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The biomechanics of back pain: what we know so far
Published on July 30, 2015 43 min
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Welcome to "The Biomechanics of Back Pain, What We Know So Far." This is going to be an account of the mechanical and biological origins of low back pain. I'm Mike Adams. I'm professor of biomechanics at the University of Bristol in the UK. My background is in physics and in biology. I'm not a clinician, and I don't treat patients. But I will, of course, be dealing with clinical matters.
Well this is a running order of the topics in this presentation. First of all, I'll begin with some functional anatomy. I'll describe some features of anatomy I'll be wanting to refer to later on. Then I'll tackle the most important question, where does back pain come from? I'll then go on to discuss spinal injuries under three headings. I'll consider where the forces come from that act on the spine, and then describe how those forces can injure different structures in the spine. And then, under vulnerable tissues, I'll try to explain why some people hurt their backs, where other people seem to get away with loading them very severely without any adverse consequences. The next, topic spinal degeneration, will be the biggest single topic. And here I'll try to explain how injury to specific tissues, particularly cartilage, can lead to degenerative changes, and how these degenerative changes can lead to chronic back pain. The final topic, functional pathology, I'll deal with very briefly. And then I'll pull the talk together in the final slide.
The diagram on the left hand side here shows you along the spine. The bones, or vertebrae, are separated by intervertebral discs, shown in blue. Each intervertebral disc is a pad of fibrocartilage, about one centimeter high. And because the discs are deformable, it means that the whole spine can move slightly, not a great deal. On the right hand side is a photograph of a typical mature intervertebral disc. The disc consists of two tissues. In the center is the nucleus pulposus, which tends to be soft and squidgy, high water content. And it can behave like pressurized fluid. The nucleus is surrounded by the concentric layers, or lamelle, of the annulus fibrosis. This is mostly made of collagen. It provides great mechanical strength to an intervertebral disc. Now before I leave this slide, if you go back to the left hand side, look at that dotted line. That dotted line runs down the long axis of the spine. And forces acting down the long axis of the spine, following this dotted line, is what I'll be referring to as a compressive force on the spine.