“Two out of three people experience some form of back pain over the course of their lives,” says Professor Hendrik Schmidt, head of the Spine Biomechanics Lab at the Julius Wolff Institute of the Berlin Institute of Health at Charité (BIH). “And we still can’t predict exactly who will be affected. This is because back pain has many causes, so we now want to gain an in-depth understanding of these causes.”
Back pain has a host of causes
The reasons why a person’s back starts to hurt are indeed many and varied: Some known causes include lack of exercise and obesity, poor posture at work, improper and frequent lifting and carrying of heavy loads. In addition, certain physical ailments can make a person more susceptible to back pain. Stress and worries also take a toll on our backs because, along with physical ailments, mood, learning processes and psychological stress have been linked to back pain as well. Less is known about genetic risk factors, biochemical mechanisms, social triggers or the interplay of multiple factors.
“As a result, it’s not yet possible to tailor therapy to the individual patient,” says Schmidt. The clinical diagnosis of back pain is currently based on a single physical examination and/or imaging techniques such as MRI and X-ray, leading to the recommendation of specific therapies. However, taken in a setting unfamiliar to the patient, such static “snapshots” do not provide sufficient information about the underlying mechanisms of back pain. This frequently results in incorrect diagnoses and therapeutic decisions that later turn out to be “therapeutic failures.” “We want to improve this unsatisfactory situation through scientific studies. Going forward, we must understand the spine as an organ system that ‘functions dynamically’ and incorporate biochemical and psychosocial relationships into the equation,” explains Schmidt. “We want to move away from a static short-term analysis (‘snapshot’) toward a dynamic view of the spine and to this end collect measurements on posture and the movement profiles in everyday situations. Only in this way we can avoid ‘therapeutic failures’ in the future.”
3,000 individuals to be recruited
For their wide-ranging project, Hendrik Schmidt and his co-spokespersons Professor Sara Checa of the Julius Wolff Institute of Biomechanics and Musculoskeletal Regeneration and Professor Christoph Stein of the Department of Anesthesiology and Intensive Care Medicine at Charité Campus Benjamin Franklin have enlisted experts in biomechanics, orthopedics, trauma surgery, sport science, kinesiology, anesthesiology, pharmacology, mathematics and health psychology from Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, the Medical School Berlin and the Zuse Institute Berlin to form the new DFG Research Unit. “Our aim is to develop a joint approach,” says Stein. “Together with Dr. Matthias Pumberger of the Center for Musculoskeletal Surgery, we plan to perform highly detailed examinations on a total of 3,000 individuals with and without back pain in order to determine where the problems originate,” says Stein. This will include magnetic resonance imaging (MRI) scans, orthopedic examinations, gait analyses, short- and long-term functional analyses, questionnaires on diet, movement profiles and psychological and social situation, as well as experimental studies and biometric measurements like height and weight.
Individualized treatment is the goal
“Our first goal is to elucidate the role and interplay of morphology, movement and mechanics in the lower back, i.e., the lumbar spine and pelvis,” explains Checa. “In the next step, we want to find out how individual parameters such as age, gender and anatomy, as well as biochemical and psychosocial factors, contribute to the development of back pain.” The studies with human subjects will be complemented by animal experiments and mathematical models. The scientists will use AI-based machine learning systems to merge and analyze the vast and diverse data collected over the course of the research.
“We hope, of course, that these elaborate studies will open up new avenues for clinically diagnosing back pain and developing individualized treatment strategies,” says Schmidt, “with the ultimate aim of effectively countering the widespread prevalence of back pain.”
For the study, the researchers are recruiting subjects aged 18 to 64 who are either healthy or suffering from lower back pain. The study is scheduled to start on January 1, 2022. Further information can be found at jwi.charite.de/research/research_biomechanics_at_organ_level/biomechanics_of_the_vertebral_spine/.
About the DFG Research Units:
Research Units enable researchers to devote themselves to current, pressing issues in their subject areas and establish innovative new fields of research. With these new additions, the DFG is currently funding 173 Research Units, 14 Clinical Research Units and 13 Centres for Advanced Studies. Clinical Research Units are additionally characterized by their close link between research and clinical work, while Centres for Advanced Studies are specifically tailored to work in the humanities and social sciences.