Functional and structural cortical changes in patients with non-specific low back pain

Authors: P. Hradilová;  J. Opavský;  D. Smékal
Authors‘ workplace: Palackého v Olomouci ;  Fakulta tělesné kultury, Univerzita
Published in: Cesk Slov Neurol N 2020; 83/116(5): 514-519
Category: Review Article


Back pain is a common part of life in most adults. The lifetime prevalence of low back pain is reported to be more than 80%. Mechanical factors, such as mild patho-anatomical imaging findings or non-ergonomic work, do not appear to play a major role in the pathogenesis of this pain. Many patients with chronic or recurrent back pain show a deficit in postural control and dysfunctional coactivation of trunk muscles. This probably significantly contributes to the development of this pain and prolonged difficulties. However, the possibilities of objectification and interpretation of functional and structural changes at the CNS level, which are the basis of these disorders, remain up to now unclear. The aim of this article is to inform the reader about the results of available recent studies which deal with changes at the highest levels of movement control in connection with non-specific low back pain. The results of these studies may contribute to understanding the nature of motor control disorders in these patients and in the future contribute also to the development of new therapeutic directions.


non-specific low back pain – motor control – cortical reorganization – functional connectivity


1. Krismer M, Van Tulder M. Low back pain (non-specific). Best Pract Res Clin Rheumatol 2007; 21 (1): 77–91. doi: 10.1016/j.berh.2006.08.004.

2. Balagué F, Mannion AF, Pellisé F et al. Non-specific low back pain. Lancet 2012; 379 (1): 482–491. doi: 10.1016/S0140-6736 (11) 60610-7.

3. Itz CJ, Geurts JW, Van Kleef M et al. Clinical course of non-specific low back pain. Eur J Pain 2013; 17 (1): 5–15. doi: 10.1002/j.1532-2149.2012.00170.x

4. Manusov EG. Evaluation and dia­gnosis of low back pain. Prim Care 2012; 39 (3): 471–479. doi: 10.1016/j.pop.2012.06.003.

5. Opavský J. Algeziologické, neurologické a rehabilitační aspekty v dia­gnostice a terapii pacientů s chronickými nespecifickými bolestmi bederního úseku páteře. Neurol praxi 2015; 16 (5): 262–265.

6. Allegri M, Montella S, Salici F et al. Mechanisms of low back pain: a guide for dia­gnosis and therapy. F1000Res 2016; 5: F1000. doi: 10.12688/f1000research.8105.

7. Maher Ch, Underwood M, Buchbinder R. Non-specific low back pain. Lancet 2017; 389 (10070): 736–747. doi: 10.1016/S0140-6736 (16) 30970-9.

8. Tawa N, Rhoda A, Diener I. Accuracy of magnetic resonance imaging in detecting lumbo-sacral nerve root compromise: a systematic literature review. BMC Musculoskelt Disord 2016; 17 (386): 386. doi: 10.1186/s12891-016-1236-z.

9. Han TS, Schouten JS, Lean ME et al. The prevalence of low back pain and associations with body fatness, fat distribution and height. Int J Obes Relat Metab Disord 1997; 21 (7): 600–607. doi: 10.1038/sj.ijo.0800448.

10. Shiri R, Karppinen J, Leino-Arjas P et al. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol 2009; 171 (2): 135–154. doi: 10.1093/aje/kwp356.

11. Hoy D, Bain C, Williams G et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012; 64 (6): 2028–2037. doi: 10.1002/art.34347.

12. Manchikanti L, Singh V, Falco FJ, Benyamin RM et al. Epidemiology of low back pain in adults. Neuromodulation 2014; 17 (Suppl 2): 3–10. doi: 10.1111/ner.1201.

13. Dankaerts W, O’Sullivan PB, Straker LM et al. The inter-examiner reliability of a classification method for non-specific chronic low back pain patients with motor control impairment. Man Ther 2006; 11 (1): 28–39. doi: 10.1016/j.math.2005.02.001.

14. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine 1996; 21 (22): 2640–2650. doi: 10.1097/00007632-199611150-00014.

15. O’Sullivan P. Dia­gnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther 2005; 10 (4): 242–255. doi: 10.1016/j.math.2005.07.001.

16. Čápová J. Od posturální ontogeneze k terapeutic­kému konceptu. Ostrava: Repronis 2016.

17. Chmelová I. Bobath koncept v pediatrické praxi. Ostrava: Ostravská univerzita v Ostravě 2011.

18. Panjabi, MM. The stabilizing system of the spine: Part I. function, dysfunction, adaptation, and enhancement. J Spinal Disord 1992; 5 (4): 383–389. doi: 10.1097/ 00002517-199212000-00001.

19. Radebold A, Cholewicki J, Polzhofer GK et al. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine 2001; 26 (7): 724–730. doi: 10.1097/00007632-200104010-00004.

20. Kolář P. Rehabilitace v klinické praxi. Praha: Galén 2009.

21. Meier ML, Vrana A, Schweinhardt P. Low back pain: the potential contribution of supraspinal motor control and proprioception. Neuroscientist 2019; 25 (6): 583–596. doi: 10.1177/1073858418809074.

22. Thapa T, Graven-Nielsen T, Chipchase LS et al. Disruption of cortical synaptic homeostasis in individuals with chronic low back pain. Clin Neurophysiol 2018; 129 (5): 1090–1096. doi: 10.1016/j.clinph.2018.01.060.

23. Wand BM, Parkitny L, O’Connell NE et al. Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. Man Ther 2011; 16 (1): 15–20. doi: 10.1016/j.math.2010.06.008.

24. Hodges PW, Galea MP, Holm S et al. Corticomotor excitability of back muscles is affected by intervertebral disc lesion in pigs. Eur J Neurosci 2009; 29 (7): 1490–1500. doi: 10.1111/j.1460-9568.2009.06670.x.

25. Tsao H, Tucker KJ, Hodges PW. Changes in excitability of corticomotor inputs to the trunk muscles during experimentally-induced acute low back pain. Neuroscience 2011; 181: 127–133. doi: 10.1016/j.neuroscience.2011.02.033.

26. Flor H, Braun C, Elbert T et al. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett 1997; 224 (1): 5–8. doi: 10.1016/s0304-3940 (97) 13441-3.

27. Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain 2008; 131 (8): 2161–2171. doi: 10.1093/brain/awn154.

28. Ferreira PH, Ferreira ML, Maher CG et al. Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain. Br J Sports Med 2010; 44 (16): 1166–1172. doi: 10.1136/bjsm.2009.061515.

29. Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord 1998; 11 (1): 46–56.

30. Jacobs JV, Henry SM, Nagle KJ. Low back pain associates with altered activity of the cerebral cortex prior to arm movements that require postural adjustment. Clin Neurophysiol 2010; 121 (3): 478–491. doi: 10.1016/j.clinph.2009.11.076.

31. Apkarian AV, Sosa Y, Sonty S. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci 2004; 24 (46): 10410–10415. doi: 10.1523/JNEUROSCI.2541-04.2004.

32. Buckalew N, Haut MW, Morrow L et al. Chronic pain is associated with brain volume loss in older adults: preliminary evidence. Pain Med 2008; 9 (2): 240–248. doi: 10.1111/j.1526-4637.2008.00412.x.

33. Schmidt-Wilke T, Leinisch E, Gaenßbauer S et al. Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients. Pain 2006; 125 (1–2): 89–97. doi: 10.1016/j.pain.2006.05.004.

34. Ung H, Brown JE, Johnson KA, et al. Multivariate classification of structural MRI data detects chronic low back pain. Cerebr Cortex 2012; 24 (4): 1037–1044. doi: 10.1093/cercor/bhs378.

35. Kong J, Spaeth B, Wey HY et al. S1 is associated with chronic low back pain: a functional and structural MRI study. Mol Pain 2013; 9: 43. doi: 10.1186/1744-8069-9-43.

