Low Back Disorders, Second Edition

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 THREE" exercises for the back:1) the curl-up,2) the side bridge,and 3) 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,- preferring one-armed and one-leg exercises as being more challenging than symmetrical exercises,- avoiding the extreme end range of motion in exercises.- avoiding being seduced by a misguided conception of "flexibility" for the back,- being wary of the overuse of "stretching" exercises for their only sake.- and being 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 only then 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 world of extreme competition, "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 AND 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.ALERT: TRY TO GET THE 4TH EDITION OF THE "ULTIMATE BACK FITNESS AND PERFORMANCE", INSTEAD OF THE 3D EDITION, AND DON'T GET CONFUSED BY AMAZING AMAZON'S LISTINGSWarning! You will find this ULTIMATE BACK FITNESS AND PERFORMANCE book listed on Amazon in two different sections:1) in the BOOKS section under its original title, which clearly figures in caps on the cover, indicating also in caps, FOURTH EDITION. However, when you examine the details of the book, you read that what is offered is the 3d edition of 2004 (in spite of the cover picture).2) in the ALL DEPARTMENTS section, the offering is the 4th edition of 2009, but it now is given a slightly different title, with "&" replacing the original "AND". The cover picture remains that of the original cover with its original title, figuring "AND".So when you search for the book with its original title, you are automatically referred to the listing in the BOOKS section offering the 3d edition. You will never guess that there is also a listing for the 4th edition, since, to find it, you have to know that you have to change the title by replacing "AND" with "&". Even I was not aware of this manipulation.So the same book is listed in two different sections, offering either the 3d edition (2004), or the 4th edition (2009) of the same book, under SLIGHTLY DIFFERENT TITLES. You have to admire marketing ingenuity, or the art of deceiving the consumer.This kind of game seems to be pretty unusual, and a tricky marketing gimmick, to keep selling the copies of the 3d edition still available.However, don't be so sure. For I wonder whether Amazon is not using this trick for other books, or other products, creating new listings in ALL DEPARTMENTS different from their original listings in their respective natural sections, but still offering the same product in slightly different formats. Think of the ethics of the practice, and question whether this does not smack of fudging.You can also get two DVDs produced by Stuart McGill, which are also helpful, as live illustrations of the two books. They offer good content, but are not professionally polished.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 AND 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 into 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.(Note, and this is one of my many criticisms directed at ULTIMATE BACK FITNESS AND PERFORMANCE, not for its content, but for its physical presentation, that the three critical features of the medical book are not incorporated in the fitness manual, which is a major nuisance to all users.)The self-references inside the medical book itself could be slightly improved, however (while they are practically non-existant in the fitness book.)Never educated as a fitness trainer nor a sports team coach, McGill used his lab expertise to compile a fitness manual: ULTIMATE BACK FITNESS AND PERFORMANCE, 4th (2009), 5th ED (2014). For the lure of profits, he regrettably self-published that manual, a poor physical product compared to the professional quality of Human Kinetics in this LOW BACK DISORDERS textbook. See my Comment/Alert about the 5th ed. (2014)ROO BOOKAROO

