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

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.280 | where we discuss science

00:00:03.700 | and science-based tools for everyday life.

00:00:05.880 | I'm Andrew Huberman,

00:00:10.520 | and I'm a professor of neurobiology and ophthalmology

00:00:13.780 | at Stanford School of Medicine.

00:00:15.780 | My guest today is Dr. Stuart McGill.

00:00:18.400 | Dr. Stuart McGill is a distinguished professor

00:00:20.920 | of spine biomechanics at the University of Waterloo.

00:00:24.360 | As a professor for more than three decades,

00:00:26.600 | Dr. McGill has analyzed the spines of injured people

00:00:29.680 | as well as healthy people,

00:00:31.320 | and developed methods to treat spine injuries and pain,

00:00:34.360 | as well as to improve spine biomechanics in anybody.

00:00:37.680 | He has authored more than 250 peer-reviewed

00:00:40.140 | research articles on these topics,

00:00:42.240 | making him a true world expert.

00:00:44.520 | During today's episode, we discuss spine anatomy,

00:00:47.240 | as well as the common sources of back pain.

00:00:50.160 | And we discuss some of the controversies

00:00:51.920 | as to the origins and different treatments for back pain.

00:00:55.440 | As you'll quickly learn,

00:00:56.600 | there is no one specific source of back pain,

00:00:59.160 | nor is there one specific solution to back pain,

00:01:02.380 | but as Dr. McGill spells out very clearly,

00:01:05.200 | there are things that anyone and everyone can do

00:01:08.080 | in order to strengthen their back

00:01:09.740 | and to reduce the amount of pain they may be experiencing.

00:01:12.620 | He explained some specific ways

00:01:14.140 | to self-diagnose your back pain,

00:01:16.040 | which of course is critical for understanding

00:01:17.680 | what specific things to do,

00:01:19.080 | as well as to avoid in dealing with any pain,

00:01:22.040 | and as it relates to applying in sport

00:01:24.920 | and in everyday life.

00:01:26.280 | Dr. McGill and I also discuss

00:01:27.920 | several of the avid controversies

00:01:29.600 | within the field of back pain

00:01:31.240 | and the treatments for back pain.

00:01:32.780 | We talk about the so-called biopsychosocial model of pain,

00:01:36.200 | which points to the various sources

00:01:37.960 | that pain can arise from,

00:01:39.520 | everything from emotional to lack of sleep,

00:01:42.100 | to specific locations in the spine and brain

00:01:44.680 | and elsewhere in the body,

00:01:45.960 | and the ways those mesh together

00:01:47.520 | to give us what we call pain,

00:01:49.080 | as well as to direct us towards specific treatments for pain

00:01:52.360 | that tend to be especially effective.

00:01:54.480 | Dr. McGill is a true encyclopedia

00:01:56.620 | on the topics of back physiology and anatomy,

00:01:59.540 | sources of back pain and treatments for back pain.

00:02:02.020 | So it's truly a special opportunity

00:02:03.940 | to be able to learn from him in such immense detail

00:02:06.880 | and in such a clear and actionable way.

00:02:09.300 | By the end of today's episode,

00:02:10.980 | you will have a quite thorough understanding

00:02:12.820 | about the anatomy and physiology of the back

00:02:15.160 | as it relates to a healthy back, to back pain,

00:02:18.100 | and of course, you'll have various remedies

00:02:20.380 | for dealing with back pain, preventing back pain,

00:02:22.900 | and for strengthening your back

00:02:24.460 | for all sorts of different kinds of movement,

00:02:26.420 | not just for exercise and sport,

00:02:28.140 | but also to move through your daily activities pain-free

00:02:30.840 | and with ease and mobility at any age.

00:02:33.660 | Before we begin, I'd like to emphasize

00:02:35.460 | that this podcast is separate

00:02:37.020 | from my teaching research roles at Stanford.

00:02:39.200 | It is, however, part of my desire and effort

00:02:41.320 | to bring zero cost to consumer information

00:02:43.260 | about science and science-related tools

00:02:45.300 | to the general public.

00:02:46.680 | In keeping with that theme,

00:02:47.940 | I'd like to thank the sponsors of today's podcast.

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00:06:20.000 | And now for my discussion with Dr. Stuart McGill.

00:06:23.360 | Dr. Stuart McGill, welcome.

00:06:25.240 | - Thank you, sir.

00:06:26.720 | - Great to have you here.

00:06:28.920 | I'm a big fan of your work.

00:06:30.400 | I've watched a lot of your other content,

00:06:33.800 | read your books, and I'm excited to discuss today

00:06:38.280 | what makes for a really strong, resilient back,

00:06:42.880 | what causes back pain and how to relieve it.

00:06:46.460 | And perhaps the bigger issue is what all of that allows

00:06:51.320 | for in terms of mobility and functionality,

00:06:53.980 | not just in sport, but in everyday life.

00:06:56.680 | So to kick things off, I'd like to ask a question

00:06:59.920 | that I think is on a lot of people's minds.

00:07:02.960 | Most people aren't thinking about their back

00:07:05.060 | unless they have pain.

00:07:07.480 | So what causes back pain?

00:07:11.240 | You start with the easy questions.

00:07:12.940 | Let me give context before I define it

00:07:18.360 | as tightly as I can for you.

00:07:20.180 | Back pain is a symptom.

00:07:23.680 | So let's just change the topic for a moment

00:07:26.880 | and talk about leg pain.

00:07:29.200 | Can you imagine asking someone,

00:07:30.800 | "Well, could you give me an exercise

00:07:32.720 | "or a prevention strategy for leg pain?"

00:07:36.260 | Okay, so that sets the stage a little bit.

00:07:38.520 | We're talking about a symptom

00:07:40.120 | for which there's a hundred or more different pathways

00:07:44.120 | and mechanisms there.

00:07:45.840 | So we've got to have a fairly comprehensive assessment now

00:07:49.040 | and understanding to focus on the type of back pain

00:07:54.040 | and then matching an appropriate intervention.

00:08:00.080 | I was listening to your new podcast

00:08:01.840 | with Andy Galpin this morning.

00:08:05.360 | - The Perform podcast.

00:08:06.440 | - With the Perform podcast, yeah.

00:08:07.800 | And he said, "I'm going to try and follow the three I's."

00:08:12.800 | And it was, I think, gather information,

00:08:16.760 | interpret the information, and then intervene.

00:08:20.280 | So it's the same kind of deal here.

00:08:22.520 | And of course, that's pan-medical condition, shall we say.

00:08:27.520 | So with that context, I'm going to answer it like this.

00:08:32.520 | What causes back pain?

00:08:33.960 | Genetics loads the gun.

00:08:38.200 | Exposure pulls the trigger.

00:08:41.220 | And then the psychosocial milieu around the individual

00:08:44.960 | influences how they respond to the pain.

00:08:49.560 | So there's a start.

00:08:51.320 | We can break it down in those three categories if you wish.

00:08:55.080 | - Sure, so when you say genetics loads the gun,

00:08:58.800 | what comes to mind, because it's my experience,

00:09:00.880 | is that I have a right shoulder

00:09:04.360 | that sits a little bit lower than my left shoulder,

00:09:06.920 | unless I'm mindful of that.

00:09:09.040 | My dad has the same thing.

00:09:11.200 | And I can, you know, put an ankle on my other knee

00:09:16.200 | a bit more easily on one side versus the other.

00:09:20.300 | I tend to pronate one foot a little bit more

00:09:22.520 | than the other when I run.

00:09:24.000 | These are subtle things.

00:09:25.380 | They don't necessarily result in back pain,

00:09:28.740 | but I'm guessing that a lot of that

00:09:30.560 | is either developmental overuse, particular sport.

00:09:35.200 | I'm regular footed, I skateboarded a bunch,

00:09:37.520 | so I push with my right foot,

00:09:38.880 | I kick a soccer ball with my right foot,

00:09:40.440 | those sorts of things.

00:09:41.280 | But let's assume that genetics played some role,

00:09:44.400 | created some bias.

00:09:46.480 | If I were to tell you that, which I just did,

00:09:49.000 | would then you immediately think

00:09:52.480 | to a particular intervention if I told you,

00:09:56.720 | okay, you know, I have a little bit

00:09:57.880 | of lower right side pain, which I occasionally do.

00:10:01.960 | I know I've got this imbalance that was loaded by genetics,

00:10:05.180 | and presumably experience as well.

00:10:07.560 | And would your mind immediately go

00:10:10.000 | to a particular origin of that pain,

00:10:14.440 | or perhaps even more importantly,

00:10:15.960 | a particular remedy to that pain?

00:10:17.480 | Or do we need to drill a little bit deeper

00:10:19.200 | and really understand more about what I do,

00:10:23.720 | what I don't do, if I'm more thin set

00:10:26.880 | or heavily set at the level of a bone structure?

00:10:30.280 | You know, what are some of the other questions

00:10:31.720 | one would ask in the investigate category?

00:10:34.520 | - My thought would not go to one or the other,

00:10:37.140 | but it would go to both.

00:10:38.780 | And I'd start that conversation with this analogy.

00:10:43.780 | Let's talk about breeds of dogs.

00:10:46.980 | We both love dogs.

00:10:48.120 | If I said to you, we're gonna take two dogs

00:10:52.900 | and we're gonna train them for the Greyhound track.

00:10:55.340 | One's a Greyhound, and one's a St. Bernard.

00:10:58.540 | How do you think you're going to make out the St. Bernard,

00:11:01.740 | no matter how you train it or condition it,

00:11:04.920 | will never make it to the performing on a Greyhound track.

00:11:08.640 | You're gonna end up with a broken St. Bernard.

00:11:11.320 | So there's a little bit of a start from a big perspective.

00:11:15.100 | But now let's drill down and talk about spines.

00:11:17.680 | It's interesting when you look at the basic

00:11:23.900 | anatomical structure of an individual.

00:11:26.500 | We just did that with dogs.

00:11:28.620 | Imagine if I took a thin willow branch,

00:11:31.200 | I could bend that willow branch back and forth

00:11:33.540 | over and over, and it wouldn't accumulate stress.

00:11:37.220 | But if I took that same willow branch

00:11:39.260 | and loaded it top to bottom, like an I-beam,

00:11:42.340 | it would just bend and break.

00:11:44.160 | So it supports bending cycles,

00:11:47.800 | but it doesn't support compression.

00:11:49.520 | Now I'm going to change that willow branch

00:11:52.380 | into a thicker stick.

00:11:54.180 | And I bend the stick once and it shatters.

00:11:57.080 | In other words, the thickness and radial diameter

00:12:02.080 | being larger means the stress is bigger in bending.

00:12:06.380 | However, let's compress the same stick.

00:12:08.980 | It can bear tremendous compression.

00:12:11.300 | So there's a very fast example on spines.

00:12:14.260 | There's a fellow who has the world record

00:12:17.580 | in consecutive sit-ups, thousands of them.

00:12:21.260 | Given what I've just said, what's your prediction?

00:12:23.860 | Do you think he has a big strong fellow

00:12:25.860 | with a thick spine, or do you think he's a very slender man

00:12:28.940 | with a willowy thin spine?

00:12:30.620 | - He's a willowy bendy guy who can just keep bending

00:12:33.460 | up and down off the ground.

00:12:34.620 | - Bingo, bingo, he has to be, there's no option.

00:12:38.480 | So there's a start on the genetics.

00:12:41.520 | Not everybody can play offensive tackle

00:12:43.740 | and not everybody can be a gymnast,

00:12:45.660 | or not everybody can simply tolerate

00:12:49.100 | sitting in a chair being a computer operator.

00:12:52.140 | There's a very mundane example for you.

00:12:55.420 | - Could I ask you a question about the willow

00:12:57.740 | versus thicker trunk example?

00:13:01.700 | Can we look to torso thickness or wrist thickness

00:13:07.460 | or ankle circumference as a way to assess ourselves

00:13:12.460 | as to whether or not we are likely to be more willowy

00:13:18.900 | or Redwood-like?

00:13:20.940 | I mean, it should be obvious just by looking at ourselves,

00:13:24.100 | knowing ourselves.

00:13:25.380 | But for instance, I have a short torso.

00:13:27.740 | I'm kind of thick through the torso front to back.

00:13:29.740 | I always have been since I was a kid.

00:13:31.460 | But, and my wrist, the wrist circumference isn't small,

00:13:34.820 | but isn't huge.

00:13:36.020 | I had a bulldog mastiff and he would often look at me

00:13:40.120 | and I knew in his mind, he was thinking,

00:13:42.220 | "My wrists are really thick compared to yours, Andrew."

00:13:46.060 | I knew that's what he was thinking.

00:13:47.860 | He had forearms, he had forearms like a longshoreman.

00:13:52.420 | - And of course he had never done any work whatsoever.

00:13:54.860 | Actually, primary goal of the bulldog

00:13:56.420 | is to do as little work as possible in life.

00:13:58.620 | But I have friends who, you know, have thick knees,

00:14:02.740 | some have smaller joints, smaller ankles.

00:14:04.940 | Can we make some general assessment about our spine

00:14:07.220 | without imaging it,

00:14:08.420 | by looking at some of these peripheral markers?

00:14:10.380 | - Absolutely, yeah.

00:14:11.660 | So the knee width, the bi-iliocrystal width,

00:14:16.660 | which is the width of your iliac crests,

00:14:21.220 | hip width are all surrogates

00:14:23.860 | to indicate general heaviness of the skeleton.

00:14:27.200 | So yes, that's one good marker.

00:14:32.680 | But there's more to the story for genetics

00:14:35.740 | and how bendy a spine can be.

00:14:38.280 | The shape of the disc matters.

00:14:41.900 | So if you take on average, a group of top golfers,

00:14:46.340 | you'll notice that their spines,

00:14:48.920 | that the disc shape, if we were to cut through,

00:14:51.420 | which is a transverse scan on an MRI,

00:14:54.300 | the discs are more ovoid.

00:14:56.500 | If you take someone who can bear a lot of compressive load,

00:14:59.340 | the discs look more like a lima bean,

00:15:02.540 | and that's called a limacon shaped disc.

00:15:04.700 | - And of course the discs are in repeating fashion

00:15:07.460 | throughout the spine, top to bottom.

00:15:09.140 | - Correct.

00:15:09.980 | - And the discs are the soft tissue

00:15:13.420 | that allow for mobility of the vertebrae,

00:15:17.380 | the bony segments.

00:15:18.840 | - Exactly.

00:15:19.680 | They are the joints,

00:15:20.500 | but they're not a ball and socket joint.

00:15:21.760 | They're actually a fabric of layer upon layer

00:15:25.560 | of collagen fibers.

00:15:26.640 | And we can talk about that as well.

00:15:28.320 | - What a beautiful adaptation, right?

00:15:30.000 | Take a bunch of bony.

00:15:31.160 | If you want to be able to bend a bone, right?

00:15:33.560 | You need to break it up into segments,

00:15:35.920 | kind of like beads on a necklace.

00:15:37.600 | And then in between those beads,

00:15:39.880 | you put some pliable yet,

00:15:46.560 | I guess a tissue that you can still compress.

00:15:49.500 | So it's both pliable and it can squeeze down

00:15:52.500 | and become more narrow in the vertical direction.

00:15:54.740 | And it can also squeeze down on one side

00:15:58.320 | or the other to some degree.

00:16:00.180 | - Yeah.

00:16:01.980 | We evolved discs

00:16:04.460 | and there really is no other better architecture.

00:16:07.420 | People say, well, why don't we have ball

00:16:09.020 | and socket joints in our spine?

00:16:10.420 | And the reason is this.

00:16:12.000 | Can you imagine stacking five oranges,

00:16:15.920 | one on top of the other?

00:16:17.480 | And then you could make them mobile

00:16:19.200 | by putting a ball and socket joint in between them.

