Experimental knee-related pain enhances attentional interference on postural control

Eneida Yuri Suda, Rogerio Pessoto Hirata, Thorvaldur Palsson, Nicolas Vuillerme, Isabel C N Sacco, Thomas Graven-Nielsen

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Purpose: To quantify how postural stability is modified during experimental pain while performing different cognitively demanding tasks. Methods: Sixteen healthy young adults participated in the experiment. Pain was induced by intramuscular injection of hypertonic saline solution (1 mL, 6%) in both vastus medialis and vastus lateralis muscles (0.9% isotonic saline was used as control). The participants stood barefoot in tandem position for 1 min on a force plate. Center of pressure (CoP) was recorded before and immediately after injections, while performing two cognitive tasks: (i) counting forwards by adding one; (ii) counting backwards by subtracting three. CoP variables—total area of displacement, velocity in anterior–posterior (AP-velocity) and medial–lateral (ML-velocity) directions, and CoP sample entropy in anterior–posterior and medial–lateral directions were displayed as the difference between the values obtained after and before each injection and compared between tasks and injections. Results: CoP total area (− 84.5 ± 145.5 vs. 28.9 ± 78.5 cm 2) and ML-velocity (− 1.71 ± 2.61 vs. 0.98 ± 1.93 cm/s) decreased after the painful injection vs. Control injection while counting forward (P < 0.05). CoP total area (12.8 ± 53.9 vs. − 84.5 ± 145.5 cm 2), ML-velocity (− 0.34 ± 1.92 vs. − 1.71 ± 2.61 cm/s) and AP-velocity (1.07 ± 2.35 vs. − 0.39 ± 1.82 cm/s) increased while counting backwards vs. forwards after the painful injection (P < 0.05). Conclusion: Pain interfered with postural stability according to the type of cognitive task performed, suggesting that pain may occupy cognitive resources, potentially resulting in poorer balance performance.

Original languageEnglish
JournalEuropean Journal of Applied Physiology
Issue number9
Pages (from-to)2053-2064
Number of pages12
Publication statusPublished - Sep 2019


  • Attention
  • Center of pressure
  • Distraction
  • Pain
  • Postural stability

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