Doc Stuart McGill Talkin' About Spine & Back Health

Bigger Stronger Leaner Injuries and Rehab
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Recently Chad Waterbury has posted a 2-part interview with this guy

There have also been articles on T-Nation in past pertaining to him:
2003’s Mister Spine:

2006: Back to McGill

Anyway, I love to talk about articles, but I hate the switch from an automatic forum into the spill (char count’s too low, it’s annoying, can’t embed images or vids either) so I figured would make a thread to talk about him.

First off, a couple of this guy’s vids are on YouTube and interesting to watch:
2009: McGill Crunch - Silver Spring, MD - YouTube
May 2011: "Train the Core the Right Way" Dr. Mc Gill - YouTube
Oct 2011: Waterloo's Dr. Spine, Stuart McGill - YouTube

I am wondering what you guys think about some things he’s asserted about the spine. Like he’s said more mobility = a higher correlation with people getting back injuries. Plus something about crunches putting too much stress on the posterior portion of the intervertebral discs, slowly wearing them down and creating bulges/herniations.

Accepting this about standard floor crunches (flat surface) I’m wondering if you guys think this necessarily applies to all dynamic movements. Like for example, if you do a hanging leg raise, isn’t the spine under less pressure? I’m figuring because since you are under traction, it allows the discs to decompress. If the vertebrae move that part and aren’t under load then maybe the discs wouldn’t bulge and be damaged by spinal flexion movements.

Same should imply to inverted crunches (like you’re upside down with hips under knees, and if you were only flexing the spine and not the hip joint. If someone does a hip flexion this would change the angle.

I think even decline crunches could have this limited traction factor (not anywhere near as much though) which could keep the spine safe during flexion.

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I would argue that McGill makes some very absolutist statements about the spine. Second, his research has not provided any outcomes based research, meaning it has not resulted in improved function, pain or disability.

Roffey, D. M., Wai, E. K., Bishop, P., Kwon, B. K., & Dagenais, S. (2010). Causal assessment of awkward occupational postures and low back pain: results of a systematic review. The spine journal : official journal of the North American Spine Society, 10(1), 89?99. doi:10.1016/j.spinee.2009.09.003

Wai, E. K., Roffey, D. M., Bishop, P., Kwon, B. K., & Dagenais, S. (2010). Causal assessment of occupational bending or twisting and low back pain: results of a systematic review. The spine journal : official journal of the North American Spine Society, 10(1), 76?88. doi:10.1016/j.spinee.2009.06.005

Wai, E. K., Roffey, D. M., Bishop, P., Kwon, B. K., & Dagenais, S. (2010). Causal assessment of occupational carrying and low back pain: results of a systematic review. The spine journal : official journal of the North American Spine Society, 10(7), 628?638. doi:10.1016/j.spinee.2010.03.027

Roffey, D. M., Wai, E. K., Bishop, P., Kwon, B. K., & Dagenais, S. (2010). Causal assessment of occupational sitting and low back pain: results of a systematic review. The spine journal : official journal of the North American Spine Society, 10(3), 252?261. doi:10.1016/j.spinee.2009.12.005

Roffey, D. M., Wai, E. K., Bishop, P., Kwon, B. K., & Dagenais, S. (2010). Causal assessment of occupational standing or walking and low back pain: results of a systematic review. The spine journal : official journal of the North American Spine Society, 10(3), 262?272. doi:10.1016/j.spinee.2009.12.023

Roffey, D. M., Wai, E. K., Bishop, P., Kwon, B. K., & Dagenais, S. (2010). Causal assessment of workplace manual handling or assisting patients and low back pain: results of a systematic review. The spine journal : official journal of the North American Spine Society, 10(7), 639?651. doi:10.1016/j.spinee.2010.04.028

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[quote]olifter1 wrote:
“I would argue that McGill makes some very absolutist statements about the spine. Second, his research has not provided any outcomes based research, meaning it has not resulted in improved function, pain or disability.”

What are the absolutist statements that you say he makes? He does say that one has to take the individual into account when designing back programs. That seems to me to work as a hedge on any absolutist or general remarks he makes.

