Alterations in cortical and cerebellar motor processing in subclinical neck pain patients following spinal manipulation.

OBJECTIVE The purpose of this study was investigate whether there are alterations in cerebellar output in a subclinical neck pain (SCNP) group and whether spinal manipulation before motor sequence learning might restore the baseline functional relationship between the cerebellum and motor cortex. METHODS Ten volunteers were tested with SCNP using transcranial magnetic stimulation before and after a combined intervention of spinal manipulation and motor sequence learning. In a separate experiment, we tested 10 healthy controls using the same measures before and after motor sequence learning. Our transcranial magnetic stimulation measurements included short-interval intracortical inhibition, long-interval intracortical inhibition, and cerebellar inhibition (CBI). RESULTS The SCNP group showed a significant improvement in task performance as indicated by a 19% decrease in mean reaction time (P < .0001), which occurred concurrently with a decrease in CBI following the combined spinal manipulation and motor sequence learning intervention (F1,6 = 7.92, P < .05). The control group also showed an improvement in task performance as indicated by a 25% increase in reaction time (P < .001) with no changes to CBI. CONCLUSIONS Subclinical neck pain patients have altered CBI when compared with healthy controls, and spinal manipulation before a motor sequence learning task changes the CBI pattern to one similar to healthy controls.

[1]  J. Cleland,et al.  Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondylalgia: a clinical trial. , 2011, Journal of manipulative and physiological therapeutics.

[2]  J. Semmler,et al.  Hemispheric differences in use-dependent corticomotor plasticity in young and old adults , 2010, Experimental Brain Research.

[3]  A. Bastian,et al.  Cerebellum and the deciphering of motor coding , 2007, The Cerebellum.

[4]  M. Hallett,et al.  Modulation of cortical motor output maps during development of implicit and explicit knowledge. , 1994, Science.

[5]  G. Cosentino,et al.  Reduced Cerebellar Inhibition in Migraine with Aura: A TMS Study , 2009, The Cerebellum.

[6]  B. Murphy,et al.  Transient Modulation of Intracortical Inhibition Following Spinal Manipulation , 2007 .

[7]  Bernadette Murphy,et al.  Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study , 2007, Clinical Neurophysiology.

[8]  G. Yao,et al.  Association between cervicocephalic kinesthetic sensibility and frequency of subclinical neck pain. , 2008, Manual therapy.

[9]  鯨井 隆.  Corticocortical inhibition in human motor cortex , 1994 .

[10]  Bill Vicenzino,et al.  Development of motor system dysfunction following whiplash injury , 2003, PAIN®.

[11]  R. Adams,et al.  Cervical Range of Motion Associations With Subclinical Neck Pain , 2004, Spine.

[12]  M. Hubka,et al.  Interexaminer reliability of palpation for cervical spine tenderness. , 1994, Journal of manipulative and physiological therapeutics.

[13]  R. Hanajima,et al.  Magnetic stimulation over the cerebellum in humans , 1995, Annals of neurology.

[14]  Robert Chen,et al.  Exploring the connectivity between the cerebellum and motor cortex in humans , 2004, The Journal of physiology.

[15]  P Cordo,et al.  The Role of Paraspinal Muscle Spindles in Lumbosacral Position Sense in Individuals With and Without Low Back Pain , 2000, Spine.

[16]  A. Kvåle,et al.  Reliability and validity of a palpation technique for identifying the spinous processes of C7 and L5. , 2009, Manual therapy.

[17]  A. Schmid,et al.  A crossover study on the effect of cervical mobilization on motor function and pressure pain threshold in pain-free individuals. , 2010, Journal of manipulative and physiological therapeutics.

[18]  B. Day,et al.  The effect of magnetic coil orientation on the latency of surface EMG and single motor unit responses in the first dorsal interosseous muscle. , 1994, Electroencephalography and clinical neurophysiology.

[19]  L. Selen,et al.  Trunk muscle activation in low-back pain patients, an analysis of the literature. , 2003, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[20]  A. Pearce,et al.  The effect of lumbosacral manipulation on corticospinal and spinal reflex excitability on asymptomatic participants. , 2012, Journal of manipulative and physiological therapeutics.

[21]  Seokyung Shin,et al.  Identification of the Correct Cervical Level by Palpation of Spinous Processes , 2011, Anesthesia and analgesia.

[22]  S. Jaric,et al.  Vertical posture and head stability in patients with chronic neck pain. , 2003, Journal of rehabilitation medicine.

[23]  J. Cholewicki,et al.  Impaired Postural Control of the Lumbar Spine Is Associated With Delayed Muscle Response Times in Patients With Chronic Idiopathic Low Back Pain , 2001, Spine.

[24]  Short-term modulation of the ipsilateral primary sensory cortex by nociceptive interference revealed by SEPs , 2008, Neuroscience Letters.

[25]  M. Hallett,et al.  Rapid plasticity of human cortical movement representation induced by practice. , 1998, Journal of neurophysiology.

[26]  H. Vernon.  The Neck Disability Index: state-of-the-art, 1991-2008. , 2008, Journal of manipulative and physiological therapeutics.

