Exercise therapy has been shown to be effective in decreasing pain and improving function for patients with recurrent low back pain (LBP). Research on the mechanisms that trigger and/or underlie the effects of exercise therapy on LBP problems is of critical importance for the prevention of recurring or persistence of this costly and common condition. One factor that seems to be crucial within this context is the dysfunction of the back muscles. Recent pioneering results have shown that individuals with recurring episodes of LBP have specific dysfunctions of these muscles (peripheral changes) and also dysfunctions at the cortical level (central changes). This work provides the foundation to take a fresh look at the interplay between peripheral and central aspects, and its potential involvement in exercise therapy. The current project will draw on this opportunity to address the following research questions: What are the immediate (after a single session) and the long-term effects (after 18 repeated sessions) of exercise training on: (1) back muscle structure; (2) back muscle function; (3) the structure of the brain; (4) and functional connectivity of the brain. This research project also aims to examine whether the effects are dependent on how the training was performed. Therefore a specific versus a general exercise program will be compared.
History of non-specific recurrent LBP with the first onset being at least 6 months ago
At least 2 episodes of LBP/year, with an 'episode' implying pain lasting a minimum of 24 hours which is preceded and followed by at least 1 month without LBP
Minimum LBP intensity during episodes should be ≥2/10 on a numeric rating scale (NRS) from 0 to 10
During remission the NRS intensity for LBP should be 0.
Chronic LBP (i.e. duration remission <1 month)
Subacute LBP (i.e. first onset between 3 and 6 months ago)
Acute (i.e. first onset <3 months ago) LBP
Specific LBP (i.e. LBP proportionate to an identifiable pathology, e.g. lumbar radiculopathy)
Parallel
Specific skilled motor training
BehavioralParticipants allocated to the skilled motor training group will receive sensorimotor training of the intrinsic muscles of the lumbopelvic region, namely the multifidus, transversus abdominis, and pelvic floor muscles.
General extension training
BehavioralParticipants allocated to the general extension training group will receive general training exercises using the David Back equipment from the Back Unit at Ghent University Hospital
Brain macro-structure
Whole brain T1-weighted structural MRI will be acquired.
Brain macro-structure
Whole brain T1-weighted structural MRI will be acquired.
Brain macro-structure
Whole brain T1-weighted structural MRI will be acquired.
Brain macro-structure
Whole brain T1-weighted structural MRI will be acquired.
Functional brain connectivity
Resting-state functional MRI will be performed to acquire insight into subnetworks relating to sensorimotor control and pain processing.
Functional brain connectivity
Resting-state functional MRI will be performed to acquire insight into subnetworks relating to sensorimotor control and pain processing.
Functional brain connectivity
Resting-state functional MRI will be performed to acquire insight into subnetworks relating to sensorimotor control and pain processing.
Functional brain connectivity
Resting-state functional MRI will be performed to acquire insight into subnetworks relating to sensorimotor control and pain processing.
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University Ghent
Lead sponsor
Fund for Scientific Research, Flanders, Belgium
Collaborator
