A New Interview with Dr. Stuart McGill04/10/06
Scroll through the archives here at T-Nation and you'll see that we don't interview just anyone. Now, scroll through the archives and check to see who's been interviewed twice. You won't find more than a few names.
However, a few people have had such a profound impact on the world of health and human performance that they deserve a second go-round. Stuart McGill is one such individual.
Elite athletes regularly seek Dr. McGill's advice in hopes of saving their careers from devastating back problems.
In March of 2006, I had the good fortune of seeing Dr. McGill speak in person for the first time. Admittedly, going into the seminar I was expecting a typical research presentation by a typical researcher. That is, I was expecting someone with a bunch of graphs and a lot of book smarts, but little real-world experience "under the bar" and on the field of performance – much less the ability to show it off to those in attendance.
My assumption couldn't have been further from the truth. Dr. McGill was fantastic – so fantastic, in fact, that I've already made plans to see him speak at a two-day seminar to dozens of physical therapists this October.
Less than twenty minutes into the presentation, Dr. McGill took off his sweater and tie so that he could get "moving around." Over the next six hours, he moved around like a skilled athlete in his twenties, taking those in attendance through a variety of functional assessments and drills designed to identify and correct problems. To say that I was impressed with his athletic ability and charismatic speaking would be an understatement – and I have to admit that I was really damn flattered when he knew who I was!
A few years ago, Dr. McGill published the first edition of Ultimate Back Fitness and Performance, a book that delved into identifying and correcting low back dysfunction in order to build a healthy, efficient athlete. Just this year, Dr. McGill introduced the second edition of the book, which takes the crucial health-efficiency-performance link to a whole new level.
Dr. McGill was kind enough to take time out of his busy lecture, writing, research, and consulting schedule to share some of his thoughts with T-Nation.
T-Nation: Welcome, Dr. McGill. Thanks for taking the time to bring us up to speed since we last touched base with you.
Dr. Stuart McGill: I'm glad to have the chance to do this again.
T-Nation: I know you're not one to hold back when it comes to challenging the traditionalists, and with good reason: you're the one doing all the latest research! With that said, let's get things started by barbecuing some sacred cows. You have some strong thoughts on traditional "ab" training. Where are so many lifters missing the boat, and how can they fix the errors in their ways to improve performance, reduce the risk of injury, and build a solid midsection?
Dr. McGill: Well, I don't know if they really are missing the boat until I can see their motion and motor patterns, listen to them describe their training, what causes their back discomfort, what they're able to do pain-free, etc., etc. There's no question that a well-conditioned torso will enhance lifting performance; the issue is about how to develop the torso, or "core," to optimal levels without injury.
I've never seen any evidence that would justify abdominal hollowing, for example. Learning to brace all three layers of the abdominal wall (this means contracting all of the abs without moving them) is superior for enhancing stability. We've developed exercises documented to spare the back but challenge the abdominal muscles in a way that can be extremely difficult. You experienced this in our clinic last week.
T-Nation: No doubt. You had some pretty experienced lifters, coaches, and trainers questioning their own foundations. Except me, of course. Tell the T-Nation audience about how perfect I was, Dr. McGill!
Dr. McGill: Yes, Eric, you showed wonderful lumbar control! Once we have ensured that lumbar control is well established in the athlete, we may follow various protocols to challenge all of the neuromuscular compartments of the abdominal obliques. We then may focus on tuning the flexor mechanism (for example, push-up position, then walking the hands out in front and maintaining the bridge).
From these, we move on to short-range plyometrics. So, I'm dismayed to see the number of people performing full range curl-ups over a gym ball, risking their backs. When is this done in real life? In the real world, the strength and power athlete uses torso stiffness as a short-range spring to direct hip and shoulder power through the linkage with minimal energy losses. Every great kicker, thrower, jumper, and lifter uses the core in this way.
T-Nation: Great points. It all comes back to efficiency once again. In the lifting population, what "energy leaks" are you looking for?
Dr. McGill: There are many. It may be a weaker joint forced into eccentric contraction while a power joint is concentrically contracting. In the back, perhaps the lumbar spine is breaking (flexing) before the required depth is reached. Here I may strap the spinal hinge with more latissimus dorsi contraction and also reap the benefits of more spine extension torque.
