Engell Shawn, Triano John J, Howarth Samuel J
Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
Clin Biomech (Bristol). 2019 Oct;69:58-63. doi: 10.1016/j.clinbiomech.2019.07.006. Epub 2019 Jul 5.
Regional interdependence is conceptually based on observations that applying manual therapy to a remote anatomical region has an effect in the area of the patient's primary complaint. The current model for regional interdependence depends on force transmissibility within the body. This investigation sought to determine transmissibility between forces applied to the thoracic spine during prone-lying high-velocity low-amplitude spinal manipulative therapy and the cervical spine.
A chiropractic treatment table was modified to allow (or disallow) translation of the headrest in the caudal-cephalad direction when unlocked (or locked). Prone-lying high-velocity low-amplitude spinal manipulative therapy was applied to the thoracic region of 9 healthy participants with the headrest in both configurations. Head and thorax kinematics and kinetics were measured at interfaces between participant and the external environment, which included the clinician's hands. Compressive forces at the cervicothoracic junction and angular kinematics of the cervical spine were derived. Ratios between the clinician-applied forces (input) and the cervical compressive force (output) were also determined.
The cervical spine extended during all high-velocity low-amplitude spinal manipulative therapy trials. Force input-to-output ratios exceeded 1 for high-velocity low-amplitude spinal manipulative therapy trials performed with the headrest in the locked configuration, which was greater than ratios for the unlocked configuration.
Forces imparted to thoracic spine during high-velocity low-amplitude spinal manipulative therapy were transmitted to the cervical spine, which provided a precursor for the regional interdependence model for manual therapy. Friction between the participant's face and the treatment table's head rest likely amplified cervical compressive forces.
区域相互依存理论在概念上基于这样的观察结果，即对身体远端解剖区域进行手法治疗会对患者主要疼痛部位产生影响。当前的区域相互依存模型依赖于体内的力传递。本研究旨在确定在俯卧位高速低幅脊柱手法治疗过程中施加于胸椎的力与颈椎之间的传递情况。
对一台整脊治疗床进行改装，使其在解锁（或锁定）时允许（或不允许）头枕在尾侧 - 头侧方向移动。对9名健康参与者的胸椎进行俯卧位高速低幅脊柱手法治疗，头枕设置为两种状态。在参与者与外部环境的界面（包括临床医生的手）处测量头部和胸部的运动学和动力学数据。得出颈胸交界处的压缩力和颈椎的角运动学数据。还确定了临床医生施加的力（输入）与颈椎压缩力（输出）之间的比率。
在所有高速低幅脊柱手法治疗试验中，颈椎均出现伸展。当头枕处于锁定状态时进行的高速低幅脊柱手法治疗试验中，力的输入与输出比率超过1，这一比率高于头枕解锁状态时的比率。
在高速低幅脊柱手法治疗过程中施加于胸椎的力传递到了颈椎，这为手法治疗的区域相互依存模型提供了一个前提。参与者面部与治疗床头枕之间的摩擦力可能放大了颈椎的压缩力。
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