Dr. Stuart McGill: Build a Strong, Pain-Proof Back
15 Jul 2024 (2 months ago)
Dr. Stuart McGill
- Dr. Stuart McGill is a distinguished professor of spine biomechanics at the University of Waterloo.
- He has analyzed the spines of injured and healthy people and developed methods to treat spine injuries and pain, as well as improve spine biomechanics.
- Dr. McGill has authored over 250 peer-reviewed research articles on these topics, making him a world expert in the field.
- There is no single specific source of back pain, nor is there a one-size-fits-all solution.
- Dr. McGill provides specific ways to self-diagnose back pain, which is critical for understanding what to do and avoid when dealing with pain.
- He also discusses several of the avid controversies within the field of back pain and the treatments for back pain.
- Dr. McGill discusses the biopsychosocial model of pain, which points to various sources of pain, including emotional factors, lack of sleep, and specific locations in the spine, brain, and elsewhere in the body.
- He explains how these factors mesh together to create pain and how they can be used to direct effective treatments for pain.
- Dr. McGill provides a thorough understanding of the anatomy and physiology of the back as it relates to a healthy back and back pain.
- He offers various remedies for dealing with and preventing back pain, as well as strengthening the back for different kinds of movement, including exercise, sports, and daily activities.
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- Dr. Stuart McGill is a world-renowned expert in spine biomechanics and the prevention and treatment of back pain.
- McGill's research has shown that the spine is not a passive structure, but rather a dynamic system that is constantly adapting to the demands placed on it.
- McGill's approach to back pain focuses on strengthening the muscles that support the spine and improving spinal mobility.
- McGill has developed a series of exercises, called the "Big 3," that are designed to strengthen the core muscles and improve spinal stability.
- The "Big 3" exercises are:
- The McGill Curl-Up
- The Side Plank
- The Bird-Dog
- McGill also emphasizes the importance of proper posture and movement mechanics to prevent back pain.
- McGill's approach to back pain has been shown to be effective in reducing pain and improving function in people with back pain.
What Causes Back Pain?; Genetics, Dog Breed Analogy
- Back pain has various causes, including genetics, exposure, and psychosocial factors.
- Genetics can influence an individual's susceptibility to back pain but are not the sole determinant.
- Individual factors such as body structure, activities, and lifestyle also play significant roles.
- Different people may require different interventions and remedies for back pain.
Tool: Skeleton & Body Type; Spine Flexibility & Discs
- The width of the knee and hip bones, as well as the shape of the discs in the spine, can indicate a person's general heaviness and ability to bear compressive loads.
- Discs in the spine act as shock absorbers, providing mobility, flexibility for bending, and stiffness for carrying heavy loads.
- Facet joints behind the vertebrae guide motion, and their angles, which are determined by genetics, affect a person's ability to twist.
- Open facet joints, common in golfers, allow for more twisting but can stress the pars bone and lead to fractures, especially in gymnasts and athletes with excessive range of motion.
Flexibility & Exercises; Discs & Collagen
- Naturally flexible individuals, like those who can easily bend their fingers back or have good shoulder extension, may be at risk of certain injuries if they engage in activities that put stress on their joints.
- Individuals with naturally stiffer spines and thicker joints may also need to avoid certain activities to prevent injury.
- When rehabilitating an athlete or a person to get back to work, it is important to consider their individual flexibility and joint structure to determine the best course of treatment.
- Individuals with plump discs that are full of fluid may have more space between their posterior spinus processes when standing upright, which can lead to problems if they arch their backs.
- The mechanical advantage of a large arch in the back for some individuals can be a mechanical disadvantage for others, leading to injuries.
- The disc is composed of approximately 80% type 1 collagen (stiff strength collagen) and 20% type 2 collagen (elastic collagen), with types 3 through 10 binding the collagen fibers together.
- Genetic variability in the binding collagen fibers can affect an individual's resilience to repeated bending drills.
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Stress & Tipping Point; Athletic Tradeoffs, Triathletes
- Different sports require different physical characteristics and adaptations.
- Swimmers have a flexible structure, cyclists have a stiff core, and runners have tuned stiffness to store and recover elastic energy.
- Muscles act as springs, storing and releasing elastic energy for efficient movement.
- Athletes need to find the right balance between muscle stiffness and relaxation for optimal performance.
- Highly elastic athletes, such as golfers who can hit the ball 330 yards, have a beautifully tuned elastic body with smooth muscles.
Back Pain, Goals & Training Program
- A comprehensive assessment of an individual's story, goals, learning style, and pain details is essential for designing an effective training program.
- Pain assessment should consider the nature of the pain, associated activities, motions, postures, loads, and changes over time.
- Dr. Stuart McGill uses provocative testing to identify the exact cause of back pain and designs specific training programs to address the identified pain pathway.
