Abstract
Low back pain (LBP) has a point prevalence of nearly 10% and ranks highest in global disease burden for years lived with disability; Parkinson’s disease (PD) ranks in the top 100 most disabling health conditions for years lost and years lived with disability (1). Recent evidence suggests that people with chronic, recurrent LBP exhibit many postural impairments reminiscent of a neurological postural disorder such as PD. We compare and contrast postural impairments associated with LBP and PD in order to inform treatment strategies for both conditions. The literature suggests that both LBP and PD associate with impaired proprioceptive function, sensory orientation during standing balance, anticipatory postural adjustments, automatic postural responses, and striatal-cortical function. Although postural impairments are similar in nature for LBP and PD, the postural impairments with LBP appear more specific to the trunk than for PD. Likewise, although both health conditions associate with altered striatal-cortical function, the nature of the altered neural structure or function differ for PD and LBP. Due to the high prevalence of LBP associated with PD, focused treatment of LBP in people with PD may render benefit to their postural impairments and disabilities. In addition, LBP would likely benefit from being considered more than just a musculoskeletal injury; as such, clinicians should consider including approaches that address impairments of postural motor control.
Highlights
Low back pain (LBP) represents one of the most prevalent health conditions worldwide, having a point prevalence of nearly 10% and ranking first in global disease burden for years lived with disability [1]
As previously described for both quiet stance and the control of the anticipatory postural adjustments (APAs), people with LBP exhibit a redistribution of control for the automatic postural responses (APRs) via compensation at distal body segments [36, 37, 39] that is not evident with Parkinson’s disease (PD). Both health conditions exhibit diminished stability, co-contraction, and directionally nonspecific APRs, but the impairment is more pervasive across body segments for PD, whereas the impairment appears localized to the trunk with compensation elsewhere for LBP
Isolated characteristics of LBP could relate to isolated characteristics of other neurological conditions to suggest other mechanisms of neuropathological involvement, we preliminarily argue that the similarities in overall presentation of posture and gait between LBP and PD are greater than for LBP with other neurological conditions, which differ in sensory conditions of impaired standing balance, truncal rigidity, the contextual specificity, scaling, and timing of APAs and APRs, as well as parkinsonian versus ataxic, neuropathic, or hemiparetic gait patterns [61,62,63,64]
Summary
Low back pain (LBP) represents one of the most prevalent health conditions worldwide, having a point prevalence of nearly 10% and ranking first in global disease burden for years lived with disability [1]. People with PD exhibit APAs that can be delayed beyond a time window of anticipatory control prior to movement-related perturbation, and these delayed postural activations are not specific to the movement [27].
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