Abstract
Chronic low back pain (CLBP) patients achieve postural stability during challenging stance conditions by increasing sway speed. We investigated the mechanisms underlying this behavior, and whether postural strategy selection may be influenced by short-term experience of postural perturbation. Thirteen CLBP patients and thirteen age-matched controls underwent posturography tests. Subjects were asked to stand quietly: (a) with eyes open and eyes closed, and (b) while expecting a series of four backward translations of the support surface. Data from condition (a) was subjected to sway density analysis (SDA). This computes the number of consecutive spaces and respectively time samples during which center of pressure (COP) displacements remained inside a 2.5 mm radius. Three parameters of this analysis were considered: the mean number of peaks (MP), reflecting the time spent by COP in regions of stability, the mean time between peaks (MT) relating to the rate of production of posturographic commands, and the mean spatial distance (MD), reflecting the distance between stable regions. In condition (b) the mean COP positions were analyzed during the time (500 ms) preceding each translation. The MD was significantly increased in the CLBP group as compared to controls (P < 0.01), while the MP and MT did not present any significant difference. The expectation of backward translations initially produced a different COP positioning between the two groups (P < 0.0001) which decreased with repetition of platform translations (controls: P Δ1-4 < 0.002; patients: P Δ1-4 < 0.005). The findings show that the timing and the rate of the balance motor commands is comparable between the two groups. On the other hand, there is greater distance between regions of stability in the patient group. Such modification of motor control patterns might be the consequence of a reweighting of sensory input, possibly due to a deterioration of its reliability. Platform translation findings show that both groups aimed at optimizing their posture selection strategy based on prior testing experience. CLBP patients make use of a different postural motor strategy to maintain quiet stance. This is probably the consequence of an imprecise internal estimate of body sway, due to reduced accuracy in the sensory integration process.
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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. Motor Control 6:246–270
Bloem BR, van Vugt JP, Beckley DJ (2001) Postural instability and falls in Parkinson’s disease. Adv Neurol 87:209–223
Brown LA, Jensen JL, Korff T, Woollacott MH (2001) The translating platform paradigm: perturbation displacement waveform alters the postural response. Gait Posture 14:256–263
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 25:989–994
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
Carpenter MG, Frank JS, Silcher CP, Peysar GW (2001) The influence of postural threat on the control of upright stance. Exp Brain Res 138:210–218
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
Chong RK, Horak FB, Woollacott MH (1999) Time-dependent influence of sensorimotor set on automatic responses in perturbed stance. Exp Brain Res 124:513–519
Corbeil P, Blouin JS, Teasdale N (2004) Effects of intensity and locus of painful stimulation on postural stability. Pain 108:43–50
Decchi B, Zalaffi A, Spidalieri R, Arrigucci U, Di Troia AM, Rossi A (1997) Spinal reflex pattern to foot nociceptive stimulation in standing humans. Electroencephalogr Clin Neurophysiol 105:484–489
Della Volpe R, Popa T, Ginanneschi F, Spidalieri R, Mazzocchio R, Rossi A (2005) Changes in coordination of postural control during dynamic stance in chronic low back pain patients. Gait Posture (in press)
Dickstein R, Shupert CL, Horak FB (2001) Fingertip touch improves postural stability in patients with peripheral neuropathy. Gait Posture 14:238–247
Diener HC, Dichgans J, Guschlbauer B, Mau H (1984) The significance of proprioception on postural stabilization as assessed by ischemia. Brain Res 296:103–109
Fairbanks J, Couper J, Davies J, O’Brien J (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273
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
Gill KP, Callaghan MJ (1998) The measurement of lumbar proprioception in individuals with and without low back pain. Spine 23:371–377
