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Uncovering the Benefits of the McGill Big Three Exercise Protocol for Low Back Pain Relief

One of the leading causes of years lived with disability is low back pain.

In my 20 years working with patients as a Physical Therapist, the number one diagnosis has been low back pain. Although there are many causes of low back pain, disc bulges are a common cause. Research studies have found that Physical Therapy has better results in managing pain and helps you avoid surgery. Physical Therapists follow evidence-based guidelines to prescribe exercise, one protocol for disc bulge/low back pain is the McGill Big Three Low Back exercises.

What are the McGill Big Three Low Back Exercises?

Dr Stuart McGill, Professor Emeritus of Spine Biomechanics at the University of Waterloo, Canada found in his research that improving endurance is important in managing low back pain. He designed the McGill Big Three to improve endurance to return you to activities of daily living and activities that you enjoy. These are:

  1. Modified Curl-up

  2. Side plank

  3. Bird Dog

Number One: Modified Curl-up

First, lie down on your back with your knees bent. The most important is to stabilize in a neutral spine.

Place one hand in the arch of your lower back. This gives you pressure feedback from back-to-front stabilization. Take the other hand and push it into your side. Take a deep breath that pushes outward to the sides (not pushing belly up). Then tighten your abdominals. Slightly raise your head, this helps further spinal stabilization. Complete short breaths out to increase work on the muscles. Hold for 10 seconds and slowly bring your head down to rest. Begin with 1-10 reps.

Number Two: Side Plank

Breathe and brace your abdominals like you did for the Modified Curl-up. Begin with the elbow bent directly under the shoulder, knees bent and together, and progress to straight legs. When you do the straight-leg plank, align your ankle, hip, shoulder, and head in the same plane (avoid letting your shoulder and head pull forward). Hold for 10 seconds and begin with 1-10 reps on each side.

Number Three: Bird Dog

Begin on hands and knees, hands below shoulders and knees directly below hips. Stabilize your spine with abdominal bracing and then extend one leg back and the opposite arm forward. Hold up to 10 seconds and complete 1-10 reps. You may have to reset your abdominal bracing between each repetition. Do the same for the other pattern of either right arm and left leg or left arm and right leg. One pattern may be weaker than the other, adjust your hold and reps if this is the case.

It is best to begin exercises with proper instruction to limit improper technique or form contributing to pain or other symptoms. That is why you need to schedule with me. Please go to

#Live Inspired,

Karen Baltz Gibbs, PT, DPT, CSCS, LMT, CMP, Owner Garage Training & Rehab Gym


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