Protecting Spinal Health When Working From Home - Dr Stu McGill | Modern Wisdom Podcast 270

1. 0:00 – 0:45

   Intro

   1. SMDr Stuart McGill0:00

      ... you cannot sit hour upon hour and expect to be pain-free. I, I shock people sometimes by saying, "You behave and you deserve your pain." And that really is, it's a psychological technique to really shock them. "How dare you say I deserve my pain? No one deserves this." And I say, "Well, actually, through your behavior, you're not feeding the signaling process that your body requires to be pain-free."

   2. CWChris Williamson0:31

      Dr. Stu McGill, welcome to the show.

   3. SMDr Stuart McGill0:33

      (laughs) Thanks so much, Chris. A little bit of, what's the word now? Familiarity. And, uh, I know I'm going to enjoy this, so I'll just let you work your magic.

2. 0:45 – 1:56

   Meeting Dr Stu

   1. SMDr Stuart McGill0:45

   2. CWChris Williamson0:45

      Thank you. Yeah, for everyone who's listening, uh, you've been on the show before, Stu, and in between then and now, I decided to take a pilgrimage up to see you two hours north of Toronto. So at the end of a road trip last year, I had been driving around a fair bit, so I'd got used to driving on the, the wrong side of the road. Uh, flew on my own to Toronto, the first time I'd ever set foot in Canada. Didn't realize I needed a different visa to that of the US. So got stopped at the border, had to sort a thing out. Got into Toronto on a different flight, got a car, went up and stayed near Gravenhurst, and then came to see you and went out on your boat and you did a huge, big, long assessment and, yeah, we've been, uh, we've been in contact ever since. So it, it definitely feels like, um, long overdue fondness, I think, today. Uh, and one of the first things that I wanted to discuss is just how different everybody's routines have become at the moment, that everyone's life has changed an awful lot since we last spoke, which is about 18 months ago, and people are, are working from home, they've got different desks, they've got different routines, uh, perhaps with no gym, restricted exercise regime. What do you see as the biggest risks to spinal health for everyone in this new world?

3. 1:56 – 3:07

   Too much sitting

   1. CWChris Williamson1:56

   2. SMDr Stuart McGill1:57

      Yeah, well, there's no question that, uh, it's too much sitting primarily. When you look at not only spinal health, but cardiovascular health, mental health, every single one of those systems requires appropriate movement for optimal health. Force movement really is one of the major languages of cells, and when they are starved of signaling, they will decline and, uh, lose optimal health. So that's a, a short and sweet answer.

   3. CWChris Williamson2:33

      People are being sat down a lot at work as well though, right? Is it just the little movements in between? Is that making that much of a difference? The walk to the car, the little set of steps to go up to the office?

   4. SMDr Stuart McGill2:45

      Well, I don't think that's nowhere near enough. Uh, that's a, uh, a very soft pedestrian life if we're down to the short strokes of the basic physical challenge of their life is walking to their car. So, uh, we didn't evolve, uh, to have optimal health with that level or lack of stimulation.

4. 3:07 – 3:45

   Old world vs new world

   1. SMDr Stuart McGill3:07

      So...

   2. CWChris Williamson3:08

      My thinking is, what's the difference between the old world and this one? People are sat perhaps now in their houses, but the only difference is they're sat in their house instead of in an office.

   3. SMDr Stuart McGill3:18

      Uh, yes, and they get up in the morning and they go to their home office and they don't go outside for a walk, which at least they did, uh, before. And, uh, there's just no question about it. The longer you sit, the more accumulated stress in your body. And, uh, I, I think it's showing on, on many levels.

5. 3:45 – 11:45

   Common issues when working from home

   1. SMDr Stuart McGill3:46

   2. CWChris Williamson3:46

      Let's talk specifically from a, a spinal position then. A lot of people will have reconstructed home offices, uh, perhaps not with the perfect lumbar support chair that they may have been given at work or an office environment. What are some of the things that you think people should absolutely steer clear of? Or what are the most common issues that you can imagine when someone's recreated their working environment at home?

   3. SMDr Stuart McGill4:12

      Well, I know what works for me, Chris. So I'm, I'm an older fella now and what works for me now wouldn't have worked for me when I was in my 30s. But if you wanna talk about that biblical training week, uh, we can. It's, it's, uh, that would be a personal answer. But a generic answer is what I think you're looking for. And, uh, it's a matter of managing demand and capacity. Uh, and there, there really is a minimum demand that's needed. So people need to artificially create that demand in their lives. Uh, uh, institute, uh, movement blocks throughout the day. I will often say to, uh, patients, "Every time you eat, go for a 15-minute walk." It's non-negotiable. You build it into your program. Uh, there's nothing stopping them from doing, uh, a round of the big three exercises which you're familiar with, a few push-ups, uh, going climbing the stairs, uh, a few air squats. Uh, you know, you cannot sit hour upon hour and expect to be pain-free. I, I shock people sometimes by saying, "You behave and you deserve your pain." And that really is, it's a psychological technique to really shock them. "How dare you say I deserve my pain? No one deserves this." And I say, "Well, actually, uh, through your behavior, you're not feeding the signaling process that your body requires to be pain-free." So, um...... you know, we can get into the subcategories of people who, well, they will, uh, sit at their desk far too long, uh, without interruption, and then they go and have a absolute blowout, a physiological blowout for 45 minutes, either in their basement or in their, uh, home gym. And, uh, that is not, uh, optimal either if they are seeking, uh, minimum pain and optimal function. So e- everyone's a little bit different, but those are some of the, uh, big rocks. Uh, if I can coin Gray Cook, who, uh, is, is well known, he's, he's very good at making things simple, and Gray says, "Move well and move often." You know, it's a wonderfully simplistic way to, to put it, but there's a lot of wisdom behind it.

