심부근육의 선행 활성화 조절(Feed-forward) 기전의 장애가 요통의 병태생리에 미치는 영향: 통합적 문헌 고찰 = The Impact of Impaired Feed-Forward Activation Control of Core Muscles on the Pathophysiology of Low Back Pain: An Integrative Review

다국어 초록 (Multilingual Abstract)

This integrative review examined how impaired feed-forward postural control mechanisms, operationalized as anticipatory postural adjustments(APA), contributed to the pathophysiology of low back pain(LBP) from the perspective of the deep core system(TrA, MF, PFM, DPH). A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for studies published between 1997 and 2023. The selection process followed the PRISMA 2020 framework. Of 1,248 records identified, 31 duplicates were removed, and title/abstract screening and full-text eligibility assessment yielded 20 included studies. The included evidence covered experimental, interventional, cross-sectional, observational, imaging-based, narrative/systematic review, and commentary/theoretical studies. Surface electromyography(EMG onset timing) was the most frequently used assessment method, while ultrasound, dynamic MRI, and kinematic/center of pressure(COP) analyses were used as complementary tools. Across studies, healthy adults consistently demonstrated pre-activation of deep core muscles prior to rapid limb movements, supporting micro-stability of the lumbo-pelvic complex through predictive neuromuscular control. In contrast, individuals with LBP showed delayed onset of anticipatory activation, reduced timing variability across repeated trials, disrupted inter-muscular coordination, and increased asymmetry of activation. These alterations were commonly accompanied by compensatory patterns such as excessive superficial muscle recruitment and increased trunk stiffness, suggesting a less flexible and maladaptive reorganization of predictive motor control that could facilitate symptom persistence and chronicity. Interventions including motor control training, sensorimotor training, and virtual reality- based programs reported partial restoration and/or maintenance of APA-related outcomes, indicating that feed-forward deficits represented modifiable neuromuscular functions rather than irreversible impairments. Overall, LBP pathophysiology was better interpreted as a failure of integrated timing and coordination within the deep core system rather than isolated weakness of a single muscle. Clinical rehabilitation strategies should therefore move beyond muscle-specific approaches toward task-specific, system-based programs targeting feed-forward control and coordination.