To examine the effect of osteopathic manipulative treatment (OMT) on heart rate variability (HRV) indices in an elite open-water swimmer. A female open-water swimmer (age =28 years, height = 172 cm, body mass = 60 kg) participated in this study. The swimmer performed a daily supine HRV test routine 12 days before the 2019 open-water World Championships. OMT was administered when parasympathetic activity (based on HRV indices) was considered below normal values. The swimmer won a bronze medal in the 25 km event and placed fourth in the 10 km event, which qualified her for the 2020 Tokyo Olympics. Parasympathetic falls occurred three times during the taper period. After OMT, we observed a rebound of parasympathetic activity with a moderate to strong increase for High Frequency (HF) values compared with the average baseline from 10 to 150% increase of Ln HF values. OMT appeared to allow a parasympathetic rebound and increase the quality of recovery in an elite open-water swimmer who performed well during the World Championships. This case report illustrates the potential effects of OMT on autonomous nervous system activity, highlighting the possibilities to improve the quality of recovery in world-class athletes. It also shows the necessity to implement individualized training in the context of elite sports.


Performance, Recovery, Autonomic Nervous System, Prevention, Case report,


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