   4. CWChris Williamson6:44

      You described-

   5. SMDr Stuart McGill6:46

      (laughs)

   6. CWChris Williamson6:46

      ... the old world of me, the, with someone who is incredibly sedentary for long periods of time and then would consider that a barn burner of a workout for an hour to 90 minutes... I remember, uh, for a long time, I was going and working in Manchester, which is around about a two-and-a-half-hour drive from where I am now. The car that I have is a small coupé, it's quite low down, uh, I didn't have my Lumbar, which is a, a lumbar support pillow, uh, that you can slot behind your back to maintain a, a nice S-curve in your lower back, um, and I would go from working all day, I'd be sat at my desk, sat down, I didn't have a standing desk as I do now, sat down working, I'd go into CrossFit, I'd warm up, I'd do my 10 minutes of, of warmup, I'd d- do whatever the workout was, and then I'd go and quickly change into some different clothes 'cause the other ones were all sweaty, and then go and sit in my small coupé for two and a half hours as I cooled down. That would be my cool down. Um, or maybe I'd put the heated seats on at sort of a mid-range and I'd, I'd cool down more slowly. Uh, and that would be the way that I did it. And now, thinking back, it was, it was simply a matter of time. Every time that I decided to do that, I was rolling the dice of what, what my physiology, how my physiology was going to respond to two periods of extreme, uh, sedentariness with one of extreme intensity slotted in the middle. And, um, yeah, "You deserve your pain," is a, a difficult pill to swallow, but I think I'm getting towards, "I caused my pain, I'm, I caused my pain, I deserve my pain," is the next level that I need to get to in terms of acceptance.

   7. SMDr Stuart McGill8:28

      Well, that- that's, that's a psychological tool that I use to shock them into a behavior change. And when I say, "You deserve it," uh, intoned in that is that it's in your control. "You deserve it." It's in your control. So now undeserve it. Change your behavior and make damn sure you don't replicate that perfect storm.

   8. CWChris Williamson8:53

      How-

   9. SMDr Stuart McGill8:53

      But it's a way to empower them, but I, if I just say it, you know, l- look at you. I would put you in, uh, as a typical CrossFitter, and when you look at the CrossFit community, you do not find sloths in the CrossFit community. They are all very keen people, they are very encouraging people, but it's always encouraging to more and the next level. Seeking biological optimums is usually not in their mindset. So, uh, they would tune me out if I said, "Oh, I think you should change your programming a little bit." "Wait a second, I need my personal best." You see, that's the philosophy that's, that's fed in the culture. And so I have to shock them a little bit and say, "You know, biology isn't infinite. You violated a principle of biology and, uh, you cannot have five personal bests in a year. Biology does not allow it." Um, so you're, so do you see what I mean? It's, it's a bit of a shock, but that's the level of shock that with certain people... Now, if, if there was someone who had a very timid personality, where you will not find that person at CrossFit, it's, it's, it's just the culture and the nature of the beast. The very timid person, I would never say, "You deserve your pain." Now, that's a very different playacting, uh, where I would be very sympathetic and quiet and, uh, show them, prove to them, that they- we can shift the locus of control. And every time they get pain, instead of recoiling from it with the attitude of a victim, "Oh, why me?" You know, I would never say, "You deserve this," to the victim. But I would show them, "Here is your pain. Understand that. Now here's the antidote to that pain. Try it. Ah, you just accomplished getting off the toilet pain-free. You just a- accomplished working on your computer for 20 minutes pain-free. Wasn't that magnificent?" So pa- so the pain is no longer the tyrant that turns them into the victim. The pain now transforms into a tutor. And, uh, they'll say, "Okay, I get it. I understand now that because I did this, I got pain. Let me go back and repeat that task with the new engram, that new way of, of moving, and, uh, I just accomplished that without the pain. I am now empowered, I'm no longer a victim, I'm in control." So do you see? There's two psychological extremes and they would require two very different types of psychologically based, uh, if, if I use the word trickery, or just good coaching, really.

6. 11:45 – 13:43

   Back pain

   1. SMDr Stuart McGill11:46

   2. CWChris Williamson11:46

      This may be a, uh, biased question given your background in spinal health for many decades. Is back pain the most debilitating sort of injury that people can get, that people will commonly have?

   3. SMDr Stuart McGill12:01

      Well, I guess that would depend on who you talk to. Uh, you know, certainly some athletes will tell you that when your back is, uh, knackered, you can't do anything. There are many people who do, uh, physical work who will tell you that. Now, I spent my career for the most part as a professor. I could have a knackered back and it wouldn't matter. I could still do my job. But if I was a construction worker, it would have been impossible to, uh, do my job. And, um, so do you see? I guess it, it needs, uh, uh, context because having a bad hip and a bad knee is no fun either. But, um, anyway, there's, uh-

   4. CWChris Williamson12:48

      Depends on what the demands are. What-

   5. SMDr Stuart McGill12:50

      Yeah. And, you know, a- again, I could take it into an ex- uh, there's just different ideas that are popping into my head as you're saying that. Say we took a strength athlete who had, uh, some spine instability as their major mechanism for their back pain. Well, when they're under a load, they might be performing a feat of strength, uh, if the body detects a little bit of joint instability, it not only gives them pain, but it entirely shuts down their neural drive. So, they fail on the next repetition or they fail mid-lift. So there's, there's much bigger consequences. But, you know, I could say that with, with, with a bad knee if, if the brain senses the unstable knee, say they're ACL deficient, it shuts down the knee, they buckle, they walk with a limp, et cetera. So,

7. 13:43 – 15:51

   Back pain in the trenches

   1. SMDr Stuart McGill13:43

      it's hard to say, isn't it?

   2. CWChris Williamson13:44

      Mm-hmm. Back pain, as someone who is absolutely, uh, uh, in the trenches as, uh, this sort of heritage of, of suffering with lower back discomfort, is very difficult to escape in a way that I'm not sure the other pains would be. Perhaps in the hip as well, but as you start to move out towards the extremities of the body, there's particular positions usually you can get yourself into. And I've just had an Achilles rupture repair.

   3. SMDr Stuart McGill14:11

      I know. (laughs)

   4. CWChris Williamson14:12

      (laughs) Certain, certain positions for that were quite uncomfortable, but other positions for, I could hide it away. And I could get myself into some places you can imagine I've got to go into that elevated position, that was a, that became a little bit uncomfortable on my back. So I needed to do an adapted, um, moon boot big three variation where I had, uh, to try, to try and reinforce that stability. But back pain to me is the one that it's just so inescapable. You can get it when you're lying down, you can get it when you're standing up. It's always there reminding you that you're injured, you're injured, something's not right, you've got instability, you've got fragileness, you are not robust.

