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Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder - A systematic review of the literature

Alexander Ruhe1*, René Fejer2 and Bruce Walker3

Author Affiliations

1 Murdoch University. Praxis fuer Chiropraktik Wolfsburg, Porschestrasse 1, 38440 Wolfsburg, Germany

2 Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt and University of Southern Denmark, Middelfart, Denmark

3 School of Chiropractic and Sports Science, Murdoch University, Murdoch, 6150, Western Australia, Australia

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Chiropractic & Manual Therapies 2011, 19:13  doi:10.1186/2045-709X-19-13

Published: 24 May 2011


Study design

Systematic literature review.


To assess differences in center of pressure (COP) measures in patients suffering from non-specific neck pain (NSNP) or whiplash-associated disorder (WAD) compared to healthy controls and any relationship between changes in postural sway and the presence of pain, its intensity, previous pain duration and the perceived level of disability.

Summary of Background data

Over the past 20 years, the center of pressure (COP) has been commonly used as an index of postural stability in standing. While several studies investigated COP excursions in neck pain and WAD patients and compared these to healthy individuals, no comprehensive analysis of the reported differences in postural sway pattern exists.

Search methods

Six online databases were systematically searched followed by a manual search of the retrieved papers.

Selection Criteria

Papers comparing COP measures derived from bipedal static task conditions on a force plate of people with NSNP and WAD to those of healthy controls.

Data collection and analysis

Two reviewers independently screened titles and abstracts for relevance. Screening for final inclusion, data extraction and quality assessment were carried out with a third reviewer to reconcile differences.


Ten papers met the inclusion criteria. Heterogeneity in study designs prevented pooling of the data and no direct comparison of data across the studies was possible. Instead, a qualitative data analysis was conducted. There was broad consensus that patients with either type of neck pain have increased COP excursions compared to healthy individuals, a difference that was more pronounced in people with WAD. An increased sway in antero-posterior direction was observed in both groups.


Patients with neck pain (due to either NSNP or WAD) exhibit greater postural instability than healthy controls, signified by greater COP excursions irrespective of the COP parameter chosen. Further, the decreased postural stability in people with neck pain appears to be associated with the presence of pain and correlates with the extent of proprioceptive impairment, but appears unrelated to pain duration.

Balance; center of pressure; force-plate; neck pain; whiplash; systematic review