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

描述（由申请人提供）：手工疗法，如关节动员/操纵已被证明影响运动神经元池的兴奋性。人工干预可直接针对关节功能障碍的局部部位或远端部位，如腰骨盆区域。膝关节的关节活动/操作已被用作各种膝关节病理的治疗干预。在治疗腰骨盆关节时，在膝关节也有类似的效果。骶髂（SI）关节手法已被用于治疗膝关节前部疼痛的患者，并已被证明在进行深蹲、上台阶和下台阶时能急剧减轻疼痛，增加股四头肌的激活，并改善力量输出。手工治疗后引起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，那么运动神经元池的兴奋性可能被调节（促进或抑制）。运动神经元池兴奋性可通过突触前和突触后脊髓机制调节。本项目的总体目的是确定局部和远处动员/操作干预对存在股四头肌抑制的个体突触前和突触后股四头肌抑制的影响。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名受试者接受骶髂操作（IV级），15名受试者接受骶髂定位（II级），15名受试者接受髌骨活动（IV级），15名受试者接受髌骨活动（I级），15名受试者不接受任何治疗（对照组）。受试者将采用隐式分配随机分配到治疗组。结果将是峰对峰h反射、成对反射抑制和复发性抑制随时间的测量。我们假设骶髂操作（IV级）和髌骨活动（IV级）干预会比仅骶髂定位（II级）、髌骨活动（I级）和对照条件产生更大的去抑制/促进h反射、配对反射抑制和复发性抑制。我们预测骶髂操作会比髌骨活动导致更大的突触后去抑制，但髌骨活动会比骶髂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。了解关节操作如何影响突触前和突触后的肌肉抑制，将为我们理解手动治疗对运动神经元池兴奋性的机制奠定基础，并指导未来关节病理的最佳治疗干预措施的发展。公共卫生相关性：本研究将有助于阐明对肌肉无力患者进行手工治疗干预后肌肉功能改善的机制。在受影响的身体部位附近或下背部/骨盆区域进行治疗的具体效果将被确定。这一信息将有助于在继发性损伤的肌肉无力患者中开发最佳的手工治疗方法。

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.