Low Back Disorders

Evidence-Based Prevention & Rehabilitation

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Stuart McGill

2nd Edition
2007
US Price: $59
328 pages
9780736066921

About the Author | Table of Contents | Audiences

Access the latest research and applications to build effective prevention and rehabilitation programs for your patients or clients with Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition. Internationally recognized low back specialist Stuart McGill presents original research to quantify the forces that specific movements and exercises impose on the low back, dispels myths regarding spine stabilization exercises, and suggests prevention approaches and strategies to offset injuries and restore function.

Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition,
presents a clear exposition of back anatomy and biomechanics and demonstrates how to interpret the latest research on low back involvement for clinical applications. The text also contains detailed information on injuries associated with seated work and sport and ergonomic issues related to manual handling of materials. With Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition, you will

• gain valuable information on measured loading of the back during specific activities and apply it to avoid common—but counterproductive—practices in back rehabilitation;
• learn how to analyze each patient’s or client’s unique physical characteristics and lifestyle factors to tailor preventive measures and treatments to individual needs;
• learn how to help patients and clients progress through the stages of rehabilitation: corrective exercise, stability or mobility, endurance, and strength; and
• acquire the information necessary to design an effective injury-prevention program.

This fully updated second edition expands knowledge of low back disorders and best practices in several areas. Enhanced algorithms guide progessive therapeutic exercise, and specially designed patient assessment provocation tests aid you in determining the cause of back troubles, guide your choices in the best ways to eliminate problems, and improve the development of appropriate activities for functional gain. Whereas the first edition focused on increasing spine stability, the second edition provides new information on dealing with both regional instability or mobility and regional stiffness present in individuals where most of the motion occurs at a single spinal segment.

With an expanded repertoire of pain-free motion exercises and additional information on ways to find and adjust stabilization exercises, Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition, offers you new tools to help your patients and clients achieve pain-free exertion.

The text includes exercises and activities that provide a solid foundation of physical work in preparation for more advanced activities in sports and occupations. Also, the process of transitioning into performance exercise is outlined with an explanation of the critical stages of the performance pyramid, including the design of appropriate corrective exercise, building joint and whole-body stability, enhancing endurance, training true strength, and transitioning to ultimate performance.

Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition,
presents foundational information and corresponding clinical applications in a clear, well-sequenced format. Part I builds your knowledge of lumbar function and injury. Part II demonstrates how to use this knowledge to build evidence-based injury-prevention programs by assessing risks, creating ergonomic interventions, and training personnel. Part III focuses on improving rehabilitation techniques, including specific diagnostic and provocative tests, with specific therapeutic exercises proven to enhance performance and reduce pain through a continuum from corrective exercise to stability and mobility, endurance, strength, and power.

Additionally, the text offers these practical features to guide your learning and inform your practice:

• More than 475 photos, graphs, and charts support the research and the scientific basis for the text’s conclusions.
• More than 50 tests and exercises with step-by-step instructions help you develop successful programs for your patients and clients.
• Special sections highlight how the anatomical, biomechanical, and research results can be applied to clinical situations.
• Extensive discussions on individualizing treatment for clients or patients help you improve your assessment skills by learning what questions to ask and what avenues of investigation to pursue with each patient or client.
• Reproducible handout sheets for each of the 25 basic rehabilitation exercises, which include photos and blank lines for instructions, enable the creation of instruction sheets tailored to the current needs and progress rates of each patient or client.

Cutting-edge research and evidence-based application strategies from the leading spine specialist in North America make Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition, the authoritative text for study, care, and treatment of the low back. Its unique approach to back care will guide you in developing intervention, rehabilitation, and prevention programs to address the unique needs of each patient or client and develop a strong scientific foundation for your practice.

About the Author

Stuart McGill, PhD, is a professor at the University of Waterloo at Waterloo, Ontario, Canada, and a world-renowned lecturer and expert in spine function, injury prevention, and rehabilitation.

McGill has written more than 200 scientific publications on the topics of lumbar function, low back injury mechanisms, investigation of tissue loading during rehabilitation programs, and the formulation of work-related injury avoidance strategies. He has received several awards for his work, including the Volvo Bioengineering Award for Low Back Pain Research from Sweden.

McGill has been an invited lecturer at many universities and delivered more than 200 addresses to societies around the world. As a consultant, he has provided expertise on assessment and reduction of the risk of low back injury to government agencies, corporations, professional athletes and teams, and legal firms. He is one of the few scientists who consults and to whom patients are regularly referred.

