To Stanford, with Stu McGill and Craig Liebenson

The upcoming Stanford event with Stu McGill and me is the brainchild of Craig Liebenson. It probably came from an issue Craig observed in his position lecturing, publishing and mentoring young clinicians in functional rehabilitation. Craig noticed people thought Stu and I were at odds about concepts like screening, assessment and spine stabilization.

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Craig is a shining light in the chiropractic world, showing that a blend of good rehabilitation, good conceptual physical therapy and exercise choices are equally as important as manual therapy, manipulation, dry needling or soft tissue work. If you’re not doing one at an expert level, the other will barely get you halfway.

Craig proposed for us to get together so people can hear what he was able to glean from our work, and we jumped into making it happen. Stu and I are probably both in the process of paring down the most important concepts we’d like to be recognized for. Two of the concepts that polarize people are spine sparing and spine stabilization. We’re both passionate about these, and I want to elaborate at bit.

If you’d prefer to listen instead of read,
here’s a longer audio version of this article,
Episode 41 of Gray Cook Radio

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One of Stu McGill’s original concerns in his work was spine sparing. That means if you’re trying to rehabilitate, stabilize or train a spine and you haven’t looked at all the reasons a spine may have to compensate—lack of hip extension, lack of medial rotation on one hip, poor balance on one leg, poor thoracic spine mobility—you’re not doing a very good job at sparing the spine. You’re trying to add a positive to a situation that would do better if you removed a negative.

Only in a few situations will spontaneous stabilization emerge from creating mobility in the system. Some stabilization training has to occur, but if you look at what we say about stabilization, if you neglect the screening and evaluation process, and you don’t identify the things that could be causing the spine to compensate in the first place, you failed to recognize the spine isn’t the problem. The spine is the victim. Until you attack the problem and then rehabilitate the victim, you’ve done nothing.

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It’s believed that 50% of back patients will probably get better regardless of what we do.

When you have an episode of low back pain that inconveniences you or disables you in some way, without someone to responsibly evaluate and rehabilitate you, you could very easily recover from that episode.

But here’s what you’re going to do: You’re not going to play golf anymore. You’re going to give up running. There are lifts in the gym you no longer do. You’re in constant search of a mattress to make you more comfortable.

In many cases, you just pare down your life and limit it so you’re more comfortable, but in no way are you more functional. The pain is gone, but it’s because you don’t agitate it—not because you rehabilitated it.

Stu’s concept of spine sparing is the most important concept in this entire body of work. My contribution was in trying to create a filter in both our movement screen (the FMS) and in our medical equivalent movement screen (the SFMA) to say, ‘You don’t just have a stability problem. You have multiple mobility or movement problems.’

gray2013If your action isn’t affecting a movement pattern, what is your action doing?

In concept, Stu and I are in total alignment in responsibly attacking the weakest link, but remember, one of the things people debate about our work is low back pain, and low back pain is not even a disease or a dysfunction. It’s a symptom and it can come from everything from tight hips to poor lifting mechanics to bone cancer.

The most responsible action in back pain is not to reach for a remedy, but to thoroughly, objectively and consistently attempt to map out the contributing factors before pursuing spine stabilization.

This leads me to a second point where I feel people think we’re in opposition. Stu and I are in pursuit of biomarkers—biomarkers that help predict problems and progress people. These are biomarkers that set baselines so you can appraise the value of your work and the amount of progress you’re offering to the people who train and rehabilitate with you.

Stu and I have also been asked if we find a valuable biomarker, ‘Can you move it? ‘Can you help it?’ Stu has adopted some remedies, as have I, but we came from two different incubators.

I’m a clinician coming out of a small clinic in Virginia with a very small education budget and no research budget. I’ve never been completely attached to a university and I’ve never had a research grant. All I had to work with were the tools I had, to be resourceful and see if I could make a simple filter to help me and my staff be a little bit better at what we did.

PavelwithStuStu has had an unbelievable research window into the inner workings of the human body with EMG, force plates and biomechanical analysis. He’s gone deep into the anatomical structure of what the spine should and shouldn’t do. And he’s also looked at the functionality of what the spine does in our most vigorous activities and during rehabilitation.

In recent strength and conditioning culture, Stu has become somehow married to the side plank. But really, he simply identified the side plank as a biomarker. Many people then took that side plank and used it as an inoculation—not as a remedy, and not as a treatment when warranted.

Many people assumed if they just add side planks to a rehabilitation or functional exercise program, they by default stabilize the spine…because Stu has a body of spine stability work and they saw him write about the side plank. Therefore, if everybody in their program hits the side plank, by default they’re stable.

That’s not Stu’s message at all. Anything Stu does, he’s going to precede it with a test and follow it with a re-test. Those tests will show him the appropriateness and benefit of the activity.

Sometimes people doing some of the exercises we discuss may trust us so much, they neglect to do the pre-test and post-test that validates they were in the right place at the right time with the right person.

What it boils down to is this: Stu and Craig and I get questions about dry needling, active release (ART), PRI, DNS or ways to get the body and the central nervous system and the movement patterns to line up. We have opinions about these, but you don’t need to ask our opinions. Run these things through our filters. If you’re correctly doing dry needling, you will change movement. If your approach to PRI or DNS techniques is on board and preceded and followed by objective evaluation, you’ll have your answer without asking.

I don’t want to be remembered for my contribution to exercise nearly as much as my contribution to assessments, screens and evaluations used so we don’t waste time with the wrong exercise.

We want to be better marksmen with our exercise choices.

We have many wonderful remedies to improve movement, restore mobility and improve stabilization. These remedies are often applied because they have value to the experts who invented them, but it’s hard to create that same value without perspective. People often take the right medicine to the wrong situation, and therein lies the need for screening, research-based biomarkers, assessments and medical intervention when warranted.

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Ultimately, the people who attend this Stanford event or get the audio, video or text transcript will realize if you lean a little bit closer and dismiss the idea of a magic bullet, you’ll discover our careers have been heading on a collision course of collaboration and support—not conflict.

This event is over.
Please click here to add your name to the email list so we can update you
on the video progress, and share exclusive video clips and transcript excerpts.

In the meantime, if you’d like to hear more from Stu, Craig and me, here are a few of our conversations.

 Craig Liebenson & Gray Cook: A Dialogue on Function

Stuart Mcgill & Craig Liebenson: From The Lab to The Trenches

Craig Liebenson & Gray Cook: Misunderstandings About The FMS and SFMA

Craig Liebenson & Gray Cook: Hat Tip to Professor Janda

Comments

  1. Don Peterson says:

    Great explanation. I’ve never thought there was a conflict as much as difference in perspectives.

    For clinicians, of course, the challenge is in first getting those bent and twisted spines out of pain.

    Next, and this is a question I emailed Craig specifically for this conference, after the patient has a reasonable degree of relief, is there a hierarchy of care? For example mobilize the thoracic spine while stabilizing the lumbar or can they be done concurrently? And what is the best approach, depending on your assessments of course, is working centrally to peripherally better or concurrently eg ankle hip thoracic mobilization at the same time as lumbar stabilization?

    Forgive the over-simplifications, really looking forward to this conference.

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