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To suggest a causal relationship between flexion movements and back pain or suggest that flexion creates back pain is what I’m talking about. I’ve provided plenty of research to refute this idea.

Another statement in his video of lifting with your knees causes knee osteoarthritis is absolutist. I’d ask for a citation.

I’ve read three texts put out by McGill (Low Back Disorders I and II, Ultimate Back Fitness and Performance) and they all have the same message, flexion causes low back pain and disc herniations. I find his approach very good for athletes and healthy individuals, but his work has not provided meaningful progress in research for low back pain or chronic low back pain.

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He does state that when working with individual clients he tailors the workouts, and perhaps he therefore does include some flexion work with his workouts.

For what it’s worth, I herniated an L5/S1 years ago and was doing fine for ~5years. My strength came back and surpassed what it used to be and I began to compete in Strongman. I became overconfident, stopped being weary of rotational and flexion movements when doing simple things like picking up something off the ground. About 6 months after I stopped being weary of keeping great form even with the little things, I had a reherniation about a year ago.

Of course, as part of Strongman, you sort of need to flex our lumbar spine in order to be able to grasp certain size atlas stones… and then it’s hard to load it to a platform without hyperextending your spine. My Atlas Stone training was very infrequent, however, so although it could have certainly contributed to my reinjury I definitely think ignoring form on simple daily tasks was a primary factor. Of course there are loads and loads of other training and life variables that may have contributed to the herniation (and likely did), but I still strongly believe ignoring my form was a huge factor.

It may also be of note that my body sort of naturally wanted to keep a neutral spine and avoid flexion, years before I read McGill’s theories. So based on the n=1 sample size of me, I’d say that McGill’s theories can benefit those recovering from disc herniations and can prevent future recurrences.

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[quote]olifter1 wrote:
To suggest a causal relationship between flexion movements and back pain or suggest that flexion creates back pain is what I’m talking about. I’ve provided plenty of research to refute this idea.

Another statement in his video of lifting with your knees causes knee osteoarthritis is absolutist. I’d ask for a citation.

I’ve read three texts put out by McGill (Low Back Disorders I and II, Ultimate Back Fitness and Performance) and they all have the same message, flexion causes low back pain and disc herniations. I find his approach very good for athletes and healthy individuals, but his work has not provided meaningful progress in research for low back pain or chronic low back pain. [/quote]

You mean others in the same field as he? Can you tell us what other ideas are on back pain and flexion? I am not a McGill specialist so, but I think he realizes that some people are blessed with lower backs that no matter how much flexion they undergo they don’t get back pain. I think furthermore you should raise your concerns with him and see what he tells you.

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silee,

To look at those questioning McGill’s work, I would recommend Eyal Lederman. McGill has written about his dissaproval with continued pressing of biomechanics.

Having listened to McGill speak and read his research, commentaries included, I am quite familiar with his approach. He is a biomechanist. Biomechanics includes kinetics (force) and kinematics (motion). His research looks at tissue loading patterns, tissue response, strain rates and failure. While this may contribute to pain, it could be, has been suggested to be, and probably is the least important aspect when talking about time frames beyond the tissue healing state.

You ask for other ideas.

The first would be to reconceptualize what a pain response means. It does not mean tissue damage. Pain is like thirst; a call to action (drink). Thirst does not tell you how hydrated you are. Pain is the same; a call to action (move, rest, go to doctor) when the brain determines there is a threat. It does not tell us the tissue’s state or whether there is actual damage. This becomes more apparent for those that have pain beyond tissue damage (this group makes up about 1.5 billion people). Understand I am speaking with the context of people in pain, not technique for resistance training.

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Olifter, thanks. Does your work involve people with back pain?

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[quote]silee wrote:
What are the absolutist statements[/quote]The best example I can think of is claims that the abdominal muscles are constructed to prevent motion instead of creating it.

Right or wrong, it seems like an absolutist claim. A non-absolutist claim would be something like “abdominal muscles can both prevent, create, or slow movement”.