The effects of combining sensorimotor training with transcranial direct current stimulation on the anticipatory and compensatory postural adjustments in patients with chronic low back pain

PurposeTo investigate the effects of concurrent sensorimotor training (SMT) and transcranial direct current stimulation (tDCS) on the anticipatory and compensatory postural adjustments (APAs and CPAs) in patients with chronic low back pain (CLBP).MethodThe interventions included (1) SMT plus tDCS and (2) SMT plus sham tDCS. Outcome measures were the normalized integrals of electromyography activity (NIEMG) during the phases of anticipatory and compensatory, and muscle onset latency. The investigated muscles were ipsilateral and contralateral multifidus (MF), transversus abdominus/internal oblique (TrA/IO), and gluteus medius (GM).ResultsBetween-group comparisons demonstrated that ipsilateral TrA/IO NIEMG during CPA1 (p = 0.010) and ipsilateral GM NIEMG during CPA1 (p = 0.002) and CPA2 (p = 0.025) were significantly lower in the SMT combined with tDCS than in the control group. Furthermore, this group had greater NIEMG for contralateral GM during APA1 than the control group (p = 0.032). Moreover, the onset latency of contralateral TrA/IO was significantly earlier after SMT combined with tDCS (p = 0.011).ConclusionsBoth groups that received SMT showed positive effects, but anodal tDCS had an added value over sham stimulation for improving postural control strategies in patients with CLBP. Indeed, SMT combined with tDCS leads to stronger APA and less demand for CPA.RCT registration numberIRCT20220228054149N1Registration date2022-04-04 Evidence suggests that reduced excitability in the sensory and motor cortex is linked to chronic and recurring lower back pain.Increasing the excitability of these two areas using anodal transcranial direct current stimulation (tDCS), in conjunction with sensorimotor training (SMT), may improve anticipatory and compensatory postural control strategies.This study showed that the combination of SMT with tDCS targeting the sensory and motor cortex notably enhances motor preparation and refines postural control strategies in patients with chronic unilateral lumbar radiculopathy.Rehabilitation professionals are encouraged to integrate SMT with tDCS into treatment protocols to enhance the ability of individuals with back pain to handle postural disturbances in daily life, thereby potentially alleviating the persistence of their symptoms.Incorporating brain stimulation enhances the effectiveness of SMT for patients with chronic unilateral lumbar radiculopathy.