Central Proprioceptive Processing and Postural Control in LBP

Low back pain is a highly prevalent health condition, with a reported lifetime prevalence of up to 84% worldwide. Currently, it induces more disability than any other health condition, such as depression, diabetes, chronic obstructive pulmonary disease or other musculoskeletal disorders. Approximately 85% of all low back pain complaints are non-specific, meaning that the pain cannot be attributed to a recognizable specific pathology such as an infection or vertebral fracture. While many patients with low back pain recover within a month, a large number of patients report a recurrence within one year. Current treatment interventions often remain unsuccessful, which highlights the current lack of knowledge on the underlying mechanisms of non-specific low back pain.

Postural control deficits have been identified as a key factor in the development and recurrence of non-specific low back pain. To achieve optimal postural control, the central nervous system needs to process, integrate and weigh proprioceptive signals from different body regions (e.g. ankle muscles and lower back muscles) with vestibular and visual inputs. Several studies have shown that patients with non-specific low back pain have a decreased ability to optimally weigh proprioceptive signals during standing, which leads to reduced postural robustness compared to pain-free individuals. More specifically, patients with low back pain dominantly rely more on proprioceptive signals from the ankle muscles and are not able to up-weigh proprioceptive signals from the lower back muscles when needed. This might be due to an impaired central processing of proprioceptive signals. However, up to now no studies have investigated central proprioceptive processing in patients with recurrent non-specific low back pain.

Therefore, this project aims to elucidate whether patients with recurrent non-specific low back pain showed altered brain activation patterns during the processing of proprioceptive signals from the ankle muscles and lower back muscles compared to healthy controls, by applying local muscle vibration during functional magnetic resonance imaging (fMRI).

Inclusion criteria

for individuals with recurrent non-specific low back pain:

• Age: 20 - 50 years old
• At least six months of low back pain with or without referred pain to the buttock or thigh
• At least three episodes of disabling low back pain
• A score of at least 14% on the Oswestry Disability Index
• Willing to sign the informed consent
• Meets specific criteria related to MRI-research

Inclusion criteria

for healthy individuals

• Age: 20 - 50 years old
• No history of low back pain
• A score of 0% on the Oswestry Disability Index
• Willing to sign the informed consent
• Meets specific criteria related to MRI-research

Exclusion criteria

for both groups:

• History of major trauma and/or major orthopedic surgery of the spine, the pelvis or the lower quadrant
• One of the following conditions: Parkinson's disease, multiple sclerosis, Stroke with sequelae
• Radicular symptoms
• Using strong opioid medication or antidepressants
• Neck pain
• Ankle problems