| |
| |
| List of Tests and Exercises | |
| |
| |
| Why and How You Should Read This Book | |
| |
| |
| Acknowledgments | |
| |
| |
| |
| Scientific Foundation | |
| |
| |
| |
| 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 | |
| |
| |
| |
| Scientific Approach Unique to This Book | |
| |
| |
| In Vitro Lab | |
| |
| |
| In Vivo Lab | |
| |
| |
| How the Virtual Spine Works | |
| |
| |
| Development of the Virtual Spine | |
| |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |
| |
| |
| |
| Injury Prevention | |
| |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |
| |
| |
| |
| Low Back Rehabilitation | |
| |
| |
| |
| Building Better Rehabilitation Programs for Low Back Injuries | |
| |
| |
| Our Five-Stage Back Training Program | |
| |
| |
| Finding the Best Approach | |
| |
| |
| Stages of Patient Progression | |
| |
| |
| |
| Detect and Correct Perturbed Motion and Motor Patterns | |
| |
| |
| |
| Establish Stability Through Exercises and Education | |
| |
| |
| |
| Develop Endurance | |
| |
| |
| Guidelines for Developing the Best Exercise Regimen | |
| |
| |
| Developing a Sound Basis for Exercise Prescription | |
| |
| |
| Basic Issues in Low Back Exercise Prescription | |
| |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |