Deficits of dynamic balance in chronic low back pain patients have been reported by different studies in terms of impaired postural control. However, they excluded the degree of pain as a determinant affecting dynamic balance.
OBJECTIVE:
To evaluate the effect of pain intensity on dynamic balance control in terms of postural stability indices (PSIs) and limits of stability (LOS) in chronic LBP patients.
METHODS:
Sixty subjects (38 men, 22 women) participated in the current study, 45 patients with chronic LBP were selected randomly and served as the chronic LBP group while 15 healthy subjects served as the asymptomatic group (AS). The chronic LBP group was further classified in terms of pain intensity into 3 subgroups; low pain (LP), moderate pain (MP) and severe pain (SP) subgroups. The Biodex Balance System was used to measure the dynamic balance control (PSIs and LOS).
RESULTS:
Statistical significant differences were found among AS group and chronic LBP subgroups in PSIs and LOS.
CONCLUSIONS:
The intensity of pain has shown to be one of the determinants affecting dynamic balance in chronic LBP patients who showed differences in the impairment of PSIs and LOS with different degrees of pain.
MellohMElferingAEgli PreslandCRoederCBarzTRolli SalathéC, et al. Identification of prognostic factors for chronicity in patients with low back pain: A review of screening instruments. Int Orthop. 2009; 33: 301-13.
2.
LeinonenVKankaanpääMLuukkonenMKansanenMHänninenOAiraksinenO, et al. Lumbar paraspinal muscle function, perception of lumbar position, and postural control in disc herniation-related back pain. Spine. 2003; 28: 842-8.
3.
HuangHMercerV. Dual-task methodology: Applications in studies of cognitive and motor performance in adults and children. Pediatr Phys Ther. 2001; 13: 133-40.
4.
SherafatSSalavatiMTakamjaniIEAkhbariBRadSMMazaheriM, et al. Effect of dual-tasking on dynamic postural control in individuals with and without nonspecific low back pain. J Manipulative Physiol Ther. 2014; 37(3): 170-9.
5.
RadeboldACholewickiJPolzhoferGKGreeneHS. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine. 2001; 26: 724-30.
6.
MariboTSchiøttz-ChristensenBJensenLDAndersenNTStengaard-PedersenK. Postural balances in low back pain patients: Criterion-related validity of centre of pressure assessed on a portable force platform. European Spine Journal. 2012; 21: 425-431.
7.
RuheAFejerRWalkerB. Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: A systematic review of the literature. European Spine Journal. 2011; 20: 358-368.
8.
SipkoTKuczyńskiM. The effect of chronic pain intensity on the stability limits in patients with low back pain. J Manipulative Physiol Ther. 2013; 36: 612-8.
9.
HenrySMHittJRJonesSLBunnJY. Decreased limits of stability in response to postural perturbations in subjects with low back pain. Clin Biomech (Bristol, Avon). 2006; 21: 881-92.
10.
PopaTBonifaziMDella VolpeRRossiAMazzocchioR. Adaptive changes in postural strategy selection in chronic low back pain. Exp Brain Res. 2007; 177: 411-8.
11.
JonesSLHenrySMRaaschCCHittJRBunnJY. Individuals with non-specific low back pain use a trunk stiffening strategy to maintain upright posture. J Electromyogr Kinesiol. 2012; 22: 13-20.
12.
RuheAFejerRWalkerB. Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain? BMC Musculoskelet Disord. 2011; 12: 162. doi: 10.1186/1471-2474-12-162.
CrossleyKMBennellKLCowanSMGreenS. Analysis of outcomemeasures for persons with patellofemoral pain: Which are reliable and valid? Arch Phys Med Rehabil. 2004; 85: 815-822.
15.
JensenMPChenCBruggerAM. Interpretation of visual analog scale ratings and change scores: A reanalysis of two clinical trials of postoperative pain. J Pain. 2003; 4: 407-414.
16.
CachupeWShifflettBKahanovLWughalterE. Reliability of Biodex Balance System measures. Measure Physi Educ Exer Sci. 2001; 5: 97-108.
17.
AydoEBalAAydoSÇakciA. Evaluation of dynamic postural balance using the Biodex Stability System in rheumatoid arthritis patients. Clin Rheumatol. 2006; 25: 462-7.
18.
SchmitzRArnoldB. Intertester and intratester reliability of a dynamic balance protocol using the Biodex Stability System. J Sport Rehabil. 1998; 7: 95-102.
19.
