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Lomond KV, Sansom JK. Effects of non-specific low back pain on static balance in emerging adults. Physiother Theory Pract 2024:1-11. [PMID: 38855981 DOI: 10.1080/09593985.2024.2364805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Postural control impairments in middle-aged or older people with chronic low back pain (CLBP) have been extensively documented. However, little is known about changes in postural control early in the disease process which may underlie compensatory movement strategies. OBJECTIVE Our purpose was to quantify postural sway and sensory weighting in emerging adults with and without CLBP. METHODS Nineteen emerging adults with CLBP (age = 18-26 years (21.11 ± 1.73)) and 19 matched peers without CLBP (18-27 years (22.20 ± 1.97)) participated in a cross-sectional study. Displacement of the center of mass during Quiet stance (QS), Tandem stance (TS), and Unilateral stance (US) on 2 surfaces (stable, unstable) were used to assess postural sway. Sensory Organization Test (SOT) was used to assess sensory weighting. RESULTS Emerging adults with CLBP showed large, significant increases in postural sway during unstable TS (p ≤ .020). Participants with CLBP relied more on somatosensory input, as evidenced by lower equilibrium scores during conditions favoring visual (p = .020) or vestibular (p < .001) input during the SOT. CONCLUSION Emerging adults with CLBP showed postural control impairments related to altered sensory weighting. These findings provide insights into the development of CLBP and its effects on postural control. This information may aid early identification, monitoring, and treatment of individuals in the initial stages of disease development who may have unrecognized postural impairments.
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Affiliation(s)
- Karen V Lomond
- Department of Physical Therapy, Center for Health Sciences, Ithaca, NY, USA
| | - Jennifer K Sansom
- Doctoral Program in Physical Therapy, College of Health Professions, Central Michigan University, Mount Pleasant, MI, USA
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Smith JA, Tain R, Sharp KG, Glynn LM, Van Dillen LR, Henslee K, Jacobs JV, Cramer SC. Identifying the neural correlates of anticipatory postural control: A novel fMRI paradigm. Hum Brain Mapp 2023; 44:4088-4100. [PMID: 37162423 PMCID: PMC10258523 DOI: 10.1002/hbm.26332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023] Open
Abstract
Altered postural control in the trunk/hip musculature is a characteristic of multiple neurological and musculoskeletal conditions. Previously it was not possible to determine if altered cortical and subcortical sensorimotor brain activation underlies impairments in postural control. This study used a novel fMRI-compatible paradigm to identify the brain activation associated with postural control in the trunk and hip musculature. BOLD fMRI imaging was conducted as participants performed two versions of a lower limb task involving lifting the left leg to touch the foot to a target. For the supported leg raise (SLR) the leg is raised from the knee while the thigh remains supported. For the unsupported leg raise (ULR) the leg is raised from the hip, requiring postural muscle activation in the abdominal/hip extensor musculature. Significant brain activation during the SLR task occurred predominantly in the right primary and secondary sensorimotor cortical regions. Brain activation during the ULR task occurred bilaterally in the primary and secondary sensorimotor cortical regions, as well as cerebellum and putamen. In comparison with the SLR, the ULR was associated with significantly greater activation in the right premotor/SMA, left primary motor and cingulate cortices, primary somatosensory cortex, supramarginal gyrus/parietal operculum, superior parietal lobule, cerebellar vermis, and cerebellar hemispheres. Cortical and subcortical regions activated during the ULR, but not during the SLR, were consistent with the planning, and execution of a task involving multisegmental, bilateral postural control. Future studies using this paradigm will determine mechanisms underlying impaired postural control in patients with neurological and musculoskeletal dysfunction.
