Center of pressure trajectories, trunk kinematics and trunk muscle activation during unstable sitting in low back pain patients

Trunk motor behavior has been reported to be altered in low-back pain. This may be associated with impaired lumbar proprioception, which could be compensated by trunk stiffening. We assessed trunk control by measuring center-of-pressure, lumbar kinematics and trunk muscle electromyography in 20 low-back pain patients and 11 healthy individuals during a seated balancing task, in conditions with and without disturbance of lumbar proprioception and occlusion of vision. We hypothesized that low-back pain patients show larger postural sway, but smaller thoraco-lumbar movements than healthy individuals. Repeated measures analyses of variance indicated that the effects of proprioception disturbance and vision occlusion were similar between groups. Interestingly, low-back pain patients grabbed the safety rail more often, while differences between groups in sway measures were rather subtle. This suggests that low-back pain patients were more cautious. Furthermore, low-back pain patients had an about 20 degrees less flexed lumbar posture than healthy individuals, and, in contrast to our hypothesis, made larger thoraco-lumbar movements in the sagittal plane, as indicated by higher SDs of thoraco-lumbar flexion and lower (more negative) correlations between pelvis and thorax movements. Activation of the intersegmental longissimus relative to the iliocostalis muscle, which spans all lumbar segments, was lower in low-back pain patients compared to healthy individuals. This difference in muscle activation may be causal for larger thoraco-lumbar movements, and may be causative of reduced control over segmental lumbar movement, but may also reflect the need for larger corrective movements to compensate balance impairments. (C) 2013 Elsevier B.V. All rights reserved.