Before we get to the McGill 3, consider this: We start kindergarten, and if we’re fortunate we complete 20 more years of formal education and then we deeply contribute to society.
But what if you don’t have access to all that education. What if all you got was kindergarten? That would be better than nothing, and the 3 most important life lessons you might be wise to take from kindergarten: Be kind, share, and listen.
If you followed just those 3 bits of advice it would serve you well. You might not ever learn how to write essays, build bridges or fly airplanes but at least you would have some fundamentals to help you through life.
This is how we should treat the "McGill 3". (There are thousands of websites devoted to the McGill 3. No need to put a link to one here.)
The 3 best exercises for back pain
It’s a bit preposterous isn’t it? The idea that there are 3 best exercises for back pain. But that’s what hurting humans look for. A quick internet search when they’re suffering and have no access to professional advice.
The point here isn’t to debate whether the McGill 3 are the best choice. The point is to remember that we are trained to provide Master’s level advice to our patients, not kindergarten advice.
Have you ever prescribed the side plank (be kind), bird dog (share) and curl up (listen) to a back pain patient? Did you feel a little guilty? You probably should. We can do better.
I once overhead through the curtains a colleague of mine tell a patient
"The research says that there is no set of exercises that is better than another for back pain.”
That patient self-discharged and transferred to see me the next week. “That other guy didn’t seem to know what to do,” she said. That ‘other guy’ was in fact a PhD researcher who wrote a textbook on back pain. He made an error in his logic. He correctly identified the state of research, which was his specialty. Yet he incorrectly assumed that he could extrapolate population-based research to the unique individual in his cubicle that day. He didn’t even try to understand who that remarkable individual was. He didn’t bother digging deep into his creative talents to come up with a personalized program for his patient. She noticed. She left.
Trust the Science
We make a mistake when we assume that the state of the research on back pain is complete. It certainly is advancing. I imagine the current state of research as a 1000 piece jigsaw puzzle. Maybe 2/3 of the pieces are visible. The rest are turned over or not even on the table. Maybe 150 pieces are in their proper place and we’ve got a bit of an idea what the underlying picture is.
We need to be careful when we trust the science. If we don’t understand the big picture and the fact that some truths are evident but haven’t been proven yet, we risk making an error. One of arrogance.
I once had a patient tell me that soaking in Epsom salts was the only thing that relieved her pain. “Trust the science”, I told her. “There’s no way that works.”
Right, well I didn’t tell her that because what she told me was the truth but it didn’t seem at that time to fit the research picture as I knew it. (Turns out there's a good bit of research on 'balneotherapy' in the management of pain. Here's a start if you're interested.)
Practice the Art
How about your patient with generic, non-specific mechanical low back pain?
How about trying a different approach from the kindergarten advice they already looked up online. How about listening deeply to their story, finding out what their day is like, stepping onto their hamster wheel of life and joining them for a while to find out what’s going on? Perhaps then you might find yourself tapping into your creative side. You might pull out all the tools and tricks you have in your repertoire and re-arrange them in a way to provide something that your patient needs.
How are you using your art supplies?
Think of it like an oil painter's supply kit. You graduated with your MScPT which gave you lots of tools. It's just like a painter who leaves the supply store with all the colours and all the brushes and a good idea of how to use them.
In order to put together a portrait that pleases it takes a keen eye, some creativity and perhaps, if it’s a commission, a good knowledge of the tastes of your patron. That might result in a good piece of art.
When it comes to prescribing exercises for back pain, do you think like that? Do you limit yourself to a small set of primary colours / basic exercises. Do you paint the same picture for each of your patrons / prescribe the same series of movements for all your patients? How often do you invent a new exercise? One that matches what you patient needs and can actually do in their busy, chaotic, resource-limited life.
Picasso?
There’s no science to prove that Picasso was a better painter than Gaugin. Think about that for a moment.
The art world adored Picasso, and still does. Do you love Picasso? I don’t. I love Gauguin. He paints way better. “Prove it,” you might say. Well I just did. I said it. I said I think Gauguin is better. That’s all that matters to me.
What matters to your patient? I’ll tell you one thing, they don’t care how a population of people with back pain responds to a set of exercises. They only care that the advice you give them works for them.
If they’re in our cubicle, they’re not looking for kindergarten advice. There is, in fact a right type of exercise for them. We are the Master. It’s our job to find it, even if we have to grab all our tools, use them in a novel way and make it up as we go.
It's the science. And the art.
Who knows, maybe you’ll turn over a few of those hidden jigsaw puzzle pieces - the ones the researches haven’t proven exist yet. And along the way, don’t forget to be kind, share, and listen.
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