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Affiliation(s)
- Jo Armour Smith
- Department of Physical TherapyChapman UniversityOrangeCaliforniaUSA
| | - Rongwen Tain
- Campus Center for NeuroimagingUniversity of CaliforniaIrvineCaliforniaUSA
| | - Kelli G. Sharp
- Department of Dance, School of ArtsUniversity of CaliforniaIrvineCaliforniaUSA
- Department of Physical Medicine and RehabilitationUniversity of CaliforniaIrvineCaliforniaUSA
| | - Laura M. Glynn
- Department of PsychologyChapman UniversityOrangeCaliforniaUSA
| | - Linda R. Van Dillen
- Program in Physical Therapy, Orthopaedic SurgeryWashington University School of Medicine in St. LouisSt. LouisWashingtonUSA
| | - Korinne Henslee
- Department of Physical TherapyChapman UniversityOrangeCaliforniaUSA
| | - Jesse V. Jacobs
- Rehabilitation and Movement ScienceUniversity of VermontBurlingtonVermontUSA
| | - Steven C. Cramer
- Department of NeurologyUniversity of CaliforniaLos AngelesCaliforniaUSA
- California Rehabilitation InstituteLos AngelesCaliforniaUSA
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Chu ECP, Chen ATC, Chiang R. Chiropractic care of Parkinson's disease and deformity. J Med Life 2022; 15:717-722. [PMID: 35815091 PMCID: PMC9262267 DOI: 10.25122/jml-2021-0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Parkinson's disease (PD) is a progressive neurological disease characterized by muscle stiffness, tremor, slowness of movement, and difficulties with posture and walking. Muscle and joint pain are frequent non-motor symptoms of PD. Pain associated with PD is mainly caused by a combination of truncal dystonia, stooped posture, and muscle rigidity. However, PD deformities were rarely discussed in the literature. A 68-year-old Asian female with PD treated with Levodopa for six years complained of progressive neck pain, contractures, and subluxation of both hands in the last two years. A positron emission tomography (PET) scan revealed decreased rostrocaudal gradient uptake in both posterior putamen. After 9 months of multimodal chiropractic rehabilitation, the patient had significant improvement in symptoms, including pain resolution as per the numeric rating scale and physical and mental improvement as per the PD questionnaire. Radiographic measurement showed significantly improved postural alignment and stability. Measurement of joint motion and angles showed an improvement in hand deformity. Although PD is a neurodegenerative disease that is not curable, multimodal rehabilitation may improve neurological and musculoskeletal functions by inducing proprioceptive balance, motor strength, and joint movement. The current study may illustrate multimodal rehabilitation addressing orthopedic deformity associated with symptoms in a PD patient.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, EC Healthcare, Hong Kong SAR, China,Corresponding Author: Eric Chun-Pu Chu, New York Chiropractic and Physiotherapy Centre, EC Healthcare, Hong Kong SAR, China. E-mail:
| | - Alan Te-Chang Chen
- New York Chiropractic and Physiotherapy Centre, EC Healthcare, Hong Kong SAR, China
| | - Ricky Chiang
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
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Chu ECP, Wong AYL, Lee LYK. Chiropractic care for low back pain, gait and posture in a patient with Parkinson's disease: a case report and brief review. AME Case Rep 2021; 5:34. [PMID: 34805753 PMCID: PMC8572672 DOI: 10.21037/acr-21-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022]
Abstract
Parkinson's disease (PD) is a progressive neurological disorder with cardinal motor features of tremor, bradykinesia, muscle rigidity, impaired gait and posture. Muscular pain or arthralgia is a common non-motor symptom in PD. The PD-related pain is probably attributed to a combination of altered posture, abnormal muscle tone, and truncal dystonia. A 59-year-old male taxi-driver with PD treated with levodopa for 18 months complained of progressive low back pain and gait difficulties that prevented him from normal activities in the past 2 months. Magnetic resonance imaging showed degenerative disc disease with multiple levels of bulging discs in the lumbar spine. After 35 chiropractic sessions, there was a significant improvement in various aspects of well-being, including pain resolution measured by a numeric rating scale, physical and mental improvement measured by the Parkinson's Disease Questionnaire, gait stability depicted by gait cyclogram, and better postural alignment and stability assessed by radiographic parameters. The current study may serve as an example of spinal manipulation showing the potential to address gait and posture problems associated with pain in a patient with PD. Aging changes in the muscles, bones and joints may accompany PD. Although PD itself is an incurable neurodegenerative disease, functional capacity of the musculoskeletal system can be enhanced by different types of manual therapy, by means of improving muscle strength, joint mobility, and postural balance. The actual duration in sustaining improved outcomes following a course of manipulative intervention remains to be determined.
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Affiliation(s)
- Eric Chun Pu Chu
- New York Chiropractic and Physiotherapy Centre, 41/F Langham Place Office Tower, Hong Kong, China
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Linda Yin King Lee
- School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong, China
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Static and Dynamic Balance in Adults Undergoing Lumbar Spine Surgery: Screening and Prediction of Postsurgical Outcomes. J Am Acad Orthop Surg 2020; 28:e553-e559. [PMID: 31589182 DOI: 10.5435/jaaos-d-19-00113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Balance and fall risk before and after lumbar surgery was assessed to determine whether balance at baseline predicts long-term postsurgical outcomes. METHODS Forty-three patients in the United States and Israel performed the single-leg stance (SLS) test, four square step test (FSST), and 8-foot up-and-go (8FUG) test before and 2 to 4 months after lumbar spine surgery. They completed the Oswestry Disability Index (ODI) and pain rating before and 12 months after lumbar surgery. RESULTS From baseline to follow-up, the SLS time was 3.74 seconds longer (P = 0.01), the FSST time was 1.94 seconds faster (P < 0.001), and the 8FUG time was 1.55 seconds faster (P = 0.02). Before surgery, 26% of the patients were considered high fall risk according to the FSST and 51% according to the 8FUG. Postsurgery, all patients could complete the physical tests, but 26% remained at high fall risk according to the 8FUG and 7.5% according to the FSST. The three physical measures together explained 30% of the variance in postsurgical ODI scores (P = 0.02). Age was not correlated with performance. DISCUSSION Risk of falling is higher than surgeons suspect. Balance tests (ie, SLS, FSST, and 8FUG) are quick and easy to administer. The findings support the importance of screening for balance and fall risk in adults undergoing lumbar spine surgery.
