Episode
168: Back Pain, Stiffness & Manual Therapy (with Stuart McGill) Listener Favorite
- Podcast
- The Thinking Practitioner
- Published
- Apr 15, 2026
- Duration seconds
- 3850
- Processing state
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Summary
🎙What if the key to resolving your client’s back pain isn’t loosening things up — but “adding” stiffness? Dr. Stuart McGill is one of the preeminent back pain researchers in the world, and in this conversation, he makes his case — passionately and controversially — for why biomechanical factors deserve far more attention than they typically get in back pain assessment and treatment. He argues that the label “nonspecific low back pain” masks what a skilled clinician could find with a thorough enough assessment, and that too many patients with real mechanical issues are being dismissed as psychosocial cases. Not everyone in the field agrees, but his perspective is fascinating, clinically detailed, and full of provocative ideas for manual therapists. This episode originally aired as episode 97 and quickly became one of our most popular — a listener favorite we’re bringing back for those who missed it and those who are ready for a second listen. ✨ Topics covered in this episode include: • Why Dr. McGill believes “nonspecific low back pain” doesn’t exist — and how he argues it undermines both research validity and clinical outcomes• The problem with averaging results across non-homogeneous groups in back pain studies• How a thorough assessment can reveal specific pain pathways — and McGill’s case for why a psychosocial diagnosis is too often a default when clinicians run out of ideas• Vivid clinical stories: a patient with a double pinch point, and the precise maneuver that resolved his symptoms• Why some patients need more stiffness, not less — and the “paradigm clash” this creates for manual therapists trained to mobilize and loosen• The prone instability test and other hands-on experiments for distinguishing when to stabilize versus mobilize• Dynamic video fluoroscopy of…