Does spinal manipulation speed determine neural response

本R21项目的目标有两个方面：1）增加我们对脊柱推拿对神经系统影响的理解，2）为继续研究本体感受器在脊柱推拿影响中的作用寻求科学依据。本项目的具体目的是确定脊柱操作的速度是否是椎旁肌本体感受器神经反应的重要决定因素。强有力的证据支持使用脊柱推拿来帮助急性腰痛和颈痛患者。脊柱推拿实践中常见的一种理论认为，脊柱推拿会改变椎旁感觉输入（即来自脊柱组织的神经输入）。初步数据表明，脊柱操作冲动刺激本体感受传入腰脊旁肌。这些传入可能有助于操纵的治疗效果。拟议的实验将确定如何肌肉梭和高尔基腱器官在腰椎旁肌响应随时间变化的脉冲脊柱操作。将提供缓慢和快速的脉冲。傅立叶变换将用于在时域中分析每个操纵脉冲的力-时间和位移-时间曲线。由此产生的功率谱的脉冲持续时间的范围将使我们能够确定，如果脊柱操作的速度是一个重要的决定因素的本体感觉输入脊柱操作过程中从椎旁肌肉。这些实验将提供有关脊柱操作影响神经系统的信息，并可能导致改善脊柱操作正确应用的训练方法。教授脊柱手法的手工技巧可以从量化临床医生应用脊柱手法的速度的角度来进行。

The goal of this R21 PROJECT is two-fold: 1) to increase our understanding regarding the effects of spinal manipulation on the nervous system and 2) to seek a scientific basis for the continued investigation of the role of proprioceptors in the effects of spinal manipulation. The specific aim of this project is to determine if the speed of a spinal manipulation is an important determinant of the neural response from paraspinal muscle proprioceptors. Strong evidence supports using spinal manipulation to help patients with acute low back pain and neck pain. A theory common to the practice of spinal manipulation proposes that spinal manipulation alters paraspinal sensory input (ie, neural input from tissues of the vertebral column). Preliminary data demonstrate that spinal manipulative impulses stimulate proprioceptive afferents from lumbar paraspinal muscles. These afferents could contribute to the therapeutic effects of manipulation. The proposed experiments will determine how muscle spindles and Golgi tendon organs in lumbar paraspinal muscle respond to the time-varying impulse of a spinal manipulation. Slow and fast impulses will be given. A Fourier transform will be used to analyze, in the time domain, the force-time and displacement-time profile of each manipulative impulse. The resulting power spectra for a range of impulse durations will enable us to determine if the speed of a spinal manipulation is an important determinant of proprioceptive sensory input from paraspinal muscles during spinal manipulation. The experiments will provide information regarding the neural systems impacted by spinal manipulation and can lead to improved training methods for the proper application of spinal manipulation . Teaching the manual skill of spinal manipulation could be approached from the perspective of quantifying the velocity with which the clinician applies a spinal manipulation.