Low Back Disorders, Second Edition » (2nd Edition)

Stuart McGill, PhD, is a professor at the University of Waterloo at Waterloo, Ontario, Canada, and a world-renowned lecturer and expert in spine function, injury prevention, and rehabilitation.

McGill has written more than 200 scientific publications on the topics of lumbar function, low back injury mechanisms, investigation of tissue loading during rehabilitation programs, and the formulation of work-related injury avoidance strategies. He has received several awards for his work, including the Volvo Bioengineering Award for Low Back Pain Research from Sweden.

McGill has been an invited lecturer at many universities and delivered more than 200 addresses to societies around the world. As a consultant, he has provided expertise on assessment and reduction of the risk of low back injury to government agencies, corporations, professional athletes and teams, and legal firms. He is one of the few scientists who consults and to whom patients are regularly referred.

Low Back Disorders: Evidence-Based Prevention and Rehabilitation, Second Edition presents research to quantify the forces that specific movements and exercises impose on the low back, dispels myths regarding spine stabilization exercises, and suggests prevention approaches and strategies to offset injuries and restore function.

Doody Review Services

Reviewer:Christopher James Hughes, PT,PhD,OCS,CSCS(Slippery Rock University)
Description:This book addresses disorders of the low back and implications for proper ergonomics and corrective rehabilitative exercise. The first edition was published by the same author in 2002.
Purpose:The purpose is to provide readers with evidence-based knowledge in the area of spine biomechanics as it relates to injury prevention and treatment. Considering the prevalence of low back pain among the population and the numerous myths associated with care of the spine, the author has picked a worthy objective. Readers will find that the author in his own unique style has been successful with this second edition.
Audience:The audience for this book is diverse. Students and professionals in the area of ergonomics, biomechanics, kinesiology, and physical medicine can benefit from its content. According to the author, many readers of the first edition were lay persons who desired a better understanding of their own experiences with low back pain. He is an established researcher, consultant, and designer of rehabilitation programs.
Features:Three major sections comprise the book. Section one contains six chapters which discuss frequently asked questions on spine care and detail how the spine functions. Epidemiologic information and clarification of common myths on spinal stability are covered. Section two focuses on injury prevention. Three chapters discuss risk assessment, reducing back injury and explain the latest research on the use of back belts. Section three is entirely devoted to rehabilitation, covering evaluation, design, and implementation of an exercise program for patients with low back disorders. Exercise progressions are uniquely presented and expanded upon in this second edition and the author provides convenient worksheets that can be copied for clients. Strong features of the book include the concise writing, clear illustrations, credible references, and current of information.
Assessment:Readers of the first edition will want to upgrade to the second edition and first time readers will find it hard to put the book down. It is unlike others on the market and complements the author's other work, Ultimate Back Fitness and Performance, 2nd edition (Backfitpro Inc., 2006). This is a fine blend between science and practical application by a credible author. The author is in a unique position to share his own valuable research and clinical experience to advance the treatment of alleviating low back disorders. I highly recommend this book for anyone who needs to understand the spine.

List of Tests and Exercises
Why and How You Should Read This Book
Acknowledgments

Part I. Scientific Foundation

Chapter 1. Introduction to the Issues
Legislative Landscape: The Unfortunate Adverse Impact on Bad Backs
Deficiencies in Current Low Back Disorder Diagnostic Practices
Is It True That 85% of Back Troubles Are of Unknown Etiology? Diagnosis by Hypothesis Testing Is It True That Most Chronic Back Complaints Are Rooted in Psychological Factors? Does Pain Cause Activity Intolerance?
Inadequacies in Current Care and Prevention of Low Back Disorders
Ill-Advised Rehabilitation Recommendations Can Back Rehabilitation Be Completed in 6 to 12 Weeks? Should the Primary Goal of Rehabilitation Be Restoring the Range of Motion? What Are Better Alternatives in Dealing With Painful Backs?
Mechanical Loading and the Process of Injury: A Low Back Tissue Injury Primer
A Final Note

Chapter 2. Scientific Approach Unique to This Book
In Vitro Lab
In Vivo Lab
How the Virtual Spine Works Development of the Virtual Spine

Chapter 3. Epidemiological Studies on Low Back Disorders (LBDs)
Multidimensional Links Among Biomechanical, Psychosocial, and Personal Variables
Three Important Studies Do Workers Experience LBDs Because They Are Paid to Act Disabled? Does Pain Have an Organic Basis-or Is It All in the Head? Are Biomechanical Variables and Psychosocial Variables Distinct? What Is the Significance of First-Time Injury Data for Cause and Prevention?
How Do Biomechanical Factors Affect LBD?
Mechanical Loading and LBD:Field-Based Risk Factors What Are the Lasting Physiological, Biomechanical, and Motor Changes to Which Injury Leads? What Is the Optimal Amount of Loading for a Healthy Spine?
What Are the Links Between Personal Factors and LBD?
What the Evidence Supports

