Protocols to Strengthen & Pain Proof Your Back

1. 0:00 – 3:47

   Back Health

   1. AHAndrew Huberman0:00

      (uptempo 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. Today, we are discussing how to build a strong, pain-free back. Having a strong, pain-free back has numerous advantages, not the least of which is you're not in pain, as well as the fact that you can carry out your daily activities, any exercise or sports you might play, interactions with family members, like picking up a kid, leaning down to get things out of a cupboard, or reaching up to get things out of a cabinet without any pain. And back pain is one of those things that, even if minor, and certainly if severe, severely impedes our ability to do most everything, even to just sit still or lay still. And one of the things about pain, in particular back and neck pain, is that it also has an effect on our emotional self. It makes us more irritable. It makes any activity, even the most mundane activities, that much more distressing to carry out. So during today's discussion, we will talk about how to ameliorate pain. However, pain as a general topic was already covered on this podcast with an expert guest, Dr. Sean Mackey, who's a medical doctor at Stanford. He's actually the director of our pain clinic. And on that episode, which we provide a link to in the show note captions, he talks about the various ways to address pain, everything from pain medication to epidurals to electrical stimulation, and importantly, the biopsychosocial model of pain, whereby our thoughts and our perceptions about pain actually influence the severity and the duration of that pain. So if you're interested in pain and the treatment of pain per se, I highly recommend that episode. Today, we will certainly talk about ways to deal with back pain, ways to reduce it, and perhaps even eliminate it altogether. But we are also going to talk a lot about how to pain-proof your back and how to build a really strong back, not just for pulling things, because the back muscles are involved in pulling things, but also just for generating a really strong, stable core, strong spinal erectors, making sure that your pelvis and your spine are interacting correctly, that your shoulders, neck, and spine, and pelvis, and even your lower limbs and feet are working together in the proper manner to make sure that you have the strongest and most pain-free back possible. So what I'm going to do is first, I'm going to describe a bit of back anatomy and physiology. I'm going to talk about the neuromuscular components as well as the spinal and disc components. I promise, even if you don't have a background in biology, I'm going to make this all very accessible to any and all of you. And then I'm going to go into the 10 or 12 specific things, in particular six things that take very little time, that require no equipment, no purchase of anything whatsoever, and involve a very minimal time investment that will allow you to build a really strong, pain-free back. What's covered are protocols from three of the world's foremost experts in back pain, but also back strengthening and building resilience into the back. So they include a medical doctor, expert in back strengthening and rehabilitation, a PhD researcher who has spent decades researching the spine and ways to strengthen the core and spine, and a world-class PhD physical therapist who is expert not just in the spine, but in fact, in the movement, rehabilitation, and strengthening of the entire body. They are the MD, Dr. Sean Miller, the PhD, Dr. Stuart McGill, and also the PhD, Dr. Kelly Starrett. I provide links to them and resources that they provide in the show note captions, and indeed, I plan to host all three of them separately on the Huberman Lab Podcast as expert guests in the not-too-distant future.

2. 3:47 – 7:57

   Sponsors: AeroPress, Joovv & Waking Up

   1. AHAndrew Huberman3:47

      Before we begin, I'd like to emphasize that this podcast is separate from my teaching and 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 AeroPress. AeroPress is like a French press, but a French press that always brews the perfect cup of coffee, meaning no bitterness and excellent taste. AeroPress achieves this because it uses a very short contact time between the hot water and the coffee, and that short contact time also means that you can brew an excellent cup of coffee very quickly. The whole thing takes only about three minutes. I started using an AeroPress over 10 years ago, and I learned about it from a guy named Alan Adler, who's a former Stanford engineer who's also an inventor. He developed things like the Aerobie Frisbee. In any event, I'm a big fan of Adler inventions, and when I heard he developed a coffee maker, the AeroPress, I tried it, and I found that indeed, it makes the best possible tasting cup of coffee. It's also extremely small and portable, so I started using it in the laboratory, when I travel on the road, and also at home. And I'm not alone in my love of the AeroPress coffee maker. With over 55,000 five-star reviews, AeroPress is the best-reviewed coffee press in the world. If you'd like to try AeroPress, you can go to aeropress.com/huberman to get 20% off. AeroPress currently ships in the USA, Canada, and to over 60 other countries around the world. Again, that's aeropress.com/huberman.Today's episode is also brought to us by Joovv. Joovv makes medical grade red light therapy devices. Now, if there's one thing I've consistently emphasized on this podcast, it's the incredible role that light can have on our biology. And of course, I'm always telling people that they should get sunlight in their eyes as soon as possible after waking on as many days of their life as possible for sake of setting circadian rhythm, daytime mood, focus, and alertness, and improved sleep. Now, in addition to sunlight, red light and near-infrared light has been shown to have positive effects on improving numerous aspects of cellular and organ health, including faster muscle recovery, improved skin health and wound healing, even improvements in acne, or that is removal of acne, reducing pain and inflammation, improving mitochondrial function, and even improving vision itself. What sets Joovv apart and why it's my preferred red light therapy device is that it has clinically proven wavelengths, meaning it uses specific wavelengths of red light and near-infrared light in combination that trigger the optimal cellar adaptations. Personally, I use the Joovv handheld light both at home and when I travel. It's only about the size of a sandwich. It's very convenient to use. I also have a Joovv whole body panel, and I use that about three or four times a week. If you would like to try Joovv, you can go to J-O-O-V v.com/huberman. Joovv is offering an exclusive discount to all Huberman Lab listeners with up to $400 off select Joovv products. Again, that's Joovv, J-O-O-V v.com/huberman to get $400 off select Joovv products. Today's episode is also brought to us by Waking Up. Waking Up is a meditation app that offers hundreds of guided meditations, mindfulness trainings, yoga nidra sessions, and more. I started meditating over three decades ago, and what I found in the ensuing years is that sometimes it was very easy for me to do my daily meditation practice. I was just really diligent. But then as things would get more stressful, which of course is exactly when I should have been meditating more, my meditation practice would fall off. With Waking Up, they make it very easy to find and consistently use a given meditation practice. And it has very convenient reminders, and they come in different durations. So even if you just have one minute or five minutes to meditate, you can still get your meditation in, which research shows is still highly beneficial. In addition to the many different meditations on the Waking Up app, they also have yoga nidra sessions, which are a form of non-sleep deep rest that I personally find is extremely valuable for restoring mental and physical vigor. I tend to do a yoga nidra lasting anywhere from 10 to 20 minutes at least once a day, and if I ever wake up in the middle of the night and I need to fall back asleep, I also find yoga nidra to be extremely useful. If you'd like to try the Waking Up app, you can go to wakingup.com/huberman to try a free 30-day trial. Again, that's wakingup.com/huberman.