- Exercises that replicate the pain should be avoided, while those that alleviate pain should be incorporated into the training program.
Spine Hygiene, Back Pain, Powerlifting
- Pain during movement, such as standing up, running, or exercising, should not be ignored.
- Avoiding movements that cause pain can worsen the pain and lead to chronic pain.
- Desensitization, gradually exposing the affected area to the movement or activity that causes pain, is crucial for reducing pain.
- Identifying the cause of pain is essential for developing an effective exercise program.
- Spine hygiene, proper form for exercises, and movement retraining can help individuals overcome pain and regain normal movement patterns.
- Strongman competitors carry and walk with 1,000 pounds on their shoulders, requiring different athleticism and strength distribution compared to traditional weightlifting.
- When lifting heavy weights, a strong spine and core are essential to withstand the force and maintain proper form.
Genetics & Running
- Dr. Stuart McGill observes that different dog breeds and humans have distinct temperaments and movement patterns that should be considered when assessing individuals with back pain.
- Sprinters tend to have a lordotic lower back, which allows for more power development during running, while a flat lower back limits the range of motion for generating propulsive forces and is less advantageous for sprinting.
- Combat athletes exhibit various movement patterns depending on their disciplines, with people with flatter backs being better at activities that require high kicks, such as combat sports.
- Runners who specialize in longer distances tend to have flatter spines and a more upright posture for efficient storage and recovery of elastic energy, while sprinters have a more arched spine and use concentric and eccentric muscle pulsing for power.
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- Hydration is crucial for brain and bodily function, and even slight dehydration can impair cognitive and physical performance.
- Adequate electrolytes are necessary for optimal body and brain function, especially for neurons.
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Rehabilitation & Reducing Volume; Injury
- Dr. Stuart McGill recommends a balanced training approach with three resistance and three cardiovascular training sessions per week.
- The goal is to build or maintain balanced strength without emphasizing specific outcomes like endurance, strength, or power.
- Individuals with a thinner stature and more flexibility may benefit from core and spine muscle development for stability.
- Individuals with a thicker torso and spine may benefit from yoga or flexibility-promoting activities.
- The primary focus should be on identifying and avoiding pain-triggering movements rather than compensating for weaknesses through specific training styles.
- Controlling the volume of exposure to potentially painful movements is crucial to prevent reaching the "tipping point" and triggering pain.
- Athletes should limit the volume and intensity of certain exercises to avoid pain and maintain strength and performance.
- Professional athletes may need to adjust their training routines as they age or switch sports to prevent injuries and maintain performance.
- Pushing into pain is not always necessary and can be counterproductive.
Tool: Training for Lifelong Fitness, Injury & Joints
- To avoid injury, focus on joint health as joints are less adaptive than muscles, and damage can have long-term consequences.
- For non-competitive exercisers, structure workouts as follows:
- 85% of workouts at 85% of maximal intensity.
- 10% of workouts at 90-95% of maximal intensity.
- 5% or less of workouts at 100% maximal intensity.
- Consider external factors that may influence workout intensity and lead to overexertion and potential injury.
- Individualize training intensity based on age, injury history, genetics, and body type.
- Younger individuals recover faster from intense training compared to older individuals.
- Optimize performance by leaving some "gas in the tank" to allow for frequent training sessions.
- Intensity can vary depending on the exercise, such as distance for running or weight for resistance training.
Pain Types, Biopsychosocial Model of Pain
- Dr. Stuart McGill suggests that different types of pain require different approaches to programming for life.
- The bio-psycho-social model of pain incorporates psychological, physiological, and social elements that play a role in pain and rehabilitation.
- For mechanical injuries, a strategy is created to avoid stressing the damaged tissue and allow healing, which can be addressed through strategic mobility and stability, core exercises, and unleashing hips and shoulders.
- Emotional trauma, guilt, or psychological stress can rewire the brain's perception of pain, making traditional fitness approaches ineffective, and desensitization techniques can be used to slowly expand the pain-free repertoire.
- Work hardening programs, funded by insurance companies, gradually increase the duration of job-related activities for individuals with chronic back pain.
Coaching, Explosivity & Endurance
- Athletes who engage in different training styles may develop certain personality traits or reactivity styles associated with their chosen activity.
- More explosive athletes tend to have shorter attention spans, while less explosive athletes have longer attention spans.
- Endurance training can improve mental focus and endurance for other activities.
- Highly explosive athletes may not be able to sustain their explosiveness for extended periods, and training to increase their endurance may come at the cost of their explosiveness.
- In combat sports, neurologically explosive athletes are designed to win in the first round, while their opponents train to survive the first round and then come on strong later in the fight.
- The coaching style for athletes should be different depending on their psychological makeup.
