A Study on the Relationship between Postural Control and Pain-Related Clinical Outcomes in Patients with Chronic Nonspecific Low Back Pain

Abstract

Objectives. To explore the relationship between postural control and pain-related clinical outcomes in patients with chronic nonspecific low back pain (cNLBP). Methods. Participants with cNLBP and healthy individuals were recruited. Muscle activities were recorded during internal and external perturbation tasks. Postural control capacity was assessed by muscle onset time and integrals of electromyography (iEMGs) of postural muscles during the phases of anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs). Correlation analysis was employed to investigate the relationship between postural control capacity, pain, and disability. Results. Twenty-seven patients with cNLBP and 27 healthy participants were recruited. Gastrocnemius (GA) muscle onset time was earlier in the cNLBP group than in the control group in the internal perturbation task. The onset time of GA and erector spinae (ES) of the cNLBP group was later than that of the controls in the external perturbation task. Disability level moderately correlated with the iEMGs of rectus abdominis (RA), GA, and external oblique (EO) during APAs. Pain score moderately correlated with the iEMGs of RA, EO, and ES during CPAs of perturbation tasks. Conclusion. cNLBP participants had altered muscle activation strategy to maintain postural stability in response to perturbation. This study further discovered that pain-related disabilities of cNLBP participants were likely related to the APAs capacity, whereas the pain intensity may relate to the CPAs capacity. Pain and disability may therefore be related to the control process of the posture-related muscles.

Effect of Cognitive Load on Anticipatory Postural Adjustment Latency and its Relationship with Pain-Related Dysfunction in Non-specific Chronic Low Back Pain: A Cross-Sectional Study

“…It has been demonstrated that an increasing delay in the latency of external oblique muscle activation is accompanied by an increased Oswestry Disability Index score in patients with chronic low back pain, which occurs when performing a rapid arm-raising task [ 51 ]. Pain-related disabilities in patients with NCLBP may be related to APA under endogenous and exogenous postural disturbances [ 52 ]. All these studies suggest that dysregulated APA onset in trunk muscles may be associated with pain-related dysfunction, but the relationship remains unclear.…”

Changes in cortical activation during upright stance in individuals with chronic low back pain: An fNIRS study

“…Low back pain (LBP) is becoming a growing socioeconomic burden (Hartvigsen et al, 2018;Cieza et al, 2021;Chiarotto and Koes, 2022) because it increases the risk of disability and contributes to poor mental health. Many studies have confirmed that pain-related disabilities and intensity were likely related to the altered structure and function of muscles in patients with CLBP (Emami et al, 2018;Yu et al, 2021). For example, when facing external disturbances or changes in sensory input, patients with CLBP show greater body sway velocity and area 10.3389/fnhum.2023.1085831 (della Volpe et al, 2006;Willigenburg et al, 2013;da Silva et al, 2018), delayed muscle activity (Knox et al, 2018) and altered spinal kinematics (Meier et al, 2019), which could accelerate spinal degeneration and muscle spasms, injuries, and fatigue.…”

Postural Control of Patients with Low Back Pain Under Dual-Task Conditions

“…LBP patients may suffer from certain degrees of postural control abnormalities, mainly manifested as decreased trunk coupling ability, 7 impaired gait, 8 increased center of gravity and center of mass deviation, 9 prolonged or disappeared preactivation time of postural muscles, 10 proprioceptive disturbances, 11 decreased attention and executive ability, 12 and reorganized structural or functional of the central nervous system. 13 …”