The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Sensory Organization and Postural Control Strategies During Quiet Standing in People with Acute Low Back Pain: A Case-Control Study

Document Type : RESEARCH PAPER

Authors
Abbas Fatehi Peykani 1
Maryam Saadat 2
Saeideh Monjezi 2
Farshad Molhemi 2
1 Department of physiotherapy, school of rehabilitation sciences, Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran -Student Research Committee, Ahvaz Jundishapur, University of Medical Sciences, Ahvaz, Iran
2 Department of physiotherapy, school of rehabilitation sciences, Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
10.22038/abjs.2025.85252.3885
Abstract
Objectives: This study aimed to compare posturographic measures between acute low back pain patients (LBP) and healthy controls.
Methods: A total of 20 participants with acute LBP were compared with a group of matched, healthy participants. Sensory organization, standing balance, and motor control strategies were assessed with the Neurocom Smart Balance Master posturography platform.
Results: The MANOVA indicated significant between-group differences in equilibrium (F = 5.58, p < 0.001) and strategy scores (F = 3.98, p = 0.006) across the six conditions of the sensory organization test. The equilibrium scores were significantly lower in participants with acute LBP compared to controls in all conditions except conditions 1 and 2 (p < 0.001). Similarly, strategy scores were significantly reduced in the acute LBP group compared to the control group in all conditions except condition 1 (p < 0.05). Visual and vestibular ratios were significantly lower in the acute LBP group than in controls (p < 0.05), whereas no significant difference was observed in somatosensory ratios between the two groups (p = 0.07).
Conclusion: Patients with acute LBP exhibit impaired postural control and altered movement strategies under sensory challenges, highlighting the importance of early assessment and rehabilitation targeting sensorimotor deficits to reduce the risk of recurrence.
        Level of evidence: III
Keywords
Balance
Low back pain
Postural control
Proprioception
Subjects
  1. Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299. doi: 10.21037/atm.2020.02.175.
  2. Wallwork SB, Braithwaite FA, O’Keeffe M, et al. The clinical course of acute, subacute, and persistent low back pain: a systematic review and meta-analysis. CMAJ. 2024;196(2):E29-E46. doi: 10.1503/cmaj.230542.
  3. Casazza BA. Diagnosis and Treatment of Acute Low Back Pain. Am Fam Physician. 2012;85(4):343-350.
  4. Jones GT, Johnson RE, Wiles NJ, et al. Predicting persistent disabling low back pain in general practice: a prospective cohort study. Br J Gen Pract. 2006;56(526):334.
  5. Nieminen LK, Pyysalo LM, Kankaanpää MJ. Prognostic factors for pain chronicity in low back pain: a systematic review. Pain reports. 2021;6(1):e919. doi: 10.1097/PR9.0000000000000919.
  6. Heneweer H, Aufdemkampe G, van Tulder MW, Kiers H, Stappaerts KH, Vanhees L. Psychosocial variables in patients with (sub) acute low back pain: an inception cohort in primary care physical therapy in The Netherlands. Spine (Phila Pa 1976). 2007;32(5):586-592. doi: 10.1097/01.brs.0000256447.72623.56.
  7. Fritz JM, Piva SR. Physical Impairment Index: Reliability, Validity, and Responsiveness in Patients with Acute Low Back Pain. Spine (Phila Pa 1976). 2003;28(11):1189-1194. doi: 10.1097/01.BRS.0000067270.50897.DB.
  8. Lederman E, eds. Neuromuscular rehabilitation in manual and physical therapy. Edinburgh, UK: Churchill Livingstone; 2010.
  9. Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. doi: 10.1097/j.pain.0000000000001939.
  10. Soysal Tomruk M, Tomruk M, Kalemci O. Comparisons of postural control, proprioception, muscle strength, pain, and disability between individuals with acute, subacute, and chronic low back pain. Somatosens Mot Res. 2024;41(1):26-33. doi: 10.1080/08990220.2023.2165057.
  11. Shumway-Cook A, Woollacott MH, eds. Motor control: translating research into clinical practice. Lippincott Williams & Wilkins; 2007.
  12. Chander H, Kodithuwakku Arachchige SNK, Turner AJ, et al. Sensory organization test conditions influence postural strategy rather than footwear or workload. Int J Environ Res Public Health. 2021;18(19):10511. doi: 10.3390/ijerph181910511.
  13. Chiba R, Takakusaki K, Ota J, Yozu A, Haga N. Human upright posture control models based on multisensory inputs; in fast and slow dynamics. Neurosci Res. 2016;104:96-104. doi: 10.1016/j.neures.2015.12.002.
