Are the changes in postural control associated with low back pain caused by pain interference?

Moseley, GL and Hodges, PW (2005) Are the changes in postural control associated with low back pain caused by pain interference?. Clinical Journal of Pain, 21 4: 323-329. doi:10.1097/01.ajp.0000131414.84596.99

Author Moseley, GL
Hodges, PW
Title Are the changes in postural control associated with low back pain caused by pain interference?
Journal name Clinical Journal of Pain   Check publisher's open access policy
ISSN 0749-8047
Publication date 2005
Sub-type Article (original research)
DOI 10.1097/01.ajp.0000131414.84596.99
Volume 21
Issue 4
Start page 323
End page 329
Total pages 7
Editor Dennis C Turk
Place of publication United States
Publisher Lippincott Williams & Wilkins
Collection year 2005
Language eng
Subject C1
321024 Rehabilitation and Therapy - Occupational and Physical
730303 Occupational, speech and physiotherapy
Abstract Background: Voluntary limb movements are associated with involuntary and automatic postural adjustments of the trunk muscles. These postural adjustments occur prior to movement and prevent unwanted perturbation of the trunk. In low back pain, postural adjustments of the trunk muscles are altered such that the deep trunk muscles are consistently delayed and the superficial trunk muscles are sometimes augmented. This alteration of postural adjustments may reflect disruption of normal postural control imparted by reduced central nervous system resources available during pain, so-called pain interference, or reflect adoption of an alternate postural adjustment strategy. Methods: We aimed to clarify this by recording electromyographic activity of the upper (obliquus extemus) and lower (transversus abdominis/obliquus internus) abdominal muscles during voluntary arm movements that were coupled with painful cutaneous stimulation at the low back. If the effect of pain on postural adjustments is caused by pain interference, it should be greatest at the onset of the stimulus, should habituate with repeated exposure, and be absent immediately when the threat of pain is removed. Sixteen patients performed 30 forward movements of the right arm in response to a visual cue (control). Seventy trials were then conducted in which arm movement was coupled with pain (pain trials) and then a further 70 trials were conducted without the pain stimulus (no pain trials). Results: There was a gradual and increasing delay of transversus abdominis/obliquus internus electromyograph and augmentation of obliquus externus during the pain trials, both of which gradually returned to control values during the no pain trials. Conclusion: The results suggest that altered postural adjustments of the trunk muscles during pain are not caused by pain interference but are likely to reflect development and adoption of an alternate postural adjustment strategy, which may serve to limit the amplitude and velocity of trunk excursion caused by arm movement.
Keyword Anesthesiology
Clinical Neurology
Low Back Pain
Trunk Muscles
Pain Interference
Lumbar Spine Stability
Transversus Abdominis
Biomechanical Model
Q-Index Code C1

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Created: Wed, 15 Aug 2007, 07:54:04 EST