Effect of Dual-Tasking on Postural Control in Subjects With Nonspecific Low Back Pain Effects of piroxicam-beta-cyclodextrin sachets on abnormal postural sway in patients with chronic low back pain. Effectiveness of fingertip light contact in reducing postural sway in older people. Postural sway in low back pain: Effects of dual tasks. Physical Activity and Postural Control in the Elderly: Coupling between Visual Information and Body Sway The relative timing of trunk muscle activation is retained in response to unanticipated postural-perturbations during acute low back pain Experimental muscle pain changes feedforward postural responses of the trunk muscles Altered postural control in anticipation of postural instability in persons with recurrent low back pain. Effects of Pelvic Asymmetry and Low Back Pain on Trunk Kinematics During Sitting: A Comparison With Standing Sensorimotor integration in human postural control. Impaired postural compensation for respiration in people with recurrent low back pain Control of sway using vibrotactile feedback of body tilt in patients with moderate and severe postural control deficits. The effects of proprioceptive ankle disk training on healthy subjects. Developmental changes in the dynamical structure of postural sway during a precision fitting task The use of a safety harness does not affect body sway during quiet standing. Effectiveness of a lumbopelvic monitor and feedback device to change postural behaviour: a protocol for the ELF cluster randomised controlled trial Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention. Effects of different types of light touch on postural sway Energetic assessment of trunk postural modifications induced by a wearable audio-biofeedback system. Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions Identification of Modifiable Personal Factors That Predict New-onset Low Back Pain: A Prospective Study of Female Nursing Students Lumbar Paraspinal Muscle Function, Perception of Lumbar Position, and Postural Control in Disc Herniation-Related Back Pain Effect of coordination training on proprioception of the functionally unstable ankle.
Study Design . Three factors mixed- design with 1 between-subject and 2 within-subject factors . Objective . To compare the main effects and interactions of postural and cognitive difficulty on quiet stance between subjects with and without nonspecific low back pain ( LBP ) . Summary of Background Data . The interference between postural control and cognitive tasks depends on factors such as sensorimotor/cognitive integrity . Changes in peripheral sensory and muscular systems as well as cognitive processes have been observed in LBP patients . It was hypothesized that the effect of cognitive task on postural performance might be different in subjects with nonspecific LBP as compared with healthy individuals . To the authors ’ knowledge this has not been investigated before . Methods . Postural stability was measured by center of pressure parameters while nonspecific LBP ( n = 22 ) and healthy ( n = 22 ) subjects r and omly performed quiet st and ing task with 3 levels of difficulty ( rigid-surface eyes open , rigid-surface eyes-closed , and foam-surface eyes-closed ) in isolation or concurrently with an easy or difficult digits backward cognitive task . Results . Subjects with nonspecific LBP had less postural sway than healthy subjects , while postural sway decreased with increase in the level of cognitive difficulty . Nonspecific LBP and healthy subjects had larger postural sway at more difficult sensory conditions such as rigid-surface eyes-closed and foam-surface eyes-closed . The response to dual-tasking was not significantly different between the 2 groups . Conclusion . The dual-tasking did not change the postural performance of nonspecific LBP subjects with low level of pain and disability differently compared to healthy subjects BACKGROUND The clinical effects of piroxicam-beta-cyclodextrin ( PBC ) in sachet form have been surveyed in patients with osteoarthritic or acute pain in western countries , but scarcely studied in those with chronic low back pain ( LBP ) , and never investigated in the field of postural sway . The aim of this study was to evaluate the clinical effects of PBC in sachet form prescribed in patients with chronic backache in local Asian when compared with those of plain piroxicam . METHODS After r and omized allocation and experimental exclusion , a total of 42 eligible patients were r and omized into two groups , the sachet group ( n = 23 ) and the piroxicam tablet group ( n = 19 ) . Both groups were administered the same dosage , orally per day ( daily dose = 20 mg ) . The duration of trial was 28 days . Efficacy was assessed with pain score , disability index and postural sway . RESULTS The patients in sachet group showed greater improvement in pain score and disability index than those who took piroxicam tablets . There were significantly lower sway velocity and intensity at almost all different conditions than baseline profiles in both groups ( P < 0.05 ) . However , there was no significant difference of sway velocity and intensity in the piroxicam tablets group