[27]  Deborah Falla,et al.  Patients With Chronic Neck Pain Demonstrate Altered Patterns of Muscle Activation During Performance of a Functional Upper Limb Task , 2004, Spine.

[28]  P. van Vliet,et al.  Motor control and the management of musculoskeletal dysfunction. , 2006, Manual therapy.

[29]  M. Garwicz,et al.  Anatomical and physiological foundations of cerebellar information processing , 2005, Nature Reviews Neuroscience.

[30]  N. Davey,et al.  Corticospinal Excitability in Patients With Chronic Low Back Pain , 2005, Journal of spinal disorders & techniques.

[31]  T. Morris,et al.  Paraspinal muscles and intervertebral dysfunction: part one. , 2004, Journal of manipulative and physiological therapeutics.

[32]  C. Richardson,et al.  Motor control problems in patients with spinal pain: a new direction for therapeutic exercise. , 2000, Journal of manipulative and physiological therapeutics.

[33]  I. Marschner,et al.  A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache , 2002, Spine.

[34]  J. R. Slack,et al.  Sacroiliac joint manipulation decreases the H-reflex. , 1995, Electromyography and clinical neurophysiology.

[35]  Scott Haldeman,et al.  The Burden and Determinants of Neck Pain in the General Population , 2008, European Spine Journal.

[36]  H. Tsuji,et al.  Intracortical facilitation and inhibition after transcranial magnetic stimulation in conscious humans. , 1997, The Journal of physiology.

[37]  P. Ashby,et al.  Mechanism of the silent period following transcranial magnetic stimulation Evidence from epidural recordings , 1999, Experimental Brain Research.

[38]  Paul W Hodges,et al.  Simultaneous feedforward recruitment of the vasti in untrained postural tasks can be restored by physical therapy , 2003, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[39]  D. Manzoni,et al.  The cerebellum may implement the appropriate coupling of sensory inputs and motor responses: Evidence from vestibular physiology , 2008, The Cerebellum.

[40]  R. Poppele,et al.  Representation of passive hindlimb postures in cat spinocerebellar activity. , 1996, Journal of neurophysiology.

[41]  B. Murphy,et al.  The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. , 2012, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[42]  D. Falla,et al.  Unravelling the complexity of muscle impairment in chronic neck pain. , 2004, Manual therapy.

[43]  D. Manzoni.  The cerebellum and sensorimotor coupling: Looking at the problem from the perspective of vestibular reflexes , 2008, The Cerebellum.

[44]  On the relation of rat's external cuneate activity to global parameters of forelimb posture. , 1999, Neuroreport.

[45]  B. Murphy,et al.  Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. , 2011, Journal of manipulative and physiological therapeutics.

[46]  M. Panjabi.  The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. , 1992, Journal of spinal disorders.

[47]  Leslie G. Ungerleider,et al.  Experience-dependent changes in cerebellar contributions to motor sequence learning , 2002, Proceedings of the National Academy of Sciences of the United States of America.

[48]  Leslie G. Ungerleider,et al.  Distinct contribution of the cortico-striatal and cortico-cerebellar systems to motor skill learning , 2003, Neuropsychologia.

[49]  B. Fierro,et al.  Effects of cerebellar TMS on motor cortex of patients with focal dystonia: a preliminary report , 2009, Experimental Brain Research.

[50]  P. Hodges,et al.  Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. , 1999, Archives of physical medicine and rehabilitation.

[51]  Leslie G. Ungerleider,et al.  Functional anatomy of motor skill learning. , 2002 .

[52]  W. Herzog,et al.  Reflex responses associated with manipulative treatments on the thoracic spine: a pilot study. , 1995, Journal of manipulative and physiological therapeutics.

[53]  B. Murphy,et al.  Delayed abdominal muscle onsets and self-report measures of pain and disability in chronic low back pain. , 2010, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[54]  M. Nordin,et al.  The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. , 2009, Journal of manipulative and physiological therapeutics.

[55]  W. Herzog,et al.  Electromyographic responses of back and limb muscles associated with spinal manipulative therapy. , 1999, Spine.

[56]  M. Hallett,et al.  Modulation of muscle responses evoked by transcranial magnetic stimulation during the acquisition of new fine motor skills. , 1995, Journal of neurophysiology.

[57]  Heidi Haavik Taylor,et al.  Altered central integration of dual somatosensory input after cervical spine manipulation. , 2010, Journal of manipulative and physiological therapeutics.

[58]  Roger D Adams,et al.  Proprioception and Rotation Range Sensitization Associated With Subclinical Neck Pain , 2005, Spine.

[59]  Marco Molinari,et al.  The cerebellum and neural networks for rhythmic sensorimotor synchronization in the human brain , 2008, The Cerebellum.

[60]  S. Rossi,et al.  Early somatosensory processing during tonic muscle pain in humans: relation to loss of proprioception and motor ‘defensive’ strategies , 2003, Clinical Neurophysiology.

[61]  K Kaneko,et al.  The effect of current direction induced by transcranial magnetic stimulation on the corticospinal excitability in human brain. , 1996, Electroencephalography and clinical neurophysiology.