Spineflexionexercise:Myths,TruthsandIssuesaffectinghealthandperformance

ProfessorStuartMcGill,PhD

UniversityofWaterloo,Canada,andBackfitproInc.(www.backfitpro.com)

Thisshortarticleisintendedtoaddresstheconfusionregardingtheissueofspineflexionand
themisquotingofourworkonthistopic.First,somegeneralthoughtsareaddressed,followedwith
discussionofthemechanismsofathleticperformance,injuryresilience,andsuggestionsfordesigning
trainingsessions.

Thereisconfusionbetweenthetermsflexionmovementandflexionmoment.Flexion
movementdefinestheactofbendingthespineforward,flexingthespine.Thisisthekinematicterm.
Flexionmomentreferstotheactofcreatingflexionmomentortorque.Thisisthekineticterm.Thisis
independentofwhethermovementoccurs.Standing,andpushingaloadrequiresthespinetostiffen
withanteriormuscleactivation,henceflexionmomentoccursrequiringabdominalmusclestrengthbut
notmovement.

Iwasshownaquoterecentlyfromatrainerwhostated,IfollowedMcGillandavoidedflexion
andgotsoweakIcouldhardlydoasitup.Apartfromaterriblemisunderstandingandmisquoteof
whatwedo,thispersondidnotunderstandthedifferencebetweenflexionmovementandmoment.It
wouldappearheavoidedmomenttraining.Hecausedhisoutcome.

Flexionmovementofthespinestrainsthelayersofcollageninthespinaldiscs.Whenloadson
thespinearesmall,movementishealthy.Weoftenrecommendthecatcamelmotionexercisetaking
thespinethroughanunloadedrangeofmotion.Thus,thereisatimeandplaceforflexionmotion.
Whenthespineloadsarehighinmagnitudewithrepeatedflexionmotion,thecollagenfibres
delaminateinacumulativefashion.Slowlythenucleusofthediscwillworkthroughthedelaminations
andcreateadiscbulge.Thegreatertheload,andthegreatertherepetitions,thefasterthiswilloccur
(Tampieretal,2007,Veresetal,2009).Severalothereventsoccurdependingontheamountofstretch
onthespineligamentsattheendrangeofflexion.Forexample,cytokineslinkedtoacuteandchronic
inflammationaccumulatewithrepeatedfullflexionmotionexposure(DAmbrosiaetal,2010).

Ihavebeenmisquotedalongthelines,McGillstatesthatXXXXXbendingcyclescausedisc
herniation.Thereisnotasinglenumberitisavariable.Manyvariablesinfluencetherateofthe
herniationprocess.Forexample,theshapeofthepersonsdiscinfluenceswhethertheherniationwillbe
focal(YatesandMcGill,2010)andresponsivetoMcKenzietypesofrehabilitativeexercises,ornot
(ScannellandMcGill,2009).Theseresponsivediscsarepredominantlylimaconshaped.Incontrast,
ovoiddiscssurvivetwistingcyclesbetter.Thethicknessofthespinealsoinfluencestherateofgradual
herniationthickerspineshavehigherbendingstressandherniatefasterwithflexioncycles.For
example,aNFLlinebackermusthavelargerdiameterdiscstosurvivethecompressiveloading,butthese
samediscswillnotdowellperforminga1000situps.Incontrast,ithasbeenpointedouttomethat
thereisafellowinBrazilonYoutubewhodoes1000situpseveryday,implyingbylogicalextensionthatI
mustbeinerror.Butyouwillnoticethathehasaveryslenderspinesothebendingstressesaresmall.
ButhisthinspinewouldnotsurvivetheloadingofasingleNFLgame.Theseelementsofbiological
variabilityprecludetherecommendingofanexerciseapproachsimplybecauseitwastolerableby
anotherindividual.Further,timeofdayinfluencestherateofherniation.Afterrisingfrombed,thedisc
nucleusarefullyhydratedandhavemuchhigherstressesduringflexion.Itismoreriskytotrain
repeatedbendingearlierinthemorning.Occupationalstudieshaveshownavoidingflexionmotionin
themorningreduceddisablingworkplacebackpain(egSnooketal,1998).Differentspinesmean
differentinjurymechanisms,differentresilienciestomotion,anddifferenttrainingapproaches.Choose
yourparents(discgeometryandthusstresspatternscamefromyourparents),thenchooseyourbest
waytotrain!

