Identifying Motor Control Strategies and Their Role in Low Back Pain: A Cross-Disciplinary Approach Bridging Neurosciences With Movement Biomechanics

Persistent low back pain (LBP) is a major health issue, and its treatment remains challenging due to a lack of pathophysiological understanding. A better understanding of LBP pathophysiology has been recognized as a research priority, however research on contributing mechanisms to LBP is often limited by siloed research within different disciplines. Novel cross-disciplinary approaches are necessary to fill important knowledge gaps in LBP research. This becomes particularly apparent when considering new theories about a potential role of changes in movement behavior (motor control) in the development and persistence of LBP. First evidence points toward the existence of different motor control strategy phenotypes, which are suggested to have pain-provoking effects in some individuals driven by interactions between neuroplastic, psychological and biomechanical factors. Yet, these phenotypes and their role in LBP need further validation, which can be systematically tested using an appropriate cross-disciplinary approach. Therefore, we propose a novel approach, connecting methods from neuroscience and biomechanics research including state-of-the-art optical motion capture, musculoskeletal modeling, functional magnetic resonance imaging and assessments of psychological factors. Ultimately, this cross-disciplinary approach might lead to the identification of different motor control strategy phenotypes with the potential to translate into clinical research for better treatment options.

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Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception

The Neuroscientist ◽

10.1177/1073858418809074 ◽

2018 ◽

Vol 25 (6) ◽

pp. 583-596 ◽

Cited By ~ 6

Author(s):

Michael Lukas Meier ◽

Andrea Vrana ◽

Petra Schweinhardt

Keyword(s):

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Control Strategies ◽

Intervertebral Discs ◽

Cortical Reorganization ◽

Potential Contribution ◽

Low Back ◽

Output Side

Motor control, which relies on constant communication between motor and sensory systems, is crucial for spine posture, stability and movement. Adaptions of motor control occur in low back pain (LBP) while different motor adaption strategies exist across individuals, probably to reduce LBP and risk of injury. However, in some individuals with LBP, adapted motor control strategies might have long-term consequences, such as increased spinal loading that has been linked with degeneration of intervertebral discs and other tissues, potentially maintaining recurrent or chronic LBP. Factors contributing to motor control adaptations in LBP have been extensively studied on the motor output side, but less attention has been paid to changes in sensory input, specifically proprioception. Furthermore, motor cortex reorganization has been linked with chronic and recurrent LBP, but underlying factors are poorly understood. Here, we review current research on behavioral and neural effects of motor control adaptions in LBP. We conclude that back pain-induced disrupted or reduced proprioceptive signaling likely plays a pivotal role in driving long-term changes in the top-down control of the motor system via motor and sensory cortical reorganization. In the outlook of this review, we explore whether motor control adaptations are also important for other (musculoskeletal) pain conditions.

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Evaluation Method of Immediate Effect of Local Vibratory Stimulation on Proprioceptive Control Strategy: A Pilot Study

Electronics ◽

10.3390/electronics10030341 ◽

2021 ◽

Vol 10 (3) ◽

pp. 341

Author(s):

Yohei Ito ◽

Keitaro Kawai ◽

Yoshifumi Morita ◽

Tadashi Ito ◽

Kazunori Yamazaki ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Control Strategy ◽

Evaluation Method ◽

Control Strategies ◽

Muscle Spindles ◽

Low Back ◽

Vibratory Stimulation ◽

The Poor ◽

Before And After

Postural instability owing to poor proprioception is considered a main cause of low back pain and falls. However, the effect of local vibratory stimulation on a poor proprioceptor on proprioceptive control strategy has yet to be evaluated. Therefore, in this study, we proposed an evaluation method of the immediate effect on proprioceptive control strategies by applying local vibratory stimulation to the poor proprioceptor. First, using our device, we determined the poor proprioceptors in each of six elderly patients with non-specific low back pain. Furthermore, we applied local vibratory stimulation to the poor proprioceptor. Finally, we compared the proprioceptive control strategy before and after applying local vibratory stimulation. As a result, the proprioceptive control strategy improved for three patients with impaired muscle spindles that responded to a higher frequency (p < 0.05). Thus, the impaired proprioceptive control strategy caused by a decline in the muscle spindle responding to a higher frequency might be improved by local vibratory stimulation. Furthermore, it was shown that our developed device and protocol might be used to evaluate proprioceptive control strategies within multiple frequency ranges, as well as activate a poor proprioceptor based on diagnosis and improve the proprioceptive control strategies.

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Reorganised motor control strategies of trunk muscles due to acute low back pain

Human Movement Science ◽

10.1016/j.humov.2015.04.001 ◽

2015 ◽

Vol 41 ◽

pp. 282-294 ◽

Cited By ~ 9

Author(s):

R.P. Hirata ◽

S.E. Salomoni ◽

S.W. Christensen ◽

T. Graven-Nielsen

Keyword(s):

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Control Strategies ◽

Trunk Muscles ◽

Low Back ◽

Acute Low Back Pain

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Individuals With and Without Low Back Pain Use Different Motor Control Strategies to Achieve Spinal Stiffness During the Prone Instability Test

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2019.8577 ◽

2019 ◽

Vol 49 (12) ◽

pp. 899-907 ◽

Cited By ~ 1

Author(s):

Won Sung ◽

Gregory E. Hicks ◽

David Ebaugh ◽

Susan S. Smith ◽

Scott Stackhouse ◽

...

