Alterations in Cortical and Cerebellar Motor Processing in Subclinical Neck Pain Patients Following Spinal Manipulation

doi:10.1016/j.jmpt.2013.08.003

Journal of Manipulative and Physiological Therapeutics

Volume 36, Issue 8, October 2013, Pages 527-537

https://doi.org/10.1016/j.jmpt.2013.08.003 Get rights and content

Abstract

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 (F_1,6 = 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.

Section snippets

Methods

This study was performed using the cortical TMS measures of SICI and long-interval intracortical inhibition (LICI) and the paired stimulator TMS technique known as cerebellar inhibition (CBI)⁴⁵ following spinal manipulation and a motor learning task.

Results

The NDI scores ranged between 5 and 12 with a mean of 7.5 ± 2.51. The SICI and LICI were performed on all SCNP participants both before and after the spinal manipulation and motor sequence learning task. However, data from only 7 participants in this group were able to be included for CBI measure analysis, as 3 of the participants had large artifacts from the high-intensity cerebellar stimulation that swamped the EMG signal, which meant the data could not be analyzed. Therefore, there were 10

Discussion

Cortical TMS measures SICI and LICI were recorded to evaluate the level of intracortical inhibition, whereas CBI was used to measure the inhibitory effect of the cerebellum on the motor cortex. The CBI was clearly modulated by increasing cerebellar magnetic stimulation in the healthy control group preintervention, and this modulation was not changed by the motor sequence learning task. There was no modulation of CBI initially in the SCNP group (ie, increasing cerebellar magnetic stimulation had

Conclusion

Cervical spine manipulation in an SCNP group leads to a pattern of cerebellar modulation more similar to a non–neck pain group. These findings suggest that normalizing afferent input from the neck may have restored a more correct internal body schema that allowed correct sensorimotor integration and normalized motor output.

Practical Applications

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The cerebellum is able to inhibit motor cortical output in a modulated fashion as demonstrated by the effect of graded cerebellar stimulation on corticomotor output.
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Funding Sources and Conflicts of Interest

The authors would like to acknowledge the following organizations for support and funding: Australian Spinal Research Foundation, Natural Science and Engineering Research Council of Canada, Canada Foundation for Innovation, Canadian Institutes of Health Research, University of Ontario Institute of Technology, and Ontario Graduate Scholarship Fund.

Contributorship

List author initials for each relevant category

Concept development (provided idea for the research): BM, JD, PY, HH
Design (planned the methods to generate the results): BM, JD
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): BM, PY, HH
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): JD, BM, JB
Analysis/interpretation (responsible for statistical analysis, evaluation, and

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Original ArticleAlterations in Cortical and Cerebellar Motor Processing in Subclinical Neck Pain Patients Following Spinal Manipulation

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Practical Applications

Funding Sources and Conflicts of Interest

Contributorship

Man Ther

Clin Neurophysiol

Neurosci Lett

Man Ther

Man Ther

J Orthop Res

J Electromyogr Kinesiol

Arch Phys Med Rehabil

J Electromyogr Kinesiol

J Manipulative Physiol Ther

Pain

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

Clin Neurophysiol

J Manipulative Physiol Ther

Neuropsychologia

J Electromyogr Kinesiol

J Manipulative Physiol Ther

J Manipulative Physiol Ther

Man Ther

Electroencephalogr Clin Neurophysiol

Electroencephalogr Clin Neurophysiol

The burden and determinants of neck pain in the general population

Eur Spine J

Cervical range of motion associations with subclinical neck pain

Spine

Proprioception and rotation range sensitization associated with subclinical neck pain

Spine

Corticospinal excitability in patients with chronic low back pain

J Spinal Disord Tech

Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task

Spine

Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain

Spine

Original Article
Alterations in Cortical and Cerebellar Motor Processing in Subclinical Neck Pain Patients Following Spinal Manipulation