Low Back Pain: Mechanism, Diagnosis and Treatment

Front cover\r......Page 1
Forward\r......Page 6
Preface\r......Page 10
Acknowledgments\r......Page 12
Contributors\r......Page 14
History of the Development of Cox Distraction Manipulation\r......Page 18
Facts on Patients Seeing Chiropractors\r......Page 21
Physical Therapy\'s View of Chiropractic and Spinal Manipulation\r......Page 22
Medical Physicians\' Interaction with Chiropractic Physicians\r......Page 24
Cost of Chiropractic Services\r......Page 25
Chiropractic Treatment: Literature\'s Negatives\r......Page 26
Chiropractic Treatment: Literature\'s (and Governmental) Positives\r......Page 27
U.S. Department of Health and Human Services Recommends Spinal Manipulation for Acute Low Back Pain\r......Page 29
Distraction Adjusting is a Specialist Procedure\r......Page 30
References\r......Page 31
Neuroanatomy and its Role in Diagnosing Disc Herniation\r......Page 34
Effects of Disc Circulation and Low Back Pain Incidence\r......Page 40
Disc and Facet Biomechanics in Low Back Pain and Sciatica Patients\r......Page 42
Intervertebral Disc Has a Dual Nerve Supply: Autonomic and Spinal Nerve\r......Page 45
Anulus Fibrosus is the Most Pain-Sensitive Structure in the Lumbar Spine\r......Page 46
Tropism\r......Page 58
Intervertebral Disc Biomechanics- Normal and Aberrant\r......Page 68
Radiographic Study of Lateral Flexion Disc Mechanics of the Lumbar Spine and Pelvis\r......Page 73
Radiographic Studies\r......Page 75
Physiologic and Abnormal Lumar Motions\r......Page 85
Normal Disc and Apophyseal Joint Anatomy and Physiology\r......Page 91
Anatomic and Demographic Factors in Low Back Pain\r......Page 98
What are the Limiting Anatomic Structures (Disc, Facet, Ligaments) to Torsional Rotation Motion of the Lumbar Spine\r......Page 99
Lumbar Spine Motion Dynamics and Aberrancies\r......Page 101
Nucleus Pulposus Motion Within the Anulus Fibrosus on Flexion and Extension\r......Page 118
Disc Changes with Degeneration and Osteoarthritis\r......Page 123
Osteophyte Role in Disc Degeneration\r......Page 125
Facet Joint in Cause of Low Back Pain\r......Page 126
Other Factors in Biomechanically Induced Low Back Pain\r......Page 129
Piriformis Syndrome\r......Page 131
Biomechanical Factors in Chiropractic Manipulation\r......Page 134
Short-Leg Biomechanics and Basic Correction\r......Page 135
References\r......Page 138
Dorsal Root Gangion Anatomy and Physiology\r......Page 148
DRG Changes Produce Radiculopathy and Thermal Hyperalgesia\r......Page 149
Chemical Radiculitis\r......Page 160
Mechanical and Chemical Irritation Compared as Cause of Radiculopathy\r......Page 163
Mechanical Compression of the DRG in the Neuroforamen\r......Page 164
How much Disc Reduction is Necessary to Relieve Pain?\r......Page 167
A Hypothesis Introducing a New Calculation for Discal Reduction: Emphasis on Stenotic Factors and Manipulative Treatment\r......Page 169
What Happens When a Nerve or Nerve Root is Exposed to a Herniated Disc or a Narrowing of the Spinal Canal?......Page 173
The Spinal Cord: Active Processor, Not Passive Transmitter of Impulses\r......Page 176
Reflex Sumpathetic Dystrophy (Complex Regional Pain Syndrome)\r......Page 177
Nerve Regeneration Factors\r......Page 178
Pelvic Pain and Disease Correlated with Nerve Compression\r......Page 179
References\r......Page 181
Stenosis\r......Page 186
Causes of Nerve Root Symptoms\r......Page 187
Clinical Relevance of Stenosis\r......Page 189
Effect of Stenosis on Intraosseous Blood Flow\r......Page 193
Symptoms of a Stenotic Canal\r......Page 195
Growth Factors in Stenosis\r......Page 196
Intermittent Claudication\r......Page 197
Plain Radiographic Evaluation for Stenosis\r......Page 199
Operative Treatment in Cases of Small Canals\r......Page 202
Grading System\r......Page 203
Causes of Stenosis\r......Page 204
Transforaminal Ligaments Cause Stenosis\r......Page 209
Degenerative Spondylolisthesis\r......Page 210
Treatment\r......Page 212
Nonsurgical Outcomes\r......Page 215
References\r......Page 221
Anatomy\r......Page 226
Biomechanics\r......Page 236
Pain Management\r......Page 244
References\r......Page 248
Chae Song Ro, M.D., Ph.D\r......Page 252
6. TRANSITIONAL SEGMENT\r......Page 254
Classification of Lumbosacral Transitional Vertebrae\r......Page 256
