Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders?

Abstract

BackgroundMusculoskeletal 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). However the structural pathology model does not adequately explain many of the clinical and experimental findings in subjects with chronic MSD and, more importantly, treatment guided by this paradigm fails to effectively treat many of these conditions.DiscussionIncreasing 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. These neuroplastic changes are reflective of adaptive neurophysiological processes occurring as the result of altered afferent stimuli including nociceptive and neuropathic transmission to spinal, subcortical and cortical areas with MSD that are initially beneficial but may persist in a chronic state, may be part and parcel in the pathophysiology of the condition and the development and maintenance of chronic signs and symptoms. Neuroplastic changes within different areas of the CNS may help to explain the transition from acute to chronic conditions, sensory-motor findings, perceptual disturbances, why some individuals continue to experience pain when no structural cause can be discerned, and why some fail to respond to conservative interventions in subjects with chronic MSD. We argue that a change in paradigm is necessary that integrates CNS changes associated with chronic MSD and that these findings are highly relevant for the design and implementation of rehabilitative interventions for this population.SummaryRecent 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. Effects of current interventions may be mediated through peripheral and central changes but may not specifically address all underlying neuroplastic changes in the CNS potentially associated with chronic MSD. Novel approaches to address these neuroplastic changes show promise and require further investigation to improve efficacy of currents approaches.

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“…Exercise in the treatment of chronic pain has neurological as well as mechanical effects, making its monitoring by brain mapping a variable of interest for comparison with changes in the above mechanical factors with treatment [48]. Future work could, therefore, usefully compare MSI and MSV in passive recumbent and active weight bearing motion in patients and controls to monitor their responses to physical therapies.…”

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“…"nother mechanism through which brain tissue restoration is pursued is neuroplasticity or synapse plasticity, which is an inherent neurophysiological adaptive trait in which preexisting connections between two neurons can gain or lose strength during neural activity [108], as well as change in structure, function and organization [109]. It responds to diferent experiences and emphaticism and has been observed in diferent sections of the CNS [109].…”

“…It responds to diferent experiences and emphaticism and has been observed in diferent sections of the CNS [109].…”

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