Effects of mobilization or manipulation of the thoracic spine on autonomic nervous system markers in symptomatic and asymptomatic participants - a systematic review and meta-analysis

Lars Hansen; Hartmut Goebel; Larissa Pagels; Kerstin Luedtke

doi:10.1080/10669817.2025.2478611

Effects of mobilization or manipulation of the thoracic spine on autonomic nervous system markers in symptomatic and asymptomatic participants - a systematic review and meta-analysis

Lars Hansen, Hartmut Goebel, Larissa Pagels, Kerstin Luedtke

Institute of Health Sciences

Abstract

OBJECTIVES: To identify the effects of thoracic mobilization/manipulation on autonomic nervous system responses.

METHODS: Four electronic databases were searched for controlled trials published before February 2024. Studies on mobilization/manipulation of the thoracic spine were included evaluating effects on the autonomic nervous system (ANS). Risk of bias was assessed by two independent assessors using the Cochrane risk-of-bias tool 2, the RoB-2 tool for crossover studies or the ROBINS-I tool. Meta-analyses using random-effects models present the overall combined mean effects.

RESULTS: 2139 articles were identified, 20 studies (863 participants) were included in the qualitative data analysis and 15 in meta-analyses. Four studies had a high risk of bias in one or more domains. Meta-analyses indicated no statistically significant effect of mobilization or manipulation on markers of the ANS. The ratio of low-frequency-to-high-frequency power did not significantly decrease after thoracic mobilization/manipulation compared to any type of control intervention (-0.28; 95% CI -0.59 to 0.04; p=0.09). Skin conductance and root mean square of successive RR interval differences as well as LFab (ms^2; absolute power of the low-frequency band) did not significantly increase after thoracic mobilization/manipulation. Subgroup and sensitivity-analyses indicated no significant effects.

DISCUSSION: Methodological limitations and heterogeneity (I2=0-94%) in reported outcomes, reduce the level of evidence. Future studies with a rigorous methodological approach and studies on symptomatic participants with longer follow-ups are warranted.

CONCLUSION: No significant effects of mobilization/manipulation of the thoracic spine on ANS markers were found. The direction of changes towards increased or decreased sympathetic or parasympathetic nervous system activity was ambiguous.

Original language	English
Journal	Journal of Manual and Manipulative Therapy
Volume	33
Issue number	6
Pages (from-to)	466-489
Number of pages	24
ISSN	1066-9817
DOIs	https://doi.org/10.1080/10669817.2025.2478611
Publication status	Published - 12.2025

Funding

Funders	Funder number
Physio-Deutschland Foundation
Friedrich Naumann Stiftung

Research Areas and Centers

Health Sciences

DFG Research Classification Scheme

2.22-27 Orthopaedics, Traumatology, Reconstructive Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1080/10669817.2025.2478611

Cite this

@article{f3f0260da07a4a8e833eeab3e7bbc667,

title = "Effects of mobilization or manipulation of the thoracic spine on autonomic nervous system markers in symptomatic and asymptomatic participants - a systematic review and meta-analysis",

abstract = "OBJECTIVES: To identify the effects of thoracic mobilization/manipulation on autonomic nervous system responses.METHODS: Four electronic databases were searched for controlled trials published before February 2024. Studies on mobilization/manipulation of the thoracic spine were included evaluating effects on the autonomic nervous system (ANS). Risk of bias was assessed by two independent assessors using the Cochrane risk-of-bias tool 2, the RoB-2 tool for crossover studies or the ROBINS-I tool. Meta-analyses using random-effects models present the overall combined mean effects.RESULTS: 2139 articles were identified, 20 studies (863 participants) were included in the qualitative data analysis and 15 in meta-analyses. Four studies had a high risk of bias in one or more domains. Meta-analyses indicated no statistically significant effect of mobilization or manipulation on markers of the ANS. The ratio of low-frequency-to-high-frequency power did not significantly decrease after thoracic mobilization/manipulation compared to any type of control intervention (-0.28; 95\% CI -0.59 to 0.04; p=0.09). Skin conductance and root mean square of successive RR interval differences as well as LFab (ms\textasciicircum{}2; absolute power of the low-frequency band) did not significantly increase after thoracic mobilization/manipulation. Subgroup and sensitivity-analyses indicated no significant effects.DISCUSSION: Methodological limitations and heterogeneity (I2=0-94\%) in reported outcomes, reduce the level of evidence. Future studies with a rigorous methodological approach and studies on symptomatic participants with longer follow-ups are warranted.CONCLUSION: No significant effects of mobilization/manipulation of the thoracic spine on ANS markers were found. The direction of changes towards increased or decreased sympathetic or parasympathetic nervous system activity was ambiguous.",

author = "Lars Hansen and Hartmut Goebel and Larissa Pagels and Kerstin Luedtke",

note = "Publisher Copyright: {\textcopyright} 2025 Informa UK Limited, trading as Taylor \& Francis Group.",

year = "2025",

month = dec,

doi = "10.1080/10669817.2025.2478611",

language = "English",

volume = "33",

pages = "466--489",

journal = "Journal of Manual and Manipulative Therapy",

issn = "1066-9817",

publisher = "Taylor and Francis Ltd.",

number = "6",

}

Effects of mobilization or manipulation of the thoracic spine on autonomic nervous system markers in symptomatic and asymptomatic participants - a systematic review and meta-analysis. / Hansen, Lars; Goebel, Hartmut; Pagels, Larissa et al.
In: Journal of Manual and Manipulative Therapy, Vol. 33, No. 6, 12.2025, p. 466-489.

