Vertebral Displacements & Ligament Strains during Simul. Spinal Mani./Gudavalli,R

脊椎手法被脊医、骨科医生和理疗师广泛用于治疗 脊椎的肌肉骨骼疾病。然而，临床研究显示，关于 脊柱手法治疗下腰痛的有效性，很少量化或控制 实施操纵性程序。SM通常涉及将手动加载应用于特定的 脊柱的位置，目的是诱导节段间运动和拉伸或压缩韧带， 圆盘和肌肉。这些解剖结构包含感官感受器，它们对 机械和化学条件，并为中枢神经系统提供输入。有证据表明 这表明机械刺激的神经反应尤其是 丹参的作用机制。国家补充和替代医学中心(NCCAM)已经 确认有必要将手法的生物力学特征描述为 研究。存在两大类SM：高速度低幅度(HVLA)程序和低速度 速度可变幅度(LWA)程序。HVLA程序在加载的情况下提供快速推力 持续时间约为100-200毫秒，作用力约为200-500 N。LWA程序 以较慢的速度提供局部脊椎水平的局部脊柱载荷和力的组合 加载并在4-20秒量级的长持续时间内循环施加的力从 80 N至200 N。除了时间特性和负载的不同外，SM程序在 这些载荷的施加点，以及载荷施加的方向。这样的变化可能 如果机械敏感的组织以不同的方式受到影响，会有临床后果。我们的长期计划 目标是通过刻画下列因素的响应来帮助理解SM机制 为椎间结缔组织的全方位推拿力量提供更多细节 特殊的SM特性会影响脊柱组织的力学环境。我们的目标是 建议的研究是为了了解不同手法的生物力学效应。我们建议四年 帕尔默脊椎按摩学院人体身体的发育性研究与实验工作 脊柱直接测量小关节囊在手术中的运动和生物力学应变 模拟的HVLA SM和LWA SM。石溪大学联合负责人和托莱多大学联合调查员 将开发并验证有限元模型，并估计无法 量过了。经过验证的计算机模型将用于研究在不同SM载荷下的响应 参数。

Spinal manipulation (SM) is widely used by chiropractors, osteopaths and physical therapists to treat musculoskeletal disorders of the spine. Clinical studies, however, have shown mixed results regarding the effectiveness of spinal manipulation to treat low back pain and have rarely quantified or controlled the delivery of the manipulative procedures. SM generally involves the application of manual loads to specific locations of the spine with the intent to induce intersegmental motions and stretch or compress ligaments, discs, and muscles. These anatomical structures contain sensory receptors which respond to changes in mechanical and chemical conditions and provide input to the central nervous system. There is evidence suggesting that mechanically stimulated neural responses, in particular, are important elements of the mechanism of action of SM. The National Center for Complementary and Alternative Medicine (NCCAM) has identified the need to biomechanically characterize manipulation procedures as an important area of research. Two broad categories of SM exist: high velocity low amplitude (HVLA) procedures, and low velocity variable amplitude (LWA) procedures. HVLA procedures deliver forces in a quick thrust with loading durations on the order of 100-200 milliseconds with approximately 200-500 N force. LWA procedures deliver a combination of regional spine loads and forces at localized vertebral levels delivered at a slow rate of loading and applied cyclically over a long duration on the order of 4-20 seconds with forces ranging from 80 N to 200 N. In addition to differences in temporal characteristics and loads, SM procedures vary in the point of application of these loads, and the directions along which loads are applied. Such variations may have clinical repercussions if mechanically sensitive tissues are affected in different ways. Our long term goal is to contribute to the understanding of SM mechanisms by characterizing the responses of intervertebral connective tissues to the full range of manipulative forces to provide more details about how specific SM characteristics affect the mechanical environment of spinal tissues. The objective of our proposed study is to understand the biomechanical effects of different manipulations. We propose a fouryear developmental study with experimental work at Palmer College of Chiropractic on human cadaver spines to measure directly the vertebral motions and the biomechanical strains of facet joint capsules during simulated HVLA SM and LWA SM. Co-Leaders at Stony Brook and Co-Investigators at University of Toledo will develop and validate a finite element model and estimate the strains of internal ligaments that cannot be measured. The validated computer model will be used to study the responses under varying SM load parameters.