Experimental muscle pain challenges the postural stability during quiet stance and unexpected posture perturbation.

UNLABELLED Musculoskeletal pain impairs postural control and stability. Nine subjects stood as quietly as possible on a moveable force platform before, during, and after experimental pain in the right leg muscles. A moveable force platform was used to measure the center of pressure and provided unexpected perturbations. Lower limb muscle activity, joint angles, and foot pressure distributions were measured. Hypertonic saline was used to induce pain in the vastus lateralis, vastus medialis, or biceps femoris muscle of the right leg. Compared to baseline and control sessions, pain in the knee extensor muscles during quiet standing evoked: 1) larger sway area, greater medial-lateral center of pressure displacement and higher speed (P < .05); 2) increased sway displacement in the anterior-posterior direction (P < .05); and 3) increased electromyography (EMG) activity for left tibialis anterior and left erector spinae muscles (P < .05). Pain provoked longer time to return to an equilibrium posture after forward EMG activity for, and pain in vastus medialis muscle decreased the time for the maximum hip flexion during this perturbation (P < .05). These results show that muscle pain impairs postural stability during quiet standing and after unexpected perturbation, which suggest that people suffering from leg muscle pain are more vulnerable to falls. PERSPECTIVE This article presents the acute responses to leg muscle pain on the postural control. This measure could potentially help clinicians who seek to assess how pain responses may contribute to patient's postural control and stability during quiet standing and after recovering from unexpected perturbations.

[1]  N. Teasdale,et al.  Postural stability is altered by the stimulation of pain but not warm receptors in humans , 2003, BMC musculoskeletal disorders.

[2]  Nicolas Vuillerme,et al.  Experimental neck muscle pain impairs standing balance in humans , 2009, Experimental Brain Research.

[3]  Relationship between balance performance and musculoskeletal pain in lower body comparison healthy middle aged and older adults. , 2007, Archives of gerontology and geriatrics.

[4]  P. Hodges,et al.  Pain induced by injection of hypertonic saline into the infrapatellar fat pad and effect on coordination of the quadriceps muscles. , 2008, Arthritis and rheumatism.

[5]  M. Akai,et al.  Anticipatory modulation of neck muscle reflex responses induced by mechanical perturbations of the human forehead , 2004, Neuroscience Letters.

[6]  Y. Pai,et al.  Predicted region of stability for balance recovery: motion at the knee joint can improve termination of forward movement. , 2000, Journal of biomechanics.

[7]  M. Latash,et al.  Effects of joint immobilization on standing balance. , 2009, Human movement science.

[8]  Lars Arendt-Nielsen,et al.  Experimental calf muscle pain attenuates the postural stability during quiet stance and perturbation. , 2010, Clinical biomechanics.

[9]  C. Kisner,et al.  Static and dynamic balance responses in persons with bilateral knee osteoarthritis. , 1997, The Journal of orthopaedic and sports physical therapy.

[10]  S. Lord,et al.  Falls risk is associated with pain and dysfunction but not radiographic osteoarthritis in older adults: Tasmanian Older Adult Cohort study. , 2006, Osteoarthritis and cartilage.

[11]  R. Hinman,et al.  Balance impairments in individuals with symptomatic knee osteoarthritis: a comparison with matched controls using clinical tests. , 2002, Rheumatology.

[12]  J. Rizzo,et al.  The labor productivity effects of chronic backache in the United States. , 1998, Medical care.

[13]  Kimitaka Nakazawa,et al.  Reciprocal angular acceleration of the ankle and hip joints during quiet standing in humans , 2001, Experimental Brain Research.

[14]  R. Hinman,et al.  Effect of experimentally induced knee pain on standing balance in healthy older individuals. , 2005, Rheumatology.

[15]  B. Jensen,et al.  Effects of experimental muscle pain on shoulder-abduction force steadiness and muscle activity in healthy subjects , 2008, European Journal of Applied Physiology.

[16]  N. Shakoor,et al.  Pain and its relationship with muscle strength and proprioception in knee OA: results of an 8-week home exercise pilot study. , 2008, Journal of musculoskeletal & neuronal interactions.

[17]  F. Horak,et al.  Influence of central set on human postural responses. , 1989, Journal of neurophysiology.

[18]  William H Gage,et al.  Kinematic and kinetic validity of the inverted pendulum model in quiet standing. , 2004, Gait & posture.

[19]  Akira Takagi,et al.  A New Method of Statokinesigram Area Measurement: Application of a Statistically Calculated Ellipse , 1985 .

[20]  Régine Roll,et al.  From balance regulation to body orientation: two goals for muscle proprioceptive information processing? , 1999, Experimental Brain Research.

[21]  Suzanne G. Leveille,et al.  Musculoskeletal Pain and Risk for Falls in Older Disabled Women Living in the Community , 2002, Journal of the American Geriatrics Society.

[22]  B. Freriks,et al.  Development of recommendations for SEMG sensors and sensor placement procedures. , 2000, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[23]  M. Nevitt,et al.  The effects of impaired joint position sense on the development and progression of pain and structural damage in knee osteoarthritis. , 2009, Arthritis and rheumatism.

[24]  Van Doornik HYDRAULICALLY ACTUATED PLATFORM FOR HUMAN GAIT AND POSTURE ANALYSIS , 2003 .

[25]  F. Blyth,et al.  Pain and falls in older people , 2007, European Journal of Pain.

[26]  S. Mense,et al.  Nociception from skeletal muscle in relation to clinical muscle pain , 1993, Pain.

[27]  D. Winter A.B.C. (anatomy, biomechanics and control) of balance during standing and walking , 1995 .

[28]  Norimasa Yamada,et al.  Anticipation of elbow joint perturbation shortens the onset time of the reflex EMG response in biceps brachii and triceps brachii , 2007, Neuroscience Letters.

[29]  Michael E. Miller,et al.  Declines in strength and balance in older adults with chronic knee pain: a 30-month longitudinal, observational study. , 2002, Arthritis and rheumatism.

[30]  M. Doherty,et al.  Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects , 2001, Annals of the rheumatic diseases.

[31]  N. Teasdale,et al.  Effects of intensity and locus of painful stimulation on postural stability , 2004, Pain.