11102013

1

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Need technical support for this live event

Please call 1800 006 293 then press 1

NOTE You will be initially asked for the email address associated with this webinar account ndash ldquoSay Irsquom a webinar attendee ndash I donrsquot have an accountrdquo

This webinar will begin in the next few minutes

Be sure to convert to your own time zone at wwwworldhealthwebinarscomau

A New Perspective on NSLBP

and its Management

Presented by Sarah Key

Will commence LIVE from Sydney AUS at 7pm AEDT

Andrew Ellis BSc (Ex Sci) M Phty

World Health Webinars CEO

World Health Webinars Host

Musculoskeletal Physiotherapist Sydney CBD

Need technical support

Please call 1800 006 293 then press 1

You will need to tell them that you are a webinar attendee and do not have an email account with Citrix

Click red button to minimise

You will be muted

during every webinar

Make as much noise as

you like )

Dodgy computer

speakers Select

Telephone and call in

toll - FREE to hear the

presentation

Questions Wersquoll

answer them all at

the end

Sarah Key

bull Best known for treating the Royal family and was made a Member of the Victorian Order by Her Majesty the Queen in 2003

bull Author of best selling back pain books including Back in Action Back Sufferers Bible Body in Action and The Back Sufferers Pocket Guide These books have sold over 100000

bull Recently published two papers on disc degeneration

bull Educates aspiring physiotherapists and holds Back-in-a-Week intensive 5 day spinal therapy programs in Australia and the UK

Physiotherapist

11102013

2

A New Perspective on

NSLBP

and its Management

SARAH KEY

Part 1 The Basics of

How a Healthy Spine Works

wwwsarahkeycom

A normal spine and lumbar spinal segment

Front

compartment

Back

compartment

Front

compartment

Back

compartment

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

The intervertebral disc is like a water-filled

pillow between the bony spinal segments

bull

Adams et al Biomechanics of Back Pain

wwwsarahkeycom

Component parts of the intervertebral disc

Prithvi Raj Pain Pract 2008 Vol 8 (1) 18ndash44

wwwsarahkeycom

The disc wall [anulus fibrosus]

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

3

Only the outer few layers of the disc wall has

a nerve and blood supply

Bogduk Clinical Anatomy of the Lumbar Spine

wwwsarahkeycom

Each 24 hours the lumbar discs exchange about

20 of their discal fluid

Wersquore all 2cm shorter when we go to bed

wwwsarahkeycom

Discs have 3 lsquonutritional enginesrsquo

bull Diffusion molecules spread from high to low density areas like a sugar cube in tea [small solute molecules]

bull Osmosis created by the complex proteoglycans molecules [small solutes]

bull Convection physical squash-and-suck effect of pressure changes [large molecules] physical=physiotherapy

Ishihara H Urban JP

Effects of low oxygen concentrations and metabolic inhibitors on

proteoglycans and protein synthesis rates in the IVDrsquo

J of Ortho research 1999 17 829-835

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Discs are huge torpid structures They need

help to transport nutrients and waste products

bull By day spinal movement helps suckampsquirt a fluid exchange through

bull By night the discs get most of their nutrition by osmosisdiffusion

wwwsarahkeycom

The paired facet joints flanking the disc

have a rich blood supply amp are lsquowired for painrsquo

wwwsarahkeycom

The spinal nerve roots exit bilaterally between

the disc and facet joints at each spinal level

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

4

Part 2 Why a Spinal Segment

Starts Causing Pain

wwwsarahkeycom

Lumbar discs break down in life earlier

than any other human tissue

Adams TBOBP

wwwsarahkeycom

The lower back sacrifices mobility for

stability

wwwsarahkeycom

We are a culture of mod con users

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Our activity mode is mostly bent forward

wwwsarahkeycom

Even moderate flexion increases disc loading

wwwsarahkeycom

11102013

5

Sedentary postures smother the metabolic

activity of discs and force too much fluid out

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

The lumbar discsrsquo metabolic rate slows and

load is transferred to the disc walls

wwwsarahkeycom

It becomes easier and easier to injure a

non-compliant outer disc wall

wwwsarahkeycom

The ligamentous outer annulus can sense injury

wwwsarahkeycom

The muscles lock up to protect the stiffer link

BUT BEWARE

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Muscular compression can escalate breakdown

wwwsarahkeycom

11102013

6

Part 3 What Can We

Therapists Do About It

wwwsarahkeycom

Mobilising first But only short term

Beattie Joint mobilisation can increase water content in a degenerated L5 disc by 22

Beattie P F Donley J W Arnot C F Miller R The change of diffusion of water in normal and degenerative lumbar intervertebral discs following joint mobilization

compared to prone lying Jan 09 Vol 39 Number 1 Journal of Orthopaedic and Sports Physical Therapy

wwwsarahkeycom

I say the heel is the most effective - and gentle - spinal

mobilising tool

lsquorestoring compliance of the outer annulusrsquo

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Part 4 The Patientsrsquo Daily Decompression

wwwsarahkeycom

Does prophylactic BackBlock Stretching the

annulus lsquoarm itrsquo against future compression

Lotz lsquoMaintaining tension in the annulus protects it from degeneration initiated by compressionrsquo

