Are neuromuscular adaptations present in people with recurrent spinal pain during a period of remission? a systematic review

Abstract

A plethora of evidence supports the existence of neuromuscular changes in people with chronic spinal pain (neck and low back pain), yet it is unclear whether neuromuscular adaptations persist for people with recurrent spinal pain when in a period of remission. This systematic review aimed to synthesise the evidence on neuromuscular adaptations in people with recurrent spinal pain during a period of remission. Electronic databases, grey literature, and key journals were searched from inception up to the 4th of September 2020. Eligibility criteria included observational studies investigating muscle activity, spine kinematics, muscle properties, sensorimotor control, and neuromuscular performance in adults (≥ 18 years) with recurrent spinal pain during a period of remission. Screening, data extraction, and quality assessment (Newcastle-Ottawa Scale) were conducted independently by two reviewers. Data synthesis was conducted per outcome domain. A meta-analysis with a random-effects model was performed where possible. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines (GRADE). From 8292 records, 27 and five studies were included in a qualitative and quantitative synthesis, respectively. Very low level of evidence supports muscle activity changes in people with recurrent low back pain, especially greater co-contraction, redistribution of muscle activity, and delayed postural control of deeper trunk muscles. Reduced range of motion of the lumbar spine was also found. Meaningful conclusions regarding other outcome domains or people with recurrent neck pain could not be drawn. In conclusion, people with recurrent low back pain during a period of remission show muscle activity and spine kinematics adaptations. Future research should investigate the long-term impact of these changes, as well as adaptations in people with recurrent neck pain.

Fig 1. PRISMA flow diagram of search and selection of studies.

Fig 2. Quantitative synthesis for TrA thickness change.

Studies comparing the change of TrA thickness measured with ultrasound in people with recurrent LBP and a control group. Means and standard deviations (SD) of the TrA activation ratio are reported.

Fig 3. Post-hoc subgroup analysis for TrA thickness change.

Forest plots of studies comparing the TrA thickness change measured with ultrasound in people with recurrent LBP and a control group. (A) Studies where participants received training and feedback before testing. (B) No practice was allowed before testing. Mean and standard deviations (SD) of the TrA activation ratio are reported.