Reducing low back injury: expanding fundamental knowledge of spine function

腰背损伤是加拿大人的主要损失。脊柱是一个非常复杂的神经、肌肉和骨骼系统，在最佳的机械负荷下茁壮成长。然而，当机械负荷过多或过少时，它就会变得痛苦和残疾。这项工作旨在了解下背部的生物力学功能，并将这些基本知识作为基础，开发更好的预防和康复方法。我们在基础研究方面的贡献有几个重点。例如，我们破译损伤机制的工作表明，椎间盘突出和突出有明显的机械原因（反复和长时间的屈曲），可以通过机械方法预防和治疗。下一阶段是了解扭转和扭转对该机制的影响。此外，脊柱肌肉产生的力量和扭矩，允许运动和负载的支持。但最重要的是，他们必须确保灵活的脊柱是稳定的，否则它就有屈曲的危险——另一种潜在的损伤机制。我们的工作改进了量化稳定性的方法，然后在患者中识别出可能导致不稳定状态发生或疼痛的肌肉激活模式。这样，不稳定性既是损伤的原因，也是损伤的结果。作为治疗的一个组成部分，我们一直在探索纠正这些紊乱模式的方法。其他人进行的疗效试验表明，这种方法是成功的。我们将继续在广泛的活动中量化稳定性，以更好地了解肌肉和被动组织的最佳激活策略，以达到足够的稳定性。这将需要非常强大的建模工作，考虑到个体的可变性，以及反射活动等特征。我们独特的实验室方法是在NSERC多年的支持下开发的，结合了体内和体外方法，已用于改善世界各地的循证临床决策。

Low back injury is a major cost to Canadians. The spine is a very complex neural, muscular and skeletal system that thrives on optimal mechanical loading. However, it becomes painful and disabled when the mechanical loading is either too much or too little. This work is directed towards understanding biomechanical function of the low back, and using this fundamental knowledge as a foundation, developing better prevention and rehabilitation approaches. Our contributions in fundamental research has several thrusts. For example, our work deciphering injury mechanisms has shown that disc bulging and herniation have a distinct mechanical cause (repeated and prolonged flexion) that can be prevented and treated mechanically. The next phase is to understand the influence of twisting and torsion on this mechanism. In addition, the muscles of the spine create force and torque that allow movement and the support of loads. But first and foremost they must ensure that the flexible spinal column is stable otherwise it is at risk of buckling - another potent injury mechanism. Our work has improved methods to quantify stability and then has recognized perturbed muscle activation patterns in patients that may allow unstable conditions to occur, or are the result of pain. In this way instability is both a cause and consequence of injury. We have been pioneering approaches to correct these perturbed patterns as a component of therapy. Efficacy trials conducted by others show the approach is successful. We will continue to quantify stability during a wide range of activities to better understand the best activation strategies for muscles and passive tissues to achieve sufficient stability. This will require very robust modeling efforts that account for individual variability, together with features such as reflex activity. Our unique laboratory approach developed with years of NSERC support, combines both in vivo and in vitro approaches that has been used to improve evidence-based clinical decision making around the world.