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01-09-2008 | Original Article

Persons with recurrent low back pain exhibit a rigid postural control strategy

Authors: Simon Brumagne, Lotte Janssens, Stefanie Knapen, Kurt Claeys, Ege Suuden-Johanson

Published in: European Spine Journal | Issue 9/2008

Abstract

Persons with recurrent low back pain (LBP) have been observed to have altered proprioceptive postural control. These patients seem to adopt a body and trunk stiffening strategy and rely more on ankle proprioception to control their posture during quiet upright standing. The aim of this study is to determine the effect of changing postural condition (stable and unstable support surface) on postural stability and proprioceptive postural control strategy in persons with recurrent LBP. Postural sway characteristics of 21 persons with recurrent LBP and 24 healthy individuals were evaluated in upright posture with or without standing on “foam” for the conditions as follows: (1) control (no vibration); (2) vibration of the triceps surae muscles; (3) paraspinal muscle vibration; (4) vibration of the tibialis anterior muscles. Vision was occluded in all conditions except for one control trial. All trials lasted 60 s. Vibration (60 Hz, 0.5 mm), as a potent stimulus for muscle spindles, was initiated 15 s after the start of the trial for a duration of 15 s. Persons with recurrent LBP showed significantly different postural control strategies favoring ankle muscle proprioceptive control (ratio closer to 1) instead of paraspinal muscle proprioceptive control (ratio closer to 0) for both standing without foam (ratio ankle muscle/paraspinal muscle control = 0.83) (P < 0.0001) and on foam (ratio ankle muscle/paraspinal muscle control = 0.87; P < 0.0001) compared to healthy individuals (0.67 and 0.46, respectively). It is concluded that young persons with recurrent LBP seem to use the same proprioceptive postural control strategy even in conditions when this ankle strategy is not the most appropriate such as standing on an unstable support surface. The adopted proprioceptive postural control strategy might be effective in simple conditions, however, when used in all postural conditions this could be a mechanism to undue spinal loading, pain and recurrences.

Aruin AS, Latash ML (1995) Directional specificity of postural muscles in feed-forward postural reactions during fast voluntary arm movements. Exp Brain Res 103:323–332PubMedCrossRef

Baecke JAH, Burema J, Frijters JER (1982) A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 36:936–942PubMed

Borkan JM, Cherkin DC (1996) An agenda for primary care research on low back pain. Spine 21:2880–2884PubMedCrossRef

Brumagne S, Lysens R, Spaepen A (1999) Lumbosacral repositioning accuracy in standing posture: a combined electrogoniometric and videographic evaluation. Clin Biomech 14:361–363CrossRef

Brumagne S, Cordo P, Lysens R et al (2000) The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine 25:989–994PubMedCrossRef

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

Brumagne S, Paulus I, Van Deun S et al (2006) Persons with recurrent low back pain exhibit a rigid postural control strategy. Eur Spine J 15(Suppl. 4):S490

Carpenter MG, Frank JS, Silcher CP et al (2001) The influence of postural threat on the control of upright stance. Exp Brain Res 138:210–218PubMedCrossRef

Carver S, Kiemel T, Jeka JJ (2006) Modeling the dynamics of sensory reweighting. Biol Cybern 95:123–134PubMedCrossRef

10.

Cholewicki J, van Dieën JH, Arsenault AB (2003) Muscle function and dysfunction in the spine. J Electromyogr Kinesiol 13:303–304PubMedCrossRef

11.

Cholewicki J, Silfies SP, Shah RA et al (2005) Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine 30:2614–2620PubMedCrossRef

12.

Cordo PJ, Gurfinkel VS, Brumagne S et al (2005) Effect of slow, small movement on the vibration-evoked kinesthetic illusion. Exp Brain Res 167:324–334PubMedCrossRef

13.

della Volpe R, Popa T, Ginanneschi F et al (2006) Changes in coordination of postural control during dynamic stance in chronic low back pain patients. Gait Posture 24:349–355PubMedCrossRef

14.

