Contents

Part I: Scientific Foundation

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

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
Are Biomechanical Variables and Psychosocial Variables Distinct?
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

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

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

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

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

7. Reducing the Risk of Low Back Injury

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

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

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

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 Stabilization
Exercises That May Be Used in a Stabilization Program
Special Conditions
A Final Note

11. Advanced Exercises

Safely Increasing Challenges
Occupational and Athletic Work Hardening
A Final Note