We left the ground-breaking, revolutionary and revered Thpinal Series with a look at spinal hygiene.
Indeed, spinal hygiene is the essential pre-requisite for everything that follows. The foundations upon which a healthy spine is built… The fucking cement holding that holds your oh-so-fragile backbone together.
Now, esteemed readers, let us venture deeper into the hoummos and moutabal of rehab.
But before we begin, a brief introduction…
What you’re about to read IS rehab - perhaps the most significant, the most impactful and the most EFFECTIVE set of back rehab exercises you will come across.
The biggest bang for your buck let’s say.
However, it isn’t a rehab programme per se. In so far as a rehab programme is “programmed” for specific outcomes, athletes and sports.
Instead, take the following exercises as “nickels and dimes” or say “water in the basement” - like brushing your teeth in the morning or taking a shower - essential daily movement patterns that you may well be doing until death itself kicks the boot in.
The following is for the young and the old. For the strong and the weak, the athlete and the vegetable.
Nonetheless, I’ll briefly remind the reader that these exercises are anything but gung ho shots in the dark.
Far from being generic solutions - they are specifically designed to rehabilitate flexion-intolerant, stability-deficient individuals - as per the issues we covered in parts I, II and III.
Walking
Unfortunately we will not be starting with the sexiest, sauciest, band and chain clad back rehab exercise. Instead.. Good ol’ walking.
As mentioned last week, walking is the tonic to your espresso, the soda to your lime, the flipping baby oil to your massage.
A balm, a tonic, a soothing ointment. And… A genuine and legitimate rehab exercise for a bad back.
Particularly if you walk briskly and swing your arms purposefully, walking relieves static loading on the spine and acts a spinal decompressor.
It also gently activates the core and spinal stabilisers across the trunk and hips, building a spine capable of modulating and grading stiffness at each step.
Try and make time for a walk without 5kg of excel spreadsheets on your back. If you really need to carry something, one-arm carry it on your side (not really pal - although of course I tried it).
The McGill Big 3
This author makes no bones about meat riding Professor Stuart Mcgill (pun very much intended). So before we get into it, it’s probably a good opportunity to kiss the posterior of the big man himself…
Everything you’re about to read (related to the big 3) is entirely his work (hopefully) uncorrupted… So if you’re interested I highly recommend you look into his work further.
Why the big 3?
The flexion-intolerant individual lacks one key attribute - stability. Remember the guy wire model from part one? Consider the spine as the radio tower itself and the spinal stabilisers around it as the guy wires.
Without strong and coordinated muscle stabilisers (e.g multifidus, transverse abdominis, quadratus lumborum) the spine will be subject to micro-perturbations which create shearing forces on the spine.
These shearing forces are lateral sliding forces between the vertebrae which impinge on the intervertebral discs and hamper recovery.
Therefore, to combat these shearing forces McGill set about formulating a set of exercises to enhance core stability and spinal stiffness.
Consider a lifter’s belt - a stiffening exoskeleton which wraps around the trunk and keeps the lifter’s spine stiff under the bar.
That is exactly the objective of the big 3 “under the hood” per se - to strengthen and stiffen the musculature around the trunk and hips for when your spine inevitably get’s jarred, knocked, compressed and flexed.
In formulating the so-called big 3, McGill measured a couple of key metrics -
Stimulation of the key spinal stabilisers through electromyography testing (sticking electrodes in the muscles basically).
Compressive and shearing forces on the lumbar spine through stress testing in-vivo and kadaver models.
In measuring these two metrics - a set of three exercises consistently rose to the top in promoting effective spine-stabiliser muscle contraction whilst simultaneously minimising compressive and shearing forces on the lumbar spine.
They are:
Modified curl up
Side plank
Bird dog
The Modified Curl Up
The objective of the modified curl up is to get crazy abs bro.
Indeed, the goal of curl up to create a HEAVY contraction in the rectus abdominis (six pack muscle) without duppying your lower back.
Unfortunately however, contracting your “abs” classically goes hand in hand with pissing off your back.
That’s why the generic Uncle solution of “just do sit ups bro”, is a very bad idea for a tweaky spine.
Whilst sit ups or crunches can strengthen your abs (although are by no means elite core exercises), they certainly do an excellent job at giving your discs a good beating.
That’s why we have the modified curl up - an amended version of the traditional curl up - which involves placing your hands under your lower back. In doing so - your abs are contracted without tilting your spine into flexion.
Performing the modified curl up
lie flat on your back and slide your hands under your lower back. (From experience - this is more effective if your hands cover the “problem area.”)
Extend one leg and post the other up on the ground - the posted leg should align with your other side knee.
Flair your elbows so they “float at your sides”
Lift your head and shoulders off the floor to contract your abs - try and keep your spine in neutral. (from experience the biggest risk here is nodding your head too far forward).
Count to ten then lower your back to the starting position.
Swap your legs over and repeat.
The Side Plank
The side plank will cook one side of your body only - you’ll feel it on the side closest to the ground when performing it. This is because you’ll get a solid contractions in your transverse abdominus, obliques, and even as high as your lats.
Performing the side plank
Lie on your side and post your forearm directly under your shoulder.
Stack your feet on top of each other or alternatively post your “top” foot on the floor.
Brace your core and lift your torso and legs off the mat, so that only your posted forearm and feet are touching the floor.
Maintain a neutral spine whilst holding the side plank then bring your torso and legs back down to the starting position.
The Bird Dog
To complete the 360 strengthening of the stabilisers across the hips and trunk, we have the bird dog: which hits the back side of your rig (glutes, Quadratus lumborus and erector spinae).
