Protocols to Strengthen & Pain Proof Your Back

Back Health (0s)

• The Huberman Lab podcast discusses science and science-based tools for everyday life.
• Today's topic is how to build a strong, pain-free back.
• Back pain can severely impede our ability to do most things, even sitting or lying still.
• Pain, especially back and neck pain, affects our emotional well-being, making us more irritable.
• A previous podcast episode with Dr. Shawn Mackey discussed pain management, including medication, epidurals, electrical stimulation, and the biopsychosocial model of pain.
• Today's discussion will focus on ways to reduce or eliminate back pain and how to pain-proof and strengthen the back.
• The speaker will explain back anatomy and physiology, including neuromuscular and spinal components.
• The information will be accessible to everyone, regardless of their biology background.
• The speaker will share 6 specific protocols that require minimal time and no equipment.
• These protocols are from 3 world-renowned experts in back pain, strengthening, and resilience:
  • Dr. Shawn Miller (MD, back strengthening and rehabilitation expert)
  • Dr. Stuart McGill (PhD, spine researcher and core and spine strengthening expert)
  • Dr. Kelly Starett (PhD, physical therapist and movement rehabilitation expert)
• Links to the experts and their resources will be provided in the show notes.
• All 3 experts will be invited as guests on the Huberman Lab podcast in the future.

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• The back is a complex structure that consists of vertebrae, discs, muscles, ligaments, and nerves.
• Back pain is a common problem that can be caused by various factors, including injury, poor posture, and muscle imbalances.
• To strengthen the back and reduce the risk of back pain, it is important to focus on core strength, flexibility, and proper posture.
• Core strength exercises help to strengthen the muscles that support the spine, including the abdominal muscles, back muscles, and pelvic floor muscles.
• Flexibility exercises help to improve the range of motion in the spine and reduce stiffness.
• Proper posture involves maintaining a neutral spine and avoiding slouching or hunching.
• It is also important to avoid lifting heavy objects with improper form and to take breaks when sitting or standing for long periods.
• If you experience back pain, it is important to consult a healthcare professional to determine the cause and receive appropriate treatment.

Back Anatomy: Spine, Vertebrae, Spinal Cord (7m57s)

• The spine is made up of bony segments called vertebrae.
• Discs, which are soft tissues, sit between the vertebrae and allow for movement and some compression of the spine.
• The vertebrae and discs have a hole down their middle through which the spinal cord passes.
• The spinal cord is a long, snake-like process of the nervous system that extends from the neck to the pelvis.
• The spinal cord is very soft and fragile, so the vertebrae protect it from damage.
• Damage to the spinal cord can cause scar tissue to form, but the neurons that are damaged do not regenerate.
• Spinal cord injuries can be caused by trauma, such as a car accident or a fall.
• Spinal cord injuries can also be caused by diseases, such as multiple sclerosis or polio.
• Spinal cord injuries can result in paralysis, loss of sensation, and other problems.
• The severity of a spinal cord injury depends on the location and extent of the damage.
• There is no cure for spinal cord injuries, but there are treatments that can help to improve function and quality of life.

Spinal Cord & Nerves; Herniated Discs (12m7s)

• The spinal cord, an extension of the brain, forms the central nervous system along with the brain.
• The brain is protected by the skull, while the spinal cord is protected by the vertebrae and discs, allowing for some movement.
• The back stabilizes the body and provides stiffness for dynamic limb movements.
• Motor neurons in the ventral spinal cord control muscle movement through axons that extend to the muscles.
• Sensory inputs from the skin, tendons, and muscles inform the brain about limb positions and muscle loads.
• Nerve roots, bundles of nerves that enter and exit the spine, can be impinged by bulging discs or inflammation, causing back pain.
• Relieving back pain often involves creating space for nerve roots to travel freely in and out of the spine.
• Building a strong, pain-free back requires stability around the spine to prevent compression of nerve pathways.

Build Strong Pain-Free Back; Bulging Discs (19m50s)

• Back pain can have various causes, including psychological, inflammatory, and neural factors.
• Stability of the feet, toes, pelvis, neck, and chin, as well as the spinal erector muscles, abdominal region, and core, are all important for a healthy back.
• The vertebrae, discs, and spinal cord make up the spine, allowing for movement and flexibility.
• Bulging discs can cause back pain, but simple movements can help push them back towards the spinal cord and relieve pressure on nerve roots.
• Building stability in the abdominal and lower back regions can protect the spine and prevent nerve root impingement.
• Focusing on stabilizers in the feet, such as proper foot positioning and toe spreading, can also support back health.
• Strengthening the neck and various muscles without equipment can contribute to a pain-free, strong back during rest and dynamic movements.