00:16:21.600 | The amount of control that you would need

00:16:24.260 | on every single orange,

00:16:26.920 | you move one orange, you have to control all the others.

00:16:29.560 | It's mission impossible.

00:16:30.840 | We would, I would do an experiment

00:16:32.640 | with students in my lectures.

00:16:34.240 | I would take four coffee cans

00:16:36.360 | and put a tennis ball between each coffee can.

00:16:38.880 | And then I would put a rope

00:16:40.420 | at the front and the back of each coffee can,

00:16:43.520 | and then one on the side.

00:16:45.100 | And I had four students take those four ropes.

00:16:48.220 | And then I took another four students

00:16:50.180 | who had the ropes on the next coffee can,

00:16:53.420 | and then on the next coffee can.

00:16:55.100 | And then I'd say, okay, group, flex the spine forward.

00:16:59.340 | So the students on the front would pull a little bit,

00:17:01.860 | but the guy on top had to pull more than the next coffee can

00:17:06.100 | and then the next coffee can a little bit less,

00:17:08.500 | vice versa, the people on the other side

00:17:10.320 | had to pay out the rope in sequence.

00:17:12.760 | And then I would say, okay, now let's twist a little bit.

00:17:16.400 | Anyway, you could imagine it was impossible to control.

00:17:21.020 | And then I took out the tennis balls

00:17:26.020 | and I put in what was a disc,

00:17:28.340 | a big round cylindrical piece of foam rubber.

00:17:31.640 | All of a sudden that added stiffness.

00:17:34.160 | So now, because the body uses stiffness

00:17:37.420 | as the control parameter, now we've added control

00:17:41.900 | in that the foam rubber would create a buffer.

00:17:46.580 | And as the deviation in motion occurred,

00:17:50.140 | the foam rubber would add more resistance.

00:17:52.820 | So it was an automatic control.

00:17:54.580 | And that's what a shock absorber does on a car.

00:17:56.940 | It has an elastic element plus the damper,

00:17:58.980 | but it's the elastic element.

00:18:01.100 | And we're gonna talk about stiffness and stability,

00:18:03.620 | I hope, that really creates the control.

00:18:08.540 | So that's why we have evolved discs.

00:18:12.380 | It's highly efficient.

00:18:13.940 | I can bend the spine to tie my shoe.

00:18:16.580 | But if I have to carry home these days,

00:18:21.100 | heavy shopping bags, I need stiffness of that flexible rod

00:18:25.020 | so it doesn't collapse.

00:18:26.600 | Or years ago, I might've been carrying home

00:18:29.880 | an animal for dinner.

00:18:31.500 | And I needed those discs to provide the stiffness

00:18:35.100 | in a very economical way.

00:18:36.940 | And in a way that didn't create stress concentrations

00:18:41.260 | the way ball and socket joints would.

00:18:43.640 | So that's an evolutionary necessity.

00:18:47.860 | Also, when we look at spines,

00:18:50.540 | there are the column of vertebrae

00:18:52.260 | with the intervening discs.

00:18:53.580 | But behind them, there's two more joints.

00:18:55.500 | And those are called facet joints.

00:18:56.900 | And they guide motion.

00:18:58.860 | Those facet joints have a variety of angles.

00:19:01.780 | They can have open angles, which allow you to twist.

00:19:05.900 | So if you took a group of golfers,

00:19:09.500 | could you imagine if they had facet angles like this,

00:19:14.180 | you can't twist.

00:19:15.380 | - So facet angles that are too close together, basically.

00:19:18.020 | - Well, it's a small angle.

00:19:19.260 | If the angle is orientated fore and aft, you can't twist.

00:19:23.820 | And you won't find, if you're dealing with a group

00:19:26.180 | of professional golfers, you'll find they all

00:19:29.340 | have open facet joints.

00:19:31.740 | - Is that genetic?

00:19:32.780 | - It's absolutely 100% genetic.

00:19:35.820 | Now, interestingly enough, when you arch back,

00:19:39.620 | when the facet joints are orientated open,

00:19:42.220 | as I'm describing, when you arch back,

00:19:44.820 | one pushes hard on the other, like shingles on a roof.

00:19:48.320 | That stresses a bone called the pars bone.

00:19:52.660 | And gymnasts, for example, get a very typical fracture

00:19:57.660 | pattern called a spondylolisthesis,

00:20:02.300 | which is a fracture of that bone.

00:20:03.820 | And then the spine shifts a little bit at that joint.

00:20:06.460 | I'm just finishing rehabbing a pro tennis player

00:20:11.300 | who had the same thing after they tried

00:20:13.420 | to have too much range of motion in their serve.

00:20:16.020 | The coach gave them excessive extension

00:20:18.780 | to try and put more miles an hour on the ball,

00:20:20.940 | but it didn't suit the spine.

00:20:23.440 | And they ended up having a stress fracture.

00:20:25.940 | - I mean, is it fair to say that if we can,

00:20:30.060 | if we are naturally flexible, for instance,

00:20:33.100 | like my sister can, you know, like her fingers

00:20:35.660 | can bend back really easily, her shoulder extension,

00:20:38.620 | which I guess for people that aren't familiar

00:20:40.060 | with shoulder extension, you know, she can,

00:20:42.620 | like, let's say you're leaning up against a railing

00:20:45.100 | with your back to the railing.

00:20:46.380 | The railing's just, let's just say,

00:20:48.180 | is just above lower back height,

00:20:50.860 | and you can put both hands on it parallel.

00:20:54.100 | So your arms are close together,

00:20:56.300 | like very close to the torso.

00:20:57.620 | And then, and people don't do this quickly

00:21:00.380 | 'cause you can tear something or injure something.

00:21:03.460 | But then with feet about, I don't know,

00:21:05.900 | a foot or two away from that bar,

00:21:09.860 | you can do a knee bend and basically

00:21:11.700 | the arms go back behind you.

00:21:13.540 | Like I happen to have a fair degree of shoulder,

00:21:15.340 | just natural shoulder extension ability.

00:21:17.620 | I'm not particularly flexible, quote unquote,

00:21:19.620 | but that's just how I'm structured.

00:21:22.340 | I have some friends that can't do that to save their life.

00:21:25.180 | But I wouldn't consider myself hyper-flexible.

00:21:28.780 | My sister is a bit more flexible.

00:21:30.180 | We're related, obviously.

00:21:32.300 | So would people like her or people that tend

00:21:36.740 | to be pretty flexible naturally,

00:21:38.440 | would they be wise to avoid certain activities

00:21:42.500 | if their goal is to remain pain-free?

00:21:44.740 | I mean, you talk about the St. Bernard running

00:21:47.740 | on the Greyhound track.

00:21:49.620 | We all can enjoy things recreationally,

00:21:51.620 | but of course we don't wanna injure ourselves.

00:21:54.100 | So is somebody who's naturally flexible,

00:21:56.000 | should they avoid certain sports and activities?

00:21:58.580 | And conversely, if somebody is naturally stiffer,

00:22:02.460 | thicker spine, thicker joints,

00:22:04.260 | should they avoid certain activities?

00:22:06.500 | - That's a huge question.

00:22:08.060 | And there's many more variables to consider.

00:22:12.920 | But I will say that when we are rehabilitating a athlete

00:22:17.920 | or just a person to get back to work,

00:22:20.320 | they're an occupational athlete,

00:22:22.400 | we take all of this into consideration.

00:22:24.600 | So as you were describing your sister arching back,

00:22:27.700 | A, I know she has plump discs,

00:22:32.480 | discs that are full of fluid to allow the mobility

00:22:36.380 | to take place in the discs.

00:22:37.960 | I also know that if we looked at an X-ray from the side,

00:22:41.780 | you know the posterior spinous processes.

00:22:44.480 | If you run your thumb down the midline of a person's back,

00:22:47.780 | you will feel the bumps of bone up the middle of the spine.

00:22:51.100 | Those are the posterior spines.

00:22:53.100 | She will have a large space between each one

00:22:58.360 | when she's standing upright.

00:22:59.720 | So when she extends back, those spaces will come together

00:23:04.720 | and eventually the spines, what we call it kissing spines.

00:23:08.320 | And it takes me back to some of the old Russian techniques

00:23:12.180 | for bench press.

00:23:13.060 | They would bench press with a huge arch in their back.

00:23:16.220 | And then other people would say,

00:23:17.340 | "Oh, well, I'm going to try and mimic

00:23:18.980 | "that particular bench press technique

00:23:21.380 | "because it allows you to get much more force

00:23:23.740 | "out of the latissimus dorsi, a stiffer back,

00:23:26.300 | "and you get a different force vector

00:23:28.540 | "and actually more effective force on the bar."

00:23:34.840 | They didn't realize that when we work with a person

00:23:38.900 | who has a huge arch, they have big spaces

00:23:41.940 | between those spinous processes.

00:23:44.100 | And if you don't have those big spaces,

00:23:46.020 | you are going to crush the interspinous ligaments,

00:23:48.780 | which naturally are between those spaces.

00:23:51.520 | And you will now fire off a whole set of new problems.

00:23:56.520 | So what is a mechanical advantage for one person

00:24:03.900 | is a mechanical disadvantage for another?

00:24:06.980 | Do you follow?

00:24:08.020 | So all of this matters.

00:24:12.380 | Going back to the disc being a fabric

00:24:16.860 | of layer upon layer of collagen strands.

00:24:20.680 | Typically, the disc is about 80% type one collagen.

00:24:25.680 | That is the stiff strength collagen.

00:24:32.140 | About another 20% is elastic collagen, type two.

00:24:37.140 | But there's types three through 10

00:24:40.580 | that bind those collagen fibers together.

00:24:44.060 | That's where there's a much greater degree

00:24:46.940 | of genetic variability.

00:24:50.040 | So there are some people who can get away

00:24:54.340 | with doing many sit-ups.

00:24:56.160 | They have a slender spine and they have the type

00:24:59.100 | of binding collagen that holds all those fibers together.

00:25:03.560 | But if I wanted to work these fibers of my shirt apart,

00:25:07.900 | get them to delaminate,

00:25:09.120 | I would create repeated stress strain reversals.

00:25:11.760 | The resistance of that fabric depends

00:25:16.140 | on the stuff holding the fibers together.

00:25:19.580 | So there will be binding fibers there.

00:25:22.160 | That's where the genetic variance lies in many people.

00:25:26.040 | So even there, the person's resilience

00:25:29.280 | to repeatedly doing a bending drill is determined

00:25:34.280 | by your parents to some degree, both in the size,

00:25:38.600 | the collagen type three through 10 makeups.

00:25:42.740 | As many of you know, I've been taking AG1

00:25:45.800 | for more than 10 years now.

00:25:47.380 | So I'm delighted that they're sponsoring this podcast.

00:25:49.840 | To be clear, I don't take AG1 because they're a sponsor.

00:25:52.600 | Rather, they are a sponsor because I take AG1.

00:25:55.720 | In fact, I take AG1 once and often twice every single day,

00:25:59.120 | and I've done that since starting way back in 2012.

00:26:02.600 | There is so much conflicting information out there nowadays

00:26:05.200 | about what proper nutrition is,

00:26:07.360 | but here's what there seems to be a general consensus on.

00:26:10.340 | Whether you're an omnivore, a carnivore,

00:26:12.680 | a vegetarian or a vegan, I think it's generally agreed

00:26:15.560 | that you should get most of your food from unprocessed

00:26:18.200 | or minimally processed sources,

00:26:20.120 | which allows you to eat enough, but not overeat,

00:26:22.620 | get plenty of vitamins and minerals,

00:26:24.200 | probiotics and micronutrients that we all need

00:26:26.960 | for physical and mental health.

00:26:28.640 | Now, I personally am an omnivore,

00:26:30.440 | and I strive to get most of my food from unprocessed

00:26:32.880 | or minimally processed sources.

00:26:34.780 | But the reason I still take AG1 once

00:26:36.760 | and often twice every day is that it ensures

00:26:39.360 | I get all of those vitamins, minerals, probiotics, et cetera,

00:26:43.120 | but it also has adaptogens to help me cope with stress.

00:26:45.940 | It's basically a nutritional insurance policy

00:26:48.200 | meant to augment, not replace quality food.

00:26:50.920 | So by drinking a serving of AG1 in the morning,

00:26:53.120 | and again in the afternoon or evening,

00:26:55.160 | I cover all of my foundational nutritional needs.

00:26:57.800 | And I, like so many other people that take AG1,

00:27:00.480 | report feeling much better in a number of important ways,

00:27:03.520 | such as energy levels, digestion, sleep, and more.

00:27:06.680 | So while many supplements out there are really directed

00:27:08.880 | towards obtaining one specific outcome,

00:27:11.240 | AG1 is foundational nutrition designed to support

00:27:13.860 | all aspects of wellbeing related to mental health

00:27:16.300 | and physical health.

00:27:17.700 | If you'd like to try AG1,

00:27:19.120 | you can go to drinkag1.com/huberman

00:27:22.560 | to claim a special offer.

00:27:23.980 | They'll give you five free travel packs with your order,

00:27:26.080 | plus a year supply of vitamin D3 K2.

00:27:28.700 | Again, that's drinkag1.com/huberman.

00:27:32.840 | Unless somebody is seeking to be a world-class athlete

00:27:36.200 | in something, in which case,

00:27:37.840 | they should probably pay attention to their genetics

00:27:39.920 | and see whether or not it lines up well with a given sport.

00:27:42.400 | Although there have been exceptions

00:27:44.680 | where people who are incredibly genetically,

00:27:51.140 | let's just say biased toward not being able to perform well

00:27:54.540 | in a sport have nonetheless succeeded in performing

00:27:56.980 | at a world-class level.

00:27:58.220 | But those are exceedingly rare exceptions.

00:28:01.140 | For most people who want to do things recreationally,

00:28:05.540 | like the heavier set person with a thicker spine

00:28:07.820 | who wants to golf or do ballet perhaps,

00:28:12.820 | or the thinner willowy person who wants to get

00:28:17.100 | into powerlifting, for instance.

00:28:20.820 | Are there certain things that they should each consider

00:28:24.940 | and embrace as activities

00:28:26.900 | in order to make themselves more resilient,

00:28:29.420 | more pain resilient and more apt to have higher performance?

00:28:33.780 | For instance, would the willowy person, so to speak,

00:28:38.540 | do well to build up some of the musculature around the spine

00:28:42.200 | to compensate for the thinness of that spine?

00:28:45.060 | And would the person with the heavier or thicker spine

00:28:49.380 | do well to try and encourage more pliability

00:28:52.860 | of their discs somehow?

00:28:54.820 | - The answer is yes, but it's a very limited yes.

00:28:58.020 | So if I can set the stage and give some context here.

00:29:02.120 | Every system in the body requires stress

00:29:08.260 | for optimal health.

00:29:09.520 | Think of the cardiovascular system,

00:29:13.580 | the musculoskeletal system, the endocrine system,

00:29:16.140 | even the psychological system.

00:29:18.020 | It needs stress to create adaptation for robustness,

00:29:23.020 | but you cannot cross what's known as the tipping point.

00:29:28.940 | Because if you do, you start building cumulative trauma

00:29:33.500 | of some form, whether it's emotional trauma psychologically

00:29:37.100 | or it's cumulative stress at the tissue level,

00:29:41.540 | at the level of the cell.

00:29:44.260 | So we have to talk about those tipping points.

00:29:48.260 | We've got to define where they are.

00:29:50.460 | Try and expand them, adapt them, but don't cross them.

00:29:54.820 | So with that context now, we can talk about

00:29:58.140 | a person's suitability for the stresses

00:30:04.700 | on different parts of their body

00:30:05.940 | associated with different sports.

00:30:08.500 | We can talk about the rate at which the adaptation occurs,

00:30:12.900 | the amount of deloads and rest that are required.

00:30:15.060 | All of these things are genetically influenced.

00:30:18.220 | The way that they perform the movement

00:30:23.140 | is going to move the stress concentration.

