Skip to main content

Alterations of static and dynamic balance in patients with lumbar radiculopathy

Abstract

Background

Lumbosacral radiculopathy (LR) is strongly associated with delayed recovery and persistent disability. Chronic LR may lead to somatosensory system impairment, resulting in decline of postural balance.

Purpose

The aim of the study was to investigate static and dynamic postural balance alterations in individuals with LR owing to lumbar disc herniation.

Participants and methods

In this case–control study design, 12 patients presenting with unilateral LR were included, whereas 12 normal individuals were randomly selected for control. Static balance was assessed functionally using Functional Reach Test. Dynamic balance was assessed via Biodex Balance System, where postural stability indices and the dynamic limits of stability were evaluated. Dynamic limits of stability parameters were expressed as direction control and time required to complete the test.

Results

There was significant reduction of mean values of Functional Reach Test in LR group (P<0.0001) when compared with the control. In addition, there was a significant increase of the mean values of overall stability index (P<0.0001) and postural stability indices (P<0.0002) and a significant decrease of the mean values of direction control (P<0.0001) in the LR group.

Conclusion

Patients with chronic LR have shown to have limited functional abilities and decreased postural balance both statically and dynamically when compared with normal individuals.

References

  1. Konstantinou K, Dunn K, Ogollah R, Vogel S, Hay E. Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. BMC Musculoskelet Disord 2015; 16:332.

    PubMed  PubMed Central  Google Scholar 

  2. Kelsey J, White A. Epidemiology of low back pain. Spine 1980; 6:133–142.

    Google Scholar 

  3. Frymoyer J. Back pain and sciatica. N Engl J Med 1988; 318:291–300.

    CAS  PubMed  Google Scholar 

  4. Arts M, Peul W. Timing and minimal access surgery for sciatica: A summary of two randomized trials. Acta Neurochir 2011; 153:967–974.

    PubMed  Google Scholar 

  5. Frymoyer J, Moskowitz R. Spinal degeneration. Pathogenesis and medical management. In: Frymoyer JW, editor. The adult spine: principles and practice. New York, NY: Raven 1991. pp. 611–634.

    Google Scholar 

  6. Kennedy D, Noh M. The role of core stabilization in lumbosacral radiculopathy. Phys Med Rehabil Clin N Am 2011; 22:91–103.

    PubMed  Google Scholar 

  7. Van Boxem K, Cheng J., Patijn J, Kleef V, Lstaster A, Mekhail N, Zundert V. Lumbosacral radicular pain evidence-based medicine. Pain Pract 2010; 10:339–258.

    PubMed  Google Scholar 

  8. Mens J, Chavannes A, Koes B, Lubbers W, Ostelo R, Spinnewijn W, Kolnaar B. NHG standard lumbosacral radicular syndrome. NHG Stand 2009; 4:436–448.

    Google Scholar 

  9. Manchikanti L, Singh V, Falco J, Benyamin M, Hirsch A. Epidemiology of low back pain in adults. Neuromodulation 2014; 17;3–10.

    PubMed  Google Scholar 

  10. Carver S, Kiemel T, Jeka J. Modeling the dynamics of sensory reweighting. Biol Cybern 2006; 95:123–134.

    PubMed  Google Scholar 

  11. Madeleine P, Prietzel H, Svarrer H, Arendt-Nielsen L. Quantitative posturography in altered sensory conditions: a way to assess balance instability in patients with chronic whiplash injury. Arch Phys Med Rehabil 2004; 85:432–438.

    PubMed  Google Scholar 

  12. Mazzocchio R, Scarfo G, Mariottini A, Muzii V, Palma L. Recruitment curve of the soleus H-reflex in chronic back pain and lumbosacral radiculopathy. BMC Musculoskelet Disord 2001; 2:4.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Sipko T, Kuczynski M. The effect of chronic pain intensity on the stability limits in patients with low back pain. J Manipulative Physiol Ther 2013; 36:612–618.

    PubMed  Google Scholar 

  14. Ruhe A, Fejer R, Walker B. Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature. Eur Spine J 2011; 20:358–368.

    PubMed  Google Scholar 

  15. Frost L, Bijman M, Strzalkowski J, Bent R, Brown M. Deficits in foot skin sensation are related to alterations in balance control in chronic low back patients experiencing clinical signs of lumbar nerve root impingement. Gait Posture 2015; 41:923–928.

    PubMed  Google Scholar 

  16. Frost L, Stephen M. Muscle activation timing and balance response in chronic lower back pain patients with associated radiculopathy. Clin Biomech 2016; 32:124–130.

    Google Scholar 

  17. Duncan P, Weiner D, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol 1990; 45:192–197.

    Google Scholar 

  18. Uchiyama M, Demura S, Shin S. Is there a relationship between the functional reach test and flexibility? Adv Phys Educ 2011; 11:11–15.

    Google Scholar 

  19. Joshi R, Rathi M, Palekar S, Sadhale S. Prediction of risk of fall in community-dwelling elderly population-a survey. Int J Pharm Bio Sci 2016; 7:1154–1157.

