Build a Strong, Pain-Proof Back | Dr. Stuart McGill

welcome to the huberman Lab podcast where we discuss science and science-based tools for everyday [Music] life I'm Andrew huberman and I'm a professor of neurobiology and Opthalmology at Stanford School of Medicine my guest today is Dr Stuart McGill Dr Stuart McGill is a distinguished professor of spine biomechanics at the University of waterl as a professor for more than three decades Dr McGill has analyzed the spines of injured people as well as healthy people and develop methods to treat spine injuries and pain as well as to improve spine biomechanics in anybody he has authored more than 250 peer-reviewed research articles on these topics making him a true World expert during today's episode we discuss spine Anatomy as well as the common sources of back pain and we discuss some of the controversies as to the origins and different treatments for back pain as you'll quickly learn there is no one specific source of back pain nor is there one specific solution to back pain but as Dr McGill spells out very clearly there are things that anyone and everyone can do in order to strengthen their back and to reduce the amount of pain they may be experiencing he explains some specific ways to self- diagnose your back pain which of course is critical for understanding what specific things to do as well as to avoid in dealing with any pain and as it relates to applying in sport and in everyday life Dr McGill and I also discuss several of the Avid controversies within the field of back pain and the treatments for back pain we talk about the so-called bioc psychosocial model of pain which points to the various sources that pain can arise from everything from emotional to lack of sleep to specific locations in the spine and brain and elsewhere in the body and the ways those mesh together to give us what we call pain as well as to direct us towards specific treatments for pain that tend to be especially effective Dr McGill is a true encyclopedia on the topics of back physiology and Anatomy sources of back pain and treatments for back pain so it's truly a special opportunity to be able to learn from him in such immense detail and in such a clear and actionable way by the end of today's episode you will have a quite thorough understanding about the anatomy and physiology of the back as it relates to a healthy back to back pain and of course you'll have various remedies for dealing with back pain preventing back pain and for strengthening your back for all sorts of different kinds of movement not just for exercise and Sport but also to move through your daily activi pain-free and with ease and Mobility at any age before we begin I'd like to emphasize that this podcast is separate from my teaching research rols at Stanford it is however part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the general public in keeping with that theme I'd like to thank the sponsors of today's podcast our first sponsor 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30-day trial again that's waking up.com huberman to access a free 30-day trial and now for my discussion with Dr Stuart McGill Dr Stuart McGill welcome thank you sir great to have you here um I'm a big fan of your work I've watched a lot of your other content read your books and I'm excited to discuss today what makes for a really strong resilient back what causes back pain and how to relieve it and perhaps the bigger issue is what all of that allows for in terms of mobility and functionality not just in sport but in everyday life so to kick things off I'd like to ask a question that I think is on a lot of people's minds most people aren't thinking about their back unless they have pain so what causes back pain you start with the easy questions let me give context before I Define it as tightly as I can for you back pain is a symptom so let's just change the topic for a moment and talk about leg pain can you imagine asking someone well could you give me an exercise or a prevention strategy for leg pain okay so that sets the stage a little bit we're talking about a symptom for which there's a hundred or more different Pathways and mechanisms there so we've got to have a fairly comprehensive assessment now and understanding uh to focus on the type of back pain and then matching an appropriate uh inter intervention I was listening to the your new podcast uh with Andy Galpin this morning the perform podcast the perform podcast yeah and he said uh I'm going to try and follow the three eyes and it was I think gather information interpret the information and then intervene so it's the same kind of deal here and of course that's pan medical condition shall we say so with that cont text I'm going to answer it like this what causes back pain genetics loads the gun exposure pulls the trigger and then the psychosocial millu around the individual influences how they respond to the pain so there's a start we can break it down in those three categories if you wish sure So when you say uh genetics loads the gun uh what comes to mind mind because it's my experience is that um I have a right shoulder that sits a little bit lower than my left shoulder unless I'm mindful of that uh my dad has the same thing and I can you know put an ankle on my other knee a bit more easily on one side versus the other I tend to pronate one foot a little bit more than the other when I run these are subtle things they don't necessarily result in back pain but I'm guessing that a lot of that is either developmental overuse particular sport I'm regular footed I skateboarded a bunch so I push with my right foot I kick a soccer ball with my right foot those sorts of things but let's assume that genetics played some role created some bias if I were to tell you that which I just did would then you immediately think to a particular intervention if I told you okay you know I I have a little bit of lower right side pain which I occasionally do I know I've got this imbalance that was loaded by genetics and presumably experience as well and would your mind immediately go to a particular uh origin of that pain or perhaps even more importantly a particular remedy to that pain or do we need to drill a little bit deeper and really understand um more about what I do what I don't do if I'm more thin set or heavily set at the level of of bone structure you know what are some of the other questions one would ask in the investigate category my thought would not go to one or the other but it would go to both and I'd start that conversation with this uh analogy uh let's talk about breeds of dogs we both love dogs if I said to you we're going to take two dogs and we're going to train them for the Greyhound track one's a greyhound and one's a St Bernard how do you think you're going to make out the St Bernard no matter how you train it or condition it will never make it to the uh performing on a greyhound track you're going to end up with a broken uh St Bernard so there's a little bit of a start from a big perspective but now let's drill down and talk about spines uh it's interesting when you look at the basic anatomical structure of an individual we just did that with dogs imagine if took a thin Willow Branch I could bend that Willow Branch back and forth over and over and it wouldn't accumulate stress but if I took that same Willow Branch and loaded it top to bottom like an ibeam it would just bend and break so it supports bending Cycles but it doesn't support compression now I'm going to change that uh Willow Branch into a thicker stick and I bend the stick once and it shatters in other words the uh thickness and Radial diameter being larger means the stress is bigger in bending however let's compress the same stick it can bear tremendous compression so there's a very fast example on spines there's a a fellow who uh has the world record in consecutive situps thousands of them given what I've just said what's your prediction do you think he has a big strong fellow with a thick spine or do you think he's a very Slender Man with a willowy thin spine he's a willowy bendy guy who can just keep bending up and down off the ground bingo bingo he has to be there's no option so there's a start on the genetics not everybody can play offensive tackle and not everybody can be a gymnast or uh not everybody can simply tolerate sitting in a chair being a computer operator there's a very mundane example for you could I ask you a question about um the willow versus um thicker thicker trunk um example can we look to torso thickness or wrist thickness or ankle um circumference as a way to of assess ourselves uh as to whether or not we are like likely to be more willowy or um Redwood like I mean I it should be obvious just by looking at ourselves knowing ourselves but for instance I have a short torso I'm kind of thick through the Torso front to back I always have been since I was a kid but and my wrist the wrist circumference isn't isn't small but isn't isn't huge I had a a a Bulldog Mastiff um and he would often look at me and I knew in his mind he was thinking my wrists are really thick compared to yours Andrew I knew that's what he was thinking he had forearms he had forearms like a like a long shoreman and of course he had never done any any work whatsoever actually primary goal of the Bulldog is to do as little work as possible in life um but I have friends who you know have thick knees some have smaller joints smaller ankles can we make some general assessment about our spine without Imaging it by looking at some of these peripheral markers absolutely yeah so the uh knee width the bi iloc Crystal width which is the width of your iliac crests uh hip width uh are all surrogates to indicate General heaviness of the skeleton um so yes that's that's one good marker um but there's more to the story for genetics and how bendy a spine can be um the shape of the disc matters so if you take on average a group of top golfers you'll notice that their spines uh that the disk shape if we were to cut through which is a transverse scan on an MRI the discs are more ovoid if you take someone who can bear a lot of compressive load the discs look more like a limma bean and that's called a limacon shaped disc and of course the discs are in repeating fashion throughout the spine top to bottom correct um and the discs are the soft tissue that allow for mobility of the vertebrae the uh the Bony segments exactly they are the joints but they're not a ball and socket joint they're actually a fabric of layer upon layer of collagen fibers and we can talk about that as well what a beautiful adaptation right take a bunch of bony if you want to be able to bend a bone right you need to um break it up into segments kind like beads on a necklace and um and then in between those beads you put some pliable yet um uh it I guess a tissue that you can still compress so it's both pliable and it can it can squeeze down and become more narrow in the vertical Direction and it can also you know squeeze down on one side uh or the other to to some degree yeah we evolved discs and there really is no other better architecture people say well why don't we have ball and socket joints in our spine and the reason is this can you imagine uh stacking five oranges one on top of the other and then you could make them Mobile by putting a ball and socket joint in between them the amount of control that you would need on every single orange you move one orange you have to control all the other it's Mission Impossible we would uh I would do an experiment with students in my lectures I would take four coffee cans and put a tennis ball between each coffee can and then I would put a rope at the front and the back of each coffee can and then one on the side and I had four students take those four ropes and then I took another four students who had the ropes on the next coffee can and then on the next coffee can and then I'd say Okay group flex the spine forward so the students on the front would pull a little bit but the guy on top had to pull more than the uh next coffee can and then the next coffee can a little bit less vice versa the people on the other side had to pay out the rope in sequence and and then I would say okay now let's twist a little bit anyway you could imagine it was impossible to control and then I took out the uh uh tennis balls and I put in what was a disc a big round cylindrical piece of foam rubber all of a sudden that added stiffness so now because the body uses stiffness as the control parameter now we've added control in that the foam rubber would create a buffer and as the deviation in motion occurred the foam rubber would add more resistance so it was an automatic control and it that that's what a shock absorber does on a car it has an elastic element plus the damper but it's the elastic element and we're going to talk about stiffness and stability I hope uh that that really creates the control so that's why we have evolved discs it's highly efficient I can bend the spine to tie my shoe but if I have to uh carry home uh these days heavy shopping bags I need stiffness of that flexible Rod so it doesn't collapse or uh years ago I might have been carrying home an animal for dinner and uh I needed those discs to provide the stiffness in a very economical way and in a way that didn't create stress contribution uh concentrations the way ball and socket joints would so that that's an evolutionary necessity um also when we look at spines there are the column vertebrae with the intervening discs but behind them there's two more joints and those are called facet joints and they guide motion those facet joints have a variety of angles they can have open angles which allow you to twist so if you took a group of golfers could you imagine uh if they had facet angles like this you can't twist so facet angles that are too close together basically a small angle if the angle is orientated for and a you can't twist and you won't find if if if you're dealing with a group of professional golfers you'll find that they all have open facet joints is that genetic it's absolutely 100% genetic now interestingly enough when you Arch back when the facet joints are orientated open as I'm describing when you Arch Back one pushes hard on the other like shingles on a roof that stresses a bone called the pars bone and uh gymnasts for example get a very uh typical fracture pattern called a spond alol lth thesis which is a fracture of that bone and then the spine shifts a little bit at that joint uh I'm just finishing rehabbing a pro tennis player who had the same thing after they tried to have too much range of motion in their serve the coach gave them excessive extension to try and put more miles an hour on the ball but it didn't suit the spine and they ended up having a stress fracture I mean is it fair to say that um if we can um if we are naturally flexible uh for instance like my sister can you know like her fingers can bend back really easily her a shoulder extension which I guess for people that aren't familiar with shoulder extension you know she can um like let's say you're you're leaning up against a railing with your back to the railing the railing is just uh let's just say is um just above lower back height and you can put both hands on it parallel so your arms are are close together like very close to the Torso and then and people don't don't do this quickly because because you can tear you can tear something or injure something but then with feet about I don't know a foot or two away from from that uh bar um you can do a knee Bend and and basically the arms go back behind you like I happen to have a fair degree of shoulder just natural shoulder extension ability I'm not particularly flexible quote unquote but that's just how I'm structured I have some friends that can't do that to save their life right um but I wouldn't consider myself hyper flexible my sister is a bit more flexible we're related obviously um so would people like her or people that tend to be pretty flexible naturally um would they be wise to avoid certain activities if their goal is to remain painfree I mean you talk about the St Bernard running um on the Greyhound track you know we all can enjoy things recreationally but of course we don't want to injure ourselves so is somebody who's naturally flexible should they avoid certain Sports and activities conversely if somebody is naturally stiffer thicker spine thicker joints should they avoid certain activities that's a huge question and there's many more variables to uh consider um but I will say that when we are rehabilitating a uh athlete or just a person to get back to work they're an occupational athlete we take all of this into consideration so as you were describing your sister arching back um a I know she has plump discs discs that are full of fluid uh to allow the mobility to take place in the diss I also know that if we looked at an x-ray from the side you know the posterior spinus processes if you run your thumb down the midline of a person's back you will feel the bumps of bone up the middle of the spine those are the posterior spines uh she will have a large space between each one when she's standing upright so when she extends back those spaces will come together and eventually the spines what we call it kissing spines and it takes me back to some of the old Russian techniques for bench press they would bench press with a huge arch in their back and then other people would say oh I'm going to try and mimic that particular bench breast technique because it allows you to get much more Force so to latissimus dorsy a stiffer back and you get a different Force vector