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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

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Abstract

Over the past 20 years, the center of pressure (COP) has been commonly used as an index of postural stability in standing. While many studies investigated COP excursions in low back pain patients and healthy individuals, no comprehensive analysis of the reported differences in postural sway pattern exists. Six online databases were systematically searched followed by a manual search of the retrieved papers. The selection criteria comprised papers comparing COP measures derived from bipedal static task conditions on a force-plate of non-specific low back pain (NSLBP) sufferers to those of healthy controls. Sixteen papers met the inclusion criteria. Heterogeneity in study designs prevented pooling of the data so only a qualitative data analysis was conducted. The majority of the papers (14/16, 88%) concluded that NSLBP patients have increased COP mean velocity and overall excursion as compared to healthy individuals. This was statistically significant in the majority of studies (11/14, 79%). An increased sway in anteroposterior direction was also observed in NSLBP patients. Patients with NSLBP exhibit greater postural instability than healthy controls, signified by greater COP excursions and a higher mean velocity. While the decreased postural stability in NSLBP sufferers further appears to be associated with the presence of pain, it seems unrelated to the exact location and pain duration. No correlation between the pain intensity and the magnitude of COP excursions could be identified.

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References

  1. Gatev P, Thomas S, Kepple T, Hallett M (1999) Feedforward ankle strategy of balance during quiet stance in adults. J Physiol 514(Pt 3):915–928

    Article  PubMed  CAS  Google Scholar 

  2. della Volpe R, Popa T, Ginanneschi F, Spidalieri R, Mazzocchio R, Rossi A (2006) Changes in coordination of postural control during dynamic stance in chronic low back pain patients. Gait Posture 24:349–355. doi:10.1016/j.gaitpost.2005.10.009

    Google Scholar 

  3. Baratto L, Morasso PG, Re C, Spada G (2002) A new look at posturographic analysis in the clinical context: sway-density versus other parameterization techniques. Mot Control 6:246–270

    Google Scholar 

  4. Madeleine P, Prietzel H, Svarrer H, Arendt-Nielsen L (2004) Quantitative posturography in altered sensory conditions: a way to assess balance instability in patients with chronic whiplash injury. Arch Phys Med Rehabil 85:432–438

    Article  PubMed  Google Scholar 

  5. Walker BF (2000) The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 13:205–217

    Article  PubMed  CAS  Google Scholar 

  6. Waddell G (1987) 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine (Phila Pa 1976) 12:632–644

    CAS  Google Scholar 

  7. Andersson GB (1999) Epidemiological features of chronic low-back pain. Lancet 354:581–585

    Article  PubMed  CAS  Google Scholar 

  8. Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA (2002) The influence of back pain on balance and functional mobility in 65–75-year-old women with osteoporosis. Osteoporos Int 13:868–873

    Article  PubMed  CAS  Google Scholar 

  9. Brumagne S, Cordo P, Lysens R, Verschueren S, Swinnen S (2000) The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine (Phila Pa 1976) 25:989–994

    CAS  Google Scholar 

  10. Mazzocchio R, Scarfo GB, Mariottini A, Muzii VF, Palma L (2001) Recruitment curve of the soleus H-reflex in chronic back pain and lumbosacral radiculopathy. BMC Musculoskelet Disord 2:4

    Article  PubMed  CAS  Google Scholar 

  11. Casadio M, Morasso PG, Sanguineti V (2005) Direct measurement of ankle stiffness during quiet standing: implications for control modelling and clinical application. Gait Posture 21:410–424

    Article  PubMed  Google Scholar 

  12. Moseley GL, Hodges PW (2005) Are the changes in postural control associated with low back pain caused by pain interference? Clin J Pain 21:323–329

    Article  PubMed  Google Scholar 

  13. Rossi A, Decchi B, Ginanneschi F (1999) Presynaptic excitability changes of group Ia fibres to muscle nociceptive stimulation in humans. Brain Res 818:12–22

    Article  PubMed  CAS  Google Scholar 

  14. Rossi S, della Volpe R, Ginanneschi F, Ulivelli M, Bartalini S, Spidalieri R, Rossi A (2003) Early somatosensory processing during tonic muscle pain in humans: relation to loss of proprioception and motor ‘defensive’ strategies. Clin Neurophysiol 114:1351–1358

