**2. Comprehensive balance parameters**

Evidence‐based intervention has stressed the importance of establishing a strong link between treatments and outcomes to both researchers and clinicians. Various studies have suggested that exercise programs are effective in the treatment of LBP [9–12]; however, most researchers fail to provide evidence favoring one exercise over another. Contradicting results might be related to poor sensitivity of the instruments, an unmatched research design, small sample sizes, and/or the lack of a valid and reliable index for standardization.

It is necessary to provide sensitive kinetic and kinematic indices for quantitative evaluation of altered postural coordination in older adults with recurrent LBP. Kinetic and kinematic data regarding spinal dysfunction and coordination may provide clinical insight into motor control and identify patterns of compensatory movements in older adults with recurrent LBP [13, 14]. Several studies have measured kinematic changes of the dominant thigh and pelvis to identify variations in balance sway compensation strategies as well as spinal alignment and core stability between older adults with LBP and control subjects [13, 15]. Another study reported that because active limb movements might be associated with early lumbopelvic motion, increased frequency of these movements may contribute to increased lumbar region tissue stress, potentially leading to LBP symptoms [16] since altered movements are known to decrease muscular force‐generating capabilities [17, 18]. These outcome studies considered the morphological and functional implications in the neuro‐musculoskeletal system.

encountered medical condition in older adults, LBP poses an even greater challenge in the

This chapter proposes biomechanical assessments of spinal function by which to evaluate LBP. The development of a valid and reliable tool for evaluating older adults with LBP is necessary to provide a link between LBP and balance deficits. It might be helpful for clinicians to consider the potential characteristics of kinematic data, such as range of motion, velocity, and acceleration as well as kinetic data, such as ground reaction force (GRF) changes, during the one‐leg standing test. This combined approach could provide a better understanding of postural stability and ground reaction forces for integrating motor control and biomechanics. Specifically, an understanding of the compensatory patterns between normalized kinematic and kinetic stability indices for spinal regions, while considering visual condition may reveal possible pain avoiding strategies from the standing limb. These would be important findings since a lack of coordination and altered postural strategy has the potential to cause muscu‐ loskeletal injuries. Individual variations between older adults might lead to different com‐ pensatory responses and should be elucidated to establish fall prevention strategies. Several studies reported that an analysis of the one‐leg standing test via a motion capture system could be used to determine balance strategies in older adults with LBP [4–8]. However, a comprehensive tool for quantifying kinematic and kinetic changes during one‐leg standing is still needed to enhance evidence‐based practice, prevent fall injuries, and identify factors

An evidence‐based, quantitative approach may enhance quality of care for older adults with LBP and aid in preventing injury. Furthermore, the development of potential interventions as a result of this quantitative approach could favorably alter motor control, which plays a key clinical role in terms of musculoskeletal and neurological functioning of older adults with

Evidence‐based intervention has stressed the importance of establishing a strong link between treatments and outcomes to both researchers and clinicians. Various studies have suggested that exercise programs are effective in the treatment of LBP [9–12]; however, most researchers fail to provide evidence favoring one exercise over another. Contradicting results might be related to poor sensitivity of the instruments, an unmatched research design, small sample

It is necessary to provide sensitive kinetic and kinematic indices for quantitative evaluation of altered postural coordination in older adults with recurrent LBP. Kinetic and kinematic data regarding spinal dysfunction and coordination may provide clinical insight into motor control and identify patterns of compensatory movements in older adults with recurrent LBP [13, 14]. Several studies have measured kinematic changes of the dominant thigh and pelvis to identify variations in balance sway compensation strategies as well as spinal alignment and core stability between older adults with LBP and control subjects [13, 15]. Another study

sizes, and/or the lack of a valid and reliable index for standardization.

health care of this population as compared to their younger counterparts.

affecting proprioception and posture.

196 Innovations in Spinal Deformities and Postural Disorders

**2. Comprehensive balance parameters**

LBP.

The one‐leg standing test was developed in order to investigate dynamic postural steadiness (**Figure 1**). Clinicians often use the one‐leg standing test to assess movement performance and to observe biomechanical deficits. It provides a sensitive analysis of postural stability, consid‐ ering 40% of human gait movement occurs during one‐leg stance [19, 20]. The one‐leg standing test examines the ability of the subject to perform spinal load transfers and to optimize pelvic girdle stability while also detecting relative innominate bone motion [21]. A kinematic analysis of the body regions and the kinetic analysis from the force plate during the one‐leg standing test could be useful in enhancing the understanding of the role of core spine activity during the test. As shown in **Figure 1**, the core spine model is a reference model for trunk motion used in motion analysis. It compares specific three‐dimensional kinematic data to the motion of the lumbar spine [13]. This measure of integrated spinal stability might allow for the development of motor control strategies in older adults with LBP since reaction forces from the platform reflect oscillations in forces about the foot needed to maintain balance [7, 14, 20].

The kinetic and kinematic changes in three‐dimensional trunk motion could also be compared to reflect standing balance contributions to postural control [7]. A lack of coordination of the

**Figure 1.** One‐leg standing balance test (A). The subject was asked to stand on a single leg with the contralateral hip and knee flexed 90° for 30 s. During the test, the subject maintained postural stability while kinetic and kinematic data were collected. In order to quantify the data, each segment was calculated as the amount of rotational displacement side‐to‐ side (Rx), back‐and‐forth (Ry), and up‐and‐down (Rz) away from a mean value (B). The core spine model was utilized as a reference to compare specific three‐dimensional spine motions including the lumbar spine and the lower and upper thoracic spines (C).

lumbar spine may cause musculoskeletal injuries, and altered coordination of the postural reaction might lead to compensatory responses to prevent injuries [14, 22, 23]. Quantifying postural compensation may lead to a better understanding of spinal movement patterns due to a fear of falling in order to clarify the relationship between kinematic and kinetic changes in older adults with recurrent LBP.

The normalized kinematic index of the lumbar spine was calculated based on the three‐ dimensional rotation angle (*Rxyz*) and relative standing index between control and recurrent LBP groups. The ratio between standing duration and requested duration could be compared with the corresponding older adults' *Rxyz* values. The analysis time window excluded the initial transition time (5 s) from standing with bilateral legs to maintaining single, dominant leg standing.