3. 7:57 – 12:07

   Back Anatomy: Spine, Vertebrae, Spinal Cord

   1. AHAndrew Huberman7:57

      Okay, let's talk about the back. The back, for many people, simply means the spine, the bony stuff that runs down your middle. Now, of course, your spine doesn't just run down your middle. You've got your cervical spine up near your neck. Don't ever forget that. Your neck is the upper part of your spine. You've got the thoracic spine, which essentially through, you know, in insects we think of the thorax. Remember that from biology class in middle school or high school? But through your region here, you know, basically down from the neck through the chest, and then you've got your lumbar spine, which is the part right below that, and then you have the sacral spine, which is the area of the spine that is in the pelvic region, and then, of course, there's the bottom region of that, which is called the coccyx spine, which is the very lowest part of the sacral region of the spine. Now, of course, that's the bony stuff. And if you've ever seen a spine on a, you know, a skeleton of any kind or a drawing of a skeleton, you know that it's a bunch of segments. It's a bunch of bony segments. It's important to understand that the back is made up not just of bony stuff, but it's got stuff in between, which are the discs. The discs are the soft tissue that sit between the vertebrae, right? The vertebrae are the bones. And those discs have some durability to them. They're, they're not easily squished, but they can be squished, that is, they can move. They're a soft tissue that allows for mobility of the bony stuff. So you've got basically bone, disc, bone, disc, bone, disc, bone, disc, and it's those discs that allow for movement of the spine from side to side, and it actually allows for some compression along the length of the spine as well, what sometimes today I'll refer to as vertical compression, but actually vertical isn't the correct anatomical term. So in anatomical terms, we talk about anterior posterior, we talk about rostral caudal, which is just different language for anterior posterior. I'm going to try and avoid using fancy nomenclature as much as possible, but the point here is that those discs allow for movement of the vertebrae. But keep in mind that the vertebrae and the discs have a hole down the middle. They look like donuts, basically. They're not perfectly round like donuts, but for the time being, just think of them as donuts, right? Some are bony donuts and others have more pliability to them. But there's a hole down their middle. Why? Well, within that hole is a long snake-like piece of the nervous system called the spinal cord, which is the neural stuff, the neurons. Now, within the spinal cord, it's not just neurons, nerve cells, okay? Neurons means nerve cells. It's also glia, which are another cell type that provides, yes, support to the neurons, but also do some really important things on their own, like clearing out a metabolic waste. They actually regulate communication between neurons. If you've ever heard that the glia are just glue, and that's actually the Latin translation of glia, glue, it implies that they're not doing much actively, that they're just sort of a passive participant keeping things together. The glia are really doing important things as well. But keep in mind that the spinal cord is this long snake-like process of the nervous system that extends down through the vertebrae and down through the discs. Or if you prefer, you can think about the long snake-like...... process of the spinal cord and then around it, all along its length, you have bony vertebrae, disc, bony vertebrae, disc, bony vertebrae, disc, going all the way from the neck region down to that coccyx region within the pelvis. Now, the thing about neural tissue is it's very soft, it's very fragile, and one of the reasons we have vertebra is to give the spinal cord some rigidity and protection from damage, and that's really important because the spinal cord, this long tube of neural tissue that sits inside of the vertebrae and the discs, it's central nervous system tissue, CNS tissue. And as CNS tissue, it does not regenerate after injury. Okay, maybe a tiny bit in certain conditions and in very young people, but if the spinal cord is damaged, typically, there's a lot of scar tissue that forms, but there is no renewal of the neurons that are damaged. So it's very important that the spinal cord be protected, which is one of the reasons why it is encased by those vertebrae and the discs.

4. 12:07 – 19:50

   Spinal Cord & Nerves; Herniated Discs

   1. AHAndrew Huberman12:07

      Now, the other thing to understand is that the spinal cord is indeed a snake-like extension out the back of the brain. So the brain and spinal cord make up what we call the central nervous system, the CNS. We just talked about that a moment ago, but now I want you to think about the brain. Your brain, of course, is encapsulated within the skull, the cranial vault. There are only two pieces of your brain that reside outside of the cranial vault. They are your neural retinas that line the back of your eyes. I know many of you have heard me say this before, but it's so cool that I can't help but share it again and again, which is that you have two pieces of your brain, literally your central nervous system, that were extruded out from the cranial vault during development while you were in utero, this happens in the first trimester when you were an embryo, that line the back of your eyes like a pie crust, and those linings of the back of your eye, like a pie crust, are made up of three layers of neurons and a bunch of glia, and they are your neural retinas. They are two pieces of brain that literally look out into the world and are activated by what? By light, by sunlight, by edges and objects, by the photons in the outside world, and that's what gives rise to vision. So starting at the front of your head and working down through the spinal cord, we can do this very quickly to give you a complete picture, you've got your neural retinas that line the back of your eyes. They are central nervous system. They are brain. They communicate with the rest of your brain through the optic nerves. Then you've got your brain. You've got the brain parts that respond to hearing, the brain parts that allow you to think, imagine, learn, remember, et cetera. And then at the back of the brain, you have the brain stem, and then extending out from the brain stem, you have the spinal cord, this tube-like neural structure that extends down through the vertebrae, down through the discs, all the way to your pelvic region. Now, why am I telling you all this neuroscience? If we're talking about strengthening the back, why am I talking about the spinal cord? Why am I talking about neurons in the brain? Well, just as your brain has the cranial vault, your skull, to protect it, your spinal cord has the vertebrae to protect it and the discs to protect it, but the discs allow for some movement of the spinal cord, in fact, uh, quite a bit of movement. If you just lean forward in your chair, you lean back, arch your back, or you twist to the side, your spinal cord is actually twisting in that way. Okay? This would be akin to your brain actually moving within the skull. It can move a little bit, but it doesn't move nearly as much as your spinal cord does. So your back has, of course, many functions. It's there to stabilize your body. It's there to provide stiffness in order to be able to move your limbs in very dynamic ways. We're going to talk about back and core stiffness as such a key feature of having a strong back. When you hear the word stiffness, you probably think, "Well, that can't be good. I don't want a stiff back. Ah," but you actually want to be able to generate rigidity within your core and spine in order to move your limbs, to throw a ball, or to do a martial arts punch, or to even dance gracefully, or even just move up some stairs without falling. So basically, when we talk about the brain and spinal cord as extending down through the vertebrae and through the discs, we're doing that to set up the other piece of this whole story, which is that the neurons that reside in the spinal cord, in particular what we call the ventral spinal cord, which, if we're going to imagine this in kind of more real world terms, they're sitting in the part of the spinal cord that's kind of on your front, okay, that- that's facing, uh, the front of the world. There are neurons there called motor neurons. The motor neurons themselves, what we call the cell bodies, reside in the spinal cord, in the so-called ventral horn of the spinal cord. You can look this up if you like, although you don't need to know that, and they extend little wires that we call axons out to the muscles, and through the release of neurotransmitters, they allow our muscles to move, our flexors to flex, like our bicep, our extensors to extend, like our tricep. Could think quadricep, hamstring, calf, abdominal muscles, all the movement of those muscles is controlled by neurons that reside within the spinal cord. Some of the movements that we generate are unconscious movements, especially movements that are required for breathing, although you can consciously take care of your breathing as well, right? You can breathe unconsciously. You're always doing that, even in sleep, or you can take conscious control of your breathing. You can generate limb movements consciously or you can generate limb movements unconsciously. Typically, once you know how to walk and you get up and you walk across the room, you're not thinking, "Right foot, left foot, right foot, left foot." All of that's handled by motor neurons in what are called central pattern generators in the spinal cord and to some extent the brain stem. But the commands for specific, deliberate movements that you're thinking about, especially when you're trying to learn a movement or you're trying to be very deliberate in a movement, those come from what are called upper motor neurons in the brain. They communicate with lower motor neurons, which then communicate with the muscles. Okay? So that's one neural outflow pathway from spinal cord out to muscles. Some of it's conscious. Some of it's unconscious. And then there are the neural pathways from skin, from the tendons and insertions of the muscles onto bone, within the muscles that register how much stretch are on our muscles.And those are the so-called sensory inputs that come into the dorsal part of the spinal cord, the part that is facing toward our back, and that sensory information tells our spinal cord, which then informs our brain whether or not our limbs are extended too far and about to snap, or whether or not a muscle is loaded too heavy and is about to be pulled off the bone. And in that case, the brain and spinal cord have these magnificent mechanisms to shut down the neurons so that, you know, we drop the load so that we don't overwhelm the muscle and rip it off the bone, or we don't stretch our limbs too far. Now, keep in mind that the neurons within the spinal cord that communicate with muscles or the neurons that innervate, as we call it, the skin or the tendons or different parts of the body and go into the spinal cord, those little wires, those axons literally leave the spinal cord, and they go out into what's called the peripheral nervous system. Now, a big source of pain in back pain is when those nerve roots, as they're called, they're little bundles, okay? Bundles of nerves are sometimes called fascicles, sometimes called nerve roots. The nomenclature kind of depends on where you are in the nervous system, but I'll call them nerve roots or bundles of nerves. Those bundles of nerves are sometimes impinged on. They're physically pressed on by, say, a bulging, what's also called a herniated disc. The discs can sometimes bulge out from the side of the spine a little bit too much, okay? Maybe by compression from the overlying vertebrae, maybe from some inflammation. We'll talk about the various sources today, and oftentimes, the source of back pain or neck pain or even pain in the pelvic region is because of a compression of the nerve roots that are going into and out of the spine, okay? So when we talk today about back pain and when we talk today about building a strong back, we need to focus on two major themes. One is the extent to which those nerve roots are free and clear of any physical pressure from, say, herniated discs, from compressed vertebrae, from inflammation in those regions, maybe all three. And what we're really trying to do when we talk about relieving back pain often is creating space, creating room for those nerve roots to travel in and out of the spine, for those messages to come in from the periphery, the skin, the tendons, the muscles, et cetera, up into the brain, because the brain needs that information to know where our limbs are, still needs to keep us safe, as well as the nerve pathways traveling out of the spine that control our musculature for deliberate movements, unconscious movements, and so on. And so much of what you'll hear about today when thinking about how to build a really strong, pain-free back is about creating the kind of stability around the spine so that we can engage in the different limb movements that we need to, but to do so in a way that doesn't create compression of those nerve pathways.

