Reviews

I saw Dr. Tiltmann in New York for a 3 hour McGill assessment in February 2022, which was after I had been struggling with almost constant lower back pain, including regularly reoccurring severe episodes, over the last 2 years. An MRI revealed that I had several herniated discs in my lumbar spine. While my surgeon did not recommend surgery at this stage, he also did not really find any other solution that would prevent severe episodes from reoccurring.   
 
I had read Dr McGill’s book (Back Mechanic) about a year ago. And while I had understood the main ideas behind it and had been doing the exercises almost daily, it still made a huge difference seeing Dr Tiltmann in person. During the 3 hour appointment, Dr Tiltmann spent an hour explaining all of the concepts and ideas of the method to me, he proceeded then to a detailed physical examination trying to discover all of my pain triggers. And he finished with teaching me the exact form of how to do the McGill Big 3 exercises. He also patiently answered all of my many questions both during the appointment, and during a follow up zoom call 2 weeks later.  
 
It turned out there were several crucial aspects of the McGill exercises that I was not quite doing correctly, because I never had anyone look at me doing them before. Dr Tiltmann walked me through the exercises in great detail, and took videos of me performing them correctly. I also learned a lot about how my movement patterns will have to change, how I have to stand up and sit down by focusing much more on hinging my hips. Dr Tiltmann really made me understand the concept of thinking of the back like a savings account, where everything I do has a cumulative effect. It turned out that I was probably doing too much too soon after each of the latest severe episodes, and I never really allowed my back to heal. 
 
All of this has already made a significant difference just in the last 3 weeks. I have less pain, and the sciatica is almost gone, since I am much more careful and focused on my movements, but also much more disciplined with doing the exercises, without overdoing it.  
 
But I think the biggest impact of seeing Dr Tiltmann for me was psychological. For the first time in 2 years I feel that I am in control of my own destiny, rather than being a victim of my back injury. For the last 2 years I had been thinking of my back issue more and more as a disability I would have to live with, whereas now I feel really confident that it is something that can heal and it is largely up to me to make that happen. 
 
I am very grateful that I saw Dr. Tiltmann and have already recommended him to several of my friends who also struggle with lower back pain.

Georg Georg is a 53-year-old, 6’2” 180 lbs. male who flew in to see me from Hong Kong. He had 2 major low back events in 2015 and 2019, but the most significant was in 2020 while carrying some heavy boxes.

I was very pleased with the consultation and especially the time you take in discussing, assessing, and explaining what the problem is and how to fix it. This is essential in the patient trusting your diagnostic and so different from the appointments with orthopedic surgeons who spend 5-10 min with their patients. And it also makes more sense, in my case, as it takes time to figure out why the symptoms kept changing and why my issue hadn't been resolved despite all the different prescriptions from previous doctors.

I would recommend anyone who has back problem to spend the money to go see a McGill trained medical professional over a traditional orthopedic surgeon.

Thank you,

Cyril Cyril is a 44-year-old, 6’, 165 lbs. male and was a CrossFit athlete and injured his back with deadlifting 4 years prior to the McGill Method assessment.

Dr Tiltmann,

I’m writing to say thank you.

I saw you two weeks ago, participating in your 3 hour review.

Prior that that review, I’ve been experiencing pronounced – often debilitating – backpain
for nine months.  In that period of time I’ve consulted with several back doctors at the
well known HSS in New York; a handful of PTs; a handful of manual therapists; acupuncture; etc, etc.

Having completed the McGill Method I have a dramatically improved understanding
of how to maintain neutral back.  This is true for basic positions like sitting, and also true
for more complicated positions involved in sports.

I appreciate the big 3 exercises and have found a nearly immediate improvement from
performing them daily.

You are a pro. I appreciated the zoom call we had prior to the 3 hour session.  I also
appreciated your follow-up today, during which time I was reminded of a few important points I was likely to have otherwise forgotten.

I will be recommending you to others with back pain.

Best regards,

Greg Greg is a 48-year-old, 6’2” 182 lbs. male who suffered a back injury from skiing two years before his McGill Method but has a 20-year history of back pain. Recently receiving 2 epidural injections with minimal improvement.

I wish I read this book [Back Mechanic] when I first had back pain.

Back pain eliminated skiing, backpacking, and my passion of mountain photography for the last 2 years. Those possible memories are gone.  I am a respectful fan of modern medicine and physical therapy, but it was making things worse (!) and my mind drifted to sadness. Dr. Stuart McGill has spent over 30 years listening to, observing, physically touching (like a mechanic on a car), following up with, and coaching back patients. Dr. McGill has been militantly critical of his own conclusions.  Absolutely regardless of the cause of your pain, insights from Stuart will at least help you navigate to heal quicker, or at best like me, back to normal and clear on what motions can get me out of the dark trail to the hell cave of back pain. Now I am looking forward to backpacking this summer.

David David is a 50-year-old, 6’2”, 216 lbs. male with a 2 year history of back pain from “forward slouching of torso”. Extensive treatment included 2 PRP injections, PT, Rolfing, Medication, Acupuncture all without significant improvement.

Finally, some answers!! After 10 years of chronic back pain, hundreds of PT, chiro, and needling visits, countless Pilates and yoga classes, FINALLY, I know what the heck is wrong with me!

It’s astounding how difficult its been to find the answer to my back pain. Everyone I had seen prior to Dr. Tiltmann was treating my symptoms, and most, if not all, lacked a true understanding of the root of my pain. How do you get better if you don’t know what is wrong with you? The answer is: you don’t! You go nuts and get depressed and resolve yourself to a lifetime of pain. For the first time in 10 years, I have hope that I will one day be pain free. The road is long, and hard for anyone who walks it, but hope is a wonderful thing. Thanks Dr. Tiltmann for giving me direction, and hope.

To any of you suffering, hang in there!!

Thanks again Dr. T!

Thomas Thomas is a 28-year-old, 6’2”, 175 lbs. male with a 10-year history of low back pain after waking up with excruciating pain and a new symptom onset of sciatica 3 weeks prior to the McGill Method.

Hi Dr. Tiltmann,

So, I have to tell you, it took some time (no surprise there!) but I'm doing great.

My back is almost fully recovered.  I took a new job as Tech Director for 2 schools so I fell off the DAILY exercises, but it doesn't take long to get back to almost perfect.

I can't thank you enough.

As an aside, my husband is using the McGill method in his practice and HIS patients are also doing much, much better!  He has found that he sees them much less after they learn what they need to do and how to maintain. But he sees that as a win/win despite the hit to revenue. It's the right thing. Why doesn't the whole world know this? My surgeon was completely baffled at how it helped me.

Many thanks, HUGE thanks,

Trena Trena is a 57-year-old 5’4”, 170 lbs. female with a 3 year history of back pain post surgical fusion of L4/L5. She is married to a chiropractor.

It is difficult to overstate the value of a McGill Method appointment with Dr. Tiltmann. I have had constant back pain for a year and a half. During that time, I have seen various doctors, completed physical therapy, and undergone a series of treatments--all of which did nothing to help my pain. After extensive research, I determined that I needed to see a doctor well-versed in the work of Dr. Stuart McGill, and I was very impressed with what others had to say about Dr. Tiltmann. I was not disappointed.

Dr. Tiltmann was the first doctor I have seen who took the time necessary to actually determine what causes my back pain and to coach me so I can work to improve it. Had I not seen him, I'm certain I would have bounced from doctor to doctor without improvement, given up, and resigned myself to surgery with little assurance that it would succeed.

Generally, my prior experiences with doctors have been positive. But when it comes to back pain, I found only disappointment after disappointment, as doctors seemed to give me a few minutes of their time, a prescription, and some generic advice that I could have found on YouTube. (And some of that advice even made things worse!) This can be a disheartening and rather lonely experience for someone living in constant pain. Dr. Tiltmann restored my faith that someone out there could guide me toward recovery.

