Stability threshold during seated balancing is sensitive to low back pain and safe to assess

N. Peter Reeves, Victor Giancarlo Sal y Rosas Celi, Ahmed Ramadan, John M. Popovich, Lawrence L. Prokop, Mathew A. Zatkin, Lisa A. DeStefano, Timothy J. Francisco, Jacob J. Rowan, Clark J. Radcliffe, Jongeun Choi, Nathan D. Cowdin, Jacek Cholewicki

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1 Citation (Scopus)


Challenging trunk neuromuscular control maximally using a seated balancing task is useful for unmasking impairments that may go unnoticed with traditional postural sway measures and appears to be safe to assess in healthy individuals. This study investigates whether the stability threshold, reflecting the upper limits in trunk neuromuscular control, is sensitive to pain and disability and is safe to assess in low back pain (LBP) patients. Seventy-nine subjects with non-specific LBP balanced on a robotic seat while rotational stiffness was gradually reduced. The critical rotational stiffness, KCrit, that marked the transition between stable and unstable balance was used to quantify the individual's stability threshold. The effects of current pain, 7-day average pain, and disability on KCrit were assessed, while controlling for age, sex, height, and weight. Adverse events (AEs) recorded at the end of the testing session were used to assess safety. Current pain and 7-day average pain were strongly associated with KCrit (current pain p < 0.001, 7-day pain p = 0.023), reflecting that people experiencing more pain have poorer trunk neuromuscular control. There was no evidence that disability was associated with KCrit, although the limited range in disability scores in subjects may have impacted the analysis. AEs were reported in 13 out of 79 total sessions (AE Severity: 12 mild, 1 moderate; AE Relatedness: 1 possibly, 11 probably, 1 definitely-related to the study). Stability threshold is sensitive to pain and appears safe to assess in people with LBP, suggesting it could be useful for identifying trunk neuromuscular impairments and guiding rehabilitation.

Original languageEnglish
Article number110541
JournalJournal of Biomechanics
Publication statusPublished - 2021 Aug 26

Bibliographical note

Funding Information:
This publication was made possible in part by grant number U19 AT006057 from the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCCIH. VS was supported by Dirección de Gestión de la Investigación at the PUCP through grant DGI-2017-496. The authors wish to thank Dr. Cody Priess for creating the robotic seat used to assess trunk neuromuscular control.

Publisher Copyright:
© 2021

All Science Journal Classification (ASJC) codes

  • Biophysics
  • Rehabilitation
  • Biomedical Engineering
  • Orthopedics and Sports Medicine


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