Relationship between balance performance and musculoskeletal pain in lower body comparison healthy middle aged and older adults

Association between physical performance and bone mass in community-dwelling postmenopausal Japanese women: The Unzen study

BACKGROUND

Low bone mass is an independent risk factor for osteoporotic fractures. We examined the association between physical performance and bone mass using quantitative ultrasound in community-dwelling postmenopausal Japanese women.

METHODS

We conducted a cross-sectional study on 524 community-dwelling postmenopausal Japanese women who were not being administered osteoporosis medications. Physical performance was assessed on the basis of grip strength, chair stand time, and functional reach. The stiffness index was measured as a quantitative ultrasound parameter for heel bone mass.

RESULTS

Physical performance, assessed by grip strength, chair stand time, and functional reach, and the stiffness index significantly decreased with age (both p<0.001). The multiple linear regression analysis showed that grip strength (p = 0.001), chair stand time (p = 0.004), and functional reach (p = 0.048) were significantly associated with the stiffness index after adjusting for age, body mass index, smoking, drinking, and exercise.

CONCLUSIONS

Physical performance was significantly associated with heel bone mass in community-dwelling postmenopausal Japanese women.

Falls in people post-Guillain-Barré syndrome in the United Kingdom: A national cross-sectional survey of community based adults

Guillain-Barré syndrome (GBS) has several enduring effects that can lead to further harm and/or lower quality of life. These effects include falling and body pain, neither of which have been fully explored. This study aims to examine the risk factors associated with falling and potential causes of body pain in a post-GBS population. A cross-sectional survey of 216 participants was conducted using an electronic questionnaire that included. Self-report measures for: overall health, balance, anxiety and depression levels, body pain and demographics related to GBS experience and falls. A large proportion of individuals post-GBS experience ongoing problems beyond those expected with ageing. Comparative tests indicated that people reporting falls in the previous 12 months had: poorer levels of mobility, poorer F-scores, higher levels of body pain, poorer balance, poorer anxiety and depression scores and higher levels of fatigue. Gender did not appear to contribute to falls. Injuries following falls were associated with a lack of physiotherapy postdischarge and time since GBS. In a regression analysis of the identified and expected key variables, age and body pain statistically predicted falls. In over a quarter of cases reported here, respondents did not receive community physiotherapy following hospital discharge. In the midst and aftermath of COVID-19, provision of rehabilitation needs to be recalibrated, not just for COVID patients, but the wider community with ongoing needs. Issues around well-being and quality of life in the post-GBS community also need further consideration.

Cross-Sectional Examination of Musculoskeletal Pain and Physical Function in a Racially and Socioeconomically Diverse Sample of Adults

BACKGROUND

Musculoskeletal pain alters physiological function, which may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for musculoskeletal pain and report functional limitations similar to older adults. However, few studies have examined the relationships between musculoskeletal pain and physical function, using objective performance measures in a sample of racially and socioeconomically diverse adults. Thus, this study examined musculoskeletal pain in relation to physical function in middle-aged (30-64 years) White and Black adults and investigated whether the relationship varied by sociodemographic characteristics.

METHODS

This cross-sectional examination incorporated data from the Healthy Aging in Neighborhoods of Diversity across the Life-Span Study. Participants (n = 875) completed measures of musculoskeletal pain and objective measures of physical performance (ie, lower and upper body strength, balance, and gait abnormalities). Physical performance measures were standardized to derive a global measure of physical function as the dependent variable.

RESULTS

Approximately, 59% of participants identified at least 1 pain sites (n = 518). Multivariable regression analyses identified significant relationships between greater musculoskeletal pain and poorer physical function (β = -0.07, p = .031), in mid midlife (β = -0.04, p = .041; age 40-54) and late midlife (β = -0.05, p = .027; age 55-64).

CONCLUSIONS

This study observed that musculoskeletal pain was associated with poorer physical function within a diverse group of middle-aged adults. Future research should longitudinally explore whether chronic musculoskeletal pain identified at younger ages is associated with greater risk for functional limitation and dependence in later life.

The effect of static and dynamic core exercises on dynamic balance, spinal stability, and hip mobility in female office workers

Objectives

This study aims to compare the effect of static and dynamic core exercises in terms of dynamic balance, spinal stability, and hip mobility in female office workers.

