McGill's Big 3

Steve W.

Quadruple-Digit Post Count
How is this not a fair representation of Stuart McGill?
You suggested he is an academic researcher who lacks practical rehab expertise or experience. You suggested he is someone who relies on theory that has not been validated in practice. You compared him to clinicians who overrely on imaging to diagnose.

In fact, he has a lot of experience working with patients, including high level athletes in a variety of sports. As Brian Carroll's experience illustrates, his method begins with an extensive in-person, individualized, hands-on functional assessment, he identifies specific individual pain triggers, evaluates individual anatomy (through observation and examination, not just imaging), takes into account lifestyle, habits, and athletic goals, and then designs a customized treatment protocol accordingly. From what I know of him, although he does research and follows general principles, he assesses and treats patients in a very individualized way.

Somehow he has become known as the "stir the pot guy." I know you didn't say this in so many words, but I think it is inaccurate to characterize him as someone who makes one-size-fits-all exercise prescriptions based solely on academic research.

By the way, I think there are some significant limitations to McGill's approach, in that it is very mechnically focused and tends not to address the role of the nervous system in pain. There is a whole fascinating field of pain science that, to my knowledge, he doesn't particularly address. But, to me, that's not a weakness of McGill as much as just not where his interest, experience and expertise lie.
 
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somanaut

More than 300 posts
@jca17 and @Steve W.
I think, that you are reading my posts in a very narrow interpretation. I am sure McGills methods work for some people under some circumstances. But the are other experts in his field who disagree with some of his conclusions. And I could not make his method work on my own, in fact it made my pain worse, hence I tried another approach that caused no pain, and even decreased my symptoms. Since this thread was about McGills methods, I thought it was relevant to post here.
 

jca17

More than 300 posts
Steve's point (forgive me if I'm mistaken) is that McGill's methods are not a cookie cutter approach, so its a confusing thing to imply that his approach doesn't work for many people. The only people to find out from are the people who have actually worked with him. I think you may be reading McGill's body of work (and vast experience with clients, not just research) with a very narrow interpretation, like the proverbial tip of the iceberg.

His big 3 look like regressions of more traditional training.
Is it specifically the curlup that causes back pain? The other two are things I'd expect someone be able to do before even loading up any movement patterns with traditional strength training, and the curlup would seem contraindicated only for specific spinal flexion intolerance cases. What are good rehab exercises for when static holds like planks are causing pain. One of my brothers has frequent back pain so I'd like to learn more about what to do in that kind of case.
 

somanaut

More than 300 posts
Steve's point (forgive me if I'm mistaken) is that McGill's methods are not a cookie cutter approach, so its a confusing thing to imply that his approach doesn't work for many people. The only people to find out from are the people who have actually worked with him. I think you may be reading McGill's body of work (and vast experience with clients, not just research) with a very narrow interpretation, like the proverbial tip of the iceberg.

His big 3 look like regressions of more traditional training.
Is it specifically the curlup that causes back pain? The other two are things I'd expect someone be able to do before even loading up any movement patterns with traditional strength training, and the curlup would seem contraindicated only for specific spinal flexion intolerance cases. What are good rehab exercises for when static holds like planks are causing pain. One of my brothers has frequent back pain so I'd like to learn more about what to do in that kind of case.
It seems to me, that you are not reading what I have actually written. I can't make you, but I am not interested in restating what I have allready written, and since I don't think, that I can explain myself any better, than I did in my original posts, I am not going to try.
 

Steve W.

Quadruple-Digit Post Count
It seems to me, that you are not reading what I have actually written.
Tried the Big 3 last week, and the pain in my back was worsened.
Doing specific exercises, especially ones that cause pain, ia NOT what McGill recommends. As Brian Carroll's story illustrates, an important aspect of McGill's method is to identify pain triggers and then avoid them until and unless they no longer cause pain. This includes exercises as well as daily habits of movement and posture.

it made my pain worse, hence I tried another approach that caused no pain, and even decreased my symptoms.
In this way you were actually FOLLOWING McGill's method (identify pain triggers and avoid them).

I have not read any of Mcgill's work, and I am in no position to evaluate it.
The first part of this statement is evident and I agree with the second part.