Ihavebeenshownquotes,McGillusespigspinestodismissourwork.Thesequotesmust
comefromkidswholiveintheirbasements.Theymayhaveseenasinglestudybutdonotknowour
bodyofwork.Wehavepublishedhundredsofexperimentsinmedicalpublicationsover30yearswith
about10%ofthemusinganimals.Theseareessentialstudieswherewecantest40identicalspinesto
establishtheinteractionandinfluenceofsomeofthevariablesintroducedabove.Ofcoursethese
mechanismsarecalibratedbacktohumanmechanisms(egYinglingetal,1999).

Whyisflexionexercisesuchapassionateissue?Coretraining,trainingtheabdominals,core
stiffnessandstabilityareallessentialcomponentsforpaincontrol,performanceenhancement,and
injuryresilience.Butthespecificissuehereiswhetherthespineneedsflexionmovementorflexion
momenttraining.Thefollowingsectionexplainsthefoundationforathleticperformancethathas4
components:1)Proximalstiffness(meaningthelumbarspineandcore)enhancesdistalathleticismand
limbspeed;2)Amuscularguywiresystemisessentialfortheflexiblespinetosuccessfullybearload;3)
Muscularcoactivationcreatesstiffnesstoeliminatemicromovementsinthejointsthatleadtopain
andtissuedegeneration;4)Abdominalarmorisnecessaryforsomeoccupational,combativeandimpact
athletes.Logically,wemustnowdiscussthepriorityforflexionmovementormoment.

First,howdoescorestiffnessenhancelimbspeedandstrength?Consideranexamplewiththe
shoulderandthepectoralismajormuscleitattachestheribcageatitsproximalend,crossesthe
shoulderjoint,andattachestothehumerusoftheupperarmatitsdistalend.Whenmusclescontract
theytrytoshorten.Considerthespecificactionherepectoralismusclecontractionflexesthearm
aroundtheshoulderjointmovingthearmfrommuscleshorteningatthedistalend.Butthesame
shorteningalsobendstheribcagetowardsthearmattheproximalendofthemuscleinotherwords
bendingthecore.Thussimplyusingthepecmusclewouldnotresultinafastnorforcefulpushorpunch.
Nowstiffentheproximalendofthepectoralismuscleattachmentmeaningstiffenthecoreand
ribcagesoitcantmove.Now100%ofpectoralismuscleshorteningisdirectedtoactionatitsdistalend
producingfastandforcefulmotioninthearm.Inthesamewayastiffenedcorelocksdowntheproximal
endsofthehipmusclesproducingfasterlegmotion.Alossofcorestiffnesscausesthetorsotobend
whensprinting,andalossofspeedsomeforcewasrobbedthatshouldhavebeenexpressedinleg
velocity.Thus,auniversallawofhumanmovementisillustratedproximalstiffnessenhancesdistal
mobilityandathleticism.Thisrequiresflexionmomenttraining(corestiffness),notmovement.
 Second,thespineisastackofvertebraethatiscalledupontobearloads,yetitisflexible.An
engineercannotdesignastructuretobegoodatboth.Asteelbeamthatisstraightandstoodonitsend
isstiff,andcanbearloadsthattrytocompress,shearandtwistit.Sothebeamcanbearloadbutitcant
move.Aflexiblerodthatallowsmovementwillbendandbuckleunderload,butabsorbsshock.Our
spinesdoitalltheybendandallowthelungstofillwithair,andevenallowustodance.Thespineis
thisbeautifulstructurethatisflexibleandallowsflowingmovement,butrequiresa3dimensionalguy
wiresystemtostiffenandstabilizeitwhenitisrequiredtobearloads.Analysisofthemuscularsystem,
togetherwithitsassociatedfasciasheetsrevealsacleverguywiresystemthatcreatesbalancedstiffness
eliminatingthepossibilityofbucklingandinjury.Theconcernisthatmodernlivingdoesnottuneand
trainthisguywiresystem.Inmanypeopleitlapsesintocomplacency.Thisrequiresflexionmoment
training(corestiffness),notmovement.