with regard to eyes open or eyes closed in 20 degrees dorsiflexion . CONCLUSIONS Piroxicam-beta-cyclodextrin ( PBC ) sachet may have greater improvement in the treatment of chronic LBP and possess the extended effects on postural abnormality relevant to chronic LBP BACKGROUND AND OBJECTIVE haptic cues from fingertip light touch ( LT ) with a stationary surface reduce postural sway even at non-mechanically supportive force levels . Aim of this study was to determine the effects of LT on postural sway in older compared with younger persons . SUBJECTS twenty young ( age 20 - 29 , mean 23.9 + 2.5 ) and 20 older participants ( age 65 - 83 , mean 74.3 + 6.4 ) . METHODS subjects stood in the semi-t and em position on a firm surface , and their postural sway was quantified using a force platform . Experimental trials , r and omised across subjects , included two sight conditions ( vision and no vision ) and three contact conditions ( no touch , NT ; light touch , LT ; and force touch , FT ) . The measured parameters were the length and the area of centre of pressure sway ( COP-L and COP-A ) and the mean velocity of COP displacements in the anterior-posterior ( COP-AP ) and medial-lateral ( COP-ML ) direction . RESULTS for all variables , the analysis showed significant differences between contact conditions , sight conditions and age . Contact-age interaction was significant between NT and LT conditions , with older participants showing greater decrease in postural sway than younger participants , but not between FT and LT conditions . CONCLUSIONS results indicate that the effectiveness of LT in reducing postural sway may be greater in older than in younger persons , perhaps because in older persons haptic cues from upper extremity might counterbalance sub- clinical sensory loss in the lower extremities . This finding supports the hypothesis that older people may sometimes use a walking aid as an informative device and suggests that during balance training external aids should not be used Recurrence quantification analysis ( RQA ) , a nonlinear method of postural analysis , was used to explore the effects of dual-tasking on postural performance in people with nonspecific low back pain ( LBP ) compared with healthy participants .  Postural performance was quantified by RQA % recurrence , % determinism , entropy and trend .  People with nonspecific LBP ( n=22 ) and unimpaired individuals ( n=22 ) r and omly performed quiet st and ing tasks with three levels of difficulty ( rigid-surface eyes open , rigid-surface eyes closed and foam-surface eyes closed ) . These tasks were performed in isolation or concurrently with an easy or difficult cognitive task . Increasing postural difficulty was associated with higher % determinism , higher entropy and lower trend in anteroposterior ( AP ) and mediolateral ( ML ) directions in people with LBP and healthy participants .  All RQA variables in the ML direction decreased as cognitive conditions became more difficult . Significant interactions between group and cognitive difficulty were shown for % recurrence , % determinism and trend in the AP direction . While healthy participants decreased % recurrence and trend by increasing the level of cognitive difficulty , the LBP patients did not . This preliminary study suggests that LBP may be one factor that modulates the posture-cognition interaction Background : Aging is characterized by a decline in the postural control performance , which is based on a coherent and stable coupling between sensory information and motor action . Therefore , changes in postural control in elderlies can be related to changes in this coupling . In addition , it has been observed that physical activity seems to improve postural control performance in elderlies . These improvements can be due to changes in the coupling between sensory information and motor action related to postural control . Objective : The purpose of this study was to verify the coupling between visual information and body sway in active and sedentary elderlies . Methods : Sixteen sedentary elderlies ( SE ) , 16 active elderlies ( AE ) and 16 young adults ( YA ) were asked to st and upright inside a moving room in two experimental conditions : ( 1 ) discrete movement and ( 2 ) continuous movement of the room . Results : In the continuous condition , the results showed that the coupling between the movement of the room and body sway was stronger and more stable for SE and AE compared to YA . In the discrete condition , SE showed larger body displacement compared to AE and YA . Conclusions : SE have more difficulty to discriminate and to integrate sensory information than AE and YA indicating that physical activity may improve sensory integration The purpose of this study was to assess the activation of the erector spinae ( ES ) and external oblique ( EO ) in response to unanticipated , bi-directional postural perturbations before and after the induction of acute low back pain ( LBP ) in healthy individuals . An experimental session consisted of a baseline , control , and an acute LBP condition . For the control and acute LBP condition , isotonic or hypertonic saline ( HS ) , respectively , was injected into the right ES muscle . In each condition , participants stood on a moveable platform during which 32 r and omized postural perturbations ( 8 repetitions of 4 perturbation types : 8 cm anterior slides , 8 cm posterior slides , 10 ° anterior tilts , and 10 ° posterior tilts ) with varying inter-perturbation time intervals were performed over a period of 4–5 min . Bilateral surface electromyography ( EMG ) was recorded from the ES and EO in addition to subjective pain records . During the acute LBP condition : ( 1 ) the onset time of the ES and EO was delayed for the forward and backward sliding perturbations ( P < 0.05 ) ; ( 2 ) EMG amplitude was reduced bilaterally for all perturbations ( P < 0.05 ) ; ( 3 ) the order of activation and interval between the onset times of the ES and EO were unaltered and ( 4 ) ES , but not EO , activity was adjusted to account for the directional differences between the perturbations . This study revealed that re-establishment of posture and balance was a result of the individuals ’ ability to rapidly modulate ES with respect to EO activity and that the bi-directional postural responses , although shifted in time and amplitude , retained temporal features in the presence of acute LBP Many studies have identified changes in trunk muscle recruitment in clinical low back pain ( LBP ) . However , due to the heterogeneity of the LBP population these changes have been variable and it has been impossible to identify a cause-effect relationship . Several studies have identified a consistent change in the feedforward postural response of transversus abdominis ( TrA ) , the deepest abdominal muscle , in association with arm movements in chronic LBP . This study aim ed to determine whether the feedforward recruitment of the trunk muscles in a postural task could be altered by acute experimentally induced LBP .  Electromyographic ( EMG ) recordings of the abdominal and paraspinal muscles were made during arm movements in a control trial , following the injection of isotonic ( non-painful ) and hypertonic ( painful ) saline into the longissimus muscle at L4 , and during a 1-h follow-up . Movements included rapid arm flexion in response to a light and repetitive arm flexion-extension . Temporal and spatial EMG parameters were measured . The onset and amplitude of EMG of most muscles was changed in a variable manner during the period of experimentally induced pain . However , across movement trials and subjects the activation of TrA was consistently reduced in amplitude or delayed . Analyses in the time and frequency domain were used to confirm these findings . The results suggest that acute experimentally induced pain may affect feedforward postural activity of the trunk muscles . Although the response was variable , pain produced differential changes in the motor control of the trunk muscles , with consistent impairment of TrA activity 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 st and ing 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 Study Design . A prospect i ve study was conducted on a group of patients with unilateral nonspecific low back pain ( LBP ) and healthy controls . Objectives . To answer 3 questions : ( 1 ) Does pelvic asymmetry measured in st and ing affect the dynamics of motion performed in sitting ? ( 2 ) Do patients with LBP perform trunk motions differently from non-LBP participants in sitting position ? and ( 3 ) Do the kinematics of lateral flexion and axial rotation differ between sitting and st and ing positions ? Summary of Background Data . The effect of pelvic asymmetry on trunk motion while sitting remains unclear . LBP has been associated with altered trunk kinematics in st and ing ; however , there is limited information available describing trunk kinematics in sitting position in comparison to st and ing . Methods . Pelvic asymmetry was measured in 54 patients with unilateral nonspecific LBP and 59 control subjects .  A motion- analysis system was used to test the  range and symmetry of lateral flexion and axial rotation  in sitting and st and ing positions . Bivariate correlations , regression , multivariate analysis of variance , and paired sample t tests were used to test for associations between variables and differences between groups . Results . We found significant : ( 1 ) correlations between pelvic asymmetry and asymmetric trunk motion performed in sitting , ( 2 ) differences between the LBP and control groups in patterns of trunk motion performed in a sitting posture , and ( 3 ) differences between kinematics of motions performed in sitting versus st and ing postures . Conclusions . This study shows a link between pelvic asymmetry and altered trunk motion in sitting position . We suggest that people with LBP may have a distinct compensatory mechanism , secondary to pelvic asymmetry , which puts the lumbar spine under higher stress . Movement asymmetry , rather than range of motion , may be a better indicator of disturbed function for people with LBP . Structural and functional asymmetries are factors that may be considered in the seating design and work environment It is generally accepted that human bipedal upright stance is achieved by feedback mechanisms that generate an appropriate corrective torque based on body-sway motion detected primarily by visual , vestibular , and proprioceptive sensory systems . Because orientation information from the various senses is not always available ( eyes closed ) or accurate ( compliant support surface ) , the postural control system must somehow adjust to maintain stance in a wide variety of environmental conditions . This is the sensorimotor integration problem that we investigated by evoking anterior-posterior ( AP ) body sway using pseudor and om rotation of the visual surround and /or support surface ( amplitudes 0.5 - 8 degrees ) in both normal subjects and subjects with severe bilateral vestibular loss ( VL ) .  