A review of Dr. Roth’s “The End of Back Pain”

Andrew Siegel, M.D.   Blog #151

This blog is a review of a recently published book by Dr. Patrick Roth entitled The End Of Back Pain. This book piqued my interest because preventive health and exercise as a means of health maintenance and management of disease are topics that are dear to my heart. I recently authored a book on male pelvic floor muscle training as a means of preventing and managing sexual and urinary issues (Male Pelvic Fitness: Optimizing Sexual and Urinary Health) and I saw great parallels between Dr. Roth’s book and my own.

The author—a neurosurgeon—argues for a revolution in the conceptualizing of back pain and explains that the majority of pain is not related to “something broken.” His conviction is that back pain represents a common, fluctuating condition of normal life. Therefore, the appropriate treatment of back pain is to facilitate the body’s natural healing and shielding ability and mitigate it by strengthening the muscles of the body’s “hidden core”. Dr. Roth has designed a regimen entitled “the hidden core workout” that is dedicated to this. How refreshing it is to be exposed to a conservative means of management from a physician whose specialty is dedicated to invasive surgical procedures! Additionally, he proposes the paradigm-shattering view that back pain is not always a warning to abandon one’s program of exercise.

The text is sprinkled with “philosophical maxims” that are applied to the back–these are not only interesting and entertaining, but many of them were principles I had never been exposed to; “hidden truths”—pearls of knowledge; “Roth’s Rx”—the author’s basic recommendations; “core concepts”; and “the gist”—bullet points at the end of each chapter that summarize the salient points.

The content is organized and extraordinarily well written in very readable prose in terms that a layperson will readily understand. It has a nice flow and rhythm and the writing is imbued with an amusing sense of humor. Facts are nicely annotated and the book is well indexed. The author makes use of clever analogies and metaphors to make comprehending difficult subjects very simple.

I do not suffer from back pain—in fact, my back is one of the few areas of my body where I have never sustained a musculo-skeletal injury. Even though back pain is not my personal issue, I found Dr. Roth’s hidden core strengthening regimen extremely useful, and in fact, I am familiar with many of the exercises from my yoga, Pilates, and P90X experiences. I came to the realization that the reason I do not have back pain is that for years I have been doing many exercises that focus on my hidden core muscles! I have been studying Pilates for 4 years—it has greatly improved my posture, core strength and has helped balance the discrepancy between my anterior and posterior core. The chapter on back anatomy gave me a clear understanding of multifidus muscle anatomy and function, which gave me a new perspective and insight in comprehending the efforts of Catherine Byron, my Pilates instructor (cbperformancepilates.com), to have me try to articulate my vertebrae in incremental, singular movements as opposed to chunky and massive movements.

The chapter on spinal stenosis, sciatica, spondylolisthesis, sacroiliac joint pain, and spinal instability shed light on subjects that I only had vague notions of. As a urologist, on a daily basis I am confronted with patients with these diagnoses and the information conveyed helped me achieve a new level of appreciation of these issues. I came away with a newfound grasp of the anatomy and function of disc and facet joints. The discussion of surgery—microdiscectomy; fusion; and decompression was very elucidating.

The final chapter has a sentence that nicely summarizes the prevailing message of the book: “Incorporating philosophical considerations like Nietzsche’s: ‘convictions are more dangerous foes of truth than are lies,’ The End of Back Pain offers a perspective that is practical, empowering and actionable in its approach to conceptualizing pain and mitigating it.”

The book ends with an optimistic view towards the future, a time when the “back genome” will come into fruition. Dr. Roth’s notion is for the development of an Internet database by and for back pain sufferers with online access to appropriate educational materials and direction to the most appropriate health care provider, effectively putting the patient in the “driver’s seat.”

The End of Back Pain is virtually flawlessly edited–I found one typographical error and one awkward sentence in the entire 225 pages of writing (both on page 168). The only other minor detraction was an incongruity between some of the exercise images and the corresponding text entries (oblique V up and bent over kettlebell row). The description of these exercises is lateralized to one side of the body while the images depict the exercise being done on the other side of the body, making it somewhat confusing to follow until you figure it out.

This book is a terrific read—educational, entertaining and empowering. I highly recommend it to anyone suffering with back pain—and to take it one step further—to anyone who has been most fortunate to have not yet had to deal with back issues and would like to maintain that healthy status.

For info on Dr. Roth: www.patrickrothmd.com

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Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; oon to be available as a paperback; now available at Amazon in Kindle edition:


For more info on Dr. Siegel: http://about.me/asiegel913

For more info on Male Pelvic Fitness: http://www.MalePelvicFitness.com

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