   5. SMDr Stuart McGill14:58

      Well, if the person has not seen a very competent clinician, uh, who has the skills to really assess the mechanism of their pain to create a precise and accurate diagnosis that will lead them to an effective intervention, yeah, th- they, they just feel helpless. And, and truth be known, when you speak to a lot of clinicians, they say, "I fear when a, when a back pain patient comes through the door 'cause I don't know what to do with them." You know, look at the medical education. Medics really get no education on how to deal with a back pain patient. When you see what goes on in physical therapy schools now and how little they get on mechanical back pain, it's, uh, they're ill-equipped in my

8. 15:51 – 17:11

   What is unique about the spine

   1. SMDr Stuart McGill15:51

      view.

   2. CWChris Williamson15:52

      Is there something unique about the spine or would it be, w- would a clinician say the same about knee pain or ankle pain? Is there a particular hole in their understanding or a complexity that they need to get to?

   3. SMDr Stuart McGill16:07

      (sighs) I've given that so much thought and I still can't converge on an answer. You know, I remember when I was training students and, uh, they, they would say to me, "Oh, well, why did you choose the spine? It's so hard." And I said, "Geez, uh, the sp- spine's easy for me. Why did you choose the shoulder?" (laughs) And, uh, anyway, uh, I, I, I, I just don't know but it just seems there's so few masters of the craft these days. And masters of the craft in anything. Uh, you know, I, a colleague of mine showed me a video the other day of the coopers at Guinness Brewery in Dublin. So these are the fellas who make the barrels. And it was an old video from the, uh, '40s and how those, uh, craftsmen spent their lifetime to become a master cooper. Well, you know, technology these days just doesn't allow very many to become a master of anything, but, uh,

9. 17:11 – 18:49

   Old school approach

   1. SMDr Stuart McGill17:11

      you know, I-

   2. CWChris Williamson17:11

      That was one thing, that was one thing I was very struck by when I spent I think on, in total around about 36 hours with you, uh, last year, uh, actually a year and a h- a year and a half ago now. One of the things I was struck by was something you said to me, uh, around social media, and I think that it was something along the lines of there are no masters of the craft who are also posting online. And this, you could call it old school approach, I suppose, to dedicating to narrow and deep, especially in something that although you might find it easy, I think it is, the spine is a complex mechanism to work out what's going on. You had to do a lot of experiments to find out the things that you now understand. Um, if you're going to take on a task like that, I do think that it requires you to... (laughs) I think if you're gonna take on a task like that, it requires you to go narrow and deep. And-... I also am concerned about what the long-term outcomes of degradation of focus and increases in stimulation are. I worry that we're not going to have any savants over the next 25 years, because everybody's just one button press away from giving themselves a little dopamine kick.

   3. SMDr Stuart McGill18:33

      Well, certainly in the medical field, I would agree with you 100%. I think the orthopedic assessments of 30 years ago were far more competent than what is current practice today. Sad to say, isn't it?

10. 18:49 – 23:10

    Story time

    1. CWChris Williamson18:49

       Especially when we have potential increases in sedentary-ness and the demand of patients is higher and the ability of clinicians is lower.

    2. SMDr Stuart McGill19:00

       I can tell you a story, Chris, and stop me if I've told you this. But there was a police officer from your area of the world, Newcastle. I was asked to see him as a patient and this was, uh, a police officer who was a veteran, a very tough man, uh, a man with experience, a physical man. And he went to the NHS and not once did he get a thorough assessment of what was going on in his back. And he was given very inappropriate, you know, here's a list of exercises on a piece of paper. Go away and do them with no coaching. Uh, no coaching on how to reduce the cause through his daily lifestyle. And it got so bad that, uh, he couldn't do his job anymore, so the NHS therapist gave him a book, and I forget what the book was called, something like Learning to Live with Your Pain. And, you know, they started to, uh, put into his mind that it was a psychological issue. The pain was magnified in his, in his head. Can you imagine how destroying this would be for a police officer and someone who's, who, who lives by laws and enforces them and, and yet is just held to such, uh, a level? Anyway, this man was suicidal. "Do you mean that I am so mentally weak that I am magnifying this pain?" And he had to retire. So I saw him and I, uh, showed him how to, uh, I'm assuming this is on video, but you know the gig. You go down and like, uh, to, to mimic that cricketer's posture, in the cricket outfield, or for the Americans it would be a shortstop position in baseball. And then how to stiffen, change the curve of the back so you've taken the stresses away from the pain triggers. You become a leaning tower, develop athleticism through the ankle, push the toes down, and then pull the hips through. And then I showed him, now sit down, now stand up, and get off the toilet and do all of these things. The man broke down in tears. He said, "I just did all this pain-free. Do you mean that I've had this ability all the time, it's not in my head, and no one has ever shown me how to stand up, how not to get pain when I sit, how not to get pain when I walk, how not to get pain when I use, uh, techniques of martial arts to frog march a person out of the pub and all of these kinds of things?" And he emotionally broke down, but that was the instant that he started to now build it all back up again. And I, you know, I can tell that story in, in many different forms, from many different experiences. But, uh, there, there's something that, that may or may not resonate. Now, look, I know the NHS, it's absolutely fabulous for cancer and all of these, these other things. However, for musculoskeletal injury, there's a massive, massive hole. And why is that? Why are they not get- I had a call from someone from the UK, uh, was that two days ago? "Oh, I showed your book, The Back Mechanic, to my physical therapist, and they flew into a rage." "Don't you believe it. Don't you do that."

    3. CWChris Williamson22:50

       Mm-hmm.

    4. SMDr Stuart McGill22:50

       And then, you know, it was all, "Well, we're, we're going to do cognitive behavioral therapy to this person." Which, um, again, was frustrating to them. They had no clue what was causing their pain, and it proceeded without an assessment. So, I don't know why it is that way.

11. 23:10 – 24:03

    Did it help you

    1. CWChris Williamson23:10

       It's a shame. I mean, I flew all the way to Canada to come and get an assessment with yourself. So, it speaks for me too.

    2. SMDr Stuart McGill23:15

       Did it help you?

    3. CWChris Williamson23:17

       It, m- I have done...

    4. SMDr Stuart McGill23:18

       (laughs)

    5. CWChris Williamson23:19

       Here's, here's one thing. I wonder whether you ever consider this. Have you thought about the cumulative amount of time that people across the planet have done the big three?