AP rotation of body center-of-mass ( COM )  was measured in response to six conditions offering different combinations of available sensory information .  Stimulus-response data were analyzed using spectral analysis to compute transfer functions and coherence functions over a frequency range from 0.017 to 2.23 Hz . Stimulus-response data were quite linear for any given condition and amplitude . However , overall behavior in normal subjects was nonlinear because gain decreased and phase functions sometimes changed with increasing stimulus amplitude . " Sensory channel reweighting " could account for this nonlinear behavior with subjects showing increasing reliance on vestibular cues as stimulus amplitudes increased . VL subjects could not perform this reweighting , and their stimulus-response behavior remained quite linear . Transfer function curve fits based on a simple feedback control model provided estimates of postural stiffness , damping , and feedback time delay . There were only small changes in these parameters with increasing visual stimulus amplitude . However , stiffness increased as much as 60 % with increasing support surface amplitude . To maintain postural stability and avoid resonant behavior , an increase in stiffness should be accompanied by a corresponding increase in damping . Increased damping was achieved primarily by decreasing the apparent time delay of feedback control rather than by changing the damping coefficient ( i.e. , corrective torque related to body-sway velocity ) . In normal subjects , stiffness and damping were highly correlated with body mass and moment of inertia , with stiffness always about 1/3 larger than necessary to resist the destabilizing torque due to gravity . The stiffness parameter in some VL subjects was larger compared with normal subjects , suggesting that they may use increased stiffness to help compensate for their loss . Overall results show that the simple act of st and ing quietly depends on a remarkably complex sensorimotor control system This study evaluated the degree to which the disturbance to posture from respiration is compensated for in healthy normals and whether this is different in people with recurrent low back pain ( LBP ) , and to compare the changes when respiratory dem and is increased . Angular displacement of the lumbar spine and hips , and motion of the centre of pressure ( COP ) , were recorded with high resolution and respiratory phase was recorded from ribcage motion . With subjects st and ing in a relaxed posture , recordings were made during quiet breathing , while breathing with increased dead-space to induce hypercapnoea , and while subjects voluntarily increased their respiration to match ribcage expansion that was induced in the hypercapnoea condition . The relationship between respiration and the movement parameters was measured from the coherence between breathing and COP and angular motion at the frequency of respiration , and from averages triggered from the respiratory data . Small angular changes in the lumbopelvic and hip angles were evident at the frequency of respiration in both groups . However , in quiet st and ing , the LBP subjects had a greater displacement of their COP that was associated with respiration than the control subjects . The LBP group had a trend for less hip motion . There were no changes in the movement parameters when respiratory dem and increased involuntarily via hypercapnoea , but when respiration increased voluntarily , the amplitude of motion and the displacement of the COP increased in both groups . The present data suggest that the postural compensation to respiration counteracts at least part of the disturbance to posture caused by respiration and that this compensation may be less effective in people with LBP We evaluated the effect of the vibrotactile display of body tilt upon the postural stability of vestibulopathic subjects during st and ing . Two groups were studied : those with moderate and with severe deficits as defined by postural stability test scores . They were studied under conditions of distorted sensory input , and during anterior-posterior perturbations .  