Age-related differences on low back pain and postural control during one-leg stance: a case–control study

Kinematic changes of the trunk and lower limbs during voluntary lateral sway postural control in adults with low back pain

Introduction: Voluntary lateral weight shifting is essential for gait initiation. However, kinematic changes during voluntary lateral weight shifting remain unknown in people with low back pain (LBP). This study aims to explore the differences in kinematics and muscle activation when performing a voluntary lateral weight shifting task between patients with LBP and asymptomatic controls without pain. Methods: Twenty-eight participants volunteered in this study (14 in both the LBP group and the control group). The Sway Discrimination Apparatus (SwayDA) was used to generate a postural sway control task, mimicking lateral weight shifting movements when initiating gait. Kinematic parameters, including range of motion (ROM) and standard deviation of ROM (Std-ROM) of the lumbar spine, pelvis, and lower limb joints, were recorded using a motion capture system during lateral weight shifting. The electroactivity of the trunk and lower limb muscles was measured through surface electromyography using root mean square (RMS). The significant level was 0.05. An independent t-test was employed to compare kinematic parameters, and muscle activation between the LBP group and the control group. A paired-sample t-test, adjusted with Bonferroni correction (significant level of 0.025), was utilized to examine differences between the ipsilateral weight shifting towards side (dominant side) and the contralateral side. Results: The results of kinematic parameters showed significantly decreased ROM and std-ROM of the ipsilateral hip in the transverse plane (tROM = -2.059, p = 0.050; tstd-ROM = -2.670, p = 0.013), as well as decreased ROM of the ipsilateral knee in the coronal plane (t = -2.148, p = 0.042), in the LBP group compared to the control group. For the asymptomatic controls, significantly larger ROM and ROM-std were observed in the hip and knee joints on the ipsilateral side in contrast to the contralateral side (3.287 ≤ t ≤ 4.500, 0.001 ≤ p≤ 0.006), but no significant differences were found between the two sides in the LBP group. In addition, the LBP group showed significantly lower RMS of the biceps femoris than the control group (tRMS = -2.186, p = 0.044). Discussion: Patients with LBP showed a conservative postural control pattern, characterized by reduced ROM of ipsilateral joints and diminished activation of the biceps femoris. These findings suggested the importance of voluntary postural control assessment and intervention to maximize recovery.

A Clinical Measure of Trunk Neuromuscular Function Predicts Falling in Older Adults With Chronic Low Back Pain

BACKGROUND AND PURPOSE

Older adults with low back pain (LBP) are at risk for falling, but condition-specific mechanisms are unknown. Trunk neuromuscular function is critical for maintaining balance during mobility tasks and is often impaired in older adults with LBP. The purpose of this study was to assess whether aberrant lumbopelvic movements (or aberrant movements), a clinical index of trunk neuromuscular function, were associated with increased fall risk among older adults with chronic LBP over a 12-month follow-up period.

METHODS

This study analyzed data from a prospective cohort study of 250 community-dwelling older adults with chronic LBP. Participants were screened for 4 aberrant movements during 3 trials of forward flexion from a standing position: instability catch, painful arc, altered lumbopelvic rhythm, and Gower's sign. Aberrant movements were totaled to yield a summary score (ie, 0-4). Prospective falls were monitored via monthly fall calendars for 12 months. A generalized linear model with Poisson distribution and log link function was used to evaluate the association between aberrant movements and prospective fall risk. Age, sex, body mass index, LBP intensity, dynamic balance performance, prior falls, anxiolytic medication usage, and hip osteoarthritis characteristics were included as covariates in the model.

RESULTS

Baseline aberrant movements were independently associated with greater fall risk (risk ratio = 1.249, 95% CI = 1.047-1.491, P = .014); each 1-unit increase in aberrant movement score imparted a 24.9% increase in the risk of falling.

CONCLUSIONS

Aberrant movements increased the risk of falling among older adults with chronic LBP over a 1-year span.

Comparison of psoas major activation during standing hip flexion between chronic low back pain and healthy populations

BACKGROUND

The psoas major (PM) has been identified as a potential contributor to chronic low back pain (LBP). However, few studies have investigated the effects of upright functional movement on PM activation in cLBP individuals.

OBJECTIVE

This cross-sectional study aims to compare PM muscle activation characteristics in chronic LBP (cLBP) and healthy subjects during the transition from quiet double-leg standing to standing hip flexion.

METHODS

Ultrasound Imaging was used to assess PM thickness at the lumbar vertebral level of L4-5 in 12 healthy and 12 cLBP participants. The changes in thickness between the test positions were utilized as a proxy for PM activation.

RESULTS

The cLBP group exhibited greater thickness changes on the non-dominant side PM during contralateral hip flexion but not ipsilateral hip flexion (p= 0.369) compared to their healthy counterparts (p= 0.011; cLBP: resting 27.85 mm, activated 34.63 mm; healthy: resting 29.51 mm, activated 29.00 mm). There were no significant differences in dominant side PM thickness changes between the two groups during either contralateral or ipsilateral hip flexion (p= 0.306 and p= 0.077).

CONCLUSION

Our findings suggest a potential overactivation of the PM in the cLBP population. This insight may aid in the development of tailored rehabilitation programs.

The effects of virtual reality training on postural sway and physical function performance on older women with chronic low back pain: A double-blind randomized clinical trial

BACKGROUND

Chronic low back pain (CLBP) is known as an important debilitating health condition among older women.

OBJECTIVE

This study aimed to evaluate the effects of eight-week virtual reality training (VRT) exercises on postural sway and physical function performance (PFP) among older women suffering from CLBP.

METHODS

Twenty-seven older women presenting with CLBP were randomized into experimental and control groups. The experimental group was instructed to perform 30-minute VRT exercises three times a week for eight weeks. Plantar pressure variables [sway velocity (SV) and anterior-posterior (AP) and medial-lateral (ML) fluctuations of the center of pressure (CoP)], 30-second chair stand test (30CST), and timed up and go (TUG) test were recorded.

RESULTS

The VRT group exhibited significant decreases in SV (p= 0.002), AP (p= 0.008), and ML (p= 0.02) fluctuations. Also, the performance of the VRT group in the 30CST and TUG tests significantly improved after the exercises (P< 0.001).

