Stu McGill: Back Mechanics
Continuing on with my little project of making blog posts on sections from books I’ve read, this next one is on Stu McGill’s book “Back Mechanic”.
Stu McGill has over 30 years of experience researching back mechanics, specifically low back mechanics/pain/pathologies etc. He’s held by many to be a guru when it comes to that stuff. However, that isn’t to say he hasn’t had his fair share of disagreements. I’m not here to defend him. I don’t consider myself a fan of his in particular, but I will say that he’s definitely someone whose points and research are usually misrepresented.
I am fascinated by musculoskeletal anatomy and the research around it, which is why I get irked whenever information is taken out of context. I’ve read enough of his work, and had the opportunity to talk to him directly and ask him questions during a couple of workshops I’ve done with him. I’ve also completed the course “Low back pain specialist” with Stu McGill and Darby Training Systems. So I’ve had many opportunities to dive deep into his claims and his research.
But rather than get into the drama surrounding his work, I want to talk specifically about his findings and views on spinal surgery.
Back Surgery: Who Needs It?
Well, according to McGill, 95% of his patients DO NOT need back surgery, despite being told they did! And you know, there’s something both incredibly sinister and also reassuring about that. Sinister because how many people are being dismissed with a blanket statement like “you need surgery”. And reassuring because I can confidently tell my clients that there are other options beside surgery.
McGill’s has over 30 years of experience with patients who were successfully able to treat and manage their back pain without surgery. And this also includes patients with “failed backs” caused by unsuccessful surgery. This lead McGill to conclude that, in many cases, people would have achieved similar results if they had simply rested properly.
This is why people usually roll the dice with surgery. And any good surgeon will even tell you there is a % chance associated with risk and reward. When I got the MRI results on my knee that showed a torn meniscus, the surgeon told me there’s a chance it might work, a chance it won’t, and a chance there will be no change.
Risks of Surgery
The first thing to keep in mind is that surgery has no “undo” button. Think about it, the surgeon is cutting into essential nerve and muscle tissue. Furthermore, there is a scarring process which itself can grab onto the nerves and cause potential chronic back pain. As far as the spine goes, bone doesn’t usually grow back in that area of the body. So in some cases essential bone is removed and be permanently lost.
That being said, surgery DOES work in some cases. But it’s important to keep in mind that in most cases the effects only last for a period of time. McGill says that studies show that, initially, patients may feel much better. But after a few years the status of the surgical patient is comparable to a non surgical patient.
The reason for this is that there are flawed mechanics that, if not trained, strengthened, and improved, would just lead to more tissue breakdown. And more tissue breakdown usually results in more pain. Moreover, I don’t think it’s just pain from the physical site of surgery/injury. There’s also the stress that arises from not knowing what’s going on, that can definitely contribute to the perception of pain.
Even though the operated site might be “stabilized”, the areas above and below can experience the same set backs and weaknesses. Those setbacks and weaknesses may eventually start to contribute to more issues later on. As such, if the symptom is surgically “cured” but the cause never addressed, then nothing has been solved. And without rehab, and strengthening to change the flawed movement patterns that contribute to the weakness in the first place, the surgery rarely ever works.
Virtual Surgery
Virtual surgery is a recovery program of a surgery patient, without doing under the knife. According to McGill, the number one reason that surgery usually works is because the patient is FORCED to rest. And that’s really all it is: Forced Rest.
Virtual surgery goes something like this: Pretend you’ve just gone through surgery. This means no more going to the gym, no more stretching, running etc. Then build a program that slowly and progressively challenges the person. The program, as McGill explains, must
1-Erase the cause of the pain
2-Establish pain-free movement patterns
3-Include some walking and some specific exercises
10 Things To Consider When Considering Surgery
1-Try virtual surgery first! Always first! Then consider points 2-10 if VS doesn’t work
2-Consider surgery when the neurological issues are substantial enough that they cause loss of bladder and bowel control
3-Never Mobilization Approach (NMA) as well as “Mechanically Based Movement Therapy” usually work for treating: *Numbness, *Muscle Atrophy, *Radiating Pain Symptoms. These are all signs of compromised or trapped nerve roots.
4-Consider surgery in cases of trauma such as broken bones and torn tissue. Those often need stabilization (Screws, rods, etc.)
5-“Severe Pain” for 3-6 weeks is not necessarily a reason for surgery. Especially if no other rehab method is employed!
6-If you have “good days” and “bad days” then identify the case of changing pain. Don’t assume you’re a candidate for surgery.
7-Beware of new treatments and devices that require surgery. These can result in long term issues.
8-“Disk Replacement” does not seem to have successful long term benefits. Success means the full resumption of former activities without the same pain. Spine joint pain is usually the result of motions and loads that aggravate the area. An artificial disk axis of rotation rarely mimics that of natural disks. It also places more stress on the other 2 facet joints. Over time those other 2 joints can become arthritic and intolerant to motion, and long term success is compromised as a result.
9-ALWAYS exhaust conservative approach options. Try all other non invasive therapies first. Try different therapists too!
10-If someone looks at imaging (CT scan, MRI) and advises on surgery options without thoroughly assessing the person first, they should be questioned and possibly even avoided. Images only tell part of the story. Structures that look fine on MRI are usually a source of pain. Nasty looking disks are usually pain free!
Final Thoughts
I decided I will break this up into 2 Parts, where the second part will deal with things you should keep in mind when selecting a surgeon, if surgery is the only option left.
As a coach, I usually begin by going through a thorough assessment to find movements, postures and loads that cause discomfort or pain for the person. I try to figure out which positions and movements the person can and cannot tolerate. I then begin to introduce small incremental loads until we find that sweet spot for the person. I tell my clients that we are looking for a bit of a challenge, a little bit of discomfort, but not to the point where you are contorting your self while grimacing and making faces the whole time.
In my 10 years+ of being a fitness specialist, I have come across countless clients suffering from low back pain. Sometimes it would be the same client complaining of pain from a spasm due to a particular activity. But out of all that time, I can only recall 2 clients who have had to get surgery. Both didn’t even involve their spines, it was their shoulders.
Back pain is no joke, and it’s rampant enough to be one of the main concerns for pretty much every single client I have trained. I can confidently say that 4 out of every 5 clients I’ve had, either had and episode of chronic low back pain. But it isn’t the kind of thing that we can cure once and for all.
Pain and discomfort is part of human life, to a certain degree. There are good days and bad days. And there are some activities that exacerbate it, and others that reduce it. And I strongly believe that any health and fitness pro should work hard to help their clients improve their abilities to have fun and enjoy their lives. All while staying within our scope of practice of course!