The Big 3
In trying to keep our backs in good order we are really taking about keeping the core muscles, strong and flexible, in general if this is achieved, back pain will be gone and at the worst way will need minimal treatment. There is unfortunately no “one size fit’s all” when it comes to core exercises because there is no one universal movement that equally stresses all of the muscles that surround your spine. For this reason, we must utilize a regime of exercises to efficiently work all of them.
There is, however, three exercises that done correctly and regularly will achieve this, developed and refined by Dr. McGill.
In his years of studying the spine, Dr. McGill has found there to be three specific exercises that most efficiently address all of these areas without placing excessive stresses on the parts of the back that may be aggravated or irritated due to injury. This group of exercises has famously become known as ‘The Big 3.’
Curl-Up
Side Plank
Bird-Dog
Mobility First
Before I describe each of these recommended core stability exercises, it is suggested to first decrease any significant mobility restrictions at the hip and thoracic spine.
If mobility in either of these areas is limited it can lead to movement compensations at the low back. For example, if there is limited hip mobility during the squat motion the pelvis can be pulled underneath (posterior pelvis tilt) causing the lower back to leave its neutral position and round.
For this reason, if you only performed core stability work but did not address any significant mobility restrictions in joints above or below the lumbar spine, the stiffness you created will always be short-lived.
Another mobility movement Dr. McGill recommends you perform before the Big 3 to reduces low back stiffness and improve motion of the spine is a ‘Cat-Camel.’ Unlike other stretches for the low back that can place harmful stresses on the spine, this exercise emphases mobility in a very spine-friendly manner.
Step 1: Assume an all-4’s (quadruped) position on your hands and knees.
Step 2: Slowly arch your entire spine and hips as high as possible without pain into a flexed or rounded position. You should end with your head looking down towards the ground. This is the camel position. After pausing for a few seconds move into the opposite downward extended position with the head looking up (the cat). Make sure you only move into a light stretch for each position and do not force your spine into any pain.
Perform 5-6 cycles of this exercise before moving on to starting the first of the Big 3, The Curl-Up.
The Curl Up
When most people perform what they have been taught to be a ‘curl up’ they bend or flex their entire spine and attempt to bring their chest towards their knees. While this exercise does activate the anterior core muscles to a great degree (especially the rectus abdominis or 6-pack muscle) the ‘crunch’ motion does a few things that isn’t so appealing, especially for those currently dealing with back pain.
First, the motion of the classic curl up places a large amount of compression on the spine that can flair up symptoms for those who are ‘load intolerant.’
Second, the motion also pulls the spine out of its neutral slightly arched position and flattens it into a bit of flexion. If your low back symptoms increase with bending of the spine (a term called ‘flexion intolerance’) this motion should be avoided at all costs.
The traditional curl up also relies heavily on the Psoas muscle of the anterior hip to pull the torso towards the thighs. So while you think you may be isolating and sculpting that sexy 6-pack by doing endless crunches, you’re actually doing a really good job of strengthening your hip flexors.
A way we can still hone in and focus our attention to improving the stabilizing ability of the anterior core muscles in a more efficient way is to perform a modified curl up.
Step 1: Lie on your back with one knee bent and the other straight. If you currently have pain that radiates down one leg, flatten that leg out against the ground. Place your hands under your low back (this will ensure your spine remains in a neutral slightly arched position during the next step).
Step 2: Pick your head off the ground only a few inches and hold that position for 10 seconds. If you’re resting your head on a pillow, imagine it as a scale and lift your head off it only enough to make it read “zero” on the dial or screen. The goal is to perform this curl-up without any movement in the low back! If you raise your head and shoulders too high (like a traditional curl-up or crunch) your low back will round and excessive forces will be transferred to the spine that could increase your symptoms.
Step 3: After a 10 second hold, relax your head back down to the resting position.
You can progress this exercise and increase the difficulty by bracing your abs before moving you head or raise your elbows from the ground to decrease your base of stability.
How Many Reps To Perform
Unlike training for pure strength or power, the endurance component of stability requires the body to perform many repetitions of an exercise in order to see improvements. Dr. McGill advocates for using a descending pyramid rep scheme with 10-second isometric holds in order to enhance stability without fatiguing and over-working the body.
An example program would be to perform five reps, then three, and finally one to end (each with a 10 second hold). Rest between each set for 20 seconds. As this rep scheme becomes easier, it is recommended to increase the amount of repetitions rather than the duration of the holds in order to build endurance without causing muscle cramping.3This can be freely modified to suit your current individual level of endurance and goals (for instance using a 6-4-2 or 8-6-4 rep scheme).
The Side Plank
After addressing the anterior core muscles, let’s now move to the sides of the body. The side plank is a unique exercise as it activates the lateral oblique and Q.L. muscles on only one side of the body, making it an excellent choice for addressing weak links in stability while placing minimal forces on the spine. It also engages an important stabilizer of the hip/pelvis on the lateral hip (the Glute Medius).
Step 1: Lie on your side with your legs bent and upper body supported through your elbow. Place your free hand on your opposite shoulder.
Step 2: Raise your hips so that only your knee and arm support your bodyweight.
Step 3: Hold this position for 10 seconds before returning back down. Perform the same descending pyramid rep-scheme for each side.
There are a number of fun progressions you can do with this exercise. You can start by moving your hand placement from your opposite shoulder to the top of your hips or even move to a full side plank (bodyweight supported by your feet and elbow).
Perform the full side plank with one foot directly in front of the other, because you can also take it one step further and incorporate a rolling pattern (where you would tilt or rotate your body towards the ground and back towards the ceiling) if the side plank alone is easy. Make sure to keep your shoulders, torso and upper leg in a direct line during this roll to keep the low back safe.
If you are unable to accomplish even the modified side plank (bridging from the knees) due to shoulder or arm pain, you can perform a side lying leg lift. Start by lying on your side, brace your core muscles appropriately and raise both legs off the floor together a few inches. Hold them for 8-10 seconds before relaxing down.
The Bird Dog
The last of the McGill ‘Big Three’ is the bird dog. This is an excellent exercise to promote a stable core while movement occurs at surrounding joints (either the legs or arms and legs together). The combination of movement occurring at the hips and shoulders while the low back remains stable allows this exercise to have excellent carry over to movements you perform throughout your day and even in the gym.
Step 1: Assume an ‘All 4’s’ position (quadruped) with your back in a neutral alignment. Remember a ‘neutral’ position is a very slight arch and not completely flat.
Step 2: Without allowing any movement to occur at the low back, kick one of your legs backwards while simultaneously raising the opposite side arm until both extremities are fully straightened. A helpful cue to make sure the leg movement doesn’t create an over-arching of your back is to think about kicking the heel of your foot straight back. Making a fist and contracting your arm muscles as you hold it in the extended position can also increase muscle activity of the core (especially of the Erector Spinae muscles).
If you are unable to perform the arm and leg movement together without pain or it is too difficult without losing balance, try the modified version with only leg movement.
Step 3:Hold each extended pose for 10 seconds before retuning back to the starting All 4’s position. You can also ‘sweep’ your arm and leg back underneath your body in between each repetition. Don’t let your back round during this motion but instead maintain the neutral spine position and allow the motion to only occur from the hips and shoulders! Again, perform the same descending rep-scheme as the previous two exercises.
You can progress this exercise by drawing a square with your outstretched hand alone or your hand and opposite foot together.
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