I recommend that anyone dealing with ongoing back pain see Dr. Tiltmann as soon as possible. His care and expertise are unparalleled.

Allison Allison is a 35-year-old, 5’6”, 154 lbs. female working as an attorney with gradual onset of constant burning central low back pain, but deep squats and other incorrect performed exercises appeared to be the cause of the onset of her spine damage 1.5 years before her McGill Method visit with me. Her MRI is unremarkable.

Even though I read the book and had a lot of faith in the McGill Method based on what I'd read, prior to the evaluation I was not feeling very optimistic because I was unable to self-diagnose using the steps in the book, and the prognosis from the spine surgeon I saw beforehand was depressing (basically "your discs are degenerated now and since they don't heal you need pain management").

Hope flared once Dr. Tiltmann started doing the evaluation: ironically the most painful test, which seemed to confirm my disc mobility issues, made me feel the best because it seemed like a specific diagnosis. Once Dr. Tiltmann explained how my activities had contributed to my condition over the years and what steps I could take to recover, I was very happy. It was a revelation to learn that my yoga practice was sabotaging my weight lifting and hurting my back. That, along with learning that I had deep hip sockets that limited my healthy range of motion (such a small difference of a few degrees between health and chronic damage!), was probably the most valuable thing I took away from the evaluation. Dr. Tiltmann was also extremely patient and answered my endless questions when we were going through the movement training and subsequent Q&A.

I found this experience to be extremely valuable and worth every penny.

Phil Phil is a 35-year-old, 5’11”, 175 lbs. male with a 6-month history of gradual onset of left low back pain debilitating enough that he couldn’t stand for more than a few minutes. 10 years prior he torn a disc during martial arts training.

Dr. McGill, thank you so much for advertising where you have McGill Certified Master Clinicians! I have always checked your website and thankfully saw an Instagram post of Dr. Tiltmann seeing people in Austin, TX and got to see him that same week. I read Back Mechanic and Gift of Injury, and while I was still able to lift and keep pain to a tolerable level for a few years, I've still had some missteps here and there and never been able to fully heal. The assessment dove into the finer details that I never knew about. I definitely needed it to be able to identify my instability and give me the tools to feel better. It's been 3 days since the assessment and I've been able to avoid small dull pains and normal mistakes outside of the gym that have plagued me for years that I couldn't recognize on my own or just with the books. Dr. Tiltmann was very professional, prompt, understood my issues and gave me the experience I was looking for and knew I could trust. I finally have full confidence that I can get back to my best thanks to Dr. Tiltmann. Thank you both for the work you do in providing world class service and information, it's been a 6 year journey trying to figure these things out.

Best,

Marcus Marcus is a 28-year-old, 5’10”, 180 lbs. male with a traumatic back injury from repeatedly deadlifting 300 lbs. which caused a loud crack in his low back resulting in a shifting of his spine followed by pain and radiating stabs into both feet. It was 1.5 years from the injury after extensive conventional treatment failed.

Dear Dr. Tiltmann,

I want to thank you once again for the thorough assessment and evaluation of my undiagnosed back pain last month. The outcome of our session was the first time I was able to believe an opinion about my back pain due to your systematic and careful approach to my problem. Every other doctor, chiropractor, or physical therapist had opinions but could not back it up with anything more than a general idea of the causes.

I was especially pleased with your ability to trigger the pain sensation while draped across the table. You were the first clinician to perform that test and I felt like you identified the precise locations where my pain was emanating from. I was also pleased that you eliminated a number of other causes that were concerning to me.

I am still moving very cautiously to avoid activating the sharp pain, but resigned to making daily “deposits” and limiting the “withdrawals”. I am somewhat disappointed that the recovery time is so long, but very grateful I won’t need surgery or suffer permanent damage if I follow your plan to heal the problem.

I’ll follow up with you in a couple months with a progress report.

Thank you again, and best regards,

Marty Marty is a 59-year-old, 5’8”, 200 lbs. male with a 10-year history of nagging low back pain, then when bending forward one day he felt a severe stab in the low back resulting in an ER visit and MRI (unremarkable). He was treated for 1.5 years before seeking the McGill Method.

I thoroughly appreciated and learned from the consultation. Dr. Tiltmann did a great job helping me diagnose the main problems with my back (namely, that I keep lifting beyond a safe range of motion) and offering targeted solutions. I have a good sense of what I need to do to recover and was able to ask all the questions that came to mind. I feel motivated to follow through. Dr. Tiltmann clearly listened to my particular issues, understood them deeply, was extremely responsive, cared, explained everything patiently and in detail, and tailored recommendations to my health status and goals.

This can be contrasted significantly with the first orthopedist I dealt with, who essentially told me to never move again, and suggested fusing my back (as a healthy 25 year old), as well as with physical therapists and chiropractors who offered generic advice or advice that seems discordant with the nature of the back. I feel like I'm on the right track!

Alexander Alexander is a 33-year-old, 5’8”, 150 lbs. male with a traumatic (and most recent) back injury from heavy squats (personal record).

It’s been a little over a week since my meeting with Dr Tiltmann in Denver. I have implemented the different movement patterns since my appointment and am having success, so far. I understand more about the McGill Method and how I can avoid harmful movement patterns as well as dialed in the Big 3 exercises to help build stability in my lumbar spine. It was helpful to review my history and speak of triggers that may be causing issues. The evaluation was particularly informative with the comprehensive investigation of many positions and forces the spine reacts to. I learned to implement the brace to avoid pain and protect the neutral spine.

Dr. Tiltmann clearly enjoys what he is doing and has a broad knowledge base. His awareness of the McGill Method is solid and he is able to communicate clearly and encourages questions throughout. I have had low back issues for years and have tried steroid and PRP injections as well as physical therapy and chiropractic. I realized no matter what I did, if I did not change my movement patterns, I would never build capacity and would always be at the whim of straining my spine in the simplest movement or in over exerting myself. I am an avid skier, horseback rider, cyclist, hiker and over all adventurer. I have reached a point where my back injury continues to limit my life. Enjoyment of activities has been impacted by pain for years. I am hopeful with the Big 3 and slow progression of exercises supporting stability, while allowing my injuries to heal, I will fully regain my active lifestyle and be pain free. Onward!

Lee Lee is a 55 year old 5’2” 120 lbs. female with a long history of low back pain and trauma, with a gradual worsening and persistence of her low back pain over the past 6 years

Thank you, Dr. Tiltmann - It was a blast meeting with you and I so appreciate your genuine concern and generosity in sharing your knowledge with me. For the first time in a while I'm hopeful I can put this back issue behind me for good.
As an active adult, it is not unusual for me to sustain various knocks, bruises, even injuries. Regularly playing indoor soccer I've torn my calf, MCL, and even suffered a sports hernia. All were acute, painful injuries that fully healed with contemporary approaches such as physical therapy. Not so with my back.

One day, doing deadlifts with my wife (admittedly, with poor form and too much weight), I felt an odd twinge in my lower back. The pain was minimal though I knew enough to stop the activity. Within a couple of days my back started getting sore from even slight activity that never bothered it before. That was over 2 years ago.

Rest, exercise, coaching and improved weightlifting form, a sports medicine specialist, two bouts of physical therapy, an SI injection, and a variety of other ancillary and home care modalities have led to absolutely no improvement. Things do not really get worse. They certainly do not get better.

Resigned to a life of almost constant back pain my wife discovered Dr. McGill. We read the book and by pure chance discovered Dr. Kai Tiltmann, a certified McGill Method practitioner who happened to be opening an office in Denver, about 40 miles from my home. I signed up and met with him just last week. I am eternally grateful I did.

Dr. Tiltmann showed a level of concern, curiosity, and compassion I have not encountered in a medical experience outside the 20-year relationship I have with my family doctor. His warmth and generosity of spirit made me immediately comfortable with him.

