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Talk: Low back pain: a composite of interacting systems? (25 min)

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DETAILED SLIDE INDEX

  1. 1. Introduction
  2. 2. Talk outline
  3. 3. Normal function/dysfunction
  4. 4. Skeletal system
  5. 5. The spine
  6. 6. So how does the spine function?
  7. 7. The spine from an engineering perspective
  8. 8. Mathematical models to understand function
  9. 9. Problems with the models
  10. 10. Potential causes why the models are wrong
  11. 11. New thoughts on posture
  12. 12. Implications of curved vs. straight spine (MRI)
  13. 13. Implications of curved vs. straight spine (lifting)
  14. 14. Implications to disc
  15. 15. Rethink ideas
  16. 16. Spine as an arch
  17. 17. Structure, functionality and failure
  18. 18. Integration of the spine in the skeleton
  19. 19. Is the spine only one pendulum?
  20. 20. Inverted pendulums & the spine
  21. 21. Stiffness feedback
  22. 22. Three systems that work together
  23. 23. People as pendulums on platforms (movies)
  24. 24. Platform results: motion
  25. 25. Ternplot: ankle, knee & hip on platform
  26. 26. Ternplot: spinal regions on platform
  27. 27. Platform results: muscle activation
  28. 28. Segmental model
  29. 29. Muscle synergy
  30. 30. Indeterminacy/patient heterogeneity
  31. 31. Muscular system
  32. 32. Key component of stability: muscles
  33. 33. Bergmark’s theory on stability 1989
  34. 34. “Local” muscles
  35. 35. The local system
  36. 36. Ultrasound
  37. 37. Degenerate muscles
  38. 38. Cohort study
  39. 39. Myelopathic changes in back pain patients
  40. 40. “Global” muscles
  41. 41. Strength, fatigue and endurance
  42. 42. Symmetry contraction
  43. 43. Spinal muscles
  44. 44. Motor control (CNS)
  45. 45. Control system: corticospinal pathways
  46. 46. Symmetry contraction
  47. 47. Thresholds to stimulation in back muscles
  48. 48. Thank you
  49. 49. END

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TALK'S CITATION

McGregor, A. (2015), "Low back pain: a composite of interacting systems?", in O’Dowd FRCS Orth , J. and Hlavsova MSc, MCSP, HPC, A. (eds), Current Thinking in Back Pain Management, The Biomedical & Life Sciences Collection, Henry Stewart Talks Ltd, London (online at http://hstalks.com/?t=BL1983909)

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ABOUT THIS TALK

Speaker(s)

Prof. Alison McGregor Show Biography

SPEAKER BIOGRAPHY

Prof. Alison McGregor – Imperial College London, UK

Alison McGregor is a Professor of Musculoskeletal Biodynamics in the Department of Surgery and Cancer, where she manages the Human Performance Group. She trained as a physiotherapist at King’s College Hospital qualifying in 1989 and then went on to study Biomedical Engineering at Surrey University which led to a PhD project in spinal mechanics and low back pain at the Royal Postgraduate Medical School. Her research focuses on the musculoskeletal system with respect to mechanisms of injury; effects of injury on function and management of injury. To date her work has largely focused on the lumbar spine by considering its function to be a composite of interacting systems including a passive or skeletal system which permits segmental joint motion; a muscular system which provides the muscles to create motion these body segments; and a control system (the central nervous system) which co-ordinates the muscles and body segments to produce function with a variety of projects in these areas. She has also investigated aspects of management and surgical care including surveys of practice, clinical cohort studies, the development of evidenced-based information [www.tso.co.uk/bookshop] and a large randomised controlled multi-centre clinical trial investigating optimal post-operative management. She has also led with Professor Anthony Bull a programme of research into rowing performance, with a focus on rowing kinematics and mechanisms of injury. This work has been in association with the GB Rowing team and on-going studies are contributing to the Team’s preparations for the last 4 0lympic Games.

Publication Date

July, 2015

Topics Covered

Skeletal system: segmental joint motion of the spine... more

TOPICS COVERED IN THIS TALK

  • Skeletal system: segmental joint motion of the spine
  • Muscular system: creating motion in body segments
  • Control system (CNS): co-ordination of muscles and body segments to produce function
  • Management and surgical care: surveys of practice, clinical studies and optimal post-operative management

Series

Current Thinking in Back Pain Management

OTHER TALKS IN THIS SERIES

SCOPE OF THE PROBLEM
Play '1. Current thinking in back pain management - introduction'
1. Current thinking in back pain management - introduction More info
Ms. Anna Hlavsova

TOPICS COVERED IN THIS TALK

  • Series overview
BIOMECHANICS, SPINAL SURGERY AND RESEARCH METHODS
Play '2. The biomechanics of back pain: what we know so far'
2. The biomechanics of back pain: what we know so far More info
Prof. Michael Adams

TOPICS COVERED IN THIS TALK

  • Spinal anatomy
  • Where back pain comes from
  • Forces acting on the spine
  • Mechanisms of injury to the lumbar spine
  • Predisposition to injury: “vulnerable” tissues
  • Spinal degeneration
  • “Functional pathology”
Now Playing
Play '4. What does physiotherapy teach us about back pain?'
4. What does physiotherapy teach us about back pain? More info
Ms. Joesphine O'Callaghan

TOPICS COVERED IN THIS TALK

  • Physiotherapy as an intervention for lower back pain (LBP)
  • Classifying LBP
  • Subjective assessment
  • Neurological evaluation
  • Movement assessment
  • Palpation & muscle testing
  • LBP management and therapy
CHRONIC PAIN AND CURRENT CHALLENGES
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TOPICS COVERED IN THIS TALK

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  • The determinants of disability (psychosocial vs. injury)
  • Psychosocial factors as obstacles to work participation
  • The key to help: Evidence-informed Psychosocial Flags Framework
CURRENT THERAPIES AND TREATMENTS
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TOPICS COVERED IN THIS TALK

  • Psychological processes/factors associated with transition to chronic pain
  • Depression in the context of pain
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Play '7. Psychological treatment for people with musculoskeletal pain - part 2 of 2'
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TOPICS COVERED IN THIS TALK

  • Psychological intervention trials for chronic pain
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  • The use of cognitive-behavioural (CBT) approaches
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8. Combined physical and psychological programmes plus alternative therapies for back pain More info
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TOPICS COVERED IN THIS TALK

  • Increasing prevalence of back pain and its impacts
  • The biopsychosocial model
  • Combined physical and psychological programs
  • Alternatives: online pain management program, complementary and alternative medicine

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