The bird dog is probably the most technical of the big 3, so stay with me for a sec:
Performing the bird dog
Start on all fours - with your hands directly under your shoulder and your knees directly under your hips. Maintain a neutral spine.
Extend one arm (with a clenched fist) and the opposite leg simultaneously.
When extending the arm - keep it at shoulder level. When extending the leg do not let it extend above hip level. For an enhanced contraction in the glute, dorsiflex (put the “boot on”) your foot of the extended leg and extend/lead with the heel.
Pause briefly at full extension - keeping everything tight (you should feel a diagonal contraction across your back and extending down to your glute).
Slowly return to the start position by “brushing the floor” with your knee.
Repeat on the other side.
For a visual breakdown of the big 3 - see this vid with power lifter, Brian Carroll below.
Tricks of the trade
The above is a great start towards rehabbing your back but the truth is, (particularly) for the trained individual - it will only get you so far.
Whilst the big 3 is all that’s needed for the average Joe, in order to cap out the big 3’s potential, you may need to make a few tweaks.
From experience, this isn’t because these exercises are “weak sauce” per se - but because you haven’t been using the below tricks of the trade to enhance progress.
Reps not duration
The single biggest mistake I did when performing the big 3 was trying to hold the curl-up and the side plank for an eternity.
Whilst I did get some great results - holding these poses until you burst a vein in your forehead is not ideal.
The literature suggests that the strength of contraction decreases within the first 10 seconds due to hypoxia (depleted oxygen) in the muscle.
So instead of holding out for the second coming whilst side-planking, do 10 second reps for the curl-up and side plank.
Prof McGill suggests employing a “Russian pyramid” model for the big 3, which consists of consecutive sets of decreasing 10s hold reps. Between each rep, take a brief 1-2s pause and then, between each set take 30s to a minute rest.
For example:
Curl up Russian Pyramid
6 reps - rest 30s
4 reps - rest 30s
2 reps - rest 30s.
Breathing
I used to perform the big 3 whilst holding my breath and, quickly would assume the complexion of a ripe grape.
Instead, consider “power breathing” - which is short choppy breaths through pursed lips. The key here is trying to keep the core tight and maintaining “intra-abdominal pressure” (trying to keep in as much air as possible) whilst power breathing when needed.
You’ll find that you actually get a more solid contraction and touch wood, you won’t have a stroke.
When doing the bird dog, which is often smeared as a pussy’s exercise - I found that I got a much more juicy contraction when holding my breath whilst extending into the pose (and then continuing to hold my breath whilst holding the pose for a short period) and then exhaling when resetting back to all-fours.
Not in the morning
For sufferers of the grandad back, It’s not recommended to do the big 3 (or any strenuous exercise) early in the morning.
Following waking - your discs are more hydrated than a gym bro on electrolytes. This means they are more pressurised and therefore are more susceptible to getting pee’d off.
Make a coffee, read The Brothers Karamazov, meditate on your mortality, go on your back-rehab walk and then (say 1-2 hours later) get busy with the big 3.
Using spinal extension to calm the back down
For the flexion-intolerant individual - a tweaky spine probably relates to an aggravated disc. In most cases - this disc will be damaged “posteriorly” - towards your back.
As we covered in part 1 - this is because when flexing your spine - the vertebrae compress the anterior (front-side) portion of the disc, resulting in elevated hydrostatic pressure in the posterior portion of the disc (which damages the disc).
Naturally, when you extend your spine - the opposite happens - which creates a pressure gradient towards the anterior side and should suck that bulge in (pause).
For the sensitive spine, Prof McGill recommends lying flat on your front and placing a fist under the chin. Relax into it for a few minutes and you will be surprised how much your back calms down.
If a single fist is well tolerated, try stacking two fists on top of each other and then repeating the same exercise.
Alternatively, as so-eloquently described by my physio - Master Tim - try “wall humping.” Stand about a foot’s length away from a wall, place your two forearms against the wall and then gently extend your pelvis towards the wall (hump it basically). Stay in the extended position for 1-2 seconds then repeat for a set of 5 to 10.
Other key exercises for your floor routine
Ok this post is getting long. But just to “add value” (as my colleagues might say) - I’ll finish with a quick run down of a few more great stability-building (and spine-sparing) exercises to add to your floor routine.
The Plank - Another six-pack builder for the road. Relatively easy to do if you keep your spine in neutral and avoid your ass sinking to the ground. I used the plank as a pitstop between two side planks. Once you get good at the side plank, rotate your chest towards the ground whilst keeping your spine neutral and then post your “floating” hand on the mat. reposition your feet so they are parallel with your hips, then incorporate the plank into your side plank Russian pyramid.
The Glute Bridge - Need I say where this one hits (pause)? This was actually an exercise I had been doing wrong for years. The key here is not just to simply lift your hips up. Instead, your hips should raise as a consequence of you squeezing your ass cheeks together. Picture a grape in the “gluteal fold” (ass crack) and try pop it.
Cat camel - This is the only exercise we’ll cover that isn’t a stability-enhancing exercise. Instead, a bit of mobility. This exercise, the cat-camel will form the foundations of moving your spine safely through flexion and extension - and represents the embryonic stages of a move towards tolerating flexion in your sport (and life) again. To perform it - assume the bird dog starting position and then start rounding your back - tucking your pelvis inwards whilst simultaneously letting your head and upper back round downwards. Once you’ve rounded your spine, gently arch your back - stretch your stomach downwards as your head and pelvis roll upwards. During both phases, avoid over-flexing or extending your spine - easy does it.
Ciao.