Dr. Stuart McGill: Build a Strong, Pain-Proof Back AI transcript and summary - episode of podcast Huberman Lab
Go to PodExtra AI's episode page (Dr. Stuart McGill: Build a Strong, Pain-Proof Back) to play and view complete AI-processed content: summary, mindmap, topics, takeaways, transcript, keywords and highlights.
Go to PodExtra AI's podcast page (Huberman Lab) to view the AI-processed content of all episodes of this podcast.
Huberman Lab episodes list: view full AI transcripts and summaries of this podcast on the blog
Episode: Dr. Stuart McGill: Build a Strong, Pain-Proof Back
Author: Scicomm Media
Duration: 02:52:15
Episode Shownotes
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 Thank you to our sponsors AG1: https://drinkag1.com/huberman Helix Sleep: https://helixsleep.com/huberman BetterHelp: https://betterhelp.com/huberman Waking Up: https://wakingup.com/huberman LMNT: https://drinklmnt.com/huberman Timestamps 00:00:00 Dr. Stuart McGill 00:02:33 Sponsors: Helix Sleep, BetterHelp & Waking Up 00:06:23 What Causes Back Pain?; Genetics, Dog Breed Analogy 00:12:55 Tool: Skeleton & Body Type; Spine Flexibility & Discs 00:20:25 Flexibility & Exercises; Discs & Collagen 00:25:43 Sponsor: AG1 00:27:32 Stress & Tipping Point; Athletic Tradeoffs, Triathletes 00:36:17 Back Pain, Goals & Training Program 00:45:57 Spine Hygiene, Back Pain, Powerlifting 00:53:33 Genetics & Running 00:59:34 Sponsor: LMNT 01:00:46 Rehabilitation & Reducing Volume; Injury 01:07:42 Tool: Training for Lifelong Fitness, Injury & Joints 01:17:40 Pain Types, Biopsychosocial Model of Pain 01:26:15 Coaching, Explosivity & Endurance 01:32:43 Virtual Surgery & Rest, Pain Recovery 01:41:25 Tool: McGill’s Big 3; Building Back Strength & Stability 01:46:39 Inversion Tables & Spine Deloading, Disc Bulge, Tool: Lumbar Support 01:51:09 Tool: Daily Walking; Sitting 01:55:33 Deadlift & Bone Density, Glute-Ham Raise 02:06:20 Training & Age, Osteoporosis, Tool: Deadlift Alternatives 02:16:47 Tools: Biblical Training Week; Spine Stability & McGill’s Big 3; Shrinking & Age 02:24:16 Platelet-Rich Plasma (PRP); Disc Damage 02:27:56 Tools: Biblical Training Week & Strength Exercises, Neck Strength 02:35:24 Tools: Sword Play, Distal Limb Loading, Training for Symmetry 02:42:38 Tools: Biblical Training Week, Mobility & Cardiovascular Exercises, Athletic Panel 02:49:22 Zero-Cost Support, YouTube, Spotify & Apple Follow & Reviews, YouTube Feedback, Protocols Book, Social Media, Neural Network Newsletter Disclaimer & Disclosures
Summary
In the 'Huberman Lab' podcast episode titled 'Dr. Stuart McGill: Build a Strong, Pain-Proof Back,' Dr. Stuart McGill, a renowned expert in spine biomechanics, offers insights into understanding and managing back pain. The discussion covers the complexities of back pain diagnosis and treatment, emphasizing the role of genetics, environment, and psychosocial factors. Dr. McGill introduces self-diagnosis methods and highlights 'McGill's Big 3' exercises for core stability. The conversation also explores anatomical and genetic differences influencing back resilience and performance, the need for personalized fitness strategies, and the biopsychosocial model's relevance in pain management. The episode provides actionable strategies to reduce, prevent, and manage back pain across ages.
Go to PodExtra AI's episode page (Dr. Stuart McGill: Build a Strong, Pain-Proof Back) to play and view complete AI-processed content: summary, mindmap, topics, takeaways, transcript, keywords and highlights.
Full Transcript
00:00:00 Speaker_00
Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Stuart McGill.
00:00:18 Speaker_00
Dr. Stuart McGill is a distinguished professor of spine biomechanics at the University of Waterloo.
00:00:24 Speaker_00
As a professor for more than three decades, Dr. McGill has analyzed the spines of injured people, as well as healthy people, and developed methods to treat spine injuries and pain, as well as to improve spine biomechanics in anybody.
00:00:37 Speaker_00
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.
00:00:50 Speaker_00
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.
00:01:02 Speaker_00
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.
00:01:12 Speaker_00
He explained 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.
00:01:26 Speaker_00
Dr. McGill and I also discuss several of the avid controversies within the field of back pain and the treatments for back pain.
00:01:32 Speaker_00
We talk about the so-called biopsychosocial 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
00:01:50 Speaker_00
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.
00:02:02 Speaker_00
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.
00:02:09 Speaker_00
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 activities pain-free and with ease and mobility at any age.
00:02:33 Speaker_00
Before we begin, I'd like to emphasize that this podcast is separate from my teaching research roles at Stanford.
00:02:39 Speaker_00
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.
00:02:50 Speaker_00
Our first sponsor is Helix Sleep. Helix Sleep makes mattresses and pillows that are customized to your unique sleep needs.
00:02:57 Speaker_00
Now, I've spoken many times before on this and other podcasts about the fact that getting a great night's sleep is the foundation of mental health, physical health, and performance.
00:03:05 Speaker_00
Now, one of the keys to getting a great night's sleep is to make sure that your mattress is suited to your unique sleep needs. What does that mean?
00:03:11 Speaker_00
Well, if you go to the Helix website, you can take a brief two-minute quiz, and it asks you questions such as, do you sleep on your back, your side, or your stomach? Do you tend to run hot or cold during the night? Things of that sort.
00:03:22 Speaker_00
Maybe you know the answers to those questions, maybe you don't. Either way, Helix will match you to the ideal mattress for you. For me, that turned out to be the Dusk mattress made by Helix.
00:03:31 Speaker_00
I started sleeping on a Dusk mattress about three and a half years ago, and it's been far and away the best sleep that I've ever had.
00:03:36 Speaker_00
So if you'd like to sleep better by sleeping on a mattress that's customized to your unique sleep needs, go to helixsleep.com slash Huberman, take that brief two-minute sleep quiz, and Helix will match you to a mattress that's ideal for you.
00:03:49 Speaker_00
Right now, Helix is giving up to 30% off mattresses and two free pillows. Again, that's helixsleep.com slash Huberman to get 30% off and two free pillows. Today's episode is also brought to us by BetterHelp.
00:04:01 Speaker_00
BetterHelp offers professional therapy with a licensed therapist carried out entirely online. I've been doing weekly therapy for well over 30 years. Initially, I didn't have a choice. It was a condition of being allowed to stay in school.
00:04:13 Speaker_00
But pretty soon I realized that therapy is an extremely important component to overall health. There are essentially three things that great therapy provides.
00:04:19 Speaker_00
First of all, great therapy consists of having good rapport with somebody that you can really trust and talk to about the issues that you're dealing with.
00:04:26 Speaker_00
Second of all, that therapist should provide support in the form of emotional support or directed guidance.
00:04:33 Speaker_00
And third, expert therapy should provide useful insights, insights that allow you to better understand not just your emotional life and your relationship life, but of course also your relationship to yourself and to career goals and school goals, meaning excellent therapy should also inspire positive action.
00:04:49 Speaker_00
BetterHelp makes it very easy for you to find an expert therapist with whom you really resonate with, and they can provide the benefits that I just described.
00:04:56 Speaker_00
If you'd like to try BetterHelp, you can go to betterhelp.com slash Huberman to get 10% off your first month. Again, that's betterhelp.com slash Huberman. Today's episode is also brought to us by Waking Up.
00:05:09 Speaker_00
Waking Up is a meditation app that offers hundreds of guided meditation programs, mindfulness trainings, yoga nidra sessions, and more. I started practicing meditation when I was about 15 years old, and it made a profound impact on my life.
00:05:23 Speaker_00
In recent years, I started using the Waking Up app for my meditations because I find it to be a terrific resource for allowing me to really be consistent with my meditation practice.
00:05:31 Speaker_00
What I and so many other people love about the Waking Up app is that it has a lot of different meditations to choose from, and those meditations are of different durations.
00:05:39 Speaker_00
So it makes it very easy to keep up with your meditation practice, both from the perspective of novelty, you never get tired, tired of those meditations, there's always something new to explore and to learn about yourself.
00:05:49 Speaker_00
And you can always fit meditation into your schedule, even if you only have two or three minutes per day in which to meditate.
00:05:55 Speaker_00
I also really like doing yoga nidra or what is sometimes called non-sleep deep rest for about 10 or 20 minutes, because it is a great way to restore mental and physical vigor without the tiredness that some people experience when they wake up from a conventional nap.
00:06:08 Speaker_00
If you'd like to try the Waking Up app, please go to wakingup.com slash Huberman, where you can access a free 30-day trial. Again, that's wakingup.com slash Huberman to access a free 30-day trial. And now for my discussion with Dr. Stuart McGill.
00:06:23 Speaker_00
Dr. Stuart McGill, welcome. Thank you, sir. Great to have you here. I'm a big fan of your work. I've watched a lot of your other content. read your books.
00:06:35 Speaker_00
And I'm excited to discuss today what makes for a really strong, resilient back, what causes back pain and how to relieve it.
00:06:46 Speaker_00
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.
00:07:03 Speaker_00
Most people aren't thinking about their back unless they have pain. So what causes back pain? You start with the easy questions.
00:07:13 Speaker_01
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.
00:07:29 Speaker_01
Can you imagine asking someone, well, could you give me an exercise or a prevention strategy for leg pain? OK. So that sets the stage a little bit. We're talking about a symptom for which there's 100 or more different pathways and mechanisms there.
00:07:45 Speaker_01
So we've got to have a fairly comprehensive assessment now and understanding. to focus on the type of back pain, and then matching an appropriate intervention. I was listening to your new podcast with Andy Galpin this morning. The Perform podcast.
00:08:06 Speaker_01
The Perform podcast, yeah. And he said, I'm going to try and follow the three I's. 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,
00:08:25 Speaker_01
medical condition, shall we say. So with that context, I'm going to answer it like this. What causes back pain? Genetics loads the gun, exposure pulls the trigger, and then the psychosocial milieu around the individual
00:08:46 Speaker_01
influences how they respond to the pain. So there's a start. We can break it down in those three categories if you wish.
00:08:55 Speaker_00
Sure. So when you say genetics loads the gun, what comes to mind, because it's my experience, is that I have a right shoulder that sits a little bit lower than my left shoulder, unless I'm mindful of that. My dad has the same thing.
00:09:11 Speaker_00
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.
00:09:26 Speaker_00
They don't necessarily result in back pain, but I'm guessing that a lot of that is
00:09:31 Speaker_00
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.
00:09:41 Speaker_00
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?
00:09:56 Speaker_00
If I told you, okay, you know, 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
00:10:12 Speaker_00
origin of that pain, or perhaps even more importantly, a particular remedy to that pain?
00:10:17 Speaker_00
Or do we need to drill a little bit deeper and really understand more about what I do, what I don't do, if I'm more thin set or heavily set at the level of a bone structure?
00:10:30 Speaker_00
What are some of the other questions one would ask in the investigate category?
00:10:34 Speaker_01
My thought would not go to one or the other but it would go to both. And I'd start that conversation with this analogy. Let's talk about breeds of dogs. We both love dogs.
00:10:49 Speaker_01
If I said to you, we're gonna take two dogs and we're gonna 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.
00:11:01 Speaker_01
Bernard, no matter how you train it or condition it, will never make it to the performing on a Greyhound track. You're gonna end up with a broken St. Bernard. So there's a little bit of a start from my big perspective.
00:11:15 Speaker_01
But now let's drill down and talk about spines. It's interesting when you look at the basic anatomical structure of an individual, we just did that with dogs.
00:11:28 Speaker_01
Imagine if I 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 I-beam, it would just bend and break.
00:11:45 Speaker_01
So it supports bending cycles, but it doesn't support compression. Now I'm going to change that willow branch into a thicker stick and I bend the stick once and it shatters. In other words, the
00:12:00 Speaker_01
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.
00:12:14 Speaker_01
There's a fellow who has the world record in consecutive sit-ups, thousands of them. Given what I've just said, what's your prediction?
