The McGill Method and Chronic Low Back Pain
Acute low back pain becomes chronic when it fails to respond to treatment. A more precise way of saying this is that patients develop chronic low back pain when the correct interventions have not been applied in a correct or consistent way. Without a clear understanding of why you have pain, treatment is often ineffective, leading to more invasive treatment and prolonged limitations. This occurs when doctors spend too much time ordering and waiting for procedures, tests and specialists and treating symptoms rather than spending the time to get to the root cause of your problem - determining why you have chronic back problems in the first place.
A ten-minute Physician’s appointment is not enough time to truly know what needs to be addressed to fix your injury. It’s barely enough time to make a frozen pizza.. To get back to living your life as you want to live it, you need a thorough assessment to determine the cause of your symptoms and a plan that is specifically for you.
Unnecessary treatments, imaging, interventions, and surgeries can be avoided by taking a thorough history, getting an assessment that demonstrates your pain triggers, and learning how to eliminate those triggers. This takes time and that is why the McGill Method requires two-three hours of doctor-patient face-to-face time. When was the last time your spine specialist spent a single hour one-on-one with you?
Causes of Chronic Low Back Pain
All low back pain has an origin, and the key to appropriate treatment is finding yours. There are two broad categories of pain origin: Systemic (diseases such as cancer) and mechanical (such as disc herniation). Systemic causes of low back pain require medical intervention, while mechanical causes can be addressed via the McGill Method.
If your chronic low back pain has a mechanical origin, a physician must assess not only your spine, but your specific exercises, stretches, movements, work habits, and activities of daily living to determine how they affect your spine. Only then can the appropriate intervention be applied and the healing begin.
Another important consideration is how pain is perceived by the brain. All pain signals travel through our nervous system, are modulated, then interpreted by our brain as pain type and severity. When you have suffered repeated or significant physical or even psychological trauma, these interpretations by the brain may not accurately reflect the severity of the injury. Thus the neurology of pain must be considered.
Typical Treatment for Low Back Pain
The American College of Physicians recommends these treatments for low back pain: superficial heat, massage, acupuncture, chiropractic, nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants, exercise, multidisciplinary rehabilitation, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, cognitive behavioral therapy, tramadol or duloxetine, and opioids.
What this list of recommended treatments leaves out are the most important details: Which of these treatments is appropriate for which type of patient, suffering from what type of low back pain, and when and for how long should the treatment be applied before moving on? So doctors generally start at the non-invasive end and work their way through this list. Sound familiar? This is the journey that most low back pain patients describe.
The McGill Method Explained
A world-renowned spine biomechanist, Professor Stuart McGill developed this method over 30 years investigating the mechanisms of low back pain and the path to rehabilitation. His research led to the publication of numerous books (Low Back Disorders: Evidenced Based Prevention and Rehabilitation’ Ultimate Back Fitness and Performance, Back Mechanic: The Step-by-step McGill Method to fix back pain, and The Gift of Injury), hundreds of peer-reviewed articles, a demand for keynote speaking engagements, and advisory positions with various international organizations and athletic organizations. While Dr. McGill has taught thousands of providers around the world, there are only a handful of McGill Method Certified Clinicians.
Our method is different from what is traditionally seen in Physician-guided healthcare: After identifying the tissue involved, the additional step is taken of determining which daily movements, postures and loads are the cause of your pain. Once identified, we show you how to remove those causes, eliminating pain and allowing your body to heal. This may sound simple, but don’t be fooled: the challenge is finding your specific problem and your specific solution, through extensive investigation and assessment. This requires more than a review of MRI findings and a quick physical exam, just as a proper assessment of an automobile requires more than looking at a picture of the engine.
If your pain is chronic, you suffer from episodic major flare-ups, or have not responded to traditional treatment interventions, our method may well be the answer you have been searching for.
What to Expect
Chronic low back pain cases are unique, complex, and require time and care to properly assess. Your three-hour appointment includes all three components of the McGill Method: your history, the examination, and movement coaching (further explained below). Video analysis and tips will be provided, as will a 5-10 page report including a detailed plan of care for after your exam.
McGill Method Part 1: Your History
During your appointment your history and daily routine will be discussed in detail, including any recreational activities and sports, exercise, work habits, furniture, and lifestyle, with the goal of identifying the cause of your chronic low back pain. Knowing how your back was injured and what activities prevent it from healing - not just the culminating event that brought on your symptoms - will help you prevent further injury or re-injury.
McGill Method Part 2: The Examination
This extensive exam is quite different from the rudimentary exams you may have experienced with other clinicians, and is vitally important. The movements, postures, and loads that both exacerbate and alleviate your symptoms are tested, and the results will determine the interventions required for healing. While X-rays or MRI imaging are valuable diagnostic tools, and are essential prior to any surgical intervention, they are supplemental and cannot replace a comprehensive physical examination.
McGill Method Part 3: Movement Coaching
Based on findings from your history and physical examination, a diagnosis is reached. Multiple spine structures may be contributing to your back pain, and we will teach and coach appropriate movement strategies and exercises specific to your diagnosis. The McGill Method is not a cookie-cutter approach (“stretches”, yoga, Pilates, “exercise”, weight loss, etc.), as these interventions, if not tailored precisely to you, have most likely already failed you.
How you respond to the McGill Method is based on numerous factors, including: the severity of your injury, the symptom duration and severity, tissues involved, number of therapies and surgeries attempted, compliance with movement coaching, age, health, and patient fitness. However, many of these factors can be addressed after learning what to do and what to avoid.
The McGill Method
Pre-McGill Assessment via Zoom, Optional (20 minutes)
McGill Method Appointment/Examination 2-3 hours
5-10 Page Written Report - Included
Coaching Video Taping - Included
1-4 subsequent visits/consultations, Optional
Pre-McGill Assessment
Jim is available for a phone or Zoom meeting to discuss your case prior to scheduling a full McGill assessment. If you follow up to schedule the full assessment within three weeks of the 20-minute consultation, 75% of the fee for this service is deducted from the cost of the McGill Assessment.
3-Hour McGill Method Assessment
The full assessment consists of your history, the examination, and movement coaching, the video taping of the coaching session, and the 5-10 page written report.
Tele-Health Consultations
These are 20-60 minute telephone or virtual consultations. It is not a replacement for an in-person visit, but it allows you to discuss your problems with Jim without having to travel.