The side of chronic low back pain matters: evidence from the primary motor cortex excitability and the postural adjustments of multifidi muscles

Massé-Alarie, Hugo; Beaulieu, Louis-David; Preuss, Richard; Schneider, Cyril

doi:10.1007/s00221-016-4834-y

Research Article
Published: 15 November 2016

The side of chronic low back pain matters: evidence from the primary motor cortex excitability and the postural adjustments of multifidi muscles

Hugo Massé-Alarie^1,2,
Louis-David Beaulieu¹,
Richard Preuss^2,3 &
Cyril Schneider ORCID: orcid.org/0000-0002-2179-0481^1,4

Experimental Brain Research volume 235, pages 647–659 (2017)Cite this article

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Abstract

Hemispheric lateralization of pain processing was reported with overactivation of the right frontal lobe. Specifically in chronic low back pain (CLBP), functional changes in the left primary motor cortex (M1) with impaired anticipatory postural activation (APA) of trunk muscles have been observed. Given the connections between frontal and M1 areas for motor planning, it is hypothesized that the pain side could differently influence M1 function and APA of paravertebral multifidus (MF) muscles. This study aimed at testing whether people with right- versus left-sided CLBP showed different M1 excitability and APA. Thirty-five individuals with lateralized CLBP (19 right-sided and 16 left-sided) and 13 pain-free subjects (normative values) were tested for the excitability of MF M1 area (active motor threshold—AMT) with transcranial magnetic stimulation and for the latency of MF APA during bilateral shoulder flexion and during unilateral hip extension in prone lying. In the right-sided CLBP group, the AMT of both M1 areas was lower than in the left-sided group and the pain-free subjects; the latency of MF APA was shorter in bilateral shoulder flexion and in the left hip extension tasks as compared to the left-sided group. In CLBP, an earlier MF APA was correlated with lower AMT in both tasks. People with right-sided CLBP presented with increased M1 excitability in both hemispheres and earlier MF APA. These results likely rely on cortical motor adaptation related to the tasks and axial muscles tested. Future studies should investigate whether CLBP side-related differences have a clinical impact, e.g. in diagnosis and intervention.

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Acknowledgements

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 studentships) and the Canadian Institute for Health Research (HMA PhD studentship).

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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
Constance Lethbridge Rehabilitation Center Research Site of the CRIR, Montreal, QC, Canada
Hugo Massé-Alarie & Richard Preuss
School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
Richard Preuss
Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
Cyril Schneider

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Hugo Massé-Alarie
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Louis-David Beaulieu
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Richard Preuss
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Cyril Schneider
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Massé-Alarie, H., Beaulieu, LD., Preuss, R. et al. The side of chronic low back pain matters: evidence from the primary motor cortex excitability and the postural adjustments of multifidi muscles. Exp Brain Res 235, 647–659 (2017). https://doi.org/10.1007/s00221-016-4834-y

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Received: 04 July 2016
Accepted: 10 November 2016
Published: 15 November 2016
Issue Date: March 2017
DOI: https://doi.org/10.1007/s00221-016-4834-y

Keywords

Primary motor cortex
Excitability
Plasticity
Anticipatory postural adjustment
Motor planning
Pain lateralization
Chronic low back pain