00:30:25.100 | Here's an interesting demonstration for you.

00:30:29.300 | If you go to the Olympics and look at the podium winners

00:30:33.060 | of a javelin thrower, they look identical.

00:30:37.620 | Do you think the swimmers look like the javelin throwers?

00:30:41.220 | No, they don't. But they look like each other.

00:30:43.460 | But they look like each other.

00:30:44.980 | The people on the podium look very similar in structure.

00:30:48.100 | Yeah, let me just give another very poignant example

00:30:53.100 | of that.

00:30:53.940 | Consider a sport that has three very separate demands

00:30:57.620 | of the athlete.

00:30:59.100 | Consider a triathlete.

00:31:00.780 | The triathlete has to swim a certain distance,

00:31:04.020 | then they bike a certain distance,

00:31:06.180 | and then they run a certain distance.

00:31:10.140 | Have you ever known a person who comes out of the lake

00:31:13.420 | or the pool, whatever it is, first winning the triathlon?

00:31:17.820 | It doesn't work that way.

00:31:19.220 | What suited them to be a fish?

00:31:21.740 | Fast in water.

00:31:23.300 | They have to be somewhat floppy in the ankles

00:31:27.020 | because they're creating a fish's fin.

00:31:29.340 | Longer in the torso.

00:31:31.000 | Consider a power lifter performing a butterfly stroke.

00:31:38.500 | Wouldn't look very pretty.

00:31:40.060 | Then they get on the bike where they have to stiffen

00:31:45.100 | to stiffen the core.

00:31:47.620 | I don't know if you know bike design.

00:31:49.140 | Well, I'm sure you do.

00:31:50.260 | You're paying for stiffness of the frame.

00:31:52.580 | That's what a really elite-

00:31:53.420 | I did not know that.

00:31:54.260 | Yeah, so when a person pushes on the pedal,

00:31:56.540 | the frame doesn't flex

00:31:57.860 | because that would be an energy leak.

00:31:59.860 | You pay for a very stiff frame,

00:32:01.340 | so every ounce of force that you apply to the crank handle

00:32:06.340 | to propel you forward propels you forward

00:32:08.620 | instead of being wasted and bending the frame.

00:32:11.100 | The same way the cyclist will lock in on the bike.

00:32:16.060 | They'll squeeze the saddle between their legs,

00:32:20.020 | lock into the bars, lock their core down

00:32:24.480 | so that when they create power through the hips

00:32:29.480 | and through the legs, it's transferred to the power.

00:32:32.660 | It isn't transferred to bending their willowy body.

00:32:36.340 | That is very different from the neurology

00:32:39.260 | and the mechanics of a swimmer.

00:32:41.540 | Now let's run.

00:32:43.220 | To run, the most efficient runners

00:32:47.420 | store and recover elastic energy in tuned springs.

00:32:53.180 | A wonderful book to read is "The Lost Art of Running"

00:32:57.860 | by Shane Benzie, who studied the Kenyan runners

00:33:02.260 | and how they store and recover elastic energy

00:33:05.980 | with each stride, almost the same way as a kangaroo would.

00:33:09.580 | A kangaroo is more efficient when it hops

00:33:12.340 | versus plodding along

00:33:14.020 | using eccentric concentric muscle contraction.

00:33:17.460 | So again, the polar opposite of a swimmer,

00:33:22.460 | it's a very tuned stiffness.

00:33:24.960 | The most efficient runners

00:33:27.300 | for the third leg of the triathlon pre-stiffen.

00:33:32.300 | They have a pre-contraction of the muscle.

00:33:34.460 | So when the foot hits the ground,

00:33:36.220 | they're already storing the elastic elements

00:33:39.060 | and they get that back for free.

00:33:40.960 | But if the springs were not tuned

00:33:42.620 | and they'd stretched away their muscles

00:33:44.300 | just to be passive elements,

00:33:46.580 | which serves them very well in the swimming element.

00:33:49.920 | Think of doing a pogo jump.

00:33:52.900 | So you're just pogoing through the ankles now.

00:33:55.140 | If you had no tone in the legs,

00:33:58.940 | you would just flop into the ground

00:34:00.940 | and you would have to use

00:34:01.820 | concentric eccentric muscle contraction.

00:34:04.540 | But if you stiffened too much,

00:34:06.500 | you're now a piece of iron

00:34:07.940 | and you won't be able to jump either,

00:34:09.540 | but you'll get a beautiful resonance, a beautiful pogo

00:34:12.900 | when you have the tuning just right.

00:34:15.180 | So when a muscle contracts, it creates force.

00:34:17.300 | We all know this, but people don't appreciate

00:34:19.300 | you're also tuning the stiffness.

00:34:21.740 | If I maximally contract my muscles, I can't move.

00:34:25.980 | So athletes have to tune muscle

00:34:27.820 | if they're impacting athletes,

00:34:30.740 | but they also have to pulse and relax.

00:34:34.620 | Pulse, we're talking about Mike Tyson

00:34:37.140 | before the podcast today

00:34:39.740 | and the mechanics of how he pulses

00:34:43.060 | and then he's got to relax to get closing velocity

00:34:45.880 | of the fist to the opponent.

00:34:47.620 | And then when his fist hits the opponent,

00:34:50.540 | he turns to granite.

00:34:52.180 | And it is just such an awesome experience

00:34:55.140 | to feel that a little bit.

00:34:56.700 | It's one of the joys of my life

00:34:57.940 | working with elite athletes to feel their athleticism,

00:35:01.300 | but then dissect it down as to how they do it.

00:35:04.320 | So there's a lot in that,

00:35:06.580 | but that lesson from the triathlete really shows us

00:35:10.580 | how you can't be good at everything.

00:35:15.420 | There's always a trade-off with athleticism

00:35:18.180 | and the genetic part.

00:35:19.540 | And then of course, in the appropriate training

00:35:23.040 | to optimize and express that genetic gift

00:35:28.040 | through technique, through technique.

00:35:32.540 | So some athletes are very loose.

00:35:34.820 | Some athletes are very tight.

00:35:36.580 | Some are very elastic.

00:35:38.520 | You won't hit a golf ball 330 yards

00:35:41.260 | if you're not an elastic athlete.

00:35:43.380 | You'll notice if you measure a golfer

00:35:45.020 | who can hit 330 yards, they don't test very strong.

00:35:47.920 | They have a beautiful, tuned, elastic body.

00:35:54.060 | You can almost see it

00:35:57.060 | if you've worked with enough of them.

00:35:59.460 | There's a smoothness to the muscle.

00:36:02.020 | So underneath the skin is a fascial net.

00:36:04.360 | Someone who can throw a baseball 110, 115, 120 miles an hour

00:36:10.340 | will be the same,

00:36:11.460 | but now you have a very asymmetric elastic effect.

00:36:16.460 | - So I know that you loathe and avoid generalizations

00:36:22.000 | with good reason,

00:36:25.540 | but given that most people listening to or watching this

00:36:30.540 | are probably not aiming to become elite athletes.

00:36:33.260 | I know I'm certainly not.

00:36:36.700 | Can we safely make at least one or two generalizations

00:36:41.700 | about what we each and all can do to try and avoid,

00:36:46.300 | let's say back pain and injury,

00:36:49.220 | by either diversifying our training

00:36:54.820 | or avoiding certain types of training?

00:36:56.820 | For instance, let's take the three major phenotypes.

00:37:00.860 | And this is obviously not how the world works,

00:37:03.180 | but the classic, you know, ectomorphic phenotype,

00:37:05.940 | very thin, very willowy, small joints,

00:37:09.100 | long and lithe, you know, or lithe.

00:37:12.520 | The mesomorph, thicker, more muscular.

00:37:17.060 | And then the so-called endomorph, the more heavier set,

00:37:22.240 | maybe even carrying some extra body fat, et cetera.

00:37:25.100 | Don't really know what's under there.

00:37:27.340 | They could fall into either of the other two phenotypes.

00:37:30.300 | I could imagine based on everything that you're saying

00:37:32.880 | that a good rule of thumb would be,

00:37:36.040 | avoid the types of activities

00:37:39.720 | that are outside of your natural genetic propensity

00:37:44.720 | based on body type, at least in the extremes.

00:37:49.800 | Like if you're not very bendy,

00:37:52.000 | don't do seven days a week of yoga, okay?

00:37:55.200 | But I could also imagine the opposite,

00:37:57.040 | which is if you're not very bendy, do seven days of yoga,

00:37:59.640 | because that's going to allow you to become more bendy.

00:38:03.300 | Or the person that is naturally shaped

00:38:05.120 | more like a shot putter,

00:38:06.320 | let's say the mesomorph or endomorph,

00:38:09.440 | and you could say, well, there'd be great power lifter.

00:38:12.920 | I mean, I knew kids like this in high school,

00:38:14.160 | you know, PE class, they're like, okay,

00:38:15.320 | weight training today.

00:38:16.200 | None of us had done weight training.

00:38:17.320 | And then the kid, you know, lies down and, you know,

00:38:19.920 | and pushes, you know, 315, and you're like, oh goodness.

00:38:22.680 | You know, like that's wild.

00:38:24.880 | But maybe they shouldn't be weight training.

00:38:29.060 | If their goal is to be all around fit,

00:38:31.600 | to be able to, which I think is the goal of most people,

00:38:34.160 | to be able to, you know,

00:38:35.000 | carry some luggage at the airport without, you know,

00:38:37.400 | having to stop every once in a while and suck for air.

00:38:39.440 | To be able to, you know,

00:38:40.800 | lean down and grab something out of a cabinet, you know,

00:38:43.000 | you know, pick up a kid, you know, you know,

00:38:44.840 | do some hard labor in the yard, you know,

00:38:48.680 | move some logs and things like that.

00:38:50.160 | To be able to do stuff without getting injured

00:38:52.560 | and without being so sore in the following days

00:38:54.620 | that you feel like you need extensive rehabilitation.

00:38:58.240 | So again, I know you like to avoid generalizations,

00:39:01.220 | but should we make it a point to train

00:39:05.500 | against our predisposition

00:39:08.900 | in order to offset the imbalances

00:39:11.800 | that would otherwise occur?

00:39:13.660 | Or would we be wise to lean into our strengths

00:39:16.100 | and just not touch stuff that taps into our weaknesses?

00:39:19.680 | - I understand the question.

00:39:24.860 | The answer is, I don't know.

00:39:26.420 | But I know people will say,

00:39:28.700 | "Oh, well, this professor, he's avoiding the question."

00:39:32.200 | And I'm not going to do that.

00:39:33.420 | So I'm gonna tell you how I find the answer.

00:39:36.160 | And it's through assessment.

00:39:37.440 | And I'm glad we're getting back to back pain, by the way,

00:39:39.520 | because it's my real, the cornerstone of my expertise.

00:39:44.460 | Our assessment is very comprehensive.

00:39:51.540 | It starts out by me simply asking the person,

00:39:55.600 | "Tell me your story."

00:39:56.900 | And some people never tell me about their pain

00:40:02.720 | when I ask them to tell me their story.

00:40:05.240 | They will be telling me about their family life

00:40:08.040 | and the pressures that they have to still go to work

00:40:10.760 | because they have two kids in school

00:40:13.280 | or four kids in school.

00:40:15.040 | They might tell me about the passions that they have,

00:40:20.720 | or they might tell me about their goals.

00:40:23.300 | So the goals are the beginning

00:40:27.060 | of answering your question, Andrew.

00:40:28.860 | We all know people who aren't suited

00:40:32.460 | for a certain occupation, or they aren't suited,

00:40:35.180 | or they, I'll take myself, for example.

00:40:39.100 | I had a high school careers counselor tell my father,

00:40:42.160 | "Well, McGill, he's not really suited academically.

00:40:45.280 | He should go to trade school."

00:40:46.940 | And so I registered for plumbing school.

00:40:50.560 | - No, you just went, "Oops,"

00:40:51.400 | 'cause clearly that's not the way you went.

00:40:52.800 | Not that going to plumbing school

00:40:55.080 | would be a bad decision for some,

00:40:56.440 | but in your case, you went a very different direction.

00:40:58.640 | - I think I would have been okay as a plumber.

00:41:01.120 | But anyway, my point in that is, what are the goals?

00:41:06.120 | Then the assessment, I'm paying attention

00:41:11.800 | to the person's learning style.

00:41:13.400 | How are we gonna coach them?

00:41:14.680 | And then we get down to the details of their pain.

00:41:17.180 | What's the nature of the pain?

00:41:18.540 | Is it when they get out of bed in the morning?

00:41:20.300 | Is it associated with a certain activity?

00:41:22.780 | Is it associated with certain motions, postures, or loads?

00:41:26.140 | Try and hone, does the pain change?

00:41:31.580 | Does it start out on one side of the back,

00:41:33.980 | and then later in the day, it's in the left glute?

00:41:36.100 | Or does it go down to your right toes?

00:41:38.020 | All of these things are telling me

00:41:40.060 | about the stability of the pain.

00:41:44.460 | It's giving me clues on what I'm going to assess.

00:41:48.200 | Then we go and assess them.

00:41:50.700 | And it begins with what we call provocative testing.

00:41:54.280 | I'm purposefully provoking their pain.

00:41:56.940 | If I can provoke their pain, I've nailed the mechanic.

00:42:00.820 | If I can't provoke it, it's not mechanical.

00:42:03.660 | Okay, well, that tells me something now.

00:42:05.820 | So now I'm starting to see, I know what their job is.

00:42:10.820 | I know what sport it is they want to do.

00:42:13.800 | I know enough about that job and sport

00:42:15.860 | that I know the physical demands.

00:42:18.140 | I know the psychological demands.

00:42:21.580 | Do they have what's required of the job or sport?

00:42:25.340 | And then I test that.

00:42:28.420 | If it triggers their pain, we have a problem.

00:42:30.900 | So now we have to focus the trainings very specifically,

00:42:34.740 | because people do not have infinite training capacity.

00:42:37.860 | They only have so much.

00:42:39.100 | And when you're hurt, you have even less.

00:42:41.800 | So we try and focus on things

00:42:46.300 | that are going to make a difference to enable them

00:42:49.000 | to have the ability to meet those specific demands

00:42:52.180 | that we've identified.

00:42:53.500 | So do you see how it's a long-winded answer,

00:42:55.480 | but I know how to get there to know how to train them.

00:42:59.200 | So now that we've recognized the very specific nature

00:43:03.080 | of their pain pathway,

00:43:05.740 | and it may be something that's going through the linkage.

00:43:11.240 | In other words, when they run,

00:43:15.380 | I could give you an example of if we put a group

00:43:20.100 | of Canadian hockey players on an elliptical trainer,

00:43:23.300 | they don't do very well because typical of the sport,

00:43:27.420 | the hockey players tend to get stiffer in the hips.

00:43:30.820 | It's the way they are.

00:43:31.660 | They skate a little bit flexed

00:43:33.040 | and they carry all heavy skates

00:43:34.980 | and heavy equipment down the legs.

00:43:36.860 | They get stiffer in the hips.

00:43:39.080 | When they go on the elliptical,

00:43:40.820 | their hips don't have the range of motion

00:43:42.720 | and their spine and pelvis gyrates

00:43:44.940 | with every rotation on the elliptical trainer.

00:43:47.560 | The elliptical gives them back pain

00:43:49.480 | if they already have motion triggered back pain.

00:43:53.420 | We take another group who has mobile hips.

00:43:56.060 | They do very well on elliptical trainers.

00:43:58.300 | The stress doesn't go into their backs.

00:44:03.940 | So now do you see why I know why one group does well

00:44:06.600 | with ellipticals, the other group does not.

00:44:08.860 | I know why one group who they,

00:44:11.180 | I'll give them a lateral shear test,

00:44:14.320 | which is basically a bear hug.

00:44:16.340 | I pull their pelvis towards me

00:44:18.500 | as I hook down their shoulder in my armpit.

