Mechanisms of Manual Therapy for the Prevention and Treatment of Repetitive Motion Disorders

 描述(申请人提供)：上肢重复运动障碍(RMD)影响到颈部、肩部、手臂和手部的软组织，在美国和世界各地很普遍，给社会带来了巨大的经济负担。不幸的是，仍然需要有效的治疗，特别是预防性治疗以及逆转组织纤维化的治疗。上肢组织结构内部和之间的纤维化被认为是慢性RMD受试者运动功能障碍、增加的不适感以及疼痛和感觉异常的关键因素。因此，我们的目标是使用我们成熟的啮齿动物模型来探索有效的治疗方法。在我们的啮齿动物模型中，长时间的高要求伸手和拉手任务最初会导致早期损伤和炎症，后来神经、肌肉和肌腱出现显著的纤维化，并伴有持续的疼痛和运动功能障碍。手法疗法是指使用医生的手对患者应用的一些相关疗法，如按摩、动员和推拿。手动疗法被认为可以预防和/或破坏纤维化，这种纤维化被认为是导致患有上肢MSD的人和大鼠出现的症状，但几乎没有数据支持这些说法。在我们的大鼠模型中，我们使用模拟按摩疗法(MMT)方法的组合进行的初步实验显示，对感觉运动功能下降和纤维化的发展具有预防作用。在这里，我们建议进一步研究MMT，目标是：1)预防和2)逆转我们的工作相关MSD模型中发展的感觉运动下降和纤维化，3)测试这种治疗的哪些成分是有效的，以及4)了解观察到的效果的关键神经生物学机制。具体地说，我们的目标是：1)目标1.模拟手动治疗方案中的哪个成分(S)能够减少在18周内执行高重复高力任务的大鼠的组织纤维化和感觉运动下降？2)按摩疗法能否逆转已经在执行高重复高力任务18周的大鼠中已经发生的组织纤维化和感觉运动下降？3)无论是否使用MMT，模型手动治疗任务如何影响支配手臂和手的伤害性感受器的放电特性和敏感性？我们拟议的研究将是第一批在慢性RMDS动物模型中进行手动治疗的研究之一，并具有科学严谨性。我们的发现有望带来新的和易于翻译的治疗策略，用于RMDS患者的临床管理。这项工作具有对预防医学和康复科学领域产生长期、持续影响的强大潜力。

 DESCRIPTION (provided by applicant): Upper extremity repetitive motion disorders (RMDs) affecting the soft tissues of the neck, shoulders, arms, and hands are prevalent in the U.S. and throughout the world and impose a large economic burden for society. Unfortunately, effective treatments are still needed, especially preventive treatments as well as treatments to reverse tissue fibrosis. Fibrosis within and between the tissue structures in the upper limb is hypothesized to be a key factor in the motor dysfunction, increased discomfort, and pain and paresthesias observed in subjects with chronic RMDs. Therefore, our goal here is to use our well-established rodent model in which prolonged performance of high demand reaching and handle-pulling tasks initially induces early injury and inflammation, and later significant fibrosi in nerves, muscles and tendons, with persistent signs of pain and motor dysfunction, to investigate effective means of treatment. Manual therapy refers to a number of related therapies that are applied to patients using the practitioner's hands, such as massage, mobilization, and manipulation. Manual therapies are thought to prevent and/or disrupt fibrosis, thought to be causing the symptoms observed in people and rats with upper extremity MSDs, but there are little data to support these claims. Our preliminary experiments using a combination of modeled massage therapy (MMT) methods in our rat model revealed preventive effects on sensorimotor declines and fibrosis development. Here, we propose to further examine MMT with the goals of: 1) preventing, and 2) reversing the sensorimotor declines and fibrosis that develops in our model of work-related MSDs, 3) testing which components is this treatment are effective, and 4) understanding key neurobiological mechanisms of the observed effects. Specifically, our aims are: 1) Aim 1. Which component(s) of a modeled manual therapy (MMT) protocol lead to reductions in tissue fibrosis and sensorimotor declines in rats that performed a high repetition high force (HRHF) task across an 18 weeks period? 2) Will massage therapy reverse tissue fibrosis and sensorimotor declines that have already occurred in rats that have performed the HRHF task for 18 weeks? 3) How does the HRHF task, with or without MMT, impact discharge properties and sensitivities of nociceptors innervating the arm and hand? Our proposed study will be among the first to study manual therapy in an animal model of chronic RMDs and with scientific rigor. Our findings are expected to lead to novel and readily translatable therapeutic strategies for the clinical management of patients with RMDs. This work has strong potential for long-term, sustained impact on the field of preventive medicine and rehabilitative sciences.