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Influence of paravertebral muscles training on brain plasticity and postural control in chronic low back pain

  • Hugo Massé-Alarie EMAIL logo , Louis-David Beaulieu , Richard Preuss and Cyril Schneider

Abstract

Background and purpose

Isometric activation (ISOM) of deep multifidi muscles (MF) can influence postural adjustments and primary motor cortex (M1) function in chronic low back pain (CLBP). In order to better understand how ISOM impacts on CLBP condition, the present study contrasted ISOM aftereffects on Ml function, MF postural activation and pain with another training, the global activation of paravertebral muscles (GLOB, hip extension). The main objective of this study was to compare the effects of ISOM and GLOB (3-week training each) on MF postural activation and Ml function in a CLBP population.

Methods

Twenty-four people with CLBP were randomly allocated to ISOM and GLOB groups for a 3- week daily practice. Pre/post-training after-effects were assessed by the onset of superficial MF (MF-S) activation during ballistic limb movements (bilateral shoulder flexion in standing; unilateral hip extension in prine lying), MF-S corticomotor control tested by transcranial magnetic stimulation of M1, and assessment of pain, kinesiophobia and disability by standardized questionnaires.

Results

Both ISOM and GLOB improved pain and disability. However, only ISOM influenced Ml function (decreased corticospinal excitability and increased intracortical inhibition), fastened MF-S postural activation and decreased kinesiophobia.

Conclusions

Changes of corticospinal excitability and of MF-S postural adjustments suggest that ISOM better influenced brain plasticity. Future studies should further test whether our novel findings relate to an influence of the exercises on the lumbopelvic control of different muscles and on cognitive function. Clinically, individual’s evaluation remains warranted before prescribing one or the other of these two conventional exercises for reducing pain.

Implications

This original study presents how motor control exercises can influence brain plasticity and postural control in chronic low back pain. This knowledge will impact on the decision of clinicians to prescribe specific exercises with a view of improving motor control in this musculoskeletal condition.


DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.04.004.



Corresponding author at: Centre de recherche du CHU de Québec, Neuroscience Division, RC-9800, 2705 Blvd. Laurier, Quebec City, Canada G1V 4G2. Tel.: +1 418 525 4444x47539; fax: +1 418 654 2753

Acknowledgments

The authors acknowledge the financial support from the Canadian Foundation for Innovation (CS equipment), the Fonds de Recherche du Québec - Santé (HMA and LDB PhD studentships) and the Canadian Institutes of Health Research (HMA studentship).

  1. Conflict of interest

    Conflict of interest statement: None.

  2. Disclosures: None.

References

[1] Lemeunier N, Leboeuf-Yde C, Gagey O. The natural course of low back pain: a systematic critical literature review. Chiropr Man Therap 2012;20:33.10.1186/2045-709X-20-33Search in Google Scholar

[2] Freburger JK, Carey TS, Holmes GM. Effectiveness of physical therapy for the management of chronic spine disorders: a propensity score approach. Phys Ther 2006;86:381-94.10.1093/ptj/86.3.381Search in Google Scholar

[3] van Oostrom SH, Monique Verschuren WM, de Vet HC, Picavet HS. Ten year course of low back pain in an adult population-based cohort - the Doetinchem cohort study. Eur J Pain 2011;15:993-8.10.1016/j.ejpain.2011.02.007Search in Google Scholar

[4] Hodges PW, Ferreira HF, Ferreira ML. Lumbar spine: treatment of instability and disorders of movement control. In: Magee DJ, Zachazewski JE, Quillen WS, editors. Pathology and intervention in musculoskeletal rehabilitation. St. Louis: Saunders Elsevier; 2009. p. 389-425.Search in Google Scholar

[5] Arendt-Nielsen L, Graven-Nielsen T, Svarrer H, Svensson P. The influence of low back pain on muscle activity and coordination during gait: a clinical and experimental study. Pain 1996;64:231-40.10.1016/0304-3959(95)00115-8Search in Google Scholar

[6] Shirado O, Ito T, Kaneda K, Strax TE. Flexion-relaxation phenomenon in the back muscles. A comparative study between healthy subjects and patients with chronic low back pain. Am J Phys Med Rehabil 1995;74:139-44.Search in Google Scholar

