Margareta Nordin

• Dr. Med. Sci.
• Professor at New York University

Spine disorders are the leading cause of disability worldwide. To promote social inclusion, it is essential to ensure that people can participate in their societies by improving their ability, opportunities, and dignity, through access to high-quality, evidence-based, and affordable spine services for all. To achieve this goal, SPINE20 recommends s...

Introduction The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods This systematic review search...

LAY SUMMARY Spinal pain is responsible for a large proportion of pain and disability in the Canadian Armed Forces (CAF). The authors developed and implemented a program of care (PoC) that included communication strategies and care pathways supporting chiropractic care for CAF personnel with spine-related problems. The authors tested the feasibility...

Chronic primary low back pain (CPLBP) is a prevalent and disabling condition that often requires rehabilitation interventions to improve function and alleviate pain. This paper aims to advance future research, including systematic reviews and randomized controlled trials (RCTs), on CPLBP management. We provide methodological and reporting recommend...

Purpose Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention...

Purpose To evaluate benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods We searched for randomized controlled trials (RCTs) from various electronic databases from July 1, 2007 to March 9, 2022. E...

Purpose Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise p...

As commissioned by the WHO, we updated and expanded the scope of four systematic reviews to inform its (in development) clinical practice guideline for the management of CPLBP in adults, including older adults. Methodological details and results of each review are described in the respective articles in this series. In the last article of this seri...

Purpose Evaluate benefits and harms of needling therapies (NT) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods Electronic databases were searched for randomized controlled trials (RCTs) assessing NT compared with placebo/sham, usual care, or no intervention (compa...

Introduction The purpose is to report on the fourth set of recommendations developed by SPINE20 to advocate for evidence-based spine care globally under the theme of “One Earth, One Family, One Future WITHOUT Spine DISABILITY”. Research question Not applicable. Material and methods Recommendations were developed and refined through two modified D...

Objective: To Identify evidence-based rehabilitation interventions for persons with non-specific low back pain (LBP) with and without radiculopathy and to develop recommendations from high-quality clinical practice guidelines (CPGs) to inform the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR). Data source: We...

Purpose The etiology of neck/shoulder pain is complex. Our purpose was to investigate if respiratory disorders are risk factors for troublesome neck/shoulder pain in people with no or occasional neck/shoulder pain. Methods This prospective cohort study was based on the Stockholm Public Health Cohorts (SPHC) 2006/2010 and the SPHC 2010/2014. We inc...

Purpose Globally, spine disorders are the leading cause of disability, affecting more than half a billion individuals. However, less than 50% of G20 countries specifically identify spine health within their public policy priorities. Therefore, it is crucial to raise awareness among policy makers of the disabling effect of spine disorders and their...

Knowledge of the pre-rehabilitation generic status of functioning in individuals with low back pain is necessary to understand the clinical utility of rehabilitation care. We conducted a scoping review to describe the pre-rehabilitation functioning status of persons with nonspecific low back pain using the World Health Organization Disability Asses...

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Despite being a topic of increasing concern, work-related musculoskeletal disorders (WMSDs) among physiotherapists, have not been comprehensively explored. This study evaluated the effects of using a passive exoskeleton on biomechanics (i.e. muscle activity of back and hip extensors) and kinematics (trunk and hip flexion angles) during a simulated...

Objective We conducted a systematic review to determine measurement properties and minimal important change (MIC) of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) short (12 questions) and full (36 questions) versions in persons with non-specific LBP. Data Sources MEDLINE, Embase, CINAHL, APA-PsycInfo, CENTRAL (inception...

Purpose The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. Methods On September 17–18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recomm...

Objective To determine whether non-pharmacological interventions delivered through synchronous telehealth are as effective and safe compared to in-person interventions for the management of patients with musculoskeletal conditions in improving pain, functioning, self-reported recovery, psychological outcomes or health-related quality of life using...

Purpose The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy gr...

Introduction Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strate...

Objectives To develop an evidence‐based guideline for the non‐invasive management of soft tissue disorders of the shoulder (shoulder pain), excluding major pathology. Methods This guideline is based on high‐quality evidence from seven systematic reviews. Multidisciplinary experts considered the evidence of effectiveness, safety, cost‐effectiveness...

Background: Among non-communicable disorders, low back and neck pain are the most common causes of severe, long-term pain and disability affecting more than a billion people globally. Yet, the burden and impact of these conditions are not well understood, especially among rural and tribal people living in low- and middle-income countries. Objecti...

Introduction: Musculoskeletal (MSK) conditions are primary reasons prohibiting Canadian Armed Forces (CAF) personnel from being deployed, with back pain the second most common activity-limiting condition. CAF provides a spectrum of services, including chiropractic care. There is a paucity of data related to chiropractic interprofessional care (IPC...

