Customer Reviews

Low Back Disorders: Evidence-Based Prevention and Rehabilitation

5 star:		(25)
4 star:		(6)
3 star:		(2)
2 star:		(2)
1 star:		(0)

 

 

This is a great evidence-based book, meaning that the information it covers is backed-up by research. On almost every page you can find multiple citations of published studies- which can provide a great starting point for a literature search if a topic interests you.

The book is divided up into 3 parts:

-Scientific Foundation, where you get a lot of general info about various topics such as anatomy of the spine, back belts, the epidemiology of back pain, and so on

-Injury Prevention, where you learn about, well, the research on preventing back problems

-Low Back Rehab, where you learn about the author's 5-stage back training program

The book definitely emphasizes spinal stability, and rightly so, as the research strongly supports this intervention. Unsafe exercises are discussed as well.

With lots of pictures and a not-too-technical tone, I can certainly recommend that anyone who deals with low back pain patients check it out. Other evidence-based back books I liked include Treat Your Own Spinal Stenosis.

Everyone who deals with backs, either in sports (athletes, coaches, trainers), physicians, therapists, and back pain patients themselves, should read this book. I am a physician who specializes in back disorders and back pain. I have followed Dr. McGill's reseach for many years and it has revolutionized my practice like nothing else. One of my top priorities with back pain patients is to review what exercises they have been given in the past. I invariably stop them from doing several excercises that Dr. McGill's research has proven to be quite harmful for the back. I Substitute the 'big three' excercises that are described in this book, and many of the patients need no further intervention. There is a great deal of misinformation regarding back excercise, and many of the excercise routines used in sports, schools, military, and fitness centers are harmful. That is why this book is so important; not because it gives another fitness guru's opinion, but because it gives good, scientifically based facts on one of the tougher clinical issues from a world renown expert. Thank you Dr. McGill - keep the research coming!
Also check out Dr. McGill's other book "Ultimate back fitness and performance" for a less technically dense description of many of the same issues.

This wonderful text focuses on the all important role of activity, exercise, and fitness in the prevention and treatment of low back disorders. In particular, the clinical publications emerging from Australia and Denmark are reviewed and balanced by scientific investigation of spinal loads with different activities. Professor McGill's book is highly practical and thoroughly evidence-based.

This new book fills a void as a perfect cornerstone to the biopsychosocial model of patient reactivation recommended by international guidelines throughout the world (AHCPR, CSAG, DIHTA). Most significantly, the patient reactivation model being advocated by evidence-based experts today is made more clinically relevant as a result of this thoughtful and practical presentation of the "tools of the trade" for presecribing physiologically sound reactivation approaches. This is the ideal complement to simple reassuring reactivation advice being recommended for acute, uncomplicated low back pain patients and more involved cognitive-behavioral strategies being recommended for complex, chronic patients. It is most relevant for those subacute patients who are at risk of becoming chronically disabled.

McGill highlights the recent scientific evidence which has unmasked the failure of diagnostic imaging to find the "cause" of back pain. He instead points clinicians towards the often ignored literature about the methods available for establishing the patient's functional diagnosis. This section is of great clinical value since most health care providers perform a limited functional assessment of low back pain patients.

Popular concepts such as stability are defined, quantified, and made practical. The author explains how he determines spinal load profiles of routine activities of daily living and common exercises. In turn, many common beliefs about exercise are revealed as based on myth rather than evidence.

For example he exposes the myths of lifting with a straight back, the pelvic tilt, performing sit-ups with bent knees, and the prone superman exercise. Other popular approaches such as the use of back belts or abdominal hollowing are discussed from a functional perspective.

This book is most valuable to practicing clinicians for his elegant presentation of safe back exercises for subacute back pain patients. These simple exercises are shown along with the evidence demonstrating their safety and value. For instance, the cat-camel, quadruped leg reach, side bridge, and trunk curl are shown as biomechanically safe exercises which can be prescribed as a beginner program for most low back pain patients. Hopefully, randomized, controlled clinical trials will soon follow to further validate such exercises in patient populations.

