EVERY SPOKEN WORD
145 min read · 28,735 words- 0:00 – 15:00
I, I never put…
- SMDr Stuart McGill
I, I never put a person's images up on the view box early in the consult. I really try and understand the person, uh, who they are, their personality, and, and then I, I assess them for their physical pain triggers, and only then will I look at the images. And when I looked at the images, I, I was quite horrified. He'd split his sacrum front to back, L5 was heavily fractured, and the discs were, uh, if I use the word obliterated-
- NANarrator
(laughs)
- SMDr Stuart McGill
... uh, that would be, um, quite accurate. So we started to talk, and he was starting to move a little bit better, and, uh, uh, but he had to humble himself right back to getting the movement patterns right and some very, very basic, uh, patterns, athletic patterns. Um, and then, uh, he said, w- in our conversation, he said, "Well, do, do you think I'm gonna get out of pain? Because the surgeons I've s- I've said- seen, th- they, they said I'm done. I, I, I'm not even gonna get out of pain, I've done so much damage to my back." And I said, "Well, I don't know, but let's, let's ... th- here's my best effort and my best suggestion on what to do." Well, believe it or not, he was outta pain in about three weeks, just learning how to avoid the, the triggers. But he said something very curious to me. He said, "Well, I'm gonna get out of pain, and when I get out of pain, I want my, my world record back." And I said to him, I said, "Well ..." and obviously I'm a lot older than he was, and I said, "Well, if you were my son, Brian, I'd give you this advice." I said, "Let's work on getting you out of pain, but I, I, I would seriously consider doing something else with your life. I mean, th- this is a pretty compromised spine. To build you back t- to set a world record again is ... " But he said, "No, I wanna do that." And I said, "All right. Well, if we do it, we'll write a book together." So that was the story behind, uh, uh, the book called Gift of Injury.
- CWChris Williamson
(wind blowing) Ladies and gentlemen, welcome back. This episode is brought to you by The Protein Works. I'm very happy to be supported by them again for this episode. They're giving away over 100 pounds of supplements this week, and all that you need to do to enter is share this episode. I'm absolutely certain it's going to be a massive help to a lot of people, so find a friend that you think would be interested, fire it in a group chat, or feel free to post it on your socials. All that you need to do is then send me a screenshot @chriswillex on whatever social media you want. Find me a screenshot or tag me in your share, and I will pick someone over the next week, and I'll announce that, uh, before next Monday. But onto today's guest, Dr. Stuart McGill. We are getting fully spinal today, aren't we? How are you? Welcome to the show.
- SMDr Stuart McGill
(laughs) Well, I'm, uh, well, Chris, uh, how about you?
- CWChris Williamson
I'm fantastic, thank you. I've been looking forward to this episode for as long as I can remember. Posted it in the gym Facebook group asking if they had any questions, so we've got crowd-sourced questions about spinal health.
- SMDr Stuart McGill
(laughs) All right.
- CWChris Williamson
It's gonna be a good one today. So first off, I guess, uh, I posted in the group, a perfect example, posted in the group and a lot of people had questions. Why is it that for people who take care of their health and fitness, spines are so problematic?
- SMDr Stuart McGill
(laughs) Well, I could go so many ways with that, uh, question, but I think it's because it's so difficult to do things without a robust back. Think of all the things we, we do. Uh, they all involve, uh, the back. So, uh, I, I guess that's why they're, they're problematic. But, uh, I, I can be a bit more specific, uh, and that is, if we sub-categorized spines in people, we would converge on common patterns. And if we did a little bit of pattern recognition, we'd notice some real cause and effect. Um, for example, athletic groups are really fun to study. Um, there are certain athletes and sports where they just clearly have an underperforming core. They spend a lot of time on other parts of their body, but, uh, the, the demands on their spines simply outpace the, uh, foundation that they've, uh, built, and, uh, they end up with either injury, or pain, or compromised performance, or any of those. But in the general public, why are spines so problematic? Look at our lives. You know, I, I started as a professor 34 years ago. Computers weren't even invented yet. We would spend time walking down halls meeting with our colleagues and, and doing our, our clinic work and our lab work. Within those 32 years, something happened. I became a computer operator. Students no longer wanted to come to office hours. They would send an email, and I'd say, "I don't do emails." (laughs) "Would you better come and we'll have some hands-on..." But, you know, it, it was just, I became a computer operator. Now, that is ... Y- you know, I had a good back, but sitting all day gave me back pain. So th- this is why, uh, I think it's, uh, problematic, to use your words. And then the solution became, well, now you've become a slave to your chair and your computer for eight or 10 hours, now you're going to blow out, uh, all of the stress one hour at the gym.
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
So let's compound the biological, uh, perturbation here, and people would start treating their spinal joints, because they were locked up all day at the computer, like ball-and-socket joints, but they're not. Biologically, they're an adaptable fabric made of collagen strands held together with a ground substance.... and they follow different rules. So, you know, uh, the, the, the, there's all kinds of other, uh, downsides to sitting a lot. Your hips get stiff. Well, mobile, powerful hips are one of the secrets of, uh, skillful athletic performance-
- CWChris Williamson
Yeah.