and and actually more effective uh force on the bar they didn't realize that when we work with a person who has a huge Arch they have big spaces between those spinus processes and if you don't have those big spaces you are going to crush the interspinous ligaments which naturally are between those spaces and uh you will now fire off a whole set of uh uh new problems so what is a mechanical advantage for one person is a mechanical disadvantage for another do you follow so it's it all of this uh matters going back to the dis being a fabric of layer upon layer of collagen strands typically uh the disc is about 80% type 1 collagen that is the stiff strength collagen about another 20% is elastic collagen type two but there's types three through 10 that bind those collagen fibers together that's where there's a much greater degree of genetic variability so there are some people who uh can get away with doing many sit-ups they have a slender spine and they have the type of binding collagen that holds all those fibers together but if I wanted to work these fibers of my shirt apart get them to delaminate I would create repeated stress strain reversals the resistance of that fabric depends on the stuff holding the fibers together so there will be binding fibers there that's where the genetic uh variance lies in many people so even there the person's resilience to repeatedly doing a bending drill is determined by your parents to some degree both in the size the collagen type three through uh 10 makeups as many of you know I've been taking ag1 for more than 10 years now so I'm delighted that they're sponsoring this podcast to be clear I don't take ag1 because they're a sponsor rather they are a sponsor because I take ag1 in fact I take ag1 once and often twice every every single day and I've done that since starting way back in 2012 there is so much conflicting information out there nowadays about what proper nutrition is but here's what there seems to be a general consensus on whether you're an omnivore a carnivore a vegetarian or a vegan I think it's generally agreed that you should get most of your food from unprocessed or minimally processed sources which allows you to eat enough but not overeat get plenty of vitamins and minerals probiotics and micronutrients that we all need for physical and mental health now I personally am an omnivore and I strive to get most of my food from unprocessed or minimally processed sources but the reason I still take ag1 once and often twice every day is that it ensures I get all of those vitamins minerals probiotics Etc but it also has adaptogens to help me cope with stress it's basically a nutritional insurance policy meant to augment not replace quality food so by drinking a serving of ag1 in the morning and again in the afternoon or evening I cover all of my foundational nutritional needs and I like so many other people that take ag1 report feeling much better in a number of important ways such as energy levels digestion sleep and more so while many supplements out there are really directed towards obtaining one specific outcome ag1 is foundational nutrition designed to support all aspects of well-being related to mental health and physical health if you'd like to try ag1 you can go to drink a1.com huberman to claim a special offer they'll give you five free travel packs with your order plus a year supply of vitamin D3 k to again that's drink a1.com huberman unless somebody is seeking to be a worldclass athlete in something in which case they should probably pay attention to their genetics and see whether or not it lines up well with a given sport although there have been you know exceptions where people who were incredibly um genetically um uh let's just say biased toward um not being able to perform well in a sport have nonetheless succeeded in performing at a world-class level the but those are exceedingly rare exceptions um for most people who want to do things recreationally like the heavier set person with a thicker spine who wants to golf or um do a um you know or do ballet perhaps um or the thinner willowy person who wants to get into powerlifting for instance um are there certain things that they should each consider and embrace as activities in order to make them themselves more resilient more pain resilient and more um apt to have higher performance for instance would the willow person so to speak do well to build up some of the musculature around the spine to compensate for the thinness of that spine and would the person with the heavier uh or thicker spine uh do well to um try and encourage more pliability of their discs somehow the answer is yes but it's a very limited yes so if I can set the stage and and give some context here every system in the body requires stress for Optimal Health think of the cardiovascular system the muscular sceletal system the endocrine system even the psychological system it needs stress to create adaptation for robustness but you cannot cross what's known as The Tipping point because if you do you start building cumulative trauma of some form whether it's emotional trauma psychologically or it's cumulative stress at the tissue level at the level of the cell uh so we have to talk about those tipping points we've got to Define where they are try and expand them adapt them but don't cross them so with that context now we can talk about uh a person's suitability for the stresses on different parts of their body associated with different sports we can talk about the rate at which the adaptation occurs the amount of Del loads and rest that are required all of these things are genetically influenced um the way that they perform the movement is going to move the stress concentration here's an interesting uh demonstration for you if you go to the Olympics and look at the podium winners of a javelin thrower they look identical do you think the swimmers look like the javelin throwers no they don't but they look like each other but they look like each other the people on the podium look very similar in structure yeah let me just give another very poignant example of that consider a sport that has three very separate demands of the athlete consider a triathlete the triathlete has to swim a certain distance then they bike a certain distance and then they run a certain distance have you ever known a person who comes out of the lake or the pool whatever it is first winning the triathlon doesn't work that way what suited them to be a fish fast in water uh they have to be somewhat floppy in the ankles because they're creating a fish's fin longer in the Torso uh uh consider uh a uh a power lifter performing a butterfly stroke it wouldn't look very pretty then they get on the bike where they have to stiffen to stiffen the core I I don't know if you know bike design well I'm sure you do you're paying for stiffness of the frame that's what a really Elite not know that yeah so when a person pushes on the pedal the frame doesn't Flex because that would be an energy leak you pay for a very stiff frame so every ounce of force that you apply to the crank handle to propel you forward propels you forward instead of being wasted and bending the frame the same way uh the the cyclist will lock in on the bike they'll squeeze the saddle between their their their legs uh lock into the bars lock their core down so that when they uh create power power through the hips and through the legs it's transferred to the power it isn't transferred to bending their willowy body that is very different from the neurology and the mechanics of a swimmer now let's run to run uh the most efficient Runners store and recover elastic energy in tune Springs uh a wonderful book to read is the the Lost Art of running but by Shane benzy who studied the Kenyon Runners and how they store and recover elastic energy with each stride almost the same way as a kangaroo would a kangaroo is more efficient when it hops versus plotting along using Ecentric concentric muscle contraction so uh again the polar opposite of a swimmer it's a very tuned stiffness the most efficient Runners for the Third Leg of the triathlon pre- stiffen they have a pre-contraction of the muscle so when the foot hits the ground they're already storing the elastic elements and they get that back for free but if the Springs were not tuned and they stretched away their muscles just to be passive Elements which serves them very well in the swimming uh element think of doing a pogo jump so you're just pogoing through the ankles now if you had no tone in the leg you just flop into the ground and you would have to use concentric Ecentric muscle contraction but if you stiffened too much you're now a piece of iron and you won't be able to jump either but you'll get a beautiful resonance a beautiful Pogo when you have the tuning just right so when a muscle contracts it creates Force we all know this but people don't appreciate you're also tuning the stiffness if I maximally contract my muscles I can't move so athletes have to tune muscle if they're impacting athletes but they also have to pulse and relax pulse we're talking about Mike Tyson before the uh podcast today and the mechanics of how he pulses and then he's got to relax to get closing velocity of the Fist to the opponent and then when his fist hits the opponent he turns to Granite and it is just such an awesome experience to to feel that a little bit it's one of the joys of my life working with Elite athletes to feel their athleticism but then dissect it down as to how they do it so there's a lot in that but that lesson from the triathlete really shows us how you can't be good at everything there's always a trade-off with athleticism and the genetic part and then of course in the appropriate training to optimize and express that genetic gift through technique through technique so some athletes are very loose some athletes are very tight some are very elastic you won't hit a golf ball 330 uh yards if you're not an elastic athlete you'll notice if you measure a golfer who can hit 330 yards they don't test very strong they have a beautiful tuned elastic body uh you can almost see it if you've worked worked with enough of them there's a smoothness to the muscle so underneath the skin is a fascial net someone who can throw a baseball 110 115 120 mil an hour will be the same but now you have a very asymmetric elastic effect so um I know that you loath and avoid generalizations um with good reason but given that most people people listening to watching this um are probably not aiming to become Elite athletes I know I'm certainly not um can we safely make at least one or two generalizations about what we each and all can do to try and avoid um let's say back pain and injury um it by either diversifying our training or avoiding certain types of training for instance let's take the three major phenotypes um and and this is obviously not how the world works but the classic you know ectomorphic phenotype very thin very willowy small joints long and live you know um or live the mesomorph thicker more muscular um uh and then the so-called endomorph the more heavier set maybe even carrying some extra body fat Etc don't really know what's under there they could fall into either of the other two phenotypes I could imagine based on everything that you're saying that A good rule of thumb would be avoid the types of activities that are outside of your natural genetic propensity um based on body type at least in the extremes like if you're not very bendy don't do seven days a week of yoga okay but I could also Imagine the opposite which is if you're not very bendy do seven days of yoga because that's going to allow you to become more bendy or the person that is naturally shaped more like a shot putter let's say the myomorph or uh endomorph and you could say well um there'd be great powerlifter I mean I knew kids like this in high school you know PE class they're like okay weight training today none of us have done weight training and then the kid you know lies down and you know and pushes you know 3:15 you're like oh goodness you know like that's that's wild um but maybe they shouldn't be weight training if their goal is to be all around fit to be a which I think is the goal of most people to be able to you know carry some luggage at the airport without you know having to stop every once in a while and suck for air to be able to you know lean down and grab something out of a cabinet you know you know pick up a kid you know you know do some hard uh labor in the yard you know move some logs and things like that just be able to do stuff without getting injured without being so sore in the following days that that you feel like you need um extensive rehabil itation so again I know you like to avoid generalizations but should we make it a point to train against our predisposition in order to offset the imbalances that would otherwise occur or would we be wise to lean into our strengths and just not touch stuff that Taps into our weaknesses I understand the question the answer is I don't know but but I know people will say oh this professor he he's avoiding the the question and I'm not going to do that so I'm going to tell you how I find the answer and it's through assessment and I'm glad we're getting back to back pain by the way because it's my real uh the Cornerstone of my expertise our assessment is very comprehensive it starts out by me simply asking the person tell me your story and some people never tell me about their pain when I ask them to tell me their story they will be telling me about their family life and the pressures that they have to still go to work because they have two kids in school or four kids in school or uh they might tell me about the passions that they have or they might tell me about their goals so the goals are the beginning of answer answering your question Andrew we all know people who aren't suited for a certain occupation or they aren't suited or or they I'll take myself for example I had a high school careers counselor tell my father well Miguel he's not really suited academically he should go to trade school and so I I registered for for for plumbing school no I just R UBS cuz clearly that's not the way you went not that going to Plumbing that going to Plumbing school would be a bad decision for some but in your case you went a very different direction I I think I would have been okay as a plumber sure but anyway uh my point in that is what are the goals uh then the assessment I'm I'm paying attention to the person's learning style how are we going to coach them and then we get down to the details of their pain what's the nature of the pain is it when they get out of bed in the morning is it associated with a certain activity is it associated with certain motions postures or loads and uh hone does does the pain change does it start out on one side of the back and then later in the day it's in the left glute or does it go down to your right toes all of things these things are telling me about the stability of the pain uh it it's giving me Clues on what I'm going to assess then we go and assess them and it begins with what we call provocative testing I'm purposefully provoking their pain if I can provoke their pain I've nailed the mechanic if I can't provoke it it's not mechanical okay well that tells me something now so now I'm starting to see um I know what their job is I know what sport it is they want to do I know enough about that job in sport that I know the physical demands I know the psych uh the psychological demands do they have what's required of the job or Sport and then I test that if it triggers their pain we have a problem so now we have to focus the training very specifically because people do not have infinite training capacity they only have so much and when you're hurt you have even less so we try and focus on things that are going to make a difference to enable them to have the ability to meet those specific demands that we've identified so do you see how it's it's a long-winded answer but I I know how to get there to know how to train them so now that we've recognized the very specific nature of their pain pathway and it may be something that's going through the linkage in other words um when they uh run I I could give you an example of if we put a group of Canadian hockey players on an elliptical trainer they don't do very well because typical of the sport the hockey players tend to get stiffer in the hips it's the way they are they skate a little bit flexed and they carry all Heavy skates and heavy equipment down the legs they get stiffer in the hips when they go on the elliptical their hips don't have the range of motion and their spine and pelvis gyrates with every rotation on the elliptical trainer the elliptical gives them back pain if they already have motion triggered back pain we take another group who has mobile hips they do very well on a tical trainers the stress doesn't go into their backs so now do you see why I know why one group does well with elliptical the other group does not I know why one group who they I'll give them uh a lateral sheer test which is basically a bear hug I pull their pelvis towards me as I hook down their shoulder in my armpit so I'm shearing their spine laterally if that triggers their pain exactly I had a pro hockey player the other day I gave him the lateral Shear test and he had a right-sided flash of pain going around his right flank it exactly replicated the pain I just found with Precision the mechanism okay what's the antidote I put my fingers into his oblique muscles and I said push my fingers out and he did it too hard he says oh no that that