[7] Sihvonen T, Partanen J, Hanninen O, Soimakallio S. Electric behavior of low back muscles during lumbar pelvic rhythm in low back pain patients and healthy controls. Arch Phys Med Rehabil 1991;72:1080-7.Search in Google Scholar

[8] van Dieen JH, Selen LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature.J ElectromyogrKinesiol 2003;13:333-51.10.1016/S1050-6411(03)00041-5Search in Google Scholar

[9] Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976) 1996;21:2640-50.10.1097/00007632-199611150-00014Search in Google Scholar PubMed

[10] MacDonald D, Moseley GL, Hodges PW. Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain 2009;142:183-8.10.1016/j.pain.2008.12.002Search in Google Scholar PubMed

[11] Silfies SP, Mehta R, Smith SS, Karduna AR. Differences in feed forward trunk muscle activity in subgroups of patients with mechanical low back pain. Arch Phys Med Rehabil 2009;90:1159-69.10.1016/j.apmr.2008.10.033Search in Google Scholar PubMed

[12] Suehiro T, Mizutani M, Ishida H, Kobara K, Osaka H, Watanabe S. Individuals with chronic low back pain demonstrate delayed onset of the back muscle activity during prone hip extension. J Electromyogr Kinesiol 2015;25:675-80.10.1016/j.jelekin.2015.04.013Search in Google Scholar PubMed

[13] Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain 2008;131:2161-71.10.1093/brain/awn154Search in Google Scholar PubMed

[14] Masse-Alarie H, Flamand VH, Moffet H, Schneider C. Corticomotor control of deep abdominal muscles in chronic low back pain and anticipatory postural adjustments. Exp Brain Res 2012;218:99-109.10.1007/s00221-012-3008-9Search in Google Scholar PubMed

[15] Tsao H, Danneels L, Hodges PW. Individual fascicles of the paraspinal muscles are activated by discrete cortical networks in humans. Clin Neurophysiol 2011;122:1580-7.10.1016/j.clinph.2011.01.048Search in Google Scholar PubMed

[16] Tsao H, Danneels LA, Hodges PW. ISSLS prize winner: Smudging the motor brain in young adults with recurrent low back pain. Spine (Phila Pa 1976) 2011;36:1721-7.10.1097/BRS.0b013e31821c4267Search in Google Scholar PubMed

[17] Tsao H, Druitt TR, Schollum TM, Hodges PW. Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. J Pain 2010;11:1120-8.10.1016/j.jpain.2010.02.004Search in Google Scholar PubMed

[18] Tsao H, Hodges PW. Immediate changes in feedforward postural adjustments following voluntary motor training. Exp Brain Res 2007;181:537-46.10.1007/s00221-007-0950-zSearch in Google Scholar PubMed

[19] Tsao H, Galea MP, Hodges PW. Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain 2010;14:832-9.10.1016/j.ejpain.2010.01.001Search in Google Scholar PubMed

[20] Tsao H, Hodges PW. Persistence of improvements in postural strategies following motor control training in people with recurrent low back pain. J ElectromyogrKinesiol 2008;18:559-67.10.1016/j.jelekin.2006.10.012Search in Google Scholar PubMed

[21] Masse-Alarie H, Flamand VH, Moffet H, Schneider C. Peripheral neurostimulation and specific motor training of deep abdominal muscles improve posturomotor control in chronic low back pain. ClinJ Pain 2013;29:814-23.10.1097/AJP.0b013e318276a058Search in Google Scholar PubMed

[22] Hall L, Tsao H, MacDonald D, Coppieters M, Hodges PW. Immediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain. J Electromyogr Kinesiol 2009;19:763-73.10.1016/j.jelekin.2007.09.008Search in Google Scholar PubMed

[23] Marshall PW, Murphy BA. Evaluation of functional and neuromuscular changes after exercise rehabilitation for low back pain using a Swiss ball: a pilot study. J Manipulative Physiol Ther 2006;29:550-60.10.1016/j.jmpt.2006.06.025Search in Google Scholar PubMed

[24] Marshall PW, Murphy BA. Muscle activation changes after exercise rehabilitation for chronic low back pain. Arch Phys Med Rehabil 2008;89:1305-13.10.1016/j.apmr.2007.11.051Search in Google Scholar