00:12:23 Speaker_01
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?
00:12:30 Speaker_00
He's a willowy, bendy guy who can just keep bending up and down off the ground. Bingo.
00:12:35 Speaker_01
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 not everybody can simply tolerate sitting in a chair being a computer operator.
00:12:53 Speaker_00
There's a very mundane example for you. Could I ask you a question about the willow versus thicker trunk example?
00:13:03 Speaker_00
Can we look to torso thickness or wrist thickness or ankle circumference as a way to assess ourselves as to whether or not we are like likely to be more willowy or
00:13:19 Speaker_00
Redwood like, I mean, 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.
00:13:31 Speaker_00
And my wrist, the wrist circumference isn't small, but isn't huge. I had a bulldog mastiff 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.
00:13:47 Speaker_00
He had forearms like a longshoreman. And of course he had never done any work whatsoever. Actually, primary goal of the bulldog is to do as little work as possible in life.
00:13:59 Speaker_00
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?
00:14:10 Speaker_01
Absolutely, yeah. So the knee width, the bi-iliocrystal width, which is the width of your iliac crests, hip width are all surrogates to indicate general heaviness of the skeleton. So yes, that's one good marker.
00:14:32 Speaker_01
But there's more to the story for genetics and how bendy a spine can be. The shape of the disc matters.
00:14:42 Speaker_01
So if you take, on average, a group of top golfers, you'll notice that their spines, that the disc shape, if we were to cut through, which is a transverse scan on an MRI, the discs are more ovoid.
00:14:56 Speaker_01
If you take someone who can bear a lot of compressive load, the discs look more like a lima bean, and that's called a limacon-shaped disc.
00:15:04 Speaker_00
And of course, the discs are in repeating fashion throughout the spine, top to bottom. Correct. And the discs are the soft tissue that allow for mobility of the vertebrae, the bony segments. Is that right?
00:15:18 Speaker_01
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.
00:15:26 Speaker_00
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 break it up into segments, kind of like beads on a necklace.
00:15:37 Speaker_00
And then in between those beads, you put some pliable yet I guess, a tissue that you can still compress. So it's both pliable and it can squeeze down and become more narrow in the vertical direction.
00:15:54 Speaker_00
And it can also, you know, squeeze down on one side or the other to some degree.
00:16:01 Speaker_01
Yeah, we evolved disks, 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.
00:16:12 Speaker_01
Can you imagine 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
00:16:26 Speaker_01
You move one orange, you have to control all the others. It's mission impossible. 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
00:16:41 Speaker_01
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.
00:16:55 Speaker_01
And then I'd say, OK, 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 next coffee can, and then the next coffee can a little bit less.
00:17:08 Speaker_01
Vice versa, the people on the other side had to pay out the rope in sequence. 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 tennis balls,
00:17:26 Speaker_01
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.
00:17:46 Speaker_01
And as the deviation in motion occurred, the foam rubber would add more resistance. So, it was an automatic control. And that's what a shock absorber does on a car. It has an elastic element plus the damper, but it's the elastic element.
00:18:01 Speaker_01
And we're going to talk about stiffness and stability, I hope. 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.
00:18:16 Speaker_01
But if I have to carry home these days heavy shopping bags, I need stiffness of that flexible rod so it doesn't collapse.
00:18:26 Speaker_01
or years ago I might have been carrying home an animal for dinner, and I needed those discs to provide the stiffness in a very economical way and in a way that didn't create stress contributions, concentrations the way ball and socket joints would.
00:18:43 Speaker_01
So, that's an evolutionary necessity. Also, when we look at spines, there are the column of vertebra with the intervening discs, but behind them there's two more joints, and those are called facet joints, and they guide motion.
00:18:58 Speaker_01
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 if they had facet angles like this, you can't twist.
00:19:15 Speaker_00
So facet angles that are too close together, basically.
00:19:18 Speaker_01
Well, it's a small angle. If the angle is orientated fore and aft, you can't twist. And you won't find, if you're dealing with a group of professional golfers, you'll find they all have open facet joints. Is that genetic? It's absolutely 100% genetic.
00:19:35 Speaker_01
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.
00:19:49 Speaker_01
that stresses a bone called the pars bone, and gymnasts, for example, get a very typical fracture pattern called a spondylolisthesis, which is a fracture of that bone, and then the spine shifts a little bit at that joint.
00:20:08 Speaker_01
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.
00:20:17 Speaker_01
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.
00:20:25 Speaker_00
I mean, is it fair to say that? if we can If we are naturally flexible
00:20:32 Speaker_00
for instance, like my sister can, you know, like her fingers can bend back really easily, her shoulder extension, which I guess for people that aren't familiar with shoulder extension, you know, she can, like, let's say you're leaning up against a railing with your back to the railing, the railings just, let's just say is just above lower back height, and you can put both hands on it,
00:20:53 Speaker_00
parallel, so your arms are close together, like very close to the torso. And then, and people don't do this quickly, because you can tear something or injure something.
00:21:03 Speaker_00
But then with feet about, I don't know, a foot or two away from that bar, you can do a knee bend and basically the arms go back behind you. Like I happen to have a fair degree of shoulder, just natural shoulder extension ability.
00:21:17 Speaker_00
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. But I wouldn't consider myself hyper-flexible. My sister is a bit more flexible. We're related, obviously.
00:21:32 Speaker_00
So would people like her or people that tend to be pretty flexible naturally, would they be wise to avoid certain activities if their goal is to remain pain-free? I mean, you talk about the St. Bernard running,
00:21:47 Speaker_00
on the Greyhound track, we all can enjoy things recreationally, but of course, we don't wanna injure ourselves. So as somebody who's naturally flexible, should they avoid certain sports and activities?
00:21:58 Speaker_00
And conversely, if somebody is naturally stiffer, thicker spine, thicker joints, should they avoid certain activities?
00:22:06 Speaker_01
That's a huge question and there's many more variables to consider. But I will say that when we are rehabilitating a athlete or just a person to get back to work, they're an occupational athlete. We take all of this into consideration.
00:22:24 Speaker_01
So as you were describing your sister arching back, A, I know she has plump discs, discs that are full of fluid to allow the mobility to take place in the discs.
00:22:38 Speaker_01
I also know that if we looked at an x-ray from the side, you know the posterior spinous 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.
00:22:55 Speaker_01
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.
00:23:08 Speaker_01
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.
00:23:16 Speaker_01
And then other people would say, oh, well, I'm going to try and mimic that particular bench press technique because it allows you to get much more force out of the latissimus dorsi, a stiffer back, and you get a different force vector and actually more effective force on the bar.
00:23:34 Speaker_01
They didn't realize that when we work with a person who has a huge arch, they have big spaces between those spinous processes.
00:23:44 Speaker_01
And if you don't have those big spaces, you are going to crush the interspinous ligaments, which naturally are between those spaces. And you will now fire off a whole set of new problems.
00:23:58 Speaker_01
So what is a mechanical advantage for one person is a mechanical disadvantage for another. Do you follow? So all of this matters. Going back to the... Disc being a fabric of layer upon layer of collagen strands.
00:24:20 Speaker_01
Typically, the disc is about 80% type one collagen. That is the stiff strength collagen. About another 20% is elastic collagen, type 2. But there's types 3 through 10 that bind those collagen fibers together.
00:24:44 Speaker_01
That's where there's a much greater degree of genetic variability. So, there are some people who 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.
00:25:03 Speaker_01
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.
00:25:22 Speaker_01
That's where the genetic 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 10 makeups.
00:25:43 Speaker_00
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.
00:25:55 Speaker_00
In fact, I take AG1 once and often twice 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.
00:26:07 Speaker_00
But here's what there seems to be a general consensus on.
00:26:10 Speaker_00
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.
00:26:28 Speaker_00
Now, I personally am an omnivore and I strive to get most of my food from unprocessed or minimally processed sources.
00:26:34 Speaker_00
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, et cetera, but it also has adaptogens to help me cope with stress.
00:26:46 Speaker_00
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.
00:26:57 Speaker_00
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.
00:27:06 Speaker_00
So while many supplements out there are really directed towards obtaining one specific outcome, AG1 is foundational nutrition designed to support all aspects of wellbeing related to mental health and physical health.
00:27:17 Speaker_00
If you'd like to try AG1, you can go to drinkag1.com slash Huberman to claim a special offer. They'll give you five free travel packs with your order plus a year supply of vitamin D3 K2. Again, that's drinkag1.com slash Huberman.
00:27:32 Speaker_00
Unless somebody is seeking to be a world-class 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
00:27:43 Speaker_00
you know, exceptions where people who were incredibly genetically, let's just say biased toward not being able to perform well in a sport have nonetheless succeeded in performing at a world-class level. But those are exceedingly rare exceptions.
00:28:03 Speaker_00
for most people who want to do things recreationally, like the heavier set person with a thicker spine who wants to golf or do ballet perhaps, or the thinner willowy person who wants to get into powerlifting, for instance.
00:28:20 Speaker_00
Are there certain things that they should each consider and embrace as activities in order to make themselves more resilient, more pain resilient, and more apt to have higher performance?
00:28:33 Speaker_00
For instance, would the willowy person, so to speak, do well to build up some of the musculature around the spine to compensate for the thinness of that spine?
00:28:45 Speaker_00
And would the person with the heavier or thicker spine do well to try and encourage more pliability of their discs somehow?
00:28:54 Speaker_01
The answer is yes, but it's a very limited yes. So if I can set the stage and give some context here, every system in the body requires stress for optimal health.
00:29:10 Speaker_01
Think of the cardiovascular system, the musculoskeletal 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.
00:29:28 Speaker_01
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. we have to talk about those tipping points.
00:29:48 Speaker_01
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 a person's suitability for the stresses on different parts of their body associated with different sports.
00:30:08 Speaker_01
We can talk about the rate at which the adaptation occurs. the amount of deloads and rest that are required, all of these things are genetically influenced. The way that they perform the movement is going to move the stress concentration.
00:30:25 Speaker_01
Here's an interesting 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.
00:30:42 Speaker_00
But they look like each other.
00:30:43 Speaker_01
But they look like each other.
00:30:45 Speaker_00
The people on the podium look very similar in structure.
00:30:48 Speaker_01
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.
00:31:00 Speaker_01
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?
00:31:17 Speaker_01
It doesn't work that way. What suited them to be a fish? Fast in water. They have to be somewhat floppy in the ankles because they're creating a fish's fin. Longer in the torso. Consider a power lifter performing a butterfly stroke.
00:31:38 Speaker_01
It wouldn't look very pretty. Then they get on the bike where they have to stiffen to – stiffen the core. I don't know if you know bike design. Well, I'm sure you do. You're paying for stiffness of the frame.
00:31:52 Speaker_01
That's what a really elite- I did 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.
00:32:01 Speaker_01
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.
00:32:11 Speaker_01
The same way the cyclist will lock in on the bike, they'll squeeze the saddle between their legs, lock into the bars, lock their core down so that when they create power through the hips and through the legs, it's transferred to the power.
00:32:32 Speaker_01
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, the most efficient runners store and recover elastic energy in tuned springs.
00:32:53 Speaker_01
A wonderful book to read is The Lost Art of Running by Shane Benzie, who studied the Kenyan runners and how they store and recover elastic energy with each stride, almost the same way as a kangaroo would.
00:33:09 Speaker_01
A kangaroo is more efficient when it hops versus plodding along using eccentric concentric muscle contraction. So again, the polar opposite of a swimmer. It's a very tuned stiffness.
00:33:25 Speaker_01
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.
00:33:40 Speaker_01
But if the springs were not tuned and they'd stretched away their muscles just to be passive elements, which serves them very well in the swimming element. Think of doing a pogo jump. So you're just pogoing through the ankles now.
00:33:55 Speaker_01
If you had no tone in the legs, you just flop into the ground and you would have to use concentric eccentric muscle contraction.
00:34:04 Speaker_01
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.
00:34:17 Speaker_01
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.
00:34:34 Speaker_01
Pulse, we were talking about Mike Tyson before the 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.
00:34:52 Speaker_01
And it is just such an awesome experience 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.
00:35:04 Speaker_01
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.
00:35:19 Speaker_01
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.
00:35:38 Speaker_01
You won't hit a golf ball 330 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.
