FOR 5177:  The Dynamics of the Spine: Mechanics, Morphology and Motion towards a comprehensive Diagnosis of Low Back Pain

• Subject Area: Medicine
• Term: since 2021
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 439742772

FOR 5177 aims to fundamentally improve the diagnosis of chronic low back pain (cLBP) through an integrated “3M” framework—Morphology, Motion, and Mechanics. In the first funding period, we demonstrated the limited validity of conventional diagnostic methods and, through everyday measurements of spinal alignment, theory-based psychosocial assessments, and lab-based electromyographic analyses of muscle activity, identified novel functional and morphological parameters that more accurately distinguish between asymptomatic individuals and those with cLBP. Strikingly, differences between cohorts did not localize to the lumbar spine itself, i.e., the reported pain site, but rather to adjacent segments, particularly the thoracic spine and pelvis, an observation corroborated by our animal studies. Moreover, an integrative, real-world diagnostic approach combining clinical findings with dynamic measurement data, MRI analyses, and psychosocial evaluations proved markedly superior. Whereas the first funding period used cross-sectional assessments to identify functional, psychological, and morphological markers of cLBP, the second funding period will capture the early biomechanical, neuromuscular, morphological, and psychosocial changes that contribute to chronification. We will employ longitudinal observational studies in humans, both in daily life, under controlled laboratory conditions, and during therapeutic interventions, augmented by in silico analyses and animal models. A central focus will be on compensatory adaptations in regions adjacent to the lumbar spine. Machine learning will define diagnostic markers, characteristic patterns, and physiological reference and threshold values, further enhancing diagnostic precision. Finally, we will determine multimodal parameter combinations that differentiate specific subpopulations of asymptomatic individuals and cLBP patients; these findings will be incorporated into standardized protocols and validated in additional cohorts. Our overarching hypothesis is that early compensatory changes in spinal-adjacent segments, combined with specific multimodal parameters, will serve as valid predictors of the transition from acute to chronic low back pain and, through algorithmic integration, enable highly accurate prediction of chronification. Through seven complementary subprojects, we will establish the foundation for a robust, evidence-based diagnostic paradigm for chronic low back pain and pave the way for individualized prevention and treatment concepts.

• DFG Programme: Research Units
• International Connection: Iran

Projects

• Articulated, statistical 3D shape and bone density model of the human spine for research in clinical biomechanics as well as for individualized diagnosis and therapy planning in orthopaedics (Applicant Zachow, Stefan )
• Coordination Funds (Applicant Schmidt, Hendrik )
• SP1 Dynamic Diagnostics and Mechanisms of Chronic Low Back Pain – Optimization of Analytical Methods and Clinical Insights (Applicants Pumberger, Matthias ;  Schmidt, Hendrik )
• SP2 Biomechanical Mechanisms in Chronic Low Back Pain –Identification of Compensatory Patterns and Clusters of Increased Spinal Loads (Applicants Becker, Luis ;  Schmidt, Hendrik )
• SP4 Advancing Diagnosis and Treatment in Chronic Low Back Pain – Insights from Spatial Distribution and Modular Organization of Activation Patterns (Applicant Arampatzis, Ph.D., Adamantios )
• SP5 BACKtivity: Dynamic assessments of psychosocial processes and physical activity in individuals with low back pain in daily life and health care (Applicants Fleig, Lena ;  Kaiser, Ulrike )
• SP6 Decoding Spinal Dysfunction: Causal Mechanisms of Muscle and Compensatory Adaptations through Functional Animal and Musculoskeletal Modeling (Applicants Checa Esteban, Sara ;  Reitmaier, Sandra )
• SP7 In vivo mechanical loading and tissue adaptation in vertebrae: Inflammation, pain and opioid effects (Applicants Celik, Ph.D., Melih Özgür ;  Duda, Georg )
• SP8 Multidimensional analytical approaches to improve LBP diagnosis and prognosis (Applicants Belavy, Daniel ;  Grittner, Ulrike )

• Spokesperson: Professor Dr. Hendrik Schmidt