Protocols to Strengthen & Pain Proof Your Back
In this episode of the Huberman Lab podcast, Dr. Andrew Huberman and Dr. Stuart McGill dive into back anatomy and physiology to provide insights on strengthening and pain-proofing the back. They delve into common causes of back pain, such as herniated discs, and offer exercises like the McGill Big 3 to strengthen the spine and improve stability.
Huberman and McGill also share practical tips for relieving disc pressure and activating critical stabilizing muscles to support the spine. By emphasizing the importance of proper movement patterns and targeted exercises, they aim to equip listeners with a comprehensive approach to building a stronger, more resilient back.
This is a preview of the Shortform summary of the Apr 29, 2024 episode of the Huberman Lab
Sign up for Shortform to access the whole episode summary along with additional materials like counterarguments and context.
1-Page Summary
Back Anatomy and Physiology
The spine consists of vertebrae, discs, and the spinal cord running through the central canal. Huberman and Dr. McGill discuss how body types relate to spinal segment size. The fragile spinal cord allows movement through flexion, extension, and twisting, and relays sensory information to the brain while enabling motor commands from the brain to control muscles.
Back Pain
Herniated discs compressing nerves are a major cause of back pain. Per Huberman, this occurred around his L3, L4 region, impairing mobility and causing referred pain down his leg and hip (sciatica). Determining the direction of herniation is key to relieving nerve compression through appropriate exercises.
Building a Strong, Pain-Free Back
McGill Big 3 Exercises
Dr. McGill developed the curl-up, side plank, and bird dog exercises to strengthen the spine and maintain stability.
Herniated Disc Relief
Hanging from a bar with toes on the floor can lengthen the spine, relieving disc pressure. Huberman found relief through pushups in a cobra pose.
Activating Stabilizers
Huberman and McGill emphasize activating stabilizers: strengthen the front neck, spread toes and feet, belly breathe at rest, do staggered stance core work, despasm the medial glute, stretch the psoas in warrior lunge, and observe daily movement patterns. Building stabilizers supports the spine.
1-Page Summary
Additional Materials
Clarifications
- When a disc herniates, the inner gel-like material leaks out and can press on nearby nerves in the spine. This compression can lead to pain, numbness, or weakness in the area where the affected nerve travels. The symptoms can vary based on the location and severity of the herniation. Treatment often involves relieving the pressure on the nerve through exercises, physical therapy, or in severe cases, surgery.
- Referred pain down the leg and hip, known as sciatica, is a common symptom of a herniated disc in the spine. When the inner core of a disc protrudes and presses on a nearby nerve root, it can cause pain that radiates along the path of the affected nerve, often extending from the lower back down through the buttock and into the leg. This type of pain can vary in intensity and may be accompanied by other sensations like tingling or numbness. Treatment for sciatica caused by a herniated disc typically involves a combination of rest, physical therapy, and in some cases, surgery.
- Determining the direction of herniation is crucial in understanding how a herniated disc is affecting the nerves. By identifying whether the disc material is pressing on the nerve from the back, side, or front, appropriate exercises can be chosen to alleviate the compression. This knowledge helps in tailoring exercises that can effectively relieve pressure on the nerve and promote healing. Understanding the direction of herniation guides the selection of movements that can reduce pain and improve mobility.
- The McGill Big 3 Exercises, developed by Dr. Stuart McGill, are a set of core exercises aimed at strengthening the spine and promoting stability. The three exercises include the curl-up, which targets the abdominal muscles, the side plank, which engages the lateral core muscles, and the bird dog, which works on core stability and balance. These exercises are commonly recommended for individuals looking to build a strong and resilient back, especially those dealing with back pain or seeking to prevent injuries.
Counterarguments
- While the spine does consist of vertebrae, discs, and the spinal cord, it's also important to consider the roles of ligaments, muscles, and facet joints in spinal anatomy and function.
- The relationship between body types and spinal segment size is not a one-size-fits-all; individual variations can be significant, and other factors such as genetics and lifestyle may also play a role.
