Discover how combining advanced manual therapies with targeted exercises can effectively address both structural and neuromuscular causes of back pain.
Low back pain remains one of the most common reasons people seek medical care. Among the leading experts in spine rehabilitation is Dr. Stuart McGill, PhD, professor emeritus of spine biomechanics at the University of Waterloo. McGill has published over 240 peer-reviewed papers and authored foundational books (Low Back Disorders, Back Mechanic, Ultimate Back Fitness and Performance). His work is recognized worldwide for shifting the conversation from general “core strengthening” to specific, evidence-based movement strategies that restore spinal health and reduce pain.
McGill’s research highlights that certain low-load, high-tension exercises—sometimes called the McGill Big Three (modified curl-up, side plank, and bird dog)—are particularly effective at activating spinal stabilizers while avoiding harmful compressive or shear forces on the discs. These exercises improve neuromuscular coordination, endurance, and load tolerance, which are critical for protecting the spine in daily movement. Clinical trials and case series have demonstrated significant reductions in pain and disability in people who adopt McGill-style programming, particularly those with discogenic back pain or recurrent instability.
In our physiotherapy practice, we see back pain through two complementary lenses:
Hardware problems occur when the joints, ligaments, and soft tissues are stiff or restricted. Much like duct tape stuck to a surface, the body can feel “stuck” in its own patterns. This restricts mobility and prevents normal function.
Software problems occur when the brain has “turned off” key stabilizing muscles—often after an injury such as a disc herniation. Even years later, these muscles may remain inhibited, running on what I like to call “buggy code.” The software that organizes movement needs to be debugged and reprogrammed.
We find that hands-on mobilization is often the first key step—freeing up restricted areas so the body regains the capacity to move. This is like unlocking the hardware: opening a door that allows optimal movement patterns to return. Without restoring mobility first, patients often struggle to perform even the best exercises effectively.
Once mobility is unlocked, manual resistance and activation techniques reinforce the “core-first” strategies of healthy movement. This retrains the brain to recruit deep stabilizers—debugging the software so muscles fire in the right sequence again.
Here is where McGill’s exercises shine. After mobility and neuromuscular activation are restored in the clinic, patients need simple, repeatable tools to reinforce those gains at home. The McGill Big Three provide that structure. They have high specificity for activating the spinal stabilizers, building endurance, and establishing efficient motor patterns.
But we also emphasize: exercises alone often aren’t enough at the beginning. Many patients remain “stuck in the rehab loop” if the hardware (joint and soft tissue mechanics) hasn’t been addressed. Once alignment and mobility are restored, however, these exercises become powerful tools to maintain progress, prevent reinjury, and gradually build strength and endurance on top of efficient, debugged movement.
Lasting relief from low back pain isn’t about chasing the latest core fad or hammering away at strength. It’s about integrating hands-on care (to fix the hardware) with precise, research-backed exercises (to reprogram the software). When mobility, neuromuscular activation, and endurance all come together, the spine has the best chance to heal—and patients regain the confidence to move fully again.
Here are two videos of Dr. McGill’s favorite exercises that we recommend after mechanics are restored: