Immediate Effects of Lumbosacral Orthosis on Postural Stability in Patients with Low Back Pain: A Preliminary Study

Document Type : RESEARCH PAPER


1 Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

2 Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

3 Department of Mechanical Engineering, Sharif University of technology, Tehran, Iran

4 Biomechanics Laboratory, Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran


Background: Lumbosacral orthosis (LSO) is commonly used for the treatment of back pain. The clinical and
mechanical effectiveness of this device has been repeatedly investigated in several studies; however, its sensorimotor
effectiveness has been rarely considered. Regarding this, the aim of the current study was to investigate the effect of
a non-extensible LSO on postural stability (as a construct of sensorimotor function) in patients with nonspecific chronic
low back pain (LBP).
Methods: This preliminary study was conducted on 17 patients with nonspecific chronic LBP using a single-group
quasi-experimental design. Postural stability was measured while the participants were placed in a quiet standing
position, under the combined conditions of base of support (rigid and foam surface), visual input (open eyes and closed
eyes), and LSO (with and without orthosis).
Results: The findings demonstrated that wearing orthosis during the most challenging postural task (i.e., blindfolded
while standing on a foam surface) significantly reduced postural sway parameters related to the position and
displacement of the center of pressure (COP; the sway area and sway amplitude in the anteroposterior direction;
P<0.001). However, the use of this device had no significant effect on COP velocity.
Conclusion: As the findings of the present study indicated, the use of a non-extensible LSO decreased the COP
displacement; however, it did not affect the COP velocity. Therefore, our data could not utterly support the effectiveness
of non-extensible LSO on postural stability as a construct of sensorimotor function. Postural control is an appropriate
indicator for assessing the global functioning of the sensorimotor system due to its dependence upon the interaction
between the neural and musculoskeletal systems. Consequently, further studies are needed to elucidate the positive
effects of LSO on the aspects of sensorimotor function.
Level of evidence: III


