EPISODE 54 – STUART MCGILL, PART 1: LOW BACK PAIN, DISC LOADING AND THE “FLOPPY PUSH UP”

Stuart McGill PhD

Stuart McGill is a Professor of spine biomechanics at the University of Waterloo. He is the author of 3 textbooks and over 300 scientific publications that address the issues of low back function, injury mechanisms, development of evidence-based rehabilitation and performance enhancement. 

As a consultant, he has provided low back expertise to various government agencies, many corporations, elite athletes, teams and Olympic programs from many countries, and legal firms. He is one of the few scientists who is regularly asked for consult by the medical and sporting community regarding particularly difficult back cases.

Show Notes

Professional Background

A professor of spine biomechanics for about 30 years.  His first lab was an in vivo lab studying live people.  The other lab, the in vitro lab, studies tissue and using specific tests and apparatus.  The third element is the clinic which came about as a result of him being asked by physicians to see a patient along with them due to the information he had presented to them. He always keeps a full teaching load and he sees patients typically on Wednesdays.  All of his patients are from out of town and either they fly in to see him or he flies to see them.  He teaches about one weekend clinical course per month. When he sees patients he will see one or two patients per Wednesday but with each patient he’ll evaluate them over about 3 hours.  Most patients he sees only once and he never sees them again.

Misconceptions of His Principles

There are many, in the days of social media, that take one piece of information or one study and make a public statement accusing him of his beliefs and he believes that to be irresponsible and unfair.  He has learned over the years that many other thought leaders who’s ideas may be quite different than his, turn out to be pleasantly positive and full of a wealth of knowledge that cause him to come away with a great deal of respect and appreciation for them once he’s spent a little time with them.  Professor McGill believes there’s no such thing as nonspecific back pain, all that means is that the person has never been assessed.  He believes most often the origin of the pain can be determined although most often he doesn’t need to know exactly the tissue of pain origin. 

McGills Work and View on the Disc and Loading

Work studying what causes a disc to bulge has been studied by he and his team.  He clarifies that discs don’t show to “tear” as much but actually delaminate where the nucleus … The shape of the discs, oval versus lima con shape, he reports, respond different to extension loading.  He hates the “floppy push up” due to his belief that repeated end-range extension will lead to facet degeneration. He deduces this as a product of loss of disc height and that leading to facet damage from that increased load.  He also resists the idea that there is a pumping mechanism.  Rather an hydraulic effect which draws a posteriorly migrated tissue more anteriorly.  He doesn’t disagree that there is a place for extension but he would discourage the prolonged use of end-range extension.