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Differences in brain processing of proprioception related to postural control in patients with recurrent non-specific low back pain and healthy controls
No full textPatients with non-specific low back pain (NSLBP) show an impaired postural control during standing and a slower performance of sit-to-stand-to-sit (STSTS) movements. Research suggests that these impairments could be due to an altered use of ankle compared to back proprioception. However, the neural correlates of these postural control impairments in NSLBP remain unclear. Therefore, we investigated brain activity during ankle and back proprioceptive processing by applying local muscle vibration during functional magnetic resonance imaging in 20 patients with NSLBP and 20 controls. Correlations between brain activity during proprioceptive processing and (Airaksinen et al., 2006) proprioceptive use during postural control, evaluated by using muscle vibration tasks during standing, and (Altmann et al., 2007) STSTS performance were examined across and between groups. Moreover, fear of movement was assessed. Results revealed that the NSLBP group performed worse on the STSTS task, and reported more fear compared to healthy controls. Unexpectedly, no group differences in proprioceptive use during postural control were found. However, the relationship between brain activity during proprioceptive processing and behavioral indices of proprioceptive use differed significantly between NSLBP and healthy control groups. Activity in the right amygdala during ankle proprioceptive processing correlated with an impaired proprioceptive use in the patients with NSLBP, but not in healthy controls. Moreover, while activity in the left superior parietal lobule, a sensory processing region, during back proprioceptive processing correlated with a better use of proprioception in the NSLBP group, it was associated with a less optimal use of proprioception in the control group. These findings suggest that functional brain changes during proprioceptive processing in patients with NSLBP may contribute to their postural control impairments.sponsorship: This study was supported by Flanders Innovation and Entrepreneurship (VLAIO) (PhD Grant for Strategic Basic Research Nina Goossens, Grant Number ZKC9172-00-W01) and the Research Foundation Flanders (FWO) (Postdoctoral Fellowship Lotte Janssens, Grant Number 12M9815N). The authors gratefully acknowledge Paul Meugens, dr. Ronald Peeters and Rene Clerckx for their technical support during fMRI scanning. Moreover, the authors are grateful to the subjects who volunteered to participate in this study. (Flanders Innovation and Entrepreneurship (VLAIO)|ZKC9172-00-W01, Research Foundation Flanders (FWO)|12M9815N)status: Publishe
Changes in the organization of the secondary somatosensory cortex while processing lumbar proprioception and the relationship with sensorimotor control in low back pain
No full textOBJECTIVES: Patients with nonspecific low back pain (NSLBP) rely more on the ankle compared with the lower back proprioception while standing, perform sit-to-stand-to-sit (STSTS) movements slower, and exhibit perceptual impairments at the lower back. However, no studies investigated whether these sensorimotor impairments relate to a reorganization of the primary and secondary somatosensory cortices (S1 and S2) and primary motor cortex (M1) during proprioceptive processing. MATERIALS AND METHODS: Proprioceptive stimuli were applied at the lower back and ankle muscles during functional magnetic resonance imaging in 15 patients with NSLBP and 13 controls. The location of the activation peaks during the processing of proprioception within S1, S2, and M1 were determined and compared between groups. Proprioceptive use during postural control was evaluated, the duration to perform 5 STSTS movements was recorded, and participants completed the Fremantle Back Awareness Questionnaire (FreBAQ) to assess back-specific body perception. RESULTS: The activation peak during the processing of lower back proprioception in the right S2 was shifted laterally in the NSLBP group compared with the healthy group (P=0.007). Moreover, patients with NSLSP performed STSTS movements slower (P=0.018), and reported more perceptual impairments at the lower back (P<0.001). Finally, a significant correlation between a more lateral location of the activation peak during back proprioceptive processing and a more disturbed body perception was found across the total group (ρ=0.42, P=0.025). CONCLUSIONS: The results suggest that patients with NSLBP show a reorganization of the higher-order processing of lower back proprioception, which could negatively affect spinal control and body perception.sponsorship: Supported by the Flanders Innovation & Entrepreneurship (VLAIO) (PhD Grant for Strategic Basic Research Nina Goossens, Grant Number ZKC9172-00-W01), Brussels, Belgium and the Research Foundation Flanders (FWO) (Postdoctoral Fellowship Lotte Janssens, Grant Number 12M9815N), Brussels, Belgium. The authors declare no conflict of interest. (Flanders Innovation & Entrepreneurship (VLAIO), Brussels, Belgium|ZKC9172-00-W01, Research Foundation Flanders (FWO), Brussels, Belgium|12M9815N)status: Publishe
