Extending Ultrasound Elastography to Manual Treatment Methods

描述(申请人提供)：推进手动医学科学的最大障碍是无法在体内测量肌肉和软组织；其效果是模糊了对治疗实际作用的直接了解。当手动治疗，甚至是一般的生物力学动作，对身体施加载荷时，软组织会变形，将力传递到骨骼和关节结构。产生的应变是由与通常是非线性的组织特性一致的内力产生的。变形和应变携带着有关身体如何对治疗做出反应的重要信息。这些数量可以通过适当的超声(USN)弹性成像技术来披露，因此，它们是本次调查的重点。该项目将扩展在一项有前景的技术方面的最新进展，以在简单和临床相关的治疗条件下评估软组织力学。在过去的三十年里，一批探索手工治疗的理论效应的知识已经开始出现。每一种临床手动治疗方法都假定一组特定的组织是治疗有益效果的接受者。然而，没有一种先前的方法直接监测哪些组织变形，以及为了证明临床假设或确定未来研究的优先顺序而开发的应变的相对强度。具体地说，可以根据哪些组织最有可能受到影响的证据，研究如何在不同的组织层中将治疗机械地转化为生物效益。目前的软组织USN弹性成像技术在静态条件下将扩展到量化组织层(例如皮下、筋膜、最长肌、肌肉间腱膜和多裂)深度的相对位移和应变(主动和被动)，这些位移和应变是由持续被动运动(CPM)临床程序和负重姿势中的小幅度运动引起的。背部分层的相对运动，不受治疗和任务产生的扰动，将使组织的弹性成像询问成为可能。这项研究的结果特别适用于一些手动治疗，并可通过躯干软组织的载荷分布来了解应变效应的生物力学。这些证据将使根据治疗相对反应的证据对组织生物标记物进行优先排序和定量测试成为可能。以位移和应变为代表的组织反应路径的信息对于从三个角度促进对手动疗法的理解非常重要：1)告知可能产生临床益处的作用机制；2)检测安全应用的界限和优化；以及3)发展关于如何通过改变治疗方向来改善临床结果的见解，以达到特定的效果。项目简介：手动治疗为一些背部疼痛的患者提供了好处，但人们对许多组织层中的哪一层受到影响知之甚少。这项研究将有助于确定哪些组织可能受到足够的刺激，以作为治疗临床效果的来源，并确定未来工作的优先顺序，以了解背痛的机制并改善护理。

DESCRIPTION (provided by applicant): The single greatest obstacle to advancing the science of manual medicine is the inability to measure muscle and soft tissue in vivo; the effect is to obscure direct understanding of what treatments actually do. When manual treatments, and even general biomechanical manoeuvres, apply loads to the body, the soft tissues deform, transmitting force to the bone and joint structures. The strains that arise are generated by internal forces consistent with the often non-linear tissue properties. The deformations and strains carry important information on how the body is responding to treatment. These quantities can be disclosed through an appropriate interrogation by ultrasound (USN) elastography techniques and therefore, they are the focus of this investigation. This project will extend recent advances in a promising technology to evaluate soft tissue mechanics under simple and clinically relevant treatment conditions. A body of knowledge probing theoretical effects of manual treatments has begun to arise over the past three decades. Each clinical manual therapy approach assumes that a specific set of tissues is the recipient of the beneficial effects of treatment. Yet, no prior method directly monitors which tissues deform and the relative intensity of the strain that is developed in order to justify clinical assumptions or to prioritize future research. Specifically, research on how mechanical transduction of treatment into biological benefit occurs in the different tissue strata can be engaged based on evidence of which tissues are most likely being affected. Current soft-tissue USN elastography techniques, under static conditions, will be extended to quantify relative displacement and strains (active and passive) across the depth of tissue strata (e.g. subcutaneous, fascia, longissimus, intermuscular aponeuroses, and multifidus) that arise from small amplitude motions during continuous passive motion (CPM) clinical procedures and in weight bearing postures. Relative movement of the stratified layers of the back, from treatment and task-generated perturbations, will enable the elastography interrogation of the tissues. Results from this study are applicable to a number of manual treatments specifically, and to understanding the biomechanics of strain effects from the load distribution through the soft-tissues of the torso. Such evidence will empower prioritization and quantitative testing of tissue biomarkers based on evidence of relative response to treatment. Information on tissue response path as represented by displacement and strain is important to advancing the understanding of manual therapies from three perspectives: 1) informing on the mechanisms of action that may yield clinical benefit; 2) detecting boundaries for and optimization of safe application; and 3) developing insights on how to improve clinical results by redirecting treatment to achieve specific effects. Project Narrative: Manual treatment offers benefit to some patients suffering from back pain but little is known about which of the many tissue layers are affected. This study will help identify which tissues may be stimulated sufficiently to be a source for the clinical effects of treatment and to prioritize future work to understand mechanisms of back pain and to improve care.