Brain Advance Access originally published online on July 28, 2004
Brain 2004 127(10):2339-2347; doi:10.1093/brain/awh248
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Brain Vol. 127 No. 10 © Guarantors of Brain 2004; all rights reserved
Does anticipation of back pain predispose to back trouble?
1 Prince of Wales Medical Research Institute, Randwick, Sydney, 2 Department of Physiotherapy, The University of Queensland, 3 School of Physiotherapy, The University of Sydney and 4 Pain Management Research Institute, Royal North Shore Hospital, Sydney, Australia
Correspondence to: Lorimer Moseley, School of Physiotherapy, The University of Sydney, PO Box 170, Lidcombe NSW 1825, Austalia E-mail: l.moseley{at}uq.edu.au
Limb movement imparts a perturbation to the body. The impact of that perturbation is limited via anticipatory postural adjustments. The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pain, even when they are pain free. The altered postural strategy probably serves to protect the spine in the short term, but it is associated with a cost and is thought to predispose spinal structures to injury in the long term. It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscles during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation. There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle. For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. We conclude that anticipation of experimental back pain evokes a protective postural strategy that stiffens the spine. This protective strategy is associated with compressive cost and is thought to predispose to spinal injury if maintained long term.
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