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The Biomechanics of Back Pain - E-Book

The Biomechanics of Back Pain - E-Book

Michael A. Adams | Nikolai Bogduk | Kim Burton | Patricia Dolan

(2012)

Additional Information

Abstract

Authored by experts of international renown, the new edition of The Biomechanics of Back Pain forms a bridge between the latest research and the effective clinical management of patients with back problems.

Now published for the first time in full colour, the volume presents a unique synthesis of the latest research findings and explains its recent changes in emphasis - from trying to understand and reverse age-related spinal degeneration to addressing the soft tissue causes of pain.

New chapters are devoted to Sensorimotor Control, and Cervical Spine Anatomy and Biomechanics, while a bonus website contains useful PowerPoint presentations, which include seminars entitled Back Pain and Forces on the Spine as well as an overview of the Psychosocial Flags Framework.

Clinically orientated and highly practical throughout, The Biomechanics of Back Pain has become the standard platform by which readers keep abreast of research and developments in the field and is essential for all clinicians involved in the care and treatment of patients with back pain, as well as for those studying its causes and methods of prevention.

    • Established authoritative text for clinicians, lecturers, researchers and those working in the medico-legal arena
    • Emphasizes the latest perspectives in research and shows how it is now leading to advances in clinical methodology
    • Provides an overview of the best original research – including more than 350 new references – to provide researchers with the latest and most important information relating to back pain
    • Contains over 150 full-colour line artworks and more than 60 photographs
    • Additional chapters devoted to Sensorimotor Control, and Cervical Spine Anatomy and Biomechanics
    • Includes more than 350 new references
    • Now published in full colour with improved page design and navigation
    • Bonus website containing useful PowerPoint presentations, which include seminars entitled Back Pain and Forces on the Spine as well as an overview of the Psychosocial Flags Framework