Association between sensorimotor impairments and functional brain changes in patients with low back pain: a critical review
No full textLow back pain (LBP) coincides with sensorimotor impairments, e.g., reduced lumbosacral tactile and proprioceptive acuity and postural control deficits. Recent functional magnetic resonance imaging (fMRI) studies suggest that sensorimotor impairments in LBP may be associated with brain changes. However, no consensus exists regarding the relationship between functional brain changes and sensorimotor behavior in LBP. Therefore, this review critically discusses the available fMRI studies on brain activation related to non-nociceptive somatosensory stimulation and motor performance in individuals with LBP. Four electronic databases were searched, yielding nine relevant studies. Patients with LBP showed reduced sensorimotor-related brain activation and a reorganized lumbar spine representation in higher-order (multi)sensory processing and motor regions, including primary and secondary somatosensory cortices, supplementary motor area and superior temporal gyrus. These results may support behavioral findings of sensorimotor impairments in LBP. Additionally, patients with LBP displayed widespread increased sensorimotor-evoked brain activation in regions often associated with abnormal pain processing. Over-activation in these regions could indicate an over-responsiveness to sensory inputs that signal potential harm to the spine, thereby inducing over-generalized protective responses. Hence, functional brain changes could contribute to the development and recurrence of LBP. However, future studies investigating the causality between sensorimotor-related brain function and LBP are imperative.sponsorship: Funding or grants or equipment provided for the project from any source: This study was funded by the Agency for Innovation by Science and Technology (Agentschap voor Innovatie door Wetenschap en Technologie IWT) (PhD Grant for Strategic Basic Research Nina Goossens, Grant Number ZKC9172-00-W01) and by the Research Foundation Flanders (Fonds Wetenschappelijk Onderzoek) (Postdoctoral Fellowship Lotte Janssens, Grant Number 12M9815N). (Agency for Innovation by Science and Technology|ZKC9172-00-W01, Research Foundation Flanders|12M9815N)status: Publishe
The effect of acute respiratory demand on postural control: a systematic review
No full textBackground: Postural control can be challenged by breathing.
Research question: What is the effect of an acute increase in respiratory demand on postural control compared to quiet breathing?
Methods: A systematic review was conducted. Electronic databases were systematically searched until October 18, 2022 on studies reporting changes in center of pressure (CoP) motion related to an acute manipulation of respiratory demand compared to quiet breathing during upright standing in healthy participants and/or participants with a clinical condition.
Results: Twenty-one studies in healthy participants showed that voluntary (not metabolic-induced) hyperventilation or inspiratory resistive loading significantly increased CoP motion, while breath-holding decreased CoP motion, compared to quiet breathing (p 0.05), except for breathing at different rates, whereas they showed greater CoP motion during quiet breathing.
Significance: The extent of postural disturbance depended on the breathing mode and how it was quantified (i.e., CoP coupled with breathing movement or overall CoP measures). Voluntary hyperventilation and inspiratory resistive loading increased postural sway. For voluntary hyperventilation, this could be explained by CoP motion being directly coupled to chest wall movements whereas metabolic-induced hyperventilation did not increase CoP motion or CoP coupling with breathing. Breath-holding decreased postural sway. Patients with low back pain show greater postural sways than pain-free individuals during quiet breathing, although they exhibit similar postural adaptations to respiratory-related challenges as controls.This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors. PH is supported by a Fellowship (APP1194937) from the National Health and Medical Research Council (NHMRC), Australia. NJ (11M2624N) and NG (G072122N) are supported by Research Foundation Flanders (FWO). They declare no competing interests
Can interventions for reducing sedentary behavior of office workers in Belgium influence low back pain?
