Z Joint Changes in Low Back Pain Following Adjusting

这一延续项目(NIH/NCCAM#RO1 AT00123)的目的是使用MRI来评估 急性低位患者侧卧位及脊柱侧卧位调整后的关节突关节 背痛(LBP)。脊椎按摩调整有益效果之一的一个基本假设是 随着这些结构的运动能力降低，在Z关节内形成的粘连被认为是通过以下方法缓解的 通过脊柱调节使Z关节分离(裂开)。在先前的研究中，侧身姿势调整被发现可以 健康受试者Z关节间隙。这项研究的目的是确定是否可以在L4/L5中测量差异 112名受试者侧卧位及腰椎侧位调整后L5/S1Z关节间隙的变化 对于急性LBP，并确定缝隙的量是否与疼痛缓解和功能改善有关。以下是2 治疗数周后，受试者将被暂时随机分为4组：1)中立体位， 其次是侧卧姿势(最痛的一侧朝上)；2)中立姿势，然后是侧卧姿势调整 (最痛的一侧朝上)，其次是中性姿势；3)中性姿势，然后是侧姿势调整(最 疼痛的一侧朝上)并保持侧卧姿势；以及4)(纯对照组)中立姿势，然后非常短暂 侧姿定位，然后是中立位。将对原件中的受试者进行核磁共振扫描 中立位和终点位。两次核磁共振扫描将在大约30分钟内连续进行 分钟(每次扫描12：19分钟)。在此预约期间提供的所有脊柱调整将直接在 第一次扫描后的MRI机架工作台。第二次核磁共振检查将在两周后进行 治疗。在第二次MRI预约时，受试者将被分配到与其相反的MRI组 在第一次核磁共振检查期间，他们被随机抽样。三个观察者，对彼此视而不见，对目标视而不见 分组，将直接从MRI扫描对Z关节进行前后测量(A-P间隙)。这个 将分析每个MRI预约的第二次扫描和第一次扫描之间的差距，以确定 这4组之间存在差异，并且缝隙的量是否与疼痛的缓解有关(视觉差异 从初次检查到核磁共振检查的模拟评分)和残疾(伯恩茅斯问卷得分的差异)。 这项研究的结果将用于增加对腰侧姿势作用机制的理解。 急性腰背痛患者的体位调整和侧卧位。

The purpose of this continuation project (NIH/NCCAM # RO1 AT00123) is to use MRI to evaluate gapping of the zygapophysial (Z) joints following side-posture positioning and side-posture spinal adjusting in subjects with acute low back pain (LBP). A fundamental hypothesis of one of the beneficial effects of chiropractic spinal adjusting is that adhesions, developing in the Zjoints following hypomobility of these structures, are thought to be alleviated by separation (gapping) of the Zjoints through spinal adjusting. In the previous study, side-posture adjusting was found to gap the Z joints in healthy subjects. The aim of this study is to determine if differences can be measured in the L4/L5 and L5/S1 Z joint spaces during side-posture positioning and after lumbar side-posture spinal adjusting of 112subjects with acute LBP, and to determine if the amount of gapping is related to pain relief and improved function. Following 2 weeks of treatment, the subjects will be temporarily randomized into one of 4 MRI groups: 1)neutral positioning, followed by side-posture positioning (most painful side up);2) neutral positioning, followed by side-posture adjusting (most painful side up),followed by neutral positioning; 3) neutral positioning, followed by side-posture adjusting (most painful side up) and remaining in side-posture; and 4) (pure control group) neutral positioning, followed by very brief side-posture positioning, followed by neutral positioning. MRI scans will be taken with the subjects in the original neutral position and in the final position. Both MRI scans will be conducted consecutively over approximately 30 minutes (12:19 minutes per scan). All spinal adjustmentsgiven during this appointment will be performed directly on the MRI gantry table after the first scan. A second MRI appointment will occur 2 weeks later after 2 weeks of treatment. At the second MRI appointment, subjects will be assigned to the MRI group opposite to the one to which they were randomized during the first MRI appointment. Three observers, blinded to each other and to subject grouping, will make anterior-to-posterior measurements (A-P gap) of the Z joints directly from the MRI scans. The gapping difference between the second and first scans of each MRI appointment will be analyzed to determine if differences exist between the 4 groups and if the amount of gapping is related to relief of pain (difference in Visual Analog Scale from initial exam to MRI appointment) and disability (difference in Bournemouth Questionnaire scores). The results of this study will be used to increase understanding of the mechanism of action of lumbar side posture adjusting and side-posture positioning in acute LBP patients.