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Nontraditional perspectives on the spine

This is an excerpt from Low Back Disorders 4th Edition With HKPropel Access by Stuart McGill.

UNIQUE SCIENTIFIC FOUNDATION OF THIS BOOK

This book contains many nontraditional viewpoints on how the spine functions and becomes damaged. Most of these perspectives have emerged from the six pillars of evidence mentioned earlier that we have been developing for over 30 years at the laboratory and clinic at the University of Waterloo in Canada. The goal of this chapter is to familiarize you with the unique general approach to obtaining much of the data described in this book and to help you understand both the limitations of and the unique insights provided by this approach.

As spine biomechanists, our initial methods of inquiry are similar to those used by mechanical or civil engineers. For example, a civil engineer charged with the task of building a bridge needs three types of information:

• The traffic to be accommodated, or the design load
• The structure to be used (e.g., space truss or Roman arch), because each type of architecture possesses specific mechanical traits and features
• The characteristics of the proposed materials that will affect strength, endurance, stability, resistance to structural fatigue, and so on

Our approach to investigating spine function is similar to that of our engineering colleagues. We begin with the following relationship to predict the risk of tissue damage:

Applied load > tissue strength = tissue failure (injury)

Recall from the tissue injury primer earlier in this chapter that tissue strength is reduced by repeated and prolonged loading but is increased with subsequent rest and adaptation. Analyzing tissue failure in this way requires two distinct methodological approaches. This is why we developed two quite distinct laboratories, which led to much of the progress documented in this book. (The “we” used in this chapter includes my research team of graduate students, visiting scholars, and technicians.) Our first lab is equipped for in vitro testing of spines, in which we purposefully try to create herniated discs, damaged end plates, and other tissue-specific injuries. The second lab is the in vivo lab, where living people (both those with and those without low back issues) are tested for their responses to stress and loading. Individual tissue loads are obtained from sophisticated modeling procedures. The final stage is to test the new findings in the clinic. The following is a brief explanation of the process.

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