    Article  PubMed  Google Scholar 

  15. Sibley KM, Carpenter MG, Perry JC, Frank JS (2007) Effects of postural anxiety on the soleus H-reflex. Hum Mov Sci 26:103–112

    Article  PubMed  Google Scholar 

  16. Capra NF, Ro JY (2000) Experimental muscle pain produces central modulation of proprioceptive signals arising from jaw muscle spindles. Pain 86:151–162

    Article  PubMed  CAS  Google Scholar 

  17. Whiting P, Harbord R, Kleijnen J (2005) No role for quality scores in systematic reviews of diagnostic accuracy studies. BMC Med Res Methodol 5

  18. Byl NN, Sinnott PL (1991) Variations in balance and body sway in middle-aged adults. Subjects with healthy backs compared with subjects with low-back dysfunction. Spine (Phila Pa 1976) 16:325–330

    Google Scholar 

  19. Mann L, Kleinpaul JF, Moro ARP, Mota CB, Carpes FP (2009) Effect of low back pain on postural stability in younger women: Influence of visual deprivation. J Bodyw Mov Ther. doi:10.1016/j.jbmt.2009.06.007

  20. Luoto S, Taimela S, Hurri H, Aalto H, Pyykko I, Alaranta H (1996) Psychomotor speed and postural control in chronic low back pain patients—a controlled follow-up study. Spine (Phila Pa 1976) 21:2621–2627

    CAS  Google Scholar 

  21. Mientjes MI, Frank JS (1999) Balance in chronic low back pain patients compared to healthy people under various conditions in upright standing. Clin Biomech (Bristol, Avon) 14:710–716

    Article  CAS  Google Scholar 

  22. Kuukkanen TM, Malkia EA (2000) An experimental controlled study on postural sway and therapeutic exercise in subjects with low back pain. Clin Rehabil 14:192–202

    Article  PubMed  CAS  Google Scholar 

  23. Hamaoui A, Mc Do, Poupard L, Bouisset S (2002) Does respiration perturb body balance more in chronic low back pain subjects than in healthy subjects? Clin Biomech (Bristol, Avon) 17:548–550

    Article  CAS  Google Scholar 

  24. Grimstone SK, Hodges PW (2003) Impaired postural compensation for respiration in people with recurrent low back pain. Exp Brain Res 151:218–224

    Article  PubMed  Google Scholar 

  25. Brumagne S, Cordo P, Verschueren S (2004) Proprioceptive weighting changes in persons with low back pain and elderly persons during upright standing. Neurosci Lett 366:63–66

    Article  PubMed  CAS  Google Scholar 

  26. Hamaoui A, Do MC, Bouisset S (2004) Postural sway increase in low back pain subjects is not related to reduced spine range of motion. Neurosci Lett 357:135–138

    Article  PubMed  CAS  Google Scholar 

  27. Mok NW, Brauer SG, Hodges PW (2004) Hip strategy for balance control in quiet standing is reduced in people with low back pain. Spine (Phila Pa 1976) 29:E107–E112

    Google Scholar 

  28. Smith M, Coppieters MW, Hodges PW (2005) Effect of experimentally induced low back pain on postural sway with breathing. Exp Brain Res 166:109–117

    Article  PubMed  Google Scholar 

  29. Popa T, Bonifazi M, Della Volpe R, Rossi A, Mazzocchio R (2007) Adaptive changes in postural strategy selection in chronic low back pain. Exp Brain Res 177:411–418

    Article  PubMed  Google Scholar 

  30. Brumagne S, Janssens L, Knapen S, Claeys K, Suuden-Johanson E (2008) Persons with recurrent low back pain exhibit a rigid postural control strategy. Eur Spine J 17:1177–1184

    Article  PubMed  Google Scholar 

  31. Lafond D, Champagne A, Descarreaux M, Dubois JD, Prado JM, Duarte M (2009) Postural control during prolonged standing in persons with chronic low back pain. Gait Posture 29:421–427. doi:10.1016/j.gaitpost.2008.10.064

    Google Scholar 

  32. Harringe ML, Halvorsen K, Renstrom P, Werner S (2008) Postural control measured as the center of pressure excursion in young female gymnasts with low back pain or lower extremity injury. Gait Posture 28:38–45

