Ianuzzi Allyson, Pickar Joel G, Khalsa Partap S
Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA.
J Biomech Eng. 2010 Jul;132(7):071008. doi: 10.1115/1.4001030.
High-velocity, low-amplitude spinal manipulation (HVLA-SM) is an efficacious treatment for low back pain, although the physiological mechanisms underlying its effects remain elusive. The lumbar facet joint capsule (FJC) is innervated with mechanically sensitive neurons and it has been theorized that the neurophysiological benefits of HVLA-SM are partially induced by stimulation of FJC neurons. Biomechanical aspects of this theory have been investigated in humans while neurophysiological aspects have been investigated using cat models. The purpose of this study was to determine the relationship between human and cat lumbar spines during HVLA-SM. Cat lumbar spine specimens were mechanically tested, using a displacement-controlled apparatus, during simulated HVLA-SM applied at L5, L6, and L7 that produced preload forces of approximately 25% bodyweight for 0.5 s and peak forces that rose to 50-100% bodyweight within approximately 125 ms, similar to that delivered clinically. Joint kinematics and FJC strain were measured optically. Human FJC strain and kinematics data were taken from a prior study. Regression models were established for FJC strain magnitudes as functions of factors species, manipulation site, and interactions thereof. During simulated HVLA-SM, joint kinematics in cat spines were greater in magnitude compared with humans. Similar to human spines, site-specific HVLA-SM produced regional cat FJC strains at distant motion segments. Joint motions and FJC strain magnitudes for cat spines were larger than those for human spine specimens. Regression relationships demonstrated that species, HVLA-SM site, and interactions thereof were significantly and moderately well correlated for HVLA-SM that generated tensile strain in the FJC. The relationships established in the current study can be used in future neurophysiological studies conducted in cats to extrapolate how human FJC afferents might respond to HVLA-SM. The data from the current study warrant further investigation into the clinical relevance of site targeted HVLA-SM.
高速低振幅脊柱推拿术(HVLA-SM)是治疗腰痛的一种有效方法,但其作用的生理机制仍不清楚。腰椎小关节囊(FJC)由机械敏感神经元支配,理论上认为HVLA-SM的神经生理益处部分是由FJC神经元的刺激诱导产生的。该理论的生物力学方面已在人体中进行了研究,而神经生理学方面则使用猫模型进行了研究。本研究的目的是确定HVLA-SM过程中猫和人腰椎之间的关系。使用位移控制装置对猫腰椎标本进行力学测试,在L5、L6和L7处进行模拟HVLA-SM,产生约25%体重的预加载力,持续0.5秒,峰值力在约125毫秒内升至50-100%体重,类似于临床施加的力。通过光学测量关节运动学和FJC应变。人体FJC应变和运动学数据取自先前的一项研究。建立了FJC应变大小与物种、推拿部位及其相互作用等因素的回归模型。在模拟HVLA-SM过程中,猫脊柱的关节运动学幅度比人类大。与人类脊柱相似,特定部位的HVLA-SM在远处运动节段产生区域性猫FJC应变。猫脊柱的关节运动和FJC应变大小大于人类脊柱标本。回归关系表明,对于在FJC中产生拉伸应变的HVLA-SM,物种、HVLA-SM部位及其相互作用具有显著且适度良好的相关性。本研究建立的关系可用于未来在猫身上进行的神经生理学研究,以推断人类FJC传入神经对HVLA-SM的反应方式。本研究的数据值得进一步研究部位靶向HVLA-SM的临床相关性。