I could not make his method work on my own, in fact it made my pain worse
You tried 3 exercises. You did not try McGill's method and admittedly know very little about it.
 

jca17

More than 300 posts
Since I can't seem to read what you have written, and you can't seem to read what I have written, I don't think we're going to get any further in discussion, which is unfortunate because I actually value and want to learn from your experience :/
 

Janko

First Timer
Hi,
More than one month ago i started with Big 3 adding it to my excercises after back problems caused by long and extensive yoga trainings. Physio helped me to come out from pain but some lesser pain remained in some situations. I returned to physio and mentioned i started big 3 which he considered a good move. Unfortunately after few weeks of excercising i felt pain and radiation to leg for the first time in my life (just few seconds coming probably from position of my body). I stopped Big 3 and all came back to previous state. I am not sure, but some part of big 3 does not help in my case.
I am sharing this since i am looking for a piece of advice.

@jca17 and @Steve W.
I think, that you are reading my posts in a very narrow interpretation. I am sure McGills methods work for some people under some circumstances. But the are other experts in his field who disagree with some of his conclusions. And I could not make his method work on my own, in fact it made my pain worse, hence I tried another approach that caused no pain, and even decreased my symptoms. Since this thread was about McGills methods, I thought it was relevant to post here.
Could you please share what is another approach in your case?
 

LukeV

More than 300 posts
Disagreeing with Stuart McGill is a little like disagreeing with Warren Buffet. You certainly can disagree with him and when convinced of your contrary position you certainly should, but it's also nice to stay humble and recognise why he is almost universally recognised at the top of his field when the people who disagree with him are not
 

william bad butt

More than 300 posts
Big fan of McGill and Back Mechanic. Also a big fan of Brian Carroll's work. It's how I train for powerlifting.

I do the McGill Big 3 excercises every day, even if it's just 5 to 10 min, especially the Bird Dogs (as important to me as brushing my teeth).
 

Tarzan

More than 500 posts
I've only just skimmed this thread so apologies if it's been covered in the discussion.

I've had more back injuries than most (both fractures and disk injuries) and I found Dr Mcgill's work more beneficial than anything else I've encountered - physio, chiro, osteo, faith healers, witch doctors and everything in between. I've never bought any of his books but I've spent countless nights writhing in pain watching anything on youtube he's ever been associated with.

This discussion seems to be somewhat focused on what is the best treatment post injury and so was pretty much every "reactive" treatment I've ever encountered from a medical professional. It seems like it's all focused on fixing the problem after the injury has happened. I know I'm oversimplifying things here as the big three are meant to be preventative/prehab exercises as well as rehab exercises.

The big difference with the Mcgill method is the focus on identifying what actually caused the injury in the first place and avoiding it like the plague. No other professional I've ever encountered even seems to care about identifying the cause of the injury in a systematic way. Some could argue that they just want you to keep coming back but I really think standard back injury treatments are nearly always taught in a reactive fashion, rather than preventing the injury they just try to fix it.

I never did any of his exercises as they just seemed like every other band aid attempt to fix an issue that could have been avoided. For most people I've met the McKenzie exercises work better than bird dogs and stirring the pot both as treatment and prehab and they do for myself probably 70% of the time. Sometimes nothing works though, so I find my best course of action is to avoid my triggers that the McGill protocols identify so well.
 

IonRod

Triple-Digit Post Count
The uncomfortable truth is that nobody really knows how to prevent back injury or back pain. That includes Dr. McGill. He is a highly respected researcher who has done a lot to promote understanding of spine biomechanics. But he is not a clinician and his biomechanical approach to pain management does not match to current scientific literature on pain.

What we know by now is that pain is more complex than just identifying a cause of "injury" (in quotes because the term is hard to define, especically in this context). It is rare that pain can be narrowed down to a specific pathology, like a fracture or a slipped disk. Furthermore, it is quite frequent to see people with pathologies on MRIs, but no pain. And also frequent to see cases where two different imaging specialists will see different "abnormalities", which an enthusiastic doctor will happily link to the patient's pain perception, thus marrying him or her to the diagnosis. I am telling this from experience as a practicing physician - there is a huge temptation to point at a finding on an MRI and say "Well, that's your problem right there", while the honest truth is that we don't actually know this.

You can see people with good form get "injured" and people with bad form do just fine. That is, by the way, another giant rabbit hole - what is good form? Where is the line between good and bad form and how should we reconcile it with the fact that people get injured regardless.
 