    6. SMDr Stuart McGill23:28

       No.

    7. CWChris Williamson23:29

       You should do, because I've done, I've done hundreds, I've spent hundreds of hours in three positions because of something that you said. Hundreds of hours.

    8. SMDr Stuart McGill23:40

       Did it make you r- did it make you robust?

    9. CWChris Williamson23:43

       It's im- it's improved me more so than any other, uh, routine that I've done. It's the-

    10. SMDr Stuart McGill23:49

        Has it built a foundation for you to get back to enjoying your life?

    11. CWChris Williamson23:54

        I also need to regrow an Achilles. Um, so yes (laughs) .

    12. SMDr Stuart McGill23:58

        Ah, yes.

    13. CWChris Williamson24:00

        I keep on, I keep on putting little hurdles in the way.

12. 24:03 – 30:24

    Most important habits

    1. CWChris Williamson24:03

       What are your most important habits for maintaining spine health? Someone isn't familiar with your work, they're entering this conversation fresh, what are the most important habits?

    2. SMDr Stuart McGill24:13

       Well, when you say your most important, I certainly have some personal habits. We can talk about those in a minute. But I think you're talking about, uh, more, more of a generic sense. Um, I don't want to use l- words that are, are unfamiliar, but let me start with them because they're very correct. So those would be manage demand and capacity. So if you were to go out and play rugby, there are demands made of rugby on your body. Do you have the capacity to meet them? If your job is to sit in front of a computer to do your work, uh, you must understand those specific demands and then make sure your body has the capacity to meet them. Because if the capacity does not meet, uh, the demand, you will have suboptimal function pain. Now let me just describe that issue of pain. Let's consider laying in bed. If you lay in bed for a while and don't change postures, slowly you will dec- de- develop a discomfort. And if you ignore that discomfort and continue to lay in bed, you will then go to pain. And if you continue to ignore that pain, you will then go to injury. You will develop bedsores where the pressure stress concentrations in the skin will, will cause a breakdown. So i- i- it should be easy to understand how different positions, different postures, uh, habitual movement patterns, uh, progress from discomfort to pain to actual tissue breakdown. You know, there are those who say, "Oh, we, we, we couldn't see the tissue breakdown in the MRIs." (laughs) While I'm the guy who developed the laboratory, m- made those radiological measures, and then did microdissection afterwards, and there was all kinds of damage that was invisible on the scans. So of course the scans don't recognize, uh, the damage. But anyway, uh, manage demand and capacity. The second thing is goal setting. So we talked about the culture of CrossFit. And again, to point out, you know, I love the CrossFit community. What a fabulous community based on movement and, and keen people interested in their health. The downside of it is, there is inherent in the structure goal setting for personal bests. Well, uh, that's a bit of a problem. When you talk to someone like Ed Coan, so Ed Coan set the world powerlifting records, and when he won, he was about a third greater than anybody else. So it would be like Usain Bolt running a 6-second 100 meter and everybody else running 10. That's how dominant he was. And he set the goal of only two personal bests per year. So once you set a personal best, your body has to adapt into that state, and that takes quite a while. So, um, I think people, A, have a myth that setting too many personal bests too frequently, uh, biology won't allow that, and secondly, the, the, the number of personal bests that you keep setting, when they start to get up there, you shorten your athletic career. So you don't see too many Olympians, true Olympians who are, who are really rocking it as master athletes. They're worn out. Go to the orthopedic surgeon's waiting room and see who's in there. And it's usually the ones who had too little stimulation or ones who had too much. Too much and too little. You either rust out or you wear out. (laughs) And then, um, so w- when, when people come here and, and th- they'll, I'll see their personality, "Oh, I gotta set my next personal best, I gotta get my weight down to this number," or whatever the, the, the thing is, and I said, "Yes, but that's why you're getting into back pain. You're just too aggressive in what you are doing. I don't have to encourage you, I need to hold you back." And then I say, "How about this for a goal?" And I believe this might be somewhat familiar to you, Chris. I would say to them, "How about if I said to you, would you like to be the most rocking 80-year-old granddad on this planet? How's that for a goal? Do you wanna get there? If that's what your goal is, you're going at it the wrong way. If you are more modest in the level of athleticism, uh, now, you will be a far more able and fit 80-year-old." How does that grab you? You'd be amazed at how that stops people in their tracks. And I'll get a message from them a year later and they will say, "You know, I'm pain-free, I'm happy, I'm fit. However, I'm not deadlifting 600 pounds. And, uh, I look good, I feel fabulous, and my daughter had her grandchild." (laughs) So you know, uh, so w- when you say what are the most important habits, uh, there's, there's just, uh, uh, a few thoughts. And, uh, a- of course, if they have pain, I, I ... just to put a plug in, I say, "You've got to follow the principles in Back Mechanic." But if you don't have pain, life opens up. Be more modest in your, in your goals. Uh, or if your goals are under the mark, you better up your goals. D- do you know what I mean? It's a difficult conversation to have until we have an individual in front of us to give us context. But when we have that context, we will set reasonable goals, manage capacity, demand, and optimize health.

