International research groups such as Drs. Nikolai Bogduk and Lourens Penning have mathematically determined the pivot point of many joints in the spine. It has been shown that these pivot points or axes of rotation are useful and relate highly to spine pathologies causing chronic pain.

Researchers Drs. Joyce DeLeo and Beth Winkelsteinhave have identified biomechanical and immunological responses as important contributors in the complex cascade of events that lead to chronic pain.