Age-related differences in stepping stability following a sudden gait perturbation are associated with lower limb eccentric control of the perturbed limb

Introduction: Falls are a leading cause of severe injuries and a major threat to quality of life in older adults. Elderly fallers demonstrate insufficient eccentric quadriceps control during the weight acceptance phase of initial single limb stance. However, the functional role of eccentric control of the perturbed (leading) leg during walking balance recovery and its age-related differences have not yet been studied; thus we investigated age-related differences in eccentric control at the knee of the perturbed leg and its influence on the postural sway and stability of the trailing leg during balance recovery following unexpected surface drop perturbations. Methods: Ten younger and ten older healthy adults were compared during balance recovery following an 8 cm unexpected surface drop perturbation at gait initiation. Outcomes related to perturbed leg included 1) eccentric knee extensor work; 2) electromyography (EMG) peak amplitude, peak latency, and eccentric EMG burst duration of the rectus femoris (RF); and 3) knee flexion angle during the single limb support. Outcomes related to stability of the trailing leg included 4) margin of stability (MoS) at first compensatory step touchdown after the perturbation. 5) Postural sway (standard deviation of center of mass acceleration) was measured in the anterior-posterior (A-P), medio-lateral (M-L), vertical directions during the single limb support. Results: Compared to younger adults, older adults demonstrated lower eccentric knee extensor work (p = 0.034), shorter RF EMG burst duration (p < 0.01), delayed RF EMG peak latency (p = 0.01), smaller knee flexion angle (p = 0.01) and MoS (p = 0.04), and higher postural sway (M-L (p = 0.02), vertical (p < 0.01)). There was a positive correlation between eccentric work and MoS (p = 0.03) and a negative correlation between M-L postural sway and 1) RF eccentric EMG burst duration (p = 0.04), and 2) eccentric work (p = 0.01). Conclusions: Older adults demonstrated deficits in eccentric knee extensor control in the perturbed leg during single limb support, which contributed to reduced stability of the trailing leg compensatory step and greater postural sway during balance recovery. This finding provides insight into mechanisms of fall recovery from an unexpected unilateral postural perturbation and directions for lower limb strengthening exercises for aging populations.