If you've ever had low back pain, you've probably heard some version of "it's all in your head." Maybe a well-meaning friend told you to just relax. Maybe a clinician suggested your pain was primarily psychological.
Dr. Stuart McGill disagrees. As one of the world's foremost spine biomechanists — with decades of research at the University of Waterloo and thousands of clinical cases — he's spent his career demonstrating that most back pain has real, identifiable mechanical causes. And more importantly, that understanding those causes is the first step to managing your pain.
Your Pain Is Real
The trend in recent years has been to frame chronic back pain as a brain problem — a matter of neural sensitization and catastrophizing. While psychological factors absolutely play a role in pain perception, Dr. McGill argues that dismissing the mechanical component does patients a disservice.
Most back pain comes from specific movement patterns and how you manage load on your spine throughout the day. There are real tissues involved, real forces at play, and real strategies that can help.
"Find the cause. Every person has specific movements, postures, or loads that trigger their pain. Identify those triggers, remove them, and then you can begin to build a foundation for recovery."
— Dr. Stuart McGill, Reason & Wellbeing
Pain Triggers Are Personal
One of Dr. McGill's most important insights is that back pain triggers are individual. What hurts one person may be perfectly fine for another. The key is identifying your specific triggers.
He broadly categorizes pain into two types:
- Flexion intolerant — Pain gets worse when you bend forward, sit for long periods, or round your spine. This is the more common type.
- Extension intolerant — Pain increases when you arch your back, stand for long periods, or walk downhill. Often associated with spinal stenosis.
These two types require different management strategies. An exercise that helps a flexion-intolerant person may worsen pain for someone who is extension-intolerant. This is why generic advice like "just do yoga" or "strengthen your core" can sometimes make things worse.
Spine Hygiene: The Morning Rule
Dr. McGill emphasizes what he calls "spine hygiene" — daily movement habits that protect your back. One of his most practical recommendations involves the morning.
Your spinal discs absorb fluid overnight, making them taller and more pressurized when you first wake up. This means your spine is most vulnerable to bending and twisting injuries in the first hour after getting out of bed.
His advice is simple: avoid bending and twisting under load in the morning. Don't rush to touch your toes, deadlift, or heave heavy objects right after waking. Give your discs 30–60 minutes to normalize.
Other spine hygiene habits include:
- Don't sit for more than 50 minutes without standing and moving briefly
- Avoid combining bending and twisting when lifting anything — keep the load close and your spine neutral
- Be mindful of your posture transitions — how you get in and out of chairs, cars, and beds matters more than your static posture
Core Stiffness, Not Just Core Strength
You've heard "strengthen your core" so many times it's lost all meaning. Dr. McGill draws an important distinction: what protects your spine isn't core strength — it's core stiffness.
A strong core that activates too slowly won't protect you during a sudden movement. What matters is your ability to brace and stiffen your trunk instantly to create a stable platform for your spine. Think of your core muscles as the guy wires on a radio tower — they need to be taut and responsive, not just strong.
His recommended exercises for building this kind of protective stiffness are refreshingly simple:
- The curl-up — a modified crunch that spares the spine
- The side plank — builds lateral stiffness
- The bird dog — trains anti-rotation and coordination
These three exercises, done consistently and with proper form, build the kind of core stiffness that can make a real difference in daily life.
Walking Is Medicine
Walking is one of the best exercises for back health. Dr. McGill recommends it frequently, and the research supports him. Walking gently loads the spine in a rhythmic, symmetrical pattern that can help reduce pain and improve function.
For many people with back pain, the best starting point isn't a gym program or a stretching routine. It's a daily walk — building duration gradually and paying attention to what feels right for your body.
A Note on Surgery
Dr. McGill is direct on this point: surgery should be a last resort. In many cases, patients who find and eliminate their specific pain triggers, build protective core stiffness, and practice spine hygiene can manage their pain without surgical intervention.
That said, he's equally clear that some conditions — like certain types of stenosis or nerve compression — may ultimately require surgery. The key is to exhaust conservative approaches first and work with a clinician who understands spine biomechanics.
The Long Game
Back pain management isn't a quick fix. It's a practice — a set of daily habits and awareness that you build over time. Taking care of your body is a long-term commitment, and your spine rewards consistency above all else.
If you're dealing with back pain, start by observing your triggers. Notice what positions, movements, and times of day make things worse. That self-awareness, combined with the principles above, can be the foundation for real, lasting improvement.
Frequently Asked Questions
Should I avoid all exercise if my back hurts?
No. Complete rest often makes back pain worse over time. The goal is to find pain-free movements and build from there. Walking is usually well-tolerated. Avoid exercises that reproduce your specific pain, and gradually expand your movement repertoire as your tolerance improves.
Is stretching good for back pain?
It depends on your pain type. Flexion-based stretches (like touching your toes) can worsen pain for people who are flexion intolerant — which is the majority of back pain sufferers. Stretching the hips and hamstrings through other means may be helpful, but aggressive spinal stretching is often counterproductive.
How do I know if I need to see a specialist?
Seek medical attention if you experience numbness or weakness in your legs, loss of bladder or bowel control, or pain that is severe and unrelenting. These may indicate nerve compression or other conditions that require professional evaluation. For persistent pain that doesn't improve with self-management, a clinician experienced in spine biomechanics can help identify your specific triggers.
Are standing desks better than sitting for back health?
Neither prolonged sitting nor prolonged standing is ideal. The best approach is to alternate between positions throughout the day. Dr. McGill recommends changing posture every 30–50 minutes. A sit-stand desk can be useful, but only if you actually use both positions regularly.
Written by the Coastline Longevity editorial team, drawing on Dr. Stuart McGill's four-part conversation with Dr. Greg Potter on the Reason & Wellbeing channel. This article is for educational purposes and is not medical advice. If you are experiencing back pain, consult a qualified healthcare provider.