- The spinal cord's ability to allow movement and relay information is crucial, but it's also important to note that the peripheral nervous system plays a significant role in these functions.
- Herniated discs are a common cause of back pain, but not all back pain is due to herniated discs; other conditions such as muscle strain, ligament sprain, and degenerative disc disease can also cause similar symptoms.
- The effectiveness of exercises like the McGill Big 3 may vary from person to person, and some individuals may require a more tailored approach to exercise based on their specific condition.
- Hanging from a bar to lengthen the spine and relieve disc pressure may not be suitable for everyone, especially those with certain shoulder or spinal conditions.
- Pushups in a cobra pose can be beneficial for some, but may exacerbate pain in others, particularly if not performed correctly or if the individual has specific contraindications.
- The emphasis on activating stabilizers is important, but it's also critical to balance this with mobility exercises and to consider the individual's overall physical condition and any potential risks of certain movements.
- Strengthening and stretching exercises are beneficial, but they should be approached with caution and potentially modified for those with certain health conditions or injuries.
- Observing daily movement patterns is useful, but it's also important to consider the impact of ergonomic factors and lifestyle habits on back health.
Related Shortform Content
Get access to the context and additional materials
Back Anatomy and Physiology
Huberman provides a detailed overview of the neuromuscular structure of the back, highlighting the vertebral and disc components as well as their relationship to the spinal cord and nerve roots.
Vertebrae, discs and nerves
The human spine is an intricate structure divided into multiple sections: cervical (neck), thoracic (chest region), lumbar (below the chest), sacral (pelvic region), and the coccyx (the lowest part of the sacral region). It is made up of vertebral bones stacked sequentially, interspersed with intervertebral discs composed of soft tissue that aid in the spine’s mobility and compression ability.
Spinal cord and nerve roots
Each vertebra and disc possess a central canal with a donut-like shape, through which the spinal cord passes. The host and Dr. Stu McGill discuss how body types, being ectomorphic (lighter and thinner skeleton) or mesomorphic (thicker bodies), correlate with the size of spinal segments, including vertebrae and discs. Typically, thicker wrists may indicate larger spinal segments and discs, while smaller wrists suggest the opposite.
The spinal cord itself, described as snake-like and residing within the hollow center of the vertebrae and discs, is composed of neurons and glial cells and makes up a significant aspect of the central nervous system (CNS). Owing to its fragile nature, the spinal cord does not regenerate after injury, with few exceptions, necessitating its protection by the rigid vertebrae.
With movements such as leaning or twisting, the spinal cord flexes or twists within this vertebral protective casing. Sensory inputs enter the dorsal part of the spinal cord, pr ...
Here’s what you’ll find in our full summary
Back Anatomy and Physiology
Additional Materials
Clarifications
- Body types, such as ectomorphic (lighter and thinner) or mesomorphic (thicker), can correlate with the size of spinal segments like vertebrae and discs. Thicker wrists may suggest larger spinal segments and discs, while smaller wrists may indicate the opposite. This correlation is due to the overall skeletal structure and body composition, influencing the size and dimensions of the spinal components. Understanding these relationships can provide insights into individual variations in spinal anatomy based on body type.
- The term "snake-like" is used metaphorically to describe the shape and flexibility of the spinal cord, emphasizing its elongated and sinuous nature within the protective vertebral column. This comparison highlights the spinal cord's ability to bend and move within the spinal canal, similar to the way a snake can flex and twist its body.
- Neurons are specialized cells in the spinal cord responsible for transmitting electrical signals, enabling communication within the nervous system. Glial cells support and protect neurons, aiding in their function and providing structural support in the spinal cord. Together, neurons and glial cells form the essential components of the spinal cord, working in harmony to facilitate sensory and motor functions in the body.
- Sensory inputs enter the dorsal part of the spinal cord through nerve fibers called dorsal roots. These roots contain sensory neurons that transmit information from the body to the spinal cord. Once inside the spinal cord, this sensory information is processed and relayed to the brain for interpretation and response. The dorsal part of the spinal cord specifically deals with sensory functions, while the ventral part is more involved in motor functions.
