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

 描述（由申请人提供）：影响颈部、肩部、手臂和手部软组织的上肢重复性运动障碍（RMD）在美国和世界各地普遍存在，并给社会带来巨大的经济负担。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。假设上肢组织结构内和组织结构之间的纤维化是慢性RMD受试者中观察到的运动功能障碍、不适增加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完善的啮齿动物模型，其中长时间执行高需求的伸手和拉拽任务最初会引起早期损伤和炎症，随后会引起神经、肌肉和肌腱的显著纤维化，并伴有持续的疼痛和运动功能障碍体征，以研究有效的治疗方法。 手法治疗是指使用医生的手应用于患者的许多相关疗法，例如按摩，动员和操纵。手动疗法被认为可以预防和/或破坏纤维化，纤维化被认为是导致上肢MSD患者和大鼠出现症状的原因，但几乎没有数据支持这些说法。我们在大鼠模型中使用模型按摩疗法（MMT）方法组合的初步实验揭示了对感觉运动下降和纤维化发展的预防作用。 在这里，我们建议进一步研究MMT，目的是：1）预防，2）逆转我们的工作相关MSD模型中出现的感觉运动下降和纤维化，3）测试哪些成分是这种治疗有效的，4）了解观察到的效果的关键神经生物学机制。具体而言，我们的目标是：1）目标1。模型化手动治疗（MMT）方案的哪些组成部分导致在18周内执行高重复高力量（HRHF）任务的大鼠中组织纤维化和感觉运动下降减少？2)按摩疗法是否会逆转已经在执行HRHF任务18周的大鼠中发生的组织纤维化和感觉运动下降？3)HRHF任务（有或没有MMT）如何影响支配手臂和手的伤害感受器的放电特性和敏感性？ 我们提出的研究将是第一个在慢性RMD动物模型中研究手动治疗的研究，并具有科学严谨性。我们的研究结果有望为RMD患者的临床管理带来新的和易于翻译的治疗策略。这项工作对预防医学和康复科学领域具有长期、持续的影响。

 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.