McGill "Big 3" Exercises for Back Pain (2024)

If you’re reading this, odds are you have back pain. It’s estimated that 80% of adults will experience back pain in their lifetime, whether from instability, bulging disc issues leading to sciatica, or compressive damage to the vertebrae or disc.

But this common complaint hasn’t gone unnoticed. Stuart McGill recently wrote his book Back Mechanic to teach those of us with back pain how to fix it at home. (You can check out my synopsis and review here.)

In his book, McGill recommends treating back pain with 3 particular exercises. From my perspective as a physical therapist, I know there is no “one-size-fits-all” routine for back pain; that’s why we PTs always customize home exercise plans for each and every patient.

However, research shows that McGill’s 3 exercises are almost universally safe and effective in reducing back pain. Although the book contains far more information than what you’ll learn in this post, below I’ll share the 3 exercises McGill recommends.

As a physical therapist, I almost always incorporate the last of these exercises when treating people with back pain. But I was surprised by the simplicity and effectiveness of the first two exercises.

3 Exercises for Back Pain (from Back Mechanic)

I recommend performing each of these twice daily: once in the morning and once in the evening around dinner time. Or, choose any two times of the day when you have the energy and stamina to perform the exercises correctly.

1. Modified Curl-Up

The first exercise in McGill’s book is called a modified curl-up.

Despite the name, this exercise is not a sit up. (With back pain, you really shouldn’t be doing sit-ups at all.)Whenever you hear the word “modified” in front of an exercise, that generally means the exercise is a simpler or less challenging version of itself.

To perform a modified curl-up, lie on your back with your legs bent and feet flat. Place your hands under the curve of your lumbar spine. Now extend one leg and keep the other bent.

From here, you’ll perform a subtle movement in three ordered steps:

1. To begin, tighten your abdominals, enough to brace your trunk but not so much that your low back flattens into the floor.
2. Next, raise your elbows slightly so they hover at your sides, keeping your hands under the curve of your lumbar spine.
3. Slightly lift your head and shoulders off the floor, keeping the neck and low back as still and stable as possible.

Hold this position for 10 seconds, then relax into the starting position. Perform 5 of these to start and rest for about 30 seconds.

To build strength with sets, McGill recommends the descending pyramidal approach:

You can alternate legs with each set, but if you have pain on one side, just keep the knee on that side bent.

Now this exercise might seem really simple, but that doesn’t undermine its effectiveness. The point of this exercise is to restore your ability to move pain-free and help you learn appropriate abdominal bracing and breathing. You should feel like you’re doing work, but not break a sweat like you would for a heavy workout (or sit-ups!).

2. The Side Plank/Side Bridge

If you have back pain right now, one of the best stabilization exercises you can do every day is a side plank or side bridge.

To perform the side bridge, lie on your side with your knees bent at 90 degrees. Prop yourself up onto your elbow and hinge your hips forward like you would in a squat.

Hold this position for 10 seconds, rest for 10 seconds, then repeat it 3 to 4 more times on this side. Repeat your set on the other side, resting for 10 seconds in between reps.

As this becomes easier with time, progress to a full side plank, supporting your body from just your feet and elbows. Hold this side bridge for 10 seconds, building up to 6 repetitions.

For a descending pyramid set, try this:

Besides the modified curl up and the side plank, there’s one more exercise you should do every day for back pain, and it’s my favorite: the bird/dog exercise.

3. Bird/Dog Exercise

Start on a firm surface on your hands and knees with your spine in a neutral position. (You may need to perform a couple light cat/cow movements to find where it feels most comfortable.)

Stiffen your abdominals as if you’re bracing for someone to punch you in the gut. With your abdominals tight, lift and extend your right leg and left arm simultaneously. Hold for 8-10 seconds, then alternate arms and legs on opposite sides.

I recommend a descending repetition progression for this exercise also:

If the bird/dog is too difficult, you can modify the movement by standing in front of a chair or countertop. Place your hands on the edge of the chair or countertop and find a neutral spine. Then begin alternating leg/arm raises. With this modification, you can still work on the stabilization component without getting down on the ground or stressing your knees.

Otherwise, to make this exercise more challenging, try “sweeping the floor” – raising and lowering your arm and leg in a continuous, smooth motion. Just be sure to keep your spine from twisting or rotating as you add this kinetic element.

Exercises for Back Pain: Be Consistent!

In his book Back Mechanic, Dr. McGill recommends balancing out each movement with the alternate side, so that you’re always doing the same number of repetitions twice. This will help you maintain a balanced approach to each exercise.

Finally, the most effective element you can bring to your back exercises is consistency. As you work on the curl up, side plank, and bird dog, be consistent in your reps, sets and routines. Work on them daily and diligently, and you’ll be sure to see good results.