Lotz J C Hadi T Bratton C Reiser K Hsieh K Anulus fibrosis tension inhibits degenerative structural changes in the lamellar collagen Eur Spine J (2008) 171149-1159

wwwsarahkeycom

Because of the proteoglycans factor itrsquos easier

separating than squashing segments

wwwsarahkeycom

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

7

There are many different ways to achieve

lumbar tractiondecompression

wwwsarahkeycom

The easiest The cheapest The best

wwwsarahkeycom

Then my patients do BackBlock [PCT] self-help

-- once per day 3 steps 3 times

bull Passive traction over BackBlock (60 secs)

bull Active assisted flexion (15 secs)

bull Reverse curl ups (15 times)

bull Each evening (for life)

wwwsarahkeycom

From our recent BackCare research grant at

Bristol University

We believe that treatment should aim to promote healing of the peripheral anulus

Adams M Key S Tarlton J Sharif M Dolan P Harding I

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Mike Adams in recent lsquoClinical Biomechanicsrsquo paper

bull lsquoPhysical therapies should aim to promote healing in the disc

periphery by stimulating cells boosting metabolite transport and

preventing adhesions and re-injury Such an approach has the

potential to accelerate pain reliefrsquo

Adams MA et al Healing of a painful intervertebral disc should not be confused with reversing disc degeneration Implications for physical therapies for discogenic back pain

Clin Biomech(2010) doi101016jclinbiomech201007016 [not in print until late 2010]

wwwsarahkeycom

The very strong anterior spinal ligament and the

hip flexors are stretched by passive extension

wwwsarahkeycom

11102013

8

Greatest velocities of discal fluid shift happens

after loading and unloading the spine

wwwsarahkeycom

The BackBlock is traction

helps restore fluid content of discs

bullGuehring lsquoDistraction results in disc rehydration and increased numbers of protein-expressing cellsrsquo

Guehring T Omlor GW Lorenz H Engelleiter K Richter W Carstens C Kroeber M Disc distraction shows evidence of regenerative potential in degenerated intervertebral

discs as evaluated by protein expression magnetic resonance imaging and messenger ribonucleic acid expression analysis Spine 2006 Jul 1 31(15)1658-65

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Cyclic stretching alone restores healthy discal

lsquobiosynthetic activityrsquo

Hee lsquoDynamic stretch at a rate of 1 Hz with 10 tensile strain is capable of increasing collagen synthesis in a previously compressed annulusrsquo

Hee H T Zhang J Wong H K Effects of cyclic dynamic tensile strain on previously compressed inner annulus fibrosus and nucleus pulposus cells of human IVD -an in vitro study J Orthop Res 2010 Apr28(4)503-9

wwwsarahkeycom

Neuro-vascular net is stretched lsquoknees rockingrsquo

wwwsarahkeycom

The lower abdominal muscles get weaker

with prolonged sitting

wwwsarahkeycom

Reverse curl-ups strengthen the lower

abdominals amp pelvic floor

bull Mainly internal oblique transversus abdominus

bull The below navel lower basket of the belly lsquoreefed inrsquo

bull No aggressive end-scoring to cause incidental shear

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

2

A New Perspective on

NSLBP

and its Management

SARAH KEY

Part 1 The Basics of

How a Healthy Spine Works

wwwsarahkeycom

A normal spine and lumbar spinal segment

Front

compartment

Back

compartment

Front

compartment

Back

compartment

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

The intervertebral disc is like a water-filled

pillow between the bony spinal segments

bull

Adams et al Biomechanics of Back Pain

wwwsarahkeycom

Component parts of the intervertebral disc

Prithvi Raj Pain Pract 2008 Vol 8 (1) 18ndash44

wwwsarahkeycom

The disc wall [anulus fibrosus]

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

3

Only the outer few layers of the disc wall has

a nerve and blood supply

Bogduk Clinical Anatomy of the Lumbar Spine

wwwsarahkeycom

Each 24 hours the lumbar discs exchange about

20 of their discal fluid

Wersquore all 2cm shorter when we go to bed

wwwsarahkeycom

Discs have 3 lsquonutritional enginesrsquo

bull Diffusion molecules spread from high to low density areas like a sugar cube in tea [small solute molecules]

bull Osmosis created by the complex proteoglycans molecules [small solutes]

bull Convection physical squash-and-suck effect of pressure changes [large molecules] physical=physiotherapy

