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

Episode 185 Jul 15, 2024 2h 52m 34 insights
In this episode, my guest is Dr. Stuart McGill, Ph.D., a distinguished professor emeritus of spine biomechanics at the University of Waterloo and a world expert on spine anatomy and physiology, back pain, and rehabilitation. We discuss the most common sources of back pain, how back pain can be assessed (including self-assessment techniques), and how to design a personalized recovery plan to reduce back pain. We discuss how to train for lifelong fitness, reduce injury risk, and protect your back and joints based on your age and personal goals. We also discuss how to prevent back pain, build core stability, and explain how “McGill’s Big 3” exercises protect and strengthen the back. Dr. McGill, who is exceptionally fit in his late 60s, describes his low-time investment, personal training routine, and the specific exercises he uses for mobility, strength, and cardiovascular fitness. We also discuss controversial issues in the back pain and rehabilitation field, including how pain originates, the biopsychosocial model of pain, and treatments such as platelet-rich plasma (PRP). This episode provides clear, actionable tools to strengthen, prevent, and remedy back pain and injury so you can be pain-free while enjoying sports, exercise, and daily activities at any age. Access the full show notes for this episode at hubermanlab.com. Watch the clip on back pain relief and spine anatomy that accompanies this episode. Demonstration of The McGill Method
Actionable Insights

1. Implement Biblical Training Week

Follow the ‘Biblical Training Week’ by dedicating one day a week to complete rest (Sabbath), two days to strength training, two days to mobility work, and two days to cardiovascular training, ensuring not to perform the same type of training on consecutive days to allow for adaptation and recovery.

2. Daily “Big Three” for Spine Stability

Perform the ‘Big Three’ exercises (bird dog, modified curl-up, side plank) six days a week to efficiently build and maintain spine stability while sparing the spine, allowing capacity for other training.

3. Stress for Optimal Health

Apply stress to all bodily systems (cardiovascular, musculoskeletal, endocrine, psychological) to promote adaptation and robustness, but ensure the stress remains below the ’tipping point’ to avoid cumulative trauma.

4. Avoid Pain-Triggering Activities

If an activity consistently causes pain, avoid it to prevent sensitization, which can lead to a heightened, maladaptive response even to light touch; instead, initiate a desensitization process.

5. Master Spine Hygiene Movements

Learn and practice proper spine hygiene, including hip hinging, squatting, lunging, getting to the floor, rolling using ball and socket joints (not twisting the spine), and even baby crawls, to avoid pain triggers and protect the spine.

6. Protect Joints in Training

When training, prioritize the health of your joints over solely building muscle, as muscle is more adaptive than joints; avoid overtraining at a young age to prevent long-term joint pain and mobility issues.

7. Minimize Injury Risk

Recognize that pushing training intensity carries an asymmetric risk, where the harm of injury far outweighs the short-term gains in resilience or performance, making injury avoidance critical.

8. Gradually Build Pain-Free Capacity

Initially, focus on understanding and avoiding specific pain triggers, then gradually build training capacity while staying below the pain ’tipping point’ to establish a margin of safety before cautiously expanding activity volume.

9. Adopt Virtual Surgery Mindset

For chronic, intransigent back pain where surgery is considered a last resort, adopt a ‘virtual surgery’ mindset by following a strict post-surgical recovery program, starting with forced rest and gradual activity, to desensitize pain and allow recovery.

10. Self-Diagnose Back Pain

Understand the specific nature of your back pain to know what activities to do and avoid, which is critical for effective management in sport and daily life.

11. Utilize Lumbar Support

Use a lumbar support when sitting for extended periods, especially during travel or work, to maintain an upright posture and prevent back pain caused by prolonged slouching or flexion.

12. Frequent Posture Changes

If experiencing discogenic back pain, avoid prolonged static postures (sitting or standing) and frequently change positions throughout the day, such as using a sit-stand desk and alternating between sitting for 20 minutes, standing for 30 minutes, and walking for 10 minutes.

13. Dose Walking for Pain-Free Activity

When walking, stay below your pain ’tipping point’; if 40 minutes causes pain, instead take multiple shorter walks (e.g., three 20-minute walks) throughout the day to achieve pain-free activity.

14. Post-Meal & Pre-Bed Walks

Incorporate short walks after every meal and before bed as a routine, even during travel, to maintain physical activity, aid digestion, and promote overall well-being.