Research output: Journal Articles › Scientific review articles › Research

TY - JOUR

T1 - Effects of mobilization or manipulation of the thoracic spine on autonomic nervous system markers in symptomatic and asymptomatic participants - a systematic review and meta-analysis

AU - Hansen, Lars

AU - Goebel, Hartmut

AU - Pagels, Larissa

AU - Luedtke, Kerstin

PY - 2025/12

Y1 - 2025/12

N2 - OBJECTIVES: To identify the effects of thoracic mobilization/manipulation on autonomic nervous system responses.METHODS: Four electronic databases were searched for controlled trials published before February 2024. Studies on mobilization/manipulation of the thoracic spine were included evaluating effects on the autonomic nervous system (ANS). Risk of bias was assessed by two independent assessors using the Cochrane risk-of-bias tool 2, the RoB-2 tool for crossover studies or the ROBINS-I tool. Meta-analyses using random-effects models present the overall combined mean effects.RESULTS: 2139 articles were identified, 20 studies (863 participants) were included in the qualitative data analysis and 15 in meta-analyses. Four studies had a high risk of bias in one or more domains. Meta-analyses indicated no statistically significant effect of mobilization or manipulation on markers of the ANS. The ratio of low-frequency-to-high-frequency power did not significantly decrease after thoracic mobilization/manipulation compared to any type of control intervention (-0.28; 95% CI -0.59 to 0.04; p=0.09). Skin conductance and root mean square of successive RR interval differences as well as LFab (ms^2; absolute power of the low-frequency band) did not significantly increase after thoracic mobilization/manipulation. Subgroup and sensitivity-analyses indicated no significant effects.DISCUSSION: Methodological limitations and heterogeneity (I2=0-94%) in reported outcomes, reduce the level of evidence. Future studies with a rigorous methodological approach and studies on symptomatic participants with longer follow-ups are warranted.CONCLUSION: No significant effects of mobilization/manipulation of the thoracic spine on ANS markers were found. The direction of changes towards increased or decreased sympathetic or parasympathetic nervous system activity was ambiguous.

AB - OBJECTIVES: To identify the effects of thoracic mobilization/manipulation on autonomic nervous system responses.METHODS: Four electronic databases were searched for controlled trials published before February 2024. Studies on mobilization/manipulation of the thoracic spine were included evaluating effects on the autonomic nervous system (ANS). Risk of bias was assessed by two independent assessors using the Cochrane risk-of-bias tool 2, the RoB-2 tool for crossover studies or the ROBINS-I tool. Meta-analyses using random-effects models present the overall combined mean effects.RESULTS: 2139 articles were identified, 20 studies (863 participants) were included in the qualitative data analysis and 15 in meta-analyses. Four studies had a high risk of bias in one or more domains. Meta-analyses indicated no statistically significant effect of mobilization or manipulation on markers of the ANS. The ratio of low-frequency-to-high-frequency power did not significantly decrease after thoracic mobilization/manipulation compared to any type of control intervention (-0.28; 95% CI -0.59 to 0.04; p=0.09). Skin conductance and root mean square of successive RR interval differences as well as LFab (ms^2; absolute power of the low-frequency band) did not significantly increase after thoracic mobilization/manipulation. Subgroup and sensitivity-analyses indicated no significant effects.DISCUSSION: Methodological limitations and heterogeneity (I2=0-94%) in reported outcomes, reduce the level of evidence. Future studies with a rigorous methodological approach and studies on symptomatic participants with longer follow-ups are warranted.CONCLUSION: No significant effects of mobilization/manipulation of the thoracic spine on ANS markers were found. The direction of changes towards increased or decreased sympathetic or parasympathetic nervous system activity was ambiguous.

UR - https://www.scopus.com/pages/publications/105003196164

UR - https://www.mendeley.com/catalogue/ef0a3a58-e3a5-3158-8c70-8c8a2ff1ce67/

U2 - 10.1080/10669817.2025.2478611

DO - 10.1080/10669817.2025.2478611

M3 - Scientific review articles

C2 - 40232939

SN - 1066-9817

VL - 33

SP - 466

EP - 489

JO - Journal of Manual and Manipulative Therapy

JF - Journal of Manual and Manipulative Therapy

IS - 6

ER -

Effects of mobilization or manipulation of the thoracic spine on autonomic nervous system markers in symptomatic and asymptomatic participants - a systematic review and meta-analysis

Abstract

Funding

Research Areas and Centers

DFG Research Classification Scheme

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this