Virtual Surgery & Rest, Pain Recovery
- Dr. Stuart McGill proposes a "virtual surgery" approach for individuals considering surgery after failed treatments. This involves simulating post-surgical recovery through rest, mobility exercises, and gradual movement reintroduction.
- McGill stresses understanding pain mechanisms and developing strategies to manage it, including identifying pain-inducing movements and performing beneficial counterpoint movements.
- To build a margin of safety, gradually increase training intensity and volume while staying pain-free.
- As individuals age, fitness goals may need to be adjusted, accepting manageable pain levels. Younger individuals should exercise caution to avoid long-term pain, while older individuals may require more recovery time.
Tool: McGill’s Big 3; Building Back Strength & Stability
- McGill's Big 3 exercises are designed to build strength and stability around the spine to prevent or rehabilitate back pain.
- The Big 3 exercises are the bird dog, roll up, and side plank.
- Many people have reported that the Big 3 exercises have helped them avoid or rehabilitate back pain.
- The choice of a fourth exercise depends on the individual's assessment and pain triggers.
- For someone with mechanical back pain and neurological involvement, an exercise that is not compressive in nature should be chosen.
- Mobilizing the nerve, providing more thoracic spine extension, or walking in multiple short doses may be beneficial.
- The specific exercise and its programming should be tailored to the individual's needs and pain mechanisms.
Inversion Tables & Spine Deloading, Disc Bulge, Tool: Lumbar Support
- Inversion tables and anti-gravity boots deload the spine.
- Traction applied by a trained clinician can reduce disc bulge and pain.
- The 'art of therapy' involves adjusting the traction to find the right balance for each individual.
- Inversion tables lack the 'art' and can be too forceful.
- The 'big three' exercises can help improve posture and endurance.
- A strong diaphragm allows for better breathing and reduces strain on the spine.
- Disc bulges can be identified through scans and tests.
- The Cobra pose can be effective for certain types of disc bulges.
- Using a lumbar support pillow or rolled-up towel during travel or prolonged sitting can provide resilience and reduce pain.
Tool: Daily Walking; Sitting
- Walking is one of the healthiest things you can do for your back.
- Don't walk to pain. If your tipping point is 40 minutes, walk for 20 minutes three times a day instead.
- People with discogenic back pain should keep changing postures throughout the day.
- Sitting for long periods can cause pain if you have pre-existing back injuries.
- Sitting all day can cause back pain, even if you don't have any pre-existing injuries.
- This is because sitting puts pressure on the spine and can lead to the delamination of collagen and disc bulges.
- If you have to sit for long periods, try to get up and move around every 20-30 minutes.
Deadlift & Bone Density, Glute-Ham Raise
- The deadlift is a complex exercise that involves almost every muscle in the body and can minimize the risk of injury when performed correctly.
- Improper deadlifting can cause broken end plates and increase the risk of disc herniation.
- Successful deadlifters usually have trained their bodies over many years to achieve the necessary bone density.
- For individuals with back pain, it's important to address the cause of the pain before considering deadlifts.
- Alternative exercises like walking backward up a hill or Nordic curls can be effective for strengthening the posterior chain and avoiding back pain.
- The choice of exercise depends on the individual's goals and physical limitations.
Training & Age, Osteoporosis, Tool: Deadlift Alternatives
- Heavy deadlifting may not be suitable for individuals who engage in diverse physical activities that require twisting and rapid movements, as it can hinder performance and cause pain.
- Alternatives to heavy deadlifts, such as hack squats, leg extensions, and glute ham raises, can provide similar benefits without causing pain.
- Avoiding heavy deadlifts can help prevent back and hip pain in individuals who are not at high risk for osteoporosis and who engage in a variety of physical activities.
- As individuals age, the risk of falling becomes greater than the risk of back injury, so exercises that improve balance and agility are important.
- Elite athletes use auxiliary exercises like the belt squat machine to target specific muscle groups without putting excessive strain on the spine.
- When choosing exercises, it's important to consider individual factors such as goals, future risks, and current physical limitations.
- Many young people influenced by social media attempt to set personal bests in deadlifting without proper technique, which can lead to long-lasting back injuries.
Tools: Biblical Training Week; Spine Stability & McGill’s Big 3; Shrinking & Age
- The "Biblical Training Week" involves alternating between strength training, mobility work, and cardiovascular exercise, with a day of rest for recovery and adaptation.
- Strength training should focus on compound movements like squats, lunges, and deadlifts, while mobility work improves range of motion and flexibility.
- Cardiovascular exercise challenges the heart and lungs through activities like running, swimming, or cycling.
- Avoid consecutive days of the same training type to allow for proper recovery.
- The "big three" exercises (squats, deadlifts, and bench press) are crucial for spine stability and should be performed regularly.