Ishihara H Urban JP

Effects of low oxygen concentrations and metabolic inhibitors on

proteoglycans and protein synthesis rates in the IVDrsquo

J of Ortho research 1999 17 829-835

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Discs are huge torpid structures They need

help to transport nutrients and waste products

bull By day spinal movement helps suckampsquirt a fluid exchange through

bull By night the discs get most of their nutrition by osmosisdiffusion

wwwsarahkeycom

The paired facet joints flanking the disc

have a rich blood supply amp are lsquowired for painrsquo

wwwsarahkeycom

The spinal nerve roots exit bilaterally between

the disc and facet joints at each spinal level

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

4

Part 2 Why a Spinal Segment

Starts Causing Pain

wwwsarahkeycom

Lumbar discs break down in life earlier

than any other human tissue

Adams TBOBP

wwwsarahkeycom

The lower back sacrifices mobility for

stability

wwwsarahkeycom

We are a culture of mod con users

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Our activity mode is mostly bent forward

wwwsarahkeycom

Even moderate flexion increases disc loading

wwwsarahkeycom

11102013

5

Sedentary postures smother the metabolic

activity of discs and force too much fluid out

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

The lumbar discsrsquo metabolic rate slows and

load is transferred to the disc walls

wwwsarahkeycom

It becomes easier and easier to injure a

non-compliant outer disc wall

wwwsarahkeycom

The ligamentous outer annulus can sense injury

wwwsarahkeycom

The muscles lock up to protect the stiffer link

BUT BEWARE

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Muscular compression can escalate breakdown

wwwsarahkeycom

11102013

6

Part 3 What Can We

Therapists Do About It

wwwsarahkeycom

Mobilising first But only short term

Beattie Joint mobilisation can increase water content in a degenerated L5 disc by 22

Beattie P F Donley J W Arnot C F Miller R The change of diffusion of water in normal and degenerative lumbar intervertebral discs following joint mobilization

compared to prone lying Jan 09 Vol 39 Number 1 Journal of Orthopaedic and Sports Physical Therapy

wwwsarahkeycom

I say the heel is the most effective - and gentle - spinal

mobilising tool

lsquorestoring compliance of the outer annulusrsquo

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Part 4 The Patientsrsquo Daily Decompression

wwwsarahkeycom

Does prophylactic BackBlock Stretching the

annulus lsquoarm itrsquo against future compression

Lotz lsquoMaintaining tension in the annulus protects it from degeneration initiated by compressionrsquo

Lotz J C Hadi T Bratton C Reiser K Hsieh K Anulus fibrosis tension inhibits degenerative structural changes in the lamellar collagen Eur Spine J (2008) 171149-1159

wwwsarahkeycom

Because of the proteoglycans factor itrsquos easier

separating than squashing segments

wwwsarahkeycom

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

7

There are many different ways to achieve

lumbar tractiondecompression

wwwsarahkeycom

The easiest The cheapest The best

wwwsarahkeycom

Then my patients do BackBlock [PCT] self-help

-- once per day 3 steps 3 times

bull Passive traction over BackBlock (60 secs)

bull Active assisted flexion (15 secs)

bull Reverse curl ups (15 times)

bull Each evening (for life)

wwwsarahkeycom

From our recent BackCare research grant at

Bristol University

We believe that treatment should aim to promote healing of the peripheral anulus

Adams M Key S Tarlton J Sharif M Dolan P Harding I

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Mike Adams in recent lsquoClinical Biomechanicsrsquo paper

bull lsquoPhysical therapies should aim to promote healing in the disc

periphery by stimulating cells boosting metabolite transport and

preventing adhesions and re-injury Such an approach has the

potential to accelerate pain reliefrsquo

Adams MA et al Healing of a painful intervertebral disc should not be confused with reversing disc degeneration Implications for physical therapies for discogenic back pain

Clin Biomech(2010) doi101016jclinbiomech201007016 [not in print until late 2010]

wwwsarahkeycom

The very strong anterior spinal ligament and the

hip flexors are stretched by passive extension

wwwsarahkeycom

11102013

8

Greatest velocities of discal fluid shift happens

after loading and unloading the spine

wwwsarahkeycom

The BackBlock is traction

helps restore fluid content of discs

bullGuehring lsquoDistraction results in disc rehydration and increased numbers of protein-expressing cellsrsquo

Guehring T Omlor GW Lorenz H Engelleiter K Richter W Carstens C Kroeber M Disc distraction shows evidence of regenerative potential in degenerated intervertebral

discs as evaluated by protein expression magnetic resonance imaging and messenger ribonucleic acid expression analysis Spine 2006 Jul 1 31(15)1658-65

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Cyclic stretching alone restores healthy discal

lsquobiosynthetic activityrsquo

Hee lsquoDynamic stretch at a rate of 1 Hz with 10 tensile strain is capable of increasing collagen synthesis in a previously compressed annulusrsquo

Hee H T Zhang J Wong H K Effects of cyclic dynamic tensile strain on previously compressed inner annulus fibrosus and nucleus pulposus cells of human IVD -an in vitro study J Orthop Res 2010 Apr28(4)503-9

wwwsarahkeycom

Neuro-vascular net is stretched lsquoknees rockingrsquo

wwwsarahkeycom

The lower abdominal muscles get weaker

with prolonged sitting

wwwsarahkeycom

Reverse curl-ups strengthen the lower

abdominals amp pelvic floor

bull Mainly internal oblique transversus abdominus

bull The below navel lower basket of the belly lsquoreefed inrsquo

bull No aggressive end-scoring to cause incidental shear

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

3

Only the outer few layers of the disc wall has

a nerve and blood supply

Bogduk Clinical Anatomy of the Lumbar Spine

wwwsarahkeycom

Each 24 hours the lumbar discs exchange about

20 of their discal fluid

Wersquore all 2cm shorter when we go to bed

wwwsarahkeycom

Discs have 3 lsquonutritional enginesrsquo

bull Diffusion molecules spread from high to low density areas like a sugar cube in tea [small solute molecules]

bull Osmosis created by the complex proteoglycans molecules [small solutes]

bull Convection physical squash-and-suck effect of pressure changes [large molecules] physical=physiotherapy