Back Pain & Professional Evaluation; Tool: Spine Self-Assessment (24m26s)

• A proper assessment and diagnosis are crucial for back pain, as the causes can vary widely from overuse of certain motor patterns to spinal compression injuries.
• Dr. Stuart McGill, a spine physiology and anatomy expert, suggests self-assessing to determine if you have a thick or thin spine, as this can impact the type of exercises and strengthening needed.
• People with thicker spines may have reduced mobility in terms of twisting and bending of the spine compared to those with thinner spines.
• People with thinner spines may need to focus more on building spinal musculature and stability to prevent pain and injury.
• People with thicker spines can tolerate heavier loads but may need to work on mobility to avoid nerve compression.
• Individuals with mixed phenotypes may need to adjust their training protocols accordingly.
• People with thin spines may need to build more musculature around the spine for stabilization but may not need as much work for side-to-side flexibility.
• People with thicker spines may not need as much work to develop spinal musculature but may benefit from more work on side-to-side flexibility.
• Most people fall somewhere in the middle of the thin and thick spine extremes and may have a combination of thin and thick musculature in different areas of the body.

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• Weak back muscles can lead to back pain and injuries.
• Strong back muscles support the spine, reduce strain, and improve posture.
• Strengthening the back involves exercises targeting different muscle groups.
• Glute bridges:
  • Lie on your back with knees bent and feet flat on the floor.
  • Press through your heels to raise your hips until your body forms a straight line from shoulders to knees.
  • Hold for a few seconds, then slowly lower back down.
• Single-leg bridges:
  • Start in the same position as glute bridges.
  • Raise one leg and extend it straight out in front of you.
  • Press through the heel of your planted foot to raise your hips until your body forms a straight line from shoulders to extended knee.
  • Hold for a few seconds, then slowly lower back down.
• Superman:
  • Lie on your stomach with arms and legs extended.
  • Simultaneously raise your arms and legs off the ground, keeping your lower back pressed into the floor.
  • Hold for a few seconds, then slowly lower back down.
• Bird dog:
  • Start on all fours with your hands directly under your shoulders and knees directly under your hips.
  • Raise one arm and the opposite leg, keeping your body in a straight line from the raised arm to the raised leg.
  • Hold for a few seconds, then slowly lower back down.
• Plank:
  • Start in a push-up position with your hands directly under your shoulders and your body forming a straight line from head to heels.
  • Hold this position for as long as you can, maintaining proper form.
• Maintain a healthy weight to reduce strain on the back.
• Practice good posture while sitting, standing, and lifting objects.
• Use proper lifting techniques to avoid back injuries.
• Stay hydrated to support spinal discs and joints.
• Get regular exercise to strengthen back muscles and improve overall health.
• Consider using a standing desk or ergonomic chair to reduce sitting time.
• Avoid prolonged sitting, especially in uncomfortable positions.
• Listen to your body and stop any activity that causes back pain.

Tool: McGill Big 3 Exercises, Curl-Up (36m29s)

• The McGill's Big Three protocols, recommended by experts, include the curl-up exercise for strengthening the back and promoting spinal health.
• The curl-up is a safer alternative to sit-ups, especially for individuals with back pain.
• To perform the curl-up, lie down with one knee bent and the other leg extended, placing both hands below the lower back and maintaining the arch of the back.
• Keep the head in a neutral position, raise the elbows off the ground, and lead with the upper chest, raising the upper torso while exhaling and contracting the abdominals for 8-10 seconds.
• Repeat the curl-up, coming up only 5-10 degrees to avoid excessive disc herniation.
• The curl-up involves contracting the abdominal muscles for 10 seconds, then relaxing for 10-30 seconds, focusing on contracting the abdominal muscles as hard as possible during the hold and then releasing.
• Variations of the curl-up include elevating the extended leg, positioning the elbows closer to the ceiling, and doing it on the floor.
• The curl-up can be done daily or a few times a week for back strengthening and pain relief.
• Avoid turning the curl-up into a sit-up by leading with the chest and keep the head in a neutral position.

Tool: McGill Big 3 Exercises, Side Plank (44m40s)

• Side planks strengthen the spine and prevent or alleviate back pain.
• To perform a side plank, start with your knees slightly bent at a 30-40° angle, place one arm down with your hand in a fist, and push your hips off the ground until your upper body is in a plank position.
• Hold this position for 8-10 seconds, maintaining rigidity.
• Progress to one foot over the other with legs straight as you get more comfortable.
• Do three sets of three 10-second holds on each side of the body.
• Avoid letting the hips sag to prevent back pain or aggravation.
• Focus on engaging the spine, not just the abdominals and obliques.

