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

18 Responses

1. Stuart McGill top ab exercises | Pilates Scene

   October 19th, 2009 at 10:54 pm

   1

   [...] NY Times video on Dr McGills fabourite ab exercises. He is anti supine spine flexion and has adapted some of the repertoire familiar to us to make it safer for the spine, according to his views. [...]

2. Stuart McGill and my exercise selection? - Page 2 - Dragon Door Forums

   November 20th, 2009 at 4:18 pm

   2

   [...] edition. You can see a recent video of McGill done by the New York Times posted on my blog here http://fixyourownback.com/blog/?p=90. Lab studies have shown that the fastest way to herniate a disc in vitro is thru repeated flexion [...]

3. Darryl Lardizabal

   January 10th, 2010 at 8:14 pm

   3

   Although I agree that rehabbed patients should work on stabilization as a requirement, I still believe that movement is necessary from any standpoint, Although proper movement is fundamental, progressions of the individual are context dependent, and shouldn’t be tool dependent.

   Problem with thinking that movement is inherently flawed is the use of poorly patterned individuals who tend to compress their disks rather than use muscles to help create a tractioning or distracting affect on their spines, thus elongating their spines before movement. Also, in understanding how joints receive nutrition, what would happen to the joints in the long-haul if they are not actively mobilized through whatever ROM the individual should have vs. what we feel they should have - increase in bone formation and calcium deposits, no?

4. Dr. Snell

   January 20th, 2010 at 7:06 pm

   4

   Often, trainers and patients mistake McGill’s approach to mean that movement in the spine is bad, and they imagine that the end result would be a stiff, zombie-like posture. A better way to see this is as APPROPRIATE movement, at the APPROPRIATE time, in the APPROPRIATE individual.

   The doctor’s job is to qualify those variables in the patient/athlete to reduce likelihood of injury and optimize performance. Active mobilization of joints, through physiological ranges of motion with appropriate loads is sparing to the joint and promotes healthy cartilage formation. Poor biomechanics combined with inappropriate loads is what places patients in offices like mine.

   I would be curious to know what specific muscles you might attempt a client to activate to create a tractioning effect on the spine.

5. Omar Zakariya

   February 26th, 2010 at 8:22 am

   5

   Dr Snell - Would you consider writing a blog post on inversion therapy, the use of gravity boots and inversion tables?

   Omar

   p.s. Love your blog.

6. Dr. Snell

   March 2nd, 2010 at 2:33 am

   6

   Good idea Omar, I’ll keep it in mind since I’ve had some nagging irritation lately with the shenanigans of some DCs with their “fix all” spinal decompression machines. You know the ones that you see the big ads for in the newspaper? The home gravity inversion tables are a nice, affordable, self help strategy. The primary downside though is that you’ll be keeping your chiropractor out of his new Lexus

7. Curtis

   March 7th, 2010 at 9:43 pm

   7

   The U.C. Berkley Wellness Newsletter lists several adverse side effects of inversion therapy, the most problematic being bleeding into the retina.

   Their bottom line: “Don’t try inversion therapy, especially not if you have heart disease, hypertension, glaucoma or other eye diseases, or are pregnant. If you do decide to try it, at least make sure there’s someone around in case you need help.”

   http://www.wellnessletter.com/html/wl/2001/wlAskExperts0901.html

8. Emily Claire

   March 14th, 2010 at 6:31 pm

   8

   It’s too bad that we have to do ‘ sit up tests’ in schools, even though we’ve now figured out that regular sit ups are harmful to our spine for certain individuals. (To pass a regular sit-up test in gym, we need to do 40 sit- ups in a row).

9. Mark Szl.

   March 29th, 2010 at 1:33 pm

   9

   McGill can’t show you a single well done clinical trial that his version of core stabilization or any other core stabilization exercise is any better than simple back exercises for either treating back pain or preventing back pain. Virtually all studies on this issue show NO difference.

10. Dr. Snell

    April 8th, 2010 at 4:06 pm

    10

    Thanks for the comment Mark. Your feelings are reflective, I think, of the frustration that many of us have about the recent literature. Some studies comparing different types of exercise have found little difference in types of exercise for back pain. This is reflective of where the understanding of back is at the research level right now. Back pain used to be seen as a “black box”, with many different subgroups grouped together in the literature. The emerging literature is helping clinicians to identify subgroups and better target them with specific exercise. These better quality studies show better effect.

    Koumantakis, 2005 in Physical Therapy
    O’Sullivan, 1997 in Spine
    Kavic, 2004 in Spine

    These are just a few I can quickly get my hands on. Stay open to the changes in the literature and try to appreciate that as our overall understanding improves the detail in the research will get more specific.

11. Mark Szl.

    April 11th, 2010 at 3:49 am

    11

    Which better quality studies do that because I know of none. Please cite some references. I’ll give you one article which is the only critical review I know about core exercises. It’s by Professor Eyal Lederman and it’s called “The Myth of Core Stability.”

12. James

    April 12th, 2010 at 6:22 pm

    12

    Dr. Snell, what about the Leg Raise? Where you hang, supported by your forearms, back against a rubber ball, and raise your legs. Is this a good core exercise? If this is a good exercise what is the correct way to do it? Raise only the top of the leg to horizontal and let the feet hang? or Raise the top of the leg to your chest? or Raise the whole leg while keeping it straight? Or does it matter?

    like this
    http://us.commercial.lifefitness.com/content.cfm/legraise_1

13. Mark Szl.

    April 22nd, 2010 at 2:00 am

    13

    Koumantakis 2005 showed no difference when compared to general exercise.

