Reference
Kiernan JE. Effects of a manual medicine treatment procedures on nitric oxide release in 23 healthy adults. J Manipulative Physiol Ther. 2010;33(1):76-79.
Design
Uncontrolled case study
Participants
23 healthy adults ranging from 18–30 years of age
Study
Cranial-based manual medicine, specifically a cranial-thoracic-trapezius stretch. A 5-minute resting period after treatment was required for all participants.
Primary Outcome Measures
Exhaled nitric oxide (NO) levels were assessed amperometrically before and after the cranial maneuver. A breath NO analyzer mask utilizing an amperometric probe, which measures the amount of NO in the mask, was used.
Key Findings
The article reported the overall average of the baseline and post treatment nitric oxide levels; the individual results of each of the 23 participants were not included.
Although pain and function were not measured, most participants reported an enhanced relaxation response after treatment.
The cranial therapy was associated with changes in NO levels in exhaled breath. The level of NO increased from 13.3 +/- 2.09 (SD) to 15.0 +/- 2.95 (SD) ppb (P=0.001, based upon the paired t tests of the subjects). The median level of NO before the cranial therapy was 13.0 ppb (ranging from 8 to 17 ppb); after cranial therapy, it was 16.0 ppb (ranging from 6 to 18 ppb).
Although pain and function were not measured, most participants reported an enhanced relaxation response after treatment; the most relaxed participants were those with the highest post-treatment exhaled NO levels.
Practice Implications
This study is the first to explore the physiological effect of cranial therapy on NO production. These finding are significant, especially since we are increasingly learning of the important role that NO plays in various aspects of health. It is also a big step for the cranial community, because despite having a long, rich history and an immense archive of anecdotal evidence, cranial therapy lacks substantial clinical research studies. Currently an explanation of how cranial therapy can produce an increase in exhaled NO levels remains theoretical.
Traditionally, elevated exhaled NO levels have been closely associated with chronic pulmonary conditions such as asthma. This is why it was so vital to choose participants who were qualified as “healthy adults.” Since there were no asthmatic participants, and those with post-treatment elevated levels of NO reported an enhanced relaxation response, I would hypothesize that there is an intimate connection between naturally increasing the body’s ability to produce NO and being able to decrease the devastating effects that stress has on the body. The article also states that this therapy could be a key adjunct in the prevention of coronary artery disease (CAD) and diabetes—both of which damage epithelial lining of blood vessels (indicative of low NO production). When lowered NO levels allow damage to the blood vessels to occur, the endothelium is less able to produce the necessary amount of NO, thus facilitating further endothelial damage. This, over time, can manifest into serious pathological conditions. Given the noninvasive nature of the procedure, this cranial therapy could potentially be an incredible asset to those treating such conditions.
Since the 1990s, NO has been aggressively studied—its relationship to cardiovascular health only discovered in 1998—and it has been found that too little NO, as seen in CAD and diabetic cases, can have a damaging effect, but too much can also be detrimental. In the instance of an excess of NO, further research to examine whether this cranial maneuver may have a modulating effect on NO levels would be interesting, as colleagues in the cranial field have reported positive results with asthmatic patients.
Although this study is small and uncontrolled, which is not typically the type of study highlighted in this column, these findings are relevant to clinical practice. NO is, as we’ve seen, a critical component in maintaining health. In the clinical field, NO and its precursors are being utilized in a variety of ways, ranging from treatment of pulmonary vascular disease in pediatrics, to pain associated with angina, to erectile dysfunction. It’s also becoming a staple for preventative and anti-aging protocols.
We’ve long known that there are noninvasive, effective methods of increasing NO levels, whether through supplementing with arginine or even regular exercise, but until now there has not been a physical modality that has shown a possible systemic increase in NO. These findings also suggest that various healthcare providers and readers of this column may, in addition to their current prevention or treatment protocols, begin to incorporate this type of cranial therapy into their practice.
