The McGill Big Three: Core Exercises for Strength and Stability
Core - Edition Nº14
If you’ve ever suffered from back pain, you’re not alone. The American Chiropractic Association says 80% of the population will experience it at some point in life, and around thirty-one million Americans alone experience it at any given time. Poor stability is one of the most common causes and problems we face for back pain today.
So, what’s the best way to minimise and avoid long term pain?
Here’s a quick overview.
What causes back pain?
Many factors can cause back pain, whether a muscle or ligament injury, poor posture, fractures, arthritis, infection or disc damage. Sometimes it appears out of nowhere — though that’s rare. Or it can come from trauma.
For me, chronic back pain came from overuse: awful stability and damaging movement patterns (and rubbish posture). As a competitive athlete in school, I ultimately overdid it, worsening my back pain for years.
One of the common myths about treating low back pain is that stretching should relieve it. But firstly that’s quite unhelpful for people with disc bulges and herniations — and can only make things worse.
Stretching tends to exacerbate the problem. It stresses our low back into flexion, and for people who struggle with flexion-based movements (bending forward), it causes more discomfort.
I’m lucky to be naturally flexible, and I naively thought that if I kept stretching and pushing my flexibility, I’d eventually lose the problems with my back. Wrong. We tend to get back pain simply because we move poorly or enact movements or exercises with inadequate form and then accumulate fatigue. Strengthening your back is about improving your core endurance: keeping your spine stable for longer and learning how to engage your core by bracing or stiffening deeper trunk muscles.
How to train your core
Core training is about recruiting the right muscles at the right time and learning to keep them engaged for as long as necessary. There’s a better way to achieve a stronger back — with less effort or strain than with stretching or tough strength training — and it’s by building core endurance.
Dr Stuart McGill, a professor and researcher of the causes and treatment of back pain for more than 30 years, demonstrated that developing our endurance, not strength, helps us avoid awkward postures that can cause back pain and maintain proper movement during the day requires endurance.
Dr McGill also believes that the key to successful back pain treatment is understanding the cause first — which tends to be a cumulative effect of poor movement patterns.
It quickly made sense to me because I noted that my back pain flared after a short time of performing a movement or exercise that loaded my spine. It was a signal that I had poor muscular endurance.
Your core relies on resilient deep trunk muscles: the transverse abdominis, multifidus, internal oblique, paraspinal and pelvic floor.
These muscles support your lumbar spine, and many work to stabilise the lumbar spine or resist the forces acting on it.
By definition, the deep trunk muscles are stabilisers. They are not prime movers. This means they should not be involved in producing movements; instead, they support static, isometric contractions. They should act as stabilisers throughout everyday activities as well as during fitness and sports activities.
Your deep trunk muscles don’t have to be very strong, but they must be well-coordinated and capable of working for long periods. They hold the lumbar spine in a “neutral” position, which requires correct alignment of the pelvis and natural spinal curvature.
Endurance movements are the backbone of Dr McGill’s core exercises. Endurance promotes spinal stability. So it’s essential to have good coordination and the ability to stiffen your core for better stability.
Learn to brace yourself
Before attempting McGill’s big three exercises, you need to learn to engage your target muscles.
Try the exercise below. It’s called abdominal bracing, and it teaches you to stiffen your core to stabilise your spine during everyday movement.
Lie on your back
Pull in and bend your knees and place your feet on the floor
Place your hands on your hips with your fingertips in front of your hip bones.
Gently press on both sides of your abdomen with your fingertips.
Tighten your abs as if you’re pulling your belly button toward your spine. You should feel the muscles under your fingertips tighten.
Hold the contraction for 10 seconds and stay relaxed. Allow yourself to breathe in and out.
Repeat 5–10 times.
This feeling is what you should have when you carry out any lift or exercise. Remember to adjust the brace to fit the activity performed. For example, when heavy lifting, you should stiffen your core more, whereas for activities requiring spine posture control (e.g. sit to stand), don’t stiffen up as much.
The Big Three
These exercises will help build endurance without fatiguing your muscles. Follow this routine using the reverse pyramid rep/set scheme. Start with more repetitions for the first set (e.g. eight reps), then decrease by two, then decrease by another two until you get four reps on the last set. Hold each movement for 8–10 seconds. And as your endurance increases, add repetitions to each set (e.g. 10–8–6 to 12–10–8).
For the side-bridge and bird dog, hold for 8–10 seconds per side.
Exercise 1: The McGill Curl-Up
This is similar to the abdominal crunch, except normal lordosis of the lumbar spine is actually maintained here.
Lie on your back, on a firm surface.
Bend one knee, and place your foot on the ground. Keep the opposite leg straight.
Place your hands under your low back to help preserve your arch during the exercise.
Lift your head, shoulder and upper back off the floor as a unit.
Hold this position for 10 seconds, then slowly lower back down.
Do 10 repetitions, performing five with one knee bent and then the rest with the other knee bent.
Exercise 2: The Side Plank
Lie on your side, on a firm surface. Place your forearm on the ground, under your shoulder.
Reach to your chest with the other hand, place it on the other side of your shoulder to stabilise your trunk.
With your legs stacked on top of each other, bend your knees to 90 degrees.
Push through your forearm and bottom knee to raise your body off the ground. You should be in a straight line from your head to your knees.
Work up to holding this position for 10 seconds on each side.
When this exercise is no longer challenging, separate your legs slightly and straighten your knees. Press down through your forearm and feet to lift into the side bridge.
Exercise 3: The Bird Dog
Go on all fours — a position called quadruped. Keep your abs tight throughout this exercise, and do not allow your belly to drop toward the ground. The core muscles are engaged isometrically, and this helps to stabilise your midsection while you move your arms and legs.
On all fours, keep your neck straight by looking at the ground between your hands.
Lift your right arm straight out in front of you until it is parallel to the floor.
At the same time, squeeze your glutes and lift your leg straight out behind you until it is parallel to the floor.
Keeping your right arm, torso and left leg in a straight line, hold this position for 10 seconds. Do not allow your hips to rotate — your pelvis should remain parallel to the ground throughout this exercise.
Slowly lower back down and repeat not the opposite arm and leg.
If this seems too hard, or you find that you can’t keep your back straight, begin by lifting just your arm, then just your leg, until you’re strong enough to move them simultaneously.
Does this work?
It can feel like this is another generic workout that may not improve your back pain. But it’s called the McGill Big Three for a reason.
A recent study on it was published in April 2018 by the Journal of Physical Therapy Science. 30 people with low back pain compared the effectiveness of McGill’s stabilisation exercises over conventional physical therapy for pain, function and range of motion. The subjects in the McGill category performed The Big Three, while the traditional therapy group focused on low back stretches and exercises that targeted the abs and back extensors. Both groups experienced similar improvements in all categories, but the benefits experienced by the patients in the McGill group were statistically greater than the group that received conventional treatment. Therefore, this can be more effective most typical treatments.
Core stability training is a more effective way to relieve back pain among many other physical discomforts and weaknesses. However, there is more than one way to treat these pains. While the benefits are clear, it’s best to pair them with treatment advised by a physical therapist or doctor and a healthy lifestyle that promotes better movement and living.