Stuart McGill Method training - You don't have to live with lower back pain!

Garry (Left) with Stuart McGill (right)

Over the last 2 days I have had the privilege of attending one of his training workshops. In my career Stuart McGill has been a name that has repeatedly come up with allied health and personal training professionals. Whether it was labelling him as the lower back guru and genius or slamming him for being too limiting on what exercises he would prescribe people. There are many myths about him I have heard and it was interesting to hear him challenge or just plainly debunk them. The classic one is that McGill says you should never flex your spine. I’ve heard this so many times. He actually says you should avoid flexing your spine if your spine is aggravated by flexion. That is a big difference. I have read his books and watched his videos and always found him to be very balanced, humble and evidence based. His ideas weren’t radical, in fact they make the most sense to me of anyone I have studied with.

Stuart McGill’s research involved using probes to measure muscle activation during exercise to figure out what muscles are involved in spinal stabilisation. He has also used many studies on actual spines to figure out the mechanisms of what injures a disc and other parts of the spine. Without a stable spine we can end up with all kinds of injuries including lumbar disc injuries, facet joint injuries (spinal joints), ligament tears and all of this is experienced as pain.

During the course we learned his methods for assessing a patients movement in different positions and then strategies and exercises to change the tension in the spine and take pressure off the spine.

Stuart McGill is famous for his lower back exercises call the daily BIG 3. These are 3 exercises that he recommends we all do every day to prevent lower back pain. We brush our teeth to prevent tooth decay not to fix it when it is there. So it is just as important to do this for our lower back. Especially if you have had a painful lower back or lower back injury.

Take aways from the course:

- if you can take away the pain temporarily then this shows that you should be able to take it away permanently. You need to stop doing the thing that aggravates your lower back pain whether it is sitting posture, standing posture, the way you move at work, your exercise, repetitive tasks etc.

- For someone with pain, the perfect movement is the one that takes their pain away. - Transversus abdominis is not a spinal stabiliser. It just helps you fart and vomit. - Spondylolysthesis is not a shear injury it is a spinal fracture.

-Radiologists and scans can't often see the injury of the spine. They don’t take a history and the scans are taken when a person isn’t in pain and they are also not moving. So then they tell you there is nothing wrong with you. McGill had examples where they had ask the patient to move into pain and then they could see either a spinal fracture or a bulging disc. Scary stuff.

- If you have disc pain and the pain is on the right side of your back then your injury likely happened from bending over to the left. Bending over to the left is likely what will aggravate you and you should avoid it. This could be the way you sit at work, the way you stand, the sport you play (think golf - always twisting to the same side).

- Your disc can heal. If you are in pain then it is in an acute phase. If you are doing something that aggravates it then it is picking the scab and re injuring it every time. This leads to chronic pain. We need to let discs heal rather than have surgery on them.

- Avulsion fractures of ligaments in the spine. These are more common in the knee and ankle, but I have never heard or seen and avulsion fracture of the ligaments in the spine. This could be an issue that is being missed. Scans will show them but the radiologist needs to be able to see them.

- End plate spinal fractures of the spinal vertebrae could be causing your spinal pain. This is a compression injury and gets worse when you are sitting for long periods of time. Often don't show up in scans. Runners and jumpers often get this type of low back pain.

- Extension stretching to take pressure off the posterior disc bulge can actually aggravate it. Some people are flexion and extension intolerant. Usually discs are aggravated through flexion only.

- Not everyone can do every sport/activity. People are usually attracted to a sport or exercise because they are good at it and that usually means that it is good for their body. If an exercise or sport is aggravating you then you may have to change it to live a healthy life.

- Choose whether you want to be training at a high level now and then have life long injuries later in life or train less now and last into pain free through your old age.

- You can be pain free.

- There were many more…

I sat in his course lamenting the fact that I didn’t take his courses sooner, as he reiterated and clarified thinking that I have had over the years and questions I have brought up in our health care system. So it was very vindicating and a breath of fresh air to hear these opinions from a veteran of the industry and someone who has helped 1000’s of people including top athletes and olympic teams to reach their maximum potential. Stuart McGill is a man who should be listened to in an industry full of inexperienced so called experts. He was vehement about not following the social media gurus and trends when it comes to health as many people online have no training or credentials to be giving advice and a lot of advice coming from health care professionals is unproven and just the latest trend. Rather than time tested assessment, case history and treatment.

As healthcare professionals we study and learn information that we hope is based in evidence. Much of it isn’t, even though it is thought to be and can actually just be a trend made up by someone who wants to leave a legacy. Trends come and go and we suddenly latch on to the newest trend and the industry changes. One year it’s posture, the next its core strength, then it was breathing, then mobility and movement and now it is moving through possibly the most unusual and dangerous trend, the biopsychosocial model and “pain science”. This model encourages practitioners to counsel clients into thinking that their pain is in their head and not a biomechanical injury that can be fixed. Whilst some pain can be in this category, most isn’t and is just misdiagnosed by doctors and practitioners who are unskilled in assessing injuries or go to default diagnosis because they are limited for time to actually figure out what is wrong with their patient or untrained in how to assess and treat these injuries. They also don't have methods of treating beyond medication and surgery.

McGill shared many stories where he had clients with debilitating chronic lower back pain who had seen all of the experts including physios, doctors, specialists, chiros and had no diagnosis or help. They had been given a cocktail of medications and misinformation and were at the end of their tether. He was able to assess their issue and give them strategies to manage their pain and then get rid of it and live their life. Sounds too good to be true, right. Well I have had the same experience in my clinical practice. I have seen the medical and allied health system let people down and then when they’d tried all their tricks they then tell the client that it is all in their head and they need to see a psychologist . I have had a couple of clients that have then gone to see a psychologist who then told them that it wasn’t in their head, it was in their body. Especially if you have an MRI with a nerve impingement pressing on the nerve. Where is this lack of understanding and assessment of lower back pain coming from? To me it is not rocket science. We are trained to assess a client, to take a thorough case history

Who is Stuart McGill?

Stuart McGill is a Phd biomechanist who has dedicated his life to studying lower back pain. He was a Professor at the University of Waterloo in Canada for 30 years and has coached olympic athletes, champion powerlifters from debilitating back pain to champion performance. He walks to walk and trains himself and at 62 claims to be pain free. He lives in a small town north of Toronto and still treats private patients, mostly high level athletes in his 3 hour assessment. He also loves getting our in his boat on the water.

He has written a book called “The back mechanic” which has been written for patients and sufferers of lower back pain. I would highly recommend you get this book if you are interested or suffer from lower back pain.