Developmental Center to Study Mechanisms & Effects of Chiropractic Manipulation

描述（由申请人提供）：脊柱推拿是一种以身体为基础的治疗形式，患者经常寻求治疗肌肉骨骼疾病。虽然临床上使用了许多技术，但每种技术都有一个共同点，即对脊柱施加力。大多数形式的脊柱操作包括短杠杆，高速，低振幅（HVLA）推力。研究HVLA脊柱操作是本应用的重点。就其本质而言，脊柱操作是一种机械干预，持续不到一秒（通常小于200毫秒），但产生的效果比干预本身更持久。如何?这个问题为我们的研究提供了基础，并激发了我们的长期目标：了解和提高脊柱操作的有效使用。我们将利用由两位共同领导开发的动物模型和方法，以了解脊柱操作的空间和时间特征之间的关系及其对棘旁组织的神经和生物力学反应的影响。我们将确定来自棘旁肌纺锤体的初级传入信号的反应性和/或被操作区域的被动生物力学特性是否比操作本身更持久。具体来说，我们将确定肌肉纺锤体反应性是否增加，脊柱僵硬度是否降低，作为1)脊柱操作时间的函数；2)操作前预载荷的存在、大小或形状；3)脊柱操作的解剖接触点；4)操作的应用方向。来自这些补充研究的信息将有助于提供有用的信息，以确定操作的剂量特征，其中神经系统和棘旁组织的生物力学特性可能是最敏感的，并确定优化SM递送的策略。这项研究的创新之处在于，它代表了第一个研究这种关系的系统研究，并使用了最常用的脊柱推拿形式，高速低振幅脊柱推拿。这项研究意义重大，因为它有助于完成NCCAM的战略计划，通过描述操作过程的生物力学特征，努力阐明操作实践中操作的机制。

DESCRIPTION (provided by applicant): Spinal manipulation is a form of body-based therapy patients often seek for treatment of musculoskeletal complaints. While numerous techniques are used clinically, each shares the common denominator of applying force to the spine. The most form of spinal manipulation includes a short lever, High Velocity, Low Amplitude (HVLA) thrust. Investigation of HVLA spinal manipulation is the focus of this application. By its very nature spinal manipulation is a mechanical intervention that lasts a fraction of a second (typically <200ms) yet produces effects that outlast the intervention itself. How? This question provides the basis for our study and motivates our long term goal: to understand and improve the effective use of spinal manipulation. We will take advantage of an animal model and approaches developed by the two co-leaders in order to understand the relationship between spatial and temporal characteristics of a spinal manipulation and their effects on neural and biomechanical responses from paraspinal tissues. We will determine whether either the responsiveness of primary afferent signaling from paraspinal muscle spindle and/or the passive biomechanical properties of the manipulated region outlast the manipulation itself. Specifically, we will determine if muscle spindle responsiveness increases and spinal stiffness decreases as a function of 1) the spinal manipulation's duration; 2) the presence, magnitude or shape of a preload preceding the manipulation; 3) the anatomical contact point used for the spinal manipulation; and 4) the direction with which the manipulation is applied. The information from these complementary studies will help provide information useful for identifying dosing features of the manipulation to which the nervous system and biomechanical properties of paraspinal tissues may be most responsive and in determining strategies for optimizing the delivery of SM. The study is innovative in that it is represents the first systematic study to investigate this relationship and uses the most commonly applied form of spinal manipulation, a high velocity low amplitude spinal manipulation. The study is significant because it contributes to accomplishing NCCAM's strategic plan by characterizing the biomechanics of manipulative procedures in an effort to clarify the mechanisms of action operative in manipulation practices.