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Manual therapy prevents onset of nociceptor activity, sensorimotor dysfunction, and neural fibrosis induced by a volitional repetitive task

Bove, Geoffrey M.a,*; Delany, Sean P.b; Hobson, Lucasb; Cruz, Geneva E.b; Harris, Michele Y.b; Amin, Mamtab; Chapelle, Susan L.c; Barbe, Mary F.b

doi: 10.1097/j.pain.0000000000001443
Research Paper

Painful and disabling musculoskeletal disorders remain prevalent. In rats trained to perform repetitive tasks leading to signs and dysfunction similar to those in humans, we tested whether manual therapy would prevent the development of the pathologies and symptoms. We collected behavioral, electrophysiological, and histological data from control rats, rats that trained for 5 weeks before performing a high-repetition high-force (HRHF) task for 3 weeks untreated, and trained rats that performed the task for 3 weeks while being treated 3x/week using modeled manual therapy (MMT) to the forearm (HRHF + MMT). The MMT included bilateral mobilization, skin rolling, and long axis stretching of the entire upper limb. High-repetition high-force rats showed decreased performance of the operant HRHF task and increased discomfort-related behaviors, starting after training. HRHF + MMT rats showed improved task performance and decreased discomfort-related behaviors compared with untreated HRHF rats. Subsets of rats were assayed for presence or absence of ongoing activity in C neurons and slow Aδ neurons in their median nerves. Neurons from HRHF rats had a heightened proportion of ongoing activity and altered conduction velocities compared with control and MMT-treated rats. Median nerve branches in HRHF rats contained increased numbers of CD68+ macrophages and degraded myelin basic protein, and showed increased extraneural collagen deposition, compared with the other groups. We conclude that the performance of the task for 3 weeks leads to increased ongoing activity in nociceptors, in parallel with behavioral and histological signs of neuritis and nerve injury, and that these pathophysiologies are largely prevented by MMT.

Manual therapy prevented functional and pathophysiological changes in rats that volitionally perform a task that leads to the development of a repetitive motion disorder.

aDepartment of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME, United States

bDepartment of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States

cSquamish Integrated Health, Squamish, BC, Canada

Corresponding author. Address: Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME 04005, United States. Tel.: 207 590 8949. E-mail address: geoffreybove@gmail.com (G.M. Bove).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received August 15, 2018

Accepted November 05, 2018

© 2019 International Association for the Study of Pain
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