Improvement in Heart Rate Variability Following Spinal Adjustment: A Case Study in Statistical Methodology for a Single Office Visit


  • John Hart Hart Chiropractic, Greenville, South Carolina



Chiropractic adjustment, heart rate variability, biostatistics, Grubbs test.


Introduction: Statistical analysis is typically applied at the group level. The present study analyzes data during a single office visit as a novel approach providing real-time feedback to the clinician and patient regarding efficacy of an intervention. In this study, heart rate variability (HRV) was analyzed before versus after a chiropractic spinal adjustment.

Methods: The patient is an adult female who signed a consent form for the study. HRV was measured twice before a chiropractic adjustment and once afterwards using app-based technology. The three HRV values (two pre and one post) were then statistically analyzed using an online calculator for outliers using Grubbs test.

Results: The two pre-adjustment HRV (rMSSD) readings were consistently low: pre 1 = 16.0 milliseconds [ms] and pre 2 = 16.2 ms. The low HRV was an indicator that the patient's nervous system was not functioning optimally. The patient's atlas (C1) vertebra was palpated to be slightly out of alignment. These two findings (low HRV and vertebral misalignment) indicated the presence of a chiropractic subluxation (of the atlas vertebra). The subluxation was adjusted and within minutes the HRV increased (improved) to 27.5 ms. This improvement was calculated to be a statistically significant outlier (p < 0.05).

Conclusion: This study is an example of how statistical methods can be applied to the level of an individual patient during one office visit to assess neurological effectiveness of a chiropractic adjustment. Since this is a case study, the results may not apply to all patients. Therefore, further studies in other patients, and for longer follow-up times, are reasonable next steps.






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