Esteemed reader, after 6 articles, an hour of reading time and copious amounts of incongruent waffling, we have reached a fork in the road.
Either, to continue spewing bastardised snippets of Stuart McGill’s work or… to collate what I’ve learned so far into a digestible roadmap based on months of rehab and yes, a bit of McGill.
Thus, I present “From Quasimodo to Hercules” - a final chapter in the now heavily over egged Thpinal Series.
A series of notes for normalising, remedying and rehabilitating the back of a flexion-intolerant stability deficient individual.
Why that specific guy? Because that’s the swamp from which I’ve emerged and; most likely, if you’re a young, strapping, overactive male (pause) you’re probably familiar with that swamp too.
Spinal Hygiene
Spinal hygiene is the foundations of relieving pain and not re-aggravating your back. As seen in “How to Use Spinal Hygiene to Fix your Spine” - the core of good spinal hygiene rests on two key principles.
A neutral spine
A hip hinge.
A neutral spine is what must be preserved, a hip hinge is how your preserve it. Hinge at the hips, avoid flexion whilst your spine is still tweaky and you’re golden.
Walk Everywhere
Walking is a soothing balm for your spine - it hydrates the discs, loosens the trunk, core and hips and relieves static loading on the spine.
Therefore, consider it an essential daily tonic for the spine. Walk briskly and swing your arms on a regular basis - and your spine will thank you for it.
Establish a Daily Stability Routine
The flexion-intolerant back lacks (above all things) stability.
Thus, a stability building daily ritual is essential for buttressing your back. For this, we have the big 3, formulated by Stuart McGill precisely because they’re 3 excellent stability promoters, but also because they won’t beat your back up.
From experience, to make the big 3 work - you’re going to have to pay that piper daily. Modified curl up after modified curl up. Side plank after side plank. Bird dog after bird dog.
Likewise, you’re going to have to make them juicier as your back stabilises. For a more comprehensive run down of the big 3, check out “Essential Daily Back Rehab Exercises.”
Mobilise your Hips Daily
Hips, Hips, Hips - as a coke head once said.
Any region that don’t lie, is a legitimate target of your mobility routine; the hip flexors, glutes, hamstrings and the psoas.
From experience - combining static and dynamic stretches works a treat - say a front split and a seated good morning for your hamstrings and a hip flexor stretch and modified lunge for your hip flexors.
Reintroduce flexion over time
For most people introducing flexion is not a nice-to-have, it’s a necessity. Therefore, building tolerance to flexion movements is an essential addition to your stability and hip mobility routine.
Start with the cat-camel mobility exercise, then slowly as the symptoms permit - start toe touches with a forward reach then progress towards a full Jefferson curl.
From experience, you should only progress from one progression to the next after a prolonged period mastering the initial move. Split your rehab into 6-8 week blocks and only progress to more aggressive flexion once you can do so in a controlled and pain free fashion.
For Athletes…
Everything you’ve read so far should serve you handily in resuming your daily business. However, for athletes, you’re going to have to make a more concerted effort to buttress your back and reintroduce sports specific training.
Build Whole body Strength and Stability
This is the overarching principle of what’s to come and I know it seems obvious - but you’re going to have to treat your body like a unified system.
As we said at the beginning of the thpinal series, every muscle is your body is technically a spinal stabiliser - meaning it can either stabilise your spine or remain a point of weakness.
Thus, you’re going to have to invest heavily in strengthening every muscle in your body and improving strength across all the key movement patterns - squat, lunge, hinge, press, pull and carry.
To do so and not fuck your back - progress slowly from easier progressions to harder ones - limit weight, avoid spinal loading (back squats) and progress over the long arc (say 6 to 8 weeks).
In the back of your mind, you should also consider the demands of your sport versus your weaknesses i.e your sticking points. In my case it was always weak and stiff hamstrings, tight hips and a weak trunk / core which meant I was unable to move safely through spinal flexion in my sport of Jiu Jitsu.
If you can’t use free weights, use machines
My back rehab program started (in conjunction with a stability and mobility routine) with a generic strength maintenance programme. I was pretty crippled at this point, so was forced to use machines instead of free weights. Looking back, this was a great way for me to maintain strength and hypertrophy whilst my body was compromised.
Carry - a lot
Often the most neglected exercise type in an athlete’s routine, carrying is an absolute essential for the flexion-intolerant athlete.
In remaining ramrod straight and putting one foot infront of the other a carry will strengthen your entire trunk and legs without pressurising your discs. I preferred one-armed carries as they would dial in the opposite side of my trunk and legs, which enabled me to target the problem area.
I stole this carry routine from my weights gym, commando temple and it worked wonders for me. I highly recommend you follow them.
Don’t forget to rotate
The greatest damage to your disc often comes through shearing forces brought about my sudden rotation about your trunk. Therefore, in order to minimise these destructive shearing forces, we need to get better at first, resisting rotational forces and then, learning to move through rotation safely.
To start with, try using the Palloff press to resist rotational forces and then move towards more taxing rotational exercises such as the plate halo and the Bulgarian bag spin. Again, progress slowly and only if your symptoms permit.
Bounce
Plyometrics are a key part of any back rehab programme designed for athletic performance.
The McGill big 3 is based on stiffness and stability but doesn’t necessarily provide the athlete with the best platform to “tune” that stability according to the needs of the sport.
This is something which is covered by plyometrics, which is why boxers always use their warm ups to skip - as their entire body needs to cyclically stiffen then relax with each bounce.
When building a plyometric routine, you could just stick with skipping or: experiment with various bunny hops on a single leg - backwards and forwards, left to right, two forward one back.
Identify safer and more dangerous movements in your sport - and then train accordingly
Every sport will have more risky and less risky movements for your back. Consider which movements are less risky and prioritise those. In my case, I’ve focused on guard passing over playing guard as there is a lesser risk of aggressively flexing my spine (e.g inverting, getting stacked) as a guard passer.
Train safely and reintroduce over time
Your training should be treated as a progression in itself. Don’t jump straight back into your previous schedule, you will only re-injure yourself. Slowly progress from drills to live training and carefully audit your output over a week. For martial artists, only train with people you trust and manage fatigue in between rounds.