13. 30:24 – 33:57

    Managing capacity vs demand

    1. CWChris Williamson30:25

       That seems very scalable, which is one of the things that I look for when trying to find fundamental principles that underlie stuff. Managing capacity versus demand and setting realistic goals. I think, I, I, I almost wish that I'd been able to had a... have a, a camera on my shoulder during some of the exchanges that I had when I came to see you. Uh, and the reason is, the main reason is, it was an inflection point for me. So I came to see you when I was 30 and it was such an inflection point because it was me realizing that I wasn't made of rubber and magic and that mismatching capacity and demand was going to result... I, I, I don't just bounce back from injury immediately now like you do when you're in your teenage years or your early 20s. And on top of that, the more existential question it asked, made me ask myself was, why am I training? What am I doing with my physical output here? Because I'm training in a gym surrounded by people whose goals are to compete, to make it to regionals in CrossFit to make it to nationals in powerlifting, to com- to go and step on stage in bodybuilding competitions. Like, is that my goal? Mm. And it's hard to say no, right? Because especially if you like the idea of the glory and the valor and the, the accomplishment and, well, why can't I have that? And this has been part of a longer journey of essentialism by Greg McKeown, do less but better. You want to focus on the vital few, not the trivial many. And accepting that if you want to become close to the best at what you do or you want to actualize your potential within a narrow domain, you have to let go of other things. That being said, some people go too far, they don't train at all, which actually negatively impacts them. I know that I podcast better and my speech is more precise if I've trained because physical health enables my mental health. But I don't need to go full send six days a week, uh, trying to keep up with people for whom that's their Everest, because that's not my Everest. I need to find something that facilitates me long term. And this is a word which I'm seeing coming up more in a, a smarter context, longevity, training for longevity. Not life extension, not taking drugs so that you can live to 150, but thinking about your health and your wellness on decade long timescales, on lifeline long timescales. And that for me is a realization that I've tried to give to a lot of other guys who are mid 20s, late 20s, early 30s, "Look, man, like, you need to think, like, what are you training for? Why are you going into the gym and doing these things? Why are you going to the club on a..." not at the moment, "Why are you going to a nightclub every weekend at the moment? Like is that part of your... does that contribute to the end goal that you want? Working out what you want and then working out if the things you're doing are contributing towards getting you there." And it's a difficult pill to swallow. Like, it's hard, right? I, I don't want to think that I need to give up something that I enjoy doing and perhaps could have brought a bit more glory into my life. But that realization was really, really important. And, um, yeah, it's a, it's a gift that I wish that I could give other people. If I could bottle it somehow and give it to a bunch of, of different sort of garage gym athletes, um, I think it would probably make their lives a lot happier.

14. 33:57 – 35:10

    Longevity

    1. CWChris Williamson33:57

    2. SMDr Stuart McGill33:58

       Well, I don't know if you want me to react to that or not, but, you know, on one hand, I think of people, and I would certainly put myself in this category, if I didn't train hard, balls to the wall, all out in my later teenage years and in my early 20s, I probably would have gone to jail. So, you know, you've got to have an outlet for the testosterone and, and finding your way in this world. And if you're a fighter by nature, you've got to have that socially acceptable outlet and, and, you know, train heavy. I'm a little older now, I've got a new wisdom and, uh, but, uh, so, you know, there, there you go. Uh, but you're right, for longevity, I mean, the injuries that you've accumulated, the injury list that I've accumulated that I now have to manage. Um, however, I've got a little bit of wisdom, uh, to manage them. But, uh, uh, you know, I think you were talking about how do we scale all of this up, um, we, we can talk about that if you're, uh...

15. 35:10 – 41:32

    Why do we have spine instability

    1. SMDr Stuart McGill35:10

    2. CWChris Williamson35:10

       I wonder, the first thing I've been thinking about-

    3. SMDr Stuart McGill35:12

       ... if, if that's where you're headed.

    4. CWChris Williamson35:13

       First thing I've been thinking about is why do we even have spine instability? Like, if our ancestors had bulging discs and sciatica all the time, they wouldn't have lived very long.

    5. SMDr Stuart McGill35:22

       Right.

    6. CWChris Williamson35:22

       Why have we got that now?

    7. SMDr Stuart McGill35:25

       Well, uh, I've thought long and hard about this question, uh, Chris, and, uh, I anticipated it, so I brought along a little model.

    8. CWChris Williamson35:33

       (laughs)

    9. SMDr Stuart McGill35:34

       Uh, injury to a joint creates laxity. And in fact, that's the definition of injury, uh, in many, uh, circles. Uh, certainly in, uh, medical and scientific biomechanical circles. So if you tear a knee ligament, you will get laxity in the joint. You've lost stiffness and stiffness is the variable that the body uses to, uh, control and guide movement. So if you have uncontrolled joint movement, it will create pain. Let me show you what I mean with this spine example. So these are made by Dynamic Disc Designs, a, a fabulous company that builds about the most highly biofidelic models of body parts for, for coaching. So this top disc is normal.This bottom disc is normal. This one has been injured. It's lost stiffness. Observe, I'm going to apply a little torque to the spine. Do you see where it moves? It moves massively at the joint that's lost stiffness. So now you see that that will trigger off and irritate all sorts of, uh, tissues at that very specific level and not others. Look at the loads now that get transferred to the facet joints in behind. So instability, uh, causes, uh, pain, but it then sets off a cascade. Unlike getting a broken leg, let's say, so you break a femur, within three months it heals, you're, you're back to normal, the bone has actually formed a callous over the fracture and it's stronger than what we started with. But look what we've done here. We've now created a lax joint and a legacy that in two or three years from now, you now have facet joints that are irritated, they're growing bone, they're becoming arthritic. So what started out initially as you, you shear the spine and trigger pain, now when you bend back you create pain with arthritic facet joints. And then over time, this will gristle and that process takes, uh, probably, uh, about 10 years. So there is why we have joint instability. Um, and I've, uh, explained a little bit about the cascade. Now let's talk about, uh, our ancestors. None of us really know what back pain they had. All we can do is go back to the Egyptian hieroglyphics and clearly they are, uh, bent over, in pain, some of them are retre- are receiving positional, postural treatments. Uh, when we exhume Viking graves, we see, uh, the same evidence of spine instability, arthritic facet joints at single levels together- together with bone spurs at single levels, so they had it. However, you've experienced yourself that when you create core fitness, you become resilient to those micro-movements. You create an exogirdle around that core, so a power lifter and a weight lifter put on lifting suits and back belts to create an exo-support system to arrest the micro-movements and, and create that stability. Now, where I'm headed towards this is I have a feeling our ancestors were tougher than we were. The management of demand and capacity was very different. There was no question, they had to be extremely physical to live, uh, and survive. I now go to the world of sport. Last week I had a consult with an NHL hockey team, so top pro hockey team. And the discussion was, when we get a farm boy from the, the plains of Canada, Saskatchewan and whatnot, they're really hard to push off the puck. They are innately strong throughout the whole linkage. Versus you get a city kid who went to the best gyms, they lifted barbells, they pulled on cables, they're so easy to push off the puck. They score higher on bench press and squat, but they can't compete with the farm kids. So I get back to this idea, when I get an elite athlete with back pain, and if you were to rephrase your question and say, "Why is that?" I would say almost every time it's because they have an underperforming core in the context of their athleticism. Rebuild their core, and I hate that word core, but at least you know what I, I'm talking about. When we rebuild that core, rebuild stability in a farm boy fashion, we have quite often really progressed in restoring their pain-free athleticism. So it's kind of a teleological circular argument, uh, but I hope that... A- at least that's where I'm currently at now, that our, um, ancestors have these same injuries. No question they did. We have evidence for that. Did it affect them? Maybe if they were a tailor that sat at a sewing desk all day or they were a writer, an accountant, may- maybe they did as well. But maybe they also had, uh, 15-minute walks, uh, throughout the day. Uh,

16. 41:32 – 43:37

    One day a week

    1. SMDr Stuart McGill41:32

       they weren't, uh-

    2. CWChris Williamson41:33

       To go and pick up some new leather to go and fix the hammer-

    3. SMDr Stuart McGill41:36

       E- exact-

    4. CWChris Williamson41:36

       ... from the blacksmith, et cetera.

