Proprioception and Geriatric Low Back Pain

Abstract

Proprioception is a deep sensation that perceives the position of each part of the body, state of movement and muscle contraction, and resistance and mass applied to the body. Proprioceptive feedback influences movement and positional accuracy, resulting in key somatosensory functions for human postural control. Proprioception encompasses signals received from proprioceptors located in the skin, subcutaneous tissue, muscles, tendons, and joint capsules, commonly known as mechanoreceptors. The muscle spindle, a crucial proprioceptor, is stretched during eccentric contraction of muscle, thus generating an action potential on afferent fibers to convey a proprioceptive information to the sensorimotor cortex in the brain. For exercise therapy in patients with locomotor disease, proprioception serves an essential function for motor control; thus, this should be considered to obtain effective muscle output. As postural control is achieved by proprioceptive function according to the balance between the lower limb and trunk, relative proprioceptive weighting ratio can help clarify proprioceptive control using muscle response to mechanical vibration. The absence of proprioceptive information congruent with motor intention activates cortical center monitoring incongruence of sensation, leading to pathological pain. Therapeutic procedures may aim to restore the integrity of cortical information processing in musculoskeletal chronic pain. Poor proprioception is one of the main causes of decreased postural balance control in elderly patients with low back pain (LBP). It has been hypothesized that proprioception of the lower limbs deteriorates with age-related muscle mass loss (sarcopenia), which increases the proprioceptive burden on the lumbar spine. Accurate diagnosis of the proprioceptive function is important for establishing a treatment procedure for proprioceptive recovery, and further prospective research is required to clarify the relationship between proprioception and LBP improvement.

The associations between lumbar proprioception and postural control during and after calf vibration in people with and without chronic low back pain

“…Significantly higher PJRS on RE of 15° and 35° were found in the CLBP group, demonstrating diminished lumbar proprioception in the CLBP group compared with the HC group, which was consistent with our previous study ( Cheng et al, 2023 ). In fact, many studies have found the poor lumbar proprioception in the CLBP group ( Brumagne et al, 2000 ; Sakai et al, 2022 ; Sheeran et al, 2012 ), which may be due to the altered paraspinal muscle spindle afference and central processing ( Brumagne et al, 2000 ). On the other hand, no differences in the repositioning tests between CLBP patients and healthy subjects was also found ( Åsell et al, 2006 ).…”

“…These results showed that the proprioception should be considered for the assessment of the patients with chronic low back pain. Thus, lumbar proprioception is impaired in patients with CLBP, the differences in lumbar proprioception may not be clinically meaningful ( Korakakis et al, 2021 ), so accurate assessment of proprioception at multiple joints in lower limbs and trunk is necessary and important for establishing a precise treatment procedure ( Sakai et al, 2022 ).…”

“…Twenty CLBP patients (CLBP group) and twenty healthy control subjects (HC group) aged between 18 and 50 years were recruited in this study. Because proprioception declines to some extent with aging, and the proprioceptive function of patients with chronic low back pain also declines ( Sakai et al, 2022 ). In order to explore the decreased proprioception associated with chronic low back pain and its relationship with postural control, it is necessary to control for factor of age.…”

“…Lumbar proprioception has been commonly investigated by passive joint repositioning sense (PJRS), active joint repositioning sense (AJRS), threshold to detect passive motion (TTDPM), and active movement extent discrimination assessment (AMEDA) in the people with CLBP ( Lin et al, 2019 ). It is generally suggested that lumbar proprioception is impaired in the patients with CLBP compared with healthy subjects ( Korakakis et al, 2021 ; Sakai et al, 2022 ), but the difference between groups is also affected by the proprioception testing methods ( Lee et al, 2010 ). In fact, no differences in lumbar proprioception between the patients with CLBP and healthy control group were also found ( Åsell et al, 2006 ; Lee et al, 2010 ).…”

Association between functional disability with postural balance among patients with chronic low back pain

“…Our findings of a significant negative correlation between age and performance of YBT and OLS are consistent with previous research ( 22 , 23 ). Postural balance deteriorates with age possibly caused by biological changes (e.g., neuromusculoskeletal alterations, mobility issues, and sensory-motor deficits) ( 22 , 28 ). Particularly, impaired postural balance increases the risk of falls in older CLBP patients ( 29 ).…”