Abstract
Background
The purpose of this study was to evaluate how acute pain changes the postural control
and stability during quiet standing and after unexpected perturbations.
Methods
Nine subjects stood as quiet as possible on a movable force platform that recorded
the centre of pressure position and provided unexpected floor perturbations, before,
during and after experimental calf muscle pain. Bilateral surface electromyography
from the tibialis anterior and medial gastrocnemius muscles was recorded. The foot
pressure distributions were measured using pressure insoles. Intramuscular injections
of hypertonic saline were administrated (right leg) to induce acute pain in the tibialis
anterior and/or medial gastrocnemius muscles, and an isotonic injection was used as
control.
Findings
Simultaneous pain in tibialis anterior and medial gastrocnemius altered the postural
control. During quiet standing: higher medial-lateral centre of pressure speed and
increased total sway displacement (P<0.05), weight moved to the non-painful side, (P<0.05) and plantar centre of pressure of the left foot was shifted towards the heel’s
direction (P<0.05). During forward perturbation: higher mean displacement in the medial-lateral
direction (P<0.05). After the perturbation: larger sway area (P<0.05). Pain only in the medial gastrocnemius muscle increased medial-lateral centre
of pressure speed (P<0.05) during the quiet standing. Pain only in the tibialis anterior muscle increased
peak pressure on the contralateral foot (P<0.05).
Interpretation
These findings suggest that large acute painful areas on the calf muscles impair the
postural control and potentially increase the risk factors for falls. Further strategies
aiming to reduce pain in patients may lead to improvement in balance.
Keywords
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References
- Effect of experimentally induced knee pain on standing balance in healthy older individuals.Rheumatology (Oxford). 2005; 44: 378-381
- Proprioceptive population coding of two-dimensional limb movements in humans: I. Muscle spindle feedback during spatially oriented movements.Exp. Brain Res. 2000; 134: 301-310
- The effects of experimental muscle and skin pain on the static stretch sensitivity of human muscle spindles in relaxed leg muscles.J. Physiol. 2008; 586: 2713-2723
- Postural stability is altered by the stimulation of pain but not warm receptors in humans.BMC Musculoskelet. Disord. 2003; 4: 23
- Risk factors for falls in a community-based prospective study of people 70 years and older.J. Gerontol. 1989; 44: M112-M117
- The influence of pain on masseter spindle afferent discharge.Arch. Oral Biol. 2007; 52: 387-390
- The influence of muscle pain and fatigue on the activity of synergistic muscles of the leg.Eur. J. Appl. Physiol. 2004; 91: 604-614
- Effects of intensity and locus of painful stimulation on postural stability.Pain. 2004; 108: 43-50
- Hydraulically actuated platform for human gait and posture analysis.in: Second International conference on biomechanical engineering (IASTED). Austria. 2004
- Experimental muscle pain changes motor control strategies in dynamic contractions.Exp. Brain Res. 2005; 164: 215-224
- Spatio-temporal evaluation of neck muscle activation during postural perturbations in healthy subjects.J. Electromyogr. Kinesiol. 2004; 14: 463-474
- Falls risk is associated with pain and dysfunction but not radiographic osteoarthritis in older adults: Tasmanian Older Adult Cohort study.Osteoarthritis Cartilage. 2006; 14: 533-539
- Influence of an asymmetrical body weight distribution on the control of undisturbed upright stance.J. Biomech. 2005; 38: 2037-2049
- Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function.Electroencephalogr. Clin. Neurophysiol. 1997; 105: 156-164
- Development of recommendations for SEMG sensors and sensor placement procedures.J. Electromyogr. Kinesiol. 2000; 10: 361-374
- Stabilometry in balance assessment of dizzy and normal subjects.Am. J. Otolaryngol. 1991; 12: 196-204
- From balance regulation to body orientation: two goals for muscle proprioceptive information processing?.Exp. Brain Res. 1999; 124: 80-88
- Musculoskeletal pain and risk for falls in older disabled women living in the community.J. Am. Geriatr. Soc. 2002; 50: 671-678
- Reorganisation of human step initiation during acute experimental muscle pain.Gait Posture. 1999; 10: 240-247
- Quantitative posturography in altered sensory conditions: a way to assess balance instability in patients with chronic whiplash injury.Arch. Phys. Med. Rehabil. 2004; 85: 432-438
- A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population.J. Gerontol. 1994; 49: M72-M84
- The effect of experimental muscle pain on the amplitude and velocity sensitivity of jaw closing muscle spindle afferents.Brain Res. 2005; 1050: 138-147
- Postural control system.Curr. Opin. Neurobiol. 1994; 4: 877-887
- Experimental muscle pain increases the human stretch reflex.Pain. 1998; 75: 331-339
- Effects of localization and intensity of experimental muscle pain on ankle joint proprioception.Eur. J. Pain. 2002; 6: 245-260
- Open-loop and closed-loop postural control mechanisms in Parkinson's disease: increased mediolateral activity during quiet standing.Neurosci. Lett. 1995; 197: 133-136
- Determinants of plantar pressures in the diabetic foot.J. Diab. Complications. 2002; 16: 277-283
- The labor productivity effects of chronic backache in the United States.Med. Care. 1998; 36: 1471-1488
- Ankle and hip postural strategies defined by joint torques.Gait Posture. 1999; 10: 161-170
- A study of biomechanical parameters in gait analysis and sensitive cronaxie of diabetic neuropathic patients.Clin. Biomech. 2000; 15: 196-202
- Redistribution of joint moments is associated with changed plantar pressure in diabetic polyneuropathy.BMC Musculoskelet. Disord. 2009; 10: 16
- Muscle pain modulates mastication: an experimental study in humans.J. Orofac. Pain. 1998; 12: 7-16
- Modulation of stretch-evoked reflexes in single motor units in human masseter muscle by experimental pain.Exp. Brain Res. 2000; 132: 65-71
- Older women with age-related macular degeneration have a greater risk of falls: a physiological profile assessment study.J. Am. Geriatr. Soc. 2008; 56: 800-807
- A new method of statokinesigram area measurement. Application of a statistically calculated ellipse.in: M. I. O. B. Vestibular and Visual Control on Posture and Locomotor Equilibrium. 1985
- Analysis of sway in Parkinson's disease using a new inclinometry-based method.Mov. Disord. 2002; 17: 663-669
- Experimental neck muscle pain impairs standing balance in humans.Exp. Brain Res. 2009; 192: 723-729
- Static and dynamic balance responses in persons with bilateral knee osteoarthritis.J. Orthop. Sports Phys. Ther. 1997; 25: 13-18
- Human balance and posture control during standing and walking.Gait Posture. 1995; 3: 193-214
Winter, D. A. (1995a) A.B.C. (anatomy, biomechanics, control) of balance during standing and walking, Ontario, Waterloo Biomechanics.
- Unified theory regarding A/P and M/L balance in quiet stance.J. Neurophysiol. 1996; 75: 2334-2343
- Development of postural responses during standing in healthy children and children with spastic diplegia.Neurosci. Biobehav. Rev. 1998; 22: 583-589
Article info
Publication history
Published online: August 09, 2010
Accepted:
June 2,
2010
Received:
September 24,
2009
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.