De BruinEDSwanenburgJBetschonEMurerK. A randomized controlled trial investigating motor skill training as a function of attentional focus in old age. BMC Geriatr. 2009 May 8; 9: 15. doi: 10.1186/1471-2318-9-15.
20.
TaimelaSOstermanKAlarantaHSoukkaAKujalaU. Long psychomotor reaction time in patients with chronic lowback pain: preliminary report. Arch Phys Med Rehabil. 1993; 74: 1161-4.
21.
TeasdaleNBardCLaRueJFleuryM. On the cognitive penetrability of posture control. Exp Aging Res. 1993; 19: 1-13.
22.
SherafatSSalavatiMEbrahimi TakamjaniIAkhbariBMohammadiradSMazaheriM, et al. Intrasession and intersession reliability of postural control in participants with and without nonspecific low back pain using the biodex balance system. J Manipulative Physiol Ther. 2013; 36(2): 111-8.
23.
PickerillMLHarterRA. Validity and reliability of limits-of-stability testing a comparison of 2 postural stability evaluation devices. J Athl Train. 2011; 46(6): 600-6.
24.
MannLKleinpaulJFPereira MoroARMotaCBCarpesFP. Effect of low back pain on postural stability in younger women: Influence of visual deprivation. J Bodyw Mov Ther. 2010; 14(4): 361-6.
25.
Della VolpeRPopaTGinanneschiFSpidalieriRMazzocchioRRossiA. Changes in coordination of postural control during dynamic stance in chronic LBP patients. Gait and Posture. 2006; 24(1): 349-355.
26.
MientjesMIFrankJS. Balance in chronic low back pain patients Compared to healthy people under various conditions in upright standing. Clin Biomech. 1999; 14: 710-6.
27.
LundJPDongaRWidmerCGStohlerCS. The pain adaptation model: A discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991; 69: 683-94.
28.
TétreauCDuboisJDPichéMDescarreauxM. Modulation of pain-induced neuromuscular trunk responses by pain expectations: A single group study. J Manipulative Physiol Ther. 2012; 35: 636-44.
29.
WallPMcMahonS. The relationship of perceived pain to afferent nerve impulse. Trends Neurosci. 1986; 6: 254-5.
30.
NachemsonAL. Advances in low-back pain. Clin Orthop. 1985; 200: 266-278.
31.
ArnoldBLSchmitzRJ. Examination of balance measures produced by the Biodex Stability System. J Athl Train. 1998; 33(4): 323-7.
32.
MannLKleinpaulJFPereira MoroARMotaCBCarpesFP. Effect of low back pain on postural stability in younger women: Influence of visual deprivation. J Bodyw Mov Ther. 2010; 14(4): 361-6.
33.
NiesNSinnottPL. Variations in balance and body sway in middle-aged adults, subjects with healthy backs compared with subjects with low back dysfunction. Spine. 1991; 16(3): 325-330.
34.
PopaTBonifaziMDella VolpeRRossiAMazzocchioR. Adaptive changes in postural strategy selection in chronic low back pain. Exp Brain Res. 2007; 177: 411-8.
35.
BrumagneSJanssensLJanssensEGoddynL. Altered postural control in anticipation of postural instability in persons with recurrent low back pain. Gait Posture. 2008; 28: 657-62.
WoollacottMShumway-CookA. Attention and the control of posture and gait: A review of an emerging area of research. Gait Posture. 2002; 16(1): 1-14.
38.
TeasdaleNBardCLaRueJFleuryM. On the cognitive penetrability of posture control. Exp Aging Res. 1993; 19(1): 1-13.
39.
DeviterneDGauchardGCJametMVanconGPerrinPP. Added cognitive load through rotary auditory stimulation can improve the quality of postural control in the elderly. Brain Res Bull. 2005; 64: 487-92.
40.
LiKZLindenbergerU. Relations between aging sensory/sensorimotor and cognitive functions. Neurosci Biobehav Rev. 2002; 26(7): 777-83.
41.
GaoYShiJGYeHLiuZRZhengLBNiZM, et al. Adaptation of muscles of the lumbar spine to sudden imbalance in patients with lower back pain caused by military training. J Spinal Cord Med. 2014; 37(6): 774-81.
42.
TaimelaSOstermanKAlarantaHSoukkaAKujalaU. Long psychomotor reaction time in patients with chronic low back pain: Preliminary report. Arch Phys Med Rehabil. 1993; 74: 1161-4.
