Mechanisms of Manual Therapy for the Prevention and Treatment of Repetitive Motion Disorders

手法治疗预防和治疗重复性运动障碍的机制

• 批准号: 9077916
• 负责人: GEOFFREY M BOVE
• 金额: $ 48.73万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9077916
• 关键词: Advisory Committees; Affect; Animal Model; Architecture; Axon; Behavior; Behavioral; Biological; Biopsy; Carpal Tunnel Syndrome; Chemicals; Chronic; Cicatrix; Clinical; Clinical Management; Clinical Research; Connective Tissue; Cumulative Trauma Disorders; Data; Deposition; Development; Diagnosis; Diffuse; Disease; Dorsal; Economic Burden; Fatigue; Fibrosis; Forearm; Goals; Hand; Health Care Costs; Individual; Inflammation; Injury; Lateral; Lead; Literature; Manipulative Therapies; Massage; Measures; Mechanics; Medial; Methods; Military Personnel; Modeling; Muscle; Muscle strain; Musculoskeletal Diseases; Myalgia; Neck; Nerve; Nerve compression syndrome; Nociceptors; Occupational; Operative Surgical Procedures; Outcome; Pain; Paresthesia; Pathology; Patients; Performance; Physically Handicapped; Prevention; Preventive; Preventive Medicine; Preventive therapy; Preventive treatment; Procedures; Property; Protocols documentation; Publishing; Rattus; Recovery; Rehabilitation therapy; Reporting; Rodent Model; Rotator Cuff; Science; Shoulder; Signs and Symptoms; Societies; Sports; Stimulus; Structure; Symptoms; Tendinopathy; Tendon structure; Tenosynovitis; Testing; Therapeutic; Time; Tissues; Upper Extremity; Work; Wrist; arm; case history; disability; effective therapy; extracellular; median nerve; motor disorder; neurobiological mechanism; novel; prevent; public health relevance; reduce symptoms; research study; soft tissue; strain injury; trapezius muscle

 DESCRIPTION (provided by applicant): Upper extremity repetitive motion disorders (RMDs) affecting the soft tissues of the neck, shoulders, arms, and hands are prevalent in the U.S. and throughout the world and impose a large economic burden for society. Unfortunately, effective treatments are still needed, especially preventive treatments as well as treatments to reverse tissue fibrosis. Fibrosis within and between the tissue structures in the upper limb is hypothesized to be a key factor in the motor dysfunction, increased discomfort, and pain and paresthesias observed in subjects with chronic RMDs. Therefore, our goal here is to use our well-established rodent model in which prolonged performance of high demand reaching and handle-pulling tasks initially induces early injury and inflammation, and later significant fibrosi in nerves, muscles and tendons, with persistent signs of pain and motor dysfunction, to investigate effective means of treatment. Manual therapy refers to a number of related therapies that are applied to patients using the practitioner's hands, such as massage, mobilization, and manipulation. Manual therapies are thought to prevent and/or disrupt fibrosis, thought to be causing the symptoms observed in people and rats with upper extremity MSDs, but there are little data to support these claims. Our preliminary experiments using a combination of modeled massage therapy (MMT) methods in our rat model revealed preventive effects on sensorimotor declines and fibrosis development. Here, we propose to further examine MMT with the goals of: 1) preventing, and 2) reversing the sensorimotor declines and fibrosis that develops in our model of work-related MSDs, 3) testing which components is this treatment are effective, and 4) understanding key neurobiological mechanisms of the observed effects. Specifically, our aims are: 1) Aim 1. Which component(s) of a modeled manual therapy (MMT) protocol lead to reductions in tissue fibrosis and sensorimotor declines in rats that performed a high repetition high force (HRHF) task across an 18 weeks period? 2) Will massage therapy reverse tissue fibrosis and sensorimotor declines that have already occurred in rats that have performed the HRHF task for 18 weeks? 3) How does the HRHF task, with or without MMT, impact discharge properties and sensitivities of nociceptors innervating the arm and hand? Our proposed study will be among the first to study manual therapy in an animal model of chronic RMDs and with scientific rigor. Our findings are expected to lead to novel and readily translatable therapeutic strategies for the clinical management of patients with RMDs. This work has strong potential for long-term, sustained impact on the field of preventive medicine and rehabilitative sciences.

 描述（由适用提供）：影响颈部，肩膀，手臂和手的柔软尖端的上肢重复运动障碍（RMD）在美国乃至全世界都普遍存在，并对社会施加了巨大的经济燃烧。不幸的是，仍然需要有效的治疗方法，尤其是预防性治疗以及逆转组织纤维化的治疗方法。假设上肢的组织结构内部和之间的纤维化是运动功能障碍，不适增加，疼痛和异常的关键因素。因此，我们的目的是使用我们建立的啮齿动物模型，在这种模型中，高需求的高需求性能和处理拉伸任务最初会引起早期损伤和感染，然后在神经，肌肉和肌腱中具有持久的疼痛和运动功能障碍的迹象，以调查有效。治疗手段。手动疗法是指使用从业人员的手（例如按摩，动员和操纵）应用于患者的许多相关疗法。人们认为手动疗法可以预防和/或破坏纤维化，这会导致上肢MSD的人和大鼠观察到的症状，但几乎没有数据支持这些主张。在大鼠模型中，我们使用建模按摩疗法（MMT）方法的组合的初步实验显示，预防性对感觉运动下降和纤维化发展的影响。在这里，我们建议以：1）预防的目标进行进一步检查MMT，以及2）逆转在我们与工作相关的MSD模型中发展的感觉运动下降和纤维化，3）测试哪种组件是有效的，4）4）理解观察到的效果的关键神经生物学机制。具体而言，我们的目标是：1）目标1。建模的手动治疗（MMT）方案的哪个组成部分导致组织纤维化和感觉运动型在18周进行高重复高力（HRHF）任务的大鼠中的减少？ 2）按摩治疗会反向组织纤维化和感觉运动下降，而这些大鼠已经在执行HRHF任务的大鼠中已经发生了18周？ 3）HRHF任务如何在有或不带有MMT的情况下，影响臂和手的伤害感受器的排放特性和敏感性？我们提出的研究将是最早在慢性RMD和科学严谨的动物模型中研究手动疗法的研究者之一。我们的发现预计将导致新颖且容易翻译的RMD患者临床治疗策略。这项工作具有对预防医学和康复科学领域的长期，持续影响的强大潜力。