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reference
Kiernan JE. Effects of manual medical treatment on nitric oxide release in 23 healthy adults.J Manipulative Physiol. Ther.2010;33(1):76-79.
design
Uncontrolled case study
Participant
23 healthy adults aged 18–30 years
Learn
Skull-based manual medicine, particularly cranial, thoracic and trapezoidal stretching. A 5-minute rest period was required for all participants after treatment.
Primary outcome measures
The exhaled nitric oxide (NO) level was determined amperometrically before and after the cranial maneuver. A respiratory NO analysis mask was used with an amperometric probe that measures the amount of NO in the mask.
Key findings
The article reported overall average nitric oxide levels at baseline and after treatment; the individual results of each of the 23 participants were not taken into account.
Although pain and function were not measured, most participants reported an increased relaxation response after treatment.
Cranial therapy was associated with changes in NO levels in exhaled air. NO levels increased from 13.3 +/- 2.09 (SD) to 15.0 +/- 2.95 (SD) ppb (P=0.001, based on the pairTtests of the test subjects). The mean NO level before cranial therapy was 13.0 ppb (range 8 to 17 ppb); after cranial therapy it was 16.0 ppb (range 6 to 18 ppb).
Although pain and function were not measured, most participants reported an increased relaxation response after treatment; The most relaxed participants were those with the highest exhaled NO levels after treatment.
Effects on practice
This study is the first to examine the physiological effect of cranial therapy on NO production. These findings are important, especially as we learn more about the important role that NO plays in various aspects of health. It's also a big step for the cranial community because, despite a long, rich history and a vast archive of anecdotal evidence, cranial therapy lacks robust clinical research studies. An explanation for how cranial therapy can lead to an increase in exhaled NO levels remains theoretical at this time.
Traditionally, elevated exhaled NO levels have been closely associated with chronic lung diseases such as asthma. This is why it was so important to select participants who were considered “healthy adults.” Since there were no asthmatics and those with elevated NO levels post-treatment reported an increased relaxation response, I would assume that there is a close connection between the body's natural increase in its ability to produce NO and the ability to reduce the devastating effects stress has on the body. The article also states that this therapy could be an important adjunct in preventing coronary artery disease (CHD) and diabetes - both diseases damage the epithelial lining of blood vessels (indicating low NO production). When reduced NO levels result in blood vessel damage, the endothelium is less able to produce the required amount of NO, promoting further endothelium damage. Over time, this can manifest itself in serious pathological conditions. Given the non-invasive nature of the procedure, this cranial therapy could potentially be of great benefit to those treating such conditions.
Since the 1990s, NO has been intensively studied - its connection to cardiovascular health was only discovered in 1998 - and it has been found that too little NO, as seen in CAD and diabetes cases, can have a harmful effect, but too much can also be harmful. In the case of NO excess, further research would be interesting to investigate whether this cranial maneuver could have a modulating effect on NO levels, since colleagues in the cranial area have reported positive results in asthma patients.
Although this study is small and uncontrolled, which is not typically the type of study highlighted in this column, these results are relevant to clinical practice. NO, as we have seen, is a crucial component in maintaining health. In the clinical setting, NO and its precursors are used in a variety of ways, from the treatment of pulmonary vascular disease in pediatrics to pain associated with angina pectoris to erectile dysfunction. It is also becoming an integral part of prevention and anti-aging protocols.
We have long known that there are non-invasive, effective methods of increasing NO levels, whether through arginine supplementation or even regular exercise, but until now there has been no physical method that has demonstrated a possible systemic increase in NO levels. These results also suggest that various health care providers and readers of this column may begin incorporating this type of cranial therapy into their practice in addition to their current prevention or treatment protocols.