References\r......Page 266
Diagnosis\r......Page 268
Differential Diagnosis\r......Page 270
Cause and Pathophysiology\r......Page 271
Chiropractic Care\r......Page 272
Miscellaneous Therapies \r......Page 273
References\r......Page 274
Research on Flexion-Distraction Procedure\r......Page 278
Intradiscal Pressure Measurements\r......Page 281
Results\r......Page 284
References\r......Page 288
Decision-Making in the Care of the Low Back Pain Patient with and Without Sciatica\r......Page 290
Chiropractic Distraction Adjustment- A Popular Conservative Treatment Regimen\r......Page 291
Effects of Flexion-Distraction Adjustments\r......Page 292
Flexion-Distraction Effects on the Lumbar Spinal Canal and Intervertebral Foramen Capacity\r......Page 293
Nucleus Pulposus and Anulus Fibrosus Movement During Flexion and Extension\r......Page 295
Biomechanics of Flexion-Distraction Adjustment\r......Page 297
No Correlation Between Size and Symptoms of Disc Herniation\r......Page 301
Mechanoreceptor Activation with Axial Distraction Adjusting\r......Page 302
Spinal Adjustments Normalize Afferent Pathways and Stop Pain\r......Page 303
Inclusion and Exclusion Criteria For Distraction Adjusting\r......Page 305
Distraction Treatment Protocol\r......Page 308
Cox Distraction-Adjustment Procedure Protocol\r......Page 312
Specialized Cox Distraction Techniques\r......Page 318
Automated Distraction Adjusting\r......Page 322
Outcome Measures of 1000 Cases Studied Using Chiropractic Distraction Adjustment\r......Page 327
References\r......Page 343
Pre-And Postdistraction Adjustment Care\r......Page 345
Electrical Stimulation\r......Page 347
Bracing\r......Page 350
References\r......Page 353
Summaries of Specific Drug Side Effects on Bone and Cartilage\r......Page 354
References\r......Page 356
Nutritional Approaches to Treating Disc Herniation and Osteoporosis\r......Page 357
Glucosamine Sulfate and Glychosaminiglycan Benefits and Clinical Outcome Studies\r......Page 359
References\r......Page 360
Osteoporosis\r......Page 361
Calcium and Vitamin D3 Treatment Results\r......Page 363
Cox Low Back Wellness School\r......Page 364
References\r......Page 367
Low Back Wellness School\r......Page 368
Return to Work Principles\r......Page 369
Pathophysiologic Findings in Back Pain Patients\r......Page 372
Muscle Strength can be Regained Through Exercise\r......Page 373
Low Back Belt Supports\r......Page 375
What is the Best Lifting Posture?\r......Page 376
References\r......Page 378
Care of Specific Low Back Conditions\r......Page 379
Two Final Factors in Treating Lumbar Disc Disease\r......Page 392
Chiropractic Specializtion in Low Back Pain is Becoming a Reality\r......Page 393
Low Back Pain Terms\r......Page 394
Sources of Low Back Pain Complaints\r......Page 396
Diagnostic Biomechanics\r......Page 399
Organic or Idiopathic Fluid Ingestion (Type II)\r......Page 401
Posterolateral Anulus Disruption (Type III)\r......Page 402
Bulgin Disc (Type IV)\r......Page 403
Displaced Sequestered Fragment (Anchored) (Type VI)\r......Page 404
Degenerative Disc (Type VII)\r......Page 405
Discography: Contributions to Disc Disease Diagnosis\r......Page 409
When to Order Diagnostic Imaging Studies\r......Page 423
Comparison of Imaging Modalities in Disc Herniation Diagnosis\r......Page 425
Gadolinium -Enhanced MRI Advantages in Diagnosis\r......Page 430
Contained (Protruded) and Noncontained (Prolapsed) Discs\r......Page 433
Examination\r......Page 440
Correlative Diagnosis of Low Back Pain\r......Page 463
Special Diagnostic Considerations\r......Page 465
Upper Lumbar Disc Herniations-Diagnostic Challenge\r......Page 466
Far Lateral Herniated Lumbar Disc Herniation\r......Page 467
Case Presentation of Typical Diagnoses Made Using Author\'s Examination Protocol\r......Page 471
Pathologic Causes of Low Back Pain and Sciatica\r......Page 480
References\r......Page 518
11. LABORATORY EVALUATION\r......Page 526
Nonspecific Laboratory Indicators of Disease\r......Page 527
Focused Laboratory Tests\r......Page 530
Laboratory Evaluation of Specific Disorders\r......Page 533
References\r......Page 540
Cost Outcome and Consideration of Back Care\r......Page 544
Surgery Contrasted With Conservative Care of Sciatica Patients\r......Page 546
Pediatric Lumbar Disc Herniation\r......Page 547