    5. SMDr Stuart McGill41:37

       But... Yes. So, um, th- those are, uh, some thoughts. And, you know, there's even evidence from Wales, believe it or not, of the old Welsh coal mines. Those lads who went down the coal mines when they were 16 had less discogenic back pain than the ones who went down when they were older. So was there an adaptive, uh, response, shall we say, that gave them a greater capacity? Uh, I'm assuming the demands were the same. They were miners. Anyway, these are all discussions, they're very interesting, but that's where I'm, I'm currently at right now.

    6. CWChris Williamson42:20

       The thing-

    7. SMDr Stuart McGill42:21

       And, uh, can I just finish off with-

    8. CWChris Williamson42:23

       Yeah, yeah.

    9. SMDr Stuart McGill42:23

       ... with one final thought? Think of every great religion, Chris.... every great religion has one day a week where you don't do anything. Now, when I grew up, we had one day a week where my dad would, would insist there's no business, you, you, you, you take it easy that day, you, you, you just do. And, you know, my current training schedule now is I take one day and I don't do anything. And that is the day that ensures biological adaptation. And I know he grew up that way and all of his colleagues did. That's, you know, he was an Irish guy, it's, it's the way the whole country did it. And in every religion, there is that practice of one day a week for the Lord, or if you're a biologist, you would say to allow biological adaptation to occur. And think of the typical CrossFitter who will go on Facebook and say, "Oh, I had my day off, I only banged out ten Olympic lifts and went for a 5K run." You know, it doesn't make sense and it violates biology. So anyway, there's a little bit of a-

    10. CWChris Williamson43:34

        Th-

    11. SMDr Stuart McGill43:34

        ... inefficient diatribe. (laughs)

    12. CWChris Williamson43:36

        The thing,

17. 43:37 – 45:41

    Getting the basics right

    1. CWChris Williamson43:37

       the thing that I'm struck by, especially recently, the last few years, has been this move toward a much more simplistic view that tries to get people to comply with the training regime. Um, I think it may be trying to fix the problems of surplus of calories, surplus of convenience, surplus of sedentary-ness, surplus of information and stimulation, and what we've realized is that aiming for something which is more easy to comply to and just sticks to getting the basics right, it sounded, when you said that I need to go for three to four 50-minute walks a day, I was thinking, "I've got, I've got, like, really bad back pain. Why am I going for... What's a walk going to do? Why am I bothered about getting up and standing? Why do I have to do a 20-second stretch where I put my, my hands over my head like this? Is it really making that much of a difference if I stand, like I'm standing in the slips when I go to brush my teeth at the bathroom?" And all of these different things. But what you realize is that those sorts of applications are so... the bar's set so low that it's almost ridiculous that you can't do it. And talking about the most advanced methods in the world, not only are they further away from how we evolved to operate and to move, but on top of that, they're actually really, really hard to do. Like, they're not... You can go for a walk anywhere in the world, at any time. Whether you've been at work, I've got back in from a, a nightlife shift at 3:00 in the morning, I can go for a walk. I can go for a little, uh, uh, a little stretch after I stand up. And I'm really enjoying watching the fluff and the complexity that I think I saw go into the fitness world probably, like, 2006 to 2016, I'm enjoying seeing some of that noise dissipate and it be a little bit more signal. Does that make sense?

    2. SMDr Stuart McGill45:35

       100%. That was a, a nice overview. That's why they call this the modern wisdom.

18. 45:41 – 47:43

    Failure to get a thorough assessment

    1. SMDr Stuart McGill45:41

       (laughs)

    2. CWChris Williamson45:41

       That's correct. That is correct. Okay, so where, w- where do you see most people going wrong when they try to deal with back pain? There may be some people listening, and f- and there will almost definitely be people listening who have it, where, w- what are the things that people do mostly which is either not helping or perhaps making it worse?

    3. SMDr Stuart McGill46:01

       Uh, number one, without question, failure to get a thorough assessment to reveal the mechanism of their pain. Without question. So, if a person is able to get a read on the precise cause, they now have a precise, targeted strategy to, uh, A, get rid of the cause, allow the pain to wind down, and B, build up the linkage, tune the linkage with strategic mobility and stability, build appropriate endurance, build strength in appropriate patterns, and then coach it in a way that transfers to, uh, the end goal. And as you know, I've done experiments in every single one of those stages. For example, we know that a certain style of instructional coaching transfers those movement skills to real life. We did that study on firefighters, for example. As you know, in Pensacola, Florida, we took the whole, uh, firefighting force and divided them up in different styles of training groups. And those who were, uh, coached in a way that they became educated as to how they were loading their body, it just transferred when they were doing real firefighting tasks. We never coached them how to do firefighting tasks, but they had much less injury markers in their movements, uh, afterwards. So, that would be my number one answer, in a generic sense, to that.

19. 47:43 – 49:26

    Not getting a competent assessment

    1. SMDr Stuart McGill47:43

    2. CWChris Williamson47:43

       What's number two? If people are, uh, n- uh, they've perhaps considered going for an assessment, but they're also doing some other things to try and fix their back pain. They've watched a, a YouTube video that doesn't include you.

