Stir the Pot-Stuart McGill Takes on Pilates and most Ab Workouts

15 Responses

1. Mary

   June 25th, 2009 at 12:39 pm

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   hello and thanks for demonstrating the exercises! i’m wondering what the implications are for exercises intended to strengthen muscles other than your abs — my experience with pilates is that you are told to hollow your abdomen and press your lower back into the floor for almost everything.

   does this mean most pilates exercises put too much strain on your spine?

2. McGill’s Stir the Pot-See the NY Times Video

   June 25th, 2009 at 7:14 pm

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   [...] folks! I’ve been getting a lot of feedback re: the last post here about spine researcher, Dr. Stuart McGill’s sentiments on commonly recommended ab exercises. [...]

3. Dr. Snell

   June 25th, 2009 at 7:22 pm

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   Excellent question Mary! Indeed, the slant of this post, and the article in the NY Times is addressing questionable ways of training the abs. The abs are only one quadrant of the core and functionally we should address ALL core areas to insure healthy spine habits. Pilates addresses all areas of the core. Our only concern is the outdated instruction on some of the ab exercises. Specifically, the cue to press the lumbar spine into the floor while performing a abdominal curl has been demonstrated in the literature to impose compressive loads on the lumbar discs that exceed what NIOSH has determined safe for the work environment. While those exercises might be great for the abs, they are detrimental to the discs. Our goal is to train the abs while minimizing disc compression, hence the exercises we talk about here. To get Stuart McGill’s take, check out his video I posted on June 25 here http://fixyourownback.com/blog/?p=90

4. melanie collie

   July 5th, 2009 at 1:50 pm

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   Interesting to read about Marys comment on pressing lower back to mat in a class, this is called imprinting the spine, and I would not recommend this at all in a Pilates class, so wonder who shes been doing Pilates with, where was her instructor trained? I dont even like the term to scoop or naval to spine for core activation, but more of a drawing the lower abdominals, sinking them down towards the mat away from your hand if it was against your lower abdomen, and only slightly, 30%..and remaining as much in your neutral spine as you can, focusing on a stability in the pelvis throughout, ribs remain soft and not flared. Also the core is the whole torso, not just the abs, whats the point in having the abs connected if your shoulders are hunched up to your ears, your neck stiff and upper back out of alignment, neutral is as much about the cervical spine as well and the lumbar spine. Could go on for hours on this one…its so hard and so tiring to re educate without sounding like a woman possessed..but its for the bodies benefit in the end..

5. Dr. Snell

   July 5th, 2009 at 5:16 pm

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   Nice to have your input Melanie! There’s a great deal of variability in the marketplace in Pilates instruction in my experience and the lowest common denominator seems to involve economics. Those patients who don’t want to ante up much for beginner classes, wind up in the largest classes with the least instruction and the most naive students. This is where the injuries occur. So folks, caveat emptor, find an experienced instructor (like Melanie here).

   Pilates helps stabilize your whole core, not just the abs. This is very important, as just building strong abs can be detrimental too if the other core musculature is neglected. This has been the drumbeat throughout this blog…whole core stabilization. If any other readers are joining the blog recently, then you can catch up on those exercises with Stuart McGill’s “Big 3″ stabilization exercises at our website. There are links there back to the blog as well.

   Melanie, if you have any insight on differences in practice of Pilates in the UK vs. the US and other parts of the world, I’d be interested to hear it.

   Since we’ve had more readers from the UK, and since I very much think we need to reward excellence in care, I took the liberty of providing a link above to melanie at Pilates Portreath in Cornwall. Thanks, and cheers!

6. Ward

   July 15th, 2009 at 9:43 pm

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   Interesting post! What is your take on the popular crossfit ab/core exercise performed on the glute ham developer

   Demo vid - http://media.crossfit.com/cf-video/cfj-oct-2005/glute-ham-demo.wmv

   Thanks,
   W

7. Dr. Snell

   July 17th, 2009 at 1:28 am

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   Yikes Ward! OK…to start with, the exercise demonstrated would be a wonderful exercise for developing many of the core muscle groups, including the abs, hip flexors, lumbar extensors, glutes and even the quads. But, and a very large BUT, the full endrange lumbar flexion and extension as described would likely place VERY high compressive loads on the disc and shear loads on the spine. In the NY Times interview and video that Stuart McGill gave that we posted here, he said it wonderfully. To paraphrase… “You have a finite number of flexion cycles on your spine in a lifetime. If you want to use those up doing crunches (or this type of flexed spine exercise), that’s your business.”