In terms of lifting performance, I usually have a look at the whole lifting motion and then begin with appropriate corrections. Perhaps the feet haven't gripped the floor. Perhaps there's too much load in the knee as opposed to the hips. The lifters who lift closer to world records have less back load and higher hip load. Perhaps some hip flexion torque is required to drop the pelvis back into the "hole." It all depends on what the lifter shows.
Usually, I'm able to add a few more pounds – and sometimes more than a few. More importantly, though, we work to address the joints closest to failure tolerance.
Dr. McGill working with powerlifter and strongwoman competitor Liane Blyn.
T-Nation: You really piqued my interest with your discussion of end-plate injuries in lifters. Can you please fill T-Nation readers in a bit more on these problems, their symptoms, diagnoses, and treatments?
Dr. McGill: Under large compressive loads on the spine, the end-plate of the vertebrae is usually the first tissue to damage (often with accompanying trabecular damage in the vertebrae). Given that it's a compressive injury, it's not surprising that the spine becomes compression intolerant, and provocative testing to assist in the diagnosis is based on compressive loading. Usually the standing heel drop will pick up compressive intolerance following an end-plate fracture. CT scans can sometimes pick them up.
Interestingly, the fresh end-plate fracture can be immediately symptomatic, and other times it's very uncomfortable but not disabling. (I've had two in my life – one in my neck where I finished the game and season, although I now have a flattened C4 disc – and one lumbar that was immediately symptomatic and quite symptomatic for a few years.) Treatment is usually time off with gradual progressions in the challenge of compressive loading. The choice of exercise is critical.
T-Nation: Millions of people feel "tight" in their lower back, so they logically assume that the best way to fix the problem is to stretch the lower back out. With our DVD and writing, Mike Robertson and I have gone to great lengths to show that it's a deficit in hip mobility that's actually one of the problems, and that stability of the spine is what these people need. Care to elaborate?
Dr. McGill: I agree. When we test athletes who complain of being tight, and who have been stretching to deal with this sensation, many show their problem to be neurogenic tension – not always tight muscles.
So, while stretching the back, hamstrings, and the like, may feel good as the stretch receptors are stimulated – the neural tissues are stretched causing more stiffness the next day. Worse yet are those who may have stiffness due to disc bulges, and stretching only makes the bulges larger.
Immobility of the hip joint has been shown to be a correlate of back troubles. True hip joint mobility can be trained in some people, but again, the source must be ferreted out. It could be a tight or compromised hip joint capsule, tight muscles, or neural tension.
By the way, in lifters, neural tension usually originates in a lumbar root from a disc bulge. Stretching is contraindicated in this case. The key is to move or change posture to assist the bulge in reducing, then proceed with nerve root flossing techniques, then correct the faulty lifting pattern that caused the bulge in the first place.
T-Nation: Relative to popular exercise "wisdom," you have some unique thoughts on hamstring stretching, too, don't you?
Dr. McGill: I don't know if they're particularly unique. Our science is usually only confirming what the great lifters and coaches already know. I've mentioned neural tension, which too many perceive as muscle tension. This should never be stretched. But stretching may be used to address tight muscles.
Interestingly, static stretching deadens the muscle from a neural perspective – diminishing the stretch reflex and reducing peak strength and power. On the other hand, "active flexibility" facilitates muscle contraction and wakens the neural system.
I find it incredible to see some lifters stretch before competition. Preferred approaches could include the nose-to-wall squat where circles are drawn with the nose mobilizing the hips, for example.
The principle is to have the joints in motion and the elongated muscles under neural drive (i.e. not passively stretched). Stiff-legged sled dragging is another very justifiable and effective active flexibility exercise that tunes both active muscle and enhances passive tissues. By this, I mean utilize passive tissue tensions enhanced with appropriate magnitude and timing of stiffening muscle contractions.
I find a general misunderstanding of the passive tissues in the North American culture; they should be tuned and enhanced for performance – not stretched away as if they're the boogeyman!
T-Nation: Last weekend, you touched on the topic of "powerful feet" in elite athletes, noting that everything starts from the ground up. Can you go into a bit more detail on this topic? How does it relate to back health and performance? And I'm sure that our audience would love some training tips in this regard.
