Huberman LabBuild a Strong, Pain-Proof Back | Dr. Stuart McGill
EVERY SPOKEN WORD
155 min read · 30,583 words- 0:00 – 2:33
Dr. Stuart McGill
- AHAndrew Huberman
(Upbeat music) Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Stuart McGill. Dr. Stuart McGill is a distinguished professor of spine biomechanics at the University of Waterloo. As a professor for more than three decades, Dr. McGill has analyzed the spines of injured people as well as healthy people, and developed methods to treat spine injuries and pain, as well as to improve spine biomechanics in anybody. He has authored more than 250 peer-reviewed research articles on these topics, making him a true world expert. During today's episode, we discuss spine anatomy as well as the common sources of back pain, and we discuss some of the controversies as to the origins and different treatments for back pain. As you'll quickly learn, there is no one specific source of back pain, nor is there one specific solution to back pain. But, as Dr. McGill spells out very clearly, there are things that anyone and everyone can do in order to strengthen their back and to reduce the amount of pain they may be experiencing. He explains some specific ways to self-diagnose your back pain, which, of course, is critical for understanding what specific things to do as well as to avoid in dealing with any pain, and as it relates to applying in sport and in everyday life. Dr. McGill and I also discuss several of the avid controversies within the field of back pain and the treatments for back pain. We talk about the so-called biopsychosocial model of pain, which points to the various sources that pain can arise from. Everything from emotional, to lack of sleep, to specific locations in the spine and brain and elsewhere in the body, and the ways those mesh together to give us what we call pain, as well as to direct us towards specific treatments for pain that tend to be especially effective. Dr. McGill is a true encyclopedia on the topics of back physiology and anatomy, sources of back pain, and treatments for back pain. So it's truly a special opportunity to be able to learn from him in such immense detail and in such a clear and actionable way. By the end of today's episode, you will have a quite thorough understanding about the anatomy and physiology of the back as it relates to a healthy back, to back pain, and of course, you'll have various remedies for dealing with back pain, preventing back pain, and for strengthening your back for all sorts of different kinds of movement. Not just for exercise and sport, but also to move through your daily activities pain-free and with ease and mobility at any
- 2:33 – 6:23
Sponsors: Helix Sleep, BetterHelp & Waking Up
- AHAndrew Huberman
age. Before we begin, I'd like to emphasize that this podcast is separate from my teaching research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Helix Sleep. Helix Sleep makes mattresses and pillows that are customized to your unique sleep needs. Now, I've spoken many times before on this and other podcasts about the fact that getting a great night's sleep is the foundation of mental health, physical health, and performance. Now, one of the keys to getting a great night's sleep is to make sure that your mattress is suited to your unique sleep needs. What does that mean? Well, if you go to the Helix website, you can take a brief two-minute quiz, and it asks you questions such as, "Do you sleep on your back, your side, or your stomach? Do you tend to run hot or cold during the night?" Things of that sort. Maybe you know the answers to those questions, maybe you don't. Either way, Helix will match you to the ideal mattress for you. For me, that turned out to be the Dusk mattress made by Helix. I started sleeping on a Dusk mattress about three and a half years ago, and it's been far and away the best sleep that I've ever had. So if you'd like to sleep better by sleeping on a mattress that's customized to your unique sleep needs, go to helixsleep.com/huberman, take that brief two-minute sleep quiz, and Helix will match you to a mattress that's ideal for you. Right now, Helix is giving up to 30% off mattresses and two free pillows. Again, that's helixsleep.com/huberman to get 30% off and two free pillows. Today's episode is also brought to us by BetterHelp. BetterHelp offers professional therapy with a licensed therapist carried out entirely online. I've been doing weekly therapy for well over 30 years. Initially, I didn't have a choice. It was a condition of being allowed to stay in school. But pretty soon I realized that therapy is an extremely important component to overall health. There are essentially three things that great therapy provides. First of all, great therapy consists of having good rapport with somebody that you can really trust and talk to about the issues that you're dealing with. Second of all, that therapist should provide support in the form of emotional support or directed guidance. And third, expert therapy should provide useful insights. Insights that allow you to better understand not just your emotional life and your relationship life, but of course also your relationship to yourself, and to career goals and school goals. Meaning, excellent therapy should also inspire positive action. BetterHelp makes it very easy for you to find an expert therapist with whom you really resonate with, and that can provide the benefits that I just described. If you'd like to try BetterHelp, you can go to betterhelp.com/huberman to get 10% off your first month. Again, that's betterhelp.com/huberman. Today's episode is also brought to us by Waking Up. Waking Up is a meditation app that offers hundreds of guided meditation programs, mindfulness trainings, yoga nidra sessions, and more. I started practicing meditation when I was about 15 years old, and it made a profound impact on my life. In recent years, I started using the Waking Up app for my meditations, because I find it to be a terrific resource for allowing me to really be consistent with my meditation practice. What I and so many other people love about the Waking Up app is that it has a lot of different meditations to choose from. And those meditations are of different durations, so it makes it very easy to keep up with your meditation practice, both from the perspective of novelty, you never get tired of those meditations. There's always something new to explore and to learn about yourself, and you can always fit meditation into your schedule even if you only have two or three minutes per day in which to meditate. I also really like doing yoga nidra, or what is sometimes called non-sleep deep rest, for about 10 or 20 minutes, because it is a great way to restore mental and physical vigor without the tiredness that some people experience when they wake up from a conventional nap. If you'd like to try the Waking Up app, please go to wakingup.com/huberman, where you can access a free 30-day trial. Again, that's wakingup.com/huberman to access a free 30-day trial. And now for my discussion with Dr. Stuart McGill.Dr.
- 6:23 – 12:55
What Causes Back Pain?; Genetics, Dog Breed Analogy
- AHAndrew Huberman
Stuart McGill, welcome.
- SMDr. Stuart McGill
Thank you, sir.
- AHAndrew Huberman
Oh, great to have you here. Um, I'm a big fan of your work. I've watched a lot of your other content, read your books, and I'm excited to discuss today what makes for a really strong, resilient back, what causes back pain and how to relieve it. And perhaps the bigger issue is what all of that allows for in terms of mobility and functionality, not just in sport, but in everyday life. So to kick things off, I'd like to ask a question that I think is on a lot of people's minds. Most people aren't thinking about their back unless they have pain. So what causes back pain?
- SMDr. Stuart McGill
You start with the easy questions. Let me give context before I define it as tightly as I can for you. Back pain is a symptom. So let's just change the topic for a moment and talk about leg pain. Can you imagine asking someone, "Well, could you give me an exercise or a prevention strategy for leg pain?" Okay, so that sets the stage a little bit. We're talking about a symptom for which there's a hundred or more different pathways and mechanisms there. So we've got to have a fairly comprehensive assessment now and understanding, uh, to focus on the type of back pain and then matching an appropriate, uh, intervention. I was listening to the... Your new podcast, uh, uh, with Andy Galpin this morning and-
- AHAndrew Huberman
The Perform podcast.
- SMDr. Stuart McGill
With the Perform podcast, yeah.
- AHAndrew Huberman
Yeah.
- SMDr. Stuart McGill
And he said, uh, "I'm going to try and follow the three Is." And it was, I think, gather information, interpret the information, and then intervene. So it's the same kind of deal here. And of course, that's pan-medical condition, shall we say. So with that context, I'm going to answer it like this. What causes back pain? Genetics loads the gun, exposure pulls the trigger, and then the psychosocial milieu around the individual influences how they respond to the pain. So there's a start. We can break it down in those three categories if you wish.
- AHAndrew Huberman
Sure. So when you say, uh, genetics loads the gun, uh, what comes to mind, because it's my experience, is that, um, I have a right shoulder that sits a little bit lower than my left shoulder, unless I'm mindful of that. Uh, my dad has the same thing. And I can, you know, put an ankle on my other knee a bit more easily on one side versus the other. I tend to pronate one foot a little bit more than the other when I run. These are subtle things. They don't necessarily result in back pain, but I'm guessing that a lot of that is either developmental, overuse at particular sport. I'm regular footed. I skateboarded a bunch, so I push with my right foot. I kick a soccer ball with my right foot, those sorts of things. But let's assume that genetics played some role, created some bias. If I were to tell you that, which I just did, would then you immediately think to a particular intervention if I told you, "Okay, you know, I, I have a little bit of lower right side pain," which I occasionally do. "I know I've got this imbalance that was loaded by genetics and presumably experience as well." And would your mind immediately go to a particular, uh, origin of that pain or perhaps even more importantly, a particular remedy to that pain? Or do we need to drill a little bit deeper and really understand, um, more about what I do, what I don't do, if I'm more thin-set or heavily set at the level of, of bone structure? You know, what are some of the other questions one would ask in the investigate category?