Patients and methods

Between May 2018 and June 2018, a total of 34 women (mean age 36.4±6.5 years; range, 28 to 54 years) who worked for a bank and exercised in the fitness center of the work place were recruited. The women were divided into two groups including 17 women in each as static and dynamic core groups and administered sessions of 20 to 30 min twice a week for six weeks. Both groups were tested for dynamic balance (Y-balance test), spinal stability (functional reach test), and hip mobility (active flexion and extension) before and after six weeks of exercise.

Results

A statistically significant improvement was found in both groups between the pre- and post-test results in terms of spinal stability, hip mobility, and dynamic balance (p<0.05). The only exception was the right and left leg anterior balance in the static core group. Dynamic core exercises seemed to be more effective than static core exercises in improving the right and left leg anterior balance. There were no statistically significant differences between the groups in terms of spinal stability, hip mobility, and dynamic balance according to the mean absolute change (p>0.05).

Conclusion

Our study results indicate that both types of exercises are effective in improving dynamic balance, spinal stability, and hip mobility in female office workers. Therefore, the expected benefits from core exercises are to enhance dynamic balance, spinal stability, and hip mobility. Female workers can perform both types of exercises safely and effectively.

Effect of Sensory Impairment on Balance Performance and Lower Limb Muscle Strength in Older Adults With Type 2 Diabetes

Objective

To compare balance performance and lower limb muscle strength between older adults with type 2 diabetes mellitus (DM), with and without sensory impairments and non-DM groups. Influence of a number of sensory impairments, and muscle strength on balance performance were explored.

Methods

Ninety-two older adults with and without type 2 DM, were examined relative to visual function with the Snellen chart, Melbourne Edge test, and Howard-Dolman test, vestibular function with the modified Romberg test, proprioception of the big toe, and diabetic peripheral neuropathy with the Michigan Neuropathy Screening Instrument. Balance performances were evaluated with the Romberg test, Functional Reach Test (FRT), and Timed Up and Go test (TUG). Strength of knee and ankle muscles was measured.

Results

FRT of type 2 DM groups with at least two sensory impairments, was lower than the non-DM group (p<0.05). TUG of all DM groups, was worse than the non-DM group (p<0.01). Lower limb muscle strength of type 2 DM groups with two and three sensory impairments, was weaker than non-DM group (p<0.05). Regression analysis showed that type 2 DM with three sensory impairments, ankle dorsiflexors strength, and age were influential predictors of TUG.

Conclusion

There were significant differences, of muscle strength and balance performance among groups. Poorer balance and reduced lower limb strength were marked in older adults with type 2 DM, even ones without sensory impairment. Muscle weakness seemed to progress, from the distal part of lower limbs. A greater number of sensory impairments, weaker dorsiflexors, and advanced age influenced balance performance.

Prospective analysis of the risk factors for falls in lymphoma patients

PURPOSE

To explore the risk factors for falls in lymphoma patients receiving chemotherapy.

METHODS

Lymphoma patients (203) who received chemotherapy were prospectively recruited and analyzed. Eligible participants were followed up by weekly telephone contact for 6 months or until the time of a fall or death. Risk factors for falling in lymphoma patients were identified using univariate regression analysis and multivariate binary logistic regression analysis.

RESULTS

Of the 203 cases, 13.3% (27 cases) had a fall during follow-up. Univariate regression analysis showed the following risk factors for falls in lymphoma patients: gender (P = 0.023), Eastern Cooperative Oncology Group (ECOG) performance status score (P < 0.0001), cancer stage (P < 0.0001), extranodal involvement (P = 0.041), serum lactate dehydrogenase (LDH) level (P < 0.0001), revised International Prognostic Index (R-IPI) (P < 0.0001), history of falls (P < 0.0001), gait (P < 0.0001), cognitive condition (P = 0.029) and intravenous catheter placement (P < 0.0001). Multivariate binary logistic regression analysis found four independent factors significantly associated with the risk of falling in lymphoma patients: female gender (P = 0.042), later stage (P = 0.021), R-IPI (P = 0.030), and intravenous catheter placement (P = 0.001).

CONCLUSIONS

Gender, stage, R-IPI, and intravenous catheter placement were independent risk factors for falls in patients with lymphoma. Lymphoma patients with these four risk factors should receive particular attention and fall prevention education to reduce the incidence of falls. The R-IPI may be a new predictor of falling in lymphoma patients and may aid in the management of falls.

The effect of spinal curvature on the photogrammetric assessment on static balance in elderly women

BACKGROUND

Involutional changes to the body in elderly patients affect the shape of the spine and the activity of postural muscles. The purpose of this study was to assess the influence of age-related changes in spinal curvature on postural balance in elderly women.