CONCLUSION

According to the results, VRT and the program used in this study should be used to enhance balance and PFP in older women with CLBP who mostly prefer activities that are accessible and feasible in low-risk environments.

Transcranial direct current stimulation over dorsolateral prefrontal cortex improves postural stability in non-specific chronic low back pain patients with high fear of pain: A randomized sham-controlled trial

Deficits in postural stability in response to environmental challenges are seen in chronic low back pain (CLBP) patients with high fear of pain (HFP). Hence, it is essential to follow effective approaches to treat postural stability deficits and improve the health status of these patients. The current study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the left dorsolateral prefrontal cortex (DLPFC) on postural stability in non-specific CLBP patients with HFP. In this randomized clinical trial study, 75 patients were randomly assigned to left DLPFC a-tDCS, left DLPFC c-tDCS and sham stimulation groups (n = 25 in each group). All groups received a single-session 2 mA tDCS for 20 min, but the stimulation was slowly turned off after 30 s in the sham group. Before, immediately, 24 h and 1 week after the interventions, postural stability indices were assessed using a Biodex Balance System. A significant reduction in most indices was shown in both a-tDCS and c-tDCS groups after interventions (immediately, 24 h and 1 week follow-up) during static and dynamic postural tasks compared with the sham tDCS group (p < .01). In addition, some tests showed a significant difference between a-tDCS and c-tDCS (p < .05). The findings indicated positive effects of both a-tDCS and c-tDCS on the left DLPFC, with more efficacy of a-tDCS on postural stability in LBP patients with HFP.

Association between functional disability with postural balance among patients with chronic low back pain

Introduction

Postural balance is impaired in patients with chronic low back pain (CLBP). In addition, the swaying velocity can be affected by low back pain (LBP) dysfunction. However, the extent to which the dysfunction affects postural balance in CLBP patients remains unclear. Therefore, this study aimed to investigate the effect of LBP-related disability on postural balance among CLBP patients and determine factors associated with postural balance impairments.

Methods

Participants with CLBP were recruited and instructed to complete the one-leg stance and Y-balance test. Moreover, they were divided into two subgroups (i.e., low and medium to high LBP-related disability groups) to compare the difference in postural balance based on the degree of LBP-related disability measured by the Roland Morris Disability Questionnaire. The relationships between postural balance and negative emotions as well as LBP characteristics were determined using the Spearman correlations.

Results

A total of 49 participants with low LBP-related disabilities and 33 participants with medium to high LBP-related disabilities participated in the study. Compared to the medium to high LBP-related disability group, patients in the low LBP-related disability group performed better in one-leg stance on the left leg (z = -2.081, p = 0.037). For Y-balance test, patients in the low LBP-related disability group also had greater normalized values of left leg reach in posteromedial (t = 2.108, p = 0.038) direction and composite score (t = 2.261, p = 0.026) and of right leg reach in posteromedial (t = 2.185, p = 0.032), and posterolateral (t = 2.137, p = 0.036) directions as well as composite score (t = 2.258, p = 0.027). Factors associated with postural balance impairments were also revealed, such as anxiety, depression, and fear avoidance belief.

Discussion

The greater the dysfunction degree, the worse the CLBP patient's postural balance impairment. Negative emotions could also be considered contributing factors for postural balance impairments.

Supervised exercise with or without laser-guided feedback for people with non-specific chronic low back pain. A randomized controlled clinical trial

BACKGROUND

Among the most effective therapeutic interventions in non-specific chronic low back pain (NSCLBP), clinical practice guidelines highlight exercise therapy and patient education; However, regarding the combined intervention of exercise and Pain Neuroscience Education (PNE), there is no consensus on the most effective form of exercise.

OBJETIVE

To find out what changes occurred after the application of two exercise modalities [Supervised Exercise (SE) and Laser-Guided Exercise (LGE)] and PNE on pain, pain pressure thresholds, disability, catastrophizing, kinesiophobia and lumbar proprioception in subjects with NSCLBP.

METHODS

Single-blind randomized clinical controlled trial. 60 subjects with NSCLBP. Both groups performed a a total of 16 therapeutic exercise sessions and 8 Pain Neuroscience Education sessions. With the Laser-Guided Exercise Therapy group performing laser-guided exercises.

RESULTS

A significant decrease was observed for pain intensity for both groups between baseline and post-intervention and the 3 month follow-up (p < 0.001). There was a significant between-group difference between baseline and post-intervention scores in terms of pain intensity and kinesiophobia in favour of the LGE group.

CONCLUSION

Supervised exercise with or without laser feedback, when combined with PNE, reduces pain intensity, disability, pain catastrophizing, kinesiophobia and improves proprioception and PPTs in patients with NSCLBP. At a 3-month follow-up, the combination of LGE plus PNE is most effective for reducing pain intensity.

Validity of On-Line Supervised Fitness Tests in People with Low Back Pain

This study aimed to investigate the concurrent validity between online evaluations (OEs) and face-to-face evaluations (IPEs) of a Senior Fitness Test and two balance tests in people with low back pain (LBP). Forty participants of 58.48 (9.87) years were included. The 30 s chair stand-up, arm curl, 2 min step, chair-sit and reach, back scratch, 8 foot up-and-go, sharpened Romberg, and one-legged stance tests were administrated using both OE and IPE methods. The results indicated no significant differences (p > 0.05) between the two methods except in the 8-foot up-and-go test (p = 0.007). Considering the ICC values and Bland-Altman plots, excellent agreement was found for the chair-sit and reach test, moderate agreement for the arm-curl and 8-foot up-and-go tests, and good agreement for the other tests. Strong correlations (p < 0.001) were observed in all variables except for the arm-curl and 8-foot up-and-go tests, where moderate correlations were found (p < 0.05). These results support the validity of OEs and IPEs in all tests, except for the arm-curl and 8-foot up-and-go tests, where lower ICC values and moderate correlations were found. However, it is important to consider the range of fluctuation of the ICC and the significant values obtained through correlations.

