Low Back Disorders 3rd Edition - 3rd Edition

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 Check Out the Web Resource!
You will notice a reference throughout this version of Low Back
Disorders, Third Edition, to a web resource. This resource is available to
supplement your e-book. The web resource includes access to online video
with 17 clips. We are certain you will enjoy this unique online learning
experience.
Follow these steps to purchase access to the web resource:

1. Visit www.tinyurl.com/LowBackDisordersWR3E.
2. Click the Add to Cart button and complete the purchase process.
3. After you have successfully completed your purchase, visit the book’s
website at www.HumanKinetics.com/LowBackDisorders.
4. Click the third edition link next to the corresponding third edition book
cover.
5. Click the Sign In link on the left or top of the page and enter the e-mail
address and password that you used during the purchase process. Once
you sign in, your online product will appear in the Ancillary Items box.
Click on the title of the web resource to access it.
6. Once purchased, a link to your product will permanently appear in the
menu on the left. All you need to do to access your web resource on
subsequent visits is sign in to
www.HumanKinetics.com/LowBackDisorders and follow the link!

Click the Need Help? button on the book’s website if you need
assistance along the way.

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 I dedicate this book to my teachers. To my parents, John and Elizabeth,
who gave what they could. To the few high school teachers who were able to
see past my impatience and occasionally misguided enthusiasm—in
particular, Ralph Colucci, who spent countless hours coaching on the track
and football fields and teaching life’s lessons. He practiced the highest
example of daily dedication and the drive to continue after others had given
up. My university professors in the tough early years, particularly Dr.
Klambauer, who was able to transform mathematics from abstract magic into
something very mechanical that I could suddenly feel in my hands. This was
a turning point. Professor David Winter, who taught me, among many other
things, how to read a scientific paper. Professor Robert Norman, my PhD
supervisor and mentor, who is the embodiment of integrity and the master of
viewing any issue from the highest of intellectual vantage points. The many
great academic personalities in the spine world with whom I have had
discussions and debates, and whose writings I have studied, have enhanced
my education and perspective—Harry Farfan, Bill Kirkaldy-Willis, Don
Chaffin, Bill Marras, Nik Bogduk, Manohar Panjabi, Lance Twomey, and
Mike Adams. And the academic clinicians who have stimulated me with their
written and spoken thoughts—Vlad Janda, Shirley Sahrmann, Dick Erhart,
Paul Hodges, Andry Vleeming, Craig Liebenson, Peter O’Sullivan, Gray
Cook, Joachim Wilke, Robin McKenzie, and Clayton Skaggs. My many
research colleagues from around the world, and visiting scholars to our lab,
too numerous to mention here, who have taught me the many perspectives
needed to temper the arrogance that comes so naturally when one is the only
person privy to new research results. And to my wonderful graduate students
—Jacek Cholewicki, Vanessa Yingling, Jack Callaghan, Sylvain Grenier,
Lina Santaguida, Crisanto Sutarno, John Peach, Craig Axler, Lisa Brereton,
Greg Lehman, Jennifer Gunning, Richard Preuss, Joan Scannell, David
Bereznick, Kim Ross, Kelly Walker, Natasa Kavcic, Simon Wang, John
Gray, Steve Brown, Janice Moreside, Sam Howarth, Leigh Marshall, Justin
Yates, Stephanie Freeman, Rupesh Patel, Dave Frost, Dianne Ikeda, Christian
Balkovec, Natalie Sidorkewicz, Ben Lee, Jordan Cannon, and Drs. Ed
Cambridge, Doug Richards, and Claudio Tampier. Our lab technicians—
Amy Karpowicz, and Chad Fenwick. The old dog has learned a few of your
new tricks. And finally, to the many performance gurus with whom I have
had many discussions and training sessions to try experimental approaches—
these have assisted me in knowing what important aspects to test. Although it

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is difficult to pick out a few, I will mention, in particular, the late Mel Siff,
Juan Carlos Santana, Al Vermeil, Jerzy Gregorek, Pavel Tsatsouline, Mark
McCoy, Art Horne, Dan John, Jon Chaimberg, and Bill Kazmaier—all
immensely clever and generous men. For this third edition I also wish to
thank many of you who have e-mailed me with your kind and encouraging
words. All of you have contributed to my forging. Any remaining personal
failings I can only attribute to the unfortunate combination of running
Canadian software on Irish hardware.
Finally, to my wife and children, Kathryn, John, and Sarah, who have
taught me to see the joy of the moment and enjoy the security of
unconditional love. Quoting John Anderson, "I’m just a chunk of coal, but
I’m gonna be a diamond some day!"

