SOFT TISSUE BIOMECHANICAL BEHAVIOR DURING ACUPUNTURE IN LOW BACK PAIN

针灸治疗腰痛时软组织的生物力学行为

• 批准号: 7952109
• 负责人: HELENE M LANGEVIN
• 金额: $ 7.27万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2010-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7952109
• 关键词: Acupuncture Points; Acupuncture Therapy; Acupuncture procedure; Alternative Medicine; Architecture; Area; Articular Range of Motion; Back; Behavior; Biological; Biomechanics; Biopsy; Bladder; Chronic low back pain; Clinical; Clinical Research; Clinical Trials; Clinical assessments; Collagen; Computer Retrieval of Information on Scientific Projects Database; Connective Tissue; Coupling; Data; Deposition; Disease; Engineering; Functional disorder; Funding; Future; Gallbladder; Grant; Human; Imagery; Individual; Institution; Intramuscular; Lead; Leg; Length; Location; Low Back Pain; Manuals; Measurement; Measures; Meridians; Modeling; Motion; Muscle; Nature; Needles; Orthopedics; Outcome Measure; Pain; Palpation; Patients; Pattern; Performance; Physical therapy; Physics; Play; Process; Property; Rehabilitation therapy; Research; Research Personnel; Resources; Role; Rotation; Series; Source; Techniques; Testing; Therapeutic; Thick; Time; Tissues; Torque; Ultrasonography; United States National Institutes of Health; Water; base; human subject; in vivo; insight; kinematics; multidisciplinary; primary outcome; response; soft tissue; subcutaneous; theories; trial comparing

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The principal aim of this proposal is to test the hypothesis that individuals with chronic low back pain (LBP) have altered soft tissue biomechanical behavior during acupuncture needling in the lower back and legs compared with individuals without LBP (No-LBP). We will also test whether or not altered tissue behavior in LBP is generalized, or localized to specific locations as predicted by traditional acupuncture theory. This proposal constitutes the first step to testing the mechanistic model that 1) altered soft tissue biomechanical behavior during needling in LBP is due to abnormalities of connective tissue (subcutaneous, perimuscular and/or intramuscular), 2) connective tissue plays an important role in both the therapeutic mechanism of acupuncture and the pathophysiological mechanism of LBP, and 3) these two mechanisms are related. Acupuncturists describe qualitatively different needling responses at locations believed to be "involved" in the patient's disease process. Although assessing abnormalities in the needling response is a fundamental aspect of acupuncture therapy, what constitutes a normal vs. abnormal needling response has never been studied quantitatively. Thus the nature of tissue changes underlying these phenomena remains unknown. We have recently developed a new in vivo technique based on ultrasound elastography in humans that allows visualization and quantification of tissue displacement and strain patterns developed in tissues during needle manipulation (65). In this proposal, we will use ultrasound elastography to perform measurement and detailed analysis of tissue biomechanical behavior during needling in human subjects with and without LBP. AIM 1: Examine tissue biomechanical behavior during acupuncture in LBP vs. No-LBP: 80 subjects with LBP and 80 control subjects without LBP will be tested. We will test acupuncture points (APs) and non-acupuncture points (Non-APs) on the Bladder (BL) and Gall Bladder (GB) meridians as well as Non-Meridian Non-APs in the back and leg. Primary outcome measures will be: 1) peak torque during needle rotation (Torque); 2) needle force decay rate during needle oscillation (Force decay); 3) tissue displacement (Displacement) in Subcutaneous, Perimuscular and Muscle zones during needle oscillation; 4) Perimuscular zone thickness (Thickness). Our preliminary data suggest that tissue behavior during needling in the lower back is abnormal in LBP. We hypothesize that Torque and Displacement are smaller and that Force decay and Thickness are greater 1) in LBP than in No-LBP, 2) at Meridians than at Non-Meridians, 3) at APs than at Non-APs, 4) in the back than in the leg. In LBP subjects, we will also examine the relationship between these outcome measures and 1) subjective pain pattern, 2) tenderness to palpation. AIM 2: Quantify tissue material properties responsible for biomechanical behavior observed in Aim 1: Data from Aim 1 will be used to develop, evaluate and implement a biomechanical model to quantify parameters including stiffness, damping and needle/tissue coupling time constant associated with each of three tissue zones (Subcutaneous, Perimuscular and Muscle). We hypothesize that stiffness is greater and that damping and needle/tissue coupling constant are smaller in LBP compared with No-LBP. These parameters also will be used to generate further hypotheses regarding connective tissue pathophysiological mechanisms potentially responsible for abnormal soft tissue behavior in LBP (e.g. increased or decreased tissue water content, abnormal connective tissue matrix architecture, increased or decreased collagen deposition). These hypotheses will be tested in future studies that will combine ultrasound elastography and tissue biopsies in LBP and No-LBP. AIM 3: Examine the relationship between tissue behavior during acupuncture and clinical assessment prior to needling: In all subjects tested in Aim 1, we will perform clinical measures of muscle length in areas that will be needled as well as range of motion (ROM) and functional assessments. These measurements will be compared with parameters calculated in Aim 2. We hypothesize that stiffness will be negatively correlated, and that damping and tissue coupling constants will be positively correlated with muscle length and ROM in corresponding muscle groups as well as physical performance measures. These data will pave the way for a future clinical trial comparing the effects of acupuncture and physical therapy using both subjective (pain reduction, functional assessment) and objective outcome measures (ultrasound elastography, bulk passive tissue stiffness, kinematic motion analysis and muscle activity) both before and after a series of treatments. This multidisciplinary study bridging the fields of alternative medicine, physical therapy, engineering, physics and orthopaedics will provide objective biomechanical measurements of phenomena fundamental to acupuncture. This study also may 1) lead to important new insights on the pathophysiology of LBP and 2) provide objective biological outcome measures for future clinical trials of acupuncture and other "alternative" manual therapies as well as physical and rehabilitation therapy.