that hurts even more okay dial it back a bit tune what we're trying to achieve here here fight me just a little bit I repeated the formerly offensive test the symptom was gone so now I'm getting more Precision on knowing what I need to do he was doing the Poff press the Poff press is a long lever exercise so you take a load usually with a cable or a band that's held laterally and you increase the length of the lever which you have to resist because it's punch it out from the body yeah you try and it it it's causing you to twist but it also creates a tremendous Shear load on your spine that was triggering his pain so we took out the Poff press which for him right now is replicating his symptoms but if you're playing in the NHL you should be able to do a Poff press you follow y yeah it it's it's a requirement of the rigors of professional hockey but he can't do it now so this is informing the programming that we're going to do so if somebody has pain in a given movement say standing up um after they sit for too long right um a particular style of hip hinge you know deadlift or or squat or when they run for instance would it be wise for them to you know think about the exact movement that makes the pain the worst in the moment that they're doing the movement or afterwards because often times pain will will arrive after we engage in a certain activity but during the activity that pain is shut down which by the way is an interesting phenomenon on its own right and um you know might be worth some uh mention as to like couple of the reasons why that that occurs we always think oh blood flow it's warm but clearly it's it's more it's much more than that more than that yeah for sure um so let's say I've uh pain in a knee when I run should I avoid running in that gate that causes pain and work around it um seems to me that would be the The Logical choice right every person that comes to us comes with back pain so initially we avoid it we can have a neurological discussion if you like we can have a biomechanical discussion or we can have a psychological discussion we can take it in the framework of any of those if we like if the pain is causing a sensitization I'm going to use the example here of stubbing your toe you stub your toe once okay well it hurts a bit and the pain goes away fairly quickly but if every day you stubbed your toe you would increase the sensitivity so that you don't have to stub it anymore all you have to do is lightly touch that sensitized toe and you are going to have a maladaptive heightened response so if we keep creating pain on that toe it will never get better MH so we have to start a desensitization wind down which is tissue based but it's also neurologically based as well and uh so so because everyone comes to us with pain we work very hard to hack our way around it so let's say sitting uh causes their pain all right we'll find out that when uh we do a sitting test if they sit slouched that causes their pain when they sit upright their pain goes away so I will give them a uh lumbar support which I'm just happening to use now I had to sit on an airplane for 5 hours yesterday coming to see you and this allows me to not get back pain on the airplane while I'm sitting because if I sit flexed for 5 hours I will have a grumpy back and I won't feel like when I get into the hotel to go for a walk which is uh and and train a bit because that's what we have to do to create a stress below the Tipping Point to optimize health so it's it's the same thing in putting together the program first of all know the cause and try and eliminate it so we'll teach them uh you you know we spend a lot of time with spine hygiene we teach them uh how to to hip hinge your squat we teach them how to Lunge how to get to the floor we teach them how to roll without twisting their spine into pain but using their ball and socket joints uh we teach them how to do a baby's crawl uh which eliminates the Torso twisting which in their current state will offend the sensitized pain trigger that must be humbling for adults to get down and do a baby's crawl hey it's it's so humbling to take a world record holding athlete and humble them right back I as you know I've I've had the current holder of the world's alltime record squat Brian Carroll and I Brian and I have written a book together so I can use his name what's the squat record 1,36 PBS if you can believe that down to parallel down to parallel no no other human has has done that that was four years ago now no one's replicated it does he wear a one of those elastic lifting suits when he does that he do yeah so he's putting on an exoskeleton of stiffness but I want to come back yeah to how humbling it was to have someone who already held World Records in squatting in two different weight categories and I had to show them how to get off the toilet but that's another story and we both laugh at this now but that was what pain had done pain had corrupted his movement patterns and he forgot how to squat but he held the world record that's how corruptive pain is to the neurological engram and we can talk about inhibition and facilitation and all of the things uh I mean I'd love to have that conversation because I know who I'm sitting with the the neural aspects are fascinating when he does that um incredible squat poundage um does he take the bar off a standard um squat rack and then walk it back or is he is it one of those ones where the bar is suspended from two hooks and then he takes it from there yeah so that particular lift was lifted off a monolith where he didn't have to walk it out so he takes it off so it's hanging from hooks then the hooks away the reason I ask is um it sounds like he's optimized for one very specific movement and a couple of you know uh couple of planes and nothing else because walking with a thousand plus pounds on one shoulders is also a feet and of itself okay shuffling backwards as it were all right you're not letting me off the hook which is fine so I've worked with competitors who compete in strong man and they can carry and walk with 1,000 lbs on their shoulders it's called the super Yol uh another client of of ours who uh held the the world Wilks score in the ipf international powerlifting Federation where they do not lift out of a monolith they take the bar off a squat rack and they have to step back and that is uh if you don't have enough lateral Al strength and control in your torso that's when you become hurt not during the squat it's during the walk out so it's a trem it's a very different feat of strength so you're very astute to say lifting from a monolith is a different athleticism and strength distribution then an ipf style where they lift off a rack and have to walk it out so you're standing on one leg so can you imagine a th000 pounds coming down your axial Spine down your midline it hits your pelvis and then it has to Shear across the pelvis and go down the stance leg as you're stepping back with the right so it requires tremendous strength to hold the pelvic platform up on the swing leg side and uh so that that is a tremendous core strength component so best not be uh carrying a willow spine for that one you want to be like a like a a mirwoods redwood um well you want to be built like Blaine Sumer who's another one of our uh clients I've worked with Blaine for quite a number of years I love the analogy to dog breeds I love going to dog shows I've only done it a few times not to actually see the Prancing around of the dogs that doesn't interest me at all best part about a a really excellent dog show as you go back behind the the arena where all the different breeds um reside so you can see the lineup of the the finest Irish wolf hounds the finest um English bulldogs at Etc you know hundreds of different breeds and you really get to see these genetic extremes not just of structure but of temperament and you get to see the similarity and temperament of the Bulldogs and of course there's variation some of them are a bit more Jolly others more stoic um you know the Terriers are magnificent in their own right um and as you pointed out earlier with respect to the podium more similar to each other within breed than across breeds in terms of temperament but there's variation within breed the reason I bring this up and the reason I bring this up now is that if you look at the movement of those animals even just the way they walk whether or not they um enjoy a a flexion of the Paw as they stride or whether or not they tend to stride differently I don't have language for this I'm not an expert in this but I have a visual system that works and I can see that they may move differently they actually walk differently even at the same Pace um and then you look at human beings shorter taller medium more Li more heavy set um and it's amazing that we don't take this into consideration that we all move very differently even within species but that we we um B into these groups so when someone walks into your laboratory as it were your clinic SL laboratory do you are you paying attention to how they move into the room irrespective of pain 100% I uh we we we time the clients I see 1 in the morning and 1 in the afternoon and they're three-hour appointments so I know when they're coming I watch them get out of the car if I can and that's when the assessment starts uh but just to go back to the dogs my sister is a vet her husband's a vet and her daughters in vet training so we have these conversations all the time do you know she's already made an assessment of that dog on how it's going to behave when she injects it or has to do a rectile exam or whatnot in what dog or breed and even in cats which ones she's going to muzzle because she's usually right on on who's going to get bet H yeah and uh interestingly as well it's how the uh dog feeds off the owner and she can look at the owner and usually determine how the dog is going to behave so talk about the psychosocial millu around dog behavior absolutely going back to your question when a person walks in so I've had gold uh have I had a gold medalist in Sprints yes I have from the Olympics uh I've had a silver medalist I've had just what every athlete that you can and then a person walks in off the street all with back pain in your mind's eye conjure up the image of a good Sprinter do you think they have a flat lower back or do you think they have a lot of lordosis which is an extend tension Hollow in their low back a sprinter now what what will they have I recall seeing Michael Johnson sprinting very upright yes so when I think upright I think either you know flat lower back or a little bit of a of a of an arch in the lower back you know this kind of yeah he was 200 meters wasn't he 2 and4 well I think he was a 200 and 400 he was um which is unusual someone could win golden both well I'll I'll think of some of the sprinters now the 100 meter men and women they you will find they have a lot more lordosis than the runners yeah they have a and what that does uh I'll just explain the running mechanics here for a minute so if you're running along you have a center of mass you have to bias the force under your feet behind the center of Mass to propel you forward because if it's in front of the center of mass you're actually breaking which wouldn't win you a gold medal so footfall has to occur behind the center of mass and then you get a very brief period of time to create an extensor pulse and then recover the leg if you can pre-t turn the pelvis with a lot of lordosis in the spine you get much more power development behind the center of mass through the extensor range if you have a flatback it's difficult now you've just shortened up the range that you can pulse into propulsive forces a Sprinter turn B the body yeah but you'll notice it's very difficult for a sprinter to kick high so you'll you know I I look at these different forms in the combat athletes if you look at someone who can kick high in a round house they will tend to have a flatter back so combat athletes tend to have a flatter back going back to the runners you'll notice that the Michael Johnson's and the more the runners with more distance have a flatter spine they're more upright and they're tuning that uh uh ability to store and recover elastic energy where where the Sprinter out of the blocks it's horsepower it's concentric and Ecentric muscle pulsing but uh anyway there there there would be uh an example since you you mentioned it with running uh the the style of running the event they're not running isn't running running is very different and again look at the podium winners of the sprinters versus the 10,000 meters very different architecture I'd like to take a brief break to thank one of our sponsors element element is an electrolyte drink that has everything you need and nothing you don't that means the electrolytes sodium magnesium and potassium in the correct ratios but no sugar now I and others on the podcast have talked a lot about the critical importance of hydration for proper brain and bodily function research shows that even a slight degree of dehydration can really diminish cognitive itive and physical performance it's also important that you get adequate electrolytes in order for your body and brain to function at their best the electrolytes sodium magnesium and potassium are critical for the functioning of all the cells in your body especially your neurons or nerve cells to make sure that I'm getting proper amounts of hydration and electrolytes I dissolve one packet of element in about 16 to 32 ounces of water when I wake up in the morning and I drink that basically first thing in the morning I also drink element dissolved in water during any kind of physical exercise I'm doing especially on hot days if I'm sweating a lot and losing water and electrolytes if you'd like to try element you can go to drink element.com huberman spelled drink LM nt.com huberman to claim a free element sample pack with the purchase of any element drink mix again that's drink element.com huberman to claim a free sample pack I love where this conversation is going because there's tremendous variation in body shape and form out there and I'm certain that by now everybody listening is starting to think about oh am I more uh likely to have a willowy spine a thinner spine or a thicker spine the kind of pliability or um what you call vertical stacking resilience that a uh one spine or the other would have um and it brings me back to this question of what can we each and all do to try and create the strongest back as well as limit the propensity for pain assuming we don't don't have it yet okay so um I would say I'm kind of in the middle I'm neither extremely live nor am I shaped like a you know like a kettle bell kind somewhere in between um so for me I make it a point across my training week to include three resistance training sessions three quote unquote cardiovascular training sessions one long one medium one short cardiovascular session the lifting sessions are geared toward building or maintaining strength in a balanced way for me everyone is going to have different requirements in other words nothing is skewed toward one particular outcome like endurance or strength or power and I think most people probably want something similar because they'd like to be able to meet the various demands of life so I frame the question I'm about to ask that way because as people start to assess themselves the question arises again should we try and compensate for our weaknesses by emphasizing a certain style of training a little bit more and if so what does that look like for the spine you said earlier and I love this quote and I want to make sure I attribute it to you now and going forward that all systems in the body require Stress For Better Health Optimal Health for op thank you for Optimal Health so assuming that somebody has a a a thinner stature they're more bendy would they be wise to build up the muscles of the core um not just the abdominals but the obliques and the lower back muscles you know all around the spine in order to give it more stability and would the person who has a thicker torso thicker spine thicker joints do well to emphasize some additional yoga training um some additional um anything that allows them to be more bendy I'm going to go back to the fact that they're coming to me with pain we are going to figure out through the thorough assessment what triggers their pain most people it's true are don't want ultimate performance they're not being paid $10 million to be able to throw a fast ball or something like that they want to enjoy life let's say they love golf my job is to get them sufficiently robust and out of pain to go and play recreational golf so it becomes a moot point now whether they have a willowy spine or not I will look at their their basic golf swing uh if I can divide that up just just binary uh some people are what we call Twisters they don't have a lot of hip mobility and they twist their spine so it's called The X Factor engulf and they store and recover elastic energy again it it is an elastic athleticism but the next person isn't so much a twister they're a Turner they have what we call Quick hips so their hips turn and their spines don't sustain as much twist and then we measure well when they impact the ball if they have a 100% violent lateral Crunch and then we measure them and assess them and that turns out to be their pain trigger what we do is we don't allow them to go to 100% in lateral Crunch at impact they go to 95% and that just moved them off the Tipping Point so they're not stubbing their toe or slamming into the pain sensitizer just stay off the D