Vertical Heterophoria and Postural Control in Nonspecific Chronic Low Back Pain
The purpose of this study was to test postural control during quiet standing in
nonspecific chronic low back pain (LBP) subjects with vertical heterophoria (VH)
before and after cancellation of VH; also to compare with healthy subjects with,
and without VH. Fourteen subjects with LBP took part in this study. The postural
performance was measured through the center of pressure displacements with a
force platform while the subjects fixated on a target placed at either 40 or 200
cm, before and after VH cancellation with an appropriate prism. Their postural
performance was compared to that of 14 healthy subjects with VH and 12 without
VH (i.e. vertical orthophoria) studied previously in similar conditions. For LBP
subjects, cancellation of VH with a prism improved postural performance. With
respect to control subjects (with or without VH), the variance of speed of the
center of pressure was higher, suggesting more energy was needed to stabilize
their posture in quiet upright stance. Similarly to controls, LBP subjects
showed higher postural sway when they were looking at a target at a far distance
than at a close distance. The most important finding is that LBP subjects with
VH can improve their performance after prism-cancellation of their VH. We
suggest that VH reflects mild conflict between sensory and motor inputs involved
in postural control i.e. a non optimal integration of the various signals. This
could affect the performance of postural control and perhaps lead to pain.
Nonspecific chronic back pain may results from such prolonged conflict.
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