00:35:55 Speaker_01
You can almost see it if you've 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 miles an hour will be the same.
00:36:11 Speaker_01
But now you have a very asymmetric elastic effect.
00:36:17 Speaker_00
So I know that you loathe and avoid generalizations with good reason. But given that most people listening to or watching this are probably not aiming to become elite athletes, I know I'm certainly not,
00:36:36 Speaker_00
can we safely make at least one or two generalizations about what we each and all can do to try and avoid, let's say, back pain and injury by either diversifying our training or avoiding certain types of training.
00:36:56 Speaker_00
For instance, let's take the three major phenotypes. And this is obviously not how the world works, but the classic, you know, ectomorphic phenotype, very thin, very willowy, small joints, long and lithe, you know, or lithe.
00:37:13 Speaker_00
the mesomorph, thicker, more muscular, and then the so-called endomorph, the more heavier set, maybe even carrying some extra body fat, et cetera. You don't really know what's under there. They could fall into either of the other two phenotypes.
00:37:30 Speaker_00
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 based on body type, at least in the extremes.
00:37:49 Speaker_00
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.
00:38:03 Speaker_00
Or the person that is naturally shaped more like a shot putter, let's say the mesomorph or endomorph, and you could say, well, There'd be great power lifter.
00:38:12 Speaker_00
I mean, new kids like this in high school, you know, PE class, they're like, okay, weight training today. None of us had done weight training. And then the kid, you know, lies down and, you know, and pushes, you know, 315.
00:38:21 Speaker_00
And you're like, oh goodness, you know, like that's, that's wild. but maybe they shouldn't be weight training.
00:38:29 Speaker_00
If their goal is to be all around fit, which I think is the goal of most people, to be able to carry some luggage at the airport without having to stop every once in a while and suck for air, to be able to lean down and grab something out of a cabinet, pick up a kid, do some hard exercises.
00:38:47 Speaker_00
labor in the yard, move some logs and things like that, to be able to do stuff without getting injured and without being so sore in the following days that you feel like you need extensive rehabilitation.
00:38:58 Speaker_00
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?
00:39:13 Speaker_00
or would we be wise to lean into our strengths and just not touch stuff that taps into our weaknesses? I understand the question.
00:39:24 Speaker_01
The answer is I don't know. But I know people will say, oh, well, this professor, he's avoiding the question. And I'm not going to do that. So I'm gonna tell you how I find the answer. And it's through assessment.
00:39:37 Speaker_01
And I'm glad we're getting back to back pain, by the way, because it's my real, the cornerstone of my expertise. Our assessment is very comprehensive. It starts out by me simply asking the person, tell me your story.
00:39:58 Speaker_01
And some people never tell me about their pain when I ask them to tell me their story.
00:40:05 Speaker_01
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 they might tell me about the passions that they have, or they might tell me about their goals.
00:40:23 Speaker_01
So the goals are the beginning of answering your question, Andrew. We all know people who aren't suited for a certain occupation, or they aren't suited, or they, I'll take myself for example.
00:40:39 Speaker_01
I had a high school careers counselor tell my father, well, McGill, he's not really suited academically, he should go to trade school. And so I registered for plumbing school.
00:40:50 Speaker_00
No, I just meant oops, because clearly that's not the way you went. Not that going to plumbing school would be a bad decision for some, but in your case, you went a very different direction.
00:40:58 Speaker_01
Well, I think I would have been OK as a plumber.
00:41:00 Speaker_00
Sure.
00:41:01 Speaker_01
But anyway, my point in that is, what are the goals? Then the assessment 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?
00:41:18 Speaker_01
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? Does the pain change?
00:41:31 Speaker_01
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 these things are telling me about the stability of the pain. It's giving me clues on what I'm going to assess.
00:41:48 Speaker_01
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.
00:42:03 Speaker_01
Okay, well, that tells me something now. So now I'm starting to see, I know what their job is. I know what sport it is they want to do. I know enough about that job and sport that I know the physical demands. I know the psychological demands.
00:42:21 Speaker_01
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 trainings very specifically because people do not have infinite training capacity. They only have so much.
00:42:39 Speaker_01
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.
00:42:53 Speaker_01
So do you see how it's a long-winded answer, but 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.
00:43:11 Speaker_01
In other words, when they run, 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.
00:43:30 Speaker_01
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.
00:43:39 Speaker_01
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.
00:43:53 Speaker_01
We take another group who has mobile hips. They do very well on elliptical trainers. The stress doesn't go into their backs. So now do you see why I know why one group does well with ellipticals, the other group does not.
00:44:08 Speaker_01
I know why one group who they, I'll give them a lateral shear 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.
00:44:24 Speaker_01
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.
00:44:39 Speaker_01
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 and he says, oh no, that hurts even more. Okay, dial it back a bit.
00:44:54 Speaker_01
Tune what we're trying to achieve 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 Pelloff Press.
00:45:10 Speaker_01
The Pelloff 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 trying to- So you punch it out from the body.
00:45:24 Speaker_01
Yeah, you try and, 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 Pelloff Press, which for him right now, is replicating his symptoms.
00:45:39 Speaker_01
But if you're playing in the NHL, you should be able to do a pell off press. You follow? Yeah. Yeah. 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.
00:45:56 Speaker_00
So if somebody has pain in a given movement, say standing up, after they sit for too long,
00:46:05 Speaker_00
a particular style of hip hinge, you know, deadlift 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?
00:46:22 Speaker_00
in the moment that they're doing the movement or afterwards, because oftentimes pain 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 in its own right.
00:46:34 Speaker_00
And, you know, might be worth some mention as to why. a couple of the reasons why that occurs. We always think, oh, blood flow, it's warm, but clearly it's warm. It's much more than that. It's much more than that. Yeah, for sure.
00:46:47 Speaker_00
So let's say I've pain in a knee when I run. Should I avoid running in that gate that causes pain and work around it? Seems to me that would be the logical choice. Right.
00:47:02 Speaker_01
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.
00:47:18 Speaker_01
We can take it in the framework of any of those if we like. If the pain is causing a sensitization, I'm gonna 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.
00:47:36 Speaker_01
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.
00:47:50 Speaker_01
So if we keep creating pain on that toe, it will never get better. So we have to start a desensitization wind down, which is tissue based, but it's also neurologically based as well. And so because everyone comes to us with pain,
00:48:14 Speaker_01
We work very hard to hack our way around it. So let's say sitting causes their pain. All right, we'll find out that when we do a sitting test, if they sit slouched, that causes their pain. When they sit upright, their pain goes away.
00:48:34 Speaker_01
So I will give them a lumbar support, which I'm just happening to use now. I had to sit on an airplane for five hours yesterday coming to see you. And this allows me to not get back pain on the airplane while I'm sitting.
00:48:49 Speaker_01
Because if I sit flexed for five hours, I will have a grumpy back. And I won't feel like when I'm getting to the hotel to go for a walk and train a bit. Because that's what we have to do to create a stress below the tipping point to optimize health.
00:49:07 Speaker_01
So, 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, you know, we spend a lot of time with spine hygiene. We teach them how to hip hinge or squat.
00:49:29 Speaker_01
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. We teach them how to do a baby's crawl.
00:49:44 Speaker_01
which eliminates the torso twisting, which in their current state will offend the sensitized pain trigger.
00:49:53 Speaker_00
It must be humbling for adults to get down and do a baby's crawl.
00:49:57 Speaker_01
It's so humbling to take a world record holding athlete. and humble them right back. As you know, I've had the current holder of the world's all-time record squat, Brian Carroll. And Brian and I have written a book together, so I can use his name.
00:50:15 Speaker_01
What's the squat record? 1,306 pounds, if you can believe that, down to parallel, down to parallel. No, no other human has done that. That was four years ago. Now, no one's replicated it.
00:50:27 Speaker_00
Does he wear one of those elastic lifting suits when he does that?
00:50:31 Speaker_01
Yeah, so he's putting on an exoskeleton of stiffness, but I want to come back to how humbling it was to have someone who already held world records in squatting in two different weight categories.
00:50:44 Speaker_01
And I had to show him 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.
00:50:58 Speaker_01
That's how corruptive pain is to the neurological engram. And we can talk about inhibition and facilitation and all of the things. I mean, I'd love to have that conversation because I know who I'm sitting with.
00:51:10 Speaker_00
The neural aspects are fascinating. When he does that incredible squat poundage, does he, take the bar off a standard squat rack and then walk it back?
00:51:21 Speaker_00
Or is he, is it one of those ones where the bar is suspended from two hooks and then he takes it from there?
00:51:25 Speaker_01
Yeah.
00:51:26 Speaker_00
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 are brought away.
00:51:35 Speaker_00
The reason I ask is it sounds like he's optimized for one very specific movement in a couple of You know, a couple of planes and nothing else because walking with a thousand plus pounds on one shoulders is also a feat in of itself.
00:51:50 Speaker_00
Shuffling backwards as it were.
00:51:51 Speaker_01
All right. You're not letting me off the hook, which is fine. So, I've worked with competitors who compete in strong men and they can carry and walk with a thousand pounds on their shoulders. It's called the super yoke.
00:52:03 Speaker_01
Another client of ours who held the world Wilkes 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.
00:52:21 Speaker_01
And that is if you don't have enough lateral strength and control in your torso, that's when you become hurt. Not during the squat, it's during the walkout. So, it's a very different feat of strength.
00:52:36 Speaker_01
So, you're very astute to say lifting from a monolith is a different athleticism and strength distribution. than an IPF style, where they lift off a rack and have to walk it out. So you're standing on one leg.
00:52:48 Speaker_01
So can you imagine 1,000 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.
00:53:00 Speaker_01
So it requires tremendous strength to hold the pelvic platform up on the swing leg side. And so that is a tremendous core strength component.
00:53:13 Speaker_00
So best not be carrying a willow spine for that one. No. You want to be like a Muir Woods, a redwood trunk.
00:53:22 Speaker_01
Well, you want to be built like Blaine Sumner, who's another one of our clients. I've worked with Blaine for quite a number of years.
00:53:31 Speaker_00
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. The best part about a really excellent dog show is you go back behind the
00:53:45 Speaker_00
the arena where all the different breeds reside. So you can see the lineup of the finest Irish Wolfhounds, the finest English Bulldogs, et cetera. Hundreds of different breeds.
00:53:58 Speaker_00
And you really get to see these genetic extremes, not just of structure, but of temperament. And you get to see the similarity in temperament of the Bulldogs. And of course there's variation. Some of them are a bit more jolly, others more stoic.
00:54:13 Speaker_00
you know, the terriers are magnificent in their own right. 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.
00:54:25 Speaker_00
The reason I bring this up and the reason I bring this up now is that
00:54:30 Speaker_00
If you look at the movement to those animals, even just the way they walk, whether or not they enjoy a flexion of the paw as they stride or whether or not they tend to stride differently. I don't have language for this.
00:54:43 Speaker_00
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. And then you look at human beings, shorter, taller, medium, more lithe, more heavyset.
00:55:01 Speaker_00
And it's amazing that we don't take this into consideration, that we all move very differently, even within species, but that we've been into these groups.
00:55:11 Speaker_00
So when someone walks into your laboratory, as it were, your clinic slash laboratory, are you paying attention to how they move into the room, irrespective of pain? 100%.
00:55:26 Speaker_01
We time the clients. I see one in the morning and one 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.
00:55:37 Speaker_01
But just to go back to the dogs, my sister's a vet, her husband's a vet, and her daughter's in vet training. So we have these conversations all the time.
00:55:45 Speaker_01
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 rectal exam or whatnot and what dog or breed, and even in cats, which ones she's going to muzzle, because she's usually right on who's going to get bit.
00:56:01 Speaker_01
Yeah. And interestingly as well, it's how the 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 milieu around dog behavior. Absolutely.
00:56:20 Speaker_01
Going back to your question when a person walks in. So I've had, have I had a gold medalist in sprints? Yes, I have from the Olympics. I've had a silver medalist. I've had just about every athlete that you can.
00:56:36 Speaker_01
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.
00:56:50 Speaker_01
Do you think they have a flat lower back or do you think they have a lot of lordosis, which is an extension hollow in their low back? A sprinter now, what will they have?
00:57:00 Speaker_00
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 an arch in the lower back, you know, this kind of- Yeah, he was 200 meters, wasn't he?
00:57:16 Speaker_00
200, well, I think he was a 200 and 400. He was. Which is unusual, someone that could win gold in both.