00:44:21.420 | So I'm shearing their spine laterally.

00:44:24.260 | If that triggers their pain, exactly.

00:44:26.660 | I had a pro hockey player the other day.

00:44:30.120 | I gave him the lateral shear test

00:44:32.260 | and he had a right-sided flash of pain

00:44:35.460 | going around his right flank.

00:44:37.180 | It exactly replicated the pain.

00:44:39.420 | I just found with precision the mechanism.

00:44:42.660 | Okay, what's the antidote?

00:44:44.980 | I put my fingers into his oblique muscles

00:44:47.020 | and I said, "Push my fingers out."

00:44:49.540 | And he did it too hard.

00:44:50.420 | And he says, "Oh no, that hurts even more."

00:44:52.820 | Okay, dial it back a bit.

00:44:54.860 | Tune what we're trying to achieve here.

00:44:57.980 | Fight me just a little bit.

00:44:59.240 | I repeated the formerly offensive test.

00:45:02.120 | The symptom was gone.

00:45:03.660 | So now I'm getting more precision

00:45:05.160 | on knowing what I need to do.

00:45:07.060 | He was doing the Pallof Press.

00:45:10.580 | The Pallof Press is a long lever exercise.

00:45:14.040 | So you take a load, usually with a cable or a band

00:45:19.040 | that's held laterally,

00:45:20.460 | and you increase the length of the lever,

00:45:22.260 | which you have to resist because it's trying to--

00:45:23.540 | So you punch it out from the body.

00:45:24.940 | Yeah, you try and it's causing you to twist,

00:45:28.260 | but it also creates a tremendous shear load on your spine.

00:45:30.980 | That was triggering his pain.

00:45:32.940 | So we took out the Pallof Press,

00:45:35.420 | which for him right now is replicating his symptoms.

00:45:39.780 | But if you're playing in the NHL,

00:45:41.340 | you should be able to do a Pallof Press.

00:45:43.540 | You follow?

00:45:44.360 | Yeah.

00:45:45.200 | Yeah, it's a requirement

00:45:46.460 | of the rigors of professional hockey,

00:45:49.920 | but he can't do it now.

00:45:51.280 | So this is informing the programming

00:45:53.940 | that we're going to do.

00:45:55.100 | So if somebody has pain in a given movement,

00:45:59.340 | say standing up, after they sit for too long,

00:46:03.280 | a particular style of hip hinge,

00:46:08.120 | deadlift or squat, or when they run, for instance,

00:46:13.120 | would it be wise for them to think about the exact movement

00:46:19.380 | that makes the pain the worst

00:46:21.180 | in the moment that they're doing the movement or afterwards?

00:46:25.180 | Because oftentimes pain will arrive

00:46:27.700 | after we engage in a certain activity,

00:46:29.580 | but during the activity, that pain is shut down,

00:46:31.820 | which by the way is an interesting phenomenon

00:46:33.460 | in its own right.

00:46:34.300 | And might be worth some mention

00:46:37.860 | as to a couple of the reasons why that occurs.

00:46:40.960 | We always think, oh, blood flow, it's warm,

00:46:42.800 | but clearly it's more-

00:46:44.100 | - It's much more than that.

00:46:44.940 | - It's much more than that.

00:46:45.780 | - Yeah, for sure.

00:46:47.420 | - So let's say I have pain in a knee when I run.

00:46:52.420 | Should I avoid running in that gate that causes pain

00:46:57.020 | and work around it?

00:46:58.940 | Seems to me that would be the logical choice.

00:47:01.340 | - Right.

00:47:02.800 | Every person that comes to us comes with back pain.

00:47:06.740 | So initially we avoid it.

00:47:09.600 | We can have a neurological discussion if you like,

00:47:14.100 | we can have a biomechanical discussion,

00:47:15.900 | or we can have a psychological discussion.

00:47:18.420 | We can take it in the framework of any of those if we like.

00:47:25.340 | If the pain is causing a sensitization,

00:47:29.480 | I'm gonna use the example here of stubbing your toe.

00:47:31.980 | You stub your toe once, okay, well, it hurts a bit

00:47:34.220 | and the pain goes away fairly quickly.

00:47:36.100 | But if every day you stubbed your toe,

00:47:38.080 | you would increase the sensitivity

00:47:40.140 | so that you don't have to stub it anymore.

00:47:42.180 | All you have to do is lightly touch that sensitized toe

00:47:44.940 | and you are going to have a maladaptive heightened response.

00:47:50.700 | So if we keep creating pain on that toe,

00:47:55.560 | it will never get better.

00:47:57.500 | So we have to start a desensitization wind down,

00:48:00.900 | which is tissue based,

00:48:04.020 | but it's also neurologically based as well.

00:48:06.800 | And so because everyone comes to us with pain,

00:48:12.700 | we work very hard to hack our way around it.

00:48:19.900 | So let's say sitting causes their pain.

00:48:24.700 | All right, we'll find out that when we do a sitting test,

00:48:29.820 | if they sit slouched, that causes their pain.

00:48:32.420 | When they sit upright, their pain goes away.

00:48:34.860 | So I will give them a lumbar support,

00:48:38.000 | which I'm just happening to use now.

00:48:40.260 | I had to sit on an airplane for five hours yesterday

00:48:42.880 | coming to see you.

00:48:44.860 | And this allows me to not get back pain

00:48:48.060 | on the airplane while I'm sitting.

00:48:49.900 | Because if I sit flexed for five hours,

00:48:52.140 | I will have a grumpy back.

00:48:53.420 | And I won't feel like when I get into the hotel

00:48:55.780 | to go for a walk and train a bit,

00:48:58.920 | because that's what we have to do to create a stress

00:49:03.560 | below the tipping point to optimize health.

00:49:05.900 | So it's the same thing in putting together the program.

00:49:12.220 | First of all, know the cause and try and eliminate it.

00:49:17.220 | And try and eliminate it.

00:49:18.820 | So we'll teach them, you know,

00:49:21.780 | we spend a lot of time with spine hygiene.

00:49:24.460 | We teach them how to hip hinge or squat.

00:49:29.460 | We teach them how to lunge, how to get to the floor.

00:49:33.300 | We teach them how to roll

00:49:35.540 | without twisting their spine into pain,

00:49:37.900 | but using their ball and socket joints.

00:49:40.420 | We teach them how to do a baby's crawl,

00:49:44.480 | which eliminates the torso twisting,

00:49:47.840 | which in their current state will offend

00:49:51.240 | the sensitized pain trigger.

00:49:53.200 | - That must be humbling for adults

00:49:54.760 | to get down and do a baby's crawl.

00:49:56.600 | - It's so humbling to take a world record holding athlete

00:50:02.600 | and humble them right back.

00:50:05.540 | I, as you know, I've had the current holder

00:50:08.800 | of the world's all time record squat, Brian Carroll.

00:50:11.560 | And Brian and I have written a book together.

00:50:14.240 | So I can use his name.

00:50:15.720 | - What's the squat record?

00:50:16.880 | - 1,306 pounds, if you can believe that.

00:50:20.120 | Down to parallel, down to parallel.

00:50:22.560 | No other human has done that.

00:50:24.480 | That was four years ago.

00:50:25.840 | Now no one's replicated it.

00:50:27.760 | - Does he wear one of those elastic lifting suits

00:50:30.200 | when he does that?

00:50:31.120 | - Yeah, so he's putting on an exoskeleton of stiffness,

00:50:34.660 | but I want to come back to how humbling it was

00:50:38.920 | to have someone who already held world records

00:50:42.260 | in squatting in two different weight categories.

00:50:44.740 | And I had to show him how to get off the toilet,

00:50:46.440 | but that's another story.

00:50:47.540 | And we both laugh at this now,

00:50:49.780 | but that was what pain had done.

00:50:52.100 | Pain had corrupted his movement patterns

00:50:55.460 | and he forgot how to squat, but he held the world record.

00:50:58.720 | That's how corruptive pain is to the neurological engram.

00:51:03.100 | And we can talk about inhibition and facilitation

00:51:05.800 | and all of the things.

00:51:07.260 | I mean, I'd love to have that conversation

00:51:08.980 | because I know who I'm sitting with.

00:51:10.660 | - The neural aspects are fascinating.

00:51:12.220 | When he does that incredible squat poundage,

00:51:16.220 | does he take the bar off a standard squat rack

00:51:20.380 | and then walk it back?

00:51:21.340 | Or is it one of those ones where the bar is suspended

00:51:23.820 | from two hooks and then he takes it from there?

00:51:25.820 | - Yeah, so that particular lift was lifted off a monolith

00:51:29.220 | where he didn't have to walk it out.

00:51:30.900 | - So he takes it off, so it's hanging from hooks,

00:51:33.260 | then the hooks are brought away.

00:51:35.180 | The reason I ask is it sounds like he's optimized

00:51:38.780 | for one very specific movement in a couple of planes

00:51:43.780 | and nothing else.

00:51:44.620 | Because walking with a thousand plus pounds

00:51:46.780 | on one shoulders is also a feat in and of itself.

00:51:49.500 | - Okay, well-

00:51:50.340 | - Shuffling backwards, as it were.

00:51:51.620 | - All right, you're not letting me off the hook,

00:51:53.460 | which is fine.

00:51:54.300 | So I've worked with competitors who compete in strong men

00:51:57.820 | and they can carry and walk with a thousand pounds

00:52:00.660 | on their shoulders.

00:52:01.500 | It's called the super yoke.

00:52:03.860 | Another client of ours who held the world Wilkes score

00:52:08.860 | in the IPF, International Powerlifting Federation,

00:52:13.180 | where they do not lift out of a monolith.

00:52:15.860 | They take the bar off a squat rack

00:52:18.740 | and they have to step back.

00:52:20.900 | And that is, if you don't have enough lateral strength

00:52:25.900 | and control in your torso, that's when you become hurt.

00:52:31.020 | Not during the squat, it's during the walkout.

00:52:33.540 | So it's a very different feat of strength.

00:52:36.020 | So you're very astute to say lifting from a monolith

00:52:39.100 | is a different athleticism and strength distribution

00:52:42.540 | than an IPF style where they lift off a rack

00:52:45.060 | and have to walk it out.

00:52:46.220 | So you're standing on one leg.

00:52:48.020 | So can you imagine a thousand pounds

00:52:50.380 | coming down your axial spine, down your midline?

00:52:53.180 | It hits your pelvis and then it has to shear

00:52:55.780 | across the pelvis and go down the stance leg

00:52:58.220 | as you're stepping back with the right.

00:53:00.700 | So it requires tremendous strength

00:53:02.980 | to hold the pelvic platform up on the swing leg side.

00:53:07.300 | And so that is a tremendous core strength component.

00:53:12.300 | - So best not be carrying a willow spine for that one.

00:53:17.780 | You wanna be like a Muir Woods, a Redwood trunk.

00:53:22.500 | - Well, you wanna be built like Blaine Sumner,

00:53:25.300 | who's another one of our clients.

00:53:28.500 | I've worked with Blaine for quite a number of years.

00:53:31.260 | - I love the analogy to dog breeds.

00:53:33.480 | I love going to dog shows.

00:53:35.900 | I've only done it a few times,

00:53:36.980 | not to actually see the prancing around of the dogs.

00:53:39.620 | That doesn't interest me at all.

00:53:41.200 | Best part about a really excellent dog show

00:53:43.460 | is you go back behind the arena

00:53:46.360 | where all the different breeds reside.

00:53:49.500 | So you can see the lineup of the finest Irish Wolfhounds,

00:53:53.220 | the finest English Bulldogs, et cetera.

00:53:57.300 | Hundreds of different breeds.

00:53:58.460 | And you really get to see these genetic extremes,

00:54:00.340 | not just of structure, but of temperament.

00:54:02.940 | And you get to see the similarity

00:54:05.300 | and temperament of the Bulldogs.

00:54:07.460 | And of course there's variation.

00:54:08.640 | Some of them are a bit more jolly, others more stoic.

00:54:11.960 | You know, the Terriers are magnificent in their own right.

00:54:17.520 | And as you pointed out earlier with respect to the podium,

00:54:20.220 | more similar to each other within breed

00:54:22.100 | than across breeds in terms of temperament,

00:54:24.100 | but there's variation within breed.

00:54:25.860 | The reason I bring this up,

00:54:26.780 | and the reason I bring this up now

00:54:28.460 | is that if you look at the movement to those animals,

00:54:32.380 | even just the way they walk,

00:54:34.140 | whether or not they enjoy a flexion of the paw

00:54:39.020 | as they stride or whether or not

00:54:40.620 | they tend to stride differently.

00:54:42.220 | I don't have language for this.

00:54:43.540 | I'm not an expert in this,

00:54:44.700 | but I have a visual system that works

00:54:47.260 | and I can see that they may move differently.

00:54:49.820 | They actually walk differently, even at the same pace.

00:54:52.720 | And then you look at human beings.

00:54:56.580 | Shorter, taller, medium, more lithe, more heavyset.

00:54:59.940 | And it's amazing that we don't take this into consideration,

00:55:04.460 | that we all move very differently, even within species,

00:55:08.300 | but that we've been into these groups.

00:55:11.600 | So when someone walks into your laboratory, as it were,

00:55:15.360 | your clinic/laboratory,

00:55:17.260 | do you, are you paying attention

00:55:19.240 | to how they move into the room, irrespective of pain?

00:55:22.020 | - 100%, we time the clients.

00:55:27.020 | I see one in the morning and one in the afternoon

00:55:29.200 | and they're three hour appointments.

00:55:30.900 | So I know when they're coming.

00:55:32.420 | I watch them get out of the car if I can.

00:55:34.780 | And that's when the assessment starts.

00:55:36.700 | But just to go back to the dogs, my sister's a vet,

00:55:40.780 | her husband's a vet and her daughter's in vet training.

00:55:43.260 | So we have these conversations all the time.

00:55:45.660 | Do you know she's already made an assessment of that dog

00:55:49.140 | on how it's going to behave when she injects it

00:55:51.420 | or has to do a rectal exam or whatnot

00:55:53.700 | and what dog or breed, and even in cats,

00:55:56.300 | which ones she's going to muzzle,

00:55:57.780 | because she's usually right on who's going to get vet.

00:56:00.860 | Yeah, and interestingly as well,

00:56:05.260 | it's how the dog feeds off the owner.

00:56:08.940 | And she can look at the owner

00:56:10.540 | and usually determine how the dog is going to behave.

00:56:13.740 | So talk about the psychosocial view around dog behavior.

00:56:18.220 | Absolutely.

00:56:20.120 | Going back to your question, when a person walks in.

00:56:24.420 | So I've had, have I had a gold medalist in sprints?

00:56:29.260 | Yes, I have, from the Olympics.

00:56:31.120 | I've had a silver medalist.

00:56:33.420 | I've had just about every athlete that you can.

00:56:36.500 | And then a person walks in off the street,

00:56:39.300 | all with back pain.

00:56:41.260 | In your mind's eye,

00:56:45.020 | conjure up the image of a good sprinter.

00:56:50.100 | Do you think they have a flat lower back

00:56:53.160 | or do you think they have a lot of lordosis,

00:56:55.480 | which is an extension hollow in their low back?

00:56:58.140 | A sprinter now, what will they have?

00:57:00.020 | I recall seeing Michael Johnson sprinting very upright.

00:57:05.560 | Yes.

00:57:06.540 | So when I think upright, I think either, you know,

00:57:09.040 | flat lower back or a little bit of an arch

00:57:12.600 | in the lower back, you know, this kind of movement.

00:57:14.520 | Yeah, he was 200 meters, wasn't he?

00:57:16.040 | 200 and 400.

00:57:16.880 | I think he was 200 and 400.

00:57:19.020 | He was.

00:57:20.060 | Which is unusual, someone that could win gold in both.

