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

Stuart McGill and his colleagues delve into the intricate relationships between genetics, body type, and spinal health, shedding light on how these factors can influence one’s susceptibility to back pain and injury, and how they might inform appropriate exercise selection.

Genetic factors can predispose individuals to different spinal structures and movement patterns that affect back health and resilience.

McGill addresses the genetic component of spinal health by equating genetics to loading a gun behind certain conditions, such as back pain. He mentions that having open facet joints, which affect one's ability to twist, is "absolutely 100% genetic." The resilience of the spine's structures, like the way body's collagen fibers bind together, is also affected by genetic variability, as evidenced by the consistency of overload in compression seen in the assays from disc surgeries. Additionally, McGill points out that top athletes usually exhibit specific body types that suggest a genetic predisposition suitable for the demands of their sports due to their body structure and movement patterns.

People with naturally thinner, more flexible spines may be more prone to disc injuries, while those with thicker, stiffer spines may be better suited for activities that require high compressive loads.

In discussing body types, McGill compares spines to branches, suggesting that those with thinner, more flexible spines—like willow branches—are more prone to disc injuries when subjected to compressive loads. Conversely, those with thicker, stiffer spines can endure high compressive loads but are more susceptible to injuries from bending. He observes the presence of spondylolisthesis, a common condition in gymnasts caused by repetitive back arching, affirming a link between certain activities and the orientation of an individual's facet joints.

An individual's body type and anatomy, such as disc shape, facet joint orientation, and bone density, play a key role in determining their susceptibility to back pain and ideal exercise selection.

McGill brings attention to differences in spine anatomy, such as the more ovoid disc shapes in top golfers and limacon (like a lima bean) shapes in those who bear heavy compressive loads. These shapes suggest an individual's innate resilience and are decisive for their approach towards exercise. He introduces the concept of individuals possessing a “stiff frame” or core to prevent energy leaks in activities like cycling, linking body core stiffness to back health. Similarly, the ability to handle heavy loads, such as carrying a thousand pounds on the shoulders, underscores the importance of having a strong, stable pelv ...

Dr. Stuart McGill, a distinguished professor of spine biomechanics, has developed methods to improve spine function, emphasizing the importance of balancing flexibility and stability to minimize injury risk and optimize performance.

The spine's intervertebral discs act as shock absorbers and facilitators of movement, with their structure and properties varying across individuals.

According to the podcast, the intervertebral discs are composed of layer upon layer of collagen strands, which vary in elasticity and strength. Dr. McGill discusses how these variations, including the shape and distribution of the facet joints, give each person a unique spinal architecture, affecting their resilience and mobility. Genetic differences in the collagen that binds the fibers of the spinal discs together can influence a person's susceptibility to back pain.

The discs' composition of collagen fibers, along with the shape and distribution of the facet joints, create a unique spinal architecture for each person that affects their resilience and mobility.

Dr. McGill notes that an individual's degree of lordosis—a larger inward curve of the lower back—can affect running mechanics by enabling more power development. He also mentions that professional golfers typically have open facet joints, suggesting a genetic basis for these anatomical features which affect movement and performance.

Maintaining appropriate spinal stiffness and stability is crucial for minimizing injury risk and optimizing performance, but this needs to be balanced with sufficient mobility.

McGill mentions the necessity of proper spinal stiffness. He suggests auxiliary exercises like the belt squat machine, which allows training the hips and legs without overloading the upper body and back system. He discusses the spine’s role as a flexible, yet controlled, linkage system. For example, "pre-stiffening" the muscle is crucial for runners to store elastic energy.

The spine functions as a flexible, yet controlled, linkage system, and the core musculature plays a key role in directing forces through the body and maintaining this balance.

Dr. McGill emphasizes the importance of core stability in transferring power efficiently through the body. Core stiffness facilitates better distal athleticism, reducing energy leaks and maximizing muscular engagement in activities. He employs the analogy of needing ...

Back pain is a complex condition with a variety of causes and mechanisms, making it crucial to properly assess and diagnose its specific origin to effectively manage and treat it.

Multifactorial Nature of Back Pain

According to Dr. Stuart McGill, back pain does not stem from a single source; instead, it's a symptom with over a hundred different pathways and mechanisms. A thorough assessment is crucial in pinpointing the specific type of back pain someone is experiencing and matching it with an appropriate intervention. McGill stresses the importance of self-diagnosing back pain to understand what specific activities should be done or avoided to alleviate the pain.

