Nougarou François, Pagé Isabelle, Loranger Michel, Dugas Claude, Descarreaux Martin
Université du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, G9A 5H7, Québec, Canada.
BMC Complement Altern Med. 2016 Jun 2;16:161. doi: 10.1186/s12906-016-1153-6.
Neuromechanical responses to spinal manipulation therapy (SMT) have been shown to be modulated through the variation of SMT biomechanical parameters: peak force, time to peak force, and preload force. Although rate of force application was modulated by the variation of these parameters, the assumption that neuromuscular responses are modulated by the rate of force application remains to be confirmed. Therefore, the purpose of the present study was to evaluate the effect of a constant rate of force application in neuromechanical responses to SMT in healthy adults.
Four SMT force-time profiles presenting different time to peak force and peak force, but with a constant rate of force application were applied on 25 healthy participants' T7 transverse processes. Muscular responses were recorded through surface electromyography electrodes (T6 and T8 levels), while vertebral displacements were assessed through pasted kinematic markers on T6 to T8 spinous processes. Effects of SMT force-time profiles on neuromechanical responses were assessed using repeated-measures ANOVAs.
There was no main effect of SMT force-time profile modulation on muscular responses (ps > .05) except for the left T8 (F (3, 72) = 3.23, p = .03) and left T6 (F (3, 72) = 2.94, p = .04). Muscular responses were significantly lower for the lowest peak force condition than the highest (for T8) or second highest (for T6). Analysis showed that increasing the SMT peak force (and concomitantly time to peak force) led to a significant vertebral displacement increase for the contacted vertebra (F T7 (1, 17) = 354.80, p < .001) and both adjacent vertebras (F T6 (1, 12) = 104.71, p < .001 and F T8 (1, 19) = 468.68, p < .001).
This study showed that peak force modulation using constant rate of force application leads to similar neuromuscular responses. Coupled with previous investigations of SMT peak force and duration effects, the results suggest that neuromuscular responses to SMT are mostly influenced by the rate of force application, while peak force modulation yields changes in the vertebral displacement. Rate of force application should therefore be defined in future studies. Clinical implications of various SMT dosages in patients with spine related pain should also be investigated.
ClinicalTrials.gov NCT02550132 . Registered 8 September 2015.
脊柱推拿疗法（SMT）的神经力学反应已被证明可通过SMT生物力学参数的变化进行调节：峰值力、达到峰值力的时间和预加载力。尽管力的施加速率通过这些参数的变化进行了调节，但神经肌肉反应由力的施加速率调节这一假设仍有待证实。因此，本研究的目的是评估在健康成年人中，以恒定的力施加速率对SMT的神经力学反应的影响。
四种呈现不同达到峰值力时间和峰值力，但力的施加速率恒定的SMT力-时间曲线，应用于25名健康参与者的T7横突。通过表面肌电图电极（T6和T8水平）记录肌肉反应，同时通过粘贴在T6至T8棘突上的运动学标记评估椎体位移。使用重复测量方差分析评估SMT力-时间曲线对神经力学反应的影响。
除左侧T8（F(3, 72) = 3.23，p = 0.03）和左侧T6（F(3, 72) = 2.94，p = 0.04）外，SMT力-时间曲线调制对肌肉反应没有主要影响（p值 > 0.05）。最低峰值力条件下的肌肉反应显著低于最高峰值力条件（T8）或第二高峰值力条件（T6）。分析表明，增加SMT峰值力（以及相应的达到峰值力的时间）会导致接触椎体（F T7(1, 17) = 354.80，p < 0.001）以及两个相邻椎体（F T6(1, 12) = 104.71，p < 0.001和F T8(1, 19) = 468.68，p < 0.001）的椎体位移显著增加。
本研究表明，使用恒定的力施加速率进行峰值力调制会导致相似的神经肌肉反应。结合先前对SMT峰值力和持续时间影响的研究，结果表明对SMT的神经肌肉反应主要受力的施加速率影响，而峰值力调制会导致椎体位移发生变化。因此，在未来的研究中应明确力的施加速率。还应研究各种SMT剂量对脊柱相关疼痛患者的临床意义。
ClinicalTrials.gov NCT02550132。于2015年9月8日注册。
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