There are countless reasons why adults 55 and over experience low back pain, including disc degeneration, arthritis, injury, muscle weakness and more. In fact, low back pain is one of the most common and poorly understood chronic conditions in older adults. One researcher making major contributions to the field is Dr. Stuart McGill.
Q&A with Dr. Stuart McGill
Dr. Mcgill is one of the world’s leading researchers on spinal mechanics and low back health. In his decades of research, he’s developed three exercises which are famously known as the McGill “Big 3” to relieve, prevent and fix your back pain. We spoke to the respected Canadian professor to better understand what triggers back pain and how older adults can build a stronger and more resilient back. Welcome, Dr. McGill.
Q: Tell us about the “Big 3” exercises, and why they’re effective for older adults.
A: The “Big 3” are the modified curl-up, the side bridge [also called the side plank] and the bird dog. For years, I’ve measured what caused back pain in different people. Our team developed new techniques, obtained different instruments and explored different clinical assessments to measure the cause of back pain. After measuring a lot of different exercises, it was these three, now called the “Big 3”, that best trained muscles while minimizing stress on the spine.
1. Modified Curl-Up
2. Side Bridge
3. Bird Dog
Improved core stability from the “Big 3” exercises will help you maintain higher athletic ability for longer. As we age, many of us train as a way to slow down our rate of physical decline. The “Big 3” will help, but adjustments or modifications may be required.
For example, doing the side bridge when you’re older may cause shoulder soreness or may be difficult if you’ve had a knee or hip replacement. In my book, the Back Mechanic, I include various modifications for the “Big 3” so that the exercises can be adapted to still be effective despite having compromised knees, hips or shoulders.
Q: What’s the most important thing to know when addressing back pain?
A: First and foremost, you have to be able to pinpoint the specific pain trigger or triggers. Something is causing the pain and once identified, we refer to the pain as “specific”. Knowing the pain trigger acts as a road map to build a pain-free foundation. This begins with using pain-free alternative movements that cause less stress for the back, giving the pain-sensitized tissues a chance to rest, heal and grow. For instance, one person’s pain-free foundation may require several 5-minute walks throughout the day. For someone else, it might be to sit using a low-back support and performing the “Big 3” exercises twice a day. The pain is specific to each individual.
Q: What causes back pain in older adults?
A: There are two broad categories that commonly cause back pain: discogenic pain, and stenosis or arthritic pain. Discogenic pain is pain that comes with changes to the vertebral discs in the spine. Spinal stenosis has to do with narrowing of the spinal canal and the pinching of nerves. Younger people tend to experience discogenic back pain and can eventually grow out of it. However, there are people who carry discogenic pain into their 70s. Biologically they have a younger spine; chronologically they have a 70-year-old spine.
The pain triggers for those who suffer from discogenic and stenosis back pain are different. A person with discogenic back pain might experience back pain after sitting in front of a computer for a short period of time. But going for a 30-minute walk takes the pain away. With stenosis or arthritic pain, it’s the opposite. Sitting for half an hour may provide relief, while walking for 15 minutes exacerbates the pain.
Q: Is back pain inevitable as we age?
A: It really depends on your level of physical activity and trauma history. When I’m working with someone who doesn’t have trauma history (i.e., hasn’t had a knee or hip replacement) and instead has a specific posture or load that triggers their back pain, I can teach them how to move differently and spare their pain trigger. It’s about much more than just age. The key is to perform the self-assessment in Back Mechanic and to understand your specific pain trigger.
Q: What’s the connection between low back pain and core stability?
A: Core stability has three elements that are essential for moving and loading the back: pain, proximal stiffness and the spine’s stability/mobility continuum. Let’s look at each one individually.
When a spine joint is damaged because a person has lifted too heavy a load, the joint becomes lax and develops painful spine-joint micro movements. There are several tests that a person can do to know if this causes their pain. A technique called the abdominal brace is an important tool to reduce or eliminate pain.
The abdominal brace isn’t just sucking in your stomach or pulling your navel in toward the spine, as we’re often taught. An abdominal brace is a mild contraction of the abdominal muscles. To try it, start with your abdominal muscles relaxed. Then push your fingers into the oblique muscles about 5 to 12 cm lateral of the navel. Do not suck the muscles in, rather gently stiffen the abdominal wall feeling your fingers being pushed out. You then gradually adjust the amount of contraction to find what best controls pain. If this strategy works for you, the muscle bracing is stiffening out the painful micro-movements.
2. Proximal Stiffness
The second part of core stability is proximal stiffness. If you have to push a heavy door or lift your four-year old grandchild off the ground, you need proximal stiffness or core stability. Your skeleton is a collection of links joined together at the joints. But pushing at the end of the linkage (distal end) require the proximal links to be stiffened.
To create the leg movements to walk, you must stiffen your core. Without core stability, you’d be unable to walk. In this case, your hip and leg muscles would move your pelvis, instead of your legs, and bend your spine causing you to collapse. Activating your core muscles adds essential stiffness to hold your pelvis up and allow your legs to move. These stiffening muscles are on the front, sides and back of your torso. We have proven that regularly performing the “Big 3” exercises conditions these essential muscles for a better outcome in people who have pain because of insufficient proximal stiffness.
3. Stability/Mobility Continuum
The third element of core stability considers the spine itself. The spine is a flexible rod, yet it must function in a system of rigid links. The spine’s flexibility allows you to move freely and dance. But if you pick up a heavy load, like a grocery bag, your flexible spine must be stiffened to prevent it from bending to pain. Your core muscles are designed to act as a “guy-wire system” providing the essential stiffness and stability to remain pain-free. Stability comes from muscle stiffness.
Q: For many older adults, getting out of bed is tough. But after a morning stretch, they can walk, run, cycle and hike. Does a morning stretch relieve low back pain or can it lead to increased sensitivity?
A: It all depends on the specific pain trigger. If the mechanism or trigger behind morning stiffness are joint or muscle related, then generally mobility and specific stretching can help. But if the trigger is linked to spine stenosis or arthritis, generally the pain will get worse. But a proper assessment will reveal this.
As discussed in the Back Mechanic, some back and leg pain is from irritated and sensitized nerves. Mobilizing the nerves by doing specific “nerve flossing exercises” can help reduce the sensitivity or it can make it worse. Some stretches simply fire off a stretch reflex to give a very brief period of relief, leaving the person perplexed as to why the pain quickly returns. What’s most important, in this case and in all cases, is nail down the nature of the specific pain trigger and to use the right clinical tools to address the discomfort.
Get the Book
Dr. McGill has helped thousands of people reclaim their lives with his evidence-based guide, Back Mechanic (available online at backfitpro.com). Back Mechanic guides you through a self-assessment to identify your specific pain triggers, then shows you step-by-step exercises to address the pain and avoid roadblocks to recovery.