Mechanical Causes of Back Pain

McGill explains how mechanical overload or injuries such as imprudent lifting techniques or competing to set personal records without proper training can lead to challenging back injuries. Mechanical overload caused by lifting with a slack body, for example, can trigger back pain. In his discussion, McGill points out that discogenic pain, which arises from prolonged sitting or standing, can often be addressed with changes in posture. Additionally, he notes that microtraumas from intense and imprudent physical exercise can lead to pain, specifically when sitting due to preexisting damage.

One significant mechanical pathway to disc problems discussed by McGill involves the delamination of concentric collagen fiber layers within intervertebral discs. When subjected to pressure, especially during heavy bending, the gel-like nucleus of a disc may exploit a weak spot between these fibers, potentially leading to bulging or herniation.

Psychological Factors

The relationship between emotional trauma and pain perception cannot be overlooked, as McGill highlights. For example, a patient might recoil wh ...

Dr. Stuart McGill, a renowned expert on back health, explicates strategies for strengthening the back to mitigate pain, emphasizing the need for a customized approach based on a comprehensive assessment of the individual's condition.

A comprehensive assessment, including a thorough history, physical examination, and potentially imaging or other diagnostic tests, is necessary to identify the underlying cause of an individual's back pain.

Provocative testing, in which specific movements or loads are applied to reproduce the individual's pain, can provide valuable insights into the mechanical drivers of their condition.

Stuart McGill discusses the significance of a thorough assessment that begins with patients sharing their story, revealing how aspects of their lifestyle, such as family life and goals, interplay with their back pain. He pinpoints the essence of not overloading the spine, especially during strength training, and choosing exercises commensurate with individual conditions like bone mineral density. A balanced approach to training encapsulates resistance, cardiovascular, and mobility training, as agreed upon by both McGill and Andrew Huberman, stressing the value of rest days for sustained joint health.

McGill elaborates on conducting meticulous assessments to identify pain triggers, using provocative actions like pulling up while seated or extending the leg and looking up to identify nerve-related pain. He underscores the necessity of robotic testing, like the lateral shear test, to garner precise information on the mechanical underpinnings of pain. These insights feed into crafting bespoke interventions that focus on providing relief and addressing the root causes rather than just the symptoms.

Treatment approaches should be tailored to the specific findings of the assessment, with a focus on addressing the root causes of the pain rather than just managing symptoms.

Interventions may include a combination of exercise, manual therapy, education, and in some cases, more passive treatments like modalities or even surgery, depending on the severity and nature of the condition.

Interventions, as suggested by McGill, may incorporate exercises that avoid activation of pain pathways, movement pattern education, and strategic exercise programming based on individual pain patterns. For patients who might be considering surgery after other interventions have failed, McGill proposes "virtual surgery," a method entailing dramatic behavioral and routine modification to promote rest and desensitization of sensitized areas.

McGill also highlights the use of tailored therapeutic interventions like prone postural adjustments and leg traction for disc issues, asserting the importance of personalized therapy over general decompression techniques. Maintaining core stability through the "big three" exercises—endorsed for their efficacy in ...

Dr. McGill and the host discuss the biopsychosocial model of pain, a critical framework for understanding and managing back pain. This model points to the complex interplay of biological, psychological, and social factors influencing pain perception.

The biopsychosocial model recognizes that pain is influenced by a complex interplay of biological, psychological, and social factors, which can all contribute to the onset, severity, and persistence of back pain.

The model takes into account the various sources from which pain can arise, such as emotions, lack of sleep, specific locations in the spine and brain, and elsewhere in the body. Stuart McGill emphasizes that genetics may predispose an individual to pain ("loads the gun"), but it is the exposure to certain factors ("pulls the trigger") that leads to pain, while the psychosocial environment influences how an individual responds to it. McGill's assessment includes understanding the patient's social context, acknowledging that family pressures and work obligations contribute to the back pain experience.

Psychological factors, such as fear, anxiety, depression, and trauma, can shape an individual's pain perception and response to treatment, necessitating a multidisciplinary approach.

Psychological trauma, such as experiencing a car accident with fatalities or severe stress like sexual abuse, can rewire the brain and alter pain perception. McGill addresses this by desensitizing patients, identifying simple movements that do not trigger pain, and then gradually expanding their pain-free repertoire. An individual recoiling from touch may exhibit responses indicative of past abuse, showing that psychological factors are an integral part of their pain experience.

Effective management of back pain often requires addressing not only the physical aspects of the condition but also the psychological and social components that may be maintaining or exacerbating the problem.

Huberman notes the significance of the biopsychosocial model which combines the nervous system, muscle feedback, proprioception, and emotional components. Dr. Sean Mackey's support for the model includes treatment pathways considering psychological and social fa ...