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

描述（由申请人提供）：已证明手动治疗（如关节松动/操作）会影响运动神经元池兴奋性。手动干预可以针对关节功能障碍的局部部位或远端部位，例如腰骨盆区域。关节松动/膝关节操作已被用作各种膝关节病变的治疗干预。通过治疗腰骨盆区域的关节，已经注意到在膝关节处的类似效果。骶髂（SI）关节操作已被用于膝前疼痛的个体，并已被证明可以在进行蹲下、上台阶和唐斯时剧烈减轻疼痛，增加股四头肌的激活，并改善力量输出。脊柱机制负责的变化，肌肉激活后的手动治疗是未知的。如果关节操纵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会被调节（促进或抑制）。运动神经元池的兴奋性可以通过突触前和突触后脊髓机制来调节。本项目的总体目标是确定局部和远程动员/操作干预对存在股四头肌抑制的个体的股四头肌突触前和突触后抑制的影响。这将是一项双盲随机对照试验，其中75名受试者将被随机分配接受四种手动治疗干预之一或不接受治疗，并对四头肌肌肉激活的测量进行比较。15名受试者将被分配接受骶髂关节操作（IV级），15名将接受骶髂关节定位（II级），15名将接受髌骨活动（IV级），15名将接受髌骨活动（I级），15名将不接受治疗（对照）。受试者将采用隐藏分配法随机分配至治疗组。结果将是测量峰间H反射、配对反射抑制和随时间推移的复发性抑制。我们假设骶髂关节操作（IV级）和髌骨松动（IV级）干预将导致H反射、成对反射抑制和复发性抑制的去抑制/易化表现大于仅骶髂关节定位（II级）、髌骨松动（I级）和对照条件。我们预测，骶髂关节操作将导致更大的突触后去抑制比髌骨动员，但髌骨动员将导致更大的突触前去抑制比骶髂关节操作。我们进一步假设，这些去抑制变化将继续存在于治疗后30，60和90分钟。了解关节操作如何影响突触前和突触后肌肉抑制将为我们理解运动神经元池兴奋性的手动治疗机制奠定基础，并指导未来开发关节病变的最佳治疗干预措施。公共卫生相关性：这项研究将有助于阐明在肌肉无力患者中进行手动治疗干预后改善肌肉功能的机制。将确定在受影响身体部位附近或下背部/骨盆区域进行治疗的具体影响。这些信息将有助于开发手动治疗的最佳使用与肌肉无力继发于受伤的人。

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.