Low Back Pain: Unveiling the Contribution of Motor Control Adaption Using Biomechanical Modeling and Neuroimaging

Low Back Pain: Unveiling the Contribution of Motor Control Adaption Using Biomechanical Modeling and Neuroimaging

Low Back Pain: Unveiling the Contribution of Motor Control Adaption Using Biomechanical Modeling and Neuroimaging

This project aims to reveal the potential sensorimotor reorganization of sensory input in low back pain patients and its association with different motor control strategies in LBP.

Background: Low back pain (LBP) is a major health issue. Treatment of chronic LBP is still a major challenge due to a lack of pathophysiological understanding. Thus, understanding LBP pathophysiology is a research priority. Adaptions of motor control likely play a significant role in chronic or recurrent LBP because motor control is crucial for spine posture, stability and movement. Different motor adaption strategies exist across individuals with LBP and two phenotypes representing the opposite ends of a spectrum have been suggested; i.e. "tight" control and "loose" control over trunk movement. The former would be associated with reduced trunk motor variability, the later with increased trunk motor variability. This conceptual framework is very useful to explain maintenance and aggravating of LBP because motor control adaptations are expected to have long-term consequences, such as increased spinal tissue loading, associated with degeneration of intervertebral discs and other tissues. Several knowledge gaps need to be addressed to test the validity of this framework: 1) Do loose/tight control phenotypes indeed exist and/or do other motor control adaption strategies exist? 2) Is reduced/altered paraspinal proprioceptive input associated with LBP related to neuroplastic cortical changes, thereby affecting the organizational structure in sensorimotor cortices and top-down trunk motor control? 3) Do psychological factors influence the organizational structure in sensorimotor cortices and motor control strategies? To address these knowledge gaps, the objectives of the current project are: I) To establish motor control phenotypes in LBP. Proprioceptive weighting and biomechanical assessment of dynamic movement tasks, including subject-specific spine kinematic variability and its relationship to pain duration, negative pain-related cognitions, segmental loadings and paraspinal muscle forces, will be performed. II) To test whether cortical proprioceptive maps differ between healthy subjects and patients with LBP. Brain activation in response to thoracolumbar vibrotactile stimulation will be interrogated using functional magnetic resonance imaging data and univariate and multivariate analysis based on machine learning. III) To test whether proprioceptive maps demonstrate a relationship to spine kinematic patterns, pain duration and negative pain-related cognitions in LBP patients.

Spine kinematics assessment during daily activities and brain responses to thoracolumbar mechanical and vibrotactile stimulation

Spine kinematics assessment during daily activities and brain responses to thoracolumbar mechanical and vibrotactile stimulation

mechanical non-painful low- and high pressure stimuli to thoracolumbar segments of healthy subjects and low back pain patients

non-painful vibrotactile stimulation within a frequency range between 20-150Hz to thoracolumbar segments of healthy subjects and low back pain patients

supraspinal BOLD responses induced by mechanical and vibrotactile stimulations of the back recorded by means of functional magnetic resonance imaging (fMRI)

Displacement (intervertebral angles) of the stimulated and adjacent spinal segments during mechanical pressure using dynamic T2 scans

Assessment of the perceived harmfulness of back stressing movements using the electronic version of the PHODA questionnaire

Inclusion criteria healthy subjects: Aged between 18 and 60 Written informed consent after being informed Inclusion criteria low back pain patients: Aged between 18 and 60 Low back pain for more than 1 week Exclusion criteria healthy subjects: Consumption of alcohol, drugs, analgesics within the last 24 h Pregnancy acute and/or low recurrent back pain within the last 3 months Prior spine surgery Other chronic pain condition history of psychiatric or neurological disorders MR-contraindications Body mass index (BMI) > 30 kg/m2 Exclusion criteria low back pain patients: Consumption of alcohol, drugs, analgesics within the last 24 h Pregnancy Specific causes for the back pain (ruled out by the clinician) Prior spine surgery History of psychiatric or neurological disorders MR-contraindications Body mass index (BMI) > 30 kg/m2