Tool: McGill Big 3 Exercises, Bird Dog; Back Pain (53m13s)

• The "big three" exercises recommended by Stu Mill for strengthening and preventing back pain are the curl-up, side plank, and bird dog.
• The bird dog exercise involves getting on all fours, extending one arm forward and the opposite leg backward while keeping the upper body parallel to the floor.
• Key points for the bird dog exercise include generating a strong neural contraction, not raising the leg too high, and pushing the ground away with the planted hand and knee.
• The exercise focuses on strengthening the muscles on either side of the spine, allowing for intense contractions and improved stability.
• Start with one set of each exercise and gradually increase repetitions and frequency as tolerated.
• Perform the exercises at the beginning of a workout to warm up the back and reduce pain.
• Avoid any movements that exacerbate back pain and consult a professional for severe pain or specific circumstances.
• Focus on proper form and technique to build muscle activation patterns and prevent injury.
• The "big three" exercises can be done in just 5-10 minutes, once or twice a week, and don't require any equipment.

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Tool: Back Pain & Oreo Analogy, Bar Hang (1h5m37s)

• Hanging from a sturdy object with toes touching the floor can help relieve back pain by lengthening the spine and reducing disc bulging.
• Avoid twisting while hanging as it can worsen the pain.
• Inversion tables and chairs can also help relieve pressure on the spine, but caution is advised for individuals with certain medical conditions, such as glaucoma, as it can increase intracranial or ocular pressure.
• This technique can be done for 10 to 30 seconds at a time, repeated two to three times.

Time & Back Pain; Tool: Reversing Disc Herniation, Cobra Push-Ups (1h10m34s)

• The author experienced intense lower back pain after doing a reverse bench dip with added weight, causing a bulging disc and nerve impingement.
• A physical therapist advised the author to avoid exercises like crunches that worsen the pain and instead perform "Cobra push-ups" or spinal extensions to relieve the pain and realign the bulging disc.
• Understanding the direction of a disc bulge is crucial for choosing appropriate exercises to prevent further herniation.
• Incorporating posterior chain exercises like glute ham raises and Nordic curls can help strengthen the muscles surrounding the discs.
• The type of exercises needed to alleviate back pain depends on the origin of the pain, whether it's a herniation towards the anterior or posterior side of the spine.
• There is a range of quality among practitioners in different fields, including physical therapy, chiropractic, and medical doctors, and certain approaches to relieving back pain may be viewed as unconventional depending on the location and medical traditions.
• Incorporating exercises like cobra push-ups and up dog type approaches has helped individuals relieve back pain and strengthen specific areas of the body to prevent further issues.
• Surgery may sometimes be necessary for severe cases, but many individuals have found significant relief through proper rehabilitative and strengthening exercises.

Sciatica, Referred Pain, Herniated Disc (1h21m28s)

• Sciatica is commonly thought of as tingling pain, numbness, or a combination of both in the lower back, glute region, hip, and down the leg.
• Sciatica can be caused by a herniated or bulging disc that impinges on a nerve.
• Referred pain is pain experienced in one part of the body due to an impingement or disruption elsewhere in the body.
• Symptoms of sciatica can vary depending on the degree of nerve impingement.
• It's important to determine the direction of the disc herniation to perform the proper exercises to alleviate the impingement on the nerve roots.
• The following exercises can help strengthen the back and prevent back pain:
  • Glute bridges: Lie on your back with your knees bent and feet flat on the floor. Squeeze your glutes to lift your hips until your body forms a straight line from your shoulders to your knees. Hold for a few seconds, then lower back down.
  • Plank: Start in a push-up position with your hands shoulder-width apart. Bend your elbows and lower your body until your forearms are on the floor. Keep your body straight and hold the position for as long as you can.
  • Superman: Lie on your stomach with your arms and legs extended. Raise your arms and legs off the floor and hold the position for a few seconds. Lower back down and repeat.
  • Cat-cow: Start on your hands and knees with your wrists aligned under your shoulders and your knees aligned under your hips. Inhale and arch your back, lifting your head and tailbone. Exhale and round your back, tucking your chin to your chest. Repeat.
  • Bird-dog: Start on your hands and knees with your wrists aligned under your shoulders and your knees aligned under your hips. Lift your right arm and left leg simultaneously, extending them out straight. Hold the position for a few seconds, then lower back down. Repeat on the opposite side.

