Yesterday I listened to Dr. Stuart McGill’s interview on SportsRehabExpert.com. Dr. McGill is one of the foremost experts in the world on the lumbar spine and has an awesome mustache!
Question: What were his thoughts on the healthcare system for the treatment of back pain (various types)?
- Any of those treatments will help someone, somewhere. The ultimate goal is to match the treatment plan to the individual. One approach might help someone’s back pain but might not help another.
- Pilates/Yoga-some believe this is an approach to solve back problems but there is not an assessment. Because of this, the very movements you may be performing may be exacerbating your injury mechanism for back pain.
Myths of Isolating Core Muscles
- Do enough sit-ups, does not matter who you are, you will hurt your discs. Think of the low back like a credit card, if you keeping bending it back and forth, eventually it will break. Some people may have more “bending cycles” but the principle is the same for all.
- Athletes use this core as a “spring for stiffness.” They do not take their torso and bend them under load. I.E. A throw or punch = The hips generate the movement–>stiffness is produced by the core (spring stiffens)–>followed by the power in the shoulder.
- Hollowing or sucking in your stomach to “activate” transverse abdominis is basically stupid for healthy individuals. Nothing new here. You brace your stomach. Hollowing will decrease performance (you don’t suck in to lift heavy weights).
*He talks about a study they performed in terms of low back pain. It was not that the low back was weak, but they do not know how to use the hips. This is why the hip hinge is known to be a superior movement pattern for low back pain clients.
McGill’s Big 3 for the Core
Curl-Up- this is not a typical sit-up type exercise. There should be no movement from the lumbar spine (your low back should not flatten against your hands).
Side Plank- great for quadratus lumborum (super important for important). McGill talks about the importance of QL for athletic movements. Suitcase carries with dumbbells or kettlebells are awesome for this as well. A lot of us know this exercise but most often it is performed incorrectly. The ankle through to the ears should be in one straight line. We encourage breathing through tension.
Bird Dog- the precision of form is what enhances performance (co-contraction of leg and opposite arm). Low load on the back as well. Mike Robertson gives a great video of how to do this perfectly. If you see most people doing this, often times you will see an increase in the lumbar curve (lack of control).
With these exercises, at Endeavor we have been doing isometric holds for repeated bouts of 10s. McGill talks about this, stating that they want to perform these with precise form and it is not about tolerating carbon dioxide or acid build up (at least at first) that occurs with long isometric holds.
A great interview to listen to and very informative but the stache’ himself. Have a great Sunday!