As we dug into the history of my back issue his insight really shined through. I'd share something offhand and he'd quickly see - and share - a perspective relating to the injury I had never considered. His questions were poignant and the way he explained complicated medical biomechanics showed his deep knowledge and his acumen in 'making the complex, simple'. By the end of the first hour, having spent the entire time discussing my history, I felt I had a keen understanding of my situation beyond anything I'd had before.

The second hour, in which he ran me through tests, was both thorough and informative. He did an excellent job explaining everything he was doing and being certain I understood the test, its purpose, and his findings.

In the final hour, Dr Tiltmann showed me a wide variety of both generalized and personalized back hygiene practices. He was sure to walk me through and demonstrate everything in a way that built confidence. As I left the appointment, I knew I had all the tools I needed to rebuild my comfort - and, in some ways, my life.

My experience with Dr. Tiltmann has provided me a new hope. Resignation has been replaced with optimistic determination and I am certain the knowledge and tools he shared with me will contribute to a fully healed, healthy back in my future. I am deeply grateful for him and the wonderful work he does.

Dr. Tiltmann possesses a mix of ingredients so rare in modern medicine, in my experience - knowledge, wisdom, and authenticity. He is both an excellent practitioner and excellent human being. He absolutely has my highest regard and I would sincerely recommend him to anyone suffering from apparently 'untreatable' back problems.

Josh Josh is a 43 year old 5’9”, 155 lbs. male who injured himself two years ago while deadlifting with poor form. He received multiple treatment interventions without any long term relief.

Hi Dr. Tiltmann,

Thank you for meeting with me and writing the report so quickly. I'm thankful we were able to meet on such short notice. This was the most in-depth back evaluation I ever had. I'd say this was the best experience I had in the last 5 yrs. of meeting with multiple providers. I was impressed with the effort and the clarify in the evaluation. I thought the evaluation was designed for the purpose it was conducted and the exercises and movement coaching appeared to be connected to the assessment. I was impressed that what I was hearing appeared to connect to actual science and data. Being able to film and review what I need to do in the future was very beneficial. I will know more as I move forward.

In the future, I'd love to be able to point to this as a process that led me to heal. I felt this was the first time that I met with anyone that had expertise regarding the low back. Thank you for all your hard work and your willingness to share the information I needed to hear, and your commitment to supporting me as I continue to move forward in this process!

Mike Mike is a 6’6”, 183 lbs. 53 year old male with low back pain for 5 years who was evaluated in Denver.

The experience I had with Dr. Tiltmann was great! Dr. Tiltmann was prompt with his responses and eager to help me. Unlike a lot of other specialists that I've been to, Dr Tiltmann really dove into my history and found out there were certain experiences in my past that could have contributed to my lower back pain. I appreciated that he was straight forward with me and let me know that I have certain limitations because of my anatomy and that I should do what works best for the way that I am built. I was impressed with the detail that he put into the tests that he performed and his explanation of the exercises that I should be doing. I was especially glad that he helped me understand the "Big three" exercises and that he not only showed me how to do them right, but he also showed how to get down to the floor without compromising my spine. I highly recommend Dr. Tiltmann if you want to learn why your back is hurting and what you can do to help correct it.

John John has a history of chronic, episodic, low back pain dating back to 1998. He is a strong 6’4”, 250 lbs. 43 year old male who practices Jiu Jitsu 2x/week.

A posture coach encouraged me to read the back mechanic by Prof. Stuart McGill. I discovered my past attempts of healing and recovering from my low back pain was inadequate. I thought when the pain would was almost gone I was healed and I went on with my usual routine. I was picking the scab and not letting it completely heal as I learned this from Dr. Tiltmann and Prof. McGill's book.

I was seen by Dr. Tiltmann and he spent lengthy amount of time learning about my history of back injury. It was during this intake interview I discovered I really never let it heal completely. Dr. Tiltmann made sure to explore each injury that occurred not just the last injury.

After the detailed history assessment, a full examination followed by Dr. Tiltmann a Master Clinical Clinician using Prof. McGill’s method. It was during this exam that the pain triggers were exposed and my understanding of the mechanism of my injury was now exposed. Dr. Tiltmann took time to show me how my lumbar spine has 3 levels of instability and how the exercises from other practitioners were creating more problems.

Dr. Tiltmann provided instruction on exercises that would help to heal my back. He demonstrated and made sure I could follow correctly the form and also the methods of safely sitting, standing, and lying down.

I arrived not knowing my lower back pain triggers, but left with a complete understanding of my lower back pain. It has only been a week after the exam. I will continue to follow Dr. Tiltmann/ Prof. McGill’s spine hygiene exercises and walking program. I had a follow up video appointment and Dr. Tiltmann answered all of my questions completely.

I have tried multiple posture coaches, Physcial therapy from the hospital, and training coaches. I lost time doing things I love to do and spending time with my family on activities that was limited by my back. I could only wish I would have found Dr. Tiltmann a year ago! It was the very best money spent and a great value. Get your life back and see Dr. Tiltmann you will not be let down!

Robert 52-year-old male surgical nurse with severe low back pain after picking up a bottle cap off the floor nine months earlier. Multiple treatment attempts did not resolve his underlying problems.

Throughout the last 5 years of suffering back pain I have never received a personalized specific assessment of my back pain. All my visits and attempts at rehabilitation through other PTs and chiropractors in my area always led to short assessments and a blanket assignment of exercises (usually in the form of brochures) to perform. I was tired of spending money on being treated without a specific intervention. After coming across Stuart McGill and reading the “Back Mechanic” I came to understand that all back pain is specific and specific pain requires specific interventions. Reading the “Back Mechanic” was incredibly beneficial and had led me to understand my back better than I had in my previous 5 years. Although the book walks you through an assessment, I still felt that the help of someone who was trained by McGill would leave no doubt in my mind that I was performing things correctly and was on the best route to success in recovering from pain. In search for someone that could help me, I came across Dr. Tiltmann – who was able to provide me exactly that.

First and foremost, Dr. Tiltmann was incredibly genuine in wanting to help me, which was something I was always skeptical of from health professionals due to previous encounters with PTs and orthopedic doctors. Dr. Tiltmann answered every question I had and did not mind going slightly beyond the allotted 3 hours to make sure that I was able to ask questions to thoroughly understand the assessment.

After the thorough examination, he was able to tell me what all my pain triggers were and really emphasized the need to eliminate them. Not “picking the scab” is one of the most crucial points in recovery and Dr. Tiltmann was able to drill that point in. He was also able to demonstrate all the movement patterns that I could incorporate into daily life to not further cause damage.

Dr. Tiltmann is incredibly knowledgeable about chronic back pain and can explain the details very effectively. I highly recommend Dr. Tiltmann to anyone suffering from chronic back pain as it really sets you on your path to recovery. Not only because he has the skill and expertise to assess your pain but also because of his ability to demonstrate a genuine care during the assessment itself. Reading the “Back Mechanic” and seeing Dr. Tiltmann gave me both hope and confidence in the recovery that is to follow.

Riddhish 23 year-old-male with 5 year history of chronic back pain from weight training injuries presents with a large L5/S1 disc extrusion (21mm x 11mm x 20 mm) severely compression the right S1 descending nerve root.

I was incredibly impressed with the McGill Method Assessment, in particular the time and care Dr. Tiltmann took in discussing my background and performing the examination. For background, I am a 38 year old male, former professional/university athlete who experienced a major pain episode about three months before the assessment. While I did not have a long history of back pain, I had experienced one other significant pain episode about a year prior. In comparing my MRI (which showed a bulging disc) and performing the hands on examination, Dr. Tiltmann was able to provide me with the most comprehensive assessment of pain triggers and areas of instability I had received. Other doctors I had visited only looked at one aspect of my situation - MRI, response to medication, symptoms, etc. - instead of taking a more comprehensive approach that more specifically identified the root causes. I had a million questions and the structure of the McGill Method assessment, conducted over three hours, allowed me the time to receive answers. As a result, I feel like I have a solid plan towards recovery that is built around the McGill Big Three and other exercises tailored to my specific issues, while understanding movements that would likely cause me pain. I have since recommended the McGill Method Assessment to a close friend suffering for over a year from back pain. This type of assessment - detailed, not rushed, and specifically tailored to the individual patient - is exactly how medical consultations should always be conducted.

