Massé-Alarie Hugo, Beaulieu Louis-David, Preuss Richard, Schneider Cyril
Research Center of CHU de Québec, Neuroscience Division, Clinical Neuroscience and Neurostimulation Laboratory, Quebec City, Qc, Canada.
McGill University, Constance-Lethbridge Rehabilitation Center-CRIR, Montreal, Qc, Canada.
Clin Neurophysiol. 2017 Mar;128(3):442-453. doi: 10.1016/j.clinph.2016.12.020. Epub 2016 Dec 28.
The study tested whether combining repetitive peripheral magnetic stimulation (RPMS) and motor training of the superficial multifidus muscle (MF) better improved the corticomotor control of spine than training alone in chronic low back pain (CLBP).
Twenty-one participants with CLBP were randomly allocated to [RPMS+training] and [Sham+training] groups for three sessions (S1-S3) over a week where MF was stimulated before training (volitional contraction). Training was also home-practiced twice a day. Changes were tested at S1 and S3 for anticipatory postural adjustments (APAs) of MF and semi-tendinosus (ST), MF EMG activation, cortical motor plasticity (transcranial magnetic stimulation) and pain/disability.
The RPMS group showed immediate decrease of pain at S1, then improvement of MF activation, ST APA, M1 facilitation, and pain/disability at S3. Changes were larger when brain excitability was lower at baseline. Disability index remained improved one month later.
Combining RPMS with training of MF in CLBP impacted motor planning, MF and lumbopelvic spine motor control and pain/disability one week after the onset of protocol. Brain plasticity might have favoured motor learning and improved daily lumbopelvic spine control without pain generation.
Clinically, RPMS impacted the function by improving the gains beyond those reached by training alone in CLBP.
本研究旨在测试，对于慢性下腰痛（CLBP）患者，重复经外周磁刺激（RPMS）与浅层多裂肌（MF）的运动训练相结合，是否比单纯训练能更好地改善脊柱的皮质运动控制。
21名CLBP患者被随机分配至[RPMS+训练]组和[假刺激+训练]组，在一周内进行三个疗程（S1-S3），其中在训练（自主收缩）前对MF进行刺激。训练也需每天在家练习两次。在S1和S3时测试MF和半腱肌（ST）的预期姿势调整（APA）、MF肌电图激活、皮质运动可塑性（经颅磁刺激）以及疼痛/功能障碍的变化。
RPMS组在S1时疼痛立即减轻，随后在S3时MF激活、ST的APA、M1易化以及疼痛/功能障碍均得到改善。当基线时脑兴奋性较低时，变化更大。功能障碍指数在一个月后仍保持改善。
在CLBP患者中，将RPMS与MF训练相结合，在方案开始一周后对运动规划、MF和腰骶部脊柱运动控制以及疼痛/功能障碍产生了影响。脑可塑性可能有利于运动学习，并改善了日常腰骶部脊柱控制且不产生疼痛。
在临床上，RPMS通过改善效果，对CLBP患者的功能产生了影响，其改善程度超过了单纯训练所达到的效果。