- Core control and stiffness are essential for directing athleticism and improving overall performance.
- Core stability arrests small micro movements and is vital for ability and performance.
- Disc height shrinkage is an ongoing issue with no known solution.
- Hanging or anti-gravity boots can temporarily increase disc height, but hydrostatic pressure causes fluid loss in gravity.
Platelet-Rich Plasma (PRP); Disc Damage
- PRP is used to restore youthful state or augment resilience of tissues.
- There's no evidence that PRP can restore tensile strength and thickness to discs.
- PRP can be effective for stubborn muscle tears and in ball and socket articular joints.
- PRP is not effective when injected into the discs.
- Young people with healthy discs can increase mobility and strengthen collagen through activities like yoga and strength training.
- After a disc injury, it becomes more difficult to adapt and maintain full range of athletic abilities.
- Individuals may need to compromise and choose between maintaining mobility or strength training to avoid further compromising the damaged disc.
- After a back injury, individuals may need to give up certain activities or modify their training to manage their condition.
Tools: Biblical Training Week & Strength Exercises, Neck Strength
- Dr. Stuart McGill recommends exercises like bird dogs, side planks, glute bridges, hip thrusts, push-ups, inverted rows, split lunge rear elevated foot squat lunges, and bilateral squats to build a strong and pain-proof back.
- Proper form and technique are crucial to avoid injury and maximize effectiveness.
- Isometric exercises are beneficial for individuals with neck injuries to strengthen flexor muscles and reduce shear forces on the neck.
- Neck work is important for stabilizing the shoulder girdle during lifts and for posture.
- Neck bridges are generally not recommended due to potential risks.
- A strong neck is more important than a large neck.
- The trapezius muscles, originating from the neck, are responsible for pulling motions.
- Building a strong neck is beneficial without necessarily increasing its size.
Tools: Sword Play, Distal Limb Loading, Training for Symmetry
- Dr. Stuart McGill suggests using an iron bar with a weight attached to the end and performing figure-eight movements to improve wrist and upper body strength.
- Carrying light weights while exercising can help maintain neuromuscular connectivity and prevent age-related degeneration.
- Calf muscle atrophy is a reliable indicator of upper motor neuron pathway degeneration and overall brain health.
- Old-time exercises like Indian clubs and heavy hands can be effective for maintaining strength and neural health.
- Loading the distal limbs cautiously and properly can help keep neural pathways healthy and prevent age-related atrophy.
- Dr. Stuart McGill emphasizes the importance of maintaining brain movement competence and dexterity by performing various activities with the opposite hand.
- When resistance training in a standing position, he suggests staggering the stance and ensuring the belly button points forward to generate anti-rotation effort.
- McGill incorporates Pikes, direct abdominal work, roll-ups, and other exercises to balance the musculature and strength on both sides of the body.
- He highlights the significance of addressing muscle imbalances resulting from activities like skateboarding and boxing, which can lead to stiffness and discomfort.
- McGill recommends weaving asymmetric stances and symmetric balancing of the musculature to promote overall coordination and balance.
Tools: Biblical Training Week, Mobility & Cardiovascular Exercises, Athletic Panel
- Dr. Stuart McGill, an expert in spine biomechanics, recommends a balanced training routine that includes strength days, mobility days, and cardiovascular days.
- Mobility days should focus on targeted exercises for the thoracic spine, neck, and hips, followed by general joint mobility work and footwork.
- Cardiovascular activities can include cross-country skiing, cycling, kayaking, swimming, canoeing, or hiking.
- Genetic testing can provide insights into individual athletic strengths and weaknesses, optimizing training and recovery strategies.
- Dr. McGill emphasizes the importance of taking a full day off each week for recovery to reduce the risk of pain and injury.
- Dr. McGill's precise and individualized approach to back pain assessment and rehabilitation has been shared with clinicians worldwide for direct coaching and rehabilitation.
- Dr. McGill expresses gratitude to Professor Huberman for promoting evidence-based approaches to spine health and exercise, positively impacting many people, including himself and his family.
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- Dr. Stuart McGill is a world-renowned expert in spine biomechanics and the author of the book "Back Mechanic: The Step-by-Step McGill Method to Fix Back Pain".
- Back pain is a common problem, affecting up to 80% of the population at some point in their lives.
- Most back pain is mechanical in nature, meaning it is caused by problems with the structures of the spine, such as the vertebrae, discs, muscles, and ligaments.
- Dr. McGill's approach to treating back pain focuses on identifying and correcting the underlying mechanical problems that are causing the pain.
- This approach involves a combination of exercises, stretches, and lifestyle modifications.
- Dr. McGill's method has been shown to be effective in reducing back pain in both the short and long term.