Thanks!

Josh Athletic 38 year old male patient with acute onset low back pain with history of sciatica the prior year.

I tell everyone that will listen to me how great your approach and the McGill method was and that it made a huge difference so I’d be happy to provide some feedback. Sadly it seems impossible to get people with orthopedic backgrounds to listen…

I was very impressed by how thorough the approach was and how much time you invested in the examination and diagnostic portion. The contrast to traditional PT and orthopedic appointments, which follow a very strict and hurried process, was evident. Dr. Tiltmann had a diagnostic flow he was were clearly following but happy to collect more evidence and go where it took him rather than a fixed outcome you were trying to justify as quickly as possible.

I learned a lot in the pain trigger portion, it was probably one of the most valuable portions of the session, as I had not previously known I was compression sensitive. The manual exam also correctly identified that I’m starting to have some problems up around T12/ L1 that I’ve become more aware of over time. I believe this is likely due to trying to limit lumbar flexion and having to make it up elsewhere in the spine along with twisting to the right to bend over to avoid straining the left side.

Although I was initially skeptical that some basic ‘spine hygiene’ steps such as modifying how I get up could make much difference it absolutely did. I would say learning to stop aggravating my back was the biggest outcome of the session we had and although it was the portion I enjoyed the least during our session it was the most impactful.

I thought the McGill Method was a great value. However, I also think people are reluctant to invest so much up front and are naturally more inclined towards a pay in small increments as you go type of approach you typically find in PT and that may be a challenge in scaling the model, particularly in more cost sensitive markets than San Francisco. However, for me personally the value was excellent and avoided the need to spread the sessions out across multiple trips. I would absolutely recommend seeing a McGill provider and Dr. Tiltmann in particular to people with back troubles.

One suggestion I’d like to make is partnering with CrossFit gyms to offer an abbreviated McGill program to help detect pending back injuries. I probably had a 6-month window during which I had a disc bulge and failed to recognize the symptoms of sciatica and could have avoided a herniation. A session to teach the basics of back pain, sciatica, hip anatomy and squatting form etc. would be great. This could either be a program for coaches and trainers or something delivered directly to gym-goers. Given this would be focused on prevention and recognition, the degree of clinical assessment could be minimized.

Thanks again

Alex of District of Columbia 35-year-old male with 1-year history of chronic low back pain after Olympic lifting exercise injury.

My core & back feel stronger & more stable than ever, and I haven't had any episodes of spasming since my evaluation with you last June. I've certainly been very proactive in my recovery - religiously maintaining my Big 3 & walking/hiking/jogging routine, which I think has been key. So, I would say my case has definitely been a very successful one, and your evaluation was the critical first step for me - thank you!!!!

I felt you were definitely very thorough in walking me through all steps of the evaluation process. I still can't believe that my knee-to-chest back stretches were a significant pain trigger for me! I was so addicted to my 2x a day knee-to-chest back stretches, and never thought I would actually THRIVE without them! This was a huge "lightbulb" for me, as was realizing that I had significant weakness in my core and key muscle groups that stabilize my back. Going through the "big three" with you was a critical learning process for me...I'm grateful to you for this!

I've already shared my success story and information about the McGill Method and your evaluation with my girlfriend and her young adult daughter, who has some back issues and has been considering surgery.

Thank you, again, for getting me on the path to a healthy back - one I honestly thought would never be possible for me!

Andrew of California 51-year-old male with a 28-year history of chronic low back pain who suffered about 40 severe flare-ups since his low back injury in 1990.

My session with Dr. Kai Tiltmann in December 2018 was paramount to my improvement in back pain symptoms.

Dr. Tiltmann thoroughly took inventory of my back pain history, provided a thorough examination of my pain triggers and included detailed notes about our visit and next steps in a comprehensive report afterwards. Especially helpful were the videos we took during the session that provided physical cues for me to follow in daily movements and the Big 3.

The examination was helpful because when I did a self-assessment at home, I wasn’t exactly sure I was performing it correctly, and Dr. Tiltmann’s clarification and guidance gave me confidence that I was getting the information I needed to evaluate my pain triggers.

The advice he gave me deepened not only my understanding of the causes and mechanisms of my back pain, but also gave me valuable, practical advice on how to adopt movement patterns and recovery exercises that would aid in my recovery.

I felt that my session was extremely helpful and educational and I would certainly recommend. Dr. Tiltmann and the McGill Method to friends and family.

Thanks

John of California 45-year-old male suffering major low back flare-ups every 4-5 years. His back “went out” after forward bending and rotating.

It was quite refreshing having a doctor go through your history with the knowledge base of movements and the accumulative effects of everyday movement to actually pinpoint what happened. The point I thought I had my injury was actually the culmination of years of spinal abuse.

Examination….where do I start. Why don’t doctors take the time to actually figure out when you move this way it hurts? When you move that way it feels better? It is so frustrating to have seen many doctors over 14-15 years and not one of them (chiropractors included) have ever done the type of examination Dr. Tiltmann did. Traditional doctors don’t treat the cause – they treat the symptoms. I felt that Dr. Tiltmann was looking for the cause -- to understand my specific mechanics and hang ups and then help move to the next phase of movement instruction. I was absolutely amazed that all of my specialists never found in 15 years what he found in an hour of moving me around. He also corrected some misdiagnoses from my specialists.

I very much appreciated reading the report because, as mentioned, it is a lot of information to take in at once and try to remember. It was very nice knowing that I had a report coming so I really focused on the visit and talking with Dr. Tiltmann and not trying to remember everything. He was very gracious in letting my husband record the entirety of his exercise instructions to me. Those recordings have been absolutely invaluable because I think I’ve remembered something and it still feels off and I reference the instruction and correct my movements.

I knew I was in for something different on the very first test. The initial movement was uncomfortable and Dr. Tiltmann told me to brace, and then asked how it felt as he went through the movement again. I said the pain was gone. And he got the greatest smile on his face – like he was genuinely happy he was going to be able to help me. I immediately thought he was a rockstar.

I have never really felt like I have ever understood what was wrong with my back before seeing Dr. Tiltmann. Prior to making an appointment with him, I went to see my back specialist after having a flare up and being down on the couch for four weeks. I asked her, “What am I doing that is causing this? What movements am I doing? How am I aggravating my condition? Am I putting my pants on wrong? Getting up off the toilet wrong? What is it?” You know what she told me? My back specialist, who has been doing lumbar back care for 15 years, said, “If I had the answer to that, I would be retired. If I had the magic pill, I wouldn’t be here.” Lovely. My husband and I just looked at each other. Time for a new doctor. She then said she could give me another shot in my back and I said, “what for? So I can be here again in 3 months? No thanks.” It was at that point I went home and started scouring the internet and found the McGill Method. I feel like I am no longer playing a guessing game about when/if my back is going out. I understand my triggers now and do everything I can to avoid it. And if I start to feel things getting a bit off, I now know how to refocus my movements and (hopefully) avoid these major flare-ups.

He was very gracious with his time and absolutely nothing was off-limits. I never once felt like I was being talked at by a doctor. I felt like I was being talked to by a caregiver who had my best interests at heart.

It is worth its weight in gold. I can’t believe how simple being cognizant of our triggers and movements (when you know what those are) can change your life. I have spent countless hours being questioned by my co-workers about what I learned from Dr. Tiltmann and recommended him to a few of my family members and co-workers. I have also purchased a few additional copies of the Back Mechanics to give out. The McGill Method is life-changing. It is the only thing I have ever read that has made any logical sense. It has only been a couple of months, and I am so impressed with the changes I’ve seen in my back and the things I have been able to tolerate that had I done before I saw Dr. Tiltmann would have had me down for a few days. But, like with anything, you can’t be upset with the results you didn’t get from the work you didn’t do. If you are dedicated – changes come. I will follow this program for the rest of my life.

