[@PeterAttiaMD] The 3 Best Exercises for Back Pain Relief | Stuart McGill, Ph.D.

Link: https://youtu.be/j2qppqLKEi0

Short Summary

Number One Action Item/Takeaway:

Understand that core stability exercises, like the "big three" (modified curl-up, side plank, and bird dog), are not universally beneficial and that an individual assessment is critical to determine appropriate exercises to create proximal stiffness (core stiffness) while sparing the spine.

Executive Summary:

The "big three" core exercises aim to enhance torso stiffness and improve movement efficiency by preventing energy leaks caused by muscle contractions. However, these exercises are not suitable for everyone, as individual needs and physical conditions vary, and assessment is necessary to choose the most appropriate and effective exercises.

Key Quotes

Okay, here are 4 direct quotes from the transcript that I found particularly valuable:

1. "No, it isn't. No, that that this is a a bit of a myth and something that I've been fighting basically my whole career. Oh, Miguel is the big Migill big three." (This quote challenges the blanket application of the "Big Three" exercises and sets the stage for a more nuanced discussion.)

2. "So what is the best most efficient way to create a proximal stiffness? We searched for years doing all kinds of tests of uh uh every abdominal exercise you could think of, back exercises, twisting, powoff presses, throwing things, etc. The three exercises that kept bubbling up to the top in the criteria of sparing the spine while you're doing them because these people are hurting. You you you don't have cart blanch to load up their spine. uh a guaranteed stability or proximal stiffness." (This quote highlights the rigorous process behind identifying the exercises.)

3. "We use the Russian training science to show you build endurance through repeated 10-second exposures, not getting tired to the point where you break form." (This provides a specific rationale and methodology for the side plank exercise.)

4. "I think the brain created a lasting neural stiffness and in some people it lasts about 20 minutes. Some people it lasts longer. So you will see some patients who say you know when I do the big three I don't have pain for the next hour. Fabulous. What you're going to do is midm morning do a 12minut big three session. Midafter afternoon do a 12. So, these are the little tricks and hacks to slowly wind a person down out of pain." (This quote suggests a mechanism for the exercises' effectiveness and a practical application for pain management.)

Detailed Summary

Here's a detailed summary of the video transcript, broken down into bullet points:

Key Topics and Arguments:

• The "Big Three" Exercises:
  • Focuses on three core exercises: Modified Curl-up, Side Plank, and Bird Dog.
  • These exercises are presented as a method for building core stability.
• Rejection of "Non-Specific Low Back Pain" Myth:
  • The speaker challenges the concept of non-specific low back pain, suggesting it's not a universally applicable diagnosis.
  • Argues that individual assessment is crucial to determine the cause of back pain and the appropriate treatment.
• The Importance of Core Stability for Overall Performance:
  • Explains core stability as crucial for transferring force efficiently throughout the body.
  • Uses the analogy of a backhoe needing stabilizer bars to effectively dig.
  • Connects core stability to improved athletic performance (e.g., faster directional changes).

Explanation and Rationale for the Exercises:

• Core Stability Definition:
  • Proximal stiffness is key to directing force distally without energy leaks.
  • Building stability proximally (core) allows for more effective movement at the distal end (e.g., pushing, punching).
• How the "Big Three" Were Selected:
  • The exercises were chosen based on their ability to spare the spine (avoiding pain aggravation).
  • They consistently demonstrated the ability to improve core stability.
  • Research showed that performing the "Big Three" could increase core stiffness, lasting for different durations in individuals.
• Modified Curl-Up:
  • Hands are placed under the low back.
  • Elbows are lifted.
  • The head, neck, and shoulders are hovered.
  • Focus is on abdominal contraction.
• Side Plank:
  • Only half the musculature is heavily challenged, making it spine-sparing.
  • The downside is heavily challenged; the upside is not.
  • Prescribed in 10-second intervals to build endurance without compromising form or causing neural fatigue.
• Bird Dog:
  • Extends one leg and the opposite arm simultaneously.
  • Activates one half of the low back and the opposite side of the upper back.
  • Creates stiffness and stability in the core.
  • Teaches the brain to dissociate ball and socket joint motion of the shoulders and hips.
  • Provides a spine-sparing alternative to exercises like Roman chair extensions.

Assessment Hallmarks:

• Provocation Testing:
  • Involves having the patient assume different postures to see if it triggers pain.
  • Example: Having the patient sit on a stool and drop their chest to assess pain provocation.
  • Identifies specific pain triggers.
• Individualized Approach:
  • Recognizes that what triggers pain for one person may not trigger pain for another.
  • Exercises are modified to suit the individual's needs and limitations (e.g., rotator cuff issues).

Practical Application:

• Frequency:
  • The "Big Three" can be performed multiple times a day (e.g., mid-morning and mid-afternoon).
  • Short sessions (e.g., 12 minutes) can be effective.
• Purpose:
  • The goal is to gradually wind a person down out of pain by improving core stability and neural control.