sensitizer now so backtracking a little bit but making sure that I'm doing that with purpose you need to know what generates the pain in order to try and localize the pain it all comes back to the assessment but then the goal is not to repeat whatever creates the pain correct perhaps what I'm hearing the goal is to get near the proximity of the pain but not go there not generate the movement that that recreates the pain but you know take the movement as far as one can without creating the pain and then think about where the instability or weakness or biomechanical failure is contributing to the pain okay so now I understand why if I can just add one I don't want to interrupt but this is a good juncture Andrew then we get into the volume of exposure so remember the Tipping Point we can have somewhat of an offense to their former pain but if we do it sparingly that's another key so it isn't a matter of selecting the exercise sometimes as much as it is controlling the volume and then having a period of time off or a d load or whatnot so it may simply be um I've I've got a an athlete that that comes to mind right now in fact I I got a an email it wasn't an email it was a WhatsApp message oh I just won so she said an international tournament today and they play every day but in getting her back it was a matter of we have to do these things that were former pain triggers but control the volume uh you can think of again combat athletes jiujitsu requires a lot of spine mobility and typically Jiu-Jitsu athletes get pain when they use too much spine Mobility what we do is we limit their training in other words they have the skill of jiujitsu but they don't need to push the end range every day because if they do they're in so much pain they can't train so we back off the volume and I could tell you stories about professional football players they were their strongest when they were in college their bodies can't take the heavy strength training once they get into the NFL they don't Squat and deadlift what they used to they're they're they're they're they're they're they're limiting the depth they're pulling off blocks it the game changes and it's not what people think and well and there's some wisdom to to not pushing into pain and extremes all the time if the goal is to have a long Arc of Fitness or athletic career a good friend of mine who's very accomplished in the fitness Community he says one of the best ways to get and stay in excellent shape your entire life is to train consistently train reasonably hard and we can talk about what his recommendation is I'd love your your thoughts but as best as one can to not get hurt you know we forget about this we hear so much about training consistently and pushing hard but the not getting hurt part is is key as well um here's his recommendation on intensity can I share it with you and just get your thoughts yeah okay I have a short attention span can I just put add added value to that don't get hurt getting hurt is tremendously asymmetric let me uh do you know the book by TB Nasim oh Nim TB Nim an antifragile yeah oh an antifragile he quotes our work he quotes my low back disorders book as an example of antifragile medicine interesting anyway um when when you talk to uh uh uh TB in an economic sense if I gave you $100 to invest if you had a 50% gain you'd end up with 150 bucks if you had a 50% loss you'd end up with 50 it's much more hurtful to lose 50 than the relative Jolly you would get of gaining 50 yeah there's some Neuroscience certainly some psychology certainly some Neuroscience to support that right in terms of how we reset our um kind of uh reinforcement threshold right and so it is so asymmetric with injury training if you push is taking a risk you might gain a little bit in short-term resilience or short-term performance but you have a chance of really screwing things up and an injury is really asymmetrically harmful MH so when we work with people and athletes we really try and avoid injury because of the asymmetry of the consequence injury is bad that's the first part that I I wanted to say the second part is people train hard and they feel a muscle burn and and they talk about muscle but they don't talk about their joints and the key to long life is don't mess up your joints you can train hard and build muscle but muscle is adaptive and resilient joints are not so much and if you start messing those up when you're younger by training too hard you'll find that oh I was training at this intensity because I wanted to be strong when I'm 70 and 80 they'll find that no their knees ache they can't get down on their knees anymore they have to crawl up a chair or a wall very sad picture it it is don't mess up your joints so that's an overarching principle to of which the spine is one obviously but uh that that's some wisdom with uh training intensely when you're young don't base the outcome on muscle think about the joints no it's ex excellent recommendations for everyone um his suggestion and by the way this is not for competitive athletes this is just for exercisers uh if you will is to make 85% of one's workouts across the year at about 85% of maximal intensity and output so still constraining the total length of a session to whatever the goal of that session is whether it's resistance training or cardiovascular training but to not go all out to go at 85% of one's subjective understanding of what all out on that day would be on that day to make 10% of one's workouts across the year at somewhere between 90 to 95% intensity of what one could gener that day again 100% all out being subjective for that day and then 5% or even less of their workouts all out everything you could possibly give quote unquote leaving it all on the mat um whatever phrase one prefers and I like that recommendation because it keeps things in check and it also creates an awareness of how intense one is training and it allows us to not um let the great night sleep or the extra cup of coffee that we had or the great song that happens to be playing or the competitive of spirit that's arising because someone joined you that day or asked you to join a workout to take you into the domain of harming yourself in fact I I can look to the times when I've been injured training and almost always it's because somebody invited me to join their workout and we got into a little bit of a competitive spirit and I'm not an ultra competitive person but you know you you push yourself to 100% on that day um and two weeks later you've got something you're dealing with or two days later you've got got something and you go God was that really worth it and I think unless one is a competitive athlete and that's competition day it's probably not worth it right well I'm very sympathetic to the overall sentiment of what you just described but I think it's it's much more individual than that you can take a younger person and drive them quite hard as some trainers do and they have success a young person responds they recover faster Etc you try doing that to a 65-year-old and you'll find that they don't recover as quickly they need many more de lo and rest days so if you go to 85% you just committed to a 5day rest well maybe that's not wise if you went to 50% you only need one day of rest between so do you see how you play and you optimize this and it's like taper what we call tapering down an athlete or you know in my life uh I have seasons uh up until two years ago I rode snowmobiles hard in the winter two years ago I hit a rock at 100 miles an hour on a lake I fractured my spine you can spot the professor so that was my passion I I I had to so my training would start in August every year I'd get into shape to ride sleds fairly uh aggressively I couldn't do it all year Andrew i' I'd become injured so I I would have a cycle of three months getting ready and then really have some fun um but obviously I I I don't do that anymore but my my point in telling that St story is uh I need much more information than just okay 85% you may get away with that when you're 20 to 25 I don't think you're going to get away with that when you're 50 as an example as we optimize performance in our clients uh sometimes you got to leave a lot of gas in the tank because you want to train every other day uh certainly if you do two days in a row 85% there's no way so do you see what I mean it depends on their age their injury history their genetics and their body type and all the rest of it what are we actually pushing to 85% is it a distance on a run is it a deadlift weight uh that's pretty heavy yeah here I'm thinking about intensity meaning um well for resistance training let's say that one could uh complete six repetitions at a given weight um but if they had a gun to their head they could complete nine right um well then you're doing six again this is crude crude calculations right but six maybe seven maybe cheating a little bit on that seventh repetition if it's a run and like for me on Sundays typically there's a long slow jog um but the slow in that component is a little bit subjective so am I pushing a little bit harder than I'm comfortable or am I hitting kind of a cruising Pace right okay so 85% of Max intensity for me would be staying at cruising pace and occasionally bumping up the the speed a little bit um but on allout day if it happens to be one then it's long quote unquote slow distance but I'm trying to increase the speed of what I'm referring to as slow so again this is all very objective but we know on a given day whether or not we're pushing past our comfort zone or not um and I'm not somebody who relies heavily on heart rate monitors and things like that um what I rely on is my consistency this is the way that I've decide to stay in allaround shape for you know more than three decades I feel like I'm in decent shape I'm not a great athlete I'll never be the strongest person in the room or have the best endurance or the most speed or explosiveness but I'm pretty sure I can keep up with most things pretty well and I don't have pain and I feel very grateful to not have pain and I think it's because I've adopted a a stance of um I don't want to call it moderation but of modulation well uh I I appreciate all what you've said in my world everyone has a back pain history so it's always I just let the guy it's it's the information that we gather from the assessment that guides our decision on how we're going to a get the mo of pain build some base resilience which is tuning their body strategic Mobility strategic stability now if if one thing we haven't talked about is is various types of pain and how yet that impacts on how we're going to approach their programming for life you did a podcast with somebody I I can't remember what it what their name was but it was a pain podcast and you were developing this idea that if the mechanism of their pain was really part of the changed engram they were traumatized at at the time of the event or maybe it was a history of sexual abuse or whatever but I can detect that person almost always I'll start to put my hands on them to feel oh is there any intelligy here and they recoil that's an abused person that's a that's a very characteristic response so you start putting together some of these reactions and and you and you note that there's something deeper than an injury to a part of their spine yeah we had um Dr sha Mackey that was it yeah Dr Shawn Macky is our um head of the essentially the pain division at Stanford School of Medicine um he's an MDM PhD and he's a big proponent of the bioc psychos social model of pain which probably makes sense for us to discuss now as the name suggests it incorporates psychological elements it incorporates of course physiological elements and it points to as I recall seven or more sort of paths to dealing with pain some of which include um thoughts about one's emotional state stress level um sleep um I mean all of these things clearly play a role in pain and Rehabilitation from pain right I love that uh podcast by the way because it's so consistent with what we've found and what we do if a person has it was just a mechanical exceeding of their Tipping Point and they now have some tissue damage we address that by creating a strategy that they don't move or load in a way to stress that and we allow the injury to heal if we can and and we should talk about whether the the the disc adapts or you have to manage it but but that's another very interesting topic to get into but nonetheless we are tuning their body with strategic mobility and stability uh giving them core exercise unleashing their hips and shoulders Etc and we will have a reasonable level of success and We Know by the way what our success is because uniquely we follow up with every patient we see to know if we were successful or not but now we have that person and I can think of many examples just to give a spectrum perhaps the person was in a car accident they survived but the person beside them who might have been their mother died so now they're carrying a hell of a lot of emotional trauma guilt trauma maybe they knotted off at the time of the accident they were driving tremendous psychological stress maybe they were sexually abused or whatever that rewires their brain so now they come in and the pain pattern doesn't fit we do physical stressing of their various tissues and the reactions they change their very they're they're they're not what they should be the way that their brain perceives the pain has been rewired if we give them the traditional approach of giving them more Fitness and ability it won't work we can't break through that maladaptive response we completely change now it might be just to desensitize and you'll laugh at this we might get a feather and brush it over further back and they say oh yeah that that triggers my pain really yes oh and now I'm getting a headache okay so we have to come up with what can they do without triggering that maladaptive response and it might be that simply the most simple of movements where the affrant and Ence all the information going into that engram which is forly triggering pain we now figure out what it is that doesn't trigger pain and then slowly desensitize it with repetition never triggering pain and then we expand that repertoire so you've heard of fibromyalgia which is a little bit of a catchall term but a flashing light uh surprising someone they're walking down the street and someone comes out of a shop and and surprises them somehow and that triggers off this massive pain response uh we do that with very gentle love doing the things that doesn't cause pain and and try and slowly expand that engram into a pain-free one there are those in uh what's called work hardening it's usually funded by insurance companies so if you have intransigent back pain we are now going to get you to do your job we start out with an hour a day you're a brick layer you're going to lay bricks for an hour tomorrow you're going to lay for an hour and a half and occasionally they have some success or they have some really miserable failures and the person says I cannot do another day of brick laying for four hours even though it's only a portion of my job and so now they get kicked out of the program because they're called a non-compliant in other words there's something psychological wrong with them and they're shattered those are the people we see so these These are you know talk about the bioc psychosocial approach I I know I get labeled sometimes as the biomechanist and I ignore all the psychosocial but these are people who've never read our work and they don't know it so I really appreciate you bringing this because I'm not a often asked uh this perspective but again I know with your background you'll appreciate all of this yeah surely the you know the nervous system is involved in generating movement and feedback from the muscles and propri reception and uh as you're describing the nervous system uh creates our sense of pain there's an emotional component to it as Dr Macky pointed out and as you're reinforcing and the neural circuits that control quote unquote pain or give rise to pain um involve the Confluence of all of these things at some level and I I appreciate that you're willing to go into this biopsychosocial model of pain and and acknowledge it um because I think all too often in this space of biomechanics and and pain and back pain in particular um people you in some cases get labeled as only subscribing to one particular pattern of Remedy or one particular framework and that's simply not true it's just not true um in fact I'll go so far as to say that that's actually a reflection of other people placing a singular lens on you and your work as opposed to your work having a singular lens I know that you look at things through the um rather complex prism that is back pain and back Rehabilitation um so thank you for touching into the biopsychosocial model and we'll put a link uh in the show note captions to that episode with Dr Macky because he went into this in some some depth and so it it is the case that we've covered uh that model in um in pretty extensive detail there's something that uh you said to me once that I really want to make sure we highlight which is that people who embark on a particular style of training not just sport selection but style of training like resistance training with heavier weights versus endurance training running longer distances or swimming longer distances will sometimes cultivate a certain should we call it personality style or reactivity style that is probably independent of who they started off as I mean you can never separate these things completely I mean we we