Horak FB (2001) Postural ataxia related to somatosensory loss. Adv Neurol 87:173–182
Horak FB, Moore SP (1993) The effect of prior leaning on human postural responses. Gait Posture 1:203–210
Horak FB, Nashner LM, Diener HC (1990) Postural strategies associated with somatosensory and vestibular loss. Exp Brain Res 82:167–177
Inglis JT, Horak FB, Shupert CL, Jones-Rycewicz C (1994) The importance of somatosensory information in triggering and scaling automatic postural responses in humans. Exp Brain Res 101:159–164
Jacono M, Casadio M, Morasso PG, Sanguineti V (2004) The sway-density curve and the underlying postural stabilization process. Motor Control 8:292–311
Kiemel T, Oie KS, Jeka JJ (2006) Slow dynamics of postural sway are in the feedback loop. J Neurophysiol 95:1410–1418
Kuczynski M, Ostrowska B (2006) Understanding falls in osteoporosis: the viscoelastic modeling perspective. Gait Posture 23:51–58
Loram ID, Lakie M (2002) Human balancing of an inverted pendulum: position control by small, ballistic-like, throw and catch movements. J Physiol 540:1111–1124
Lynn SG, Sinaki M, Westerlind KC (1997) Balance characteristics of persons with osteoporosis. Arch Phys Med Rehabil 78:273–277
Magnusson M, Enbom H, Johansson R, Wiklund J (1990) Significance of pressor input from the human feet in lateral postural control. The effect of hypothermia on galvanically induced body-sway. Acta Otolaryngol 110:321–327
Maki BE, Whitelaw RS (1993) Influence of expectation and arousal on center-of-pressure responses to transient postural perturbations. J Vestib Res 3:25–39
Maurer C, Peterka RJ (2005) A new interpretation of spontaneous sway measures based on a simple model of human postural control. J Neurophysiol 93:189–200
Maurer C, Mergner T, Peterka RJ (2006) Multisensory control of human upright stance. Exp Brain Res 171:231–250
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
Mergner T, Rosemeier T (1998) Interaction of vestibular, somatosensory and visual signals for postural control and motion perception under terrestrial and microgravity conditions–a conceptual model. Brain Res Brain Res Rev 28:118–135
Mok NW, Brauer SG, Hodges PW (2004) Hip strategy for balance control in quiet standing is reduced in people with low back pain. Spine 29:E107–E112
Morasso PG, Baratto L, Capra R, Spada G (1999) Internal models in the control of posture. Neural Netw 12:1173–1180
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
Moseley GL, Nicholas MK, Hodges PW (2004) Pain differs from non-painful attention-demanding or stressful tasks in its effect on postural control patterns of trunk muscles. Exp Brain Res 156:64–71
Nardone A, Tarantola J, Miscio G, Pisano F, Schenone A, Schieppati M (2000) Loss of large-diameter spindle afferent fibres is not detrimental to the control of body sway during upright stance: evidence from neuropathy. Exp Brain Res 135:155–162
Rossi A, Decchi B (1995) Cutaneous nociceptive facilitation of Ib heteronymous pathways to lower limb motoneurones in humans. Brain Res 700:164–172
Rossi A, Decchi B, Groccia V, Della Volpe R, Spidalieri R (1998) Interactions between nociceptive and non-nociceptive afferent projections to cerebral cortex in humans. Neurosci Lett 248:155–158
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
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
Simoneau M, Richer N, Mercier P, Allard P, Teasdale N (2006) Sensory deprivation and balance control in idiopathic scoliosis adolescent. Exp Brain Res 170:576–582
Thoumie P, Do MC (1996) Changes in motor activity and biomechanics during balance recovery following cutaneous and muscular deafferentation. Exp Brain Res 110:289–297
Wijnberg N, Quinn NP, Bloe BR (2001) Posture in Parkinson patients: a proprioceptive problem? In: Duysens J, Smits-Engelsman BCM, Kingma H (eds) Control of posture and gait. Symposium of the International Society for Postural and Gait Research, Maastricht, pp 758–762
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Popa, T., Bonifazi, M., Della Volpe, R. et al. Adaptive changes in postural strategy selection in chronic low back pain. Exp Brain Res 177, 411–418 (2007). https://doi.org/10.1007/s00221-006-0683-4
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DOI: https://doi.org/10.1007/s00221-006-0683-4