title: Viscoelastic stresses on anisotropic annulus fibrosus of lumbar disk under compression, rotation and flexion in manual treatment.
abstract: BACKGROUND
  Twisting (spinal rotation) and bending (flexion) are commonly reported as triggers for low back pain. This paper addresses whether the twisting stress on the annulus fibrosus of the lumbar disk is greater or less than the bending stress for the same angle of twist or bending.
  
  
  METHODS
  Stress-strain relation for transversely isotropic material is applied to the transversely isotropic annulus fibrosus of the lumbar disk to analyze the viscoelastic stresses produced due to 6% compression, 10 degrees twist and 10 degrees bending.
  
  
  RESULTS
  The bending stress is 450 times greater than the twisting stress for the same angle of twist or bending of the annulus fibrosus. The twisting and bending moments increase two-fold in quick maneuvers lasting 0.1s (as in high velocity manipulations), compared to slow maneuvers lasting 60s.
  
  
  CONCLUSIONS
  From biomechanical perspective, in situations where both flexion and spinal rotation occur, the stress on the intervertebral disk is markedly higher with flexion compared to rotation. In patients with low back pain that has a disk mediated (discogenic) component, manipulation and mobilization therapies should avoid flexion to minimize stress on the disks. This is particularly relevant for high velocity manipulations where the stress on the disk is doubled for both flexion and rotation. The results in this paper can help guide manual therapists to adjust their treatments to minimize stress on the intervertebral disk.
authors.affiliation: Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA.
authors.forename: Hans
authors.initials: H
authors.lastname: Chaudhry
authors.forename: Zhiming
authors.initials: Z
authors.lastname: Ji
authors.forename: Nigel
authors.initials: N
authors.lastname: Shenoy
authors.forename: Thomas
authors.initials: T
authors.lastname: Findley