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Low back disorders: evidence-based prevention and rehabilitation
  1. C Richardson1,
  2. J Hides2
  1. 1Department of Physiotherapy, University of Queensland, Brisbane, Queensland 4072, Australia
  2. 2Clinical Supervisor, University of Queensland/ Mater Hospital Back Stability Clinic, South Brisbane, Queensland 4101, Australia; juliehides{at}bigpond.com

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    S McGill. Champaign, IL: Human Kinetics (www.HumanKinetics.com), 2002, £34.00, pp 312. ISBN 0736042415

    There are many ways in which rehabilitative exercise, postural correction, ergonomics, as well as vast numbers of pain relieving techniques can assist in the prevention and treatment of low back pain. Research teams throughout the world are beginning to provide evidence for effective management strategies within their areas of expertise. This research often relies on development of valid and reliable measurement techniques. Some research teams focus on clinical trials, in which validated pain and disability measures are used to provide evidence for efficacy of a particular method of treatment. Other back pain research teams (as that of McGill) focus on the development of management approaches, based on an understanding of how muscles function to provide spinal stability and load transfer through the spine and pelvis. These management strategies have been developed through a focus on either biomechanical or neurophysiological models of muscle function. McGill has developed exercises for prevention and rehabilitation of low back pain based on biomechanical models.

    The strength of McGill’s text lies in his anatomical and biomechanical research evidence on how injury develops in specific anatomical structures (including an excellent depth of understanding of “tissue creep”) and the methods through which tissue loading can be reduced to minimise the risk of injury. This important information can direct strategies for the prevention (and rehabilitation) of low back pain, which involve postural correction and adherence to sound ergonomic principles. We would highly recommend this text for these essential aspects of low back pain management.

    However, the rehabilitative exercise regimen described by McGill in this text differs markedly from many other evidence based exercise programmes devised for the treatment and prevention of low back pain. Other approaches, which have been based more on neurophysiological research on the joint protection mechanisms, base their exercise treatment on a problem solving approach and, more importantly, on the impairments that develop in these mechanisms, in low back pain patients. These impairments are different in each patient, and depend on issues such as the specific location of the injury, lifestyle factors, and pain. The impairments in muscle recruitment patterns result in some muscles becoming less active or inhibited and others becoming more active, less fatigable, and tight. These factors are used to direct exercise treatment.

    Thus McGill’s text is ideal for gaining an understanding of how to prevent and treat low back pain using some important principles of postural correction and ergonomic management. Future clinical trials will be required to estimate the efficacy of the rehabilitative exercise programme.

    The book is targeted mainly at health practitioners dealing with ergonomics and occupational health.

    The author is well known, well published, and well respected in his area of research.

    The book definitely has a “feel good factor” and we would buy it. The only issues we found slightly irritating in the book were the rather simplistic explanations of theories of motor control.

    Rating

    Presentation 15/20

    Comprehensiveness 15/20

    Readability 15/20

    Relevance 16/20

    Evidence basis 16/20

    Total 77/100

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