Is force control altered in patients with chronic low back pain? A systematic review

Abstract

Background

Chronic low back pain (CLBP) is a significant public health concern. Proprioceptive and motor control deficits are contributing factors to its development and persistence; however, the force control has been scarcely investigated in this population.

Objective

This Systematic review aimed to synthesize evidence on whether trunk force control is altered in individuals with non-specific CLBP.

Methods

Three databases were searched (PubMed, Web of Science, and Scopus) from inception to March 30, 2025. Following PRISMA guidelines, studies evaluating force sense, effort sense, or force steadiness in CLBP patients were included. Methodological quality was assessed using the Appraisal tool for Cross-Sectional Studies tool and certainty of evidence using the GRADE approach. The study was registered on PROSPERO (CRD420251028869).

Results

Ten cross-sectional studies met the inclusion criteria. Four reported reduced accuracy in trunk force sense, one alteration in effort sense, and three decreased force steadiness, with a very low certainty of evidence. Due to substantial heterogeneity in assessment protocols, including movement types, target force levels, and feedback conditions, a meta-analysis was not feasible.

Conclusion

Overall, CLBP patients demonstrate impairments in trunk force sense and force steadiness, but the certainty of evidence was very low These proprioceptive deficits may compromise movement efficiency and safety by causing over or under estimation of required force for a given task. There is a critical need to standardize assessment protocols to enable consistent evaluation of force control and for the development of interventions aimed at improving trunk force control in CLBP patients.