- SMDr. Stuart McGill
My thought would not go to one or the other, but it would go to both. And I'd start that conversation with this, uh, analogy. Uh, let's talk about breeds of dogs. We both love dogs.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
If I said to you, "We're gonna take two dogs and we're gonna train them for the greyhound track." One's a Greyhound and one's a Saint Bernard. How do you think you're going to make out? (laughs) The Saint Bernard, no matter how you train it or condition it, will never make it to the, uh, performing on a greyhound track. You're gonna end up with a broken, uh, Saint Bernard. So there's a little bit of a start from a big perspective, but now let's drill down and talk about spines. Uh, it's interesting when you look at the basic anatomical structure of an individual. We just did that with dogs. Imagine if I took a thin willow branch. I could bend that willow branch back and forth over and over and it wouldn't accumulate stress. But if I took that same willow branch and loaded it top to bottom like an I-beam, it would just bend and break.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
So it supports bending cycles, but it doesn't support compression. Now, I'm going to change that, uh, willow branch into a thicker stick and I bend the stick once and it shatters. In other words, the, uh, thickness and radial diameter being larger means the stress is bigger in bending. However, let's compress the same stick. It can bear tremendous compression. So there's a very fast example on spines. There's a, a fellow who, uh, has the world record in consecutive sit-ups, thousands of them. Given what I've just said, what's your prediction? Do you think he is a big strong fellow with a thick spine or do you think he's a very slender man with a willowy thin spine?
- AHAndrew Huberman
He's a willowy, bendy guy who can just keep-
- SMDr. Stuart McGill
He has to.
- AHAndrew Huberman
... bending up and down off the ground.
- SMDr. Stuart McGill
Bingo.... bingo, he has to be. There's no option. So there's a start on the genetics. Not everybody can play offensive tackle and not everybody can be a gymnast or, uh, not everybody can simply tolerate sitting in a chair being a computer operator. There's a very mundane example for
- 12:55 – 20:25
Tool: Skeleton & Body Type; Spine Flexibility & Discs
- SMDr. Stuart McGill
you.
- AHAndrew Huberman
Co- could I ask you a question about, um, the willow versus, um, thicker, thicker trunk, um, example? Can we look to torso thickness or wrist thickness or ankle, um, circumference as a way to kind of assess ourselves, uh, as to whether or not we are like- likely to be more willowy or, um, redwood-like? I mean, I- it should be obvious just by looking at ourselves, knowing ourselves, but for instance, I have a short torso. I'm kind of thick through the torso front to back. I always have been since I was a kid, but... And my wrists, the wrist circumference isn't, isn't small, but isn't, isn't huge. I had a, uh, a bulldog mastiff, um, and he would often look at me and I knew in his mind he was thinking, "My wrists are really thick compared to yours, Andrew." I knew that's what he was thinking.
- SMDr. Stuart McGill
(laughs)
- AHAndrew Huberman
Uh, he had forearms, he had forearms like a, like a longshoreman.
- SMDr. Stuart McGill
Yeah.
- AHAndrew Huberman
And of course he had never done any, any work whatsoever. Actually, primary goal of the bulldog is to do as little work as possible in life.
- SMDr. Stuart McGill
(laughs)
- AHAndrew Huberman
Um, but I have friends who, you know, have thick knees, some have smaller joints, smaller ankles. Can we make some general assessment about our spine without imaging it by looking at some of these peripheral markers?
- SMDr. Stuart McGill
Absolutely. Yeah. So the, uh, knee width, the bi-iliocrystal width, which is the width of your iliac crests, uh, hip width, uh, are all surrogates to indicate general heaviness of the skeleton. Um, so yes, that's- that's one, uh, good marker. Um, but there's more to the story for genetics and how bendy a spine can be. Um, the shape of the disc matters. So if you take on average a group of top golfers, you'll notice that their spines, uh, that the disc shape, if we were to cut through, which is a transverse scan on an MRI, the discs are more ovoid. If you take someone who can bear a lot of compressive load, the discs look more like a lima bean and that's called a limacon-shaped disc.
- AHAndrew Huberman
And of course, the discs are in repeating fashion throughout the spine, top to bottom.
- SMDr. Stuart McGill
Correct.
- AHAndrew Huberman
Um, and the discs are the soft tissue that allow for mobility of the vertebrae, the, uh, the bony segments. Is that right?
- SMDr. Stuart McGill
Exactly. They are the joints, but they're not a ball and socket joint. They're actually a fabric of layer upon layer of collagen fibers. And we can talk about that as well.
- AHAndrew Huberman
What a beautiful adaptation, right? Take a bunch of bony... If you want to be able to bend a bone, right, you need to, um, break it up into segments, kind of like beads on a necklace. And, um, and then in between those beads, you put some pliable yet, um, uh, it could... I- I guess a- a tissue that you can still compress. So it's both pliable and it can, it can squeeze down and become more narrow in the vertical direction. And it can also, you know, squeeze down on one side, uh, or the other to- to some degree.
- SMDr. Stuart McGill
Yeah. We evolved discs and there really is no other better architecture. People say, "Well, why don't we have ball and socket joints in our spine?" And the reason is this. Can you imagine, uh, stacking five oranges, one on top of the other, and then you could make them mobile by putting a ball and socket joint in between them? The amount of control that you would need on every single orange, if you move one orange, you have to control all the others. It's mission impossible. We would, uh, I would do an experiment with students in my lectures. I would take four coffee cans and put a tennis ball between each coffee can. And then I would put a rope at the front and the back of each coffee can and then one on the side. And I had four students take those four ropes. And then I took another four students who had the ropes on the next coffee can and then on the next coffee can. And then I'd say, "Okay, group, flex the spine forward." So the students on the front would pull a little bit, but the guy on top had to pull more than the, uh, next coffee can. And then the next coffee can, a little bit less, vice versa. The people on the other side had to pay out the rope in sequence. And the- and then I would say, "Okay, now let's twist a little bit." Any way you could imagine, it was impossible to control. And then I took out the, uh, uh, tennis balls and I put in what was a disc, a big round cylindrical piece of foam rubber. All of a sudden that added stiffness. So now see, because the body uses stiffness as the control parameter. Now we've added control in that the foam rubber would create a buffer. And as the deviation in motion occurred, the foam rubber would add more resistance. So it was an automatic control and it... That- that's what a shock absorber does on a car. It has an elastic element plus the damper, but it's the elastic element. And we're gonna talk about stiffness and stability, I hope, uh, that that really creates the control. So that's why we have evolved discs. It's highly efficient. I can bend the spine to tie my shoe, but if I have to, uh, carry home, uh, these days heavy shopping bags, I need stiffness of that flexible rod so it doesn't collapse. Or, uh, uh, years ago, I might have been carrying home an animal for dinner and, uh, I needed those discs to provide the stiffness in a very economical way.... and in a way that didn't create stress contribution, uh, concentrations the way ball and socket joints would. So that, that's, uh, an evolutionary necessity. Um, also when we look at spines, there are the column vertebra with the intervening discs, but behind them, there's two more joints and those are called facet joints and they guide motion. Those facet joints have a variety of angles. They can have open angles, which allow you to twist. So w- if you took a group of golfers, could you imagine, uh, if they had facet angles like this, you can't twist.
- AHAndrew Huberman
So facet angles that are too close together, basically.
- SMDr. Stuart McGill
Well-
- AHAndrew Huberman
It's a small angle.
- SMDr. Stuart McGill
If the angle is orientated fore and aft, you can't twist. And you won't find, if, if, if you're dealing with a group of professional golfers, you'll find they all have open facet joints.
- AHAndrew Huberman
Is that genetic?
- SMDr. Stuart McGill
It's absolutely 100% genetic. Now interestingly enough, when you arch back, when the facet joints are orientated open as I'm describing, when you arch back, one pushes hard on the other like shingles on a roof. That stresses a bone called the pars bone and, uh, gymnasts for example get a very, uh, typical fracture pattern called a spondylolisthesis, which is a fracture of that bone and then the spine shifts a little bit at that joint. Uh, I'm just finishing rehabbing a pro tennis player who had the same thing after they tried to have too much range of motion in their serve. The coach gave them excessive extension to try and put more miles an hour on the ball, but it didn't suit the spine and they ended up having a stress
- 20:25 – 25:43
Flexibility & Exercises; Discs & Collagen
- SMDr. Stuart McGill
fracture.