Postural Control of Patients with Low Back Pain Under Dual-Task Conditions

Low back pain is a major global public health problem, but the current intervention effect is not ideal. A large body of previous literature suggests that patients with chronic low back pain may have abnormal postural control, which is more evident in the dual task situation. In recent years, research on postural control in patients with low back pain under dual-task conditions has gradually become a hot topic. However, the results obtained from these studies were not entirely consistent. In this review, we summarized relevant studies on the performance of postural control in patients with low back pain under dual-task conditions, analyze it from the perspective of the theoretical model of dual-task interaction, the specific research paradigm of dual task, the performance of postural control, and the related factors affecting postural control performance, etc. It was reasonable to assume that patients with low back pain might have a certain degree of abnormal postural control, and this abnormality was affected by comprehensive factors such as age, cognitive resource capacity, attention needs, complex sensorimotor integration, external environment, etc. Furthermore, postural control performance in low back pain patients under dual-task conditions was further influenced by the nature and complexity of the different tasks. In general, the more attention resources were needed, the external environmental conditions were worse, and the age-related functions were degenerate, etc., the weaker posture control ability was. In short, a deeper understanding of postural control in patients with low back pain under dual-task conditions may shed light on more references for the rehabilitation and management of low back pain, as well as some new ideas for scientific research on cognition and postural control.

Immediate Effect of Lumbosacral Orthosis and Abdominal Drawing-In Maneuver on Postural Control in Adults With Nonspecific Chronic Low Back Pain

OBJECTIVE

The purpose of this study was to examine the immediate effects of lumbosacral orthosis and the abdominal drawing-in maneuver on the trunk postural control of adults with chronic low back pain compared with asymptomatic controls during 1-legged and semi-tandem stances.

METHODS

An experimental and comparative study (cross-sectional design) was conducted in a laboratory setting. Twenty adults with chronic low back pain and 20 asymptomatic controls randomly performed 2 postural balance tasks over a force platform, considering 3 experimental conditions: (1) natural posture (baseline-control), (2) lumbosacral orthosis, and (3) abdominal drawing-in maneuver. Linear variables (mean amplitude, ellipse area, and sway velocity) derived from the center of pressure were computed, and 2-way analysis of variance (group × condition) for repeated measures were conducted.

RESULTS

No group × condition interactions (.139 ≤ P ≤.938) were detected in any center of pressure parameters. No condition effect was detected, but a group effect (P = .042) was observed for 1 center of pressure parameter. The chronic low back pain group presented with a lower mean anteroposterior center of pressure amplitude than asymptomatic controls (∆ = 0.31 ± 0.66 cm [95% confidence interval, 0.05-0.56], P = .019) during the semi-tandem stance balance task.

CONCLUSION

Neither lumbosacral orthosis nor the abdominal drawing-in maneuver showed immediate improvement in trunk postural control in any group. Thus, clinicians should not expect immediate benefits or improvements yielded by lumbosacral orthosis or the abdominal drawing-in maneuver when patients with chronic low back pain undergo these interventions.

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

OBJECTIVES

Balance quickly diminishes after the mid-50s increasing the risk for falls and other adverse health outcomes. Our aim was to assess whether the ability to complete a 10- s one-legged stance (10-second OLS) is associated with all-cause mortality and whether it adds relevant prognostic information beyond ordinary demographic, anthropometric and clinical data.

METHODS

Anthropometric, clinical and vital status and 10-s OLS data were assessed in 1702 individuals (68% men) aged 51-75 years between 2008 and 2020. Log-rank and Cox modelling were used to compare survival curves and risk of death according to ability (YES) or inability (NO) to complete the 10-s OLS test.

RESULTS

Overall, 20.4% of the individuals were classified as NO. During a median follow-up of 7 years, 7.2% died, with 4.6% (YES) and 17.5% (NO) on the 10-s OLS. Survival curves were worse for NO 10-s OLS (log-rank test=85.6; p<0.001). In an adjusted model incorporating age, sex, body mass index and comorbidities, the HR of all-cause mortality was higher (1.84 (95% CI: 1.23 to 2.78) (p<0.001)) for NO individuals. Adding 10-s OLS to a model containing established risk factors was associated with significantly improved mortality risk prediction as measured by differences in -2 log likelihood and integrated discrimination improvement.

CONCLUSIONS

Within the limitations of uncontrolled variables such as recent history of falls and physical activity, the ability to successfully complete the 10-s OLS is independently associated with all-cause mortality and adds relevant prognostic information beyond age, sex and several other anthropometric and clinical variables. There is potential benefit to including the 10-s OLS as part of routine physical examination in middle-aged and older adults.

Effects of an 8-Week Virtual Reality Training Program on Pain, Fall Risk, and Quality of Life in Elderly Women with Chronic Low Back Pain: Double-Blind Randomized Clinical Trial

Objective: Low back pain (LBP) and falls are among the major problems experienced by the elderly population. The present study investigated the effectiveness of an 8-week virtual reality training (VRT) program in helping relieve pain, minimize fall risk, and improve quality of life (QoL) in elderly women suffering from chronic LBP (CLBP). Materials and Methods: Twenty-five elderly women (VRT/intervention group = 13, control group = 12) with CLBP and aged 65 to 75 years were recruited. The VRT involved three 30-minute weekly sessions of exercises that were carried out using the Xbox Kinect headset. Pain intensity, fall risk, and QoL were assessed via the Visual Analog Scale, the Biodex Balance System, and the 36-Item Short Form Health Survey, respectively. Results: The outcomes of a one-way analysis of covariance indicated that the pain intensity score of the intervention group significantly decreased after participation in the VRT program (P = 0.001). The intervention group also showed reduced fall risk (P = 0.001) and elevated QoL (P = 0.001). Conclusion: The results confirmed that the VRT program can be regarded as a valid therapeutic intervention that helps reduce patients' symptoms and increase the effectiveness of exercises in the elderly by teaching pain-related insight as well as enhancing QoL and reduce fall risk through various movements.

