The Biomechanics of Back Pain / Edition 1

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Back pain is a major problem for modern society, affecting most people at some time in their lives. Much has been published on back pain but when it comes to the vital issue of 'what causes it?' most books either become vague or else offer an individual interpretation based on personal experience and selected research literature. The Biomechanics of Back Pain is different: it strives to incorporate all aspects of the relevant scientific evidence in order to present a comprehensive, mechanistic and clinically relevant account of the initiation of spinal pathology and pain.

Key Features: Detailed analysis of the latest spinal research, fully updated for the 2nd edition. Covers material previously available only in research journals. Emphasizes the relevance of research to clinical practice and medico-legal issues. Integrates current knowledge to provide a cogent natural history of back pain. Illustrated with high-quality colour photographs of spinal pathology, and numerous line diagrams to explain the anatomy and biomechanics. Written by four of the leading researchers in the field.

The Biomechanics of Back Pain is written primarily for health professionals who manage patients with back pain, and for students at the advanced undergraduate/graduate level. It also provides essential information for those involved in back pain prevention in sports and fitness training and in medico-legal practice. For biomechanists, it indicates how their science can be applied to answer a range of clinical questions. The authors are internationally renowned for their research into various aspects of back pain, and they integrate their expertise to present an authoritative account of the subject. Intheir own words: 'The Biomechanics of Back Pain does not imply a bias towards mechanical explanations... it merely reflects the fact that mechanical factors are the most obvious and preventable influences in a complex natural history which involves biological and psychological processes as well... The word "biomechanics" implies a mechanistic approach to back pain, in which our knowledge of science is applied to explaining the chains of events which lead to back pain. Back pain is certainly a difficult and multifaceted problem, but not so difficult that we must abandon the normal scientific method... Back pain should be explained, not explained away'.

In this 2nd edition, a few subjects have been expanded that were neglected previously, including spinal growth and ageing, spinal degeneration and spinal surgery. Several chapters have been divided or otherwise rearranged to make the information easier to find. Finally, the number of colour plates has been increased, and many new black and white photographs and illustrations have been included in the text.

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Editorial Reviews

Doody's Review Service
Reviewer: Dana J Lawrence, DC, MMedEd, MA (Palmer College of Chiropractic)
Description: The authors' emphasis is on understanding the mechanical explanations for back pain; thus, the book examines anatomy and loads, forces, and pathology for the lumbar spine, with particular importance placed upon biomechanics (as opposed to psychosocial factors). A number of illustrative color photographs benefit the text, whose content includes discussions of functional anatomy of the low back, biology of spinal tissues, epidemiology, spinal loading, and mechanisms of injury. The book concludes with a disucssion of medicolegal issues.
Purpose: The authors' purpose is to examine all the factors that influence back pain, focusing on the mechanical factors in particular. Inasmuch as there has been an emphasis upon psychosocial factors for low back pain in the medical literature, this is a welcome change in direction, since its focus is on biomechanics. This is therefore a needed book and one that should be well accepted. It does exactly what the authors ask it to do, and it does it well.
Audience: This book is directed mainly at those who treat low back pain such as physiotherapists, osteopaths, chiropractors, general practitioners, and nurse and occupational health practitioners. Students in each discipline will find it quite useful as well. The authors are some of the most well-known people in this field in all the world. Their expertise cannot be faulted in any way.
Features: The direction that this book takes is to first discuss the general anatomy of the lumbar spine, from a perspective that goes beyond strict anatomical detail and combines the kinematics and biomechanics of this region. By presenting the musculature of the lumbar region, it is easier to understand how forces created by those muscles will affect the low back. Microstructure is described as well, making it easier to understand the physiology affecting this region. Descriptions of epidemiology help to understand the scope of the problem. Pathology is described in detail. Some detail on prevention is presented. Especially well done are the two chapters on mechanical function of the spine and mechanical damage to the spine. The color plates illustrate key concepts. Shortcomings include the fact that references do not appear at the end of each chapter but are grouped at the end of the text, making it hard to check references. Also, the information on manipulation is glossed over very quickly.
Assessment: This excellent book presents in one location a sythesis of much of the recent literature on the mechanical factors contributing to low back pain. The logic of the text is easy to follow and each chapter builds upon concepts and ideas presented in earlier chapters. This is written at a relatively sophisticated level and as a result provides a wealth of information. I can think of few books to compare to it. I recommend it highly.
From the Publisher
Review quotes from previous editions