5. 19:50 – 24:26

   Build Strong Pain-Free Back; Bulging Discs

   1. AHAndrew Huberman19:50

      Now, with all that said, it's really important to also understand that not all of back pain is neural in nature. Now, technically, all pain is neural in the sense that it's a perception, okay? If you listened to the episode with Doctor Sean Mackey, which includes a deep description of the biopsychosocial model of pain, it will tell you, or I'll just tell you now, that indeed pain involves a lot of different things. It involves psychology, it involves prediction, it involves history, it involves inflammation, it involves a lot of things, and yes, ultimately it's neural. It is the firing of nerves that create the perception of pain, and your perception of pain is also the firing of neurons in your brain and spinal cord. However, what you'll also learn today is that there are many things that you can do, including creating stability of your feet, your toes, believe it or not, the position of your pelvis, your neck, your chin, all these things, as well as the spinal erector muscles in your lower back, as well as your abdominal region, your so-called core. All of those things combine to create a milieu for the spine and back to function at its best. So if by now you're getting overwhelmed and you're thinking, "Oh my goodness, we have to learn about the entire body's physiology and anatomy in order to understand back pain and strengthening?" To some extent, that's true, but really all we've said so far and all you need to know, or keep in mind, that is, is we have the vertebrae, the bony segments that surround the spinal cord. In between those, we have the discs, the soft tissue that also have a hole through them. The spinal cord travels through that so that the vertebrae can move, so that we have some pliability and mobility of our spine forward, flexion, so your chin closer to your belly, extension, your chin back and away from your belly, sort of arching of the lower back. You can twist to side to side to some extent. You have all that stuff, and through the middle is the spinal cord and the brain, and then you have sensory information going into the spinal cord from the body, from the muscles, from the skin, and then you have motor commands going out the bottom of the spinal cord, so literally traveling out past those vertebrae and discs, out to the muscles to control those muscles for involuntary and voluntary movement. If you can understand that and you can envision it just a little bit, even just a little bit, you're going to be able to think about all of the various protocols that we talk about next in the most functional way, meaning as you learn about and hopefully incorporate the various protocols for strengthening and pain-proofing your back, that you'll occasionally think back to, "Okay, it's my spinal cord that I'm bending in my lower back region." I'm allowing the discs to kind of move forward, and they likely are kind of bulging out a little bit. They're not necessarily herniating, let's hope not, but they're bulging a little bit in that direction, then back in the other direction. And if you happen to have herniated, that is, bulging discs, which many people do. In fact, I've had that, I've got a sort of an L3, a kind of lumbar three, four bulge that got activated a few years ago. I'll tell you what allowed me to very quickly fix that permanently with no medication, no surgery whatsoever, and it was extremely debilitating. There's some simple movements that one can do if done in the proper direction and in the proper way that can allow you to push that bulge, that herniated disc back under, or I should say closer to the spinal cord, okay? Moving it from the kind of bulging out from between the vertebrae to-Closer, again, toward the center point of the spine. By doing that, one can take pressure off of the nerve roots that are traveling out to the muscles and in from the skin and other sensory information coming into the spinal cord and allow yourself relief from back pain. And then by building up stability in the abdominal region, the lower back region, you can create a nice firm core that will allow you to protect all of that with plenty of space so the nerve roots are not impinged. And then of course, by focusing on some of the stabilizers that exist really distal, which means far from all of that, further from all of that, such as the feet. Literally, how you position your feet, the ability to spread your toes, (laughs) believe it or not, as a way to provide support for your back, not just when doing exercise, but also at rest. There are some things you can do about neck positioning, strengthening of the front of the neck, strengthening of various muscles, again, that involves no equipment whatsoever, that allows you to have a pain-free, strong back both at rest and during movements of different kind, different dynamic sport movements like tennis or golf, et cetera, as well as, if you're into it, resistance training, if you're putting yourself under heavy loads, all of that pain-free and moving through life with a tremendous amount of mobility and

