Back pain is a complex problem. To find out how to best prevent and eliminate it, I spoke with Stuart McGill, PhD, a world-renowned expert in low-back disorders and spine biomechanics with over 30 years of experience including research, training clinicians and seeing patients. He is a professor emeritus at the Department of Kinesiology, University of Waterloo. He’s written several books including Back Mechanic: The Step-by-step McGill Method to fix back pain.
The majority of adults will experience back pain at some point in their lives. McGill says poor posture and prolonged sitting contribute to this widespread problem, as does combining improper loading with unhealthy movements such as spine-flexing. Compression followed with bending the lumbar spine can lead to disc bulging and herniation which can press on a nerve and cause pain. Some exercises such as forward-bending yoga poses, sit-ups and crunches can result in injury with repeated use, though not everyone is as anatomically susceptible. McGill says crunches put the equivalent of 340 kilograms of compression force on the spine!
If your back hurts, don’t ignore it. You need to find out what’s causing the pain.
“There’s no such thing as non-specific back pain. Every person’s pain is different and has different mechanisms,” said McGill.
He says avoiding all movement due to fear of exacerbating the pain is not the solution. He recommends a precautionary visit to your physician to rule out sinister causes (e.g., a tumour). Next, conduct a thorough self-assessment using his book. He believes not all clinicians are highly skilled when it comes to back issues and they may not be able to precisely diagnose the mechanical cause.
Once you’ve identified the problem, stop doing whatever triggers your pain. Some people may find sitting painful and walking provides relief; others may experience the opposite. Still other people may find bending forward to put on shoes painful. McGill says avoiding the specific personal triggers desensitizes the pain. Acute back pain involving disk degeneration can be episodic. It may go away but if you keep repeating behaviours that trigger the pain, it will eventually come back. McGill describes chronic back pain as micro acute pain that occurs daily.
Next, choose spine-sparing restorative exercises that suit your needs and abilities. For example, an older person with arthritis might require a progressively challenging therapeutic walking program. In addition, use pain-free alternative movements to complete a task, such as lowering down into a lunge rather than bending forward to tie your shoes.
“You have to build the foundation for pain-free movement and develop core stability with ‘the Big 3’,” said McGill.
McGill’s Big 3 exercises are the: 1-curl-up; 2-side-bridge; 3-bird-dog. This series of effective core exercises conserves your spine by keeping it in a neutral position maintaining the natural curves. These exercises are both preventative and suitable for people who already have pain. They provide stability and are not intended for strength training.
“Endurance, not strength, makes the back more resilient,” said McGill.
McGill says stiffness can cause back pain but so can too much flexibility. There’s no one-size-fits-all solution.
To do the bird-dog, go on your hands and knees on a mat so you’re in a tabletop position. Extend your right arm forward and your left leg straight back and parallel to the floor. Try to hold this position for 10 seconds then switch to the other arm and leg. People with limited mobility can perform a modified version by leaning against a kitchen counter. Athletes can do more challenging core stabilization exercises such as one McGill aptly calls stir-the-pot: holding a plank position with forearms on a stability ball and making small circular motions with the elbows. McGill shows how to correctly perform the Big 3 and stir-the-pot exercises in a three-minute video.
Resolving back pain can have a profound effect on people’s lives. McGill recounts a case of an elderly woman whose family wanted to move her to a nursing home because she was unable to get on and off the toilet due to back pain. After teaching her for just a few minutes how to squat and stand up in a non-pain-triggering manner, she was able to continue living independently.
McGill has found that 95 per cent of back pain sufferers who haven’t found lasting relief with chiropractic, physical therapy or other treatments and who’ve been told that surgery is their last option can successfully avoid surgery using his methods.