Effect of Lumbar Hypo & Hypermobility on Sensory Responses to Spinal Manipulation

描述(由申请人提供)：手法治疗从业者在临床检查和治疗腰背痛患者时经常包括对脊柱关节活动度的评估。越来越多的证据表明，临床识别脊柱关节活动度低和高活动度亚组以及相应的量身定制的手法治疗方法可以带来更成功的治疗结果。例如，腰部疼痛和脊柱活动能力低下的人被证明比那些脊柱关节活动能力高的人对脊柱操作的反应更好。在脊柱手法治疗时，哪些潜在的生物/神经机制可能会导致这些亚组不同的临床反应？这个问题激发了应聘者的职业发展计划，使应聘者能够实现他的直接目标：a)使用将模拟脊柱操作与腰椎旁肌肉的周围神经记录相结合的动物模型，以及b)通过教学课程获得与脊柱操作过程中应用的脊柱负荷相关的肌肉骨骼生物力学知识。在这项研究中，将使用已建立的猫腰椎模型来确定在不同持续时间(25-400ms)的模拟高速低幅度脊柱操作中，近端、远端和双节段脊柱关节的低和高活动度对椎旁肌梭放电的影响。通过小关节置入单侧骨钉，将造成脊柱关节活动不足；通过单侧小关节切除，可产生高活动能力。这项研究将揭示脊柱关节功能障碍与一种特定的手法干预(脊柱手法)相关的感觉反馈之间的关系，该疗法在治疗下腰痛方面已被证明有效。通过在用于研究脊柱手法的已建立的动物模型中增加脊柱关节活动不足和过度活动的情况，这一职业发展奖为候选人提供了工具和经验，以实现他的长期职业目标，即确定在脊柱关节功能障碍的情况下脊柱手法如何影响中枢神经系统。候选人是第二代脊医，这一职业发展计划将在世界上最大的脊骨疗法研究中心(帕尔默脊椎疗法研究中心)完成，该中心最近获得了NIH/NCCAM的拨款，将建立一个为期四年的临床和转化科学多学科发展中心。 公共卫生相关性：背部疼痛是第二个最常见的就诊原因，第三个是手术原因。这项动物研究旨在了解限制或过度的脊柱关节活动度对常用的手法疗法(脊柱手法)治疗背痛的神经反应的影响。这项研究的结果可能为临床上针对特定的脊柱关节功能障碍量身定做手法治疗方法提供理论基础。

DESCRIPTION (provided by applicant): Manual therapy practitioners frequently include assessment of spinal joint mobility in their clinical examination and treatment of patients with low back pain. There is increasing evidence that clinical identification of spinal joint hypo- and hypermobility subgroups along with correspondingly tailored manual therapy treatment approaches can lead to more successful therapeutic outcomes. For example, individuals with low back pain and spinal hypomobility have been shown to respond better to spinal manipulation than those with spinal joint hypermobility. What underlying biological/neural mechanisms could be responsible for the different clinical responses from these subgroups when treated with spinal manipulation? This question motivates this career development plan which allows the candidate to accomplish his immediate goals of: a) working with an animal model that combines simulated spinal manipulation with peripheral neural recordings from lumbar paraspinal muscles and b) attaining knowledge of musculoskeletal biomechanics pertinent to the applied spinal loading that occurs during spinal manipulation through didactic coursework. In this study, an established cat lumbar spine model will be used to determine the effects of proximal, distal, and bi-segmental spinal joint hypo- and hypermobility on paraspinal muscle spindle discharge during simulated high velocity low amplitude spinal manipulation of different durations (25-400ms). Spinal joint hypomobility will be created by placing unilateral bone screws through the facet joint; hypermobility will be created via unilateral facetectomies. This study will reveal relationships between spinal joint dysfunction and sensory feedback related to a specific manual therapy intervention (spinal manipulation) with demonstrated effectiveness in the treatment of low back pain. By adding spinal joint hypo- and hypermobility conditions to an established animal model used to investigate spinal manipulation, this career development award provides the candidate with tools and experience to accomplish his long-term career goal of determining how spinal manipulation in the presence of spinal joint dysfunction affects the central nervous system. The candidate is a second generation chiropractor and this career development plan will be completed at the largest chiropractic research center in the world (Palmer Center for Chiropractic Research) which recently received a NIH/NCCAM grant to establish a four year multi-disciplinary Developmental Center for Clinical and Translational Science. PUBLIC HEALTH RELEVANCE: Back pain is the second most frequent reason for physician visits and the third for surgery. This animal study is directed toward understanding the consequences of restricted or excessive spinal joint mobility on neural responses to a commonly used manual therapy treatment (spinal manipulation) for back pain. The results of this study may provide a rationale for clinically tailoring manual therapy treatment approaches for specifically identified spinal joint dysfunctions.