- Neurons in the spinal cord communicate with muscles, skin, tendons, and other body parts through axons that extend from the spinal cord into the peripheral nervous ...
Counterarguments
...
Related Shortform Content
Get access to the context and additional materials
Back Pain
Back pain is a common, debilitating condition that often results from nerve roots being compressed by herniated or bulging discs.
Herniated discs compressing nerves
Sciatica symptoms
A significant source of back pain is the physical pressure from herniated discs, known as bulging discs, on nerve roots. These discs may protrude excessively from the spine, potentially due to compression from the vertebrae above, inflammation, or other issues. This pressure can lead to pain in various regions, including the back, neck, and pelvic area.
Huberman explains that herniated discs can impinge on nerves, creating significant pain and limiting mobility. Notably, Huberman had back pain from bulging discs around the L3, L4 region, which caused discomfort in his back, hip socket, and down his leg. This impingement required awareness of the herniation's direction to choose exercises that could alleviate the pain without worsening the condition. Building up the musculature around the discs can help prevent further herniation and associated pain.
Moreover, herniated disc issues can lead to sciatica, commonly characterized by tingling, pain, or numbness. These symptoms may occur not only in the area of nerve compression but also as referred pain in areas not directly innervated by the affected nerve. Huberman experienced what some might refer to as classic sciatica symptoms, with intense discomfort in the hip and the o ...
Here’s what you’ll find in our full summary
Back Pain
Additional Materials
Clarifications
- Neural pathway impingement occurs when there is pressure or interference with the nerves' normal function due to factors like herniated discs. This can lead to symptoms like pain, tingling, or numbness along the affected nerve's pathway. Understanding the direction and extent of this impingement is crucial for selecting appropriate treatments or exercises to alleviate the associated discomfort. Impingement can cause symptoms not only at the site of compression but also in areas connected to the affected nerve.
- Referred pain is when pain is felt in a location different from where the issue originates. It can occur when nerves from the affected area share pathways with nerves from another part of the body. This phenomenon can lead to confusion in pinpointing the exact source of pain. Referred pain is distinct from radiating pain, where pain spreads from a central point to a wider area.
- Nerve root impingement occurs when ...
Counterarguments
- While herniated discs can compress nerve roots and cause pain, not all back pain is due to herniated discs; there are many other potential causes such as muscle strain, ligament sprain, arthritis, or even psychosocial factors.
- Bulging discs are common and can be asymptomatic; not all bulging discs will lead to pain or require treatment.
- The relationship between disc herniation and back pain is complex, and the presence of a herniated disc on imaging does not necessarily mean it is the source of pain.
- Conservative treatments like physical therapy can be effective for managing herniated disc symptoms, but in some cases, surgery may be necessary.
- Building muscle around the spine can be beneficial, but it is not a guaranteed method to prevent further herniation or pain, and overexertion can sometimes exacerbate symptoms.
- Sciatica is commonly associated with herniated discs, but other conditions such as spinal stenosis or pi ...
Related Shortform Content
Get access to the context and additional materials
Building a Strong, Pain-Free Back
Andrew Huberman and Dr. Stuart McGill discuss protocols for building and maintaining a strong and healthy spine, emphasizing the need for public awareness around spine health and injury prevention.
McGill Big 3 Exercises
Dr. Stuart McGill, a PhD researcher with decades of experience studying the spine, developed the McGill Big 3 exercises: the curl-up, side plank, and bird dog. These exercises are adopted by various communities, including physical therapy and sports medicine, and are a staple for those wanting to maintain spinal health and stability.
Curl-up
The curl-up is designed to strengthen the abdominal wall without exacerbating back pain, replacing traditional sit-ups. It involves lying down with one knee up and one leg extended, hands placed under the lower back to preserve the natural arch. The upper chest is lifted just a few degrees off the ground, maintaining a neutral chin position while holding the contraction for 8 to 10 seconds. The curl-up should be done for three to five sets, beginning with five 10-second holds and decreasing the number of holds in subsequent sets.
