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

Schmid, Stefan; Bangerter, Christian; Schweinhardt, Petra; Meier, Michael L.

doi:10.3389/fpain.2021.715219

Cited by 15 publications

(15 citation statements)

References 66 publications

(73 reference statements)

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“…Nonetheless, detailed cortical topographic maps of paraspinal sensory input along the thoracolumbar axis are still lacking, perhaps due to technical challenges in providing reliable sensory stimulation across the back in a magnetic resonance imaging (MRI) environment. Establishing finely-grained cortical maps of the back is not only of interest for fundamental neuroscience but could also be crucial for further research into possible links between brain changes and the development and maintenance of neurological disorders and clinical conditions such as chronic low back pain (LBP; Van Dieën et al, 2017; Schmid et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

In the back of your mind: Cortical mapping of paraspinal afferent inputs

Cole

Stämpfli

Gandia

et al. 2021

Preprint

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Persistent pain alters brain-body representations, highlighting their potential pathological significance. In chronic low back pain (LBP), sparse evidence points towards a shift of the cortical representation of sensory afferents of the back. However, systematic investigations of the cortical representation of tactile and proprioceptive paraspinal afferents along the thoracolumbar axis are lacking. Detailed cortical maps of paraspinal afferent input might be crucial to further explore potential relationships between brain changes and the development and maintenance of chronic LBP. We therefore validated a novel and functional magnetic resonance imaging- (fMRI-)compatible method of mapping cortical representations of tactile and proprioceptive afferents of the back, using pneumatic vibrotactile stimulation ("pneuVID") at varying frequencies and paraspinal locations, in conjunction with high-resolution fMRI. We hypothesised that: (i) high (80 Hz) frequency stimulation would lead to increased postural sway compared to low (20 Hz) stimulation, due to differential evoked mechanoreceptor contributions to postural control (proprioceptive vs tactile); and (ii) that high (80 Hz) versus low (20 Hz) frequency stimulation would be associated with neuronal activity in distinct primary somatosensory (S1) and motor (M1) cortical targets of tactile and proprioceptive afferents (N=15, healthy volunteers). Additionally, we expected neural representations to vary spatially along the thoracolumbar axis. We found significant differences between neural representations of low and high frequency stimulation and between representations of thoracic and lumbar paraspinal locations, in several bilateral sensorimotor cortical regions. Proprioceptive (80 Hz) stimulation preferentially activated sub-regions S1 3a and M1 4p, while tactile (20 Hz) stimulation was more encoded in S1 3b and M1 4a. Moreover, in S1, lower back proprioceptive stimulation activated dorsal-posterior representations, compared to ventral-anterior representations activated by upper back stimulation. As per our hypotheses, we found distinct sensorimotor cortical tactile and proprioceptive representations, with the latter displaying clear topographic differences between the upper and lower back. This thus represents the first behavioural and neurobiological validation of the novel pneuVID method for stimulating muscle spindles and mapping cortical representations of paraspinal afferents. Future investigations of detailed cortical maps will be of major importance in elucidating the role of cortical reorganization in the pathophysiology of chronic LBP.

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Section: Introductionmentioning

confidence: 99%

In the back of your mind: Cortical mapping of paraspinal afferent inputs

Cole

Stämpfli

Gandia

et al. 2021

Preprint

Self Cite

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“…We believe that the main study should include workers with experience in unstable lifting, e.g., fishermen, farmers, truck drivers, scaffolders, etc., to have a possibility to extrapolate the results to the population of interest. At the time of measurement, these workers should be pain-free, since we know from previous studies that ongoing pain could alter lifting techniques [ 24 – 26 ]. It is, however, difficult to estimate what the impact of the choice of these subjects could have on the results in the main study.…”

Section: Discussionmentioning

confidence: 99%

“…It is, however, difficult to estimate what the impact of the choice of these subjects could have on the results in the main study. We know that experience and expectations can alter motor control strategies [ 26 ] and a previous experience of unstable floors during heavy lifting could have led to the development of a specific lifting technique. For example, the workers could have expectations that there could be disturbances of the base of support during their lifting task, and they have developed one specific lifting technique that applies to possible situations: stable, semi-instable, and unstable conditions [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of lifting on stable versus unstable surfaces—a laboratory-based proof-of-concept study

