The Effect of Theta Burst Stimulation Over the Primary Motor Cortex on Experimental Hamstring Pain: A Randomized, Controlled Study

  • Nadia Moukhaiber
    Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
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  • Simon J Summers
    Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia

    Queensland University of Technology, School of Biomedical Sciences, Queensland, Australia
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  • David Opar
    Australian Catholic University, Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, School of Behavioural and Health Sciences, Victoria, Australia
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  • Jawwad Imam
    Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
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  • Daniel Thomson
    Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
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  • Wei-Ju Chang
    University of Newcastle, College of Health Medicine and Wellbeing, School of Health Sciences, New South Wales, Australia

    Neuroscience Research Australia (NeuRA), Centre for Pain IMPACT, New South Wales, Australia
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  • Toni Andary
    South Western Sydney Local Health District, New South Wales, Australia
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  • Rocco Cavaleri
    Address reprint requests to Rocco Cavaleri, PhD, BHS (Hons 1)/M Physio, Western Sydney University, School of Health Sciences, Locked Bag 1797, Penrith, NSW 2751, Australia.
    Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
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Published:December 01, 2022DOI:


      • Active theta burst stimulation (TBS) reduces hamstring mechanical sensitivity compared to sham.
      • TBS did not influence corticomotor organisation.
      • Pain intensity and function did not change following TBS, contrasting reports in the upper limb.


      Theta burst stimulation (TBS) over the primary motor cortex (M1) is an emerging technique that may have utility in the treatment of musculoskeletal pain. However, previous work exploring the analgesic effects of noninvasive brain stimulation has been limited largely to the arm or hand, despite 80% of acute musculoskeletal injuries occurring in the lower limb. This is a pertinent point, given the functional and neurophysiological differences between upper and lower limb musculature, as well as evidence suggesting that reorganization of corticomotor pathways is region-specific. This study investigated the effect of excitatory TBS on pain, function, and corticomotor organization during experimentally induced lower limb pain. Twenty-eight healthy participants attended 2 experimental sessions. On Day 0, participants completed 10 sets of 10 maximal eccentric contractions of the right hamstring muscles to induce delayed onset muscle soreness. Four consecutive blocks of either active or sham TBS were delivered on Day 2. Measures of mechanical sensitivity, pain (muscle soreness, pain intensity, pain area) function (single-leg hop distance, maximum voluntary isometric contraction, lower extremity functional scale), and corticomotor organization were recorded before and after TBS on Day 2. Pain and function were also assessed daily from Days 2 to 10. Active TBS reduced mechanical sensitivity compared to sham stimulation (P = .01). Corticomotor organization did not differ between groups, suggesting that improvements in mechanical sensitivity were not mediated by changes in M1. Subjective reports of pain intensity and function did not change following active TBS, contrasting previous reports in studies of the upper limb.
      Perspective: M1 TBS reduces mechanical sensitivity associated with experimentally induced hamstring pain. Though further work is needed, these findings may hold important implications for those seeking to expedite recovery or reduce muscle sensitivity following hamstring injury.

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