Ishihara H Urban JP

Effects of low oxygen concentrations and metabolic inhibitors on

proteoglycans and protein synthesis rates in the IVDrsquo

J of Ortho research 1999 17 829-835

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Discs are huge torpid structures They need

help to transport nutrients and waste products

bull By day spinal movement helps suckampsquirt a fluid exchange through

bull By night the discs get most of their nutrition by osmosisdiffusion

wwwsarahkeycom

The paired facet joints flanking the disc

have a rich blood supply amp are lsquowired for painrsquo

wwwsarahkeycom

The spinal nerve roots exit bilaterally between

the disc and facet joints at each spinal level

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

4

Part 2 Why a Spinal Segment

Starts Causing Pain

wwwsarahkeycom

Lumbar discs break down in life earlier

than any other human tissue

Adams TBOBP

wwwsarahkeycom

The lower back sacrifices mobility for

stability

wwwsarahkeycom

We are a culture of mod con users

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Our activity mode is mostly bent forward

wwwsarahkeycom

Even moderate flexion increases disc loading

wwwsarahkeycom

11102013

5

Sedentary postures smother the metabolic

activity of discs and force too much fluid out

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

The lumbar discsrsquo metabolic rate slows and

load is transferred to the disc walls

wwwsarahkeycom

It becomes easier and easier to injure a

non-compliant outer disc wall

wwwsarahkeycom

The ligamentous outer annulus can sense injury

wwwsarahkeycom

The muscles lock up to protect the stiffer link

BUT BEWARE

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Muscular compression can escalate breakdown

wwwsarahkeycom

11102013

6

Part 3 What Can We

Therapists Do About It

wwwsarahkeycom

Mobilising first But only short term

Beattie Joint mobilisation can increase water content in a degenerated L5 disc by 22

Beattie P F Donley J W Arnot C F Miller R The change of diffusion of water in normal and degenerative lumbar intervertebral discs following joint mobilization

compared to prone lying Jan 09 Vol 39 Number 1 Journal of Orthopaedic and Sports Physical Therapy

wwwsarahkeycom

I say the heel is the most effective - and gentle - spinal

mobilising tool

lsquorestoring compliance of the outer annulusrsquo

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Part 4 The Patientsrsquo Daily Decompression

wwwsarahkeycom

Does prophylactic BackBlock Stretching the

annulus lsquoarm itrsquo against future compression

Lotz lsquoMaintaining tension in the annulus protects it from degeneration initiated by compressionrsquo

Lotz J C Hadi T Bratton C Reiser K Hsieh K Anulus fibrosis tension inhibits degenerative structural changes in the lamellar collagen Eur Spine J (2008) 171149-1159

wwwsarahkeycom

Because of the proteoglycans factor itrsquos easier

separating than squashing segments

wwwsarahkeycom

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

7

There are many different ways to achieve

lumbar tractiondecompression

wwwsarahkeycom

The easiest The cheapest The best

wwwsarahkeycom

Then my patients do BackBlock [PCT] self-help

-- once per day 3 steps 3 times

bull Passive traction over BackBlock (60 secs)

bull Active assisted flexion (15 secs)

bull Reverse curl ups (15 times)

bull Each evening (for life)

wwwsarahkeycom

From our recent BackCare research grant at

Bristol University

We believe that treatment should aim to promote healing of the peripheral anulus

Adams M Key S Tarlton J Sharif M Dolan P Harding I

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Mike Adams in recent lsquoClinical Biomechanicsrsquo paper

bull lsquoPhysical therapies should aim to promote healing in the disc

periphery by stimulating cells boosting metabolite transport and

preventing adhesions and re-injury Such an approach has the

potential to accelerate pain reliefrsquo

Adams MA et al Healing of a painful intervertebral disc should not be confused with reversing disc degeneration Implications for physical therapies for discogenic back pain

Clin Biomech(2010) doi101016jclinbiomech201007016 [not in print until late 2010]

wwwsarahkeycom

The very strong anterior spinal ligament and the

hip flexors are stretched by passive extension

wwwsarahkeycom

11102013

8

Greatest velocities of discal fluid shift happens

after loading and unloading the spine

wwwsarahkeycom

The BackBlock is traction

helps restore fluid content of discs

bullGuehring lsquoDistraction results in disc rehydration and increased numbers of protein-expressing cellsrsquo

