Date of Award

2024

Degree Name

Doctor of Philosophy (School of Physiotherapy)

Schools and Centres

Physiotherapy

First Supervisor

William Gibson

Second Supervisor

Benedict Wand

Third Supervisor

Dana Hince

Fourth Supervisor

Mervyn Travers

Abstract

Changes in various body representations have been increasingly investigated and subsequently posited to be potentially important factors in the development and maintenance of chronic low back pain. Three main domains of body representation are considered here: body model, body schema (comprising superficial and postural schema), and body image. Most studies informing our contemporary understanding of these body representations have been undertaken in areas such as the hand and forearm, with a comparative dearth of studies performed on the low back. Consequently, this thesis consists of a comprehensive investigation of body representation initially in healthy back pain-free individuals and then in a comparative fashion between healthy back pain-free individuals and people living with chronic low back pain. Firstly, the development of, and then reliability data for, a novel testing device measuring body landmark and tactile localisation tasks in the back is presented (Chapter 2). Establishing this device as reliable allowed progression into formal testing for the body model of the back in healthy back pain-free individuals with midline and lateral body landmark localisation (Chapter 3). Chapter 4 investigated tactile localisation in healthy back pain-free individuals, providing information on the superficial schema at the low back. The investigation of width perception via calipers, and a back picture mapping task, supplied information on the body image of the back for healthy back pain-free individuals (Chapter 5). Having established normative values of these phenomena in healthy back pain-free individuals, comparative analysis was then made between this group and participants with mild and moderate chronic low back pain (CLBP) (Chapter 6). Results described within this thesis indicate minimal differences exist between groups. The body model for all groups presented as a squatter back, wider at the waist and hips (although not significant at the hips for the Mild CLBP group). With tactile localisation, lateral landmarks were perceived more lateral than they actually were, and vertically, landmarks were perceived with an increasing inferior mislocalisation when moving down the back. With body image, all groups overestimated width perception at the thorax and waist, while in the picture mapping task, accuracy did not differ between groups, and group was not related to whether a person was accurate, underestimated, or overestimated in terms of the accuracy of size depiction in the images. Further, those who were inaccurate in their selection were no more likely to over or underestimate in their image choice. The hope is this project may provide the foundation for future work in this area and enable researchers and clinicians to better understand body representation in patients with CLBP. Such understanding may inform management strategies that could be employed to address these differences.

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