Though longer and harder to read than exercise books written for the general reader, Stuart McGill's, Low Back Disorders, blends such a useful evaluation of the research of others with his own groundbreaking research that it is well worth buying. The general reader can refer to helpful lists and charts that summarize his research. One such chart provides a comprehensive list of the common back exercises that physical therapists have prescribed over the years and their effects on every relevant torso muscle.Here is just a sample of the teachings on which McGill builds his exercise routine for backs:1. Endurance is more protective than strength;2. Though all torso muscles play a roll in back stability, back extensors need to have significantly more endurance than back flexors.3. For most back problems stability is more important than flexibility because usually flexibility will return after you stop hurting and start building your back in spine saving ways. Flexibility is crucial for the hips, hamstrings and calves, but is of limited and/or sports specific value for the back. Use the "Cat and Camel" to warmup and equalize pressure in the disks. For me, the "Cat and Camel" is all I need whenever my lower back muscles tighten.4. "Preserving the normal low back curve" during exercise causes less stress on the spine than doing the old fashioned pelvic tilt which flattens the back against the exercise mat;5. Why the accumulation of nutrient fluid in the discs during sleep means that back exercises should not be done during the first 1 or 2 hours after arising;6. Why adding repetitions to an exercise is safer and more productive than prolonging the hold of each repetition beyond 7-8 seconds.7. Why, if possible, it is best to stress only one side of the back at a time during exercise.Following these and other specific recommendations makes doing McGill's exercises and those in other books safer and more effective.McGill correctly assets that no one exercise plan can fit the needs of every patient. So, apart from reverse pyramids, he leaves it up to the therapist to determine the number of sets and repetitions needed to generate endurance. This is fine for therapists but gives inadequate guidance for the non-therapist reader. It fails to take into account the needs of all those whose back problems are not so unique or troublesome as to require a therapist and those who cannot afford to see a therapist. Just as there are back problems of different severity and clients with different goals, so there could be sample exercise programs that represent a broad range of different needs while still allowing flexibility for the physical therapist.By paying attention to the table of contents and the section headings, the reader can, if desired, avoid the details of the research findings. Or one can come back later to the research after starting to exercise. To do so, read the injury prevention primer (pp. 154-156), chapter 10 for the background to the exercises, and chapter 12 for the exercises.McGill is particularly insightful about which exercises are key and why. He skillfully uses his research knowledge to tailor the exercises so that the stresses on the back are minimized while still challenging the muscles.One topic I would have liked McGill to cover would be an exercise routine for those who have chronic lumbar pain that is associated with widespread chronic, musculoskeletal pain. It is possible, however, that humanity simply doesn't yet have the knowledge necessary to plan such a routine.MCGill's other book,Ultimate Back Fitness and Performance,is focused on exercises (not research), is easy to read, well organized, and is probably what most people are looking for in an exercise book. It begins with a very readable summary of key research findings, goes on to the exercises every back sufferer needs to do, and then concludes by clearly illustrating what athletes need for their particular sport. For more information and resources see McGill's web site, backfitpro.I also highly recommend:8 Steps to a Pain-Free Back by Esther Gokhale (Go-clay),a revolutionary approach to back therapy based on her observations of people in other cultures where back pain is virtually nonexistant. It very easy to read and has a clear step-by-step approach to the common activities of daily life, e.g., sitting, standing, bending, lying in bed, and walking.In summary, what I have learned from McGill and Gokhale has helped my back more than what I have learned from other authors.

Helpful content

Very interesting. I have found the information very helpful in my development as a therapist. There is little content in practical application, but only because the solutions to low back problems are, in a way, so simple. I recommend this highly to lay a foundation in the understanding of lumbar troubles.