    O’Sullivan showed a difference with CS being better.

    Kavic, et al’s Spine research found that no single muscle dominated in the enhancement of spine stability. Individual roles continuously changed according to specific tasks. Their advice was to focus on enhancing motor patterns that incorporate many muscles rather that targeting only a select few.

14. Dr. Snell

    April 22nd, 2010 at 3:19 am

    14

    @Curtis,
    Perhaps more germane just a bit further up in the text on that site’s recommendations on inversion therapies is this:
    “If you have back pain, consult a professional skilled in back care. “

15. Dr. Snell

    April 22nd, 2010 at 3:22 am

    15

    @James,
    The hanging leg lift imposes high compressive loads on the spine according to McGill’s lab work. This is due to the bilateral contraction of the hip flexors. Lessen that compressive force with hanging single leg lifts. Alternate sides, while you’re there, might as well knock out some pull ups!

16. Dr. Snell

    April 22nd, 2010 at 3:47 am

    16

    @Mark (Sorry for the late reply, full plate recently),

    Dr. Eyal Lederman (he’s a D.O.) has a beef with specific “core” exercises that place higher value on one exercise or one muscle group. McGill does too has extensively pointed out the flaws in this approach, and is cited extensively in Lederman’s article to refute that approach. Much of FixYourOwnBack.com is modeled on the research of Stuart Mcgill. I think the problem here is the misinterpretation of the purpose of the ENTIRE site here (promote exercise for pain relief and overall health, help to provide the ground swell for better research to dial in various types of back pain that respond to specific types of exercise) vs. this one video. This one video highlights 3 exercises that each build ENDURANCE in all of the core muscles, but each exercise has higher MVC of one particular aspect of the core. For higher levels of rehab, the next steps in McGill’s approach after building endurance, are improving strength, power, and agility of the muscles through complex movements. We are watching the same movie Mark, we just walked in at different points. For the majority of viewers here, these 3 exercises will be easily accessible, improve endurance of key muscles that research has determined are frequently low in endurance in chronic back pain, and reduce their frequency and severity of future back pain. Beyond this are the green fields of training (as opposed to rehab), to improve performance in work and play goals. And yes, you are precisely right, ALL muscles of the core, AND those that integrate with the core need to be used in coordinated fashion to achieve those goals. Cheers!

17. Mark Szl.

    April 24th, 2010 at 4:46 am

    17

    Fair enough but just so your readers know, there is nothing special about McGill’s or Pilates exercises for back pain, prevention of injuries nor for “health” over other approaches as shown so far by the science. Maybe more research will show something but it’s currently not present. If one likes doing McGill’s approach that’s fine but doing others will work (generally) just as well. Also, Eyal Lederman has the virtue of being a clinician for decades that see’s real patients unlike McGill. But like McGill he also has a PhD however it happens to be in physical therapy.

    Time will tell if any of these are superior and for who.

18. Dr. Snell

    April 26th, 2010 at 9:58 pm

    18

    Hey Mark,
    The science is progressing a bit these days in regards to whether exercise is of benefit to low back pain (LBP). It shows slight benefit in some meta-analyses( i.e. Ann Intern Med. 2005 May 3;142(9):765-75.
    Meta-analysis: exercise therapy for nonspecific low back pain.
    Hayden JA, van Tulder MW, Malmivaara AV, Koes BW.). The same authors investigated whether personalized exercise strategies had superior effect and found that they did (Ann Intern Med. 2005 May 3;142(9):776-85.
    Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Hayden JA, van Tulder MW, Tomlinson G.) Of note, they found that stretching improved pain the best, while strengthening improved function the best. Aerobic exercise, mobility and coordination strategies were of lower value.

    Slightly more germane to this site which is geared toward extension-biased, discogenic LBP, some research from the McKenzie camp has begun to indicate that in this population of LBP, extension based exercises are superior to “strengthening” exercises. It is my clinical experience that a combination of McKenzie based therapy during acute/subacute phase, and stabilization per McGill’s work is superior in the long term. This clinical approach with the clinician’s personal experience, informed by the best available evidence is Sackett’s definition of evidence based medicine as found on the home page of http://www.fixyourownback.com.

    In Stu’s defense from your statements, he is a reluctant but very good clinician whom I have seen at work on high level athletes. I am not familiar with Leyderman’s work but in the reading of what I have found, he seems well informed. As I pointed out before, his slant in his articles has been to argue that the notion of attempting to isolate specific muscles (as has been the trend with isolation of TrA per Hodges work) is misinformed at best, harmful at worst. Those same sentiments are foremost in McGill’s approach and indeed, Leyderman uses McGill’s work and his grad students (Cholewicki, Kavcic, etc) to make his points. I have emailed him to encourage him to lean on his students to investigate this topic of comparison of exercise methods directly in a prospective fashion. Much of the comparison research that we are talking about are retrospective reviews of the literature and make it difficult to make hard and fast clinical decisions with them. Too many apples and oranges in the same basket.