In collaboration with Professor Emeritus Stuart McGill,
PhD
In
the Fall of 2010, when I was a student at the University of Waterloo, I first
met Dr. Stuart McGill. He was gracious enough to take the time out of his day
to answer a few questions that I had from reading his book Low Back Disorders
over that summer. Since then, Stu has been a great friend and has “had my back”
ever since. Because of my friendship with Dr. McGill over the years I get asked
a lot about his work and get dragged into various social media threads
concerning him, his philosophy, and his methodology.
Quite
often, despite all the interviews and podcasts he’s been in recently (thanks to
his book Gift Of Injury with Brian Carroll which I highly recommend), I find a
lot of people misinterpret Dr. McGill’s work, teaching and principles &
criticize what they don’t know. When people ask me about Stu’s work or pull me
into an online thread I find myself more clarifying misinterpretations of his
work than anything else. Yes there are some things Stu and I do differently but
I would say 90%+ of our philosophy & methods are the same.
In
this article I will discuss some of the common misconceptions about Stuart
McGill’s work
1) The McGill method ignores psychosocial factors
This is one of the biggest criticisms and misconceptions of
the McGill method, particularly by some of my colleagues who are renowned for
their knowledge in pain science & the biopsychosocial model.
What people forget is that some of Dr. McGill’s vast research
on sports injury risk prediction has looked at psychosocial factors as a risk
factor for injury.
McGill has also stated in his Back Mechanic book, and in
various interviews, that he looks at the personality types and factors of his
clients. Are they Type A personalities who are competitive, hard-driving,
ambitious and sometimes push too hard or are they Type B personalities who are
more lazy, sedentary & need to be motivated? McGill also looks at life
stresses and contextual factors that may be affecting the person’s pain. His
extensive interview and assessment process of a patient probes their past impediments
to success, many of which involve social and psychological variables. He works
to address these impediments with custom strategies for each person.
Side note from Eric: In addition to a McGill style
assessment I like to have my patients fill out the Orebro Questionnaire (link
here) before the assessment to try to “catch” any psychosocial factors or
maladaptive beliefs that may be problematic and predispose someone to a higher
likelihood of chronic pain.
2) NO Spinal flexion when using McGill’s principles
This is the other, if not bigger, main criticism and
misconception of Stuart McGill’s principles.
One of the big principles of the McGill method is
minimizing movements that worsen pain. Both Stu and I find that the vast
majority of our patients don’t tolerate flexion very well. I find that, using a
repeated movement style of assessment, all but maybe 1-2 of my patients in the
last 2.5 years were made progressively worse with repeated spinal flexion. Towards
that end it makes sense to give people alternative ways to move and do their
ADLs that are preferably less painful.
When I hear (or read) comments like “McGill said never do
a situp again” or “McGill said never flex your spine again” – that reflects a
big misunderstanding & stereotype again. McGill is a fan of moving in a way
that achieves the end goal in the most “biomechanically friendly” way. Towards that
end he (and I) encourage hip hinging whenever possible but also understand that
some tasks & some sports require spinal movement. Examples of common
athletes McGill works with who do have to move their spines are
-
Rowers, MMA and jiu jitsu fighters, gymnasts,
tennis players, and strongmen who have to flex & extend their spines in
their respective sports
-
And powerlifters who extend during the bench
press
For these athletes McGill recommends programming training
in a way that provides enough training stimulus to build the required fitness
for those sports, but also incorporates deloads & emphasizes joint sparing
movement strategies to allow the spine to recover & build capacity for
further sport-specific training. Once a spine has desensitized from pain, and
adapted with appropriate rehab, then he trains protective stabilization within
the movements and tasks for the athlete – these must include deviated postures.
His record for restoring back pained athletes from virtually all of the
professional sports and many Olympic sports is hard to beat.
3) The McGill method is all about core stiffening and
“The McGill Big 3”
Many people I talk to think that McGill’s principles are
all about bracing and doing lots of core exercises. As McGill often so
eloquently says “it depends.”
The McGill methods works to isolate the movements,
postures and loads that worsen an individuals’ pain – than it directs a strategy
to address the cause. For example in Brian Carroll’s case, fractured vertebral bone
had to be calloused during the rehabilitation phase prior to programming
performance training. Many other medical experts failed to accomplish this.
During some of McGill’s tests; which are further
described in his books Low Back Disorders, Back Mechanic, and Gift of Injury;
McGill will get his patients to do the test without bracing and then with
bracing. If bracing reduces symptoms during these tests than bracing and core
exercises are emphasized. If bracing increases symptoms the emphasis shifts to
relaxing the core musculature.
McGill has documented how tuning core stiffness reduces pain
in some whereas other patients may require relaxation of the core musculature.
He has measured how tuning stiffness increases performance variables such as
enhanced load bearing and strength, strike speed and power in MMA athletes, to
name just a few. This involves strategic muscle pulsing at the distal joints
reinforced with proximal linkage core stiffness.
Too often I see patients that have mindlessly done core
exercises without any critical thinking about why they are doing them or the
effect its having on their symptoms.
4) McGill’s research is all done on pig spines
Another issue where I see people dismissing McGill’s work
is to say he used animal spines to reach his conclusions. Perhaps they read a
single paper. About 10 percent of his publications involved animal spines. Studying
any medical condition needs animal models to control variables in a scientific
experiment – testing fifty identical human spines is not feasible. But his
observations were scaled and verified in humans. For example, the mechanisms he
documented leading to disc herniation have been matched by many other
scientific groups.
What people may not realize is that his clinical work
with people with back pain formed the questions he probed with his scientific
experiments. The lab and the clinic were closely linked. And the findings from
probing different back pain mechanisms were then used to desensitize pain and
restore a foundation for performance training. When he expresses an opinion
there is a body of evidence to support it obtained from the lab and the clinic.
I hope this article clears up some misconceptions about
the McGill method and gives you a greater appreciation of his work. As always,
thanks for reading.
