Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders.
Author: Pelletier R1, Higgins J2, Bourbonnais D3.
Affiliation:
1R. Pelletier, MSc, Sciences de la Réadaptation, École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada. 2J. Higgins, PhD, École de Réadaptation, Faculté de Médecine, Université de Montréal, CP 6128, Succursale Centre-ville, Montréal, Québec, Canada H3C 3J7, and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada. 3D. Bourbonnais, PhD, École de Réadaptation, Faculté de Médecine, Université de Montréal, and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal.
Conference/Journal: Phys Ther.
Date published: 2015 May 7
Other:
Word Count: 278
Abstract
Present interventions utilized in musculoskeletal rehabilitation are in large part guided by a biomedical model where peripheral structural injury is believed to be the sole driver of the disorder. There are however neurophysiological changes across different areas of the peripheral and central nervous system including peripheral receptors, dorsal horn of the spinal cord, brain stem, sensorimotor cortical areas and in the meso-limbic and prefrontal areas associated with chronic musculoskeletal disorders including chronic low back pain, osteoarthritis, and tendon injuries. These neurophysiological changes appear to be not only a consequence of peripheral structural injury but play a part in the pathophysiology of chronic musculoskeletal disorders. Neurophysiological changes are consistent with a bio-psycho-social formulation reflecting the underlying mechanisms associated with sensory and motor findings, psychological traits, and perceptual changes associated with chronic musculoskeletal conditions. These changes therefore have important implications in the clinical manifestation, pathophysiology and for rehabilitative treatment of chronic musculoskeletal disorders. Musculoskeletal rehabilitation professionals have at their disposal tools to address these neuroplastic changes including top down cognitive based interventions (such as education, cognitive behavioral therapy, mindfulness meditation and motor imagery), and bottom up physical interventions (such as motor learning, peripheral sensory stimulation, and manual therapy) that induce neuroplastic changes across distributed areas of the nervous system and impact outcomes in patients with chronic musculoskeletal disorders. Furthermore, novel approaches such as the use of transcranial direct current stimulation and repetitive transcranial magnetic stimulation may also be utilized to help renormalize neurological function. Comprehensive treatment addressing peripheral structural injury as well as neurophysiological changes occurring across distributed areas of the nervous system may help to improve outcomes in patients with chronic musculoskeletal disorders.
© 2015 American Physical Therapy Association.
PMID: 25953594
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