    3. SMDr Stuart McGill47:58

       Well, this will sound very self-serving, but it's very difficult to find a competent assessment. Nowhere in the medical system, uh, is it available. It certainly isn't available in the UK. I don't think it's avai- ame- available in the American, uh, insurance-based medical system. It's not available in Canada. So, there are individual clinicians, there are a few in UK that do very thorough, competent back assessments, uh, there are a, a f- few scattered around the world, but in the absence of the average person...... uh, to get that assessment, that's why I wrote Back Mechanic. It guides the person through a self-assessment. Is it as good as seeing a master clinician? No. But it's better than, I hate to say it, close to 100% of the family docs and, and many of the physios and chiros that they will see. Although there are someone who, some who are specially trained in that. So, uh, then I, I have to say, sub-categorize your back pain. In one person, they might need more core fitness, more stiffness, more control. Uh, and what are they doing? Oh, well, they're stretching their hamstrings, touching their toes, pulling their knees to their chest, and that is the very thing that's causing their pain. And yet the very next person is overly stiff.

20. 49:26 – 51:43

    Two subcategories of back pain

    1. SMDr Stuart McGill49:26

       They are so stiff and in control, they're petrified by their pain, they're locked up. And just to get them to stand up and say, "No muscle. Hover your ears over your shoulders. Hover your shoulders over your hips. Jazz knees, loosen your knees, put your hands behind your back and float. You're at military at ease." And they'll say, "Oh, Doc, you're magical. You just took my pain away." And I said, "Well all we did was shut your muscles down. I would have a muscle cramp as well if I walked around holding five pounds of butter in my hand. But that's what you're doing all day long, clenching your back." So do you see there's two subcategories of back pain, and two polar extreme opposite interventions that are needed. So you've got to have the assessment, and you keep peeling the onion. Now some of the people I get are really challenging. They take me to the end of my clinical smarts in their, in the consult. And they might have three or four things, all interacting together. Um, you know, a- and then there's the whole psychosocial milieu. You, you might have someone who I say, "You know, I need you to go for a walk every time you eat for 15 minutes." And they look at you with a blank stare. And, uh, they'll say, "Well, I can't do that. I'm afraid to go out, where I live, at night and go for a walk." So what do you think the compliance is gonna be with that kind of person? We have an impediment there that if we don't deal we- with that, we've just guaranteed failure. So there is a social force now imp- imp- impeding their pain. Or they were treated like a psychological warrior when they're really a psychological mouse. Very timid person. Or vice versa. So there's no end to this, and we get back to that master of the craft, you know, and there are clinicians who come to me and they say, "You know, I want to become a master of the craft. Can we come and work with you?" And what not. And after five minutes of talking with them, I, I know that they will never, ever be a master of the craft. We're, we're beating a dead horse. So not everyone ca- can be a master healer.

21. 51:43 – 52:13

    How can people find mcgill certified clinicians

    1. SMDr Stuart McGill51:43

    2. CWChris Williamson51:43

       How can people-

    3. SMDr Stuart McGill51:43

       They just don't read people. They, they don't-

    4. CWChris Williamson51:44

       How can people find, um, McGill certified clinicians? What's the website?

    5. SMDr Stuart McGill51:51

       Backfitpro.com.

    6. CWChris Williamson51:52

       And there's just a find your country, find someone near you function on there as well?

    7. SMDr Stuart McGill51:57

       Right. Yeah, there's two portals of entry. Are you a patient, back pain patient, or are you a clinician? If you're a back pain patient, the next question is, uh, you know, if you want to find a master clinician, click here.

22. 52:13 – 53:21

    Mental state and physical recovery

    1. SMDr Stuart McGill52:13

    2. CWChris Williamson52:14

       And direct some people there. Hopefully they'll be able to get some, uh, some help. O- One thing that, obviously with my Achilles injury that I've been considering a lot is the role that mental state plays in the physical recovery process. Have you got some insight around that?

    3. SMDr Stuart McGill52:28

       Well, I, I, I think I have a lot. Um, we've already talked about how once you can shift the locus of control to a person, they're empowered, and a lot of the psychological dissonance then disappears. The key in all of that is to get the person to realize their pain. So I did provocative testing on you when you were here. I purposefully provoked your pain. We loaded you in compression, we sheared you, we bent you. We, um, went through extension, torsion, twisting. Um, we did ballistic loading. Uh, we did traction. Uh, we probably did a few ... Oh, and then I provoked your nerve roots. We pulled on different nerve roots.

    4. CWChris Williamson53:20

       It was loads.

    5. SMDr Stuart McGill53:20

       I found out

23. 53:21 – 1:13:04

    Spinal assessment

    1. SMDr Stuart McGill53:21

       whether the nerve-

    2. CWChris Williamson53:21

       It was absolutely loads of fun. You even got-

    3. SMDr Stuart McGill53:24

       Well-

    4. CWChris Williamson53:24

       You even got your wife in and she, she contributed to you poking and prodding different bits of my spine as well. It was a, a multiple-

    5. SMDr Stuart McGill53:35

       I, I-

    6. CWChris Williamson53:36

       ... multiple vector attack.

    7. SMDr Stuart McGill53:36

       I recall that now because you had a little bit of friction on the nerve root. So as the nerve root moved, you got friction on that nerve root. So I had to pull on your ankles and your knees in certain directions to migrate the nerves away from your spine down your leg, and she had to release your head at the same time because the nerve pathway is basically a long rope. And if you're going to pull it at one end, you have to release it at the other to get the slide. And it's the slide that in, that causes pain in some people. So yes, I do need an assistant with, uh, some of the tests. But never will you get that assessment anywhere else than when you got it here. And for the first time, we really learned, uh, you know, it's this particular disc bulge that shrinks and grows. So we then did an intervention to shrink the disc bulge, and immediately we got a better slide on the nerve root. So we knew there was potential. Anyway, um...... once we've empowered the person by showing them exactly what their pain is, then we give them the mechanical antidote. And all of a sudden, and I keep coming back to this psy- to use this psychological word, shifting the locus of control to the person and that empowerment immediately addresses a lot of their psychological concerns. Because before they were a victim, but now they're an active participant in them becoming stronger. Uh, and then, you know, now we have to talk about the interplay. They can now sleep better. If you want to give someone psychological distress so you break them down to the point that they're willing to divulge in- information. So let's go to torture mechanics 101. You deprive a person of sleep, you make them hungry, and you give them chronic low-grade pain. That's torture. But that's how you extract information out of a, a mentally strong person. You break them down. But I just described back pain for a lot of people. So we interrupt that, and then they start getting their mental toughness back again, and away we go. We build it all back up. So yes, is, is mental state, yeah, you know, they come here suicidal, absolutely hopeless. I've had people say, "If you can't help me, Doc, next week I'm ending it all. Some therapist told me the pain was in my head and I can't live with that. That means I'm crazy. I don't think I'm crazy, but if that's what it is, I don't deserve to live." And I say, "Hold on now. Give me a week." (laughs)