Guehring T Omlor GW Lorenz H Engelleiter K Richter W Carstens C Kroeber M Disc distraction shows evidence of regenerative potential in degenerated intervertebral

discs as evaluated by protein expression magnetic resonance imaging and messenger ribonucleic acid expression analysis Spine 2006 Jul 1 31(15)1658-65

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Cyclic stretching alone restores healthy discal

lsquobiosynthetic activityrsquo

Hee lsquoDynamic stretch at a rate of 1 Hz with 10 tensile strain is capable of increasing collagen synthesis in a previously compressed annulusrsquo

Hee H T Zhang J Wong H K Effects of cyclic dynamic tensile strain on previously compressed inner annulus fibrosus and nucleus pulposus cells of human IVD -an in vitro study J Orthop Res 2010 Apr28(4)503-9

wwwsarahkeycom

Neuro-vascular net is stretched lsquoknees rockingrsquo

wwwsarahkeycom

The lower abdominal muscles get weaker

with prolonged sitting

wwwsarahkeycom

Reverse curl-ups strengthen the lower

abdominals amp pelvic floor

bull Mainly internal oblique transversus abdominus

bull The below navel lower basket of the belly lsquoreefed inrsquo

bull No aggressive end-scoring to cause incidental shear

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

4

Part 2 Why a Spinal Segment

Starts Causing Pain

wwwsarahkeycom

Lumbar discs break down in life earlier

than any other human tissue

Adams TBOBP

wwwsarahkeycom

The lower back sacrifices mobility for

stability

wwwsarahkeycom

We are a culture of mod con users

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Our activity mode is mostly bent forward

wwwsarahkeycom

Even moderate flexion increases disc loading

wwwsarahkeycom

11102013

5

Sedentary postures smother the metabolic

activity of discs and force too much fluid out

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

The lumbar discsrsquo metabolic rate slows and

load is transferred to the disc walls

wwwsarahkeycom

It becomes easier and easier to injure a

non-compliant outer disc wall

wwwsarahkeycom

The ligamentous outer annulus can sense injury

wwwsarahkeycom

The muscles lock up to protect the stiffer link

BUT BEWARE

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Muscular compression can escalate breakdown

wwwsarahkeycom

11102013

6

Part 3 What Can We

Therapists Do About It

wwwsarahkeycom

Mobilising first But only short term

Beattie Joint mobilisation can increase water content in a degenerated L5 disc by 22

Beattie P F Donley J W Arnot C F Miller R The change of diffusion of water in normal and degenerative lumbar intervertebral discs following joint mobilization

compared to prone lying Jan 09 Vol 39 Number 1 Journal of Orthopaedic and Sports Physical Therapy

wwwsarahkeycom

I say the heel is the most effective - and gentle - spinal

mobilising tool

lsquorestoring compliance of the outer annulusrsquo

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Part 4 The Patientsrsquo Daily Decompression

wwwsarahkeycom

Does prophylactic BackBlock Stretching the

annulus lsquoarm itrsquo against future compression

Lotz lsquoMaintaining tension in the annulus protects it from degeneration initiated by compressionrsquo

Lotz J C Hadi T Bratton C Reiser K Hsieh K Anulus fibrosis tension inhibits degenerative structural changes in the lamellar collagen Eur Spine J (2008) 171149-1159

wwwsarahkeycom

Because of the proteoglycans factor itrsquos easier

separating than squashing segments

wwwsarahkeycom

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

7

There are many different ways to achieve

lumbar tractiondecompression

wwwsarahkeycom

The easiest The cheapest The best

wwwsarahkeycom

Then my patients do BackBlock [PCT] self-help

-- once per day 3 steps 3 times

bull Passive traction over BackBlock (60 secs)

bull Active assisted flexion (15 secs)

bull Reverse curl ups (15 times)

bull Each evening (for life)

wwwsarahkeycom

From our recent BackCare research grant at

Bristol University

We believe that treatment should aim to promote healing of the peripheral anulus

Adams M Key S Tarlton J Sharif M Dolan P Harding I

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Mike Adams in recent lsquoClinical Biomechanicsrsquo paper

bull lsquoPhysical therapies should aim to promote healing in the disc

periphery by stimulating cells boosting metabolite transport and

preventing adhesions and re-injury Such an approach has the

potential to accelerate pain reliefrsquo

Adams MA et al Healing of a painful intervertebral disc should not be confused with reversing disc degeneration Implications for physical therapies for discogenic back pain

Clin Biomech(2010) doi101016jclinbiomech201007016 [not in print until late 2010]

wwwsarahkeycom

The very strong anterior spinal ligament and the

hip flexors are stretched by passive extension

wwwsarahkeycom

11102013

8

Greatest velocities of discal fluid shift happens

after loading and unloading the spine

wwwsarahkeycom

The BackBlock is traction

helps restore fluid content of discs

bullGuehring lsquoDistraction results in disc rehydration and increased numbers of protein-expressing cellsrsquo

Guehring T Omlor GW Lorenz H Engelleiter K Richter W Carstens C Kroeber M Disc distraction shows evidence of regenerative potential in degenerated intervertebral

discs as evaluated by protein expression magnetic resonance imaging and messenger ribonucleic acid expression analysis Spine 2006 Jul 1 31(15)1658-65