Table of Contents

• List of Tests and Exercises
• Why and How You Should Read This Book
• Acknowledgments
• Part I. Scientific Foundation
  • Chapter 1. Introduction to the Issues
    • Legislative Landscape: The Unfortunate Adverse Impact on Bad Backs
    • Deficiencies in Current Low Back Disorder Diagnostic Practices
    • Is It True That 85% of Back Troubles Are of Unknown Etiology? • Diagnosis by Hypothesis Testing • Is It True That Most Chronic Back Complaints Are Rooted in Psychological Factors? • Does Pain Cause Activity Intolerance?
    • Inadequacies in Current Care and Prevention of Low Back Disorders
    • Ill-Advised Rehabilitation Recommendations • Can Back Rehabilitation Be Completed in 6 to 12 Weeks? • Should the Primary Goal of Rehabilitation Be Restoring the Range of Motion? • What Are Better Alternatives in Dealing With Painful Backs?
    • Mechanical Loading and the Process of Injury: A Low Back Tissue Injury Primer
    • A Final Note
  • Chapter 2. Scientific Approach Unique to This Book
    • In Vitro Lab
    • In Vivo Lab
    • How the Virtual Spine Works • Development of the Virtual Spine
  • Chapter 3. Epidemiological Studies on Low Back Disorders (LBDs)
    • Multidimensional Links Among Biomechanical, Psychosocial, and Personal Variables
    • Three Important Studies • Do Workers Experience LBDs Because They Are Paid to Act Disabled? • Does Pain Have an Organic Basis—or Is It All in the Head? • Are Biomechanical Variables and Psychosocial Variables Distinct? • What Is the Significance of First-Time Injury Data for Cause and Prevention?
    • How Do Biomechanical Factors Affect LBD?
    • Mechanical Loading and LBD: Field-Based Risk Factors • What Are the Lasting Physiological, Biomechanical, and Motor Changes to Which Injury Leads? • What Is the Optimal Amount of Loading for a Healthy Spine?
    • What Are the Links Between Personal Factors and LBD?
    • What the Evidence Supports
  • Chapter 4. Functional Anatomy of the Lumbar Spine
    • Basic Neural Structure
    • Vascular Anatomy
    • The Vertebrae
    • Vertebral Architecture and Load Bearing • Posterior Elements of the Vertebrae
    • Intervertebral Disc
    • Load-Bearing Abilities • Progressive Disc Injury
    • Muscles
    • Muscle Size • Muscle Groups • Abdominal Muscles • Psoas • Quadratus Lumborum • Muscle Summary
    • Ligaments
    • Longitudinal Ligaments • Interspinous and Superspinous Ligaments • Other Ligaments in the Thoracolumbar Spine • Normal Ligament Mechanics and Injury Mechanics
    • Lumbodorsal Fascia (LDF)
    • A Quick Review of the Pelvis, Hips, and Related Musculature
    • Clinically Relevant Aspects of Pain and Anatomic Structure
    • Tissue-Specific Types of Pain • Can Pain Descriptors Provide a Reliable Diagnosis?
    • A Final Note
  • Chapter 5. Normal and Injury Mechanics of the Lumbar Spine
    • Kinematic Properties of the Thoracolumbar Spine
    • Kinetics and Normal Lumbar Spine Mechanics
    • Loads on the Low Back During Functional Movements • Loads on the Low Back During Various Exercises
    • Dubious Lifting Mechanisms
    • Intra-Abdominal Pressure • Lumbodorsal Fascia • Hydraulic Amplifier • IAP, LDF, and Hydraulic Amplifier: A Summary
    • Other Important Mechanisms of Normal Spine Mechanics
    • Biomechanics of Diurnal Spine Changes • Spinal Memory • Anatomical Flexible Beam and Truss: Muscle Cocontraction and Spine Stability
    • Injury Mechanisms
    • Summary of Specific Tissue Injury Mechanisms • Injury Mechanics Involving the Lumbar Mechanism • Staying Within the “Biomechanical Envelope”
    • Biomechanical and Physiological Changes Following Injury
    • Tissue Damage Pathogenesis, Pain, and Performance • Injury Process: Motor Changes • Specific Patterns of Muscle Inhibition Following Injury • The Crossed-Pelvis Syndrome and Gluteal Amnesia
  • Chapter 6. Myths and Realities of Lumbar Spine Stability
    • Stability: A Qualitative Analogy
    • Quantitative Foundation of Stability