    CAS  Google Scholar 

  20. Karimi N, Ebrahim I, Kahrizi S, Torkaman G. Evaluation of postural balance using the biodex balance system in subjects with and without low back pain. Pak J Med Sci 2008; 24:372–377.

    Google Scholar 

  21. Cachupe W, Shifflett B, Kahanov L, Wughalter E. Reliability of Biodex Balance System measures. Meas Phys Edu and Exerc Sci. 2001; 5: 97–108.

    Google Scholar 

  22. Schmitz R, Arnold B. Intertester and intratester reliability of a dynamic balance protocol using the Biodex Stability System. J Sport Rehabil 1998; 7:95–102.

    Google Scholar 

  23. Baldwin S, vanArnam T, Ploutz-Snyder L. Reliability of dynamic bilateral postural stability on the Biodex Stability System in older adults. In: MARC Annual Meeting. Mid-atlantic chapter of the American College of Sports Medicine. Indianapolis, USA: Symposium Book; 2003. 44–52.

    Google Scholar 

  24. Pincivero DM, Lephart SM, Henry T. Learning effects and reliability of the Biodex Stability System. J Athl Train 1995; 30:S35.

    Google Scholar 

  25. Aydog ST, Aydog E, Çakci A, Doral MN. Reproducibility of postural stability score in blind athletes. Isokinet Exerc Sci 2004; 12:229–232.

    Google Scholar 

  26. Aydo E, Bal A, Aydo S, Çakci A. Evaluation of dynamic postural balance using the Biodex Stability System in rheumatoid arthritis patients. Clin Rheumatol 2006; 25:462–467.

    Google Scholar 

  27. Testerman C, Griend RV. Evaluation of ankle instability using the Biodex Stability Systems. Foot Ankle Int 1999; 20:317–321.

    CAS  PubMed  Google Scholar 

  28. Hinman M. Factors affecting reliability of the Biodex Balance System: a summary of four studies. J Sport Rehabil 2000; 9:240–252.

    Google Scholar 

  29. Pereira H, Campos T, Santos M, Cardoso J, Garcia M, Cohen M. Influence of knee position on the postural stability index registered by the Biodex Stability System. Gait Posture 2008; 28:668–672.

    PubMed  Google Scholar 

  30. Sherafat S, Salavati M, Ebrahimi Takamjani I, Akhbari B, Mohammadirad S, Mazaheri M, Negahban H. Intrasession and intersession reliability of postural control in participants with and without nonspecific low back pain using the Biodex Balance System. J Manipulative Physiol Ther 2013; 36:111–118.

    PubMed  Google Scholar 

  31. Bisson E, Ewen D, Lajoie Y, Bilodeau M. Effects of ankle and hip muscle fatigue on postural sway and attentional demands during unipedal stance. Gait Posture 2011; 33:83–87.

    PubMed  Google Scholar 

  32. Liu-Ambrose T, Eng J, Khan K, Mallinson A, Carter N, McKay H. The influence of back pain on balance and functional mobility in 65-75-year-old women with osteoporosis. Osteoporos Int 2002; 13:868–873.

    CAS  PubMed  Google Scholar 

  33. Mok N, Brauer S, Hodges P. Hip strategy for balance control in quiet standing is reduced in people with low back pain. Spine 2004; 29:107–112.

    Google Scholar 

  34. Mok N, Brauer S, Hodges P. Failure to use movement in postural strategies leads to increased spinal displacement in low back pain. Spine 2007; 32:537–543.

    Google Scholar 

  35. Henry S, Hitt J, Jones S, Bunn J. Decreased limits of stability in response to postural perturbations in subjects with low back pain. Clin Biomech (Bristol, Avon) 2006; 21:881–892.

    Google Scholar 

  36. Radebold A, Cholewicki J, Polzhofer G, Greene H. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine 2001; 26:724–730.

    CAS  PubMed  Google Scholar 

  37. Brumagne S, Cordo P, Lysens R, Verschueren S, Swinnen S. The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine 2000; 25:989–994.

    CAS  PubMed  Google Scholar 

  38. Claeys K, Brumagne S, Dankaerts W, Kiers H, Janssens L. Decreased variability in postural control strategies in young people with non-specific low back pain is associated with altered proprioceptive reweighting. Eur J Appl Physiol 2011; 111:15–123.

    Google Scholar 

  39. Descarreaux M, Blouin JS, Teasdale N. Repositioning accuracy and movement parameters in low back pain subjects and healthy control subjects. Eur Spine J 2005; 14:185–191.

    PubMed  Google Scholar 

  40. Brumagne S, Cordo P, Verschueren S. Proprioceptive weighting changes in persons with low back pain and elderly persons during upright standing. Neurosci Lett 2004; 366:63–66.

