Pre- and post-synaptic spinal mechanisms with local and distant manual therapies

突触前和突触后脊柱机制与局部和远程手法治疗

• 批准号: 7471968
• 负责人: CHRISTOPHER D. INGERSOLL
• 金额: $ 22.47万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7471968
• 关键词: Affect; Aftercare; Anterior; Back; Body part; Condition; Development; Disease regression; Disinhibition; Distant; Double-Blind Method; Foundations; Functional disorder; Future; H-Reflex; Individual; Injury; Interneurons; Intervention; Ipsilateral; Joint by Site; Joints; Knee; Manuals; Measurement; Measures; Mediating; Mental Depression; Modeling; Motor Neurons; Muscle; Muscle Weakness; Muscle function; Outcome; Output; Pain; Pathology; Pelvis; Positioning Attribute; Public Health; Randomized; Randomized Controlled Trials; Recurrence; Reflex action; Regulation; Relative (related person); Research; Sacroiliac joint structure; Secondary to; Site; Spinal; Stimulus; Synapses; Techniques; Therapeutic Intervention; Time; base; improved; presynaptic; recurrent depression; response; synaptic inhibition

DESCRIPTION (provided by applicant): Manual therapies such as joint mobilization/manipulation have been shown to affect motoneuron pool excitability. The manual intervention can be directed at the local site of joint dysfunction or distant sites such as the lumbopelvic region. Joint mobilization/manipulations of the knee have been utilized as a treatment intervention for a variety of knee pathologies. Similar effects at the knee have been noted by treating the joints of a lumbopelvic region. A sacroiliac (SI) joint manipulation has been utilized with individuals with anterior knee pain and has been shown to acutely reduce pain when performing squats, step ups, and step downs, increase quadriceps muscle activation, and improve force output. The spinal mechanisms responsible for the changes in muscle activation following manual therapies are unknown. If joint manipulation can affect the afferent or efferent information mediated by the interneuron then it is possible that motoneuron pool excitability may be modulated (facilitated or inhibited). Motoneuron pool excitability can be modulated by both pre-synaptic and post-synaptic spinal mechanisms. The overall aim of this project is to determine the effect of local and distant mobilization/manipulation interventions on pre-synaptic and post-synaptic inhibition of the quadriceps muscle in individuals with existing quadriceps inhibition. This will be a double-blinded randomized controlled trial in which 75 subjects will be randomly assigned to receive one of four manual therapy interventions or no treatment and compared on measures of quadriceps muscle activation. Fifteen subjects will be assigned to receive a sacroiliac manipulation (Grade IV), 15 will receive sacroiliac positioning (Grade II), 15 will receive a patellar mobilization (Grade IV), 15 will receive patellar mobilization (Grade I), and 15 will receive no treatment (control). Subjects will be randomly assigned to treatment groups using concealed allocation. Outcomes will be the measurements of peak-to-peak H-reflex, paired reflex depression, and recurrent inhibition over time. We hypothesize that the sacroiliac manipulation (Grade IV) and patellar mobilization (Grade IV) interventions will result in a larger disinhibitory/facilitory representations of H-reflex, paired reflex depression and recurrent inhibition than the sacroiliac positioning only (Grade II), patellar mobilization (Grade I) and control conditions. We predict that the sacroiliac manipulation will result in greater post-synaptic disinhibition than the patellar mobilization, but the patellar mobilization will result in greater pre-synaptic disinhibition than the sacroiliac manipulation. We further hypothesize that these disinhibitory changes will continue to be present 30, 60, and 90 minutes after the treatments. Understanding how joint manipulation affects pre- and post-synaptic muscle inhibition will lay the foundation for our understanding of the mechanisms of manual therapies on motoneuron pool excitability and guide future development of optimal treatment interventions for joint pathologies. PUBLIC HEALTH RELEVANCE: This study will help elucidate the mechanisms responsible for improved muscle function following manual therapy interventions in people with muscle weakness. The specific effects from performing the treatment near the affected body part or at the lower back/pelvic region will be determined. This information will help develop optimal use of manual therapy treatments in people with muscle weakness secondary to injury.

描述（由申请人提供）：关节动员/操作等手动疗法已被证明会影响运动神经元池的兴奋性。手动干预可以针对关节功能障碍的局部部位或腰盆区域等远处部位。膝关节的关节松动/操作已被用作多种膝关节病变的治疗干预措施。通过治疗腰骨盆区域的关节，也发现了对膝盖的类似影响。骶髂 (SI) 关节手法已用于治疗膝前疼痛的患者，并已被证明可以在进行深蹲、上台阶和下台阶时显着减轻疼痛，增加股四头肌的激活并提高力量输出。手法治疗后导致肌肉激活变化的脊柱机制尚不清楚。如果关节操作可以影响由中间神经元介导的传入或传出信息，则运动神经元池的兴奋性可能会被调节（促进或抑制）。运动神经元池的兴奋性可以通过突触前和突触后脊髓机制来调节。该项目的总体目标是确定局部和远程动员/操作干预对现有股四头肌抑制的个体股四头肌突触前和突触后抑制的影响。这将是一项双盲随机对照试验，其中 75 名受试者将被随机分配接受四种手动治疗干预中的一种或不接受治疗，并比较股四头肌激活的测量结果。 15 名受试者将被分配接受骶髂关节操纵（IV 级），15 名受试者将接受骶髂定位（II 级），15 名受试者将接受髌骨松动（IV 级），15 名受试者将接受髌骨松动（I 级），15 名受试者将不接受治疗（对照）。将使用隐藏分配将受试者随机分配到治疗组。结果将是峰间 H 反射、配对反射抑制和随时间的反复抑制的测量。我们假设，与仅骶髂定位（II 级）、髌骨活动（I 级）和控制条件相比，骶髂关节操作（IV 级）和髌骨活动（IV 级）干预将导致 H 反射、配对反射抑制和反复抑制更大的去抑制/易化表现。我们预测骶髂关节操作将导致比髌骨活动更大的突触后去抑制，但髌骨活动将比骶髂关节操作导致更大的突触前去抑制。我们进一步假设这些去抑制变化将在治疗后 30、60 和 90 分钟继续存在。了解关节手法如何影响突触前和突触后肌肉抑制将为我们理解手法治疗对运动神经元池兴奋性的机制奠定基础，并指导关节病理学最佳治疗干预措施的未来发展。公众健康相关性：这项研究将有助于阐明对肌无力患者进行手法治疗干预后改善肌肉功能的机制。将确定在受影响的身体部位或下背部/骨盆区域进行治疗的具体效果。这些信息将有助于针对因损伤而导致肌肉无力的患者制定最佳的手法治疗方法。