The Amount and Temporal Structure of Center of Pressure Fluctuations During Quiet Standing in Patients With Chronic Low Back Pain

in Motor Control
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The characteristics of postural sway were assessed in quiet standing under three different postural task conditions in 14 patients with nonspecific chronic low back pain and 12 healthy subjects using linear and nonlinear center of pressure parameters. The linear parameters consisted of area, the mean total velocity, sway amplitude, the SD of velocity, and the phase plane portrait. The nonlinear parameters included the Lyapunov exponent, sample entropy, and the correlation dimension. The results showed that the amount of postural sway was higher in the patients with low back pain compared with the healthy subjects. Assessing the nonlinear parameters of the center of pressure showed a lower sample entropy and a higher correlation dimension in the patients with low back pain compared with the healthy subjects. The results of this study demonstrate the greater regularity and higher dimensionality of the center of pressure fluctuations in patients with nonspecific chronic low back pain, which suggests that these patients adopt different postural control strategies to maintain an upright stance.

Azadinia and Kamyab are with the Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. Ebrahimi-Takamjani is with the Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. Asgari is with the Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran. Parnianpour is with Biomechanics Laboratory, Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.

Ebrahimi-Takamjani (ebrahimi.pt@gmail.com) is corresponding author.
  • Baszczyk, J.W., & Klonowski, W. (2001). Postural stability and fractal dynamics. Acta Neurobiologiae Experimentalis, 61, 105–112.

  • Byl, N.N., & Sinnott, P. (1991). Variations in balance and body sway in middle-aged adults: Subjects with healthy backs compared with subjects with low-back dysfunction. Spine, 16(3), 325–330. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carpenter, M., Murnaghan, C., & Inglis, J. (2010). Shifting the balance: Evidence of an exploratory role for postural sway. Neuroscience, 171(1), 196–204. PubMed ID: 20800663 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cavanaugh, J.T., Guskiewicz, K.M., Giuliani, C., Marshall, S., Mercer, V., & Stergiou, N. (2005). Detecting altered postural control after cerebral concussion in athletes with normal postural stability. British Journal of Sports Medicine, 39(11), 805–811. PubMed ID: 16244188 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cavanaugh, J.T., Mercer, V.S., & Stergiou, N. (2007). Approximate entropy detects the effect of a secondary cognitive task on postural control in healthy young adults: A methodological report. Journal of Neuroengineering and Rehabilitation, 4(1), 42. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cignetti, F., Kyvelidou, A., Harbourne, R.T., & Stergiou, N. (2011). Anterior-posterior and medial-lateral control of sway in infants during sitting acquisition does not become adult-like. Gait & Posture, 33(1), 88–92. PubMed ID: 21050764 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Claeys, K., Brumagne, S., Dankaerts, W., Kiers, H., & Janssens, L. (2011). Decreased variability in postural control strategies in young people with non-specific low back pain is associated with altered proprioceptive reweighting. European Journal of Applied Physiology, 111(1), 115–123. PubMed ID: 20824281 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Collins, J.J., & De Luca, C.J. (1993). Open-loop and closed-loop control of posture: A random-walk analysis of center-of-pressure trajectories. Experimental Brain Research, 95(2), 308–318. PubMed ID: 8224055 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Corbeil, P., Blouin, J.S., & Teasdale, N. (2004). Effects of intensity and locus of painful stimulation on postural stability. Pain, 108(1), 43–50. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Davids, K., Kingsbury, D., George, K., O’Connell, M., & Stock, D. (1999). Interacting constraints and the emergence of postural behavior in ACL-deficient subjects. Journal of Motor Behavior, 31(4), 358–366. PubMed ID: 11177643 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Deffeyes, J.E., Harbourne, R.T., Kyvelidou, A., Stuberg, W.A., & Stergiou, N. (2009). Nonlinear analysis of sitting postural sway indicates developmental delay in infants. Clinical Biomechanics, 24(7), 564–570. PubMed ID: 19493596 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Della Volpe, R., Popa, T., Ginanneschi, F., Spidalieri, R., Mazzocchio, R., & Rossi, A. (2006). Changes in coordination of postural control during dynamic stance in chronic low back pain patients. Gait & Posture, 24(3), 349–355. PubMed ID: 16311036 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Donker, S.F., Roerdink, M., Greven, A.J., & Beek, P.J. (2007). Regularity of center-of-pressure trajectories depends on the amount of attention invested in postural control. Experimental Brain Research, 181(1), 1–11. PubMed ID: 17401553 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Duarte, M., & Zatsiorsky, V.M. (2000). On the fractal properties of natural human standing. Neuroscience Letters, 283(3), 173–176. PubMed ID: 10754215 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Era, P., Sainio, P., Koskinen, S., Haavisto, P., Vaara, M., & Aromaa, A. (2006). Postural balance in a random sample of 7, 979 subjects aged 30 years and over. Gerontology, 52(4), 204–213. PubMed ID: 16849863 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Freburger, J.K., Holmes, G.M., Agans, R.P., Jackman, A.M., Darter, J.D., Wallace, A.S., . . . Carey, T.S. (2009). The rising prevalence of chronic low back pain. Archives of Internal Medicine, 169(3), 251–258. PubMed ID: 19204216 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Grassberger, P., & Procaccia, I. (1983). Characterization of strange attractors. Physical Review Letters, 50(5), 346–349. doi:

