Motor control in people with low back pain : the effects of pain, exercise, and a simulated round of golf

Abstract

Low back pain is considered a multifactorial condition, with biological and psychosocial features contributing to symptoms. Contemporary theories on motor adaptations to pain implicate altered motor control as a biological feature that contributes to the onset, recurrence, and persistence of low back pain. Unsurprisingly, ameliorating altered motor control is a target for some therapeutic interventions for people with low back pain. However, whether motor control is consistently altered in the presence of low back pain is unclear. In addition, motor control improvements following exercise in people with low back pain are conflicting when examined using muscle onsets, yet few studies have examined changes in other motor control measures. Finally, despite contemporary theories suggesting altered motor control contributes to symptom recurrence, there is currently a paucity of evidence observing altered motor control leading to symptom exacerbation during ecologically valid tasks. To address these gaps in the literature, a series of studies were conducted. This thesis therefore investigated: (1) is motor control consistently altered in the presence of low back pain based on measures of anticipatory and compensatory postural adjustments? (2) Do commonly prescribed exercise interventions improve motor control in people with low back pain based on anticipatory and compensatory postural adjustments? And (3) do golfers with low back pain exhibit altered motor control during the golf downswing and are these alterations accompanied by an exacerbation of low back pain? The findings of this thesis improve our understanding of the role of motor control alterations in people with LBP. This thesis provides support for contemporary theoretical models of altered motor control in people with LBP, suggesting altered motor control is a feature of LBP. This thesis provides support for exercise interventions that aim to improve trunk motor control in people with LBP. An interesting finding was the reduction in EO activity which was accompanied by increased trunk deviation phase and X-factor variables - recorded during the golf swing - over the course of a simulated round of golf in golfers with LBP. This finding suggests the adoption of a "loose" motor control strategy. However, the adoption of a "loose" motor control strategy was not accompanied by subsequent pain provocation, which challenges the proposed causal relationship between altered motor control and pain.

Date of Award	2021
Original language	English