Question 1

Severe Stenosis and Spinal Stimulator Implant - Will McGill Method Have a Positive Impact?

Dan · Accepted Answer

I am a 60 year old male with severe Stenosis who had a Spinal Stimulator implanted 3 years ago to manage the pain from the cocktail of bulging discs, scoliosis and stenosis. As a result my hips have shooting pain and my question is this : Since I have the Spinal Stimulator will the McGill Method still have a positive impact on my pain and lack total mobility?

Hi Dan,

Thank you for your question. Many patients have disc bulges and scoliosis without pain, but severe stenosis can be difficult to treat. There are 2 main types of spinal stenosis, 1) Central Canal Stenosis, which is stenosis or narrowing of the area where the spinal cords travels down the spine and 2) IVF or intervertebral foraminal stenosis where the nerve root from the spinal cord exit the spine (either right or left side) and can be pinched causing stenosis and of course a patient can have both at the same time.

A key differentiator if the McGill Method will be beneficial is if your symptoms fluctuate. Do you have good and bad day or weeks or months? If your symptoms are always strong no matter what position, posture or loads you experience and if the stenosis is causing frank compression on the neural tissue (either spinal cord or nerve roots), then the McGill Method may not provide significant relief as the main problem is the physical compression of the nerve tissue which is typically relieved by a surgical procedure euphemistically called a "Rotor Rooter" procedure where the surgeon decompression the compressed nerve tissue by a variety of means.

However, if the patient notices changes in severity of symptoms, both getting better and worse with various postures, movements and loads, then the McGill Method has a good change to intervene.

Many patients do not receive a detailed history, physical examination or taught to move in a way to load the spine optimally and bio-mechanically correctly. Patients are often given generic exercises, stretches, medication, and recommended surgical procedures for their symptoms, but rarely are the specific postures, movements and loads that hurt and provide relief ever discovered. This is one reason the McGill Method is 3 hours long, much longer than most if not all doctor visits especially specialty doctors who often rely exclusively on imaging.

We often recommend a 30 min. Zoom consult to discuss your case in greater detail and to help you determine if the 3 hour McGill Method in-person consultation is right for you. Hope this helps and thank you for your question.

Dr. Kai Tiltmann, DC

Question 2

What is the difference between a McGill Master Clinician and a McGill Certified Provider?

Kai · Accepted Answer

This information is directly from the Backfitpro.com website from Professor Stuart McGill.

McGill Method Master Clinician

A McGill Method Master Clinician is an elite clinician who has demonstrated clinical competency with patients. Becoming a “McGill Method Master Clinician” requires candidates to first become McGill Method Certified. They must also possess a clinical degree, pass the Master Clinician exam having both written and live patient components. McGill Method Master Clinicians will be actively referred patients from Professor McGill and passively referred patients from the Backfitpro website and other sources.

Achieving the status (McGill Method Master Clinician) is rare and has a very high standard. Professor McGill’s work over the years has shown that back pain has a cause. The cause may be quite simple in terms of mechanism, or it may be very complex. There are often elements of mechanics, neurology, personality and psychology, anatomy, load exposure, age, and social forces, to name a few. Some patients have several mechanisms that may be independent of one another or they may feed into one another. Nonetheless a thorough assessment will reveal the pain mechanism. Obtaining an understanding of the pain mechanism guides the approach to wind down the pain sensitivity as the first priority, followed with a plan to build a foundation for pain-free activity.

A McGill Method Master Clinician has competence to conduct the assessment and execute the therapeutic plan. Professor McGill has confidence in their abilities demonstrated with an exam and an in-person observation of their assessment skill abilities. Backfitpro Inc, will list McGill Method Master Clinicians on the website (www.backfitpro.com/backpain/master-clinician) and will refer patients to them.

A McGill Method Master Clinician patient:

Has failed several clinical approaches and upon leaving the assessment will:

Understand their pain trigger mechanism
Clearly understand what to do to allow pain de-sensitization
Clearly understand how to build a foundation for pain-free movement
Clearly understand some progressions and milestones
Have a report with a precise diagnosis (most of the time) sent to the referring clinician with a recovery plan
Have read Back Mechanic
Have a follow-up contact to quantify efficacy

A McGill Method Master Clinician:

Performs an assessment that reveals the pain mechanism
Has the skills to coach the patient to understand their pain trigger mechanism
Has the skills to coach the movements that allow pain de-sensitization, followed with how to build a foundation for pain-free movement
Prepares a report with a precise description of the pain mechanism (most of the time) sent to the referring clinician with a recovery plan
Is competent with the material in Low Back Disorders (3^rd Edition)
Has a follow-up contact with the patient to quantify efficacy
Will be listed on the Backfitpro.com website as a McGill Method Master Clinician
Will be referred patients from prof McGill and Backfitpro Inc.

Qualification process

Pre-requisites: A McGill Method Master Clinician candidate will have been a delegate attending McGill 1, 2 and 3 level courses. They have a clinical qualification such as PT, MD, DC, DO. They will have obtained certification in the McGill Method and will have practiced as a certified clinician for several years.

Candidates must spend some time with Professor McGill, Dr Ed Cambridge or Joel Proskewitz seeing patients. This will hone skill in assessment technique to converge on a precise understanding of their pain mechanism(s). Also coaching skills will be enhanced to migrate tissue loading that desensitize pain mechanisms and build a foundation for pain-free activity.

