Devecchi Valter, Falla Deborah, Cabral Hélio V, Abboud Jacques, Hodges Paul, Gallina Alessio
School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Science, University of Birmingham, Birmingham, UK.
Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.
Eur J Pain. 2025 Nov;29(10):e70142. doi: 10.1002/ejp.70142.
People with chronic low back pain (LBP) often experience pain evoked by movement (movement-evoked pain [MEP]). Although pain changes how people move, it remains unclear whether motor adaptations to LBP are specific to the pain-provocative movement. This crossover experimental study aimed to understand whether pain modulated by movement in different directions induces distinct motor adaptations, and if these adaptations are consistent with a purposeful strategy to minimise pain.
Thirty healthy adults performed a repetitive box lifting task in two experimental sessions. Experimental pain was induced in the lumbosacral region using nociceptive electrical stimulation, with intensity modulated proportionally to either lumbar flexion or extension. Within-subject changes in kinematics and centre of pressure were assessed both during and post-pain.
During both sessions and over time, participants reduced their lumbar movement in the pain-provocative direction (p < 0.01), but not in the non-pain-provoking direction (p > 0.078). The reduction in lumbar flexion was strongly associated with perceived pain intensity (p < 0.001) and persisted beyond pain resolution (p < 0.001). Pain during lumbar flexion also induced other acute motor adaptations, including reduced elbow flexion (p = 0.027) and an anterior shift of the centre of pressure (p < 0.001).
This study revealed that the direction of the pain-provocative movement is a determinant factor in motor adaptations to pain, with clinical implications in developing personalised, movement-based interventions for LBP. Further, motor adaptations were not simply a generic acute response to pain but evolved to minimise pain, supporting the proposal that MEP is a motivational stimulus for adaptive behaviour driven by learning.
This study shows that motor adaptations to MEP are specific to the direction of pain-provocative movement, evolve over time and represent a purposeful strategy to reduce pain. These findings highlight the reciprocal interactions between pain and movement, supporting the rationale for assessing motor strategies in people with movement-evoked LBP.
慢性下腰痛（LBP）患者常经历由运动诱发的疼痛（运动诱发疼痛[MEP]）。尽管疼痛会改变人们的运动方式，但尚不清楚对LBP的运动适应是否特定于诱发疼痛的运动。这项交叉实验研究旨在了解不同方向运动所调制的疼痛是否会诱发不同的运动适应，以及这些适应是否与旨在最小化疼痛的有目的策略一致。
30名健康成年人在两个实验环节中执行重复的搬箱子任务。使用伤害性电刺激在腰骶部诱发实验性疼痛，强度根据腰椎前屈或后伸成比例调制。在疼痛期间和疼痛后评估运动学和压力中心的受试者内变化。
在两个环节以及整个时间段内，参与者在诱发疼痛的方向上减少了腰椎运动（p < 0.01），但在未诱发疼痛的方向上没有减少（p > 0.078）。腰椎前屈的减少与感知到的疼痛强度密切相关（p < 0.001），并且在疼痛缓解后仍持续存在（p < 0.001）。腰椎前屈期间的疼痛还诱发了其他急性运动适应，包括肘部屈曲减少（p = 0.027）和压力中心向前移动（p < 0.001）。
本研究表明，诱发疼痛运动的方向是运动对疼痛适应的决定性因素，对制定针对LBP的个性化、基于运动的干预措施具有临床意义。此外，运动适应不仅仅是对疼痛的一般急性反应，而是演变为最小化疼痛，支持了MEP是由学习驱动的适应性行为的动机性刺激这一观点。
本研究表明，对MEP的运动适应特定于诱发疼痛运动的方向，随时间演变，代表了一种减少疼痛的有目的策略。这些发现突出了疼痛与运动之间的相互作用，支持了评估运动诱发LBP患者运动策略的基本原理。
