July 15, 2024 • 2hr 52min

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

Huberman Lab

In this episode, Dr. Andrew Huberman interviews Dr. Stuart McGill, a world-renowned expert on spine biomechanics and back pain. Dr. McGill is a distinguished professor emeritus at the University of Waterloo and has spent decades researching spine function, injury mechanisms, and rehabilitation strategies. The discussion covers a wide range of topics related to back health, pain, and fitness, providing listeners with valuable insights on how to build a strong, resilient back and maintain overall physical health throughout life. Dr. McGill emphasizes the importance of individualized assessment and treatment approaches, while also offering some general principles and exercises that can benefit many people.

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Key Takeaways

Back pain is complex and individualized - There is no one specific source or solution for back pain. A comprehensive assessment is needed to determine the cause and appropriate treatment.
Genetics plays a major role in back health and pain - Our genetic makeup influences spine structure, disc shape, and susceptibility to certain types of back issues.
The "tipping point" concept is crucial - All body systems require some stress for optimal health, but exceeding the tipping point leads to injury and pain. Finding the right balance is key.
McGill's "Big 3" exercises are effective for building core strength and stability: bird dog, side plank, and curl-up.
A "Biblical Training Week" approach with varied training types and rest days can promote overall fitness and joint health as we age.
Heavy deadlifts and squats are not necessary or advisable for everyone, especially those with a history of back issues. Alternative exercises can often provide similar benefits with less risk.
Walking is one of the healthiest activities for back health and overall fitness. Multiple shorter walks throughout the day are often better than one long walk.
Core stability is essential for athletic performance as it allows for better force transfer and control throughout the body.
The biopsychosocial model of pain recognizes that pain has physiological, psychological and social components that all need to be addressed.

Introduction

In this episode, Dr. Andrew Huberman interviews Dr. Stuart McGill, a world-renowned expert on spine biomechanics and back pain. Dr. McGill is a distinguished professor emeritus at the University of Waterloo and has spent decades researching spine function, injury mechanisms, and rehabilitation strategies.

The discussion covers a wide range of topics related to back health, pain, and fitness, providing listeners with valuable insights on how to build a strong, resilient back and maintain overall physical health throughout life. Dr. McGill emphasizes the importance of individualized assessment and treatment approaches, while also offering some general principles and exercises that can benefit many people.

Topics Discussed

Causes and Assessment of Back Pain (6:23)

Dr. McGill explains that back pain is a symptom with many potential causes. He outlines his approach to assessing back pain:

Gathering the patient's full story and history
Identifying pain triggers through provocative testing
Analyzing movement patterns and physical demands
Considering genetic factors that influence spine structure and resilience

He emphasizes: "Genetics loads the gun. Exposure pulls the trigger, and then the psychosocial milieu around the individual influences how they respond to the pain."

Spine Anatomy and Biomechanics (12:55)

Dr. McGill provides an overview of spine structure and function:

The spine consists of vertebrae separated by discs that allow for mobility
Disc shape and composition vary between individuals, influencing flexibility and strength
Facet joints behind the vertebrae guide motion and influence twisting ability
Thicker spines tend to be stronger in compression but less flexible
Thinner, more flexible spines may be more prone to certain types of injuries

The "Tipping Point" Concept (27:32)

Dr. McGill introduces the important idea of the "tipping point":

All body systems require some stress for optimal health and adaptation
Exceeding the tipping point leads to cumulative trauma and injury
The goal is to provide enough stress for positive adaptation without crossing this threshold
Finding the right balance is key for both rehabilitation and athletic training

Rehabilitation Strategies (36:17)

Dr. McGill outlines his approach to back pain rehabilitation:

Identify and eliminate pain triggers
Teach proper movement patterns (e.g. hip hinge)
Build core stability and strength gradually
Progress carefully, staying below the "tipping point"
Consider the individual's goals and lifestyle needs

He notes: "We start out by giving them the tools to not have pain. From a physical point of view, that's really important. From a psychological point of view, we've just empowered that person."

McGill's "Big 3" Exercises (1:41:25)

Dr. McGill discusses his well-known "Big 3" exercises for building core strength and stability:

Bird dog
Side plank
Curl-up (modified crunch)

He explains that these exercises were chosen based on biomechanical research to effectively engage core muscles while minimizing spine stress.

Deadlifts and Squats: Risks and Alternatives (1:55:33)

Dr. McGill provides a nuanced view on heavy deadlifts and squats:

Can be beneficial for some, but carry significant injury risk, especially if done improperly
May not be necessary or advisable for many people, particularly those with a history of back issues
Alternative exercises can often provide similar benefits with less risk
Suggests exercises like split squats, goblet squats, and hip thrusts as potential alternatives

He cautions: "Right now there's too many young people influenced by social media who are trying to set, oh, I'm gonna set personal best in deadlift. Not really knowing how to densify the neural drive, take out all the slack... they end up with a back injury."

The "Biblical Training Week" (2:16:47)

Dr. McGill outlines his concept of a "Biblical Training Week" for balanced fitness:

2 days of strength training
2 days of mobility work
2 days of cardiovascular exercise
1 full rest day
Avoid doing the same type of training on consecutive days
Adapt activities based on individual needs, limitations, and environment

Walking for Back Health (1:51:09)

Dr. McGill emphasizes the benefits of walking:

One of the healthiest activities for back health and overall fitness
Multiple shorter walks (e.g. 20 minutes) throughout the day are often better than one long walk
Can help relieve pain for many people with back issues

He advises: "Don't walk to pain. So if your tipping point is 40 minutes, you can't go for a 40 minutes 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."

Core Stability and Athletic Performance (2:19:11)

Dr. McGill explains the importance of core stability for overall athletic performance:

Allows for better force transfer from the core to the limbs
Improves efficiency and power in many movements
Essential for injury prevention

He uses the analogy: "A heavy equipment operator using a backhoe, the first thing they do is they put down the stabilizers... to stabilize the tractor, so that now the arm can be the athlete pulling earth. Failure to stabilize, you're just pulling the tractor around."

Biopsychosocial Model of Pain (1:17:40)

Dr. McGill discusses the importance of considering psychological and social factors in pain:

Pain is not just a physical phenomenon
Emotional trauma, stress, and past experiences can influence pain perception
Treatment may need to address psychological aspects alongside physical rehabilitation

He notes: "We completely change [our approach]. Now it might be just to desensitize them... We have to come up with what can they do without triggering that maladaptive response?"

Conclusion

This wide-ranging discussion with Dr. Stuart McGill provides valuable insights into back health, pain management, and overall fitness. Key takeaways include the importance of individualized assessment, the concept of training up to but not beyond the "tipping point," and the value of a balanced approach to fitness that includes strength, mobility, and cardiovascular training.

Dr. McGill's expertise shines through in his nuanced discussion of complex topics like spine biomechanics and pain perception. His practical advice, including the "Big 3" exercises and the "Biblical Training Week" concept, offers actionable strategies for listeners to improve their back health and overall fitness.

The episode underscores the complexity of back pain and the need for careful, individualized approaches to both prevention and treatment. It also highlights the importance of considering psychological and social factors alongside physical aspects when addressing pain and pursuing fitness goals.

Ultimately, Dr. McGill's message emphasizes the value of building a strong, resilient back through thoughtful, balanced training and careful attention to our body's signals and limitations. This approach can help us maintain our physical health and enjoy an active lifestyle well into our later years.