- SMDr Stuart McGill
... and spine-sparing strategies. So, uh, are, are people undoing the chronic adaptations and stress in their hips when they go to the gym? Sometimes, they do the opposite. Uh, I, I guess the final bit, and, and this is coming a bit randomly, uh, in, in a thought pattern between my ears, very few people these days get a competent and thorough assessment of the mechanism of their back pain. So they willy-nilly try untargeted therapies, and, uh, their spines remain problematic, to, to really answer your question. So if a person has a back issue, and they have a thorough, competent assessment, so they understand very precisely what the, uh, pain trigger or mechanism is, they then have a roadmap to guide a strategy to remove the cause, and, uh, secondly, to build a, a foundation to be pain-free and as functional and, and fit as, as they want to be. So it's a bit of a long-winded answer, but those are some random thoughts as to why spines are problematic.
- CWChris Williamson
Well, I guess, first and foremost, spines are a complex system, right? There's a lot going on with your spine.
- SMDr Stuart McGill
Yeah.
- CWChris Williamson
It runs for a lot of your body. There's a lot of interactions going on there, so it wouldn't ever be (laughs) a, a single, a single answer. One of the things definitely, one of the questions I've got down, what are your views on workplace ergonomics? Uh, you know, you've already touched on it.
- SMDr Stuart McGill
Yeah.
- CWChris Williamson
The, the sedentary nature of us being sat. Is it simply that we're sat for a long period of time, or is it that we're stationary? Uh, is a standing desk a, a solution for this? What, what are your thoughts on the ergonomics of, of workplaces?
- SMDr Stuart McGill
Well, I have several thoughts. I wrote a, uh, an opinion piece, uh, quite a number of years ago for the journal called Ergonomics, and, uh, think of the office where you can, uh, organize it in a way to reduce stress. Uh, you can adjust heights, the way you sit, and these kinds of things. But then I would say, well, is there such a thing as an ideal posture? And I think we would both converge that, no, there isn't. The ideal posture is one that frequently changes, because you migrate stress concentrations in your body through posture change. So, uh, that, that's a little bit of a myth. There are many jobs, by the way, that you can't do ergonomics with. Can you imagine a farmer, a forester, a fisherman, a lumber-
- CWChris Williamson
Bus driver.
- SMDr Stuart McGill
A bus driver, a miner. Very few can do ergonomics. Uh, all they have is the skill to move their body in ways that do not create stress concentrations to the point of pain. So ergonomics, uh, is limited in, in, in many jobs, uh, for sure, and even some of the foundational principles of ergonomics may not be appropriate for certain people in certain jobs, in that there is no ideal. Uh, the ideal is, is a moving target, and that's just the biological reality of it.
- CWChris Williamson
If you were to prescribe a cadence of movement from seating to standing, or from, if someone was to potentially be able to do their work, what, let's say they were able to do some calls. They were able to walk while they were on a call perhaps with a hands-free kit or something like that.
- SMDr Stuart McGill
Yeah.
- CWChris Williamson
Is moving as frequently as possible, whilst obviously not completely degrading your ability (laughs) to do the work on your laptop or your, or your computer, is that optimal? Is it to move as much as possible and vary the, vary the posture?
- SMDr Stuart McGill
Well, you're on the right track. Now, I would, I think you've gone from one stream- extreme to the other, saying move as much as possible, but, uh, I would say move more, absolutely. So as Greg Cook, uh, who many of your listeners will know, uh, I think he coined the phrase, "Move well and move often." And there's a lot of wisdom to that. Now, what is optimal will be, uh, very specific to the person, uh, for sure. Their age, their past injury history, uh, all of these factors.
- CWChris Williamson
So as-
- SMDr Stuart McGill
But there's no, no, no, no, there's no substitute. You've gotta get up out of the chair and, and move for, uh... You, you think of every system in the body, and every single one of them thrives on movement for optimal health. But that optimum is between not too much and not too little. So moving as often as possible, you're going to need to sit down to have a rest if you do that. (laughs)
- CWChris Williamson
Yeah. Yeah, yeah, yeah.
- SMDr Stuart McGill
But, but you know what I mean. The, the, bi- biology, uh-
- CWChris Williamson
Mm-hmm.
- 15:00 – 30:00
Pretty, pretty damn close.…
- SMDr Stuart McGill
loaded flexion, and, uh, it's accelerated by, uh, lifting too heavy in the first place. So quite often, it starts off with a heavy deadlift, and then, uh, goes on to repeated, um, uh, loaded flexion. How close am I on that?
- CWChris Williamson
Pretty, pretty damn close. I was going to ask you-
- SMDr Stuart McGill
I'm- I'm bang on, aren't I?
- CWChris Williamson
(laughs) Yeah, it's a bang on.
- SMDr Stuart McGill
Yeah.
