Understand & Treat Back Pain – A Simple Analogy

The Flat Tire Analogy

Imagine 23 fully pumped car tires stacked 23 high, one on top of the other. Then a few of those tires lose a little bit of air, becoming more pliable and soft. Now every time the tires waver in the wind, an unequal amount of movement occurs at the level of the softer and more pliable tires. This excess movement, akin to segmental spinal instability, causes pain—a jolt that can radiate into the back, butt, or leg. This can lead to further issues like disc bulges, herniation, or stenosis, and typically segmental spinal instability is a large factor in this process. But perhaps you’ve been told you only have a muscle strain or maybe your SI joint is the problem. Well, Stuart McGill says that’s typically a misdiagnosis.

Trusting the Researcher – Stuart McGill

Who do you trust more? A clinician with limited musculoskeletal training or a spine researcher like Stuart McGill, dedicated to researching the spine? McGill's methods align with the literature and have shown remarkable results, challenging the common notion of low back pain being a mere muscle strain. His research coincides more with the tire analogy. While it may feel like the SI joint or a particular muscle, back pain is tricky and it’s typically a deeper issue at play—a disc bulge, herniation, or stenosis, with underlying segmental spinal instability.

Questioning Common Diagnoses

If you still believe it's a muscle strain or pelvic rotation, ask yourself why scientific literature disagrees with these diagnoses. For the majority of cases Stuart McGill dismisses SI joint issues as a typical source of pain, challenging certain localized beliefs. While true SI joint issues do exist, they are extremely rare and more commonly they are the wrong diagnosis.

Treatment Recommendations

Treatment Approach: The car tire analogy concludes as we delve into treatment. Unlike changing a tire, quality research of the spine often discourages disc replacement or fusion surgery. Alternatives like opioids, muscle relaxers, and crystal healing are discouraged as well.

Research-Backed Recommendations: What treatments are still on the table? Recommendations, although no substitute for professional advice, include avoiding painful movements and making the spine more robust. McGill's principles, emphasizing endurance over strength, form the basis.

Less Pain, More Gain

Stop the Hurt: The idea of no pain, no gain is a misnomer. It’s less pain, more gain. So if it hurts, don’t do it. Every time you feel pain, you are likely experiencing microtrauma leading to more inflammation and pain sensitization. Instead, you want to move in a way that protects the deep structures of your spine. For most people, it’s advisable to avoid bending over at the waste, especially in the morning when your spine is in its most decompressed and vulnerable state. Therefore, take it easy in those waking hours. With most activity, keep your back somewhat straight or neutral and keep your knees about two feet apart. By keeping your knees apart, this opens up the hip joints and places them in what is called the open-packed position. This allows more movement to occur through the hips as opposed to occurring through the spine.

Spine Made Simple

Low back pain is as common as a flat tire and can be even more debilitating. Drawing parallels to a flat tire, the spine experiences a similar phenomenon. Often, the discs in our spine start to flatten, becoming more pliable and mobile, but in a detrimental way.

McGill Big Three – Exercise Routine

Core Endurance, Not Strength: Contrary to common belief, core strength is not the goal. Instead, aim for core endurance, stressing muscles metabolically without impacting spinal joints. Isometrically stress the muscle with positions held for no more than 8 to 10 seconds to prevent muscle spasms. Perform reps of 6, then 4, then 2 with a 30-second rest between sets.

The McGill Big Three: The routine includes a curl up, side bridges, and birddogs, emphasizing isometric endurance while limiting shear forces to the spine.

Curl Up (abdominals): Lay on your back with your hands under your low back and one leg bent. Raise head, shoulders, and chest off the ground just high enough to slide a piece of paper under your head and no higher than that. Feel the contraction in your abs. Hold each rep for 8-10 seconds, no more or you’ll cause a muscle spasm. Relax for a full second in between each rep. Switch the bent leg after each rep and repeat the exercise.

Side Bridge (obliques): Lay on your side with knees bent. Thrust hips up and forward while resting on forearm. Feel the contraction in your obliques. Hold each rep for 8 seconds, no more or you’ll cause a muscle spasm. Relax for a full second in between each rep.