Spine Biomechanics Lab, Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, Thailand.
Applied Neuromechanics Lab, Arnold School of Public Health, University of South Carolina, Public Health Research Center, Columbia, South Carolina, USA.
Physiother Res Int. 2024 Jul;29(3):e2111. doi: 10.1002/pri.2111.
Aberrant movement in chronic low back pain (CLBP) is associated with a deficit in the lumbar multifidus (LM) and changes in cortical topography. Anodal transcranial direct current stimulation (a-tDCS) can be used to enhance cortical excitability by priming the neuromuscular system for motor control exercise (MCE), thereby enhancing LM activation and movement control. This study aimed to determine the effects of a 6-week MCE program combined with a-tDCS on cortical topography, LM activation, movement patterns, and clinical outcomes in individuals with CLBP.
Twenty-two individuals with CLBP were randomly allocated to the a-tDCS group (a-tDCS; n = 12) or sham-tDCS group (s-tDCS; n = 10). Both groups received 20 min of tDCS followed by 30 min of MCE. The LM and erector spinae (ES) cortical topography, LM activation, movement control battery tests, and clinical outcomes (disability and quality of life) were measured pre- and post-intervention.
Significant interaction (group × time; p < 0.01) was found in the distance between LM and ES cortical locations. The a-tDCS group demonstrated significantly fewer discrete peaks (p < 0.05) in both ES and LM and significant improvements (p < 0.05) in clinical outcomes post-intervention. The s-tDCS group demonstrated a significant increase (p < 0.05) in the number of discrete peaks in the LM cortical topography. No significant changes (p > 0.05) in LM activation were observed in either group; however, both groups demonstrated improved movement patterns.
Our findings suggest that combined a-tDCS with MCE can separate LM and ES locations over time while s-tDCS (MCE alone) reduces the distance. Our study did not find superior benefits of adding a-tDCS before MCE for LM activation, movement patterns, or clinical outcomes.
慢性下腰痛（CLBP）患者的异常运动与腰椎多裂肌（LM）功能障碍和皮质拓扑变化有关。经颅直流电刺激（tDCS）阳极刺激（a-tDCS）可以通过启动运动控制训练（MCE）的神经肌肉系统来增强皮质兴奋性，从而增强 LM 激活和运动控制。本研究旨在确定为期 6 周的 MCE 方案与 a-tDCS 联合治疗对 CLBP 患者皮质拓扑、LM 激活、运动模式和临床结果的影响。
22 例 CLBP 患者随机分为 a-tDCS 组（a-tDCS；n=12）或假刺激-tDCS 组（s-tDCS；n=10）。两组均接受 20 分钟 tDCS 治疗，随后进行 30 分钟 MCE。在干预前后分别测量 LM 和竖脊肌（ES）皮质地形图、LM 激活、运动控制电池测试和临床结果（残疾和生活质量）。
发现 LM 和 ES 皮质位置之间的距离存在显著的组间交互作用（p<0.01）。a-tDCS 组 ES 和 LM 的离散峰明显减少（p<0.05），干预后临床结果显著改善（p<0.05）。s-tDCS 组 LM 皮质地形图中的离散峰数显著增加（p<0.05）。两组 LM 激活均无明显变化（p>0.05）；然而，两组运动模式均有所改善。
我们的研究结果表明，a-tDCS 联合 MCE 可以随着时间的推移将 LM 和 ES 位置分开，而 s-tDCS（仅 MCE）则会缩小两者之间的距离。我们的研究没有发现在 MCE 之前增加 a-tDCS 对 LM 激活、运动模式或临床结果有更好的益处。