A candidate will be invited to apply to Backfitpro Inc. to begin the exam process. Copies of the last 5 consulting reports shall be submitted for review togther with patient followup results. Following this they can obtain a qualification exam time. The exam will consist of a written portion together with a member of the assessor staff observing an assessment session with a real patient(s). There is a fee for the taking the exam to cover patient admin costs, insurance, evaluators time etc.

There will be a continual audit normally conducted every 4 years.

Evaluation

Backfitpro’s assessor staff will evaluate each candidate’s effectiveness to assess a patient, converge on a precise diagnosis, create a recovery plan and teach and coach a patient on movement and exercise technique. The candidate will be evaluated via a written exam and practical hands-on session using the following three criteria/competencies:

Competency with foundational material: Candidates will be quizzed on material contained in the three McGill courses and textbooks (Low Back Disorders, Back Mechanic and Ultimate Back Fitness and Performance);
Assessment competency: Interpretation of the patient from the interview portion, and skill in conducting pain provocation and converging on pain reduction strategies, and building training capacity;
Teaching-coaching competency: The ability to effectively communicate the essential elements of movement appropriate for pain desensitization and pain-free ability enhancement. The candidate recognizes the learning style of the patient/client and coaches appropriately.

McGill Method Certified Practitioner

“McGill Method Certified Practitioners” have completed the McGill Method clinical courses and passed a knowledge competency test. They are listed on the Backfitpro website to assist back-pained patients looking for practitioners practicing the McGill Method. Certified practitioners are not intended to address people with substantial back pain mechanisms. Such people are directed to the McGill Method Master Clinicians. 1. Study the content in Dr. Stuart McGill’s books Back Mechanic, Low Back Disorders (3rd Ed.) and Ultimate Back Fitness and Performance (6th Ed.). You must demonstrate competence in interpreting the assessments of motion, posture, loads, and tissue specific tests such as hips, SI joints, and nerves. 2. Attend a McGill Method Summit: this includes 48 hours of online modules + 3 days in-person with Stuart McGill at Backfitpro HQ. 3. Review the study guide 4. Apply to take the McGill Method certification exams: See application button at the bottom of this page. This includes a short interview over video call before being invited to write the exams. You can consider this a job interview since you will be referred clients from Backfitpro and in turn, Backfitpro requires appropriate representation. 5. Take the McGill Method Certification written exam: This written exam will be administered online and composed of a series of short answer questions. The written exam is worth 45% of your McGill Method Certification grade. 6. Submit the McGill Method Certification practical exam. The practical exam requires a video submission of a full patient assessment. You must demonstrate competence in interpreting the assessments of motion, posture, loads, and tissue specific tests such as hips, SI joints, and nerves. If you want the best outcomes for your chronic low back pain, consider seeing a McGill Method Master Clinician.

Question 3

Why is the McGill Method 3 hours long?

Jeff · Accepted Answer

Many patients with low back pain are treated by various physicians, therapists and practitioners to address the source of the pain, treat symptoms and hopefully resolve the low back complaints. Often, the traditional health care system is effective and the patient gets better and moves on with their life. This is especially true if the problem is soft tissue - muscle, ligament or tendon injuries (not so much for disc injuries)

However, when patients develop chronic low back pain (frequently from disc injuries), these same treatment interventions often provide only temporary relief and the condition does not fully resolve resulting in episodic, severe, flare ups with relatively minor forces or trauma (like bending over, or picking something up off the floor). Part of the problem is that physicians don't have the luxury to spend the time they need to properly and thoroughly evaluate the patient to determine why they have not improved and why the condition has become chronic instead of resolved. The McGill Method is different in that regard, because we know that chronic low back pain cases are not typical, have failed traditional treatments, require a detailed and in-depth look at potential cases and remedies that will allow the spine to heal.  Therefore, the McGill Method is a 3 hour visit that is roughly divided into 1 hour segments where:

1) A detailed history (including review of intake forms, imaging, and learning about the patients story including what worked and what didn't) is conducted to help determine why the patient is continuing to suffering in the first place. Many patients with chronic low back pain have inadvertently caused their own problem with how they move, work, or workout. If the cause of the problem is not determined, the likelihood the patient will recreate the injury mechanism is high once the symptoms have resolved.

2) After the history, a detained physical examination is conducted  to determine which movements, postures and loads are both relieving and aggravating. This will help determine the rehabilitation phase in part 3. However, many patients report that the physical examination they receive from other providers is either very rudimentary, or non-existent as the physician is trying to determine the cause of pain from MRI or other imaging.

3) Part 3 is movement competency and proficiency. How the spine is moved, loaded and used will have a major impact on its ability to recover. Typically, more therapy is not the answer because if it were, the patient would not have chronic low back pain in the first place as all kinds of therapy has already been received and failed to provide long term relief.

Patient education is a big part of the McGill Method which empowers the patient to have the tools necessary to recover without the need for ongoing therapy and treatments. Many chronic low back pain conditions can resolve on their own if the patient knows what to do and not do and why. This critical information is often not provided by other therapists, which means the patient becomes reliant on the therapist instead of being in control themselves.

Dr. Tiltmann provides a 30 min. follow-up post McGill Method Zoom consult as part of the 3 hour McGill Method session which allows for a recap and further Q & A session. Some clinicians charge extra for that time.

Many McGill Method Master Clinicians, including Dr. Tiltmann, are out-of-network with health insurance, so they are not beholden to or restricted by strict reimbursement limitations and have the time needed to really figure out what is going on once and for all. This can not be done in a 15 minute office visit without a proper history, physical exam and movement coaching session.

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