Description of research into the relationship between sensory acuity at the back and motor control of the back in people with back pain, Luomajoki & Moseley Br J Sport Med 2009 and Moseley, Zalucki & Wiech Pain, 137 (2008)

1. Tactile acuity at the back and motor control
of the trunk are decreased in people with
back pain
Lorimer Moseley
NHMRC Senior Research Fellow
Prince of Wales Medical Research Institute & School of Medical Sciences,
University of New South Wales, Sydney, Australia
Team leader
The GAMFI project
University of Oxford, UK
© GL Moseley http://
www.bodyinmind.com.au

2. TPD ver(cal
TPD horizontal
TPD = two point discrimina(on threshold – a
measure of tac(le acuity.
© GL Moseley
Luomajoki & Moseley 2009 Br J Sport Med www.BodyInMind.com.au

3. This shows that tac(le acuity is less in
people with back pain than it is in
those without.
This shows voluntary
lumbopelvic control is worse
in people with back pain
than in those without.
© GL Moseley
Luomajoki & Moseley 2009 Br J Sport Med www.BodyInMind.com.au

4. This shows voluntary
lumbopelvic control and
tac(le acuity are related.
© GL Moseley
Luomajoki & Moseley 2009 Br J Sport Med www.BodyInMind.com.au

5. Can we train tac(le acuity?
© GL Moseley
www.BodyInMind.com.au

6. A. Stimulation B. Condition NO ATTENTION
Probes
Screen
5
1 2 34
2 mm 11 mm
In one condi(on, we just touched the affected hand at these points while the pa(ent read a book. In the other condi(on,
we did iden(cal touches but now they had to discriminate between them – which point and which probe.
Affected part ATTENTION
Stimulation
sites
5
1 2 4
3 5
5 5
1 2 34 1 2 34
Photograph of affected part,
with stimulation sites marked. © GL Moseley
Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 www.BodyInMind.com.au

7. This shows that while there was no effect of the s(mula(on alone, there was significant improvement in pain, tac(le
acuity and func(on. Improvements were maintained at 3 month follow‐up.
NO ATTENTION
8
Pain NRS
4
Screen
5
0 1 2 34
60
TPD
mm
ATTENTION
30
10
Task-specific
NRS
5
5 5 5
1 2 34 1 2 34
0 Wait No Attention Review
attention © GL Moseley
Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 www.BodyInMind.com.au

8. 6
Change 7
in pain
12 9
NRS
3 24 8 11
ATTENTION
3 5 10 1
13
r2 = 0.34
This shows that during 0 P = 0.04
discrimina(on, the change in
tac(le acuity and the change -0.5 6
0 1 2
in pain were related. Change in TPD
3
Change
in pain 4
NRS
7 6 9 8
NO ATTENTION
12 3
0 2 1 13 10
11 5
-0.5 0 1 © GL Moseley
Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 Change in TPD www.BodyInMind.com.au

9. Can we use vision and gaze
direction to make it better?
Taylor-Clarke et al (2002) Curr Biol 12, 233-6
These (and other) studies show that if you can see skin and look in the
direction of a stimulus, our tactile acuity is better and sensory cortex
response is bigger. © GL Moseley
www.BodyInMind.com.au

10. In this experiment we used the
same method as the clinical trial
(condi(on E) and then a
condi(on that also captured
visual input of skin (C),
a condi(on that captured gaze
direc(on but not visual input of
skin (D)
and a condi(on that captured
both (B).
Each session involved 72 s(muli
randomly to five points with
either a fat or a skinny probe (A).
© GL Moseley
Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 www.BodyInMind.com.au

11. This shows that, a]er a single 30
minute discrimina(on training
session, the increase in tac(le
acuity was greatest in the
condi(on that captured both
visual input of skin and gaze
direc(on.
This shows that there was also a
significant decrease in pain.
© GL Moseley
Moseley, Zalucki & Wiech (2008) Pain 137,3 600‐8 www.BodyInMind.com.au

12. Does the same apply for the back?
How do we use vision there?
We should use vision & spa(al a^en(on to
enhance TPD training
In CRPS, TPD training can reduce pain
© GL Moseley
www.BodyInMind.com.au