Tool: Improve Spine Stability, Strengthen Neck (1h24m21s)

• Strengthening certain muscles, even those far from the spine, can improve spinal mobility, strength, and potentially relieve back pain.
• Strengthening the muscles in the front of the neck is crucial for avoiding pain, maintaining good posture, and ensuring safety.
• A simple exercise to strengthen the neck muscles involves placing fists on either side of the jaw, keeping the tongue on the roof of the mouth, and performing 10-second static contractions by pushing the chin down against the resistance of the fists.
• This exercise can be repeated for three to four sets of 10-second contractions, two to five times a day.
• Strengthening the front neck muscles has several benefits for strengthening and pain-proofing the spine, including improving airway passage and nasal breathing.

Tools: Strengthen Feet, Toe Spreading (1h29m23s)

• Strengthening the feet, particularly by spreading the toes, can improve overall body health and alleviate back pain.
• Spreading the toes activates neural pathways and enhances foot and spine stability.
• Toe spreaders or tissue paper can be used to assist in spreading the toes.
• Strengthening foot muscles can be achieved by lifting each toe independently and exploring advanced toe exercises with bands.
• Strengthening the neck and spreading the toes are essential for creating a stable base for the body, which is crucial for various activities such as standing, walking, running, lifting, and playing sports.

Tools: Belly Breathing; Stagger Stance (1h34m35s)

• When performing resistance training, brace the body by filling it with air to create stability and avoid injury.
• While at rest, relax the abdominal muscles and practice belly breathing.
• Incorporate a staggered stance during resistance training exercises to engage the abdominal muscles more effectively.
• Maintain a wide stance with a slight bend in the knees for stability during staggered stance exercises.
• Keep the belly button facing forward to avoid twisting the torso and promote spine stability.
• Staggering one stance while performing resistance training, such as curls or overhead tricep extensions, can strengthen the abdominals through anti-rotation.

Tools: Relieve Low Back Pain, Medial Glute Activation; Rolled Towel (1h42m3s)

• Activating and strengthening the medial glute can help relieve lower back pain, especially for those who sit or drive a lot.
• Jeff Cavaliere's YouTube channel, Athlean-X, provides valuable information and protocols for resistance and cardiovascular training.
• To strengthen the back and relieve lower back pain, lie on your side and extend your top leg with your toe pointed down and heel towards the back wall and ceiling.
• Hold this position for 10-20 seconds, feeling the activation of the medial glute, and repeat for 5-10 repetitions on each side.
• This exercise can be done as part of a warm-up, while watching TV, or as a standalone routine to maintain neuromuscular activation of the medial glute.
• Strengthening the medial glutes and despasming them can often relieve lower back pain.
• The exercise is safe for individuals with lower back pain, requires no equipment, and helps relieve pain by despasming the medial glute and activating the nerve-to-muscle connection.
• The activated medial glutes can then stabilize the pelvis and strengthen the pelvic spine interface.

Tool: Psoas Stretching (1h50m59s)

• The protocol involves a lunge position with one leg extended behind and the other leg forward.
• Raise the arm on the same side as the extended leg, with the palm parallel to the ceiling.
• Rotate the wrist so that the pinky finger is pointing towards the head, while maintaining a flat palm.
• This stretches the soas muscle and activates neurofascial aspects from the palm to the heel.
• It relieves tension in the spine-pelvic interface, promoting better posture and a longer, stronger spine.
• To stretch the psoas muscle and relieve compression in the spine, point your pinky towards your head while seated and hold the stretch for 5-10 seconds on each side.

Tool: Back Awareness; Strengthen & Pain-Proof Back (1h57m0s)

• Be aware of your movement patterns, posture, and foot position throughout the day, including during exercise.
• Pay attention to any pain or limitations in your back's ability to manage loads or generate movement.
• Balance pushing exercises with pulling exercises to maintain muscle balance.
• Consider alternative ab exercises like rollups if crunches cause or worsen back pain.
• Strengthen the back and prevent back pain by addressing imbalances in neuromuscular activation patterns.
• Follow protocols for back strengthening and pain relief, such as Stu Mill's big three exercises (Curup, Side plank, Bird dog), which have research support and expert consensus.
• These protocols are accessible, requiring minimal time, no equipment, and low cost.
• Back pain sufferers should approach these protocols with caution and consider seeking professional guidance.
• Consider the relationship between the back, pelvis, legs, feet, and neck in overall back health.

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• The video discusses protocols to strengthen and pain-proof the back.