Keyword(s):

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Control Strategies ◽

Low Back ◽

Spinal Stiffness ◽

Prone Instability Test

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Fatigability and Altered Motor Control Strategies of Trunk Muscles in Low Back Pain Patients: An Observational Study

International Journal of Health and Rehabilitation Sciences (IJHRS) ◽

10.5455/ijhrs.0000000117 ◽

2017 ◽

Vol 6 (1) ◽

pp. 1

Author(s):

Olfat Ali ◽

Wanees Badawy ◽

Ibrahim Ragab ◽

Soheir Rezkalla

Keyword(s):

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Observational Study ◽

Control Strategies ◽

Trunk Muscles ◽

Low Back ◽

Pain Patients

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Effects of Tailored Motor Control Rehabilitation Vs Standard Exercise Program in Management Of Chronic Nonspecific LBP

10.53350/pjmhs2115113219 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3219-3221

Author(s):

Maryam Liaquat ◽

Wajida Perveen ◽

Danish Hassan ◽

Misbah Amanat Ali ◽

Muhammad Akhtar ◽

...

Keyword(s):

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Clinical Study ◽

Exercise Program ◽

Low Back ◽

Randomized Clinical Study ◽

Lower Back ◽

Group A ◽

Group B

Lower back pain is one of the most common problems in adults all over the world, and chances of having back pain increases with the age. Objectives: To determine the effect of tailored motor control rehabilitation versus standard exercise program in chronic nonspecific lower back pain. Study Design: Non randomized clinical study. Methodology: A non randomized clinical study was conducted in six-month during 2018 after ethical approval. 40 patients were enrolled through non-probability purposive sampling technique and allocated into two groups (Group A & B). Informed consent was obtained. Individuals between twenty to forty years with chronic nonspecific low back pain with intensity at least 3 on a 10cm visual analog scale (VAS) were included and individuals with past history of trauma of the spine and hip and with any red flags were excluded. Outcomes were measures by Modified Oswestry Disability Index (MODI) and Visual Analogue Scale (VAS). Statistical analysis: Data was analyzed by SPSS software, version 19 as qualitative variables were expressed as mean ± SD. Independent sample T test was also applied. Results: The mean age Group A was 29.05±8.58 and Group B, was 32.05±6.53 years. The result shows that there was a significant difference in outcomes among tailored motorcontrol rehabilitation (Group A) and standard exercise program (Group B). Conclusion: We concluded that motor control rehabilitation was more effective than standard exercise program in decreasing low back pain and improving quality of life. Key Words: Low Back Pain, Tailored Motor Control Rehabilitation, Standard Exercise Program and Modified Oswastry Disability Index.

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Motor Control Exercise for Chronic Low Back Pain: A Randomized Placebo-Controlled Trial

Physical Therapy ◽

10.2522/ptj.20090218 ◽

2009 ◽

Vol 89 (12) ◽

pp. 1275-1286 ◽

Cited By ~ 155

Author(s):

Leonardo O.P. Costa ◽

Christopher G. Maher ◽

Jane Latimer ◽

Paul W. Hodges ◽

Robert D. Herbert ◽

...

Keyword(s):

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Chronic Low Back Pain ◽

Exercise Intervention ◽

Patient Specific ◽

Low Back ◽

Functional Scale ◽

The Mean ◽

Control Exercise

BackgroundThe evidence that exercise intervention is effective for treatment of chronic low back pain comes from trials that are not placebo-controlled.ObjectiveThe purpose of this study was to investigate the efficacy of motor control exercise for people with chronic low back pain.DesignThis was a randomized, placebo-controlled trial.SettingThe study was conducted in an outpatient physical therapy department in Australia.PatientsThe participants were 154 patients with chronic low back pain of more than 12 weeks’ duration.InterventionTwelve sessions of motor control exercise (ie, exercises designed to improve function of specific muscles of the low back region and the control of posture and movement) or placebo (ie, detuned ultrasound therapy and detuned short-wave therapy) were conducted over 8 weeks.MeasurementsPrimary outcomes were pain intensity, activity (measured by the Patient-Specific Functional Scale), and patient's global impression of recovery measured at 2 months. Secondary outcomes were pain; activity (measured by the Patient-Specific Functional Scale); patient's global impression of recovery measured at 6 and 12 months; activity limitation (measured by the Roland-Morris Disability Questionnaire) at 2, 6, and 12 months; and risk of persistent or recurrent pain at 12 months.ResultsThe exercise intervention improved activity and patient's global impression of recovery but did not clearly reduce pain at 2 months. The mean effect of exercise on activity (measured by the Patient-Specific Functional Scale) was 1.1 points (95% confidence interval [CI]=0.3 to 1.8), the mean effect on global impression of recovery was 1.5 points (95% CI=0.4 to 2.5), and the mean effect on pain was 0.9 points (95% CI=−0.01 to 1.8), all measured on 11-point scales. Secondary outcomes also favored motor control exercise.LimitationClinicians could not be blinded to the intervention they provided.ConclusionsMotor control exercise produced short-term improvements in global impression of recovery and activity, but not pain, for people with chronic low back pain. Most of the effects observed in the short term were maintained at the 6- and 12-month follow-ups.

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