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.
Research Center of CHU de Québec, Neuroscience Division, Clinical Neuroscience and Neurostimulation Laboratory, Quebec City, QC, Canada.
Scand J Pain. 2016 Jul;12:74-83. doi: 10.1016/j.sjpain.2016.03.005. Epub 2016 May 11.
Isometric 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 after-effects on M1 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 M1 function in a CLBP population.
Twenty-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.
Both ISOM and GLOB improved pain and disability. However, only ISOM influenced M1 function (decreased corticospinal excitability and increased intracortical inhibition), fastened MF-S postural activation and decreased kinesiophobia.
Changes 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.
This 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.
慢性下腰痛（CLBP）患者深层多裂肌（MF）的等长收缩激活（ISOM）可影响姿势调整和初级运动皮层（M1）功能。为了更好地理解ISOM如何影响CLBP病情，本研究将ISOM对M1功能、MF姿势激活和疼痛的后效应与另一种训练——椎旁肌整体激活（GLOB，髋关节伸展）进行了对比。本研究的主要目的是比较ISOM和GLOB（各进行3周训练）对CLBP人群MF姿势激活和M1功能的影响。
24名CLBP患者被随机分配到ISOM组和GLOB组，进行为期3周的每日训练。通过弹道式肢体运动（站立位双侧肩屈曲；俯卧位单侧髋关节伸展）期间浅层MF（MF-S）激活的起始时间、经颅磁刺激M1测试MF-S皮质运动控制，以及通过标准化问卷评估疼痛、运动恐惧和残疾情况，来评估训练前后的后效应。
ISOM和GLOB均改善了疼痛和残疾情况。然而，只有ISOM影响了M1功能（皮质脊髓兴奋性降低，皮质内抑制增加），加快了MF-S姿势激活，并降低了运动恐惧。
皮质脊髓兴奋性和MF-S姿势调整的变化表明，ISOM对脑可塑性的影响更好。未来的研究应进一步测试我们的新发现是否与这些运动对不同肌肉的腰骶骨盆控制和认知功能的影响有关。临床上，在为减轻疼痛而开这两种传统运动处方之前，仍有必要对个体进行评估。
这项原创研究展示了运动控制练习如何影响慢性下腰痛患者的脑可塑性和姿势控制。这些知识将影响临床医生开特定运动处方的决策，以期改善这种肌肉骨骼疾病的运动控制。