could argue um people who have a lot of mental endurance pick endurance sports or people that are rather ballistic in their personality here I'm playing psychologist um pick sports with a lot of speed and Ballistic uh motion involved but perhaps the reverse is also true that the more we engage in activities for which the nervous system is required to generate a particular pattern of movement like ballistic movement or endurance or strength that we exacerbate certain aspects of our mental self our emotional self as well I realize this is not the stuff of um detailed peer-reviewed studies necessarily or at least I'm not aware of them but in your experience working with a variety of different people from the general population who engage in different activities as well as athletes who engage in very different activities and let's keep in mind the discussion we had earlier about dog breeds they are selected for not just based on physical fena type and movement but also personality type right temperament what sort of broad correlations have you observed in say endurance Runners do they have more mental endurance for other activities versus say strength athletes or sprinters do they tend to have less but tend to excel in other domains of their mental life you're right in that I haven't seen good science to back up this whole issue but after working with people for 40 years years and seeing the extremes of the phenotype I I do have some opinions on this and it comes from coaching so if you take an athlete who has by Nature they're very explosive neurologically they're quick they're explosive but they can't do it for very long it's almost and and I I hate using this label but it's it's just a way to describe it they have attenion deficit now I've been told I have this every High School teacher would have told you yeah Miguel he's attention deficit is now maybe it was just I wasn't interested in what they were talking about my brain was thinking about something else but I I I think I do have a certain degree of attention deficits if someone's not holding my attention I'm thinking of something that's more important the more explosive the athlete is the shorter the time you have to coach them that they're present with you the less explosive they are the more time you have to coach them so I will say that I find that really interesting um and I can think of a number of self- experiments uh that I'd like to embark on of you know including more endurance training at particular times of year and seeing how that correlates with um mental focus and endurance for say writing or preparing podcasts things of that sort um but of course now that I have some sense of what the answer could be I'd be biasing the the outcomes but if it's a self- experiment and the goal is simply to to shift one's um uh mental life or or behavior then I don't know that it matters that much C can I go with a little anecdote there that you may appreciate I'll get a call from a uh a coach say an MBA coach and it'll be uh with their medical staff and they'll say we have this player they play 18 minutes a game can you help and they have a back pain history could you help us to get them to play 27 minutes a game and then I'll investigate and understand the player and then I I may ask a question to the uh coach what puts paying bums in the seats in the stadium and they'll say well what do you mean and I said well it's that player that we're talking about that player is magical for the 18 minutes that they play because they're Sparky they're explosive if we train them and they have a plastic physiology and neurology that we can train so that they can last 27 minutes you realize that you're trading off the explosiveness you cannot have a really high V2 Max and be maximally explosive they're competing mechanisms one's a fast twitch mechanism for Speed and explosiveness and the other one one is an endurable physiology and you trade one for the other so do you really want to compromise that explosiveness and and you see this when you're uh uh on a team getting a uh combat athlete ready if they are neurologically explosive you design the fight and the training that they pretty much have to win in the first round and if they don't win in the first round they're going to gas out and uh the person who is uh preparing to compete against them is training to survive the first round and then come on in the second so they're training endurance to compare those two different athletes from a psychological point of view uh and if you do it enough I I think you'll come to agree with me and you will notice that there is how you coach them uh it it has to be short consumable bites and and it's not that they're any more or less intelligent they get it but but you have to be on Q and choose your words be efficient do you see what I mean the coaching style changes quite a bit do you think that if somebody has pain that they should have the capacity both to like lean into and push into the pain not exacerbate it but to you know sit with with it and and feel it as opposed to just avoiding it how should people think about their own pain and how to work with it that's the reason I'm asking right it depends and it's a dance so I can give you some examples one one chapter in my back mechanic book it's called well it's about surgery and should you have surgery we did this uh because as you know in our experimental clinic at the University we followed up with every patient we ever saw we would assess them and then we would subcategorize them into different bins if a person was told you've tried everything you've been to the chiropractor you've been to the physical therapist the osteopath you've had a surgical consult uh you've been to the psychologist Etc and you failed every single one of them so basically you've been conditioned to fail we tried a process called virtual surgery so I'm defining the group now you've tried everything and you've been told the last thing for you is surgery that's the subcategory of people that we're now going to talk about and I'll say fine you can go and roll a dice and have surgery most of them don't want it obviously and I'll say but what we're going to do is try virtual surgery and I make a bit of a a production out of it I anoint them like a knight I touch them on the shoulder and I say that's your surgery and I'm looking into their eyes and now I give them one of these we're looking into each other's Soul now you've had surgery you're going to behave like you've had surgery tomorrow your first posts surgical recovery day you're going to lay in bed relax get up for a pee every 2 or three hours have short little shuffles the next day we'll add a little bit more Etc we give you a posts surgical recovery program a really good one and then we start tuning the body strategically stability Mobility eventually adding a little bit of endurance long before strength and then getting the movement patterns Etc if the person was an exercise addict as well so you can imagine the person who has the personality that you're describing they tell me in the interview you know I have to ride the elliptical for 40 minutes every day because if I don't I'm going to murder my kids and my husband because that's my stress relief oh my goodness not not literally but that's what they'll say as a as painting the picture that person a treadmill right or exercise okay so they've won that negotiation with every previous clinician well they're not going to win it with me because all I care about is outcome my job is to get them better by whatever means so uh I have to tame that surgery Works in a lot of cases because it's forced rest surgery for that exercise addict forced them to have rest and allowed them to desensitize so we fake it and we do it now for the evidence we followed up with every patient and in a 2-year follow up 95% of those people who avoided surgery but did the virtual surgery we're glad that they did yeah that answers the question it's uh follow the advice of the clinician and it gets back to this issue of of predisposition to move a certain way to therefore avoid other forms of movement to engage in certain activities but not other activities I I realize that I'll get in trouble if I say you know 70% of the training that we do should be in line with our predisposition and 30% should be uh countercurrent to that but I'm kind of veering towards numbers more or less like that right I mean we know for instance in the um machine learning algorithms that relate to learning in the nervous system that a rough this is a rough estimate of difficulty should be about uh 15% of questions or challenges so these could be cognitive challenges or physical challenges should lead to failures noninjurious failures getting the answer wrong about 15 % of the time tends to optimize learning across a number of different domains okay like is that true for everything is it true for language math dance is no but it's true for a lot of things that's an argument that's used a lot and I I uh however as I said I've I've done the work and I've done the followup and I have an opinion for a reason we start out by giving them the tools to not have pain from a physical point of view uh that's really important from a psychological point of view we've just empowered that person they are now in control because they never had the tools a they didn't understand what the real mechanism of pain was so they had no strategy to downregulate it if I'm a neuroscientist or to desensitize it but now they know with some Precision what the moves the loads the activities are that cause their pain they know the Counterpoint points what actually are beneficial for their pain and they begin this life of having as little pain as possible now I go back to uh the Tipping Point and all systems need stress but in the beginning we cannot cross the Tipping Point and that's really the essence of your question when do we start pushing them now to allow a little bit of pain some people start it way too early we do not we know where that Tipping Point is and we keep building the training capacity of being pain-free until we have a margin of safety now it's that margin of safety that we start to play with can we expand the volume of training and get them ready to go back to work or to go back to their sport or maybe they just want to play recreational golf we've talked about that eventually we're going to go to the point where they're we're butting up against The Tipping Point now now we have another conversation remember what the goal is how important is it for you to set a personal past and deadlift or to play 18 holes of golf 5 days a week would you settle for three and and now they they've had a year of no pain their life has changed they're they're they're they're mentally in a different place uh they have their answer and they they converged on it themselves I'm not 18 I'm 55 years of age I've got two young grandkids I'm looking forward to playing golf with them when I'm 75 so do you see how when we bring them through that way accepting a certain amount of pain that's that's more of a younger person's Outlook there's still some Warriors left a lot of us soften up as we when as we get older but you know I just think of my own journey I trained heavy as a kid and I remember remember my dad saying why are you doing this you're you're you know you're really shortening your athletic career not that I had one but uh you know and uh he was right and now my my training has totally changed but I as you know I I have no pain I I uh I'm I'm still fairly physical yeah you're in great shape at 67 yeah just just remark remarkable shape for those listening and not watching I encourage you to take a look at the top card or the YouTube video I mean stew is moves around great and um and you're I mean well your your posture is great and you're you're an awesome shape for any age um much less 67 um so that's a testament to your methods well the the point was it's okay to push when you're younger you don't have the capacity to push now if I go into pain I'm in pain for a few days not an hour so you're cautious yeah and older people will will get to that point I'd like to ask you about Mill's big three I know that again you loath to um impart generalizations on people but at some point you realized that people need something to do to work with in order to try and quote unquote pain prooof their back or reinforce their back so um we did a video that um included the big three we'll provide a link to those in the show note captions where I perform the big three probably not perfectly admittedly um I I should have invited you to critique my form and we can always shoot another another one of those but I think it captures the big three well enough um the bird dog the roll up and the side plank right um designed to build strength and stability around the spine and to Stave off back pain or some cases rehabilitate back pain an enormous number of people wrote to us and commented how much the big three have helped them so I just want to make sure that it's clear that despite the fact that you are appropriately reluctant to say that the big three is the solution to everything in terms of back pain for everyone they have helped a a large large number of people um avoid and in some cases rehabilitate back pain if you were to add a fourth exercise to the big three what would it be depends on the assessment let's say somebody has a willowy spine and they want more spine stability they want to be able to generate more spine rigidity for whatever purpose what are their pain triggers uh they have a lower back pain on one that's unilateral um and when they sit too long and then stand up it feels like that that side is locked up and there's some pain shooting down the leg okay so they've got mechanical back pain they've got neurological involvement if it's shooting down the leg how old are they early 50s maybe in their 40s or older a big range so they will have some discogenic disorder there's there's a disorder of the joint and uh it will be causing the nerve to react uh in such a way and when they walk a bit 10 15 minutes they tend to feel better ah okay so they have a younger spine because uh discogenic disorders are more common among younger people and sitting is the causitive pathway going for a walk is the relieving pathway but that will switch over when they get uh older is that right yeah sitting becomes the relief and walking then becomes the uh exacerbator of their pain well again I need to know with some Precision what the uh pathway is but if they have neurological uh Parts I need to know why what makes them worse so I might have them sit upright in a chair grab the seat pan of the chair and pull up I'm adding compression does that cause more nerve uh radiation if it does they've got a little bit of compression in toolerance okay so now I have to choose an exercise that is not compressive uh By Nature um if I move the nerve so if I extend their leg at the same time asks them to look up it releases the whole spinal cord and all the nerve roots from above and it pulls it from Below in other words it flosses it through if that causes pain as they're doing it they've got nerve friction if they do it and it's tensile tension then it's it's nerve tension so these are these are very different uh uh mechanisms of their pain and they require different approaches so do you see why I'm still hedging on that that that next exercise it might be mobilizing the nerve it might be giving them more thoracic spine extension through a thoracic uh and now they've taken the load off when they sit and uh stand so you can imagine standing you can palpate your erector spine a muscles and they might be relaxed you poke your chin and those muscles come on and if the but it the cramp was on one side and if it was muscular that's probably not related to this uh that's still a very discogenic sign there's a bulge or there's something off that's mechanical that we will determine I might just say walk more but not in a single dose and and again I've described all of this in in back mechanic instead of walking an hour in one dose have three 20 minute walks walking for an hour increase the risk of getting pain walking for 20 minutes guaranteed you have no pain so do it in three doses you've just guaranteed success so I might add another exercise but I might program it very strategically as well what are your thoughts on um inversion tables and anti-gravity boots um and things to deload the spine right well uh again if you you follow our work we do uh do uh D loading of the spine through traction uh it's usually applied by one of our trained clinicians and the reason for that is let's take that younger person again as you just described maybe laying on their tummy as they exhale they allow the low back to sink into the table increasing the lordosis which is we measured this in the lab if they have a posterior disc bulge with an open Fisher which is probably one of the more common ones the that maneuver Vacuums in the disc Bulch if that immediately reduces the pain down their leg I would say lay prone and have someone pull on your legs along the plane of the table five or six pounds per leg now the next person comes in and say oh that hurts well now we play what we call Jazz this is the art of therapy I'm playing with how we're going to apply a twisting torque to their feet M no no decompression table does all of this it doesn't have the art it's it it it's more of a brutal hammer and to really get difficult people because remember no one has back pain and says oh I think I'll go see Miguel it doesn't work that way we only get the ones who've failed 10 previous attempts every other every other treatment no we've got to know we've got to have some skills here well I started doing the big three on the basis of your book um and it certainly has help my lower right side back pain that occasionally flares up I also noticed I've gotten stronger in various lifts but the most Salient consequence has been when I run I feel like my torso can um uh stay more upright as I can kind of cycle my legs underneath me like I'm pedaling on a bike and I feel like I have endurance for days that's exactly what you should feel so you've improved the cylinder so the diaphragm pumps up and down inside the cylinder to allow you to lung ventilate if you don't have that athletic diaphragm you're entraining your abdominal muscles the oblique muscles to the breathing effort while you're running it wears you out it also compromises your spine so you need those muscles to form a girdle and hold it all together now I know enough of your history that I suspect you will have a little bit of a disc bulge I do yeah I had a whole body um scan right um for just you know for fun I guess is the sort of thing I do for fun and indeed there's a I think it's like an L3 L4 bulge uh on one side which is fully consistent with the the pattern of pain that I've had right um and I've managed to avoid for a number of years now doing um Cobra type pose um these kinds of things the Cobra doesn't work for everybody but it is a powerful vacuum in of certain types of dis bulges so I'm glad it works for you and you found it and it will work for some others or it will make the pain worse than some others and there's tests for figuring that out I notice if I travel and it forces me to sit for long periods of time and then the next day I train with any kind of hip hinge movement it flares up again right don't forget to use your Lumar on the airplane right yes Dr Mill gave me this uh little pillow they call it the Lumar that inflates you putting in the lower back and it's um It's a Wonderful tool right um that gives you resilience for travel if one didn't have access to that um they could just roll up a towel and put in their lower back AB absolutely yeah or sitting in a lecture uh if they're a student travel with it sitting in a restaurant people who go and say oh my back's killing me after sitting in that booth in the restaurant you might get some funny looks but you'll be the person still mobile and not complaining about your pain uh when everyone else is is grunting I'm past the funny looks I'm I'm okay with that that's that's a that's an advanced neuroplasticity trick that comes with age yeah I'm right there with you I have a a question about walking yeah um these days we're hearing more and more about benefits of walking after meals walking several times per day blood sugar regulation I think it's all wonderful anything that gets people moving in healthy ways um I think is terrific when it comes to walking uh none of us want to be the person paying careful attention to our gate especially when we're not in pain and things of that sort but if you were going to recommend a daily walk is there a duration and speed that you think you know could be beneficial in terms of staving off back pain um just you know General posture things of that sort are we talking about a Brisk 5 minute walk or a Brisk 20 minute walk this kind of thing I'm with you 100% with the notion that walking is one of the most healthy things you can do I get stuck a little bit when you want me to give numbers in a generic broad application ranges are fine if I saw the person uh and they have a back pain history I would know uh a should I just leave walking alone and tell them to walk it's quite fine that's not your problem but we still want you to walk three or four times a day but I I I know what the question is and you want some general rules on all of this um don't walk to pain so if your Tipping Point is 40 minutes you can't go and for a 40 minute walk you've just guaranteed that you will be unsuccessful in having a pain-free day but can you walk 20 minutes good walk 20 minutes three times a day now you've got a full hour of pain-free walking guaranteed so it was the exposure and how you dosed it throughout the day um if the person has discogenic back pain they will find that they don't like to stand in one position for very long sit in one position for very long or do any single activity for a long period of time so the the key for their daily regimen is to keep changing posture so something like a sit stand desk desk at work would be a really good idea but now the magic comes if they could sit for 20 minutes stand for 30 minutes and walk for 10 now that was the magic that just of the dosing that uh allows them to do their job as a computer programmer or whatever it is where they're a slave to the computer there's no option so there's an idea uh there um in my own life it's a habit I walk after every meal I walk before I go to bed and that's my time with my wife and my dog and it's it's our routine and it is uh even when we we we travel in the winter we Drive South we break up the drive and we do our walks and uh it keeps us painfree if i s it doesn't matter who you are if you sit all day uh chances are you will cause pain I can talk about damage which is interesting we've probably loaded more spines than any other laboratory in the world I I think that's a fair thing to say if we put a cadaveric spine that is what we call a virgin spine in other words it came from a young donor it wasn't traumatized uh so there's no pre-existing cumulative damage to it if you put it in a sitting posture you cannot create new injury so if a person has never had back pain and I can give you an example you know that the person that they're probably overweight and all they do is sit it's so unfair they don't have any back pain and then their colleague is much more fit they go to the gym every day they have back pain and and and they think this is so unfair but what they didn't realize is they are not training wisely at the gym they they are probably uh going far too hard in a short period of time with too much intensity and they're creating a little bit of microt trauma so now they just made sitting painful so so do you see what I mean you can't injure the spine sitting if if you have no pre-existing injury but if you have pre-existing delamination of the collagen an old disc bulge sitting for a long time will then make it painful if ever there were two exercises that bring to mind Notions of back strengthening and potentially back pain it's the deadlift and the squat what are your thoughts on deadlifts and squats as a function of one 's age one's perhaps phenotype Ecto Endo or myomorph or any other factors that would lead you to say yes deadlift Endor squat no don't deadlift Endor squat or maybe you should deadlift Andor squat okay uh those who know me know it could be any of those three options at the highest level every exercise is a tool and it's a tool to reach a specific goal so in our world of limited capacity when a person is fresh coming out of back pain or they're training to really achieve something physically have they defined the goal and have they chosen the best tool to keep as much capacity as they can for training other things that really matter the deadlift is an an extraordinary exercise and and as you know I I don't know of anyone who's been involved with more world class deadlifters than myself through the back pain uh relationship so you know on one hand I can say well I love the deadlift and on another hand I can say I hate the deadlift I can tell you Andrew that if you take the clients who ask for consults now and they're under 30 years of age I will say half of them will say in their interview with me it started with a deadlift so I would say that is getting onto the category of an epidemic and yet I will still tell you I love the deadlift so there's a lot of variables here a lot of moving Parts the deadlift is a tremendously neurologically dense exercise whether you're lifting a light weight or a heavy weight I love these bodybuilding uh charts that say oh well to do a deadlift it it it lights up the erector spine a the glutes and the and the quads perhaps every single muscle of the body should be involved to a deadlift every single muscle there are no agonists and antagonists every muscle the full fascial complex will be tightened up to take the slack out to pull a bar from the ground that's a good deadlift uh that's what minimizes the risk of injury and as you know competitive deadlifters will actually put on a exoskeleton of even more fascial stiffness it's called a lifting suit but not everybody obviously is uh in that category now I'm going to talk about one of the most potent Pathways to disc herniation so we have the disc from an anatomical point point of view it's a gel core wrapped with layer upon layer concentric layers of collagen fibers that in order to get a dis bulge or a disc herniation they needed to delaminate and the gel nucleus when it's pressurized under a heavy Bend will seek the weak spot between these fibers work through the delamination and create a disc bulge there's been several recent studies now that have done assay investigations of the harvested nucleus in a in a disc surgery more than half the time that harvested nucleus contain fragments of broken endplate broken endplate comes from excessive compression and then you go into the history of the person oh well maybe they fell on ice and they pile drived their back there's a candidate mechanism to create small fractured bits of end plate but then they will say no this whole discernation story it started with a deadlift two years ago my back got a bit Tweaky after that I kept deadlifting and what not and then they find the fragments of bone so more than half of that harvested nucleus shows evidence of an overload and compression when you put that together with with with the history and again it's it's not the fault of the deadlift it's the fault of the progression uh there are some trainers who will take a person from an unfit State through to lifting in a deadlift twice their body weight in half a year when you look at the stimulus to bone growth it takes a lot longer than half a year and when you look at the uh characteristics of really successful deadlifters they're not Young men and women they are people who've trained their body over many years to get that density of bone because that that really is the weakest link uh in a deadlift as far as uh back injury goes so there's something to consider first of all um let's go back to the back pained person now and there are some people who do not perform an assessment and they say oh if you've got back pain the symptom of back pain pain do deadlifts well well hold on a second one of the first things we do after we've assessed them is to try and get rid of the cause that almost always involves teaching them how to bend at the hips and not stressing and creating concentrations in the spine it's called a hip hinge uh then we may put a load in their hands and then we have to assess their hips to determine whether the hips have shallow sockets or deep sockets in other words what's the hip range of motion that will allow you to pick a bar off the ground there are many people who shouldn't be picking heavy bars off the ground uh when you look at the size of an Olympic I call them cookies but a a 45lb plate I suppose uh that was arbitrarily chosen in fact it was actually chosen that if someone dropped the bar uh on the ground your head could fit between the bar and the ground that was where that original size of the came from is my understanding of it people lifting alone quite often is that why oh yeah well there's lots of YouTubes of those injuries but anyway yeah that's uh that's something that I both encourage and discourage people from searching for because it can scare you appropriately but it's also can be traumatizing to see right so now we've put together the idea of uh what Anatomy do they have in the hips and where's the Tipping Point in picking something off the ground we may start to progress the uh hip hinge into a loaded situation if the person doesn't have compressive load triggers to their back pain pattern uh I doubt we'll be pulling a bar off the ground though we will Elevate the bar and put it on blocks so if you come to backfit Pro and you look at our our uh rack that has uh 1300 lb there available to lift if you wish they pull off pins in other words we're we're were matching the height of the pole to their biomechanical Optimum uh in the beginning and then we have to decide is the deadlift the best tool to get them to their goal you know I I did the podcast with uh Peter AA and Peter had a uh a little section on the deadlift and he asked me the same question but he just told me his personal story of conflict and whether he should be deadlifting you know he's had a couple of spine surgeries as a younger man when you know none of us knew better in those days I suppose and my answer was to him and a lot of people took it and I we got a lot of blowback on this that it was a generic answer for deadlifts and it wasn't it was an answer for him where I started to talk about well maybe for yourself why don't we walk backwards up a hill in a monster walk style and you will feel the quads burning how many squats and deadlifts do you really need to do and then neurology comes into this you walk backwards up a hill say it's about 50 yards your quads are burning then walk down to the bottom of the hill and walk forwards up the hill the brain says I'm perceiving exhausted quads let's go get the next in the hierarchy your glutes it's a fabulous stimulator to glutes so there you go I've just found a better tool for a person who has limited capacity deadlift was not the way to go they're going to walk backwards up hill and then they're going to walk forward and really uh feel tremendous exhaustion if that's how they get their jolies and if that's what we need in the athleticism to keep them going and building robustness what are your thoughts on um glute ham raises I'm a big fan of Nordic curls and glute ham raises for the posterior chain to me a glute ham raise folks can look it up is basically a deadlift into a leg curl into a hamstring leg curl except that your feet are um instead of uh being on the floor for the deadlift part you've rotated yourself uh 90° um so that the feet are effectively at the wall right that and from the bottom position up to the parallel to Floor position that's more or less a dead deadlift right stiff-legged or partially stiff legged deadlift and then the rest of the way is the Nordic curl or the leg curl to me that seems like almost the perfect exercise for the posterior chain hamstrings and glutes which is why I do them regularly what are your thoughts about them for back strengthening and for people that are trying to avoid back pain both in the present and in the future it's exactly the same answer that I gave you for deadlifts a it depends and B is it the best tool to reach the goal that is an auxiliary exercise it's not a deadlift it's just challenging a part of the chain involved in the full chain that's required for a deadlift if I go back to some of the criticism after that original uh deadlift statement there was a lot of older fellas who were who were saying you know I love the deadlift when I stop deadlifting my back pain actually increases and uh deadlifting keeps the bogey man away I get it okay that was the right tool for them but I can tell you about the characteristic of those people they will be somewhat unidimensional in their athleticism I will bet you dollars to Donuts actually Donuts are getting more expensive now so that that's that's a poor analogy that worked when I was a kid but anyway ask them to throw a football ask them to swing a golf club I'll bet you the ones who say deadlifts are good for their back pain won't do well in either of those activities so it's a it's a very unidimensional because they can't generate that kind of twist and snap with the uh with the throwing a football for instance like the the stiffening up of the body precisely the right moment and the relaxing of the the arm the flicking and and spiral a deadlift is not a pulsing strength it's a grinding strength and again if you want neurology to adapt to create you know when again I know people don't like when I do this but when I I I love uh athletic examples and I learn so much because it's like a car mechanic working on a McLaren uh and then a dump truck which which carries heavy load and then a Baja eraser which is incredibly endurable because it shows you in terms of engineering and automotive technology what is possible so when you work with a great athlete you learn what is humanly possible so something like a deadlift it teaches the nerves to carry electricity when you measure a very good deadlift it is an exhausting but think of it what is strength strength starts with this thought and now you have to densify that thought then you have to densify the pulse train down through the nerves and you've got to teach the nerves to carry that amount of electrical pulse and you've got to teach the muscles to utilize it so in terms of grinding strength capacity a deadlift is pretty good but does that have to do with most people uh with back pain a few years ago the professional golf Community LED by a few personalities got into heavier lifting now this was rather odd if you go back to the old days of Jack Nicholas and Gary Player and Arnold Palmer do you think they lifted heavy weights and I think Arnold Palmer is still playing I mean some of those guys back when were were known for having a few alcohol sure drinks plus smoking cigarettes on yeah uh on the course but but but my point is the more you deadlift the less you will be able to throw a football and play golf so if your goal in life is to be generally able to enjoy a a a really diverse array of activities be careful on the tools that you choose uh so going back to the the the the pro golfers of say uh 15 years ago when a few of them got into Olympic lifting which is heavy hip mobility down to the Deep squat for the snatch and tremendous uh shoulder Mobility uh and deadlifts not one of them to my knowledge and I know some of them intimately well hit the ball further but they ended up with sore knees and disc bulges essentially really heavily compromising their careers and then a few of them and I've worked with quite a number of them have now backed off that heavy lifting and they have less pain far more resilience and I think they're going to be playing a lot longer for it so I know that's going to create uh some controversy but so be it well that's okay I mean I I've gone on record saying that I'll do and and genuinely do heavy hack squats hack machine squats leg extensions those kinds of things Alternatives that for me have just led to you know progressively more of what I'm looking for when training legs um and and back of course lower back and I do the glute ham raises and I can do all of those without pain um I don't know the last time I ever did a deadlift I I was never particularly strong in the deadlift but if you're telling me that avoiding deadlifts as I get older heavy deadlifts that is is going to help me avoid back and hip pain then you know I'm I'm all for avoiding heavy deadlift if you want first of all I don't put you in the category of high risk for osteoporosis which is mineral loss from your bones through genetics and uh way under the Tipping Point in terms of load stimulation so I'm not worried about that for you so if I was that would justify a he heavier loading regimen for now but as Alternatives uh a rear leg elevated split squat you can do it just with body weight or consider this interlace your fingers put them behind your head become a peacock lift your your your chest up now do the split leg rear elevated uh squats like lunge squats and and you're potentiating the erector spiny and the whole stabilizing me mechanism by pushing up and resisting do you see how I flare do I need to flare my elbows back uh you can do yeah okay now do you see how that just stimulated your whole upper body and the more you push and traps everything light up right you just lit up your whole erector spine a we did all of that without a heavy bar you could do a goblet squat hold it in front now the whole body takes a more upright attitude uh it's more knee load if you want more knee load and less back and hip load or you know a back squat you add more hip and low backload and you take some off the knees so you can band the knees we can really play jazz on this to optimize the best variant to get optimal reward with with minimal risk and that will change as you recover from the back injury it will change with age it will uh change with other coorilos would be uh another example now you've added a balance challenge as you get older your risk will not be mitigated by deadlifts because the biggest risk as you get older is falling that will really change your life as it does in many people do you have the agility and neural dexterity that when you stumble can you get your foot out ahead of the center of mass which is now ahead of the base of support so you're going to fall you got to get that quick so it's hip power quick restr the fall and really mitigate against catastrophe which is that fall so do you see how that changed but can I just finish off with one thing and I want to talk about deadlifts and capacity as well and again it's it's a lesson that we learn from Elite athletes when we have an athlete whose goal it is to set a world record be it in deadlifting or squatting or whatever they can't train maximum deadlifts and squats two or three times a week it is just to exhausting and the recovery period required between training sessions becomes so long they actually lose the peak off the training progress so we do it through auxiliary exercise so when I think of someone like Brian Carroll you know again this is all sort of content validity types of arguments I get it but until someone produces a few more winners I I'm I'm going to stick with the the way our science has shown to go if you train and really push you know you're talking about training at 85% well are you going to set the world record if you only train at 85% probably not but if you go to 100% youve got to take a couple of weeks off so instead you do some auxiliaries like Brian used heavily the belt squat machine which you can really train hips legs Etc tremendous power but it doesn't take or exhaust the whole upper body and back system where you're not loading the spine or compressing the spine that's right because it it you just can't do it so if do you see why you know it's very difficult for me without knowing the person knowing what the goals are knowing what their future risks are is it a bone mineral density issue or is it their knees are getting a bit cranky now or whatever the I I have to choose the most efficient uh tools occasionally it's a deadlift but I also told you that right now there's too many young people influenced by social media who are trying to set oh I'm going to set personal the best in deadlift not really knowing how to densify the neural Drive take out all the slack so when they grip the bar the final squeeze of the bar actually gets the the the bar moving they're breaking it from the floor with they're so stiff throughout their body and they they don't know this yet um and they they end up with a a back injury and and those are longlasting they're hard to recover from you talked about the so-called biblical training week I love this uh it's something that I plan to adopt for myself it's not too far off from what I do now but it's distinctly different enough that I'm excited because it's going to require some psychological adaptation physical adaptation tell me what is the biblical training week and why is it so useful it is the underlying philosophy of how I train now it wouldn't have appealed to me when I was in my 20s and 30s in those days it was all about uh strength power looking good impressive Etc but you know my joints aren't what they used to be uh my training has evolved with my age so the name training uh biblical training week came from the idea that every major religion has a Sabbath day a day off and I I when I was a kid and working with my dad you you didn't do any work on Sunday and that was his day of allowing all the cumulative work during the week to adapt and settle out so it's a very wise thing to do there's six days to train in its basic form two days a week I Strength train two days a week I work on the things that are a bit sticky and not moving moving very well because I'm getting older and I have a few injuries so those are the mobility days two days a week I work on my ticker cardiovascular system things to challenge uh my heart Etc there's more caveats to all of this so I live in a rural setting most of the time uh we heat our cabin I live in most most of the days the week by wood so I have to split firewood if I split firewood I've checked all the boxes it's cardiovascular training it's Mobility training and it's strength training so it's also a lot of power so I've done my training for that particular day but I wouldn't split wood two days in a row I wouldn't strength train two days in a row I wouldn't Mobility train two days in a row so that's another caveat don't do the same thing two days in a row and allow this soreness to really develop into into something another thing that suits me well is routine I try and go to bed at the same time get up at the same time so th th those are the basic tenants of the uh biblical training week the components of each you know I've I've had some neck trauma some shoulder trauma I broke my hip I'm hip replaced uh these are the things that I focus on for strategic uh Mobility uh the strength training is a little bit of bodybuilding a little bit of strengthen patternings so uh patterns of a squat a lift a lunge a push a pull uh Etc so I don't run because of my hips but in the summertime I will swim kayak uh canoe but I'll I'll put a bit of beef into it a bit of effort I ride my bike uh in the winter I cross country ski uh shovel snow is a big part where I live um Etc so those are the uh oh by the way I do do the big three six days out of seven and I didn't really discuss that of why they're essential we didn't invent those exercises but we measured we were one of the few groups in the world to actually measured spine stability in a quantitative way doing the big three was the most efficient way to guarantee spine stability but spare the spine while you're doing it well some people will say well why are you sparing your spine it's allows me to have capacity The Limited capacity to do other things so why why would I waste them all on core training the other thing is we live in a linkage so the spine is a flexible Rod there's no coincidence that either end of your core is a ball and socket joint the shoulder and the hips if I wanted to put P you or an object a heavy door perhaps at the University or at a shopping mall say I could bench press 300 lb well I can't anymore but say I could the bench press muscle is the PEC major let's look at the architecture of the PEC major the PEC major crosses the shoulder joint distal to the shoulder joint to where it connects on the upper arm bone the humorous the muscle contracts and creates the desired push but proximal it connects to my rib cage look what it does it collapses my torso into my shoulder which is an energy leak that is anti- push but if I can use core control and core stiffness and lock down proximately 100% of that muscle activity now goes distally to the athleticism so you may have heard the expression a stronger core makes you stronger throughout your body well how does that work I've just explained to you that when you create proximal control and stiffness it directs the athleticism distally if you want to wiggle your finger quickly you had to stiffen your wrist if you want to wiggle your arm quickly you had to stiffen your upper arm Etc so the mother of all proximal stability is your core in exactly the same way a heavy equipment operator using a backo the first thing they do is they put down the stabilizers which are posts that go into the ground and lift the tires off the ground to stabilize the tractor so that now the arm can be the athlete pulling Earth failure to stabilize you're just pulling the tractor around so core stability is essential for ability and performance it's arresting all little micro movements I'm we're all shrinking you you will notice this probably over the next decade the dis heite is now shrink Ing and there's going to be a little bit more micro movement in the discs is there anything that can be done to offset the shrinking not that I know of hey people will ask with an hanging or uh anti-gravity boots that oh well I've measured that yes it uh will it will increase disc heite for 15 minutes and then gravity and the hydrostatic pressures will cause the fluid flow and the fluid flow there's a little bit through uh laterally through the dis but most of it comes through the end plates so from the vertebral body into the nucleus of the disc and you can draw fluid in under tension but the hydrostatic pressure overrides the osmotic pressure in gravity and then the discs lose all the fluid so it's a 15minute uh effect I feel like every tissue in the body has been the uh Target of an attempt to either restore its more youthful State um or somehow augment its um I don't know resilience over time so these days we hear a lot about FDA approved treatments using so-called platelet rich plasma PRP injected into the knee or PRP injected into an ovary or PRP injected into whatever tissue it is that people are attempting to restore uh youthful state to is there any evidence for any compounds or injectable um drugs that can restore the um tensile strength and thickness to the discs I haven't seen any evidence of PRP doing so now I didn't condemn PRP throughout the body I swear by it for uh stubborn muscle tears interesting in in one example uh ball and socket articular joints uh they it there's no question not all the time but uh it it can make a a measurable difference but not injected into the dis so uh I I just need to give a little bit of a context to this now if we take someone's dis who's never been traumatized so they're a young person uh they can expose their spine to Mobility be it yoga or ballet or whatever and they will probably increase the range of motion and Mobility they can strength Trin and toughen the collagen in the Imp plate and build some bone and in other words they can do both Andrew they can increase the the the con constituent strength of the various parts and they can create Mobility but once you have an injury to the disc and you lose a little bit of dis height the world changes it's not so easy to adapt those full range of athletic abilities anymore so now you're forced to make a compromise most people we can get them to do one or the other they can maintain Mobility to play golf after a disc injury or they want to pop up on a surfboard that's their thing in life they just want to be able to Surf I'll say good we can manage it's no longer adapting we can manage you to to achieve that but you're going to have to back off the dead lifts and uh some of the strength exposures because they will just further compromise the dis heite of a damaged disc and we can do the opposite if you want to strength train and bear a load you're going to have to give up the mobility so that game that Dance with the Devil that comes after the after the back injury so I think the question was a little bit about adaptation uh if you haven't experienced dis damage yet you have a lot more leeway to adapt your spine after that it becomes a game of management and encouraging uh an athletic ability you become a little bit more uni-dimensional and if you want a little bit of everything okay but you have to be very modest you just have to try and Achieve sufficient Mobility sufficient strength to do whatever to just to get through life and it's and it's a bit of a dance so I don't know if that gives a bit of a context that's perfect yeah uh could you walk us through your biblical week training with some examples of what one could select from the buffet of training options right um okay I I can so Le let let's say to today I'm going into our Clinic gym and I will start with uh doing the big three so I will do uh bird dogs and I'm going to work on good form and then I'm going to put some d nism into it uh I don't lift the leg so much I push the heel away and it really causes you to lock the core to create the proximal stability and then pushing the heel Away really engages the glutes and hamstrings then I draw small squares I Square out with the hand and foot down towards the midline and up so now I'm creating a little bit of a disassociation through the ball and socket joints with I want which is what I want with the core or control so that is translatable we did an experiment with the Pensacola fire department by the way where those firefighters who were trained with a coach who explained why they were insisting on certain exercise forms we measured them doing fire ground tasks before the training sessions in other words we measured them uh putting up a fire ladder advancing a loaded fire hose which is a tremendous reactive push as you know uh piking open an elevator door chopping a hole in a burning Roof then half the group trained with this attention to exercise form and we explained the principles to them and then the other uh half of the firefighters had trainers who were more like cheerleaders trying to get them to do more reps and encouraging them both groups got fit and then we measured them all again out of on the fire ground remember now we never trained them how to do the fire ground tasks they went back to the fire ground those who trained with the cheerleader types of oh just do more reps had more known injury markers do you know valgal collapse of the knee is a very strong predictor of future risk of ACL injury being one of them so there would be an example of that um A sagittal plain spine motion under load I mean every study that surveils groups who have to bend down through their spine and pick up more load has a much higher incidence a bill maris's study showed 10 times the risk factor to having a dis injury U if if if you do that so uh I will then do side planks rolling side planks uh I will do a variety of uh abdominal exercises the modified abdominal curl that you're familiar with and I'll do some uh glute uh Bridges MH then I'll do them one-legged and I'll get the arm involved and crossbody um I may put a kettle bell on my belly and do some hip thrusts uh that way but a very mindful way I'm focused my brain on squeezing the glutes uh pushing the feet away uh Etc then I will probably stand up and do the strength patterns so I'll go over and do uh pushes now uh consider a push-up which rather than me load heavy with with a with a bench press or something like that I'll do push-ups you know the Clapping push-up where you dynamically explode up clap and go down