- AHAndrew Huberman
I mean, is it fair to say that, um, if we can, um, if we are naturally flexible, uh, for instance, like my sister can, you know, like her fingers can bend back really easily. Her, uh, shoulder extension, which I guess for people that aren't familiar with shoulder extension, you know, she can... Um, like let's say you're, you're leaning up against a railing with your back to the railing. The railing is just, uh, let's just say is, um, just above lower back height and you can put both hands on it parallel. So your arms are, are close together, like very close to the torso and then, and people don't, don't do this, uh, quickly 'cause, because you can tear, you can tear something or injure something. But then with feet about, I don't know, a foot or two away from, from that, uh, bar, um, you can do a knee bend and, and basically the arms go back behind you. Like, I happen to have a fair degree of shoulder, just natural shoulder extension ability. I'm not particularly "flexible," but that's just how I'm structured. I have some friends that can't do that to save their life.
- SMDr. Stuart McGill
Right.
- AHAndrew Huberman
Um, but I wouldn't consider myself hyper-flexible. My sister's a bit more flexible. We're related obviously. Um, so would people like her or people that tend to be pretty flexible naturally, um, would they be wise to avoid certain activities if their goal is to remain pain-free? I mean, you talk about the Saint Bernard running, um, on the greyhound track. You know, we all can enjoy things recreationally, but of course we don't wanna injure ourselves. So as somebody who's naturally flexible, should they avoid certain sports and activities? And, uh, conversely if somebody is naturally stiffer, thicker spine, thicker joints, should they avoid certain activities?
- SMDr. Stuart McGill
That's a huge question and there's many more variables to, uh, consider. Um, but I will say that when we are rehabilitating a, uh, athlete or just a person to get back to work, they're an occupational athlete, we take all of this into consideration. So as you were describing your sister arching back, um, A, I know she has plump discs, discs that are full of fluid, uh, to allow the mobility to take place in the discs.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
I also know that if we looked at an x-ray from the side, you know the posterior spinous processes, if you run your thumb down the midline of a person's back, you will feel the bumps of bone up the middle of the spine. Those are the posterior spines. Uh, she will have a large space between each one when she's standing upright. So when she extends back, those spaces will come together and eventually the spines, what we call it kissing spines, and it takes me back to some of the old Russian techniques for bench press. They would bench press with a huge arch in their back.
- AHAndrew Huberman
Mm.
- SMDr. Stuart McGill
And then other people would say, "Oh, well, I'm gonna try and mimic that particular bench press technique" because it allows you to get much more force out of latissimus dorsi, a stiffer back and you get a, a different force vector and, and actually more effective, uh, force on the bar. They didn't realize that when we work with a person who has a huge arch, they have big spaces between those spinous processes. And if you don't have those big spaces, you are going to crush the interspinous ligaments, which naturally are between those spaces, and, uh, you will now fire off a whole set of, uh, uh, new problems. So what is a mechanical advantage for one person is a mechanical disadvantage for another. Do, do, do you follow? So it's, it, it... All of this, uh, matters. Going back to the disc being a fabric of layer upon layer of collagen strands. Typically, uh, the disc is about 80% type one collagen. That is the stiff strength collagen. About another 20% is elastic collagen, type two.But there's types three through ten that bind those collagen fibers together. That's where there's a much greater degree of genetic variability. So there are some people who, uh, can get away with doing many sit-ups. They have a slender spine and they have the type of binding collagen that holds all those fibers together. But if I wanted to work these fibers of my shirt apart, get them to delaminate, I would create repeated stress strain reversals. The resistance of that fabric depends on the stuff holding the fibers together, so there will be binding fibers there. That's where the genetic, uh, variance lies in many people. So even there, the person's resilience to repeatedly doing a bending drill is determined by your parents to some degree, both in the size, the collagen type three through, uh, ten makeups.
- 25:43 – 27:32
Sponsor: AG1
- SMDr. Stuart McGill
- AHAndrew Huberman
As many of you know, I've been taking AG1 for more than 10 years now, so I'm delighted that they're sponsoring this podcast. To be clear, I don't take AG1 because they're a sponsor. Rather, they are a sponsor because I take AG1. In fact, I take AG1 once and often twice every single day, and I've done that since starting way back in 2012. There is so much conflicting information out there nowadays about what proper nutrition is, but here's where there seems to be a general consensus on. Whether you're an omnivore, a carnivore, a vegetarian, or a vegan, I think it's generally agreed that you should get most of your food from unprocessed or minimally processed sources, which allows you to eat enough, but not overeat, get plenty of vitamins and minerals, probiotics and micronutrients that we all need for physical and mental health. Now, I personally am an omnivore and I strive to get most of my food from unprocessed or minimally processed sources, but the reason I still take AG1 once and often twice every day is that it ensures I get all of those vitamins, minerals, probiotics, et cetera, but it also has adaptogens to help me cope with stress. It's basically a nutritional insurance policy meant to augment, not replace quality food. So by drinking a serving of AG1 in the morning and again in the afternoon or evening, I cover all of my foundational nutritional needs. And I, like so many other people that take AG1, report feeling much better in a number of important ways, such as energy levels, digestion, sleep, and more. So while many supplements out there are really directed towards obtaining one specific outcome, AG1 is foundational nutrition designed to support all aspects of wellbeing related to mental health and physical health. If you'd like to try AG1, you can go to drinkag1.com/huberman to claim a special offer. They'll give you five free travel packs with your order, plus a year supply of vitamin D3 K2. Again, that's drinkag1.com/huberman.
- 27:32 – 36:17
Stress & Tipping Point; Athletic Tradeoffs, Triathletes
- AHAndrew Huberman
Unless somebody is seeking to be a world-class athlete in something, in which case they should probably pay attention to their genetics and see whether or not it lines up well with a given sport. Although there have been e- you know, exceptions where people who are incredibly, um, genetically, um, uh, let's just say biased toward, um, not being able to perform well in a sport have nonetheless succeeded in performing at a world-class level. Th- but those are exceedingly rare exceptions. Um, for most people who want to do things recreationally, like the heavier set person with a thicker spine who wants to golf or, um, do a, um, you know, or do ballet perhaps, um, or the thinner willowy person who wants to get into power lifting, for instance, um, are there certain things that they should each consider and embrace as activities in order to make themselves more resilient, more pain resilient, and more, um, apt to have higher performance? For instance, would the willowy person, so to speak, do well to build up some of the musculature around the spine to compensate for the thinness of that spine? And would the person with the heavier, uh, or thicker spine, uh, do well to, um, try and encourage more pliability of their discs somehow?
- SMDr. Stuart McGill
The answer is yes, but it's a very limited yes. So, eh, if I can set the stage and, and give some context here, every system in the body requires stress for optimal health. Think of the cardiovascular system, the musculoskeletal system, the endocrine system, even the psychological system. It needs stress to create adaptation for robustness, but you cannot cross what's known as the tipping point, because if you do, you start building cumulative trauma of some form, whether it's emotional trauma, psychologically, or it's cumulative stress at the tissue level, at the level of the cell. Uh, so we have to talk about those tipping points. We've got to define where they are, try and expand them, adapt them, but don't cross them. So with that context now, we can talk about, uh, a person's suitability for the stresses on different parts of their body associated with different sports. We can talk about the rate at which the adaptation occurs, the amount of deloads and rest that are required. All of these things are genetically influenced. Um, the way that they perform the movement is going to move the stress concentration. Here's a, an interesting, uh, demonstration for you. If you go to the Olympics and look at the podium winners of a javelin thrower, they look identical. Do you think the swimmers look like the javelin throwers?No, they don't.
- AHAndrew Huberman
But they look like each other.
- SMDr. Stuart McGill
But they look like each other.
- AHAndrew Huberman
Mm-hmm. The people on the podium look very similar in structure.
- SMDr. Stuart McGill
Yeah. Let- let- let me just give another very poignant example of that. Consider a sport that has three very separate demands of the athlete. Consider a triathlete. That triathlete has to swim a- a certain distance, then they bike a certain distance, and then they run a certain distance. Have you ever known a person who comes out of the lake or the pool, whatever it is, first winning the triathlon? It doesn't work that way. What suited them to be a fish, fast in water, uh, they have to be somewhat floppy in the ankles because they're creating a fish's fin, longer in the torso. Uh, uh, consider, uh, a- a power lifter performing a butterfly stroke (laughs) . It wouldn't look very pretty. Then they get on the bike where they have to stiffen to, uh, stiffen the core. It- it- it- I don't know if you know bike design. Well, I'm sure you do. You're paying for stiffness of the frame. That's what a really elite-
- AHAndrew Huberman
I did not know that.