This book is an excellent addition to the literature on back pain. Biomechanics is fundamental to understanding the physical basis of back pain, but many biomechanical textbooks are very technical and difficult for the non-specialist. What is new and different about this book is that it presents complex ideas very simply and clearly, and applies them to the clinical situation.

This volume is to be highly recommended to all doctors and therapists who deal with patients with back pain.

Professor Gordon Waddell DSc, MD, FRCS Orthopaedic Surgeon, Glasgow [Amazon]

This excellent book presents in one location a synthesis of much of the recent literature on the mechanical factors contributing to low back pain. The logic of the text is easy to follow and each chapter builds upon concepts and ideas presented in earlier chapters. I can think of few books to compare to it and I recommend it highly.

Dana J Lawrence, DC, MMedEd, MA(Palmer College of Chiropractic)

It is refreshing to see a book that interprets and integrates the literature instead of simply repeating studies.

W.S. Marras, Biodynamics Laboratory, Ohio State University

The book is one of the most evidence-based books on the market. The authors are research active and always updating their knowledge.

Principal Lecturer in Physiotherapy, University of Cumbria

"The third edition of The Biomechanics of Back Pain (previous editions 2002 and 2006) is a beautifully produced volume with extraordinarily clear text and superb, relevant colour illustrations of very high quality. All authors are recognized experts in biomechanics, anatomy, pain and spinal research.

The layout is very reader friendly. Each chapter may be read in isolation for reference; or for those with a more intense interest in all aspects of back pain the book can be read from cover to cover. It is primarily intended for practitioners who treat back pain-physiotherapists, osteopaths, chiropractors, general practitioners, nurses and occupational health (OH) professionals, including those involved in personal injury litigation.

There are 21 concise chapters. The first four set the scene by describing the anatomy of the vertebral column, muscles, fascia, nerves and blood supply. Other chapters in the first half of the book cover growth, aging and very detailed mechanical aspects of the back. Chapter five, on back pain itself, opens-‘In principle, any of the structures of the lumbar spine that receives an innervation could be a source of back pain.’ Further-‘it is quite easy to invent an explanation of how any of these structures could be affected by injury or disease in order to become painful. It is another matter, however, to prove that such explanations are realistic and obtain in a given patient.’

A comprehensive but clear list of no less than 14 disorders that can cause back pain follows. The chapter concludes-‘ Although many lesions have been implicated as the cause of low-back pain, few are supported by objective evidence.’ I was somewhat surprised by the comment, ‘The best available data implicate the sacroiliacjoint, the zygapophyseal joints and the intervertebral discs as the leading sources of chronic low-back pain.’

The chapter on ‘Epidemiology of back trouble’ will certainly be of considerable interest to all OH professionals and this together with the preceding short chapter on pain nicely encapsulates the cardinal issues faced in OH. The chapters on posture, prevention, conservative management and surgical treatments are of considerable interest. The penultimate section of the book deals with medico-legal considerations and will be of help and support to OH professionals.

The book is really well indexed and readers will have no difficulty in finding sources of information on specific topics. And for those who wish to explore further there is a list of 1639 references! A website contains useful PowerPoint presentations including an overview of the Psychological Flags Framework.