Zusammenfassung Das Aus- und Fortbildungskonzept von EUROSPINE, der Spine Society of Europe, basiert auf 3 Säulen: Das EUROSPINE Basic Diploma, das EUROSPINE Advanced Diploma und das EUROSPINE Diploma in Interprofessional Spine Care (EDISC). Während die ersten beiden einen operativen Schwerpunkt haben, ist EDISC konservativ und interprofessional au...

BACKGROUND The COVID-19 pandemic has greatly limited the access of patients to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic lockdown. In most low- and middle-income countries, as well as many underser...

Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, bett...

Purpose: To update the findings of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) on prognostic factors for whiplash-associated disorder (WAD) outcomes. Materials and methods: We conducted a systematic review and best-evidence synthesis. We systematically searched MEDLINE, EMBASE, CIN...

Introduction Surgical rates for low back pain (LBP) have been increasing in Europe, North America and Asia. Many patients treated surgically will require postsurgical rehabilitation. Little is known about the effectiveness of postsurgical rehabilitation interventions on health outcomes or about patients’ experiences with these interventions. Objec...

Purpose: To describe characteristics and activity limitations of new patients with musculoskeletal conditions presenting to the World Spine Care (WSC) clinic located in the underserved community of Moca, Dominican Republic. Methods: We conducted a prospective case series of consecutive adults between October 12 and December 5, 2015. A survey of...

Purpose A multi-morbidity perspective of troublesome low back pain (LBP) has been highlighted for example in relation to respiratory disorders. Our purpose was to investigate whether respiratory disorders are risk factors for reporting troublesome LBP in people with no or occasional LBP at baseline. Methods This prospective cohort study was based...

The purpose of this study is to determine the reliability and validity of clinical tests used to assess cervical function, muscle strength and endurance in adults with neck pain and its associated disorders (NAD). Systematic review and update of the Bone and Joint Decade 2000–2010 Task Force on NAD. We systematically searched five electronic databa...

Objectives To develop an evidence‐based guideline for the non‐pharmacological management of persistent headaches associated with neck pain (i.e., tension‐type or cervicogenic). Methods This guideline is based on systematic reviews of high‐quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost‐effective...

Introduction: Musculoskeletal (MSK) conditions have a significant impact on the health and operational readiness of military members. The Canadian Forces Health Services (CFHS) provides a spectrum of health services in managing Canadian Armed Forces (CAF) personnel health care needs with on-base and off-base services provided by civilian and unifo...

Purpose: The purpose of this review was to develop recommendations for non-invasive management of pain due to osteoporotic vertebral compression fractures (OVCF) that could be applied in medically underserved areas and low- and middle-income countries. Methods: We conducted a systematic review and best evidence synthesis of systematic reviews on...

Purpose: The purpose of this study was to develop a stratification scheme for surgical spinal care to serve as a framework for referrals and distribution of patients with spinal disorders. Methods: We used a modified Delphi process. A literature search identified experts for the consensus panel and the panel was expanded by inviting spine surgeo...

Purpose: The purpose of this study was to synthesize recommendations on the use of common elective surgical and interventional procedures for individuals with persistent and disabling non-radicular/axial with or without myelopathy, radicular back pain, cervical myelopathy, symptomatic spinal stenosis, and fractures due to osteoporosis. This review...

Purpose: The purpose of this review was to describe psychological and social factors associated with low back pain that could be applied in spine care programs in medically underserved areas and low- and middle-income countries. Methods: We performed a narrative review of cohort, cross-sectional, qualitative and mixed methods studies investigati...

PurposeThe purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain. Methods We synthesized two evidence-based clinical practice guidelines for the management of low ba...

Purpose: The purpose of this systematic literature review was to develop recommendations for the assessment of spine-related complaints in medically underserved areas with limited resources. Methods: We conducted a systematic review and best evidence synthesis of guidelines on the assessment of spine-related complaints. Independent reviewers cri...

Purpose: The purpose of this study was to develop recommendations for prevention interventions for spinal disorders that could be delivered globally, but especially in underserved areas and in low- and middle-income countries. Methods: We extracted risk factors, associations, and comorbidities of common spinal disorders (e.g., back and neck pain...

Purpose The purpose of this report is to describe the development of a list of resources necessary to implement a model of care for the management of spine-related concerns anywhere in the world, but especially in underserved communities and low- and middle-income countries. Methods Contents from the Global Spine Care Initiative (GSCI) Classificat...