00:57:23.340 | Well, I'll think of some of the sprinters now,

00:57:26.500 | the 100 meter men and women, you will find

00:57:29.820 | they have a lot more lordosis than the-

00:57:32.860 | So arch in the back.

00:57:33.860 | Yeah, they have a low, and what that does,

00:57:36.060 | I'll just explain the running mechanics here for a minute.

00:57:39.940 | So if you're running along, you have a center of mass.

00:57:43.940 | You have to bias the force under your feet

00:57:47.800 | behind the center of mass to propel you forward.

00:57:50.620 | Because if it's in front of the center of mass,

00:57:52.540 | you're actually breaking,

00:57:53.720 | which wouldn't win you a gold medal.

00:57:55.820 | So footfall has to occur behind the center of mass,

00:58:00.820 | and then you get a very brief period of time

00:58:03.140 | to create an extensor pulse and then recover the leg.

00:58:06.900 | If you can pre-turn the pelvis

00:58:09.760 | with a lot of lordosis in the spine,

00:58:11.780 | you get much more power development

00:58:14.440 | behind the center of mass through the extensor range.

00:58:17.500 | If you have a flat back, it's difficult now,

00:58:21.340 | you've just shortened up the range

00:58:22.940 | that you can pulse into propulsive force as a sprinter.

00:58:26.740 | So they bow the body.

00:58:28.540 | Yeah, but you'll notice it's very difficult

00:58:31.660 | for a sprinter to kick high.

00:58:34.140 | So I look at these different forms in the combat athletes.

00:58:39.300 | If you look at someone who can kick high in a roundhouse,

00:58:42.860 | they will tend to have a flatter back.

00:58:44.840 | So combat athletes tend to have a flatter back.

00:58:49.620 | Going back to the runners,

00:58:50.860 | you'll notice that the Michael Johnsons

00:58:52.860 | and the runners with more distance have a flatter spine.

00:58:57.860 | They're more upright,

00:58:59.140 | and they're tuning that ability

00:59:03.380 | to store and recover elastic energy.

00:59:05.340 | Where the sprinter out of the blocks,

00:59:07.220 | it's horsepower, it's concentric and eccentric muscle pulsing.

00:59:10.980 | But anyway, there would be an example

00:59:15.980 | since you mentioned it with running,

00:59:18.840 | the style of running, the event.

00:59:22.380 | Running isn't running, running is very different.

00:59:25.340 | And again, look at the podium winners

00:59:27.180 | of the sprinters versus the 10,000 meters,

00:59:30.660 | very different architecture.

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01:00:45.060 | I love where this conversation is going

01:00:46.820 | because there's tremendous variation

01:00:48.780 | in body shape and form out there.

01:00:50.900 | And I'm certain that by now,

01:00:52.300 | everybody listening is starting to think about,

01:00:54.340 | oh, am I more likely to have a willowy spine,

01:00:58.100 | a thinner spine, or a thicker spine?

01:01:02.040 | The kind of pliability

01:01:03.360 | or what you called vertical stacking resilience

01:01:07.240 | that one spine or the other would have.

01:01:10.660 | And it brings me back to this question

01:01:13.400 | of what can we each and all do

01:01:17.160 | to try and create the strongest back

01:01:21.160 | as well as limit the propensity for pain,

01:01:25.400 | assuming we don't have it yet, okay?

01:01:27.720 | So I would say I'm kind of in the middle.

01:01:30.480 | I'm neither extremely lithe

01:01:32.320 | nor am I shaped like a kettlebell,

01:01:35.520 | somewhere in between.

01:01:36.560 | So for me, I make it a point across my training week

01:01:40.840 | to include three resistance training sessions,

01:01:44.480 | three "cardiovascular training sessions,"

01:01:47.920 | one long, one medium, one short cardiovascular session.

01:01:51.200 | The lifting sessions are geared

01:01:52.480 | toward building or maintaining strength

01:01:55.720 | in a balanced way for me.

01:01:57.120 | Everyone is going to have different requirements.

01:01:59.480 | In other words,

01:02:00.840 | nothing is skewed toward one particular outcome

01:02:03.920 | like endurance or strength or power.

01:02:06.600 | And I think most people probably want something similar

01:02:08.640 | because they'd like to be able to meet

01:02:10.040 | the various demands of life.

01:02:12.400 | So I frame the question I'm about to ask that way

01:02:17.400 | because as people start to assess themselves,

01:02:22.000 | the question arises again,

01:02:23.760 | should we try and compensate for our weaknesses

01:02:27.600 | by emphasizing a certain style of training

01:02:29.760 | a little bit more?

01:02:31.200 | And if so, what does that look like for the spine?

01:02:32.880 | You said earlier, and I love this quote,

01:02:35.240 | and I want to make sure I attribute it to you

01:02:38.080 | now and going forward,

01:02:39.000 | that all systems in the body

01:02:40.520 | require stress for better health.

01:02:43.240 | - Optimal health.

01:02:44.480 | - Thank you, for optimal health.

01:02:46.200 | So assuming that somebody has a thinner stature,

01:02:50.880 | they're more bendy,

01:02:52.280 | would they be wise to build up the muscles of the core,

01:02:56.360 | not just the abdominals,

01:02:57.600 | but the obliques and the lower back muscles,

01:03:00.320 | all around the spine in order to give it more stability?

01:03:03.080 | And would the person who has a thicker torso,

01:03:05.720 | thicker spine, thicker joints,

01:03:08.040 | do well to emphasize some additional yoga training,

01:03:11.880 | some additional, anything that allows them to be more bendy?

01:03:16.360 | - I'm gonna go back to the fact

01:03:18.640 | that they're coming to me with pain.

01:03:20.840 | We are going to figure out through the thorough assessment

01:03:24.280 | what triggers their pain.

01:03:26.640 | Most people, it's true, don't want ultimate performance.

01:03:30.840 | They're not being paid $10 million

01:03:33.000 | to be able to throw a fastball or something like that.

01:03:36.360 | They want to enjoy life.

01:03:37.480 | Let's say they love golf.

01:03:39.760 | My job is to get them sufficiently robust and out of pain

01:03:44.720 | to go and play recreational golf.

01:03:47.480 | So it becomes a moot point now,

01:03:50.360 | whether they have a willowy spine or not.

01:03:53.120 | I will look at their basic golf swing.

01:03:56.760 | If I can divide that up to just binary,

01:04:00.680 | some people are what we call twisters.

01:04:03.640 | They don't have a lot of hip mobility

01:04:05.360 | and they twist their spine.

01:04:06.480 | So it's called the X factor in golf

01:04:08.480 | and they store and recover elastic energy.

01:04:10.840 | Again, it is an elastic athleticism.

01:04:14.280 | But the next person isn't so much a twister,

01:04:17.440 | they're a turner.

01:04:18.320 | They have what we call quick hips.

01:04:20.040 | So their hips turn

01:04:21.600 | and their spines don't sustain as much twist.

01:04:25.200 | And then we measure, well, when they impact the ball,

01:04:28.840 | if they have 100% violent lateral crunch,

01:04:32.800 | and then we measure them and assess them,

01:04:34.560 | and that turns out to be their pain trigger,

01:04:36.960 | what we do is we don't allow them

01:04:38.920 | to go to 100% in lateral crunch at impact,

01:04:43.200 | they go to 95%.

01:04:45.080 | And that just moved them off the tipping point.

01:04:47.360 | So they're not stubbing their toe

01:04:49.280 | or slamming into the pain sensitizer.

01:04:54.280 | They just stay off the desensitizer now.

01:04:56.880 | - So backtracking a little bit,

01:04:58.600 | but making sure that I'm doing that with purpose,

01:05:02.480 | you need to know what generates the pain

01:05:04.720 | in order to try and localize the pain.

01:05:06.480 | - It all comes back to the assessment.

01:05:07.880 | - But then the goal is not to repeat

01:05:10.400 | whatever creates the pain.

01:05:12.280 | - Correct.

01:05:13.120 | - Perhaps, what I'm hearing,

01:05:14.700 | the goal is to get near the proximity of the pain,

01:05:18.880 | but not go there,

01:05:19.800 | not generate the movement that recreates the pain,

01:05:22.460 | but take the movement as far as one can

01:05:25.680 | without creating the pain.

01:05:28.040 | And then think about where the instability or weakness

01:05:32.680 | or biomechanical failure is contributing to the pain.

01:05:37.680 | Okay, so now I understand why.

01:05:41.400 | - If I can just add one, I don't want to interrupt,

01:05:43.340 | but this is a good juncture, Andrew.

01:05:46.480 | Then we get into the volume of exposure.

01:05:49.480 | So remember the tipping point.

01:05:51.560 | We can have somewhat of an offense to their former pain,

01:05:56.560 | but if we do it sparingly, that's another key.

01:06:00.960 | So it isn't a matter of selecting the exercise sometimes

01:06:04.360 | as much as it is controlling the volume

01:06:06.880 | and then having a period of time off

01:06:09.440 | or a deload or whatnot.

01:06:11.280 | So it may simply be,

01:06:14.020 | I've got an athlete that comes to mind right now.

01:06:18.500 | In fact, I got an email.

01:06:20.900 | It wasn't an email.

01:06:21.740 | It was a WhatsApp message.

01:06:23.380 | Oh, I just won.

01:06:24.460 | So she's at an international tournament today

01:06:28.100 | and they play every day.

01:06:30.300 | But in getting her back,

01:06:35.300 | it was a matter of we have to do these things

01:06:39.900 | that were former pain triggers, but control the volume.

01:06:43.840 | You can think of, again, combat athletes.

01:06:48.480 | Jiu-jitsu requires a lot of spine mobility.

01:06:52.320 | And typically, jiu-jitsu athletes get pain

01:06:55.400 | when they use too much spine mobility.

01:06:58.180 | What we do is we limit their training.

01:07:01.000 | In other words, they have the skill of jiu-jitsu,

01:07:03.680 | but they don't need to push the end range every day.

01:07:08.240 | Because if they do,

01:07:09.860 | they're in so much pain they can't train.

01:07:12.060 | So we back off the volume.

01:07:13.780 | And I could tell you stories

01:07:15.220 | about professional football players.

01:07:17.340 | They were their strongest when they were in college.

01:07:20.860 | Their bodies can't take the heavy strength training

01:07:23.620 | once they get into the NFL.

01:07:25.300 | They don't squat and deadlift what they used to.

01:07:29.180 | They're limiting the depth.

01:07:32.780 | They're pulling off blocks.

01:07:34.580 | The game changes.

01:07:38.100 | And it's not what people think.

01:07:40.080 | - And well, there's some wisdom

01:07:41.640 | to not pushing into pain and extremes all the time.

01:07:45.240 | If the goal is to have a long arc of fitness

01:07:48.600 | or athletic career, a good friend of mine,

01:07:51.880 | who's very accomplished in the fitness community,

01:07:54.600 | he says one of the best ways to get

01:07:56.480 | and stay in excellent shape your entire life

01:07:59.640 | is to train consistently, train reasonably hard.

01:08:03.280 | And we can talk about what his recommendation is.

01:08:05.720 | I'd love your thoughts.

01:08:07.400 | But as best as one can to not get hurt.

01:08:11.120 | You know, we forget about this.

01:08:12.220 | We hear so much about training consistently

01:08:13.960 | and pushing hard,

01:08:15.220 | but the not getting hurt part is key as well.

01:08:18.720 | Here's his recommendation on intensity.

01:08:20.380 | Can I share it with you and just get your thoughts?

01:08:22.280 | - Yeah.

01:08:23.320 | I have a short attention span.

01:08:24.680 | Can I just add added value to that?

01:08:28.120 | Don't get hurt.

01:08:29.720 | Getting hurt is tremendously asymmetric.

01:08:33.000 | Let me, do you know the book by Taleb Nassim?

01:08:37.280 | - Oh, Nassim Taleb.

01:08:38.380 | - Nassim Taleb, yeah.

01:08:39.440 | - "Antifragile."

01:08:40.280 | - Yeah.

01:08:41.100 | Oh, in "Antifragile," he quotes our work.

01:08:44.040 | He quotes my "Low Back Disorders" book

01:08:46.360 | as an example of antifragile medicine.

01:08:48.880 | Interesting.

01:08:51.440 | Anyway, when you talk to Taleb,

01:09:00.480 | in an economic sense,

01:09:02.960 | if I gave you $100 to invest,

01:09:05.480 | if you had a 50% gain,

01:09:08.440 | you'd end up with 150 bucks.

01:09:10.480 | If you had a 50% loss, you'd end up with 50.

01:09:13.280 | It's much more hurtful to lose 50

01:09:18.040 | than the relative jolly you would get of gaining 50.

01:09:22.720 | - Yeah, there's some neuroscience,

01:09:24.160 | certainly some psychology,

01:09:25.360 | but certainly some neuroscience to support that

01:09:27.880 | in terms of how we reset our reinforcement threshold.

01:09:32.880 | - Right, and so it is so asymmetric with injury.

01:09:37.460 | Training, if you push, is taking a risk.

01:09:42.360 | You might gain a little bit in short-term resilience

01:09:46.200 | or short-term performance,

01:09:47.900 | but you have a chance of really screwing things up,

01:09:51.380 | and an injury is really asymmetrically harmful.

01:09:56.120 | So when we work with people and athletes,

01:09:59.640 | we really try and avoid injury

01:10:01.520 | because of the asymmetry of the consequence.

01:10:04.640 | Injury's bad.

01:10:06.220 | That's the first part that I wanted to say.

01:10:08.260 | The second part is people train hard

01:10:11.420 | and they feel the muscle burn,

01:10:13.480 | and they talk about muscle,

01:10:15.120 | but they don't talk about their joints.

01:10:17.300 | And the key to long life is don't mess up your joints.

01:10:21.000 | You can train hard and build muscle,

01:10:22.940 | but muscle is adaptive and resilient.

01:10:25.960 | Joints are not so much.

01:10:28.960 | And if you start messing those up when you're younger

01:10:31.460 | by training too hard, you'll find that,

01:10:33.800 | oh, I was training at this intensity

01:10:35.640 | because I wanted to be strong when I'm 70 and 80.

01:10:38.300 | They'll find that, no, their knees ache.

01:10:40.820 | They can't get down on their knees anymore.

01:10:42.740 | They have to crawl up a chair or a wall.

01:10:46.180 | - Very sad picture.

01:10:47.300 | - It is.

01:10:48.580 | Don't mess up your joints.

01:10:50.340 | So that's an overarching principle

01:10:53.180 | of which the spine is one, obviously.

01:10:55.940 | But that's some wisdom

01:10:58.080 | with training intensely when you're young.

01:11:01.400 | Don't base the outcome on muscle.

01:11:03.680 | Think about the joints.

01:11:06.040 | - No, it's excellent recommendations for everyone.

01:11:09.600 | His suggestion, and by the way,

01:11:10.720 | this is not for competitive athletes.

01:11:12.600 | This is just for exercisers, if you will,

01:11:17.280 | is to make 85% of one's workouts across the year

01:11:22.280 | at about 85% of maximal intensity and output.

01:11:27.280 | So still constraining the total length of a session

01:11:30.240 | to whatever the goal of that session is,

01:11:32.760 | whether it's resistance training or cardiovascular training,

01:11:35.440 | but to not go all out,

01:11:37.280 | to go at 85% of one's subjective understanding

01:11:40.880 | of what all out on that day would be, on that day.

01:11:44.220 | To make 10% of one's workouts across the year

01:11:49.840 | at somewhere between 90 to 95% intensity

01:11:54.320 | of what one could generate that day.

01:11:56.920 | Again, 100% all out being subjective for that day.

01:12:01.040 | And then 5% or even less of their workouts all out,

01:12:06.040 | everything you could possibly give,

01:12:09.720 | quote unquote, leaving it all on the mat,

01:12:12.360 | whatever phrase one prefers.

