Insights from a Back Pain Chiropractor in Maroubra, Eastern Suburbs Sydney
Chronic low back pain (CLBP) is not just a problem of joints, discs or muscles – it’s also a problem of the brain’s control system. Modern neuroscience has revealed that people with CLBP show measurable differences in the primary motor cortex (M1) – the brain region that plans and drives movement -particularly in how it represents and controls the back muscles.
For patients presenting to a chiropractor in Maroubra with long-standing or recurrent back pain, this helps explain why imaging findings alone often fail to match pain severity or functional limitation.
The Brain’s “Map” of the Back Is Altered
In healthy individuals, the motor cortex contains well-defined maps for specific muscle groups. But in CLBP, these maps become blurred or shifted – a phenomenon sometimes called “smudging.”
Research using Transcranial Magnetic Stimulation (TMS) has shown that people with CLBP have an anterior shift in the center of gravity (CoG) of the motor map for their paraspinal muscles compared to pain-free controls.
This means the part of the brain normally responsible for precise back-muscle activation has reorganized forward, possibly as an adaptation (or maladaptation) to pain and altered movement patterns commonly seen in patients seeking back pain chiropractic care in Maroubra and the Eastern Suburbs.
The map volume (i.e. how much of the cortex is dedicated to the back muscles) is often smaller in people with CLBP – and smaller maps are linked to greater pain during movement tasks.
Clinically, this suggests that chronic pain may lead to less precise brain control of the trunk – and that this disorganisation correlates with worse pain and function, even in physically active individuals!
Altered Cortical Excitability and Neural Drive
Beyond map shifts, CLBP also involves impaired corticomotor control – the way the brain excites or inhibits its motor outputs.
Studies combining ultrasound imaging and TMS have shown that CLBP is associated with reduced intracortical inhibition (the brain’s ability to “fine-tune” its motor signals).
This reduction means the motor cortex may fire in a less coordinated, less selective way – producing inefficient or over-protective muscle activation patterns such as stiffness and guarding. These patterns are frequently observed during movement assessments by a chiropractic clinic in Maroubra treating chronic back pain.
Importantly, the normal link between cortical excitability and muscle activation seen in healthy individuals is lost in CLBP – indicating a decoupling between brain and muscle performance.
So when a patient “tries to activate” their multifidus, the brain’s signal may be weak or poorly timed – helping explain why strengthening alone often fails to resolve persistent low back pain.
Timing and Coordination Are Disrupted
A complementary study examining post-silent period EMG bursts (after cortical inhibition) found that people with CLBP showed earlier but smaller bursts of muscle activity compared to controls.
This reflects altered cortical disinhibition – the brain “rebounds” too quickly but not strongly enough, leading to less effective recruitment of the spinal stabilisers required for confident, pain-free movement.
In practice, this helps explain the erratic or delayed paraspinal activation often observed during screening in patients presenting with back pain in our chiropractic clinic in Maroubra.
Clinical Implications – Rethinking Rehabilitation
These neurophysiological findings are reshaping how evidence-informed chiropractors approach chronic low back pain rehabilitation. Rather than viewing persistent pain purely through a structural or tissue-based lens, contemporary care recognises the central role of altered motor control, cortical reorganisation and disrupted brain-muscle communication. This shift has important implications for assessment and treatment, highlighting the need to evaluate movement quality, timing and neuromuscular coordination alongside traditional orthopaedic findings. Rehabilitation, therefore, must move beyond symptom management or isolated strengthening and instead focus on restoring efficient sensorimotor control, confidence in movement and adaptability of the nervous system in real-world tasks.
Focus on Motor Control, Not Just Strength
Traditional strengthening may not correct abnormal cortical control! Instead, rehabilitation should emphasise:
- Selective activation of the multifidus and deep trunk muscles
- Motor learning and timing-focused exercises (not just load)
- Proprioceptive and sensorimotor retraining, including varied tasks and feedback
This approach aligns with best practice chiropractic care for chronic back pain in Sydney’s Eastern Suburbs.
Engage the Sensorimotor Cortex
Studies using functional near-infrared spectroscopy (fNIRS) show that even non-painful pressure on the lower back activates sensorimotor cortical areas (S1, SMA).
This suggests that mechanosensory stimulation, including hands-on care, graded movement and controlled loading, can help re-engage cortical networks and support recovery.
Re-map the Brain
Emerging “cortical remapping” therapies – such as mirror feedback, tactile discrimination, and sensorimotor retraining – show early promise in improving pain and movement control in CLBP by restoring more precise cortical representations.
The Take-Home Message
- Chronic low back pain is as much a brain problem as a back problem.
- The motor cortex reorganises, shifting its representation of back muscles.
- Cortical inhibition and neural drive are altered, leading to inefficient muscle control.
- Pain severity correlates with cortical “smudging”.
- Effective rehabilitation must aim to retrain both the brain and the back.
- For patients seeking a chiropractor in Maroubra for persistent or recurrent back pain, this means care should go beyond symptom relief and address how the nervous system controls movement.
In short: To treat the back, we must train the brain!
If you are experiencing persistent or recurrent low back pain and feel that standard approaches have not addressed the full picture, a more integrated evaluation may be appropriate. At Sydney Neuro & Integrative Health, care is guided by current neuroscience, detailed diagnostic analysis, and a deep understanding of how the nervous system adapts pain over time.
Appointments can be booked promptly, allowing for a comprehensive evaluation and an evidence-informed comprehensive plan that addresses both the brain and the body, rather than focusing on symptoms alone.
References:
Tsao, H., Galea, M. P., & Hodges, P. W. (2008). Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain, 131(8), 2161–2171. https://doi.org/10.1093/brain/awn154
Schabrun, S. M., & Hodges, P. W. (2012). Muscle pain differentially modulates short-interval intracortical inhibition and intracortical facilitation in primary motor cortex. The Journal of Pain, 13(2), 187–194. https://doi.org/10.1016/j.jpain.2011.10.009
Tsao, H., & Hodges, P. W. (2006). Persistence of lumbar multifidus muscle atrophy after acute low back pain. Spine, 31(23), E702–E708. https://doi.org/10.1097/01.brs.0000241141.45006.0b
Massé-Alarie, H., Schneider, C., Schabrun, S. M., Hodges, P. W., & Tsao, H. (2016). Corticomotor control of deep abdominal muscles in chronic low back pain. Journal of Neurophysiology, 115(5), 2501–2511. https://doi.org/10.1152/jn.00959.2015
Moseley, G. L., & Flor, H. (2012). Targeting cortical representations in the treatment of chronic pain: A review. Neurorehabilitation and Neural Repair, 26(6), 646–652. https://doi.org/10.1177/1545968311433209