How do skeletal and postural parameters contribute to maintain balance during walking?

Abstract

Introduction: Maintaining balance during gait allows subjects to minimize energy expenditure and avoid falls. Gait balance can be measured by assessing the relationship between the center of mass (COM) and center of pressure (COP) during gait. Demographics, skeletal and postural parameters are known to influence gait balance. Purpose: What are the determinants of dynamic balance during gait in asymptomatic adults among skeletal and demographic parameters? Methods: 115 adults underwent 3D gait analysis and full-body biplanar X-rays. Angles between the COM-COP line and the vertical were calculated in frontal and sagittal planes during gait: maxima, minima, and ROM were evaluated. Full-body 3D reconstructions were obtained; skeletal and postural parameters of the spine (lumbar lordosis, thoracic kyphosis, sagittal vertical axis SVA), pelvis (pelvic tilt and incidence, acetabular orientation in the 3 planes) and lower limbs (neck shaft angle femoral and tibial torsions) were calculated. A univariate followed by a multivariate analysis were computed between the COM-COP parameters and skeletal and demographic parameters. Results: The univariate analysis showed that in the frontal plane, maximum (4.6°) of the COMCOP angle was significantly correlated with weight (r =0.53), age (r =0.28), height (r = 0.35), SVA (r = 0.23), T1T12 (r = 0.24) and pelvic width (r = 0.25).In the sagittal plane, maximum COM-COP (19.7 ± 2.8°) angle was significantly correlated to acetabular tilt (r = 0.25) and acetabular anteversion (r =0.21). The multivariate analysis showed that, in the frontal plane, an increase in the maximum of the COM-COP angle was determined by a decreasing height (β = −0.28), an increasing weight (β = 0.48), being a male (β = −0.42), and an increasing posterior acetabular coverage (β = 0.22). In the sagittal plane, an increasing maximum COMCOP angle was determined by a decreasing height (β = −0.38) and an increasing SVA (β = 0.19). Conclusion: Frontal imbalance appeared to be mainly correlated to demographic parameters. Sagittal imbalance was found to be correlated with weight, height, acetabular parameters and SVA. These results suggest that in addition to demographic parameters, acetabular parameters and SVA are important determinants of balance during gait.