Seventeen subjects , with uni- or bilateral vestibular deficits , as determined by electronystagmography and vertical axis rotation , were tested using  Equitest computerized dynamic posturography ( CDP ) . Based on their performance on the CDP they were divided into two groups having either moderate ( nine subjects ) or severe ( eight subjects ) postural control deficits . Their anterior-posterior ( A/P ) body motion at the waist was measured with a micromechanical rate gyroscope and a linear accelerometer . The result ing tilt estimate was displayed by a vibrotactile array attached to the torso . The vibration served as a tilt feedback to the subject . The subject 's performance was evaluated using the root-mean-square ( RMS ) of both the A/P body motion and center-of-pressure ( CoP ) estimates . Sensory distortions were introduced using the Equitest Sensory Organization Tests ( SOT ) . These tests are design ed to distort A/P sensory inputs while st and ing . The SOT 5 distorts proprioceptive information about ankle joint movement , while the subject st and s eyes-closed on a moving support platform that measures foot pressure . The SOT 6 adds distorted visual information about body movement instead of testing with eyes closed . Perturbations were introduced using the Equitest Motor Control Tests ( MCT ) . These move the support platform forward or backward with small , medium and large displacements in the horizontal plane while measuring subjects ' foot pressure responses . We used the medium and large backward tests . Vibrotactile display of body tilt reduced the subjects ' A/P sway and improved their balance . The finding was more evident for those subjects with severe deficits than those moderate ones . This trend was found for both SOT 5 and 6 , as well as the medium and large MCT . Additionally , during the MCT , the peak deflection and mean recovery time also decreased significantly According to research , proprioceptive training enables injured subjects to reduce proprioceptive deficits and increase postural control . However , the effects of proprioceptive training have not been research ed in healthy subjects . This study investigated the effects of Biomechanical Ankle Platform System ( BAPS ) training on postural sway of healthy subjects ( N = 28 ) . Subjects were pretested and posttested using the Kistler force platform while performing a single limb stance . The subjects stood on their dominant leg with the opposite hip and knee held in a self-selected position . Subjects trained the dominant leg three times per week for 10 weeks on the BAPS . Experimental subjects showed significant improvements in both the medial-lateral and anterior-posterior parameters of postural sway when compared with a control group . In conclusion , 10 weeks of proprioceptive ankle disk training  significantly decreased postural sway in both the medial-lateral and anterior-posterior directions Recent research using measures to assess the time-dependent structure of postural fluctuations has provided new insights into the stability and adaptability of human postural control in adults . To date , little research has examined how postural dynamics reflecting the stability and adaptability of postural control may change as a function of development , especially during supra-postural tasks . The goal of this study was to examine the dynamics of postural fluctuations during a manual-fitting task in which precision , visual and postural task constraints were altered in children and adults . Three age groups were tested : 7- , 10-year olds and college aged adults .  Recurrence quantification analysis ( RQA ) was used to assess the regularity ( percent determinism ) and complexity ( entropy ) of the center of pressure ( CoP ) in the anterior – posterior ( AP ) and medial-lateral ( ML ) directions . The CoP patterns exhibited by adults were more deterministic and more complex ( higher entropy ) than those of the 7-year-old children under the different experimental manipulations . No differences between the adults and the 10-year-old children were observed . The increase in determinism with a corresponding increase in entropy exhibited by the adults and older-children during a manual fitting task may be a prospect i ve mechanism over which postural movements follow a more predictable path allowing for stable and flexible task performance . Our results also support the notion that complex postural fluctuations ( as measured by RQA entropy ) are functional and typically increase as the precision requirements of a manual task increase BACKGROUND Postural sway during quiet st and ing reduces when somatosensorial information is provided by an active or passive " light touch " of different body parts with a surface . The contact of the safety harness with the body could induce a similar effect , leading to an undesirable side effect in the balance evaluation . METHODS This study investigated if a safety harness system , commonly used in balance studies , affects body sway during the balance evaluation . Healthy adults stood as quietly as possible for 60s in a comfortable position on a force plate . First , we performed an experiment on the light-touch effect with 10 subjects to determine the necessary sample size for the main investigation . Then , 60 subjects completed four tasks where the use of the safety harness and the visual information were manipulated . Area , root-mean