The Biomechanics of Back Pain

I commenced research into spinal pain, in 1972, when essentially nothing was known about the problem. There being no established groups or departments working on this problem, I forged my own career, using borrowed resources. I commenced in a Department of Anatomy, where I pursued the innervation of the vertebral column as a fundamental element in understanding the sources and mechanisms of spinal pain. Professor Jim Lance fostered this interest, and accommodated my PhD studies. In his department I continued my anatomy studies but was able also to commence clinical applications. I developed and tested new diagnostic and surgical procedures for back pain and for neck pain. While in Professor Lance's Department, I participated in laboratory studies of the mechanisms of migraine. At the University of Queensland I continued to develop and apply the diagnostic and surgical techniques that I started at the University of NSW, serving as an honorary medical officer at the Pain Clinic of Princess Alexandra Hospital. Meanwhile I supervised science and medicine postgraduate students who undertook basic science studies into the biomechanics of the back and neck. At the University of Newcastle, I had established a reputation sufficient to attract a grant from the Motor Accidents Authority of NSW to investigate the cause and treatment of neck pain after whiplash. The grant supported three PhD students over a six year period. They performed studies that validated the diagnostic procedures and which tested the surgical procedures in a placebo-controlled double-blind randomized trial. Having established an international standing in the development and testing of treatments for spinal pain, I participated in the design and analysis of controlled trials conducted elsewhere in Australia and in the USA. These tested the efficacy of: lumbar radiofrequency neurotomy for back pain, intradiscal electrothermal anuloplasty for back pain, prolotherapy for back pain, exercises for neck pain. Between 1997 and 2002 I conducted the National Musculoskeletal Medicine Initiative which developed and tested evidence-based practice guidelines for the management of back pain, neck pain, shoulder pain, knee pain, and pain in the foot, wrist, and elbow. My work has been awarded the Volvo Award for Back Pain Research, the Research Prize of the Cervical Spine Research Society, the Award for Outstanding Research of the North American Spine Society, and three times the Research Prize of the Spine Society of Australia. My students have been awarded research prizes by the International Association for the Study of Pain, the Australian Rheumatology Association, and the Australian New Zealand College of Anaesthetists. I have never had a funded department to which to attract investigators and academics. I have relied on scholarships for students, and the goodwill of private practitioners who wished to contribute to clinical research. Of late, I have been supervising Neurosurgery residents undertaking studies of the outcomes of treatment for Radicular pain and back pain.

1. Introduction

2. The vertebral column and adjacent structures

3. Muscles and fascia of the lumbar spine

4. Nerves and blood supply to the lumbar spine

5. Back pain

6. Epidemiology of back trouble

7. Biology of spinal tissues

8. Growth and ageing of the spine

9. Forces acting on the thoracolumbar spine

10. Mechanical function of the thoracolumbar spine

11. Mechanical damage to the thoracolumbar spine

12. Cervical spine biomechanics

13. Posture, creep and "functional pathology"

14. Sensorimotor control

15. Spinal degeneration

16. Preventing back pain

17. Conservative management of back pain

18. Biomechanics rationale for spinal surgery

19. Surgery for disc prolapse, spinal stenosis and back pain

20. Medico-legal considerations

21. Summary and Conclusions