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McGill Big 3 Alternatives: What to Try Next for Chronic Low Back Pain

The McGill Big 3 are three exercises from the spine researcher Stuart McGill: the modified curl-up, the side bridge, and the bird-dog. Each one asks your trunk muscles to hold still while a limb or your body weight pulls on them. If you have done them for weeks and your back is no better, or they never felt like enough, there are other places to go.

I have no medical or physical-therapy credentials. I have had low back pain for years and written down what I tried. This page cannot tell you why your back hurts, and none of the options below is a promise of a result.

What the Big 3 are

The modified curl-up lifts your head and shoulders a short way off the floor with one knee bent and your hands under the small of your back. The side bridge holds your body in a line on one elbow and your feet. The bird-dog reaches one arm and the opposite leg out from hands and knees. McGill and Karpowicz measured muscle activity and spine position for these exercises in 8 healthy men in a 2009 lab study, and described progressions from easier to harder forms (Arch Phys Med Rehabil). That study was not a treatment trial and had no one with back pain in it.

What trials of similar exercise found

The nearest evidence comes from trials of core stability and motor-control exercise. The Big 3 fit under that heading, but these reviews pool many kinds of programs and do not test the Big 3 as a set.

• Wang and colleagues pooled 5 trials with 414 people with chronic low back pain. Core stability exercise beat general exercise for pain and disability at the short-term follow-up, and there was no significant difference in pain at 6 or 12 months (PLoS One, 2012).
• The Cochrane review by Saragiotto and colleagues pooled 29 trials. Motor-control exercise was not clinically more effective than other exercise, and the authors said the choice of exercise should probably depend on preference, therapist training, cost and safety (Cochrane, 2016).
• The 2021 Cochrane review of 249 trials found exercise probably reduces chronic low back pain compared with no treatment, usual care or placebo. Differences between exercise and other conservative treatments were small, and there was no difference against manual therapy (Hayden and colleagues).

Put together, the reviews do not single out one type of exercise, so changing exercise when one is not working for you is a reasonable move.

Why people look for something else

People who have tried the Big 3 write about them with hope and with disappointment. One App Store reviewer wrote that they had done the McGill Big 3 with poor results (review, September 2026). A r/backpain commenter wrote that generalist physios will give you "generic core exercises" (thread), and there is a r/backpain thread about moving from McGill to a Roman chair (thread).

These are individual reports, and other people get on well with the Big 3. I cannot tell you which group you are in. Three things are worth checking before you drop them:

• Whether the dose ever changed. Holding a bird-dog for the same 10 seconds in month three that you held in week one is the same demand, and the PT sheet plateau page covers that.
• Whether your form was ever checked by someone who knows the exercises. The Cochrane authors list therapist training as a reason to choose one program over another.
• Whether a flare followed a particular exercise, which is a reason to talk to a clinician before you try a harder one.

Alternatives

Keep the Big 3 and change how you do them

A physical therapist who teaches them can check your form, pick an easier or harder version of each one, and set a dose. This is the lowest-change option if the exercises suited you and you stalled.

A different supervised program

Motor-control work, graded activity, general strengthening, and pain education are all used for chronic low back pain. The 2016 review found motor-control exercise similar to other exercise, and the 2021 review found small differences between exercise and other conservative treatments, so a clinician you trust and a program you will keep doing count for a lot. The appointment questions page has a list to bring.

General exercise you can keep up

Walking, cycling and swimming are all exercise, and the 2021 review found small differences between exercise and other conservative treatments. Start at a level that does not set off a flare and build from there. The walking and standing page covers a long day on your feet.

A loaded movement with a number to progress

The program in this app uses one movement, the back extension on a 45-degree bench, and changes one thing at a time: hold time, then range, then a plate at your chest. It starts with the isometric hold, 3 holds of 15 seconds, and your pain log the next morning sets the next session. Where the Big 3 are a set of three exercises for your trunk, this is one exercise with four stages. This exact progression has not been tested in a trial, and it needs the bench. The bird-dog also appears in the app's floor session for people without a bench yet, so the two overlap rather than compete.

Pain education and pain psychology

If fear of movement or a long history of flares is part of what keeps you stuck, apps and programs built on pain education may fit better than another exercise. The Curable comparison and fear-avoidance pages cover that side.

The Big 3 and the bench side by side

Back extensions are not suitable for everyone. In the r/backpain thread on McGill and the Roman chair, one commenter wrote that with an active herniation they would avoid it (comment). Ask the clinician who knows your back.

Who should not start any of this yet

Go to emergency care now for new numbness, tingling or a change in feeling in the saddle area (around the groin, inner thighs, genitals or anus), new bladder or bowel changes, new changes in sexual function, new pain, tingling, numbness or weakness in both legs, leg or foot weakness that is getting worse, or back pain that started after a recent serious accident. See a clinician today for other new weakness or numbness in one leg or foot, fever or chills with back pain, new pain after a recent smaller fall or knock, unexplained weight loss or a history of cancer, pain that is rapidly getting worse, or pain that is constant at rest and worse at night, not tied to movement. Use urgent care if you cannot get an appointment today. The red-flag page has the full list.

Try it

The first guided session in Low Back Pain Coach is free, and the app needs a 45-degree bench. After that it is $59.99 a year or $9.99 a month, with a 7-day free trial for eligible new subscribers. What the app does and costs.

Common questions

What are the McGill Big 3 exercises?

The modified curl-up, the side bridge, and the bird-dog. They come from the spine researcher Stuart McGill and train the trunk muscles to hold the spine still.

Are the McGill Big 3 better than other back exercises?

Trials of similar core stability and motor-control exercise found short-term benefits over general exercise in one meta-analysis and similar results to other exercise in a Cochrane review. No review shows the Big 3 beating every other option.

Do I need equipment for these alternatives?

Walking and the floor exercises need none. The bench program in this app needs a 45-degree back-extension bench, at home or at a gym.

The app