Pain and motor control of the lumbopelvic region: effect and possible mechanisms
Introduction
Changes in motor control and function of the trunk muscles have been reported frequently in the literature. These changes range from changes in recruitment to reduced strength and endurance of the trunk muscles. Notably, patterns of hyperactivity and hypoactivity have been reported and a variety of hypotheses have been developed to explain the effects and mechanisms of the changes. The majority of available hypotheses are broadly consistent with two main theories that propose; (i) that changes in muscle activity cause spinal pain (muscle–tension or pain–spasm–pain model), or (ii) changes in muscle activity serve to restrict spinal motion (pain adaptation model). Experimental (e.g. [11], [70], [95], [113]), and clinical [7], [50] data suggest that the muscle tension model is too simplistic, and offer support for the pain adaptation model [63], however considerable debate exists [114]. The purpose of this paper is to review the evidence for changes in motor control, discuss possible mechanisms for these changes and the effect of these changes on function of the lumbopelvic region.
Section snippets
Changes in motor control of the lumbopelvic region
Although early studies of trunk muscle function focused on the strength and endurance of the trunk muscles in patients with LBP (e.g. [94], [101]), more recently the focus has shifted to issues of motor control. The challenge of motor control of the lumbopelvic region is immense and must serve to move and control the spine in a range of environments and with a complex interaction between internal and external forces. The challenge is further complicated by the fact that without muscle the spine
Possible mechanisms for pain to affect motor control of the trunk muscles
It is not certain whether pain causes changes in motor control or whether motor control changes lead to pain, or both. Farfan [25] and Panjabi [77], amongst others, have presented models that suggest that deficits in motor control lead to poor control of joint movement, repeated microtrauma and pain. Consistent with this model, Janda [53] has argued that people who have mild neurological signs (e.g. minor coordination difficulties) are more likely to have pain as adults. Furthermore slow
Possible outcomes of motor control changes
In view of the differential changes in the deep intrinsic muscles and the superficial muscles in the presence of pain, it is critical to consider possible sequelae of these changes. All trunk muscles are required for control and stability of the spine [77] and it is clear that stability is dependent on the interplay between an array of muscles, both intrinsic and superficial [5], [14], [115]. Yet, there is considerable redundancy in the motor system with many muscles potentially able to perform
Paul Hodges is an NHMRC Senior Research Fellow and Associate Professor at the University of Queensland where he heads the Human Neuroscience Unit. Paul’s research involves integration of neuroscience and biomechanics to investigate the nervous system control of joint stability and movement. Key areas of research include investigation of: task conflict of the trunk muscles, in vivo and in vitro studies of the biomechanical effect of contraction of intrinsic spinal muscles on the spine,
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Paul Hodges is an NHMRC Senior Research Fellow and Associate Professor at the University of Queensland where he heads the Human Neuroscience Unit. Paul’s research involves integration of neuroscience and biomechanics to investigate the nervous system control of joint stability and movement. Key areas of research include investigation of: task conflict of the trunk muscles, in vivo and in vitro studies of the biomechanical effect of contraction of intrinsic spinal muscles on the spine, mechanisms for pain to affect motor control, strategies used by the central nervous system to control joint stability, and the mechanism of efficacy of therapeutic exercise for musculoskeletal pain. In addition to his research in Brisbane, Paul has ongoing collaborations with laboratories in Sydney, Stockholm (Sweden), and Portland (USA). He has published more than 50 research papers in international physiology and medical journals, has presented more than 15 keynote lectures at International back pain and motor control conferences in Australia, Europe and North America and has co-authored a clinical text. Paul’s research has resulted in several awards from the Australian Society for Medical Research and the International Society for Biomechanics and led to him being awarded the Young Australian of the Year Award for Science and Technology for 1997.
Lorimer Moseley completed his Ph.D. at the Pain Management and Research Centre, University of Sydney, where he investigated the psychophysiology of pain and spinal control. He has also conducted several clinical trials into the use of high level pain physiology education as a therapeutic strategy. Lorimer is an Australian NHMRC Clinical Research Fellow currently researching perceptual and motor mechanisms of pain at Royal Brisbane Hospital and The University of Queensland. His particular interests are the interface between physiotherapy, psychology and physiology; conceptual paradigms of pain; and therapeutic strategies for the integration of pain sciences and clinical practice, particularly for those with chronic and recurrent pain.