Cortney of Oregon 44-year-old female with a 15-year history of chronic, non-traumatic low back pain.

This was the most thorough examination I have ever received over the course of visiting over 30 other medical professionals including PT, Chiro, Massage, Ortho, Spinal Specialists, Podiatrists etc. The report detailed every aspect of the entire appointment and has been a useful reference throughout the ongoing process.

Dr. Tiltmann identified all of my pain triggers. Before seeing him, I was beginning to finally notice some of them myself, however, he determined even more than I was unaware of. He helped me find positions that alleviated my symptoms in the same way, but finding more than I had found myself. I developed a much better understanding of my specific conditions and the requirements for recovery.

Dr. Tiltmann cleared every sense of confusion about my circumstances that I had developed over the preceding 2 years. He explained thoroughly and logically why I never found relief from every single doctor I had already been to. This in itself was a huge weight off my shoulders and gave me an incredible amount of much needed clarity.

I would recommend it to anyone; even those who just recently had a back-related accident/injury.

Cyrus of New York 21-year-old male with a 2-year history of chronic, severe, low back pain and left side sciatica from injuries sustained while deadlifting and squatting. During the past two years, he received extensive treatment including spinal surgery without reduction or resolution of his symptoms.

I am in my early forties and have been living with chronic lower back pain for almost fifteen years. The level of pain has increased slowly every year, however during the last few years it's gotten bad enough where I realized I had to do something about it. I can't even begin to recount all the things I've tried... Doctor's visits, physical therapy, chiropractic adjustments, aerobic and core strengthening exercises, Pilates, even a holistic healer, deep tissue massages, electric impulse therapy, iced and hot back braces, a kneeling chair and sit/stand desk for work, etc. I also tried a couple of different prescription medicines, even though I've never been in favor of painkillers. I couldn't understand why nothing worked! I am a very conscientious "pupil", so whenever I'd be prescribed a new routine or exercise regimen, I'd make sure to follow it to a tee. Little did I know that the vast majority of these things actually hurt my back instead of healing it.

Early in 2018, I heard of The Back Mechanic by Dr. Stuart McGill and promptly purchased the book. By that time, I was very skeptical of everything and anything, yet desperate enough to keep trying new things. I remember reading the introduction and bursting into tears. I could immediately tell this was not just another "fix your back in ten steps" kind of book, fast to grab your attention, but incapable to deliver up to its promises. For the first time in a very long time, I had found renewed hope. I could relate to so many of the patient experiences described in the book, and realized I had for a long time believed in so many myths about the back pain that I was now discovering were not true... I read the book four times, performed the self-prognosis, and started doing the Big 3 exercises twice a day, every day during the work week, with breaks on the weekends. Yet, for some reason, I was still in pain. I couldn't understand why, yet I was nowhere near ready to discard this book as yet another source of false hope. The scientific findings and methods described here are the results of over three decades of work Dr. McGill had dedicated to the issue of back pain, and I totally trusted this amazing research and expertise. I had to conclude I was missing something. That is when I started looking for a certified clinician, only to discover there are only four in the United States! To my surprise, one of them, Dr. Kai Tiltmann, was only three hours away from where I lived! Honestly, I would have flown or driven anywhere to meet him, that's how desperate I was. By this time, my pain would keep me awake at night, so I was very close to feeling hopeless and had started battling depression... So I made the call. A call that has completely changed my life.

I left a message asking for an appointment, and got a prompt call from the office manager, asking if I had half an hour available to chat with Dr. Tiltmann himself. I was already blown away. Instead of simply scheduling the appointment, they wanted to make sure I was a good candidate for the McGill Method, and Dr. Tiltmann made time in his busy schedule to talk to me! I mean, I can't even see my primary care physician for more than ten minutes, and now I was going to get a free thirty minute pre-consultation?!

I teared up for a couple of seconds, talking with Dr. Tiltmann that day. That's because I could tell he knew what I was talking about and actually understood me! My own doctor, whom I love and respect very much, having been in his care for over 12 years, had exhausted all the avenues with me, and honestly, I had started suspecting that he thought this pain was all in my head! And now, I was talking with someone who not only knew what I had been going through, but told me he could definitely help! The three weeks waiting for my appointment felt like a kid feverishly waiting for Christmas. The time went by painstakingly slow... But the appointment day finally came, and my husband and I drove to a San Francisco for my three-hour appointment.

I can't even begin to describe how life changing these three hours were for my life! Dr. Tiltmann had done a lot of preparation work for our appointment, having analyzed my MRIs, X-ray, intake forms, and even a video my husband took of me performing the daily farm chores (which we knew could have been taxing to my back, if not done with proper form). At the office, we went over all these things, as well as my medical history, after which Dr. Tiltmann performed a series of thorough physical tests. Some of these were the ones I had tried by myself, only now I was realizing I had performed most of them incorrectly. Obviously that's why I had not been able to identify my own triggers before! With Dr. Tiltmann's help, I now have a very clear understanding of what triggers the flare-ups, what relieves and what aggravates my pain. This entire part of the evaluation was such a great eye opener for me and my husband!

Next, I demonstrated for Dr. Tiltmann how I used to perform my exercises, and surprise-surprise, I had been doing most of the motions all wrong! No wonder I was not getting better! Having read The Back Mechanic again, after my appointment, I realized the instructions were all there, clear and written for the layperson, yet for some reason I had not properly translated them into my personal exercise routine! Not to mention, I had been trying to do too much too soon, due to my "conscious" nature, something Dr. McGill does warn his readers about. With Dr. Tiltmann's guidance, we found the right balance for me, and I learned the proper way of performing these exercises. He was kind enough to let my husband film each routine, so I could have this resource available if ever in need for a refresher course. Aside from the main exercises, I learned how to properly sit, stand, lie down, and get up, as even in these areas my posture was seriously flawed, despite my thinking that I was always keeping a straight back in these activities.

We finished the session with Dr. Tiltmann answering my various questions about the spine, it's anatomy, some of the myths most of us grew up believing, that are in fact detrimental to our understanding of the back and the associated chronic pain. Both my husband and I left the office extremely hopeful, re-energized, knowing I did not need surgery, and that I will indeed get better. Of course, this depends on my commitment to it, but as I have already told you I am the type that goes above and beyond when putting my mind to something, especially since this is for my husband's and my own well-being and, ultimately, happiness. I keep mentioning my sweet husband because the truth is, my chronic back pain has been impacting him almost as much as it has me. He has been so supportive and loving all these years, that my getting healthy will equally affect him, and our marriage. He deserves this as much as I do!

A few days after the appointment, Dr. Tiltmann sent me a comprehensive report with everything we discussed during our session, impeccably organized in main sections, including the exercise routines prescribed in detail, with recommendations of when and how I could progress to the next level of endurance training. He has also indicated he'd check up on me and my progress six months after our appointment.

All these things demonstrate the highest level of professionalism, knowledge and expertise on the subject of chronic back pain, as well as compassion and understanding that I have ever encountered in my long quest for finding answers in order to get better. The fact that Dr. Tiltmann is also a very personable, fun, and easy to talk to professional is just a bonus. He possesses this great ability of explaining complicated medical jargon in laymen terms, while making his patients comfortable asking questions some might be afraid to ask on the account that they could be "stupid" or "silly" questions.

I have not stopped talking about this amazing experience to anyone who's willing to listen to me, and would highly recommend Dr. Tiltmann and the McGill Method to any chronic back pain sufferers like myself. I have already started my journey towards a pain free life, and am already seeing results. I am once again hopeful and I feel empowered. I have no doubt that in one or two years I will be one of the "successful stories" in Dr. Tiltmann's portfolio. I wish there would be more of him all throughout the country, as I know there are a lot of back pain sufferers out there, tired of having tried everything but this method, and feeling hopeless and helpless. Dr. Tiltmann, I will forever be grateful to you, as well as to The Back Mechanic and Dr. Stuart McGill!