No full textAssociations between Measures of Structural Morphometry and Sensorimotor Performance in Individuals with Nonspecific Low Back Pain
No full textBACKGROUND AND PURPOSE: To date, most structural brain imaging studies in individuals with nonspecific low back pain have evaluated volumetric changes. These alterations are particularly found in sensorimotor-related areas. Although it is suggested that specific measures, such as cortical surface area and cortical thickness, reflect different underlying neural architectures, the literature regarding these different measures in individuals with nonspecific low back pain is limited. Therefore, the current study was designed to investigate the association between the performance on a sensorimotor task, more specifically the sit-to-stand-to-sit task, and cortical surface area and cortical thickness in individuals with nonspecific low back pain and healthy controls. MATERIALS AND METHODS: Seventeen individuals with nonspecific low back pain and 17 healthy controls were instructed to perform 5 consecutive sit-to-stand-to-sit movements as fast as possible. In addition, T1-weighted anatomic scans of the brain were acquired and analyzed with FreeSurfer. RESULTS: Compared with healthy controls, individuals with nonspecific low back pain needed significantly more time to perform 5 sit-to-stand-to-sit movements (P < .05). Brain morphometric analyses revealed that cortical thickness of the ventrolateral prefrontal cortical regions was increased in patients with nonspecific low back pain compared with controls. Furthermore, decreased cortical thickness of the rostral anterior cingulate cortex was associated with lower sit-to-stand-to-sit performance on an unstable support surface in individuals with nonspecific low back pain and healthy controls (r = -0.47, P < .007). In addition, a positive correlation was found between perceived pain intensity and cortical thickness of the superior frontal gyrus (r = 0.70, P < .002) and the pars opercularis of the inferior ventrolateral prefrontal cortex (r = 0.67, P < .004). Hence, increased cortical thickness was associated with increased levels of pain intensity in individuals with nonspecific low back pain. No associations were found between cortical surface area and the pain characteristics in this group. CONCLUSIONS: The current study suggests that cortical thickness may contribute to different aspects of sit-to-stand-to-sit performance and perceived pain intensity in individuals with nonspecific low back pain.sponsorship: This work was supported by the Agency for Innovation by Science and Technology Flanders (http://www.iwt.be) (PhD fellowship to Madelon Pijnenburg and PhD fellowship to Nina Goossens, grant No,141037) and by the Research Foundation Flanders (http://www.fwo.be) (postdoctoral fellowship: Lotte Janssens, grant No.12M9815N). (Agency for Innovation by Science and Technology Flanders|141037, Research Foundation Flanders|12M9815N)status: Publishe
Physiotherapist- and patient-reported barriers to guideline implementation of active physiotherapeutic management of low back pain: A theory-informed qualitative study
No full textBackground and objective: Adoption of low back pain (LBP) guidelines in physiotherapeutic management is a welldocumented problem. Thereby, an in-depth understanding of the barriers to implement an active approach for both patients and physiotherapists is needed. Design: Semi-structured interviews were conducted with physiotherapists and patients with non-specific LBP. Interviews, guided by the Theoretical Domains Framework (TDF), were analyzed using the Qualitative Analysis Guide of Leuven. Results: A total of 20 participants were interviewed, including ten physiotherapists and ten patients. Our findings reveal that patients and physiotherapists face each 23 barriers spanning 14 TDF domains. The TDF domain "social influences" revealed the most barriers, followed by "beliefs about consequences" and "environmental context" for patients and physiotherapists, respectively. Five barriers did overlap between both groups (lack of guideline awareness, incorrect exercise performance, interdisciplinary communication gaps, time constraints and challenges in patient compliance). Conclusions: Barriers to LBP guideline recommended physiotherapeutic practices span all 14 TDF domains. Consequently, future implementation interventions need to address multiple TDF domains for effective LBP guideline implementation.Liedewij Bogaert received funding from Research Foundation - Flanders (FWO, 118152N). This research did not receive any other specific grant from funding agencies in the public, commercial, or notfor-profit sectors
Structural brain connectivity and the sit-to-stand-to-sit performance in individuals with non-specific low back pain: A diffusion MRI based network analysis
No full textIndividuals with non-specific low back pain (NSLBP) show an impaired sensorimotor control. They need significantly more time to perform five consecutive sit-to-stand-to-sit (STSTS) movements compared to healthy controls. Optimal sensorimotor control depends on the co-activation of many brain regions, which have to operate as a co-ordinated network to achieve correct motor output. Therefore, the examination of brain connectivity from a network perspective is crucial for understanding the factors that drive sensorimotor control. In the current study, potential alterations in structural brain networks of individuals with NSLBP and the correlation with the performance of the STSTS task were investigated. Seventeen individuals with NSLBP and 17 healthy controls were instructed to perform five consecutive STSTS movements as fast as possible. In addition, data of diffusion magnetic resonance imaging were acquired and analyzed using a graph theoretical approach. Results showed that individuals with NSLBP needed significantly more time to perform the STSTS task compared to healthy controls (p < 0.05). Both groups exhibited small-world properties in their structural networks. However, local efficiency was significantly decreased in the NSLBP patients compared with controls (p < 0.05, FDR corrected). Moreover, global efficiency was significantly correlated with the sensorimotor task performance within the NSLBP group (r = -0.73, p = 0.002). Our data show disrupted network organization of white matter networks in patients with NSLBP, which may contribute to their persistent pain and motor disabilities.sponsorship: This work was supported by the Agency for Innovation by Science and Technology-Flanders (IWT) (PhD fellowships M.P. and N.G., grant number 141037) (www.iwt.be) and The Research Foundation-Flanders (FWO) (postdoctoral fellowship L.J., grant number: 12M9815N). The funders had no role in study design; collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The authors are grateful to the study volunteers for their participation and to Alexander Leemans for his help with ExploreDTI. (Agency for Innovation by Science and Technology-Flanders (IWT)|141037, Research Foundation-Flanders (FWO)|12M9815N)status: Publishe
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