Postural adjustments impairments in elderly people with chronic low back pain

Abstract

Chronic low back pain (CLBP) is associated with postural control impairments and is highly prevalent in elderly people. The objective of this study is to verify whether anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) are affected by CLBP in elderly people by assessing their postural control during a self-initiated perturbation paradigm induced by rapid upper arm movement when pointing to a target. The participants’ lower limb muscle onset and center of pressure (COP) displacements were assessed prior to perturbation and throughout the entire movement. T0 moment (i.e., the beginning of the movement) was defined as the anterior deltoid (DEL) onset, and all parameters were calculated with respect to it. The rectus femoris (RT), semitendinosus (ST), and soleous (SOL) showed delayed onset in the CLBP group compared with the control group: RF (control: − 0.094 ± 0.017 s; CLBP: − 0.026 ± 0.012 s, t = 12, p < 0.0001); ST (control: − 0.093 ± 0.013 s; CLBP: − 0.018 ± 0.019 s, t = 12, p < 0.0001); and SOL (control: − 0.086 ± 0.018 s; CLBP: − 0.029 ± 0.015 s, t = 8.98, p < 0.0001). In addition, COP displacement was delayed in the CLBP group (control: − 0.035 ± 0.021 s; CLBP: − 0.015 ± 0.009 s, t = 3; p = 0.003) and presented a smaller amplitude during APA COPAPA [control: 0.444 cm (0.187; 0.648); CLBP: 0.228 cm (0.096; 0.310), U = 53, p = 0.012]. The CLBP group required a longer time to reach the maximum displacement after the perturbation (control: 0.211 ± 0.047 s; CLBP 0.296 ± 0.078 s, t = 3.582, p = 0.0013). This indicates that CLBP elderly patients have impairments to recover their postural control and less efficient anticipatory adjustments during the compensatory phase. Our results suggest that people with CLBP have altered feedforward hip and ankle muscle control, as shown from the SOL, ST, and RT muscle onset. This study is the first study in the field of aging that investigates the postural adjustments of an elderly population with CLBP. Clinical assessment of this population should consider postural stability as part of a rehabilitation program.

A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open‐access code*

“…Static balance is controlled in a complex way by different sensory (visual, vestibular, proprioceptive, and tactile) and neuromotor systems (involving both sensory integration and movement planning to cortical control of standing and spinal reflex action resulting in changes in joint stiffness and damping; Goodman & Tremblay, 2021;Kang et al, 2013;Winter et al, 1998). Older people show altered motor strategies compared to young and healthy people, either for balance maintenance tasks or postural anticipation in the face of destabilization (Garcez et al, 2021;Woollacott & Manchester, 1993). But, in addition to the difficulty of studying the interactions between these systems and their actions in posture maintenance, there is a lack of interpretability of the COP variables (Palmieri et al, 2002), which is enhanced by the diversity of methods for calculating them.…”

Comparative Study of Anticipatory Postural Adjustments between Normal and Cervical Myelopathy Patients

“…Moreover, recent studies reported impaired or altered APAs in musculoskeletal diseases. Garcez et al [12] reported that elderly patients who had chronic low back pain demonstrated impaired postural control and less efficient APAs. Takeuchi et al [13] reported impaired APAs in patients with hip osteoarthritis.…”

“…Therefore, inadequate initial physical reaction due to impaired APAs may lead to falls. To date, impaired and altered APAs were reported in the elderly population and in those with Parkinson's disease, stroke, and chronic low back pain [7][8][9][10][11][12][13][14]. To the best of our knowledge, there are no reports that investigated APAs in cervical myelopathy patients.…”

Assessing fall risk in osteoporosis patients: a comparative study of age-matched fallers and nonfallers

“…Therefore, investigating the postural sway and physical activity levels of osteoporosis faller and nonfaller groups is necessary to indicate who is more prone to fall and mitigate the risk of bone fracture. Moreover, age/gender-matched comparison of faller and non-faller in osteoporosis patients is essential because it minimizes age-related confounds, such as muscle, bone density, vestibular, and vision deterioration, where these aspects significantly differ among the various ages and dictates the capability of postural stability ( 14 ). The objective of this study is to analyze the disparities between fallers and non-fallers age/gender-matched osteoporosis patient's postural stability, and physical activity levels, and to elucidate how the fall status leads to a decrease in both the postural stability and physical activity levels.…”