METHODS

The study population consisted of 90 women, with a mean age of 70 ± 8.01 years. Static balance assessments were conducted on a tensometric platform, and posturographic assessments of body posture were performed using a photogrammetric method based on the Projection Moiré method.

RESULTS

The results obtained were analysed using the Spearman's rank correlation coefficient test. We found a statistically significant correlation between body posture and the quality of the balance system response based on the corrective function of the visual system. The shape of the spinal curvature influenced postural stability, as measured by static posturography. Improvement in the quality of the balance system response depended on corrective information from the visual system and proprioceptive information from the paraspinal muscles.

CONCLUSIONS

The sensitivity of the balance system to the change of centre of pressure location was influenced by the direction of the change in rotation of the shoulder girdle and spine. Development of spinal curvature in the sagittal plane and maintenance of symmetry in the coronal and transverse planes are essential for correct balance control, which in turn is essential for the development of a properly proportioned locomotor system.

[Association between chronic pain and self-reported falls in the SABE study population]

The objective of this study was to assess the association between chronic pain and self-reported falls. This was a cross-sectional sample of elderly individuals without cognitive deficits, living in the city of São Paulo, Brazil, and with chronic pain. The study considered elderly that reported chronic pain for at least one year. History of falls was defined as at least one reported fall in the 12 months prior to the study. Data were obtained by home surveys of the elderly. Stata 11.0 was used for statistical analysis. Prevalence of chronic pain was 29.7% (95%CI: 25.4-33.9). Prevalence of falls in the previous year for individuals with pain was 31.6% (95%CI: 26.4-37.5) and did not differ significantly from those without pain (26.4%; 95%CI: 23.1-30.0; p = 0.145). Risk of falls was 50% higher (p = 0.019) for those with pain and osteoporosis and 48% higher for those with pain and urinary incontinence (p = 0.010). History of pain for at least one year and osteoporosis, pain, and urinary incontinency showed higher odds of falls.

Experimental knee pain impairs postural stability during quiet stance but not after perturbations

The objective of this study was to examine the effect of experimental knee-related pain on postural control. Twelve healthy subjects stood as quietly as possible on a movable force platform (that measured the centre of pressure and provided fast perturbations) before, during, and after experimental knee-related pain. Lower limb electromyographic (EMG) activity and joint angles were measured. Experimental pain was induced by injecting hypertonic saline into the infrapatellar fat pad (unilateral and bilateral) and isotonic saline was used for control sessions. Compared with the baseline and control sessions, unilateral and bilateral knee-related pain during quiet standing evoked (1) an increased sway displacement in the anterior-posterior direction (P < 0.05), (2) larger knee flexion (P < 0.05), and (3) larger EMG changes. Bilateral pain also induced (1) larger medial-lateral sway displacement and speed (P < 0.05) and (2) larger left hip flexion (P < 0.05). During forward perturbations, subjects leaned forward during both painful conditions when compared with baseline (P < 0.05). The additional impairment by bilateral pain suggests that the non-painful limb in unilateral pain conditions compensates for the impaired postural control. These results show that knee-related pain impairs postural stability during quiet standing, indicating the vulnerability of patients with knee pain to falls. This measure could potentially help clinicians who seek to assess how pain responses may contribute to patient's postural control and stability during quiet standing.

Experimental muscle pain challenges the postural stability during quiet stance and unexpected posture perturbation

Musculoskeletal pain impairs postural control and stability. Nine subjects stood as quietly as possible on a moveable force platform before, during, and after experimental pain in the right leg muscles. A moveable force platform was used to measure the center of pressure and provided unexpected perturbations. Lower limb muscle activity, joint angles, and foot pressure distributions were measured. Hypertonic saline was used to induce pain in the vastus lateralis, vastus medialis, or biceps femoris muscle of the right leg. Compared to baseline and control sessions, pain in the knee extensor muscles during quiet standing evoked: 1) larger sway area, greater medial-lateral center of pressure displacement and higher speed (P < .05); 2) increased sway displacement in the anterior-posterior direction (P < .05); and 3) increased electromyography (EMG) activity for left tibialis anterior and left erector spinae muscles (P < .05). Pain provoked longer time to return to an equilibrium posture after forward EMG activity for, and pain in vastus medialis muscle decreased the time for the maximum hip flexion during this perturbation (P < .05). These results show that muscle pain impairs postural stability during quiet standing and after unexpected perturbation, which suggest that people suffering from leg muscle pain are more vulnerable to falls.

