Low Back Disorders - 2nd Edition: Evidence - Based Prevention and Rehabilitation

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Low Back Disorders - 2nd Edition: Evidence-Based Prevention and Rehabilitation By Stuart McGill

© 2007
Book 328 pages
ISBN-13: 9780736066921

Product Description

Access the latest research and applications to build effective prevention and rehabilitation programs for your patients or clients with Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition. Internationally recognized low back specialist Stuart McGill presents original 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.

Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition,
presents a clear exposition of back anatomy and biomechanics and demonstrates how to interpret the latest research on low back involvement for clinical applications. The text also contains detailed information on injuries associated with seated work and sport and ergonomic issues related to manual handling of materials. With Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition, 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 rehabilitation;

learn how to analyze each patient’s or client’s unique physical characteristics and lifestyle factors to tailor preventive measures and treatments to individual needs;

learn how to help patients and clients progress through the stages of rehabilitation: corrective exercise, stability or mobility, endurance, and strength; and

acquire the information necessary to design an effective injury-prevention program.
This fully updated second edition expands knowledge of low back disorders and best practices in several areas. Enhanced algorithms guide progessive therapeutic exercise, and specially designed patient assessment provocation tests aid you in determining the cause of back troubles, guide your choices in the best ways to eliminate problems, and improve the development of appropriate activities for functional gain. Whereas the first edition focused on increasing spine stability, the second edition provides new information on dealing with both regional instability or mobility and regional stiffness present in individuals where most of the motion occurs at a single spinal segment.

With an expanded repertoire of pain-free motion exercises and additional information on ways to find and adjust stabilization exercises, Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition, offers you new tools to help your patients and clients achieve pain-free exertion.

The text includes exercises and activities that provide a solid foundation of physical work in preparation for more advanced activities in sports and occupations. Also, the process of transitioning into performance exercise is outlined with an explanation of the critical stages of the performance pyramid, including the design of appropriate corrective exercise, building joint and whole-body stability, enhancing endurance, training true strength, and transitioning to ultimate performance.

Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition,
presents foundational information and corresponding clinical applications in a clear, well-sequenced format. Part I builds your knowledge of lumbar function and injury. Part IIdemonstrates how to use this knowledge to build evidence-based injury-prevention programs by assessing risks, creating ergonomic interventions, and training personnel. Part III focuses on improving rehabilitation techniques, including specific diagnostic and provocative tests, with specific therapeutic exercises proven to enhance performance and reduce pain through a continuum from corrective exercise to stability and mobility, endurance, strength, and power.

Additionally, the text offers these practical features to guide your learning and inform your practice:

More than 475 photos, graphs, and charts support the research and the scientific basis for the text’s conclusions.

More than 50 tests and exercises with step-by-step instructions help you develop successful programs for your patients and clients.

Special sections highlight how the anatomical, biomechanical, and research results can be applied to clinical situations.

Extensive discussions on individualizing treatment for clients or patients help you improve your assessment skills by learning what questions to ask and what avenues of investigation to pursue with each patient or client.

Reproducible handout sheets for each of the 25 basic rehabilitation exercises, which include photos and blank lines for instructions, enable the creation of instruction sheets tailored to the current needs and progress rates of each patient or client.
Cutting-edge research and evidence-based application strategies from the leading spine specialist in North America make Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition, the authoritative text for study, care, and treatment of the low back. Its unique approach to back care will guide you in developing intervention, rehabilitation, and prevention programs to address the unique needs of each patient or client and develop a strong scientific foundation for your practice.


List of Tests and Exercises
Why and How You Should Read This Book

Part I. Scientific Foundation

Chapter 1. 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

Chapter 2. Scientific Approach Unique to This Book
In Vitro Lab
In Vivo Lab
How the Virtual Spine Works • Development of the Virtual Spine

Chapter 3. 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

Chapter 4. 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 • Psoas • 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

Chapter 5. 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

Chapter 6. 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

Part II. Injury Prevention

Chapter 7. 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

Chapter 8. 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

Chapter 9. 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

Part III. Low Back Rehabilitation

Chapter 10. Building Better Rehabilitation Programs for Low Back Injuries
Our Five-Stage Back Training Program
Finding the Best Approach
Stages of Patient Progression
Stage 1: Detect and Correct Perturbed Motion and Motor Patterns • Stage 2: Establish Stability Through Exercises and Education • Stage 3: Develop Endurance
Guidelines for Developing the Best Exercise Regimen
Developing a Sound Basis for Exercise Prescription • Basic Issues in Low Back Exercise Prescription

Chapter 11. 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

Chapter 12. 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

Chapter 13. 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


A reference for physical and occupational therapists, sport and orthopedic physicians, rehabilitation specialists, athletic trainers, and fitness specialists. Also useful for students as a primary or secondary resource on low back disorders.

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