Mapping the cortical representation of the lumbar paravertebral muscles

O’Connell, Neil E; Maskill, David; Cossar, John; Nowicky, Alexander V.

doi:10.1016/j.clinph.2007.08.006

Cited by 45 publications

(76 citation statements)

References 29 publications

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“…This stimulation site has been used in previous TMS studies of the lumbar paraspinal muscles [18][19][20][21][22] . However, we should note that vertex stimulation may not be the optimal site for evoking lumbar MEPs as recent findings indicate that the optimal site for evoking responses in the contralateral lumbar paraspinal muscles is situated 1-cm anterior and 4-cm lateral to the vertex 23 . Lastly, we should note that it is our experience that tightly controlling for biomechanical/postural positioning of the lumbar spine is critical to obtaining reliable TMS data from the ES muscle group.…”

Section: Issues To Be Aware Of When Performing Tms On the Erector Spimentioning

confidence: 98%

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Goss

Hoffman

Clark

2012

JoVE

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Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1 , and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 ( Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3 . Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5 . For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,[6][7][8] . In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate singlepulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance 6,9 , and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain 8 . With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system. Video LinkThe video component of this article can be found at http://www.jove.com/video/3387/ Protocol 1. Single and Paired-Pulse TMS of the FCR and ES Muscles 1. Basic Safety Precautions: Prior to performing TMS on a human subject it is necessary to first screen them for basic safety precautions as it pertains to exposure to a magnetic field. In our laboratory we follow the screening guidelines set forth by the Institute for Magnetic Resonance Safety, Education and Research 10 . In our laboratory we also routinely exclude individuals with a family history of epilepsy seizures. We also require subjects undergoing TMS of the ES muscles to wear earplugs and a mouth guard due to the less focal and stronger stimulation intensities. Electrical Recordings:To examine TMS responses in the motor system it is necessary to record electromyographic (EMG) signals from skeletal muscles. For the FCR muscle we place surface electrodes on the forearm using a bipolar electrode arrangement located longitudinally over the muscle on shaved and abraded skin as we have previously described 7,11 . For the erector spinae muscles we use a similar electrode arrangement located longitudinally over the muscles at the L3-L5 vertebral level...

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Section: Issues To Be Aware Of When Performing Tms On the Erector Spimentioning

confidence: 98%

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Goss

Hoffman

Clark

2012

JoVE

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“…The participants were seated on a chair without arm support and the feet flat on the floor [15,16,32]. TMS testing of MF-S is challenging at rest [33] and M1 function worth being tested with tonic activity of the muscle for increasing M1 excitability and stabilizing motoneuronal excitability and spinal cord output [34].…”

Section: Tms Testing Of Mf Musclementioning

confidence: 99%

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

Massé‐Alarie

Beaulieu

Preuss

et al. 2016

Scandinavian Journal of Pain

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AbstractBackground and purposeIsometric 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.MethodsTwenty-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.ResultsBoth 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.ConclusionsChanges 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.ImplicationsThis 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.

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“…This coil orientation provides consistent paraspinal MEPs with minimal concurrent excitation of the opposite hemisphere. 22 Subjects wore a tight-fi tting bathing cap and the vertex was determined using the International 10/20 system. 24 Using a stimulator intensity of 100%, stimuli were delivered over premarked scalp sites on a 5 × 7-cm grid over each hemisphere (0-5 cm lateral, and from 5-cm anterior to 2-cm posterior to the vertex; Figure 1 ).…”

Section: Motor Cortex Mappingmentioning

confidence: 99%

ISSLS Prize Winner

Tsao¹,

Danneels²,

Hodges³

2011

Spine

216

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The findings highlight that LBP is associated with a loss of discrete cortical organization of inputs to back muscles. Increased overlap in motor cortical representation of DM and LES may underpin loss of differential activation in this group. The results further unravel the neurophysiological mechanisms of motor changes in recurrent LBP and suggest motor rehabilitation that includes training of differential activation of the paraspinal muscles may be required to restore optimal control in LBP.

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Mapping the cortical representation of the lumbar paravertebral muscles

Cited by 45 publications

References 29 publications

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

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

ISSLS Prize Winner

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