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Cyclic stretching alone restores healthy discal

lsquobiosynthetic activityrsquo

Hee lsquoDynamic stretch at a rate of 1 Hz with 10 tensile strain is capable of increasing collagen synthesis in a previously compressed annulusrsquo

Hee H T Zhang J Wong H K Effects of cyclic dynamic tensile strain on previously compressed inner annulus fibrosus and nucleus pulposus cells of human IVD -an in vitro study J Orthop Res 2010 Apr28(4)503-9

wwwsarahkeycom

Neuro-vascular net is stretched lsquoknees rockingrsquo

wwwsarahkeycom

The lower abdominal muscles get weaker

with prolonged sitting

wwwsarahkeycom

Reverse curl-ups strengthen the lower

abdominals amp pelvic floor

bull Mainly internal oblique transversus abdominus

bull The below navel lower basket of the belly lsquoreefed inrsquo

bull No aggressive end-scoring to cause incidental shear

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

5

Sedentary postures smother the metabolic

activity of discs and force too much fluid out

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

The lumbar discsrsquo metabolic rate slows and

load is transferred to the disc walls

wwwsarahkeycom

It becomes easier and easier to injure a

non-compliant outer disc wall

wwwsarahkeycom

The ligamentous outer annulus can sense injury

wwwsarahkeycom

The muscles lock up to protect the stiffer link

BUT BEWARE

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Muscular compression can escalate breakdown

wwwsarahkeycom

11102013

6

Part 3 What Can We

Therapists Do About It

wwwsarahkeycom

Mobilising first But only short term

Beattie Joint mobilisation can increase water content in a degenerated L5 disc by 22

Beattie P F Donley J W Arnot C F Miller R The change of diffusion of water in normal and degenerative lumbar intervertebral discs following joint mobilization

compared to prone lying Jan 09 Vol 39 Number 1 Journal of Orthopaedic and Sports Physical Therapy

wwwsarahkeycom

I say the heel is the most effective - and gentle - spinal

mobilising tool

lsquorestoring compliance of the outer annulusrsquo

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Part 4 The Patientsrsquo Daily Decompression

wwwsarahkeycom

Does prophylactic BackBlock Stretching the

annulus lsquoarm itrsquo against future compression

Lotz lsquoMaintaining tension in the annulus protects it from degeneration initiated by compressionrsquo

Lotz J C Hadi T Bratton C Reiser K Hsieh K Anulus fibrosis tension inhibits degenerative structural changes in the lamellar collagen Eur Spine J (2008) 171149-1159

wwwsarahkeycom

Because of the proteoglycans factor itrsquos easier

separating than squashing segments

wwwsarahkeycom

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

7

There are many different ways to achieve

lumbar tractiondecompression

wwwsarahkeycom

The easiest The cheapest The best

wwwsarahkeycom

Then my patients do BackBlock [PCT] self-help

-- once per day 3 steps 3 times

bull Passive traction over BackBlock (60 secs)

bull Active assisted flexion (15 secs)

bull Reverse curl ups (15 times)

bull Each evening (for life)

wwwsarahkeycom

From our recent BackCare research grant at

Bristol University

We believe that treatment should aim to promote healing of the peripheral anulus

Adams M Key S Tarlton J Sharif M Dolan P Harding I

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Mike Adams in recent lsquoClinical Biomechanicsrsquo paper

bull lsquoPhysical therapies should aim to promote healing in the disc

periphery by stimulating cells boosting metabolite transport and

preventing adhesions and re-injury Such an approach has the

potential to accelerate pain reliefrsquo

Adams MA et al Healing of a painful intervertebral disc should not be confused with reversing disc degeneration Implications for physical therapies for discogenic back pain

Clin Biomech(2010) doi101016jclinbiomech201007016 [not in print until late 2010]

wwwsarahkeycom

The very strong anterior spinal ligament and the

hip flexors are stretched by passive extension

wwwsarahkeycom

11102013

8

Greatest velocities of discal fluid shift happens

after loading and unloading the spine

wwwsarahkeycom

The BackBlock is traction

helps restore fluid content of discs

bullGuehring lsquoDistraction results in disc rehydration and increased numbers of protein-expressing cellsrsquo

Guehring T Omlor GW Lorenz H Engelleiter K Richter W Carstens C Kroeber M Disc distraction shows evidence of regenerative potential in degenerated intervertebral

discs as evaluated by protein expression magnetic resonance imaging and messenger ribonucleic acid expression analysis Spine 2006 Jul 1 31(15)1658-65

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Cyclic stretching alone restores healthy discal

lsquobiosynthetic activityrsquo

Hee lsquoDynamic stretch at a rate of 1 Hz with 10 tensile strain is capable of increasing collagen synthesis in a previously compressed annulusrsquo

