Treating Low Back Pain

reflection on my journey to McGill Method certification

learning how to apply lumbar traction with mild flexion from the GOAT

Before starting PT school I read the book Low Back Disorders by Dr. Stuart McGill. Having dealt with intermittent back issues like most other soldiers, I was interested to see if there was anything I could apply. I was rewarded with that and so much more. There are too few individuals in the broader field of medical science with the clarity of reason Stu brings to the page. Not only is he conversant with the relevant literature to the greatest extent possible when it comes to the lumbar spine, his wealth of experience and bias towards practical application is unmatched. The confluence of these factors produce such invaluable insights that ignorance of this work on the part of clinicians working with back pained individuals is borderline criminal.

PT School

While I believe my PT education was excellent, I was disappointed with the lack of coverage of McGill’s work. In the Army-Baylor program we take a regional approach, and I hoped that some of the key insights provided by McGill would have made their way into some of the course materials. Not only was this not the case, but assumptions that McGill very persuasively demonstrated to be erroneous were included in various blocks of instruction out of what appeared to be ignorance of his work. The only mention of McGill’s work was a single slide in the therapeutic exercise block mentioning that “some people think global stability is most important” but not bothering to cover the very persuasive and straightforward reasons as to why. Doing my internship, I was encouraged to do things that made no sense, like prescribe repeated extension exercises even if they didn’t work in clinic to see if the patient doing them multiple times per day then returning after a week would work better. As my intuition told me then, risking making a patient worse for an entire week isn’t the best approach…

Early Practice

After graduation I came to practice more and more in line with what is advanced by McGill’s work, not only for lumbar spine, but for all body regions. This approach seems obvious, but for a variety of reasons including the biases of professions that began when we understood less about injury and healing, it isn’t universally adopted. The approach consists of identifying through evaluation what tissue or structures are injured/overloaded to inform the optimal path to rehabilitation. Modifying load through movement and posture to get out of pain precedes exercises targeting building a robust foundation which leads into full return to pain free activity. There are many therapists who insist precise diagnosis isn’t possible, so not to bother. Likewise, there are many who assume painful exercises and movements are an important part of therapy. I think more often than not these approaches rely on favorable natural history for success. If you’re interested in more of my thoughts on this, I wrote an article about this general approach:

Certification

I began taking McGill’s online course in 2021. After getting side tracked by the world going totally insane around that time, I came back to finish the online instruction and attend a McGill Summit this year in Ontario, Canada along with some of my work colleagues. It was a fantastic experience. There were small but critical things that I had been missing. I was able to immediately begin incorporating these changes into my practice which has made a meaningful difference for my patients. Following completion of the Summit, I passed both written and practical exams to become fully certified in the McGill Method. I really believe in this approach, not least of all because I have witnessed its efficacy firsthand. This certification is the culmination of a lot of work, but to be honest, it didn’t feel much like work. It felt like I was learning things that I absolutely had to know in order to be an effective clinician, and there’s nothing like applying yourself towards learning and doing something meaningful.

trying out Chris Duffin’s early prototype Transformer Bar

What’s Next

In my current status, I’m able to provide treatment to any TRICARE beneficiary interested in seeing a McGill Method certified clinician. If that applies to you and you’re able to travel to Kansas to come see me, don’t hesitate to reach out. I’m hoping if I can continue to get patients excellent outcomes using this approach that more military medical providers might be interested in using it themselves. For reasons I won’t go into, that will be more of an uphill battle than you might think, but nothing worth doing isn’t these days. In any case, I hope to continue to develop my skills in order to deliver the quality of care Soldiers deserve over the rest of my career. I’m well positioned to do that as of now, and I owe a lot to Dr. Stuart McGill for the tireless effort he’s put into his work to enable me to not only get here, but be a part of a community of clinicians that will be able to help me continue to improve.

If you want to learn more about the McGill Method, everything from books to helpful products and other certified clinicians can be found at backfitpro.com.