01:12:14.120 | And I like that recommendation

01:12:15.800 | because it keeps things in check

01:12:19.400 | and it also creates an awareness

01:12:21.320 | of how intense one is training.

01:12:23.800 | And it allows us to not let the great night's sleep

01:12:28.540 | or the extra cup of coffee that we had

01:12:30.360 | or the great song that happens to be playing

01:12:32.340 | or the competitive spirit that's arising

01:12:35.340 | because someone joined you that day

01:12:36.700 | or asked you to join a workout

01:12:38.320 | to take you into the domain of harming yourself.

01:12:42.760 | In fact, I can look to the times

01:12:45.800 | when I've been injured training and almost always,

01:12:49.480 | it's because somebody invited me to join their workout.

01:12:52.480 | And we got into a little bit of a competitive spirit.

01:12:55.240 | And I'm not an ultra competitive person,

01:12:57.400 | but you push yourself to 100% on that day.

01:13:02.400 | And two weeks later,

01:13:05.760 | you've got something you're dealing with

01:13:07.400 | or two days later, you've got something

01:13:09.480 | and you go, "God, was that really worth it?"

01:13:11.320 | And I think unless one is a competitive athlete

01:13:13.640 | and that's competition day, it's probably not worth it.

01:13:16.160 | Right.

01:13:17.040 | Well, I'm very sympathetic to the overall sentiment

01:13:21.360 | of what you just described,

01:13:22.860 | but I think it's much more individual than that.

01:13:28.400 | You can take a younger person and drive them quite hard

01:13:32.640 | as some trainers do, and they have success.

01:13:36.240 | A young person responds, they recover faster, et cetera.

01:13:41.320 | You try doing that to a 65 year old,

01:13:45.160 | and you'll find that they don't recover as quickly.

01:13:47.640 | They need many more deload and rest days.

01:13:50.860 | So if you go to 85%, you just committed to a five day rest.

01:13:54.920 | Well, maybe that's not wise.

01:13:56.480 | If you went to 50%, you only need one day of rest between.

01:14:00.120 | So do you see how you play and you optimize this?

01:14:03.200 | And it's like what we call tapering down an athlete

01:14:06.480 | or in my life, I have seasons.

01:14:10.880 | Up until two years ago,

01:14:13.840 | I rode snowmobiles hard in the winter.

01:14:17.460 | Two years ago, I hit a rock at 100 miles an hour on a lake.

01:14:21.480 | I fractured my spine.

01:14:22.660 | You can spot the professor.

01:14:25.400 | So that was my passion.

01:14:27.200 | So my training would start in August.

01:14:30.960 | Every year I'd get into shape to ride sleds

01:14:34.640 | fairly aggressively.

01:14:37.600 | I couldn't do it all year, Andrew.

01:14:40.000 | I'd become injured.

01:14:41.600 | So I would have a cycle of three months getting ready

01:14:46.080 | and then really have some fun.

01:14:48.420 | But obviously I don't do that anymore.

01:14:53.120 | But my point in telling that story is

01:14:56.440 | I need much more information than just, okay, 85%.

01:15:03.400 | You may get away with that when you're 20 to 25.

01:15:06.920 | I don't think you're gonna get away with that

01:15:08.720 | when you're 50, as an example.

01:15:11.840 | As we optimize performance in our clients,

01:15:16.360 | sometimes you gotta leave a lot of gas in the tank

01:15:21.160 | because you want to train every other day.

01:15:25.280 | Certainly if you do two days in a row, 85%, there's no way.

01:15:31.280 | So do you see what I mean?

01:15:32.460 | It depends on their age, their injury history,

01:15:36.080 | their genetics and their body type and all the rest of it.

01:15:39.200 | What are we actually pushing to 85%?

01:15:41.840 | Is it a distance on a run?

01:15:44.120 | Is it a deadlift weight?

01:15:46.520 | That's pretty heavy.

01:15:49.120 | - Yeah, here I'm thinking about intensity, meaning,

01:15:51.680 | well, for resistance training,

01:15:54.400 | let's say that one could complete six repetitions

01:15:58.640 | at a given weight.

01:16:01.540 | But if they had a gun to their head,

01:16:03.080 | they could complete nine.

01:16:04.700 | Well, then you're doing six.

01:16:08.640 | Again, this is crude calculations, right?

01:16:12.560 | But six, maybe seven,

01:16:13.960 | maybe cheating a little bit on that seventh repetition.

01:16:16.320 | If it's a run and like for me on Sundays,

01:16:20.200 | typically there's a long, slow jog,

01:16:22.180 | but the slow in that component is a little bit subjective.

01:16:27.520 | So am I pushing a little bit harder than I'm comfortable

01:16:30.980 | or am I hitting kind of a cruising pace?

01:16:33.360 | Okay, so 85% of max intensity for me

01:16:35.920 | would be staying at cruising pace

01:16:37.520 | and occasionally bumping up the speed a little bit.

01:16:41.480 | But on all out day, if it happens to be one,

01:16:46.480 | then it's long, quote unquote, slow distance,

01:16:50.520 | but I'm trying to increase the speed

01:16:52.600 | of what I'm referring to as slow.

01:16:54.040 | So again, this is all very subjective,

01:16:55.900 | but we know on a given day,

01:16:58.020 | whether or not we're pushing past our comfort zone or not.

01:17:02.300 | And I'm not somebody who relies heavily

01:17:04.200 | on heart rate monitors and things like that.

01:17:06.560 | What I rely on is my consistency.

01:17:10.040 | This is the way that I've decided

01:17:11.240 | to stay in all around shape for more than three decades.

01:17:16.240 | I feel like I'm in decent shape.

01:17:17.840 | I'm not a great athlete.

01:17:18.680 | I'll never be the strongest person in the room

01:17:20.480 | or have the best endurance

01:17:21.600 | or the most speed or explosiveness,

01:17:23.100 | but I'm pretty sure I can keep up

01:17:24.720 | with most things pretty well.

01:17:27.480 | And I don't have pain.

01:17:29.520 | And I feel very grateful to not have pain.

01:17:31.520 | And I think it's because I've adopted a stance

01:17:34.280 | of, I don't want to call it moderation, but of modulation.

01:17:38.440 | - Well, I appreciate all what you've said.

01:17:43.440 | In my world, everyone has a back pain history.

01:17:48.420 | So it's always, I just let the,

01:17:51.680 | it's the information that we gather from the assessment

01:17:55.520 | that guides our decision on how we're going to,

01:17:59.040 | A, get them out of pain, build some base resilience,

01:18:02.000 | which is tuning their body,

01:18:03.920 | strategic mobility, strategic stability.

01:18:07.000 | Now, if one thing we haven't talked about

01:18:09.720 | is various types of pain and how yet that impacts

01:18:14.040 | on how we're going to approach their programming for life.

01:18:17.760 | You did a podcast with somebody,

01:18:20.480 | I can't remember what their name was,

01:18:23.160 | but it was a pain podcast.

01:18:25.480 | And you were developing this idea

01:18:27.880 | that if the mechanism of their pain

01:18:32.880 | was really part of the changed engram,

01:18:37.520 | they were traumatized at the time of the event,

01:18:41.020 | or maybe it was a history of sexual abuse or whatever.

01:18:43.920 | But I can detect that person almost always,

01:18:48.520 | I'll start to put my hands on them to feel,

01:18:50.640 | oh, is there any intelligere?

01:18:51.840 | And they recoil.

01:18:53.920 | That's an abused person.

01:18:55.720 | That's a very characteristic response.

01:18:58.560 | So you start putting together some of these reactions

01:19:01.800 | and you know that there's something deeper

01:19:05.040 | than an injury to a part of their spine.

01:19:08.960 | - Yeah, we had Dr. Sean Mackey.

01:19:11.720 | - That was it.

01:19:12.880 | - Yeah, Dr. Sean Mackey is our head of the,

01:19:16.560 | essentially the pain division

01:19:17.760 | at Stanford School of Medicine.

01:19:20.040 | He's an MD and PhD,

01:19:21.200 | and he's a big proponent

01:19:23.800 | of the biopsychosocial model of pain,

01:19:26.120 | which probably makes sense for us to discuss now.

01:19:28.980 | As the name suggests,

01:19:30.120 | it incorporates psychological elements.

01:19:32.960 | It incorporates, of course, physiological elements.

01:19:35.080 | And it points to, as I recall,

01:19:36.800 | seven or more sort of paths to dealing with pain.

01:19:40.400 | Some of which include thoughts about one's emotional state,

01:19:45.360 | stress level, sleep.

01:19:48.520 | I mean, all of these things clearly play a role

01:19:51.840 | in pain and rehabilitation from pain.

01:19:55.040 | - Right.

01:19:56.320 | I love that podcast, by the way,

01:19:59.360 | because it's so consistent with what we've found

01:20:03.080 | and what we do.

01:20:04.040 | If a person has,

01:20:08.200 | it was just a mechanical exceeding of their tipping point,

01:20:15.400 | and they now have some tissue damage,

01:20:18.880 | we address that by creating a strategy

01:20:23.960 | that they don't move or load in a way to stress that,

01:20:28.960 | and we allow the injury to heal if we can.

01:20:31.600 | And we should talk about whether the disc adapts

01:20:36.040 | or you have to manage it.

01:20:37.520 | But that's another very interesting topic to get into.

01:20:40.640 | But nonetheless, we are tuning their body

01:20:44.600 | with strategic mobility and stability,

01:20:47.260 | giving them core exercise,

01:20:49.920 | unleashing their hips and shoulders, et cetera.

01:20:53.000 | And we will have a reasonable level of success.

01:20:58.080 | And we know, by the way, what our success is,

01:21:00.000 | because uniquely, we follow up with every patient we see

01:21:03.520 | to know if we were successful or not.

01:21:05.520 | But now we have that person,

01:21:09.040 | and I can think of many examples just to give a spectrum.

01:21:14.000 | Perhaps the person was in a car accident.

01:21:16.880 | They survived, but the person beside them

01:21:18.960 | who might've been their mother died.

01:21:21.240 | So now they're carrying a hell of a lot

01:21:23.160 | of emotional trauma, guilt, trauma.

01:21:25.440 | Maybe they nodded off at the time of the accident

01:21:29.120 | they were driving.

01:21:30.240 | Tremendous psychological stress.

01:21:34.320 | Maybe they were sexually abused or whatever.

01:21:38.080 | That rewires their brain.

01:21:42.620 | So now they come in and the pain pattern doesn't fit.

01:21:46.120 | We do physical stressing of their various tissues.

01:21:51.120 | And the reactions, they change, they're variable.

01:21:54.920 | They're not what they should be.

01:21:57.180 | The way that their brain perceives the pain

01:22:01.400 | has been rewired.

01:22:02.760 | If we give them the traditional approach

01:22:06.780 | of giving them more fitness and ability, it won't work.

01:22:10.840 | We can't break through that maladaptive response.

01:22:14.080 | We completely change.

01:22:17.720 | Now it might be just to desensitize,

01:22:21.200 | and you'll laugh at this.

01:22:22.520 | We might get a feather and brush it over their back.

01:22:25.720 | And they'll say, "Oh, yeah, that triggers my pain."

01:22:28.920 | "Really?"

01:22:29.760 | "Yes."

01:22:30.600 | "Oh, and now I'm getting a headache."

01:22:32.600 | "Okay."

01:22:33.500 | So we have to come up with what can they do

01:22:37.480 | without triggering that maladaptive response.

01:22:40.200 | And it might be that.

01:22:42.200 | Simply, the most simple of movements

01:22:44.880 | where the afferent and efference,

01:22:48.520 | all the information going into that engram,

01:22:51.520 | which is formerly triggering pain,

01:22:54.880 | we now figure out what it is that doesn't trigger pain

01:22:58.840 | and then slowly desensitize it with repetition,

01:23:01.800 | never triggering pain, and then we expand that repertoire.

01:23:04.600 | So you've heard of fibromyalgia,

01:23:07.560 | which is a little bit of a catch-all term,

01:23:10.920 | but a flashing light,

01:23:14.020 | surprising someone.

01:23:18.000 | They're walking down the street

01:23:19.360 | and someone comes out of a shop and surprises them somehow,

01:23:22.680 | and that triggers off this massive pain response.

01:23:25.720 | We do that with very gentle love,

01:23:31.440 | doing the things that doesn't cause pain

01:23:33.440 | and try and slowly expand that engram

01:23:36.920 | into a pain-free one.

01:23:38.280 | There are those in what's called work hardening.

01:23:43.320 | It's usually funded by insurance companies.

01:23:45.320 | So if you have intransigent back pain,

01:23:48.000 | we are now going to get you to do your job.

01:23:50.200 | We start out with an hour a day.

01:23:51.480 | You're a bricklayer, you're gonna lay bricks for an hour.

01:23:53.560 | Tomorrow, you're gonna lay for an hour and a half.

01:23:55.460 | And occasionally they have some success

01:23:58.920 | or they have some really miserable failures.

01:24:03.280 | And the person says,

01:24:04.380 | I cannot do another day of bricklaying for four hours,

01:24:07.320 | even though it's only a portion of my job.

01:24:10.000 | And so now they get kicked out of the program

01:24:12.160 | because they're called a non-compliant.

01:24:14.440 | In other words, there's something psychological

01:24:16.200 | wrong with them and they're shattered.

01:24:21.200 | Those are the people we see.

01:24:23.000 | So these are, you know,

01:24:25.600 | talk about the biopsychosocial approach.

01:24:28.620 | I know I get labeled sometimes as the biomechanist

01:24:32.800 | and I ignore all the psychosocial,

01:24:34.400 | but these are people who've never read our work

01:24:36.960 | and they don't know it.

01:24:37.800 | So I really appreciate you bringing this

01:24:39.560 | 'cause I'm not often asked this perspective.

01:24:44.000 | But again, I know with your background,

01:24:46.360 | you'll appreciate all of this.

01:24:48.040 | - Yeah, surely the, you know,

01:24:49.240 | the nervous system is involved in generating movement

01:24:51.640 | and feedback from the muscles and proprioception.

01:24:54.520 | And as you're describing,

01:24:56.560 | the nervous system creates our sense of pain.

01:25:00.820 | There's an emotional component to it as Dr. Mackey pointed

01:25:04.120 | out and as you're reinforcing and the neural circuits

01:25:07.600 | that control quote unquote pain or give rise to pain

01:25:10.660 | involve the confluence of all of these things at some level.

01:25:15.200 | And I appreciate that you're willing to go

01:25:17.880 | into this biopsychosocial model of pain and acknowledge it

01:25:21.720 | because I think all too often in this space of biomechanics

01:25:26.000 | and pain and back pain in particular people,

01:25:30.860 | you in some cases get labeled as only subscribing

01:25:34.700 | to one particular pattern of remedy

01:25:37.300 | or one particular framework.

01:25:38.620 | And that's simply not true.

01:25:39.820 | It's just not true.

01:25:41.380 | In fact, I'll go so far as to say

01:25:42.700 | that that's actually a reflection of other people

01:25:45.280 | placing a singular lens on you and your work

01:25:48.540 | as opposed to your work having a singular lens.

01:25:50.420 | I know that you look at things

01:25:51.420 | through the rather complex prism that is back pain

01:25:55.740 | and back rehabilitation.

01:25:57.400 | So thank you for touching into the biopsychosocial model

01:26:01.000 | and we'll put a link in the show note captions

01:26:03.320 | to that episode with Dr. Mackey

01:26:05.000 | because he went into this in some depth.

01:26:07.600 | And so it is the case that we've covered that model

01:26:11.000 | in pretty extensive detail.

01:26:13.760 | There's something that you said to me once

01:26:16.900 | that I really wanna make sure we highlight,

01:26:19.160 | which is that people who embark

01:26:21.500 | on a particular style of training,

01:26:23.880 | not just sport selection, but style of training,

01:26:25.940 | like resistance training with heavier weights

01:26:28.620 | versus endurance training, running longer distances

01:26:31.740 | or swimming longer distances,

01:26:34.060 | will sometimes cultivate a certain,

01:26:37.620 | what should we call it?