00:57:23 Speaker_01
Well, I'll think of some of the sprinters now, the 100 meter men and women, you will find. they have a lot more lordosis than the- So arch in the back.
00:57:33 Speaker_01
Yeah, they have a low, and what that does, 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.
00:57:50 Speaker_01
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,
00:57:58 Speaker_01
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.
00:58:06 Speaker_01
If you can pre-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.
00:58:17 Speaker_01
If you have a flat back, it's difficult now, you've just shortened up the range that you can pulse into propulsive force as a sprinter.
00:58:26 Speaker_00
So they bow the body.
00:58:28 Speaker_01
Yeah, but you'll notice it's very difficult for a sprinter to kick high. So, you know, I look at these different forms in the combat athletes. If you look at someone who can kick high in a roundhouse, they will tend to have a flatter back.
00:58:44 Speaker_01
So, combat athletes tend to have a flatter back. Going back to the runners, you'll notice that the Michael Johnsons and the runners with more distance have a flatter spine.
00:58:58 Speaker_01
They're more upright and they're tuning that ability to store and recover elastic energy. Where the sprinter out of the blocks, it's horsepower, it's concentric and eccentric muscle pulsing.
00:59:12 Speaker_01
But anyway, there would be an example since you mentioned it with running, the style of running, the event. Running isn't running. Running is very different. And again, look at the podium winners of the sprinters versus the 10,000 meters.
00:59:30 Speaker_01
Very different architecture.
00:59:32 Speaker_00
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.
00:59:39 Speaker_00
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.
00:59:52 Speaker_00
Research shows that even a slight degree of dehydration can really diminish cognitive and physical performance. It's also important that you get adequate electrolytes in order for your body and brain to function at their best.
01:00:02 Speaker_00
The electrolytes, sodium, magnesium, and potassium are critical for the functioning of all the cells in your body, especially your neurons or nerve cells.
01:00:09 Speaker_00
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.
01:00:20 Speaker_00
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.
01:00:28 Speaker_00
If you'd like to try Element, you can go to drinkelement.com slash Huberman, spelled drinkelement.com slash Huberman, to claim a free Element sample pack with the purchase of any Element drink mix.
01:00:39 Speaker_00
Again, that's drinkelement.com slash 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.
01:00:51 Speaker_00
And I'm certain that by now everybody listening is starting to think about, oh, am I more likely to have a willowy spine, a thinner spine or a thicker spine, the kind of pliability or what you called vertical stacking resilience that one spine or the other would have.
01:01:11 Speaker_00
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 have it yet, okay?
01:01:27 Speaker_00
So I would say I'm kind of in the middle, I'm neither extremely lithe nor am I shaped like a... you know, like a kettlebell, kind of somewhere in between.
01:01:37 Speaker_00
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
01:01:53 Speaker_00
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.
01:02:06 Speaker_00
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,
01:02:24 Speaker_00
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?
01:02:32 Speaker_00
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. Thank you, for optimal health.
01:02:46 Speaker_00
So assuming that somebody has a thinner stature, they're more bendy, would they be wise to build up the muscles of the core, not just the abdominals, but the obliques and the lower back muscles, all around the spine in order to give it more stability?
01:03:03 Speaker_00
And would the person who has a thicker torso, thicker spine, thicker joints, do well to emphasize some additional yoga training, some additional anything that allows them to be more bendy.
01:03:16 Speaker_01
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, don't want ultimate performance.
01:03:30 Speaker_01
They're not being paid $10 million to be able to throw a fastball 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.
01:03:47 Speaker_01
So, it becomes a moot point now, whether they have a willowy spine or not. I will look at their basic golf swing. if I can divide that up to just binary, some people are what we call twisters.
01:04:03 Speaker_01
They don't have a lot of hip mobility and they twist their spine. So it's called the X factor in golf and they store and recover elastic energy. Again, it is an elastic athleticism. But the next person isn't so much a twister, they're a turner.
01:04:18 Speaker_01
They have what we call quick hips. So their hips turn and their spines don't sustain as much twist.
01:04:25 Speaker_01
And then we measure, well, when they impact the ball, if they have 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%.
01:04:43 Speaker_01
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 desensitizer now.
01:04:56 Speaker_00
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.
01:05:06 Speaker_01
It all comes back to the assessment.
01:05:07 Speaker_00
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.
01:05:19 Speaker_00
Not generate the movement that recreates the pain, but 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.
01:05:39 Speaker_00
Okay, so now I understand why.
01:05:41 Speaker_01
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,
01:05:59 Speaker_01
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 deload or whatnot. So, it may simply be, I've got an athlete that comes to mind right now.
01:06:18 Speaker_01
In fact, I got an email. It wasn't an email. It was a WhatsApp message. Oh, I just won. She's at an international tournament today and they play every day.
01:06:30 Speaker_01
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. You can think of, again, combat athletes. Jiu-jitsu requires a lot of spine mobility.
01:06:52 Speaker_01
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 jiu-jitsu, but they don't need to push the end range every day. Because if they do,
01:07:09 Speaker_01
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.
01:07:20 Speaker_01
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 limiting the depth. They're pulling off blocks. The game changes and it's not what people think.
01:07:40 Speaker_00
And well, and there's some wisdom to not pushing into pain and extremes all the time.
01:07:45 Speaker_00
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.
01:08:03 Speaker_00
And we can talk about what his recommendation is. I'd love 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 key as well.
01:08:18 Speaker_00
Here's his recommendation on intensity. Can I share it with you and just get your thoughts?
01:08:22 Speaker_01
Yeah. I have a short attention span. Can I just add added value to that? Don't get hurt. Getting hurt is tremendously asymmetric. Let me, do you know the book by Taleb Nassim? Oh, Nassim Taleb.
01:08:38 Speaker_00
Nassim Taleb, yeah.
01:08:39 Speaker_01
Anti-fragile. Yeah. Oh, and anti-fragile, he quotes our work, he quotes my low back disorders book as an example of anti-fragile medicine. Interesting. Anyway, when you talk to Taleb, in an economic sense,
01:09:03 Speaker_01
If I gave you $100 to invest, if you had a 50% gain, you'd end up with $150. 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.
01:09:21 Speaker_00
Yeah, there's some neuroscience, certainly some psychology, but certainly some neuroscience to support that in terms of how we reset our, kind of a reinforcement threshold.
01:09:33 Speaker_01
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.
01:09:51 Speaker_01
And an injury is really asymmetrically harmful. So when we work with People and athletes, we really try and avoid injury because of the asymmetry of the consequence. Injury's bad. That's the first part that I wanted to say.
01:10:08 Speaker_01
The second part is people train hard and they feel the muscle burn 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.
01:10:21 Speaker_01
You can train hard and build muscle, but muscle is adaptive and resilient. Joints are not so much.
01:10:29 Speaker_01
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.
01:10:40 Speaker_01
They can't get down on their knees anymore. They have to crawl up a chair or a wall. Very sad picture. It is. Don't mess up your joints. So that's an overarching principle of which the spine is one, obviously.
01:10:55 Speaker_01
But that's some wisdom with training intensely when you're young. Don't base the outcome on muscle. Think about the joints.
01:11:06 Speaker_00
No, it's excellent recommendations for everyone. His suggestion, and by the way, this is not for competitive athletes. This is just for exercisers, if you will, is to make 85% of one's workouts across the year at about 85% of
01:11:25 Speaker_00
maximal intensity and output.
01:11:28 Speaker_00
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.
01:11:45 Speaker_00
to make 10% of one's workouts across the year at somewhere between 90 to 95% intensity of what one could generate that day. Again, 100% all out being subjective for that day. And then 5% or even less,
01:12:05 Speaker_00
of their workouts all out, everything you could possibly give, quote unquote, leaving it all on the mat, whatever phrase one prefers. And I like that recommendation because it keeps things in check.
01:12:19 Speaker_00
And it also creates an awareness of how intense one is training. And it allows us to not
01:12:27 Speaker_00
let the great night's sleep or the extra cup of coffee that we had or the great song that happens to be playing or the competitive spirit that's arising because someone joined you that day or asked you to join a workout to take you into the domain of
01:12:41 Speaker_00
harming yourself. In fact, 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.
01:12:52 Speaker_00
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 a hundred percent on that day.
01:13:02 Speaker_00
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, what was that really worth it?
01:13:11 Speaker_00
And I think unless one is a competitive athlete and that's competition day, it's probably not worth it.
01:13:16 Speaker_01
Right. Well, I'm very sympathetic to the overall sentiment of what you just described. But I think 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.
01:13:36 Speaker_01
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 deload and rest days. So if you go to 85% you just committed to a five-day rest.
01:13:54 Speaker_01
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 what we call tapering down an athlete or, you know, in my life, I have seasons.
01:14:12 Speaker_01
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. So, my training would start in August.
01:14:31 Speaker_01
Every year, I'd get into shape to ride sleds fairly aggressively. I couldn't do it all year, Andrew. I'd become injured. So I would have a cycle of three months getting ready and then really have some fun. But obviously, I don't do that anymore.
01:14:53 Speaker_01
But my point in telling that story is I need much more information than just, OK, 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.
01:15:11 Speaker_01
As we optimize performance in our clients, sometimes you got to leave a lot of gas in the tank because you want to train every other day. Certainly if you do two days in a row, 85%, there's no way. So do you see what I mean?
01:15:32 Speaker_01
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?
01:15:48 Speaker_00
That's pretty heavy. Yeah, here I'm thinking about intensity, meaning, well, for resistance training, let's say that one could complete six repetitions at a given weight. but if they had a gun to their head, they could complete nine.
01:16:05 Speaker_00
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, but,
01:16:24 Speaker_00
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?
01:16:32 Speaker_00
Okay, so 85% of max intensity for me would be staying at cruising pace and occasionally bumping up the speed a little bit. But on all out day, if it happens to be one, then it's,
01:16:48 Speaker_00
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 subjective, but we know on a given day whether or not we're pushing past our comfort zone or not.
01:17:02 Speaker_00
And I'm not somebody who relies heavily on heart rate monitors and things like that. What I rely on is my consistency. This is the way that I've decided to stay in all around shape for, you know, more than three decades. I feel like I'm in decent shape.
01:17:17 Speaker_00
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.
01:17:29 Speaker_00
And I feel very grateful to not have pain. And I think it's because I've adopted a stance of, I don't wanna call it moderation, but of modulation.
01:17:38 Speaker_01
Well, I appreciate all what you've said. In my world, everyone has a back pain history.
01:17:48 Speaker_01
It's the information that we gather from the assessment that guides our decision on how we're going to A, get them out of pain, build some base resilience, which is tuning their body. strategic mobility, strategic stability.
01:18:07 Speaker_01
Now, one thing we haven't talked about is various types of pain and how yet that impacts on how we're going to approach their programming for life.
01:18:17 Speaker_01
You did a podcast with somebody, I can't remember 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.
01:18:37 Speaker_01
They were traumatized 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 intelligere? And they recoil.
01:18:53 Speaker_01
That's an abused person. That's a very characteristic response. So you start putting together some of these reactions and you know that there's something deeper than an injury to a part of their spine.
01:19:08 Speaker_00
Yeah, we had Dr. Sean Mackey.
01:19:11 Speaker_01
That was it.
01:19:12 Speaker_00
Yeah, Dr. Sean Mackey is our head of the essentially the pain division at Stanford School of Medicine. He's an MD and PhD and he's a big proponent of the biopsychosocial model of pain, which probably makes sense for us to discuss now.
01:19:29 Speaker_00
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.
01:19:40 Speaker_00
Some of which include thoughts about one's emotional state. stress level, sleep. I mean, all of these things clearly play a role in pain and rehabilitation from pain.
01:19:55 Speaker_01
Right. I love that podcast, by the way, because it's so consistent with what we 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
01:20:22 Speaker_01
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 we should talk about whether the disc adapts or you have to manage it. But that's another very interesting topic to get into.
01:20:40 Speaker_01
But nonetheless. We are tuning their body with strategic mobility and stability, giving them core exercise, unleashing their hips and shoulders, et cetera. And we will have a reasonable level of success.
01:20:58 Speaker_01
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.
01:21:14 Speaker_01
Perhaps the person was in a car accident. They survived, but the person beside them who might've been their mother died. So now they're carrying a hell of a lot of emotional trauma, guilt, trauma.
