All protocols

For some people who have failed many treatments, act as if surgery occurred: first day mostly bed rest with brief bathroom walks every 2–3 hours, then gradually add activity.

For exercise-addicted individuals with back pain, forced rest may be necessary to desensitize pain rather than continuing daily cardio.

Identify what movements and loads cause pain and what counterpoints reduce it; use those tools to stay as pain-free as possible.

Build pain-free training capacity first; only later, after a margin of safety exists, approach the tipping point.

Use the Bird Dog, Modified Curl-Up, and Side Plank to build spine stability while sparing the spine; McGill personally does them six days out of seven.

Instead of one long walk, split walking into shorter bouts; example given was three 20-minute walks instead of one 60-minute walk.

For certain posterior disc bulges with open fissure, lie on the stomach and, as you exhale, allow the low back to sink into the table to increase lordosis and potentially vacuum in the bulge.

If prone extension immediately reduces leg pain, have someone pull on the legs along the plane of the table with about 5–6 pounds per leg.

Cobra can vacuum in certain disc bulges for some people, but can worsen pain in others; use only if it helps your pattern.

General recommendation, especially if walking itself is not the pain trigger.

Stay below your walking pain threshold; for example, if 40 minutes triggers pain, do 20 minutes three times per day instead of one 40-minute walk.

Especially for discogenic back pain, avoid staying in one position or activity too long; for example, alternate sitting, standing, and walking such as sit 20 minutes, stand 30 minutes, walk 10 minutes.

Used as a nightly routine.

Excessive gym intensity can create microtrauma that later makes sitting painful.

Deadlifts are a tool, not a universal recommendation; use them only if they are the best tool for the specific goal and person, and avoid heavy deadlifts when lower-risk alternatives better fit the goal.

For some people, elevate the bar and match pull height to their biomechanical optimum rather than pulling from the floor.

Use as an alternative to deadlifts or squats for quad loading with less spinal cost; example given was about 50 yards.

After backward uphill walking, walk forward uphill to shift recruitment toward the glutes.

Use if you want more knee load and less back and hip load than a back squat.

Use if you specifically want more hip and low-back load and less knee load than a goblet squat.

Use knee banding as one way to modify squat mechanics and optimize reward with minimal risk.

Suggested as another alternative lower-body exercise that adds a balance challenge.

Use a six-day training structure plus one full day off per week: two strength days, two mobility days, and two cardiovascular days; avoid doing the same training modality two days in a row.

Used as cardiovascular training in winter.

May transiently increase disc height for about 15 minutes; not presented as a durable fix.

Used on mobility days, especially if thoracic extension is limited or there is injury history.

Used on mobility days, especially with age or injury history.

Used as a pulling exercise; can rotate from pronated grip into hammer grip with power breathing and explosive intent.

Used for inverted rows.

After targeted mobility work, go through the motion of every joint without adding load.