Chronic low back pain influences trunk neuromuscular control during unstable sitting among persons with lower-limb loss

Courtney M. Butowicz, Julian C. Acasio, Sheri P. Silfies, Maury A. Nussbaum, Brad D. Hendershot*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Persons with unilateral lower-limb loss are at increased risk for developing chronic low back pain. Aberrant trunk and pelvis motor behavior secondary to lower-limb loss potentially alters trunk postural control and increases demands on the trunk musculature for stability. However, it is unclear whether trunk postural control is associated with the presence or chronicity of low back pain within this population. Research question: Is there a potential role of impaired trunk postural control among persons with lower limb loss and chronic low back pain? Methods: Two groups of males with unilateral lower-limb loss (n = 18 with chronic low back pain; n = 13 without pain) performed an unstable sitting task. Trunk postural control was characterized using traditional and non-linear measures derived from center-of-pressure time series, as well as trunk kinematics and the ratio of lumbar to thoracic erector spinae muscle activations. Results: Traditional and non-linear center-of-pressure measures and trunk muscle activation ratios were similar between groups, while participants with chronic low back pain demonstrated greater trunk motion and reduced local dynamic stability. Significance: Our results suggest that persons with both lower-limb loss and chronic low back pain exhibit impaired trunk postural control compared to those with limb loss but without pain. Aberrant trunk motor behavior may be a response to altered functional requirements of walking with a prosthesis. An inability to adequately control the trunk could lead to spinal instability and pain in the presence of repetitive exposure to aberrant motor behavior of these proximal structures during everyday activities.

Original languageEnglish
Pages (from-to)236-241
Number of pages6
JournalGait and Posture
StatePublished - Oct 2019
Externally publishedYes


  • Amputation
  • Biomechanics
  • Low back pain
  • Postural control


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