01:21:26 Speaker_01
Maybe they nodded 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.
01:21:46 Speaker_01
We do physical stressing of their various tissues and the reactions, they change, they're variable. They're not what they should be. The way that their brain perceives the pain has been rewired.
01:22:03 Speaker_01
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.
01:22:22 Speaker_01
We might get a feather and brush it over their back and they'll say, oh yeah, 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.
01:22:40 Speaker_01
And it might be that. Simply, the most simple of movements where the afferent and efference, all the information going into that engram, which is formerly triggering pain, we now
01:22:56 Speaker_01
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.
01:23:04 Speaker_01
So you've heard of fibromyalgia, which is a little bit of a catch-all term, but a flashing light,
01:23:15 Speaker_01
They're surprising someone, they're walking down the street and someone comes out of a shop and surprises them somehow and that triggers off this massive pain response.
01:23:28 Speaker_01
We do that with very gentle love, doing the things that doesn't cause pain and try and slowly expand that engram into a pain-free one. There are those in what's called work hardening. It's usually funded by insurance companies.
01:23:45 Speaker_01
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 bricklayer, you're gonna lay bricks for an hour. Tomorrow, you're gonna lay for an hour and a half.
01:23:56 Speaker_01
Occasionally they have some success or they have some really miserable failures. And the person says, I cannot do another day of bricklaying for four hours, even though it's only a portion of my job.
01:24:10 Speaker_01
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.
01:24:24 Speaker_01
So these are, you know, talk about the biopsychosocial approach. 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.
01:24:37 Speaker_01
So I really appreciate you bringing this because I'm not often asked this perspective. But again, I know with your background, you'll appreciate all of this.
01:24:48 Speaker_00
Yeah, surely the nervous system is involved in generating movement and feedback from the muscles and proprioception. And as you're describing, the nervous system creates our sense of pain.
01:25:00 Speaker_00
There's an emotional component to it, as Dr. Mackey pointed out and as you're reinforcing. the neural circuits that control quote unquote pain or give rise to pain involve the confluence of all of these things at some level.
01:25:15 Speaker_00
And I appreciate that you're willing to go into this biopsychosocial model of pain and acknowledge it because I think all too often in this space of biomechanics and pain and back pain in particular, people,
01:25:30 Speaker_00
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.
01:25:41 Speaker_00
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.
01:25:50 Speaker_00
I know that you look at things through the rather complex prism that is back pain and back rehabilitation. So thank you for touching into the biopsychosocial model.
01:26:01 Speaker_00
And we'll put a link in the show note captions to that episode with Dr. Mackey, because he went into this in some depth. And so it is the case that we've covered that model in pretty extensive detail. There's something that you said to me,
01:26:16 Speaker_00
ones that I really wanna 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, what should we call it?
01:26:39 Speaker_00
personality style or reactivity style that is probably independent of who they started off as. I mean, you can never separate these things completely.
01:26:49 Speaker_00
I mean, we could argue 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, pick sports with a lot of speed and ballistic motion involved.
01:27:05 Speaker_00
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.
01:27:14 Speaker_00
ballistic movement or endurance or strength, that we exacerbate certain aspects of our mental self, our emotional self as well.
01:27:24 Speaker_00
I realize this is not the stuff of 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,
01:27:41 Speaker_00
And let's keep in mind the discussion we had earlier about dog breeds. They are selected for not just based on physical phenotype and movement, but also personality type, temperament.
01:27:55 Speaker_00
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?
01:28:08 Speaker_00
Do they tend to have less but tend to excel in other domains of their mental life?
01:28:12 Speaker_01
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 and seeing the extremes of the phenotype, I do have some opinions on this. And it comes from coaching.
01:28:35 Speaker_01
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 I hate using this label, but it's just a way to describe it.
01:28:55 Speaker_01
They have attention deficit. Now, I've been told I have this. Every high school teacher would have told you, yeah, McGill, his attention deficit is, now, maybe it was just I wasn't interested in what they were talking about.
01:29:07 Speaker_01
My brain was thinking about something else. But 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.
01:29:18 Speaker_01
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.
01:29:35 Speaker_00
I find that really interesting. And I can think of a number of self-experiments that I'd like to embark on, including more endurance training at particular times of year and seeing how that correlates with mental focus and endurance for
01:29:52 Speaker_00
say, writing or preparing podcasts, things of that sort. But of course, now that I have some sense of what the answer could be, I'd be biasing the outcomes.
01:30:02 Speaker_00
But if it's a self-experiment and the goal is simply to shift one's mental life or behavior, then I don't know that it matters that much.
01:30:11 Speaker_01
Can I go with a little anecdote there that you may appreciate? I'll get a call from a coach, say an NBA coach. and it'll be with their medical staff. And they'll say, we have this player. They play 18 minutes a game. Can you help?
01:30:29 Speaker_01
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 may ask a question to the coach. What puts paying bums in the seats in the stadium?
01:30:50 Speaker_01
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.
01:31:01 Speaker_01
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 VO2 max and be maximally explosive.
01:31:17 Speaker_01
They're competing mechanisms. One's a fast twitch mechanism for speed and explosiveness. And the other one is an endurable physiology. And you trade one for the other. So do you really want to compromise that explosiveness
01:31:37 Speaker_01
And you see this when you're on a team getting a 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.
01:31:51 Speaker_01
And if they don't win in the first round, they're going to gas out. And the person who is preparing to compete against them is training to survive the first round And then come on in the second. So they're training endurance.
01:32:10 Speaker_01
To compare those two different athletes from a psychological point of view, and if you do it enough, I think you'll come to agree with me. And you will notice that there is how you coach them. It has to be in short, consumable bites.
01:32:27 Speaker_01
And it's not that they're any more or less intelligent. They get it. but you have to be on cue and choose your words, be efficient. Do you see what I mean? The coaching style changes quite a bit.
01:32:41 Speaker_00
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 sit with it and feel it as opposed to just avoiding it.
01:32:58 Speaker_00
How should people think about their own pain and how to work with it? That's the reason I'm asking.
01:33:03 Speaker_01
It depends, and it's a dance. So I can give you some examples. One chapter in my back mechanic book is called, well, it's about surgery and should you have surgery.
01:33:18 Speaker_01
We did this 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.
01:33:36 Speaker_01
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, you've been to the psychologist, et cetera, and you failed every single one of them.
01:33:51 Speaker_01
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.
01:34:06 Speaker_01
That's the subcategory of people that we're now going to talk about. And I'll say, fine, you can go and roll the 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.
01:34:21 Speaker_01
And I make a bit of 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.
01:34:35 Speaker_01
You've had surgery. You're gonna behave like you've had surgery. Tomorrow, your first post-surgical recovery day, you're going to lay in bed, relax, get up for a pee every two or three hours, have short little shuffles.
01:34:50 Speaker_01
The next day we'll add a little bit more, et cetera. We give you a post-surgical recovery program, a really good one.
01:34:59 Speaker_01
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.
01:35:14 Speaker_01
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.
01:35:28 Speaker_01
Because if I don't, I'm going to murder my kids and my husband because that's my stress relief. Not literally, but that's what they'll say is painting the picture.
01:35:38 Speaker_00
Give that person a treadmill.
01:35:39 Speaker_01
Right. Or exercise. OK. 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 I have to tame that.
01:35:59 Speaker_01
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.
01:36:14 Speaker_01
We followed up with every patient and in a two year followup, 95% of those people avoided surgery but did the virtual surgery, we're glad that they did.
01:36:26 Speaker_00
Yeah, that answers the question. It's follow the advice of the clinician. It gets back to this issue of predisposition to move a certain way to therefore avoid other forms of movement, to engage in certain activities but not other activities.
01:36:45 Speaker_00
I realized 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 countercurrent to that. But I'm kind of veering towards numbers more or less like that, right?
01:36:59 Speaker_00
I mean, we know for instance, in the machine learning algorithms that relate to learning in the nervous system, that a rough, this is a rough estimate of difficulty should be about,
01:37:12 Speaker_00
15% of questions or challenges, so these could be cognitive challenges or physical challenges, should lead to failures, non-injurious failures.
01:37:22 Speaker_00
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? No, but it's true for a lot of things.
01:37:33 Speaker_01
That's an argument that's used a lot. However, as I said, I've done the work and I've done the follow-up and I have an opinion for a reason. We start out by giving them the tools to not have pain.
01:37:53 Speaker_01
from a physical point of view, 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.
01:38:05 Speaker_01
A, they didn't understand what the real mechanism of pain was, so they had no strategy to down-regulated, if I'm a neuroscientist, or to desensitize it.
01:38:16 Speaker_01
But now they know with some precision what the moves, the loads, the activities are that cause their pain. They know the counterpoints, what actually are beneficial for their pain. And they begin this life of having as little pain as possible.
01:38:33 Speaker_01
Now I go back to 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?
01:38:50 Speaker_01
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.
01:39:04 Speaker_01
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.
01:39:18 Speaker_01
Eventually, we're going to go to the point where we're butting up against the tipping point now. Now we have another conversation. Remember what the goal is.
01:39:29 Speaker_01
How important is it for you to set a personal best in deadlift or to play 18 holes of golf five days a week? Would you settle for three? And now they've had a year of no pain. Their life has changed. They're mentally in a different place.
01:39:50 Speaker_01
They have their answer and 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.
01:40:03 Speaker_01
So do you see how when we bring them through that way, accepting a certain amount of pain, that's more of a younger person's outlook. There's still some warriors left. A lot of us soften up as we get older. But I just think of my own journey. I trained.
01:40:21 Speaker_01
heavy as a kid. And I remember my dad saying, well, why are you doing this? You're, you know, you're really shortening your athletic career. Not that I had one, but you know, and he was right. And now my training has totally changed.
01:40:38 Speaker_01
But as you know, I have no pain. I'm still fairly physical.
01:40:44 Speaker_00
Yeah, you're in great shape at 67. Yeah. Just 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, Stu moves around great. And I mean, well, your posture is great.
01:41:00 Speaker_00
And you're in awesome shape for any age, much less 67. So, that's a testament to your methods. Well, the point was it's okay to push when you're younger.
01:41:12 Speaker_01
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 get to that point.
01:41:24 Speaker_00
I'd like to ask you about McGill's big three. I know that, again, you loathe to impart generalizations on people, but at some point you realized that people need something to do, to work with in order to try and,
01:41:40 Speaker_00
quote unquote, pain proof their back or reinforce their back. So we did a video that 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.
01:41:55 Speaker_00
I should have invited you to critique my form and we can always shoot another one of those. But I think it captures the big three well enough. The bird, dog, the roll up and the side plank.
01:42:10 Speaker_00
designed to build strength and stability around the spine and to stave off back pain or in some cases rehabilitate back pain. An enormous number of people wrote to us and commented how much the big three have helped them.
01:42:26 Speaker_00
So I just want to make sure that it's clear that despite
01:42:29 Speaker_00
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 large, large number of people avoid, and in some cases, rehabilitate back pain.
01:42:45 Speaker_00
If you were to add a fourth exercise to the big three, what would it be?
01:42:52 Speaker_01
It depends on the assessment.
01:42:53 Speaker_00
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.
01:43:03 Speaker_01
What are their pain triggers?
01:43:05 Speaker_00
They have a lower back pain that's unilateral. And when they sit too long and then stand up, it feels like that side is locked up and there's some pain shooting down the leg.
01:43:16 Speaker_01
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. It's a big range. So they will have some discogenic disorder.
01:43:31 Speaker_01
There's a disorder of the joint. And it will be causing the nerve to react in such a way.
01:43:40 Speaker_00
And when they walk a bit, 10, 15 minutes, they tend to feel better.
01:43:44 Speaker_01
Ah, OK. So they have a younger spine because discogenic disorders are more common among younger people. And sitting is the causative pathway. Going for a walk is the relieving pathway. But that will switch over when they get older. Is that right? Yeah.
01:44:03 Speaker_01
Sitting becomes the relief. And walking then becomes the exacerbator of their pain. Well, again, I need to know with some precision what the pathway is. But if they have neurological parts, I need to know why, what makes them worse.
01:44:24 Speaker_01
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 radiation? If it does, they've got a little bit of compression intolerance.
01:44:39 Speaker_01
Okay, so now I have to choose an exercise that is not compressive by nature.
01:44:47 Speaker_01
If I move the nerve, so if I extend their leg at the same time, ask 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.