Bill Been

More than 500 posts
CAUTION: LONG POST AHEAD!!

@Steve Freides - you don’t have to read this. There’s nothing mean in it.

There’s a lot of fascinating pain research happening world wide, much of it driven by the enormous impact of back pain.

To understand the applicability of any of this to strength coaching, you must understand “the Nocebo Effect”. We should all be familiar with Placebo Effect whereby patients experience improved outcomes from “sugar pills” or some other faux treatment that has no actual physiological effect, no mechanistic avenue to create an impact. The only remaining avenue is mental, psychological. The patient gets better because he *believes* he’s going to get better via this treatment. He believes as much due to the interweaving of a complex matrix of experience, belief, and context along with all the physical stuff.

The “Nocebo Effect” is the flip side of placebo effect. Nocebo effect is something beginning to hurt because you believe it should hurt. If I, as your coach, tell you that a 100lb Bench Press is the upper limit of where we can safely progress to, I have just inserted a danger trigger in your head. The trainee is now far more likely to begin to experience discomfort and even pain as we approach and attempt to surpass 100lb. If I tell a trainee that “at your age you should never train S&S more than twice a week”, the same thing happens if she sees another coach who tries to get her to train 3x per week. If you stop and think, the examples in “fitness” are nearly limitless. This is the Nocebo Effect - creating a belief that damage is being done or will soon be done because of the context in which the activity is taking place. Viewed through a more medical lens: what happens if you get medical imagery done for some reason unrelated to your spine. The doctor walks in and says everything looks fine. Then he asks “do you have a lot of back pain? I ask, because you have a lot of bulging disks and one of them might even be ruptured.”. He just “Nocebo’ed” you in a huge way. From now on, you’re very likely to be The Bad Back Guy. “I can’t do that!! Ferpitysakes, my doctor told me I have the spine of a 75 year-old!!” Walk in with no back pain and no fear of injuring your back; walk out as Bad Back Guy.

This segues nicely into the two current pain models. The traditional and still overwhelmingly dominant model is the Structural Model. Basically, something is wrong and it’s making you hurt. The something could be an injury, a “tight” muscle, a spinal subluxation, etc. But there is always a cause, a physical explanation, for the pain. The pain is created at the site of the physical defect and interpreted by the brain. Pain is an Input TO the brain.

The competing and much younger model is the Bio/Psycho/Social model of pain. In this model, sensory information is fed to the brain, the brain accesses experience, context, etc and through a grossly complicated process I won’t pretend to understand- decides how big a deal to make out of the situation. In this model, pain is multi factorial and is always an Output FROM the brain.

There’s a famous story of a Brit construction worker who stepped on a nail and drove the thing straight through his boot sole, his foot, and the top leather of his boot so that it was sticking out. In the emergency ward the guy was absolutely writhing in excruciating pain. Inconsolable. He had to be sedated in order to sit still enough for them to cut the boot away to see what they were dealing with. At which time they saw that the nail had gone between his toes, missing flesh altogether. But the pain was REAL. In the Bio/Psycho/Social model the pain is ALWAYS real because it’s an output of the brain, created after the brain has catalogued and contextualized a vast array of sensory, emotional, and experiential data.

As coaches, the implications inherent in each model are significant. If you are a Structuralist, a trainee experiencing pain must be treated by a medical professional and the underlying cause of the pain corrected before any sort of training is appropriate - or even responsible - because any physical activity could further disturb the physical malady that is causing the pain thereby increasing the pain. If you embrace the Bio/Psycho/Social model of pain, your goal becomes to reduce the perception of threat. Again, I won’t pretend to have a firm handle on how this is done. All I know about it is that the trainee needs to progress from “I’m broken and I hurt” to “I’m ten feet tall and bulletproof”. This is not compatible with Structuralism because the process of becoming ten feet tall and bulletproof might involve learning to ignore discomfort because you’ve developed a different way to catalog it and experience it.

There are unavoidable areas of overlap between the models. One important one I can think of is the Structuralist idea of neural facilitation which means that the neural pathway that brings the original sensory perception of an acute injury to the brain keeps getting better and better at carrying that signal, despite the reduction in the intensity of said signal as healing progresses. That’s physical, structural. Where it steps over into the BPS model is after the wound has healed and you’re still feeling excruciating pain. It seems likely to me that avoiding these triggers and returning the trainee to a state in which his pain perception is not hyper-sensitized is what drives Dr. Magill’s approach, which means a Structuralist is instinctively employing BPS methodology!