square , speed , and frequency of the center of pressure displacement were analyzed . FINDINGS A light touch decreased postural sway on both visual conditions but there was no effect of the use of a safety harness on sway when quietly st and ing , independent of the visual information . Postural sway increased on both somatosensorial conditions when the visual information was not provided . INTERPRETATION This result shows that the safety harness does not interfere with the evaluation what is of major importance to method ological aspects of balance evaluation Introduction Low back pain ( LBP ) is the most common , costly and disabling musculoskeletal disorder worldwide , and is prevalent in healthcare workers . Posture is a modifiable risk factor for LBP shown to reduce the prevalence of LBP . Our feasibility research suggests that postural feedback might help healthcare workers avoid hazardous postures . The Effectiveness of Lumbopelvic Feedback ( ELF ) trial will investigate the extent to which postural monitor and feedback ( PMF ) can reduce exposure to hazardous posture associated with LBP . Methods This is a participant-blinded , r and omised controlled trial with blocked cluster r and om allocation . Participants will include volunteer healthcare workers recruited from aged care institutions and hospitals . A postural monitoring and feedback device will monitor and record lumbopelvic forward bending posture , and provide audio feedback whenever the user sustains a lumbopelvic forward bending posture that exceeds predefined thresholds . The primary outcome measure will be postural behaviour ( exceeding thresholds ) . Secondary outcome measures will be incidence of LBP , participant-reported disability and adherence . Following baseline assessment , we will r and omly assign participants to 1 of 2 intervention arms : a feedback group and a no-feedback control group . We will compare between-group differences of changes in postural behaviour by using a repeated measures mixed-effect model analysis of covariance ( ANCOVA ) at 6 weeks . Postural behaviour baseline scores , work-related psychosocial factors and disability scores will be input as covariates into the statistical models . We will use logistic mixed model analysis and Cox 's proportional hazards for assessing the effect of a PMF on LBP incidence between groups . Discussion Posture is a modifiable risk factor for low back disorders . Findings from the ELF trial will inform the design of future clinical trials assessing the effectiveness of wearable technology on minimising hazardous posture during daily living activities in patients with low back disorders . Trial registration number ACTRN12616000449437 OBJECTIVE To examine the reliability of postural sway assessment in women with lower extremity arthritis and to ascertain the effects of an aquatic exercise intervention program on these measures . DESIGN The reliability of postural sway measures was analyzed by within-subjects ( Subject times Trial ) analysis of variance ( ANOVA ) . The effects of aquatic exercise were analyzed by repeated measures ANOVA using a planned comparison approach with an independent 2 x 2 ( Group times Test ) design . SETTING Testing in a motor control research laboratory ; aquatic exercise in a warm water pool at an area YMCA . PARTICIPANTS Volunteer sample , 24 women with lower extremity arthritis ( rheumatoid [ RA ] n = 11 , osteo [ OA ] n = 13 ) r and omly assigned into an aquatic exercise group  ( n = 14 ) or  control group  ( n = 10 ) . INTERVENTION  Postural sway measures under a two-legged stance test on two separate test days : day 1 , pretest ; day 2 , posttest , administered after a 6-week aquatic exercise program . RESULTS Reliability correlation coefficients for postural sway measures ranged from .64 to .94 for both subject groups . Aquatic exercise subjects significantly reduced lateral sway and total sway area scores ( by 18 % to 30 % ) under both visual conditions after the 6-week intervention . Postural sway scores were significantly higher under the no-vision condition than under the vision condition in each group for both test sessions . Both OA and RA groups had normal sagittal/lateral ratio scores . CONCLUSION Women with lower extremity arthritis can be reliably assessed on postural sway measures on a stable two-legged stance test . Although they had normal sagittal/lateral sway ratio scores ( ie , scores typical for nonarthritic peers ) , vision played an important role in their postural stability for this balance task . Aquatic exercise reduced postural sway in women with lower extremity arthritis , as demonstrated by a two-legged stance test , and this exercise program appears to be a viable treatment for increasing postural stability in this population Abstract . When a st and ing person applies a light finger touch to an external stable object ,  postural sway  is reduced . We tested a hypothesis that two factors related to touch can induce this effect , the presence of a stable reference point and the modulation of contact forces leading to tissue deformation . Force platform signals were analyzed while subjects stood quietly with or without