14 May Why Cookie-Cutter Back Pain Plans Could Be Destroying Your Spine
Article Rundown
- The problem with one-size-fits all plans
- The McKenzie press-up problem
- Why context matters
- Why you need a true assessment
Why Cookie-Cutter Back Pain Plans Could Be Destroying Your Spine
In today’s digital world, it’s easier than ever to purchase pre-made rehab templates or follow a YouTuber’s go-to exercises for back pain. But just because a plan is popular—or even comes from a well-known professional—doesn’t mean it’s the right fit for you. In fact, relying on a cookie-cutter program that hasn’t been tailored to your unique pain triggers or injury mechanism can be one of the worst decisions you make for your back.
Let’s break down why these templated approaches often fail—and how they can actually leave you worse off than when you started.
The Problem with One-Size-Fits-All Plans
I hear from people all the time who’ve paid $500, $700, even $1,000 for generic back pain plans. These programs often come from doctors, chiropractors, or physical therapists who’ve never met the client, never asked them about their pain triggers, and—critically—never performed a proper assessment.
What do these plans typically include?
- McGill Big Three
- Walking protocols
- Nerve flossing drills
- McKenzie press-ups
While each of these tools can be helpful under the right conditions, they’re not universally effective, and they can be downright harmful if applied without context.
McKenzie Extensions: A Double-Edged Sword
Directional therapy, such as McKenzie press-ups, can be incredibly effective for some disc herniations. The goal is to encourage the nucleus of the disc to move back into position through extension-based postures. For someone with posterior disc bulges, this vacuum-like effect can relieve pressure on nerves and reduce pain.
But here’s what most online programs don’t tell you:
You’re not supposed to do these exercises indefinitely.
If you’ve lost significant disc height—meaning your disc is no longer thick, healthy, and well-hydrated—aggressive extension-based movements can wreak havoc on your spine’s facet joints.
The Facet Joint Fallout
When discs degenerate and lose height, the biomechanics of the spine change. Your facet joints, which once glided smoothly through flexion and extension, begin to grind. This constant irritation can lead to:
- Facet arthritis
- Bone spurs
- Synovial cysts
- Joint effusions (swelling with fluid)
In many cases, people who overdo press-ups or other extension-based exercises end up trading in short-term relief from disc pain for long-term, chronic facet joint pain. And unlike some disc herniations, facet issues often don’t go away—they stick with you.
Context Is King: What You Really Need
The key message? Context matters. As the late Dr. Andrew Lock often emphasized, the exercise must match the injury mechanism. It’s not enough to say “extensions help discs” or “the Big Three are always safe.”
You need to know:
- What kind of injury you have (discogenic, facetogenic, ligamentous, nerve-related?)
- What movement patterns trigger your pain?
- Which positions soothe your symptoms?
Without this information, blindly following a plan can make things worse.
The Safer Starting Point
Instead of jumping into a templated plan full of press-ups, start with something more diagnostic and gentle, like the “tummy lying” variations in Back Mechanic by Dr. Stuart McGill. These allow you to explore what positions relieve pressure without forcing any specific direction.
Yes, some people may respond well to McKenzie-style work or even basic walking and Big Three exercises. But that doesn’t mean everyone will.
The Bottom Line: You Need an Assessment
If you’ve been struggling with a back pain plan and it’s just not working—or if your pain is shifting or worsening—it’s time to shut it down.
Don’t keep following a plan from someone who never asked about your history, your pain triggers, or your specific injury. Seek out a qualified practitioner who will perform a thorough assessment and craft a plan that’s tailored to you.
You deserve more than a generic handout. You deserve a path forward that actually helps you reclaim your life and reduce pain at the source, not just cover it up.
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