Impairment of Proprioception in Young Adult Nonradicular Patients with Lumbar Derangement Syndrome

Maintaining body balance is a complex function based on the information deriving from the vestibular, visual, and proprioceptive systems. The aim of the study was to evaluate quiet single stance stability in young adults with lumbar derangement syndrome (LDS) and in the control group of the healthy subjects. The second aim of this study was to determine whether pain intensity, degree of disability, and the level of physical activity can influence postural control in patients with LDS. It is important to underline that selecting a homogeneous group of LBP patients using, for example, mechanical diagnosis and therapy method and Quebec Task Force Classification, can result in an increased sensitivity of the study. The study included 126 subjects: 70 patients with LDS (37 women, 33 men) and the control group 56 healthy volunteers (36 women, 20 men). In case of multiple group comparisons for variables with normal distribution, ANOVA post hoc test was used or, as the nonparametric equivalent, Kruskal-Wallis test. In all these calculations, the statistical significance level was set to p < 0.05. The stability index eyes open for the study group was 88.34 and for the control group 89.86. There was no significant difference in the level of postural control between the study and control groups (p > 0.05). The level of stability index eyes closed (SI EC) for the study group was 71.44 and for the control group 77.1. SI EC results showed significant differences in proprioceptive control during single leg stance between the study and control groups (p < 0.05). The level of pain intensity, the degree of disability, and physical activity level did not influence postural control in the study group with LDS. In summary, patients with LDS showed significantly worse proprioceptive control.

Pain Is Associated With Poor Balance in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis

OBJECTIVES

Pain is a risk factor for falls in older adults, but the mechanisms are not well understood, limiting our ability to implement effective preventive strategies. The aim of this study was to systematically review and synthesize the literature that has examined the impact of pain on static, dynamic, multicomponent, and reactive balance in community-dwelling older adults.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Studies from inception to March 2019 were identified from electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL), contact with the primary authors, and reference lists of included articles.

METHODS

Cross-sectional and case-control studies that compared objective balance measures between older (minimum age 60 years) adults with and without pain were included.

RESULTS

Thirty-nine eligible studies (n = 17,626) were identified. All balance modalities (static, dynamic, multicomponent, and reactive) were significantly poorer in participants with pain compared to those without pain. Subgroup analyses revealed that chronic pain (pain persisting ≥3 months) impaired balance more than pain of unspecified duration. The effects of pain at specific sites (neck, lower back, hip, knee, and foot) on balance were not significantly different.

CONCLUSIONS AND IMPLICATIONS

Pain is associated with poor static, dynamic, multicomponent, and reactive balance in community-dwelling older adults. Pain in the neck, lower back, hip, knee, and foot all contribute to poor balance, and this is even more pronounced for chronic pain. Comprehensive balance and pain characteristic assessments may reveal mechanisms underlying the contribution of pain to instability and increased fall risk in older people.

Effects of low back pain on balance performance in elderly people: a systematic review and meta-analysis

Background

Research suggests that individuals with low back pain (LBP) may have poorer motor control compared to their healthy counterparts. However, the sample population of almost 90% of related articles are young and middle-aged people. There is still a lack of a systematic review about the balance performance of elderly people with low back pain. This study aimed to conduct a systematic review and meta-analysis to understand the effects of LBP on balance performance in elderly people.

Methods

This systematic review and meta-analysis included a comprehensive search of PubMed, Embase, and Cochrane Library databases for full-text articles published before January 2020. We included the articles that 1) investigated the elderly people with LBP; 2) assessed balance performance with any quantifiable clinical assessment or measurement tool and during static or dynamic activity; 3) were original research. Two independent reviewers screened the relevant articles, and disagreements were resolved by a third reviewer.

Results

Thirteen case-control studies comparing balance performance parameters between LBP and healthy subjects were included. The experimental group (LBP group) was associated with significantly larger area of centre of pressure movement (P < 0.001), higher velocity of centre of pressure sway in the anteroposterior and mediolateral directions (P = 0.01 and P = 0.02, respectively), longer path length in the anteroposterior direction (P < 0.001), slower walking speed (P = 0.05), and longer timed up and go test time (P = 0.004) than the control group.

Conclusion

The results showed that balance performance was impaired in elderly people with LBP. We should pay more attention to the balance control of elderly people with LBP.

Energy spectral density as valid parameter to compare postural control between subjects with nonspecific chronic low back pain vs healthy subjects: A case-control study

BACKGROUND

Nonspecific chronic low back pain (NSCLBP) is one of the most common and frequent health problems. OBJETIVE: to compare postural control (i.e. center of pressure (CoP) displacement and energy spectral density (ESD)) using technological devices (accelerometers and pressure platform) between subjects with NSCLBP and healthy subjects.

METHODS

A cross-sectional case-control study was conducted. Observational study (STROBE). The final sample consisted of 60 subjects (30 NSCLBP subjects and 30 healthy subjects). Triaxial accelerometer and pressure platform were used in order to obtain ESD and CoP displacement measurements during four balance tasks (i.e. with and without vision and on stable versus unstable surface). Independent t tests were used to compare participants with NSCLBP and healthy controls in the two clinical measurements (i.e., CoP displacement and ESD) for the four balance tests. A multivariate analysis of variance (MANOVA) together with a Fisher's linear discrimination was applied in order to categorize NSPLBP.

RESULTS

Patients with NSCLBP showed greater CoP migration in the positions eyes open, stable surface on the anteroposterior axis (p = 0.012), eyes closed, stable surface on the mediolateral axis (p = 0.025), eyes closed, stable surface on the anteroposterior axis (p = 0.001), eyes open, unstable surface on the anteroposterior axis (p = 0.040), eyes closed, unstable surface on the anteroposterior axis (p = 0.015). Also the ESD was significantly greater for the four situations described (p ≤ 0.01) in subjects with NSCLBP.

CONCLUSIONS

Accelerometer appears to be a technological device that could offer a potential benefit within the battery of tests on physical performance among subjects with NSCLBP and healthy subjects.

Effects of back extensor and hip abductor fatigue on dynamic postural stability in patients with nonspecific chronic low back pain: A case-control study

INTRODUCTION

Patients with nonspecific chronic low back pain (NSCLBP) complain of pain and fatigue during functional activities. Poor back muscle endurance has been associated with recurrent pain and long-term disability. However, the relationship between proximal muscle fatigue and postural stability is not well understood.