Amalia of California 44-year-old female with a 15-year history of chronic, non-traumatic low back pain.

I want to express my thanks for your service in treating my lower back pain. I had struggled with increasing pain over the last four years, beginning at the age of 25. Then, several months ago, the pain escalated to the point that I had to give up most every physical activity that brought me pleasure and meaning.

When I reached out to your office, I was desperate. I’d heard of the McGill method but had lost confidence in most treatments. I had tried acupuncture, chiropractic manipulation, physiotherapy, and two different spinal injections – all to no relief. But meeting you and working with you in the McGill method gave me hope. You were the first provider who took the time to really listen to my story and explore the many possible causes of the pain. The method you provided me, including education and instructions for exercise, was comprehensive and plain old ‘made sense’ to me.

I left our session feeling hopeful and prepared to face the recovery period ahead. I can say now that when I follow your treatment plan, the pain decreases.

Thank you for helping me at a time when I was truly down and out. I will quickly recommend you to anyone I know who is struggling with worsening back pain.

Cameron of California 29-year-old male with a 4-year history of chronic non-traumatic low back pain.

My experience has been remarkable! As Dr. Kai knows I am a corrective exercise specialist/FMS and have been in the fitness industry since 1989. I am TPI level 3 with mentors like Greg Rose and Gray Cook. I have studied under Paul Chek and really thought I was on the leading edge of being I was able to help people who came in with back pain. The problem was I wasn't able to "fix" my own. Between my husbands knowledge as an ART instructor and mine, I felt like we had exhausted our resources and I was just to live with this pain. Every activity had ended for about the last 5 years. I was extremely active in many outdoor sports and now barely being able to get through my daily activities (working, cooking, sleeping etc.)

Years of competitive gymnastics as a child and then competitive bodybuilding and a stint on the American Gladiators show had taken its toll. My MRI read to me was a sentence to a lifetime of a pain. 2 fractured end plates, severe compressions, annular tears etc. My job is very physical and that now was getting harder and harder to get through each day.

I was constantly searching and came across Stuart’s books and ordered them. I immediately started the big 3. I then found Dr. Kai, who really gave me the answers I had been searching for.

Dr. Kai gave me a full assessment, which I know is necessary to get the appropriate information needed and NO doctors know how to properly assess! He really listened to my history and went over what he saw on the MRI's. I knew that my pain may have nothing to do with what the image said, but I didn’t know what else it could be.

That is where Dr. Kai really, really helped me. I have known that you need to be mindful of how you move, but not like he described it to me. He said, carry yourself as if you have just had back surgery. That was an eye opener. The year before I had a labral hip repair done, because they said the dysfunctional hip was causing my back pain. In hindsight I was most likely over stretching the Psoas and everything else.

Kai told me to STOP stretching. I hadn't stretched my hamstrings in a long time, but stop the rest?? It was completely opposite of what I felt my body needed. He was so sure that this would work and I would be pain free if I followed the protocols. I left feeling like I had hope. I did exactly what he prescribed, no more, which is usually my thought process. Day by day I started feeling better.

I am just about 1 year out and I am doing really good. Some days 100% pain free. I was in a lot of pain 24/7. Days that I am sore I know that my mechanics were off and I got lazy, or had a really bad golf swing that day.
Dr. Kai was great. I have given his name out to many people that have been told they need surgery. He has the demeanor and obviously the knowledge to let his patients know that they will get better. There was never a "this might work" attitude. It was you are going to get better and will be fine if you follow this correctly. I trusted him. I don't trust traditional doctors.

I had seen many of the top people in the country who are functional movement specialist. I traveled all over the place looking for answers. Dr. Kai gave me those answers and I am ever so grateful for his knowledge and professionalism.

My husband and I are looking into doing some of Stuart's courses. We have just read Crooked by Cathryn Jakobson Ramin. What a GREAT book. It reinforces why your work, works. That it is really, IMO the only way to get better. We encourage all of our clients to read it. It will lead them directly to professionals who understand what they are going through and can help them to get out of their pain.

I am so thoroughly impress with Stuart McGill and grateful for his work.

Jeannine

Jeannine of California 55-year-old female with 2 hamstring injuries in 2007/08 leading to chronic low back pain.

My back is progressing slowly, but still progressing, which is something that I couldn’t say before the assessment. I am doing my best to stay away from my pain triggers, I fail sometimes in moments of carelessness, but for the most part I am staying away from them, which has helped me progress. I perform the Big 3 everyday and have also progressed on to some of the other exercises, I am not able to perform the bridge pain free, I have checked and double-checked my form but still have pain so I have put that on the shelf until a later date. The single leg stand/squat and airplane are coming along nicely and I have progressed to a 19 min. walk without compressive pain building up. Thank you.

Dr. Tiltmann did a thorough examination of my past pain history and provided a comprehensive coaching session to help me move pain free. During the examination Dr. Tiltmann was able to identify my specific pain triggers as well as pinpoint positions that allow me to alleviate the pain that comes with flare-ups.

I was able to learn more about my back and how it functions and why I am experiencing pain. Dr. Tiltmann was also able to help me understand why I can’t do things because of my anatomy that others can pain free (i.e. deep squat, deadlift, Olympic lift, etc.). This understanding has completely changed how I am going to approach training in the future when I am pain free.
Dr. Tiltmann was clear and concise and used terminology that a layperson such as myself could easily understand.

I would definitely recommend an assessment to someone that is suffering chronic low-back pain. Initially I was worried that I would not get the value from an assessment that I was looking for, especially after buying and studying “Back Mechanic”; however after the assessment I realized the things I learned are going to make a huge difference in my recovery, and that it was well worth the cost.

Thanks with regards

Robert of Utah 36-year-old male injured low back lifting logs at work 8 years earlier.

Thank you again for going above and beyond to provide such an amazing service. You were so thorough, kind, and considerate, and I would go as far to say that you changed my life!

Dr. Tiltmann was incredibly accommodating from my first email with him. Even before my appointment, he wrote me an email offering to answer any of my questions about the McGill method. He even offered to have a phone conversation to address any of my concerns. As a clinician he goes above and beyond the efforts of every medical provider I've had to date. He reviewed my history, performed a thorough exam, and ended with a coaching session, which included a walk-through of how to do the McGill 3 in addition to other adjunct exercises. He videotaped me doing these movements and reviewed exactly if they were incorrect or correct. He identified my pain triggers as well as positions that alleviated my symptoms by going through a series of tests with me. He identified why my specific anatomy may not be suited for certain exercises and helped me understand what led to my back injury in the first place. All this information was consolidated into an understandable report that I could review after our session. Dr. Tiltmann extended our three-hour appointment to make sure I understood how to perform every movement on the worksheet he provided, and even after ALL that, made sure every single one of my questions was answered. No one has ever made such a huge time investment in my health!

After my experience I believe the McGill assessment is invaluable to chronic back pain sufferers. As an anesthesiology resident I often see patients so quickly turning to surgery for an answer to their suffering, which too often doesn't solve the root of the problem. I think knowing that providers like Dr. Tiltmann are out there would be a great comfort to these types of patients. I will not hesitate to recommend him for that reason.

Caitlin of California 30-year-old female with a 6-month history of low back pain from deadlifting injury.

I am religiously following the doctor’s orders. Been having some hiccups getting into a brisk walking pace with the hips/low back, but the pain will dissipate once I'm moving. There is a constant "disconnected" sensation between legs, hips, back, and neck movement. But the BIG 3 are helping. Strong, engaged core is the missing key to reducing the instability sensations. Although there is a constant slipping/teetering sensation at the L4/L5; unbalanced positions of torso and pelvis increase that. I am working on taking all flexion out of the low back with all movements. The slightest tipping back of torso/neck from what I feel is "standing normal" disengages low back muscles making spine neutral while standing.

