PAIN+ CPN

Doctor, I have musculoskeletal pain. Will motor imagery help me to reduce pain and improve my range of motion?


If you have a chronic musculoskeletal pain condition, motor imagery performed for 15 minutes 3 times per week may improve your pain and range of motion at 4 weeks. Motor imagery does not appear to have an effect on pain or range of motion for patients with acute musculoskeletal pain.

What is the evidence?


Researchers looked at patients with both acute and chronic musculoskeletal pain conditions, who either received motor imagery in addition to standard rehabilitation, or standard rehabilitation alone. They measured pain and range of motion. They found that: 

  • Patients with chronic musculoskeletal pain conditions who practiced motor imagery had reduced pain and increased range of motion
  • Motor imagery did not improve pain or range of motion for patients with acute musculoskeletal conditions
  • The most common frequency of motor imagery was 15 minutes per session, 3 sessions per week, for 4 weeks
  • These results were based on low and very low quality of evidence. There were a small number of patients enrolled in the 8 included studies (153 total: 77 patients had motor imagery and 76 had standard rehabilitation). The methods of motor imagery and the kinds of standard rehabilitation were very different among the studies. 


What kind of study was this?

This was a systematic review. A systematic review summarises all available studies on a health care intervention to provide high quality evidence on the effectiveness of that health care intervention.

Who participated in the study? This review included 8 randomized controlled trials involving 153 people who had acute and chronic musculoskeletal disorders, including ankle sprains, shoulder pain, total knee replacement, ACL reconstruction, and chronic neck pain.

How was the study done? The reviewers included studies that compared motor imagery combined with standard rehabilitation with standard rehabilitation alone.


Motor Imagery

vs

Standard rehabilitation


In motor imagery, the patient imagines and rehearses the action in their mind without performing it. In these studies, patients imagined the movement to be performed (such as a stretch) and used visual, computer, or kinesthetic imagery to assist them in doing so.

Motor imagery sessions lasted from 2-45 minutes, up to 5 times per week, for up to 8 weeks.

The motor imagery was performed in addition to a usual physiotherapy routine, as described under ‚Äústandard rehabilitation‚ÄĚ.



In these studies, standard rehabilitation included a variety of techniques, including aerobic and strengthening exercises, hydromassage, ultrasound, electrotherapy, and cryotherapy.

Why was this research done?


Pain and fear of experiencing pain after a musculoskeletal injury can slow down or prevent recovery, and this can result in poorer functional outcomes for patients. When people move less and/or fear to move because of pain, it is believed that this causes changes in the brain (changes to cortical thickness).

Motor imagery and motor execution share overlapping areas of the brain. It is believed that by activating this area through motor imagery (rehearsing the movement), real changes are made in the brain that assist in actually performing the movement. Because of this, researchers think that motor imagery may help patients with musculoskeletal pain disorders improve their level of pain and range of motion when performing movements.

Several studies have been performed using motor imagery in the rehabilitation for pain conditions such as chronic regional pain syndrome and phantom limb pain, and pain was improved for patients in these studies. The authors of this study decided to look for all studies that have used motor imagery in addition to other kinds of rehabilitation for patients with any kind of musculoskeletal pain.


This Evidence Summary is based on the following article:

Yap BWD, Lim ECW. The Effects of Motor Imagery on Pain and Range of Motion in Musculoskeletal Disorders: A Systematic Review Using Meta-Analysis. Clin J Pain. 2019 Jan;35(1):87-99. doi: 10.1097/AJP.0000000000000648. PubMed

Published: Tuesday, February 26, 2019