PURPOSE

To investigate the effects of lumbar extensor and hip abductor fatigue on postural stability in NSCLBPs.

METHODS

To induce isolated fatigue, participants (24 LBPs, 24 controls) were asked to perform multiple back extension and hip abduction in the separate sessions until the muscle force reached 60% of pre-fatigued force. The overall (OSI), anteroposterior (APSI), and mediolateral (MLSI) stability indices were measured during single-leg stance using the Biodex dynamic platform.

RESULTS

The results revealed higher postural instability (APSI and OSI) following fatiguing lumbar extensor and hip abductor muscles (greater effect size for APSI than OSI) in LBPs than controls. Furthermore, significant and inverse relationships were found between the level of physical activity, pain, and post-fatigue postural instability (OSI) in NSCLBPs.

CONCLUSION

Fatigue of proximal muscles could differentiate postural stability primarily in the sagittal plane between NSCLBPs and controls. Therefore, reducing the fatigability of these muscles by endurance training in addition to balance training may improve physical activity.

Test-Retest Reliability of an iPhone® Inclinometer Application to Assess the Lumbar Joint Repositioning Error in Non-Specific Chronic Low Back Pain

Background: The joint position sense (JPS) has been used as an indirect marker of proprioception in subjects with non-specific chronic low back pain (NSCLBP), showing impairment in previous studies. It seems necessary to devise reliable tests to measure proprioceptive deficits in subjects with NSLBP. The objective of this study was to analyse the test-retest reliability and smallest real difference (SRD) of lumbar proprioception through the JPS indicator in a sample of patients with NSCLBP. Methods: Fifty participants with NSCLBP performed three repetitions of 30° lumbar flexion while standing and sitting using the iPhone^® inclinometer application to measure the lumbar joint repositioning error. For the reliability analysis, we performed an intra-session test-retest. Results: The total sample ICC values were excellent for standing (0.96) and sitting (0.93) 30° lumbar flexion. In addition, our results showed that, for the total sample, an SRD < 12% can be considered as a true change in proprioception concerning this procedure. On the other hand, men have better reliability than women in both standing and sitting positions. Additionally, the sitting position has better reliability than the standing position. The standard error of measurement (SEM) percentage was 4.2 for standing and 3.8 for sitting. The SRD percentage was 11.6 for standing and 10.4 for sitting. Conclusions: The iPhone^® inclinometer seems reliable for assessing proprioceptive ability through the lumbar joint repositioning error in subjects with NSCLBP in both standing (ICC = 0.96) and sitting (ICC = 0.93) positions. This technological device showed a lower measurement error for sitting position (SRD < 12%).

How cognitive loads modulate the postural control of older women with low back pain?

BACKGROUND

The capacity of postural control is a key factor related to falling in older people, particularly in older women with low back pain (LBP). Cognitive involvement in postural control increases with age. However, most scholars have not considered different difficulty levels of cognitive loads when exploring the effects of cognition on postural control in older patients with LBP. The present study is to investigate how different levels of cognitive loads modulate postural control in older women with LBP.

METHODS

This was a cross-sectional study. Twenty older women with LBP were recruited into the LBP group, and 20 healthy older women without the history of LBP were recruited into the healthy control group. Balance parameters were computed to quantify postural control. All participants underwent the balance test, which required the participant to maintain stability during standing on a force platform with or without a concurrent cognitive task. The balance test included three levels of difficulties of posture tasks (eyes-open vs. eyes-closed vs. one-leg stance) and three cognitive tasks (without cognitive task vs. auditory arithmetic task vs. serial-7 s arithmetic task).

RESULTS

A repeated-measure analysis of variance (3 postural tasks × 3 congnitive tasks× 2 groups) testing the effects of the different congnitive task levels on the performance in different postural conditions. Older women with LBP had worse postural control (as reflected by larger center of pressure (COP) parameters) than control group regardless of postural or cognitive difficulties. Compared with the single task, the COP parameters of participants with LBP were larger during dual tasks, even though the difficulty level of the cognitive task was low. Larger COP parameters were shown only if the difficulty level of the cognitive task was high in control group. Correlations between sway area/sway length and the number of falls were significant in dual tasks.

CONCLUSION

Our findings shed light on how cognitive loads modulate postural control for older women with LBP. Compared with control group, cognitive loads showed more disturbing effects on postural control in older women with LBP, which was associated with falling.

The immediate effect of two lumbar stabilization methods on postural control parameters and their reliability during two balance tasks

Background: Lumbosacral orthosis (LSO) and/or the isolated contraction of the transversus abdominis muscle by the abdominal drawing-in maneuver (ADIM) can increase lumbar stiffness, consequently influencing postural control. The purpose of this study was to compare the effects of LSO and ADIM on postural control during two balance tasks and determine their reliability.Methods: Twenty participants (50% men) randomly performed three experimental conditions: 1) without lumbar stabilization, 2) with LSO), and 3) with ADIM. Each experimental condition was tested in two postural tasks: semi-tandem and one-legged stance on a force platform for 30 seconds, while the Center of pressure postural (COP) parameters were computed.Results: The two methods of lumbar stabilization were comparable and did not significantly reduce the COP values across time, even though a few individuals presented a change in their COP data above the levels of measurement errors. The reliability of these measurements was generally acceptable and sometimes excellent (≥ 0.90 and ≤10% error measurement).Conclusions: Both LSO and isolated contraction of the transversus abdominis muscle by ADIM do not change postural control in one-legged stance and in semi-tandem tasks. These results have implications for use or not these methods for postural control on a rehabilitation perspective.

Low-Back Pain and Knee Position-Related Differences on Postural Control Measures During a One-Legged Stance in Athletes

CONTEXT

Chronic low-back pain (CLBP) may be associated with changes in postural balance in athletes as poor postural control during sports practice.

OBJECTIVE

To compare the postural control of athletes with and without CLBP during 2 one-legged stance tasks and identify the center of pressure (COP) cutoff values to determine the main differences. Designed: A cross-sectional study.

SETTING

Laboratory of functional evaluation and human motor performance.