Hee H T Zhang J Wong H K Effects of cyclic dynamic tensile strain on previously compressed inner annulus fibrosus and nucleus pulposus cells of human IVD -an in vitro study J Orthop Res 2010 Apr28(4)503-9

wwwsarahkeycom

Neuro-vascular net is stretched lsquoknees rockingrsquo

wwwsarahkeycom

The lower abdominal muscles get weaker

with prolonged sitting

wwwsarahkeycom

Reverse curl-ups strengthen the lower

abdominals amp pelvic floor

bull Mainly internal oblique transversus abdominus

bull The below navel lower basket of the belly lsquoreefed inrsquo

bull No aggressive end-scoring to cause incidental shear

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

6

Part 3 What Can We

Therapists Do About It

wwwsarahkeycom

Mobilising first But only short term

Beattie Joint mobilisation can increase water content in a degenerated L5 disc by 22

Beattie P F Donley J W Arnot C F Miller R The change of diffusion of water in normal and degenerative lumbar intervertebral discs following joint mobilization

compared to prone lying Jan 09 Vol 39 Number 1 Journal of Orthopaedic and Sports Physical Therapy

wwwsarahkeycom

I say the heel is the most effective - and gentle - spinal

mobilising tool

lsquorestoring compliance of the outer annulusrsquo

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Part 4 The Patientsrsquo Daily Decompression

wwwsarahkeycom

Does prophylactic BackBlock Stretching the

annulus lsquoarm itrsquo against future compression

Lotz lsquoMaintaining tension in the annulus protects it from degeneration initiated by compressionrsquo

Lotz J C Hadi T Bratton C Reiser K Hsieh K Anulus fibrosis tension inhibits degenerative structural changes in the lamellar collagen Eur Spine J (2008) 171149-1159

wwwsarahkeycom

Because of the proteoglycans factor itrsquos easier

separating than squashing segments

wwwsarahkeycom

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

7

There are many different ways to achieve

lumbar tractiondecompression

wwwsarahkeycom

The easiest The cheapest The best

wwwsarahkeycom

Then my patients do BackBlock [PCT] self-help

-- once per day 3 steps 3 times

bull Passive traction over BackBlock (60 secs)

bull Active assisted flexion (15 secs)

bull Reverse curl ups (15 times)

bull Each evening (for life)

wwwsarahkeycom

From our recent BackCare research grant at

Bristol University

We believe that treatment should aim to promote healing of the peripheral anulus

Adams M Key S Tarlton J Sharif M Dolan P Harding I

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Mike Adams in recent lsquoClinical Biomechanicsrsquo paper

bull lsquoPhysical therapies should aim to promote healing in the disc

periphery by stimulating cells boosting metabolite transport and

preventing adhesions and re-injury Such an approach has the

potential to accelerate pain reliefrsquo

Adams MA et al Healing of a painful intervertebral disc should not be confused with reversing disc degeneration Implications for physical therapies for discogenic back pain

Clin Biomech(2010) doi101016jclinbiomech201007016 [not in print until late 2010]

wwwsarahkeycom

The very strong anterior spinal ligament and the

hip flexors are stretched by passive extension

wwwsarahkeycom

11102013

8

Greatest velocities of discal fluid shift happens

after loading and unloading the spine

wwwsarahkeycom

The BackBlock is traction

helps restore fluid content of discs

bullGuehring lsquoDistraction results in disc rehydration and increased numbers of protein-expressing cellsrsquo

Guehring T Omlor GW Lorenz H Engelleiter K Richter W Carstens C Kroeber M Disc distraction shows evidence of regenerative potential in degenerated intervertebral

discs as evaluated by protein expression magnetic resonance imaging and messenger ribonucleic acid expression analysis Spine 2006 Jul 1 31(15)1658-65

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Cyclic stretching alone restores healthy discal

lsquobiosynthetic activityrsquo

Hee lsquoDynamic stretch at a rate of 1 Hz with 10 tensile strain is capable of increasing collagen synthesis in a previously compressed annulusrsquo

Hee H T Zhang J Wong H K Effects of cyclic dynamic tensile strain on previously compressed inner annulus fibrosus and nucleus pulposus cells of human IVD -an in vitro study J Orthop Res 2010 Apr28(4)503-9

wwwsarahkeycom

Neuro-vascular net is stretched lsquoknees rockingrsquo

wwwsarahkeycom

The lower abdominal muscles get weaker

with prolonged sitting

wwwsarahkeycom

Reverse curl-ups strengthen the lower

abdominals amp pelvic floor

bull Mainly internal oblique transversus abdominus

bull The below navel lower basket of the belly lsquoreefed inrsquo

bull No aggressive end-scoring to cause incidental shear

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

7

There are many different ways to achieve

lumbar tractiondecompression

wwwsarahkeycom

The easiest The cheapest The best

wwwsarahkeycom

Then my patients do BackBlock [PCT] self-help

-- once per day 3 steps 3 times

bull Passive traction over BackBlock (60 secs)

bull Active assisted flexion (15 secs)

bull Reverse curl ups (15 times)

bull Each evening (for life)

wwwsarahkeycom

From our recent BackCare research grant at

Bristol University

We believe that treatment should aim to promote healing of the peripheral anulus

Adams M Key S Tarlton J Sharif M Dolan P Harding I

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Mike Adams in recent lsquoClinical Biomechanicsrsquo paper

bull lsquoPhysical therapies should aim to promote healing in the disc

periphery by stimulating cells boosting metabolite transport and

preventing adhesions and re-injury Such an approach has the

potential to accelerate pain reliefrsquo

Adams MA et al Healing of a painful intervertebral disc should not be confused with reversing disc degeneration Implications for physical therapies for discogenic back pain

