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Dr. McGill: 20 Take Home Points

Written on January 8, 2008 at 5:28 pm, by Eric Cressey

I was out of town for a two-day seminar with Stuart McGill last weekend and managed to get sick for the first time in as long as I can remember.  Fortunately, though, along with the flu, I brought back plenty of insights from a great weekend with Dr. McGill.  First, though, let’s get to some quick logistics…

Newsletter Re-Opt-in

As I’ve mentioned in the past two newsletters, we just switched our newsletter over to a new server and imported all the email addresses we had on file.  To complete the switch, we need to have everyone re-opt-in by clicking through the confirmation email they received.  If you didn’t receive an email earlier this week (and hadn’t confirmed previously), just drop us a note at ec@ericcressey.com and we’ll take care of making sure you’re still on the list.  Some of you likely received this newsletter announcement twice; it’s because we’re sending it to both lists temporarily to ensure that everyone gets the word.  This will be the last week of that; thanks for your patience!

The Sturdy Shoulder Seminar Update

Sign-ups are rolling in for the Sturdy Shoulder seminar at Excel Sport and Fitness Training in Waltham, MA.  To say that I’m excited about “christening” the new place with our first seminar would be an understatement, especially in light of the fact that there will be some of the best minds from the strength and conditioning and physical industries present.  For more information and a registration brochure, please drop us an email at ec@ericcressey.com.

20 Take-Home Points from a Weekend with Dr. McGill

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.

6. Shear forces are far more of a concern than compressive forces; our spines actually handle compressive forces really well.  You can’t buttress shear effectively in flexion, so it’s important to avoid it – especially at the most commonly injured lumbar spine segments – at all costs.  The spine doesn’t buckle until 12,000-15,000N of pressure are applied in compression, but as little as 1,800-2,8000N in shear will get the job done.

7. The rectus abdominus is not about trunk flexion; it’s an anti-rotator that is responsible for transferring hoop stresses.  If it was about trunk flexion, it wouldn’t have the lateral tendinous inscriptions; we’d have hamstrings there instead!

8.  Don’t just train the glutes in hip extension; really pay attention to their role as external rotators.  Once you’ve mastered linear movements (e.g. supine bridges), you need to get into single-leg and emphasis movements like bowler squats and lunges with reaches to various positions.  These are great inclusions in the warm-up.

9. Contrary to popular belief, the vertebral bodies – and not the discs – are the shock absorbers of the spine.  Amazingly, the elasticity we see is actually in the bone; blood is responsible for pressurizing the bone.

10. End-plate fractures are the most common injury with compression; they almost always are accompanied by a “pop” sound.

11. Full flexion reduces strength in buttressing against shear by 23-43%, depending on hydration status (more hydrated equates to a bigger drop).  Our spines are “superhydrated” when we first wake up in the morning, so it’s especially important to avoid flexion at this time of day.

12. If your chiropractor is doing flexion-distraction, tell him to stop.  There are already some pretty noteworthy lawsuits taking place in this regard already.  Our spines aren’t designed to buttress shear that comes from the lower body moving backward on the upper body (one more reason to avoid the “hyper” part of reverse hyperextensions).  When the upper body shears forward on the lower body (e.g., hyperextensions), the facets take the stress (a problem, but not as huge a problem).  When the lower body moves on the upper body in flexion, the shearing stress goes on the discs.

13. Those with flat backs stand with less stress, but sit with more (on the posterior ligaments).  Those with lordotic backs have less stress posteriorly seated, but have more in standing.

14. Twisting isn’t a problem.  Torque isn’t a problem.  However, when you apply torque from a twisted position (especially chronically with faulty recruitment patterns), you’re setting yourself up for a world of back pain.

15. If you have 5% or more endurance on one side than the other with side bridges, it’s an injury predisposition.  The flexion to extension endurance ratio should be no more than 1.0.  Watch for unilateral side bridge endurance in unilaterally dominant sports like golf, tennis, baseball, etc.  Full lateral flexion at ball contact is a huge problem in golfers, and the best golfers don’t combine twisting and torque.

16. Disc herniations can actually tolerate quite a bit of compression as long as the spine is positioned in neutral.  Speaking from my own personal experience, disc injuries are not death sentences, people; you can bounce back and still do a lot of the things you enjoy if you handle things appropriately.

17. Abdominal hollowing is about as useful as a crap-flavored lollipop (that was my pun – not Dr. McGill’s – for the record).

18. Supermans and Roman Chair hyperextensions are ridiculously outdated.  You’re much better off with birddogs – both from EMG and reduction of spine load standpoints.

19. Stability balls might increase fiber recruitment, but they can also double the spine load.  Most rehab patients have no places on stability balls – and I can’t say that the rest of the population ought to be on them that much, either (more to come from me on that in the next few months).

20. Twenty minutes appears to be the “golden timeframe” when it comes to creep (the loss in stiffness and disc equilibrium that occurs when ligaments are stretched).  Whether you’re an athlete coming off the bench or someone at a desk job, move around every 20 minutes – and make sure that you warm-up thoroughly before all activities.

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 at www.MagnificentMobility.com.

Additionally, I can’t say enough great things about Dr. McGill’s book, Ultimate Back Fitness and Performance; a resource like this can protect you from a lifetime of pain, so it’s impossible to put a dollar value on it.  That said, $49.95 is a steal.  And, on a related note, if you ever have the chance to see him speak, don’t pass it up.

That’ll do it for this week, but before I go, I want to send out a special thanks to everyone who made donations to Boston Medical Center after last week’s newsletter; we raised $265 for a great cause.  We’ll be back next week with a great interview that I’m sure you’ll all really enjoy.

All the Best,


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