title: Identification of potential neuromotor mechanisms of manual therapy in patients with musculoskeletal disablement: rationale and description of a clinical trial.
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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov identifier NCT00847769.
authors.affiliation: Neuroplasticity and Imaging Laboratory, Division of Biokinesiology and Physical Therapy at the School of Dentistry, University of Southern California, Los Angeles, California, USA. bfisher@usc.edu
authors.forename: Beth E
authors.initials: BE
authors.lastname: Fisher
authors.forename: Todd E
authors.initials: TE
authors.lastname: Davenport
authors.forename: Kornelia
authors.initials: K
authors.lastname: Kulig
authors.forename: Allan D
authors.initials: AD
authors.lastname: Wu
mesh_terms: D000203:Activities of Daily Living; D016512:Ankle Injuries / Q000534:rehabilitation*; D013181:Cortical Spreading Depression / Q000502:physiology; D004558:Electric Stimulation; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology; D006181:H-Reflex / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009043:Motor Activity / Q000502:physiology*; D026201:Musculoskeletal Manipulations / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D013180:Sprains and Strains / Q000534:rehabilitation*; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D016896:Treatment Outcome