Clin Biomech(2010) doi101016jclinbiomech201007016 [not in print until late 2010]

wwwsarahkeycom

The very strong anterior spinal ligament and the

hip flexors are stretched by passive extension

wwwsarahkeycom

11102013

8

Greatest velocities of discal fluid shift happens

after loading and unloading the spine

wwwsarahkeycom

The BackBlock is traction

helps restore fluid content of discs

bullGuehring lsquoDistraction results in disc rehydration and increased numbers of protein-expressing cellsrsquo

Guehring T Omlor GW Lorenz H Engelleiter K Richter W Carstens C Kroeber M Disc distraction shows evidence of regenerative potential in degenerated intervertebral

discs as evaluated by protein expression magnetic resonance imaging and messenger ribonucleic acid expression analysis Spine 2006 Jul 1 31(15)1658-65

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Cyclic stretching alone restores healthy discal

lsquobiosynthetic activityrsquo

Hee lsquoDynamic stretch at a rate of 1 Hz with 10 tensile strain is capable of increasing collagen synthesis in a previously compressed annulusrsquo

Hee H T Zhang J Wong H K Effects of cyclic dynamic tensile strain on previously compressed inner annulus fibrosus and nucleus pulposus cells of human IVD -an in vitro study J Orthop Res 2010 Apr28(4)503-9

wwwsarahkeycom

Neuro-vascular net is stretched lsquoknees rockingrsquo

wwwsarahkeycom

The lower abdominal muscles get weaker

with prolonged sitting

wwwsarahkeycom

Reverse curl-ups strengthen the lower

abdominals amp pelvic floor

bull Mainly internal oblique transversus abdominus

bull The below navel lower basket of the belly lsquoreefed inrsquo

bull No aggressive end-scoring to cause incidental shear

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

8

Greatest velocities of discal fluid shift happens

after loading and unloading the spine

wwwsarahkeycom

The BackBlock is traction

helps restore fluid content of discs

bullGuehring lsquoDistraction results in disc rehydration and increased numbers of protein-expressing cellsrsquo

Guehring T Omlor GW Lorenz H Engelleiter K Richter W Carstens C Kroeber M Disc distraction shows evidence of regenerative potential in degenerated intervertebral

discs as evaluated by protein expression magnetic resonance imaging and messenger ribonucleic acid expression analysis Spine 2006 Jul 1 31(15)1658-65

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Cyclic stretching alone restores healthy discal

lsquobiosynthetic activityrsquo

Hee lsquoDynamic stretch at a rate of 1 Hz with 10 tensile strain is capable of increasing collagen synthesis in a previously compressed annulusrsquo

Hee H T Zhang J Wong H K Effects of cyclic dynamic tensile strain on previously compressed inner annulus fibrosus and nucleus pulposus cells of human IVD -an in vitro study J Orthop Res 2010 Apr28(4)503-9

wwwsarahkeycom

Neuro-vascular net is stretched lsquoknees rockingrsquo

wwwsarahkeycom

The lower abdominal muscles get weaker

with prolonged sitting

wwwsarahkeycom

Reverse curl-ups strengthen the lower

abdominals amp pelvic floor

bull Mainly internal oblique transversus abdominus

bull The below navel lower basket of the belly lsquoreefed inrsquo

bull No aggressive end-scoring to cause incidental shear

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

11102013

9

Sarah Keyrsquos Masterclasses (SKMC)

are held 2xyear in Sydney

bull SKMC

bull SKMC L1 (8 hour online theory component + 1 day practical)

bull SKMC L2 (8 hour online theory component + 2 days practical)

bull SKMC L3 (8 hour online theory component + 2 days practical)

bull SKMC L4 (8 hour online theory component + 2 days practical)

bull Upcoming Course Dates

bull SKMC L1 14 Feb 2014 (Sydney)

bull SKMC L2 15-16 Feb 2014 (Sydney)

bull wwwsarahkeycommasterclasses

wwwsarahkeycom

wwwsarahkeycom

wwwsarahkeycom

PREVIEW ONLY

These notes are a preview

Slides are limited

Full notes available after purchase from

wwwworldhealthwebinarscomau

Live Q amp A With Sarah Key

Coming up next

Facebook Twitter LinkedIn Google +

Live Q amp A With Sarah Key

11102013

10

Thank you

From Sarah Key

amp

World Health Webinars Australia

httpworldhealthwebinarscomau

11102013

10

Thank you

From Sarah Key

amp

World Health Webinars Australia

httpworldhealthwebinarscomau