01:45:03 Speaker_01
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 nerve tension. So these are very different mechanisms of their pain, and they require different approaches.
01:45:21 Speaker_01
So do you see why I'm still hedging on that next exercise? It might be mobilizing the nerve. it might be giving them more thoracic spine extension through a thoracic. And now they've taken the load off when they sit and stand.
01:45:40 Speaker_01
So you can imagine standing, you can palpate your erector spinae muscles and they might be relaxed. You poke your chin and those muscles come on. But the cramp was on one side and if it was muscular, that's probably not related to this.
01:45:57 Speaker_01
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 again, I've described all of this in Back Mechanic.
01:46:17 Speaker_01
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.
01:46:32 Speaker_01
So I might add another exercise, but I might program it very strategically as well.
01:46:38 Speaker_00
What are your thoughts on inversion tables and anti-gravity boots and things to deload the spine?
01:46:44 Speaker_01
Right. Well, again, if you follow our work, we do do deloading of the spine through traction. It's usually applied by one of our trained clinicians.
01:46:59 Speaker_01
And the reason for that is, let's take that younger person again, as you just described, maybe laying on their tummy.
01:47:07 Speaker_01
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 fissure, which is probably one of the more common ones,
01:47:24 Speaker_01
that maneuver vacuums in the disc bulge. 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.
01:47:38 Speaker_01
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. No decompression table does all of this.
01:47:54 Speaker_01
It doesn't have the art. 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.
01:48:07 Speaker_01
we only get the ones who've failed 10 previous attempts, the difficult ones. Yeah, no, we've got to know, we've got to have some skills here.
01:48:17 Speaker_00
Well, I started doing the big three on the basis of your book. And it certainly has helped my lower right side back pain that occasionally flares up.
01:48:27 Speaker_00
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 stay more upright as I can cycle my legs underneath me, like I'm pedaling on a bike.
01:48:46 Speaker_00
And I feel like I have endurance for days.
01:48:49 Speaker_01
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.
01:48:59 Speaker_01
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.
01:49:12 Speaker_01
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.
01:49:23 Speaker_00
I do. Yeah. I had a whole body scan 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 on one side, which is fully consistent with the pattern of pain that I've had.
01:49:40 Speaker_00
And I've managed to avoid for a number of years now doing Cobra type pose, these kinds of things. The Cobra doesn't work for everybody, but it is a powerful,
01:49:52 Speaker_01
vacuuming in of certain types of disc 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.
01:50:04 Speaker_00
I noticed 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. Don't forget to use your lumbar on the airplane.
01:50:20 Speaker_00
Dr. McGill gave me this little pillow called lumbar that inflates you put it in the lower back. And it's a wonderful tool. That gives you resilience for travel.
01:50:33 Speaker_00
If one didn't have access to that, they could just roll up a towel and put in their lower back. Absolutely.
01:50:37 Speaker_01
Yeah.
01:50:38 Speaker_00
Or sitting in a lecture.
01:50:40 Speaker_01
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.
01:50:49 Speaker_00
You might get some funny looks, but you'll be the person still mobile and not complaining about your pain when everyone else is grunting.
01:50:57 Speaker_01
I'm past the funny looks. I'm okay with that.
01:51:01 Speaker_00
That's an advanced neuroplasticity trick that comes with age. I'm right there with you. I have a question about walking.
01:51:11 Speaker_00
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, I think is terrific.
01:51:24 Speaker_00
When it comes to walking, none of us want to be the person paying careful attention to our gait, especially when we're not in pain and things of that sort.
01:51:32 Speaker_00
But if you were going to recommend a daily walk, is there a duration and speed that you think could be beneficial in terms of staving off back pain, just general posture, things of that sort.
01:51:46 Speaker_00
Are we talking about a brisk five minute walk or a brisk 20 minute walk, this kind of thing?
01:51:52 Speaker_01
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,
01:52:10 Speaker_01
and they have a back pain history, I would know, 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.
01:52:22 Speaker_01
But I know what the question is, and you want some general rules on all of this. Don't walk to pain.
01:52:30 Speaker_01
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.
01:52:48 Speaker_01
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.
01:52:56 Speaker_01
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.
01:53:08 Speaker_01
So the key for their daily regimen is to keep changing posture. So something like a sit-stand 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.
01:53:27 Speaker_01
Now that was the magic that just of the dosing that 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 there. In my own life, it's a habit.
01:53:45 Speaker_01
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 our routine. And it is, even when we travel in the winter, we drive south, we break up the drive and we do our walks, and it keeps us pain-free.
01:54:04 Speaker_01
It doesn't matter who you are. If you sit all day, 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 think that's a fair thing to say.
01:54:24 Speaker_01
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, so there's no pre-existing cumulative damage to it. If you put it in a sitting posture, you cannot create new injury.
01:54:42 Speaker_01
So, if a person has never had back pain, and I can give you an example, you know 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.
01:54:55 Speaker_01
They go to the gym every day. They have back pain and they think this is so unfair. But what they didn't realize is they are not training wisely at the gym.
01:55:05 Speaker_01
They are probably going far too hard in a short period of time with too much intensity and they're creating a little bit of micro trauma. So now they just made sitting painful. So do you see what I mean?
01:55:19 Speaker_01
You can't injure the spine sitting if you have no preexisting injury. But if you have preexisting delamination of the collagen, an old disc bulge, sitting for a long time will then make it painful.
01:55:32 Speaker_00
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.
01:55:48 Speaker_00
What are your thoughts on deadlifts and squats as a function of one's age, one's perhaps phenotype, ecto, endo, or mesomorph, or any other factors that would lead you to say, yes, deadlift and or squat. No, don't deadlift and or squat.
01:56:07 Speaker_00
Or maybe you should deadlift and or squat.
01:56:11 Speaker_01
Okay. 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.
01:56:26 Speaker_01
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?
01:56:50 Speaker_01
The deadlift is an extraordinary exercise. And as you know, I don't know of anyone who's been involved with more world-class deadlifters than myself through the back pain relationship. So, you know, on one hand I can say, well, I love the deadlift.
01:57:12 Speaker_01
And on another hand, I can say, I hate the deadlift. I can tell you, Andrew,
01:57:16 Speaker_01
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.
01:57:36 Speaker_01
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.
01:57:56 Speaker_01
I love these bodybuilding charts that say, oh, well, to do a deadlift, it lights up the erector spinae, the glutes, and the quads, perhaps. Every single muscle of the body should be involved at a deadlift. Every single muscle.
01:58:09 Speaker_01
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. That's what minimizes the risk of injury.
01:58:26 Speaker_01
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 in that category.
01:58:41 Speaker_01
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 of view. It's a gel core wrapped with layer upon layer concentric layers of collagen fibers.
01:58:59 Speaker_01
that in order to get a disc 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.
01:59:22 Speaker_01
There's been several recent studies now that have done assays, investigations of the harvested nucleus in a disc surgery. More than half the time that harvested nucleus contained fragments of broken end plate.
01:59:40 Speaker_01
Broken end plate comes from excessive compression. And then you go into the history of the person. Oh, well, maybe they fell on ice and they piledrived their back. There's a candidate mechanism to create small fractured bits of end plate.
01:59:56 Speaker_01
But then they will say, no, this whole disc herniation story, it started with a deadlift two years ago my back got a bit tweaky after that I kept dead lifting and whatnot and then they find the fragments of bone.
02:00:11 Speaker_01
So more than half of that harvested nucleus shows evidence of an overload and compression. When you put that together with the history and again it's not the fault of the deadlift it's the fault of the
02:00:26 Speaker_01
progression 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.
02:00:38 Speaker_01
When you look at the stimulus to bone growth it takes a lot longer than half a year and when you look at the characteristics of really successful deadlifters they're not young men and women.
02:00:53 Speaker_01
They are people who've trained their body over many years to get that density of bone, because that really is the weakest link in a deadlift as far as back injury goes. So there's something to consider, first of all.
02:01:13 Speaker_01
Let's go back to the back pain 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 do deadlifts. Well, hold on a second.
02:01:28 Speaker_01
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.
02:01:44 Speaker_01
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.
02:01:58 Speaker_01
There are many people who shouldn't be picking heavy bars off the ground. When you look at the size of an Olympic, I call them cookies, but a 45 pound plate, I suppose, that was arbitrarily chosen.
02:02:12 Speaker_01
In fact, it was actually chosen that if someone dropped the bar on the ground, your head could fit between the bar and the ground. That was where that original size of the cookie came from, is my understanding of it.
02:02:23 Speaker_01
People lifting alone quite often, is that why? Yeah. Well, there's lots of YouTubes of those injuries, but anyway.
02:02:29 Speaker_00
Yeah. 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.
02:02:40 Speaker_01
Right. So now we've put together the idea of what anatomy do they have in the hips and where's the tipping point in picking something off the ground?
02:02:52 Speaker_01
We may start to progress the hip hinge into a loaded situation if the person doesn't have compressive load triggers to their back pain pattern. I doubt we'll be pulling a bar off the ground though. We will elevate the bar and put it on blocks.
02:03:09 Speaker_01
So if you come to BackFit Pro and you look at our rack that has 1,300 pounds there available to lift if you wish, they pull off pins. In other words, we're matching the height of the pull to their biomechanical optimum in the beginning.
02:03:28 Speaker_01
And then we have to decide, Is the deadlift the best tool to get them to their goal?
02:03:35 Speaker_01
You know, I did the podcast with Peter Atiyah and Peter had 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.
02:03:51 Speaker_01
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.
02:03:58 Speaker_01
And my answer was to him, and a lot of people took it, and we got a lot of blowback on this, that it was a generic answer for deadlifts. And it wasn't.
02:04:07 Speaker_01
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?
02:04:21 Speaker_01
And then urology 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.
02:04:37 Speaker_01
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.
02:04:52 Speaker_01
They're going to walk backwards, uphill, and then they're going to walk forward and really feel tremendous exhaustion if that's how they get their jollies, and if that's what we need in the athleticism to keep them going and building robustness.
02:05:05 Speaker_00
What are your thoughts on glute ham raises? I'm a big fan of Nordic curls and glute ham raises for the posterior chain.
02:05:11 Speaker_00
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, instead of being on the floor for the deadlift part, you've rotated yourself 90 degrees.
02:05:28 Speaker_00
so that the feet are effectively at the wall, right? And from the bottom position up to the parallel to floor position, that's more or less a deadlift, right? Stiff-legged or partially stiff-legged deadlift.
02:05:39 Speaker_00
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.
02:05:49 Speaker_00
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?
02:05:58 Speaker_01
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.
02:06:08 Speaker_01
It's just challenging a part of the chain involved in the full chain that's required for a deadlift.
02:06:18 Speaker_01
If I go back to some of the criticism after that original deadlift statement, there was a lot of older fellows who were saying, you know, I love the deadlift.
02:06:30 Speaker_01
When I stop deadlifting, my back pain actually increases and deadlifting keeps the bogeyman away. I get it. Okay, that was the right tool for them, but I can tell you about the characteristic of those people.
02:06:46 Speaker_01
They will be somewhat unidimensional in their athleticism. I will bet you dollars to donuts. Actually, donuts are getting more expensive now, so that's a poor analogy. That worked when I was a kid. But anyway, ask them to throw a football.
02:07:01 Speaker_01
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 very unidimensional.
02:07:13 Speaker_00
Because they can't generate that kind of twist and snap with the throwing a football, for instance, like the stiffening up of the body at precisely the right moment and the relaxing of the- Yeah, it's a pulsing strength. The flicking and spiral.
02:07:27 Speaker_01
Yeah, a deadlift is not a pulsing strength. It's a grinding strength. And again, if you want neurology, to adapt, to create.
02:07:38 Speaker_01
Again, I know people don't like when I do this, but I love athletic examples and I learn so much because it's like a car mechanic working on a McLaren. And then a dump truck, which carries heavy load.
02:07:52 Speaker_01
And then a Baja racer, 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.
02:08:05 Speaker_01
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.
02:08:23 Speaker_01
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. Then you've got to teach the muscles to utilize it.
02:08:35 Speaker_01
So in terms of grinding strength capacity, a deadlift is pretty good, but does that have to do with most people with back pain? A few years ago, the professional golf community led by a few personalities, got into heavier lifting.