6. 24:26 – 34:58

   Back Pain & Professional Evaluation; Tool: Spine Self-Assessment

   1. AHAndrew Huberman24:26

      versatility. Now, before we get into the specific protocols and exercises for strengthening and pain-proofing your back, it's worth mentioning something that really was first told to me by Dr. Stuart McGill. Again, he's going to be a guest on this podcast. Dr. Stuart McGill is a world expert in spine physiology and anatomy, and he's worked with a lot of athletes, but his work is not specific to athletes. It's really for the everyday person as well. And in discussions with Stu, he raises some really important points. First of all, if you have back pain, you need a proper assessment and diagnosis. It's really impossible for me in this format to try and diagnose your back pain or for you to try and diagnose your back pain. That would just be irresponsible of both of us. There's just so many things that are specific to each circumstance. For instance, some people get back pain or neck pain or both because of overuse of certain motor patterns. Maybe they are avid golf players, and they're always swinging a certain way with one foot forward. That's typically the way it works. And they built up some strength in certain pathways, both muscular strength and neural strength, but they have a weakness in the opposite side muscles and nerves, and they need to rehabilitate those in order to eliminate the back pain. Other people have an injury, right? They have a spinal compression injury. They don't just have a herniated disc, they have a ruptured disc. Oftentimes, ruptured discs need surgery. I don't want to give the impression that all back pain can be resolved without surgery. There are cases where surgery is necessary, okay? So it's very important that if you have severe back pain or persistent back pain and you're not able to alleviate it with non-surgical methods, that you talk to a back expert, perhaps even a surgeon. There are cases for epidurals, for painkillers, for, you know, different types of rehabilitative approaches, but Dr. Stu McGill has also pointed out that there are a number of things that any and all of us can do by just self-assessing that I think are appropriate for today's discussion that relate to whether or not we are likely to have a thick spine or a thin spine, okay? This isn't a psychological feature, (laughs) at least not to my knowledge. But if you look at different body types, you know, what in the old days used to be called the ecto-, endo-, and mesomorphic body types, okay? This nomenclature isn't used quite as much anymore, but just to kind of return to it, the ectomorphic body phenotype is one in which people are typically kind of light boned, meaning thinner wrists, smaller knees, smaller ankles, so not really thick bones and thick wrists. So that's the ectomorphs. These are people that tend to be pretty thin, sometimes referred to as people that have, you know, very low body fat, less muscle mass, although that's not always the case. Just think lighter, thinner skeleton versus mesomorphs, which tend to be people with kind of thicker wrists, thicker knee joints, kind of thicker overall, and then endomorph, which was, at the time, used to describe people that are carrying more body weight in the form of body fat. I don't know how often the endomorph phenotype, um, language is used anymore. But what Dr. Stu McGill has pointed out is that people in general tend to be more ectomorphic or mesomorphic. They tend to be more thick through the torso or thin through the torso. They tend to have thinner wrists or smaller wrists as compared to their age-matched, sex-matched counterparts, okay? But in general, so these are generalizations, people who have thicker wrists generally are going to have thicker spinal segments, okay? In terms of the circumference of the spinal segments and discs, whereas people with smaller wrists, smaller joints, smaller ankles are going to have thinner spines, so thinner vertebrae, thinner discs between them and so on. Now, neither is good or bad. They are just different, and they create a situation where people have different needs in order to build a strong, pain-free spine. So for instance, people who have thick spinal segments, so these are people who tend to be more barrel-chested, thick through the torso, maybe thicker wrists and ankles and knees, have thicker spinal segments and therefore may not need quite as much buildup of the musculature around their spine in order to handle vertical loads, okay? Compression along the spinal length, because they have those big, thick spinal segments and discs. It's not to say that they don't need to do any spinal strengthening. They do, but they are generally going to be very stable along the, I'm calling it the vertical axis, but along the length of the spine. Those people, perhaps not surprisingly, are not going to be as mobile in terms of the twisting and bending of the spine, meaning spine mobility along the different axes, apart from that vertical axis that I was referring to along the length of the spine, but twisting and bending is going to be harder for them. Now, at the opposite extreme, you're going to have people with smaller wrists, smaller ankles, smaller knees, and they in general are going to have a thinner spine, meaning vertebrae and discs that are smaller in circumference, and they are not going to have the capacity to sustain as much vertical compression along the length of the spine as somebody with thick spinal segments, but they are going to be more, quote-unquote, bendy, if you will. Now, that doesn't always mean more flexibility. What I'm referring to here is a capacity or a potential for the ability to generate movements in which the spine is twisting from side to side with more ease than would be the power lifter. So imagine at the extremes the thick torso and spine of the power lifter, of the shot-putter, somebody like that, versus the spine of, say...... the yoga teacher, the dancer. They have these smaller wrists, smaller pelvis, smaller knees, et cetera, but they're going to have more ability to twist themselves, their spine. So imagine just kind of like bending over to the side a little bit while looking up, the spine is going to do that very easily as compared to the person with the thicker torso and spine. These two distinctions, and here I'm really making them polarized distinctions, and in reality, there's a whole distribution of thick spine, very thick spine, moderately thick spine, thin spine, ultra-thin spine, and so on. But at these two extremes, you can start to imagine that each of those spines, each of those backs probably has different requirements in order to make it strong and pain-proof depending on the activities that those people are engaged in. Now, of course, a thin spine person can decide to power lift. That can be very good for them, and indeed one of the things that somebody with a thin spine should do, according to Dr. Stu McGill, and I'll reiterate this several times today, is build up the musculature around the spine so that they can stabilize that otherwise bendy spine along both the vertical and side-to-side axis so they don't injure it, they want to make it strong, as well as the person with the thick spine who can tolerate heavy loads around one axis but maybe needs to generate more mobility of that spine so that they don't go reaching for a glass up in the cupboard and (cracking sound) , all of a sudden they have compression of a nerve root coming out the spine because they just twisted it to the side by about five to seven degrees. Both groups have specific needs, meaning specific protocols that they can emphasize to a greater or lesser degree in order to strengthen and pain-proof their spine. So while we can't do an assessment of spinal pain and your exact needs for your particular body type in this kind of format through the tunnel of the internet, you can take a look at yourself or just think about yourself and think, "Oh, do I tend to have thicker wrists, knees, elbows, et cetera? Am I more of a, you know, kind of thick torso person or do I tend to be someone who's more lithe, who's more, um, you know, small wristed, somebody who can move from side to side with a lot of ease but probably can't handle as much what I was calling vertical load along the length of the spine?" And some people have a kind of mixed phenotype, not purely ecto, not purely mesomorphic. I can say that about myself. I have fairly long limbs. In fact, I have, like, almost a sort of like gibbon arms. I have this kind of really long reach, so more a kind of, um, ectomorphic, um, arms, and at the same time I have a short torso, and I am fairly thick through the circumference of my torso. I've always been like that, even before I started doing any kind of resistance training. My legs are somewhere in between, okay? So I don't have small knees or small ankles. They're kind of moderate in that way. My wrists and my arms, probably a bit more ectomorphic, not strong ectomorphic phenotype, but then my torso is a short torso and it's kind of thick through the circumference. That's just the way that my genetics landed me into the world. You have genetics that landed you into the world in a particular way. You can take a look at these kind of external phenotypes about joint size and kind of take- do an assessment just thinking about it, and by doing that, you'll be able to know which protocols, which we're about to talk about, you may want to emphasize or de-emphasize in order to best strengthen and pain-proof your back. So a good analogy that Dr. Stuart McGill offers when thinking about this thin spine versus thick spine thing is if you think about a willow tree, which has essentially a thin trunk and thin branches relative to, say, an oak tree or a redwood tree, the willow tree trunk and branches can bend to quite a considerable degree without breaking. So it's just very bendy from side to side, but they're thin and they can't sustain a lot of vertical pressure, a lot of loads from top to bottom, or else they'll simply collapse. They might not snap to the point of breaking, but they will definitely bend to the point of not being able to bend back. As opposed to the trunk and branches of a full-grown oak tree or redwood tree, which are very thick and very strong and can sustain a lot of loads from top to bottom along this vertical axis, but if they bend even just a tad too far from one side to the next, (cracking sound) they're going to snap and essentially break off. So while that analogy isn't a perfect one to explain the situation with thin spines versus thick spines, I think it gives you a mental image of the general situation for which some people who have the more willow-like spine probably need to build more musculature around the spine in order to stabilize it, but probably don't have to do quite as much work in order to generate more side-to-side flexibility as opposed to people who have a thicker spine who probably don't need to do quite as much work to develop the musculature of the spinal erectors, of the abdominals. It's not to say they don't need to develop those at all. They do, but that they don't need to do quite as much work to build the musculature around the spine in order to stabilize it for vertical loads, but they perhaps want to do more work aimed at generating more flexibility in these planes of motion from side to side and at different angles, you know, relative to the vertical axis. And again, most people don't fall at either extreme of willow-like or redwood-like. Most people are going to fall somewhere in the middle, and as I mentioned before, many of us, including myself, have a sort of combination of more thin musculature and thick musculature depending where in the body you look.

7. 34:58 – 36:29

   Sponsor: AG1

   1. AHAndrew Huberman34:58

      I'd like to take a brief break and acknowledge our sponsor, AG1. By now most of you have heard me tell my story about how I've been taking AG1 once or twice a day every day since 2012, and indeed that's true. I started taking AG1 and I still take AG1 once or twice a day because it gives me vitamins and minerals that I might not be getting enough of from whole foods that I eat, as well as adaptogens and micronutrients. Those adaptogens and micronutrients are really critical because even though I strive to eat most of my foods from unprocessed or minimally processed whole foods, it's often hard to do so, especially when I'm traveling and especially when I'm busy. So by drinking a packet of AG1 in the morning and oftentimes also again in the afternoon or evening, I'm ensuring that I'm getting everything I need. I'm covering all of my foundational nutritional needs.And I, like so many other people that take AG1 regularly, just report feeling better. And that shouldn't be surprising because it supports gut health and, of course, gut health supports immune system health and brain health, and it's supporting a ton of different cellular and organ processes that all interact with one another. So while certain supplements are really directed towards one specific outcome, like sleeping better or being more alert, AG1 really is foundational nutritional support. It's really designed to support all of the systems of your brain and body that relate 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's supply of vitamin D3 K2. Again, that's drinkag1.com/huberman.