I believed I received a complete and thorough session. For note, I noticed that the history portion is more subjective because it’s based on so many different unknowns that its hard to know where to begin. So many events filled the back to its limit before it decided enough was enough. However, I'm now confident that the years of sitting with the low back in constant flexion with head forward in a bad chair with no spine sparing core stabilizing exercises was the ticking time bomb. Your examination and coaching sessions made perfect sense as well, and resonate with how I've been feeling.

In addition, all the pain triggers and positions to alleviate my symptoms were clearly sited and specific to the troubled low back. However, I do believe there are some additional mechanical "disjointed" symptoms in the pelvis/hips, but I'm hoping they will subside with the healing of the low back. They seem to be muscularly connected, and were unable to be evaluated because of the low back instability. The understanding of this is in alignment with the Back Mechanics book I read. And the "how not to aggravate it" will be life changing; sounds like common sense but its not because no doctor had told me that before. Very grateful to have a clear path ahead.

Recovery, priceless.

I highly recommend the McGill Method to anyone that is suffering from low back pain. It has only been a week since assessment, so I can't speak to the success of the treatment, but the value is acceptable at this stage in the game. I wish I would have found ya'll sooner. I believe this should be incorporated into our educational system as a preventative health and wellness program, especially for children active in sports and fitness.

Thank you for your help Dr. Tiltmann, Dr. McGill, and the research teams!

Sylus of California 33-year-old male with gradual low back pain onset 9 years earlier.

I have been doing well since we saw one another and have made leaps and bounds in regard to my back health. Since the assessment, I gained awareness of my movements that triggered my pain. The exercises helped me tremendously with maintaining neutral spine, increase the muscle endurance I needed, and help correct my muscle imbalances.

Dr. Tiltmann provided thorough documentation after the examination and coaching part of my visit, it greatly helped me realize not only my triggers but also areas that were either out of balance and/ or weak.

Dr. Tiltmann showed me some positions without me even knowing at the time that greatly relieved the pain I was having. He was able to answer my questions and concerns in a way that no other Dr. of any sort was able too. He was able to not only identify, but explain MY issue. Every other Dr. would always generalize their opinion. It was the ability of Dr. Tiltmann to understand my pain and my issue that has greatly helped me improve. I found the process I went through with Dr. Tiltmann priceless. My only regret is that I cannot see him more.

Thank you

Blake of Texas 35-year-old male with low back pain since high school.

The exam/history of my back issues was far more thorough than any I had ever experienced. The coaching made me feel empowered to be able to improve, rather than a victim of unchangeable circumstance. Eliciting the pain triggers was performed gently and no more than needed. Dr. Tiltmann's explanations were very clear and enlightening, as many of the exercises and stretches I was doing to "help" my situation were actually aggravating it. Dr. Tiltmann communicates clearly and answers questions for the layperson helpfully but not condescendingly. I would highly recommend this assessment/protocol. While at first blush it might appear expensive, it is indeed a good value for the very thorough and personalized approach to the road to recovery. This is not for people looking for an instant magic bullet, but if one is willing to employ the protocol, improvement will follow! As a bonus, Dr. Tiltmann has a very pleasant bedside manner, which is really nice for people in pain.

Best regards

Dana of California 56-year-old female sustained a low back injured in a car accident 16 years ago.

Good morning Kai,

Thank you for your follow-up email on the progress on my back injury healing process.

Since our meeting I have focused on moving in a spine friendly, hygienic way. I have done the big 3 every day, taking an occasional day off once every 2-3 weeks. I typically choose such a day based on tiredness of my proximal stabilizers or soreness and find the following day I feel rested and more technically proficient.

Right now I am completing the descending Russian pyramid of 8, 6, 4, holding each contraction for 10 seconds. I bumped it from 6 to 8 after a couple of months to increase the difficulty per your instructions to increase resistance over time. I have also started building in stir the pot, which my back and body is tolerating well. I have a walking regimen I follow every day.

Interestingly, not surprisingly, your prediction in my evaluation results of a 30-40% reduction at this time frame was spot on. I feel it is actually a bit more than that. I notice small improvements in many areas like the car, bed, sitting, etc. that show slow healing.

Last, I have taken it upon myself, to more fully educate my kinesthetic and exercise physiology knowledge base on back injuries and training through Dr. McGill and his research. I have listened to numerous podcasts, read articles, and am currently reading Ultimate Back Fitness. To this end, I need to train again eventually, and am building a home gym in my oversize garage, which I am excited about. Slow, spine friendly, "wading" back in to regular resistance exercise will be the plan with an absence of damaging movements and type A mentality.

As a former cross-fitter, I have focused on learning about why this exercise regimen is so potentially damaging to the human linkage and specifically lower back. Although I can see clearly that Stu and you shy away from saying "don't do crossfit", here is my understanding and opinions, that you are free to share with your clients if it helps them:

Crossfit is dangerous for many participants, risking both short and long term back injury for a number of reasons.

First, it takes Olympic lifting movements that are supposed be each completed with perfect form (load the spine but don't move it, or move the spine but don't load it) in lower repetitions (lower equals more focus on perfect technique with each movement) and builds them into workouts with high numbers of repetitions in a competitive, personal, group, and time focused competition. This results in breakdown of technique and the spinal linkage bearing the brunt of the force caused by loading and moving the linkage concurrently.

Second, Olympic lifts place tremendous stress on the discle structure, vertebrae, and end plates. Based on human physiology, the body needs adequate time (days) to heal before repeating such stress input in another workout. In crossfit, this stress input is not solitary, meaning it is almost always paired with other movements as part of the workout. Example: 12 hang power cleans, paired with toes to bar, and double unders - 6 rounds for time. At some boxes, participants specifically weight train for the first part of class prior to the workout, thus increasing this stress on the body (spine) before completing the group workout. Again, likely further breakdown of technique due to muscular and mental fatigue for movements that demand precision and solid technique. Part of the amazing group motivation and fun of crossfit is doing multiple days per week when in actuality, even though a participant may be performing a different lift each day (Clean and Jerk Monday, Squats Tuesday, Snatches Wednesday), the human body is not getting the rest days in between the stress inputs, which allow for healing of the discle structures, micro fractures of the end plates, and necessary adaptation and "callousing" before another stress stimulus. This repeated stress day after day, week after week, will eventually push the spinal linkage past the tipping point for many participants, resulting in injury. The argument that "crossfitters never train at a weight level where they could damage themselves" is in fact untrue. If they trained at very heavy weight levels, damage to the linkage and back will certainly come sooner. But based on the combination of exercises, higher reps, etc. lower weights will still cause injury, just take longer to do so.

Third, Crossfit combines totally separate, opposite end of the spectrum disciplines of power moving weight training and gymnastics into the workouts that participants regularly follow. This in fact contradicts what a properly coached and trained athlete would do. Humans are genetically pre dispositioned to typically be better at power moving or flexibility based disciplines. Think of the extreme end of the spectrum examples of a powerlifter versus a gymnast. In a crossfit workout, participants in fact try and do both, as fast as possible. So for example, a participant may be snatching (trying to keep the spine motionless with proximal stiffness) and then run to the wall and perform kipping handstand pushups, with each bending the lumbar spine and legs down to be able to kip under load. Another example is heavy front squats paired with kettlebell swings and toes to bar. This results in contradictory and co-damaging requests of the body i.e. have proximal stiffness and lack of motion in the linkage, immediately followed by lots of spinal bending under load with flexion and extension. Is it possible to do - yes. Will it hurt the linkage and cause damage if the tipping point is crossed - yes.

Fourth, crossfit has many movements that when combined together result in direct delamination to the discle structure and collagen. Think olympic lifts combined with burpees as an example.