Purpose: Spinal disorders, including back and neck pain, are major causes of disability, economic hardship, and morbidity, especially in underserved communities and low- and middle-income countries. Currently, there is no model of care to address this issue. This paper provides an overview of the papers from the Global Spine Care Initiative (GSCI)...

Purpose: The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally. Methods: The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evid...

Purpose: The purpose of this report is to describe the Global Spine Care Initiative (GSCI) contributors, disclosures, and methods for reporting transparency on the development of the recommendations. Methods: World Spine Care convened the GSCI to develop an evidence-based, practical, and sustainable healthcare model for spinal care. The initiati...

Purpose: The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. Methods: Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discuss...

Purpose: Spine-related disorders are a leading cause of global disability and are a burden on society and to public health. Currently, there is no comprehensive, evidence-based model of care for spine-related disorders, which includes back and neck pain, deformity, spine injury, neurological conditions, spinal diseases, and pathology, that could b...

BACKGROUND CONTEXT Spinal disorders contribute to the global burden of disease and are especially burdensome for medically underserved communities and low- and middle-income countries (LMIC). A model of care (MoC) that could be implemented in these regions may help to relieve this burden. PURPOSE The purpose of this study was to develop a MoC for...

Objective The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders. Methods A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pai...

Search strategy used for the literature search. (DOCX)

Risk factors, associations, and comorbidities for spinal syndromes. (DOCX)

Risk factors and comorbidities for spinal tuberculosis. (DOCX)

PRISMA checklist for the reporting of this literature review. (DOC)

Risk factors, associations, and comorbidities for neck pain. (DOCX)

Risk factors, associations, and comorbidities for arthritic spinal disorders. (DOCX)

Risk factors, associations, and comorbidities for low back pain. (DOCX)

Risk factors, associations, and comorbidities for traumatic spinal disorders. (DOCX)

Risk factors, associations, and comorbidities for metabolic spinal disorders. (DOCX)

Risk factors, associations, and comorbidities for congenital spinal disorders. (DOCX)

Tot het collagene bindweefsel dat om het skeletstelsel heen ligt, behoren de ligamenten (waaronder de gewrichtskapsels), de pezen en de huid. Deze structuren zijn passief, dat wil zeggen dat zij niet uit zichzelf een actieve beweging kunnen voortbrengen.

Het heupgewricht is een van de grootste en meest stabiele gewrichten in het lichaam. In tegenstelling tot het kniegewricht heeft het heupgewricht intrinsieke stabiliteit door de kop-en-komconfiguratie.

De knie geeft belastingen door, is betrokken bij beweging, helpt bij het behoud van impuls en voorziet in koppels voor activiteiten waarbij het been betrokken is.

Het doel van het skelet is het beschermen van de inwendige organen, het verschaffen van starre kinematische schakels, het voorzien in aanhechtingsplaatsen voor spieren en het vergemakkelijken van de spierwerking en de lichaamsbeweging.

Evenals de andere grote gewrichten in de onderste extremiteit, neemt het enkelgewricht deel aan kinematische functies en het dragen van belasting. Dit gewricht bestaat uit het tibiotalaire, fibulotalaire en distale tibiofibulaire gewricht (figuur 9.1).

Het succesvolle Amerikaanse boek Basic biomechanics of the skeletal system is inmiddels verschenen in onder andere de Zweedse, Chinese en Japanse vertaling. Ook de Nederlandse vertaling en bewerking werd enthousiast ontvangen. Deze vierde, licht gewijzigde druk van Biomechanica van het spier-skeletstelsel geeft opnieuw op heldere wijze en met vele...

Force may be defined as mechanical disturbance or load. When you pull or push an object, you apply a force to it. You also exert a force when you throw or kick a ball. In all of these cases, the force is associated with the result of muscular activity. Forces acting on an object can deform, change its state of motion, or both. Although forces cause...

Uniaxial motion is one in which the motion occurs only in one direction, and it is the simplest form of linear or translational motion. A car traveling on a straight highway, an elevator going up and down in a shaft, and a sprinter running a 100-m race are examples of uniaxial motion.

The material response discussed in the previous chapters was limited to the response of elastic materials, in particular to linearly elastic materials. Most metals, for example, exhibit linearly elastic behavior when they are subjected to relatively low stresses at room temperature. They undergo plastic deformations at high stress levels. For an el...

Basic concepts of statics were introduced in Chaps. 4 and 5 along with some of their applications. The field of statics is based on Newton’s laws (Newtonian mechanics). It constitutes one of the two main branches of the more general field of rigid body mechanics, dynamics being the other branch. The basic assumption in rigid body mechanics is that...