    CAS  PubMed  Google Scholar 

  41. Brumagne S, Janssens L, Janssens E, Goddyn L. Altered postural control in anticipation of postural instability in persons with recurrent low back pain. Gait Posture 2008; 28:657–662.

    PubMed  Google Scholar 

  42. Moseley G, Hodges P. Are the changes in postural control associated with low back pain caused by pain interference? Clin J Pain 2005; 21:323–329.

    PubMed  Google Scholar 

  43. Rossi A, Decchi B, Ginanneschi F. Presynaptic excitability changes of group Iafibres to muscle nociceptive stimulation in humans. Brain Res 1999; 818:12–22.

    CAS  PubMed  Google Scholar 

  44. Rossi S, della Volpe R, Ginanneschi F, Ulivelli M, Bartalini S, Spidalieri R, Rossi A. Early somatosensory processing during tonic muscle pain in humans: relation to loss of proprioception and motor ‘defensive’ strategies. Clin Neurophysiol 2003; 114:1351–1358.

    PubMed  Google Scholar 

  45. Sibley K, Carpenter M, Perry J, Frank J. Effects of postural anxiety on the soleus H-reflex. Hum Mov Sci 2007; 26:103–112.

    PubMed  Google Scholar 

  46. Capra N, Ro J. Experimental muscle pain produces central modulation of proprioceptive signals arising from jaw muscle spindles. Pain 2000; 86:151–162.

    CAS  PubMed  Google Scholar 

  47. Claeys K, Dankaerts W, Janssens L, Brumagne S. Altered preparatory pelvic control during the sit-to-stance-to-sit movement in people with nonspecific low back pain, J Electromyogr Kinesiol 2012; 22:821–828.

    PubMed  Google Scholar 

  48. Cordo P, Gurfinkel V. Motor coordination can be fully understood only by studying complex movements. Prog Brain Res 2004; 143:29–38.

    PubMed  Google Scholar 

  49. Cordo P, Hodges P, Smith T, Brumagne S, Gurfinkel V. Scaling and non-scaling of muscle activity, kinematics, and dynamics in sit-ups with different degrees of difficulty. J Electromyogr Kinesiol 2006; 16:506–521.

    PubMed  Google Scholar 

  50. Shum G, Crosbie J, Lee R. Energy transfer across the lumbosacral and lower-extremity joints in patients with low back pain during sit-to-stand. Arch Phys Med Rehabil 2009; 90:127–135.

    PubMed  Google Scholar 

  51. Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J 2010; 19:435–438.

    PubMed  Google Scholar 

  52. Hamaoui A, Mc Do, Poupard L, Bouisset S. Does respiration perturb body balance more in chronic low back pain subjects than in healthy subjects? Clin Biomech (Bristol, Avon) 2002; 17:548–550.

    CAS  Google Scholar 

  53. Hamaoui A, Do MC, Bouisset S. Postural sway increase in low back pain subjects is not related to reduced spine range of motion. Neurosci Lett 2004; 357:135–138.

    CAS  PubMed  Google Scholar 

  54. Popa T, Bonifazi M, Della Volpe R, Rossi A, Mazzocchio R. Adaptive changes in postural strategy selection in chronic low back pain. Exp Brain Res 2007; 177:411–418.

    PubMed  Google Scholar 

  55. Lund J, Donga R, Widmer C, Stohler C. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 1991; 69:683–694.

    CAS  PubMed  Google Scholar 

  56. Van Dieën H, Selen P, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol 2003; 13:333–351.

    PubMed  Google Scholar 

  57. Hodges W, Moseley L. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol 2003; 13:361–370.

    PubMed  Google Scholar 

  58. Kuai S, Zhou W, Liao Z, Ji R, Guo D, Zhang R, Liu W. Influences of lumbar disc herniation on the kinematics in multi-segmental spine, pelvis, and lower extremities during five activities of daily living. BMC Musculoskelet Disord 2017; 18:216.

    PubMed  PubMed Central  Google Scholar 

  59. Mense S. Muscle pain: mechanisms and clinical significance. Dtsch Arztebl Int 2008; 105:214–219.

    PubMed  PubMed Central  Google Scholar 

  60. Tsao H, Galea P, Hodges P. Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain 2010; 14:832–839.

    PubMed  Google Scholar 

  61. Schmidt-Wilcke T, Leinisch E, Gänssbauer S, Draganski B, Bogdahn U, Altmeppen J, May A. Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients. Pain 2006; 125:89–97.

    CAS  PubMed  Google Scholar 

  62. Apkarian V, Sosa Y, Sonty S, Levy M, Harden N, Parrish B, Gitelman R. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci 2004; 24:10410–10415.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mary K.N. Takla PT, PhD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Takla, M. Alterations of static and dynamic balance in patients with lumbar radiculopathy. Bull Fac Phys Ther 24, 49–55 (2019). https://doi.org/10.4103/bfpt.bfpt_22_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/bfpt.bfpt_22_18

Keywords

  • balance
  • Biodex Balance System
  • lumbosacral radiculopathy