[25] Lefaucheur JP, Drouot X, Menard-Lefaucheur I, Keravel Y, Nguyen JP. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. Neurology 2006;67:1568-74.10.1212/01.wnl.0000242731.10074.3cSearch in Google Scholar

[26] Liepert J, Classen J, Cohen LG, Hallett M. Task-dependent changes of intracortical inhibition. Exp Brain Res 1998;118:421-6.10.1007/s002210050296Search in Google Scholar

[27] Perez MA, Lungholt BK, Nyborg K, Nielsen JB. Motor skill training induces changes in the excitability of the leg cortical area in healthy humans. Exp Brain Res 2004;159:197-205.10.1007/s00221-004-1947-5Search in Google Scholar

[28] Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 2009;120:2008-39.10.1016/j.clinph.2009.08.016Search in Google Scholar

[29] Hermens HJ, Freriks B. www.seniam.orgSearch in Google Scholar

[30] Marshall P, Murphy B. The validity and reliability of surface EMG to assess the neuromuscular response of the abdominal muscles to rapid limb movement. J ElectromyogrKinesiol 2003;13:477-89.10.1016/S1050-6411(03)00027-0Search in Google Scholar

[31] Masse-Alarie H, Beaulieu LD, Preuss R, SchneiderC.Task-specificity of bilateral anticipatory activation of the deep abdominal muscles in healthy and chronic low back pain populations. Gait Posture 2015;41:440-7.10.1016/j.gaitpost.2014.11.006Search in Google Scholar

[32] O'Connell NE, Maskill DW, Cossar J, Nowicky AV. Mapping the cortical representation of the lumbar paravertebral muscles. Clin Neurophysiol 2007;118:2451-5.10.1016/j.clinph.2007.08.006Search in Google Scholar

[33] Ferbert A, Caramia D, Priori A, Bertolasi L, Rothwell JC. Cortical projection to erectorspinae muscles in man as assessed by focal transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol 1992;85:382-7.10.1016/0168-5597(92)90051-CSearch in Google Scholar

[34] Darling WG, Wolf SL, Butler AJ. Variability of motor potentials evoked by transcranial magnetic stimulation depends on muscle activation. Exp Brain Res 2006;174:376-85.10.1007/s00221-006-0468-9Search in Google Scholar PubMed PubMed Central

[35] Davey NJ, Lisle RM, Loxton-Edwards B, Nowicky AV, McGregor AH. Activation of back muscles during voluntary abduction of the contralateral arm in humans. Spine (Phila Pa 1976) 2002;27:1355-60.10.1097/00007632-200206150-00019Search in Google Scholar

[36] Nowicky AV, McGregor AH, Davey NJ. Corticospinal control of human erector spinae muscles. Motor Control 2001;5:270-80.10.1123/mcj.5.3.270Search in Google Scholar

[37] Kujirai T, Caramia MD, RothwellJC, Day BL, Thompson PD, Ferbert A, Wroe S, Asselman P, Marsden CD. Corticocortical inhibition in human motor cortex. J Physiol 1993;471:501-19.10.1113/jphysiol.1993.sp019912Search in Google Scholar

[38] Ortu E, Deriu F, Suppa A, Tolu E, Rothwell JC. Effects of volitional contraction on intracortical inhibition and facilitation in the human motor cortex. J Physiol 2008;586:5147-59.10.1113/jphysiol.2008.158956Search in Google Scholar

[39] Valls-Sole J, Pascual-Leone A, Wassermann EM, Hallett M. Human motor evoked responses to paired transcranial magnetic stimuli. Electroencephalogr Clin Neurophysiol 1992;85:355-64.10.1016/0168-5597(92)90048-GSearch in Google Scholar

[40] Ilic TV, Meintzschel F, Cleff U, Ruge D, Kessler KR, Ziemann U. Short-interval paired-pulse inhibition and facilitation of human motor cortex: the dimension of stimulus intensity. J Physiol 2002;545:153-67.10.1113/jphysiol.2002.030122Search in Google Scholar

[41] Tokimura H, Ridding MC, Tokimura Y, Amassian VE, Rothwell JC. Short latency facilitation between pairs of threshold magnetic stimuli applied to human motor cortex. Electroencephalogr Clin Neurophysiol 1996;101: 263-72.10.1016/0924-980X(96)95664-7Search in Google Scholar