- CWChris Williamson
I was gonna ask you another question. I've not told you about my training history. If I was to present you with the particular symptoms that I've just explained to you now, what methodolo-
- SMDr Stuart McGill
Yeah.
- CWChris Williamson
... what methodology would you predict that I'm following?
- SMDr Stuart McGill
CrossFit.
- CWChris Williamson
100% right.
- SMDr Stuart McGill
Yeah. I know. I see them all the time. (laughs)
- CWChris Williamson
Why is it... So I read, I read, and I will be linking in the show notes below, an article, uh, article/interview that you did with T Nation.
- SMDr Stuart McGill
Yeah.
- CWChris Williamson
Um, and it was on the, I guess, the common injuries that are associated with CrossFit and a biomechanical breakdown of that.
- SMDr Stuart McGill
Right.
- CWChris Williamson
There will be a lot of CrossFitters who will be lift- listening. There will also be some, some powerlifters, some weightlifters, and some endurance athletes as well.
- SMDr Stuart McGill
Right.
- CWChris Williamson
But I would be interested to hear if you could give a, uh, an explanation of what are the typical injuries and why that you see them with CrossFit, your assessment of the injury to methodology relationship?
- SMDr Stuart McGill
Yeah. Well, it's a fabulous question, but, uh, injuries cluster around specific for- uh, sports and specific training methods, and there's a reason for it. It's the chronic exposure. So, uh, ph- physical exposure to the body causes adaptations. Now that apt- adaptation can be good or it can be bad, but you load the body and the body will adapt. So that's the beginning opening principle. Um, if you go back to that T Nation article, I, I s- I think it was in the title of the first paragraph, I have a love, uh, hate relationship with CrossFit. I mean, I absolutely love CrossFit for the culture, for the supportive community. I love it. I, I, if I was younger, I, I would have been in there 100%. Uh, w- wha- but now let's get into the biological adaptation, and then I can give you a solution. So, um, CrossFit combines adaptations to stimulate mobility, and then the next exercise is asking you to have a tougher collagen. Let me give you an example. So if you start out a routine with 10 burpees, you are creating a high mobility in the back without much load. So burpees on their own are probably not going to, uh, create too much challenge to the adaptation process. You're teaching the spine to be a bit more mobile, but it doesn't pay the price because there's no load. Then the next routine is repeated Olympic lifts. Now we have a problem. There's no margin for bad form. So CrossFit, uh, tries to create an endurable athlete.... a power athlete and a mobile athlete. That's very, very difficult to do in terms of biological adaptations. So by programming 10 Olympic lifts, you know the form is going to deteriorate. Now you're migrating stress. Uh, the first two reps might be all right, and, and interestingly enough, I don't get many Olympic lifters in as back pain patients. They have to go and see the knee and shoulder guys.
- CWChris Williamson
Hmm.
- SMDr Stuart McGill
Those are the joints that, uh, the Olympic lifters are, uh, having trouble with. Not really the ... They've got quite healthy low backs as-
- CWChris Williamson
And they're being very stiff.
- SMDr Stuart McGill
Well, uh, they lock them into much more of a neutral position because the mobility is at the, uh, the hips. And, uh, they're actually a speed power athlete. They're very, very quick. They have good pulsing on and off. They, they relax to catch the bar and the snatch and all of these kinds of things. But let's get back to, uh, the CrossFit programming. Um, the first two lifts might be fine. The third one now, you're starting to get a little bit tired. You're polluting the perfect movement muscle memory of an Olympic lift. So do you see? To be a great Olympic lifter, you would never pollute it when you're tired. But CrossFit's a different sport. It is an endurance. And look, I get the sport. Uh, you know, there's lots of sports that, that aren't necessarily, uh, the best for your long-term, uh, athleticism. That's just, you know, I, I have a lot of MMA athletes.
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
I, I, I don't think that's a particularly healthy thing to do for your body.
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
But, uh, it's a sport nonetheless, and they come to me asking for help. So of course, I, I, I get, uh, CrossFit athletes as well, and it's my job to try and adapt their body to, uh, be resilient. But we have to make a compromise here. Um, but that's the nature of the programming. So somewhere you have to be between stiffening the spine collagen through, uh, repeated load exposures, heavy load exposures, but you can't move your back. You know, that, that's the difference. So on rep one and two, you might be fine on the Olympic lift, but re- re- rep eight, nine, and ten are, are pretty (laughs) not very nice in, in, in terms of, uh, the bending stresses. And it's at that point where things, uh, fall off the rails in terms of biological adaptations and the collagen starts to ... The fibers ... Not the fibers necessarily, but the ground substance be- be- between them start to, uh, loosen up. And, uh, the fact of the matter is, the nucleus will slowly work its way through the, uh, delaminating collagen and get a disc bulge. So every sport has its, uh, uh, pattern, shall we say, and that certainly is ... Now, if, if I could offer this, and, and I think in that article, I, I did offer a solution at the end, and it comes from let's take the good things from CrossFit and mitigate the things that are not so good in terms of biological adaptation. And, uh, Dan John, if you, you j- have you ever heard of Dan John out of the US?