Main Subjects

1. Jellema P, van Tulder MW, van Poppel MN, Nachemson
AL, Bouter LM. Lumbar supports for prevention and
treatment of low back pain: a systematic review
within the framework of the Cochrane Back Review
Group. Spine. 2001; 26(4):377-86.
2. Morrisette DC, Cholewicki J, Patenge WF, Logan S, Seif
G, McGowan S. A randomized clinical trial comparing
extensible and inextensible lumbosacral orthoses and
standard care alone in the management of lower back
pain. Spine. 2014; 39(21):1733-42.
3. Calmels P, Queneau P, Hamonet C, Le Pen C, Maurel F,
Lerouvreur C, et al. Effectiveness of a lumbar belt in
subacute low back pain: an open, multicentric, and
randomized clinical study. Spine. 2009; 34(3):215-20.
4. Azadinia F, Ebrahimi-Takamjani I, Kamyab M,
Parnianpour M, Asgari M. Comparing lumbosacral
orthosis to routine physical therapy on postural
stability in patients with chronic low back pain:
A randomized trial. Med J Islam Repub Iran. 2017;
5. van Poppel MN, de Looze MP, Koes BW, Smid T, Bouter
LM. Mechanisms of action of lumbar supports: a
systematic review. Spine. 2000; 25(16):2103-13.
6. Newcomer K, Laskowski ER, Yu B, Johnson JC, An
KN. The effects of a lumbar support on repositioning
error in subjects with low back pain. Arch Phys Med
Rehabil. 2001; 82(7):906-10.
7. Cholewicki J, Reeves NP, Everding VQ, Morrisette DC.
Lumbosacral orthoses reduce trunk muscle activity in
a postural control task. J Biomech. 2007; 40(8):1731-6.
8. Cholewicki J, McGill KC, Shah KR, Lee AS. The effects
of a three-week use of lumbosacral orthoses on
trunk muscle activity and on the muscular response
to trunk perturbations. BMC Musculoskelet Disord.
2010; 11(1):154.
9. Oleske DM, Lavender SA, Andersson GB, Kwasny MM.
Are back supports plus education more effective than
education alone in promoting recovery from low back
pain?: Results from a randomized clinical trial. Spine.
2007; 32(19):2050-7.
10. van Poppel MN, Koes BW, van der Ploeg T, Smid T,
Bouter LM. Lumbar supports and education for the
prevention of low back pain in industry: a randomized
controlled trial. JAMA. 1998; 279(22):1789-94.
11. Azadinia F, Ebrahimi Takamjani E, Kamyab M,
Parnianpour M, Cholewicki J, Maroufi N. Can
lumbosacral orthoses cause trunk muscle weakness?
A systematic review of literature. Spine J. 2016;
12. Leitner C, Mair P, Paul B, Wick F, Mittermaier C, Sycha
T, et al. Reliability of posturographic measurements in
the assessment of impaired sensorimotor function in
chronic low back pain. J Electromyogr Kinesiol. 2009;
13. Schelldorfer S, Ernst MJ, Rast FM, Bauer CM, Meichtry
A, Kool J. Low back pain and postural control, effects
of task difficulty on centre of pressure and spinal kinematics. Gait Posture. 2015; 41(1):112-8.
14. Yahia A, Jribi S, Ghroubi S, Elleuch M, Baklouti S,
Elleuch MH. Evaluation of the posture and muscular
strength of the trunk and inferior members of
patients with chronic lumbar pain. Joint Bone Spine.
2011; 78(3):291-7.
15. 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(3):358-68.
16. Karimi N, Ebrahimi 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(3):372-7.
17. Shahabazi Seraj Moheb S, Sarrafzadeh J, Maroufi
N, Ebrahimi Takamjani I, Ahmadi A, Negahban H.
Comparison of postural balance between subgroups
of nonspecific low-back pain patients based on
o’sullivan classification system and normal subjects
during lifting. Arch Bone Jt Surg. 2019; 7(1):52-60
18. Mok NW, Brauer SG, Hodges PW. Changes in lumbar
movement in people with low back pain are related
to compromised balance. Spine. 2011; 36(1):E45-52.
19. Mok NW, Brauer SG, Hodges PW. Failure to use
movement in postural strategies leads to increased
spinal displacement in low back pain. Spine. 2007;
20. Mok NW, Brauer SG, Hodges PW. Postural recovery
following voluntary arm movement is impaired in
people with chronic low back pain. Gait Posture.
2011; 34(1):97-102.
21. Brumagne S, Janssens L, Knapen S, Claeys K, Suuden-
Johanson E. Persons with recurrent low back pain
exhibit a rigid postural control strategy. Eur Spine J.
2008; 17(9):1177-84.
22. Jones SL, Henry SM, Raasch CC, Hitt JR, Bunn JY.
Individuals with non-specific low back pain use a
trunk stiffening strategy to maintain upright posture.
J Electromyogr Kinesiol. 2012; 22(1):13-20.
23. Van Daele U, Hagman F, Truijen S, Vorlat P, Van
Gheluwe B, Vaes P. Differences in balance strategies
between nonspecific chronic low back pain patients
and healthy control subjects during unstable sitting.
Spine. 2009; 34(11):1233-8.
24. O’Sullivan PB, Burnett A, Floyd AN, Gadsdon K,
Logiudice J, Miller D, et al. Lumbar repositioning
deficit in a specific low back pain population. Spine.
2003; 28(10):1074-9.
25. Reeves NP, Everding VQ, Cholewicki J, Morrisette
DC. The effects of trunk stiffness on postural control
during unstable seated balance. Exp Brain Res. 2006;
26. Cholewicki J, Lee AS, Reeves NP, Morrisette DC.
Comparison of trunk stiffness provided by different
design characteristics of lumbosacral orthoses. Clin
Biomech. 2010; 25(2):110-4.
27. Mazaheri M, Coenen P, Parnianpour M, Kiers H,
van Dieën JH. Low back pain and postural sway
during quiet standing with and without sensory
manipulation: a systematic review. Gait Posture.
2013; 37(1):12-22.
28. Munoz F, Rouboa AI, Rougier PR. The balance control
effects on sitting posture induced by lumbosacral
orthosis wear vary depending on the level of stability.
Appl Ergon. 2013; 44(4):511-6.
29. Munoz F, Salmochi JF, Faouen P, Rougier P. Low back
pain sufferers: is standing postural balance facilitated
by a lordotic lumbar brace? Orthop Traumatol Surg
Res. 2010; 96(4):362-6.
30. Mok NW, Brauer SG, Hodges PW. Hip strategy for
balance control in quiet standing is reduced in people
with low back pain. Spine. 2004; 29(6):E107-12.
31. Corbeil P, Blouin JS, Teasdale N. Effects of intensity
and locus of painful stimulation on postural stability.
Pain. 2004; 108(1):43-50.
32. Reeves NP, Narendra KS, Cholewicki J. Spine stability:
the six blind men and the elephant. Clin Biomech.
2007; 22(3):266-74.
33. Cenciarini M, Loughlin PJ, Sparto PJ, Redfern MS.
Stiffness and damping in postural control increase
with age. IEEE Trans Biomed Eng. 2010; 57(2):267-75.
34. Hodges P, van den Hoorn W, Dawson A, Cholewicki J.
Changes in the mechanical properties of the trunk in
low back pain may be associated with recurrence. J
Biomech. 2009; 42(1):61-6.
35. Salavati M, Hadian MR, Mazaheri M, Negahban H,
Ebrahimi I, Talebian S, et al. Test–retest reliabty of
center of pressure measures of postural stability
during quiet standing in a group with musculoskeletal
disorders consisting of low back pain, anterior cruciate
ligament injury and functional ankle instability. Gait
Posture. 2009; 29(3):460-4.