Table of Contents

Section Title Page Action Price
Front cover cover
The Biomechanics of Back Pain i
Copyright page iv
Table of Contents v
Preface to the 3rd Edition vii
Additional On-line Information viii
1 Introduction 1
Mechanical loading and back pain 1
Purpose of this book 1
The authors 2
Who should read this book? 2
Introduction to individual chapters 2
Biomechanical terms and concepts 3
Force 3
Mass 4
Weight 4
Stress 4
Fluid 4
Pressure (or hydrostatic pressure) 5
Displacement 5
Velocity 5
Acceleration 5
Strain 5
Energy 5
Momentum 5
Bending moment 5
Torque 6
Stiffness and strength 6
Damage 6
Modulus 6
Strain energy, hysteresis and toughness 6
Creep 7
Fatigue failure 7
Cube-square law 7
Biomechanics and aesthetics 8
2 The vertebral column and adjacent structures 9
Design features 9
Rigidity 9
Separation 10
Compression 10
Mobility 11
Intervertebral discs 11
Microstructure 12
Disc height 13
The essential lumbar vertebral column 13
Posterior elements 14
The complete lumbar vertebral column 16
Ligaments 17
Zygapophyseal joints 17
The sacrum 19
Sacroiliac joint 22
Thoracic spine 24
Thoracic vertebral column 24
Sternum 24
Ribs 24
Muscle surface 25
Further reading 25
3 Muscles and fascia of the lumbar spine 27
Intersegmental muscles 27
Anterolateral muscles 27
Psoas major 28
Quadratus lumborum 28
Posterior back muscles 28
Multifidus 29
Longissimus thoracis pars lumborum 29
Iliocostalis lumborum pars lumborum 29
Longissimus thoracis pars thoracis 31
Iliocostalis lumborum pars thoracis 32
Erector spinae aponeurosis 32
Forces and line of action 32
Thoracolumbar fascia 38
Abdominal muscles 39
Latissimus dorsi 40
Further reading 40
4 Nerves and blood supply to the lumbar spine 41
Vertebral canal 41
Spinal nerves 41
Ventral rami 42
Dorsal rami 43
Innervation of the disc 43
Blood vessels 45
Nutrition of the disc 46
Further reading 46
5 Back pain 47
Experimental studies 47
Red-flag disorders 47
Ligament sprain 48
Muscle sprain 48
Muscle spasm 48
Trigger points 48
Iliac crest syndrome 48
Segmental dysfunction 48
Dural pain 48
Spondylolysis 49
Sacroiliac joint pain 49
Zygapophyseal joint pain 49
Discogenic pain 49
Disc prolapse 51
Vertebral body pain 52
Synopsis 52
6 Epidemiology of back trouble 53
Introduction 53
Symptoms, pathology and disability 53
Epidemiological terminology 54
The nature of epidemiological evidence 54
Symptoms 55
Back pain and sciatica in adults 55
Back pain in children 56
The time course of back pain 57
Care-seeking 58
Pathology 58
Intervertebral disc herniation and degeneration 58
Other spinal pathology 59
Disability 59
Risk factors 61
Genetic risk factors 61
Individual risk factors 62
Environmental (physical) risk factors 62
Psychosocial influences 65
Concluding remarks 66
7 Biology of spinal tissues 67
Introduction 67
Muscle 68
Structure and composition 68
Metabolism 70
Bone 73
Structure and composition 73
Metabolism 73
Hyaline (articular) cartilage 76
Structure and composition 76
Metabolism 77
Tendon and ligament 79
Structure and composition 80
Metabolism 80
Intervertebral discs 81
Structure and composition 82
Metabolism 82
Biological compatibility of spinal tissues 85
8 Growth and ageing of the spine 87
Introduction 87
Prenatal development and growth 87
Differentiation 87
Embryological development 88
Fetal development 88
Postnatal growth 89
Neonatal and infant growth 89
Childhood and adolescence 90
Age-related changes in the adult spine 91
Muscles 92
Vertebrae 93
Hyaline cartilage 95
Tendon and ligament 95
Intervertebral discs 95
Biochemical changes 95
Histological changes 96
Metabolic changes 96
Functional changes 96
Gross functional changes in the ageing spine 98
9 Forces acting on the thoracolumbar spine 101
Compression, shear, bending and torsion 101
Where do the forces come from? 101
Gravity and inertial effects 101
Muscles 102
Fascia and ligaments 103
Intra-abdominal pressure 104
Use of lifting belts 105
Compressive loading of the spine 105
Measuring spinal compression 105
Intradiscal pressure 105
Spinal shrinkage 106
Linked-segment and EMG-assisted models 106
Direct EMG estimates of spinal loading 106
Comparison between direct EMG and linked-segment model techniques 107
Compressive loading in vivo 107
Shear 109
Bending 110
Measuring spinal bending 110
Spinal bending in vivo 110
Bending moments on the spine during manual handling 110
When do bending moments rise to high levels? 110
Dangers of sustained and repeated bending 111
Diurnal variations in bending moment 112
Torsion 112
10 Mechanical function of the thoracolumbar spine 113
Introduction 114
Why is the spine curved? 114
Movements of the lumbar spine 115
Range of movement: radiographs, CT, MRI and implanted pins 115
Range of movement: skin surface techniques 116
Assessment of techniques 116
Variations in lumbar mobility with age and gender 116
Other influences on lumbar mobility 116
Patterns of movement 117
Centre of rotation 117
Intersegmental movements 118
Coupled movements 118
Movements of the whole lumbar spine 118
Spinal movements and spinal disorders 118
Techniques used to investigate spinal function 119
Mechanical testing of cadaveric tissues 119
Load and loading rate 119
Centre of rotation 119
Effect of death on the spine’s mechanical properties 119
Changes in the hours following death 119
Effect of frozen storage on mechanical properties 120
‘Motion segment’ experiments 120
Mathematical models 121
