Postural Sway in Back Pain Patients

Purpose: Fall risk prediction is an active area of research due to the devastating impact of falls. Millions of Americans are injured by falls every year, with a significant portion suffering serious injuries such as head trauma and hip fractures (Bergen). Studies have demonstrated that postural sway (PS) is a crucial predictor of fall risk and indicator of several disease processes, which has prompted The University of North Texas Health Science Center (UNTHSC) to research the relationship between PS and other variables. Back pain (BP) has been proposed as one of these potential variables due to its prevalence and association with posture and balance. The purpose of our study is to analyze the relationship between BP and PS. Methods: Balance testing was collected as a vital at the UNTHSC Geriatrics and Family Medicine clinics. As part of the collection process, cooperating patients were instructed to stand quietly on a Bertec dual-balance force plate (Bertec, Columbus, Ohio) with their hands by their sides for 2 trials, each lasting 30 seconds and divided into 3 intervals of 10 seconds. In the first trial patients were instructed to open their eyes (eyes open condition), while in the second trial patients were instructed to close their eyes (eyes closed condition). A chart review was then conducted to gather patients with back pain that also had a balance assessment, while a healthy control group was established using data from previous PS collection projects at UNTHSC. The data was processed and analyzed using statistical analysis in Microsoft Excel. Results: The range for the center of pressure in the anterior posterior (COP AP) direction, which measures the movement of the COP AP, was found to be statistically significantly decreased for the BP group versus the control for the eyes open condition. No statistically significant relationships were identified for the eyes closed condition. Conclusion: These results demonstrate that during the eyes open trial BP patients exhibited less PS. We postulate that this is due to factors such as decreased lumbar proprioception and reduced motor control caused by BP, leading patients to depend more on their vision for positional sense. In contrast, the lack of statistical significance for the eyes closed condition may be attributed to the increased difficulty in maintaining balance without visual input, potentially masking the impact of BP on PS. Another consideration is that the BP patients could have been in pain and therefore concentrated more on not moving, which may have been easier during the eyes open condition than the eyes closed condition. Possible limitations of the experiment include the duration of the balance testing, as 30 seconds per trial may not have been enough time to adequately measure each condition, and the grouping of all BP patients into one group without considering the pain characteristics, intensity, and duration. We recommend that additional studies be conducted to address these factors, while considering other relevant confounding variables as well, with the ultimate goal of better understanding and preventing falls.