This is a part of the Ultimate Back Fitness & Performance book from Professor Stuart McGill. where he was a professor for 30 years. His laboratory and experimental research clinic investigated issues related to the causal mechanisms of back pain, how to rehabilitate back-pained people, and enhance both injury resilience and performance. His advice is often sought by governments, corporations, legal experts, medical groups, and elite athletes and teams from around the world. 

Exercise professionals face the challenge of designing exercise programs that consider a wide variety of objectives. Consider these guidelines for those with back troubles; performance training guidelines are later in this book:

1. Exercise daily. While some experts believe that exercise sessions should be performed at least three times per week, low back exercises appear to be most beneficial when performed daily (e.g., Mayer et aI., 1985).
2. Exercise must not exacerbate back pain. The no pain-no gain axiom does not apply when exercising the low back, particularly when applied to weight training. Scientific and clinical wisdom would suggest the opposite is true. If the exercise causes back pain, you are doing something wrong.
3. Add walking to the routine. Research has shown that general low back exercise programs that combine cardiovascular components (such as walking) are more effective in both rehabilitation and injury prevention (e.g., Nutter, 1988). In particular, fast walking with an upright torso and arm swing reduces aggravating spine loading.
4. Avoid spine bending after rising from bed. Diurnal variation in the fluid level of the intervertebral discs (discs are more hydrated early in the morning after rising from bed) changes the stresses on the disc throughout the day. People should not perform full-range spine motion under load shortly after rising from bed (e.g., Adams and Dolan, 1995, McGill and Axler, 1996).
5. More repetitions of less demanding exercises will enhance endurance and strength. Low back exercises performed for health maintenance need not emphasize strength with high-load, low-repetition tasks. Given that endurance has more protective value than strength (Luoto et aI., 1995), strength gains should not be overemphasized at the expense of endurance, at least during the first three stages of training detailed in this book. Of course, serious strength training demands far fewer repetitions.
6. No set of exercises is ideal for all individuals. An appropriate exercise regimen should consider an individual’s training objectives, be they rehabilitation, reducing the risk of injury, optimizing general health and fitness or maximizing athletic performance. While science cannot evaluate the optimal exercises for each situation, the combination of science and clinical experiential wisdom will result in enhanced low back health.
7. Be patient and stick with the program. While many people report almost immediate benefits, others with the intransigent bad back will occasionally need patience. For example, success with earlier stages of training to increase function and reduce pain may not be experienced for up to three months (e.g., Manniche et aI., 1988). The good news is that this approach is successful at preventing recurrent acute episodes and disability (Suni et ai, 2006). The corollary to this approach is that when training for performance, gains must be continuous or a program change is necessary.

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