Low Back Disorders : Evidenced Based Prevention and Rehabilitation

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  • Edition: 2nd
  • Format: Hardcover
  • Copyright: 2007-08-13

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"Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition" presents 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.

Author Biography

Stuart McGill is a professor at the University of Waterloo at Waterloo, Ontario.

Table of Contents

List of Tests and Exercises
Why and How You Should Read This Book
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
Muscle Size
Muscle Groups
Abdominal Muscles
Quadratus Lumborum
Muscle Summary
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)
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
Handouts for Patients or Clients
References and Additional Readings
About the Author
Table of Contents provided by Publisher. All Rights Reserved.

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