Many sufferers of low back pain are engaged in ardous sport or occupational activities. The book concludes with a section on more advanced exercises that have preventive and conditioning value, although would be inappropriate for the subacute treatment phase. This is once again invaluable information for practicing clinicians which can help steer patients away from chronic pain, disability, treatment dependency, overmedication, deconditioning, fear-avoidance behavior, and unncessary surgery. Pr. McGill is to be applauded for this utterly brilliant and practical patient information presented in such a humble, small package.

This wonderful text focuses on the all important role of activity, exercise, and fitness in the prevention and treatment of low back disorders. In particular, the clinical publications emerging from Australia and Denmark are reviewed and balanced by scientific investigation of spinal loads with different activities. Professor McGill's book is highly practical and thoroughly evidence-based.

This new book fills a void as a perfect cornerstone to the biopsychosocial model of patient reactivation recommended by international guidelines throughout the world (AHCPR, CSAG, DIHTA). Most significantly, the patient reactivation model being advocated by evidence-based experts today is made more clinically relevant as a result of this thoughtful and practical presentation of the "tools of the trade" for presecribing physiologically sound reactivation approaches. This is the ideal complement to simple reassuring reactivation advice being recommended for acute, uncomplicated low back pain patients and more involved cognitive-behavioral strategies being recommended for complex, chronic patients. It is most relevant for those subacute patients who are at risk of becoming chronically disabled.

McGill highlights the recent scientific evidence which has unmasked the failure of diagnostic imaging to find the "cause" of back pain. He instead points clinicians towards the often ignored literature about the methods available for establishing the patient's functional diagnosis. This section is of great clinical value since most health care providers perform a limited functional assessment of low back pain patients.

Popular concepts such as stability are defined, quantified, and made practical. The author explains how he determines spinal load profiles of routine activities of daily living and common exercises. In turn, many common beliefs about exercise are revealed as based on myth rather than evidence.

For example he exposes the myths of lifting with a straight back, the pelvic tilt, performing sit-ups with bent knees, and the prone superman exercise. Other popular approaches such as the use of back belts or abdominal hollowing are discussed from a functional perspective.

This book is most valuable to practicing clinicians for his elegant presentation of safe back exercises for subacute back pain patients. These simple exercises are shown along with the evidence demonstrating their safety and value. For instance, the cat-camel, quadruped leg reach, side bridge, and trunk curl are shown as biomechanically safe exercises which can be prescribed as a beginner program for most low back pain patients. Hopefully, randomized, controlled clinical trials will soon follow to further validate such exercises in patient populations.

Many sufferers of low back pain are engaged in ardous sport or occupational activities. The book concludes with a section on more advanced exercises that have preventive and conditioning value, although would be inappropriate for the subacute treatment phase. This is once again invaluable information for practicing clinicians which can help steer patients away from chronic pain, disability, treatment dependency, overmedication, deconditioning, fear-avoidance behavior, and unncessary surgery. Pr. McGill is to be applauded for this utterly brilliant and practical patient information presented in such a humble, small package.

Clinicians who wish to competently evaluate, manage, and rehabilitate low back disorders will find this book indispensable due to its unique content. While other texts cover topics related to examination, differential diagnosis, or specific therapeutics, this text focuses on a thorough, component-by-component research-based review of each part of the human lumbopelvic region for the purpose of providing a comprehensive understanding of how the low back truly functions, how to credibly evaluate its function, and how to properly restore as much normal function as possible. Sufficiently detailed for scholars, yet understandable by virtually anyone, Dr. McGill uses a practical, evidence-based dialogue with the reader to address issues which I have rarely seen adequately addressed by anyone. Just what is the true function of the iliopsoas muscle in relation to the low back? And is there really such a thing as an iliopsoas muscle? And how would one properly rehabilitate a weakened rectus abdomonis muscle, without potentially aggravating a low back disorder? And why is this necessary? And is it possible that many of the exercises currently prescribed for chronic low back pain are actually detrimental to the spine, and why? These are but a few of the many important and practical topics that are covered within this book. Frankly, I don't believe anyone can competently care for low back conditions of any kind without this valuable information. I consider this book a valued and essential part of my professional library.

