THE BACK PAGE RESEARCH REVIEW Postural instability in older adults with neck pain STUDY TITLE: An exploratory study examining factors underpinning postural instability in older adults with idiopathic neck pain AUTHORS: Quek J, Treleaven J, Clark RA & Brauer SG PUBLICATION INFORMATION: Gait & Posture 2018; 60: 93–98. REVIEWED BY SHAWN THISTLE Applications, conclusions The cervical spine is a critical contrib-utor to the overall sensorimotor system that governs movement and balance. This system relies on the ability of cervical mechanoreceptors to integrate multisensory input from the visual, vestibular, proprioceptive and central nervous systems. Patients with neck pain have demonstrated sensorimotor disturbances, often manifesting as im-paired postural stability (1). Older pa-tients similarly have poorer dynamic postural stability, which increases the risk of injury due to fall (2). Those who are older and also have neck pain may theoretically be vulnerable via two dis-tinct, yet perhaps related, mechanisms. The impact of neck pain on the multitude of variables that influence postural control is an important con-cept and one that requires careful in-vestigation. Decreased levels of physi-cal activity are known to be associated with poorer limb function and conse-quently contribute to decreased pos-tural stability in older adults with neck pain (3-5). Also, neck pain in older adults is expected to diminish cervical proprioception and vestibular, visual and central nervous system functions, ultimately increasing the risk of falls in older adults with neck pain (6, 7). This is a complex topic that has not yet been extensively studied. The purpose of this cross-sectional, Background information exploratory study was to understand the mechanisms associated with postural control deficits in older adults with or without neck pain. Pertinent results 84 older adults with (n = 35, average age 69.6 ± 6.3 yrs) and without (n = 49, average age 69.5 ± 4.9) idiopathic neck pain were enrolled in the study. Physical activity level, lower limb motor and sensory function, vestibular function and visual contrast sensitivity did not differ between the study groups (p > 0.05 for all). Patients with neck pain did demonstrate poorer Activi-ties-Specific Balance (ABC) scale scores (p = 0.01), lower Dynamic Gait Index (DGI) (p = 0.02) and higher Dizziness Handicap Inventory (DHI) scores (p < 0.01). Older patients also showed higher NDI scores (p > 0.001). Patients with neck pain also demon-strated greater centre-of-pressure (CoP) velocity (both overall and in the A-P axis) in both eyes-open and eyes-closed conditions. CoP and standard deviation of path length were also greater in the eyes-open condition in patients with neck pain. Finally, pa-tients with neck pain demonstrated significantly higher CoP velocity only in the moderate (1.56–6.25 Hz) and low (0.39–1.56 Hz) frequencies in eyes-open and eyes-closed conditions. The results of this cross-sectional, exploratory study suggest that pos-tural control deficits in older patients with neck pain may not be associated with variables such as physical activity level, lower limb motor or sensory function, vestibular function and visual contrast sensitivity. Rather, impairments to cervical propriocep-tive inputs (likely related to their neck pain) are most likely responsible for change in postural activity in this co-hort. The authors suggest that further research is necessary to determine the relationship between the observed reduced balance confidence, poorer dynamic balance and higher fall risk in older patients with neck pain. Cli-nicians should be aware of these concerns when treating such patients. COMMENT: Unraveling the complex relationship among balance, postural stability, aging and neck pain is a chal-lenging proposition that requires further research. This study adds to our existing body of knowledge and should stimulate clinicians to investigate for these deficien-cies in your older patients with neck (or low back?) pain. Simple balance exercises and progressions could form a standard component of treatment provided in ad-dition to manual and other therapies for our older patients, in an effort to preserve and enhance their postural stability and general balance. Study methods DR. SHAWN THISTLE is a practising chiropractor, educator, international speaker, knowledge-transfer leader, evidence-based health care advocate, entrepreneur and medicolegal consultant. He founded RRS Education in 2006 and currently acts as the company’s CEO. RRS Education helps chiropractors and other manual medicine clinicians around the world integrate research into patient care via weekly research reviews, online courses and seminars. rrseducation.com 28 Canadian Chiropractor July/August 2019 This was a cross-sectional, explora-tory study conducted on older adults who were recruited via convenience sampling. Participants were added to the neck pain (NP) group if they had chronic NP for ≥ 3 months, a Neck Disability Index (NDI) score of ≥ 10 per cent and neck-related pain of ≥ 2/10 on a Visual Analogue Scale (VAS). www.canadianchiropractor.ca
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