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Silveira Barezani AL, de Figueiredo Feital AMB, Gonçalves BM, Christo PP, Scalzo PL. Low back pain in Parkinson's disease: A cross-sectional study of its prevalence, and implications on functional capacity and quality of life. Clin Neurol Neurosurg 2020; 194:105787. [PMID: 32244035 DOI: 10.1016/j.clineuro.2020.105787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 02/04/2020] [Accepted: 03/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to estimate the prevalence of low back pain (LBP) in patients with Parkinson's disease (PD) and its impact on functional capacity and quality of life. METHODS Patients with idiopathic PD answered a questionnaire and were submitted to a clinical and functional assessment. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr Scale, Beck Depression Inventory (BDI), McGill Pain Questionnaire (McGill), Roland Morris Disability Questionnaire (RMDQ), 39-item Parkinson's Disease Questionnaire (PDQ-39) were used. In addition, the ability to contract transversus abdominis (TrA) was assessed. RESULTS One hundred and fifteen patients answered the questionnaire, and 95 (82.6 %) reported painful symptoms. Of these, 67 (58.3 %) had chronic LBP, and approximately 40 % patients reported its onset before diagnosis of PD. Higher scores in pain intensity, depressive symptoms and UPDRS II and III, more advanced stages of PD, and absence of TrA contraction determined poor functional limitation induced by LBP. However, pain intensity (McGill), severity of PD symptoms (UPDRS III) and absence of TrA contraction were identified as predictive factors for functional limitation and explained 66.1 % of the variance in the RMDQ. Pain intensity and LBP-related disability caused negative impact on the quality of life. CONCLUSION LBP is common in patients with PD and it causes disability and poor quality of life. Pain intensity, UPDRS III and absence of TrA contraction were the most significant predictive factors for disability assessed by the RMDQ.
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Affiliation(s)
| | | | - Bernardo Machado Gonçalves
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Paulo Pereira Christo
- Centro de Especialidades Médicas da Santa Casa de Belo Horizonte, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
| | - Paula Luciana Scalzo
- Department of Morphology, Institute of Biological Sciences and Program in Neuroscience, Universidade Federal de Minas Gerais, Belo Horizonte, Mina Gerais, Brazil.
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Bussey MD, Aldabe D, Shemmell J, Jowett T. Anticipatory postural control differs between low back pain and pelvic girdle pain patients in the absence of visual feedback. Hum Mov Sci 2019; 69:102529. [PMID: 31726292 DOI: 10.1016/j.humov.2019.102529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 10/06/2019] [Accepted: 10/06/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to examine the effect of vision on anticipatory postural control (APA) responses in two groups of clinically diagnosed chronic low back pain patients, those with Posterior Pelvic Girdle pain and those with Non-Specific Low Back Pain compared to a matched group of healthy controls during the modified Trendelenburg task. METHODS Seventy-eight volunteer participants (60 females and 18 males) gave informed consent to take part in this study. 39 with confirmed LBP or PGP lasting longer than 12 weeks and 39 healthy matched controls performed 40 single leg lift tasks (hip flexion to 90° as quickly as possible) with their non-dominant lower limb. A force plate was used to determine the medial-lateral displacement of the center of pressure, and the initiation of weight shift; kinematics was used to determine initiation of leg lift; and electromyography was used to determine onset times from the external oblique (EO), internal oblique (IO) and lumbar multifidus (MF), gluteus maximus (GM) and biceps femoris (BF). RESULTS The PGP group showed significantly longer muscle onset latencies in the BF, EO MF with visual occlusion (F2,746 = 4.51, p < .0001). CONCLUSION The muscle onset delays identified between the two LBP sub-groups suggests that pain may not be the primary factor in alteration of APA response. The PGP group show a greater reliance on vision which may signal impairment in multiple feedback channels.
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Affiliation(s)
- Melanie D Bussey
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9013, New Zealand.
| | - Daniela Aldabe
- Department of Anatomy, University of Otago, Dunedin 9013, New Zealand.
| | - Jonathan Shemmell
- Neural Control of Movement Lab, Medical and Exercise Science, School of Medicine, University of Wollongong, Australia.
| | - Tim Jowett
- Department of Mathematics & Statistics, University of Otago, Dunedin 9013, New Zealand.
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