Decreased postural control in patients with chronic low back pain

  Chronic low back pain (cLBP) is defined as persistent lumbosacral pain for more than 12 weeks. cLBP affects a broad spectrum of the adult population, with approximately 12C33% of the adult population developing cLBP and approximately 11 to 84% of the lifetime population developing cLBP, in addition to being a common cause of hospital admissions nationally and internationally.  Previous studies have shown that patients with cLBP have deficits in motor control of their deep lumbosacral muscles, characterized by delayed muscle responses to neural efferent signals and altered proprioception of the lumbosacral muscles, which in general can lead to reduced postural control and instability under certain test conditions. Pain can affect motor function in patients with cLBP, delaying or even reducing changes in the center of pressure (COP) in uneven conditions and increasing the oscillation of the coronal and sagittal COP with the eyes closed or in unipedal stance.  The diminished postural control in complex conditions confirms that low back pain (LBP) is associated with reduced information processing of peripheral and central proprioception in patients. There is much debate about the understanding of postural control in patients with cLBP, and the relevant literature has not yet reached a unified conclusion, but cLBP remains a possible risk factor for poor posture.  Some studies have shown that some functions are altered in patients with LBP compared to those without low back pain due to impaired processing of sensory afferent information in order to adapt to reduced postural control; however, Kuukkanen et al. also showed no difference in postural control between patients with and without LBP; the most recent systematic analysis only showed that postural instability was more pronounced in patients with nonspecific low back pain than in healthy controls, and only one paper addressed postural control in young cLBP patients (in this study the duration of LBP was 3.4 years and only posture during stationary standing was assessed in closed-eye, uneven conditions, respectively).  Thus, Rene Rogieri Caffaro et al. of the University of São Paulo School of Medicine assessed differences in postural control during upright standing in young patients with and without non-specific cLBP and published their results in a recent issue of Eur Spine J.