It’s a complex and fascinating area to study.
 

The Nail

Quadruple-Digit Post Count
There’s nothing mean in it
All I know about it is that the trainee needs to progress from “I’m broken and I hurt” to “I’m ten feet tall and bulletproof”
You're saying that sometimes Buttercup needs to suck it up?

This is incredibly mean and hateful. I'm super triggered. I'm going to go to my safe space and admire my participation trophies.
 

IonRod

Triple-Digit Post Count
One way in which we can all help reduce the nocebo effect is to not tell people who ask form questions or post form checks that they will hurt themselves if they do X. Instead, the focus should be on improving performance of the exercise. Not that I saw anybody do that here, but you can find numerous examples of such doom-filled rhetoric on the web.

On a personal anecdote side about bad doctors noceboing patients. After I was born my mom had pretty bad back pains that would shoot down her legs. When she went to see the doctor, he looked at her XRay and said "Weird, it looks as though you should be bedridden". Imagine hearing that from a doctor! Good luck, my mother is a very strong-willed lady and it is hard to influence her, so the nocebo effect did not occur and here, over 30 years later she is moving perfectly fine without any treatment of pain medication for her back. Despite all the severity of her symptom and apparently a very "Bad Back" image on the XRay, her pain resolved all by itself.
 

Bill Been

More than 500 posts
I'm not a giant fan of either the notion of telling trainees their form is going to hurt them, nor of assuming that form doesn't matter because so many people lift with poor form and don't get hurt. I think the proponent of that mix go way too far. For one thing, the notion that plenty of folks lift with poor form and don't get hurt overlooks the fact that the ones who did get hurt lifting with poor form don't show up at the gym and warn everybody. They're not in some club and they're not automatically part of some research database. Nor do they necessarily know they were lifting with poor form so even hurt they'd be fairly unreliable as testimonies anyway. Finally, there is a biomechanical reason to suspect that poor form could transfer an enormous moment force onto a muscle mass that is not prepared to accept it. I'm not willing to sit there through some valgus-kneed monstrosity of a squat because the trainee is perfectly content to accept a performance compromise.

This is pretty small beer as complaints go. I get that we don't want to nocebo our trainees by saying "you're gonna get hurt doing it that way". But, I'm not going to pretend there's not a correct way to do a movement in order to give nocebo a 50 mile buffer instead of a 5 mile buffer.

My own n=1 experience is that my shoulders used to hurt. Enough to wake me up at night. I decided to believe that they hurt because they were weak. So I started kettlebell presses and Get Ups as if none of it could hurt me. I knew that if I went to a Doc and said "hey, my shoulders hurt", the odds that he would be able to "cure" it were about nil. So, I decided to try to make my shoulders strong and that if I tore the crap out of something in there (I have since learned some stuff about shoulder anatomy) the docs would know what to do with an actual broken thing. Then my shoulders got strong, I did a Beast Get Up and pressed a 40, then picked up a barbell and drove my Press 1RM up to 180 and my PR in training to 167.5x5x3. And now they don't hurt and I know they are not fragile.

Lots of people have had the same experience with back pain.
 

North Coast Miller

More than 2500 posts
My concern about this is pretty much limited to large amounts of lumbar flexion. If someone can at least maintain a neutral or slightly flexed spine under moderate load they are unlikely to cause any harm. The next step back is to reduce the ROM or keep the load moderate until their form tightens up, depending on the individual (and the particular exercise).

When it comes to pre-existing back pain I agree that strengthening the back is the best way to help. The best way to strengthen that back is where knowing what's wrong comes in real handy. This is why PT without an MRI or other competently interpreted diagnostic and PT with same usually will have a very different outcomes.

When in doubt get several opinions if possible. I wound up in extreme pain and on receiving end of a lumbar epidural with more recommended (to no relief). Second opinion looked at MRI for about 60 seconds "you don't have bulging disks - this is normal in someone your age. You have arthritis of the facet joints at L4, L5, S1. It'll tone down over time, no further action required. Avoid movements that aggravate it and pay attention to your daily posture".

