Author: Prof Stuart M. McGill. Amazon Kindle and paperback editions available.
Reviewed by: Jonathan Palmer BSc(Pod) FFPM RCPS (Glasgow) FRCPM
Back pain is very common and many patients report a history when presenting to our clinic with lower limb, foot and ankle pain. As my Podiatry career has developed, my interest has “crept” and I am now quite fascinated by lower back pain. My interest was further peaked by having become a back-pained person myself. I understand first hand having tried many different approaches that self help, the proactive approach to my pain is necessary.
I came across this book by accident when googling ‘back pain exercises’. To date I have been doing many conventional exercises (in particular yoga exercises) which were mainly designed to ‘stretch’ my back’. Having read Dr McGill’s book, I realise that in trying to ‘put something back in place’ and ‘mobilise my spine (stretch)’ I have been missing a key component of Biomechanical health of the spine. This missing component is working on better posture and core spinal strength. I have helped many of our patients work towards better Gait and Posture, but like many Physicians, perhaps have not taken enough of my own medicine.
The book starts by inviting the reader to understand their pain and the potential causes. Dr McGill explains that the spine needs stability and not flexibility. The book equips the reader with a toolbox to enable self diagnosis of the reasons why you might have pain, which structures in the spine might be causing pain and teaches the concept that avoidance of triggers, good posture and spinal strength are key to managing pain in the long term.
The concept that speed walking, what we call at Northernhay Clinic ‘purposeful walking’ is the balm for most back pained patients. The recommended good posture that is outlined and explained by McGill is exactly aligned with what we have advised our patient’s for nearly 30 years. We tell our patients to keep the chin tucked in (no chin poke as McGill puts it), shoulders back and feel that the core is engaged when standing and walking.
The reader is directed to daily performance of the “Big 3” exercises to promote stiffness and strength in the core (spine) and to manage pain. The exercises are side bridge, gentle abdominal strength (the modified curl up) & finally the bird-dog. The reader is directed to perform a Russian Pyramid of all 3 exercises with 6 sets of 10 seconds, a rest of 20 seconds, then 4 sets of 10 seconds with the same 20 second rest. Finally 2 sets of 10 seconds. As a fairy fit 55 year old who attends a gym to resistance train on a regular basis, I found the exercises quite challenging. I think some readers might need to start with a modified approach, perhaps 3 sets, 2 sets, and finally 1 set.
A central concept to the book and McGill’s research, is that the hips and shoulders need to create the movement and the back needs to be stable, stiff and strong to function well and without pain. A squat exercise is taught to the reader and is quite complex. Patients may be advised to seek a personal trainer to take a look at the exercises and methods and teach them at a hands on sessions. Performance of the manoeuvres in the correct way and with the correct technique is the key to managing your pain.
The importance of hip mobility and its role in chronic back pained patients are highlighted. Similarly, certain exercises are taught. Two other exercises that are key to the programme and performed ONCE daily are a single squat manoeuvre from standing to squat and back to standing and also the Cat/Camel stretch. Dr McGills research suggests that 8 repetitions of Cat/Camel a day is optimal and any more is not helpful.
In terms of a critique – if I had to be picky, I think a little more could be made of Rheumatology as a potential cause of low back pain, with a specific reference to Ankylosing Spondylitis (AS) which tends to affect younger people. Classically AS patients have nocturnal back pain in the second half of the night and can’t wait to get out of bed and get moving in the morning. Rheumatology patients are unlikely to benefit directly in the long term from the McGill approach and obtaining a diagnosis is important in order that treatment can be started to avoid unnecessary inflammatory damage to the pelvis and spine. Rheumatology back pain patients are encouraged to discuss the potential of this method with their Rheumatologist. McGill does recommend patients who cannot self diagnose with the tools in the book to consult a specialist, which is correct and responsible.
Finally, there could be a little more reference to foot structure and function as we certainly have many patients with back pain who tell us that since we stabilised their foot function (created resilience and stiffness), with custom foot orthoses their back pain has been much improved.
A real gem of a book and having practiced the techniques for only the last few weeks, already I am feeling the benefit. This morning was the first pain free resistance training session that I have been able to perform for months.
Best wishes to you all.
Dr. Stuart M. McGill is a distinguished professor emeritus, University of Waterloo, where he was a professor for 30 years. His laboratory and experimental research clinic investigated issues related to the causal mechanisms of back pain, how to rehabilitate back-pained people and enhance both injury resilience and performance.
His work produced over 245 peer-reviewed scientific journal papers, several textbooks, and many international awards including the Order of Canada in 2020 for leadership in the back pain area. He mentored over 37 graduate students during this scientific journey. During this time he taught thousands of clinicians and practitioners in professional development and continuing education courses around the world.
He continues as the Chief Scientific Officer for Backfitpro Inc. Difficult back cases, and elite performers, are regularly referred to him for consultation. Any product associated with this website has been tested in Dr. McGill’s laboratory.
The book is aimed at non clinicians and is a self directed learning and management programme for those with back pain. If you don’t have a reasonable knowledge of Anatomy and Physiology, the book might be heavy going, but with some research and careful reading, it is manageable for sure.