Functional Anatomy in Low Back Rehabilitation: Balance in the Biopsychosocial Model

The work presented in this thesis examines whether a more prominent role of functional anatomy within multidisciplinary treatment of non-specific chronic low back pain (NCLBP) will increase its therapeutic effect. The multidisciplinary treatment of NCLBP is based on the biopsychosocial (BPS) model. This model is derived from systems theory and was introduced by Engel in 1977 to replace the traditional biomedical model. Fundamental to the BPS model is that not only biological but also psychological and social aspects are included in the aetiology of diseases, such as chronic back pain. However, in the ongoing development of new diagnostic and therapeutic techniques based on this BPS model, the behavioural aspects prevailed whilst the physical aspects (especially physical exercises) lagged behind. Consequently, in contemporary multidisciplinary treatment protocols, physical training is subordinate and mainly in service of the desired modification of behaviour. Recent studies of multidisciplinary programmes for NCLBP show that the results of these predominantly psychological, behaviourorientated treatments are far from optimal. Therefore, the question arose as to how multidisciplinary treatment can be improved. One option for improvement is to intensify the application of functional anatomical knowledge and incorporate corresponding specific training within existing multidisciplinary programmes. Functional anatomical research has made significant progress in the last decade; this has led to new knowledge on spine function and, consequently, to the development of new physical exercises. In the context of multidisciplinary treatment of NCLBP patients, and based on the new functional anatomical knowledge, the aim of this thesis was to address the following questions: 1. Taking into account the available recent data on functional anatomy, is there a need to reconsider the role of the physical domain within the BPS model? 2. Will a more pronounced role of functional anatomy in the BPS model contribute to better diagnosis? 3. Will functional anatomy applied in the BPS model contribute to improved therapy?

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