This is a vital book concerning one of the major problems of our modern life.
Prof. Stuart McGill is a professor in the Dep't of Kinesiology at the University of Waterloo, Ontario. He is the director of its Spine Biomechanics Laboratory.
This is his famous textbook, "Low Back Disorders", which examines back injuries in the light of biomechanics' scientific knowledge, and prescribes exercises and tests for the rehabilitation of injured backs and the prevention of future injuries.
The book has 241 pages of solid, dense text and extremely valuable information, with a great number of pictures and tables. And it comes in a superb hard cover. You get full value for the money.

"Low Back Disorders" is primarily geared to professionals in back treatment and rehabilitation, who want to become more sophisticated practitioners and learn the scientific facts underlying rehab techniques.
But, in the same light, this book is also essential for any member of the 3F club (Physical Fitness Fanatics) concerned about the impact on the back of fitness training and athletic practices.
Saving one's back from injury is vital, the more so that most physical fitness fanatics are urban professionals who tend to spend a large portion of their lives sitting, not a natural posture for the architecture of the back, and as they grow older, when the back becomes more fragile and vulnerable.

Stuart McGill assumes that most readers are not familiar with the full scientific facts of back architecture and function. So, he starts with the very basics and gives us a primer on "Essentials of the Back 101".

Central to Stuart McGill's tenets is insisting on the importance of maintaining the "neutral posture" of the spine, respecting the natural lower-back curvature, and not imposing extra flexion to the natural curvature of the upper spine.
This leads to the debunking of traditional training exercises, such as the classic sit-ups and all varieties of crunches, which create extreme flexion and high levels of compression in the spine, and undermine back stability.
He insists on tensing all the abdominal muscles in an isometric bracing of the abdominal girdle as the fundamental principle of providing stability and protection to the back, and using a stable torso solidly linked to the pelvis as a relay of force generated by the hips and shoulders, and not by the back.

In the same vein, the good professor warns against the use of most machines offered in commercial gyms, such as the Roman chair, back twisting machines, leg press-up machines. He objects to the permanent sitting required for these machines, and the fact that they limit joint motion to a strict mechanical pattern, depriving all the soft passive tissues of their natural range.
He deplores the perversion introduced by bodybuilding in the current trends of physical training. Very strong men have only hypertrophied muscles, and no overall fitness. Just pull sideways on his sleeve, and the strongman may well lose his balance. Prof. Stuart McGill's famous motto is "Groove the motion, train the movement, not the muscle".
Prof. Stuart McGill is famous for his preferred "Big 3" exercises for the back: the curl-up, the side bridge, and the birddog, all of them with stages of increasing challenge and complexity. There are quite a few more, if not so basic as the "Big Three", all detailed throughout the book, with an abundance of good pictures. For warm-up of the spine, nothing better than the cat/camel exercice.
Stuart McGill shows how to achieve back stability and spare the low back by maximizing the fundamental use of hips (the "hip hinge") and recruiting the use of the powerful gluteal muscles (with the clam and one-leg squats).

In general, he recommends use of free weights, dumbbells, cables, stretch bands and resistance tubes, and prefers one-armed and one-leg exercises as being more challenging than symmetrical exercises. He recommends avoiding the extreme end range of motion in exercises. And he criticizes a misguided conception of "flexibility" for the back, and the overuse of "stretching" exercises for their only sake. He is very skeptical of many practices of the fashionable vogues, such as yoga, or Pilates.

