| One-Minute Clinician

Neuroplasticity and Improving Back Pain Perception

One of the most common complaints that people have with back pain is they feel stiff: “It feels stiff and achy,” “It hurts to move first thing in the morning and it’s hard to get out of bed.” What the literature is showing is that, for individuals who have high levels of perceived stiffness, when the mobility of their back is actually measured, the patient’s ability or inability to accurately process that information has led to an overmagnification of the actual stiffness. So when they were assessing with movement, how much is this moving, and they’re actually getting data on their perception of how much it was moving, they were finding that that touch was leading to an overmagnification of the actual perception of the stiffness, meaning they felt more stiff than they actually were. In these folks as well, when you look at the site in which they have their low back pain, if you show them pictures and you say “Hey, which way is this back rotated?” they’re unable to accurately identify which way it’s rotated. Same thing with touch: if they’re trying to localize specific tactile stimulation to that area in the back (let’s say they have left-sided low back pain) when they do that compared to the right side, they’re significantly less accurate in their ability to differentiate touch. What all that means is that when you consider the cortical changes in the brain, in the somatosensory homunculus, the area of the brain responsible for identifying where we are in space, when you’re looking at that site-specific region within the brain, there are alterations and there are changes. There is change as evidenced with functional MRIs. Those are some of the changes that are happening at the brain, not to mention everything that’s happening at the spinal cord that’s magnifying any type of sensory information that they’re getting, which can lead to that overmagnification of stiffness, pain, and so on. The body’s and brain’s protective mechanism is being overly protective and, because of that, it’s processing information inaccurately. It’s a vicious cycle: “I don’t want to move,” “I don’t want to do this,” “I don’t want to exercise because it may hurt,” or “I feel stiff when I do it,” “I feel like I’m not flexible,” etc.