Dr. Sheri Silfies, an associate professor in the exercise science department’s doctor of physical therapy (DPT) program at the University of South Carolina’s Arnold School of Public Health, and psychology associate professor Jennifer Vendemia (University of South Carolina) are co-principal investigators on a nearly $1.6 million R01 grant from the National Institutes of Health. This project will enable the researchers to understand how changes in the brain may explain the development of movement limitations and persistent pain in individuals with lower back injuries.
“Despite a wide array of treatment options, the number of people who struggle to recover from painful back injuries continues to grow at an alarming rate,” says Dr. Silfies. “It is unknown why back pain remains so treatment resistant.”
To answer this question, Dr. Silfies and Dr. Vendemia have some ideas they’d like to explore. Based on findings from previous studies, the researchers believe that this type of back pain may be connected to a pattern of integration errors between sensory feedback and motor behavior. These errors trigger remodeling of the motor cortex, which controls voluntary movements.
Back injuries often lead to temporary adaptations in spinal movement and muscle activation patterns. The short-term effect of these adaptations helps protect injured tissues and avoid further pain, but these same protective measures can lead to maladaptive patterns during and following the recovery period of an acute back pain episode. These patterns result in a cycle of stress to spinal structures that can lead to recurrent and chronic lower back pain.
“We believe that these habitual, maladaptive movement patterns are driven, in large part, by changes in how the brain controls spine movement which in turn synergistically interacts with the behavioral, cognitive, and emotional aspects of the pain experience,” explains Dr. Silfies. “Our preliminary data suggests that individuals with chronic lower back pain synthesize sensory feedback differently and have altered relationships between sensory and motor regions of the brain during tasks that require movement and stabilization of the spine. These alterations complicate an individual’s ability to refine movements, thus making change in movement deployment and response to pain rehabilitation more difficult.”
With this new project, the researchers plan to collect additional evidence supporting this relationship between the brain and back pain. They also hope to gain a better understanding of the underlying mechanisms that support this relationship, paving the way for improved treatment options.
“I have always been fascinated by human anatomy and its role in how the body moves,” says Dr. Silfies, who first became interested in becoming a physical therapist when she was in high school. That interest became a passion during college when she began to understand the mechanisms underlying musculoskeletal injuries and how those injuries, along with pain, affect movement patterns and function.