  • Guskiewicz, K.M., & Perrin, D.H. (1996). Research and clinical applications of assessing balance. Journal of Sport Rehabilitation, 5(1), 45–63. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hamaoui, A., Do, M.C., & Bouisset, S. (2004). Postural sway increase in low back pain subjects is not related to reduced spine range of motion. Neuroscience Letters, 357(2), 135–138. PubMed ID: 15036593 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Harbourne, R.T., & Stergiou, N. (2003). Nonlinear analysis of the development of sitting postural control. Developmental Psychobiology, 42(4), 368–377. PubMed ID: 12672087 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Harringe, M., Halvorsen, K., Renström, P., & Werner, S. (2008). Postural control measured as the center of pressure excursion in young female gymnasts with low back pain or lower extremity injury. Gait & Posture, 28(1), 38–45. PubMed ID: 18023584 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hodges, P.W., & Tucker, K. (2011). Moving differently in pain: A new theory to explain the adaptation to pain. Pain, 152(Suppl. 3), S90–S98. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Horak, F., Nutt, J., & Nashner, L. (1992). Postural inflexibility in parkinsonian subjects. Journal of the Neurological Sciences, 111(1), 46–58. PubMed ID: 1402997 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Huisinga, J.M., Yentes, J.M., Filipi, M.L., & Stergiou, N. (2012). Postural control strategy during standing is altered in patients with multiple sclerosis. Neuroscience Letters, 524(2), 124–128. PubMed ID: 22824302 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jafari, H., Ebrahimi, I., Salavati, M., Kamali, M., & Fata, L. (2010). Psychometric properties of Iranian version of Tampa Scale for Kinesiophobia in low back pain patients. Journal of Rehabilitation, 11(1), 15–22.

    • Search Google Scholar
    • Export Citation
  • Johanson, E., Brumagne, S., Janssens, L., Pijnenburg, M., Claeys, K., & Pääsuke, M. (2011). The effect of acute back muscle fatigue on postural control strategy in people with and without recurrent low back pain. European Spine Journal, 20(12), 2152–2159. PubMed ID: 21533851 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kantz, H., & Schreiber, T. (2004). Nonlinear Time Series Analysis (2nd ed). New York: Cambridge University Press.

  • Karimi, N., Ebrahimi, I., Kahrizi, S., & Torkaman, G. (2008). Evaluation of postural balance using the biodex balance system in subjects with and without low back pain. Pakistan Journal of Medical Sciences, 24(3), 372–377.

