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Heart Rate Variability in Osteopathic Practice.

Updated: Jul 11, 2023

A Biological marker and a window to psychophysiology and general physiology.



From Pascal Grolaux, BSc, DO, MOst, Dr (Hon) ACoPM

“Heart Rate Variability (HRV) analysis is an affordable, non-invasive method that assesses the balance between sympathetic and vagal tone. This analysis can be easily implemented in YOUR osteopathic practice to objectively measure the physiological response of your treatments”

Heart Rate Variability


As the term suggests, heart rate variability is a measurement of the variation in time between each heartbeat. In other words, it expresses how well the heart changes speeds throughout the day.

For example, you may measure your heart rate and find it’s about 90 beats per minute. However, that doesn’t mean that every single heartbeat takes about ⅔ of a second. The interval between each heartbeat varies. In this same example, you may have ⅓ of a second between beats and later a full second between beats.

These increments between beats are called R-R intervals and are measured in milliseconds. The term “R-R intervals” comes from the heartbeat’s R-phase. These intervals are essentially the spikes you see on the results of an electrocardiogram (EKG).

“During the R phase, most of the heart is activated resulting in the greatest wave shown by the ECG recording,” according to a 2016 review on heart rate variability in humans.

The smaller the standard deviation in your R-R intervals, the lower your HRV score is. You may also see the term NN interval used instead of R-R intervals.


The variation in heart rate relies on the modulation of the autonomic nervous system but also on baroreceptors and hormonal activity, like the renin-angiotensin system..

The autonomic modulation is dependant of the brain centers that are part of the Central Autonomic Network.


HRV represents the delicate balance of the autonomic nervous system. When the sympathetic nervous system has greater influence, the heart speeds up and HRV decreases. Conversely, the parasympathetic influence slows down the heart and increases HRV.


When the autonomic nervous system is out of balance, the sympathetic nervous system can exceed its boundaries, affecting the body in numerous ways that includes a low HRV score.

Essentially, the more variation there is between heartbeats, the more flexible and resilient your mind and body are. A low HRV has been associated with mental health disorders, including depression, anxiety, PTSD, etc, but also with cancers, obesity, chronic pain, etc. Generally low HRV is related to conditions associated with hyper sympathetic activity and inflammation, like in automimmune diseases, for instance.

HRV is overall considered as a physiological window to health or disease, and physiological changes appearing before symptoms manifests,

Importantly, watching your patient's HRV can help you track then physiological responses induced by your treatments therefore tracking your patients emotional and behavioral well-being along with their physical condition. It will also help you to dosage properly or adjust your treatment in order to make it more effective, physiologically. Lastly, but not least, HRV analysis results will be a good motivation for your patients to globally improve their health, because they will see the positives physiological changes induced by YOUR treatments and their combined efforts to improve their health! You and your patients will be able to compare physiological changes, before and after treatment! It is also a objective means to justify your treatment and showing their physiological effects.


A course targeting HRV analysis, short-term EKG-based, will explain you how to easily perform an HRV analysis in your daily practice after understanding the makers of the analysis. We will see the basic of EKG, as well as how to avoid certain traps through the understanding of the most used and recommended HRV analysis software, Kubios. We are recommending this unusual and original course supported by evidence related to osteopathic manipulative medicine. Note, that using an EKG is not forbidden for our profession and the purpose IS NOT to make a cardiological disagnosis!


HRV analysis will be part of the following course: The Neurovisceral Integrative Model and its Application to Osteopathy


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