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

Hugo Massé-Alarie; Louis-David Beaulieu; Richard Preuss; Cyril Schneider

doi:10.1016/j.sjpain.2016.03.005

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

Scand J Pain. 2016 Jul:12:74-83. doi: 10.1016/j.sjpain.2016.03.005. Epub 2016 May 11.

Authors

Hugo Massé-Alarie¹, Louis-David Beaulieu², Richard Preuss³, Cyril Schneider⁴

Affiliations

¹ Research Center of CHU de Québec, Neuroscience Division, Clinical Neuroscience and Neurostimulation Laboratory, Quebec City, QC, Canada. Electronic address: hugo.masse-alarie.1@ulaval.ca.
² Research Center of CHU de Québec, Neuroscience Division, Clinical Neuroscience and Neurostimulation Laboratory, Quebec City, QC, Canada.
³ McGill University, Constance-Lethbridge Rehabilitation Center-CRIR, Montreal, QC, Canada.
⁴ Research Center of CHU de Québec, Neuroscience Division, Clinical Neuroscience and Neurostimulation Laboratory, Quebec City, QC, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.

PMID: 28850499
DOI: 10.1016/j.sjpain.2016.03.005

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 after-effects on M1 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 M1 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 M1 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.

Keywords: Anticipatory postural adjustment; Chronic low back pain; Cortical motor plasticity; Multifidus; Training.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Low Back Pain / therapy*
Motor Cortex
Paraspinal Muscles / physiology*
Posture*
Transcranial Magnetic Stimulation*

Grants and funding

CIHR/Canada