Low Back Disorders

Stuart McGill.

Get the latest information on evidence-based prevention and rehabilitation approaches from an internationally recognized expert; and learn how to apply the principles in industry, sport, and everyday settings.

Low Back Disorders: Evidence-Based Prevention and Rehabilitation provides professionals with the foundation to make the best clinical decisions for building the best prevention and rehabilitation programs. The author’s unique research results quantify forces that specific movements and exercises impose on the low back. The text identifies commonly prescribed practices that are, in fact, contraindicated in promoting back health. Additionally, it provides appropriate strategies to offset injuries and restore function. Low Back Disorders will build your understanding of the science behind the practices so that you can use them effectively with clients and patients.

The book presents a clear exposition of back anatomy and biomechanics. It also provides the evidence to dispel myths regarding spine stabilization exercise and various prevention approaches. For example, the quantification of stability will show which muscles are important and which exercises groove motor patterns to ensure spine stability. With Low Back Disorders, 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 rehab
• learn how to analyze patients’ and clients’ unique physical characteristics and lifestyle factors and tailor treatments and preventive measures to their individual needs,
• learn how to help patients and clients achieve the low back stability required to prevent future damage, and
• acquire the information necessary to prescribe effective exercises clearly and easily.

Low Back Disorders is well organized and easy to understand. Part 1 provides a solid foundation on how the back works and how the back becomes injured. Part 2 shows you how to use this foundation to build evidence-based prevention programs by assessing risks, creating ergonomic interventions, and training personnel. Part 3 focuses on improving rehabilitation techniques, and specifically, quantification of spine stability to determine which exercises are important for spine stability for each person.

The text offers practical guidelines for developing optimal exercise regimens and 31 tests and exercises for diagnosis and prevention, carefully selected or developed based on measured biomechanical factors.

Low Back Disorders addresses in detail the ergonomic issues related to manual materials handling and injuries associated with seated work and sport, and throughout the book it reinforces their application in functional activities.

Table of Contents

• Acknowledgments
• Why and How You Should Read This Book

Part I The Scientific Foundation

Chapter 1 Introduction to the Issues

• Legislative Landscape: Unfortunate Adverse Impact on Bad Backs
• Deficiencies in Current Low Back Disorder Diagnostic Practices
• Inadequacies in Current Care for Low Back Disorders
• Mechanical Loading and the Process of Injury: A Low Back Tissue Injury Primer
• A Final Note
• References

Chapter 2 Scientific Approach Unique to This Book

• In-Vitro Lab
• In-Vivo Lab
• References

Chapter 3 Epidemiological Studies on Low Back Disorders (LBDs)

• Multidimensional Links Among Biomechanical, Psychosocial, and Personal Variables
• How Do Biomechanical Factors Affect LBD?
• What Are the Links Between Personal Factors and LBD?
• What the Evidence Supports
• References

Chapter 4 Functional Anatomy of the Lumbar Spine

• The Vertebrae
• Intervertebral Disc
• Muscles
• Ligaments
• Lumbodorsal Fascia
• Clinically Relevant Aspects of Pain and Anatomic Structure
• A Final Note
• References

Chapter 5 Normal and Injury Mechanics of the Lumbar Spine

• Kinematic Properties of the Thoraco-Lumbar Spine
• Kinetics and Normal Lumbar Spine Mechanics
• Dubious Lifting Mechanisms
• Other Important Mechanisms of Normal Spine Mechanics
• Injury Mechanisms
• Biomechanical and Physiological Changes Following Injury
• References

Chapter 6 Lumbar Spine Stability

• Stability: A Qualitative Analogy
• Quantitative Foundation of Stability
• Stability Myths, Facts, and Clinical Implications
• References

Part II Injury Prevention

Chapter 7 LBD Risk Assessment

• NIOSH Approach to Risk Assessment
• Snook/Psychophysical Approach
• Lumbar Motion Monitor (LMM)
• 4D WATBAK
• Biological Signal-Driven Model Approaches
• The Challenge Before Us
• References

Chapter 8 Reducing the Risk at Work

• Lessons From the Literature
• LBD Prevention for Workers
• LBD Prevention for Employers
• Injury Prevention Primer
• References

Chapter 9 Reducing the Risk in Athletes—Guidelines

• Reducing the Risk in Athletes
• What Coaches Need to Know
• References

Chapter 10 The Question of Back Belts

• Issues of Back Belts
• Scientific Studies
• Summary of Prescription Guidelines
• References

Part III Low Back Rehabilitation

• Chapter 11 Building Better Rehabilitation Programs for Low Back Injuries
• Finding the Best Approach
• Three Stages of Patient Progression
• Guidelines for Developing the Best Exercise Regimen
• References

Chapter 12 Evaluating the Patient

• First Clinician-Patient Meeting
• Specific Tests
• References

Chapter 13 Developing the Exercise Program

• Preliminary Matters
• Exercises for Training the Stabilizing Muscles
• Beginner’s Program for Stabilization
• References

Chapter 14 Advanced Exercises

• Safely Increasing Challenges
• Occupational and Athletic Work Hardening
• Looking Forward
• References

• List of Tests and Exercises
• Flexor Endurance Test
• Lateral Musculature Test
• Back Extensors Test
• Manual Testing for Lumbar Joint Shear Stability
• Challenged Breathing Test
• McKenzie Posture Test
• Sitting Slump Test
• Fajersztain Test
• Hip Flexion and Rotation Tests
• Flossing
• Curl-Up, Beginner’s
• Isometric Exercises for the Neck
• Curl-Up, Intermediate
• Curl-Up, Advanced
• Side Bridge, Remedial
• Side Bridge, Beginner’s
• Side Bridge, Intermediate
• Side Bridge, Intermediate Variation
• Side Bridge, Advanced
• Birddog, Remedial
• Birddog, Beginner’s
• Birddog, Intermediate
• Birddog, Advanced
• Curl-Up, Highest Level
• Side Bridge, Highest Level
• Birddog, Highest Level
• Advanced Exercise for Back Strength and Endurance
• Establishing Spine Stability in Elevated Breathing
• Training for Torsional Capacity
• Special Prescription for Those Whose Back Is Worse With Sitting and Then Have Trouble Standing
• Star Exercises

• Appendix
• Glossary
• Index
• About the Author