[42] Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983;17:45-56.10.1016/0304-3959(83)90126-4Search in Google Scholar

[43] Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271-3.10.1037/t04205-000Search in Google Scholar

[44] Stratford P, Gill C, Westaway M, Binkley J. Assessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy Canada 1995;47:258-63.10.3138/ptc.47.4.258Search in Google Scholar

[45] Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62:363-72.10.1016/0304-3959(94)00279-NSearch in Google Scholar

[46] Chapman JR, Norvell DC, Hermsmeyer JT, Bransford RJ, DeVine J, McGirt MJ, Lee MJ. Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine (Phila Pa 1976) 2011;36:S54-68.10.1097/BRS.0b013e31822ef74dSearch in Google Scholar PubMed

[47] Richardson CA, Hides JA, Hodges PW. Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. 2nd ed. Edinburgh, London, NewYork, Oxford, Philadelphia, St Louis, Sydney, Toronto: Elsevier; 2004.Search in Google Scholar

[48] McGill SM. Low back disorders: evidence-based prevention and rehabilitation. 2nd ed. Human Kinetics; 2007.10.2310/6640.2003.37832Search in Google Scholar

[49] McGill SM, Karpowicz A. Exercises for spine stabilization: motion/motor patterns, stability progressions, and clinical technique. Arch Phys Med Rehabil 2009;90:118-26.10.1016/j.apmr.2008.06.026Search in Google Scholar PubMed

[50] Hodges PW, Bui BH. A comparison of computer-based methods for the determination of on set of muscle contraction using electromyography. Electroencephalogr Clin Neurophysiol 1996;101:511-9.Search in Google Scholar

[51] Orth M, Rothwell JC. The cortical silent period: intrinsic variabilityand relation to the waveform of the transcranial magnetic stimulation pulse. Clin Neurophysiol 2004;115:1076-82.10.1016/j.clinph.2003.12.025Search in Google Scholar PubMed

[52] Jensen JL, Marstrand PC, Nielsen JB. Motor skill training and strength training are associated with different plastic changes in the central nervous system. J Appl Physiol 2005;99:1558-68.10.1152/japplphysiol.01408.2004Search in Google Scholar PubMed

[53] Pascual-Leone A, Grafman J, Hallett M. Modulation of cortical motor output maps during development of implicit and explicit knowledge. Science 1994;263:1287-9.10.1126/science.8122113Search in Google Scholar PubMed

[54] Pascual-Leone A, Nguyet D, Cohen L, Brasil-Neto J, Cammarota A, Hallett M. Modulation of muscle responses evoked by transcranial magnetic stimulation during the acquisition of new fine motor skills. J Neurophysiol 1995;74:1037-45.10.1152/jn.1995.74.3.1037Search in Google Scholar PubMed

[55] Schabrun SM, Elgueta-Cancino EL, Hodges PW. Smudging of the motor cortex is related to the severity of low back pain. Spine (Phila Pa 1976) 2015.10.1097/BRS.0000000000000938Search in Google Scholar PubMed

[56] Tsao H, Tucker KJ, Hodges PW. Changes in excitability of corticomotor inputs to the trunk muscles during experimentally-induced acute low back pain. Neuroscience 2011;181:127-33.10.1016/j.neuroscience.2011.02.033Search in Google Scholar PubMed

[57] Liepert J, Tegenthoff M, Malin JP. Changes of cortical motor area size during immobilization. Electroencephalogr Clin Neurophysiol 1995;97:382-6.10.1016/0924-980X(95)00194-PSearch in Google Scholar

[58] Rothwell JC. Techniques and mechanisms of action of transcranial stimulation of the human motor cortex. J Neurosci Methods 1997;74:113-22.10.1016/S0165-0270(97)02242-5Search in Google Scholar

[59] Ziemann U, Reis J, Schwenkreis P, Rosanova M, Strafella A, Badawy R, Muller-Dahlhaus F. TMS and drugs revisited. Clin Neurophysiol 2014:2014.10.1016/j.clinph.2014.08.028Search in Google Scholar PubMed

