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Proprioceptive Weighting Ratio for Balance Control in Static Standing Is Reduced in Elderly Patients With Non–Specific Low Back Pain

Ito, Tadashi PT, PhD∗,†,‡; Sakai, Yoshihito MD, PhD; Morita, Yoshifumi PhD§; Yamazaki, Kazunori PhD; Igarashi, Kazuma MS§; Nishio, Reiya BS§; Sato, Noritaka PhD§

doi: 10.1097/BRS.0000000000002817

MINI Elderly patients older than 65 years were divided into non-specific low back pain (NSLBP) and non-LBP (NLBP) groups. The postural control study of the relative contributions of different proprioceptive signals (relative proprioceptive weighting ratio [RPW]) revealed lower leg proprioceptive decreases (RPW 240 Hz) in NSLBP compared to NLBP.

Study Design. A cross-sectional, observational study.

Objective. The aim of this study was to determine a specific proprioceptive control strategy during postural balance in elderly patients with non-specific low back pain (NSLBP) and non-LBP (NLBP).

Summary of Background Data. Proprioceptive decline is an important risk factor for decreased balance control in elderly patients with NSLBP. The resulting reduction in proprioception in the trunk or lower legs may contribute to a reduction in postural sway. This study aims to determine the specific proprioceptive control strategy used during postural balance in elderly patients with NSLBP and NLBP and to assess whether this strategy is related to proprioceptive decline in NSLBP.

Methods. Pressure displacement centers were determined in 28 elderly patients with NSLBP and 46 elderly patients with NLBP during upright stances on a balance board without the benefit of vision. Gastrocnemius and lumbar multifidus muscle vibratory stimulations at 30, 60, and 240 Hz, respectively, were applied to evaluate the relative contributions of the different proprioceptive signals (relative proprioceptive weighting ratio, RPW) used in postural control.

Results. Compared to elderly patients with NLBP, those with NSLBP had a lower RPW at 240 Hz and significantly higher RPW at 30 Hz. A logistic regression analysis showed that RPW at 240 Hz was independently associated with NSLBP after controlling for confounding factors.

Conclusion. Elderly patients with NSLBP decreased their reliance on ankle strategy (RPW at 240 Hz) and hip strategy (RPW at 30 Hz) proprioceptive signals during balance control. The inability to control hip and ankle strategies indicates a deficit of postural control and is hypothesized to result from proprioceptive impairment. Moreover, elderly patients with NSLBP are at higher risk for lower leg proprioceptive decrease (240 Hz) through the NSLBP exacerbation.

Level of Evidence: 4

Three-Dimensional Motion Analysis Room, Aichi prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan

Nagoya City University School of Design & Architecture, Nagoya, Japan

Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan

§Department of Computer Science and Engineering, Graduate School of Engineering, Nagoya Institute of Technology, Nagoya, Japan

Faculty of Clinical Engineering, School of Health Sciences, Fujita Health University, Toyoake, Japan.

Address correspondence and reprint requests to Tadashi Ito, PT, PhD, Three-dimensional motion analysis room, Aichi prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan, 9-3 Koyaba Kouryuji cho, 444-0002; E-mail:

Received 26 March, 2018

Revised 28 April, 2018

Accepted 4 May, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Geriatrics and Gerontology research and development cost grant funds were received in support of this work.

No relevant financial activities outside the submitted work.

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