A Tale of Two Back Doctors

The two big doctors in the world of bad backs are Dr Stuart McGill and Dr Paul Sherwood.

Dr Sherwood passed away a few years ago, but is still very much a colossus in the back world.

In many ways they both say the same thing:
“High-end bad backs can be fixed without surgery”
and they both did the same thing:
“Fixing high-end bad backs”

Where they differ is in what they see as the cause of bad backs and the techniques they use to treat them.

For Dr Stuart McGill – AKA “The Back Mechanic” – the way people use their backs is a major cause of a bad back.
He sees repeated full range flexion (bending forward) and extension (bending backwards essentially)
of the spine and flexion under weight (sit-up exercises and picking up weights with a bent spine) as the cause of herniated discs.
His solution to a bad back is to find out what movements and use of your spine cause the problem – your pain triggers – and to fix it:
a) You stop it – “stop picking the scab”
b) You strengthen the stabilising muscles of the spine with the “Big 3” exercises and a few others that suite your situation.

Dr Sherwood saw something different – He saw things like bad posture as a result of a bad back rather than its cause. The cause of a bad back he saw as being an injury – a trauma – and often an old one “…on average 11 years…” via this mechanism:

After a trauma injury, the facet joints are jammed together, and they send a nerve signal to the powerful para-spinal muscles to provide a protective corset in the form of a long term but painless spasm.
For light injuries, this mechanism works fine – in a short time, the back heals and spasm releases.
But for serious injuries, the spasm is too tight and too long lasting and as a result the tissues become all stagnant
and oedemas build up. Any healing ceases as fresh white blood cells cannot get past the oedemas to the damaged area and, as the
pressure of the para-spinal muscles in long term spasm is squashing the facet joints, the facet joints react in the only way they know how when they are stressed – they produce nerve signals that request the para-spinal muscles to go further into spasm to “protect” them.
After living like this for years, one day … “…while reaching for the toothpaste” or something like that… bang ! the painless spasm turns into a painful cramp and/or the nerve gets trapped, a disc moves and squashes a nerve….
Dr Sherwood’s solution to this is to wind things down and straighten things up:
a) Ultrasound is used to reduce the spasm in the muscles thus taking the stress off the facet joints
b) EMS – Electro-Muscular Stimulation is used to get the muscles to pump out the stale oedemas in the tissues
c) The ASMI (PAM) machine is used to mobilise the vertebrae and get them moving to get them back into their correct place.

Can they both be right ?
Well as a back therapist myself, I have only ever had one patient come in with a bad back after doing sit-up exercises… but even then
I’m sure he had a previous trauma injury from what I saw.
Had this patient – or his gym instructor – read Dr Stuart McGill – then he would not have done the sit-up competition.
– Sit-ups being just about the dumbest exercise on the planet: During a sit-up, the spine is flexed – so squashing the discs at an angle – and the stress of the lifting your torso against the force of gravity is a powerful compressive force – all explained very well by Dr Stuart McGill in his books.
If Dr Sherwood is right – and an existing trauma injury needs to be present for a back to go like this – Dr Stuart McGill would have been “right enough” to have prevented this painful back problem.
In a world of unknowns – which is the real world we live in – being “right enough” is as good as you need in most cases, which is why this blog is not entitled “Dr Sherwood Vs Dr McGill” or  some other such “either/or” type phrase.

At the time Dr Sherwood was building up his experience, many people still worked in factories in the UK and there was no such thing as
a “gym” outside of the world of professional wrestles and the like.
Now more people work in gyms than they do in factories in the UK never mind the numbers who use gyms.
So there may well be a new kid on the block – the dumb gym exercise that is causing a new wave of bad backs… but I have not actually seen it yet myself. “Roll up! Roll up! – do strange and unusual things to your body under weights to loud music to help reduce body awareness and repeat and repeat till you injure yourself” – I asked a Personal Trainer in a gym a couple of weeks ago: Why when even the US navy has stopped doing sit-ups do you continue to a) do this disc stressing exercise  and b) “enhance” them…and now add a sharp twist ! .. and repeat !” He replied: “Oh they are easy to do in the floor class and they take up very little space”

