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Open Access Highly Accessed Research article

Pain relief is associated with decreasing postural sway in patients with non-specific low back pain

Alexander Ruhe1*, René Fejer2 and Bruce Walker3

Author Affiliations

1 Murdoch University, Praxis fuer Chiropraktik Wolfsburg, Wolfsburg, Germany

2 Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt and University of Southern Denmark, Middelfart, Denmark

3 School of Chiropractic and Sports Science, Murdoch University, Murdoch, Western Australia, Australia

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BMC Musculoskeletal Disorders 2012, 13:39  doi:10.1186/1471-2474-13-39

Published: 21 March 2012



Increased postural sway is well documented in patients suffering from non-specific low back pain, whereby a linear relationship between higher pain intensities and increasing postural sway has been described. No investigation has been conducted to evaluate whether this relationship is maintained if pain levels change in adults with non-specific low back pain.


Thirty-eight patients with non-specific low back pain and a matching number of healthy controls were enrolled. Postural sway was measured by three identical static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11). The patients received three manual interventions (e.g. manipulation, mobilization or soft tissue techniques) at 3-4 day intervals, postural sway measures were obtained at each occasion.


A clinically relevant decrease of four NRS scores in associated with manual interventions correlated with a significant decrease in postural sway. In contrast, if no clinically relevant change in intensity occurred (≤ 1 level), postural sway remained similar compared to baseline. The postural sway measures obtained at follow-up sessions 2 and 3 associated with specific NRS level showed no significant differences compared to reference values for the same pain score.


Alterations in self-reported pain intensities are closely related to changes in postural sway. The previously reported linear relationship between the two variables is maintained as pain levels change. Pain interference appears responsible for the altered sway in pain sufferers. This underlines the clinical use of sway measures as an objective monitoring tool during treatment or rehabilitation.