    • Search Google Scholar
    • Export Citation
  • Kiers, H., van Dieën, J.H., Brumagne, S., & Vanhees, L. (2015). Postural sway and integration of proprioceptive signals in subjects with LBP. Human Movement Science, 39, 109–120. PubMed ID: 25436915 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kirchner, M., Schubert, P., Schmidtbleicher, D., & Haas, C. (2012). Evaluation of the temporal structure of postural sway fluctuations based on a comprehensive set of analysis tools. Physica A: Statistical Mechanics and Its Applications, 391(20), 4692–4703. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lacour, M., Bernard-Demanze, L., & Dumitrescu, M. (2008). Posture control, aging, and attention resources: Models and posture-analysis methods. Neurophysiologie Clinique/Clinical Neurophysiology, 38(6), 411–421. PubMed ID: 19026961 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lafond, D., Champagne, A., Descarreaux, M., Dubois, J.D., Prado, J.M., & Duarte, M. (2009). Postural control during prolonged standing in persons with chronic low back pain. Gait & Posture, 29(3), 421–427. PubMed ID: 19084411 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lake, D.E., Richman, J.S., Griffin, M.P., & Moorman, J.R. (2002). Sample entropy analysis of neonatal heart rate variability. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 283(3), R789–R797. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lamoth, C.J., van Lummel, R.C., & Beek, P.J. (2009). Athletic skill level is reflected in body sway: A test case for accelometry in combination with stochastic dynamics. Gait & Posture, 29(4), 546–551. PubMed ID: 19138522 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Leitner, C., Mair, P., Paul, B., Wick, F., Mittermaier, C., Sycha, T., & Ebenbichler, G. (2009). Reliability of posturographic measurements in the assessment of impaired sensorimotor function in chronic low back pain. Journal of Electromyography and Kinesiology, 19(3), 380–390. PubMed ID: 18023594 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mann, L., Kleinpaul, J.F., Moro, A.R.P., Mota, C.B., & Carpes, F.P. (2010). Effect of low back pain on postural stability in younger women: Influence of visual deprivation. Journal of Bodywork and Movement Therapies, 14(4), 361–366. PubMed ID: 20850043 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mazaheri, M., Coenen, P., Parnianpour, M., Kiers, H., & van Dieën, J.H. (2013). Low back pain and postural sway during quiet standing with and without sensory manipulation: A systematic review. Gait & Posture, 37(1), 12–22. PubMed ID: 22796243 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mazaheri, M., Heidari, E., Mostamand, J., Negahban, H., & van Dieen, J.H. (2014). Competing effects of pain and fear of pain on postural control in low back pain? Spine, 39(25), E1518–E1523. PubMed ID: 25271501 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mientjes, M., & Frank, J. (1999). Balance in chronic low back pain patients compared to healthy people under various conditions in upright standing. Clinical Biomechanics, 14(10), 710–716. PubMed ID: 10545625 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mok, N.W., Brauer, S.G., & Hodges, P.W. (2004). Hip strategy for balance control in quiet standing is reduced in people with low back pain. Spine, 29(6), E107–E112. PubMed ID: 15014284 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mok, N.W., Brauer, S.G., & Hodges, P.W. (2007). Failure to use movement in postural strategies leads to increased spinal displacement in low back pain. Spine, 32(19), E537–E543. PubMed ID: 17762795 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mousavi, S.J., Parnianpour, M., Mehdian, H., Montazeri, A., & Mobini, B. (2006). The Oswestry disability index, the Roland-Morris disability questionnaire, and the Quebec back pain disability scale: Translation and validation studies of the Iranian versions. Spine, 31(14), E454–E459. PubMed ID: 16778675 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Murray, M., Seireg, A., & Sepic, S.B. (1975). Normal postural stability and steadiness: Quantitative assessment. The Journal of Bone and Joint Surgery. American Volume, 57(4), 510–516. PubMed ID: 1141262 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Newell, K.M., van Emmerik, R.E., Lee, D., & Sprague, R.L. (1993). On postural stability and variability. Gait & Posture, 1(4), 225–230. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • O’sullivan, P.B., Burnett, A., Floyd, A.N., Gadsdon, K., Logiudice, J., Miller, D., & Quirke, H. (2003). Lumbar repositioning deficit in a specific low back pain population. Spine, 28(10), 1074–1079.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Plowman, S.A. (1992). Physical activity, physical fitness, and low back pain. Exercise and Sport Sciences Reviews, 20(1), 221–242. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reeves, N.P., Cholewicki, J., & Narendra, K.S. (2009). Effects of reflex delays on postural control during unstable seated balance. Journal of Biomechanics, 42(2), 164–170. PubMed ID: 19121523 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reeves, N.P., Everding, V.Q., Cholewicki, J., & Morrisette, D.C. (2006). The effects of trunk stiffness on postural control during unstable seated balance. Experimental Brain Research, 174(4), 694–700. PubMed ID: 16724177 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reeves, N.P., Narendra, K.S., & Cholewicki, J. (2007). Spine stability: The six blind men and the elephant. Clinical Biomechanics, 22(3), 266–274. PubMed ID: 17210212 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rhea, C.K., Kiefer, A.W., Wright, W.G., Raisbeck, L.D., & Haran, F.J. (2015). Interpretation of postural control may change due to data processing techniques. Gait & Posture, 41(2), 731–735. PubMed ID: 25737236 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rhea, C.K., Silver, T.A., Hong, S.L., Ryu, J.H., Studenka, B.E., Hughes, C.M., & Haddad, J.M. (2011). Noise and complexity in human postural control: Interpreting the different estimations of entropy. PLoS ONE, 6(3), e17696. PubMed ID: 21437281 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Roerdink, M., De Haart, M., Daffertshofer, A., Donker, S., Geurts, A., & Beek, P. (2006). Dynamical structure of center-of-pressure trajectories in patients recovering from stroke. Experimental Brain Research, 174(2), 256–269. PubMed ID: 16685508 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosenstein, M.T., Collins, J.J., & De Luca, C.J. (1993). A practical method for calculating largest Lyapunov exponents from small data sets. Physica D: Nonlinear Phenomena, 65(1–2), 117–134. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ruhe, A., Fejer, R., & Walker, B. (2011a). 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. European Spine Journal, 20(3), 358–368. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ruhe, A., Fejer, R., & Walker, B. (2011b). Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain? BMC Musculoskeletal Disorders, 12, 162. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ruhe, A., Fejer, R., & Walker, B. (2012). Pain relief is associated with decreasing postural sway in patients with non-specific low back pain. BMC Musculoskeletal Disorders, 13(1), 1. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sabatini, A. (2000). Analysis of postural sway using entropy measures of signal complexity. Medical and Biological Engineering and Computing, 38(6), 617–624. PubMed ID: 11217878 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sadeghisani, M., Manshadi, F.D., Azimi, H., & Montazeri, A. (2016). Validity and reliability of the Persian version of Baecke habitual physical activity questionnaire in healthy subjects. Asian Journal of Sports Medicine, 7(3), e31778. PubMed ID: 27826396 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Salavati, M., Mazaheri, M., Negahban, H., Ebrahimi, I., Jafari, A.H., Kazemnejad, A., & Parnianpour, M. (2009). Effect of dual-tasking on postural control in subjects with nonspecific low back pain. Spine, 34(13), 1415–1421. PubMed ID: 19478663 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schelldorfer, S., Ernst, M.J., Rast, F.M., Bauer, C.M., Meichtry, A., & Kool, J. (2015). Low back pain and postural control, effects of task difficulty on centre of pressure and spinal kinematics. Gait & Posture, 41(1), 112–118. PubMed ID: 25270326 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shumway-Cook, A., & Woollacott, M.H. (2012). Motor control: Translating research into clinical practice. Philadelphia: Lippincott Williams & Wilkins.