Analytical models 121
Finite element models 121
Animal models 121
Vertebrae 122
Vertebral body 122
Neural arch 122
Zygapophyseal joints 122
Articular surfaces 122
Joint capsule 123
Lubrication 123
Spinal ligaments 124
Interspinous and supraspinous ligaments 125
Intertransverse ligament 125
Ligamentum flavum 125
Zygapophyseal joint capsular ligaments 125
Posterior longitudinal ligament 125
Anterior longitudinal ligament 126
Iliolumbar ligaments 126
Intervertebral discs 126
Annulus fibrosus 127
Tensile properties of the annulus 128
How does collagen reinforce the annulus? 128
Nucleus pulposus 129
Cartilage endplates 130
Stress distributions within intervertebral discs 130
Compression of an intervertebral disc 132
Bending of an intervertebral disc 133
Axial rotation of an intervertebral disc 134
Sacrum and sacroiliac joints 134
Sacrum 134
Sacroiliac joints 134
Movements in vivo 134
Movements in vitro 135
Mechanical function 135
11 Mechanical damage to the thoracolumbar spine 137
Introduction 138
Damage, injury and fatigue failure 138
Compression 138
Resistance to compression 138
Vertebral compression fracture 139
The endplate is usually the spine’s ‘weak link’ in compression 139
‘Osteoporotic’ compression fractures of the vertebral body 140
Compressive strength of thoracolumbar vertebrae 141
Fatigue failure of the vertebral body 144
Vibrations 144
Internal disc disruption 144
Activities which could injure the spine in compression 146
Shear 146
Resistance to shear 146
Damage in shear 146
Activities which could injure the spine in shear 146
Torsion 146
Centre of rotation 146
Resistance to torsion 147
Torsional damage 147
Activities which could injure the spine in torsion 148
Backwards bending 149
Centre of rotation 149
Resistance to backwards bending 149
Damage in backwards bending 149
Activities which could injure the spine in backwards bending 149
Forward bending 150
Centre of rotation 150
Resistance to forward bending 150
Damage in forward bending 151
Rapid bending 151
Slow and sustained bending 152
Interactions between bending and compression 152
Activities which could injure the spine in forward bending 152
Lateral bending 153
Bending and compression: disc prolapse 153
Disc prolapse by sudden loading 153
Disc prolapse by repetitive loading 155
Consequences of disc prolapse 158
Mechanical consequences 158
Biological consequences 158
Activities which could cause disc prolapse 159
Segmental ‘instability’ 160
Mechanical instability 160
Excessive intersegmental movement 160
Qualitatively abnormal intersegmental movement 161
Abnormally low intersegmental resistance to small movements 161
Discogenic causes of segmental instability 161
Spondylolysis and spondylolisthesis 162
Spinal trauma 163
Flexion distraction (’seat belt’) injuries 163
Burst fractures of the vertebral body 163
12 Cervical spine biomechanics 165
Introduction 165
Gross anatomy 165
Movements of the cervical spine 165
Disc mechanics 166
Strength of the cervical spine 166
Resistance to bending 169
Cervical spine trauma classification 169
Whiplash 169
What is whiplash? 169
What is injured in whiplash? 169
13 Posture, creep and ‘functional pathology’ 173
Introduction 173
Posture and the lumbar spine 173
Posture and lumbar curvature in the sagittal plane 174
Posture and load-sharing in the lumbar spine 176
Posture and the neural arch 176
Posture and intervertebral disc mechanics 177
Posture and intervertebral disc nutrition 180
Posture and spinal nerve roots 180
Posture and muscle action 181
Postures involving lateral bending of the lumbar spine 181
‘Creep’ in spinal tissues 182
Compressive ‘creep’ deformation of intervertebral discs 182
Compressive ‘creep’ deformation of vertebrae 183
Total time-dependent compressive deformations of the elderly spine 183
Diurnal changes in human stature 184
Diurnal changes in spinal mechanics 184
Spinal ‘creep’ in flexion and extension 186
‘Good’ and ‘bad’ posture for the lumbar spine 186
Sitting and standing 186
Manual handling 187
Postural advice for those with back pain 187
14 Sensorimotor control 189
Introduction 189
Asymmetrical muscle ACTIVITY 189
Antagonistic muscle activity 190
Flexion–relaxation 190
Reflex control of spinal movements 190
Factors that impair reflex control 192
Creep 192
Muscle fatigue 194
Pain 194
Consequences of impaired reflex control 194
15 Spinal degeneration 195
Introduction 195
Intervertebral disc degeneration 196
What is disc degeneration? 196
What causes disc degeneration? 198
Precipitating causes of disc degeneration 198
Time course of disc degeneration 198
Underlying causes of disc degeneration 199
Structural features of disc degeneration 199
Annulus tears or fissures 199
Disc prolapse 200
Endplate damage 201
Internal collapse of annulus 201
Disc narrowing, radial bulging and vertebral osteophytes 201
Other features of degenerated discs 202
Functional changes in degenerated discs 202
Are there two distinct routes to disc degeneration? 203
Disc degeneration and pain 203
Degenerated discs are often painful 203
Nerve and blood vessel ingrowth in degenerated discs 204
Pain sensitisation of nerve roots and intervertebral discs 205
Inflammation and healing in the disc periphery 205
Schmorl’s nodes and Modic changes 206
Instability 207
What is spinal instability? 207
What causes spinal instability? 207
Spinal instability and pain 208
Vertebral body osteophytes 208
Apophyseal joint osteoarthritis 208