Does GoodBack use “The Sherwood Technique” ?
www.GoodBack.co.uk, based in St Albans UK, uses the Sherwood Technique quite a lot… but not entirely – The Dr Sherwood Technique can take some time to work – maybe 15 to 20 sessions and the patient has to have a treatment once every two days till the problem is fixed. In most therapy situations it is struggle enough for the patient to turn up for therapy weekly so at GoodBack a Sherwood-esque approach is used:
A typical protocol would be to use all 3 of the Ultra-Sound, EMS and ASMI on the first few sessions and when the tissues no longer
look and feel stagnant, then to move to using the entire therapy session just with the ASMI machine.
There are 3 modes on the ASMI machine: the Anti-Spasm, the Reflex stimulation and the Mobilisation mode. Dr Sherwood only used the
Anti-Spasm and the Mobilisation mode, restricting his therapy this way I think he missed a trick: At GoodBack, all three modes are used.
The Reflex mode mode, not used by Dr Sherwood, stimulates the nerve reflexes in the spine and gets the vertebrae to “jump” back
into the correct place bit by bit after the ligaments had been stretched by the mobilisation mode. So the Reflex mode is an integral part of the therapy and a huge reason why patients can get better in a far quicker time frame than without it.

This approach fixes most bad backs in a few treatments.

Does GoodBack use “The McGill Technique” ? – as homework – toward the end of the treatment, it is sometimes a good idea to point the patient
in the direction of the McGill books and videos and pick out the best bits for them:
a) His method of getting up from chair is brilliant, as is his whole “Spinal Hygiene” section – brushing teeth etc – all explained in “The Back Mechanic”.
b) McGill’s lifting advice: Well, most of the manual workers I treat, already have excellent lilting techniques but for office workers it is well worth a read.

c) I’m not too happy about his “Big 3” exercises as these are floor exercises and most of the patients I have would struggle to get on the floor and back up again and, as the trauma damage is visible and palpable (you can feel the vertebrae dip up & down, twist here & there as you run your fingers along the spine) – and fixable via the GoodBack Big 3:  Ultra sound, EMS & ASMI, I like to get the vertebrae back into their correct position before doing exercises – and by then you don’t really need any. Add to this the risk of the patient not doing the exercise correctly unattended… this is why exercise is not a treatment modality I much recommend. But if the patient asks… then Dr Stuart McGill is the place to go to.

Prevention – well the best prevention is not being in car accident, not falling off a horse… as trauma is the main cause.
But for those niggling pains and for safe gym work, my preference over the McGill “Big 3” are the other standing exercises
McGill recommends in his “Ultimate Back Fitness and Performance” using the “Cables” in the Gym.

If you look at the paintings of human “work” since the dawn of time, we are not lying down on an ancient gym mat, neither are we lifting heavy weights gym style – most of it is pushing carts and pulling ropes with donkeys or buckets on the end of them.
Dr Stuart McGill is rightly “against machines” in the gym – which includes anything you sit down in, He recommends standing up and using the cable machines to push and pull – while holding a stiff full core, stiff arms, firm hand grip, stick neck, stiff legs, well placed feet, a neutral back – don’t bend over – even a bit. So I see cable work as a wonderful early bronze age… up to quite recent times… style – full body engagement – human sized exercise – with the advantage that you can start with a very light weight and don’t have to struggle to get down on a mat and back up again.

So two excellent back doctors, both have added  huge amount to the world of bad backs. Not quite an “either-or” situation but in the therapy room I do tend to “Dr Sherwood it” a lot more than I “Dr Stuart McGill it”. Outside of the therapy room, Dr Stuart McGill’s gym work and how to move around the house and brush your teeth work is the go to.

Dr Paul Sherwood’s Materials:

“Your Back, Your Heath” & “Get Well Stay Well”

Obituary Independent Newspaper

Thames TV News

TV Interview

Dr Stuart McGill’s Materials:

“The Back Mechanic”, “Ultimate Back Fitness and Performance” & “Low Back Disorders”

Website