If you are a patient with chronic back pain - please read on........This book changed my life but it is not be suitable for all. It is targeted primarily for healthcare professionals treating or researching into spinal injury. As a consequence, it's a very meaty, technical book, presenting and discussing a lot of data from many scientific studies. The author is a prof of biomechanics (so there is a lot about Newton force, vectors and torque) but I didn't find it too hard and you can easily skip the numbers and not miss out hugely from a patient's perspective: the written style is very accessible and not at all "academic" or high brow. The book gives professionals the understanding to treat patients: it is not a book that will give patients an exercise programme per se. It therefore makes complete sense for the author to stress that if you are a patient, it is important to apply anything from this book in conjunction with relevant health care professionals.Having said that, I am a patient, and not only did this book give me insight into my condition that I can apply to my daily life, but it also gave me a framework to rehabilitate my back after years of suffering whilst coming up against a dead end through the health services. Furthermore after 9 months, it continues to serve as a great reference work for me: there is barely a week goes by that I do not delve into this book for 5 minutes or less and remind myself of some tip that I can directly integrate into my daily activities and exercises.If you are a sufferer, and are willing to take control of your back pain and understand it in a lot more detail, I would definitely consider buying this book and investing the time to read it. For the price of this book, it could be more than worth it!My storyI have had chronic lower back pain for years. Specialists suspected it was due to disc degeneration and had all but given up with any chance of improving my condition. Indeed, I spent years going from one physio or consultant to another, each optimistically offering if not a cure, only to be palmed off several months later no further forward. I was doing pilates and was apparently quite good - but still I had a lot of pain and no real improvement. Surgery was an option offered but not taken up - since there was no confidence is cause or benefit.My life prior to this bookI was despondent. Sometimes, waking up in the morning, the only thing I had to look forward to is whether I would have any pain free time on that day (most pain killers just sent me to sleep). My quality of life was massively impacted. I could not participate in any of my hobbies (gardening, sport, jogging, cycling, playing guitar, travelling and even going to restaurants I didn't know the seating of). My personal life was affected: suffering from chronic pain doesn't make for good company or a healthy relationship. Daily life such as housework and shopping were big projects that I needed to restrict. And then trying to keep a job was a nightmare - working at a computer.How did I find this book?When I was feeling well enough, I took a weeks off work to research back pain online (with regular pauses after working on the PC). There is a lot of help out there, but also a lot of rubbish to. I came across this author as someone who seemed to be substantiating why certain exercises or movements were beneficial and why some were harmful. It was evidence based and some of what I initially read struck a chord with things I had discovered empirically (although few health care professionals seemed to understand or believe me eg not exercising for a few hours after getting up, extending my back backwards in an arc). In short, this author gave me hope. I later found out the book is available from his website ([...]) and received another item from him promptly.My recovery using this bookI was a bit daunted by the technical nature of the book but I persisted and quickly found a lot of great tips and a very simple basic exercise plan. Using this - and building up gradually over 6 m - I was able to start contemplating a new live (my old life). My improvement is already better than I would have settled for prior to using the book. Walking without pain is beautiful. Not thinking about my back has made me human again. I may probably not do some things ever again (eg jog or do heavy lifting) but I have a good life back. Stu McGill deserves an award.The bookThe book is divided into three main sections:1. Background to the spine and spinal injury - 120 pages2. Preventing injury - 40 pages3. Rehabilitation - 80 pagesThe first section covers spine anatomy and what's going on in spinal injury, his research methodology, and popular myths on back pain. I found this bit useful reference but pretty hard going as a layman. Whilst this is a technical book, he is however a very good communicator so for example, his explanation of the spine being an upright fishing rod that is strong only when supported by guy-ropes is very powerful.The second section on preventing injury is full of useful tips for a lay person. His central thesis is that the first step to recovery is to ensure no further injury. The chapters include photos of everyday life activities with correct or harmful postures.Finally the last section is really designed to give professionals the tools to assess patient's injuries and design a programme of rehabilitation. It does not give a programme of exercises however does suggest some very basic exercises (in varying degrees of severity) that got me back on the path to normality. My problem was that I couldn't even do exercises I had been given without immense pain and getting worse. Very gently versions of the exercises are given which once I had seen were making a difference, I took to my physio who refined them further. The section also talks about the importance of warming up the spine and "grooving" good muscle movement patterns - all very useful and things not really touched on in anything else I have been told or read.I can't praise this book enough. In conjunction with Sarah Keys Back Bible, I got the tools to have a life back (I use exercises prescribed by Sarah Keys as warm downs and id use them as occasional therapeutic interventions during the months when I was bad).

This book is well structured and well written. The exercises are well described and well presented, in context and with progressions. I currently teach his findings to all my clients with back-pain. I also do the exercises myself. The scientific background is cutting edge and finally gives all the answers to back related troubles.

Nice