15. Consistent Sleep Schedule

Establish and adhere to a consistent sleep schedule, going to bed and waking up at the same time daily, to support overall health and recovery.

16. Match Mattress to Sleep Needs

Use a mattress customized to your unique sleep needs (e.g., sleep position, temperature preference) to improve sleep quality, which is foundational for mental health, physical health, and performance.

17. Seek Professional Therapy

Seek professional therapy with a licensed therapist to gain rapport, emotional support, directed guidance, and useful insights that inspire positive action in various aspects of life.

18. Consistent Daily Meditation

Use a meditation app like Waking Up to engage in guided meditation, mindfulness, or yoga nidra daily, even for short durations, to maintain consistency and explore new practices.

19. Cultivate Core Stability for Performance

Develop core stability to create proximal control and stiffness, which directs athleticism distally, enhancing overall ability and performance by preventing energy leaks during movements.

20. Prioritize Disc Health Proactively

If discs are healthy, engage in both mobility (e.g., yoga, ballet) and strength training to enhance range of motion, toughen collagen, and build bone; after disc injury, adaptation becomes management, often requiring compromises between mobility and strength.

21. Refine Bird Dog Technique

When performing bird dogs, focus on pushing the heel away rather than just lifting the leg to engage glutes and hamstrings and lock the core for proximal stability; incorporate dynamic movements like drawing small squares with hand and foot to enhance disassociation through ball and socket joints with core control.

22. Vary Core and Glute Training

Incorporating a variety of core and glute exercises beyond the basics, such as rolling side planks, modified abdominal curls, one-legged glute bridges with cross-body arm involvement, and mindful kettlebell hip thrusts, focusing on glute engagement and foot drive.

23. Dynamic Push Exercises

For push strength, consider dynamic exercises like clapping push-ups or variations that emphasize explosive power generation, rather than solely relying on heavy loaded movements like bench press, to build strength and athleticism.

24. Dynamic Pull Exercises

For pull strength, opt for dynamic exercises like inverted rows using a TRX with varied grips (pronated to hammer grip) and explosive power breathing, focusing on power generation rather than heavy barbell rows.

25. Posture-Enhanced Split Squats

Execute rear-elevated split squats by interlacing hands behind the head, lifting the chest (‘peacocking high’), and focusing on pushing back and pulling forward, to challenge balance and strengthen the entire extensor chain.

26. Safe Neck Flexor Strengthening

To strengthen neck flexors without shearing forces, get tall, push the tongue hard to the roof of the mouth, grimace to activate flexors, and then perform isometric pushes with hands underneath the chin, controlling the movement to build strength and stability.

27. “Sword Play” for Dexterity

Engage in ‘sword play’ by holding a weighted iron bar (e.g., two pounds on the end) and performing figure-eight movements to enhance wrist shot, slap shot, or racket power and finesse, improving distal limb dexterity and control.

28. Ambidexterity for Brain Dexterity

Regularly perform daily tasks (e.g., brushing teeth, combing hair) or exercises (e.g., splitting firewood) with your non-dominant hand to maintain and improve brain movement competence and dexterity.

29. Stagger Stance for Core Engagement

When performing standing exercises, adopt a staggered stance and ensure your belly button points forward to generate anti-rotation effort, effectively engaging abdominal muscles and balancing musculature on both sides of the midline.

30. Full Body Deadlift Engagement

If performing deadlifts, ensure every single muscle of the body is involved, tightening the full fascial complex to take out slack, as this minimizes the risk of injury and constitutes a ‘good deadlift’.

31. Elevate Bar for Deadlift Modification

For individuals with back pain sensitive to compressive loads, modify deadlifts by elevating the bar on blocks to match their biomechanical optimum, progressing the hip hinge into a loaded situation without pulling from the ground.

32. Uphill Backwards Walk for Glutes

To effectively stimulate quads and glutes, walk backwards uphill in a ‘monster walk’ style until quads burn, then walk forwards uphill; this neurological trick engages glutes after quad exhaustion, offering a non-compressive alternative to squats and deadlifts.

33. Single-Leg Step-Ups for Balance

Incorporate single-leg step-ups to challenge balance and develop hip power and neural dexterity, which are crucial for quickly arresting falls as one ages and mitigating the risk of injury.

34. Unloaded Full-Body Mobility

On mobility days, perform targeted exercises like thoracic spine extension, neck work, and hip mobility, then move every joint through its full range of motion without adding load, respecting individual capacity to avoid overdriving.