Reorganised motor control at cortical, subcortical and spinal levels in neck and low back pain

Spinal pain (including low back and neck pain) is characterized by changes throughout the sensorimotor system from changes in the organization of the sensory and motor regions of cortex of the brain to changes in the structure of the muscles that move and support the spine. A person with pain may present with changes in motor function that range from subtle changes in the manner in which muscles are recruited to complete avoidance of a posture, a movement, a function, or a social role. The diversity of observations in clinical populations and experimental studies has evaded explanation by simple theories of motor adaptation to pain and more complex models of adaptation in the presence of pain have been proposed. Despite the diversity and incomplete understanding, changes in sensorimotor function are likely to be relevant to a patient with spinal pain if their pain presentation includes a nociceptive component whereby loading of tissues generates nociceptive input that contributes to or maintains the pain state. The aim of this chapter is to outline a contemporary theory to explain the diversity of presentations, to consider the scope of changes in sensorimotor control related to back and neck pain, to highlight recent evidence of the diverse mechanisms that underpin sensorimotor adaptations, and to consider the options for rehabilitation based on neuroplastic changes at multiple levels of the nervous system.