RP is an osteopath and has been working as a clinical therapist for more than 20 years with individuals suffering from chronic musculoskeletal disorders. He is presently enrolled in a PhD program involved in research looking at neuroplastic changes in the primary motor cortex associated with chronic wrist and hand conditions including carpal tunnel syndrome and osteoarthritis. JH research interests include the study of neuroplasticity in the primary motor cortex to assess and improve upper extremity function in stroke patients utilizing Transcranial Magnetic Stimulation.
DB has performed research in the kinetic and electromyographic assessment of hand and finger function in neurological and musculoskeletal disorders. National Center for Biotechnology Information , U. Published online Feb Johanne Higgins 1 grid. Daniel Bourbonnais 1 grid. Received Jun 10; Accepted Jan This article has been cited by other articles in PMC. Abstract Background Musculoskeletal rehabilitative care and research have traditionally been guided by a structural pathology paradigm and directed their resources towards the structural, functional, and biological abnormalities located locally within the musculoskeletal system to understand and treat Musculoskeletal Disorders MSD.
Discussion Increasing evidence reveals structural and functional changes within the Central Nervous System CNS of people with chronic MSD that appear to play a prominent role in the pathophysiology of these disorders. Summary Recent findings suggest that a change in model and approach is required in the rehabilitation of chronic MSD that integrate the findings of neuroplastic changes across the CNS and are targeted by rehabilitative interventions.
Musculoskeletal disorders, Chronic low back pain, Osteoarthritis, Neuroplasticity, Periaqueductal grey, Rostral ventromedial medulla, Rehabilitation, Primary somatosensory cortex, Primary motor cortex, Limbic, Pre-frontal, Pain.
Log in Register Recommend to librarian. Reorganization of cortical representations of the hand following alterations of skin inputs induced by nerve injury, skin island transfers, and experience. Experimental Brain Research, Vol. The possibility of rescuing a normal phenotype in animal models of these pathologies by manipulating levels of intracortical inhibition draws attention on the GABAergic system as an eligible candidate for the development of new therapeutic strategies. Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain. Restoration of motor activity and function are integral to current practice in rehabilitation [ 51 , ]. Under the structural-pathology paradigm neurophysiological consequences, with the exception of damage to the nerve s , is secondary and should disappear when normal tissue properties are restored and receptor activity, sensory transmission, and perception should renormalize to reflect the state of the healed structure s.
Discussion The structural pathology paradigm is guided by the inherent belief that pain and other neurophysiological changes are secondary to local structural insult to musculoskeletal structures. Principles of experience dependent plasticity Neuroplasticity refers to changes in neuronal properties, structure and organization and is the manner in which the nervous system encodes new experiences. Neuroplastic changes in the primary somatosensory cortex and perceptual changes with MSD Studies of cortical properties and organisation within the sensorimotor areas have been performed with subjects with PFPS [ ], anterior cruciate ligament ACL deficiency and reconstruction [ 33 , - ], CLBP [ 17 - 19 , - ], cervical pain and whiplash injury [ 91 , ], rotator cuff tears [ , ], dystonia [ - ] and CTS [ - ].
Changes in primary motor cortex associated with MSD Studies that investigate changes in the properties, function and organisation within the primary motor cortex M1 of subjects with different MSD have been performed, of which the majority utilise Transcranial Magnetic Stimulation TMS. Neuroplastic changes in meso-limbic and prefrontal structures in chronic pain states Of all the areas of the CNS with documented changes occurring in association with chronic MSD, the meso-limbic and prefrontal structures are the most impressive and possibly the most important as changes in these areas demonstrate strong correlations with chronicity [ 13 ], and furthermore can be predictive and possibly even determine who will transit from acute to chronic pain [ 15 , 27 , 28 ].
Integrating CNS changes into a more comprehensive model of chronic MSD It would appear that behavioural changes and psychological processes in chronic pain subjects involve activity in the meso-limbic and pre-frontal areas that influence pain perception and behaviour. Impact of CNS plasticity in the rehabilitation of chronic MSD Restoration of motor activity and function are integral to current practice in rehabilitation [ 51 , ].
Research Research investigating changes in S1 and M1 across a large range of MSD, including changes in responsiveness, inhibitory processes, and somatotopic organization would help elucidate the mechanisms and their presence in MSD. Summary In our opinion the present structural-pathology paradigm guiding treatment for MSD is at the very least incomplete as it fails to integrate recent findings of important neurophysiological changes associated with chronic MSD and that appear to be involved in the pathophysiology of these conditions either in isolation or co-existing with peripheral mechanisms.
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