Biomechanical effects of manual therapy in healthy and impaired shoulders

描述（由申请人提供）：本提案是为了响应NIH和CIHR对机械和/或临床前研究的呼吁，这些研究集中在PAR-06- 312（标题为“手动治疗生物学”）中确定的手动治疗生物力学后果的机制。“这个项目的广泛目标是了解物理治疗师，运动训练师，按摩治疗师和其他人用于治疗肌肉骨骼疾病的常见手动治疗形式的生物力学机制。我们计划开发，测试和应用，创新的，客观的肌肉骨骼评估技术的肩膀，关节最常见的治疗手法之一。我们将使用实时磁跟踪传感器和微型力传感器研究15个健康和15个不健康的肩部，这些传感器在临床医生进行手动治疗技术时连接到临床医生的手上。同时记录肌电图、力和关节位移。关节组织的生物力学行为将通过其刚度、顺应性和粘性反应来表征。我们将记录专家临床医生重现特定技术的能力。长期目标是将评估方法扩展到其他关节，确定手动活动对恢复肌肉骨骼关节功能障碍患者活动度的有效性，并建立基于生物力学的参数以区分，分类和诊断健康和非健康组织。一个必然的目标是为临床医生提供一个客观的，具有成本效益的工具来记录人工评估和治疗关节功能障碍。具体目标：1.使用健康和受损的肩关节，表征应用于肩关节的手动活动技术的生物力学行为和相关的肌肉反射反应。2.在手动应用特定活动技术期间，根据肩关节的生物力学行为区分健康与受损的组织反应3。阐明在制定动员方法时使用的关键理论结构：A.接头的“密包”和“松包”位置，以及，B。这种临床反应被称为“末端感觉”。“4.测量并客观定义由经验丰富的临床医生进行的Maitland临床分级（I-IV）与5.使用现场焦点小组分析，在当地诊所评估我们基于便携式笔记本电脑的测量和评估系统。我们的研究将产生一个用户友好的，用户可配置的，便携式的运动和力测量系统，可用于大多数主要关节作为治疗评估，检查和教学工具。将我们的初步研究集中在肩关节上，为多方向治疗技术评估提供了最佳模型，并使我们能够在广泛的范围内识别不同的组织病理，从肩关节不稳定到冻结肩，从而可以研究连续的组织反应。公共卫生相关性：在肌肉骨骼疾病的保守治疗方法中，手工疗法占绝大多数。旨在了解这些方法如何影响身体的研究是循证医学实践系统的基础。我们的建议是高度相关的公共卫生，因为它提供了机械的理解，和实用的工具和方法，科学地评估一种常见形式的手动治疗所使用的按摩治疗师，运动教练，脊椎按摩师，物理治疗师和其他“身体工作”治疗师。

DESCRIPTION (provided by applicant): This proposal is in response to the NIH and the CIHR call for mechanistic, and/or preclinical research focused on the mechanisms underlying the biomechanical consequences of manual therapies as identified in PAR-06- 312 titled "Biology of Manual Therapy." The broad objective of this project is to understand the biomechanical mechanisms underlying the application of a common form of manual therapy used to treat musculoskeletal conditions by physical therapists, athletic trainers, massage therapists, and others. We plan to develop, test, and apply, innovative, objective musculoskeletal assessment techniques to the shoulder, one of the joints most commonly treated with manual therapy. We will investigate 15 healthy and 15 non-healthy shoulders using real-time magnetic tracking sensors, and subminiature force transducers that are attached to clinicians hands as they perform manual therapy techniques. Electromyography, forces, and joint displacements will be simultaneously recorded. Biomechanical behavior of joint tissue will be characterized by its stiffness, compliance, and viscous responses. We will record expert clinicians' ability to reproduce specific techniques. The long-term goals are to expand the assessment method to other joints, determine the effectiveness of manual mobilization for restoring mobility in patients with musculoskeletal joint dysfunction, and to establish biomechanically based parameters to distinguish, categorize and diagnose healthy and non-healthy tissue. A corollary goal is to provide clinicians with an objective, cost effective tool to document manual assessment and treatment of joint dysfunction. Specific aims: 1.Characterize the biomechanical behavior and the associated muscular reflex responses resulting from manual mobilization techniques applied to the shoulder using both healthy and impaired shoulders. 2. Distinguish healthy vs. impaired tissue responses based on the shoulder joint's biomechanical behavior during manual application of specific mobilization techniques 3. Clarify key theoretical constructs used in formulation of mobilization approaches: A. The "close-pack" and "loose-pack" position of joints, and, B. The clinical response known as "End-Feel." 4. Measure and objectively define the differences between Maitland's clinical grades (I-IV) of mobilization as performed by experienced clinicians and 5. Evaluate our portable laptop based measurement and assessment system in local area clinics using field focus group analysis. Our study will result in a user-friendly, user- configurable, portable motion and force measurement system that can be used for most major joints as a treatment assessment, examination, and teaching tool. Focusing our initial study on the shoulder joint provides the best model for multidirectional treatment technique evaluation, and allows us to identify distinct tissue pathologies over a broad spectrum, from shoulder instability to frozen shoulder, so that a continuum of tissue responses can be studied. PUBLIC HEALTH RELEVANCE: Manual therapies constitute the overwhelming percentage of conservative treatment approaches for musculoskeletal conditions. Research directed to the understanding of how these approaches affect the body is fundamental to an evidence-based medical practice system. Our proposal is highly relevant to public health since it provides both mechanistic understanding, and practical tools and methods for scientifically evaluating a common form of manual therapy used by massage therapists, athletic trainers, chiropractors, physical therapists and other "body work" therapists.