Low back disorder: evidence-based prevention and rehabilitation: Stuart McGill. Champaign, Ill, Human Kinetics, 2002. 312 pages, $45.00

This excellent new text discusses the role of exercise in the treatment of low back disorders. The work of clinical scientists in Australia and Denmark is reviewed and put into perspective based on laboratory analysis of spinal loads with different activities. Professor McGill presents his ideas in an orderly fashion beginning with the scientific evidence for exercise. Then, he presents a series of tests for establishing the patient’s functional diagnosis. Finally, he shows how to prescribe both introductory and more advanced exercises for the low back pain patient.

One of McGill’s more cogent arguments centers on his discussion of the limited value of imaging to establish a clinically useful pathological diagnosis. This is followed by a rigorous literature review documenting the need for clinicians to establish the patient’s functional diagnosis. This section is one of the book’s strongest, especially in light of the limited functional assessment provided by most health care providers for patients with low back pain.

McGill succeeds admirably in articulating what stability means and how it can be measured. What could easily be clinically meaningless mathematical jargon becomes the foundation for a very simple, yet highly sophisticated, clinical approach. For instance, he explains how he determines spinal load profiles of routine activities of daily living and common exercises. In turn, the reader is enlightened to discover that many beliefs about exercises are based on myth rather than evidence.

One of the most valuable aspects of the book is McGill’s presentation of the evidence regarding many popular myths of ergonomics and exercise training. 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.

McGill’s 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.

The book concludes with a section on more advanced exercises that have preventive and conditioning value, although they would be inappropriate for the subacute treatment phase. McGill has, at times, been criticized for not including more information regarding advanced or functional exercises. However, as this section shows, his work is broadening all the time.

In summary, this book has something to offer all health care providers dealing with patients suffering lower back pain. For those who do not prescribe exercise, this explains the value and methods for doing so. For those who already are involved in rehabilitation, this book is a necessary source of new information, as well as a simple yet comprehensive resource for the biomechanical basis for exercise therapy.