An Interview with Professor Stuart McGill, Backfitpro.
I was saddened for the back pain-suffering public to read an article in The Times claiming that nothing works to address low back pain.
I have worked with several clients over the last 18months since I qualified as a McGill Practitioner, to help them resolve their low back pain and have the evidence that this is not true. Thanks to the discovery of Prof.Stuart McGill’s research 6 years ago, I have witnessed many clients resolve their back pain, avoid surgery and are now stronger and fitter than they were previously.
Below, the master himself explains …..
The CBC (Canadian Public Broadcasting radio) aired a special report on a back pain article that ran in the New York Times (and The Times in the UK) Professor McGill was asked to come on air and provide perspective and his opinion. The article created a large reaction because it concluded that nothing works to address low back pain. It was a study on non-specific pain, which will only provide a non-specific conclusion. But this threw many excellent clinicians under the bus, and removed hope from the pain-suffering public. This piece is from Professor McGill's preparation for the interview.
The New York Times article reports on the study of non-specific low back pain. As you know, his work shows that all back pain is specific, and a thorough assessment is required to reveal the specific pain pathway. Nonetheless, the authors of the paper being discussed concluded that nothing works. However, McGill argued if the subjects were sub classified into specific categories, and the specific treatment approach addressed their specific pain mechanism, then efficacy increases. Because of this, we must ignore this study.
For example, take a group of non-specific back pained people and give them an intervention of walking one hour each day; half get better, half get worse. Your conclusion is that walking, on average, does not work. But if you subclassified based upon their walking ability and whether walking eliminates their pain, or triggers their pain, obviously you would conclude that walking was effective for those in that specific category. Then, if you keep refining the classifications, you will find those who are younger with discogenic pain will be the ones who benefit, while older people with central stenosis will do poorly. You get the idea. In our world of specific and precise diagnosis, the sub-categories will form a group N=1, meaning that each person would have a precise understanding of their specific pain pathway, with a specific approach to follow, a specific dose, a specific mattress to sleep on if they have morning pain, etc.
Can you imagine taking your car that is not running well to a mechanic, and they tell you, "we do not do diagnostics - we take a picture (think MRI) and for every sick car we change the engine"?
Generally, Medics are not trained to conduct a thorough assessment as they do not have time in the current medical model. There is no billing code for a thorough assessment so it rarely happens. Thus, I have been training clinicians to provide these assessments.
When I started the experimental research clinic at the University of Waterloo, I set aside two hours for a back pain consult. My medical colleagues wondered "what are you going to do for two hours"? After a year I changed that to three hours!
A good diagnostician needs expertise in anatomy, neurology, biomechanics, physiology, psychology, pattern recognition, injury mechanics, tissue adaptation and tissue mechano-stimulation, to name a few. There is no single discipline that trains this - that is what motivated our training of these uniquely skilled clinicians. In fact, this weekend, I will be seeing patients in front of a group of a dozen of our Backfitpro clinicians where we workshop the assessments. Both patients have been to at least 10 different clinicians of different professions and still have no clue as to what is causing their pain. We will find it, and that will inform an approach unique to them that will stop the cause, allow pain desensitization, re-tune their body for pain free activity, and then restore some athleticism. Of course, there will be limits to each of these components, but they will have a strategy to manage their pain to sub-clinical levels. These skill development weekends are part of the effort for continual enhancement of mastery of our McGill Method clinicians, myself included.
How are we able to predict patients success when previous experiences have conditioned them to fail? They have some relatively pain-free days. Thus, they have the capability to be pain-free. They simply need to be aware of their specific pain triggers, have a specific strategy to reduce their exposure, and employ mechano-stimulation (appropriate specific movement and exercise) to stimulate adaptations to increase their robustness. This is empowering for them to the point that the psychological burden disappears.
I was fortunate to attend the latest McGill Method Provider Weekend in BC, Canada, to increase my knowledge and hone my skills from the master Stuart McGill.
“11 of our McGill Method providers from around the world gathered together for a weekend of continuing education. We saw patients together, went out for dinners, lunch time hill walks, and an early morning hike to get a sweat on. We had terrific patients with issues to solve together, and coach some pain reducing strategies. We look forward to the next one”.