- SMDr. Stuart McGill
Yeah. So when a person pushes on the pedal, the frame doesn't flex because that would be an energy leak. You pay for a very stiff frame. So every ounce of force that you apply to the crank handle to propel you forward propels you forward instead of being wasted and bending the frame. The same way, uh, the- the cyclist will lock in on the bike. They'll squeeze the saddle between their- their- their legs, uh, lock into the bars, lock their core down so that when they, uh, create power through the hips and through the legs, it's transferred to the power. It isn't transferred to bending their willowy body. That is very different from the neurology and the mechanics of a swimmer. Now, let's run. To run, uh, the most efficient runners store and recover elastic energy in tuned springs. Uh, a wonderful book to read is The- The Lost Art of Running by Shane Benzie, who studied the Kenyan runners and how they store and recover elastic energy with each stride almost the same way as a kangaroo would. A kangaroo is more efficient when it hops versus plodding along using eccentric-concentric muscle contraction. So, uh, again, the polar opposite of a swimmer. It's a very tuned stiffness. The most efficient runners for the third leg of the triathlon pre-stiffen. They have a pre-contraction of the muscle. So when the foot hits the ground, they're already storing the elastic elements and they get that back for free. But if the springs were not tuned and they stretched away their muscles just to be passive elements, which serves them very well in the swimming, uh, element, th- think of doing a pogo jump. So you're just pogoing through the ankles now. If you had no tone in the legs, you just flop into the ground and you would have to use concentric-eccentric muscle contraction. But if you stiffened too much, you're now a piece of iron and you won't be able to jump either but you'll get a beautiful resonance, a beautiful pogo when you have the tuning just right. So when a muscle contracts, it creates force. We all know this, but people don't appreciate you're also tuning the stiffness. If I maximally contract my muscles, I can't move. So athletes have to tune muscle if they're impacting athletes, but they also have to pulse and relax. Pulse, we were talking about Mike Tyson, uh, before the, uh, podcast today and the mechanics of how he pulses and then he's got to relax to get closing velocity of the fist to the opponent. And then when his fist hits the opponent, he turns to granite. And it is just such an awesome experience to- to feel that a little bit. It's one of the joys of my life working with elite athletes to feel their athleticism, but then dissect it down as to how they do it. So there- there's a lot in that, but that lesson from the triathlete really shows us how you can't be good at everything. There's always a trade-off with athleticism and the genetic part and then, of course, in the appropriate training to optimize and express that genetic gift (laughs) -
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
... through technique-
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
... through technique. So some athletes are very loose, some athletes are very tight, some are very elastic. You won't hit a golf ball 330, uh, yards if you're not an elastic athlete. You'll notice if you measure a golfer who can hit 330 yards, they don't test very strong. They have a beautiful tuned elastic body. Uh, you can almost see it if you've worked with enough of them. There's a smoothness to the muscle. So underneath the skin is a fascial net. Someone who can throw a baseball 110, 115, 120 miles an hour will be the same, but now you have a very asymmetric elastic effect.
- 36:17 – 45:57
Back Pain, Goals & Training Program
- AHAndrew Huberman
So, um, I know that you loathe and avoid generalizations, um, with good reason, but given that most people listening to or watching this, um, are probably not aiming to become elite athletes, I know I'm certainly not-
- SMDr. Stuart McGill
(laughs) .
- AHAndrew Huberman
... um, can we m- safely make at least one or two generalizations about what we each and all can do to try and avoid, um, let's say back pain and injury-... um, e- by either diversifying our training or avoiding certain types of training. For instance, let's take the three major phenotypes. Um, and the... and this is obviously not how the world works, but the classic, you know, ectomorphic phenotype, very thin, very willowy, small joints, long and lithe, you know, um, or lithe. The mesomorph, thicker, more muscular. Um, uh, and then the so-called endomorph, the more heavier set, maybe even carrying some extra body fat, et cetera. You don't really know what's under there. They could fall into either of the other two phenotypes. I could imagine based on everything that you're saying that a good rule of thumb would be avoid the types of activities that are outside of your natural genetic propensity, um, based on body type, at least in the extremes. Like if you're not very bendy, don't do seven days a week of yoga, okay? But I could also imagine the opposite, which is if you're not very bendy, do seven days of yoga because that's going to allow you to become more bendy. Or the person that is naturally shaped more like a shot putter, let's say the mesomorph or en- uh, endomorph and you could say, well, um, they'd be great powerlifter. I mean, I knew kids like this in high school, you know, PE class. They're like, "Okay, weight training today," none of us had done weight training. And then the kid, you know, lies down and, you know, and pushes, you know, 315 and you're like, "Oh, goodness," you know? Like that's, that's wild. Um, but maybe they shouldn't be weight training if their goal is to be all-around fit, to be a- which I think is the goal of most people, to be able to, you know, carry some luggage at the airport without, you know, having to stop every once in a while and suck for air, to be able to, you know, lean down and grab something out of a cabinet, you know, you know, pick up a kid, you know, you know, do some hard, uh, labor in the yard, you know, move some logs and things like that just to be able to do stuff without getting injured and without being so sore in the following days that, that you feel like you need, um, extensive rehabilitation. So again, I know you like to avoid generalizations, but should we make it a point to train against our predisposition in order to offset the imbalances that would otherwise occur? Or would we be wise to lean into our strengths and just not touch stuff that taps into our weaknesses?
- SMDr. Stuart McGill
I understand the question. The answer is, I don't know, but I know people will say, "Oh, well, this professor (laughs) he, he's avoiding the, the question," and I'm not going to do that. So I'm gonna tell you how I find the answer and it's through assessment, and I'm glad we're getting back to back pain, by the way, because it's my real, uh, the cornerstone of my expertise. Our assessment is very comprehensive. It starts out by me simply asking the person, "Tell me your story." And some people never tell me about their pain when I ask them to tell me their story. They will be telling me about their family life and the pressures that they have to still go to work because they have two kids in school or four kids in school. Or, uh, they might tell me about the passions that they have, or they might tell me about their goals. So the goals are the beginning of answering your question, Andrew. We all know people who aren't suited for a certain occupation or they aren't suited or, or they... I'll take myself for example. I had a high school careers counselor tell my father, "Well, Miguel, he's not really suited academically. He should go to trade school." And so I, I registered for-
- AHAndrew Huberman
Oops.
- SMDr. Stuart McGill
... for, for plumbing school.
- AHAndrew Huberman
I just went oops 'cause clearly that's not the way you went. Not that going to plumbing... uh, that going to plumbing school-
- SMDr. Stuart McGill
Yeah, right, right.
- AHAndrew Huberman
... would be a bad decision for some, but in your case, you went a very different direction.
- SMDr. Stuart McGill
Well, I, I, I think I would've been okay as a plumber.
- AHAndrew Huberman
Sure.
- SMDr. Stuart McGill
But, uh, anyway, uh, my, my point in that is what are the goals? Uh, then the assessment, I'm, I'm paying attention to the person's learning style. How are we gonna coach them? And then we get down to the details of their pain. What's the nature of the pain? Is it when they get outta bed in the morning? Is it associated with a certain activity? Is it associated with certain motions, postures or loads? Try and, uh, hone d- d- does, does the pain change? Does it start out on one side of the back and then later in the day it's in the left glute? Or does it go down to your right toes? All of things... these things are telling me about the stability of the pain. Uh, it, it's giving me clues on what I'm going to assess. Then we go and assess them. And it begins with what we call provocative testing. I'm purposefully provoking their pain. If I can provoke their pain, I've nailed the mechanic. If I can't provoke it, it's not mechanical. Okay, well, that tells me something now. So now I'm starting to see, um, I know what their job is. I know what sport it is they want to do. I know enough about that job and sport that I know the physical demands. I know the cycle... uh, the psychological demands.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
Do they have what's required of the job or sport? And then I test that. If it triggers their pain, we have a problem. So now we have to focus the training sp- very specifically because people do not have infinite training capacity. They only have so much. And when you're hurt, you have even less. So we try and focus on things that are going to make a difference to enable them to have the ability to meet those specific demands that we've identified. So do you see how it's, it's a long-winded answer, but I, I know how to get there to know how to train them.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
So now that we've recognized the very specific nature of their pain pathway, and it may be something that's going through the linkage. In other words, um, when they, uh, run... Like, I could give you an example of if we put a group of Canadian hockey players on an elliptical trainer, they don't do very well, because typical of the sport, the hockey players tend to get stiffer in the hips. It's the way they are. They skate a little bit flexed and they carry all the heavy skates and heavy equipment down the legs. They get stiffer in the hips. When they go on the elliptical, their hips don't have the range of motion and their spine and pelvis gyrates with every rotation on the elliptical trainer. The elliptical gives them back pain if they already have motion-triggered back pain. We take another group who has mobile hips, they do very well on elliptical trainers. The stress doesn't go into their backs. So now do you see why I know why one group does well with ellipticals, the other group does not? I know why one group who they... I'll give them a, a lateral shear test, which is basically a bear hug. I pull their pelvis towards me as I hook down their shoulder in my armpit. So I'm shearing their spine laterally. If that triggers their pain el- exactly... I had a pro hockey player the other day, I gave him the lateral shear test and he had a right-sided flash of pain going around his right flank. It exactly replicated the pain. I just found with precision the mechanism. Okay, what's the antidote? I put my fingers into his oblique muscles and I said, "Push my fingers out." And he did it too hard and he says, "Oh, no, that, that, that hurts even more." "Okay, dial it back a bit. Tune what we're trying to achieve here. Fight me just a little bit." I repeated the formerly offensive test, the symptom was gone. So now I'm getting more precision on knowing what I need to do. He was doing the Pallof press. The Pallof press is a long lever exercise. So you take a load, usually with a cable or a band that's held laterally, and you increase the length of the lever, which you have to resist because it's-
- AHAndrew Huberman
So you punch it out from the body.
