Ultimate Back Fitness and Performance (6th Edition-2017)

Get the latest scientific evidence on back exercise - what helps and what hurts, and why.

Ultimate Back Fitness and Performance provides the evidence base to design and prescribe the most appropriate exercise programs for the back. Professor McGill’s unique approach is based upon years of scientific research into back function of injured people through to elite athletes. His expertise is sought by governments, corporations, professional sports teams and athletes worldwide. A complete description of a 5 stage program is provided.

Examples are provided for each stage within a back pain rehabilitation program together with performance enhancement programs for athletes and coaches in all sports. Beginning with recognizing and re-patterning perturbed motor programs and progressing to the enhancement of stability/mobility, then endurance, the final stages continue with strength, power and agility training. Each step is well illustrated and instructive. Added to this are general approaches to assess the demands of individual activities and sports and how to identify the critical components that need specific focus in an individual’s back. Dr McGill’s style makes for an easy read of this thorough and rich resource.

If you just want pictures of exercises, get another book. If you want to know WHY, HOW and WHEN specific exercises work and how to design a logical progression, then this is the book for you

Be prepared for a new approach. Ultimate Back Fitness and Performance is a myth buster!

Transition training guidelines are described and the concept of “superstiffness” is introduced with new exercises based on his recent studies. Tips to employ this effective principle are also described with examples – eliminate energy leaks, conquer sticking points, enhance speed and achieve ultimate performance. Practical sections include the “squat clinic”. Typical of Dr McGill’s writings, the guidance is evidence-based.

Note that this book is intended to assist in the design of a wider spectrum of the best exercise progression to enhance back fitness in the safest way. It was written for savvy lay people and professionals alike.

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Table of Contents

Acknowledgments (pg 1)
Preface (pg 3)

Part I Scientific Foundation

Chapter 1 – Laying the foundation – Why we need a different approach (pg 9)

    • The Ultimate approach
      • The concept of tolerance and capacity
    • Current low back disorder myths
      • The myths associated with stretching
      • The myths associated with strengthening – rehabilitation vs training for performance
      • Motion and motor changes from back injury – pain inhibits optimal motor patterns
      • What distinguishes the best athletes?
      • Another Myth: Getting stronger always makes a better athlete
    • Misdirected clinical effort
      • Focusing on multifidus, or transverse abdominis or any other single muscle
      • The confusion between rehabilitation and performance training
      • The pollution of body building approaches in low back training
      • Athletic painful backs: Dealing with the cause and the role of prevention The mind and performance
      • The doctor says the pain is in your head – don’t believe it!
      • Each person is an individual – there are no approaches that work with all Are back troubles a life sentence?
    • How we obtain the evidence to improve back training – Our unique approach
      • In-vitro lab The in vivo lab
      • Clinical Research and Field Trials
    • References for the modeling process
    • References

Chapter 2 – Exercise science and the back – Removing the confusion (pg 27)

  • Introduction
  • Training affects all systems
  • Preliminary issues for designing a program
    • Strength
    • Factors that limit training outcome Biomechanics and training The concept of the moment
    • Muscle mechanics
    • The Russian philosophy of training
    • Competent coaching matters
    • A note on Plyometrics
    • Strength and posture
    • Proprioception training
    • The science of flexibility
    • Progression of a program with younger athletes
    • Training balance
    • The popularity of the Olympic lifts: Justifiable or misdirected Training with machines – a discussion
    • The principle of dynamic correspondence
    • Safety Issues – a generic discussion
    • Principles for designing a good warm-up
  • Specific Considerations for Rehabilitative Back Exercise
    • Back Flexibility
    • Strength and Endurance
    • Spine Power – integration of flexibility and strength discussions Motor patterns
    • Eliciting volitional movement
    • Aerobic exercise
    • Studies on the connection between fitness and injury disability Order of exercises within a session
    • Establishing grooved patterns (Movement Engrams) Breathing
    • Time of day for exercise
    • Clinical Relevance for the Rehabilitative Exercise
  • The process of injury: Tissue response to mechanical load
  • References

Chapter 3 – Helpful Facts: Anatomy, Injury Mechanisms and Effective Training (pg 61)

  • Some anatomically based facts
  • Basic neural structure – activating back muscles
    • Are you a master of your motor control domain?
  • The full spine
  • The vertebrae
    • Vertebral endplate fractures
    • Posterior elements of the vertebrae and neural arch fracture
  • Optimizing health of the intervertebral disc
    • Avoiding disc herniation
  • Muscles
    • The proprioceptive function of the small rotators and the intertransversarii
    • The back extensors have several important roles: Longissimus, iliocostalis and multifidus Latissimus dorsi is a critical performance muscle
    • Abdominal muscles
    • Abdominal fascia
    • Rectus abdominis
    • Abdominal wall – Obliques and transverse abdominis
    • Psoas
    • Quadratus lumborum
    • Ligaments
  • The pelvis and hips and related musculature are important considerations for the back
    • The great ones train the hips
  • References

