The effect of gentle, soft tissue manipulation in the suboccipital region on digital blood flow, as a measure of sympathetic nervous system activity, was studied. Digital strain gauge plethysmography was used to measure the changes in pulse contour during (1) a normative test period with the subject in the supine position, (2) after a control interval (placebo) during which the investigator placed his hands under the suboccipital region, and (3) after an interval during which the investigator's fingers applied slow, steady, circular kneading in the suboccipital triangle region. Twenty-five studies were performed in a crossover design with the patient as his or her own control. Total pulse amplitude (Y) and the height from the dicrotic notch to the peak (X) were measured. Examination of the total data of all subjects revealed the occurrence of a significant change in X and Y with simply touching the suboccipital region with the hands. An even more favorable response ensued when suboccipital manipulation was applied. Those subjects reporting comfort or neutral responses had larger significant changes with manipulation when compared with the group reporting the experience as uncomfortable. The response within each group suggests that favorable autonomic changes (sympathetic dampening) occur with specific suboccipital manipulation as well as, indeed, the simple touching of the suboccipital triangle.

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