CNS reorganization in chronic musculoskeletal disorders
Although evidence of maladaptive motor and sensory cortex changes in patients with chronic musculoskeletal conditions is continuously emerging, most rehabilitation approaches continue to focus on local and peripheral structural dysfunction. To address these central nervous system (CNS) adaptations, clinical evaluation and management strategies are described. Suggested valuation elements include motor control, fear avoidance and central sensitization. Active management techniques suggested are minimal use of passive techniques, education on pain neuroscience, sensorimotor training and self-efficacy building.
Chronic musculoskeletal pathology has been shown to cause CNS plasticity both structurally and functionally. These changes include increased overlapping of cortical representations, alterations in facilitation/ inhibition pathways and increased cortical nociceptive reactivity. The authors argue that for the effective management of these disorders, a global approach addressing both neural and joint-level changes is needed.
In this article, the role of CNS reorganizations in chronic musculoskeletal disorders was discussed. Given the growing body of evidence related to the presence of these reorganizations, the authors call for the need for clinicians to better understand the CNS mechanisms that lead to pain. The use of dedicated evaluation and management strategies is also advocated. Despite this, and although studies of CNS interventions in chronic pain show promising results, it is noted that larger studies are still needed.
> From: Roy et al., J Orthop Sports Phys Ther 47 (2017-12-04 09:40:20) 817-821. All rights reserved to Journal of Orthopedic & Sports Physical Therapy. Click here for the online summary.