    Article  PubMed  CAS  Google Scholar 

  33. Salavati M, Mazaheri M, Negahban H, Ebrahimi I, Jafari AH, Kazemnejad A, Parnianpour M (2009) Effect of dual-tasking on postural control in subjects with nonspecific low back pain. Spine (Phila Pa 1976) 34:1415–1421

    Google Scholar 

  34. Hue O, Simoneau M, Marcotte J, Berrigan F, Dore J, Marceau P, Marceau S, Tremblay A, Teasdale N (2007) Body weight is a strong predictor of postural stability. Gait Posture 26:32–38

    Article  PubMed  Google Scholar 

  35. Demura S-I, Kitabayashi T, Noda M, Aoki H (2008) Age-stage differences in body sway during a static upright posture based on sway factors and relative accumulation of power frequency. Percept Mot Skills 107:89–98

    PubMed  Google Scholar 

  36. Ruhe A, Fejer R, Walker BF (2010) The test-retest reliability of centre of pressure measures in bipedal static task conditions: a systematic review of the literature. Gait Posture (under review)

  37. Santos BR, Delisle A, Lariviere C, Plamondon A, Imbeau D (2008) Reliability of centre of pressure summary measures of postural steadiness in healthy young adults. Gait Posture 27:408–415

    Article  PubMed  Google Scholar 

  38. Lafond D, Champagne A, Descarreaux M, Dubois J-D, Prado JM, Duarte M (2009) Postural control during prolonged standing in persons with chronic low back pain. Gait Posture 29:421–427

    Article  PubMed  Google Scholar 

  39. Salavati M, Hadian MR, Mazaheri M, Negahban H, Ebrahimi I, Talebian S, Jafari AH, Sanjari MA, Sohani SM, Parnianpour M (2009) Test–retest reliability of center of pressure measures of postural stability during quiet standing in a group with musculoskeletal disorders consisting of low back pain, anterior cruciate ligament injury and functional ankle instability. Gait Posture 29:460–464. doi:10.1016/j.gaitpost.2008.11.016

    Google Scholar 

  40. Brumagne S, Janssens L, Janssens E, Goddyn L (2008) Altered postural control in anticipation of postural instability in persons with recurrent low back pain. Gait Posture 28:657–662

    Article  PubMed  Google Scholar 

  41. Leinonen V, Kankaanpaa M, Luukkonen M, Kansanen M, Hanninen O, Airaksinen O, Taimela S (2003) Lumbar paraspinal muscle function, perception of lumbar position, and postural control in disc herniation-related back pain. Spine (Phila Pa 1976) 28:842–848

    Google Scholar 

  42. Roland M, Morris R (1983) A study of the natural history of back pain. Part I. Development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 8:141–144

    CAS  Google Scholar 

  43. Fairbanks J, Couper J, Davies J, O’Brian J (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    Google Scholar 

  44. Gill J, Allum JH, Carpenter MG, Held-Ziolkowska M, Adkin AL, Honegger F, Pierchala K (2001) Trunk sway measures of postural stability during clinical balance tests: effects of age. J Gerontol A Biol Sci Med Sci 56:M438–M447

    PubMed  CAS  Google Scholar 

  45. Corbeil P, Blouin JS, Teasdale N (2004) Effects of intensity and locus of painful stimulation on postural stability. Pain 108:43–50. doi:10.1016/j.pain.2003.12.001

    Google Scholar 

  46. de Vet HC, Heymans MW, Dunn KM, Pope DP, van der Beek AJ, Macfarlane GJ, Bouter LM, Croft PR (2002) Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine (Phila Pa 1976) 27:2409–2416. doi:10.1097/01.BRS.0000030307.34002.BE

    Google Scholar 

  47. Era P, Sainio P, Koskinen S, Haavisto P, Vaara M, Aromaa A (2006) Postural balance in a random sample of 7,979 subjects aged 30 years and over. Gerontology 52:204–213. doi:10.1159/000093652

    Google Scholar 

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Acknowledgments

The author(s) like to thank Tino Bos (TB) for his valuable contribution during the first phase of the literature search.

Conflict of interest

The author(s) declare that they have no competing interests. No funding was received for this review.

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Correspondence to Alexander Ruhe.

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Ruhe, A., Fejer, R. & Walker, B. 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. Eur Spine J 20, 358–368 (2011). https://doi.org/10.1007/s00586-010-1543-2

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