Civil Engineering Reference
In-Depth Information
FIGURE 20.11 A challenge for the torsional components that produces low spine loads is to support the extensor
moment of the flexed torso with one hand while the other raises a modest weight. The lumbar torso is braced
(including all layers of the abdominal wall) in a neutral posture resisting the twisting moments generated by the weight.
In summary, progression of a patient through rehabilitation to function follows the three-step
procedure:
1. Establish motion and motor patterns that avoid the injury mechanisms identified earlier in this
chapter. Painful motion
motor patterns may have also been identified through provocative
testing of the worker and should be avoided in this first step
2. Enhance lumbar stability
3. Progress to functional tasks while ensuring sufficient stability, but staying with the current
tolerance to withstand the elevated loads placed on the spine
/
This chapter focussed on the second step in the process.
20.11 Looking Forward
Rehabilitation endeavors are continuing to embrace techniques that consider notions of lower torso, or
“core,” stability. While there is no question that first a systemmust be stable before presented with a phys-
ical challenge, the enhancement of low back health and the avoidance of troubles have motivated scien-
tific inquiry into the mechanics of stability. Many groups continue to work to understand the
contributions to stability of various components of the anatomy at particular joints — and the ideal
ways to enhance their contribution; to understand what magnitudes of muscle activation are required
to achieve sufficient stability; to identify the best methods to re-educate faulty motor control systems
to both achieve sufficient stability and reduce the risk of inappropriate motor patterns occurring in
the future. Clearly, it is these objectives that are needed to deal with the well-documented deficits in
those workers with back troubles — namely the need to ensure sufficient spine stability.
Acknowledgments
The continual financial support from the Natural Science and Engineering Research Council, Canada is
gratefully acknowledged and has made this series of work possible.
References
1. Adams, M.A., McNally, D.S., Chinn, H., and Dolan, P., Posture and the compressive strength of the
lumbar spine, Clin. Biomech., 9, pp. 5-14, 1994.
2. Adams, M.A. and Dolan, P., Recent advances in lumbar spine mechanics and their clinical signifi-
cance, Clin. Biomech., 10, pp. 3-19, 1995.
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