02:08:55 Speaker_01
Now, this was rather odd. If you go back to the old days of Jack Nicklaus and Gary Player and Arnold Palmer, do you think they lifted heavy weights? And I think Arnold Palmer is still playing.
02:09:06 Speaker_00
I mean, some of those guys back when were known for having a few alcohol drinks plus smoking cigarettes on the course.
02:09:17 Speaker_01
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 really diverse array of activities, be careful on the tools that you choose.
02:09:39 Speaker_01
So, going back to the pro golfers of, say, 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 shoulder mobility and deadlifts, not one of them, to my knowledge, and I know some of them intimately well, hit the ball further.
02:10:06 Speaker_01
but they ended up with sore knees and disc bulges, essentially really heavily compromising their careers.
02:10:14 Speaker_01
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.
02:10:26 Speaker_01
So I know that's going to create some controversy, but so be it.
02:10:30 Speaker_00
Well, that's okay. I mean, I've gone on record saying that I'll do an end,
02:10:35 Speaker_00
genuinely do heavy hack squats, hack machine squats, leg extensions, those kinds of things, alternatives that for me have just led to progressively more of what I'm looking for in training legs.
02:10:51 Speaker_00
and back, of course, lower back, and I do glute ham raises, and I can do all of those without pain. I don't know the last time I ever did a deadlift.
02:10:59 Speaker_00
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 I'm all for avoiding heavy deadlifts.
02:11:13 Speaker_01
Well, it depends. 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 way under the tipping point in terms of load stimulation. So I'm not worried about that for you.
02:11:30 Speaker_01
So if I was, that would justify a heavier loading regimen for now. But as alternatives, A rear leg elevated split squat.
02:11:42 Speaker_01
You can do it just with body weight or consider this, interlace your fingers, put them behind your head, become a peacock, lift your chest up. Now do the split leg, rear elevated squats, like lunge squats.
02:11:59 Speaker_01
And you're potentiating the erector spinae and the whole stabilizing mechanism by pushing up and resisting.
02:12:07 Speaker_00
Do you see how- Do I need to flare my elbows back? You can do, yeah.
02:12:12 Speaker_01
Now, do you see how that just stimulated your whole upper body? And the more you push and the more you- The more traps, everything lined up. Right, you just lit up your whole erector spinae. We did all of that without a heavy bar.
02:12:25 Speaker_01
you could do a goblet squat, hold it in front. Now the whole body takes a more upright attitude. It's more knee load.
02:12:33 Speaker_01
If you want more knee load and less back and hip load, or, you know, a back squat, you add more hip and low back load and you take some off the knees. So you can band the knees.
02:12:44 Speaker_01
We can really play jazz on this to optimize the best variant to get optimal reward with minimal risk. And that will change as you recover from the back injury. It will change with age. It will change with other comorbidities.
02:13:03 Speaker_01
Oh, my neck's a bit sore, or you've dinged up your shoulder, or whatever the case may be. Single leg step ups. would be another example. Now you've added a balance challenge.
02:13:16 Speaker_01
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.
02:13:30 Speaker_01
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.
02:13:46 Speaker_01
Rest 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.
02:14:01 Speaker_01
And again, 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.
02:14:20 Speaker_01
It is just too 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.
02:14:34 Speaker_01
So when I think of someone like Brian Carroll, again, this is all sort of content validity types of arguments. I get it. But until someone produces a few more winners, I'm going to stick with the way our science has shown to go.
02:14:55 Speaker_01
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%, you've got to take a couple of weeks off.
02:15:12 Speaker_01
So instead you do some auxiliaries, like Brian used heavily the belt squat machine, which you can really train hips, legs, et cetera, tremendous power, but it doesn't take or exhaust the whole upper body and back system.
02:15:30 Speaker_01
Where you're not loading the spine or compressing the spine. That's right, because you just can't do it. So if, do you see why, you know,
02:15:42 Speaker_01
It's very difficult for me without knowing the person, knowing what the goals are, knowing what their future risks are.
02:15:49 Speaker_01
Is it a bone mineral density issue or is it their knees are getting a bit cranky now or whatever the, I have to choose the most efficient tools. Occasionally, it's a deadlift.
02:16:05 Speaker_01
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 gonna set a personal best in deadlift, not really knowing how to densify the neural drive, take out all the slack.
02:16:22 Speaker_01
So when they grip the bar, the final squeeze of the bar actually gets the bar moving. They're breaking it from the floor with, they're so stiff throughout their body and they don't know this yet. And they end up with a back injury.
02:16:41 Speaker_01
And those are long lasting. They're hard to recover from.
02:16:45 Speaker_00
You've talked about the so-called biblical training week. I love this. 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
02:17:00 Speaker_00
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?
02:17:11 Speaker_01
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 strength, power, looking good, impressive, et cetera.
02:17:29 Speaker_01
But, you know, my joints aren't what they used to be. My training has evolved with my age. So the name training, Biblical Training Week, came from the idea that every major religion has a Sabbath day, a day off.
02:17:48 Speaker_01
And when I was a kid and working with my dad, 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.
02:18:11 Speaker_01
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 very well because I'm getting older and I have a few injuries. So those are the mobility days.
02:18:28 Speaker_01
Two days a week, I work on my ticker, cardiovascular system, things to challenge my heart, et cetera. There's more caveats to all of this. So I live in a rural setting most of the time.
02:18:46 Speaker_01
We heat our cabin, I live in most of the days of 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.
02:19:00 Speaker_01
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.
02:19:14 Speaker_01
Don't do the same thing two days in a row and allow the soreness to really develop 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.
02:19:30 Speaker_01
So those are the basic tenets of the biblical training week. The components of each, you know, I've had some neck trauma, some shoulder trauma. I broke my hip, I'm hip replaced. These are the things that I focus on for strategic mobility.
02:19:49 Speaker_01
The strength training is a little bit of bodybuilding, a little bit of strength and patternings. So patterns of a squat, a lift, a lunge, a push, a pull, etc. So I don't run because of my hips, but in the summertime I will swim, kayak.
02:20:11 Speaker_01
a canoe, but I'll put a bit of beef into it, a bit of effort. I ride my bike in the winter, I cross country ski, shovel snow is a big part where I live, et cetera. So those are the, oh, by the way, I do do the big three six days out of seven.
02:20:33 Speaker_01
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 who actually measured spine stability in a quantitative way.
02:20:48 Speaker_01
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?
02:20:58 Speaker_01
It allows me to have capacity, the limited capacity to do other things. So 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.
02:21:13 Speaker_01
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 push you or an object, a heavy door perhaps at the university or at a shopping mall, say I could bench press 300 pounds.
02:21:29 Speaker_01
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.
02:21:37 Speaker_01
The pec major crosses the shoulder joint, distal to the shoulder joint, to where it connects on the upper arm bone, the humerus. The muscle contracts and creates the desired push. But proximal, it connects to my rib cage. Look what it does.
02:21:54 Speaker_01
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 proximally, 100% of that muscle activity now goes distally to the athleticism.
02:22:14 Speaker_01
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.
02:22:28 Speaker_01
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, et cetera. So the mother of all proximal stability is your core.
02:22:42 Speaker_01
In exactly the same way a heavy equipment operator using a backhoe, 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.
02:22:58 Speaker_01
Failure to stabilize, you're just pulling the tractor around. So core stability is essential for ability and performance.
02:23:10 Speaker_01
arresting all little micro-movements, we're all shrinking, you will notice this probably over the next decade, the disc height is now shrinking and there's gonna be a little bit more micro-movement in the discs.
02:23:24 Speaker_00
Is there anything that can be done to offset the shrinking? Not that I know of. People will ask whether or not hanging or anti-gravity boots.
02:23:31 Speaker_01
Oh, I've measured that, yes. It will increase disc height for 15 minutes And then gravity and the hydrostatic pressures will cause the fluid flow.
02:23:48 Speaker_01
And the fluid flow, there's a little bit through laterally through the disc, 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.
02:24:03 Speaker_01
But the hydrostatic pressure overrides the osmotic pressure in gravity, and then the discs lose all the fluid. So it's a 15-minute effect.
02:24:14 Speaker_00
I feel like every tissue in the body has been the target of an attempt to either restore its more youthful state or somehow augment its, I don't know, resilience over time.
02:24:32 Speaker_00
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 youthful state to.
02:24:50 Speaker_00
Is there any evidence for any compounds or injectable drugs that can restore the tensile strength and thickness to the discs?
02:25:01 Speaker_01
I haven't seen any evidence of PRP doing so. Now, I didn't condemn PRP throughout the body. I swear by it for stubborn muscle tears in one example. Ball and socket articular joints. There's no question.
02:25:23 Speaker_01
Not all the time, but it can make a measurable difference, but not injected into the disc. So I just need to give a little bit of a context to this now. If we take someone's disc who's never been traumatized, so they're a young person,
02:25:44 Speaker_01
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 train and toughen the collagen in the end plate and build some bone.
02:25:59 Speaker_01
And in other words, they can do both, Andrew. They can increase the 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 disc height, the world changes.
02:26:20 Speaker_01
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.
02:26:32 Speaker_01
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.
02:26:48 Speaker_01
We can manage you to achieve that, but you're gonna have to back off the deadlifts and some of the strength exposures because they will just further compromise the disc height of a damaged disc. And we can do the opposite.
02:27:04 Speaker_01
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 back injury. So I think the question was a little bit about adaptation.
02:27:19 Speaker_01
If you haven't experienced disc damage yet, you have a lot more leeway to adapt your spine. After that, it becomes a game of management and encouraging an athletic ability. You become a little bit more unidimensional.
02:27:35 Speaker_01
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, just to get through life. And it's a bit of a dance.
02:27:50 Speaker_01
So I don't know if that gives a bit of a context. That's perfect.
02:27:53 Speaker_00
Yeah. Could you walk us through your biblical week training with some examples of what one could select from the buffet of training options.
02:28:04 Speaker_01
Right. So let's say today I'm going into our clinic gym, and I will start with doing the big three. So I will do bird dogs, and I'm going to work on good form, and then I'm going to put some dynamicism into it. I don't lift the legs so much.
02:28:24 Speaker_01
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.
02:28:36 Speaker_01
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 control. So that is translatable.
02:28:55 Speaker_01
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.
02:29:10 Speaker_01
We measured them doing fire ground tasks before the training sessions. In other words, we measured them putting up a fire ladder, advancing a loaded fire hose, which is a tremendous reactive push, as you know.
02:29:24 Speaker_01
Picking open an elevator door, chopping a hole in a burning roof. Then half of the group trained with this attention to exercise form, and we explained the principles to them.
02:29:35 Speaker_01
And then the other 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 on the fire ground.
02:29:51 Speaker_01
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.
02:30:05 Speaker_01
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. Sagittal plane spine motion under load.
02:30:18 Speaker_01
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. Bill Maris' study showed 10 times the risk factor to having a disc injury. if you do that.
02:30:34 Speaker_01
So, I will then do side planks, rolling side planks. I will do a variety of abdominal exercises, the modified abdominal curl that you're familiar with and I'll do some glute bridges.
02:30:52 Speaker_01
Then I'll do them one-legged and I'll get the arm involved and cross body. I may put a kettlebell on my belly and do some hip thrusts that way, but a very mindful way. I'm focused my brain on squeezing the glutes, pushing the feet away, et cetera.
02:31:12 Speaker_01
Then I will probably stand up and do the strength patterns. So I'll go over and do pushes. Now, consider a pushup, which rather than me load heavy, with a bench press or something like that.
02:31:28 Speaker_01
I'll do pushups, you know, the clapping pushup 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.
02:31:42 Speaker_01
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 hammer grip, power breathing and exploding. really trying to get some power into it.
02:31:59 Speaker_01
Then I will go to probably a split lunge, rear elevated foot 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 lunge squat.
02:32:20 Speaker_01
So that's challenging my balance. The whole extensor chain strength, etc. I might do some bilateral squats with my hips. I've broken my ankle. I do heel elevated squats, usually with a banded knee.
02:32:38 Speaker_01
And sometimes I just use my brain and try and spread the floor. Then I get into the auxiliaries. So I broke C4. I have to, yeah, not a good thing. Playing football? Hockey. Hockey. Head down into the boards, classic.
02:32:54 Speaker_01
Anyway, I 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.
02:33:12 Speaker_01
So now I've activated all the flexors and I put my hands underneath and I just push up isometrically and I control that. So there's no shear anymore, but I've really started to build the flexor family. Keep your neck strong. It's important for me. Yeah.
