The Effect of Inspiratory Muscles Fatigue on Postural Control in People With and Without Recurrent Low Back Pain (original) (raw)
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Persons with recurrent low back pain exhibit a rigid postural control strategy
European Spine Journal, 2008
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.
World Academy of Science, Engineering and Technology, International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering, 2010
The study of the variability of the postural strategies in low back pain patients, as a criterion in evaluation of the adaptability of this system to the environmental demands is the purpose of this study. A cross-sectional case-control study was performed on 21 recurrent non-specific low back pain patients and 21 healthy volunteers. The electromyography activity of Deltoid, External Oblique (EO), Transverse Abdominis/Internal Oblique (TrA/IO) and Erector Spine (ES) muscles of each person was recorded in 75 rapid arm flexion with maximum acceleration. Standard deviation of trunk muscles onset relative to deltoid muscle onset were statistically analyzed by MANOVA . The results show that chronic low back pain patients exhibit less variability in their anticipatory postural adjustments (APAs) in comparison with the control group. There is a decrease in variability of postural control system of recurrent non-specific low back pain patients that can result in the persistence of pain and ...
Gait & Posture, 2008
Insight into the mechanisms of altered postural control in persons with low back pain (LBP) could lead to better interventions for patients with LBP. This study investigated (1) whether persons with recurrent LBP have an altered body inclination, and (2) whether anticipation of postural instability further alters body inclination. Thirty-three young healthy individuals and 56 young persons with recurrent LBP participated in this study. The upright standing posture was evaluated by means of two piezo-resistive electrogoniometers and a force platform for the conditions as follows: (1) quiet stance with and without vision, and (2) in anticipation of postural instability due to a ballistic arm movement or ankle muscle vibration. No differences in body inclination were observed when visual information was available between the two groups (P > 0.05). However, significant more forward inclination was seen in the persons with recurrent LBP when vision was occluded (+7.4%) and in anticipation of postural instability (+19%) (P < 0.05) compared to the healthy individuals. The results suggest that young persons with recurrent LBP have an altered body inclination that might be caused by anticipation of postural instability. The adopted forward inclined posture may potentially be a factor in the recurrence of LBP. #
European Spine Journal, 2011
Back muscle fatigue decreases the postural stability during quiet standing, but it is not known whether this fatigue-induced postural instability is due to an altered proprioceptive postural control strategy. Therefore, the aim of the study was to evaluate if acute back muscle fatigue may be a mechanism to induce or sustain a suboptimal proprioceptive postural control strategy in people with and without recurrent low back pain (LBP). Postural sway was evaluated on a force platform in 16 healthy subjects and 16 individuals with recurrent LBP during a control (Condition 1) and a back muscle fatigue condition (Condition 2). Back muscle fatigue was induced by performing a modified Biering-Sørensen test. Ankle and back muscle vibration, a potent stimulus for muscle spindles, was used to differentiate proprioceptive postural control strategies during standing on a stable and unstable support surface, where the latter was achieved by placing a foam pad under the feet. Ankle signals were predominantly used for postural control in all subjects although, in each condition, their influence was greater in people with LBP compared to healthy subjects (p \ 0.001). The latter group adapted their postural control strategy when standing on an unstable surface so that input from back muscles increased (p \ 0.001). However, such adaptation was not observed when the back muscles were fatigued. Furthermore, people with LBP continued to rely strongly on ankle proprioception regardless of the testing conditions. In conclusion, these findings suggest that impaired back muscle function, as a result of acute muscle fatigue or pain, may lead to an inability to adapt postural control strategies to the prevailing conditions.
The Spine Journal, 2014
BACKGROUND: People with low back pain (LBP) exhibit impaired anticipatory postural adjustments (APAs). OBJECTIVE: To evaluate whether current motor retraining treatments address LBP-associated changes in movement coordination during tasks that do and do not require APAs. DESIGN: Prospectively registered randomized controlled trial with a blinded assessor. SETTING: Outcome evaluations occurred in a university laboratory; treatments were carried out in outpatient physical therapy clinics. PATIENTS: Fifteen subjects without LBP and 33 subjects with chronic, recurrent, and nonspecific LBP. INTERVENTION: Twelve subjects with LBP received stabilization treatment, 21 received movement system impairment-based treatment, for more than 6 weekly 1-hour sessions plus home exercises. MEASUREMENTS: Pre-and post-treatment, surface electromyography (EMG) was recorded bilaterally from trunk and leg muscles during unsupported and supported leg-lifting tasks, which did and did not require an APA, respectively. Vertical reaction forces under the contralateral leg were recorded to characterize the APA. Oswestry disability scores and numeric pain ratings were also recorded. RESULTS: Persons with LBP demonstrated an impaired APA compared with persons without LBP, characterized by increased premovement contralateral force application and increased postmovement trunk EMG amplitude, regardless of the task. After treatments, both groups similarly improved in disability and function; however, APA characteristics did not change (ie, force application or EMG amplitude) in either task. LIMITATIONS: Treating clinicians were not blinded to treatment allocation, only short-term outcomes were assessed, and main effects of treatment do not rule out nonspecific effects of time or repeated exposure.
Adaptive changes in postural strategy selection in chronic low back pain
Experimental Brain Research, 2007
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.
Effect of lower-extremity muscle fatigue on postural control
Archives of Physical Medicine and Rehabilitation, 2004
Objective: To examine the effects of fatigue of the lower extremity on postural control during single-leg stance. Design: Pretest-posttest. Setting: University research laboratory. Participants: Fourteen healthy volunteers (age, 21Ϯ2y) with no history of lower-extremity injury or neurologic deficits. Interventions: Testing consisted of isokinetically fatiguing the sagittal plane movers of the ankle, knee, or hip with measures of static postural control. Postural control was assessed with three 30-second trials during unilateral stance with eyes open. Main Outcome Measure: Center of pressure excursion velocity (COPV) in the frontal and sagittal planes. Results: Fatigue at the knee and hip led to postural control impairment in the frontal plane, whereas fatigue at the ankle did not. In the sagittal plane, fatigue at all 3 joints contributed to postural control impairment. Conclusions: Our results suggest that there is an effect of localized fatigue of the sagittal plane movers of the lower extremity on COPV. It appears that fatigue about the hip and knee had a greater adverse affect on COPV.