8. 36:29 – 44:40

   Tool: McGill Big 3 Exercises, Curl-Up

   1. AHAndrew Huberman36:29

      So now let's discuss the protocols that allow you to strengthen your back. The first three of these protocols are the so-called McGill's Big Three, named after Dr. Stuart McGill who, again, has done a tremendous amount of work in the research and practical realm and has developed a number of different protocols for strengthening and de-paining the spine, but has distilled down three specific protocols that everyone I spoke to in the PT community, in the MD community, for those that specialize on spine, and in the sports community, as well as people who don't play sports but are simply interested in having a healthy spine for sake of daily mobility, all agree are extremely useful for everybody to carry out. Now, the one caveat is that Stu McGill himself has told me that he doesn't want the big three to be viewed as the be-all, end-all of back strengthening and pain relief. By no means is it exhaustive to do just the big three, so I'm also going to include a bunch of other protocols that are gleaned from other practitioners and that Dr. McGill often offers himself in his books, and I'll certainly put links in the show note captions to his books. And again, he'll be a guest on this podcast. But for sake of clarity and simplicity, the big three are as follows. The first is called the curl-up. The curl-up is, in many ways, a replacement for the sit-up. Most people are familiar with ab crunches and sit-ups where you lie down. Typically, people will bend their knees, although not always. They'll often put their hands behind their head or on their chest, and then they'll essentially sit up to contract the abdominals. Turns out that if- if you have back pain, and even if you don't, that is probably the least efficient and perhaps even the worst thing that you can do for your back pain. And if you think about the discs that sit between those vertebrae, remember those soft tissue discs that allow for some mobility of the spine? Well, if you happen to have a disc that's bulging even slightly, that is, it's herniating, it's getting pushed out from between the vertebrae, and it's impinging on a nerve and there's some pain, if you are crunching, you can imagine that's essentially bringing the vertebrae together in the front of that sandwich that is vertebrae, disc, vertebrae, and what it's going to do is it's going to have that disc bulge out even further. It's going to herniate even further and impinge on those nerves even further. So what's required in a situation where you wanna strengthen the back or try and eliminate or reduce pain of the back is a way in which you can strengthen the abdominals because the abdominals and the abdominal wall is very important for stabilizing the spine, and you want a stable spine. That's a very important point. But you want to do it in a way where you're not adding to the herniation of the disc in any way. So the curl-up is an excellent exercise for people who have back pain and who don't have back pain to strengthen the abdominal wall, and it's done as follows. You lie down. You put one knee up, meaning one leg is bent, the other leg is extended. You put your hands, both hands below the lower portion of your back, so in the arch of your back, and you actually want to maintain the arch of your back. That's one of the reasons your hands are there. The head is in a neutral position, okay? So your chin isn't tucked toward your chest. The chin is in a neutral position. And this is important. Your tongue is on the roof of your mouth. This is something I talked a little bit about in my description of neck exercises in a previous video. We're gonna get back to this. But tongue on the roof of the mouth often puts the head into a safe default position. It also allows for breathing, in particular nasal breathing, to be done very easily. So you got your tongue on the roof of your mouth. The mouth is typically closed. And then what you do is you raise your elbows off the ground, and then while maintaining that small of the back, you're going to just raise your upper chest. You're gonna lead with the upper chest, not with the chin and head, although of course the head will follow. You're going to raise the upper chest, meaning raise the upper torso, so the head's gonna move forward, and you're going to exhale and contract the abdominals for anywhere from eight to 10 seconds. Okay? So you get a very strong contraction of the abdominals, but you're not doing a full sit-up. You're only coming up maybe about, I don't know, somewhere between five to 10 degrees. So your back is coming up, the head is coming up, and the chin is not moving towards the chest. It's staying in a neutral position. You're going to repeat that, so meaning you're going to go up, contract for eight to 10 seconds. You're gonna contract the abdominal walls. If you want to exhale, you can usually get a stronger contraction of the abdominal walls, and then you're going to go back down and relax on the floor. Maybe rest 10 to 30 seconds, maybe a minute, and then repeat. Okay? So that's the basic movement, and then you would switch to the other side, meaning you're then going to extend the leg that was bent. You're going to bend the other leg, and you're going to repeat. In terms of sets and repetitions, typically the best way to do this is to do anywhere from three to five sets, starting with 10-second contractions done five times for the first set. So it'd be 10-second hold, then relax, 10-second hold, then relax, doing that five times, maybe four times, but five would be ideal. That would be one set, and then on the next set, you're going to do four repetitions, meaning four 10-second holds with rest in between.And then on the next one, three, on the next one, two, and the next one, one ten-second hold or so. These are just rough guidelines. You certainly don't have to do quite as long holds as those. If you can't do those, you don't have to do all of those sets if you find you're fatiguing. One of the advantages, however, of doing these brief ten-second holds and really focusing on the contraction of the abdominals hard or as hard as you can and then releasing is that as opposed to doing a long hold, just trying to hold as long as you can and building a lot of endurance in the abdominals, when you repeatedly contract a neuromuscular connection, you build the pathways. You basically allow the pathways that can engage those strong muscular contractions to a greater degree than if you're trying to just statically hold that particular position for a very, very long time, like 30 seconds or 60 seconds or longer. Okay? Now, there are a bunch of different variations of the curl-up. You can do the curl-up with the extended leg elevated slightly to make it harder. You can do the curl-up with your elbows positioned closer to the ceiling, so you're, you're really lifting your elbows and arms far off the, the ground as opposed to having them just hovering right above the ground. There are a bunch of different variations of these. We include links to a few short videos in the show note captions so you can see the different variations of the curl-up. It has me doing these, uh, on the floor in my, uh, typical street clothes, so you don't need to get into workout gear to do these. And I should mention that the curl-up is something that you can do every day if it occurs to you and if you have the time. It's something that you would certainly benefit from doing every day, but it's also something that even if you do once or twice a week for even just a couple of sets, you're going to see some benefit in terms of strengthening your back and probably relieving some pain of your back as well. The other terrific thing about the curl-up is if you have back pain and doing the curl-up doesn't aggravate it, you are most certainly doing things to strengthen the musculature around the back that's going to help you avoid more back pain as you work through the different rehabilitative practices that hopefully you're doing with a PT or with a excellent MD who specializes in back pain relief. As the pain dissipates, you're going to be building up the musculature of the abdominals that's going to then further protect your spine, especially if you're one of those people that has a thinner spine that needs more muscular support around the spine in order to support it. Just as a final note about the curl-up, two of the most common errors that people make when doing the curl-up is to make it more like a sit-up and generate a chin-to-chest movement first and let the chest follow. You really want the chest to lead and keep the head in a neutral position, tongue on the roof of your mouth, try and breathe through your nose. And if you find that you can't do the big exhale as you bring it up to the top, don't worry about it. It's perfectly fine to hold your breath as you come up and then just maybe release a little bit of air to enhance the, uh, intensity of that abdominal