- CWChris Williamson
No. No.
- SMDr Stuart McGill
Uh, they, they call him the, um, the quirky uncle or something of, of training. He's, he's a fabulous fella. We're, we're both the same age. We're, we're both in our middle 60s.
- CWChris Williamson
Yeah.
- 30:00 – 45:00
So you earned your…
- CWChris Williamson
took a backseat, um, and last year, when my back went for want of a better term, uh, that was when I decided to really pay a lot of attention to my rehab. Now, I did, but then over the space of a month last summer-... flew for 60 hours, did a powerlifting meet in Hawaii, went and trained CrossFit with Michael Casio in Texas, and then came back to the UK and just started all over again, and the same thing happened. I'd been sat on planes, cramped up, pretzeled up into all manner of different, different postures, and then the same, (laughing) same thing happened again. Um, so I-
- SMDr Stuart McGill
So you earned your pain.
- CWChris Williamson
I have... Oh, yeah, I really did. I mean-
- SMDr Stuart McGill
(laughs)
- CWChris Williamson
It just... It, it, it's one of those things. Uh, uh, another interesting point on that, in terms of, um, the injury, giving people the motivation to do their rehab, was when I had an MRI scan at the beginning of this year. So I'd been working after... back end of last year, sort of five months or so, working quite hard on my rehab, but was seeing an upper limit in terms of my recovery. I then saw the MRI scan this year. Now, I know that there is a very tenuous link between pathologies that present on scans and pain that presents. A lot of people who do strength sports would present some sort of abnormality if you were to show them an MRI, but many of them may not have pain, and some people with pain may not present on an MRI. But for me to see the fact that there was something actually there, it wasn't just pain, this kind of nebulous, weird, ephemeral thing in the back of my mind, to see that there was something actually there that had been caused th- that was the, the cause of my pain, and also the cause of my... the, uh, due to my training, that really hit home, and the last few months have really stepped up how much I've taken care, how consistent I've been with the big three, and a bunch of other things as well. It's... The MRI was a real kind of like, whoa moment.
- SMDr Stuart McGill
Well, MRIs, if they're used properly, are absolutely fabulous, and you're a ca- you're a case in point. And, and I argue the statement that, uh, MRI evidence does not link to pain. In fact, I would argue the opposite. The problem is an MRI image shows anatomy. And I don't know how old you are, but say you're 30.
- CWChris Williamson
31. Uh, good call.
- SMDr Stuart McGill
Uh, 30, 31. Uh, yeah, you can't fool me. Stu knows. But anyway.
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
Uh, if, if, if, uh, eh, what I'm looking at on your MRI is 31 years of life. Now, uh, some of the features that are on the MRI are old wounds. Uh, sorry, old scars. They don't cause pain anymore. Some of them will be fresh wounds. Now, a radiologist has no way of knowing which are wounds and which are scars, what is painful and what is not. However, if you precede the MRI session with a thorough assessment of the person, you know exactly what you're going to see on the MR. So you can do a thorough assessment and you know the pain is coming from whatever, uh, structures, end plates, uh, y- you know, (laughs) compromised nerve roots, uh, sacroiliac joints, or whatever. The assessment will reveal those sources, and then you go look at the MRI scans, and you'll get pretty close to a one-to-one match. So I wouldn't blame the, uh, MRIs of not being linked to pain. It's the system that, uh, prevents them from being linked to pain. Uh, so they become quite powerful after you've already seen the person. But here's the thing. The radiologist has no idea whether that person is a CrossFitter, a powerlifter, or, uh, a sedentary worker at a, uh, 10-hour-a-day computer job. And what I mean by that is, uh, I, I've seen athletes who bring in their MRI reports, and the report says, "Oh, they've got degenerative disc disease." And then I look at the MRIs and I say, "That's a, that's a powerlifter spine. That's not an MR... That, those are sclerotic end plates. That's what... That's the bony callus that an- that a powerlifter has developed and adapted over 20 years of heavy lifting." But the, uh, but the radiologist had no idea whether that was an adaptation to heavy exposure. So now that's healthy.
- CWChris Williamson
Mm-hmm.
- SMDr Stuart McGill
That's exactly what the powerlifter needed to set a world record.
- CWChris Williamson
Yep.
- SMDr Stuart McGill
So, so do you... do, do you see my issue when I hear that MRIs are not linked? It's the system that, uh... and, and the fact that radiolo- I don't think radiologists should be allowed to write a report. They've never seen the person, so they have no context. Now, they're good at looking for cancerous tumors and things like that, but in the world of back pain, that's extremely rare. So to link it to physicality, you've got to know the person first, and, uh, then we can interpret the MRIs, and they can be very helpful for people who are a bit stubborn in the, in the response to, to therapies.
- CWChris Williamson
Yeah.
