软组织手法可能会减轻炎症、调节疼痛，并改善诱导出下背痛的有意识的啮齿动物的步态。
Soft Tissue Manipulation May Attenuate Inflammation, Modulate Pain, and Improve Gait in Conscious Rodents With Induced Low Back Pain.
机构信息
Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN 46202, USA.
出版信息
Mil Med. 2021 Jan 25;186(Suppl 1):506-514. doi: 10.1093/milmed/usaa259.
INTRODUCTION
Low back pain (LBP) is common in warfighters. Noninvasive interventions are necessary to expedite return-to-function. Soft tissue manipulation, for example, massage, is a method used to treat LBP. Instrument-assisted soft tissue manipulation (IASTM) uses a rigid device to mobilize the tissue. This study explored the effects of IASTM on pain, function, and biomarkers.
METHODS
Sprague-Dawley rats (n = 44) were randomized to groups (n = 6/grp): (A) cage control; (B) 3 days (3d) postinjury (inj), untreated; (C) 3d inj, < 30-minute post-IASTM treatment; (D) 3d inj, 2 hours (2h) post-IASTM; (E) 14 days (14d) inj, untreated; (F) 14d inj, < 30-minute post-IASTM; and (G) 14d inj, 2h post-IASTM. Researchers induced unilateral LBP in Sprague-Dawley rats using complete Freund's adjuvant injection. Conscious rodents received IASTM for 5 min/session once at 3 days or 3×/week × 2weeks (6× total) over 14 days. Biomarker plasma levels were determined in all groups, while behavioral outcomes were assessed in two groups, D and G, at three time points: before injury, pre-, and post-IASTM treatment. Circulating mesenchymal stem cell levels were assessed using flow cytometry and cytokine plasma levels assayed.
RESULTS
The back pressure pain threshold (PPT) lowered bilaterally at 3 days postinjury (P < .05), suggesting increased pain sensitivity. IASTM treatment lowered PPT more on the injured side (15.8%; P < 0.05). At 14 days, back PPT remained lower but similar side to side. At 3 days, paw PPT increased 34.6% in the contralateral rear limb following treatment (P < .01). Grip strength did not vary significantly. Gait coupling patterns improved significantly (P < .05). Circulating mesenchymal stem cell levels altered significantly postinjury but not with treatment. Neuropeptide Y plasma levels increased significantly at 3 days, 2h post-IASTM (53.2%) (P < .05). Interleukin-6 and tumor necrosis factor-alpha did not vary significantly. At 14 days, regulated on activation, normal T cell expressed and secreted decreased significantly <30-minute post-IASTM (96.1%, P < .002), while IL-10 trended upward at 2h (53.1%; P = .86).
CONCLUSIONS
LBP increased pain sensitivity and diminished function. IASTM treatment increased pain sensitization acutely in the back but significantly reduced pain sensitivity in the contralateral rear paw. Findings suggest IASTM may positively influence pain modulation and inflammation while improving gait patterns. Soft tissue manipulation may be beneficial as a conservative treatment option for LBP.
简介
腰痛（LBP）在战士中很常见。为了加速恢复功能，需要进行非侵入性干预。软组织操作，例如按摩，是一种用于治疗 LBP 的方法。仪器辅助软组织操作（IASTM）使用刚性设备来动员组织。本研究探讨了 IASTM 对疼痛、功能和生物标志物的影响。
方法
将 Sprague-Dawley 大鼠（n = 44）随机分为组（n = 6/grp）：（A）笼对照；（B）受伤后 3 天（3d），未治疗；（C）3d 受伤，IASTM 治疗后 <30 分钟；（D）3d 受伤，IASTM 后 2 小时；（E）14 天（14d）受伤，未治疗；（F）14d 受伤，IASTM 后 <30 分钟；和（G）14d 受伤，IASTM 后 2 小时。研究人员使用完全弗氏佐剂注射诱导 Sprague-Dawley 大鼠单侧 LBP。有意识的老鼠接受 IASTM 治疗，每次 5 分钟/次，一次在 3 天或 3×/周×2 周（共 6 次）内完成 14 天。所有组均测定生物标志物血浆水平，而在两组 D 和 G 中，在三个时间点评估行为结果：受伤前、IASTM 治疗前和治疗后。使用流式细胞术评估循环间充质干细胞水平，并测定细胞因子血浆水平。
结果
受伤后 3 天双侧背压疼痛阈值（PPT）降低（P <.05），提示疼痛敏感性增加。IASTM 治疗使受伤侧的 PPT 降低更多（15.8%；P < 0.05）。在 14 天时，背部 PPT 仍然较低，但双侧相似。在 3 天时，治疗后对侧后肢的爪 PPT 增加了 34.6%（P <.01）。握力没有明显变化。步态耦合模式明显改善（P <.05）。循环间充质干细胞水平在受伤后明显改变，但治疗后没有改变。神经肽 Y 血浆水平在 3 天时显着升高，IASTM 后 2 小时（53.2%）（P <.05）。白细胞介素-6 和肿瘤坏死因子-α没有明显变化。在 14 天时，调节激活、正常 T 细胞表达和分泌的 RANTES 在 IASTM 后 30 分钟内显着降低（96.1%，P <.002），而 IL-10 在 2 小时时呈上升趋势（53.1%；P = 0.86）。
结论
LBP 增加了疼痛敏感性并降低了功能。IASTM 治疗急性增加背部疼痛敏感性，但显着降低对侧后爪的疼痛敏感性。研究结果表明，IASTM 可能会积极影响疼痛调节和炎症，同时改善步态模式。软组织操作可能是治疗 LBP 的一种有益的保守治疗选择。
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