Approximately 1 in 6 people (16.9%) in England have back pain at any given time, with disc bulges and herniations being the most common causes of lower back pain.
One of the most common myths about treating back pain is that stretching will solve all your problems, and while certain stretches may result in a temporary reduction of pain, others may increase pain, but either way, stretching does not address the route cause of most lower back issues, which is a severe lack of core stability and the endurance to maintain that stability.
In his years of research, lower back rehab specialist Dr. Stuart McGill has discovered that enhancing endurance, not strength, is the key to helping people avoid awkward postures that can lead to back pain. In short: maintaining proper movement patterns throughout the day requires core stability and the endurance to maintain that stability.
Dr. McGill designed a treatment intervention comprised of three exercises, or the "Big Three" — to build endurance in the muscles of the core and lower back that help stabilise the spine.
"True spine stability is achieved with a 'balanced' stiffening from the entire musculature including the rectus abdominis and the abdominal wall, quadratus lumborum, latissimus dorsi and the back extensors of longissimus, iliocostalis and multifidus."
Before attempting the 'Big Three' it's vital that you understand how to properly engage the targeted muscles. McGill refers to this as abdominal bracing or stiffening the core to stabilize the spine.
How To Brace and Engage Your Core
Lie on your back, on a firm surface.
Bend your knees and place your feet on the floor.
Place your hands on your hips, with your fingertips in front of your front hip bones.
Gently press into both sides of your abdomen with your fingertips.
Tighten your abs as if you are pulling your belly button toward your spine. You should feel the muscles under your fingertips tighten.
Once you have mastered the abdominal brace, practice incorporating it into daily activities — particularly when lifting — to help protect your back.
The Big Three
To ensure the effectiveness of the Big Three and to reduce the risk of injury, proper form is non-negotiable and maximum control is paramount, so please adhere to the exact guidelines outlined below for each exercise.
Exercise One: The Curl Up
Reps: 5-3-1 (10 sec holds)
At first glance, the McGill curl-up might appear similar to an abdominal crunch. However, lordosis of the lumbar spine is maintained with McGill's exercise.
Step 1: Lie on your back with one knee bent and the other straight. If you currently have pain that radiates down one leg, flatten that leg out against the ground.
Place your hands under your lower back (this will ensure your spine remains in a neutral slightly arched position during the next step).
Step 2: Pick your head off the ground only a few inches and hold that position for 10 seconds. The goal is to perform this curl-up without any movement in the lower back. If you raise your head and shoulders too high (like a traditional curl-up or crunch) your lower back will round and excessive forces will be transferred to the spine that could increase your symptoms.
Step 3: After a 10-second hold, relax your head back down to the resting position, this is one rep.
You can progress this exercise and increase the difficulty by bracing your abs before moving your head or raise your elbows from the ground to decrease your base of stability.
Exercise Two: The Side Plank
Reps: 5-3-1 (10 sec holds)
The side plank is a unique exercise as it activates the lateral oblique and QL muscles on only one side of the body, making it an excellent choice for addressing weak links in stability while placing minimal forces on the spine. It also engages an important stabilizer of the hip/pelvis on the lateral hip (the glute medius)
Step 1: Lie on your side with your legs bent and your upper body supported through your elbow. Place your free hand on your opposite shoulder.
Step 2: Raise your hips so that only your knee and arm support your body weight.
Step 3: Hold this position for 10 seconds before returning back down (this is one rep). Perform the same descending rep-scheme for each side.
Exercise Three: The Bird Dog
Reps: 5-3-1 (10 sec holds)
The last of the McGill ‘Big Three’ is the bird dog. This is an excellent exercise to promote a stable core while movement occurs at surrounding joints (either the legs or arms and legs together). The combination of movement occurring at the hips and shoulders while the lower back remains stable allows this exercise to have excellent carry over to movements you perform throughout your day and in the gym.
Step 1: Assume an ‘All 4’s’ position (quadruped) with your back in a neutral alignment. Remember a ‘neutral’ position is a very slight arch and not completely flat.
Step 2: Without allowing any movement to occur at the lower back, kick one of your legs backwards while simultaneously raising the opposite side arm until both extremities are fully straightened.
A helpful cue to make sure the leg movement doesn’t create an over-arching of your back is to think about kicking the heel of your foot straight back.
Step 3: Hold each extended pose for 10 seconds before returning back to the starting All 4’s position. Again, perform the same descending rep-scheme as the previous two exercises.
As your endurance improves and you become more competent at each of the exercises you can look to progress the exercises to more advanced variations and/or increase the number of reps performed in each set — but continue to reduce the reps at regular intervals to maintain the descending rep scheme (e.g 6-4-2 instead of 5-3-1)
While the total number of repetitions performed should be increased as endurance improves, do not increase the amount of time you hold any position during a particular repetition. The side plank and bird dog exercises should each be held for a maximum of 10 seconds per repetition.
McGill recommends using these exercises not only as a foundation for your rehabilitation from back pain but also as a part of your weekly training program to prevent future injury once your symptoms have disappeared.
While these exercises can be safely performed daily when trying to recover from a back injury they should not be performed directly after rising from bed in the morning (that is the time at which the discs of your spine are most hydrated and prone to injury due to increased stiffness/reduced flexibility).
The last thing Dr McGill recommends alongside the “Big 3” exercises is a regimented walking program. Getting up and walking throughout your day can be extremely helpful in maintaining the health of your spine. Start with smaller bouts of walking (5-10 minutes at first with a fast pace that causes you to swing your arms). The goal should be to eventually reach a 10-minute walk three times a day.
I hope that you found this blog post valuable and it has given you a better understanding of the role that core stability plays in reducing back pain.
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