This week, we’re honored to feature a guest post from renowned spine researcher, Dr. Stuart McGill. Dr. McGill is the author of over 300 peer-reviewed research papers, 3 books and several DVDs. In 2015, we hosted his Ultimate Back Fitness course in Portland in Chris Duffin’s gym and got wind of his new book which was released in January, 2016. Readers and subscribers here should know that Dr. McGill’s work figured heavily in my arsenal to mend my back after an injury and subsequently figured heavily in how I was able to help others with spine injury. FixYourOwnBack owes much of its chassis to the work of Dr. McGill and I thank Stu personally for all that he has done to help myself and others better help our patients. If you are struggling with back pain yourself, you should own Stu’s book which is linked here as well as below. Enjoy this week’s post by Dr. Stuart McGill!
Dr. Phillip Snell
Learning to Be Your Own Back Mechanic
Everyday my inbox will have messages from people asking, “Can you recommend exercises for my back pain”, or, “How much weight and how many reps to help my back”. This shows me that they will fail in their quest for a pain-free and resilient back. Exercises, on their own, rarely lead to a long lasting solution. The first task must be to identify the cause of the pain and eliminate it.
The cause of back pain is different in each case. Some overload their backs by choosing poor movement patterns throughout the day. Others expect a healthy body when they sit for 10 hours a day and negate the effects with 1 hour of blasting their body in a gym. There is a trend promoted on the internet of more load during exercises, to set new personal bests. But biology sets limits and rules so that to enhance one variable in spine fitness means a sacrifice must be made with another variable. For example, building a spine to bear high loads in a sport such as powerlifting requires a stiffening of the matrix holding collagen fibers together in the spinal discs. Repeated bending of the spine softens the collagen matrix causing delamination stresses leading to disc disorders during powerlifting. If the objective is to train a pliable spine, then heavy loads must be reduced. Pain results when Peter is robbed to pay Paul.
Building a load-resilient back requires the hips and shoulders to be mobile. This is why the torso (or core) has two ball and socket joints at either end. Then patterns of moving need to be practiced so they become default patterns. These will spare the spine of cumulative bending stress throughout the day. This is part of the science of building training capacity. Building capacity depends on many other variables as well. For example, using a lumbar support when sitting at the computer also builds training capacity. Injury reduces capacity. The greater the loss of resilience, the more clever and all-encompassing the plan must be to build training capacity. Moving well to avoid the pain mechanisms must precede a progressive training program. General failure to address this missing component when designing pain reduction strategies motivated my new book Back Mechanic.
Other stumbling blocks include the failure to perform a competent assessment that identifies the pain triggers. A proper assessment will identify the precise postures, motions and loads that trigger pain, or sensitize the pained tissues to trigger at lower cumulative loads. Some stumble by choosing performance enhancing activities too early rather than pain de-sensitizing activities. They fail to get out of pain and fail to regain their pain-free athleticism. Once again this is addressed by grooving joint-sparing default movement patterns.
A stable spine is non-negotiable. But how to build stability in a back that is pained? 30 years of scientific investigation has allowed us to converge on the best way, although the best way will change as progression through a rehab plan unfolds.
Back Mechanic was written in a step-by step format of 17 chapters to guide the reader. There are no short cuts, no quick fixes, no ignoring the biology that governs your body. The reality is that the medical system is not designed to assist those with back pain. There are a few clinicians who have studied anatomy, pain neurology, exercise science, biomechanics, physical assessment, and movement science, but I emphasize they are a very few. Common practice is to assess a patient for 10-15 minutes which has no chance to identify the cause, and create a plan of pain trigger avoidance to desensitize the tissues. Only they find and correct these offending activities will they be successful in building a progressive plan to ensure resilience. The frank conclusion is that you must become your own Back Mechanic. Become savvy and Fix your own back.
Stuart McGill, PhD.