additional light touch to an external object ( contact forces under 1 N ) . The point of touch on the body was manipulated . We also investigated the effects of active touch vs fixation of a finger at a point in external space . The results show that touch to the head or neck can be more effective in reducing body sway than a finger touch . A larger reduction in sway was observed when the finger was fixed in a clip ( the net forces between the clip and the point of its fixation to the st and were under 1 N ) as compared to a free light touch to a pad . The subjects showed a reduction in postural sway while holding a load suspended using a pulley system ; in this situation , contact with the load via the pulley provided modulation of contact forces but not a fixed reference point . This finding emphasizes the importance of such factors as stability of the contact point and modulation of contact forces , as compared to active touch or to an implicit task of stabilizing the kinematic chain . The system of postural stabilization can reduce postural sway , making use of either of two sources of sensory information associated with touch , one related to providing a fixed reference point in space , and the other related to transient force changes at the point of contact related to the sway This paper investigates the trunk postural modifications induced by a wearable device which assesses the trunk sway and provides biofeedback information through sonification of trunk kinematics . The device is based on an inertial wearable sensing unit including three mono-axial accelerometers and three rate gyroscopes embedded and mounted orthogonally . The biofeedback device was tested on nine healthy subjects during quiet stance in different conditions of sensory limitation eyes closed on solid surface , eyes open on foam cushion surface , eyes closed on foam cushion surface . Five trials were performed for each condition ; the order of the trials was r and omized . The results reported in this paper show how subjects reduced their rotational kinetic energy by using the biofeedback information and how this reduction was related to the limitation of sensory information Objective To identify potentially effective complementary approaches for musculoskeletal (MSK)–mental health ( MH ) comorbidity , by synthesis ing evidence on effectiveness , cost-effectiveness and safety from systematic review s ( SRs ) . Design Scoping review of SRs . Methods We search ed literature data bases , registries and reference lists , and contacted key authors and professional organisations to identify SRs of r and omised controlled trials for complementary medicine for MSK or MH . Inclusion criteria were : published after 2004 , study ing adults , in English and scoring > 50 % on Assessing the Method ological Quality of Systematic Review s ( AMSTAR ) ; quality appraisal checklist ) . SRs were synthesis ed to identify research priorities , based on moderate/good quality evidence , sample size and indication of cost-effectiveness and safety . Results We included 84 MSK SRs and 27 MH SRs . Only one focused on MSK – MH comorbidity . Meditative approaches and yoga may improve MH outcomes in MSK population s. Yoga and tai chi had moderate/good evidence for MSK and MH conditions . SRs reported moderate/good quality evidence ( any comparator ) in a moderate/large population for :  low back pain ( LBP )  ( yoga , acupuncture , spinal manipulation/mobilisation , osteopathy ) , osteoarthritis ( OA ) ( acupuncture , tai chi ) , neck pain  ( acupuncture , manipulation/manual therapy ) , myofascial trigger point pain ( acupuncture ) , depression ( mindfulness-based stress reduction ( MBSR ) , meditation , tai chi , relaxation ) , anxiety ( meditation/MBSR , moving meditation , yoga ) , sleep disorders ( meditative/mind – body movement ) and stress/distress ( mindfulness ) . The majority of these complementary approaches had some evidence of safety — only three had evidence of harm . There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP , and manual therapy/manipulation for neck pain , but few SRs review ed cost-effectiveness and many found no data . Conclusions Only one SR studied MSK – MH comorbidity . Research priorities for complementary medicine for both MSK and MH ( LBP , OA , depression , anxiety and sleep problems ) are yoga , mindfulness and tai chi . Despite the large number of SRs and the prevalence of comorbidity , more high- quality , large r and omised controlled trials in comorbid population s are needed Objectives Prevention of occupational low back pain ( LBP ) in nurses is a research priority . Recent research suggests intervening before commencing nursing employment is ideal ; however , identification of modifiable risk factors is required . The objective of this study was to investigate modifiable personal characteristics that predicted new-onset LBP in nursing students . Methods This prospect i ve study was conducted on female nursing students ( n=117 ) without LBP at baseline to predict new-onset LBP ( an episode of significant LBP during the follow-up period ) . At the 12-month follow-up , participants with ( n=31 ) and without