PERSPECTIVE

This article presents the acute responses to leg muscle pain on the postural control. This measure could potentially help clinicians who seek to assess how pain responses may contribute to patient's postural control and stability during quiet standing and after recovering from unexpected perturbations.

Lumbar spinal stenosis-diagnosis and management of the aging spine

Low back pain and lumbar spinal stenosis (LSS) is an extensive problem in the elderly presenting with pain, disability, fall risk and depression. The incidence of LSS is projected to continue to grow as the population ages. In light of the risks, costs and lack of long-term results associated with surgery, and the positive outcomes in studies utilizing physical therapy interventions for the LSS patient, a non-invasive approach is recommended as a first line of intervention. This Masterclass presents an overview of LSS in terms of clinical examination, diagnosis, and intervention. A focused management approach to the patient with LSS is put forward that emphasizes a defined four-fold approach of patient education, manual physical therapy, mobility and strengthening exercises, and aerobic conditioning.

Age-related changes in the performance of forward reach

Aging is widely considered to be associated with limited balance capacity. It is not clear if forward reach ability is also affected by aging. The purpose of this study was to determine if aging was associated with reduced ability of forward reach or changes in movement patterns. Thirty-three young and 31 older adults were instructed to reach forward as far as possible without losing balance. A motion analysis system was used to record the body kinematics to calculate the joint angle and estimate the motion of center of mass (COM) using a five-segment model. Reach distance (measured from the finger marker), COM displacement, and the distance that the COM exceeded the 2nd toe marker (COM-toe) were used to represent reach performance. The movement patterns were classified as hip, ankle or mixed strategies based upon joint kinematics. It was found that the initial location of the COM was significantly more anterior in the older adults. Older adults were found to have significantly smaller COM displacement and greater hip flexion, but did not differ from young adults in reach distance or COM-toe. Older adults overwhelmingly adopted a hip strategy, but none adopted an ankle strategy. The distribution of the different strategies also differed significantly between groups. These findings suggest that aging appears to be associated with modifications in movement patterns, but not necessarily with a reduction in the ability to approach the boundary of stability. Clinically, balance training for older adults may include the exploration and instruction of atypical movement patterns.

Measures of physical performance capture the excess disability associated with hip pain or knee pain in older persons

BACKGROUND

Hip pain (HP) and knee pain (KP) may specifically affect function and performance; few studies investigate the functional impact of HP or KP in the same population.

METHODS

Population-based sample of older individuals living in the Chianti area (Tuscany, Italy) (1998-2000); 1006 persons (564 women and 442 men) were included in this analysis; 11.9% reported HP and 22.4% reported KP in the past 4 weeks. Self-reported disability and lower extremity performance, measured by 400-m walk test and by the short physical performance battery (SPPB, including standing balance, chair raising, and 4-m walk test), were compared in participants reporting HP or KP versus those free of these conditions; the relationship of HP or KP with performance and self-reported disability was studied, adjusting for age, sex, hip or knee flexibility, muscle strength, multiple joint pain, major medical conditions, and depression.

RESULTS

Participants reporting HP were more likely to report disability in shopping, cutting toenails, carrying a shopping bag, and using public transportation; those with KP reported more disability in cutting toenails and carrying a shopping bag. Participants reporting HP or KP had significantly lower SPPB scores. Adjusting by SPPB, pain no longer predicted self-reported disability, except for "HP-carrying a shopping bag."

CONCLUSIONS

In our cohort of older persons, those with HP reported disability in a wider range of activities than those with KP. Physical performance measured by SPPB was impaired in both conditions. Reduced lower extremity performance captures the excess disability associated with either HP or KP.

Posture and equilibrium in orthopedic and rheumatologic diseases

Posture and balance may be affected in many spine or lower-limb disorders. An extensive evaluation including clinical tests and movement analysis techniques may be necessary to characterize how rheumatologic or orthopedic diseases are related to static or dynamic changes in postural control. In lower limbs, unbalance may be related to a decreased stability following arthrosis or ligament injuries at knee or ankle levels, while hip lesions appear less associated with such troubles. Spinal diseases at cervical level are frequently associated with postural changes and impaired balance control, related to the major role of sensory inputs during stance and gait. At lower levels, changes are noticed in major scoliosis and may be related to pain intensity in patients with chronic low-back pain. Whatever the initial lesion and the affected level, improvement in clinical or instrumental tests following rehabilitation or brace wearing provides argument for a close relationship between rheumatologic or orthopedic diseases and related impairments in posture and balance control.