MOTOR TRAINING ASSOCIATED

NEURAL PLASTICITY WITH

CHRONIC LOW BACK PAIN :
LITERATURE REVIEW

US NO:NU18UPY030
 INTRODUCTION
• Low back paini(LBP)is the fifth most common reason for
hospital visits, affecting about 60% to 80% of people at
some point in their lives. Chronic low back pain is
defined as pain that lasts longer than three months,
causes of LBP are infrequent, and a specific generator
cannot be identified with certainly in about 90% of
cases.i
• In persistent low back pain, neurochemical, structural,
and functional cortical abnormalities have been related
to several brain regions, including the somatosensory
cortex. Complex peripheral and central sensitization
pathways may impact the transition from acute to
chronic pain
• The nervous system's ability to adjust itself, functionally
and structurally, in response to experience and injury is
referred to as “neural plasticity”.
• Plasticity is an important part of neuronal development
and normal nervous system function, as well as a
response to environmental changes, aging, and
pathological damage. Plasticity is required not just for
neural networks to obtain new functional features, but
also for them to remain robust and stable
 TYPES OF LOW BACK PAIN

• Sciatica:
Sciatica pain is often described as a sudden, hot pain
that shoots down the buttocks and leg.
• Non-sciatica:
Non-sciatica pain is mostly in your back and not felt in
the legs.
 TYPES OF NEUROPLASTICITY
• Structural neuroplasticity
• Functional neuroplasticity

Structural neuroplasticity:
Structural plasticity is often understood as the brain's ability
to change its neuronal connections. New neurons are
constantly produced and integrated into the central
nervous system throughout the life span based on this type
of neuroplasticity.
Functional neuroplasticity:
Functional plasticity refers to brain's ability to alter and
adapt the functional properties of neurons. The changes
can occur in response to previous activity (activity-
dependent plasticity) to acquire memory or in response
to malfunction or damage of neurons (reactive plasticity)
to compensate a pathological event.
 METHODOLOGY
Inclusion criteria:
• Studies published in English
• Included quantification of atleast one neuroplastic outcome
measure.
• Studies were made on the certain group of people in which few
participants were selected in which the low back pain is seen in
them.
• Observational studies were made and participants in whom the
back pain is seen where included for the inclusion study
Exclusion criteria:
• Studies are not included LBP.
• Outcome measures not assessing motor neuroplasticity
• Studies Including : reviews 5/74 and conference abstracts or
presentations.
• Studies that are not performed individual with LBP.
• Studies not performed on Human participants
 SUMMARY OF LITERATURE
AUTHOR METHODOLOGY RESULT CONCLUSION

Hugo Masse- 24 people ISOM and GLOB ISOM influenced

Alariea, Louis- suffering with low both helped with brain plasticity
David Beaulieua, back pain given pain and better, based on
Richard preuss b isometric and impairment. 22 changes in
Cyril Schneider global exercises, people completed cortico-spinal
a,c for 3-week daily the whole excitability and
practice. session, no MF-S postural
adverse effects adaptations.
were noticed.
 AUTHOR METHODOLOGY RESULT CONCLUSION

Adriaan Louw, The study enlisted the There were no The findings show
Kevin Farrell, and participation of 62 statistically significant that a neuroplasticity
Laura Timmerman patients with persistent interactions between explanation, as
LBP. all the the groups for LBP, leg opposed to a typical
demographic pain, or trunk flexion. biomechanical
information , pain SLR revealed a explanation, resulted
ratings for low back significant difference in in a significant change
and leg pain , favor of the in SLR in LBP
disability , fear neuroplasticity patients. There were
avoidance , forward explanation, no differences in LBP,
flexion and SLR were participants in the leg pain, or forward
collected. patients were neuroplasticity group flexion across the
then randomly were 7.2times more groups, according to
assigned to one of two likely than those in the the findings.
explanations. mechanical group to
(neuroplasticity or improve beyond the
mechanical) MDC ion the SLR
 AUTHOR METHODOLOGY RESULT CONCLUSION

F.A. Hazime, A.F. 92 patients with low Only the tDCS+PES The findings imply
Baptista D.G. de back pain were groups achieved a that in the near
Freitas R.L. randomly assigned two-point drop term, both
Monteiro R.L. to receive 12 compared to the tDCS+PES and
Maretto R.H. Hasue sessions ion non sham group, but not PES alone are
S.M.A. Joao consecutive days the tDCS alone. beneficial in
for 3 months. after only four alleviating LBP.
tDCS+PES, is used weeks of therapy
and even sham with tDCS+PES,
group. pain global perception
intensity, disability, improved and
and global remained stable for
perception were 3 months.
assessed.
 DISCUSSION
• This study tried to understand the effect of
physiotherapy techniques on neuroplasticity in
individuals with CLBP.
• study was conducted utilising tDCS, PES, and a Sham
group.
• This original experimentally constructed investigation in
CLBP confirmed the workings of two exercises on
Anticipatory postural adjustment (APA) and primary
motor cortex (M1) function.
• Isometric exercise(ISOM) training impacted brain
function and accelerated Multifidus, Anticipatory
postural adjustment, but only in a short-term manner
following the each exercise session.

