Unraveling the Mechanisms of Manual Therapy: Modeling an Approach

被引:326
作者
Bialosky, Joel E. [1 ,2 ]
Beneciuk, Jason M. [1 ,2 ]
Bishop, Mark D. [1 ]
Coronado, Rogelio A. [3 ,4 ]
Penza, Charles W. [1 ]
Simon, Corey B. [5 ,6 ,7 ]
George, Steven Z. [6 ,7 ]
机构
[1] Univ Florida, Dept Phys Therapy, Gainesville, FL USA
[2] Brooks PHHP Res Collaborat, Jacksonville, FL USA
[3] Univ Texas Med Branch, Dept Phys Therapy, Galveston, TX 77555 USA
[4] Univ Texas Med Branch, Dept Orthopaed Surg & Rehabil, Galveston, TX 77555 USA
[5] Duke Univ, Phys Therapy Program, Durham, NC USA
[6] Duke Univ, Duke Clin Res Inst, Durham, NC USA
[7] Duke Univ, Dept Orthopaed Surg, Durham, NC USA
基金
美国国家卫生研究院;
关键词
manipulation; mobilization; neurophysiology; pain; theory; LOW-BACK-PAIN; CLINICAL-PREDICTION RULE; SPINAL MANIPULATIVE THERAPY; ARTICULAR DYSFUNCTION PATTERNS; RANDOMIZED CONTROLLED-TRIALS; GUIDE SPECIFIC MOBILIZATION; BASE-LINE CHARACTERISTICS; MOVEMENT-EVOKED PAIN; CHRONIC NECK PAIN; JOINT MOBILIZATION;
D O I
10.2519/jospt.2018.7476
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Manual therapy interventions are popular among individual health care providers and their patients; however, systematic reviews do not strongly support their effectiveness. Small treatment effect sizes of manual therapy interventions may result from a "one-size-fits-all" approach to treatment. Mechanistic-based treatment approaches to manual therapy offer an intriguing alternative for identifying patients likely to respond to manual therapy. However, the current lack of knowledge of the mechanisms through which manual therapy interventions inhibit pain limits such an approach. The nature of manual therapy interventions further confounds such an approach, as the related mechanisms are likely a complex interaction of factors related to the patient, the provider, and the environment in which the intervention occurs. Therefore, a model to guide both study design and the interpretation of findings is necessary. We have previously proposed a model suggesting that the mechanical force from a manual therapy intervention results in systemic neurophysiological responses leading to pain inhibition. In this clinical commentary, we provide a narrative appraisal of the model and recommendations to advance the study of manual therapy mechanisms.
引用
收藏
页码:8 / 18
页数:11
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