{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:45:30Z","timestamp":1783557930120,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People with chronic low back pain (LBP) often experience pain evoked by movement (movement\u2010evoked pain [MEP]). Although pain changes how people move, it remains unclear whether motor adaptations to LBP are specific to the pain\u2010provocative movement. This crossover experimental study aimed to understand whether pain modulated by movement in different directions induces distinct motor adaptations, and if these adaptations are consistent with a purposeful strategy to minimise pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty healthy adults performed a repetitive box lifting task in two experimental sessions. Experimental pain was induced in the lumbosacral region using nociceptive electrical stimulation, with intensity modulated proportionally to either lumbar flexion or extension. Within\u2010subject changes in kinematics and centre of pressure were assessed both during and post\u2010pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During both sessions and over time, participants reduced their lumbar movement in the pain\u2010provocative direction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), but not in the non\u2010pain\u2010provoking direction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.078). The reduction in lumbar flexion was strongly associated with perceived pain intensity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and persisted beyond pain resolution (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Pain during lumbar flexion also induced other acute motor adaptations, including reduced elbow flexion (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.027) and an anterior shift of the centre of pressure (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study revealed that the direction of the pain\u2010provocative movement is a determinant factor in motor adaptations to pain, with clinical implications in developing personalised, movement\u2010based interventions for LBP. Further, motor adaptations were not simply a generic acute response to pain but evolved to minimise pain, supporting the proposal that MEP is a motivational stimulus for adaptive behaviour driven by learning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>This study shows that motor adaptations to MEP are specific to the direction of pain\u2010provocative movement, evolve over time and represent a purposeful strategy to reduce pain. These findings highlight the reciprocal interactions between pain and movement, supporting the rationale for assessing motor strategies in people with movement\u2010evoked LBP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70142","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T08:20:21Z","timestamp":1759825221000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Direction Matters: A Crossover Study on Motor Adaptations to Movement\u2010Evoked Pain Induced in the Lumbar Region"],"prefix":"10.1002","volume":"29","author":[{"given":"Valter","family":"Devecchi","sequence":"first","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Science University of Birmingham  Birmingham UK"},{"name":"Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, 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and Environmental Sciences University of Birmingham  Birmingham UK"},{"name":"Department of Clinical and Experimental Sciences Universit\u00e0 degli Studi di Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Abboud","sequence":"additional","affiliation":[{"name":"D\u00e9partement des Sciences de l'Activit\u00e9 Physique Universit\u00e9 du Qu\u00e9bec \u00e0 Trois\u2010Rivi\u00e8res  Trois\u2010Rivi\u00e8res Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Hodges","sequence":"additional","affiliation":[{"name":"School of Health and Rehabilitation Sciences The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1945-5518","authenticated-orcid":false,"given":"Alessio","family":"Gallina","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, College 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