• M1 plasticity and APA: Previous findings of this study

show that 3-week ISOM training helps in increasing
neuroplasticity and helped to minimize pain.
• Manual therapy is a type of sensory discrimination,
integration, and remapping therapy. As a result, recent
pain neuroscience education studies using single-case
functional magnetic resonance imaging have revealed
immediate cortical changes in the brains of patients with
LBP, with one showing immediate changes in the motor
cortex and the patient's SLR improving 7 degrees after
the education.
 CONCLUSION
• Our study found that manual therapy, tDCS, PES, And
manual therapy education on neural plasticity have
shown to bring in neuroplastic changes in the brain,
however further studies with a larger sample size need
to be assessed to generalise the findings of the study.
REFERENCE
1. Pai S, Sundaram LJ. Low back pain: an economic assessment in the United States.
Orthopedic Clinics. 2004;35(1):1-5. https://doi.org/10.1016/S0030-5898(03)00101-9
2. Andersson GB. Epidemiological features of chronic low-back pain. The lancet. 1999.
14;354(9178):581-5. https://doi.org/10.1016/S0140- 6736(99)01312-4
3. Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back
pain in adults. Neuromodulation: Technology at the Neural Interface.2014 .17:3-10.
https://doi.org/10.1111/ner.12018
4. Cassidy JD, Côté P, Carroll LJ, Kristman V. Incidence and course of low back pain
episodes in the general population.Spine.2005 15;30(24):2817- 23.
https://doi:10.1097/01.brs.0000190448.69091.53
5. Wand BM, Parkitny L, O‟Connell NE, Luomajoki H, McAuley JH, Thacker M, Moseley
GL. Cortical changes in chronic low back pain: current state of the art and implications
for clinical practice. Manual therapy. 2011 1;16(1):15-20.
https://doi.org/10.1016/j.math.2010.06.008
6. Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in
patients with „unexplained‟chronic pain: an update. Expert opinion on
pharmacotherapy. 2014 1;15(12):1671-83.
https://doi.org/10.1517/14656566.2014.925446
7. Wand BM, Parkitny L, O‟Connell NE, Luomajoki H, McAuley JH, Thacker M, Moseley
GL. Cortical changes in chronic low back pain: current state of the art and implications
for clinical practice. Manual therapy. 2011 1;16(1):15-20.
https://doi.org/10.1016/j.math.2010.06.008
8. Mifflin KA, Kerr BJ. The transition from acute to chronic pain: understanding how
different biological systems interact. Canadian Journal of Anesthesia/Journal canadien
d'anesthésie. 2014 61(2):112-22. https://doi.org/10.1007/s12630-013-0087-4
9. Warraich Z, Kleim JA. Neural plasticity: the biological substrate for neurorehabilitation.
Pm&r. 2010 ;2:S208-19. https://doi.org/10.1016/j.pmrj.2010.10.016
10. Abraham WC, Robins A. Memory retention–the synaptic stability versus plasticity
dilemma. Trends in neurosciences. 2005 1;28(2):73-8.
https://doi.org/10.1016/j.tins.2004.12.003
11.Myers LK. Application of neuroplasticity theory through the use of the Feldenkrais Method®
with a runner with scoliosis and hip and lumbar pain: A case report. Journal of Bodywork and
Movement Therapies. 2016 1;20(2):300-9. https://doi.org/10.1016/j.jbmt.2015.06.003
12.Hazime FA, Baptista AF, de Freitas DG, Monteiro RL, Maretto RL, Hasue RH, Joao SM.
Treating low back pain with combined cerebral and peripheral electrical stimulation: A
randomized, double‐blind, factorial clinical trial. European Journal of Pain. 2017 (7):1132-43.
https://doi.org/10.1002/ejp.1037
13.Massé-Alarie H, Beaulieu LD, Preuss R, Schneider C. Influence of paravertebral muscles
training on brain plasticity and postural control in chronic low back pain. Scandinavian Journal
of Pain. 2016;1:74-83. https://doi.org/10.1016/j.sjpain.2016.03.005
14.Massé-Alarie H, Beaulieu LD, Preuss R, Schneider C. Repetitive peripheral magnetic
neurostimulation of multifidus muscles combined with motor training influences spine motor
control and chronic low back pain. Clinical Neurophysiology. 2017 (3):442-53.
http://dx.doi.org/10.1016/j.clinph.2016.12.020