PARTICIPANTS

A total of 56 male athletes, 28 with and 28 without CLBP (mean age = 26 y).

INTERVENTION

The one-legged stance with knee extension and with the knee at 30° flexion tasks were measured and analyzed on a force platform. The participants completed three 30-second trials (30 s of rest between each trial).

MAIN OUTCOME MEASURES

The COP parameters: the area of COP, mean COP sway velocity in both the anteroposterior and mediolateral directions, and total COP displacement were computed, and a receiver operating characteristics curve analysis was applied to determine the group differences.

RESULTS

Athletes with CLBP had poorer postural control (P < .01) in both tasks. The 30° knee flexion reported more postural instability than the knee extension for all COP parameters (a large effect size d = 0.80).The knee extension cutoffs identified were >7.1 cm2 for the COP area, >2.6 cm/s for the COP sway velocity in the anterior-posterior direction, and >3.2 cm/s for the mediolateral direction. Whereas, the 30° knee flexion cutoffs were >10.9 cm2 for the COP area, >2.9 cm/s for the COP sway velocity in the anterior-posterior direction, and >4.1 cm/s for the mediolateral direction. Both measures showed enough sensitivity and specificity (ie, area under the curve = 0.88 in and 0.80, respectively) to discriminate both groups.

CONCLUSIONS

The athletes with CLBP had poorer postural control than the healthy athletes and obtained specific cutoff scores from the COP values.

Comparison between high-velocity low-amplitude manipulation and muscle energy technique on pain and trunk neuromuscular postural control in male workers with chronic low back pain: A randomised crossover trial

BACKGROUND

A therapeutic recommendation for restoring function in individuals with chronic low back pain (CLBP) is manual therapy through manipulative spinal or muscle energy techniques.

OBJECTIVES

To compare the effectiveness of two osteopathic manipulative techniques on clinical low back symptoms and trunk neuromuscular postural control in male workers with CLBP.

METHOD

Ten male workers with CLBP were randomly allocated to two groups: high-velocity low-amplitude (HVLA) manipulation or muscle energy techniques (MET). Each group received one therapy per week for both techniques during 7 weeks of treatment. Pain and function were measured by using the Numeric Pain-Rating Scale, the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. The lumbar flexibility was assessed by Modified Schober Test. Electromyography (EMG) and force platform measurements were used for evaluation of trunk muscular activation and postural balance, respectively at three different times: baseline, post intervention, and 15 days later.

RESULTS

Both techniques were effective (p < 0.01) in reducing pain with large clinical differences (-1.8 to -2.8) across immediate and after 15 days. However, no significant effect between groups and times was found for other variables, namely neuromuscular activation and postural balance measures.

CONCLUSION

Both techniques (HVLA thrust manipulation and MET) were effective in reducing back pain immediately and 15 days later. Neither technique changed the trunk neuromuscular activation patterns nor postural balance in male workers with LBP.

CLINICAL IMPLICATIONS

These results may facilitate clinical decision-making for CLBP management in physiotherapy programs.

Time course and variability of tendinous vibration-induced postural reactions in forward and backward directions

Mechanical vibration of tendons induces large postural reactions (PR-VIB) but little is known about how these reactions vary within and between subjects. We investigated the intra- and inter-individual variability of PR-VIB and determined the reliability of center of pressure (COP) measures. Bipodal postural control (eyes closed) of 30 healthy adults were evaluated using a force platform under 02 conditions: bilateral VIB of the tibialis anterior (TA) and Achilles tendons (ACH-T) at 80 Hz. Each condition consisted of 03 trials of 30 s duration (Baseline: 10 s; VIB: 10 s; POST-VIB: 10 s). The Amplitude and Velocity of the COP in the antero-posterior/medio-lateral (AP/ML) directions were recorded and analyzed according to 5 time-windows incremented every 2 s of vibration (i.e. the first 2 s; 4 s; 6 s; 8 s & 10 s), whereas the COP position/AP was monitored every 0.5 s. All postural parameters increased significantly during TA and ACH-T vibration compared to the Baseline. The reliability of the COP measures showed good ICC scores (0.40-0.84) and measurement errors that varied depending on the duration of VIB time-windows. The COP position/AP reveals a lower intra- and inter-subject variability of PR-VIB in the first 2 s of VIB. The metrological characteristics of PR-VIB should be investigated further to guide their future use by clinicians and researchers.

Effects of a Multimodal Exercise Program Plus Neural Gliding on Postural Control, Pain, and Flexibility of Institutionalized Older Adults: A Randomized, Parallel, and Double-Blind Study

BACKGROUND AND PURPOSE

The effect of adding neural mobilization to a multimodal program of exercises has not been investigated, despite its potential positive effects. The aim of this study was to compare the acute effects of a multimodal exercise program and neural gliding against a multimodal exercise program only, on pain intensity, gait speed, Timed Up and Go (TUG) test, lower limb flexibility, and static balance of institutionalized older adults.

METHODS

Older adults who were institutionalized (n = 26) were randomized to receive a multimodal exercise program plus neural gliding or a multimodal exercise program only. Both interventions were delivered twice a week for 8 weeks. Participants were assessed for pain, gait velocity, balance, flexibility, and TUG at baseline and postintervention.

RESULTS

A significant main effect of time for pain intensity (F1,24 = 8.95, P = .006), balance (F1,24 = 10.29, P = .004), and gait velocity (F1,24 = 5.51, P = .028) was observed, indicating a positive impact of both interventions. No other significant effects were found (TUG and flexibility; P > .05).

DISCUSSION

A 45-minute multimodal exercise program, twice a week for 8 weeks, has a positive impact on pain intensity, balance, and gait velocity, but neural gliding has no additional benefit. It is unclear whether dose and type of neural mobilization may have had an impact on results. Considering the structural and physiological changes that tend to occur with age, future studies could explore the effects of neural tensioning or of higher doses of neural mobilization.

CONCLUSIONS

This study suggests that adding neural gliding to a multimodal exercise program has no additional benefit.

