In the world of spine research, few have contributed as much as Dr. Michael Adams. In his work as a clinical professor of biomechanics at the University of Bristol in the U.K., he and his research colleagues have helped to further our understanding of the cause of one of the most common maladies affecting humans…back pain. His watershed research 20 years ago helped us understand the diurnal phenomenon in lumbar discs which results in markedly increased risk of disc injury in the first hour after arising due to increased hydrostatic pressure. Over the past 30 years, his area of focus in his dozens of research projects have moved from pain of vertebral endplate origin, to pain of nucleus pulposus origin, to his most recent interest in pain of annulus fibrosus origin.
Mr. Adams’ recent opinion paper on future strategies for treatment of back pain of annular origin raises some interesting questions that touch on some hot topics in the world of rehab. He notes the similarity of the annular tissue to tendon tissue and wonders whether clinicians should consider loading the annulus strategically during specific phases of rehab to improve outcomes. Given that some of that loading might be arguably be into flexion, I wanted to talk with Mr. Adams about how we might explore these loading vectors safely to avoid risk of re-injury to patients. I also wanted to get his opinion on what the research says about the wisdom of loading the flexed spine with exercise in the un-injured spine.
Quick bullet points in this interview include
- Disc injuries take a long time to heal and may never heal to ‘original factory specifications’
- Endrange loading of the lumbar spine injures discs
- Loading of discs into flexion, but not to endrange, AND WITH CAREFUL ASSESSMENT AND MONITORING may help improve health of a disc during late phase of remodelling
- Tendons may represent the closest other body tissue that we have some understanding of the effect of loading on during healing
- We still haven’t figured out many things about tendonopathy
- We still need to define what constitutes ‘loading’ during flexion of the spine and what safe frequency of loading might be
- Sit ups and crunches at the right time, at the right frequency, and in the right volume, MAY theoretically help to improve the health of discs
Click on the arrow below to hear the interview with Michael Adams, PhD.
Adams MA, Stefanakis M, Dolan P. Healing of a painful intervertebral disc should not be confused with reversing disc degeneration: implications for physical therapies for discogenic back pain. Clin Biomech (Bristol, Avon). 2010 Dec;25(10):961-71. Epub 2010 Aug 23.