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Context: Chronic low-back pain (CLBP) may be associated with changes in postural balance in athletes as poor postural control during sports practice. Objective: To compare the postural control of athletes with and without CLBP during 2 one-legged stance tasks and identify the center of pressure (COP) cutoff values to determine the main differences. Designed: A cross-sectional study. Setting: Laboratory of functional evaluation and human motor performance. Participants: A total of 56 male athletes, 28 with and 28 without CLBP (mean age = 26 y). Intervention: The one-legged stance with knee extension and with the knee at 30° flexion tasks were measured and analyzed on a force platform. The participants completed three 30-second trials (30 s of rest between each trial). Main Outcome Measures: The COP parameters: the area of COP, mean COP sway velocity in both the anteroposterior and mediolateral directions, and total COP displacement were computed, and a receiver operating characteristics curve analysis was applied to determine the group differences. Results: Athletes with CLBP had poorer postural control (P < .01) in both tasks. The 30° knee flexion reported more postural instability than the knee extension for all COP parameters (a large effect size d = 0.80).The knee extension cutoffs identified were >7.1 cm2 for the COP area, >2.6 cm/s for the COP sway velocity in the anterior-posterior direction, and >3.2 cm/s for the mediolateral direction. Whereas, the 30° knee flexion cutoffs were >10.9 cm2 for the COP area, >2.9 cm/s for the COP sway velocity in the anterior-posterior direction, and >4.1 cm/s for the mediolateral direction. Both measures showed enough sensitivity and specificity (ie, area under the curve = 0.88 in and 0.80, respectively) to discriminate both groups. Conclusions: The athletes with CLBP had poorer postural control than the healthy athletes and obtained specific cutoff scores from the COP values.

Nowotny, Calderon, Oliveira, Andraus, Aguiar, and da Silva are with the Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Londrina-PR, Brazil. Amorim and da Silva are with the Département des Sciences de la Santé, Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi Saguenay, Chicoutimi, QC, Canada. da Silva is also with the Département des Sciences de la Santé, Clinique Universitaire de physiothérapie (CUpht), Centre intersectoriel en santé durable, UQAC, Lab BioNR, CUpht, UQAC, Université du Québec à Chicoutimi, Saguenay, Québec, Canada. Alves and Amorim are with the Department of Physical Therapy, University of the City of São Paulo, UNICID, São Paulo, Brazil. Alves is also with the Paris Saint Germain Department of Physical Therapy and Biomechanics, Paris, France. Amorim is with the Department of Physical Therapy—Human Performance Laboratory at the College of Nursing & Health Sciences, Florida International University, Miami, FL, USA. Leonard is with the School of Rehabilitation, Faculty of Medicine and Health Sciences, Research Center on Aging, Institute of Geriatrics, Université de Sherbrooke, Sherbrooke, QC, Canada.

da Silva (rubens.dasilva@uqac.ca) is corresponding author.
  • 1.

    Trompter K, Fett D, Platen P. Prevalence of back pain in sports: a systematic review of the literature. Sports Med. 2017;47(6):11831207.

  • 2.

    Mortazavi J, Zebardast J, Mirzashahi B. Low back pain in athletes. Asian J Sports Med. 2015;6(2):e24718. PubMed ID: 26448841 doi:

  • 3.

    Oyarzo CA, Villagrán C, Silvestre RE, Carpintero P, Berral FJ. Postural control and low pain in elite athletes comparison of static balance in elite athletes with and without low back pain. J Back Musculoeskelet Rehabil. 2014;27(2):141146. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Caffaro RR, França FJR, Burke TN, Magalhães MO, Ramos LAV, Marques AP. Postural control in individuals with and without non-specific chronic low back pain: a preliminary case–control study. Eur Spine J. 2014;23(4):807813. PubMed ID: 24570125 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2006;15(5):668676. doi:

  • 6.

    Correia JP, Oliveira R, Vaz JR, Silva L, Pezarat-Correia P. Trunk muscle activation, fatigue and low back pain in tennis players. J Sci Med Sport. 2016;19(4):311316. PubMed ID: 25987492 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Granata KP, Gottipati P. Fatigue influences the dynamic stability of the torso. Ergonomics. 2008;51(8):12581271. PubMed ID: 18608477 doi:

  • 8.