- SMDr. Stuart McGill
Yeah, you try and... It, it, it's causing you to twist, but it also creates a tremendous shear load on your spine. That was triggering his pain. So we took out the Pallof press, which for him right now is replicating his symptoms. But if you're playing in the NHL, you should be able to do a Pallof press. You follow?
- AHAndrew Huberman
Yep.
- SMDr. Stuart McGill
Yeah. It, it's, it's a requirement of the rigors of professional hockey, but he can't do it now. So this is informing the programming that we're going to do.
- AHAndrew Huberman
So if somebody
- 45:57 – 53:33
Spine Hygiene, Back Pain, Powerlifting
- AHAndrew Huberman
has pain in a given movement, say standing up, um, after they sit for too long-
- SMDr. Stuart McGill
Right.
- AHAndrew Huberman
... um, a particular style of hip hinge, you know, deadlift or, or squat, or when they run for instance, would it be wise for them to, you know, think about the exact movement that makes the pain the worst in the moment that they're doing the movement or afterwards? Because oftentimes pain will arrive after we engage in a certain activity, but during the activity that pain is shut down.
- SMDr. Stuart McGill
Right.
- AHAndrew Huberman
Which by the way is an interesting phenomenon in its own right. And, um, you know, might be worth some, uh, mention as to like couple other reasons why that, that occurs. We always think, "Oh, blood flow, it's warm." But clearly it's, it's more, uh...
- SMDr. Stuart McGill
It's much more than that.
- AHAndrew Huberman
It's much more than that.
- SMDr. Stuart McGill
Yeah, for sure.
- AHAndrew Huberman
Yeah. Um, so let's say I've, uh, pain in a knee when I run. Should I avoid running in that gait that causes pain and work around it? Um, seems to me that would be the, the logical choice.
- SMDr. Stuart McGill
Right. Every person that comes to us comes with back pain. So initially we avoid it.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
We can, uh, have a neurological discussion if you like. We can have a biomechanical discussion or we can have a psychological discussion. We can take it in the framework of any of those if we like. If the pain is causing a sensitization, I'm gonna use the example here of stubbing your toe. You stub your toe once, okay, well, it hurts a bit and the pain goes away fairly quickly. But if every day you stubbed your toe, you would increase the sensitivity so that you don't have to stub it anymore. All you have to do is lightly touch that sensitized toe-
- AHAndrew Huberman
Right.
- SMDr. Stuart McGill
... and you are going to have a maladaptive heightened response. So if we keep creating pain on that toe, it will never get better.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
So we have to start a desensitization wind down, which is tissue-based, but it's also neurologically based as well. And, uh, so, so because everyone comes to us with pain, we work very hard to hack our way around it. So let's say sitting, uh, causes their pain. All right, we'll find out that when, uh, we do a sitting test, if they sit slouched, that causes their pain. When they sit upright, their pain goes away. So I will give them a, uh, a lumbar support, which I'm just happening to use now. I had to sit on an airplane for five hours yesterday coming to see you, and this allows me to not get back pain on the airplane while I'm sitting, because if I sit flexed for five hours, I will have a grumpy back and I won't feel like when I get into the hotel to go for a walk, which is, uh, and, and train a bit, because that's what we have to do to create a stress below the tipping point to optimize health.So it's, it's the same thing in putting together the program. First of all, know the cause and try and eliminate it. So we'll teach them, uh, you, you know, we spend a lot of time with spine hygiene. We teach them, uh, how to hip hinge or squat. We teach them how to lunge, how to get to the floor. We teach them how to roll without twisting their spine into pain, but using their ball and socket joints. Uh, we teach them how to do a baby's crawl, uh, which eliminates the torso twisting, which in their current state will offend the sensitized pain trigger. And we-
- AHAndrew Huberman
That must be humbling for adults to get down and do a baby's crawl. Hey.
- SMDr. Stuart McGill
It, it's so humbling to take a world record holding athlete and humble them right back. I, uh, as you know, I've, I've had the current holder of the world's all-time record squat, Brian Carroll, and I, Brian and I have written a book together (laughs) . So I can use his name.
- AHAndrew Huberman
What's the squat record?
- SMDr. Stuart McGill
1,306 pounds, if you can believe that.
- AHAndrew Huberman
Wow. Yeah.
- SMDr. Stuart McGill
Down to parallel. Down to parallel.
- AHAndrew Huberman
Wow.
- SMDr. Stuart McGill
No, no other human has, has done that. That was, uh, four years ago now. No one's replicated it.
- AHAndrew Huberman
Does he wear a li- one of those elastic lifting suits-
- SMDr. Stuart McGill
Yeah, he does.
- AHAndrew Huberman
... when he does that?
- SMDr. Stuart McGill
Yeah. So he's putting on an exoskeleton of stiffness. But I want to come back-
- AHAndrew Huberman
Yeah.
- SMDr. Stuart McGill
... to how humbling it was to have someone who already held world records in squatting in two different weight categories, and I had to show him how to get off the toilet. But that's another story. And h- we both laugh at this now, but that was what pain had done. Pain had corrupted his movement patterns, and he forgot how to squat, but he held the world record. That's how corruptive pain is to the neurological engram. And we can talk about inhibition and facilitation and all of the things. Uh, I mean, I'd love to have that conversation because I know who I'm sitting with.
- 53:33 – 59:34
Genetics & Running
- AHAndrew Huberman
Uh, I love going to dog shows. I've only done it a few times. Not to actually see the prancing around of the dogs. That doesn't interest me at all. Best part about a, a really excellent dog show is you go back behind the, the arena where all the different breeds, um, reside. So you can see the lineup of the f- the finest Irish Wolfhounds, the finest, um, English Bulldogs, et cetera.
- SMDr. Stuart McGill
Right.
- AHAndrew Huberman
You know, hundreds of different breeds. And you really get to see these genetic extremes, not just of structure, but of temperament. And you get to see the similarity in temperament of the Bulldogs. And of course there's variation. Some of them are a bit more jolly, others more stoic. Um, you know, the terriers are magnificent in their own right. Um, and as you pointed out earlier with respect to the podium, more similar to each other within breed than across breeds in terms of temperament, but there's variation within breed. The reason I bring this up, and the reason I bring this up now is that if you look at the movement of those animals, even just the way they walk, whether or not they, um, enjoy a, uh, a flexion of the paw as they stride, or whether or not they tend to stride differently, I don't have language for this. I'm not an expert in this. But I have a visual system that works, and I can see that they may move differently. They actually walk differently, even at the same pace. Um, and then you look at human beings, shorter, taller, medium, more lithe, more heavy set. Um, and it's amazing that we don't take this into consideration, that we all move very differently even within species, but that we, we, um, bin into these groups. So when someone walks into your laboratory, as it were-... your clinic/laboratory. Do you, are you paying attention to how they move into the room, irrespective of pain?
- SMDr. Stuart McGill
100%. I, uh, we- we- we time the clients. I see one in the morning and one in the afternoon, and they're three-hour appointments. So, I know when they're coming. I watch them get out of the car if I can, and that's when the assessment starts. Uh, but just to go back to the dogs, my sister's a vet, her husband's a vet, and her daughter's in vet training. So, we have these conversations all the time. Do you know she's already made an assessment of that dog on how it's going to behave when she injects it or has to do a rectal exam or whatnot on what dog or breed? And even in cats, which ones she's going to muzzle, because she's usually right on- on who's gonna get bit.