I'll do a variety of those very Dynamic power generating pushes then I'll do some pulls uh I probably won't do a row with a barbell but I'll do an inverted row pulling on a TRX pronated grip pulling into him grip power breathing and exploding really trying to get some power into it uh then I will go to um probably a split lunge rear elevated foot uh squat lunge squat with the techniques that I showed you hands interlaced behind my head peacocking high pushing back pulling forward and now doing the the lunge squat so that's that's challenging my balance uh the whole extensor chain uh strength uh Etc I might do some bilateral squats uh with my hips uh I've broken my ankle I do heel elevated squats usually with a banded knee and sometimes I just use my brain and try and spread the floor then I get into the auxiliaries so I broke C4 um I have to uh yeah not not a good thing playing football uh hockey hockey head down into the boards classic anyway um I uh can't really do shearing exercises where I push against resistance that will get my neck a bit cranky so I take out the shear I get tall I push my tongue hard to the roof of the mouth and I Grimace so now I've activated all the flexors and I put my hands underneath and I just push up isometrically and I control so there's no Shear anymore but I've really started to build the flexer uh family keep your neck strong it's important for me yep now put your your chin poking retract now push up you got it that's it push your tongue yeah don't go crazy and add add a little bit of endurance to that I appreciate the neck work that you do though which I have a four-way neck machine but I don't require one I've actually found that taking a plate lying on and wrapping in a towel lying on one side making sure to hook my foot under the wrench and stabilize with my other hand on the ground and then just gently doing repetitions Jeff Cavalier from athl Nex has a great set of videos on this where he really spells out the dangers of things like neck Bridges they can be done but there's a risk there um that probably outweighs the potential benefits for most people right but every once in a while I can't help myself and I do some bridges y i cuz I really enjoy them if you're ler at University of Iowa you're doing bridg for a good while you're probably okay doing neck ridges yeah I get teased for saying this too often but the the value of having a strong neck is just um hard to overstate you don't have to have a big neck but a strong neck for the sake of stabilizing the whole shoulder G girdle excuse me during um pressing and pulling lifts uh for posture um for you know feeling like your head is stably placed on your body think of every pulling motion where does it start the trapezius originates off the neck stack that flag pole and really get those muscles ready to pull it it requires a a stiff strong neck absolutely so every strong puller yeah my Bulldog was alive um he had the larger neck in the house um but it's again it's not about um building size into the neck it's really that strength and stability right that I just think translates to so many things that are valuable anyway I'll finish out my strength routine with some more auxiliaries uh people laugh at this I call it sword play the amount of athletic gain that we've achieved with sword play I take an iron bar like a uh you know the old uh weer dumbbell weight it'll be an iron bar about that long and I'll put maybe a two pound weight on the end and then I grab it and I do figure eights over here over here over here around there you wouldn't believe I have professional hockey players in the NHL who say wow those figure eight sword plays my wrist shot my Slap Shot have two are tennis players I've never had such power and finesse off the racket because of that Sword Play exercise yeah this is interesting um I love older exercise books and recently I came across one called heavy hands this must be from the 70s yeah and the the entire book was centered around people being encouraged to carry some dumbbells during exercise not all the time and doing some lunges or walking uphill and getting the weights out from their body and um and I was kind of chuckling about it on the one hand pun intended but at the same time you know we know based on a number of really good studies using neuroimaging and functional scoring of neural system function as one ages that the ination of some of the distal muscles and the fine control of the the digits you know fingers and toes and foot uh foot uh toe spreading and things like that um even calf size and atrophy um are Fairly reliable markers of the extent to which there's been degeneration of the upper motor neuron Pathways um other brain areas or not so the idea of keeping the nervous system and neuromuscular connectivity youthful by quote unquote heavy hands or maybe ankle weights provided they're not going to induce injury makes a lot of sense waiting the most distal portion of our body um in order to generate adaptations I think is going to be something that returns to the uh kind of modern uh sphere of of fitness and Longevity may I give you a couple of comments please that was fabulous it's so much fun when I see someone getting out of their car and and walking up to the clinic door and I can see the muscle wasting on their calf and they'll say oh I have to get out my EMG uh nerve conduction velocity scores here I said are you kidding me you telling me the doc needed to do an EMG conduction velocity and all they had to do was look at your leg we know exactly the nerve roots that are deficit because I know exactly what serves those muscles that have wasted I mean it's it's crazy how technology has made so many people oblivious to the signs that we all show that was my first comment but the second one was going back to the oldtime books I collect a lot of those actually uh I have quite a library of the old time strength books from some from the 1800s the old inch book of strength and oh they're fabulous uh Indian clubs are you familiar with Indian clubs so it's a wooden club that looks like a bowling pin basically but some of the old style Indian clubs were this long well there's uh a great manual strength athlete that not too many people have heard of uh John Brookfield he lives in North Carolina Pinehurst North Carolina in Pinehurst there's a sculpture a very heavy steel that johon bent with his bare hands to make this sculpture with and yeah he'll he'll take heavy rebar and bend it and you know put on strength shows with his hands he's fabulous fell too by the way I uh he's he's got a set of Indian clubs I can hardly pick one up but he just picks up this Indian club and it was from some famous guy from the 1800s and somehow he got the the Indian clubs and they're about this long but he can just get them and play sword play with very heavy Indian clubs there's actually uh a good friend of mine he's an Australian fellow Andrew Lock I don't know if you've ever heard of Andrew Lock and Andrew has collected kettle bells and Indian clubs from the oldtimers he's got quite a a lovely collection in Melbourne where where he's from in Australia but uh they're wonderful exercises and none of these things require fancy equipment one could imagine just grabbing a hold of some either well an iron bar an iron bar yeah I really think there's something to this loading of the distal limbs um cautiously right properly but there's something there in terms of keeping the neural Pathways healthy and Alive because we know they atrophy with age and that explains in part the the calf muscle atrophy which as you point out is a well-known clinical marker for neurod degeneration yeah um well simply things and you can certainly comment about this I try and do things with my opposite hand so today I'm just going to brush my teeth comb my hair with my opposite hand now don't ask me to throw a a ball because I'm a but you know if I'm splitting firewood okay it's 10 reps this way 10 reps that way uh and that that's all in an attempt to keep my brain as uh movement competent and dextrous as possible well certainly when I resistance train if I'm doing anything standing I make it a point to um stagger my stance yes um and at the same time to make sure that my belly button is pointing forward so that I generate some anti-rotation um effort uh so that most of my abdominal work can be um placed within the workout for other things I do some Pikes and some direct abdominal work as well in the roll up and and things of that sort that you've recommended but I find that um from a coordination standpoint and especially from a balancing the musculature and the strength on both sides of the body this is extremely important and I know this because after years of skateboarding where you push with one leg that was when I was younger um boxing I'm traditional stance as opposed to Southpaw you know you start getting into all these imbalances um that and it goes Way Beyond anything aesthetic I mean the aesthetic stuff is might concern certain people but it was more the feeling that I could turn to my right very easily without pain turning my left I felt stiff and it was just a imbalance in um some of the muscles controlling uh anti- rotation so I think that weaving asymmetric stance weaving um the requirement for symmetric balancing of the musculature on both sides of the midline just makes you know all the sense in the world to me uh especially if one is going to be a regular exerciser which hopefully people are well if I can convince you to uh consider the biblical training week all of that fits into your Mobility days yeah let's talk about those because you talked about the strength days what about the two days of Mobility well G given my history I do thoracic spine extension MH I do a little bit of neck work uh hip mobility but again I have a a certain capacity there that I can't uh overdrive and then uh once I've done the targeted ones I just go through the motion of of every joint and uh don't add load and then I will do uh the footwork so with my background I'll do a little bit of Shadow Boxing I'll play uh uh traditional Southpaw um Etc if you could just repeat the cardiovascular days since in depend on the time of year of I I I really like to be outside so if it's winter time and uh I for some reason couldn't go for a cross country ski that day or whatnot I will ride a stationary bike in in the clinic I'd prefer not to but I will uh if it's summertime I'm riding outside and uh uh I could uh kayak swim canoe um just go to the Hills and walk with Tico my dog hard and that might be my cardiovascular uh that day and uh going back to the genetics which is how we started this uh uh podcast uh have you ever had your athletic panel done from a genetic base in other words they look at your genes and determine what you're genetically good at and what you're genetically horrible at do you know that I mean I know a few things that I'm horrible at but you haven't had it tested genetically no okay I have and they gave me a panel of 10 athleticism now interestingly enough if I didn't have my athletic panel and you just asked me to check am I good at this or am I bad at it and check somewhere in between I would have got every single one 100% right interesting yeah so I know my abilities and it aligns 100% and other words I'm ultra which is the highest for grip strength I always knew that you know they're a pair of hands but if I got my hands on you in football you weren't getting you know what I mean I I've always had a very good grip strength so genetically that came through was Ultra and the other thing I was Ultra at was I can be quick for the first 35 milliseconds boom if you want something done like that I I can usually pop it you know when I was playing hockey uh you typically it's a 45502 Anor robic blast and you sit down for 3 minutes there's two more shifts and then the coach Taps you on the helmet and I'm still breathing heavily and my two line mates they're they're ready to go again I was terrible at recovering from an from an athletic anerobic blast guess what I'm the worst possible genetic category for Recovery of uh uh heart rate and I you know i' i' I've worked with some of the best heart rate recovery uh people and I'm hopeless at it I have a feeling I'm naturally inclined to do endurance work because once I start running distance I can just run and run and then eventually it just feels like the um the stopping comes from you know I don't know some nagging little injury or something like that or pain as opposed to anything stopping me from continuing to run which is unfortunate because I tend to like the the shorter workout type stuff right it brings us back to what we were talking about earlier uh try and do a balance of of those um and everything in between I love the biblical training week and given that currently I've been doing three days of resistance training total per week and three days of cardiovascular training all it requires is Shifting one each of those days toward Mobility training still taking the full day off each week make sure you take that day off you will be less painful with your joints I predict when you're going into your 60s and 70s and knock on wood having a blast when you're 80 that's the plan and I've certainly had a blast today Dr McGill this has been amazing I mean you've given us such a wealth of knowledge about the back it's Anatomy neurology the sources of pain for those that have back pain Avenues to relieve back pain avenues for people to Stave off back pain including the big three but not limited to the big three you also gave us a wonderful window into the Precision with which you approach assessment and during the introduction and also in the show note captions um I mention and link to the many clinicians that you've trained all over the world so that if people want to try and access um direct coaching and Rehabilitation they can do that I also really appreciate the books you've written and we linked to that as well um back mechanic and I really just appreciate your Devotion to public education through your own channels through your students the many many many many peer-reviewed papers that you've published I mean I can't overemphasize this enough you have a you know vast number of highquality peer-reviewed Publications in these areas and um it's just wonderful to sit across from somebody who's devoted their professional life to this really important area that so many people confront whether or not they be athletes or conventional exercisers or just people who are experiencing some pain or want to get in shape or all of the above so on behalf of myself and everyone listening and watching watching I just want to extend a really deep heartfelt and genuine thank you thank you so much well thank you Professor huberman I you know you know this but I'm going to mention this for the listeners you have done a great deed in changing the behavior of many people myself included and my family uh it's it's not the easiest thing to do because there's always the critics but you uh have done a tremendous service and uh I thank you for that as well and I thank you personally because uh you've improved my life and hopefully I'll have a few more years to enjoy it but thank you well thank you for those words it's a labor of love for me and that's extremely gratifying to hear and um God willing I'll be in your kind of shape at your age let's do this again again I would love it thanks thank you for joining me for today's discussion with Dr Stuart McGill to learn more about his work as well as to find a link to his excellent book back mechanic the step-by-step Mill method to fix back pain please see the show note caption also in the caption you'll find a link to backfitpro dcom which is Dr Mill's website where he has links to specific practitioners you can work with if you're experiencing back pain if you're learning from Andor enjoying this podcast please subscribe to our YouTube Channel please also subscribe to the podcast on both Spotify and apple that's a terrific zeroc cost way to support us and on both Spotify and apple you can leave us up to a five-star review please also check out the sponsors that I mentioned at the beginning and throughout today's episode that's the best way to support this podcast if you have questions for me or comments about the podcast or topics or guests you'd like me to consider for the huberman Lab podcast please put those in the comments section on YouTube I do read all the comments for those of you that haven't heard I have a new book coming out it's my very first book it's entitled protocols an operating manual for the human body this is a book that I've been working on for more than 5 years and that's based on more than 30 years of research and experience and it covers protocols for everything from sleep to exercise to Stress Control protocols related to focus and motivation and of course I provide the scientific substantiation for the protocols that are included the book is now available by pre-sale at protocols book.com there you can find links to various vendors you can pick the one that you like best again the book is 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foundational Fitness protocol includes everything set reps cardiovascular training again all available completely zero cost you simply go to huberman lab.com go to the menu tab scroll down to newsletter and provide us your email but I should point out we do not share your email with anybody thank you once again for joining me for today's discussion with Dr Stuart Mcgill and last but certainly not least thank you for your interest in science [Music]