Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 5, 77

Does a Better Perfusion of Deconditioned Muscle Tissue Release Chronic Low Back Pain?


Does a Better Perfusion of Deconditioned Muscle Tissue Release Chronic Low Back Pain?

Paola Valdivieso et al. Front Med (Lausanne).


Non-specific chronic low back pain (nsCLBP) is a multifactorial condition of unknown etiology and pathogenesis. Physical and genetic factors may influence the predisposition of individuals to CLBP, which in many instances share a musculoskeletal origin. A reduced pain level in low back pain patients that participate in exercise therapy highlights that disuse-related muscle deconditioning may predispose individuals to nsCLBP. In this context, musculoskeletal pain may be the consequence of capillary rarefaction in inactive muscle as this would lower local tissue drainage and washing out of toxic waste. Muscle activity is translated into an angio-adaptative process, which implicates angiogenic-gene expression and individual response differences due to heritable modifications of such genes (gene polymorphisms). The pathophysiologic mechanism underlying nsCLBP is still largely unaddressed. We hypothesize that capillary rarefaction due to a deconditioning of dorsal muscle groups exacerbates nsCLBP by increasing noxious sensation, reducing muscle strength and fatigue resistance by initiating a downward spiral of local deconditioning of back muscles which diminishes their load-bearing capacity. We address the idea that specific factors such as angiotensin-converting enzyme and Tenascin-C might play an important role in altering susceptibility to nsCLBP via their effects on microvascular perfusion and vascular remodeling of skeletal muscle, inflammation, and pain sensation. The genetic profile may help to explain the individual predisposition to nsCLBP, thus identifying subgroups of patients, which could benefit from ad hoc treatment types. Future therapeutic approaches aimed at relieving the pain associated with nsCLBP should be based on the verification of mechanistic processes of activity-induced angio-adaptation and muscle-perfusion.

Keywords: gene polymorphisms; muscle perfusion; non-specific chronic low back pain; pain sensation; therapeutics.


Figure 1
Figure 1
Peripheral blood perfusion in relationship with angiogenic factors (ACE and TNC) and chronic muscle pain. Interactions between muscle deconditioning/conditioning responses and the Angio-adaptation process. Arrows (+) indicate promotion and Arrows (−) indicate reduction. Documented interactions are fully colored in green and red, while dotted lines represent our postulated interactions in this pathway. ACE I, angiotensin-converting enzyme insertion; ACE D, angiotensin-converting enzyme deletion; TNC, Tenascin-C (rs2104772); A, adenine; T, thymine. The TNC-T and ACE-D polymorphism may result in a less-efficient vascular remodeling-perfusion and exacerbation of muscle pain by an increase of nitric oxide (NO) and acidosis-related process.

Similar articles

See all similar articles


    1. GBD 2013 DALYs and HALE Collaborators. Murray CJ, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet (2015) 386(10009):2145–91.10.1016/S0140-6736(15)61340-X - DOI - PMC - PubMed
    1. Conway R, Behennah J, Fisher J, Osborne N, Steele J. Associations between trunk extension endurance and isolated lumbar extension strength in both asymptomatic participants and those with chronic low back pain. Healthcare (Basel) (2016) 4(3):E70.10.3390/healthcare4030070 - DOI - PMC - PubMed
    1. Deyo RA, Weinstein JN. Low back pain. N Engl J Med (2001) 344(5):363–70.10.1056/NEJM200102013440508 - DOI - PubMed
    1. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet (2017) 389(10070):736–47.10.1016/S0140-6736(16)30970-9 - DOI - PubMed
    1. Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet (2012) 379(9814):482–91.10.1016/S0140-6736(11)60610-7 - DOI - PubMed