- AHAndrew Huberman
Hmm.
- SMDr. Stuart McGill
Yeah. And, uh, interestingly as well, it's how the, uh, dog feeds off the owner. And she can look at the owner and usually determine how the dog is going to behave. So, talk about the psychosocial milieu around dog behavior. Absolutely. Going back to your question when a person walks in. So, I've had gold, uh, have I had a gold medalist in sprints? Yes, I have, from the Olympics. Uh, I've had a silver medalist. I've had just about every athlete that you can. And then a person walks in off the street, all with back pain. In your mind's eye, conjure up the image of a good sprinter. Do you think they have a flat lower back or do you think they have a lot of lordosis, which is an extension hollow in their low back? A sprinter now, what- what will they have?
- AHAndrew Huberman
I recall seeing Michael Johnson sprinting, very upright.
- SMDr. Stuart McGill
Yes.
- AHAndrew Huberman
So when I think upright, I think either, you know, flat lower back or a little bit of a- of a- of an arch in the lower back. You know, this kind of thing.
- SMDr. Stuart McGill
Yeah. He was 200 meters, wasn't he? 2 and 400 meters.
- AHAndrew Huberman
200, well, I think he was, uh, 200 and 400.
- SMDr. Stuart McGill
He was.
- AHAndrew Huberman
Um, which is unusual, someone that could win-
- SMDr. Stuart McGill
Right.
- AHAndrew Huberman
... gold in both.
- SMDr. Stuart McGill
Well, I'll- I'll-
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
Think of some of the sprinters now, the 100-meter men and women. They- you will find they have a lot more lordosis-
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
... than the distance runners.
- AHAndrew Huberman
So, arch in the back.
- SMDr. Stuart McGill
Yeah. They have a low...
- AHAndrew Huberman
Arch in the back.
- SMDr. Stuart McGill
And what that does, uh, I'll just explain the running mechanics here for a minute. So if you're running along, you have a center of mass. You have to bias the force under your feet behind the center of mass to propel you forward, because if it's in front of the center of mass, you're actually braking, which wouldn't win you a gold medal. So, footfall has to occur behind the center of mass, and then you get a very brief period of time to create an extensor pulse and then recover the leg. If you can pre-turn the pelvis with a lot of lordosis in the spine, you get much more power development behind the center of mass through the extensor range. If you have a flat back, it's difficult now. You've just shortened up the range that you can pulse into propulsive force as a sprinter. So it turns into a very-
- AHAndrew Huberman
So, they bow the body.
- SMDr. Stuart McGill
Yeah. But you'll notice it's very difficult for a sprinter to kick high. So you'll, you know, I- I look at these different forms in the combat athletes. If you look at someone who can kick high in a roundhouse, they will tend to have a flatter back. So, combat athletes tend to have a flatter back. Going back to the runners, you'll notice that the Michael Johnsons and the more, uh, uh, the runners with more distance have a flatter spine. They're more upright and they're tuning that, uh, uh, ability to store and recover elastic energy. Where- where the sprinter out of the blocks, it's horsepower, it's concentric and eccentric muscle pulsing. But, uh, anyway, there- there- there would be, uh, an example, since you- you mentioned it, with running. Uh, the- the style of running, the event. They're not... Running isn't running. Running is very different. And again, look at the podium winners of the sprinters versus the 10,000 meters. Very different architecture.
- AHAndrew Huberman
I'd like to take a brief break
- 59:34 – 1:00:46
Sponsor: LMNT
- AHAndrew Huberman
to thank one of our sponsors, LMNT. LMNT is an electrolyte drink that has everything you need and nothing you don't. That means the electrolytes sodium, magnesium, and potassium in the correct ratios, but no sugar. Now, I and others on the podcast have talked a lot about the critical importance of hydration for proper brain and bodily function. Research shows that even a slight degree of dehydration can really diminish cognitive and physical performance. It's also important that you get adequate electrolytes in order for your body and brain to function at their best. The electrolytes sodium, magnesium, and potassium are critical for the functioning of all the cells in your body, especially your neurons or nerve cells. To make sure that I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of LMNT in about 16 to 32 ounces of water when I wake up in the morning, and I drink that basically first thing in the morning. I also drink LMNT dissolved in water during any kind of physical exercise I'm doing, especially on hot days if I'm sweating a lot and losing water and electrolytes. If you'd like to try LMNT, you can go to drinklmnt.com/huberman, spelled drink L-M-N-T dot com slash Huberman, to claim a free LMNT sample pack with the purchase of any LMNT drink mix. Again, that's drinklmnt.com/huberman to claim a free sample pack. I love where this conversation
- 1:00:46 – 1:07:42
Rehabilitation & Reducing Volume; Injury
- AHAndrew Huberman
is going because there's tremendous variation in body shape and form out there, and I'm certain that by now everybody listening is starting to think about, "Oh, am I more, uh, likely to have a willowy spine, a thinner spine, or a thicker spine?" The kind of pliability or, um, what you called vertical stacking resilience that a- a- one spine or the other would have. Um, and it brings me back to this question of what can we each and all do to try and create the strongest...... back, as well as limit the propensity for pain, assuming we don't have it yet. Okay? So, um, I would say I'm kind of in the middle. I'm neither extremely lithe nor am I shaped like a, you know, like a kettlebell, kind of somewhere in between. Um, so for me, I make it a point across my training week to include three resistance training sessions, three, quote unquote, "cardiovascular training sessions," one long, one medium, one short cardiovascular session. The lifting sessions are geared toward building or maintaining strength in a balanced way for me. Everyone's going to have different requirements. In other words, nothing is skewed toward one particular outcome, like endurance or strength or power. And I think most people probably want something similar because they'd like to be able to meet the various demands of life. So I frame the question I'm about to ask that way because as people start to assess themselves, the question arises again, should we try and compensate for our weaknesses by emphasizing a certain style of training a little bit more? And if so, what does that look like for the spine? You said earlier, and I love this quote, and I wanna make sure I'd attribute it to you now and going forward, that all systems in the body require stress for better health. So-
- SMDr. Stuart McGill
Optimal health.
- AHAndrew Huberman
For op- Thank you. For optimal health. So assuming that somebody has a, a, a thinner stature, they're more bendy, would they be wise to build up the muscles of the core, um, not just the abdominals but the obliques and the lower back muscles, you know, all around the spine in order to give it more stability? And would the person who has a thicker torso, thicker spine, thicker joints do well to emphasize some additional yoga training, um, some additional, um, anything that allows them to be more bendy?
- SMDr. Stuart McGill
I'm gonna go back to the fact they're coming to me with pain. We are going to figure out through the thorough assessment what triggers their pain. Most people, it's true, are, don't want ultimate performance. They're not being paid $10 million to be able to throw a fastball or something like that.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
They want to enjoy life. Let's say they love golf.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
My job is to get them sufficiently robust and out of pain to go and play recreational golf.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
So it becomes a moot point now whether they have a willowy spine or not. I will look at their, their basic golf swing. Uh, if I can divide that up just, just binary. Uh, some people are what we call twisters. They don't have a lot of hip mobility and they twist their spine, so it's called the X factor in golf-
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
... and they store and recover elastic energy. Again, it, it is an elastic athleticism. But the next person isn't so much a twister. They're a turner. They have what we call quick hips, so their hips turn and their spines don't sustain as much twist. And then we measure, well, when they impact the ball, if they have 100% violent lateral crunch, and then we measure them and assess them and that turns out to be their pain trigger, what we do is we don't allow them to go to 100% in lateral crunch at impact. They go to 95%, and that just moved them off the tipping point-
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
... so they're not stubbing their toe or slamming into the pain sensitizer.
- AHAndrew Huberman
Got it.
- SMDr. Stuart McGill
They just stay off the desensitizer now.
- AHAndrew Huberman
So backtracking a little bit, but making sure that I'm doing that with purpose, you need to know w- what generates the pain in order to-
- SMDr. Stuart McGill
Exactly.
- AHAndrew Huberman
... try and localize the pain.
- SMDr. Stuart McGill
Yeah, it all comes back to the assessment.
- AHAndrew Huberman
Right. But then the goal is not to repeat whatever creates the pain.
- SMDr. Stuart McGill
Correct.
- AHAndrew Huberman
Perhaps what I'm hearing, the goal is to get nearer the proximity of the pain, but not go there. Not generate the movement that, that recreates the pain, but, you know, take the movement as far as one can without creating the pain and then think about where the instability or weakness or biomechanical failure is contributing to the pain. Oh, okay. So now I understand why-
- SMDr. Stuart McGill
I- I- if I can just add one... I don't want to interrupt, but this is a-
- AHAndrew Huberman
No, please.
