72152
Extending Ultrasound Elastography to Manual Treatment Methods.
Triano, Jay

The single greatest obstacle to advancing the science of manual medicine is the inability to measure muscle and soft tissue in vivo; the effect is to obscure direct understanding of what treatments actually do. When manual treatments, and even general biomechanical manoeuvres, apply loads to the body, the soft tissues deform, transmitting force to the bone and joint structures. The strains that arise are generated by internal forces consistent with the often non-linear tissue properties. The deformations and strains carry important information on how the body is responding to treatment. These quantities can be disclosed through an appropriate interrogation by ultrasound (USN) elastography techniques and therefore, they are the focus of this investigation. This project will extend recent advances in a promising technology to evaluate soft tissue mechanics under simple and clinically relevant treatment conditions.

A body of knowledge probing theoretical effects of manual treatments has begun to arise over the past three decades. Each clinical manual therapy approach assumes that a specific set of tissues is the recipient of the beneficial effects of treatment. Yet, no prior method directly monitors which tissues deform and the relative intensity of the strain that is developed in order to justify clinical assumptions or to prioritize future research. Specifically, research on how mechanical transduction of treatment into biological benefit occurs in the different tissue strata can be engaged based on evidence of which tissues are most likely being effected.

Current soft-tissue USN elastography techniques, under static conditions, will be extended to quantify relative displacement and strains (active and passive) across the depth of tissue strata (e.g. subcutaneous, fascia, longissimus, intermuscular aponeuroses, multifidus) that arise from small amplitude motions during continuous passive motion (CPM) clinical procedures and in weight bearing postures.

Relative movement of the stratified layers of the back, from treatment and task-generated perturbations, will enable the elastography interrogation of the tissues.

Results from this study are applicable to a number of manual treatments specifically, and to understanding the biomechanics of strain effects from the load distribution through the soft-tissues of the torso. Such evidence will empower prioritization and quantitative testing of tissue biomarkers based on evidence of relative response to treatment. Information on tissue response path as represented by displacement and strain is important to advancing the understanding of manual therapies from three perspectives: 1) informing on the mechanisms of action that may yield clinical benefit; 2) detecting boundaries for and optimization of safe application; and 3) developing insights on how to improve clinical results by redirecting treatment to achieve specific effects.

72160
Determination of mRNA TNFα levels in peripheral blood leukocytes from SMT-treated asymptomatic subjects.
Injeyan-Teodorczyk, Julita

Previous work from our laboratory has suggested that normal subjects who received a single manipulative therapy demonstrate a significantly reduced production of the soluble inflammatory mediators, tumor necrosis factor β, (TNFα) and interleukin-1 β, (IL-1β) (Teodorczk-Injeyan et al, 2005). These results are in concordance with other reports on the anti-inflammatory potential of SMT (Song et al, 2005; Mohammadian et al 2002). In vivo studies have shown alleviation of symptoms and shortening of the duration of pain and hyperalgesia caused by experimental induction of intervertebral foramen (IVF) inflammation following application of a manipulative force in an animal model (Song et al, 2005). Furthermore, using the same model, a manipulative force applied by activator was able to reduce hyperexcitibility in inflamed dorsal ganglion neurons thus, possibly, leading to a decrease in pain (Song et al, 2005). In contrast, Xu et al. have recently shown that neuropathic pain is associated with the up-regulation of immunoactive TNFα production (Xu et al, 2006).

While the available evidence suggests that spinal manipulative therapy can produce anti-inflammatory systemic effects, potential mechanisms underpinning such effects have not been explored. The proposed study will begin such an investigation.

82007
The effectiveness of the Logic Back™support in promoting a comfortable neutral low back position, reduced muscular effort, improved performance, and decreased postural shifts in seating.
Triano, Jay

Back pain and chair use are the second most important health factors for the aging workforce(Government of Canada, 2007). Besides personal suffering, postural discomfort in the workplace reduces performance and productivity, (Government of Canada, 2007; Fenety & Walker, 2002) both of which can be improved by raising comfort levels. The “Effortless Neutral Position” is the natural lordotic standing posture of the spine. The Logic Back™ support offers a simple means to alter posture and achieve the ENP while seated, thereby reducing the strain on the lower back during seated tasks in the workplace. Although its clinical success has been accepted by many practitioners, the current study seeks to quantify the effectiveness of the Logic Back to achieve the ENP and improve comfort and functional performance in healthy individuals and those with low back pain (LBP).

This study will test for differences of chair support on measures of comfort and functional performance in healthy individuals and LBP patients. The Logic Back will be compared to a standard, ergonomic chair. Comfort level will be quantified by the rate of position shift in the chair and functional performance will be measured by task repetition frequency during standardized seated lift and reach tests, devised at McMaster University(WSIB Annual Report, 2006). Secondary measures of ratings of perceived discomfort, muscular exertion, posture, and model predictions of compressive load will help explain any effect of chair support on the primary measures.

82022
Sensori-motor changes in an animal model of lumbar facet joint inflammation.
Vernon, Howard

Back pain is the most commonly-reported type of persistent pain and costs the US economy an estimated $90 billion annually (Luo et al., 2003; see also Borghouts et al., 1999; Mantyselka et al., 2002; Sheehan et al., 1996). Facet joint dysfunction is a common source of back pain, thought to be due to inflammation or trauma (Kikuchi et al. 1984; Ng et al., 2005), but while studies have been undertaken on animal models of facet joint inflammation, there have been none directed at a range of sensory and of motor dysfunction tests, especially studies on long-term changes.