The final remarks of the authors include-‘There is good evidence that the psychosocial characteristics of many patients with chronic back pain are not the underlying cause of the problem; rather they are a response to vague diagnosis,ineffective treatment and a “compensation culture”.’ As more than half the content of this book is of direct relevance to OH professionals, I have no hesitation in recommending that it has a place on our bookshelves."

John Challenor, Oxford Journals Clippings,Occupational Medicine, vol 64, no 7, October 2014

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Product Details

  • ISBN-13: 9780443062070
  • Publisher: Elsevier Health Sciences
  • Publication date: 6/19/2002
  • Edition number: 1
  • Pages: 240
  • Product dimensions: 7.30 (w) x 9.80 (h) x 0.70 (d)

Meet the Author

I commenced research into spinal pain, in 1972, when essentially nothing was known about the problem. There being no established groups or departments working on this problem, I forged my own career, using borrowed resources. I commenced in a Department of Anatomy, where I pursued the innervation of the vertebral column as a fundamental element in understanding the sources and mechanisms of spinal pain. Professor Jim Lance fostered this interest, and accommodated my PhD studies. In his department I continued my anatomy studies but was able also to commence clinical applications. I developed and tested new diagnostic and surgical procedures for back pain and for neck pain. While in Professor Lance's Department, I participated in laboratory studies of the mechanisms of migraine. At the University of Queensland I continued to develop and apply the diagnostic and surgical techniques that I started at the University of NSW, serving as an honorary medical officer at the Pain Clinic of Princess Alexandra Hospital. Meanwhile I supervised science and medicine postgraduate students who undertook basic science studies into the biomechanics of the back and neck.
At the University of Newcastle, I had established a reputation sufficient to attract a grant from the Motor Accidents Authority of NSW to investigate the cause and treatment of neck pain after whiplash. The grant supported three PhD students over a six year period. They performed studies that validated the diagnostic procedures and which tested the surgical procedures in a placebo-controlled double-blind randomized trial.
Having established an international standing in the development and testing of treatments for spinal pain, I participated in the design and analysis of controlled trials conducted elsewhere in Australia and in the USA. These tested the efficacy of: lumbar radiofrequency neurotomy for back pain, intradiscal electrothermal anuloplasty for back pain, prolotherapy for back pain, exercises for neck pain.
Between 1997 and 2002 I conducted the National Musculoskeletal Medicine Initiative which developed and tested evidence-based practice guidelines for the management of back pain, neck pain, shoulder pain, knee pain, and pain in the foot, wrist, and elbow.
My work has been awarded the Volvo Award for Back Pain Research, the Research Prize of the Cervical Spine Research Society, the Award for Outstanding Research of the North American Spine Society, and three times the Research Prize of the Spine Society of Australia. My students have been awarded research prizes by the International Association for the Study of Pain, the Australian Rheumatology Association, and the Australian New Zealand College of Anaesthetists.
I have never had a funded department to which to attract investigators and academics. I have relied on scholarships for students, and the goodwill of private practitioners who wished to contribute to clinical research. Of late, I have been supervising Neurosurgery residents undertaking studies of the outcomes of treatment for Radicular pain and back pain.

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Table of Contents

Preface to the second edition     vii
Plates     1
Introduction     1
The lumbar vertebral column and sacrum     11
Muscles and fascia of the lumbar spine     29
Nerves and blood supply to the lumbar spine     43
Low back pain     49
Epidemiology of low back trouble     55
Biology of spinal tissues     73
Growth and ageing of the lumbar spine     93
Forces acting on the lumbar spine     107
Mechanical function of the lumbosacral spine     121
Mechanical damage to the lumbar spine     147
Functional pathology     177
Spinal degeneration     195
Preventing back pain     215
Conservative management of back pain     225
Biomechanics of spinal surgery     239
Surgery for disc prolapse, spinal stenosis and back pain   Brian J.C Freeman     243
Medico-legal considerations     257
Summary: spinal ageing, degeneration and pain     265
References     273
Index     309
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