The limitation of the McGill's Big 3

McGill’s ‘Big 3’

Thanks to years studying the spine, Dr McGill has identified three specific exercises that work together to effectively rehabilitate the back and build core stability. Known throughout the industry as ‘the Big 3’, these are some of the first exercises reached for by people and professionals alike when trying to overcome lower back pain.

In this tutorial, however, I want to explain why I think there’s more to it than that.

What do I know?

I’m not trying to be controversial, or to negate the work Dr McGill has done. I use it with people with lower back pain all the time, so I have a good understanding and appreciation of it. But we do have to understand the context in which we’re doing the exercises and make sure we don’t build them up to be something that they’re not.

I’ve read all four of Dr McGill’s books, I’ve completed his level one foundation course, his level two course on assessing lower back pain and his level 4 performance course. And I’ve interviewed him three times on various aspects of lower back pain. So I have a competent understanding of the work that he has done.

But I’ve had lots of questions from people, through both my Christopher Hole Training YouTube channel and other social media platforms. They say they’ve been doing the ‘Big 3’ for a long time and their cores feel more stable, but they haven’t reduced their lower back pain.

Or they ask, “What’s the best exercise for my bad back?” or, “Can you give me some exercises to help?”

Because in people’s minds, the therapy or rehabilitation of back pain is centred around exercises to be performed. Which unfortunately means they’re not addressing the trigger of the pain. And that can be a problem.

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What are pain triggers?

When I’m working with someone who suffers from lower back pain my first port of call will be a proper assessment of the lower back.  This is McGill’s method, looking for triggers – the ones that create the pain.

I like to explain to people that there are postures, positions, movements and loads that trigger pain and there are also postures, positions, movements and loads that keep you pain free. My overall aim  in developing a treatment plan, will be to look for those pain triggers and then work to eliminate them.

That could be as simple as if you know you suffer with lower back pain that comes on around 10 minutes after you’ve sat down, that’s the trigger of pain. One of the strategies I’d suggest, to overcome this, would be to change posture after five minutes or get out of seat and walk around and then sit back down. If that enables you to sit for another five minutes you will have sat for 10 minutes without pain.

As you start to reduce pain you can then begin to develop the building blocks of the endurance to cope with being able to sit down for longer.

The first step should be understanding not exercises

It’s important to remember that it’s not necessarily exercises that will get you to where you want to be. As a professional, using the McGill method and the principles that he teaches, I will first work to understand someone’s lower back pain. That may take time and I won’t necessarily learn everything in one go.

It might be a case of trial and error. Coaching for recovery is about putting something in place based on my investigation and understanding, waiting a week or two to see how the back responds and then tweaking recommendations accordingly. There is definitely no one size fits all.

I talk about all of this in more detail in the video above.

Why not reach straight for the ‘Big 3’?

While the ‘Big 3’ are useful when implemented correctly and at the right time, there is, I believe, work to do first.  Building a strong core or a core with more endurance, while potentially reducing the risk of back pain in the future, won’t necessarily reduce pain in the here and now.

The important thing is to understand and reduce the pain triggers first and then build on this with exercises. In that way you’ll be in a much more effective and efficient place to be able to overcome the pain.

In my mind, exercises are just a piece of the puzzle. As a professional I have to understand not just where that piece goes but when it is the right time to slot it in. It’s a common opinion that exercise is the cure – I don’t believe this is always the case.

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