BOOK
The Biomechanics of Back Pain - E-Book
Michael A. Adams | Nikolai Bogduk | Kim Burton | Patricia Dolan
(2012)
Additional Information
Book Details
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 |