01:26:39.220 | Personality style or reactivity style

01:26:43.140 | that is probably independent of who they started off as.

01:26:47.420 | I mean, you can never separate these things completely.

01:26:49.380 | I mean, we could argue people

01:26:52.020 | who have a lot of mental endurance pick endurance sports

01:26:54.960 | or people that are rather ballistic in their personality,

01:26:57.920 | here I'm playing psychologist,

01:26:59.960 | pick sports with a lot of speed

01:27:01.720 | and ballistic motion involved.

01:27:04.140 | But perhaps the reverse is also true,

01:27:07.080 | that the more we engage in activities

01:27:09.960 | for which the nervous system is required

01:27:12.200 | to generate a particular pattern of movement,

01:27:14.800 | like ballistic movement or endurance or strength,

01:27:17.640 | that we exacerbate certain aspects of our mental self,

01:27:22.600 | our emotional self as well.

01:27:24.640 | I realize this is not the stuff

01:27:26.920 | of detailed peer-reviewed studies necessarily,

01:27:30.280 | or at least I'm not aware of them,

01:27:31.880 | but in your experience,

01:27:33.220 | working with a variety of different people

01:27:34.880 | from the general population

01:27:36.240 | who engage in different activities,

01:27:37.720 | as well as athletes who engage in very different activities.

01:27:41.800 | And let's keep in mind the discussion we had earlier

01:27:43.880 | about dog breeds.

01:27:45.640 | They are selected for not just based on physical phenotype

01:27:48.640 | and movement, but also personality type, temperament.

01:27:53.640 | What sort of broad correlations have you observed

01:27:58.480 | in say endurance runners?

01:28:01.380 | Do they have more mental endurance for other activities

01:28:04.520 | versus say strength athletes or sprinters?

01:28:08.240 | Do they tend to have less,

01:28:09.240 | but tend to excel in other domains of their mental life?

01:28:12.880 | - You're right in that I haven't seen good science

01:28:17.280 | to back up this whole issue.

01:28:20.120 | But after working with people for 40 years

01:28:24.720 | and seeing the extremes of the phenotype,

01:28:28.360 | I do have some opinions on this.

01:28:31.980 | And it comes from coaching.

01:28:35.320 | So if you take an athlete who has by nature,

01:28:40.720 | they're very explosive neurologically.

01:28:43.800 | They're quick, they're explosive.

01:28:45.800 | But they can't do it for very long.

01:28:47.860 | It's almost, and I hate using this label,

01:28:52.360 | but it's just a way to describe it.

01:28:55.800 | They have attention deficit.

01:28:57.960 | Now, I've been told I have this.

01:29:00.160 | Every high school teacher would have told you,

01:29:02.120 | yeah, McGill, he's attention deficit.

01:29:04.000 | Now, maybe it was just,

01:29:05.000 | I wasn't interested in what they were talking about.

01:29:06.960 | My brain was thinking about something else.

01:29:08.460 | But I think I do have a certain degree

01:29:11.200 | of attention deficits.

01:29:12.560 | If someone's not holding my attention,

01:29:13.920 | I'm thinking of something that's more important.

01:29:16.920 | The more explosive the athlete is,

01:29:21.080 | the shorter the time you have to coach them,

01:29:23.400 | that they're present with you.

01:29:24.900 | The less explosive they are,

01:29:30.240 | the more time you have to coach them.

01:29:32.080 | So I will say that.

01:29:34.160 | - Find that really interesting.

01:29:37.880 | And I can think of a number of self-experiments

01:29:40.680 | that I'd like to embark on of,

01:29:43.240 | including more endurance training

01:29:45.480 | at particular times of year

01:29:46.720 | and seeing how that correlates with mental focus

01:29:50.320 | and endurance for, say, writing or preparing podcasts,

01:29:55.240 | things of that sort.

01:29:56.680 | But of course, now that I have some sense

01:29:58.580 | of what the answer could be,

01:30:00.100 | I'd be biasing the outcomes.

01:30:02.320 | But if it's a self-experiment

01:30:03.980 | and the goal is simply to shift one's,

01:30:07.820 | mental life or behavior,

01:30:09.460 | then I don't know that it matters that much.

01:30:11.840 | - Can I go with a little anecdote there

01:30:13.600 | that you may appreciate?

01:30:15.200 | I'll get a call from a coach,

01:30:18.080 | say an NBA coach,

01:30:20.360 | and it'll be with their medical staff.

01:30:23.720 | And they'll say, "We have this player.

01:30:25.580 | "They play 18 minutes a game.

01:30:28.420 | "Can you help?"

01:30:29.260 | And they have a back pain history.

01:30:30.760 | "Could you help us to get them to play 27 minutes a game?

01:30:34.940 | "And then I'll investigate and understand the player.

01:30:38.520 | "And then I may ask a question to the coach.

01:30:43.520 | "What puts paying bums in the seats in the stadium?"

01:30:48.560 | And they'll say, "Well, what do you mean?"

01:30:52.320 | And I said, "Well, it's that player

01:30:53.560 | "that we're talking about.

01:30:55.420 | "That player is magical for the 18 minutes that they play

01:30:58.180 | "because they're sparky, they're explosive."

01:31:00.960 | If we train them,

01:31:03.500 | and they have a plastic physiology and neurology

01:31:06.100 | that we can train so that they can last 27 minutes,

01:31:09.060 | you realize that you're trading off the explosiveness.

01:31:13.380 | You cannot have a really high VO2 max

01:31:16.300 | and be maximally explosive.

01:31:17.820 | They're competing mechanisms.

01:31:19.060 | One's a fast twitch mechanism for speed and explosiveness.

01:31:23.340 | And the other one is an endurable physiology.

01:31:26.700 | And you trade one for the other.

01:31:30.280 | So do you really want to compromise that explosiveness?

01:31:35.280 | And you see this when you're on a team

01:31:41.420 | getting a combat athlete ready.

01:31:44.620 | If they are neurologically explosive,

01:31:46.620 | you design the fight and the training

01:31:50.060 | that they pretty much have to win in the first round.

01:31:51.980 | And if they don't win in the first round,

01:31:53.620 | they're going to gas out.

01:31:55.900 | And the person who is preparing to compete against them

01:32:00.900 | is training to survive the first round

01:32:05.120 | and then come on in the second.

01:32:06.960 | So they're training endurance.

01:32:08.460 | To compare those two different athletes

01:32:12.480 | from a psychological point of view,

01:32:15.060 | and if you do it enough,

01:32:16.000 | I think you'll come to agree with me.

01:32:18.360 | And you will notice that there is how you coach them.

01:32:23.000 | It has to be in short consumable bites.

01:32:25.860 | And it's not that they're any more or less intelligent.

01:32:29.820 | They get it, but you have to be on cue

01:32:34.500 | and choose your words, be efficient.

01:32:36.360 | Do you see what I mean?

01:32:38.920 | The coaching style changes quite a bit.

01:32:41.340 | - Do you think that if somebody has pain,

01:32:44.880 | that they should have the capacity

01:32:47.220 | both to like lean into and push into the pain,

01:32:50.420 | not exacerbate it,

01:32:52.040 | but to sit with it and feel it

01:32:56.080 | as opposed to just avoiding it?

01:32:58.080 | How should people think about their own pain

01:33:00.300 | and how to work with it?

01:33:01.140 | That's the reason I'm asking.

01:33:02.260 | - Right.

01:33:03.900 | It depends and it's a dance.

01:33:06.840 | So I can give you some examples.

01:33:08.200 | One chapter in my "Back Mechanic" book is called,

01:33:13.160 | well, it's about surgery.

01:33:15.120 | And should you have surgery?

01:33:18.700 | We did this because as you know,

01:33:21.280 | in our experimental clinic at the university,

01:33:23.520 | we followed up with every patient we ever saw.

01:33:26.820 | We would assess them

01:33:30.120 | and then we would subcategorize them into different bins.

01:33:34.120 | If a person was told you've tried everything,

01:33:40.120 | you've been to the chiropractor,

01:33:41.640 | you've been to the physical therapist, the osteopath,

01:33:44.120 | you've had a surgical consult,

01:33:46.240 | you've been to the psychologist, et cetera,

01:33:49.620 | and you failed every single one of them.

01:33:51.180 | So basically you've been conditioned to fail.

01:33:53.740 | We tried a process called virtual surgery.

01:33:59.400 | So I'm defining the group now.

01:34:02.420 | You've tried everything

01:34:03.500 | and you've been told the last thing for you is surgery.

01:34:06.880 | That's the subcategory of people

01:34:09.300 | that we're now gonna talk about.

01:34:11.180 | And I'll say, fine,

01:34:12.020 | you can go and roll the dice and have surgery.

01:34:14.740 | Most of them don't want it, obviously.

01:34:17.180 | And I'll say, but what we're going to do

01:34:18.880 | is try virtual surgery.

01:34:21.600 | And I make a bit of a production out of it.

01:34:24.120 | I anoint them like a knight.

01:34:25.500 | I touch them on the shoulder and I say, that's your surgery.

01:34:28.060 | And I'm looking into their eyes

01:34:29.960 | and now I give them one of these.

01:34:32.120 | We're looking into each other's soul now.

01:34:35.620 | You've had surgery.

01:34:36.940 | You're gonna behave like you've had surgery.

01:34:39.380 | Tomorrow, your first post-surgical recovery day,

01:34:42.740 | you're going to lay in bed, relax,

01:34:45.460 | get up for a pee every two or three hours,

01:34:47.840 | have short little shuffles.

01:34:50.580 | The next day we'll add a little bit more, et cetera.

01:34:53.940 | We give you a post-surgical recovery program,

01:34:56.920 | a really good one.

01:34:57.980 | And then we start tuning the body strategically,

01:35:02.180 | stability, mobility,

01:35:04.120 | eventually adding a little bit of endurance

01:35:06.100 | long before strength,

01:35:07.860 | and then getting the movement patterns, et cetera.

01:35:11.820 | (sighs)

01:35:14.100 | If the person was an exercise addict as well,

01:35:18.180 | so you can imagine the person who has the personality

01:35:21.860 | that you're describing.

01:35:23.020 | They tell me in the interview,

01:35:25.840 | I have to ride the elliptical for 40 minutes every day,

01:35:28.540 | because if I don't, I'm gonna murder my kids and my husband

01:35:31.780 | because that's my stress relief.

01:35:33.180 | - Oh my goodness.

01:35:34.020 | - Not literally, but that's what they'll say

01:35:35.860 | as painting the picture.

01:35:38.180 | - Give that person a treadmill.

01:35:39.220 | - Right.

01:35:40.060 | - An exercise book.

01:35:40.900 | - Okay, so they've won that negotiation

01:35:43.460 | with every previous clinician.

01:35:44.780 | Well, they're not gonna win it with me

01:35:46.020 | because all I care about is outcome.

01:35:48.980 | My job is to get them better by whatever means.

01:35:53.940 | So I have to tame that.

01:35:59.240 | Surgery works in a lot of cases because it's forced rest.

01:36:03.340 | Surgery for that exercise addict

01:36:06.620 | forced them to have rest

01:36:08.820 | and allowed them to desensitize.

01:36:10.580 | So we fake it and we do it.

01:36:13.340 | Now for the evidence.

01:36:14.600 | We followed up with every patient

01:36:16.300 | and in a two-year follow-up,

01:36:18.300 | 95% of those people who avoided surgery

01:36:22.540 | but did the virtual surgery were glad that they did.

01:36:26.880 | - Yeah, that answers the question.

01:36:28.380 | It's follow the advice of the clinician.

01:36:31.080 | And it gets back to this issue of predisposition

01:36:36.540 | to move a certain way,

01:36:38.980 | to therefore avoid other forms of movement,

01:36:42.380 | to engage in certain activities, but not other activities.

01:36:45.500 | I realized that I'll get in trouble if I say,

01:36:48.420 | 70% of the training that we do

01:36:50.220 | should be in line with our predisposition

01:36:52.380 | and 30% should be countercurrent to that.

01:36:55.420 | But I'm kind of veering towards numbers

01:36:57.260 | more or less like that, right?

01:36:59.260 | I mean, we know for instance,

01:37:01.020 | in the machine learning algorithms

01:37:04.200 | that relate to learning in the nervous system

01:37:06.180 | that a rough, this is a rough estimate of difficulty

01:37:09.940 | should be about 15% of questions or challenges.

01:37:14.740 | So these could be cognitive challenges

01:37:16.420 | or physical challenges should lead to failures,

01:37:20.200 | non-injurious failures, right?

01:37:22.180 | Getting the answer wrong about 15% of the time

01:37:24.460 | tends to optimize learning

01:37:25.660 | across a number of different domains.

01:37:27.620 | Okay, like, is that true for everything?

01:37:29.700 | Is it true for language, math, dance?

01:37:31.740 | No, but it's true for a lot of things.

01:37:33.900 | - That's an argument that's used a lot

01:37:36.020 | and I, however, as I said,

01:37:41.020 | I've done the work and I've done the follow-up

01:37:44.940 | and I have an opinion for a reason.

01:37:46.740 | We start out by giving them the tools to not have pain.

01:37:53.300 | From a physical point of view, that's really important.

01:37:57.780 | From a psychological point of view,

01:37:59.900 | we've just empowered that person.

01:38:01.900 | They are now in control because they never had the tools.

01:38:05.540 | A, they didn't understand

01:38:06.820 | what the real mechanism of pain was,

01:38:09.340 | so they had no strategy to down-regulate it,

01:38:12.960 | if I'm a neuroscientist, or to desensitize it.

01:38:16.260 | But now they know with some precision

01:38:18.780 | what the moves, the loads, the activities are

01:38:21.400 | that cause their pain.

01:38:22.580 | They know the counterpoints,

01:38:23.820 | what actually are beneficial for their pain.

01:38:26.660 | And they begin this life

01:38:30.660 | of having as little pain as possible.

01:38:33.740 | Now I go back to the tipping point

01:38:38.740 | and all systems need stress.

01:38:40.900 | But in the beginning, we cannot cross the tipping point.

01:38:44.100 | And that's really the essence of your question.

01:38:46.100 | When do we start pushing them now

01:38:48.140 | to allow a little bit of pain?

01:38:50.240 | Some people start it way too early.

01:38:51.860 | We do not.

01:38:53.060 | We know where that tipping point is

01:38:55.620 | and we keep building the training capacity

01:38:58.660 | of being pain-free until we have a margin of safety.

01:39:01.620 | Now it's that margin of safety that we start to play with.

01:39:04.860 | Can we expand the volume of training

01:39:08.980 | and get them ready to go back to work

01:39:12.900 | or to go back to their sport?

01:39:14.180 | Or maybe they just wanna play recreational golf.

01:39:16.540 | We've talked about that.

01:39:17.800 | Eventually, we're going to go to the point

01:39:21.820 | where we're butting up against the tipping point now.

01:39:24.960 | Now we have another conversation.

01:39:27.260 | Remember what the goal is.

01:39:29.800 | How important is it for you

01:39:31.400 | to set a personal past in deadlift

01:39:33.480 | or to play 18 holes of golf five days a week?

01:39:36.520 | Would you settle for three?

01:39:41.000 | And now they've had a year of no pain.

01:39:43.720 | Their life has changed.

01:39:45.320 | They're mentally in a different place.

01:39:48.160 | They have their answer

01:39:51.080 | and they converged on it themselves.

01:39:53.520 | I'm not 18.

01:39:54.520 | I'm 55 years of age.

01:39:58.160 | I've got two young grandkids.

01:39:59.960 | I'm looking forward to playing golf with them when I'm 75.

01:40:03.640 | So do you see how, when we bring them through that way,

01:40:06.400 | accepting a certain amount of pain,

01:40:09.320 | that's more of a younger person's outlook.

