Li Xin, Zhang Haojie, Lo Wai Leung Ambrose, Ge Le, Miao Ping, Liu Howe, Li Le, Wang Chuhuai
Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Rehabilitation Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Front Neurol. 2022 Jul 12;13:904002. doi: 10.3389/fneur.2022.904002. eCollection 2022.
The transversus abdominis (TrA) and multifidus (MF) muscles are essential in preventing chronic low back pain (CLBP) recurrence by maintaining segmental stabilization and stiffness. Sling exercise is a high-level core stability training to effectively improve the activities of the TrA and MF muscles. However, the neural mechanism for sling exercise-induced neural plasticity change in the primary motor cortex (M1) remains unclear. This study aimed to investigate the role of sling exercise in the reorganization of the motor cortical representation of the TrA and MF muscles.
Twenty patients with CLBP and 10 healthy individuals were recruited. For map volume, area, the center of gravity (CoG) location (medial-lateral location and anterior-posterior location), and latency, two-way ANOVA was performed to compare the effects of groups (the CLBP-pre, CLBP-post, and healthy groups) and the two muscles (the TrA and MF muscles). The Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and postural balance stability were assessed at baseline and at the end of 2 weeks of sling exercise. Linear correlations between VAS or ODI and CoG locations were assessed by 's correlation test.
2 weeks of sling exercise induced both the anterior-medial ( < 0.001) and anterior-posterior ( = 0.025) shifts of the MF muscle representation at the left motor cortex in patients with CLBP. Anterior-medial ( = 0.009) shift of the TrA muscle representation at the right motor cortex was observed in patients with CLBP. The motor cortical representation of the two muscles in patients with CLBP after sling exercise (TrA: 2.88 ± 0.27 cm lateral and 1.53 ± 0.47 cm anterior of vertex; MF: 3.02 ± 0.48 cm lateral and 1.62 ± 0.40 cm anterior of vertex) closely resembled that observed in healthy individuals (TrA: 2.83 ± 0.48 cm lateral and 2.00 ± 0.43 cm anterior of vertex; MF: 2.94 ± 0.43 cm lateral and 1.77 ± 0.48 cm anterior of vertex). The VAS and the ODI were reduced following the sling exercise (VAS: < 0.001; ODI: < 0.001).
This study provides evidence that sling training can drive plasticity changes in the motor system, which corresponds with the reduction in pain and disability levels in patients with CLBP. This study was registered in the Chinese Clinical Trial Registry (Clinical Trial Registration Number: ChiCTR2100045904, http://www.chictr.org.cn/showproj.aspx?proj=125819).
ChiCTR2100045904.
腹横肌（TrA）和多裂肌（MF）对于通过维持节段稳定性和刚度来预防慢性下腰痛（CLBP）复发至关重要。悬吊运动是一种高级核心稳定性训练，可有效改善TrA和MF肌肉的活动。然而，悬吊运动诱导初级运动皮层（M1）神经可塑性变化的神经机制仍不清楚。本研究旨在探讨悬吊运动在TrA和MF肌肉运动皮层代表区重组中的作用。
招募20例CLBP患者和10名健康个体。对于图谱体积、面积、重心（CoG）位置（内外侧位置和前后位置）以及潜伏期，进行双向方差分析以比较组间（CLBP术前、CLBP术后和健康组）和两块肌肉（TrA和MF肌肉）的影响。在基线和悬吊运动2周结束时评估视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和姿势平衡稳定性。通过皮尔逊相关检验评估VAS或ODI与CoG位置之间线性相关性。
2周的悬吊运动导致CLBP患者左侧运动皮层MF肌肉代表区出现前后内侧移位（P<0.001）和前后移位（P=0.025）。CLBP患者右侧运动皮层TrA肌肉代表区出现前后内侧移位（P=0.009）。悬吊运动后CLBP患者两块肌肉的运动皮层代表区（TrA：顶点外侧2.88±0.27 cm和前方1.53±0.47 cm；MF：顶点外侧3.02±0.48 cm和前方1.62±0.40 cm）与健康个体中观察到的情况非常相似（TrA：顶点外侧2.83±0.48 cm和前方2.00±0.43 cm；MF：顶点外侧2.94±0.43 cm和前方1.
