Neurophysiological effects of spinal manipulation.
Neurophysiological effects of spinal manipulation.
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DOI：
10.1016/s1529-9430(02)00400-x
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发表时间：
2002-09-01
期刊：
影响因子：
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通讯作者：
Pickar, Joel G
中科院分区：
文献类型：
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作者：
Pickar, Joel G
背景：尽管临床证据表明脊柱推拿的好处及其明显的广泛使用，但脊柱推拿影响的生物学机制尚不清楚。虽然这并没有否定脊柱手法的临床效果，但它阻碍了更广泛的科学和医疗保健界的接受，并阻碍了改善脊柱手法实施的合理策略。目的：这篇综述文章的目的是研究脊柱手法效果的神经生理学基础。研究设计：一篇主要讨论基础科学文献和面向临床的基础科学研究的综述文章。方法：这篇综述文章主要来自 Medline 上的同行评审文献。参考了一些教科书出版物和报告。提出了一个理论模型来描述脊柱操纵、节段生物力学、神经系统和终末器官生理学之间的关系。给出了这些关系的实验数据。结果：脊柱操作引起的生物力学变化被认为通过影响感觉信息流入中枢神经系统而产生生理后果。通过脊柱操作刺激肌梭传入神经和高尔基腱器官传入神经。较小直径的感觉神经纤维可能被激活，尽管这尚未得到直接证明。椎间盘突出引起的椎间孔机械和化学变化可影响背根和背根神经节，但尚不清楚脊柱手法是否直接影响这些变化。腰椎间盘突出症患者对脊柱操作的反应已显示出临床改善。已知中枢促进现象会增加中枢神经元的感受野，从而使阈下刺激或无害刺激进入中枢疼痛通路。大量研究表明，脊柱按摩可以提高疼痛耐受性或其阈值。因此，脊柱操纵影响的一种机制可能是操纵通过从椎旁组织消除阈下机械或化学刺激来改变中枢感觉处理的能力。脊柱操作也被认为会影响肌肉和内脏器官的反射神经输出。大量证据表明，脊柱操作会引起椎旁肌肉反射并改变运动神经元的兴奋性。脊柱操作对这些躯体反射的影响可能相当复杂，产生兴奋和抑制作用。虽然大量信息还表明，来自椎旁组织的感觉输入，尤其是有害输入，可以反射性地引发交感神经活动，但有关脊柱操纵对这些反射和终末器官功能的影响的知识更加有限。结论：存在一个理论框架，可以根据该框架提出有关脊柱操纵的神经生理学效应的假设。大量实验证据表明，脊柱操作会影响椎旁组织的初级传入神经元、运动控制系统和疼痛处理。这一领域的实验工作是必要的，并且应该受到鼓励，以帮助更好地理解脊柱推拿治疗范围的潜在机制。
BACKGROUND CONTEXT: Despite clinical evidence for the benefits of spinal manipulation and the apparent wide usage of it, the biological mechanisms underlying the effects of spinal manipulation are not known. Although this does not negate the clinical effects of spinal manipulation, it hinders acceptance by the wider scientific and health-care communities and hinders rational strategies for improving the delivery of spinal manipulation.PURPOSE: The purpose of this review article is to examine the neurophysiological basis for the effects of spinal manipulation.STUDY DESIGN: A review article discussing primarily basic science literature and clinically oriented basic science studies.METHODS: This review article draws primarily from the peer-reviewed literature available on Medline. Several textbook publications and reports are referenced. A theoretical model is presented describing the relationships between spinal manipulation, segmental biomechanics, the nervous system and end-organ physiology. Experimental data for these relationships are presented.RESULTS: Biomechanical changes caused by spinal manipulation are thought to have physiological consequences by means of their effects on the inflow of sensory information to the central nervous system. Muscle spindle afferents and Golgi tendon organ afferents are stimulated by spinal manipulation. Smaller-diameter sensory nerve fibers are likely activated, although this has not been demonstrated directly. Mechanical and chemical changes in the intervertebral foramen caused by a herniated intervertebral disc can affect the dorsal roots and dorsal root ganglia, but it is not known if spinal manipulation directly affects these changes. Individuals with herniated lumbar discs have shown clinical improvement in response to spinal manipulation. The phenomenon of central facilitation is known to increase the receptive field of central neurons, enabling either subthreshold or innocuous stimuli access to central pain pathways. Numerous studies show that spinal manipulation increases pain tolerance or its threshold. One mechanism underlying the effects of spinal manipulation may, therefore, be the manipulation's ability to alter central sensory processing by removing subthreshold mechanical or chemical stimuli from paraspinal tissues. Spinal manipulation is also thought to affect reflex neural outputs to both muscle and visceral organs. Substantial evidence demonstrates that spinal manipulation evokes paraspinal muscle reflexes and alters motoneuron excitability. The effects of spinal manipulation on these somatosomatic reflexes may be quite complex, producing excitatory and inhibitory effects. Whereas substantial information also shows that sensory input, especially noxious input, from paraspinal tissues can reflexively elicit sympathetic nerve activity, knowledge about spinal manipulation's effects on these reflexes and on end-organ function is more limited.CONCLUSIONS: A theoretical framework exists from which hypotheses about the neurophysiological effects of spinal manipulation can be developed. An experimental body of evidence exists indicating that spinal manipulation impacts primary afferent neurons from paraspinal tissues, the motor control system and pain processing. Experimental work in this area is warranted and should be encouraged to help better understand mechanisms underlying the therapeutic scope of spinal manipulation.