- SMDr Stuart McGill
So, I mean, you're, you're a perfect case in point. I mean, these people who argue, "Oh, it's a psycho- psycho- psychological, um, issue that people will start to obsess over their MRI." Wait a second. You just gave an example of you've just got psychological relief in understanding that you do have something there, it's not something to ignore, it's time to get on it and treat it, and get your health back. So it, it, it all boils down to just being a good human being and, uh, telling the truth, uh, e- e- respecting that the patient you're dealing with is not a five-year-old. They're a 31-year-old athlete-
- CWChris Williamson
Mm-hmm.
- SMDr Stuart McGill
... who needs to know a strategy to get rid of their pain and get back to what they love, which is training CrossFit with their friends, and I get it 100%.
- CWChris Williamson
Yeah. Uh, I mean-You, you... Totally correct. I was in the gym today watching some of the guys throw down, doing a class work- uh, doing a competition qualifier, and I'm thinking, "Ugh, like, I wish that, I wish that I could go back in there and do that." But previously, before the MRI, I'd have probably been like, "Oh, well, my back feels okay today." Like, "Oh, boys, can I just join in?" And then that would be me, throw... Like, I'll just go, "Oh, no, no, no, it's fine. Like, uh, my back, it'll just be a thing." But then you're right, the MRI really hit home, um, with regards to the fact, no, no, no, no, no, hang on. Like, your spine is something that you're going to need for more than just satiating the CrossFit hunger for the next however long that's your methodology. It's something that you're going to have to have-
- SMDr Stuart McGill
(laughs)
- CWChris Williamson
... functioning effectively for the rest of your life. So take some time, focus on the rehab, and work on that, and then slowly begin to build things back in, which is currently now the strategy and has been, has been for a while. Um, w-
- SMDr Stuart McGill
And it's working, I, I take it.
- CWChris Williamson
So it is. Specifically, I won't bore the listeners with my particular pathology (laughs) in my back. There's some, there's some oddities that I- I can't quite work out, and perhaps once I, uh, we, we get off the call, I might be able to explain them to you. But yeah, there's some, there's some interesting things. However, since I've focused a lot more, since I've taken more care about it, I have seen a... The plateau that I spoke about before the MRI has now been pushed through, and the only real thing which has changed has been, uh, compliance with the rehab plan. And-
- SMDr Stuart McGill
Yeah. What, what people don't realize is just because the pain is gone one day, it doesn't mean their back is healed, and this is the mistake. The underlying adaptations still need to continue to build that robustness back again. So if you've got a disc bulge, it's time to get the, uh, loss of stiffness back into the disc with stabilization exercise and whatnot. And the, the, the... That- that- that's... I hate that word because it, it doesn't mention what specific exercises they should be. But nonetheless, um, uh, you do have to honor that history because, you know, there's some physical therapists these days who say, "Oh, well, uh, just because you have back pain, there's no evidence of tissue damage." And again, I would argue w- w- very vehemently against the opposite. I see the damage, uh, and, uh, I've created it (laughs) in, in the, in the clinic and laboratory, and, uh, we document it, and, uh, we know what to look for. Most radiologists have no idea what to look for and whether they're looking at wounds or scars. So, uh, a- again, just because you're out of pain, behave and, uh, organize a proper adaptation schedule, and really enhance the chance for being successful at gaining your athletic robustness once again.
- CWChris Williamson
(smacks lips) I get you. So we've touched one of the things that you come up with a lot is the relationship between stiffness and flexibility in the spine. Um, would it be possible to have a yogi who's also a powerlifter?
- SMDr Stuart McGill
No.
- CWChris Williamson
(laughs) See, one of the interesting things is this. I, I spoke to Dr. Quinn Henoch, doctor of physical therapy for Jugger-nut Training Systems, about a year ago, and he was talking about what he referred to as mobility myths. So we were going through the typical tools and approaches that people use, um, that you see in a gym, the static stretching, the, the Theragun, the vibrating foam roller, the dynamic stretching, the PNF, and all these different things, and he was talking about the mechanisms that actually occur when, when these things happen. But I, I certainly know that in strength sports, at least in the UK, in my, my experience, I see a lot of static stretching. There's a number of subscription services that you can get that, uh, focus exclusively on static stretching as a way to enhance mobility and to improve your range of motion. But it sounds like you potentially might be doing more damage than good with something like that.
- SMDr Stuart McGill
Well, that wasn't your question. You asked me, could there be a powerlifter and a yogi?
- CWChris Williamson
And a yogi.
- SMDr Stuart McGill
Uh, let, let me say why I said that, and very emphatically. Have you built a world champion powerlifter?
- 45:00 – 1:00:00
(laughs) …
- SMDr Stuart McGill
Well, they are asymmetrically mobile on one side-
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
... but they have a hell of an elastic. You know, the first elastic across their hips, the second one across the front of their chest, and the third one in their- in their wrist. You put those three elastics together, and you can throw 110 miles an hour. If you don't, uh, and all you have is mobility, you won't throw a ball very ... Do you know yogis who can throw 110 miles an hour?
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
Do you know a powerlifter who can throw 110 miles an hour?
- CWChris Williamson
Nope.