    Reeves NP, Cholewicki J, Dieën JH, Kawchuk G, Hodges PW. Are stability and instability relevant concepts for back pain? J Orthop Sports Phys Ther. 2019;49(6): 415424. PubMed ID: 31021689 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Hrysomallis C. Balance ability and athletic performance. Sports Med. 2011;41(3): 221232. PubMed ID: 21395364 doi:

  • 10.

    Renkawitz T, Boluki D, Grifka J. The association of low back pain, neuromuscular imbalance, and trunk extension strength in athletes. Spine J. 2006;6(6):673683. PubMed ID: 17088198 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Kiers H, Van Dieen J, Dekkers H, Wittink H, Vanhees L. A systematic review of the relationship between physical activities in sports or daily life and postural sway in upright stance. Sports Med. 2013;43(11):11711189. PubMed ID: 23955562 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Mazaheri M, Coenen P, Parnianpour M, Kiers H, Dieën JH. Low back pain and postural sway during quiet standing with and without sensory manipulation: a systematic review. Gait Posture. 2013;37(1):1222. PubMed ID: 22796243 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ruhe AR, 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): 358368. PubMed ID: 20721676 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Matsuda S, Demura S, Uchiyama M. Centre of pressure sway characteristics during static one-legged stance of athletes from different sports. J Sports Sci. 2008;26(7):775779. PubMed ID: 18409108 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    da Silva RA, Vieira ER, Fernandes KBP, et al. People with chronic low back pain have poorer balance than controls in challenging tasks. Disabil Rehabil. 2018;40(11):12941300. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    da Silva RA, Vieira ER, Carvalho CE, Oliveira MR, Amorim CF, Neto EN. Age-related differences on low back pain and postural control during one-leg stance: a case-control study. Eur Spine J. 2016;25(4): 12511257. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Van Daele UF, 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): 12331238. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Willigenburg NW, Kingmaa I, Hoozemansab MJM, van Dieën JH. Precision control of trunk movement in low back pain patients. Hum Mov Sci. 2013;32(1):228239. PubMed ID: 23427936 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Berenshteyn Y, Gibson K, Hackett GC, Trem AB, Wilhelm M. Is standing balance altered in individuals with chronic low back pain? A systematic review. Disabil Rehab. 2019;41(13):15141523. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    da Silva RA, Vieira ER, Léonard G, et al. Age-and low back pain-related differences in trunk muscle activation during one-legged stance balance task. Gait Posture. 2019;69:2530. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    van Dieën JH, Selen LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol. 2003;13(4): 333351. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    da Silva RA, Vieira ER, Cabrera M, et al. Back muscle fatigue of younger and older adults with and without chronic low back pain using two protocols: a case-control study. J Electromyogr Kinesiol. 2015;25(6): 928936. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Brumagne S, Cordo P, Verschueren S. Proprioceptive weighting changes in persons with low back pain and elderly persons during upright standing. Neurosci Lett. 2004;366(1): 6366. PubMed ID: 15265591 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Appiah-Dwomoh EK, Müller S, Mayer F. Reproducibility of static and dynamic postural control measurement in adolescent athletes with back pain. Rehabil Res Pract. 2018;2018:18.

    • Search Google Scholar
    • Export Citation
  • 25.

    Hammami R, Behm D, Chtara M, Othman AB, Chaouach A. Comparison of static balance and the role of vision in elite athletes. J Hum Kinet. 2014;41(1):3341. doi:

  • 26.

    Paillard, T, Noe F, Riviere T, Marion V, Montoya R, Dupui P. Postural performance and strategy in the unipedal stance of soccer players at different levels of competition. J Athl Train. 2006;41(2):172176.

    • Search Google Scholar
    • Export Citation
  • 27.