9. 44:40 – 53:13

   Tool: McGill Big 3 Exercises, Side Plank

   1. AHAndrew Huberman44:40

      contraction. The second exercise in the McGill Big Three is the side plank. I confess, and I don't know why, I hate doing side planks. I don't know why I hate doing side planks. I just hate doing side planks, which tells me I should do side planks. So, I've started doing some side planks recently after talking to Dr. McGill. I'm fortunate that right now I don't have back pain. I haven't for a while. I'll talk about how I alleviated my back pain, but I spent a lot of time as a 48-year-old thinking about having a strong spine, being able to jump off things and land with confidence, all the sorts of things that set one up for both healthspan and lifespan as has been taught to us by Dr. Peter Attia. Some of you may know Dr. Peter Attia because he's been a guest on this podcast. He wrote the incredible book Outlive, and he talks about how having a strong spine, having the ability to break falls by virtue of training your ability to jump down things and step down things with confidence is essential to offset the aging process. So, I've decided I'm going to do side planks. I'm going to embrace the, uh, spine strengthening exercises that Stu McGill has put forward as the Big Three, and that includes side planks. So, how do you do side planks? Well, most people think that a side plank is just getting on your side, essentially, on the floor, then putting one arm down and stacking your feet on the other side and trying to make yourself as stiff as a plank as you possibly can. And while that is certainly one way to do it, most people find that they are going to get the most in terms of strengthening in their spine and preventing back pain and maybe even alleviating back pain if they build up through a set of incremental steps, making sure that the form on each of the steps is absolutely perfect. So, the way to really start doing side planks, and if you think you can already do side planks, to assess whether or not you're, you're doing them properly, is to start with knees slightly bent, so maybe at about a 30 or 40-degree angle. So, you're on your side, your knees are bent. The feet are stacked. You're of course going to push one arm down, although many people find that putting their hand in a fist as opposed to a flat hand is going to be best. I don't know if, uh, most of you are aware of this, but any time that we generate a fist in either hand, it sets in motion a number of different neural pathways that allow for a firmer contraction of muscles not just within the fist, but elsewhere in the body. Okay? If, um, you've ever heard the great teachings of Pavel Tsatsouline, who I hope to have on this podcast as a guest, he's talked about how if you were, say, to try and squeeze a metal bar or think about just trying to give your friend the firmest handshake you possibly can, you're having that handshake squeeze competition, if you make a fist with your other hand, you're actually going to be able to generate a harder contraction of the shaking hand, okay, or of the squeezing hand. And this is because of the way that we have these bilaterally, uh, wired, uh, nerve-to-muscle connections and the fact that neural activation on one side is related to neural activation on the other side and so forth, but basically what you're going to do for the side plank in order to generate the strongest and most efficient side plank for strengthening and hopefully de-paining your back is to get on the side, bend those knees, put the hand down in a fist position.Okay? Then you're going to push the hips off the ground so the upper body is indeed in a plank position. Then you're going to raise the hips up, and you're going to have to put some considerable effort into pushing the floor away from you. That's really the key here, pushing the floor away from you. Now, if you find that you can do that and you can hold that position for a good eight to 10 seconds with a strong degree of rigidity, so you're not quaking and you're not feeling as if the hips want to collapse down to the floor, something you really want to avoid, especially if you already have some back pain or even a subtle back injury. You wanna make sure that your, your spine is straight, okay, and that those hips come off the ground and you're really in a plank position, right? No bend. If you find that you can do that and it's fairly straightforward for you, well then feel free to then extend your feet out further. Put the top foot on top of the other foot and out to the front, okay? So you're not stacking the feet right on top of one another, with just shoe on top of shoe, but you've got, or foot on top of foot if you're doing this barefoot or in socks. But you've got one foot in front of you for some stability, and then you're generating that long side plank pose and holding that for eight to 10 seconds. Then pause for 10, maybe 30 seconds if you have to, and then repeat again, all of that part of one set, just as we talked about for the curl-up previously. So you're working through the progression from bent legs to straightening your legs. If the top foot is placed in front of the other foot with legs straight, and that's something that you can do for, say, anywhere three to five repetitions of those eight to 10-second holds, which make up one set. Well, then you have the option to make the whole thing more difficult by doing a sort of roll forward where you actually take the part of your shoulders which is on the side of your free arm, so the hand that is not pressing into the floor, and you rotate forward so that your chest is now aiming toward the floor, maybe not to a full push-up position but maybe close, and then back again to the side plank. What you're doing there is you're activating some of the musculature that is for rotation of the spine, okay? And as you do that, you're getting closer and closer to a front plank. And of course, front planks are also an excellent way to generate spine stability. Most people can do a front plank by resting on their forearms. Why start with the side plank? Well, there are a lot of different reasons for that. But what you'll realize is that when you're doing a side plank, you're actually only really loading half of the spine maximally. The other half of the spine is not being loaded maximally 'cause it's the side of the spine that's, that's up. And of course, that's a reason why you want to do these on both sides of your body, right? So what's the sets and repetition scheme that's going to work here? Well, if you're like me and you loathe doing side planks and you find that they do take a lot more effort than perhaps, uh, you would like, either psychologically or physically, then for me, what I've been doing is one set consists of three 10-second holds. I've been doing these with knees bent, although I've now progressed to the point where I can do one foot over the other and resting that top foot, um, across the bottom foot, so legs straight. Doing that for three 10-second holds to make up one set and doing that for two or three sets on one side of my body, two or three sets on the other side of my body. So slightly different than as I described for the curl-up, where it was descending repetitions, where, you know, the first set you're doing five 10-second holds, next one four 10-second holds, next one three, two, one. For the side planks, I don't like them enough that I just prefer to do two or three sets of three 10-second holds on each side, although I'm starting to enjoy them just enough that I might progress to the kind of what's called reverse pyramid, where you go five, five, four, three, two, one, this sort of thing, increasing the number of sets. And again, I have a link in the show note captions that shows you how the side planks are done in these different variations. I should mention that the most common mistake with side planks is letting the hips sag. So if you don't push the floor away from you enough, if you're not stable enough through the foot contact with the floor or the leg contact with the floor, if you're doing these with knees bent, even if you go to, like, straight, and you consider yourself very, very strong in the side plank, if the hips start to sag, you can imagine, based on what you now know about back anatomy, right, the spinal cord being this, um, kind of snake-like extension out the back of the brain with the vertebrae as segments and the discs in between them, if that's sagging, well, especially if you have an issue with a disc bulge and some impingement on one of those nerve roots either coming into or out of the spinal cord, you're going to get into some trouble, meaning it's going to cause some pain or at least some aggravation. So the goal is to get that spine really straight as you're doing the side planks, regardless of whether or not you're doing that with knees bent or you're doing it with legs straight. In fact, that's the reason I went through all of that anatomy earlier, so that as you're doing these exercises, whether or not it's the big three or the other protocols I'll talk about, you can really envision the major components of the spine that are getting engaged, okay? It's not just about the abdominals and the obliques and the lower back. Of course, it's about all of that. That's what you're exercising, but you're also getting the neural engagement within the spine. You should think about the vertebral segments, the discs, the fact that those nerve roots need to run in and out of the spinal cord, out past the bony and disc material, and to do that without impingement. So as you do these movements, it can be very beneficial to think about the different anatomical features of the back, including spinal cord, vertebrae, discs, nerves, et cetera, but mainly those. And as you're doing that, you'll not just be strengthening your back. You'll also be strengthening your learning of neuroanatomy. So