Chapter 4. Functional Anatomy of the Lumbar Spine
Basic Neural Structure
Vascular Anatomy
The Vertebrae
Vertebral Architecture and Load Bearing Posterior Elements of the Vertebrae
Intervertebral Disc
Load-Bearing Abilities Progressive Disc Injury
Muscles
Muscle Size Muscle Groups Abdominal Muscles Psoas Quadratus Lumborum Muscle Summary
Ligaments
Longitudinal Ligaments Interspinous and Superspinous Ligaments Other Ligaments in the Thoracolumbar Spine Normal Ligament Mechanics and Injury Mechanics
Lumbodorsal Fascia (LDF)
A Quick Review of the Pelvis, Hips, and Related Musculature
Clinically Relevant Aspects of Pain and Anatomic Structure
Tissue-Specific Types of Pain Can Pain Descriptors Provide a Reliable Diagnosis?
A Final Note

Chapter 5. Normal and Injury Mechanics of the Lumbar Spine
Kinematic Properties of the Thoracolumbar Spine
Kinetics and Normal Lumbar Spine Mechanics
Loads on the Low Back During Functional Movements Loads on the Low Back During Various Exercises
Dubious Lifting Mechanisms
Intra-Abdominal Pressure Lumbodorsal Fascia Hydraulic Amplifier IAP, LDF, and Hydraulic Amplifier: A Summary
Other Important Mechanisms of Normal Spine Mechanics
Biomechanics of Diurnal Spine Changes Spinal Memory Anatomical Flexible Beam and Truss: Muscle Cocontraction and Spine Stability
Injury Mechanisms
Summary of Specific Tissue Injury Mechanisms Injury Mechanics Involving the Lumbar Mechanism Staying Within the "Biomechanical Envelope"
Biomechanical and Physiological Changes Following Injury
Tissue Damage Pathogenesis, Pain, and Performance Injury Process: Motor Changes Specific Patterns of Muscle Inhibition Following Injury The Crossed-Pelvis Syndrome and Gluteal Amnesia

Chapter 6. Myths and Realities of Lumbar Spine Stability
Stability: A Qualitative Analogy
Quantitative Foundation of Stability
Potential Energy as a Function of Height Potential Energy as a Function of Stiffness and Elastic Energy Storage Muscles Create Force and Stiffness Sufficient Stability
Stability Myths, Facts, and Clinical Implications

Part II. Injury Prevention

Chapter 7. LBD Risk Assessment
Brief Review of the Risk Factors for LBD
NIOSH Approach to Risk Assessment
1981 Guideline 1993 Guideline
Snook Psychophysical Approach
Lumbar Motion Monitor (LMM)
Ergowatch
Biological Signal-Driven Model Approaches
The Marras Model and the McGill Model EMG-Assisted Optimization Simple or Complex Models?
The Challenge Before Us

Chapter 8. Reducing the Risk of Low Back Injury
Lessons From the Literature
Compensation Board Statistics-An Artifact? Ergonomic Studies Rehab and Prevention Studies Studies on the Connection Between Fitness and Injury Disability Beyond Ergonomics: Is It Time to "Modify" the Worker?
LBD Prevention for Workers
Should Workers Avoid End Range of Spine Motion During Exertion? What Are the Ways to Reduce the Reaction Moment? Should One Avoid Exertion Immediately After Prolonged Flexion? Should Intra-Abdominal Pressure (IAP) Be Increased While Lifting? Are Twisting and Twisting Lifts Particularly Dangerous? Is Lifting Smoothly and Not Jerking the Load Always Best? Is There Any Way to Make Seated Work Less Demanding on the Back? Some Short-Answer Questions
LBD Prevention for Employers
Injury Prevention Primer
A Note for Consultants

Chapter 9. The Question of Back Belts
Issues of the Back Belt Question
Scientific Studies
Clinical Trials Biomechanical Studies Studies of Belts, Heart Rate, and Blood Pressure Psychophysical Studies
Summary of Prescription Guidelines

Part III. Low Back Rehabilitation

Chapter 10. Building Better Rehabilitation Programs for Low Back Injuries
Our Five-Stage Back Training Program
Finding the Best Approach
Stages of Patient Progression
Stage 1: Detect and Correct Perturbed Motion and Motor Patterns Stage 2: Establish Stability Through Exercises and Education Stage 3: Develop Endurance
Guidelines for Developing the Best Exercise Regimen
Developing a Sound Basis for Exercise Prescription Basic Issues in Low Back Exercise Prescription

Chapter 11. Evaluating the Patient
The Most Crucial Element in Evaluation
First Clinician-Patient Meeting
Some Provocation Tests
A Note on Motion Palpation Distinguishing Between Lumbar and Hip Problems
Some Functional Screens
The "Stiff" Spine Control of Torsional Motion Testing for Aberrant Gross Lumbar Motion
Testing Muscle Endurance

Chapter 12. Developing the Exercise Program
Philosophy of Low Back Exercise Design
Clinical Wisdom
Sparing the Back While Stretching the Hips and Knees Flossing the Nerve Roots for Those With Accompanying Sciatica
Identifying Safe and Effective Exercises
Incorporating and Patterning the Muscles Eliminating Unsafe Exercises Selecting Safe and Effective Exercises
Beginner's Program for Stabilization - A Sample
Exercises That May Be Used in a Stabilization Program

Chapter 13. Advanced Exercises
Safely Increasing Challenges
Labile Surfaces and Resistance Training Machines Safely Progressing Back Exercises
Occupational and Athletic Work Hardening
Low Back Exercises for High-Performance Workers or Athletes Low Back Exercises Only for Athletes
Looking Forward

Epilogue
Handouts for Patients or Clients
Appendix
Glossary
References and Additional Readings
Index
About the Author