    Shirabe NA, da Silva RA, Oliveira MR, et al. Taekwondo athletes have better postural control than Handball and American Football athletes. Revista Brasileira de Medicina do Esporte. 2017;23(6)473476. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Kim HY, Kim KJ, Yang DS, Jeung SW, Choi HG, Choi WS. Screw-home movement of the tibiofemoral joint during normal gait: three-dimensional analysis. Clin Orthop Surg. 2015;7(3):303309. PubMed ID: 26330951 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Pereira HM, Nowotny AH, Santos AB, Cardoso JR. Electromyographic activity of knee stabilizer muscles during six different balance board stimuli after anterior cruciate ligament surgery. Electromyogr Clin Neurophysiol. 2009;49(2–3);117124. PubMed ID: 19400407

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA. Nonsurgical or surgical treatment of ACL injuries: knee function, sports participation, and knee reinjury. The Delaware-Oslo ACL Cohort Study. J Bone Joint Surg Am. 2014;96(15):12331241. PubMed ID: 25100769 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Davlin CD. Dynamic balance in high level athletes. Percept Mot Skills. 2004; 98(3):11711176. PubMed ID: 15291203 doi:

  • 32.

    Nowotny AH, Calderon MG, de Souza PA, et al. Lumbar stabilization exercises versus back endurance-resistance exercise training in athletes with chronic low back pain: protocol of a randomized controlled trial. BMJ Open Sport Exerc Med. 2018;4(1):e000452. PubMed ID: 30555717 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Cohen J. Chapter 11: Some issues in power analysis. In: Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988:531537.

    • Search Google Scholar
    • Export Citation
  • 34.

    Hosmer Jr DW, Lemeshow S, Sturdivant RX. Special topics: Exact methods for logistic regression models, Chapter 10 (10.3). In: Applied Logistic Regression. 3rd ed. Hoboken, NJ: John Willey & Sons; 2013:387394.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Borujeni BG, Yalfani A. Reduction of postural sway in athletes with chronic low back pain through eight weeks of inspiratory muscle training: a randomized controlled trial. Clin Biomech. 2019;69:215220. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Mueller S, Mueller J, Stoll J, Cassel M, Hirschmüller A, Mayer F. Back pain in adolescent athletes: results of a biomechanical screening. Sports Med Int Open. 2017;1(1):E16E22. PubMed ID: 30539081 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Radebold A, Cholewicki J, Polzhofer GK, Greene HS. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine. 2001;26(7): 724730. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Mok NW, Brauer SG, Hodges PW. Failure to use movement in postural strategies leads to increased spinal displacement in low back pain. Spine. 2007;32(19): E537E543. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Catalá MM, Schroll A, Laube G, Arampatzis A. Muscle strength and neuromuscular control in low-back pain: elite athletes versus general population. Front Neurosci. 2018;12:436. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Abdelraouf OR, Abdel-Aziem AA. The relationship between core endurance and back dysfunction in collegiate male athletes with and without nosspecific low back pain. Int J Sports Phys Ther. 2016;11(3):337344. PubMed ID: 27274419

    • Search Google Scholar
    • Export Citation
  • 41.

    Grosdent S, Demoulin C, Rodriguez de La Cruz C, et al. Lumbopelvic motor control and low back pain in elite soccer players: a cross-sectional study. J Sports Sci. 2016;34(11):10211029. PubMed ID: 26407007 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Shenoy S, Balachander H, Sandhu JS. Long latency reflex response of superficial trunk musculature in athletes with chronic low back pain. J Back Musculoskelet Rehabil. 2013;26(4):445450. PubMed ID: 23948831 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Sung W, Abraham M, Plastaras C, Silfies SP. Trunk motor control deficits in acute and subacute low-back pain are not associated with pain or fear of movement. Spine J. 2015;15(8):17721782. PubMed ID: 25862508 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Crombez G, Vervaet L, Lysens R, Baeyens F, Eelen P. Avoidance and confrontation of painful, back-straining movements in chronic back pain patients. Behav Modif. 1998;22(1):6277. PubMed ID: 9567737 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Pereira HM, de Campos TF, Santos MB, Cardoso JR, Garcia Mde C, Cohen M. Influence of knee position on the postural stability index registered by the biodex stability system. Gait Posture. 2008;28(4):668672. PubMed ID: 18573663 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Alonso AC, Mochizuki L, Luna NM, et al. Men and women do not have the same relation between body composition and postural sway. J Morphol Sci. 2015;32(02):9397. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Luoto BM, Aalto H, Taimela S, Hurri H, Pyykkö I, Alaranta H. One footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy control subjects. Spine. 1998;23(19):20812089. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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