By Eric Bowman in consultation with Dr. Stuart McGill
The original article was published for PT Perspectives on January 28, 2014.
If you have been around the rehabilitation or functional training world over the last three decades you’ve likely heard of the name Stuart McGill. Dr. McGill is a Professor Emeritus in Spine Biomechanics at the University of Waterloo who has authored the popular books “Low Back Disorders” and “Ultimate Back Fitness and Performance” together with several hundred peer-reviewed journal papers documenting research findings. In addition, he sees patients with painful backs ranging from everyday people to elite athletes.
The McGill Big Three core exercises have become popular with clinicians and personal trainers as they train the core muscles while providing less stress on the lumbar spine in comparison to traditional exercises such as situps, reverse hypers, and leg raises (1,2). While those exercises aren’t necessarily evil and can be applied & programmed properly many elderly people suffer from osteoporosis – a decrease in bone density predisposing people to fracture. Biomechanics research has shown us that osteoporotic vertebrae are more likely to fracture under end range, loaded, repetitive spinal flexion (3).
Here is a video of the McGill Big 3 (along with Stir The Pot) in their basic forms. Each exercise has progressions and regressions that are described in more detail in his books.
As with any training system or exercise, the McGill Big 3 must be tweaked to suit the needs of the individual. Elderly clients have other health conditions that must be accounted for when designing a training program.
Having worked with seniors who have cardiovascular disease, osteoporosis, and other conditions; I’ve developed some modifications to the McGill Big Three that are addressed in this article.
Concern #1: Hypertension
In many individuals blood pressure rises with age and isometric exercise is known to elevate blood pressure (4). For some individuals, a 10 second hold of a core exercise may rise blood pressure to levels of concern.
Solution: Do less more often. Instead of doing five reps of 10 seconds each, do more reps with shorter holds (e.g. 3-5 seconds).
Concern #2: Osteoarthritis
Osteoarthritis is one of the most common musculoskeletal conditions in the elderly (5).
Exercises such as the birddog aren’t always tolerated by seniors due to the kneeling position required to perform them. Kneeling is a risk factor for osteoarthritis (6,7) and some people with osteoarthritis experience pain when kneeling (8).
Solution: Perform the birddog standing against the wall, on a comfortable yoga mat, or supported by a chair. Be careful when coaching this exercise to ensure that the hips are extending and that the lumbar spine remains in a neutral position. To progress this exercise you can narrow the base of support and then add perturbations from the trainer/therapist.
Concern #3: Balance disorders
As we age our balance and proprioceptive abilities decrease, increasing our risk of falls (9). A fall in the elderly has a higher two year mortality rate than everything except for the death of a spouse (10).
I’ve dealt with trainers and Kinesiologists who shy away from the birddog and other core exercises for fear that they would lead to a fall. In reality these exercises just need to be modified a little bit.
Solution #1: Regressions
As outlined in Low Back Disorders, the birddog can be regressed in two ways. The first is to have the client extend either an arm or a leg (not both) and the second is to have the client lift one hand up a few inches and hold it in that position (1).
Solution #2: Gain a more stable base
Doing planks, side planks, and/or birddogs against the wall or against a stable chair can be a safer option for some individuals.
Concern #4: Cardiac Insufficiency
Supine exercise has been shown to decrease cardiac output (11,12). For individuals with angina, congestive heart failure, or other cardiovascular conditions; the curl-up may not be appropriate.
Solution: Switch to a front plank and have the client perform the exercise against a wall.
I hope this article gives you some thoughts as to how I modify Dr. McGill’s exercises for the populations I work with.
1. McGill, S.M. (2007). Low back disorders: Evidence-based prevention and rehabilitation (2nd ed.). United States of America: Human Kinetics
2. McGill, S.M. (2009). Ultimate back fitness and performance (4th ed.). Waterloo, ON: Backfitpro Inc.
3. Maquer G, Schwiedrzik J, Huber G, Morlock MM, Zysset PK. Compressive strength of elderly vertebrae is reduced by disc degeneration and additional flexion. J Mech Behav Biomed Mater. 2015 Feb;42:54-66. doi: 10.1016/j.jmbbm.2014.10.016. Epub 2014 Nov 11.
4. Chrysant, S.G. (2010, September). Current evidence on the hemodynamic and blood pressure effects of isometric exercise in normotensive and hypertensive persons. J Clin Hypertens (Greenwich), 12(9), 721-726. doi: 10.1111/j.1751-7176.2010.00328.x.
5. Michael, J.W., Schlüter-Brust, K.U., & Eysel, P. (2010, March 5). The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int, 107(9), 152-162. doi: 10.3238/arztebl.2010.0152
6. Fransen, M., Agaliotis, M., Bridgett, L., & Mackey, M.G. (2011, February). Hip and knee pain: role of occupational factors. Best Pract Res Clin Rheumatol, 25(1), 81-101. doi: 10.1016/j.berh.2011.01.012.
7. Cozzensa da Silva, M., Fassa, A.G., Rodrigues Domingues, M., & Kriebel, D. (2007, August). Knee pain and associated occupational factors: a systematic review. Cad Saude Publica, 23(8), 1763-1775. Retrieved from http://www.scielosp.org.proxy1.lib.uwo.ca/scielo.php?script=sci_pdf&pid=S0102-311X2007000800003&lng=en&nrm=iso&tlng=pt
8. Hassaballa, M.A., Porteous, A.J., Newman, J.H., & Rogers, C.A. (2003, June). Can knees kneel? Kneeling ability after total, unicompartmental and patellofemoral knee arthroplasty. Knee, 10(2), 155-160.
9. Sturnieks, D.L., St George, R., & Lord, S.R. (2008, December). Balance disorders in the elderly. Neurophysiol Clin, 38(6), 467-478. doi: 10.1016/j.neucli.2008.09.001.
10. Liebenson, C. (2013, October 3). Training the frontal plane by Craig Liebenson. Retrieved from http://www.youtube.com/watch?v=uVADBwPpzgk
11. Cotsamire, D.L , Sullivan, M.J , Bashore, T.M , & Leier, C.V. (1987, March). Position as a variable for cardiovascular responses during exercise. Clin Cardiol, 10(3), 137-142.
12. Takahashi, T , Okada, A , Saitoh, T., Hayano, J , & Miyamoto, Y. (2000, February). Difference in human cardiovascular response between upright and supine recovery from upright cycle exercise. Eur J Appl Physiol, 81(3), 233-239.