Low Back Disorders: Evidence-based Prevention and Rehabilitation by Stuart McGill Summary and Reviews
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Book Reviews of Low Back Disorders: Evidence-based Prevention and Rehabilitation
Book Review: Help for Sufferers of Low Back Pain
Summary: 5 Stars
This is a superb book that is useful for both clinicians and patients alike. Using methods based on electromyographic measurements published by McGill and his colleagues in many scientific journals, he ascertains which muscles are activated in a variety of exercises. This becomes important for patients who have low back problems and must avoid heavy spine loads both in the fitness center and at work. He lists a variety of commonly prescribed exercises that should be avoided by persons with low back problems: sit ups, pelvic tilts, leg raises, low back extension exercises on machines and hip flexion exercises using the Roman chair. He then recommends a series of exercises that are designed to strengthen back muscles and stabilize the spine while at the same time minimizing spinal compression that could exacerbate back problems: the curl-up, side bridges and "bird dog" leg extensions. This book should be recommended reading for all physical therapists and strength trainers with clients having low back problems and is a must for those suffering from low back pains.
Book Review: Scientific Basis of Reactivation of low back patients
Summary: 5 Stars
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.
Book Review: An Investigation of the Role of Biomechanics in LBP
Summary: 5 Stars
This impressive text sets out with the ambitious task of condensing over two decades of the author's research on the understanding of low back biomechanics. However, this text is not an abstract academic work. Much of Professor McGill's work involves developing conservative rehabilitation programs for individuals with chronic, treatment-resistant, low back pain, with particular focus on ergonomics, posture, and selective exercises. This well-illustrated text is organized into brief, reader-friendly, chapters that explain the issues surrounding low back disorders, and specific issues of clinical relevance are indicated. Noteworthy is the emphasis placed on developing individual, as opposed to formulaic, strategies for patients. The chapter on epidemiological studies provides findings that argue for the role of both physical and psychosocial factors in the etiology and perpetuation of low back disorders. However, given the author's area of expertise, the text is primarily focused on the understanding of lumbar biomechanics and the impact of different activities and exercises on the low back.
The author examines, and dispels, a number of myths surrounding low back disorders and their care. Some revelations are: lumbar vertebras serve as shock absorbers of the spine as opposed to the discs, the use of exercises that engage hip flexors (i.e. bent knee sit-ups) are likely to aggravate low back disorders, and exercise programs that emphasize spinal mobility or early morning exercise can actually exacerbate low back problems. These and many other discussions within this text are invaluable in understanding why many traditional active approaches to rehabilitation of low back disorders are unlikely to produce results, and may even compound the original injury.
The chapters on evaluation of patients and development of appropriate, patient-specific, exercise programs are invaluable to clinicians. Once the preceding chapters to evaluation and treatment have been understood, the reader is easily able to use the information in these chapters to approach low back disorders with a thorough understanding of the relevant biomechanical issues. More importantly, this understanding allows for explanation to patients why some activities aggravate their low back pain while others do not, and why previous exercise programs failed to produce results. Patients are encouraged to become active participants in their recovery process and to become `experts' in their own particular low back disorder. This seminal text provides a comprehensive and practical overview of current information on management of low back disorders, from a biomechanical perspective, that is simply unavailable elsewhere. Low Back Disorders: Evidence-Based Prevention and Rehabilitation is an invaluable addition to any clinician's library.
Book Review: Comprehensive and Practical Approach to Patient Reactivation
Summary: 5 Stars
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.
Book Review: Very myopic view on LBP
Summary: 2 Stars
As an avid proponent of evidence based medicine (EBM), I was very disappointed in this book. To cut to the point, I found this title incredibly misleading. Dr. McGill has blatantly disregarded the contemporaneous EBM studies that have conclusively shown that the biopsychosocial model for chronic lower back pain is by far more appropriate model that the outmoded biomedical approach. Dr. McGill flagrantly misses the point when he makes such broad generalizations such as, "It is currently popular for many authorities to suggest that back trouble is not a medical condition"; "The position that biomechanics plays no role in back health and activity tolerance can be held by those who have never performed physical labour"; "The significance of psychology for back problems is often greatly exaggerated".
It is my humble opinion that NONE of the world authorities (e.g. Waddell, Nachemson, Deyo, Walsh, Volinn, Skovron, Carron, Turk, Arnold, Miller, Bongers, Hall, etc.) on low back pain are oblivious to the fact that biomedical issues are IMPORTANT in the etiology of low back pain. These authorities are unanimous in their belief that chronic (> 6 months) low back pain does have a biomedical component; however, these research scientist have proved, beyond a shadow of a doubt, that psychosocial issues are just as important, and in some cases even more important, than biomedical issues in giving rise to and sustaining chronic low back pain. Hence, it would be a great travesty, for any one who is managing chronic lower back pain, to ignore the psychosocial aspect of their patients' medical histories. Such an omission would not only be a travesty but it must also be classified as an act of gross negligence.
Dr. McGill's book, LOW BACK Disorders - Evidence- Based Prevention and Rehabilitation, has exposed his myopic view re the subject of low back pain, unfortunately he has produced a book that does little to advance the clinical management of low back pain.
While this book may be useful to the research scientist - i.e. those who are learning more about less and less, this book is of little value to the clinician, like myself, who finds themselves on the front lines re the management of low back pain.
For those clinicians who are attempting to expand their evidence-based medical knowledge on low back pain I'll unconditionally recommend:
? Neck and Back Pain - The Scientific Evidence of Causes, Diagnosis and Treatment by Alf Nachemson (2000)
? Low Back Pain: An Evidence-Based, Biopsychosocial Model for Clinical Management by Jane Derebery (2002)
? The Back Pain Revolution by Gordon Waddell (1998)