    • Search Google Scholar
    • Export Citation
  • Sipko, T., & Kuczyński, M. (2013). Intensity of chronic pain modifies postural control in low back patients. European Journal of Pain, 17(4), 612–620. PubMed ID: 23065907 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stergiou, N. (2004). Innovative analyses of human movement. Champaign, IL: Human Kinetics Publishers.

  • Stergiou, N., & Decker, L.M. (2011). Human movement variability, nonlinear dynamics, and pathology: Is there a connection? Human Movement Science, 30(5), 869–888. PubMed ID: 21802756 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stergiou, N., Harbourne, R.T., & Cavanaugh, J.T. (2006). Optimal movement variability: A new theoretical perspective for neurologic physical therapy. Journal of Neurologic Physical Therapy, 30(3), 120–129. PubMed ID: 17029655 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Van Daele, U., Hagman, F., Truijen, S., Vorlat, P., Van Gheluwe, B., & Vaes, P. (2009). Differences in balance strategies between nonspecific chronic low back pain patients and healthy control subjects during unstable sitting. Spine, 34(11), 1233–1238. PubMed ID: 19444072 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • van Dieën, J.H., Koppes, L.L., & Twisk, J.W. (2010). Low back pain history and postural sway in unstable sitting. Spine, 35(7), 812–817. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • van Emmerik, R.E., & van Wegen, E.E. (2002). On the functional aspects of variability in postural control. Exercise and Sport Sciences Reviews, 30(4), 177–183. PubMed ID: 12398115 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vuillerme, N., Anziani, B., & Rougier, P. (2007). Trunk extensor muscles fatigue affects undisturbed postural control in young healthy adults. Clinical Biomechanics, 22(5), 489–494. PubMed ID: 17346866 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Winter, D.A., Patla, A.E., Prince, F., Ishac, M., & Gielo-Perczak, K. (1998). Stiffness control of balance in quiet standing. Journal of Neurophysiology, 80(3), 1211–1221. PubMed ID: 9744933 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yahia, A., Jribi, S., Ghroubi, S., Elleuch, M., Baklouti, S., & Elleuch, M.H. (2011). Evaluation of the posture and muscular strength of the trunk and inferior members of patients with chronic lumbar pain. Joint Bone Spine, 78(3), 291–297. PubMed ID: 20971670 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
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