Reducing low back injury: expanding fundamental knowledge of spine function

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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.