- SMDr Stuart McGill
Have you measured the great golfers? How strong are they?
- CWChris Williamson
I'm not sure. How strong are they?
- SMDr Stuart McGill
Have you tried ... Well, uh, I've measured them. How- how- how- how much effort ... Have you ever tried to hit a golf ball a long way?
- CWChris Williamson
Yes.
- SMDr Stuart McGill
Okay. You noticed it didn't go very far.
- CWChris Williamson
No. (laughs)
- SMDr Stuart McGill
Yeah, it goes further when you don't try. So when you have a muscle pulse of about, uh, 40% to 50% to 60%, that is the sweet spot for speed, because when a muscle contracts, it creates force. It also creates stiffness. If I maximally contract my bicep, I can't punch you. I've got to really boom! I've got to let it go. When I measure the guys who hit the hardest in- in, uh, the MMA leagues, like the UFC, for example, do you think it's the guys with the great big muscles? No, they push their punches. It's the guy who can snap, bam, that hits the hardest. So it's a neural priming of a spring that is then released. Uh, we've got a lot to talk about in terms of optimal, uh, athleticism, so let's be a little bit careful now when we talk about static stretching to enhance injury resilience and, uh, athletic performance, because, uh, in the great athletes ... And- and I'm, and I'm not talking about duffers here. I'm talking (laughs) about world-class people. Um, be very careful with stretching.
- CWChris Williamson
If it's good enough for them, then it's- it's definitely good enough for us. You touched on a- a couple of interesting sports there, baseball and- and golf, specifically. I've always wondered what the physiology of an athlete who has such a unique type of movement as their, um, flagship of- of- of what their, what their athleticism is built around. Are there some odd abnormalities, especially with someone like a baseball pitcher? They may be less so than someone, I guess, who's an arm wrestler, that would only have a focus on, like, a very, very ... You see these arm wrestlers who have one huge arm that's much bigger than the other one. What's the sort of structure that you would see on- on golfers and on, um, baseball pitchers, and people like that?
- SMDr Stuart McGill
Well, first of all, they're highly asymmetric athletes, so they're not gonna pass a- a screen for symmetry.
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
But- but- but nor would you want them to.
- CWChris Williamson
Yeah.
- SMDr Stuart McGill
You know, they're a- a tuned, elastic, asymmetric athlete. Uh, I- I don't really know what more you want me to- to say on this.
- CWChris Williamson
(laughs) Well, I didn't think it would be anything else.
- SMDr Stuart McGill
Uh, I mean, I can give you all kinds of, uh, uh, tests. I mean, it's so interesting when we look at the, uh, uh, fascial linkage, for example, through the arm, uh, down the right side of the body to the psoas muscle, for example, and how I can tighten the psoas by internally and externally rotating the arm through the shoulder, and you can palpate the psoas tendon, uh, contra- uh, getting tight and then releasing by doing this. So there would be an example of a highly tuned thrower, for example, who has a beautiful, elastic, tuned, uh, chain. If- if you- you- you didn't have that body type, you- you won't throw very fast. Um, and if you didn't adapt it, you probably wouldn't throw very fast, either. So, you know, it's a combination of, uh ...... things. And there's all kinds of things with lever ratios and tendon lengths and all kinds of things. I mean, a sprinter looks like a sprinter for a reason, right?
- CWChris Williamson
Yeah.
- SMDr Stuart McGill
They have a lot of lordosis in their low back, and, uh, y- you know, you- you- you don't need much calf muscle, uh, but you need a- a pre-turned, uh, pelvis to get the power production and hip extension out the back to run. Um, if y- if you plant your foot ahead of your pelvis, you're actually slowing down. All the power has to be out of the extensor range of the foot behind the- the pelvis. But, uh, by the same token, they're not in the UFC kicking people in the head.
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
Those... The- the fighters have flat backs because they have to pre-turn their pelvis to kick high.
- CWChris Williamson
Uh-huh.
- SMDr Stuart McGill
So, you know, a- again, uh, we can talk about, uh, all of these adaptations and- and what you get from your parents and what- what makes a good athlete and how you tune them. But, uh, I- I'd be very careful with discussions of, uh, stretching and... (laughs)
- CWChris Williamson
All understood. Um, I wanted s-
- SMDr Stuart McGill
Yeah.
- CWChris Williamson
I wanted to move on to the big three. There will be a lot of people listening who are familiar with them. Um.
- 1:00:00 – 1:15:00
That must be so…
- SMDr Stuart McGill
people will be shortening their athletic career by keep trying to push, push, push. So there is a concept of sufficient athleticism, sufficient stability, sufficient strength, sufficient mobility, and that is where their optimal health will lie. However, it's not gonna get you to the, uh, peak of the CrossFit games or the Olympics or anything else. So if I was preparing the average fighter for, uh, a three-rounder in the UFC, so that's five minutes on, one minute off, that's your work-rest schedule, um, I would then say, let's do stir the pot. So they're doing, uh, their feet are on the ground, and their elbows are on a gym ball. And now, they stir through the elbows for five minutes, and they can have one minute off times three. So if you think you're ready for a little progression, there's a, there's a little bit of a calibration for you.