   I could possibly rationalize limited use of an exercise like this in a very small, well selected high level athlete population (MMA fighter, gymnast, diver) who might need similar kinds of movements and need explosive power in the abs. But, we could still design exercises to build strength and power in those muscles, which spare the spine discs and surrounding tissues in the process.

   Short answer for my take on the exercise, performing that exercise regularly will shortly make you an income source in my office or in a spine surgeon’s office.

8. Ben

   July 28th, 2009 at 3:40 am

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   Dr. Snell,

   I love the website, it’s great that you’ve provided all this useful info. I’m currently doing the advanced versions of the four exercises listed (bird-dog, modified crunch, oblique holds, and stir the pot). I do each exercise for ~10 seconds, with a few seconds rest, to near failure. In addition to this I’m on a weight training workout in which I do a fairly intense leg day twice a week (2 exercises for quads, glutes, hamstrings). I also have a pulling day (back/shoulder) and a pushing day (chest/shoulder).

   I have two questions:

   How often and on what workout day would recommend doing these exercises?

   Should I be splitting each exercise into sets (i.e. 3 sets of 20) or is doing each exercise once to near failure appropriate?

   Thanks!

9. Dr. Snell

   July 28th, 2009 at 10:08 pm

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   Hey Ben,
   Glad you find the site helpful. First question is have you performed the lumbar functional capacity evaluation (FCE)? Once you have achieved those endurance values, the focus on core work moves into establishing better strength, power and agility.

   Assuming you have reached the desired endurance in the core muscles you can then use these exercises as tune up exercises prior to your workouts or as active recovery in between sets when lifting. Your core work focus then would shift to other higher levels of core challenge not covered here yet. Things like abdominal walk outs or roll outs, “chopping” exercises with cables and kettlebell work might then provide more of a functional challenge.

   Ideally, some level of core work should be done daily. One set to near failure is fine.

10. Ben

    July 29th, 2009 at 2:59 am

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    Dr. Snell,

    I haven’t taken the lumbar evaluation, though I’ve done a lot of core work in the past (up to 30mins devoted to core). I have a bulging disk in my lumbar and a degenerated disk w/schmorl’s node above that, in addition to a thoracic spinal fusion. Most of the core work I did in the past was focused on the abs which I believe lead to a muscle imbalance and potentially the cause of my lumbar pain/sciatica.

    Basically I’m looking for a good core program that I can do after a lifting workout that focuses on the Erector Spinae and Transverse Abdominus muscles, in addition to the obliques and abs. Is there anyway you could send me a link/describe those weighted exercises that won’t harm my back, and how they would fit in with the current exercises?

    Thanks so much for your help.

    Ben

11. Dr. Snell

    July 29th, 2009 at 5:24 am

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    Hey Ben,
    As you can imagine, making clinical decisions for someone via this type of forum is a foolish person’s work. I don’t want to cop out here, but given your history, I suggest that you have a good clinician in your corner who can help you make more informed decisions about the specifics you’re looking for. As for the lumbar FCE, the test only takes about 15 minutes to complete, so give it a shot to make sure you’ve got that dialed in. I’m often surprised when the obviously fit athletes come up a bit short on some of these tests.

    To comment on some of your requests: I’d suggest investigating the current evidence regarding attempting to isolate specific core muscles (like the transversus abdominus) vs. training the whole core as a unit. It sounds like you’re on the right track, but I want to make sure that your focus is on making all the muscles play well together rather than some of the misinterpretations of Hodges literature on the TA.

    To get you started on the workout program you desire, I HIGHLY recommend Stuart McGill’s new (3rd) edition of Ultimate Back Fitness and Performance.
    
    You can hear an interview with Dr. McGill at Joe Heiler, PT, CSCS at Joe’s website which is chocked full of great training info. The interview is an audio file and lasts about 40 minutes so plan some time to take it all in.