He insists on learning correct motions, grooving them to obtain perfect form, and then only cultivate endurance by a series of short sets, instead of increasing the number of reps in one long set. Endurance comes before strength, which is developed only once endurance is established.

Only Ch. 13, the last one, analyzes "Advanced Exercises", those for high-performance workers and athletes, putting the accent on low-back exercises to be practiced only by athletes who already have established a solid base of fitness and overall strength.
He wisely warns that Olympic lifting is an expert specialty that should be left to the professionals in this sport. He bemoans the fact that many young lifters, even though aware of his warnings, still manage to damage their backs.
He insists that regular 3F members, ordinary urban physical fitness fanatics, should be very cautious in trying to imitate too eagerly the training programs of professional competitors before they have established enough advanced fitness and strength.
Top professional competitors are not in sports and athletic pursuits for fitness, or good looks, or losing weight, but they enter an arena as modern Samurai or heroic warriors engaged in intense fights where the only goal is pulverizing an opponent and "winning," as a step to gaining fame and riches. In this picture, "back fitness" is a secondary consideration, and "back injuries" a professional hazard that's par for the game.

This last chapter is revisited and vastly amplified in Prof. Stuart McGill's other book, "Ultimate Back Fitness & Performance", especially geared to performers in sports and athletic competitions. This fitness manual is indeed another essential book for any member of the 3F club (Physical Fitness Fanatics) concerned about his/her back.
Warning! You will find the 4th edition of this Back Fitnessmanual, the last one, listed on Amazon as "Ultimate Back Fitness & Performance 4th Ed", with an "&" and not "and", bizarrely not in the "Books" section, but in "All Departments". In the "Books" only the 3d edition is mentioned.

You can also get two DVDs produced by Stuart McGill, which are also helpful, as live illustrations of the two books.

The great value of "Low Back Disorders" is that it is based on a scientific understanding of the basic facts in the anatomy, physiology, and biomechanics of the back.
In spite of some readers' objections, I feel it is extremely valuable to exactly understand how the back works -- basic facts about which most people have not the faintest idea --, and Prof. Stuart McGill does a first-class job in giving us the fundamentals.
We discover our neglected extension muscles, "Longissimus," "Iliocostalis," and "Multifidus". We regain acquaintance with our familiar "Rectus Abdominis", which happens to be one and not a family of six. We get a full picture of the Abdominal Wall, with the famous "External and Internal Obliques" and do not try to isolate "Transverse Abdominis." We get to meet our new friend, "Quadratus Lumborum", and acknowledge the vital importance of "Psoas" and "Iliacus" in hip flexion and stabilization, while greeting the key contributions of "Gluteus Medius" and "Gluteus Maximus".
Surrounded by all the members of this new family, we are in good shape to absorb Prof. Stuart McGill's instruction. This kind of knowledge should be taught in high school to all children. Knowledge of the musculoskeletal system is fundamental and vital for all sports and the conduct of our daily lives.

Sadly, most people know nothing about the biomechanics of the back beyond the simplistic and popular myths spread by school coaches and commercial fitness trainers for whom the primary interest is making money by joining fads and vogues, and not providing basic scientific information, which they often don't even have.
In that sense, "Low Back Disorders" is an indispensable primer to any fitness enthusiast.

This book is also a joy to use and study. It has been superbly edited by a full technical team at Human Kinetics, which unfortunately was not in charge of producing the companion book, "Ultimate Back Fitness & Performance," which does not enjoy the same kind of professional presentation.
The critically useful features of "Low Back Disorders" are: 1) a completely detailed table of contents describing all the material and concepts; 2) a complete list of all the exercises mentioned in the book; and 3) an extensive index at the end allowing the reader to zero in immediately on any item of interest.
All this increases the usefulness and effectiveness of the book, and becomes extremely helpful when you start digging seriously in the text. For instance, you can find where the variations of "cable exercises" are mentioned and illustrated. Or all the instances of analyzing and illustrating the "abdominal bracing", and " the "neutral spine position", two key concepts of Stuart McGill's doctrine. Same for any other kind of research: "Learning to activate the gluteus" or the "hip hinge," and "hip flexion". You don't have to waste precious time leafing through the chapters. To any professional book user, the three editing features mentioned above are a major convenience.
The self-references inside the book itself could be slightly improved, however.