10. 53:13 – 1:04:10

    Tool: McGill Big 3 Exercises, Bird Dog; Back Pain

    1. AHAndrew Huberman53:13

       the last of Stu McGill's big three. Again, Stu kind of cringes every time people say, "Okay, it's just McGill's big three," and that's back strengthening and pain relief, and he always just kind of, "Ugh." I can tell it pains him, uh, no pun intended, because he knows and it's true that there's a lot more involved in strengthening and pain-proofing the back. But always good to have a great place to start, a simple place to start, and something that's really tractable without equipment or any cost. And so we're very grateful that Stu is willing to kind of resist his temptation to be, um, beyond nuanced and thorough, which he always is, and offer us...... the curl-up, the side plank, which we've covered, and now the third, which is the bird dog. The bird dog, as some of you may know, is where you get into all fours on the ground. (clicks tongue) You extend one arm forward, and you extend the opposite one leg backward, okay? So if you're down on all fours and you extend your right hand in front of you, you're going to extend your left leg behind you. Now, there are a couple key things about this. One is, again, have the extended hand in a fist. Why? Because you want to generate a strong neural contraction so that you don't forget and, in fact, facilitate keeping your upper body parallel to the floor, so no tilting from side to side, or as best you can. And you also want the neural activation to allow you to then engage the lift of the leg in a way that's also very strong and stable, okay? So nothing floppy, no leaks, as they say. A key point is to make sure you don't raise the leg too high. You're not trying to arch your lower back. In fact, what you want to do is raise the hand in front of you, generate that fist. It can even just be out in front of your, your eyes at first, maybe a little bit higher, and then the leg that's extending toward the back, feel free to either point the toe toward the ground, or if you want to extend the toe a little bit, like you're doing a little bit of calf raise in the air, right? Pointing your toe, that is. That's fine too. But don't get that heel up too high or even the upper thigh up too high that you're getting a really big arch in the back. The idea is to envision one long line between the extended arm and fist all the way back across the midline, because it's to the opposite leg, and to the foot behind you. Again, it's about creating a strong, stable reach, a strong, stable lift of the foot, but not too high, and this is very important, with the hand that remains planted and the knee that remains planted, pushing the ground away from you. Okay? That's as important as is the lifting of the arm, the clasping of the fist, and the raising of the leg. In all of these movements, the pushing of the ground away from you, the resistance to gravity is as important as whatever movement you happen to be doing. Again, this is a terrific movement for strengthening the spine that most people can do, because you're only working one half of the musculature on either side of the spine, okay? There's of course activation of the musculature on the other side to some degree in order to balance things out, but by emphasizing only one half of the musculature, A, you can really focus on the contractions. Again, you can really put a lot of mind into the pushing of the floor away. You can put your mind into where the fist is and your foot is, and of course, you can generate the kind of hard contractions that are really going to strengthen those lower back muscles, as well as the upper back and shoulder muscles that are required for generating stability of the spine. Again, that's really what this is all about. Again, it's going to be maybe three to five repetitions of eight to 10-second holds for one set done for repeated sets, maybe for a descending number of repetitions where you're going five holds, four holds, three holds, two holds, one hold, all of that being done repeatedly and with the greatest amount of intensity and focus so that those nerve pathways can be engaged over and over again very easily, generating a lot of strength of contraction that then, of course, carries over into your exercise activities and even just your passive activities throughout the day, and even stability of the spine while at rest, which is something that we're going to talk about more as we get into some of the other protocols. Now, of course, with the bird dog exercise, you also need to train the opposite side of your body. So after doing, say, two to five sets of those two to five repetitions of eight to 10-second holds on one side, you're going to want to switch to the other side and do the same thing, or you could alternate. You could do right hand extended, left leg extended, do one set, then switch to the other side, left hand extended, or I should say left fist extended, uh, right leg extended, do those repetitions, call that one set, and then shift back to the other side, and so on and so forth. Really depends on how much time you have, how frequently you're doing this throughout the week. Again, right now, I'm striving to do all of Stu McGill's big three at least once a week, maybe twice a week. I know many of you will say, "Oh, that's pretty wimpy. You know, you should be doing this every single day or five times a week." Well, I have a busy schedule, just as many of you do, and it's something that I'm trying to incorporate more and more, typically at the end of a workout, although some people decide to do this at the beginning of a workout. Right now, fortunately, I'm not dealing with any back pain, knock on wood, but it's something that, for many people who have back pain, they find that if they do it, this at the beginning of a workout, it allows them to then move into the workout warmed up and to avoid a lot of the back pain they would otherwise experience. With that said, I want to be very clear that if any of these movements exacerbate your back pain, then you should definitely avoid doing them, and of course, if you have back pain, you should be working with a licensed professional to figure out how to treat that back pain. You may very well need pain meds and/or surgery. I don't know, because I don't know your specific circumstance. But for most people who are just trying to strengthen their back, who perhaps are dealing with a little bit of nagging back pain, the big three are often very, very accessible, meaning they don't exacerbate back pain, and in many cases, they alleviate it, sometimes partially, sometimes completely. There are a lot of wonderful anecdotes out there of people who have benefited from doing the big three in all of those categories. Now, again, we have a link in the show note captions showing how the bird dog exercise is done. There are a couple of variations that you can do to make it harder. One is to draw boxes with the extended fist and the extended foot. That's actually a coordination issue, too, for some people. So some people choose to do a box with their hand. Maybe they do it clockwise, then they do it counterclockwise. Some people choose to do the hand and foot moving in a box together, meaning simultaneously. Sometimes they'll alternate foot, then hand, this sort of thing. Any kind of movement that you're doing with the extended fist and/or foot is going to add some degree of difficulty to this.But you want to make sure that if you're going to add those movements, those progressions, that you're keeping the pushing away of the floor constant throughout, and that you're keeping your torso parallel to the floor as you go. Now, when I say parallel, I realize that as you do an extension of one fist or the other fist, as you kick out that back leg, it's going to be near impossible for most people to stay perfectly parallel to the floor. What you're trying to do, however, is to make sure that you're not rolling from one side to the next. You're trying to make sure that you don't get tilted onto the stabilizing shoulder hand side. Okay? So, that's what's really important. You can also, if you really want to make it difficult, you can start to take the extended hand, fist that is, and reach back and then touch the knee that was a few seconds ago extended, so you can do that in kind of a, a kind of reaching back, touching the knee, then ex- re-extending the leg. You can do that for one side, both sides, et cetera. Again, there are a number of different progressions that, um, I do in the video. I must say, these are challenging for me, especially doing more than three sets. After you've contracted your muscles really hard in the way that you're supposed to for these exercises in the big three, you're not going to have the sort of fatigue that you experience after sprinting or after doing heavy deadlifts or something of that sort, but it's a certain kind of fatigue that prevents you from performing the movements properly. And so the whole point here is to perform the movements properly, to build a pattern, what's sometimes called an engram, but basically it's an activation pattern of nerve to muscle, and the resulting limb movements that allow you to do the movements perfectly. So, don't be in a big rush to do tons of this stuff right out the gate. Be in a rush to do as much of it as you can perform properly, and consider it a progression and something that you're going to keep up, not just for a week, not just for a year, but it's something that you're going to do for the rest of your life. Even if that means doing it just once a week or once in a while, learn the movements properly. That's the most important thing. And of course, I'd be remiss if I didn't mention the common mistakes that people make when they do the bird dog. One is people will often raise that front fist way too high, okay, so they're reaching for the sky, or they're kicking way too high in the back. They're generating a sort of bow shape from extended fist to extended back foot. That's not good. You really want to raise these things up as stiff, straight levers, while also maintaining, as much as you can, parallel to the floor stance and pushing the floor away. This is about generating strength of contraction and, I know the word sounds bad, but rigidity. It's about generating stiffness in the spinal muscles and in the abdominal muscles and in the upper back muscles and the other muscles that are required for this. And when I say stiffness, I don't mean a lack of ability (laughs) for the muscles to move once you're in sport or once you're about your daily activities. What I'm talking about is an ability to generate a really firm muscular contraction so that those nerve pathways are strong so that you can stabilize the spine in any number of different dimensions and planes and orientations as you embark on your daily activities, sports activities, et cetera. That's what all of this big three stuff is about. It's about strengthening the musculature of the abdominals, of the lower back, of the shoulders, and everything that connects it neurally. Again, these are pathways. It's something that I should have said earlier and didn't, which is we often experience pain in a given location, like lower back pain or pain in the lower back and down the hip into the leg, but pain is always the consequence of a pathway being irritated or a pathway being activated, and in order to strengthen the components around the back, to strengthen the components of the back to avoid pain, you want to work pathways. And so the big three that Stu McGill has developed is really about generating the kind of muscular strength and stability, the neuromuscular activation patterns, and doing it in a way that is generally safe for most people to perform to get the strongest and most pain-free back possible. And what I just described might sound like a lot of exercise. It's actually something that, if you decide to just include one or two sets of each of those, curl-up, side plank, bird dog, you could complete in anywhere from five to 10 minutes. Again, if done once a week or twice a week or as a warmup before, you know, weightlifting or at the end of, say, a cardiovascular training session, maybe even while watching TV or listening to a podcast or something of that sort, it actually doesn't take that much time at all and, of course, doesn't require any equipment, and it can be done in essentially work or street

11. 1:04:10 – 1:05:37

    Sponsor: Plunge

    1. AHAndrew Huberman1:04:10

       clothes. I'd like to take a quick break and acknowledge one of our sponsors, Plunge. Plunge makes what I believe is the best self-cooling cold water plunge. Over the last decade, and especially in the last five years, there's been an increasing amount of excitement about cold water plunging for sake of mental health, physical health, and performance. And that's in large part because one of the most robust effects of cold water exposure are big increases in adrenaline, also called epinephrine, and dopamine. So, while some people do cold water plunging in pursuit of increasing metabolism or reducing inflammation, it's really those big increases in adrenaline and dopamine that lead to those long-lasting increases in alertness and feelings of well-being, not just in the seconds or minutes after the cold plunge, but indeed for several hours afterwards. I've been using a Plunge for several years now, typically first thing in the morning or after cardiovascular training. I do agree that doing cold water plunging after a workout designed to generate hypertrophy or strength gains is not a good idea, but doing cold plunging at the other times of day can be tremendously beneficial. I use the version of Plunge called the All-In Ice Bath, and Plunge now also makes saunas that get up to 230 degrees Fahrenheit. I love how the Plunge ice bath and sauna can both be controlled from an app on my phone, so that if I'm headed home, I can turn on the sauna, and it'll be hot when I arrive. So, if you would like to try a Plunge ice bath or sauna, you can go to plunge.com/huberman to get $150 off either product. Again, that's plunge.com/huberman.

