Book review: Get your fix from the back mechanic
In the industry of rebuilding backs, Stuart McGill’s name deserves neon light treatment. His three text books are designed “for everyone who wants their swagger back.” While Low Back Disorders: Evidence-Based Prevention and Rehabilitation was written wholly for clinicians, his second book, Ultimate Back Fitness and Performance attracted a captive trainer, coach and athlete-dominant audience.
April 18, 2017 By Jules Torti
Mc Gill’s latest, Back Mechanic: The Secrets to a Healthy Spine Your Doctor Isn’t Telling You is a step-by-step, non-preachy showcase of the “McGill Method” to fix back pain for the layman.
The University of Waterloo professor of spine biomechanics oversees a lab that explores low back function, injury prevention, rehabilitation and performance training. His cheerleading team boasts an ever-growing crew. He’s earned street cred from champion powerlifters, White House consultants, combat medics and the editor-in-chief of Men’s Health magazine. No slouches. Of course, there are also hundreds (possibly thousands now), who have been able to reclaim a pain-free life by designing a custom recovery program kudos to McGill and his books.
He’s been deemed the Jedi Master of spine rehab, and it’s easy to see why. When I mentioned his name to colleagues, everyone had something to say. My sister treated his textbooks as bibles, even considering a flight from Alberta back home to Ontario to see McGill about her own chronically grumpy back. And, she’s a kinesiologist. She should know better – and best.
And that’s just the thing. The Back Mechanic is for lay people, but it’s also a solid refresher (and applicable) to massage therapists experiencing back pain too. What’s that famous quote about the shoemaker whose children had no shoes? For those of us counting their years in the industry on two hands (or by decades), McGill’s book can be a saviour for self-care.
May I boldly suggest client investment? Handing each of your clients with low-back pain a copy of his book to keep is a simple approach to retention and referral. For clients eager to resolve pain, a hard copy of the Back Mechanic could be the best homework you ever assign them. Yes, this will help dramatically with business generation, referrals and retention. But, it might also take your client to the next level. One that passive treatment alone can’t achieve.
Why McGill’s theories? He’s been using “motion capture technology” long before the producer of the film Avatar. He recognizes personality types and those who aren’t going to abide by rest because it will disrupt their perceived fitness levels. He knows how to rebuild backs, no matter what level of physicality is being addressed.
Unlike car manuals or recipe books, you can’t fast forward to the applicable sections. It’s all applicable in identifying the cause of symptoms, removing pain “hammers” (triggers), acknowledging roadblocks and detours. McGill examines myths and truths. He questions blanket advice like, “try yoga.” He questions the merits of static stretching, prescription drugs and traditional remedial exercise approaches like the often-suggested “knees-to-chest” remedy. The neurological phenomenon of knee-to-chest movement only triggers stretch reflexes, a technique that only decreases pain sensitivity in individuals temporarily (15-20 minutes).
He explores avenues that don’t involve surgery, the grey area around MRIs, X-rays as diagnostic tools for degenerative disc disease and flawed movement patterns.
A few pages in, you’ll be nodding in agreement and questioning the merit of Pilates and yoga. Loading and straining discs in unnatural positions may not be the cure-all for every client. And then there’s the emotional component to consider. As health-care providers, we are often the bullies, challenging someone’s way of life and livelihood.
Can we teach the brain pain-free movement and overwrite painful pathways? McGill has intriguing observations on fibromyalgia clients and rehabilitation of clients injured in motor vehicle accidents. In a generalist approach, he explains how to make healthy spine choices when sleeping, sitting and performing simple activities like teeth brushing or washing dishes. If you’ve ever experienced knee-buckling back pain associated with discs and associated nerve pain, you’ll recognize the need to re-learn ergonomics and postural stances for driving and, even sitting on the toilet.
The most powerful concept that lends to simple clinical application is McGill’s “virtual surgery.” His simulated surgery approach requires imposed rest from exercise and pain triggers. He tells his clients to pretend like they’ve just had back surgery and rest accordingly. He believes “some surgeries work for no other reason than they have forced the patient to take the time to rest.” Often, his “virtual recuperation” is impactful enough to allow simple rest to do its intended work and provide results as good as surgery.
We can all take note and observe the difference between our pain-free days and painful ones (increased client load, longer commute, hot yoga, hill training, Netflix binge, lazy naps on the couch, lumpy pull-out couch at a friend’s house Saturday night). What’s the difference? McGill provides a guide to pain-free ways to sit, walk, lift, sleep and live life. His approach is one that most of us key in on during training and our first foray into treating the public. The “McGill Approach” is that of a “forensic detective – always looking for clues and visual tips from clients.”
In a hurried clinic shift when I was still in college (circa 1998), I totally missed ‘seeing’ the obvious posture and gait of a client with polio. I also missed an obvious check mark on his case history. It wasn’t until he was on the table and I undraped his leg that I realized my gaffe. Our forensic work is constant and immediate – beginning long before that first client handshake.
The Back Mechanic is chock full of “simple life hacks” like using a taller counter when chopping vegetables, lowering a too-high desk chair and how to do laundry without pain-induced swearing fits. It’s practical. It’s no-guff. The diagrams are engaging, client-friendly and a gentle re-education for conditioned and complacent therapists. There’s lots to learn here, for the first or second or 100th time.
If you’ve been wondering about “nerve flossing” and the premise behind it, it’s here. How does flossing weigh in against standard stretching? Do you know how to “tickle the dragon’s tail?”
You’ll find several relatable chunks to pass on to clients and colleagues and family too. Have you observed the cultural differences between how Americans and Russians walk? Statistically, Americans walk head down while Russians are chest-forward. While walking seems like the most natural movement, “nature’s back balm” can take painful twists with “mall strolling” (which can cause static muscle cramping). Taking micro-breaks and finding your “sweet spot” makes sense not just for our clients, but us too, in terms of job performance, enthusiasm and longevity.
For therapists, McGill’s back-of-the-book activity and exercise logs will make perfect take-homes for clients. Also at the back of the book, McGill doesn’t shy away from the topic that is rarely addressed by health professionals. Sex. There are illustrated strategies (not exactly the Joy of Sex), that reinforces hip movement versus low back impact. What’s the point of brushing our teeth and lifting backpacks ergonomically if sex leaves us truly bed ridden?
The Back Mechanic is a dynamic reference guide that I encourage each of you to responsibly read and share. In the Spring 2016 issue of Massage Therapy Canada I discussed how to build a client-friendly library in a clinic space. I recommend adding this title to your shelf. Whether you’re looking for last-minute CEUs, pain-free work days, a client perk, the inspiration to kick-start a book club for massage therapists in your area, look no further. And, bend no further until you learn the McGill Approach.
Jules torti, RMT, has been in practice since 1999 and a freelance writer since age six. In between massage engagements, she travels to Africa to be with chimpanzees and writes about her zany travels for Matador Network.
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