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Changes in Motor Cortex Following Exercises for Chronic Low Back Pain

This study has been completed.
Information provided by:
The University of Queensland Identifier:
First received: March 17, 2009
Last updated: NA
Last verified: March 2009
History: No changes posted
The motor cortex of the brain changes following chronic pain and injury, and this is linked to pain-associated changes in motor behaviour. This study aimed to investigate whether therapeutic exercises in patients with chronic pain can induce reorganisation of the motor cortex and restore normal motor behaviour. The investigators hypothesised that motor training can induce reorganisation of the motor cortex and that these changes are related to improved motor behaviour.

Condition Intervention Phase
Chronic Low Back Pain Behavioral: Skilled motor training Behavioral: Walking exercise Phase 1

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Investigator)
Primary Purpose: Basic Science
Official Title: Driving Plasticity in the Motor Brain in Chronic Back Pain

Resource links provided by NLM:

Further study details as provided by The University of Queensland:

Primary Outcome Measures:
  • Motor cortical map and excitability from transcranial magnetic stimulation [ Time Frame: Pre and 2 weeks post-intervention ]

Secondary Outcome Measures:
  • Motor activation of the abdominal muscles during functional arm movement task [ Time Frame: Pre and 2 weeks post-intervention ]
  • Self-reported pain (VAS scale) and functional scale (patient-specific functional scale) [ Time Frame: Pre and 2 weeks post-intervention ]

Enrollment: 20
Study Start Date: October 2006
Study Completion Date: September 2007
Primary Completion Date: September 2007 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1 Behavioral: Skilled motor training
This involves training subjects to independently and cognitively activate the deep abdominal muscles, transversus abdominis, with minimal or no activity in other trunk muscles. The contraction is held for 10 seconds and subjects complete three blocks of ten contractions, twice per day for two weeks. This training protocol is commonly used clinically for people with chronic back pain.
Active Comparator: 2 Behavioral: Walking exercise
The control intervention involves walking exercises for ten minutes, twice per day. Subjects are advised to walk at their own pace with no instructions on activation of specific trunk muscles. The exercise is performed over two weeks.

Detailed Description:
The sensory and motor systems can reorganize following injury and learning of new motor skills. Recently we observed adaptive changes in motor cortical organization in patients with chronic back pain, which are closely linked to changes in motor behavior. Although pain-related alterations in behavior can be trained and are associated with improved symptoms, it remains unclear whether these meaningful functional outcomes are related to motor cortical reorganization. Here we investigate the effects of two interventions in people with chronic back pain: skilled motor training and a control intervention of self-paced walking exercise. We measured motor cortical excitability (motor threshold (MT)) and organization (center of gravity (CoG) and map volume) of the deep abdominal muscle, transversus abdominis (TrA), using transcranial magnetic stimulation (TMS). In addition, motor behavior of TrA was assessed during single rapid arm movements. The study helps to elucidate the mechanisms of specific motor exercises in chronic back pain management.

Ages Eligible for Study:   18 Years to 55 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Sustained or episodic non-specific low back pain lasting longer than 3 months

Exclusion Criteria:

  • Orthopaedic, neurological, circulatory or respiratory conditions
  • History or family history of epilepsy
  • Recent or current pregnancies
  • Previous surgery to the abdomen or back
  • Abdominal or back exercises in the preceding 12 months
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Please refer to this study by its identifier: NCT00864422

Australia, Queensland
Centre for Clinical Research Excellence in Spinal Pain, Injury and Health
Brisbane, Queensland, Australia, 4072
Sponsors and Collaborators
The University of Queensland
Study Director: Paul W Hodges, MedDr (Neurosci) PhD BPhty The University of Queensland
Principal Investigator: Henry Tsao, PhD MPhty (Manipulative) BPhty The University of Queensland
  More Information

Responsible Party: Dr Henry Tsao, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health Identifier: NCT00864422     History of Changes
Other Study ID Numbers: NHMRC-ID351656
Study First Received: March 17, 2009
Last Updated: March 17, 2009

Keywords provided by The University of Queensland:
low back pain
motor training
motor cortex
brain plasticity

Additional relevant MeSH terms:
Back Pain
Low Back Pain
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms processed this record on September 20, 2017