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

描述（由申请人提供）：手法治疗从业者经常在其临床检查和治疗腰痛患者时评估脊柱关节活动度。越来越多的证据表明，临床识别脊柱关节低活动度和高活动度亚组沿着相应定制的手动疗法治疗方法可以获得更成功的治疗结果。例如，患有腰痛和脊柱活动度低的个体对脊柱操作的反应比脊柱关节活动度高的个体更好。当采用脊柱推拿治疗时，哪些潜在的生物/神经机制可能导致这些亚组的不同临床反应？这个问题激发了这个职业发展计划，使候选人能够实现他的直接目标：a）与动物模型合作，该模型将模拟脊柱操作与来自腰椎旁肌肉的外周神经记录相结合，以及B）通过教学课程获得与脊柱操作期间发生的应用脊柱负荷相关的肌肉骨骼生物力学知识。在本研究中，将使用已建立的猫腰椎模型来确定在不同持续时间（25- 400 ms）的模拟高速低幅度脊柱操作期间，近端、远端和双节段脊柱关节低活动度和高活动度对椎旁肌梭放电的影响。将通过小关节放置单侧骨螺钉来产生脊柱关节低活动性;将通过单侧小关节切除术来产生高活动性。本研究将揭示脊柱关节功能障碍和与特定手动治疗干预（脊柱推拿）相关的感觉反馈之间的关系，并证明其在治疗腰痛方面的有效性。通过将脊柱关节低和高活动性条件添加到用于研究脊柱操作的既定动物模型中，该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操作如何影响中枢神经系统。候选人是第二代脊椎指压治疗师，这个职业发展计划将在世界上最大的脊椎指压治疗研究中心（帕尔默脊椎指压治疗研究中心）完成，该中心最近获得了NIH/NCCAM的资助，建立了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：背痛是医生就诊的第二大常见原因，是手术的第三大原因。本动物研究旨在了解脊柱关节活动受限或过度对背痛常用手动治疗（脊柱手法）神经反应的影响。本研究的结果可能为临床定制专门识别的脊柱关节功能障碍的手法治疗方法提供了依据。

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.