The McGill Big 3
Introduction
Firstly, I’d just like to start by stating that there are NO perfect exercises that fix all types of back pain. Every person and every injury is unique and therefore may require different methods of treatment. However, there is one common theme that seems to crop up when I work with clients suffering from back pain... that is the ability (or lack there of) to engage core muscles and create intra-abdominal pressure. I have talked about this topic in a previous article untitled “First steps to engaging your core”, so if you’re unsure what I’m talking about I’d suggest reading that article first. Creating intra-abdominal pressure or engaging your core helps to stabilise the spine, which is the first port of call when it comes to rehabbing an injured back.
Dr Stuart McGill
Dr. Stuart M. McGill was a professor at the University of Waterloo for 30 years. He is an expert when it comes to issues related to the causal mechanisms of back pain, how to rehabilitate back-pained people and enhance both injury resilience and performance. Dr McGill is famous for creating “the big 3” exercises to help deal with back pain. They are three isometric holds that help to create stiffness and stability around the spine and help to relieve pressure on the aggravated areas of the back. Dr McGill used EMG (Electromyographic) machines to determine which exercises allow people to engage their core muscles most effectively whilst keeping their spine in neutral (safe) position.
Those exercises are:
The curl up
Side plank
Bird / Dog
The Curl Up
This exercise helps you to engage your core muscles when you start to flex your spine whilst also strengthening neck flexor muscles. So why is it more effective then a traditional curl or sit up? The McGill curl up is an isometric hold and therefore allowed you to focus on breathing and create that core “lifters belt”. Due to the small range of movement it also means that you can keep your lower back in a neutral position whilst not letting the hip flexors dominate, which tends to happen when most people perform a full sit.
Teaching Points:
Lie on your back with one leg straight and one bent. Place the back of your hand into the small of your back on the side of the straight leg. This will allow you to feel if your lower remains in neutral whilst performing the exercise.
Then brace your core, tuck your chin and lift your head and shoulders just far enough off the ground so that you are holding the weight of them. This is a very small lift off the ground.
Dr McGill recommends holding this position for no longer than 10 seconds so you can focus on maximum core contraction to stabilise your spine and a descending pyramid of reps. For example you could to 5 reps in the first set, then 3, then 1.
Side Plank
Next is an Isometric exercise that focuses mainly on the side of your torso as to limit spinal load and compression. The obliques and quadratus lumborum (QL) are targeted along with some glute medius engagement. Strengthen these muscles are the first steps towards performing safe twisting and rolling motions further down the line.
Teaching Points:
Start by lying on your side with your elbow tucked in towards torso.
Then lift your hips into a bridge position either from your knees or toes.
Whilst holding focus on your breathing along with lat, glute and core engagement.
Again place importance on concentration rather than time under tension initially and follow the same set/ rep scheme that is recommended in the curl up section.
Bird/Dog
Having focussed on anterior and side muscles of your core in the first 2 exercises we finish with one that focuses on your back extensors, whilst still minimising spinal load. The “superman” exercise is often prescribed to strengthen your back extensors, however, it results in compression of the spine in a hyperextended position. This is not a clever exercise design for anyone. The Bird/Dog spares the spine of high compression whilst challenging the individual’s lumbar and thoracic extensors.
Teaching Points:
Assume a quadruped (all 4s) position with your spine in neutral.
Brace your core and raise opposite arm and leg a couple of inches off the ground until fully extended.
Be careful not to raise limbs too high as it will result in over extension of your spine.
Focus on staying tight and follow the same set/rep scheme set above in the first 2 exercises.
Conclusion
As stated at the top of this article there is NO perfect exercise to fix all back pain. However, if our core is stronger and more engaged then we have a better chance of stabilising our spine and relieving pressure. Studies have proven that although McGill’s Big Three may not work for everyone, they definitely help people to activate their core muscles and provide a good base to build from regarding back injuries and rehabilitation. Even people that do not suffer from back pain would benefit from doing these exercises regularly to help understand just how to breathe, activate and improve the lifters belt you never knew you had.
Let me know how you get on implementing these exercises into your next workout and if you have any follow up questions please do not hesitate to get in touch.
References
Stuart McGill, 2017, Ultimate back fitness and performance