When Does Diagnostic Imaging Become Necessary in a Patient with Radiculopathy?\r......Page 548
Natural Course of Disc Herniation\r......Page 549
Comparison of Surgical Approaches\r......Page 551
Complications of Lumbar Disc Surgery\r......Page 552
Differential Diagnosis of Recurrent Herniated Disc Material From Scar Tissue\r......Page 553
Spinal Fusion-Controversial\r......Page 554
Presentation of Failed Back Surgical Syndromes\r......Page 557
Other Less Used Forms of Treatment for Low Back Pain\r......Page 567
Epidural Steroid Injections\r......Page 568
Return to Work Factors Following Low Back Injury\r......Page 570
Manual Therapy Superior to Conventional Medical Care for Low Back Pain Patients\r......Page 572
Diagnostic Imaging Changes Following Treatment of Herniated Lumbar Disc Patients\r......Page 574
Postsurgical Recurrent Disc or Scar Tissue Fails to Correlate with Pain\r......Page 576
Manipulative Expectation in the Clinical Setting\r......Page 579
Manipulation and Distraction Techniques and Concepts for Low Back and Leg Pain Treatment\r......Page 581
Another Opinion on Traction Application\r......Page 583
Stoddard\'s Osteopathic Technique\r......Page 584
Treatment of the Intervertebral Disc Protrusion Patient\r......Page 585
Presentation of Disc Herniation Patients From the Author\'s Clinical Practice\r......Page 587
Lumbar Spine Treatment Ending\r......Page 594
Treatment of Thoracic Disc Herniation\r......Page 599
References\r......Page 600
Compressive Forces Acting on the Articular Joints\r......Page 608
Pain Sensitivity of the Facet Synovial-Lined Joint\r......Page 610
Radiographic Concepts of Facet Syndrome\r......Page 613
Stability in the Facet Syndrome and an Indication of Response to Manipulation\r......Page 616
Structural Factors of the Lumbosacral Region\r......Page 618
Facet Pain Patterns\r......Page 619
Lumbar Facet Injections with Corticosteroids: Are They of Any Benegit in Chronic Low Back Pain?\r......Page 620
Summary of Manipulative Principles\r......Page 622
Retrolisthesis Subluxation\r......Page 623
References\r......Page 625
Classification\r......Page 628
Incidence of Spondylolysis and Spondylolisthesis\r......Page 630
Pain Origin in Spondylolisthesis\r......Page 632
Mechanisms of Nerve Root Compression in Spondylolisthesis\r......Page 633
Conditions Influencing Symptoms\r......Page 634
Stability of Spondylolisthesis and its Therapeutic Implications\r......Page 635
Multiplanar Computed Tomography, Magnetic Resonance Imaging, and Discographic Examination\r......Page 644
Diagnosis and Treatment of Children with Spondylolisthesis\r......Page 648
Degenerative Spondylolisthesis\r......Page 649
Case Presentations of Degenerative Spondylolisthesis From the Author\'s Clinic\r......Page 651
Nonsurgical Treatment of Degenerative Spondylolisthesis\r......Page 658
Treatment of Athletes with Spondylolysis or Spondylolisthesis\r......Page 660
Conservative Treatment\r......Page 661
Results of Treatment\r......Page 662
References\r......Page 666
Overview: Exercise, Functional Recovery, and Low Back Pain......Page 670
Mechanisms of Spinal Stability\r......Page 671
Linking Muscular Dysfunction with LBP\r......Page 672
Evaluating Muscle Balance: Concepts and Common Syndromes\r......Page 674
Patient Assessment\r......Page 676
Exercise Prescription for Lumbar Stabilization\r......Page 682
References\r......Page 693
16. PSYCHOLOGICAL PERSPECTIVES IN TREATING LOW BACK PAIN\r......Page 696
What Risks Lead to Chronic Low Back Pain?\r......Page 697
What Psychiatric Relationships Have Been Indentified?\r......Page 699
How Do We Care For These Patients?\r......Page 701
Diagnosis and Indentification\r......Page 702
References\r......Page 703
Biomechanics and Causes of Low Back Pain\r......Page 706
Nerve Root Irritation Research\r......Page 708
Disc\r......Page 710
Incidence\r......Page 712
Treatment\r......Page 713
Chiropractic Results and Opinions\r......Page 714
Poor Outcome with Pedicle Screw Fusion\r......Page 715
Less Disc Reduction in Poor Clinical Outcomes\r......Page 716
Osteoporosis\r......Page 717
References\r......Page 720
Finite Element Modeling\r......Page 724
Intervertebral Disc Pressure Changes During Different Table Motions......Page 726
References\r......Page 728
INDEX\r......Page 730