[60] Huang, Edwards M, Rounis E, Bhatia K, Rothwell J. Theta burst stimulationof the human motor cortex. Neuron 2005;45:201-6.10.1016/j.neuron.2004.12.033Search in Google Scholar PubMed

[61] Zoghi M, Pearce SL, Nordstrom MA. Differential modulation of intracortical inhibition in human motor cortex during selective activation of an intrinsic hand muscle. J Physiol 2003;550:933-46.10.1113/jphysiol.2003.042606Search in Google Scholar PubMed PubMed Central

[62] Rittig-Rasmussen B, Kasch H, Fuglsang-Frederiksen A, Jensen TS, Svensson P. Specific neck training induces sustained corticomotor hyperexcitability as assessed by motor evoked potentials. Spine (Phila Pa 1976) 2013;38: E979-84.10.1097/BRS.0b013e3182975310Search in Google Scholar PubMed

[63] Rittig-Rasmussen B, Kasch H, Fuglsang-Frederiksen A, Svensson P, Jensen TS. Effect of training on corticomotor excitability in clinical neck pain. Eur J Pain 2014;18:1207-16.10.1002/j.1532-2149.2014.487.xSearch in Google Scholar PubMed

[64] Ziemann U, Siebner HR. Modifying motor learning through gating and homeostatic metaplasticity. Brain Stimul 2008;1:60-6.10.1016/j.brs.2007.08.003Search in Google Scholar PubMed

[65] Strutton PH, Theodorou S, Catley M, McGregor AH, Davey NJ. Corticospinal excitability in patients with chronic low back pain. J Spinal Disord Tech 2005;18:420-4.10.1097/01.bsd.0000169063.84628.feSearch in Google Scholar PubMed

[66] Devanne H, Lavoie BA, Capaday C. Input-output properties and gain changes in the human corticospinal pathway. Exp Brain Res 1997;114:329-38.10.1007/PL00005641Search in Google Scholar PubMed

[67] Reis J, Swayne OB, Vandermeeren Y, Camus M, Dimyan MA, Harris-Love M, Perez MA, Ragert P, Rothwell JC, Cohen LG. Contribution of transcranial magnetic stimulation to the understanding of cortical mechanisms involved in motor control. J Physiol 2008;586:325-51.10.1113/jphysiol.2007.144824Search in Google Scholar

[68] Watson PJ, Booker CK, Main CJ. Evidence for the role of psychological factors in abnormal paraspinal activity in patients with chronic low back pain. J Musculoskelet Pain 1997;5:41-56.10.1300/J094v05n04_05Search in Google Scholar

[69] Alschuler KN, Neblett R, Wiggert E, Haig AJ, Geisser ME. Flexion-relaxation and clinical features associated with chronic low back pain: a comparison of different methods of quantifying flexion-relaxation. Clin J Pain 2009;25:760-6.10.1097/AJP.0b013e3181b56db6Search in Google Scholar

[70] Karayannis NV, Smeets RJ, van den Hoorn W, Hodges PW. Fear of movement is related to trunk stiffness in low back pain. PLoS One 2013;8:e67779.10.1371/journal.pone.0067779Search in Google Scholar

[71] Marras WS, Davis KG, Heaney CA, Maronitis AB, Allread WG. The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine. Spine (Phila Pa 1976) 2000;25:3045-54.10.1097/00007632-200012010-00012Search in Google Scholar

[72] Masse-Alarie H, Beaulieu LD, Preuss R, Schneider C. Influence of chronic low back pain and fear of movement on the activation of the transversely oriented abdominal muscles during forward bending. J Electromyogr Kinesiol 2016;27:87-94.10.1016/j.jelekin.2016.02.004Search in Google Scholar

[73] Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther 2001;81:776-88.10.1093/ptj/81.2.776Search in Google Scholar

[74] Stokes IA, Henry SM, Single RM. Surface EMG electrodes do not accurately record from lumbar multifidus muscles. Clin Biomech (Bristol, Avon) 2003;18:9-13. DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.04.004.10.1016/S0268-0033(02)00140-7Search in Google Scholar

Received: 2015-11-18
Revised: 2016-02-19
Accepted: 2016-03-17
Published Online: 2016-07-01
Published in Print: 2016-07-01

© 2016 Scandinavian Association for the Study of Pain

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