An object subjected to an external force will move in the direction of the applied force. The object will deform if its motion is constrained in the direction of the applied force. Deformation implies relative displacement of any two points within the object. The extent of deformation will be dependent upon many factors including the magnitude, dir...

When a structure is subjected to uniaxial tension, the transverse dimensions decrease (the structure undergoes lateral contractions) while simultaneously elongating in the direction of the applied load. This was illustrated in the previous chapter through the phenomenon called necking. For stresses within the proportionality limit, the results of u...

Two-dimensional angular motions of bodies are commonly described in terms of a pair of parameters, r and θ (theta), which are called the polar coordinates. Polar coordinates are particularly well suited for analyzing motions restricted to circular paths. As illustrated in Fig. 9.1, let O and P be two points on a two-dimensional surface. The locatio...

Statics is an area within the field of applied mechanics, which is concerned with the analysis of rigid bodies in equilibrium. In mechanics, the term equilibrium implies that the body of concern is either at rest or moving with a constant velocity. A rigid body is one that is assumed to undergo no deformation under the effect of externally applied...

The kinetic characteristics of objects undergoing translational motion were discussed in Chap. 8. Kinetic analyses utilize Newton’s second law of motion that can be formulated in terms of the equations of motion and work and energy methods. Similar methods can be employed to analyze the kinetic characteristics of objects undergoing rotational motio...

In Chap. 8, Newton’s second law of motion is presented in the form of “equations of motion.” In Chap. 10, the concepts of work and energy are introduced. Based on the same law, “work-energy” and “conservation of energy” methods are devised to facilitate the solutions of specific problems in kinetics. In this chapter, the concepts of linear momentum...

Dynamics is the study of bodies in motion. Dynamics is concerned with describing motion and explaining its causes. The general field of dynamics consists of two major areas: kinematics and kinetics. Each of these areas can be further divided to describe and explain linear, angular, or general motion of bodies. The fundamental concepts in dynamics a...

As studied in the previous chapter, kinematic analyses are concerned with the description of the geometric and time-dependent aspects of motion in terms of displacement, velocity, and acceleration without dealing with the factors causing the motion. The field of kinetics, on the other hand, is based on kinematics and incorporates into the analysis...

A force applied to an object can translate, rotate, and/or deform the object. The effect of a force on the object to which it is applied depends on how the force is applied and how the object is supported. For example, when pulled, an open door will swing about the edge along which it is hinged to the door frame (Fig. 3.1). What causes the door to...

The human body is rigid in the sense that it can maintain a posture, and flexible in the sense that it can change its posture and move. The flexibility of the human body is due primarily to the joints, or articulations, of the skeletal system. The primary function of joints is to provide mobility to the musculoskeletal system. In addition to provid...

Mechanics is a branch of physics that is concerned with the motion and deformation of bodies that are acted on by mechanical disturbances called forces. Mechanics is the oldest of all physical sciences, dating back to the times of Archimedes (287–212 BC). Galileo (1564–1642) and Newton (1642–1727) were the most prominent contributors to this field....

Background: Neck pain and its associated disorders (NAD) are common in the general population. More than 80% of individuals experience NAD during their lifetime and 30-50% of the general adult population reports neck pain annually. An accurate diagnosis is necessary to guide patient management and inform prognosis. Clinicians require an approach th...

The World Spine Care (WSC), established by volunteers from 5 continents, is dedicated to providing sustainable, evidence-based spine care to individuals and communities in low and middle-income countries consistent with available health-care resources and integrated within the local culture. The research committee approves and oversees the WSC's co...

Background context Little is known about the effectiveness of multimodal care for individuals with whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD). Purpose To update findings of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of multimodal care...

We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Ser...

Purpose To update findings of the 2000–2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and evaluate the effectiveness of non-invasive and non-pharmacological interventions for the management of patients with headaches associated with neck pain (i.e., tension-type, cervicogenic, or whiplash-related headaches). Methods...

Purpose: To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD). Methods: This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and...

Study Design Systematic review. Background Acupuncture is a commonly used treatment for musculoskeletal disorders (MSDs); however, little is known about the effectiveness of acupuncture therapies for the management of MSDs. Objective To summarize and evaluate the available research on the effectiveness and safety of acupuncture therapies for MSDs o...

Background Manual therapy as spinal manipulation, spinal mobilization, stretching and massage are common treatment methods for neck and back pain. The objective was to compare the treatment effect on pain intensity, pain related disability and perceived recovery from a) naprapathic manual therapy (spinal manipulation, spinal mobilization, stretchin...

Objective: To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. Methods: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. R...

Objective: The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the shoulder. Methods: We conducted a systematic review and searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Two independent revie...