Study Design: A cross-sectional, observational study. Objective: The aim of this study was to determine a specific proprioceptive control strategy during postural balance in elderly patients with non-specific low back pain (NSLBP) and non-LBP (NLBP). Summary of Background Data: Proprioceptive decline is an important risk factor for decreased balance control in elderly patients with NSLBP. The resulting reduction in proprioception in the trunk or lower legs may contribute to a reduction in postural sway. This study aims to determine the specific proprioceptive control strategy used during postural balance in elderly patients with NSLBP and NLBP and to assess whether this strategy is related to proprioceptive decline in NSLBP. Methods: Pressure displacement centers were determined in 28 elderly patients with NSLBP and 46 elderly patients with NLBP during upright stances on a balance board without the benefit of vision. Gastrocnemius and lumbar multifidus muscle vibratory stimulations at 30, 60, and 240 Hz, respectively, were applied to evaluate the relative contributions of the different proprioceptive signals (relative proprioceptive weighting ratio, RPW) used in postural control. Results: Compared to elderly patients with NLBP, those with NSLBP had a lower RPW at 240Hz and significantly higher RPW at 30Hz. A logistic regression analysis showed that RPW at 240 Hz was independently associated with NSLBP after controlling for confounding factors. Conclusion: Elderly patients with NSLBP decreased their reliance on ankle strategy (RPW at 240 Hz) and hip strategy (RPW at 30Hz) proprioceptive signals during balance control. The inability to control hip and ankle strategies indicates a deficit of postural control and is hypothesized to result from proprioceptive impairment. Moreover, elderly patients with NSLBP are at higher risk for lower leg proprioceptive decrease (240 Hz) through the NSLBP exacerbation.
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