Balance control in unstable sitting in individuals with an acute episode of low back pain

Wolbert van den Hoorn; Roberto Meroni; David M Klyne; Mansour Abdullah Alshehri; Paul W Hodges

doi:10.1016/j.gaitpost.2022.03.014

Balance control in unstable sitting in individuals with an acute episode of low back pain

Gait Posture. 2022 Jun:95:15-21. doi: 10.1016/j.gaitpost.2022.03.014. Epub 2022 Mar 24.

Authors

Wolbert van den Hoorn¹, Roberto Meroni², David M Klyne³, Mansour Abdullah Alshehri⁴, Paul W Hodges³

Affiliations

¹ The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Australia. Electronic address: w.vandenhoorn@uq.edu.au.
² Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg; School of Medicine and Surgery, University of Milan Bicocca, Monza, Italy.
³ The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Australia.
⁴ The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Australia; Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia.

PMID: 35398705
DOI: 10.1016/j.gaitpost.2022.03.014

Abstract

Background: Low back pain (LBP) is associated with altered postural control, mostly observed at later stages in the LBP trajectory. It is unclear whether postural control differs in the acute phase of LBP.

Research question: Is postural control different in the acute phase of LBP (<2 weeks) and do differences depend on pain intensity, psychological features and/or availability of vision to control posture?

Methods: Cross-sectional study design. An unstable sitting paradigm (to reduce the contribution of the legs) assessed postural control of participants with acute LBP (n = 133) and pain-free controls (n = 74). Centre of pressure (CoP) reflected seat movements. Participants balanced with eyes closed, open, or with visual feedback of the anteroposterior CoP position. Balance performance was expressed by CoP displacement and velocity, and stabilogram diffusion analysis. Generalised estimating equations (GEEs) including body mass index, sex, and safety bar touch, tested differences between groups and between balance conditions. Separate GEEs were used to model performance measures and bar touch (yes/no) including pain intensity, disability and psychological features.

Results: CoP displacement and critical point coordinates (time and distance where CoP diffusion rate or spread slows) were larger in LBP than pain-free controls independent of balance condition. Long-term diffusion rate was greater in LBP than controls with eyes closed. CoP velocity measures (RMS, short term diffusion rate) were not different between groups. Pain intensity and psychological features were not linearly related to balance performance in participants with acute LBP. Higher pain catastrophizing was associated with touching the safety bar.

Significance: Postural control differs in acute LBP than pain-free controls. Findings might be explained by altered sensory processing, lesser ability to reweight proprioceptive information and/or less accurate trunk muscle control. Although not linearly related to pain-intensity or psychological features in the acute stage, reduced balance performance could potentially have impact on LBP recovery.

Keywords: Centre of pressure; Low back pain; Postural control; Stabilogram diffusion analysis; Unstable sitting.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Cross-Sectional Studies
Humans
Low Back Pain*
Postural Balance / physiology
Posture / physiology
Sitting Position