Side plank
No specific transcript information was provided for the side plank exercise.
Bird dog
The bird dog, performed on all fours, involves extending one arm forward and the opposite leg backward, with the extended hand in a fist to generate a strong neural contraction. It is crucial to keep the torso parallel to the floor and not to allow the lower back to arch excessively. Pushing away from the floor with the stabilizing hand and knee is as essential as the lifting actions. Typically, three to five repetitions of eight to 10-second holds for one set are suggested, potentially done for more sets with descending repetitions.
Herniated disc relief
For those suffering from herniated disc-related back pain, hanging from a bar with toes still touching the floor for support can help lengthen the spine, potentially relieving pressure on the discs. Huberman also found relief from back pain through pushups from a Cobra pose, keeping his hips on the floor. These exercises can help adjust the direction of disc bulging and may provide relief.
Activating stabilizers
Strengthen front of neck
Strengthening the muscles in the front of the neck supports spine stability, especially as many individuals now exhibit a forward chin posture. Huberman describes an exercise for this area involving pushing the chin down against the resistance of the fists.
Spread toes and feet
Huberman emphasizes the importance of strengthening the feet and spreading the toes as this contributes to spine stability. Exercises to increase toe strength and independence support ...
Here’s what you’ll find in our full summary
Building a Strong, Pain-Free Back
Additional Materials
Clarifications
- The McGill Big 3 exercises, developed by Dr. Stuart McGill, consist of the curl-up, side plank, and bird dog. These exercises are widely used in various fields like physical therapy and sports medicine to promote spinal health and stability. The curl-up targets the abdominal muscles, the side plank focuses on core strength, and the bird dog enhances coordination and stability. These exercises are recommended for individuals looking to strengthen their spine and prevent injuries.
- The curl-up exercise is a core-strengthening movement that replaces traditional sit-ups. It involves lying down with one knee up and one leg extended, hands under the lower back, lifting the upper chest slightly off the ground while maintaining a neutral chin position. The exercise is done for sets of 8 to 10-second holds, gradually decreasing the number of holds in subsequent sets.
- The bird dog exercise involves being on all fours and extending one arm forward and the opposite leg backward. It is crucial to maintain a parallel torso to the floor and avoid excessive arching of the lower back. The extended hand should be in a fist to engage the muscles effectively. Pushing away from the floor with the stabilizing hand and knee is important for stability.
- Herniated disc relief techniques involve exercises like hanging from a bar to lengthen the spine and relieve pressure on the discs. Pushups from a Cobra pose can help adjust the direction of disc bulging and potentially provide relief from ...
Counterarguments
- While the McGill Big 3 exercises are widely respected, some critics argue that they may not be suitable for everyone, especially those with specific spinal pathologies or acute injuries.
- The effectiveness of the curl-up exercise has been debated, with some experts suggesting that it could still place unnecessary stress on the spine, particularly in individuals with existing lower back issues.
- The side plank and bird dog exercises, although beneficial for many, might need to be modified for individuals with shoulder or wrist issues that could be exacerbated by these positions.
- Hanging from a bar for herniated disc relief may not be advisable for individuals with certain shoulder conditions or those who lack the grip strength to safely support their body weight.
- Pushups from a Cobra pose might not be suitable for individuals with certain types of disc herniation or other spinal conditions, as it could potentially worsen their symptoms.
- Strengthening the front of the neck is important, but some may argue that focusing too much on these muscles without addressing the entire cervical musculature could lead to imbalances.
- The emphasis on toe strength and independence may overlook the need for a comprehensive approach to foot health that includes flexibility and proprioception.
- Belly breathing is beneficial, but some individuals with respiratory conditions or those who have difficulty with diaphragmatic brea ...
Related Shortform Content
Get access to the context and additional materials
Create Summaries for anything on the web
Download the Shortform Chrome extension for your browser
