Experimental calf muscle pain attenuates the postural stability during quiet stance and perturbation

Background

The purpose of this study was to evaluate how acute pain changes the postural control and stability during quiet standing and after unexpected perturbations.

Methods

Nine subjects stood as quiet as possible on a movable force platform that recorded the centre of pressure position and provided unexpected floor perturbations, before, during and after experimental calf muscle pain. Bilateral surface electromyography from the tibialis anterior and medial gastrocnemius muscles was recorded. The foot pressure distributions were measured using pressure insoles. Intramuscular injections of hypertonic saline were administrated (right leg) to induce acute pain in the tibialis anterior and/or medial gastrocnemius muscles, and an isotonic injection was used as control.

Findings

Simultaneous pain in tibialis anterior and medial gastrocnemius altered the postural control. During quiet standing: higher medial-lateral centre of pressure speed and increased total sway displacement (P < 0.05), weight moved to the non-painful side, (P < 0.05) and plantar centre of pressure of the left foot was shifted towards the heel’s direction (P < 0.05). During forward perturbation: higher mean displacement in the medial-lateral direction (P < 0.05). After the perturbation: larger sway area (P < 0.05). Pain only in the medial gastrocnemius muscle increased medial-lateral centre of pressure speed (P < 0.05) during the quiet standing. Pain only in the tibialis anterior muscle increased peak pressure on the contralateral foot (P < 0.05).

Interpretation

These findings suggest that large acute painful areas on the calf muscles impair the postural control and potentially increase the risk factors for falls. Further strategies aiming to reduce pain in patients may lead to improvement in balance.