12. 1:05:37 – 1:10:34

    Tool: Back Pain & Oreo Analogy, Bar Hang

    1. AHAndrew Huberman1:05:38

       Okay, so before I get into some of the other protocols for strengthening the back...... which largely center around building strength into the stabilizing muscles and parts of the body that allow the spine to move through different planes of motion safely, I wanna talk about two protocols that one can use to alleviate back pain that many people find beneficial. Now, all this goes back to this thing about vertebrae, disc, vertebrae, right? That's the alternating sequence along the length of the spine, and again, the vertebrae are bony tissue, so it's hard stuff. The discs are softer, all right? It's got some durability to it, but it's a softer tissue, but it allows for pliability of the spine because it's a soft tissue. So imagine an Oreo cookie, something that, um, I'm not a fan of eating. Um, I don't like the way they taste and I'm told, uh, they're probably not good for us. But in any case, if you like Oreos or you don't, it's a good analogy here, where you've got the two cookies and the cream center. So the two cookies are analogous to the vertebrae here and the cream center is analogous to the disc. If you squeeze the cookies evenly from top to bottom, the cream center is gonna move out towards all sides along the full circumference, right? So all the white stuff is gonna move towards the edges more or less equally. If you squeeze just on one side, right, the cream filling is gonna move out toward one side. If you squeeze on the other side, the cream filling will move out toward the other side. And of course, if you were to crush the cookies from top and bottom, or even just the top cookie or the bottom cookie, the cream filling is gonna go up and through. That would be equivalent to the rupturing of the disc along that dimension. Okay? Why am I mentioning this? Well, as I said before, a lot, not all, but a lot of back pain has to do with compression or impingement of nerves at some point along a pathway, sometimes multiple points along a pathway. And one of the most common sources of back pain is when those discs are bulging, they're herniating, and they're impinging on a fascicle of nerves, a bundle of nerves. So two of the things that many people find beneficial when they're experiencing back pain are first, if you can find a bar or something that you can hang from, but don't worry, you're not going to have to actually hang in a full dead hang position. If you don't have the strength for that, or even if you do, the idea here is to get your arms overhead onto a bar. You're holding onto the bar, and your legs are going to drape down and your toes are going to be in contact with the floor. So we're not talking about a dead hang here, okay? Which actually requires that you engage some muscles that can actually aggravate back pain. What you're doing here is you're going to hold onto the bar. You're in more or less a hang, except that your toes are supporting you, or your feet, or sometimes your heels are supporting you. What you're trying to do is get lengthening of the spine. Basically what you're doing is the opposite of pressing down on those spinal discs, and you're going to do that for anywhere from 10 to 30 seconds. You're not going to twist, okay? You can imagine how twisting of the spine could be bad depending on where the bulge is and which nerves are being impinged. What you're trying to do is just create length along the spine to relieve some of that disc bulging which is impinging on the nerves. Again, without knowing the source of your back pain, it's impossible to know whether or not this will help or it won't, but many people get some degree of pain relief by doing this. Of course, you need to be cautious in how you do it. You don't want to hang for a long time if you don't have the strength to do that while trying to find the distance to the floor with your toes. You're going to want to progress toward this very carefully. But this is something that many people find beneficial. It's also the kind of logic behind, you know, inversion tables and these, um, kind of, look more like, um, kind of chair apparati where people, uh, have designed chairs that then can invert so that people can relieve some of the pressure on their spine. I've personally never tried those inversion chairs. I did used to have an inversion table that I had out on my deck in the morning, and I liked to, you know, lock my ankles in and in- and invert on that thing. It was kind of fun. Keep in mind, if you're going to do any kind of inversion, you are going to generate intracranial pressure. If you're somebody, and I feel obligated to say this because I'm a vision scientist and I worked on glaucoma for a number of years, which is intraocular pressure, if you have glaucoma or you're predisposed to glaucoma, you're going to increase ocular pressure if you're inverted in that way or any way. So keep that in mind. You would want to avoid that in those cases. But for many people, just generating some degree of lengthening of the spine by hanging from a bar or from some other physical object that's sturdy while keeping your toes or your feet or your heels in contact with the floor, so you're just kinda lightly touching there so that you can keep that going for anywhere from 10 to 30 seconds and then just kind of relax, let go, maybe walk around a little bit, and then repeat, doing that two or three times. Many people experience some degree of pain relief from doing that for all the reasons that now should be logical and obvious to you based on your understanding of spine anatomy and physiology that we talked about earlier, and the general theme of just trying to relieve compression that is herniation of the discs.

13. 1:10:34 – 1:21:28

    Time & Back Pain; Tool: Reversing Disc Herniation, Cobra Push-Ups

    1. AHAndrew Huberman1:10:34

       Now, what about reversing herniation of the discs? Okay. So this is something I'm very familiar with, and I have an anecdote here that, of course, just relates to my experience, so it certainly doesn't carry over to everybody. But it's an experience that I've shared with a number of people who've also experienced lower back pain to some degree of success, and the story goes as follows. A few years ago when I was in Seattle giving a talk, I decided to go to the gym that morning, and I did an exercise which was not a deadlift. It wasn't anything spinal really. It was kind of a reverse bench dip that I do for my triceps. I've always enjoyed doing these. I've always, um, been able to do these completely pain-free. But that morning, I got ambitious and I put a couple, um, plates on my lap in order to do them, and I don't know exactly when it happened, but as I was doing these bench dips with the weight on my lap, something felt like it, quote-unquote, went in my back. Something, something felt off. I, I don't know what happened, but it felt like a little, kinda like a little, uh, pull or something of that sort. And when I stood up, I felt okay.And then as I started to walk around a little bit more and went through my workout, I thought, "Uh-oh, s- something happened back there. This is not good." And what essentially was happening is I was experiencing pain on my kind of lower and mid-right side of my back down the hip, so intense pain at the hip socket and down the leg, kind of what some people might describe as classic sciatica or something similar to that. I thought, "Oh, goodness, this is not good." And as the morning progressed, I was having a harder and harder time not walking, walking was okay, but if I sat down and then I need to stand up, it was incredibly painful. And I thought, "Oh, no, this is it. I really did something bad to my back," so much so that I was literally bent over at about 20 or 30 degrees walking back to the Space Needle in Seattle, 'cause we were giving the talks, um, up in the, one of the rooms there. I don't know if it was the top room, but one of the rooms at the Space Needle, and I could barely walk up to the Space Needle. I was just, you know, hunched over. It was miserable. Now, eventually what happened was I was able to fly home. I was in a ton of pain. I started reaching out to colleagues of mine that work on the back, that understand pain. They were suggesting painkillers. I personally like to avoid taking painkillers unless I have to take them, and I basically don't take them. I might take an aspirin every once in a while, but I really like to avoid taking painkillers. That's just me. I don't judge those that need painkillers. But basically in talking to medical colleagues, I thought, "Okay, maybe I'm going to need a corticosterone shot. Maybe I'm going to need to just wait it out." And keep in mind that a lot of back pain does relieve itself if people just wait it out and avoid the movement or movements that caused or exacerbate that back pain. This is something really important to know. A lot of back pain will just relieve over time. But I wanted to stay active, so I started reading online, as one does, and I even started doing some abdominal strengthening exercises. At the time, I wasn't aware of the curl up, and instead what I was doing was some crunches, so I was doing sit-ups, which, you guessed it, made things way, way worse for the obvious reasons. It was actually causing more of bulging of the discs that were impinging on those nerves, bulging out the, I guess it would be the back side of the back, the posterior side of the back. At the time, I didn't really understand disc anatomy and vertebral anatomy in a way that would tell me that the sit-ups were gonna cause that problem, but they were making it worse and worse. Eventually, I crossed paths with a PT who said, "Absolutely stop doing any

Episode duration: 2:08:03