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Changes in Motor Cortex Following Exercises for Chronic Low Back Pain

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00864422
Recruitment Status : Completed
First Posted : March 18, 2009
Last Update Posted : March 18, 2009
Information provided by:
The University of Queensland

Brief Summary:
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 or disease Intervention/treatment Phase
Chronic Low Back Pain Behavioral: Skilled motor training Behavioral: Walking exercise Phase 1

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.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 20 participants
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
Study Start Date : October 2006
Actual Primary Completion Date : September 2007
Actual Study Completion Date : September 2007

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
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.

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

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

Information from the National Library of Medicine

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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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00864422

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Australia, Queensland
Centre for Clinical Research Excellence in Spinal Pain, Injury and Health
Brisbane, Queensland, Australia, 4072
Sponsors and Collaborators
The University of Queensland
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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
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Responsible Party: Dr Henry Tsao, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health Identifier: NCT00864422    
Other Study ID Numbers: NHMRC-ID351656
First Posted: March 18, 2009    Key Record Dates
Last Update Posted: March 18, 2009
Last Verified: March 2009
Keywords provided by The University of Queensland:
low back pain
motor training
motor cortex
brain plasticity
Additional relevant MeSH terms:
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Back Pain
Low Back Pain
Neurologic Manifestations