Low Back Disorders: Evidence-Based Prevention and Rehabilitation.

McGill S. Champaign, IL 61825-5076, Human Kinetics, 2002, hardcover, 310 pp, illus, ISBN: 0-7360-4241-5, $45.

Low Back Disorders: Evidence-Based Prevention and Rehabilitation is intended to provide the best scientific evidence available on optimal prevention strategies and rehabilitation interventions for low back injury. Stuart McGill, a spine biomechanist and clinician, notes that this book is not about perpetuating clinical myths, but rather challenging them and proposing valid and justifiable alternatives related to the prevention and treatment of low back disorders.

This book comprises 14 chapters that are organized into 3 parts. Part I, which includes the first 6 chapters, provides a sound scientific foundation for the rest of the text. Part I includes chapters describing the book's biomechanically based methodological approach, epidemiological studies on low back disorders, and functional anatomy of the lumbar spine. The chapter on normal and injury mechanics of the lumbar spine is particularly beneficial to clinicians, because it explains the role of different lumbar tissues during various activities and the changes that occur following injury.

Part II comprises Chapters 7 through 10, and it provides valuable insight into the prevention of low back disorders. More specifically, it suggests practical strategies for identifying and removing stresses that create or exacerbate low back disorders and enhancing activities that build healthy supportive tissue. This section therefore is extremely useful for ergonomic consultants as well as clinicians who want to prevent future occurrences of low back pain in patients they are currently treating. Part II includes chapters describing risk assessment for low back disorders, strategies for reducing the risk of injury at work and sport, and the use of back belts in industry and athletics.

Part III, which comprises chapters 11 through 14, is specifically geared toward rehabilitating patients with low back disorders through an evidence-based approach. This part includes chapters dealing with patient examination and the development of exercise programs for patients with low back disorders. The author accurately describes, in some detail, the forces that specific rehabilitation activities impose on the spine, information that can help clinicians prescribe the appropriate stabilization/mobilization exercise for the various stages of rehabilitation.

This book is an outstanding contribution to the rehabilitation literature, and the author is indeed successful in proposing valid and justifiable strategies related to the prevention and treatment of low back disorders. It is well written and includes recent research findings, with comprehensive reference lists provided at the end of each chapter. However, more references on the effectiveness of rehabilitation interventions for patients with low back disorders would have been useful, especially in part III. High-quality figures and tables are used effectively to complement the text. In addition, areas of clinical relevance within the chapters are nicely highlighted with stand-alone text boxes. I highly recommend this book for physical therapists or physical therapist students who serve as ergonomic consultants or who practice in orthopedic or sports medicine settings.

Michael D Ross, PT, DHS, OCS 

Vallejo, Calif

Dr Ross is a US Air Force physical therapist. He is currently a resident in the orthopedic and primary care physical therapy program at Kaiser Permanente Medical Center.