    I hope that helps get you started Ben and kudos for doing the leg work to figure this stuff out and help yourself!

12. frank witthoeft

    January 20th, 2010 at 10:02 pm

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    Hi,

    Thank you for the thought provoking and easy to follow presentations. I really appreciate your thoroughness.

    I am trying to think thru some basics such as why Dr. McGill and you think that the traditional crunch is hard on the spine in the first place considering that the abdominals are not connected to the spine? Is it because the abs are under tension which puts the back under a corresponding compression?

    I think that traditionally, forces on the spine that caused it to curve and thus tend individual vertebrae to impinge on the “edges” (posterior or anterior, depending on the curve) were contraindicated - hence the admonition to maintain neutral position. Is simple compression along the axis of the spine now also considered contraindicated if it exceeds certain amounts?

    And if so, wouldn’t any exercise, especially ones that involve muscles attached to the spine, which would tend to compress and put curving forces on the spine simultaneously also be potentially dangerous? This may rule out exercises like lat pull downs, for instance and the 60 degree sit-up in the Lumbar FCE test (which involves the hip flexors which are attached to the lumbar spine)?

    regards,

    Frank

13. frank witthoeft

    January 20th, 2010 at 10:07 pm

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    Oops, I goofed.

    The lat pull down puts the spine under tension and hence is a bad example of the point I was trying to illustrate. Hope I don’t have to sit in the corner.

    Frank

14. Dr. Snell

    January 20th, 2010 at 11:39 pm

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    Hey Frank,
    Glad you find the vids informative! All of the abs (rectus abdominus, transversus abdominus, internal/external obliques) provide a flexion action on the lumbar spine. (Juker, McGill and Kropf, 1998). In the case of the rectus, it’s origin on the xiphoid and insertion on the pubis will bend the spine, much as the load on a crane arm will place a bending stress on the vertical member of the crane without actually touching it. Psoas typically activates with ab contraction and produces compression and flexion on the spine as well.

    Discs can be injured with endrange loading in any vector, but the injury to the posterior portion is far and away the most common clinical presentation we see. This is due to loading of a flexed spine. This loading can be repetitive (sit ups and crunches) or acute (a deadlift with a flexed lumbar spine). As McGill puts it, the lab studies show that loaded flexion of the spine creates disc injury quicker than any other vector. We all have a limited number of those flexion moments. If one chooses to use them up doing sit ups, that’s their right. But, then they become another statistic in the 80% lifetime prevalence of low back pain.

    Pure compressive loads on the spine can also injure the spine but usually at another area. Compressive loads can cause the vertebral endplates to fracture (often audibly–pop). This allows the nucleus of the disc to migrate into the bony trabeculae of the vertebra under subsequent compression. This being bony tissue, it is more adaptive to stress (Wolff’s Law), so with gradual loading and appropriate rest, is less likely to be injured than the relatively avascular disc.

    In regards to your question on the 60 deg sit up test on the FCE, good eye. However, placing a flexion load on the spine in neutral position does not mean the spine flexes. The point of those types of exercises is to develop appropriate buttressing of those forces with the extensors. Exceed your ability to counter that flexion force with the extensors, and bad things happen. Remember that “neutral” spine does not mean straight spine. It refers to the position of the spine in which the natural lordotic (forward) curve is maintained, not exagerrated, not compromised. Cheers.

15. Laila Wierzba

    March 9th, 2010 at 1:58 am

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    This is my first time on this blog - thanks for the excellent comments. I wholeheartedly agree that core exercises are important and know that in a good well supervised Pilates class upper body forward flexion is only a very small portion of the entire movement repertoire. Participants must be guided, supervised and corrected, when needed, in order to do each exercise with precise movement patterns. Imprinting is a NO-NO and dangerous, especially if used to compensate for lack of core strength.

    Each class should be balanced combining core mobility and stability patterns. That is the true essence of Pilates that should be and is, at least by some of us, practiced today. And by the way a class should never have more than 10 participants and should be geared to specific levels of ability.

    Thanks for letting me have a say.

    Laila