What is osteoarthritis? 208
Involvement of the apophyseal joints 209
What causes osteoarthritis? 210
Osteoporosis and senile kyphosis 211
Introduction 211
What causes senile kyphosis? 212
How can senile kyphosis be prevented and treated? 213
Other disorders of vertebrae 214
Stenosis 215
Scoliosis 217
Sacroiliac joint degeneration 218
Back muscles 218
16 Preventing back pain 219
Introduction 219
Epidemiology revisited 220
Prevention in low-back pain 221
Outcomes and interventions 221
Evidence 221
Recommendations 222
General population 222
Physical exercise 222
Information/education/training (back schools) 222
Lumbar supports/back belts 222
Mattresses 222
Chairs 222
Shoe insoles/correction of leg length discrepancies 222
Manipulation 222
Workers 223
Physical exercise/physical activity 223
Information/advice/instruction 223
Back belts/lumbar supports 223
Shoe inserts, shoe orthoses, shoe insoles, flooring and mats 223
Physical ergonomics 223
Organisational ergonomics 223
Multidimensional interventions 223
Modified work for return to work after sick leave due to LBP 223
School age 224
School-based interventions 224
Modifiable risk factors 224
Summary of the concepts of prevention in low-back pain 224
Overarching messages from the guidelines 225
Update 225
Summary 225
Postscript: practical advice 226
17 Conservative management of back pain 227
Introduction 227
Work as a health outcome 229
A short history of back pain guidelines 229
Primary care guidelines 229
Occupational health guidelines 230
European guidelines 231
Diagnosis of acute non-specific low-back pain 231
Treatment of acute non-specific low-back pain 231
Chronic guidelines: overarching comments 231
Diagnosis in chronic low-back pain 232
Patient assessment 232
Physical examination and case history 232
Imaging 232
Electromyography 232
Prognostic factors 232
Treatment of chronic low-back pain 232
Conservative treatments 232
Pharmacological treatments 232
Invasive treatments 232
Rehabilitation for the management of low-back pain 233
Obstacles to recovery/return to work 233
Biological obstacles 233
Personal/psychological obstacles 234
Thoughts 234
Feelings 234
Behaviours 234
Employee 234
Workplace 234
Context obstacles 234
Biopsychosocial interactions 235
Clinical management 235
Restoration of function 235
An occupational focus 235
Stepped care 235
Occupational management 236
Modified work 236
Health at work 236
Summary 237
Cultural shifts in the management of low-back pain1512 237
Cultural interventions 237
Novel non-surgical therapies for back disorders 238
Promoting intervertebral disc healing 238
New injection therapies for back pain and sciatica 238
Regenerative medicine 239
Other 239
Summary 239
Practical advice for preventing back problems 240
Practical advice for coping with back pain 240
18 Biomechanics rationale for spinal surgery 243
Introduction 243
Resection 243
Resection 244
Disc replacement 244
19 Surgery for disc prolapse, spinal stenosis and back pain 247
Introduction 247
Disc prolapse 248
Cauda equina syndrome 249
Lumbar spinal stenosis 249
Spondylolysis 250
Spondylolisthesis 251
Facet joint pain 252
Discogenic low-back pain 252
Intradiscal electrothermal therapy 252
Total disc replacement 253
Low-friction total disc replacement 254
Compliant total disc replacement 254
Dynamic stabilisation 255
Spinal fusion 256
Posterolateral fusion 256
Instrumented posterolateral fusion 256
Posterior lumbar interbody fusion 256
Anterior lumbar interbody fusion 256
Combined anterior and posterior fusion 256
Interbody cage devices 257
Does spinal fusion reduce discogenic back pain? 257
Which type of spinal fusion? 257
Summary 258
20 Medicolegal considerations 259
Introduction 259
Background issues 260
Epidemiology 260
Underlying and precipitating causes of back disorders 261
All backs are more or less vulnerable to injury 261
Mechanisms of injury and fatigue failure 262
Can mechanical loading cause a normal disc to prolapse? 262
Retrospective analyses of spinal loading 263
How strong is the back? 263
Relating spinal loading to pathology and pain 263
Summary 264
21 Summary and conclusions 265
Introduction 265
Structure and function of the back 266
What does what? 266
Motor control 266
Some backs are more vulnerable than others 266
Genetic inheritance predisposes to injury and degeneration 266
Ageing contributes to tissue vulnerability 266
Loading history 266
Medicolegal significance 267
Back injuries 267
Forces acting on the spine 267
Epidemiological evidence 267
Injury mechanisms 267
Healing of back injuries 267
Muscle 267
Tendons and ligaments 268
Bone 268
Articular cartilage and intervertebral discs 268
Ageing and degeneration of the spine 268
Development and growth 268
Ageing 268
Intervertebral disc degeneration 268
Spine ‘degenerative cascade’ 268
Apophyseal joint osteoarthritis 269
Segmental ‘instability’ 269
Osteophytosis 269
Spinal stenosis 269
Osteoporosis and senile kyphosis 269
Back pain 269
Pain from disrupted tissues 269
Muscles 269
Vertebrae 269
Zygapophyseal joints 269
Sacroiliac joints 270
Intervertebral discs 270
Neurogenic pain 270
‘Functional’ pain 270
Psychosocial factors influence pain behaviour 270
Current and future treatment options 270
Manual therapy 270
Surgery 271
Drugs 271
Regenerative medicine 271
Cognitive-behavioural therapy (CBT) 271
Exercise 272
Other 272
Concluding remarks 272
References 273
Index 327