Identification of potential neuromotor mechanisms of manual therapy in patients with musculoskeletal disablement: rationale and description of a clinical trial

Beth E Fisher, Todd E Davenport, Kornelia Kulig, Allan D Wu, Beth E Fisher, Todd E Davenport, Kornelia Kulig, Allan D Wu

Abstract

Background: Many health care practitioners use a variety of hands-on treatments to improve symptoms and disablement in patients with musculoskeletal pathology.Research to date indirectly suggests a potentially broad effect of manual therapy on the neuromotor processing of functional behavior within the supraspinal central nervous system (CNS) in a manner that may be independent of modification at the level of local spinal circuits. However, the effect of treatment speed, as well as the specific mechanism and locus of CNS changes, remain unclear.

Methods/design: We developed a placebo-controlled, randomized study to test the hypothesis that manual therapy procedures directed to the talocrural joint in individuals with post-acute ankle sprain induce a change in corticospinal excitability that is relevant to improve the performance of lower extremity functional behavior.

Discussion: This study is designed to identify potential neuromotor changes associated with manual therapy procedures directed to the appendicular skeleton, compare the relative effect of treatment speed on potential neuromotor effects of manual therapy procedures, and determine the behavioral relevance of potential neuromotor effects of manual therapy procedures.

Trial registration: http://www.clinicaltrials.gov identifier NCT00847769.

Figures

Figure 1
Figure 1
Flow diagram for subjects' screening, testing, and intervention.
Figure 2
Figure 2
Screenshot image from Brainsight stereotactic image guidance software used to localize motor hotspot. A 3-dimensional reconstruction (A, bottom image) of a single T1 magnetic resonance scan of the brain (B) with positioning of the transcranial magnetic stimulation coil. An infrared optical sensor co-registers the position and orientation of the TMS coil relative to small refractory markers on the subject's cranium (A, top image). This provides the investigator with real-time information regarding the brain locus that will receive TMS given a position and orientation of the TMS coil, in order to minimize spatial variability in TMS application. (Image courtesy of Roch M. Comeau, Brainsight, Rogue Industries, Canada.).
Figure 3
Figure 3
Ankle high-velocity low-amplitude, slow velocity, and control interventions under study. With the subject in a supine position on a treatment table and the lower extremity of interest stabilized to the table with a belt (A), the treating investigator will grasp the foot of interested with the thenar eminences on the foot's plantar surface (B) and induce passive dorsiflexion to end range (B; open arrow). Iatrogenic force will be provided along the long axis of the tibia in the intervention groups. (B; hatched line) In the control group, the treating investigator will maintain passive dorsiflexion (B; open arrow) for the duration of 1 deep inhalation and exhalation by the subject rather than induce an iatrogenic force.

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