Neural Responses to Physical Characteristics of a High-velocity, Low-amplitude Spinal Manipulation: Effect of Thrust Direction.
Neural Responses to Physical Characteristics of a High-velocity, Low-amplitude Spinal Manipulation: Effect of Thrust Direction.
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DOI：
10.1097/brs.0000000000001344
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发表时间：
2018-01-01
期刊：
影响因子：
3
通讯作者：
Pickar JG
中科院分区：
文献类型：
--
作者：
Reed WR;Long CR;Kawchuk GN;Sozio RS;Pickar JG
在高速低幅度脊柱推拿（HVLA-SM）过程中，从麻醉猫的腰深椎旁肌本体感受器获得电生理记录。确定HVLA-SM的推力方向如何影响背部肌肉组织的神经输入。临床医生在指定方向上施加HVLA-SM推力的能力被认为是其最佳输送的重要组成部分。然而，先前的生物力学研究表明，推力矢量的剪切力分量实际上并没有传递到胸腰椎筋膜深处的椎旁组织，因为皮肤-筋膜界面是无摩擦的。从18只麻醉猫的L 6背根记录了多裂肌和最长肌肌梭的神经活动。预加载到脊柱组织后，通过覆盖L 6椎板的完整皮肤施加HVLA-SM（100 ms推力持续时间）。采用6×6拉丁方设计，重复3次，以垂直于背部和倾斜15°和30°向内侧或向颅侧的角度施加推力。法向力分量保持恒定在21.3N。在HVLA-SM之前和之后，对L 6椎骨施加模拟脊柱运动。在前伸过程中和脊柱运动过程中测定肌梭平均瞬时放电频率（ΔMIF）的变化。与单独预加载相比，HVLA-SM期间对所有推力方向的Δ MIF显著更大，但HVLA-SM期间任何推力方向的ΔMIF均无差异。HVLA-SM降低了一些对模拟脊柱运动的反应，但推力方向对这些变化没有影响。HVLA-SM的推力矢量的剪切力分量不足以传递到下面的椎骨以激活附接的肌肉的肌梭。临床实践和临床研究的意义进行了讨论。
Electrophysiological recordings were obtained from proprioceptors in deep lumbar paraspinal muscles of anesthetized cats during high velocity low amplitude spinal manipulation (HVLA-SM). To determine how thrust direction of an HVLA-SM affects neural input from back musculature. A clinician's ability to apply the thrust of an HVLA-SM in a specified direction is considered an important component of its optimal delivery. However, previous biomechanical studies indicate that the shear force component of the thrust vector is not actually transmitted to paraspinal tissues deep to the thoracolumbar fascia because the skin-fascia interface is frictionless. Neural activity from muscle spindles in the multifidus and longissimus muscles were recorded from L6 dorsal rootlets in 18 anesthetized cats. Following preload to the spinal tissues, HVLA-SMs (100ms thrust duration) were applied through the intact skin overlying the L6 lamina. Thrusts were applied with at angles oriented perpendicularly to the back and obliquely at 15° and 30° medialward or cranialward using a 6×6 Latin square design with 3 replicates. The normal force component was kept constant at 21.3N. HVLA-SMs were preceded and followed by simulated spinal movement applied to the L6 vertebra. Changes in mean instantaneous discharge frequency (ΔMIF) of muscle spindles were determined during the thrust and during spinal movement. ΔMIFs during the HVLA-SM were significantly greater in response to all thrust directions compared to the preload alone but there was no difference in ΔMIF for any of the thrust directions during the HVLA-SM. HVLA-SM decreased some of the responses to simulated spinal movement but thrust direction had no effect on these changes. The shear force component of an HVLA-SM's thrust vector is not transmitted to the underlying vertebra sufficient to activate muscle spindles of the attached muscles. Implications for clinical practice and clinical research are discussed.