10 years later its fine unless I sleep on it wrong. YMMV, the spine in a biped is a mighty complex system.

This quote from McGill sums it up nicely and lays out the parameters around which one can work:

Dr. McGill: The spine's discs are quite tough and resilient to high load when they're not bent but remain in a neutral posture. Second best is when they are flexed and then loaded, but they must not move.


Think of flexing the spine when picking up an atlas stone and the spine is curled over the stone and lifted with extension at the hips – the spine stays locked.


The injury bogeyman appears when the spine is flexed and then loaded with high compression, and then it extends while still bearing the high compression.
 

George Locke

Double-Digit Post Count
Here's an extensive, non-peer-reviewed survey of the literature from a chiropractor+physical therapist
Revisiting the spinal flexion debate: prepare for doubt (bio of the author Bio — Greg Lehman)
My bias through the years has been to go Neutral especially under heavy load conditions and I would stay with that recommendation for many reasons, the least of which being injury risk.I would suggest that performance goals and symptoms should drive our clinical and movement strategies.
...
Repeated Flexion based activities

Suggestion: No flexion fear (perhaps my most contentious statement and I completely respect the opposite view)

If you love doing sit-ups, have done them for years and you don't have low back pain I would be hard pressed to tell someone to stop doing them. Being too worried about this movement is a little like "stranger danger" and never letting my kids out of my sight....

Heavy Load Activities

Suggestion: try to maintain neutral

Even though some research suggests that flexion may not be worse than neutral there is no research showing it is safer. I think we can certainly listen to our superstar biomechanists here.
 

Bill Been

More than 500 posts
Quite apart from whether flexion or moving into flexion is “bad”, there’s no doubt about what causes a lifter’s inability to hold neutral to slight extension: weak spinal erectors. The spinal erectors are the muscles that would hold your back straight/neutral if they were strong enough. This nicely demonstrates the importance of religious devotion to keeping your “chest up” or “flat back” throughout every rep, every session. This dedication to a neutral spine will bring your erector spinae muscle strength along with all the other muscle groups that are trained in the deadlift.

Think of a light, bendy fishing pole. If you take it very slow, you can lift a weight with it by taking it to the point where its resistance to further bending moment equals then exceeds the load and the weight comes off the floor. In your spine, the structure that creates this resistance to further bending moment is the smooshing down of your discs. This may be perfectly okay for you. Or it may not. But why are we deadlifting in the first place? To make our fishing pole stronger. As you all know, one of the principles StrongFirst teaches is that safety is a component of performance, not its rival.

Some will say “but-but-but-but.....Konstantinovs!”. Yes, it’s true - if you go to powerlifting meets you’re GOING to see a lot of rounded-backed deadlifts.
Keep these things in mind:
-First, you’re not Konstantinovs. Don’t automatically assume what Elite level international competitors do has ANY bearing on what YOU should do;
-Second, the guys who allow their backs to round are doing so in order to move their hips closer to the bar to reduce moment force at the hip. One inch closer on a 1,000lb deadlift is 1,000/12 is 83lb-ft of moment force that goes away. You, on the other hand, as a general strength trainee WANT that moment force to remain so your can get stronger by training against it.
-Third, many times a maximal, bone-on-bone, record-setting lift will unlock a guy’s back because......it’s really, really heavy and the bar simply pulls the lifter out of his perfect position. Important to note here that the exposure time - the number of reps in the career of an otherwise flat-backed lifter wherein he’ll flex slightly is really small.
-Lastly, the Atlas Stone is an example we must be careful with. Consider our fishing pole again: if we begin to lift with our weak fishing pole and it begins to flex in response but this time the pole is actually wrapped around an Atlas Stone, the stone will be the thing limiting the amount of flexion. This should make things safer for the pole, that’s true. But it may not be the best way to make that pole - our back - stronger. Safe, but possibly not maximally effective as an anti-flexion training tool. That last part is speculative.
 

The Nail

Quadruple-Digit Post Count
Some will say “but-but-but-but.....Konstantinovs!”. Yes, it’s true - if you go to powerlifting meets you’re GOING to see a lot of rounded-backed deadlifts.
Keep these things in mind:
-First, you’re not Konstantinovs
When considering how KK deadlifted, we should also remember that he was very muscular. The piles of muscle on his upper back likely made it look like he was rounding over more than he actually was.
 
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