At Evolution Physiotherapy, we utilize best practice principles when helping clients recover from or reduce their risk of future low back pain. When it comes to scientific research for treating low back, pain, your healthcare practitioner should be very familiar with Dr Stuart McGill. If their assessment and treatment of low back pain hasn’t been strongly influenced by Stuart McGill, you should be asking them why???

Our low back pain rehabilitation programs and low back injury prevention (risk reduction) programs follow Stuart McGill’s 5 stage Ultimate Back Fitness and Performance Program.

In stage 1, the focus is on GROOVING the appropriate MOTOR PATTERNS. In simple terms, we need to teach your body to move in a way that reduces or eliminates your pain. We reduce pain by decreasing stress on the injured or sensitive tissues. By moving better and improving your posture, you’ll also improve your ability to be strong. Virtually all people have movement or posture flaws or incorrect muscle activation patterns. We must correct these flaws in order to proceed with stages 2 to 5.

In stage 2, we BUILD WHOLE BODY MOBILITY AND JOINT STABILITY. The core (which includes the scapulae, torso, spine, and pelvis), needs to be stable to allow the arms and legs to be athletic. The hips and shoulder joints need to be mobile and powerful. The keys to stage 2 are ensuring that your technique is excellent, and that the exercises are pain-free.

Stage 3 is the ENDURANCE phase. We need to improve endurance (capacity) to build a large base that will allow higher levels of training and performance. Many strong individuals get hurt as they get fatigued and break their form. Parameters would include a descending pyramid, and maximum hold times of 6-10 seconds. This is a critical stage to reinforce perfect form, and not go to exhaustion. Reps should not be continued if your form is breaking down.

Stages 4 and 5 are the PERFORMANCE ENHANCEMENT AND INJURY PREVENTION STAGES. STAGE 4 is the STRENGTH building phase. Strength gains are necessary to improve function and to improve performance. The goal is to train strength without causing injury. Parameters would include 3-5 sets of 8-10 repetitions per set. Once 10 is easy, increase the load; if 8 is too difficult, decrease the load. To ensure safety, athletes should be assessed prior to starting this stage to ensure they are qualified to do so.

The focus of STAGE 5 is to develop SPEED, POWER, and AGILITY. Speed, power, and agility are required for high performance athletics. Power should be developed in the extremities, not in the spine. Stage 5 exercises should only be trained 1-2x per week. The load and tempo will vary each week, based on the periodization schedule.
Plyometric exercises enhance ‘speed-strength’ with elastic stretch shortening of the muscle-tendon complex. It is essential that the body is appropriately prepared and conditioned to perform plyometric training to reduce the risk of injury.