    • Potential Energy as a Function of Height • Potential Energy as a Function of Stiffness and Elastic Energy Storage • Muscles Create Force and Stiffness • Sufficient Stability
    • Stability Myths, Facts, and Clinical Implications
• Part II. Injury Prevention
  • Chapter 7. LBD Risk Assessment
    • Brief Review of the Risk Factors for LBD
    • NIOSH Approach to Risk Assessment
    • 1981 Guideline • 1993 Guideline
    • Snook Psychophysical Approach
    • Lumbar Motion Monitor (LMM)
    • Ergowatch
    • Biological Signal–Driven Model Approaches
    • The Marras Model and the McGill Model • EMG-Assisted Optimization • Simple or Complex Models?
    • The Challenge Before Us
  • Chapter 8. Reducing the Risk of Low Back Injury
    • Lessons From the Literature
    • Compensation Board Statistics—An Artifact? • Ergonomic Studies • Rehab and Prevention Studies • Studies on the Connection Between Fitness and Injury Disability • Beyond Ergonomics: Is It Time to "Modify" the Worker?
    • LBD Prevention for Workers
    • Should Workers Avoid End Range of Spine Motion During Exertion? • What Are the Ways to Reduce the Reaction Moment? • Should One Avoid Exertion Immediately After Prolonged Flexion? • Should Intra-Abdominal Pressure (IAP) Be Increased While Lifting? • Are Twisting and Twisting Lifts Particularly Dangerous? • Is Lifting Smoothly and Not Jerking the Load Always Best? • Is There Any Way to Make Seated Work Less Demanding on the Back? • Some Short-Answer Questions
    • LBD Prevention for Employers
    • Injury Prevention Primer
    • A Note for Consultants
  • Chapter 9. The Question of Back Belts
    • Issues of the Back Belt Question
    • Scientific Studies
    • Clinical Trials • Biomechanical Studies • Studies of Belts, Heart Rate, and Blood Pressure • Psychophysical Studies
    • Summary of Prescription Guidelines
• Part III. Low Back Rehabilitation
  • Chapter 10. Building Better Rehabilitation Programs for Low Back Injuries
    • Our Five-Stage Back Training Program
    • Finding the Best Approach
    • Stages of Patient Progression
    • Stage 1: Detect and Correct Perturbed Motion and Motor Patterns • Stage 2: Establish Stability Through Exercises and Education • Stage 3: Develop Endurance
    • Guidelines for Developing the Best Exercise Regimen
    • Developing a Sound Basis for Exercise Prescription • Basic Issues in Low Back Exercise Prescription
  • Chapter 11. Evaluating the Patient
    • The Most Crucial Element in Evaluation
    • First Clinician–Patient Meeting
    • Some Provocation Tests
    • A Note on Motion Palpation • Distinguishing Between Lumbar and Hip Problems
    • Some Functional Screens
    • The “Stiff” Spine • Control of Torsional Motion • Testing for Aberrant Gross Lumbar Motion
    • Testing Muscle Endurance
  • Chapter 12. Developing the Exercise Program
    • Philosophy of Low Back Exercise Design
    • Clinical Wisdom
    • Sparing the Back While Stretching the Hips and Knees • Flossing the Nerve Roots for Those With Accompanying Sciatica
    • Identifying Safe and Effective Exercises
    • Incorporating and Patterning the Muscles • Eliminating Unsafe Exercises • Selecting Safe and Effective Exercises
    • Beginner’s Program for Stabilization - A Sample
    • Exercises That May Be Used in a Stabilization Program
  • Chapter 13. Advanced Exercises
    • Safely Increasing Challenges
    • Labile Surfaces and Resistance Training Machines • Safely Progressing Back Exercises
    • Occupational and Athletic Work Hardening
    • Low Back Exercises for High-Performance Workers or Athletes • Low Back Exercises Only for Athletes
    • Looking Forward
• Epilogue
• Handouts for Patients or Clients
• Appendix
• Glossary
• References and Additional Readings
• Index
• About the Author

Audiences

A reference for physical and occupational therapists, sport and orthopedic physicians, rehabilitation specialists, athletic trainers, and fitness specialists. Also useful for students as a primary or secondary resource on low back disorders.