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 Contents
Preface
Accessing and Using the Web Resource
Acknowledgments
Why And How You Should Read This Book
How the Book Is Organized
Focus and Features of the Text
Some Encouraging Words
A Note to Lay Readers
Part I: Scientific Foundation
Chapter 1: Introduction to the Issues and Scientific Approach Unique to
This Book
Legislative Landscape: The Unfortunate Adverse Impact on Painful Backs
Deficiencies in Current Diagnostic Practices
Inadequacies in Current Care and Prevention
Mechanical Loading and the Process of Injury: A Low Back Tissue Injury
Primer
Excellent Clinicians and Excellent Practice
Unique Scientific Foundation of This Book
In Vitro Lab
In Vivo Lab
A Final Note
Chapter 2: Epidemiological Studies and What They Really Mean
Influence of Randomized Controlled Trials and Other Epidemiological
Approaches
Misunderstandings of Epidemiology
Multidimensional Links Among Biomechanical, Psychosocial, and Personal
Variables
How Do Biomechanical Factors Affect LBD?
Links Between Personal Factors and LBD
Studies of Exercise Intervention
Practical Application: What the Evidence Supports
What Works Clinically
A Final Note

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Chapter 3: Functional Anatomy of the Lumbar Spine
Anatomy Trains
Basic Neural Structure
Vascular Anatomy
Vertebrae
Sacroiliac Joints
Intervertebral Disc
Muscles
Ligaments
Lumbodorsal Fascia (LDF)
Quick Review of the Pelvis, Hips, and Related Musculature
Clinically Relevant Aspects of Pain and Anatomic Structure
A Final Note
Chapter 4: Normal and Injury Mechanics of the Lumbar Spine
Kinematic Properties of the Thoracolumbar 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
A Final Note
Chapter 5: Myths and Realities of Lumbar Spine Stability
Why Spine Stability Is Important for Everyone
Stability: A Qualitative Analogy
Quantitative Foundation of Stability
Stability Myths, Facts, and Clinical Implications
A Final Note
Part II: Injury Prevention
Chapter 6: LBD Risk Assessment
Brief Review of the Risk Factors for LBD
NIOSH Approach to Risk Assessment
Snook Psychophysical Approach
Lumbar Motion Monitor (LMM)
Ergowatch
Biological Signal–Driven Model Approaches
A Final Note
Chapter 7: Reducing the Risk of Low Back Injury

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Lessons From the Literature
LBD Prevention for Workers
The Question of Back Belts
LBD Prevention for Employers
Injury Prevention Primer
A Note for Consultants
Reducing the Risk in Athletes
A Final Note
Part III: Low Back Rehabilitation
Chapter 8: Building Better Rehabilitation Programs for Low Back
Injuries
Pain-Reducing Mechanisms of Exercise
Five-Stage Back Training Program
Finding the Best Approach
Stages of Patient Progression
Guidelines for Developing the Best Exercise Regimen
A Final Note
Chapter 9: Evaluating the Patient
Most Crucial Element in Evaluation
First Clinician–Patient Meeting
Assessing Posture and Movement Quality
Some Provocation Tests
Some Functional Screens
Testing Muscle Endurance
A Final Note
Chapter 10: Developing the Exercise Program
Philosophy of Low Back Exercise Design
Clinical Wisdom
Thoughts on Mobility
Identifying Safe and Effective Exercises
Beginner’s Program for Pain Control and Stabilization
Exercises That May Be Used in a Stabilization Program
Special Conditions
A Final Note
Chapter 11: Advanced Exercises
Safely Increasing Challenges
Occupational and Athletic Work Hardening

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A Final Note
Epilogue
Handouts for Patients or Clients
Appendix
Glossary
References and Additional Readings
About the Author

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 Preface
Over the years since the first and second editions hit the bookstores, I
have appreciated the testimonials and feedback from patients, clinicians, and
educators who have used the book. This has motivated my research team to
refocus on expanding our knowledge and best practice in several areas, which
we were able to synthesize into an improved edition. Although updates are to
be found throughout, major additions were made to several chapters, as noted
here.
Ensuring a stable spine was the focus of the first edition. The second
edition also addressed dealing with patients who have the opposite difficulty;
that is, they have too much stiffness and crush their spines with chronic
contraction, and are often locked in problematic postures. Yet others have
regional stiffness, and most of the motion occurs at a single segment. We call
this the spinal hinge. More often than not, these hinges are the site of pain.
New studies have shown that these also predict where future back troubles
will occur. Buttressing them with muscular straps or girdles is the key—and
this is explained in this third edition.
Patient assessment has been extensively enhanced with more information
about provocative testing. This will help you determine the cause of back
troubles and, in turn, the best ways to eliminate the causes so that you can
make better therapeutic exercise decisions. Our intention was to create a more
thorough resource and reference for clinicians and savvy individuals. I have
written a book for the lay public with back pain (Back Mechanic: The Step-
by-Step McGill Method to Fix Back Pain) that is much more accessible to
those unfamiliar with medical jargon. However, because back pain is often
not simple to resolve, this resource remains essential.
Another emphasis of the first two editions was finding versions of
stabilization exercises that could be conducted pain free. As new findings
have emerged in our laboratory, we have been able to incorporate more
information about tweaking the exercises to establish pain-free rehabilitation
and training. Expansion of the pain-free motion repertoire is another critical
component.
Too many patients believe that performing some exercises will take their
pain away, and they simply add them to their daily routine. This is a mistake.