- SMDr. Stuart McGill
... good juncture, Andrew. Then we get into the volume of exposure.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
So remember the tipping point. We can have somewhat of an offense to their former pain, but if we do it sparingly, that's another key. So it isn't a matter of selecting the exercise sometimes as much as it is controlling the volume and then having a period of time off or a deload or whatnot. So it may simply be, um, I've, I've got a, a, an athlete that, that comes to mind right now. In fact, I, I got a, an email. It wasn't an email. It was a WhatsApp message, "Oh, I just won." So (laughs) she's at an international tournament today, and they play every day. But in getting her back, it was a matter of we have to do these things that were former pain triggers, but control the volume. Uh, you can think of, again, combat athletes. Jujitsu requires a lot of spine mobility, and typically, jujitsu athletes get pain when they use too much spine mobility. What we do is we limit their training. In other words, they have the skill of jujitsu, but they don't need to push the end range every day, because if they do, they're in so much pain they can't train. So we back off the volume. And I could tell you stories about professional football players. They were their strongest when they were in college. Their bodies can't take the heavy strength training once they get into the NFL.... they don't squat and deadlift what they used to (laughs) .
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
They're, they're, they're, they're, they're, they're, they're limiting the depth. They're pulling off blocks. I- it... The, the game changes and it's not what people think.
- 1:07:42 – 1:17:40
Tool: Training for Lifelong Fitness, Injury & Joints
- AHAndrew Huberman
to not pushing into pain and extremes all the time if the goal is to have a long arc of fitness or athletic career. A good friend of mine who's very accomplished in the fitness community, he says one of the best ways to get and stay in excellent shape your entire life is to train consistently, train reasonably hard, and we can talk about what his recommendation is, I'd love your, your thoughts, but as best as one can to not get hurt. You know, we forget about this. We hear so much about training consistently and pushing hard, but the not getting hurt part is, is key as well. Um, here's his recommendation on intensity. Can I share it with you and just get your thoughts?
- SMDr. Stuart McGill
Yeah. Okay. Uh, b- I have a short attention span. Can I just p- put... Add-
- AHAndrew Huberman
Sure.
- SMDr. Stuart McGill
... added value to that-
- AHAndrew Huberman
Please.
- SMDr. Stuart McGill
... "Don't get hurt." Getting hurt is tremendously asymmetric. Let me... Uh, do you know the book by, uh, Taleb, N- Nasim, uh-
- AHAndrew Huberman
Oh, Nassim Taleb.
- SMDr. Stuart McGill
Nassim Taleb, yeah.
- AHAndrew Huberman
Ani- Antifragile.
- SMDr. Stuart McGill
Yeah.
- AHAndrew Huberman
Yeah.
- SMDr. Stuart McGill
Oh, in Antifragile he quotes our work, he quotes my Low Back Disorders book as an example of antifragile medicine. Interesting. Anyway, um, when y- when you talk to, uh, uh, uh, Taleb, in an economic sense, if I gave you $100 to invest, if you had a 50% gain, you'd end up with 150 bucks. If you had a 50% loss, you'd end up with 50. It's much more hurtful to lose 50 than the relative jolly you would get of gaining 50.
- AHAndrew Huberman
Yeah, there's some neuroscience-
- SMDr. Stuart McGill
Yes.
- AHAndrew Huberman
... certainly some psychology, but certainly some neuroscience to support that-
- SMDr. Stuart McGill
Right.
- AHAndrew Huberman
... in terms of how we reset our, um, kind of, uh, reinforcement threshold.
- SMDr. Stuart McGill
Right.
- AHAndrew Huberman
Yeah.
- SMDr. Stuart McGill
And so it is so asymmetric with injury. Training, if you push, is taking a risk. You might gain a little bit in short-term resilience or short-term performance, but you have a chance of really screwing things up. And an injury is really asymmetrically harmful.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
So when we work with people and athletes, we really try and avoid injury because of the asymmetry of the consequence. Injury's bad. That's the first part that I, I wanted to say. The second part is, people train hard and they feel the muscle burn and, and they talk about muscle, but they don't talk about their joints. And the key to long life is don't mess up your joints. You can train hard and build muscle, but muscle is adaptive and resilient. Joints are not so much. And if you start messing those up when you're younger by training too hard, you'll find that, "Oh, I was training at this intensity because I wanted to be strong when I'm 70 and 80." They'll find that, no, their knees ache. They can't get down on their knees anymore. They have to crawl up a chair or a wall.
- AHAndrew Huberman
Very sad picture.
- SMDr. Stuart McGill
It, it is. Don't mess up your joints. So that's an overarching principle-
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
... to... Of which the spine is one, obviously. But, uh, tha- that's some wisdom with, uh, training intensely when you're young. Don't base the outcome on muscle. Think about the joints.
- AHAndrew Huberman
No, it's ex- excellent recommendations for everyone. Um, his suggestion... And by the way, this is not for competitive athletes, this is just for exercisers, uh, if you will, is to make 85% of one's workouts across the year at about 85% of maximal intensity in output. So still constraining the total length of a session to whatever the goal of that session is, whether it's resistance training or cardiovascular training, but to not go all out, to go at 85% of one's, uh, subjective understanding of what all out on that day-
- SMDr. Stuart McGill
Sure.
- AHAndrew Huberman
... would be on that day. To make 10% of one's workouts across the year at somewhere between 90 to 95% intensity of what one could generate that day. Again, 100% all out being subjective for that day. And then 5% or even less of their workouts all out, everything you could possibly give, quote unquote, "Leaving it all on the mat." Um, whatever phrase one prefers. And I like that recommendation because it keeps things in check and it also creates an awareness of how intense one is training and it allows us to not, um, let the great night's sleep or the extra cup of coffee that we had or the great song that happens to be playing or the competitive, uh, spirit that's arising because someone joined you that day or asked you to join a workout to take you into the domain of harming yourself. In fact, I, I can look to the times when I've been injured training, and almost always it's because somebody invited me to join their workout and we got into a little bit of a competitive-
- SMDr. Stuart McGill
Right.
- 1:17:40 – 1:26:15
Pain Types, Biopsychosocial Model of Pain
- SMDr. Stuart McGill
I, I appreciate all what you've said. In my world, everyone has a back pain history.
- AHAndrew Huberman
Hmm.
- SMDr. Stuart McGill
So it's always... Well, I just let the gu- it's, it's the-
- AHAndrew Huberman
Interesting.
- SMDr. Stuart McGill
... information that we gather from the assessment that guides our decision on how we're going to, A, get them out of pain, build some base resilience, which is tuning their body, strategic mobility, strategic stability. Now, if, if one thing we haven't talked about is, is various types of pain and how yet that impacts on how we're going to approach their programming for life. You did a podcast with somebody, I, I can't remember what it w- what their name was, but it was a pain podcast, and you were developing this idea that if the mechanism of their pain was really part of the changed engram, they were traumatized at, at the time of the event or maybe it was a, a history of sexual abuse or whatever, but I can detect that person almost always. I'll start to put my hands on them to feel, "Oh, is there any entalgia here?" And they recoil. "Ugh."
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
That's an abused person. That's a, that's a very characteristic response. So you start putting together some of these reactions and, and you, and you know that there's something deeper than an injury to a part of their spine.
- AHAndrew Huberman
Mm-hmm. Yeah, we had, um, Dr. Sean Mackey.
- SMDr. Stuart McGill
That was it. Yeah.
- AHAndrew Huberman
Yeah. Dr. Sean Mackey is our, um, head of the... Essentially the pain division at Stanford-
- SMDr. Stuart McGill
Right.
- AHAndrew Huberman
... School of Medicine. Um, he's an MD and PhD, and he's a big proponent of the biopsychosocial model of pain, which probably makes sense for us to discuss. Now, as the name suggests, it incorporates psychological elements. It incorporates, of course, physiological elements, and it points to, as I recall, seven or more sort of paths to dealing with pain, some of which include, um, thoughts about one's emotional state.
... stress level, um, sleep. Um, I mean, all of these things clearly play a role in pain and rehabilitation from pain.
- SMDr. Stuart McGill
Right. I love that, uh, podcast, by the way, because it's so consistent with what we found and what we do. If a person has... It was just a mechanical exceeding of their tipping point and they now have some tissue damage, we address that by creating a strategy that they don't move or load in a way to stress that, and we allow the injury to heal if we can. And, and we should talk about whether the, the, the disc adapts or you have to manage it. But, but that's another very interesting topic to get into. But nonetheless, we are tuning their body with strategic mobility and stability, uh, giving them core exercise, unleashing their hips and shoulders, et cetera. And we will have a reasonable level of success, and we know, by the way, what our success is, because uniquely, we follow up with every patient we see to know if we were successful or not.
