Does spinal manipulation speed determine neural response

这个R21项目的目标有两个：1)增加我们对脊柱手法对神经系统影响的理解；2)为继续研究本体感受器在脊柱手法效果中的作用寻求科学基础。这个项目的具体目的是确定脊柱操作的速度是否是脊柱旁肌肉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椎手法来帮助急性下腰痛和颈部疼痛的患者。脊椎手法实践中常见的一种理论认为，脊柱手法改变了脊柱旁的感觉输入(即来自脊柱组织的神经输入)。初步数据显示，脊柱推拿冲动刺激腰椎旁肌肉的本体感觉传入。这些传入信息可能有助于手法的治疗效果。拟议中的实验将确定腰椎旁肌肉中的肌梭和高尔基肌腱器官如何对脊柱操作的时间变化脉冲做出反应。将给出慢速和快速的脉冲。傅立叶变换将被用来在时间域中分析每个操纵脉冲的力-时间和位移-时间分布。由此得到的一系列脉冲持续时间的功率谱将使我们能够确定脊柱操作的速度是否是脊柱操作过程中来自脊柱旁肌肉的本体感觉输入的重要决定因素。这些实验将提供有关脊柱手法影响的神经系统的信息，并可能导致改进训练方法，以正确应用脊柱手法。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.