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The first, and most critical, stage is to remove the cause of pain. This may be
a poor choice of movement pattern that overstresses the paining tissue. More
emphasis on choosing less stressful ways to move, together with reducing
loading in the early stage of rehabilitation is provided in this latest edition.
Also, the assessment section has been expanded.
The first edition was printed over a decade ago. Since that time several
studies have tested the approaches we described and found them to be
successful in reducing and eliminating pain in both individuals and
populations such as the military. Some of this supporting evidence has been
documented in this edition.
New to this edition is an accompanying web resource available at
www.HumanKinetics.com/LowBackDisorders. The web resource includes
video clips that showcase 17 exercises and tests explained throughout the
book. These videos will help you apply the techniques discussed in this book
to your own clients and patients. The web resource also provides blank copies
of the handouts appearing at the back of this book. These handouts are
presented as fillable PDFs that you may download and customize with
instructions unique to patients’ needs.
Also new to this edition is an image bank of the art, content photos, and
tables used in the book. Instructors may access the image bank at
www.HumanKinetics.com/LowBackDisorders and use the files to create
customized presentations.
Finally, graduating into performance exercise is outlined in this edition.
Although detailed data and guidance are contained in my other book,
Ultimate Back Fitness and Performance (www.backfitpro.com), this text
explains the critical stages of the performance pyramid:

1. 1. Design appropriate corrective exercise to address the causes of the

disorder.
2. 2. Build joint and whole-body stability (and, by default, mobility).
3. 3. Enhance endurance.
4. 4. Train true strength.
5. 5. Transition to ultimate performance with superstiffness techniques,
speed, power, and agility.

The back is not like any other joint or area of the body. It follows
different rules—learn the rules and you will rule the back.

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 Accessing and Using the Web Resource
The web resource for Low Back Disorders, Third Edition, features 20
handouts in PDF format that clinicians may customize with detailed exercise
instructions specific to individual clients. All of these handouts are
accompanied by at least one photo showing a key movement of the exercise.
The handouts can be printed out and distributed to clients for their use. In
addition, the web resource features high-definition video of 17 of the tests
and exercises described in the book.
To access the web resource, visit
www.HumanKinetics.com/LowBackDisorders. If you purchased a new print
book, follow the directions included on the orange-framed page at the front of
your book. That page includes access steps and the unique key code that
you’ll need the first time you visit the Low Back Disorders, Third Edition,
website. If you purchased an e-book from HumanKinetics.com, follow the
access instructions that were e-mailed to you following your purchase.
To download and print out the handouts, select Web Resource in the
ancillary items box in the upper left corner of the screen. You will now be
taken to a page with two buttons: One for the handouts and one for the
videos. Click the button for the handouts. At the bottom of the screen, select
the link to open a handout.

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 To view the video clips, select Videos button on the Web Resource page.
Select the link for the chapter you want. Once you select a chapter link, you’ll
see a video player. The video numbers along the right side of the player
correspond with video number cross-references in the book, and the title
under the player corresponds with the exercise title in the book. Scroll
through the list of clips until you find the video you want to watch. Select
that clip and the full video will play.

Here is a listing of the exercise handouts in the web resource, including

an asterisk to denote the exercises that are demonstrated in video:

Bird dog, remedial*

Bird dog, beginner*
Bird dog, intermediate*
Bird dog, advanced*
Bird dog, highest level*
Cat–camel
Curl-up, beginner*
Curl-up, intermediate*
Curl-up, advanced*
Curl-up, highest level*
Educating all back extensor muscle motor units
Flossing, beginner*
Isometric exercises for the neck
Potty squat
Remedial side bridge for deconditioned, chronic patient
Remedial side bridge for painful shoulders 1
Remedial side bridge for painful shoulders 2
Side bridge, beginner
Side bridge, intermediate

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Side bridge, intermediate variation
Side bridge, advanced

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