Z Joint Changes in Low Back Pain Following Adjusting

描述（由申请人提供）：父母资助的目的是量化急性腰痛受试者在侧位定位和侧位脊柱推拿治疗（SMT；又称调整）后L4/L5和L5/S1关节间隙的治疗性开放（间隙）。此外，家长补助金正在评估疼痛、功能障碍和Z关节间隙之间的关系。这一竞争性修订独特地结合了声学和MRI成像领域的技术，通过进一步研究SMT的作用机制之一，即SMT后空化（可听释放）与Z关节间隙之间的关系，加深了对母grant的研究。此外，如果发现空化与Z关节间隙有关，则空化可以作为临床试验和临床实践中SMT管理的简单，廉价和量化的标准。本研究的具体目的是将40名健康受试者中(1)在SMT和(2)侧位定位时发生的空化（可听释放）与L3-S1 - Z关节间隙联系起来。合作研究人员将使用既定的方法，并结合可行性研究中测试的方法来完成研究。间隙将根据SMT前后（调整组）或腰椎侧位定位前后（对照组）MRI扫描的Z关节间隙测量值的差异来计算。通过使用从一个线性阵列和两个三角形阵列加速度计接收的数据，将在调整或侧位定位期间确定椎体的水平和空化的侧面。通过对Z关节进行数据分析，确定空化与间隙的关系：调整后空化、调整后不空化、侧位定位后空化、侧位定位后不空化。进一步的工作将评估健康受试者的空泡和其他Z关节声音的强度和独特的声学特征。本研究与NCCAM战略计划一致，通过帮助确定脊柱调节过程中关节运动空化的重要性，加深对手工疗法的理解。如果两者之间存在正相关关系，则可以利用空化来识别对高速低振幅调节反应最佳的患者。如果发现负相关，则空化不能作为脊柱调节过程中关节运动的指标。因此，无论结果如何，这项研究将加深对SMT和手工疗法的理解。

DESCRIPTION (provided by applicant): The objectives of the parent grant are to quantify the therapeutic opening (gapping) of the L4/L5 and L5/S1 zygapophysial (Z) joint space following side posture positioning and side posture spinal manipulative therapy (SMT; a.k.a., adjusting) in subjects with acute low back pain. In addition, the parent grant is assessing the relationships among pain, functional impairment, and Z joint gapping. This competitive revision uniquely combines technologies from the fields of acoustics and MRI imaging to deepen the research of the parent grant by allowing further investigation of one of the mechanisms of action of SMT, namely the relationship between cavitation (audible release) and Z joint gapping following SMT. In addition, if cavitation is found to correlate with Z joint gapping, cavitation could be used as a simple, inexpensive, and quantified standard for SMT administered in clinical trials and possibly in clinical practice. The specific aims of this study are to correlate cavitation (audible release) that occurs (1) during SMT and (2) during side posture positioning, with gapping of the L3-S1 Z joints in 40 healthy subjects. The collaborating investigators will use established methods, combined with those tested in a feasibility study, to complete the research. Gapping will be calculated from the difference of Z joint space measurements made from MRI scans taken before and after SMT (adjusting group) or before and after lumbar side posture positioning (control group). The vertebral level and side of cavitation will be determined during the adjustment or side posture positioning by using data received from one linear array and two triangular arrays of accelerometers. Data analysis will determine the relationship between cavitation and gapping by comparing Z joints that: cavitate following adjusting, do not cavitate following adjusting, cavitate following side posture positioning, and do not cavitate following side posture positioning. Further work will be conducted to assess the intensity and unique acoustic characteristics of cavitations and other Z joint sounds of healthy subjects. This research is consistent with the NCCAM Strategic Plan to deepen understanding of manual therapies by helping to determine the significance of cavitation to joint movement during spinal adjusting. If a positive relationship is found, cavitation could possibly be used to identify patients who would respond optimally to high velocity low amplitude adjusting. If a negative relationship is found then cavitation would not be used as an indicator of joint movement during spinal adjusting. Consequently, regardless of the outcome, this research will deepen the understanding of SMT and manual therapies. PUBLIC HEALTH RELEVANCE: This project will deepen the research of the parent grant by further investigating one of the mechanisms of action of spinal manipulative therapy (SMT, or spinal adjusting), that is the relationship between cavitation (audible release) and gapping (separation) of the zygapophysial joint (Z joint) spaces following SMT. Although cavitation and gapping are thought to be related, there has been no evidence to support this hypothesis. If a positive relationship is found, cavitation could be used to identify patients who would respond optimally to high velocity low amplitude SMT, whereas no or a negative relationship would provide evidence that cavitation is not a suitable indicator of joint movement during spinal adjusting.