So, all in all, this is a must have, deserving five stars without any restriction or reservation.
There is just nothing else like it on the market.

ROO.BOOKAROO

This book is fantastic. I wish I could thank Dr. McGill personally for this well-researched, well-founded book on rehabilitating the lower back. This book should be required reading for low back pain patients and their care givers. After reading the book, I was able to relieve a tremendous amount of back pain through very careful application of the ideas. It also helped me understand why my symptoms seemed to be aggravated by physical therapy. If you suffer from lower back pain, this is a great way to take better control of your therapy. The "evidence-based" nature of the book makes it invaluable.

I have been using this text in my office for over a year, and rarely a day goes by that I don't reference information from Dr. McGill's wonderful book. It is a scientifically detailed and rich text which translates it's tremendous quantification of the tolerances, characteristics and capacities of the human spine into practicle clinical application that is well understood by the clinician and patient alike. All physical medicine specialists should be required to read this book.

An appreciative reference to psychosocial issues is made, yet, the currently vogue practice of looking purely to psychosocial considerations and de-emphasising the biological/biomechanical components of back injury is challenged. The current approach is a Biopsychosocial one, and Proff. McGill fills this book with concrete reasons not to ignore the physical characteristics of the spine. He makes the point, that is dramatically clear in day to day clinical practice, that with effective care based on sound principles many of the psychosocial issues become much more manageable.

In this text common beliefs and practices are rigorously scrutinized experimentally so as to better understand the clinical rationalle. When strategies for injury prevention are found to be unsound, alternatives commiserate with biomechanical and practicle safety considerations are offered with sound data based reasoning given.

One of the most unique and valuable features of this text is that throughout the Scientific Foundations chapters, which describes the laboratory based biomechanical data in grand detail, are relatively short "Clinical Relavence" sections. These prominent and easy to read sections take the data just described and provide remarkably practicle applications of this knowledge. This feature has been tremendously helpful in my practice as it has allowed me to make strong recommendations to my patients with the ability to educate them as to why. Their understanding has increased compliance and empowered them by adding to their ability to help themselves.

Thank you Dr.McGill for such an in depth scientific analysis of a complex problem that is so remarkably practicle as a resource.

This book is full of information that every doctor who sees patients should have in their office. A must have , detail of structure issues and resvoling layout and protocol.Highly recommended. Also recommend The Backsmart Fitness Plan By Dr. Adam Weiss, a book written for pateint care in laymen's term for a complete full body workout.

I've had 42 years of intense back problems and had fusion of the last three lumbar vertebrae and S-1. Prior to reading the book and applying the recommended exercises, I was bedridden up to 20 hours a day for weeks. After trying the FIRST SET of the "Big Three" exercises, I noticed a slight improvement in the back! Within a week, I was hiking in the mountains and two weeks later skiing! Following the book's suggestions has given me a pain-free life of mobility.

If you are an exercise traditionalist, prepare for a shock. This book turns the world of back exercises upside down! Almost everything I had learned-and I was a coach-was incorrect and would lead to tissue injury according to research. I should have been born in Missouri, because my mantra is "Prove it to me!" My natural skepticism melted away as Prof. McGill presented scientific evidence to bolster his statements. He lists numerous pages of investigative results to give credence to the findings. Illustrations and commentary explain clearly the proper way to exercise to protect the back as you build endurance in the torso. It is written to address the minutia desired by professionals, but lucid enough in explanations to satisfy the "anatomy-challenged."

If you are frustrated with low back pain and its deleterious effect on your personality and living, this book delivers!