Walking and postural balance in adults with severe short stature due to isolated GH deficiency

OBJECTIVES

Walking and postural balance are extremely important to obtain food and to work. Both are critical for quality of life and ability to survive. While walking reflects musculoskeletal and cardiopulmonary systems, postural balance depends on body size, muscle tone, visual, vestibular and nervous systems. Since GH and IGF-I act on all these systems, we decided to study those parameters in a cohort of individuals with severe short stature due to untreated isolated GH deficiency (IGHD) caused by a mutation in the GHRH receptor gene. These IGHD subjects, despite reduction in muscle mass, are very active and have normal longevity.

METHODS

In a cross-sectional study, we assessed walking (by a 6-min walk test), postural balance (by force platform) and fall risk (by the 'Timed Up and Go' test) in 31 IGHD and 40 matched health controls.

RESULTS

The percentage of the walked distance measured in relation to the predicted one was similar in groups, but higher in IGHD, when corrected by the leg length. Absolute postural balance data showed similar velocity of unipodal support in the two groups, and better values, with open and closed eyes and unipodal support, in IGHD, but these differences became non-significant when corrected for height and lower-limb length. The time in 'Timed Up and Go' test was higher in IGHD cohort, but still below the cut-off value for fall risk.

CONCLUSION

IGHD subjects exhibit satisfactory walking and postural balance, without increase in fall risk.

Age- and low back pain-related differences in trunk muscle activation during one-legged stance balance task

BACKGROUND

Postural control declines with age and can be affected by low back pain. Poor balance has been reported in people with chronic low back pain (CLBP), which in turn could be explained by the changes in trunk muscle activation.

RESEARCH QUESTION

Are there differences between younger and older adults with and without chronic low back pain (CLBP) on trunk muscle activity during one-legged stance task?

METHODS

Twenty (20) with, and 20 subjects without nonspecific CLBP participated in the study. Each group was comprised of 10 younger (50% males; mean age: 31 years) and 10 older adults (50% males; mean age: 71 years). Subjects performed 3 × 30-second trials of one-legged stance, with eyes open, on a force platform, while surface electromyography (EMG) measurements were obtained bilaterally on the multifidus at L5, iliocostalis lumborum at L3, rectus abdominis and biceps femoris muscles.EMG amplitude analysis was processed by the Root Mean Square (250 ms window epochs) and normalized by the peak of activation during the balance tasks, to determine the muscular activity of each muscle.

RESULTS

Participants with CLBP presented 15% lower lumbar muscle activation (p <  0.05), and 23% higher co-activation (ratio between rectus adominis by multifidus) than participants without CLBP, regardless of age. Significant differences (p <  0.05) between older and young groups were observed only for lower lumbar muscles (mean 24% lower in older than younger adults) and rectus adominis muscles (mean 17% lower in older than younger adults).

SIGNIFICANCE

CLBP individuals have different trunk muscle activity than those without CLBP, and older adults exhibit lower trunk activation during one-legged stance balance task. The use of the EMG in evaluation of trunk neuromuscular function during one-legged stance may thus be a valuable tool when assessing balance in CLBP and older people.

Lumbar stabilisation exercises versus back endurance-resistance exercise training in athletes with chronic low back pain: protocol of a randomised controlled trial

Background

Chronic low back pain (CLBP) is an important disorder in athletes that may negatively affect their performance in competitions. The literature usually recommends physiotherapy based on exercises for back pain management in athletes. Recent evidence suggests that interventions based on lumbar muscle stabilisation exercises (LMSE) and back endurance-resistance exercises (BERE) may improve back pain and function performance. However, it is still unclear which type of exercise is more effective for the treatment of CLBP in athletes.

Objective

To compare the efficacy of LMSE versus BERE in athletes with CLBP.

Design

The study is a 2-arm, prospectively registered, randomised controlled trial.

Setting

The physical therapy clinical and biomechanics laboratory of the UNOPAR University.

Participants

32 male athletes with CLBP, age between 18 and 40 years old, recruited from the local community.

Intervention

An 8-week intervention programme will be carried out with LMSE s versus BERE.

Measurements

Trunk neuromuscular patterns during balance tasks (unipodal and over a ball) using electromyography and force platform parameters, pain, disability, fear and avoidance will be assessed by a blinded assessor at baseline and at follow-up after 8 weeks of intervention period.

Limitations

The absence of blinding intervention and the exclusion of female athletes, seated sports and swimmers will affect the internal and external validity of the study.

Conclusions

The results of this study will elucidate which of these two interventions promote better results in trunk neuromuscular pattern, back pain and function in male athletes with CLBP.

Neuromuscular electrical stimulation for treating postpartum low back pain

In this retrospective study, we investigated the effect of neuromuscular electrical stimulation (NMES) in patients with postpartum low back pain (PPLBP).We included 67 patients with PPLBP in this study. All patients received NMES, each session 30 minutes, 1 session weekly for a total of 4 weeks. The primary outcome was measured by the reduction in pain intensity, based on the visual analogue scale (VAS). The secondary outcomes included functional status, measured by the Roland-Morris disability questionnaire (RMDQ), and quality of life, measured by the World Health Organization Quality of Life questionnaire (WHOQOL-BREF), as well as the adverse events related to the treatment. The outcome data were evaluated at baseline and at the end of 4-week treatment.After 4-week treatment, NMES did not exert better outcomes in pain relief, measured by VAS, and functional status, measured by RMDQ compared with those before the treatment. In addition, no significant improvement in quality of life, measured by WHOQOL-BREF, compared to it before the treatment.The results of our study did not find that NMES is effective in patients with PPLBP after 4-week treatment.

Is standing balance altered in individuals with chronic low back pain? A systematic review

PURPOSE

To examine the static standing balance of individuals with chronic low back pain when compared to a healthy control group.

METHODS

A search of available literature was done using PubMed, SPORTDiscus, CINAHL, and Scopus databases. Studies were included if they contained the following: (1) individuals with chronic low back pain 3 months or longer; (2) healthy control group; (3) quantified pain measurement; and (4) center of pressure measurement using a force plate. Two authors independently reviewed articles for inclusion, and assessed for quality using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. Cohen's d effect size was calculated to demonstrate the magnitude of differences between groups.

