Stuart Mcgill Back Exercises

[Eloisa Stawasz]

Itvaries in severity from acute, sub-acute to chronic. People of all ages may be affected and it is often influenced by a range of factors including an acute injury (causing muscle or joint damage), poor posture (leading to wear and tear), core weakness (placing too much pressure on the spine) or a disc bulge.

The constellation of symptoms and possible causes makes diagnosis and treatment difficult. Developed by a renowned spine specialist, the Stuart McGill Method is a set of specific exercises to help patients recover from lower back pain by strengthening the muscles that surround the spine and reducing the risk of future injury.

The McGill Method recommends three exercises based on the concept of improving muscle strength and support around the spine. In particular, these exercises focus on the transverse abdominals (deep core), obliques (side of abdominals) and multifidus (small muscles which stabilise the spine).

At Dr Miki Humphrey Chiropractic, we use all these exercises for lower back pain and injuries when necessary and also recommend them as a way of preventing an injury from occurring in the first place.

If you would like help with an injury or need advice concerning rehabilitation, we would love to help. Chiropractic treatments use spinal adjustments, exercises and stretches that strengthen muscles, release tension and improve wellbeing. Book a consultation with Dr Miki Humphrey at her Brisbane chiropractic clinic today!

These three exercises were developed by Dr. Stuart McGill and are designed to increase strength and protect your back. They are more commonly know as the McGill Big 3 and are comprised of the curl-up, side bridge (or side plank), and birddogs. Dr. McGill noticed in his research of athletes that those who failed to build proper muscles for core stability ended up with more injuries and pain. When the core fails to meet the stability demands placed on the body during a certain lift, parts of the spine will be overloaded with forces that increase injury risk and performance will suffer. Doing these exercises helps build the muscles in the complete core (not just the abs) and increases the core stability.

If you want more of a challenge, you can go into full plank with legs extended and stacked, one in front of the other and place your top hand on your opposite shoulder or on you hip and then do the lift and hold for 10 seconds.

If you need to modify the move, keep your hands on the ground and just kick your leg back and hold for 10 seconds. If you want more of a challenge, draw a small square with your extended arm before bringing elbow and knee together.

For the last few weeks, we have been discussing the topic of low back pain. In our most recent article, I unveiled a simple step-by-step protocol screening your back along with a few ways to start winding down your symptoms. Today I want to share how to start fixing your injury so you can return safely to barbell training.

While eliminating what triggers your pain for a few weeks will likely decrease your symptoms, it is never a final solution. Chances are the pain will eventually return because you never addressed why the problem started in the first place.

Eliminating the movement, posture or load that causes your pain is only half of the battle in fixing any injury. Anyone can tell you to stop doing something that hurts. Eliminating symptoms and building your body to become more resilient to future injury requires a different and more active approach.

Imagine for a moment a symphony orchestra composed of countless musicians. Just as each and every person must play their instruments in a united manner with constant changes in tempo and volume, our body must too coordinate each and every muscle and joint to create purposeful and sound movement.

Spinal stability is something Professor McGill has been able to define and measure with his work. First, when muscles contract they create force and stiffness. It is the stiffness part that is important for stability. Think of the spine as a flexible rod that needs to be stiffened to bear load. This is the role of the muscles. Through his research, he has measured athletes who fail to obtain appropriate muscular stiffness around the spine by coordinating muscle activation, and their subsequent injuries and pain.

In order to enhance the quality of stiffness, one must train the core differently. This comes through the second approach of using isometric exercises built to enhance muscular endurance and coordination.

This is because the core functions to limit excessive motion (especially in barbell lifting) rather than creating it. Therefore, the traditional way in which the fitness and rehab world has approached addressing the core for years has been completely backwards! This is why someone can have a ripped six-pack and yet have poor core stability when it comes to deadlifting or performing a squat.

