In a career spanning several decades, Margareta Nordin has gained renown for her evidence-based approach to spine care. She talks to Spinal News International about how her early career and education has shaped her thinking.
When did you know you wanted to go into research, and what drew you to spine research in particular?
From early on I was interested in looking for facts. After graduating, my first employment was at the Department of Handicap Research, University of Goteborg, under the late Sven Olof Brattgård. Under his leadership Sweden changed its view on disability. The aim of the research was to make people with a handicap self-sufficient with technology, education, innovation, and policies. My interest in spine ailments came later when I realised people with back pain could not perform at work and a person with chronic back pain was often miserable. Spine pain causes the largest burden of disability in the world today.
You have a background in physical therapy. How has this been important throughout your career?
I am very grateful for my background as a physical therapist, combining the goals of restoring the patient’s function, educating them, and returning them to full activity. A robust education in musculoskeletal disorders, biomechanics, psychosocial factors, pain behaviours, and teaching the patient how to move was essential in my career.
My life changed when I was elected as a rotary fellow. I was one of two individuals chosen for a stipend and chose the University of Washington in Seattle, USA. My topic was biomechanics of the musculoskeletal system and I wrote my first book in collaboration with Victor H Frankel, professor and chairman at the Department of Orthopaedics. This book is now in its fifth edition and has been translated into 10 languages. My years in the USA convinced me to return to Sweden and complete a Doctor of Medical Science.
Have you had important mentors throughout your career? What have they taught you?
I have worked with so many wonderful people and I still learn every day. My first mentor was my mother—a warm, intelligent, very diplomatic woman who always supported me. From her I learned diplomacy, thoughtfulness, kindness, humour, and that a smile can go further than anger. This has served me well during my career. Another mentor was my thesis director the late Alf N Nachemson, professor and chair at the Department of Orthopaedics, Goteborg University, Sweden. He was an incredibly innovative, knowledgeable, honest, and demanding, yet supportive, thesis director, and was instrumental in changing the perception of physical therapy in Sweden. Today there are eight departments of physiotherapy and more than 300 physical therapists that have a doctorate. In 1984 Victor H Frankel offered me a position to start the Occupational and Industrial Orthopedic Center (OIOC) at the Hospital for Joint Diseases Orthopedic Institute in New York, USA. Victor was a formidable mentor and was always positive, creative, and supportive. OIOC specialises in people with spine pain, combining clinic, research, and education with a multidisciplinary team. It was unusual at the time. My friend Christina Wiktorin (Karolinska Institute, Stockholm, Sweden), was another mentor and is a formidable woman who I could always call and discuss things with. She always challenged me in the best way. She taught me to be precise and patient.
What is the main focus of your current research?
My main research focus today is education and implementation of evidence-based care for spine ailments. After I left New York in 2012 and moved to France, I worked with EUROSPINE and World Spine Care (WSC). I was supported to create the EUROSPINE Diploma in Interprofessional Spine Care (EDISC) to promote evidence based care for spine clinicians. The first EDISC took place in July 2019 and attracted multidisciplinary participants from 13 countries. It is a very exciting project with a great task force representing 10 countries, co-chaired by the esteemed epidemiologist Pierre Côté. WSC establishes low-cost evidence-based care in communities with little access to affordable spine care, currently serving Botswana, India, Dominican Republic, and Ghana. We set up clinics in remote areas, staffed with physiotherapists or chiropractors with training of evidence-based protocols. It is very rewarding work.
You have participated in several national and international task forces on spine pain. What have been the most significant results to come out of these?
From 1984 to 2017 I participated in six large task forces in the USA, Canada and France: Agency for Healthcare Policy and Research (AHCPR) Clinical Practice Guidelines for Acute Low Back Problems in Adults; the Quebec Task Force on Whiplash Associated Disorders (WAD); the Paris Task Force on Exercises Low Back Pain; the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders (NPTF); Development of Minor Injury Treatment Protocol Project, Ontario Government; and the Global Spine Care Initiative (GSCI). All these task forces have been published and heavily referenced over the years. It takes about 10 years to see the fruit of these efforts, so you must be patient. I feel very grateful to have participated in all these task forces and want to thank all my colleagues for a very busy, sometimes difficult but wonderful time.