02:33:29 Speaker_01
Now put your chin poking, retract. Now push up. You got it. That's it. Push your tongue. Yeah. Don't go crazy. And add a little bit of endurance to that.
02:33:41 Speaker_00
I appreciate the neck work that you do though, which I- I have a four-way neck machine, but I don't require one.
02:33:46 Speaker_00
I've actually found that taking a plate and wrapping it 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.
02:34:00 Speaker_00
Jeff Cavalier from Athlean-X 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 that probably outweighs the potential benefits for most people.
02:34:14 Speaker_00
But every once in a while, I can't help myself and I do some bridges.
02:34:18 Speaker_01
because I really enjoy them. If you're a wrestler at University of Iowa, you've been doing it for a good while, you're probably okay doing neck ridges.
02:34:26 Speaker_00
Yeah, I get teased for saying this too often, but the value of having a strong neck is just hard to overstate.
02:34:33 Speaker_00
You don't have to have a big neck, but a strong neck for sake of stabilizing the whole shoulder girdle, excuse me, during pressing and pulling lifts, for posture, for, you know, Feeling like your head is stably placed on your body?
02:34:49 Speaker_01
Think of every pulling motion. Where does it start? The trapezius originates off the neck. Stack that flagpole and really get those muscles ready to pull. It requires a stiff, strong neck. Absolutely. So every strong puller has that.
02:35:07 Speaker_00
Yeah, when my bulldog was alive, he had the larger neck in the house. But again, it's not about building size into the neck. It's really that strength and stability that I just think translates to so many things that are valuable.
02:35:22 Speaker_01
Anyway, I'll finish out my strength routine with some more auxiliaries. 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, you know, the old weeder dumbbell weight.
02:35:39 Speaker_01
It'll be an iron bar about that long. And I'll put a, 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.
02:35:52 Speaker_01
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 tour tennis players.
02:36:03 Speaker_01
I've never had such power and finesse off the racket because of that sword play exercise.
02:36:08 Speaker_00
Yeah, this is interesting. I love older exercise books. And recently I came across one called Heavy Hands. This must be from the seventies. And the entire book was centered around people
02:36:22 Speaker_00
I'm 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 I was kind of chuckling about it on the one hand.
02:36:34 Speaker_00
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 innervation of some of the distal muscles and the fine control of the,
02:36:52 Speaker_00
the digits, you know, the fingers and toes and toes spreading and things like that. Even calf size and atrophy are fairly reliable markers of the extent to which there's been degeneration of the upper motor neuron pathways, other brain areas or not.
02:37:13 Speaker_00
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.
02:37:28 Speaker_00
Weighting the most distal portion of our body in order to generate adaptations, I think is going to be something that returns to the kind of modern sphere of fitness and longevity.
02:37:41 Speaker_01
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 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.
02:37:59 Speaker_01
nerve conduction velocity scores here." I said, are you kidding me? You're telling me the doc needed to do EMG conduction velocity and all I had to do was look at your leg?
02:38:08 Speaker_01
We know exactly the nerve roots that are deficit because I know exactly what serves those muscles that have wasted. It's crazy how technology has made so many people oblivious to the signs that we all show. That was my first comment.
02:38:27 Speaker_01
But the second one was going back to the old-time books. I collect a lot of those, actually. I have quite a library of the old-time strength books, some from the 1800s, the old Inchbook of Strength, and they're fabulous.
02:38:41 Speaker_01
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.
02:38:51 Speaker_01
Well, there's a great manual strength athlete that not too many people have heard of, John Brookfield. He lives in North Carolina, Pinehurst, North Carolina.
02:39:02 Speaker_01
In Pinehurst, there's a sculpture of very heavy steel that John bent with his bare hands to make this sculpture with. Yeah, he'll take heavy rebar and bend it and, you know, put on strength shows with his hands. He's a fabulous fella too, by the way.
02:39:21 Speaker_01
He's got a set of Indian clubs.
02:39:23 Speaker_01
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 Indian clubs, and they're about this long, but he could just get them and play swordplay with very heavy Indian clubs.
02:39:38 Speaker_01
There's actually a good friend of mine. He's an Australian fellow, Andrew Locke. I don't know if you've ever heard of Andrew Locke. And Andrew has collected kettlebells and Indian clubs from the old timers.
02:39:51 Speaker_01
He's got quite a lovely collection in Melbourne, where he's from in Australia. But they're wonderful exercises.
02:40:00 Speaker_00
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 cautiously, right? Properly.
02:40:17 Speaker_00
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 calf muscle atrophy, which as you point out is a well-known clinical marker.
02:40:31 Speaker_00
for neurodegeneration.
02:40:33 Speaker_01
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.
02:40:42 Speaker_01
Now, don't ask me to throw a ball because I'm a moron, but if I'm splitting firewood, okay, 10 reps this way, 10 reps that way. And that's all in an attempt to keep my brain as movement competent and dexterous as possible.
02:41:01 Speaker_00
Well, certainly when I resistance train, if I'm doing anything standing, I make it a point to stagger my stance. Yes. And at the same time to make sure that my belly button is pointing forward so that I generate some anti-rotation
02:41:17 Speaker_00
effort so that most of my abdominal work can be placed within the workout for other things. I do some pikes and some direct abdominal work as well and the roll up and things of that sort that you've recommended.
02:41:30 Speaker_00
But I find that from a coordination standpoint and especially from a balancing the musculature and the strength on both sides of the body, this is extremely important.
02:41:42 Speaker_00
And I know this because after years of skateboarding where you push with one leg, that was when I was younger, boxing where I'm traditional stance as opposed to southpaw.
02:41:52 Speaker_00
you know, you start getting into all these imbalances that goes way beyond anything aesthetic.
02:41:57 Speaker_00
I mean, the aesthetic stuff is my concern in 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 an imbalance in some of the muscles controlling my body.
02:42:09 Speaker_00
anti-rotation.
02:42:11 Speaker_00
So I think that weaving asymmetric stance, weaving the requirement for symmetric balancing of the musculature on both sides of the midline just makes all the sense in the world to me, especially if one is going to be a regular exerciser, which hopefully people are.
02:42:29 Speaker_01
Well, if I can convince you to consider the biblical training week, all of that fits into your mobility days.
02:42:37 Speaker_00
Yeah, let's talk about those, because you talked about the strength days. What about the two days of mobility?
02:42:41 Speaker_01
Well, given my history, I do thoracic spine extension. I do a little bit of neck work, hip mobility. But again, I have a certain capacity there that I can't overdrive.
02:42:54 Speaker_01
And then once I've done the targeted ones, I just go through the motion of every joint and don't add load. And then I will do the footwork. So, with my background, I'll do a little bit of shadow boxing. I'll play traditional southpaw, etc.
02:43:16 Speaker_00
If you could just repeat the cardiovascular day since in- It depends on the time of year.
02:43:21 Speaker_01
I really like to be outside. So, if it's winter time and I for some reason couldn't go for a cross-country ski that day or whatnot, I will ride a stationary bike in the clinic. I'd prefer not to but I will. If it's summertime, I'm riding outside.
02:43:39 Speaker_01
And I could kayak, swim, canoe, just go to the hills and walk with Tico, my dog, hard. And that might be my cardiovascular that day. And going back to the genetics, which is how we started this podcast.
02:44:02 Speaker_01
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?
02:44:14 Speaker_01
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 athleticisms.
02:44:26 Speaker_01
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.
02:44:39 Speaker_01
Yeah, so I know my abilities and it aligns 100%. In 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 it.
02:44:53 Speaker_01
You know what I mean. I've always had a very good grip strength. So genetically, that came through as ultra. And the other thing I was ultra at was I can be quick for the first 35 milliseconds. Boom.
02:45:03 Speaker_01
If you want something done like that, I can usually pop it, you know. When I was playing hockey, typically it's a 45, 50 second anaerobic blast.
02:45:16 Speaker_01
And you sit down for three 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 ready to go again. I was terrible at recovering from an athletic. anaerobic blast.
02:45:30 Speaker_01
Guess what? I'm the worst possible genetic category for recovery of heart rate. And I've worked with some of the best heart rate recovery people, and I'm hopeless at it.
02:45:46 Speaker_00
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 stopping comes from
02:45:59 Speaker_00
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 shorter workout type stuff.
02:46:10 Speaker_00
But it brings us back to what we were talking about earlier, trying to do a balance of those. everything in between. I love the biblical training week.
02:46:19 Speaker_00
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.
02:46:33 Speaker_00
So.
02:46:33 Speaker_01
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.
02:46:48 Speaker_00
That's the plan. Well, 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
02:46:59 Speaker_00
the back, its 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.
02:47:11 Speaker_00
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, I mentioned and linked to the many clinicians that you've trained all over the world.
02:47:27 Speaker_00
so that if people want to try and access direct coaching and rehabilitation, they can do that. I also really appreciate the books you've written and we linked to that as well, Back Mechanic.
02:47:41 Speaker_00
And I really just appreciate your devotion to public education through your own channels, through your students, the many, many, many peer-reviewed papers that you've published. I mean, I can't overemphasize this enough. You have a vast number of
02:47:57 Speaker_00
high quality peer reviewed publications in these areas.
02:47:59 Speaker_00
And 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.
02:48:15 Speaker_00
So on behalf of myself and everyone listening and watching, I just want to extend a really deep, heartfelt and genuine thank you. Thank you so much.
02:48:26 Speaker_01
Well, thank you, Professor Huberman. You know this, but I'm gonna mention this for the listeners. You have done a great deed in changing the behavior of many people, myself included, and my family. It's not the easiest thing to do.
02:48:51 Speaker_01
because there's always the critics, but you have done a tremendous service. And I thank you for that as well. And I thank you personally because you've improved my life and hopefully I'll have a few more years to enjoy it, but thank you.
02:49:06 Speaker_00
Well, thank you for those words. It's a labor of love for me, and that's extremely gratifying to hear. And God willing, I'll be in your kind of shape at your age. Let's do this again.
02:49:18 Speaker_01
I would love it.
02:49:20 Speaker_00
Thanks. Thank you for joining me for today's discussion with Dr. Stuart McGill.
02:49:25 Speaker_00
To learn more about his work, as well as to find a link to his excellent book, Back Mechanic, The Step-by-Step McGill Method to Fix Back Pain, please see the show note caption.
02:49:34 Speaker_00
Also in the caption, you'll find a link to backfitpro.com, which is Dr. McGill's website, where he has links to specific practitioners you can work with if you're experiencing back pain.
02:49:45 Speaker_00
If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel. Please also subscribe to the podcast on both Spotify and Apple. That's a terrific zero cost way to support us.
02:49:55 Speaker_00
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.
02:50:05 Speaker_00
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.
02:50:16 Speaker_00
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.
02:50:23 Speaker_00
This is a book that I've been working on for more than five years and that's based on more than 30 years of research and experience. And it covers protocols for everything from sleep
02:50:33 Speaker_00
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 presale at protocolsbook.com.
02:50:47 Speaker_00
There you can find links to various vendors. You can pick the one that you like best. Again, the book is called Protocols, an Operating Manual for the Human Body.
02:50:55 Speaker_00
If you're not already following me on social media, I am Huberman Lab on all social media channels. So that's Instagram, X, formerly known as Twitter, Threads, LinkedIn, and Facebook.
02:51:06 Speaker_00
And on all those platforms, I discuss science and science-related tools, some of which overlap with the contents of the Huberman Lab podcast, but much of which is distinct from the contents of the Huberman Lab podcast.
02:51:16 Speaker_00
Again, that's Huberman Lab on all social media channels. If you haven't already subscribed to our Neural Network newsletter,
02:51:23 Speaker_00
Our Neural Network newsletter is a zero-cost monthly newsletter that includes podcast summaries as well as protocols in the form of brief PDFs of one to three pages where I spell out the specific do's and in some cases do nots, but mostly do's related to things like how to optimize your sleep, how to regulate your dopamine levels.
02:51:40 Speaker_00
There's a protocol for neuroplasticity and learning. as well as protocols for fitness, which we call the foundational fitness protocol, includes everything, sets, reps, cardiovascular training, again, all available, completely zero cost.
02:51:52 Speaker_00
You simply go to hubermanlab.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.
02:52:01 Speaker_00
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.