该子项目是利用该技术的众多研究子项目之一 资源由 NIH/NCRR 资助的中心拨款提供。子项目及 研究者 (PI) 可能已从 NIH 的另一个来源获得主要资金， 因此可以在其他 CRISP 条目中表示。列出的机构是 对于中心来说，它不一定是研究者的机构。 该提案的主要目的是检验以下假设：与没有慢性腰痛 (LBP) 的个体 (No-LBP) 相比，慢性腰痛 (LBP) 个体在下背部和腿部针灸过程中软组织生物力学行为发生了改变。 我们还将测试腰痛中组织行为的改变是否是普遍的，或者是像传统针灸理论所预测的那样局限于特定位置。 该提议构成了测试机械模型的第一步，即 1) LBP 针刺过程中软组织生物力学行为的改变是由于结缔组织（皮下、肌周和/或肌内）的异常引起的，2) 结缔组织在两者中都发挥着重要作用针灸的治疗机制和腰痛的病理生理机制，3）这两种机制是相关的。 针灸师描述了被认为“参与”患者疾病过程的不同部位的针刺反应。 尽管评估针刺反应的异常是针灸疗法的一个基本方面，但从未定量研究过什么构成正常与异常的针刺反应。 因此，这些现象背后的组织变化的本质仍然未知。我们最近开发了一种基于人体超声弹性成像的新体内技术，可以对针操作过程中组织中产生的组织位移和应变模式进行可视化和量化（65）。 在本提案中，我们将使用超声弹性成像对有或没有腰痛的人体受试者在针刺过程中的组织生物力学行为进行测量和详细分析。 目标 1：检查 LBP 与无 LBP 针刺期间的组织生物力学行为：将测试 80 名患有 LBP 的受试者和 80 名没有 LBP 的对照受试者。 我们将测试膀胱经 (BL) 和胆经 (GB) 上的穴位 (AP) 和非穴位 (Non-AP) 以及背部和腿部的非经络非 AP。主要结果指标为： 1) 针旋转期间的峰值扭矩（扭矩）； 2）针振荡时针力衰减率（Force Decay）； 3）针摆动过程中皮下、肌周和肌肉区的组织位移（Displacement）； 4）肌周区厚度（Thickness）。 我们的初步数据表明腰痛患者在腰部进针时的组织行为是异常的。我们假设扭矩和位移更小，力衰减和厚度更大：1) LBP 中比无 LBP 中，2) 经络处比非经络处，3) AP 处比非 AP 处，4) 在后面比腿上。 在 LBP 受试者中，我们还将检查这些结果测量与 1）主观疼痛模式、2）触诊压痛之间的关系。 目标 2：量化与目标 1 中观察到的生物力学行为有关的组织材料特性：来自目标 1 的数据将用于开发、评估和实施生物力学模型，以量化与每个相关的参数，包括刚度、阻尼和针/组织耦合时间常数三个组织区域（皮下、肌周和肌肉）。我们假设与无 LBP 相比，LBP 的刚度更大，阻尼和针/组织耦合常数更小。这些参数还将用于生成有关结缔组织病理生理学机制的进一步假设，这些机制可能导致腰痛中软组织行为异常（例如组织含水量增加或减少、结缔组织基质结构异常、胶原蛋白沉积增加或减少）。这些假设将在未来的研究中得到检验，这些研究将结合超声弹性成像和 LBP 和 No-LBP 的组织活检。 目标 3：检查针灸过程中的组织行为与针刺前的临床评估之间的关系：在目标 1 中测试的所有受试者中，我们将对将要针刺的区域的肌肉长度以及运动范围 (ROM) 和运动范围进行临床测量。功能评估。 这些测量结果将与目标 2 中计算的参数进行比较。我们假设刚度将呈负相关，阻尼和组织耦合常数将与相应肌肉群的肌肉长度和 ROM 以及物理性能测量呈正相关。这些数据将为未来的临床试验铺平道路，该试验使用主观（疼痛减轻、功能评估）和客观结果测量（超声弹性成像、大量被动组织硬度、运动分析和肌肉活动）来比较针灸和物理治疗的效果。在一系列治疗之前和之后。 这项跨越替代医学、物理治疗、工程学、物理学和骨科领域的多学科研究将为针灸的基本现象提供客观的生物力学测量。 这项研究还可能1）带来关于LBP病理生理学的重要新见解，2）为针灸和其他“替代”手法疗法以及物理和康复疗法的未来临床试验提供客观的生物学结果测量。