#287 ‒ Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D.
Jan 29, 2024
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Stuart McGill, a renowned expert on lower back pain and a distinguished professor emeritus, dives deep into the complexities of spinal health. He challenges misconceptions surrounding nonspecific back pain and emphasizes the importance of understanding its causes. With fascinating case studies, he shares effective treatments and exercises for recovery. McGill discusses the mechanics of the spine, focusing on injury-prone areas, and offers vital advice for maintaining core stability and preventing chronic pain. This conversation is a must-listen for anyone looking to strengthen their back!
Maintaining core stability is crucial for preventing and managing back pain.
Individuals with a very flexible spine may be more susceptible to disc bulges from extension, while powerlifters with a stiffer spine may experience disc bulges from flexion.
Chronic back pain is often inaccurate and is better characterized as repeated acute attacks due to ongoing insults to the back.
The McGill Big Three exercises (modified curl-up, side plank, and bird dog) enhance stability, strength, and endurance in the core muscles.
Understanding the precise mechanisms of pain is crucial for effective pain management, and identifying specific movements or activities that trigger pain empowers patients to mitigate and manage pain more effectively.
Deep dives
The Importance of Core Stability in Preventing Back Pain
Maintaining core stability is crucial for preventing and managing back pain. The three key exercises recommended for core stability are the modified curl-up, side plank, and bird dog. The modified curl-up involves lifting the head, neck, and shoulders while keeping the back flat on the ground. The side plank strengthens one half of the low back and one half of the upper back. The bird dog exercise targets the core by extending one leg and the opposite arm. These exercises help develop proximal stiffness and stability, leading to improved resilience and performance. Regular practice of these exercises can prevent back pain and enhance athletic performance.
Flexibility vs Stiffness in Spine Adaptation
Individuals with a very flexible spine, like those in yoga, may be more susceptible to disc bulges from extension. Conversely, powerlifters with a stiffer spine may experience disc bulges from flexion. This highlights the importance of understanding one's body and adapting exercise routines accordingly. The aim is to strike a balance between mobility and stability to optimize spine health and minimize the risk of injury.
Acute vs Chronic Back Pain
The concept of chronic back pain is often inaccurate. Many individuals with chronic pain actually experience repeated acute attacks due to ongoing insults to their back. Chronic pain is typically unrelenting and may result from neural or psychological factors. Assessment is essential to determine the appropriate treatment approach for each individual.
Benefits of the McGill Big Three Exercises
The McGill Big Three exercises consist of the modified curl-up, side plank, and bird dog. These exercises enhance stability, strength, and endurance in the core muscles. They help individuals achieve stiffness and resilience in the torso, enabling better athletic performance and reducing the risk of back pain. Regular practice of these exercises can yield lasting benefits and improve overall spine health.
Importance of Understanding the Mechanism of Pain
In this podcast episode, the speaker emphasizes the crucial role of understanding the precise mechanisms of pain in order to effectively address and manage it. They present several stories that highlight the importance of identifying the specific movements or activities that trigger pain in individuals with musculoskeletal issues. By utilizing techniques like video fluoroscopy and assessing movement patterns, the speaker demonstrates how identifying the root cause of pain can empower patients and provide them with strategies to mitigate and manage their pain more effectively.
The Role of Stability and Strength in Longevity and Injury Prevention
The podcast explores the significance of stability and strength in maintaining long-term health and preventing injuries. The speaker emphasizes the importance of core stability and muscle strength in enabling individuals, especially as they age, to perform daily activities without the risk of injury. Stories are shared to illustrate how targeted exercises and techniques can enhance stability and minimize energy leakage, ultimately reducing the likelihood of injury. The focus shifts from pursuing maximum effort and performance to developing sufficient strength, mobility, and endurance for sustainable athleticism.
Psychological Trauma and Empowerment in Dealing with Lower Back Pain
The podcast delves into the psychological trauma often associated with lower back pain and explores ways to empower individuals in their pain management journey. The speaker shares stories of patients who faced dismissive attitudes from the medical community and were left feeling hopeless. By providing accurate assessments and explanations of the pain mechanisms, the patients gain a newfound sense of control and empowerment. The podcast emphasizes the importance of understanding the mind-body interplay in order to effectively address and help individuals who experience lower back pain.
Training clinicians to address back pain
There is a lack of specific billing codes for back pain, which results in clinicians offering a range of treatments without a clear understanding of the most effective approach. To address this, BackFit Pro offers a 50-hour online course for clinicians from various backgrounds, focusing on anatomy, physiology, neurology, biomechanics, and pain mechanisms. The course also includes hands-on skills training to develop the necessary assessment and coaching abilities. By training clinicians in this comprehensive approach, they are better equipped to evaluate and treat back pain effectively.
When surgery is the best option for back pain
Surgery may be the best course of action for certain cases of back pain, such as severe stenosis, spondylolisthesis, or specific nerve-related symptoms like foot drop. However, surgery should be approached with caution, and understanding the underlying causes and addressing them post-surgery is crucial. In some cases, virtual surgery, where patients are guided through a strategic mobility and stability program, can mimic the effects of surgery and help manage symptoms without invasive procedures. The decision for surgery should be made with careful assessment, considering the individual's specific condition and response to non-surgical interventions.
Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.
We discuss:
Peter’s experience with debilitating back pain [3:30];
Anatomy of the back: spine, discs, facet joints, and common pain points [14:45];
Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:45];
Why the majority of back injuries happen around the L4, L5, and S1 joints [31:00];
How the spine responds to forces like bending and loading, and how it adapts do different athletic activities [36:15];
The pathology of bulging discs [43:15];
The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [46:00];
The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:15];
The significance of strength and stability in preventing injuries and preserving longevity [1:08:15];
Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:30];
Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:30:00];
Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:39:00];
When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:45];
Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:30];
Tarlov cysts: treatment and surgical considerations [2:00:15];
The evolution of patient assessments and the limitations of MRI [2:02:15];
Pain relief related to stiffness and muscle bulk through training [2:07:00];
Advice for the young person on how to keep a healthy spine [2:14:15];
Resources for individuals dealing with lower back pain [2:25:30]; and