36. Yu R, Gollub RL, Spaeth R et al. Disrupted functional connectivity of the periaqueductal gray in chronic low back pain. Neuroimage Clin 2014; 6: 100–108. doi: 10.1016/j.nicl.2014.08.019.

37. O‘Neill S, Manniche C, Graven-Nielsen T et al. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. Eur J Pain 2007; 11 (4): 415–420. doi: 10.1016/j.ejpain.2006.05.009.

38. Kobayashi Y, Kurata J, Sekiguchi M et al. Augmented cerebral activation by lumbar mechanical stimulus in chronic low back pain patients: an FMRI study. Spine 2009; 34 (22): 2431–2436. doi: 10.1097/BRS.0b013e3181b1fb76.

39. Hotz-Boendermaker S, Marcar VL, Meier ML et al. Reorganization in secondary somatosensory cortex in chronic low back pain patients. Spine 2016; 41 (11): 667–673. doi: 10.1097/BRS.0000000000001348.

40. Baliki MN, Chialvo DR, Geha PY et al. Chronic pain and the emotional brain: specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain. J Neurosci 2006; 26 (47): 12165–12173. doi: 10.1523/JNEUROSCI.3576-06.2006.

41. Shimo K, Ueno T, Younger J et al. Visualization of painful experiences believed to trigger the activation of affective and emotional brain regions in subjects with low back pain. PLoS One 2011; 6 (11): e26681. doi: 10.1371/journal.pone.0026681.

42. Brumagne S, Janssens L, Knapen S et al. Persons with recurrent low back pain exhibit a rigid postural control stratégy. Eur Spine J 2008; 17 (9): 1177–1184. doi: 10.1007/s00586-008-0709-7.

43. della Volpe R, Popa T, Ginanneschi R et al. Changes in coordination of postural control during dynamic stance in chronic low back pain patients. Gait Posture 2006; 24 (3): 349–355. doi: 10.1016/j.gaitpost.2005.10.009.

44. Gill KP, Callaghan MJ. The measurement of lumbar proprioception in individuals with and without low back pain. Spine 1998; 23 (3): 371–377. doi: 10.1097/00007632-199802010-00017.

45. Moseley GL. I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain 2008; 140 (1): 239–243: doi: 10.1016/j.pain.2008.08.001.

46. Tong ML, Mousavi SJ, Kiers H et al. Is there a relationship between lumbar proprioception and low back pain. Arch Phys Med Rehabil 2017; 98 (1): 120–136. doi: 10.1016/j.apmr.2016.05.016.

47. Airaksinen O, Brox JI, Cedraschi C et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 (2): 192–300. doi: 10.1007/s00586-006-1072-1.

48. Chou R, Qaseem A, Snow V et al. Dia­gnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147 (7): 478–491. doi: 10.7326/0003-4819-147-7-200710020-00006.

49. Ferreira ML, Ferreira PH, Latimer J et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain 2007; 131 (1–2): 31–37. doi: 10.1016/j.pain.2006.12.008.

50. Koes BW, Van Tulder M, Lin CW et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19 (12): 2075–2094. doi: 10.1007/s00586-010-1502-y.

51. Searle A, Spink M, Ho A et al. Exercise interventions for the treatment of chronic low back pain. Clin Rehabil 2015; 29 (12): 1155–1167. doi: 10.1177/0269215515570379.

52. Hall AM, Maher CG, Lam P et al. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res 2011; 63 (11): 1576–1583. doi: 10.1002/acr. 20594.

53. Kong LJ, Lauche R, Klose P et al. Tai chi for chronic pain conditions. Sci Rep 2016; 6 (25325): 25325. doi: 10.1038/srep25325.

54. Sherman KJ, Cherkin DC, Erro J et al. Comparing yoga, exercise, and a self-care book for chronic low back pain. Ann Intern Med 2005; 143 (12): 849–856. doi: 10.7326/0003-4819-143-12-200512200-00003.

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