Work-related muscle disorders are a main cause of missed work, globally, and arecostly for public health systems. However, development of musculoskeletal tissue diagnostics is lagging compared to other tissues and organs. Myofascial trigger points (MTP) are unique muscle tissue phenomenon that are challenging to address due to a lack of objective assessment methodology. This study seeks to meet this need by devising a non-invasive, objective methodology for evaluating musculoskeletal tissue following intervention or physical provocation, specific to the anterior forearm region. In Aim 1, current literature on MTP pathophysiology informs a multi-modal assessment approach, including: 1) pain pressure threshold (PPT), 2) power Doppler (PD) ultrasound, 3) strain elastography (SE), and 4) surface electromyography (sEMG). In Aim 2, controlled ultrasound image acquisition and standardization techniques are developed for imaging muscle tissue with PD (Aim 2a) and SE (Aim 2b) . These techniques improved differentiability of vascularity and compliance estimation after physical provocation or intervention. In Aim 3, the multi-modal approach is implemented in a human pilot study (n=34) investigating MTP response to osteopathic manipulative treatment, compared to rest and light exercise. Positive trends and significant changes are detected after OMT and rest. PPT significantly increased after OMT (p = 0.021). Tissue compliance significantly increase after rest (p ≪ 0.0001) and after OMT( p = 0.002). Principal component analysis finds 9 of 13 outcome measures to be salient features of MTP treatment effect. The data suggests high and low responders, yielding insights for improved patient screening and study design for future work. With further optimization and development, this method may be applied to a broad array of clinical scenarios for musculoskeletal tissue evaluation directed towards amelioration of neuromuscular symptoms.

Objective: Examine cardiovascular response to OMT via central and peripheral measurements. Methods: Central and peripheral cardiovascular signals of asymptomatic human subjects were monitored during a procedure with alternating rest and active phases. Active phases included systemic perturbations and application of controlled vertebral pressure (OMT) by an experienced osteopathic physician. Pulse plethysmograph and laser Doppler flow sensors measured peripheral flow from index and middle fingers bilaterally. A three-lead EKG monitored cardiac activity. The biosignals were recorded continuously, in real time, and analyzed in time and frequency domains. Results from the control group (n=11), without OMT, and active group (n=16), with OMT, were compared. Peripheral (n=5) and central responders (n=6), subsets of the active group showing stronger peripheral or central response, were examined. In an additional effort, a modified clinical device recorded spectral Doppler ultrasound signals of the radial and dorsalis pedis arteries of clinically asymptomatic human subjects. Controlled physiologic provocations (limb occlusion and elevation), were performed. Time domain and spectral analyses were completed. Results: In the human subject study, the time wave characteristics and spectral analysis resulted in similar trends. Peripheral blood flow attenuated in the control group over time, while it was maintained in the active group, and increased specifically during OMT in the responder groups. Heart rate remained around 65 BPM in the control group, fluctuated between 64-68 BPM in the active group, and dropped 4 and 3 BPM in the peripheral and central responder groups, respectively. The effect in the OMT group was statistically significant compared to no-OMT, however, was not statistically significant within-groups. For the preliminary spectral ultrasound Doppler study, segmental flow was successfully monitored. A prototype "Quick Assessment" tool was developed, providing instant post-processing results for clinical use. Conclusions: OMT along the vertebral column may influence autonomic processes that regulate heart rate and peripheral vascular flow.