  14. Sohn MK, Lee SS, Song HT. Effects of acute low back pain on postural control. Ann Rehabil Med. 2013;37(1):17-25. doi: 10.5535/arm.2013.37.1.17.
  15. Dickin DC. Obtaining Reliable Performance Measures on the Sensory Organization Test: Altered Testing Sequences in Young Adults. Clin J Sport Med. 2010;20(4):278-285. doi: 10.1097/JSM.0b013e3181e8f8b1.
  16. Leitner C, Mair P, Paul B, et al. Reliability of posturographic measurements in the assessment of impaired sensorimotor function in chronic low back pain. J Electromyogr Kinesiol. 2009;19(3):380-390. doi: 10.1016/j.jelekin.2007.09.007.
  17. Horak FB, Henry SM, Shumway-Cook A. Postural perturbations: new insights for treatment of balance disorders. Physical therapy. 1997;77(5):517-33.
  18. Knox MF, Chipchase LS, Schabrun SM, Romero RJ, Marshall PWM. Anticipatory and compensatory postural adjustments in people with low back pain: a systematic review and meta-analysis. Spine J. 2018;18(10):1934-1949. doi: 10.1016/j.spinee.2018.06.008.
  19. Freddolini M, Strike S, Lee RYW. The role of trunk muscles in sitting balance control in people with low back pain. J Electromyogr Kinesiol. 2014;24(6):947-953. doi: 10.1016/j.jelekin.2014.09.009.
  20. Niri HG, Ghanavati T, Mostafaee N, et al. Oswestry disability index, roland-morris disability questionnaire, and Quebec back pain disability scale: responsiveness and minimal clinically important changes in Iranian people with lumbar disc herniation following physiotherapy. Arch Bone Jt Surg. 2024;12(1):58. doi: 10.22038/ABJS.2023.72246.3366.
  21. Cohen H, Heaton LG, Congdon SL, Jenkins HA. Changes in sensory organization test scores with age. Age Ageing. 1996;25(1):39-44. doi: 10.1093/ageing/25.1.39.
  22. Fong SSM, Tsang WWN, Ng GYF. Altered postural control strategies and sensory organization in children with developmental coordination disorder. Hum Mov Sci. 2012;31(5):1317-1327. doi: 10.1016/j.humov.2011.11.003.
  23. Richardson JT. Eta squared and partial eta squared as measures of effect size in educational research. Educational research review. 2011;6(2):135-47.
  24. Park J, Nguyen VQ, Ho RLM, Coombes SA. The effect of chronic low back pain on postural control during quiet standing: A meta-analysis. Sci Rep. 2023;13(1):7928. doi:10.1038/s41598-023-34692-w.
  25. Seraj MSM, Sarrafzadeh J, Maroufi N, Takamjani IE, 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.
  26. Marcuzzi A, Wrigley PJ, Dean CM, Graham PL, Hush JM. From acute to persistent low back pain: a longitudinal investigation of somatosensory changes using quantitative sensory testing-an exploratory study. Pain Rep. 2018;3(2):e641. doi: 10.1097/PR9.0000000000000641.
  27. Starkweather AR, Ramesh D, Lyon DE, et al. Acute low back pain: Differential somatosensory function and gene expression compared with healthy no-pain controls. Clin J Pain. 2016;32(11):933-939. doi: 10.1097/AJP.0000000000000347.
  28. Boudreau S, Farina D, Kongstad L, et al. The relative timing of trunk muscle activation is retained in response to unanticipated postural perturbations during acute low back pain. Exp Brain Res. 2011;210(2):259-267. doi: 10.1007/s00221-011-2629-8.
  29. Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC. Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res. 2003;151(2):262-271. doi: 10.1007/s00221-003-1457-x.
  30. Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152(3):S90-S98. doi: 10.1016/j.pain.2010.10.020.
  31. Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgrad Med. 2019;131(7):438-444. doi: 10.1080/00325481.2019.1663705.
  32. Van Dieën JH, Reeves NP, Kawchuk G, Van Dillen LR, Hodges PW. Motor control changes in low back pain: divergence in presentations and mechanisms. J Orthop Sport Phys Ther. 2019;49(6):370-379. doi: 10.2519/jospt.2019.7917.
  33. Cholewicki J, Silfies SP, Shah RA, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine (Phila Pa 1976). 2005;30(23):2614-2620. doi: 10.1097/01.brs.0000188273.27463.bc.
  34. Brumagne S, Janssens L, Janssens E, Goddyn L. Altered postural control in anticipation of postural instability in persons with recurrent low back pain. Gait Posture. 2008;28(4):657-662. doi: 10.1016/j.gaitpost.2008.04.015.
  35. Mok NW, Brauer SG, Hodges PW. A hip strategy for balance control in quiet standing is reduced in individuals with low back pain. Spine (Phila Pa 1976). 2004;29(6):E107-E112. doi: 10.1097/01.brs.0000115134.97854.c9.

 

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 14, Issue 4
April 2026
Pages 313-320

  • Receive Date 16 April 2025
  • Revise Date 27 August 2025
  • Accept Date 30 August 2025