Altered spinal-level sensorimotor control related to pain and perceived instability in people with chronic ankle instability

Thompson, Cassandra; Hiller, Claire E.; Schabrun, Siobhan M

doi:10.1016/j.jsams.2018.10.009

Cited by 23 publications

(32 citation statements)

References 22 publications

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“…Abstracts of the remaining 42 studies were further screened, causing an additional 26 studies to be excluded. The full-text screening performed over the remaining 19 studies determined 17 studies for final inclusion [27,28,32,33,34,35,36,38,39,40,44,52,53,54,55,56,57], with two studies [31,58] excluded because they reported the same subject data as two other studies that were already included [52,53]. No additional studies were identified based on the references in previously included studies.…”

Section: Resultsmentioning

confidence: 99%

“…The earliest studies [27,28] investigated the spinal excitability of lower leg muscles using the electrically evoked Hoffmann (H-) reflex and found decreased spinal excitability in the soleus and fibularis longus muscles that may limit optimal muscle activation vital for joint stability. Subsequent studies [29,30,31,32] attempted to relate these neurophysiological changes to clinical or functional outcomes and implied that the decreased neural drive to the spinal motoneurons innervating ankle stabilizers may contribute to sensorimotor deficits, which in turn may lead to functional limitations and self-reported disability. In addition to decreased spinal excitability, recent research has begun to examine supraspinal excitability in patients with CAI using transcranial magnetic stimulation (TMS).…”

Section: Introductionmentioning

confidence: 99%

“…Collectively, the alterations in neural excitability at both spinal and supra-spinal levels suggest that neuroplastic adaptations appear to exist and may contribute to the sensorimotor dysfunction commonly seen in patients with CAI [37]. It is noted, however, that some studies [32,38,39,40] failed to identify neural changes in CAI patients. These conflicting results across individual studies may be due to small sample sizes, which raises the need for a synthesis of the data to provide conclusive evidence.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

Kim

Cruz‐Díaz

et al. 2019

JCM

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The objective of this systematic review with meta-analysis was to determine alterations in spinal and corticospinal excitability of ankle muscles in patients with chronic ankle instability (CAI) compared to uninjured controls. Independent researchers performed comprehensive literature searches of electronic databases and included studies that compared groups with and without CAI and investigated neural excitability with Hoffmann reflex (H-reflex) and/or transcranial magnetic stimulation (TMS). A fixed-effect meta-analysis was conducted to determine group differences for (1) soleus and fibularis maximal H-reflex (Hmax)/maximal M-wave (Mmax)-ratios, and (2) soleus and fibularis longus cortical motor thresholds (CMTs). Seventeen studies were included in the current meta-analysis. They showed that the Hmax/Mmax-ratios of the soleus and the fibularis longus in the CAI group were significantly lower than those in the uninjured control group (soleus: d = −0.41, p < 0.001; fibularis longus: d = −0.27, p = 0.04). There was no evidence for changes in the CMT. This systematic review is the first to demonstrate evidence that patients with CAI present decreased spinal reflex excitability in the soleus and fibularis longus. However, there is no evidence of changes in supraspinal excitability when considering only the CMT. The latter result needs to be interpreted with caution as all except one study demonstrate some changes at the supraspinal level with CAI.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

Kim

Cruz‐Díaz

et al. 2019

JCM

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“…No differential effect of pain across muscles was observed for SL and LL responses, and in fact, no influence of pain at all was observed for these responses, suggesting that experimental tonic pain does not affect the excitability at the spinal level. As mentioned earlier, previous results using stimulation at the cervicomedullary junction, H-reflex, or stretch reflex to study the effect of pain on spinal excitability are conflicting [6,12,13,15,16]. Discrepancies might be explained by the different experimental pain models used across these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Only one study looked at motor responses evoked by stimulation applied both at the motor cortex and at the cervicomedullary junction, and the results obtained suggest reciprocal changes at the cortical (inhibition) and spinal (facilitation) level in the presence of pain [ 12 ]. However, results of studies focusing solely on the effect of pain at the spinal level are mixed, with studies reporting either an increase in H-reflex or stretch reflex amplitude, i.e., a spinal facilitation [ 12 – 14 ] or an absence of modulation [ 6 , 15 , 16 ]. Another limitation of the literature on the impact of pain on the motor system is that most studies are performed with the motor system at rest or involve only isometric contraction.…”

Section: Introductionmentioning

confidence: 99%

Impact of Experimental Tonic Pain on Corrective Motor Responses to Mechanical Perturbations

et al. 2020

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Movement is altered by pain, but the underlying mechanisms remain unclear. Assessing corrective muscle responses following mechanical perturbations can help clarify these underlying mechanisms, as these responses involve spinal (short-latency response, 20-50 ms), transcortical (long-latency response, 50-100 ms), and cortical (early voluntary response, 100-150 ms) mechanisms. Pairing mechanical (proprioceptive) perturbations with different conditions of visual feedback can also offer insight into how pain impacts on sensorimotor integration. The general aim of this study was to examine the impact of experimental tonic pain on corrective muscle responses evoked by mechanical and/or visual perturbations in healthy adults. Two sessions (Pain (induced with capsaicin) and No pain) were performed using a robotic exoskeleton combined with a 2D virtual environment. Participants were instructed to maintain their index in a target despite the application of perturbations under four conditions of sensory feedback: (1) proprioceptive only, (2) visuoproprioceptive congruent, (3) visuoproprioceptive incongruent, and (4) visual only. Perturbations were induced in either flexion or extension, with an amplitude of 2 or 3 Nm. Surface electromyography was recorded from Biceps and Triceps muscles. Results demonstrated no significant effect of the type of sensory feedback on corrective muscle responses, no matter whether pain was present or not. When looking at the effect of pain on corrective responses across muscles, a significant interaction was found, but for the early voluntary responses only. These results suggest that the effect of cutaneous tonic pain on motor control arises mainly at the cortical (rather than spinal) level and that proprioception dominates vision for responses to perturbations, even in the presence of pain. The observation of a muscle-specific modulation using a cutaneous pain model highlights the fact that the impacts of pain on the motor system are not only driven by the need to unload structures from which the nociceptive signal is arising.

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The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review

Sanderson

Wang

Cancino

et al. 2021

European Journal of Pain

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Altered spinal-level sensorimotor control related to pain and perceived instability in people with chronic ankle instability

Cited by 23 publications

References 22 publications

Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

Impact of Experimental Tonic Pain on Corrective Motor Responses to Mechanical Perturbations

The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review

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