Dr. McGill: It depends on the athlete. In the lifter, optimal hip extensor power requires hip external rotation and abduction. To do this, the lifter needs to grip the floor isometrically, try and externally rotate the hips, and also "spread the floor."
The floor grip is accomplished with the toes and the heels actually gripping the floor inside the shoe. This also widens the base of support and gives the lifter more stability, which ultimately creates the conditions for optimal hip drive and the steerage of load through the linkage.
Sometimes we start shoeless foot gripping exercises with the lifter to develop this type of essential foot athleticism. We'd also do this with golfers and strongman competitors who have to grip the ground when pulling/pushing, etc.
On the other hand, a runner or jumper needs to stiffen the foot and optimize the short-range spring. This would constitute an entirely different type of training that would probably include rapid foot "ricochet" exercises, for example.
I must also mention that I claim no expertise beyond the back; however, if the issue relates to the back, I want to investigate it. Foot athleticism is very important for back performance!
Dr. McGill working with research subjects in the "Lifting Lab."
T-Nation: Fantastic stuff. Now, let's talk about the new edition of your Ultimate Back Fitness and Performance book. I'm just one of many coaches who hasn't been able to say enough good things about the first version since it was introduced. What can readers expect to see in the new edition?
Dr. McGill: The new edition has a new chapter on transitional training – going from stability, endurance, strength, speed, and power, to a specific performance requirement. I also introduce the concept of "Superstiffness," which has resulted from our recent work.
In a nutshell, we show techniques to bind muscles together to create stiffness at weaker joints so that the power joints aren't constrained – the leapers know how to do this as do the big lifters and martial artists. It was really a matter of studying the best to see how they did it. We show how to conquer sticking points and how to enhance speed. It's the same principle.
Take a sprinter, for example. Muscle contraction is stiffening and paradoxically slows movement. When we measured top sprinters, they were amazingly relaxed with incredible speed of contraction and incredible relaxation within each cycle. They ran on their tightened passive tissues with a short explosion of muscular force and stiffness at the precise time.
We saw the same in the great golfers – a relaxed backswing and downstroke, but an enormous stiffening contraction at ball impact. This was followed with immediate relaxation to preserve the speed of the follow through. We learned why we have a poor shot when we try to "kill the ball." We actually slow ourselves down with too much muscle force! Optimizing superstiffness is a wonderful concept.
Also, in the book I've added a new "squat clinic" that shows how to systematically go through the mechanics while looking for potential improvement opportunities. The new edition has another 60 pages of new text. The postmen are going to have to start training!
T-Nation: What's coming up next for you in the research world?
Dr. McGill: There's certainly more to come down the road as further research develops. While it's our policy to not disclose too much information about our research until we know for sure, I can tell you that we're making substantial progress in our understanding of the disc herniation process and what may be done to interrupt the cumulative trauma. On the training front, we're perfecting the tuning of the core muscles for specific performance events.
T-Nation: It sounds like a third edition is already in the works! Let's conclude on a general note. If you had to make a few broad recommendations on avoiding lower back pain for everyone from the weekend warrior to the elite athlete, what would they be?
Dr. McGill: This is a huge question and really needs the book. We cover the five stages of organizing a training regimen, starting with recognizing perturbed motion/motor patterns and various corrective exercises. Then we move to stability, endurance, strength, speed, and power, in that order. We give suggestions and tests for assessing the "balance" among strength, mobility, stability, endurance, balancing skill, etc.
For example, a football running back can train with power cleans to a high level of proficiency, but if he can't perform a one-legged squat matrix without falling over, he can't truly make use of that strength and power in an athletic context. We've tried to encompass these ideas into algorithms to guide athletes and coaches in a systematic way.
T-Nation: Interesting stuff. Thanks for your time, Dr. McGill. Where can readers pick up a copy of your new book?
Dr. McGill: My pleasure. The book is available through www.backfitpro.com.
Note: Three years ago, Marc Demers also interviewed Dr. McGill. If you liked this article, be sure to checkout that original interview for more great info.
Mister Spine: Part I
Mister Spine: Part II