Last, most powerlifters, olympic lifters, bodybuilders and most certainly gymnasts, have full time coaches that closely observe them, video them and guide their training to insure technique is optimal. That the athlete's regimen and stress input is appropriate for the cycle, timing and periodization of training. There are many great crossfit coaches I have been coached by. Overall, throughout crossfit, the observation and knowledge base necessary to coach this type of technical training is not present in such a large group setting. Nor would it be possible, as many coaches are enthusiasts and not full time professional coaches with the appropriate educational background. Not to generalize all crossfit gyms, but how many perform an assessment of each athlete before training commences (hip scour test for example to determine depth of socket and range of motion)? In my case, I heard from day one that I had to go as deep as possible on all movements and limitation to do so, was caused by lack of mobility. In actuality I have deep sockets and ended up butt winking and causing damage and flexion intolerance by going past parallel in many lifts, in combination with all stated above.

Best regards

Darren 46-year-old male Cross Fit athlete with 1-year history of low back pain initiated after a squatting exercise. Review is 6 months post McGill Method.

Hello Dr. Tiltmann,

It has been about three months since our appointment and I can happily say that my condition is about 70% improved and I have had no major flare ups since. I have also been able to stop taking NSAIDs and Tylenol, which is amazing after having been taking them regularly for so long. I do sometimes feel a bit of tightness in the left leg, and I am still very careful about every movement I make. It is not near the as tender as it once was however. I have been diligently doing the big 3 every single day and am now beginning to incorporate some of the other recommended exercises. I will continue practicing excellent spine hygiene every day. It is already almost second nature to properly squat, sit, stand and walk.

Thank you

Rich 37-year-old male injured in crossfit training, received a micro discectomy 2 years later, which provided pain relief for 6 weeks. Review is 3 months post McGill Method.

Hi Dr. Tiltmann!

I'm doing well. In mid-August, my sciatic nerve pain disappeared virtually overnight. The herniation must have receded on its own naturally enough to stop pinching the nerve. Since then, I have worked to re-gain some of my endurance standing and walking, and today I feel almost entirely back to normal outside of some stiffness or occasional movement that causes pain.

Meeting with you was incredibly helpful and I would absolutely recommend you to people with chronic low back pain. Although the appointment was expensive out of pocket for me, it was worth every penny. I really appreciated how you took so much time to listen to my full history and help me understand the root cause of my back pain. No one else had been able to do that with me. This really lead to a deeper understanding of my back condition, as well as tools I could deploy around how to move, how to tuck my neck or walk with my pelvic bone tucked up or walk fast with my arms swinging. This made me feel empowered and more in control of pain that had felt extremely out of control for me up until that point. I also learned some core concepts like "No pain no gain does not apply to back pain" and "Pretend like you had virtual back surgery" which became mantras for me and really informed my recovery after that. The written report you provided me after the appointment was also very valuable. You treated me with the utmost respect and true compassion, and I could really sense your passion for this work. You used "plain language" in a way I could understand and kept me laughing throughout my appointment. Thank you for your care.

Be well and enjoy the fall

Lindsay 35-year-old female lifting something incorrectly caused 2 months of low back pain then several months later flared low back after scuba diving and was now suffering from sciatica too. Review is 3 months post McGill Method.

Hi Dr. Tiltmann,

I am much improved, and only notice back tension when I do something physical without paying full attention to my form. In my normal day-to-day now I almost never notice any back tension. The most recent time when I noticed some back tension was while doing maintenance on a car that required me to be in an awkward position for over an hour, but that resolved pretty quickly!

I have kept up with daily walking (I'm up to 60 minutes a day) and I am doing exercises, but not exactly the big three. I found that the curl-up continued to tighten my neck muscles, even after trying the neck exercises recommended in Dr. McGill's book, so I have switched to doing dead-bugs, which are much easier on my neck and shoulders (which are chronically tight from typing on a computer all day, every day). I have added glute bridges, which have made a big difference as well. I still do planks, and I do both side and front planks now. I did the bird dog for a couple months, and have now switched to doing step-ups on a 1.5 foot high step. I spent about two weeks just practicing good form, doing one step at a time as slowly as possible, and I find that it really helps with training my abs and glutes to work together.

Charles 43-year-old male with low back tightness for 14 years but flared 5 years ago after having 1st child and moving poorly. Review is 4 months post McGill Method.

Dr. Tiltmann is a back expert, coach and teammate all rolled into one. I came to Dr. Tiltmann after noticing that folks with surgically repaired backs often end up requiring additional surgery into the future. This is not a pattern I am keen to join. It’s been a week since my McGill Method assessment and I feel confident I have the knowledge/tools to make a full recovery and stay off the operating table.

One thing that stands out is how invested Dr. Tiltmann is in my recovery. Because the assessment is a three hour allotment of time, Dr. Tiltmann is able to listen, diagnose and educate without cutting corners. He listens to every detail of your back history and helps you to understand the mechanics of back issues. I left knowing much more about the various back issues that exist (and those that I have). Knowledge is central to recovery in the McGill Method.

Dr. Tiltmann performs an extensive array of tests to identify your pain triggers as well as positions to alleviate pain. The idea is to establish a knowledge foundation for how we will modify our movements in the future. Dr. Tiltmann was incredibly patient as I sometimes struggled to quantify pain levels. However, I now have a much better understanding of what aggravates my pain and which positions are more comfortable for me. Unfortunately, before the session I was practicing some pain inducing postures in my well-intentioned attempts to heal my back.

Finally, Dr. Tiltmann coaches you through everyday movements and rehabilitation exercises. Some of these moves are foreign and require a bit of practice. Dr. Tiltmann was patient and helped every step of the way. Even going so far as to record me on my phone moving (with his voice over) moving correctly. He worked up an exercise regimen tailored around my specific pain triggers.

I think the McGill Method assessment with Dr. Tiltmann is great value. Back problems are complex and personal, it requires time and effort to get a diagnoses/plan of attack correct. The three hour allotment (while reflected in the price) is necessary, and for this reason good value. Have you ever had a medical professional’s attention for three solid hours? I came to the session with a notebook full of questions but by the time we got to the Q&A at the end, virtually all had been addressed already.

It’s a lot of information for a three hour period. Fortunately, Dr. Tiltmann provides a detailed report of the session for your reference. The videos regarding movement, exercises are helpful to ensure you continue to move correctly once you’ve left the office. And in case you forgot to ask a question or encounter challenges in the real world – a follow up conversation is included. I’m very happy to have worked with Dr. Tiltmann and have already recommended him to family and friends.

Ben 32 year-old-male with 15-year history of intermittent low back pain presents with constant bilateral low back pain, right groin pain, numbness in the left lateral foot including all toes.

My initial assessment with Dr. Tiltmann was fantastic. Up until meeting with him, I felt confused, frustrated, and discouraged about my situation to say the least. However, after several hours meeting with Dr. Tiltmann, I felt for the first time in 4 years that I had an accurate, no nonsense diagnosis of what was causing my pain. I also know that I now have the necessary knowledge and tools in order to truly become pain-free! I sincerely appreciated the fact that Dr. Tiltmann cared about me as a person, and did not treat me as merely a billable entity. He had great attention to detail, and was willing to be candid with me on my likely path to recovery. There's no doubt about it, having chronic back pain is brutal and takes hard work to recover from. However, if you're willing to put in the time and effort, Dr. Tiltmann has the expertise in order to maximize the results of your effort.

Thank you

Ben 27 year old fit male from Arizona, with chronic low back pain for 4 years after repeated deadlifting with poor form. No other treatment has provided any longer term relief.

Hello Kai,

Already I have a huge improvement! I am no longer waking up with debilitating aches and pains. I think my biggest problem was stretching and not understanding a neutral spine. I want to refer my dad to you, he lives in Sacramento. Thank you again.

Mark 34 year old male from New York, has had low back pain since 2008 while in the military and provided this review two weeks after his McGill Method.