Developmental Center to Study Mechanisms & Effects of Chiropractic Manipulation

描述(申请人提供)：脊柱手法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，但每一种技术都有一个共同点，那就是对脊柱施力。最常见的脊柱手法包括短杠杆、高速度、低幅度(HVLA)推力。这项应用的重点是对HVLA脊柱手法的研究。从本质上讲，脊椎手法是一种机械干预，持续时间不到一秒(通常为200毫秒)，但产生的效果比干预本身更持久。多么?这个问题为我们的研究提供了基础，并激励了我们的长期目标：理解和改进脊柱手法的有效使用。我们将利用两位共同领导者开发的动物模型和方法来了解脊柱手法的空间和时间特征之间的关系，以及它们对脊柱旁组织的神经和生物力学反应的影响。我们将确定是否来自脊柱旁肌梭的初级传入信号的反应性和/或操作区域的被动生物力学特性是否比操作本身持续时间更长。具体地说，我们将确定肌梭反应性是否随1)脊柱手法的持续时间而增加，而脊柱僵硬是否随着以下因素而降低：1)脊柱手法的持续时间；2)手法前预载荷的存在、大小或形状；3)脊柱手法使用的解剖接触点；以及4)手法的应用方向。来自这些互补性研究的信息将有助于确定神经系统和脊柱旁组织的生物力学性质可能对其最敏感的手法的剂量特征，并有助于确定优化SM递送的策略。这项研究的创新之处在于，它是第一次系统地研究这种关系，并使用了最常用的脊柱手法形式--高速低幅度脊柱手法。这项研究具有重要意义，因为它有助于完成NCCAM的战略计划，通过表征手法过程的生物力学，努力阐明在手法实践中操作的作用机制。

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.