The End of Back Pain- A Book Review

Remember book reports? I loved them. Because I loved reading, it didn't really seem too much like homework. And now, I get to do book reports for you!

I was asked to review an advanced copy of The End of Back Pain by Patrick A. Roth, MD because of my affiliation with Girls Gone Sporty. The book is now available on and 

I was excited to read this book, because, as a Pilates instructor, I have seen exercise do great things for people who experience back pain. One of my students in Philadelphia, when I was just starting, included a women with herniated discs. When she came to me, she couldn't even bend over to tie her shoes. Through her work with me, she was able to not only tie her shoes, but return to hiking, and accomplish a complete Intermediate Reformer, with spine-heavy exercise like Short Spine Massage and The Semi-Circle. It was absolutely incredible to watch, and as a new instructor, was so inspiring, and proof that the Pilates method worked!

Currently, one of my students is a woman in her 60s with spinal stenosis and fibromyalgia who finds great relief and increased mobility in her work with me. Another is a former professional wrestler with multiple spine and joint issues. His Pilates work is the only thing that helps to mobilize and relieve pain in his neck. 

So, I think I was understandably surprised to read on page 6 that Pilates would not be the best course of action for someone with back pain, as it only works the front of the body. Um, what?  Clearly, Dr. Roth has never had a classical Pilates private session with a certified instructor. Dr. Roth, if you are ever in South Florida, please call me! You can have one with me! I'd love to introduce you to the magic that is real Pilates.

This error is likely not Dr. Roth's fault. There are so many "Pilates" methods out there, and what many think of as Pilates is the mat work, done in a class in a gym with an instructor who got certified in a weekend. Not the in depth, personal work on equipment as well as the mat, tailored to individual needs and goals, with an instructor who has spent over 1000 hours studying and practicing and has taken 6 exams, both written and practical, to prove her capabilities.

Dr. Roth describes his workout, The Hidden Core Workout, as a way to "build all of your muscles to form an internal brace around your entire core- front, sides, and back." Perhaps Dr. Roth would be surprised to learn that Mr. Pilates described the PowerHouse in much the same way, he defined it as the muscles that run from shoulders to hips/buttocks, on both the front AND back of the body.  Actually, Dr. Roth, if you are reading this, I recommend you check out Joseph Pilates' Return to Life Through Contrology, or his second book, Your Health. He was a man quite ahead of his time!

The Hidden Core Workout is a series of exercises for someone with back pain to do at home, to both strengthen and stretch (another Pilates concept!) the spine and the muscles around it. As an exercise professional, of course I recommend that people do these with a trainer or instructor, to make sure they are maintaining their form, and engaging the proper muscles. Dr. Roth believes that these exercises are safe enough to do at home, without supervision. And he may be totally correct. But, I know how easy it is to cheat in our workouts. Or even to be earnestly trying, and not quite get it right. 

Despite our disagreement on Pilates, I fully agree with the premise of this book. Exercise is a great option for sufferers of back pain and must be considered as viable as physical therapy, pain killers and therapy. But many people shy away from it for fear of more pain. 

Dr. Roth does a great job of breaking down scientific concepts and medical theories into understandable examples. I definitely have a better understanding of the spine, and several common back issues because of reading his book. I'm certain this will help my Pilates teaching immensely. 

My two favorite lines in the book line up with Pilates exactly: 

The key to back health, however, is to focus on muscles that can't be seen in the mirror. (This does not necessarily imply that we must devote ourselves only to the mere development of any particular pet set of muscles, but rather more rationally to the uniform development of our bodies as a whole....- Joseph Pilates, A Return to Life Through Contrology)

I'm going to engage not only your body, but also your intellect. (Logically, man should develop his physical condition simultaneously with the development of his mind. Neither should be sacrificed at the expense of the other, otherwise the all-important balance of body and mind is not attainable. It is this very lack of harmony between man's physical and mental health that is primarily responsible for man's unfortunate physical and mental condition today.- Joseph Pilates, Your Health)

Dr. Roth makes it clear that a big part of alleviating pain comes from being an active and engaged participant in your course of treatment- whether that means exercise, therapy, pills or surgery. Dr. Roth provides clear, non-scary descriptions of conditions, as well as questions to ask your doctor along the way. He encourages patients to use their minds and their intuitions. After all, they are the only ones in their bodies!

I definitely learned a great deal from this book, and will be keeping it on hand. After I get it back from the chiropractor friend I lent it to!