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Corticomotor control of lumbar multifidus muscles is impaired in chronic low back pain: concurrent evidence from ultrasound imaging and double-pulse transcranial magnetic stimulation

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Abstract

Chronic low back pain (CLBP) is often associated with impaired control of deep trunk muscles and reorganization of the primary motor areas (M1). Precisely, functional changes of the lumbar multifidus muscles (MF) involved in spine stability may be of special interest in rehabilitation. Therefore, we tested MF corticomotor control using double transcranial magnetic stimulation (TMS) paradigms for the first time in this muscle and examined its link with MF volitional activation. Eleven individuals with lateralized CLBP and 13 pain-free participants were recruited. Ultrasound imaging enabled measurement of MF volitional isometric contraction in prone lying. TMS of MF M1 area was used to test hemispheric excitability and mechanisms in relation to motor programming, i.e., active motor threshold (AMT), amplitude of motor-evoked potentials and short-interval intracortical inhibition (SICI) and facilitation (SICF). In CLBP, SICI level was lower in the left hemisphere and MF volitional contraction was not related to AMT (M1 excitability), conversely to what was observed in the pain-free group. No other between-group difference was detected. These original findings support a plasticity of cortical maps controlling paravertebral muscles and likely including a different motor strategy for the control of MF. Changes of M1 function may thus underlie impaired motor control of lumbopelvic spine and pain persistence in CLBP.

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Acknowledgments

The authors acknowledge the support of the Canadian Foundation for Innovation (CS equipment), the Fonds de Recherche en Santé du Québec (HMA and LDB PhD studentship), the Canadian Institute for Health Research (HMA PhD studentship), Université Laval (HMA PhD studentship) and Ms. Mélaine Henry for recruitment and study coordination.

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  1. Laboratory of Clinical Neuroscience and Neurostimulation, Neuroscience Division of the Centre de Recherche du CHU de Québec, RC-9800, 2705 Blvd. Laurier, Quebec City, QC, G1V 4G2, Canada

    Hugo Massé-Alarie, Louis-David Beaulieu & Cyril Schneider

  2. Constance Lethbridge Rehabilitation Center Research Site of the CRIR, Montreal, QC, Canada

    Hugo Massé-Alarie & Richard Preuss

  3. School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada

    Richard Preuss

  4. Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, QC, Canada

    Cyril Schneider

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  1. Hugo Massé-Alarie
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Correspondence to Cyril Schneider.

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Massé-Alarie, H., Beaulieu, LD., Preuss, R. et al. Corticomotor control of lumbar multifidus muscles is impaired in chronic low back pain: concurrent evidence from ultrasound imaging and double-pulse transcranial magnetic stimulation. Exp Brain Res 234, 1033–1045 (2016). https://doi.org/10.1007/s00221-015-4528-x

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