebral blood flow (CBF) [2, 3]: cerebrovascular reactivity to blood gases [4], cerebral autoregulation [5], neurovascular coupling [6], neurogenic factor [7, 8], and systemic factor [9]. Although the authors reported no changes in heart rate and blood pressure with the osteopathic manipulation, one major mechanism was not considered in this study. Indeed, carbon dioxide is a potent CBF determinant [4]. Surprisingly, arterial partial pressure of carbon dioxide was omitted from data collection nor was its absence addressed in discussion of study limitations. Without inclusion of this important variable, it is difficult to ensure blood velocity changes reported by the authors are a direct consequence of the osteopathic manipulation.
Another crucial methodological consideration is that cerebral blood velocity is representative of CBF only if the diameter of cerebral arteries remains stable [10]. It would have thus been interesting to monitor ICA and VA blood flow – not only blood velocity – since it is feasible to measure the diameter of these extracranial arteries. Regarding the MCA, it is not possible to measure its diameter with transcranial Doppler ultrasound, which is another important but unaddressed limitation of this study. Interpreting these cerebral blood velocity changes as representing CBF changes following the osteopathic manipulative intervention without appropriate nuances and caveats is problematic. Knowing if an osteopathic manipulative intervention increases or decreases CBF is relevant for a safe and efficient practice. However, end-diastolic velocity alone may not be sufficient [11], [12], [13].
The authors [1] are congratulated for their effort aimed at examining the influence of an osteopathic manipulation on cerebral blood velocity responses. This being acknowledged, concomitant examination of key CBF determinants, appropriately interpreted cerebral blood velocity data, and/or inclusion of volumetric blood flow are essential in future studies to provide an adequate understanding of the short- and long-term cerebrovascular consequences of osteopathic manipulative interventions.
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Research funding: None reported.
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Author contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Competing interests: None reported.
References
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© 2021 Audrey Drapeau et al., published by De Gruyter, Berlin/Boston
This work is licensed under the Creative Commons Attribution 4.0 International License.
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Articles in the same Issue
- Frontmatter
- General
- Review Article
- Advances in the therapeutic approach of pudendal neuralgia: a systematic review
- Medical Education
- Brief Report
- The pandemic silver lining: preparing osteopathic learners to address healthcare needs using telehealth
- Musculoskeletal Medicine and Pain
- Original Article
- Preventing progression from chronic to widespread pain and its impact on health-related quality of life: a historical cohort study of osteopathic medical care
- Neuromusculoskeletal Medicine (OMT)
- Original Article
- Evaluating for a correlation between osteopathic examination and ultrasonography on thoracic spine asymmetry
- Pediatrics
- Review Article
- Analysis of the effects of isotretinoin on the premature epiphyseal closure in pediatric populations: a literature review
- Public Health and Primary Care
- Review Article
- A renaissance in the treatment of diabetic kidney disease, hypertension in chronic kidney disease, and beyond
- Case Report
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- Letter to the Editor
- Influence of an osteopathic manipulative intervention on cerebral blood velocity changes: do we have the whole story to appropriately interpret the data?
