Experimental and clinical neck pain: Studies on training-induced neuroplasticity

The present studies on training‐induced neuroplasticity are inspired by the biomedical and biomechanical paradigms that have been employed in the clinical management of musculoskeletal disorders for several decades. Consequently, this thesis focuses on the neuroplastic mechanisms occurring in healthy participants and in experimental and clinical neck pain induced by training.



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Bjarne Rittig-Rasmussen på Fag og Forsknings ph.d.-liste

Summary by Bjarne Rittig-Rasmussen

Training is a mainstay in the clinical management of neck pain; however, effects of various training protocols are small and improvements are required. Implicitly, the interaction between neck pain and training needs further exploration. A growing body of evidence indicates that injury, inflammation and pain arising from spinal structures not only affect the involved musculoskeletal structures, but also have a significant impact on the nervous system. Such impacts have been shown to correlate with the level of injury and functional recovery following neurological and musculoskeletal conditions. Yet, knowledge about training‐induced neuroplasticity in neck pain is still lacking.

This thesis investigates the neuroplastic effects of training in pain‐free participants, participants exposed to experimental pain and patients with chronic neck pain. The investigation comprises three experimental studies using transcranial magnetic stimulation and electromyography to elicit and monitor amplitudes and latencies of motor evoked potentials (MEPs) from the trapezius and thumb muscles.

One study included 60 pain‐free participants performing specific neck training, coordination training or no training; a second study included 52 participants randomized to either experimental pain or no pain; and the third included 35 patients with either chronic neck or knee pain and a group of 15 pain‐free participants. Pain‐free participants performing specific neck training yielded significantly increased responsiveness of MEPs from the trapezius muscle lasting 7 days after training. No significant changes were seen following coordination training, no training or in the within subject control muscle. In participants exposed to experimental neck pain in combination with training, MEPs from the trapezius were also reduced 7 days after training.

In patients with chronic neck pain, MEPs were briefly but significantly reduced for 30 minutes after the training. One training session induced a sustained neuroplastic effect measured by MEP amplitudes and lasted for 7 days after training in pain‐free participants. Experimental pain inversely induced a sustained inhibition lasting for 7 days. In patients with neck pain, a brief inhibition of the corticomotor excitability was induced and, notably, the training‐induced neuroplasticity did not increase as in participants with no pain.

These results have contributed with novel information about neuroplastic responses induced by neck training in no pain, experimental pain and clinical neck pain. The results may prove valuable in the ongoing process of developing more effective training protocols and combinatorial therapies for patients with chronic neck pain.

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