- AHAndrew Huberman
Mm-hmm.
- SMDr. Stuart McGill
But now we have that person, and I can think of many examples just to give a spectrum. Perhaps the person was in a car accident, they survived, but the person beside them, who might have been their mother, died. So now they're carrying a hell of a lot of emotional trauma, guilt, trauma. Maybe they nodded off at the time of the accident, they were driving. Tremendous psychological stress. Maybe they were sexually abused or whatever. That rewires their brain. So now they come in and the pain pattern doesn't fit. We do physical stressing of their various tissues, and the reactions, they change their variable. They're, they're, they're, they're not what they should be. The way that their brain perceives the pain has been rewired. If we give them the traditional approach of giving them more fitness and ability, it won't work. We can't break through that maladaptive response. We completely change. Now it might be just to desensitize them. You'll laugh at this. We might get a feather and brush it over their back and they'll say, "Oh, yeah, that, that triggers my pain." "Really?" "Yes. Oh, now I'm getting a headache." Okay. So we have to come up with what can they do without triggering that maladaptive response? And it might be that simply the most simple of movements where the afferent and efferents, all the information going into that engram which is formally triggering pain, we now figure out what it is that doesn't trigger pain and hence slowly desensitize it with repetition, never triggering pain, and then we expand that repertoire. So you've heard of fibromyalgia, which is a little bit of a catchall term, but a flashing light, uh, surprising someone, they're walking down the street and someone comes out of a shop and, and surprises them somehow and that triggers off this massive pain response. Uh, we do that with very gentle love, doing the things that doesn't cause pain and, and try and slowly expand that engram into a pain-free one. There are those in, uh, what's called work hardening. It's usually funded by insurance companies. So if you have intransigent back pain, we are now going to get you to do your job. We start out with an hour a day. You're a bricklayer, you're gonna lay bricks for an hour. Tomorrow you're gonna lay for an hour and a half. And occasionally they have some success or they have some really miserable failures and the person says, "I cannot do another day of bricklaying for four hours even though it's only a portion of my job." And so now they get kicked out of the program because they're called a non-compliant. In other words, there's something psychological wrong with them and they're shattered. Those are the people we see. So these, these are... You know, talk about the biopsychosocial approach. I, I know I get labeled sometimes as the biomechanist and I ignore all the psychosocial, but these are people who've never read our work and they don't know. So I really appreciate you bringing this 'cause I'm not a- af- often asked, uh, this perspective. But again, I know with your background you'll appreciate all of this.
- AHAndrew Huberman
Yeah. Surely the, you know, the nervous system is involved in generating movement and feedback from the muscles and proprioception and, uh, as you're describing, the nervous system, uh, creates our sense of pain. There's an emotional component to it, as Dr. Mackey pointed out, and as you're reinforcing, and the neural circuits that control "pain" or give rise to pain, um, involve the confluence of all of these things at some level. And I, I appreciate that you're willing to go into this biopsychosocial model of pain and, and acknowledge it, um, because I think all too often in the space of biomechanics and, and pain, and back pain in particular, um, people, you in some cases, get labeled as only subscribing to one particular pattern of remedy or one particular framework, and that's simply not true. It's just not true. Um, in fact, I'll go so far as to say that-That's actually a reflection of other people placing a singular lens on you and your work, as opposed to your work having a singular lens. I know that you look at things through the, um, rather complex prism that is back pain and back rehabilitation. Um, so thank you for touching into the biopsychosocial model. And we'll put a link, uh, in the show note captions to that episode with, uh, Dr. Mackey because he went into this in some, some depth. And so it, it is the case that we've covered, uh, that model in, um, in pretty extensive detail. Th- there's something that, uh,
- 1:26:15 – 1:32:43
Coaching, Explosivity & Endurance
- AHAndrew Huberman
you said to me once that I really wanna make sure we highlight, which is that people who embark on a particular style of training, not just sport selection, but style of training, like resistance training with heavier weights versus endurance training, running longer distances or swimming longer distances, will sometimes cultivate a certain, should we call it personality style or reactivity style, that is probably independent of who they started off as. I mean, uh, th- you can never separate these things completely. I mean, we, we could argue, um, people who have a lot of mental endurance pick endurance sports, or people that are rather ballistic in their personality, here I'm playing psychologist, um, pick sports with a lot of speed and ballistic, uh, motion involved. But perhaps the reverse is also true, that the more we engage in activities for which the nervous system is required to generate a particular pattern of movement, like ballistic movement or endurance or strength, that we exacerbate certain aspects of our mental self, our emotional self as well. I realize this is not the stuff of, um, detailed peer-reviewed studies necessarily, or at least I'm not aware of them, but in your experience working with a variety of different people from the general population who engage in different activities, as well as athletes who engage in very different activities, and let's keep in mind the discussion we had earlier about dog breeds, they are selected for not just based on physical phenotype and movement, but also personality type, right? Temperament. What sort of broad correlations have you observed in, say, endurance runners? Do they have more mental endurance for other activities versus, say, strength athletes or sprinters? Do they tend to have less, but tend to excel in other domains of their mental life?
- SMDr. Stuart McGill
You're right in that I haven't seen good science to back up this whole issue, but after working with people for 40 years and seeing the extremes of the phenotype, I, I do have some opinions on this and it comes from coaching. So if you take an athlete who has, by nature, they're very explosive neurologically, they're quick, they're explosive, but they can't do it for very long. It's almost, and, and I, I hate using this label, but it's, it's just a way to describe it, they have attention deficit. Now, I've been told I have this, every high school teacher would've told you, "Yeah, McGill, he's attention deficit." Is now maybe it was just, I wasn't interested in (laughs) what they were talking about. My brain was thinking about something else, but I, I th- I think I do have a certain degree of a- attention deficit. If someone's not holding my attention, I'm thinking of something that's more important. The more explosive the athlete is, the shorter the time you have to coach them, that they're present with you. The less explosive they are, the more time you have to coach them. So I will say that.
- AHAndrew Huberman
I find that really interesting. Um, and I can think of a number of self experiments, uh, that I'd like to embark on of, you know, including more endurance training at particular times of year and seeing how that correlates with, um, mental focus and endurance for, say, writing or preparing podcasts, things of that sort. Um, but of course, now I, that I have some sense of what the answer could be, I'd be biasing the, the outcomes.
- SMDr. Stuart McGill
(laughs)
- AHAndrew Huberman
But if it's a self experiment and the goal is simply to, to shift one's, um, uh, mental life or, or behavior, then I don't know that it matters that much.
- SMDr. Stuart McGill
C- c- can I go with a little anecdote there that-
- AHAndrew Huberman
Please.
- SMDr. Stuart McGill
... you, you may appreciate? I'll get a call from a, uh, a coach, say a, an NBA coach, and it'll be, uh, with their medical staff, and they'll say, "We have this player, they play 18 minutes a game. Can you help?" And they have a back pain history. "Could you help us to get them to play 27 minutes a game?" And then I'll investigate and understand the player. And then I'll, I may ask a question to the, uh, coach, "What puts p- p- paying bums in the seats in the stadium?" And they'll say, "Well, what do you mean?" And I said, "Well, it's that player that we're talking about. That player is magical for the 18 minutes that they play because they're sparky, they're explosive. If we train them and they have a plastic physiology and neurology that we can train so that they can last 27 minutes, you realize that you're trading off the explosiveness." You cannot have a really high VO₂ max and be maximally explosive. They're competing mechanisms. One's a fast twitch mechanism for speed and explosiveness, and the other one is an endurable physiology, and you trade one for the other. So do you really want to compromise that explosiveness? And, and you see this when you're, uh, uh, on a team getting a, uh, combat athlete ready. If they are neurologically explosive, you design the-... fight and the training that they pretty much have to win in the first round and if they don't win in the first round, they're going to (laughs) gas out. And, uh, the, the person who is, uh, preparing to compete against them is training to survive the first round, (laughs) and then come on in the second. So they're training endurance. To compare those two different athletes from a psychological point of view, uh, and if you do it enough, I, I think you'll come to agree with me and you will notice that there is how you coach them. Uh, it, it has to be in short, consumable bites.
Episode duration: 2:52:15
Install uListen for AI-powered chat & search across the full episode — Get Full Transcript
Transcript of episode mAlt_HKX4as
Get more out of YouTube videos.
High quality summaries for YouTube videos. Accurate transcripts to search & find moments. Powered by ChatGPT & Claude AI.
Add to Chrome