Third,backinjurycausesjointlaxity.Forexample,injurytothedisccausesittolooseheight
allowingaberrantjointmicromovements.Themicromovementsirritatesensorynervesresultingin
backpainandradiatingpains.Spinestiffnessfromcocontractedtorsomusclesminimisethemicro
movementsandcontrolpain.Notethiscocontractionistunedtocreatesufficientstiffness.This
requiresflexionmomenttraining(corestiffness),notmovement.

Fourth,athleteswhorequireabdominalarmortosurvivekicksandblowsneedabdominal
training.Topcombativeathletesseekmyconsultingexpertiseforbackpain.Typically,theyhavetrained
highrepetitionsitupstobuildarmor,buteventuallydevelopbackpainendingtheircareers.Ichangethe
flexionmovementapproachtoflexionmoment(corestiffness)byhavingthemperformexercisessuch
asstirthepot.Nomotionoccursintheirspine.Theirstrikespeedisenhanced(LeeandMcGill,in
press),andtheirtrainingtolerancehasbeenrestored.Theircareershavebeensalvaged.

Finallythereispractical/appliedevidencefromgrouptrials.Forexample,militarygroupshave
madespeedsitupsamandatorycomponentforannualfitnesstests.Soldierstrainthetest.Recognizing
theUSmilitaryunacceptablelowbackinjurystatistics,Childsetal,(2009)testedthesubstitutingof
situptrainingwithplanksandstirthepotconsistentwithflexionmomenttraining(corestiffness,not
movement).Thegroupofsoldierswithmomenttrainingperformedbetterinthesituptestseven
thoughtheydidnottrainthem.Theyhadhealthierbacks.

The"big3"exercises(McGill,1998andMcGill,2014)havebeenproventoenhancestiffness
thatlastsafterthesessionhasfinished(LeeandMcGill,inpress),tuningtheguywiresupportofloads.
Forthosewithbackinjury,andunstablespinejoints,enhancingstiffnesswithflexionmomenttraining
togetherwithflexionmovementavoidanceareessentialtocontrolandeliminatethemicromovements
thatcausepain(IkedaandMcGill,2012).Theseexercisesshouldbeperformedeveryday.Theyarethe
foundationfromwhichlargerexerciseprogressionscanbedesignedtooptimallyreducepain,and
enhanceathleticism.Theseprogressionswillincludetheobjectivesofendurance,strengthandpower
whilebuildingresilience,reactiontimeandwhateverelsetheyneedtobetheirbest.

Therearethosewhoclaimthattheirsportisflexionmovementbasedandtheymusttrain
flexionmovementsuchasjiujitsuathletes.ButagainIhaveconsultedwithseveraltopjiujitsu
players.Theywerenotabletotrainbecauseofthebackpaintheyinducedovertimetrainingflexion
movementcycles.Withnopainfreecapacitytotraintheywerefinished.Wechangedthetrainingfrom
aflexionmovementtoaflexionmomentapproach,thusregainingpainfreespineflexionabilitybut
savingthespineflexionfortheringandoctagon.Theircapacitytotrainwasrestored.Againsome
careersweresalvagedandindeedflourished.

Howarethesethoughtsputintopractice?Itdepends!Theanswerdependsonhistorydoes
thepersonhaveepisodicbackpain,orchronicpainorperhapshasneverhadpain.Iftheyareagrand
masterofpowerliftingandhaveneverhadbackpainIsuggestkeepingtheirstyle.Butiftheyhaveapain
history,theanswerisdifferent.First,ifthespineisunderload,itisbesttonotmoveitkeepitstiff.
Thisprincipleisnotcontestable.Thesecondbestis,ifthespinemustflexsuchasastrongmanevent
competitorliftinganatlasstone,thespineisstiffenedinanisometricallyflexedspineposture.Thestone
ishookedbythethighs,armsandpectoralismusclesasthespinecurlsoverthestone.Thespinedoes
notmoveasthemotionisfocussedaboutthehipjointsuntilthefinalhoik.Sothespineisflexedwhile
underloadbutitdoesnotmove.Theworsttechniquewouldbetomovethespineintoflexion,overand
over,sothecombinationofloadwithmotionwouldslowlyandcumulativelydelaminatethedisc
collagen.Herethespineisfatiguedbeforethemuscles.Trainingvolumeiscompromised.Itwouldbe
moreeffectivetobuildtrainingvolumebyreducingthespinemovement,trulytrainthemusclesto
perform,andsparethespine.Myconsultingwiththisapproachhastakenmanyinjuredathletesbackto
functionsufficienttocompeteattheOlympics,andintheUFC,NBA,NHL,NFLetc.andwin.