    8. CWChris Williamson56:26

       (laughs)

    9. SMDr Stuart McGill56:26

       And can we start to change the course? And I remember one fella who did come and he said, "Doc, I hear you're different. Um, but I'm telling you, I've been to the pain clinic. If this is in my head, I'm putting an end to it next week." And I said, "Well tell me about your symptoms." And, you know, stop me if I've told this story before, but he said, "Well most of the time I'm pretty good, but when I move a certain way, it feels as though someone has opened up my hamstring with a shard of glass. It's the most excruciating pain." And I said to him, "Can you show me that?" He said, "What? You want me to cause that pain?" And I said, "Yes, it's the only way I have to understand the mechanism of your pain and then show you how to, uh, deal with it, do something about it." So he did this very funny maneuver, it was a circular maneuver, and then he got... And, you know, we, we, we gave him some, uh, drills to decompress his back and he, he was okay again after two or three days and I said, "Come back, but again don't think about lead poisoning, uh, here. Just, just keep working with me." Um, anyway, uh, uh, he never did have another attack. Never once. So people will ask me, "How long does it take to, to cure back pain?" Well I can say in some cases it took 10 minutes of coaching and they never ever had a, an acute back pain again. And remember, he was labeled as having chronic pain and it was in his head. I said, "You don't have chronic pain. You have many acute insults all day long. It appears to be chronic, but it's not. It's acute pain over and over again. Let's, let's understand the acute cause and, and deal with it." I met him just a few years ago again. I lost track of him, and this was about 10 years later. He brought his daughter to me who was a heavy field, uh, athlete on scholarship down in the US. I can't remember whether a discus thrower or a, a shot-putter or something like that. And I said, "Well tell me did, did... How's your back these days?" He says, "Fabulous." He says, "Never ever, ever did I have another shot of pain." So how about that for mental state that had driven him to the point of suicide and becoming empowered, uh, changed his life that it became an absolute non-issue.

    10. CWChris Williamson58:58

        So that's the first step.

    11. SMDr Stuart McGill58:58

        Now the... I failed a few times too, by the way. I, I don't wanna...

    12. CWChris Williamson59:01

        Yeah, these are... This is the highlight reel.

    13. SMDr Stuart McGill59:04

        Yes. Yeah, of course.

    14. CWChris Williamson59:06

        That's the first step to take control, to understand that you're an agent as opposed to a victim. And this, this comes up in a, a ton of different situations. I've spoken to a bunch of endurance athletes, ultra-endurance runners who've done 50 hour long races without sleep going vertically up mountainsides in pitch black and scrambling down hilltops and all sorts of stuff, and they say the same thing, that you need to internalize that locus of control. But even once you've made that change, even once you've said, "Okay, I'm the architect of my own recovery or at least I'm the builder of my own recovery and perhaps I have a experienced clinician who's giving me the building plans that I'm following," but it can still be quite draining long term dealing with discomfort, watching your friends have to go and b- be able to go and do things and you know that you can't anymore. Have you got any more long-term strategies for how people can continue to stay mentally robust during injury?

    15. SMDr Stuart McGill1:00:06

        I d- I don't know if I have any great secrets in this. It's just a systematic scientific approach that never really wavers. Get an assessment, know the cause, address it appropriately, wind it down, build it all back up again, and then at the end of the day, uh, I told you about my Irish father, he had a saying, "A little bit of what tickles your fancy is good for you." So if that was a little bit of Irish whiskey, all right. But what it really meant was go and have a little bit of joy and a little bit of fun and make sure that you do.... uh, and that's, wha- whatever that little tickling your fancy is, is very different for each person. Um, and it may have an element of danger or risk for your back, but you just keep learning how to do it. And, you know, when we finish this call, I'm going out, I've, I've bought myself probably the most athletic racing snowmobile made in production in year 2020. (laughs)

    16. CWChris Williamson1:01:14

        How quick does this thing go?

    17. SMDr Stuart McGill1:01:17

        Uh, it's an easy 100 mile an hour sled.

    18. CWChris Williamson1:01:21

        On snow?

    19. SMDr Stuart McGill1:01:22

        On snow, yeah. But I've, I probably, I'm going out to do some jumps and pop a few wheelies and things like that. So, I'm not gonna be hitting 100 miles an hour, but I'm going to a golf course and, and all the lads around here all have these machines. But, uh, they, I'm the oldest of them, so I've, I've got to, uh, you know, uh, go and tickle my fancy a little bit. So I'm gonna be, have to be very careful on the landings, but damn, I'm gonna do a few. And, uh, it tickles my fancy, and I'm going to, uh, have a little bit of a push. Uh, you know, over the years I've had a few injuries. Uh, I re- one winter I broke my ribs twice.

    20. CWChris Williamson1:02:08

        What thing?

    21. SMDr Stuart McGill1:02:09

        Uh, snow... Well, snowmobile accidents. I came up a hill one time, and I've always told my kids, "If you go up a hill and you catch air, know where you're gonna land." I came up this hill and caught air, and then I looked down where I'm gonna land and there was a picnic table right there.

    22. CWChris Williamson1:02:31

        (laughs)

    23. SMDr Stuart McGill1:02:31

        And I hit the picnic table and I, I, uh, broke the table, broke my sled, broke my ribs, and then, uh, oh, it was probably two months later, I hit a log that I didn't see, so... (laughs)

    24. CWChris Williamson1:02:45

        Something that strikes me about that, kind of looping back to what we said at the very beginning, is about knowing-

    25. SMDr Stuart McGill1:02:50

        I, I don't know. We, maybe we should edit that out. Uh-

    26. CWChris Williamson1:02:52

        No, I think this is-

    27. SMDr Stuart McGill1:02:53

        ... that's, uh, that's totally irresponsible.

    28. CWChris Williamson1:02:55

        (laughs) No, it's, it's you were, you were young and foolish.

    29. SMDr Stuart McGill1:02:58

        (laughs)

    30. CWChris Williamson1:02:59

        What, what strikes me-

Episode duration: 1:13:05