Chapter 4 – Normal Back Function and Changes Following Injury (pg 85)

  • How you stand is important
  • Lumbo-Pelvic rhythm, bending, performance and injury risk
  • Additional thoughts on spine bending
  • General muscle activity amplitudes
  • Mechanics of specific activities
    • Loads on the low back during lifting
    • Consider sitting to be a dynamic task
    • The mechanics and implications of walking
    • Elliptical machines
    • Pulling and pushing technique is critical
    • Loads on the low back during flexion exercises
    • Loads on the low back during various push-up exercises
    • Loads on the low back during extension exercises
    • Pulling patterns for the posterior chain:
    • Sled drag and mini bands – Integrating the hips
    • On backpack carriage and training
    • Bedrest, back pain and exercise
  • Other facts that assist performance
    • Spinal memory
    • Confusion over twisting
    • What about back belts
    • Guidelines for serious athletes
    • Nature’s back belt – the abdominal hoop and the Lumbodorsal fascia Pain Pain
    • Predominant pain generating mechanisms in athletes
    • Sciatic symptoms
    • Sacroiliac pain – Is it from the joint?
    • Staying within the “Biomechanical envelope”
  • Biomechanical, Physiological and Motor Changes Following Injury
    • Pain and central sensitization
    • Motor control changes
    • The crossed-pelvis syndrome and gluteal amnesia
    • Other lingering deficits following injury
    • A commentary on the new “Pain Science”
  • References

Chapter 5 – Enhancing Lumbar Spine Stability (pg 113)

  • Why spine stiffness/stability is essential
  • Finding about spine stability can be summarized as follows:
  • A few crucial issues to enhance fitness and stability training
    • A classic- viewing instability and injury
    • Illustrating the important conditions for stability
    • Stability myths, facts, and clinical implications
    • Ensuring sufficient stability usually only needs modest levels of muscle activation
    • The special case of transverse abdominis
    • Abdominal bracing vs. hollowing
    • Breathing and stability
    • Why do athletes “Grunt?”
    • The hammer and the stone
    • Summary: The lesson for athletes
  • References

Part II Individualizing Programs

Chapter 6 – Fundamental principles of movement and causes of movement error (pg 127)

  • Section 1. Identifying the fundamental movement patterns
  • Section 2. Identifying movement errors and correcting their cause
    • Finding optimal movement and performance techniques
    • Movement error checklist
    • Principles for optimizing performance
    • Summation and continuity of joint forces and moments
    • Production of linear impulse
    • Direction of force application
    • Principle of stability
    • Summation of segment velocities
    • Production of angular impulse (rotational motion)
    • Conservation of momentum
    • Manipulation of moment of inertia
    • Eliminate energy leaks
    • Principles for safety
    • Minimization of tissue stress
    • Optimal joint positioning
    • Minimization of fatigue
    • Qualitative biomechanics to analyze the movement – putting the principles together
    • Final thoughts: Control feedback and proprioception
  • Section 3. Understanding the stages of motor skill development to better teach motor skills

Chapter 7 – Injury prevention and injury proofing (pg 141)

  • Preparing the athlete
  • The importance of spine hygiene throughout the day
  • Reducing the risk in athletes – guidelines
  • What coaches need to know
  • References

Chapter 8 – Evaluating and qualifying the Athlete/Client (pg 155)

  • The first consultant-athlete (with back symptoms) meeting
    • So what have we learned?
  • The first meeting for those without back troubles
  • Some additional performance-specific tests
    • Assess posture
  • Basic Movement – The squat
  • Basic Movement – The squat – Choosing optimal hip and foot width
    • Looking for spine “hinges”
  • Poor control in torsional tasks
    • Stable patterns during challenged breathing
    • Endurance Testing
    • Specific movement screens
  • A philosophical approach for selecting specific tests, and designing the program
    • Step 1. What are the demands of the sport/activity?
    • Step 2. What are the capabilities of the athlete – together with current deficits
    • Step 3. Designing the program
  • A final note on qualifying the athlete for specific training exercises References

Part III Building the ultimate performer – Putting it all together

Chapter 9 – Developing the Program (pg 177)

  • Some preliminary matters
    • Some notes for the chronic back
    • Keeping a journal of daily activities
    • Ensure continual improvement
    • How long should each stage be?
    • Training with labile surfaces underneath the athlete
    • Training harder and longer is not always better
    • Some final thoughts on reps, sets and sessions
  • Stages of athlete progression References