You have been the president of several societies over the course of your career, most recently EUROSPINE. What did you achieve in this position?
I have always believed in professional associations and their capacity to deliver education and research on a professional level in spine care. I was elected the first female president of the International Society for the Study of the Lumbar Spine (ISSLS) for the year 1999–2000. When my workload diminished a bit and I moved to France I was asked and elected EUROSPINE president for 2016–2017 by Everad Munting. There were only men in the executive and I am not sure what they expected from me, nor was I sure what to do, as I did not expect this honourable position. It was one of my best years with a thoughtful and supportive executive committee. I had three major accomplishments with EUROSPINE which included the creation of Task Force Research (TFR) which runs research courses and distributes money for grants to members. Also the creation of EDISC, a continuous education program for all professions interested in spine care. Finally, increasing the interest from larger institutions such as the World Health Organization (WHO), the European community and national governments in spine disorders.
There is still a gender disparity among the top researchers in spine. How well do you think institutions are doing in assisting more women into following a career in spine, and could this be improved?
There are too few women in top positions. Research tells us that women outperform men in emotional intelligence which is a core trait to leadership. Men tend to perform better when the focus is on managing tasks, while women tend to perform better when the focus is on managing people. The gender mix is therefore important. When it comes to including women in leadership positions, Eastern Europe leads the world in gender-diverse leadership while elsewhere it is declining. Institutions have to recruit and support women in taking a leadership position, but that is not enough. We must educate women to acquire leadership skills and create more female mentors.
What advice would you give to someone wishing to start their career in spine research?
Communicate that you want to do research with your colleagues and supervisors, attend conferences, join groups that do research, and visit departments or research groups that do research that you are attracted to. If you are a clinician start with taking EUROSPINE research courses. You can also be more ambitious and take a master’s in clinical research or methodology. Some people cannot live without research, I am one of them, it gives you many problems and sometimes insomnia but you get friends all over the world and you eventually make a change for the better for your patients or the community.
What are your interests and hobbies outside spine?
Outside of spine I enjoy walking and hiking, reading, cooking, and dogs.
1982 Doctor of Medical Science, Gothenburg, Sweden
1969 Physical Therapist, Gothenburg, Sweden
Professional positions (selected)
Director, Occupational and Industrial Orthopaedic Center, Hospital for Joint Diseases, New York, USA
Program Director, Program of Ergonomics and Biomechanics, New York University, New York, USA
Professor, research, Departments of Orthopaedic Surgery and Department of Environmental Medicine, New York University, USA
President, International Society for the Study of the Lumbar Spine (ISSLS)
President, EUROSPINEPresident, World Spine Care Europe
North American Spine Society (NASS)
American Academy of Orthopaedic Surgeons (AAOS)
American Occupational Medical Association (AOMA)
International Society for the Study of the Lumbar Spine (ISSLS)
Orthopaedic Research Society (ORS)
World Spine Care
Awards & Prizes (selected)
1988 The Volvo Award (Biomechanics), International Society for the Study of the
Lumbar Spine (ISSLS)
2001 Grammer European Spine Journal Award, Recovery of impaired muscle function in
severe sciatica, Gothenburg, Sweden
2004 Junior Faculty Nobel Forum Lecture, Nobel Forum, Factors predicting delayed recovery in back and neck problems
Peer reviewed articles: 219 Books: Three.
Are respiratory disorders risk factors for troublesome low-back pain? European Spine
Evidence-based management of spine pain disorders among underserved people in Navi
Mumbai, India: A two-year observation report, Critical Reviews in Physical and Rehabilitation Medicine 2019
The Global Spine Care Initiative: model of care and implementation, European Spine Journal 2018