McGill’s Big 3 Exercises for Low Back Pain

Low back pain is an ailment that affects a significant number of people. Whether you are a competitive athlete, a weekend warrior, or a complete couch potato, low back pain doesn’t seem to escape anyone.

The prevalence of low back pain means that it is no surprise that this will be one of the top complaints from your clients. Knowing how to minimize the symptoms will improve your clients quality of life and earn you a sterling reputation.

Dr. Stuart McGill, a biomechanics professor at the University of Waterloo, is considered one of the world’s leading experts on low back pain. His texts Low Back Disorders and Ultimate Back Fitness and Performance are great resources for understanding the mechanisms behind chronic low back pain.

Low back pain is a multi-faceted issue. One common cause is lack of spine stability combined with poor hip mobility. When clients lack the hip mobility to perform movements properly, the spine is often the next place to go to get the mobility. The constant flexion and extension through the spine to compensate for the lack of hip mobility overtaxes the muscles surrounding spine. Therefore, teaching your clients how to properly stabilize their spine is an important early step to managing low back pain.

Known as McGill’s Big 3, the following exercises should become a staple to develop spinal stability for your clients with low back pain.

Curl Up

 

Top image: Correct form. Head and shoulders are slightly elevated from the floor. Bottom image: Incorrect form. Head and shoulders are too high
Top image: Correct form. Head and shoulders are slightly elevated from the floor.
Bottom image: Incorrect form. Head and shoulders are too high

The purpose of this exercise is to activate and strengthen the rectus abdominus without producing spinal flexion like a sit up would.

To perform the movement, have your client lie on their back with one leg extended and the other leg bent. This helps to stabilize the lumbar spine, reducing movement through the area. Place their hands, palms down, under the lumbar spine.

Elevate the head and shoulders just off the floor. The head and neck must be rigid and move as one unit.

Side Plank

Side plank on feet
Side plank on feet

The side plank is a great exercise to build lateral stability.

To begin the movement, have your client lie on their side, supported by her elbow and hip, with the knees bent to 90 degrees. Bracing the spine, your client should elevate her hips from the floor, using a hip hinge pattern. The hips should be fully extended, forming a straight line from the head to the knees. Ensure that the spine remains stable and that movement only occurs through the hip and shoulder.

Bird dog

 

Top image: Start position. Bottom image: Finish position. Ensure that a straight line forms from heel to fist.
Top image: Start position.
Bottom image: Finish position. Ensure that a straight line forms from heel to fist.

The bird dog allows you to train your clients’ back extensors without placing the spine under a large compressive load.

Have your client get into a quadruped position (on their hands and knees). Help them find a neutral spine position. Lightly brace the torso and extend one leg and the opposite arm until it is horizontal to the floor. Ensure that the spine remains stable and that movement only occurs through the hip and shoulder. The following video demonstrates the correct way of performing the bird dog and an example of the incorrect way to perform the bird dog.

Programming

McGill’s research shows that muscular endurance, not strength is the main issue when it comes to low back pain. Therefore, the “Big 3″ exercises should be performed for time to build up muscular endurance.

Begin with sets of 5 reps with a 3 second hold for each rep.Work up to 10 reps before increasing the length of the isometric hold. When time is increased, decrease the number of reps back to 5 and work up to 10.

Week 1 – 5 reps at 3 seconds

Week 2 – 8 reps at 3 seconds

Week 3 – 10 reps at 3 seconds

Week 4 – 5 reps at 5 seconds

Quality Over Quantity

Quality is the most important aspect for all of these exercises. Once form deteriorates, stop the exercise and allow your client to rest. If they are unable to control their spine with these lower level movements, it would be unreasonable to expect that they will be able to control their spine in a more difficult movement, such as a squat or deadlift.

Practice doesn’t make perfect. Perfect practice makes perfect.

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