- CWChris Williamson
That must be so uncomfortable. That must be absolutely torturous, that final-
- SMDr Stuart McGill
No, no. Don't, don't give me that.
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
You're a crossfitter, bro. That, that, that's what you live for.
- CWChris Williamson
Yeah, get comfortable being uncomfortable, yeah.
- SMDr Stuart McGill
That's, that's the rush. That's what it's all about.
- CWChris Williamson
That, um, that doesn't s- well, I- I'm, I'll, I'll wait and see. I will post it in the members' group, and the, the guy who, uh, who asked the question, I'll see if he can do the five minutes, five minutes on, one minute off, times three rounds.
- SMDr Stuart McGill
Oh, I've, I've got plenty of other tortures for you, if you want. But, you know, it's, it's interesting. I have a, a, an acquaintance, we'll call him, who is a very, very successful person. I'm sure if I revealed his name, most of your listeners would know of the person I'm talking about. He says, "The measure and the predictability of one's success is how willing they're, uh, how, how willing are they to tolerate d- discomfort." That is, in a nutshell, what he says will separate those... Anyway, uh, I'm sure there's other things as well, but that, that would have been his, uh, and, uh, there's, there's CrossFit to it. So do you see? You see why I love it and I hate it.
- CWChris Williamson
Yeah, absolutely.
- SMDr Stuart McGill
(laughs)
- CWChris Williamson
There's, um, a quote in James Clear's Atomic Habit. It's a book which came out this year. James is a habit expert. I'm not sure if you've read it yet.
- SMDr Stuart McGill
No.
- CWChris Williamson
But if you, if you haven't and if you've got time to read something, you're looking for s- for a holiday read, highly recommended. My favorite book of 2019. Uh, I had j-
- SMDr Stuart McGill
Oh, beautiful.
- CWChris Williamson
I had James on the podcast about three months ago, and he's, he really is, he's the real deal. Um-
- SMDr Stuart McGill
Yeah.
- CWChris Williamson
... and he went and interviewed the coach of a, one of the Chinese weightlifting team's coaches, and he asked him the question, "What makes the difference between the guys who are good and the guys who become the absolute best?" And the coach's answer was that it is the people who can put up with the boredom of doing the same thing day in, day out. And what he identified there was that I think a lot of normal athletes, like myself, look at someone like Matt Fraser or, uh, Adele Beckham or whatever it might be and think, "Well, that person must never get bored. Their training must always be fantastic for them." Anthony Joshua, you see him, he, he is the sort of person who's quite forthcoming about his training online, his training diaries and stuff like that. You see him training a lot, and you think he must, he must just turn up to training and love it every single day. And the coach of this particular weightlifting team said that's not the case at all. He's like, "There's days when my athletes turn up and they don't wanna be there. They don't wanna, they don't wanna have to do yet another set of pulls from blocks or whatever it might be. They don't wanna have to do more back extensions, but they do, and they go through it." And he said that the difference is the person who is able to turn up and follow the program and just stick to the plan and, and grind through those days. Uh, I thought that was really, really interesting and illuminating.
- SMDr Stuart McGill
I agree.
- CWChris Williamson
I'm glad. I'm glad. It, as well, the other thing that I really liked about that was that it, um, it put the power for someone to change their athletic ability in their hands. It's like, look, if, if, if the best crossfitter on the planet, Matt Fraser, gets bored training and he works through it, then it's exactly the same for you. He doesn't have some superhuman level of motivation. He just grits his teeth and does the work. I thought it was nice.
- SMDr Stuart McGill
Yeah. Yeah. Well, I, I don't know Matt Fraser, but, um, he, he, he has to be of that type.
- CWChris Williamson
Cut from that cloth.
- SMDr Stuart McGill
There's no option. Yeah.
- CWChris Williamson
Um, I wanted you to tell the listeners the story behind The Gift of Injury, if you could.
- SMDr Stuart McGill
Well, that was a book. Uh, it's co-authored by Brian Carroll. Uh, so the story is this. Uh, I knew the name Brian Carroll. I'd never met him, but he held, uh, several records in powerlifting. Um, you know, he'd squatted well over 1100 pounds. He'd squatted over 1000 pounds over 50 times in international competition, so he'd been around the block. So I, I knew the name and I knew some of those statistics. I got a phone call one day and, uh, he, uh, it w- he said very politely, "This is Brian Carroll, uh, professor, I've, I've hurt my back. Would you see me?" And I said, "Well, yes." And, uh, he came up and, uh, he was not moving well. And, uh, I thought, "Wow, this is one of the best squatters and he has difficulty getting i- getting in and out of a chair." And it, it seemed as though he'd lost his discipline. Anyway, within, uh, not too long, uh, within an hour, I would say, he was starting to move without, uh, triggering his back pain. And, uh, I said, uh... Oh, and then I, I, I never put a person's images up on the view box early in the consult. I really try and understand the person, uh, who they are, their personality, and, and then I, I assess them for their physical pain triggers. And only then will I look at the images. And when I looked at the images, I, I was quite horrified. He'd split his sacrum front to back, L5 was heavily fractured, and the discs were, uh, if I used the word obliterated, uh, that-
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
... would be, um, quite accurate. Now-
- CWChris Williamson
Wow. I mean, what does that look like on an MRI? Is it just like-
- SMDr Stuart McGill
Well, if, if you get the book, you'll see.
