This is from my good friend (Eric Cressey’s) blog. 80% of people in the US will experience some form of lower back pain at some point in time. Most (read not all) physicians and/or physical therapists are totally clueless when it comes to treating low back pain. Luckily we have Dr. Stuart McGill, who is smarter than all of us.
I’ve seen Dr. McGill in seminar before, and by my own admission, I’ve always been more of a “listen and watch” guy than a note-taker. However, that’s not to say that I didn’t hear a lot of great points that went right to my notepad. Here were some highlights along with (in some cases) my commentaries on their applicability to what we do:
1. As counterintuitive as it may seem, flexion-intolerant individuals (e.g. disc herniations) will sit in positions of flexion, and extension-intolerant patients (e.g. spondylolisthesis) will sit in positions of extension. It might give them temporary relief, but it’s really just making the problem worse in the long run. We become intolerant to certain lumbar spine postures not only because we’re in them so much (e.g., cyclist or secretary in long-term lumbar flexion), but also because we’re forced into this posture due to a lack of hip mobility or lumbar spine stability.
2. It’s absolutely comical that the American Medical Association still uses loss of spinal range of motion as the classification scheme of lower back dysfunction. There isn’t a single study out there that shows the lumbar spine range of motion is correlated with having a healthy back; in fact, the opposite is true! Those with better stability (super-stiffness, as Dr. McGill calls it) and optimal hip mobility are much better off.
3. Lower back health is highly correlated with endurance, while those with stronger and more powerful lower backs are more commonly injured. The secret is to have power at the hips – something you’ll see in world-class lifters.
4. There is really no support for bilateral stretching of the hamstrings to prevent and treat lower back pain. In most cases, the tightness people feel in their hamstrings is a neural tightness – not a purely soft-tissue phenomenon. Dr. McGill believes that the only time the hamstrings should be stretched is with an asymmetry. This is something I’ve been practicing for close to a year now with outstanding results; the tighter my hamstrings have gotten, the stronger and faster I’ve become. The secret is to build dynamic flexibility that allows us to make use of the powerful spring effect the hamstrings offer; static stretching – especially prior to movement – impairs this spring.
5. Next time you see an advanced powerlifter or Olympic lifter, check out the development of his erectors. You’ll notice that the meat is in the upper lumbar and thoracic regions – not the “true” lower back. Why? They subconsciously know to avoid motion in those segments most predisposed to injury, and the extra meat a bit higher up works to buttress the shearing stress that may come from any flexion that might occur higher up. Novice lifters, on the other hand, tend to get flexion at those segments – L5-S1, L4-L5, L3-L4, L2-L3 – at which you want to avoid flexion at all costs. Our body is great at adapting to protect itself – especially as we become better athletes and can impose that much more loading on our bodies.
Eric Cressey
P.S. As an interesting aside to all of this, Dr. McGill and I actually spoke at length about the importance of hip mobility – something that obviously is closely related to all twenty of these points. If you lack mobility at the hips, you’re forced to go to the lumbar spine to get it, and that is a serious limitation to building stability. On several occasions, Dr. McGill alluded to Mike Robertson and my Magnificent Mobility DVD, so if you’re looking to protect your back, improve performance, and feel better than you ever thought possible, check it out.
