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

描述(由申请人提供)：手动疗法，如关节动员/手法，已被证明影响运动神经元池的兴奋性。人工干预可针对关节功能障碍的局部部位或远端部位，如腰盆区。膝关节的关节松动/手法已被用作各种膝关节病变的治疗干预手段。在治疗腰盆部的关节时，也注意到了对膝盖的类似影响。对于膝关节前疼痛的患者，已经使用了一种骶髂骨(SI)关节手法，并已被证明在进行下蹲、上台阶和下台阶时可以显著减轻疼痛，增加股四头肌的肌肉激活，并改善力量输出。手动治疗后肌肉激活变化的脊椎机制尚不清楚。如果联合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制(促进或抑制)。运动神经元的兴奋性可以由突触前和突触后的脊髓机制来调节。本项目的总体目标是确定局部和远程活动/手法干预对存在股四头肌抑制的个体的突触前和突触后抑制股四头肌的影响。这将是一项双盲随机对照试验，75名受试者将被随机分配到四种手动治疗干预或不治疗中的一种，并比较股四头肌肌肉激活的指标。15名受试者将被分配接受骶髂手法(IV级)，15名受试者将接受SAI定位(II级)，15名受试者将接受膝盖骨松动术(IV级)，15名受试者将接受膝盖骨松动术(I级)，15名受试者将不接受治疗(对照)。受试者将被随机分配到使用隐蔽分配的处理组。结果将是测量从峰到峰的H反射、成对反射抑制和随时间推移的反复抑制。我们推测，与单纯的骶骨定位(II级)、髌骨松动(I级)和对照条件相比，推拿(IV级)和髌骨松动(IV级)干预将导致更大的H反射、成对反射抑制和反复抑制的去抑制/易化表现。我们预测，在突触后去抑制方面，坐骨神经手法的效果要强于髌骨松动术，但在突触前去抑制方面，髌骨关节松动术的效果要好于坐骨神经手法。我们进一步假设，这些去抑制性变化将在治疗后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的肌肉抑制，将为我们理解手法治疗运动神经元兴奋性的机制奠定基础，并指导未来关节病理最佳治疗干预措施的发展。公共卫生相关性：这项研究将有助于阐明在肌肉无力患者进行手动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附近或在下背部/骨盆区域进行治疗的具体效果。这些信息将有助于开发对继发于损伤的肌肉无力的人进行最佳手动治疗的方法。

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.