new-onset LBP ( n=76 ) were compared across baseline social or lifestyle , psychologic ( distress , back pain beliefs , coping strategies , and catastrophising ) , and physical ( spinal postures and spinal kinematics in functional tasks , leg and back muscle endurance , spinal repositioning error , and cardiovascular fitness ) characteristics . Results Participants response rate at follow-up was excellent ( 91 % ) . After controlling for earlier LBP , age , and BMI , regression analysis showed that modifiable social or lifestyle , psychologic and physical characteristics ( namely , smoking , increased physical activity , higher stress , reduced back muscle endurance , greater posterior pelvic rotation in slump sitting , and more accurate spinal repositioning in sitting ) were significant and independent predictors of new-onset LBP at follow-up . Inclusion of these factors in multivariate logistic regression analysis , with significant new-onset LBP as the outcome , result ed in a substantial model R2 of 0.45 . Discussion Modifiable personal characteristics across multiple domains are associated with new-onset LBP in female nursing students . These findings may have implication s for the development of prevention and management interventions for LBP in nurses Study Design . A follow-up study evaluating postural control , lumbar movement perception , and paraspinal muscle reflexes in disc herniation-related chronic low back pain ( LBP ) before and after discectomy .  Objectives . To assess the effect of discectomy on postural control , lumbar perception , and reflex activation of paraspinal muscles during sudden upper limb loading . Summary of Background Data . Impaired muscle function , postural control , and lumbar proprioception have been observed in LBP . However , they have not been studied in sciatica patients after surgery . Methods . The study included 20 patients selected for an operation for chronic LBP caused by disc herniation and 15 controls without chronic LBP . The paraspinal muscle responses for upper limb loading during unexpected and expected conditions were measured by surface electromyography . The ability to sense lumbar rotation was assessed in a previously vali date d motorized trunk rotation unit in the seated position . The postural control was measured with a vertical force platform . Pain , disability , and depression scores were recorded . Results . Patients had poorer lumbar perception ( P = 0.012 ) and postural control ( P < 0.05 ) than did healthy controls . The postural control remained unchanged , but lumbar perception ( P = 0.054 ) and the lumbar feed-forward control ( P = 0.043 ) improved after the surgery . Conclusions . The results demonstrate impaired lumbar proprioception and postural control in sciatica patients . During short-term follow-up after operative treatment , postural control does not seem to change , but impaired lumbar proprioception and feed-forward control of paraspinal muscles seem to recover Exercises to improve joint proprioception and coordination of the functionally unstable ankle are advocated throughout the literature , yet there is little evidence that these exercise have any effect on proprioception and balance . The purpose of this study was to determine the effects of a 6-week coordination and balance training program on proprioception of subjects with functional ankle instability . Forty-five subjects ( age = 22.53 + /- 3.95 years , height = 172.04 + /- 10.0 cm , weight = 71.72 + /- 15.7 kg ) were r and omly placed into a control ( Group 1 ) , sham ( Group 2 ) , or experimental ( Group 3 ) group . The experimental group trained 3 days per week , 10 minutes each day , performing various balance and proprioception exercises .  Postural sway and active and passive joint position sense were assessed . Analysis of variance for postural sway modified equilibrium score for anterior and posterior sway , as well as medial and lateral sway revealed significant four-way interactions . Tukey post hoc analyses revealed that Group 3 performed significantly better ( p < .05 ) than Group 1 and Group 2 on the posttests . There were no significant differences for joint position sense or postural sway index . Results suggest that balance and coordination training can improve some measures of postural sway . It is still unclear if joint position sense can be improved in the functionally unstable ankle
A previous review concluded that postural sway is increased in patients with low back pain ( LBP ) .
In a minority of studies , a decreased sway was found in LBP patients .
There were no systematic differences between studies finding an effect and those reporting no effect of LBP .
The proportion of studies finding between-group differences did not increase with increased complexity of sensory manipulations .
However , more detailed analysis of the literature shows that postural deficit may be dependent on experimental conditions in which patients with LBP have been assessed .
The research question to be answered in this review was : " Is there any difference in postural sway between subjects with and without LBP across several sensory manipulation conditions ? " .