Chapter 10 – Stage 1: Eng rain motion/motor patterns and corrective exercise (pg 183)

    • A note on the training environment
    • Awareness of spine position and muscle contraction
      • Lumbar spine proprioception training
      • Corrective standing approaches
    • Corrective walking approaches
    • A convincing demonstration of the influence of posture on strength
    • Distinguishing hip flexion from lumbar flexion – Teaching the motion pattern
    • Perfecting the “hip hinge”
    • A note on spine stability, spine motion and control
    • Locking the rib cage onto the pelvis
    • Mental imagery
    • Steps of mental imagery
    • Other imagery exercises to develop motion/motor awareness
    • Important abdominal patterns
    • Abdominal hollowing is dysfunctional – Abdominal brace instead
    • Teaching abdominal bracing
    • A note on fascial raking
    • Building squat patterns
    • Re-training the gluteal complex
      • Learning to activate gluteus medius
      • Learning to activate gluteus maximus
      • Beginning basic squat patterns
      • Star exercises
    • Active flexibility and stretching for back performance
      • Active flexibility for the back
    • Sparing the back while stretching the hips and knees

Chapter 11 – Stage 2: Building whole body and spine stability (pg 215)

      • Whole body balance
      • Balance training examples that progress from less demanding to more demanding for the back
      • Specific exercises to develop whole body balance
        • Soft hands
        • Japanese stick
      • Exercises for training the stabilizing muscles
      • Training the stabilizers of the lumbar spine: The “Big Three”
        • The Curl-up
        • A trick to alleviate neck symptoms
        • Isometric exercises for the neck
        • Curl-up progressions
        • More on the abdominal progression
      • The side bridge
      • Training spine stability during high physiological work rates
      • The Birddog
        • Advanced motor patterns with the Birddog
        • Building the stabilization program
        • Safe progressions of back exercises
      • References

Chapter 12 – Stage 3: Endurance (pg 233)

      • The reverse pyramid for endurance training
      • Training for endurance events
      • Breathing mechanics
      • References

Chapter 13 – Stage 4: Developing Ultimate Strength (pg 237)

      • Stage 4. Strength training considerations
        • Qualifying the athlete
        • Training motor units
      • Body weight resistive exercises and surrounding the dragon
      • Dumbells vs barbells
      • Cables: For multidimensional strength
        • Choosing the cable load
      • Bands Chains
      • Abdominal Strength
      • Training hip flexion strength and power
      • Building squat performance
      • Building more hip and back extension strength and performance
        • Training to power squat
        • What about box squats?
      • Don’t forget hip external rotation
      • Quadratus lumborum – essential for functional strength
      • Building torsional strength capabilities
      • References

Chapter 14 – Stage 5: Ultimate performance with speed, power, and agility (pg 269)

      • A note about the dead lift
      • Speed strength
        • Tips for speed strength
      • Agility
      • Progressing into plyometrics
      • Some final thoughts on program design References

Chapter 15 – Final transitional training – Ultimate performance with the techniques of Super Stiffness, and other tricks (pg 279)

      • Principle #1 Proximal stiffness enhances distal athleticism
      • Principle #2 Rapid contraction and then relaxation of muscle
      • Principle #3 Tuning of the muscles
      • Principle #4 Muscular binding and weaving
      • Principle #5 Directing neuronal overflow
      • Principle #6 Eliminate energy leaks
      • Principle #7 Get through the “sticking points”
      • Principle #8 Optimize the passive connective tissue system
      • Principle #9 Create shockwaves
      • References

Chapter 16 Putting it all together – Case Studies (pg 291)

      • Enhancing the agility of a soccer goalkeeper
      • Re-grooving the chronic back of an elite golfer
      • The rower who had to continue
      • The washed-up baseball catcher
      • The CEO who had painful “midnight movement”
      • Building the power lifter
      • Rebuilding a power lifting beast
      • A sprint kayaker broken with an endurance warmup
      • Pelvic and S.I. pain in an elite sprinter: squat vs spit-squat
      • Jiu Jitsu: Bucking tradition to rebuild a career
      • Body builder with underperforming core
      • Pro footballer with sleeping challenges
      • The misguided football lineman
      • Training a sprinter
      • Back troubles in the long distance runner
      • The Rock Climber
      • The champion squash player
      • The dancer building to the arabesque
      • Two former gymnasts and the spine instability legacy
      • Sciatic case-flossing
      • The “Strongman” competitor unable to conquer the sticking points
      • Blending speed, stiffness, strength and compliance for the martial artist
      • A Squat “Clinic”
      • A comment on forensic cases

Epilogue: Becoming the Elite Builder of Ultimate Backs (pg 317)
lndex (pg 321)
About the Author (pg 331)