- CWChris Williamson
Yeah.
- 1:15:00 – 1:24:28
Yeah. Yeah, it's a,…
- SMDr Stuart McGill
of a person who can do that with their body, and then, uh, carry it through all the way to the end.
- CWChris Williamson
Yeah. Yeah, it's a, it's a really, a really fascinating story, and I love every time that I hear that story about Brian, I absolutely love it. I'm very, very excited to get stuck into the book as well. I appreciate-
- SMDr Stuart McGill
Well, why, why don't you have him on your podcast? H- hear it from the horse's mouth. He's a, he's a fabulous man, and a good storyteller, and, and, uh, uh-
- CWChris Williamson
Would you be able to do an introduction?
- SMDr Stuart McGill
... super athlete. Of course.
- CWChris Williamson
Absolutely. Well, listeners, you've heard it here first. I might be speaking to Brian Carroll sometime soon. Wouldn't that be cool?
- SMDr Stuart McGill
Yeah.
- CWChris Williamson
That would be a cool second part. Um, I'm-
- SMDr Stuart McGill
I'm sure Brian would love to.
- CWChris Williamson
I s-
- SMDr Stuart McGill
He's a lovely fellow.
- CWChris Williamson
I, I would love to hear where his mind's at. A- again, you know, as some of the listeners, and I'm sure a lot of people will be tuning in, seeing your name, uh, uh, seeing the particular topic that we're talking about, and thinking, "I want to hear ... I want to frame my mind about injury in the right way. I want to have the mindset which is going to be optimal to help me progress my injury." So one of the things that the, uh, uh, physio that's helping me with my rehab says it's that making sure that you're in the right mindset is a large part of the battle to get to-
- SMDr Stuart McGill
It's huge.
- CWChris Williamson
Yeah.
- SMDr Stuart McGill
It, it's huge, you know, but, uh, uh, I'll, I'll just pick up on that because in particular in your country, there are, there, there's been a little bit of a transformation in physical therapy where some, uh, if a person comes in with back pain, without even assessing the patient, they'll say, "Oh, well, your back isn't fragile. You know, you just carry on and, and keep m- m- doing the, whatever it is you're doing and whatnot." And I say, "Well, hold on a second. There are different types of people." If you get a CrossFitter and you say, "Well, just carry on," the person who's a CrossFitter is a go-getter to start with.
- CWChris Williamson
Yeah.
- SMDr Stuart McGill
And they don't need to be encouraged to keep going for it. (laughs)
- CWChris Williamson
(laughs) No, no, no, no, no.
- SMDr Stuart McGill
When, when, when he-
- CWChris Williamson
For the love of God, pump the brakes.
- SMDr Stuart McGill
Yes. Thank you. For the love of God, pump the brakes. Um-
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
And, but the next person who has this idea, well, you know, the, the, the, they are magnifying every little ache and pain, uh, y- and, you know, they've had a good fart, and they're calling the doctor.
- CWChris Williamson
(laughs)
- SMDr Stuart McGill
It's, it's ... Uh, so there's a time and a place to tell a person, "Yeah, your back is fragile," and for a CrossFitter, you've got to hold them back and let biology adapt the robustness to the tissues, uh, that al- you can't see the fractures, the microfractures on the MRI, but they're there, and, uh, it takes time. Versus the next person who, uh, just is a little bit more on the movement adverse side of the spectrum, yes, you are a little bit more robust than you think. Let's, let's prove it. Let's try a few things.
- CWChris Williamson
Yeah.
- SMDr Stuart McGill
And show them some good mechanics. Once they've mastered the good mechanics, load them, make sure the mechanics are preserved, and all of a sudden, they've just broken through an interior ... "Wow, I'm training now. I'm pain-free. Now I just have to organize the progression in a way that, uh, isn't too greedy. I'll respect the time process of the adaptation and build them back." So, you know, it's different strokes for different st- uh, folks, th- that's for sure.
- CWChris Williamson
Yeah. Um, I appreciate that you have athletes ringing you because you need to, you need to deal with some people who might be in a little bit of back pain, Dr. McGill, so I'm, uh, I'm going to-
- SMDr Stuart McGill
(laughs)
- CWChris Williamson
I'm, I'm gonna try and, try and call it there. If there was one, uh, final question that I had, we've touched on it already, and you mentioned about stirring the pot as one potential extra. If you were to have, um, the next closest exercises that were the close runners up for the big three, were there any, or would there be any that are your staple favorites for a broad cross-section of athletes?
Episode duration: 1:24:24
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