Otherconsiderationsbesidespainhistorywouldincludefindingsfromanassessment.Iwould
assessthegeometryoftheirhipjoints,theirfunction,andlookforopportunitytoenhancethe
mechanicsthroughthelinkagetothepelvisandspine.ThenIwouldperformprovocativetestingto
identifythemechanismofpaingeneration.Ifthepainisresultingfromflexionmotion,orflexionmotion
whencombinedwithaspecificcompressiveload,thereisnooptionregardingthetrainingstrategythat
willallowthecontinuationofpainfreetrainingflexionmustbeavoided.ThenIexaminelifestyleand
therestofthetrainingprogram.Forexampleiftheindividualsitsatacomputerasanoccupation,most
likelythetrainingprogramwillneedtoaddresstheconsequencesoflongdurationspineflexionfirst.
Then,togetherweidentifythetraininggoalsoftheindividual,assesstheircurrentstatus,anddecideon
thebestexercisetoolstotakethemtothegoal.

Thereaderappreciatesthattheissueofspineflexion,fromtheperspectiveofinjury
mechanicsandexerciseprescription,iscomplex.Themostjustifiableapproachwillnotbeguidedbya
singlestudy,notoneonpigs,humans,orwithininstitutionslikethemilitary.Buttogether,allofthese
studiesareimportant.Interpretationofthiscollectionofworkrequiresmuchtimeandexpertise.WhileI
haveinjectedafewreferences,theyaresparsesoastonotburdenthereader.Ihavesynthesizedthese
manypaperstoguidetraininginmytextbookUltimatebackfitnessandperformance(fifthedition
2014,www.backfitpro.com).ManyoftheoriginalscientificpapersarelistedinmyCVontheuniversity
website(https://uwaterloo.ca/kinesiology/peopleprofiles/stuartmcgill).

References:

Callaghan,J.P.,andMcGill,S.M.(2001)Intervertebraldischerniation:Studiesonaporcine
modelexposedtohighlyrepetitiveflexion/extensionmotionwithcompressiveforce.Clin.
Biom.16(1):2837.

Childs,J.D.,George,S.Z.,Wright,A.,Dugan,J.L.,Benedict,T.,Bush,J.,Fortenberry,A.,Preston,
J.,McQueen,R.,Teyhen,D.S.,(2009)Theeffectsoftraditionalsituptrainingversuscore
stabilizationexercisesonsitupperformanceinUSArmySoldiers:Aclusterrandomizedtrial,J.
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D'Ambrosia,P.,King,K.,Davidson,B.,Zhou,B.,Lu,Y.,Solomonow,M.,(2010)Proinflammatory
cytokinesexpressionincreasesfollowinglowandhighmagnitudecyclicloadingoflumbar
ligaments,Eur.SpineJ.,doi10.1007/s0058601013714.

Ikeda,D.,McGill,S.M.(2012)Canalteringmotions,posturesandloadsprovideimmediatelow
backpainrelief:Astudyoffourcasesinvestigatingspineload,postureandstability.SPINE.37
(23):E1469E1475

Lee,B.,andMcGill,S.M.,(inpress)TheBig3stabilizationexercisesenhancespinestiffness.

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McGill,S.M.Ultimatebackfitnessandperformance,BackfitproInc.,Waterloo,Canada,ISBN0
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Scannell,J.P.,McGill,S.M.(2009)Discprolapse:Evidenceofreversalwithrepeatedextension.
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Tampier,C.,Drake,J.,Callaghan,J.,McGill,S.M.(2007)Progressivedischerniation:An
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Veres,S.P.,Robertson,P.A.,Broom,N.D.,(2009)Themorphologyofacutedischerniation:A
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