RESULTS

Nine articles were included in this review. Quality scores ranged from 5/8 to 8/8. Although center of pressure measures were nonhomogeneous, subjects with chronic low back pain had poorer performance overall compared to healthy controls. Despite inconsistencies in statistical significance, effect sizes were frequently large, indicating a lack of sufficient power in the included studies. Data were insufficiently reported among certain studies, limiting the ability of direct study comparison.

CONCLUSIONS

Results suggest that balance is impaired in individuals with chronic low back pain when compared to healthy individuals. Implications for rehabilitation Static balance is affected in individuals with chronic low back pain. Balance assessments should be completed for individuals with chronic low back pain. Results from balance assessments should be used to indicate areas of improvement and help guide the course of treatment, as well as reassess as treatment progresses.

Reliability of the Kinematic Steadiness Index during one-leg standing in subjects with recurrent low back pain

PURPOSE

To assess the reliability of standing time and the Kinematic Steadiness Index (KSI) in one-leg standing compared with the Timed Up and Go (TUG) test while considering anthropometric factors in subjects with recurrent low back pain (LBP).

METHODS

Sixty-six individuals participated in the study. The data were collected on two different days, 1 week apart. The KSI of the core spine, using video motion-capture techniques, was based on the relative standing time and relative standstill time. The intraclass correlation coefficient (ICC_2,1) was compared for the reliability between measures. The covariates, such as age, Body Mass Index, and the Oswestry Disability Index (ODI), were analyzed for any interactions based on these measures.

RESULTS

The standing time (t = - 1.01, p = 0.32) and the KSI (t = - 1.70, p = 0.09) were not significantly different between measures. The TUG results were not different between measures (t = 1.01, p = 0.32). The Cronbach's alpha for the standing time was 0.84, for KSI was 0.89, and for TUG was 0.76. The standing time and KSI demonstrated an interaction with age, while the TUG demonstrated an interaction with the ODI score.

CONCLUSIONS

The KSI during one-leg standing could help to develop a practical tool to justify quantity and quality of balance outcome measures, which identify balance deficits and core spine rehabilitation strategies in subjects with recurrent LBP.

Immediate effects of Pilates based therapeutic exercise on postural control of young individuals with non-specific low back pain: A randomized controlled trial

OBJECTIVES

Low back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain.

DESIGN

Controlled laboratory design.

SETTINGS AND MAIN OUTCOME MEASURES

Forty-six participants with non-specific low back pain were randomized to a Pilates (n=23, 10 males; age: 21.8±3.2years) and a control group (n=23, 9 males; age: 22.8±3.6years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed.

INTERVENTION

The intervention lasted 20min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach.

RESULTS

At baseline, no differences were found between groups. The Pilates group improved in all the postural sway values (area of CoP: 11.5±3.4 to 9.7±2.7cm², p=0.002 and CoP velocity: 2.8±0.6 to 2.3±0.5cm/s, p<0.001) and in the Star Excursion Balance Test. Control group only improved in CoP velocity, however, this improvement was significantly inferior compared to the Pilates group.

CONCLUSIONS

Pilates exercises immediately improved postural sway and dynamic balance in young adults with non-specific low back pain.

Effects of Holding an External Load on the Standing Balance of Older and Younger Adults With and Without Chronic Low Back Pain

OBJECTIVE

The purpose of this study was to assess the effect of holding an external load on the standing balance of younger and older adults with and without chronic low back pain (CLBP).

METHODS

Twenty participants with and 20 without CLBP participated in the study. Each group contained 10 younger (50% men) and 10 older adults (50% men). Participants were instructed to look straight ahead while standing on a force platform during two 120-second trials with and without holding an external load (10% of body mass). The center of pressure area, mean velocity, and mean frequency in the anteroposterior and mediolateral directions were measured.

RESULTS

Older adults had worse standing balance than younger adults did (P < .001, d = 0.20). There were no significant balance differences between participants with and without CLBP within age groups during standing balance condition. However, holding the external load significantly increased postural instability for both age groups and CLBP status, with mean effect size across center of pressure variables of d = 0.82 for older participants without CLBP and d = 2.65 for younger participants without CLBP. These effects for people with CLBP were d = 1.65 for subgroup of older and d = 1.60 for subgroup of younger participants.

CONCLUSION

Holding an external load of 10% of body mass increased postural instability of both younger and older adults with and without CLBP.

People with chronic low back pain have poorer balance than controls in challenging tasks

PURPOSE

To compare the balance of individuals with and without chronic low back pain during five tasks.

METHOD

The participants were 20 volunteers, 10 with and 10 without nonspecific chronic low back pain, mean age 34 years, 50% females. The participants completed the following balance tasks on a force platform in random order: (1) two-legged stance with eyes open, (2) two-legged stance with eyes closed, (3) semi-tandem with eyes open, (4) semi-tandem with eyes closed and (5) one-legged stance with eyes open. The participants completed three 60-s trials of tasks 1-4, and three 30-s trials of task 5 with 30-s rests between trials. The center of pressure area, velocity and frequency in the antero-posterior and medio-lateral directions were computed during each task, and compared between groups and tasks.

RESULTS

Participants with chronic low back pain presented significantly larger center of pressure area and higher velocity than the healthy controls (p < 0.001). There were significant differences among tasks for all center of pressure variables (p < 0.001). Semi-tandem (tasks 3 and 4) and one-leg stance (task 5) were more sensitive to identify balance impairments in the chronic low back pain group than two-legged stance tasks 1 and 2 (effect size >1.37 vs. effect size <0.64). There were no significant interactions between groups and tasks.

CONCLUSIONS

Individuals with chronic low back pain presented poorer postural control using center of pressure measurements than the healthy controls, mainly during more challenging balance tasks such as semi-tandem and one-legged stance conditions. Implications for Rehabilitation People with chronic low back had poorer balance than those without it. Balance tasks need to be sensitive to capture impairments. Balance assessments during semi-tandem and one-legged stance were the most sensitive tasks to determine postural control deficit in people with chronic low back. Balance assessment should be included during rehabilitation programs for individuals with chronic low back pain for better clinical decision making related to balance re-training as necessary.