Much like the symphony orchestra illustration from before, each and every muscle of the core has a role to play, but none is more important than the other. For this reason, proper stability training should not focus on one specific muscle. For decades, medical practitioners were incorrectly taught to focus and isolate certain muscles such as the transverse abdominus (TA), multifidus, or QL in an effort to enhance core stability. This method however, is flawed for a number of reasons.

First, research has shown it is impossible for an individual to solely activate one specific muscle of the core. Despite what your physical therapist or doctor says, you cannot train your multifidus, QL or even your TA muscle in isolation.

Even it were possible to target a specific muscle of the core (as some would argue is possible through exercises like abdominal hollowing), methods like this have been shown to be far less efficient in creating stability for the spine compared to abdominal bracing (contracting all of the core muscles together).15

If mobility in either of these areas is limited it can lead to movement compensations at the low back. For example, if there is limited hip mobility during the squat motion the pelvis can be pulled underneath (posterior pelvis tilt) causing the lower back to leave its neutral position and round.

For this reason, if you only performed core stability work but did not address any significant mobility restrictions in joints above or below the lumbar spine, the stiffness you created will always be short-lived.

Step 2: Slowly arch your entire spine and hips as high as possible without pain into a flexed or rounded position. You should end with your head looking down towards the ground. This is the camel position. After pausing for a few seconds move into the opposite downward extended position with the head looking up (the cat). Make sure you only move into a light stretch for each position and do not force your spine into any pain.

Step 1: Lie on your back with one knee bent and the other straight. If you currently have pain that radiates down one leg, flatten that leg out against the ground. Place your hands under your low back (this will ensure your spine remains in a neutral slightly arched position during the next step).

Unlike training for pure strength or power, the endurance component of stability requires the body to perform many repetitions of an exercise in order to see improvements. Dr. McGill advocates for using a descending pyramid rep scheme with 10-second isometric holds in order to enhance stability without fatiguing and over-working the body.

An example program would be to perform five reps, then three, and finally one to end (each with an 8-10 second hold). Rest between each set for 20-30 seconds. As this rep scheme becomes easier, it is recommended to increase the amount of repetitions rather than the duration of the holds in order to build endurance without causing muscle cramping.3This can be freely modified to suit your current individual level of endurance and goals (for instance using a 6-4-2 or 8-6-4 rep scheme).

There are a number of fun progressions you can do with this exercise. You can start by moving your hand placement from your opposite shoulder to the top of your hips or even move to a full side plank (bodyweight supported by your feet and elbow).

Perform the full side plank with one foot directly in front of the other, because you can also take it one step further and incorporate a rolling pattern (where you would tilt or rotate your body towards the ground and back towards the ceiling) if the side plank alone is easy. Make sure to keep your shoulders, torso and upper leg in a direct line during this roll to keep the low back safe.

If you are unable to accomplish even the modified side plank (bridging from the knees) due to shoulder or arm pain, you can perform a side lying leg lift. Start by lying on your side, brace your core muscles appropriately and raise both legs off the floor together a few inches. Hold them for 8-10 seconds before relaxing down.

At the time this exercise made sense. Those who had difficulty standing for long periods or lying flat on their back often felt better when in a flexed position. Many who complained of feeling stiff and painful in their low back had instant relief of their symptoms after performing a few of these stretches.

However, I realized (after reading and studying from Dr. Stuart McGill) that this relief is only a temporary relief for most. When you stretch your low back, you are stimulating the stretch receptors deep inside the muscles that give the perception of pain relief and the feeling of less stiffness.

As I have written about in earlier blogs, most of the muscle pain and stiffness you may feel in your back is consequence of a chemical reaction called inflammation that occurs from the real injury located deeper in the spine (disc bulge, facet irritation, etc).5,6 The underlying injury is what causes the secondary contraction or spasm of the surrounding muscles and pain.

For this reason, rehabbing from a back injury for a large majority of athletes should aim to stabilize the core and reeducate proper movement to treat why the problem started rather than stretch the surrounding muscles to increase mobility of the low back and treat the symptoms.

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