Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males

Abstract

Objective Risk factors for falling in elderly people remain uncertain, and the effects of spinal factors and physical ability on body balance and falling have not been examined. The objective of this study was to investigate how factors such as spinal sagittal alignment, spinal range of motion, body balance, muscle strength, and gait speed influence falling in the prospective cohort study. Methods The subjects were 100 males who underwent a basic health checkup. Balance, SpinalMouse Ò data, grip strength, back muscle strength, 10-m gait time, lumbar lateral standing radiographs, body mass index, and fall history over the previous year were examined. Platform measurements of balance included the distance of movement of the center of pressure (COP) per second (LNG/TIME), the envelopment area traced by movement of the COP (E AREA), and the LNG/E AREA ratio. The thoracic/lumbar angle ratio (T/L ratio) and sagittal vertical axis (SVA) were used as an index of sagittal balance. Results LNG/TIME and E AREA showed significant positive correlations with age, T/L ratio, SVA, and 10-m gait time; and significant negative correlations with lumbar lordosis angle, sacral inclination angle, grip strength and back muscle strength. Multiple regression analysis showed significant differences for LNG/TIME and E AREA with T/L ratio, SVA, lumbar lordosis angle and sacral inclination angle (R 2 = 0.399). Twelve subjects (12 %) had experienced a fall over the past year. Age, T/L ratio, SVA, lumbar lordosis angle, sacral inclination angle, grip strength, back muscle strength, 10-m gait time, height of the intervertebral disc, osteophyte formation in radiographs and LNG/E AREA differed significantly between fallers and non-fallers. The group with SVA [ 40 mm (n = 18) had a significant higher number of subjects with a single fall (6 single fallers/18: p = 0.0075) and with multiple falls (4 multiple fallers/18: p = 0.0095). Conclusion Good spinal sagittal alignment, muscle strength and 10-m gait speed improve body balance and reduce the risk of fall. Muscle strength and physical ability are also important for spinal sagittal alignment. Body balance training, improvement of physical abilities including muscle training, and maintenance of spinal sagittal alignment can lead to prevention of fall.

Postural changes versus balance control and falls in community-living older adults: a systematic review

“…This is confirmed by the findings of this review, in which poorer stabilometry results were associated with postural malalignment and falls [21,22,24,29,31]. Previous studies have also associated thoracic hyperkyphosis with loss of mobility, reduced quality of life and increased falls risk in osteoporotic older adults [11,16,39,40].…”

“…Participants' falls risk was assessed using Pluijm's assessment [26] and the Physiological Profile Assessment (PPA) [34]. While most studies followed participants for 12 months [10,21,24,28,34], in one study participants were followed for only six months [27].…”

“…Body balance was assessed using more accurate methods of measurement, such as stabilometry, force plate [14,21,22,24,29,36], and functional tests such as the Timed Up and Go (TUG) test [8, 23, 32 -35], functional reach (FR) [8], Berg Balance Scale (BBS) [30], one-led stance [23,32,33], Four-Square Step Test (FSST) [34,35] and feet-together stance, semitandem and tandem standing [25]. Table 2 -Characteristics of the studies with regard to methodologies, sample profile, outcomes and tools used for assessing body posture, balance and falls risk Table 2 -Characteristics of the studies with regard to methodologies, sample profile, outcomes and tools used for assessing body posture, balance and falls risk -Characteristics of the studies with regard to methodologies, sample profile, outcomes and tools used for assessing the feet and the ankle, as well as balance and falls risk The methodological quality of the studies is shown in Table 4.…”

“…The following methods and tools were used to assess body posture: SpinalMouse [8, 21 -24], occiput-to-wall distance (OWD) [25 -27], method using 1.7 cm blocks [28], flexicurve ruler [29,30], Cobb angle [24,26,27], photogrammetry/Moiré method [31], method with photographic recording [32] and digital inclinometer [33]. Foot posture was assessed using the Foot Posture Index (FPI) [34,35], which tests foot characteristics across six domains: foot posture, foot deformity and lesions, plantar tactile sensation, toe muscle strength and foot pain, and a three-dimensional foot scanner (Footstep PRO, Dream GP Company, Japan) [36].…”

Methodology and demographics of a single blinded, randomized controlled trial of chiropractic compared to physical therapy for balance impairments in community dwelling geriatric patients with or without low back pain

“…Spinal manipulation as a method of restoring normal motion of the lumbar spine and pelvis has been investigated in several studies [21][22][23]. Normal sagittal spinal alignment has been shown to play an important role in the reduction of fall risk [24]. Hawk et al published feasibility clinical trials looking at the effects of chiropractic care on balance, dizziness and chronic pain in the elderly [25,26].…”