Lower limb proprioception and postural control strategies in people with non-specific low back pain: A systematic review and meta-analysis

Objective To investigate whether lower limb proprioception and postural control strategies are impaired in people with non-specific low back pain. Data sources A literature search was performed in the Cochrane Library, Web of Science, PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature, between January 2000 and June 2025. Review methods Studies comparing lower limb proprioception and postural control strategies in adults with non-specific low back pain versus asymptomatic controls were included. Postural control was assessed through relative proprioception weighting, with higher values indicating greater reliance on ankle strategies and lower values indicating reliance on hip strategies. Quality appraisal utilised the Newcastle-Ottawa scale, while evidence certainty was evaluated using the grading of recommendations assessment, development and evaluation system. Results Seventeen studies with 1187 participants were included, of which 14 had Newcastle-Ottawa Scale scores above five. The pooled analysis showed that the non-specific low back pain group had significantly decreased ankle proprioception compared to the control group (standardised mean difference = −0.710). People with non-specific low back pain relied more on ankle strategies for postural control on both stable (weighted mean difference = 0.086) and unstable surfaces (weighted mean difference = 0.195). However, the three pooled outcome measures showed very low level of evidence due to research design and heterogeneity. Conclusion Very low level of evidence showed that people with non-specific low back pain had impaired lower limb proprioception and a higher reliance on an ankle strategy compared to asymptomatic controls, suggesting potential benefits of assessing and improving lower limb function in this population.