Eklund G (1972) General features of vibration-induced effect on balance. Ups J Med Sci 77:112–124PubMed

15.

Fairbank JCT, Pynsent PB (2000) The oswestry disability index. Spine 25:2940–2953PubMedCrossRef

16.

Fomin SV, Gurfinkel VS, Feldman AG et al (1976) Moments in human leg joints during walking. Biofizika 21:556–561PubMed

17.

Goodwin GM, McCloskey DI, Matthews PBC (1972) The contribution of muscle afferents to kinesthesia shown by vibration induced illusions of movement and by the effects of paralysing joint afferents. Brain 95:705–748PubMedCrossRef

18.

Gurfinkel VS, Ivanenko Y, Levik Y et al (1995) Kinesthetic reference for human orthograde posture. Neuroscience 68:229–243PubMedCrossRef

19.

Henry SM, Hitt JR, Jones SL et al (2006) Decreased limits of stability in response to postural perturbations in subjects with low back pain. Clin Biomech 21:881–892CrossRef

20.

Hides JA, Richardson CA, Jull GA (1996) Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 21:2763–2769PubMedCrossRef

21.

Hodges PW, Richardson CA (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine 21:2640–2650PubMedCrossRef

22.

Hodges PW, Richardson CA (1999) Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil 80:1005–1012PubMedCrossRef

23.

Isableu B, Vuillerme N (2006) Differential integration of kinaesthetic signals to postural control. Exp Brain Res 174:763–768PubMedCrossRef

24.

Ivanenko YP, Grasso R, Lacquaniti F (1999) Effect of gaze on postural responses to neck proprioceptive and vestibular stimulation in humans. J Physiol 519.1:301–314CrossRef

25.

Ivanenko YP, Solopova IA, Levik YS (2000) The direction of postural instability affects postural reactions to ankle muscle vibration in humans. Neurosci Lett 292:103–106PubMedCrossRef

26.

Kent P, Keating JL (2005) Classification in nonspecific low back pain: what methods do primary care clinicians currently use? Spine 30:1433–1440PubMedCrossRef

27.

Latash ML (2000) There is no motor redundancy in human movements. There is motor abundance. Motor Control 4:259–261PubMed

28.

Marras WS, Ferguson SA, Burr D et al (2007) Low back pain recurrence in occupational environments. Spine 32:2387–2397PubMedCrossRef

29.

McGorry RW, Webster BS, Snook SH, Hsiang SM (2000) The relation between pain intensity, disability, and the episodic nature of chronic and recurrent low back pain. Spine 25:834–841PubMedCrossRef

30.

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

31.

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

32.

Moseley GL, Hodges PW (2006) Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: a risk factor for chronic trouble? Behav Neurosci 120:474–476PubMedCrossRef

33.

Newcomer K, Laskowski ER, Yu B et al (2000) Differences in repositioning error among patients with low back pain compared with control subjects. Spine 25:2488–2493PubMedCrossRef

34.

Roll JP, Vedel JP (1982) Kinaesthetic role of muscle afferents in man, studied by tendon vibration and microneurography. Exp Brain Res 47:177–190PubMedCrossRef

35.

Vuillerme N, Teasdale N, Nougier V (2001) The effect of expertise in gymnastics on proprioceptive sensory integration in human subjects. Neurosci Lett 311:73–76PubMedCrossRef

36.

Wijnberg N (2001) Posture in Parkinson patients: a proprioceptive problem? In: Duysens J, Smits-Engelsman BCM, Kingma H (eds) Control of posture and gait. International Society for Postural and Gait, Maastricht, pp 758–761

Title: Persons with recurrent low back pain exhibit a rigid postural control strategy
Authors: Simon Brumagne
Lotte Janssens
Stefanie Knapen
Kurt Claeys
Ege Suuden-Johanson
Publication date: 01-09-2008
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 9/2008
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-008-0709-7

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Persons with recurrent low back pain exhibit a rigid postural control strategy

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