Ultimate Back Fitness and Performance

Dr. McGill's most recent text presents a view of the foundation of rehabilitation and injury prevention for the lumbar spine that is different from that prevalent within orthopaedic physiotherapy during the past 10 years. For this reason, the book is sure to be controversial within the rehabilitation community.

Based at the University of Waterloo, Stuart McGill is one of the world's premier spine biomechanists. He has published extensively regarding spinal motion, control and injury etiology. In addition to his laboratory experience, Dr. McGill also provides clinical consultation and patient treatment programs.

Although the preface of the book indicates that it was written both for clinicians and the general public, it is assumed that the reader has a good understanding of the relevant anatomy and muscle mechanics of the lumbar spine. Much of the same information from the previous text, Low Back Disorders: Evidence-Based Prevention and Rehabilitation, appears within this text.¹ However, the present text is geared more toward high-performance athletes and physical labourers.

In an attempt to reduce its cost, Ultimate Back Fitness and Performance was self-published. This is apparent in the formatting of the text, with some headings that spill over onto subsequent pages; a lack of colour, making interpretation of many of the electromyographic figures difficult; and an overabundance of exclamation marks throughout the text.

The book is divided into three parts. Part One focuses on the underlying science of the spine and begins with a chapter on the myths associated with low back pain and rehabilitation, such as stretching, strengthening principles and muscle isolation exercises. Subsequent chapters in Part One focus on the principles of exercise adaptation in the back, anatomy of the lumbar region, biomechanics of the spine and stability concepts and use of back belts.

Part Two progresses to motor programming principles and patient assessment. Although some assessment approaches are common to most physiotherapists, several muscular endurance-testing protocols are unique to Dr. McGill's approach and later figure strongly into his rehabilitation strategy.

Part Three addresses the specifics of treatment and injury prevention, with illustrative case studies to pull the information together. There is a strong emphasis on functional exercises and their varied progressions, both of which are clear and creative.

The controversy that this book will likely create lies not in the proposed benefits of spinal stabilization but in the method used to achieve that stability. Dr. McGill argues strongly against the focus on transverse abdominus and multifidi that have formed the cornerstone of back stabilization programs since the groundbreaking work of Hodges and Richardson. Dr. McGill's approach hinges on global activation of core musculature, which he has called the “abdominal brace”; instead of isolation of specific muscles. Although he argues against isolation of lumbar stabilizers and suggests that they may decrease spinal stability, he does not refute the results that these programs have reported in the literature. This presents an interesting counterpoint to his theory.

Because Dr. McGill is a biomechanist and not a manual therapist, the rehabilitation approach taken within this book focuses entirely on education and exercise. However, he has published several articles on the effect of manipulation on lumbar kinematics and electromyography, and it is unfortunate that this aspect of spinal rehabilitation is not addressed within this text. Much more discussion of the physiology of manual therapy is needed among both clinicians and researchers.

Dr. McGill's approach to lumbar rehabilitation is unique, controversial and likely to stir much discussion among those who treat individuals with lumbar pain. The rationale within the text is well-grounded and supported by extensive research. Those involved in treating persons with low back pain will find the book valuable and interesting. In addition, those involved with high-performance athletes and clinicians interested in ergonomic rehabilitation will benefit greatly from this text. I hope that Dr. McGill's decision to self-publish this text does not limit its recognition within the rehabilitation community.