Grooten

Billsten

Stedingk

et al. 2022

Pilot Feasibility Stud

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Background Many workers performing manual handling tasks suffer from musculoskeletal disorders (MSD). Previous research has identified several loading aspects associated with manual handling, but it is still unknown if lifting on an unstable surface is associated with increased biomechanical loading of different body parts. Aim This proof-of-concept study aims to study what kinematic and kinetic movement parameters, such as movement time, joint angles, torque, and muscle activity are feasible and of importance when studying the effect of lifting on surfaces with varying degrees of stability in an experimental set-up. Methods Measurements were taken during three different surface conditions: stable, slightly unstable, and unstable. The participants were instructed to lift a box from the floor and place it on a table in front of them. The weight of the box varied from 0.5 to 15.5 kg. By using a motion capture system (VICON) with 28 reflective markers placed on the participants and one on the box, one Kistler force plate for measuring force levels and center of pressure movements (CoP), and four electromyographic transmitters (EMG), we analyzed the downward and upward phases of the lifting movement, using the Friedman’s test for repeated measures. Results Statistically significant results with less joint movements in the lower and upper back were seen with increased instability during both the downward and upward phases. The decrease in trunk movements with increased instability resulted in a somewhat more flexed knee position during the movement, a lower torque in the lower back, and a decrease in CoP movements, but no differences in movement time or muscle activity in back and knee muscles. Conclusion Lifting while standing on unstable surfaces resulted in an alteration of both kinematics and kinetics parameters; however, further studies regarding whether this is an additional risk factor for developing lower back pain are needed. Muscle activity levels were not altered due to instability and due to the complexity of the measurement, and we suggest not including EMG measures in future experiments of this type.

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“…Our results thus support the measurement of lumbar angular amplitude and angular velocity in any functional task in future studies. Nevertheless, there is an urgent need for well-conducted longitudinal studies to detangle if and how spinal kinematic changes are associated with patients’ changes in pain and disability ( Wernli et al, 2020b ; Schmid et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Such task–independent measures could produce more robust assessments and reduce the number of variables to deal with in statistical analyses, which would be beneficial for both the design and the interpretation of future studies. If possible, this simplified description of spinal movement could prove particularly useful to detangle the role of spinal movement alterations in CLBP development or recovery and inform rehabilitation principles ( Wernli et al, 2020b ; Schmid et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Patients With Chronic Low Back Pain Have an Individual Movement Signature: A Comparison of Angular Amplitude, Angular Velocity and Muscle Activity Across Multiple Functional Tasks

Christe

Aussems

Jolles

et al. 2021

Front. Bioeng. Biotechnol.

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Despite a large body of evidence demonstrating spinal movement alterations in individuals with chronic low back pain (CLBP), there is still a lack of understanding of the role of spinal movement behavior on LBP symptoms development or recovery. One reason for this may be that spinal movement has been studied during various functional tasks without knowing if the tasks are interchangeable, limiting data consolidation steps. The first objective of this cross-sectional study was to analyze the influence of the functional tasks on the information carried by spinal movement measures. To this end, we first analyzed the relationships in spinal movement between various functional tasks in patients with CLBP using Pearson correlations. Second, we compared the performance of spinal movement measures to differentiate patients with CLBP from asymptomatic controls among tasks. The second objective of the study was to develop task-independent measures of spinal movement and determine the construct validity of the approach. Five functional tasks primarily involving sagittal-plane movement were recorded for 52 patients with CLBP and 20 asymptomatic controls. Twelve measures were used to describe the sagittal-plane angular amplitude and velocity at the lower and upper lumbar spine as well as the activity of the erector spinae. Correlations between tasks were statistically significant in 91 out of 99 cases (0.31 ≤ r ≤ 0.96, all p < 0.05). The area under the curve (AUC) to differentiate groups did not differ substantially between tasks in most of the comparisons (82% had a difference in AUC of ≤0.1). The task-independent measures of spinal movement demonstrated equivalent or higher performance to differentiate groups than functional tasks alone. In conclusion, these findings support the existence of an individual spinal movement signature in patients with CLBP, and a limited influence of the tasks on the information carried by the movement measures, at least for the twelve common sagittal-plane measures analysed in this study. Therefore, this work brought critical insight for the interpretation of data in literature reporting differing tasks and for the design of future studies. The results also supported the construct validity of task-independent measures of spinal movement and encouraged its consideration in the future.

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

Cited by 15 publications

References 66 publications

In the back of your mind: Cortical mapping of paraspinal afferent inputs

In the back of your mind: Cortical mapping of paraspinal afferent inputs

Biomechanical analysis of lifting on stable versus unstable surfaces—a laboratory-based proof-of-concept study

Patients With Chronic Low Back Pain Have an Individual Movement Signature: A Comparison of Angular Amplitude, Angular Velocity and Muscle Activity Across Multiple Functional Tasks

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