01:40:13.040 | There's still some warriors left.

01:40:14.920 | A lot of us soften up as we get older.

01:40:17.780 | But I just think of my own journey.

01:40:20.080 | I trained heavy as a kid.

01:40:22.960 | And I remember my dad saying,

01:40:24.200 | well, why are you doing this?

01:40:26.480 | You're really shortening your athletic career.

01:40:29.160 | Not that I had one, but you know.

01:40:31.200 | And he was right.

01:40:34.040 | And now my training has totally changed.

01:40:38.360 | But as you know, I have no pain.

01:40:40.560 | I'm still fairly physical.

01:40:44.220 | - Yeah, you're in great shape at 67.

01:40:46.200 | - Yeah.

01:40:47.020 | - Just remarkable shape.

01:40:48.760 | For those listening and not watching,

01:40:50.440 | I encourage you to take a look at the top card

01:40:52.360 | or the YouTube video.

01:40:53.200 | I mean, Stu moves around great

01:40:56.280 | and your posture's great

01:41:00.040 | and you're in awesome shape for any age,

01:41:03.840 | much less 67.

01:41:05.760 | So that's a testament to your methods.

01:41:07.640 | - Well, the point was,

01:41:09.680 | it's okay to push when you're younger.

01:41:12.940 | You don't have the capacity to push now.

01:41:14.840 | If I go into pain, I'm in pain for a few days,

01:41:18.520 | not an hour.

01:41:19.520 | - So you're cautious.

01:41:20.360 | - Yeah, and older people will get to that point.

01:41:24.280 | - I'd like to ask you about McGill's Big Three.

01:41:27.560 | I know that, again, you loathe

01:41:29.320 | to impart generalizations on people,

01:41:32.160 | but at some point you realized

01:41:34.200 | that people need something to do,

01:41:37.740 | to work with in order to try and "pain-proof" their back

01:41:41.900 | or reinforce their back.

01:41:43.880 | So we did a video that included the Big Three.

01:41:48.680 | We'll provide a link to those in the show note captions

01:41:50.880 | where I performed the Big Three,

01:41:52.400 | probably not perfectly, admittedly.

01:41:55.000 | I should have invited you to critique my form,

01:41:57.920 | and we can always shoot another one of those,

01:41:59.840 | but I think it captures the Big Three well enough.

01:42:03.340 | The bird dog, the roll-up and the side plank,

01:42:08.620 | designed to build strength and stability around the spine

01:42:14.720 | and to stave off back pain,

01:42:17.320 | or in some cases, rehabilitate back pain.

01:42:21.160 | An enormous number of people wrote to us

01:42:23.080 | and commented how much the Big Three have helped them.

01:42:26.200 | So I just want to make sure that it's clear

01:42:28.120 | that despite the fact that you are appropriately reluctant

01:42:32.760 | to say that the Big Three is the solution to everything

01:42:35.360 | in terms of back pain for everyone,

01:42:37.000 | they have helped a large, large number of people avoid,

01:42:41.960 | and in some cases, rehabilitate back pain.

01:42:45.020 | If you were to add a fourth exercise to the Big Three,

01:42:51.080 | what would it be?

01:42:52.160 | - It depends on the assessment.

01:42:53.760 | - Let's say somebody has a willowy spine

01:42:56.360 | and they want more spine stability.

01:42:58.960 | They want to be able to generate more spine rigidity

01:43:02.440 | for whatever purpose.

01:43:03.680 | - What are their pain triggers?

01:43:05.440 | - They have a lower back pain that's unilateral,

01:43:10.400 | and when they sit too long and then stand up,

01:43:13.320 | it feels like that side is locked up

01:43:15.240 | and there's some pain shooting down the leg.

01:43:16.880 | - Okay, so they've got mechanical back pain,

01:43:19.440 | they've got neurological involvement

01:43:21.320 | if it's shooting down the leg.

01:43:23.360 | How old are they?

01:43:24.480 | - Early 50s, maybe in their 40s, or older.

01:43:27.360 | - Okay. - It's a big range.

01:43:28.200 | - So they will have some discogenic disorder.

01:43:31.000 | There's a disorder of the joint

01:43:33.600 | and it will be causing the nerve to react in such a way.

01:43:38.600 | - And when they walk a bit, 10, 15 minutes,

01:43:43.200 | they tend to feel better.

01:43:44.280 | - Ah, okay, so they have a younger spine

01:43:47.000 | because discogenic disorders

01:43:50.000 | are more common among younger people

01:43:53.080 | and sitting is the causative pathway.

01:43:57.080 | Going for a walk is the relieving pathway,

01:43:59.280 | but that will switch over when they get older.

01:44:02.440 | - Is that right?

01:44:03.280 | - Yeah, sitting becomes the relief

01:44:04.340 | and walking then becomes the exacerbator of their pain.

01:44:08.420 | Well, again, I need to know with some precision

01:44:14.780 | what the pathway is,

01:44:17.980 | but if they have neurological parts,

01:44:22.020 | I need to know why, what makes them worse.

01:44:24.740 | So I might have them sit upright in a chair,

01:44:27.100 | grab the seat pan of the chair and pull up.

01:44:30.100 | I'm adding compression.

01:44:31.860 | Does that cause more nerve radiation?

01:44:36.400 | If it does, they've got a little bit

01:44:37.940 | of compression intolerance.

01:44:39.600 | Okay, so now I have to choose an exercise

01:44:41.620 | that is not compressive by nature.

01:44:44.880 | If I move the nerve, so if I extend their leg,

01:44:52.040 | at the same time, ask them to look up,

01:44:54.440 | it releases the whole spinal cord

01:44:58.240 | and all the nerve roots from above

01:45:00.260 | and it pulls it from below.

01:45:01.420 | In other words, it flosses it through.

01:45:03.780 | If that causes pain as they're doing it,

01:45:06.240 | they've got nerve friction.

01:45:08.020 | If they do it and it's tensile tension,

01:45:11.940 | then it's nerve tension.

01:45:13.380 | So these are very different mechanisms of their pain

01:45:18.380 | and they require different approaches.

01:45:21.100 | So do you see why I'm still hedging on that next exercise?

01:45:24.540 | It might be mobilizing the nerve.

01:45:28.060 | It might be giving them more thoracic spine extension

01:45:32.860 | through a thoracic, and now they've taken the load off

01:45:37.260 | when they sit and stand.

01:45:39.900 | So you can imagine standing,

01:45:41.860 | you can palpate your erector spinae muscles

01:45:44.100 | and they might be relaxed.

01:45:45.500 | You poke your chin and those muscles come on.

01:45:48.140 | And if the, but the cramp was on one side

01:45:51.740 | and if it was muscular, that's probably not related to this.

01:45:55.740 | That's still a very discogenic sign.

01:46:00.100 | There's a bulge or there's something off that's mechanical

01:46:03.300 | that we will determine.

01:46:05.180 | I might just say walk more, but not in a single dose.

01:46:10.180 | And again, I've described all of this in back mechanic.

01:46:14.820 | Instead of walking an hour in one dose,

01:46:20.660 | have three 20 minute walks.

01:46:22.620 | Walking for an hour, increase the risk of getting pain.

01:46:26.620 | Walking for 20 minutes, guaranteed you have no pain.

01:46:29.580 | So do it in three doses, you've just guaranteed success.

01:46:32.900 | So I might add another exercise,

01:46:35.260 | but I might program it very strategically as well.

01:46:38.140 | - What are your thoughts on inversion tables

01:46:40.660 | and anti-gravity boots and things to deload the spine?

01:46:44.700 | - Right, well, again, if you follow our work,

01:46:49.340 | we do do deloading of the spine through traction.

01:46:54.340 | It's usually applied by one of our trained clinicians.

01:46:59.940 | And the reason for that is,

01:47:01.340 | let's take that younger person again,

01:47:03.340 | as you just described, maybe laying on their tummy.

01:47:06.800 | As they exhale, they allow the low back

01:47:10.860 | to sink into the table, increasing the lordosis,

01:47:13.860 | which is, we measured this in the lab.

01:47:16.300 | If they have a posterior disc bulge with an open fissure,

01:47:19.260 | which is probably one of the more common ones,

01:47:21.900 | that maneuver vacuums in the disc bulge.

01:47:27.940 | If that immediately reduces the pain down their leg,

01:47:31.140 | I would say lay prone and have someone pull on your legs

01:47:35.340 | along the plane of the table, five or six pounds per leg.

01:47:38.800 | Now the next person comes in and say, "Oh, that hurts."

01:47:41.600 | Well, now we play what we call jazz.

01:47:43.540 | This is the art of therapy.

01:47:45.580 | I'm playing with how we're going to apply

01:47:48.100 | a twisting torque to their feet.

01:47:50.080 | No decompression table does all of this.

01:47:54.260 | It doesn't have the art.

01:47:57.900 | It's more of a brutal hammer.

01:48:00.860 | And to really get difficult people,

01:48:02.720 | because remember, no one has back pain and says,

01:48:05.140 | "Oh, I think I'll go see Miguel."

01:48:06.300 | It doesn't work that way.

01:48:07.580 | We only get the ones who've failed 10 previous attempts.

01:48:11.700 | The difficult ones.

01:48:12.520 | - Try every other treatment.

01:48:14.140 | - No, we've got to know, we've got to have some skills here.

01:48:17.300 | - Well, I started doing the big three

01:48:18.860 | on the basis of your book.

01:48:21.720 | And it certainly has helped my lower right side back pain

01:48:25.640 | that occasionally flares up.

01:48:27.280 | I also noticed I've gotten stronger in various lifts,

01:48:30.980 | but the most salient consequence has been when I run,

01:48:35.980 | I feel like my torso can stay more upright

01:48:41.760 | as I can kind of cycle my legs underneath me,

01:48:45.120 | like I'm pedaling on a bike.

01:48:46.760 | And I feel like I have endurance for days.

01:48:49.280 | - That's exactly what you should feel.

01:48:50.920 | So you've improved the cylinder.

01:48:53.400 | So the diaphragm pumps up and down inside the cylinder

01:48:56.680 | to allow you to lung ventilate.

01:48:58.640 | If you don't have that athletic diaphragm,

01:49:03.000 | you're entraining your abdominal muscles,

01:49:05.320 | the oblique muscles to the breathing effort

01:49:07.980 | while you're running, it wears you out.

01:49:10.000 | It also compromises your spine.

01:49:12.120 | So you need those muscles to form a girdle

01:49:14.960 | and hold it all together.

01:49:16.680 | Now, I know enough of your history

01:49:20.080 | that I suspect you will have a little bit of a disc bulge.

01:49:23.320 | - I do, yeah.

01:49:24.280 | I had a whole body scan for fun,

01:49:29.280 | I guess is the sort of thing I do for fun.

01:49:31.120 | And indeed, I think it's like an L3, L4 bulge on one side,

01:49:35.560 | which is fully consistent with the pattern of pain

01:49:38.920 | that I've had.

01:49:40.240 | And I've managed to avoid for a number of years now

01:49:42.680 | doing Cobra type pose, these kinds of things.

01:49:46.520 | - The Cobra doesn't work for everybody,

01:49:48.600 | but it is a powerful vacuuming in

01:49:53.120 | of certain types of disc bulges.

01:49:55.040 | So I'm glad it works for you and you found it.

01:49:57.480 | And it will work for some others,

01:49:59.320 | or it will make the pain worse than some others.

01:50:01.680 | And there's tests for figuring that out.

01:50:04.200 | - I noticed if I travel and it forces me to sit

01:50:07.040 | for long periods of time, and then the next day

01:50:09.400 | I train with any kind of hip hinge movement,

01:50:13.360 | it flares up again.

01:50:15.000 | - Right.

01:50:16.480 | - Don't forget to use your lumbar on the airplane.

01:50:19.120 | - Right, yes.

01:50:20.200 | Dr. McGill gave me this little pillow called lumbar

01:50:23.840 | that inflates you put it in the lower back.

01:50:25.640 | And it's a wonderful tool.

01:50:27.840 | - Right, that gives you resilience for travel.

01:50:32.840 | - If one didn't have access to that,

01:50:34.840 | they could just roll up a towel and put in their lower back.

01:50:37.280 | - Absolutely, yeah, or sitting in a lecture.

01:50:39.520 | If they're a student, travel with it.

01:50:42.640 | Sitting in a restaurant, people who go and say,

01:50:45.000 | "Oh, my back's killing me,"

01:50:46.840 | after sitting in that booth in the restaurant.

01:50:49.880 | - You might get some funny looks,

01:50:50.940 | but you'll be the person still mobile

01:50:52.720 | and not complaining about your pain

01:50:54.680 | when everyone else is grunting.

01:50:57.160 | - I'm past the funny looks, I'm okay with that.

01:51:00.560 | - That's an advanced neuroplasticity trick

01:51:03.760 | that comes with age, I'm right there with you.

01:51:06.420 | I have a question about walking.

01:51:10.200 | These days we're hearing more and more

01:51:12.760 | about benefits of walking after meals,

01:51:15.200 | walking several times per day, blood sugar regulation.

01:51:17.760 | I think it's all wonderful.

01:51:18.600 | Anything that gets people moving in healthy ways,

01:51:21.480 | I think is terrific.

01:51:22.620 | When it comes to walking,

01:51:26.280 | none of us want to be the person paying careful attention

01:51:28.460 | to our gait, especially when we're not in pain

01:51:30.980 | and things of that sort.

01:51:32.160 | But if you were going to recommend a daily walk,

01:51:35.680 | is there a duration and speed that you think

01:51:38.920 | could be beneficial in terms of staving off back pain,

01:51:43.020 | just general posture, things of that sort?

01:51:46.880 | Are we talking about a brisk five minute walk

01:51:48.720 | or a brisk 20 minute walk, this kind of thing?

01:51:51.180 | - I'm with you 100% with the notion

01:51:55.200 | that walking is one of the most healthy things you can do.

01:51:58.960 | I get stuck a little bit when you want me to give numbers

01:52:02.280 | in a generic broad application.

01:52:05.640 | - Ranges are fine.

01:52:06.520 | - If I saw the person and they have a back pain history,

01:52:11.520 | I would know, A, should I just leave walking alone

01:52:16.960 | and tell them to walk?

01:52:18.120 | It's quite fine, that's not your problem,

01:52:20.280 | but we still want you to walk three or four times a day.

01:52:22.920 | But I know what the question is

01:52:24.680 | and you want some general rules on all of this.

01:52:27.240 | Don't walk to pain.

01:52:30.440 | So if your tipping point is 40 minutes,

01:52:33.680 | you can't go and for a 40 minute walk,

01:52:35.960 | you've just guaranteed that you will be unsuccessful

01:52:39.500 | in having a pain-free day.

01:52:41.440 | But can you walk 20 minutes?

01:52:43.800 | Good, walk 20 minutes three times a day.

01:52:48.120 | Now you've got a full hour of pain-free walking guaranteed.

01:52:51.360 | So it was the exposure

01:52:52.720 | and how you dosed it throughout the day.

01:52:54.720 | If the person has discogenic back pain,

01:52:59.480 | they will find that they don't like to stand

01:53:02.240 | in one position for very long,

01:53:03.720 | sit in one position for very long,

01:53:05.720 | or do any single activity for a long period of time.

01:53:08.480 | So the key for their daily regimen

01:53:10.520 | is to keep changing posture.

01:53:12.080 | So something like a sit-stand desk at work

01:53:15.680 | would be a really good idea.

01:53:17.540 | But now the magic comes if they could sit for 20 minutes,

01:53:22.440 | stand for 30 minutes and walk for 10.

01:53:27.000 | Now that was the magic that just of the dosing

01:53:30.680 | that allows them to do their job as a computer programmer

01:53:34.200 | or whatever it is where they're a slave to the computer,

01:53:36.480 | there's no option.

01:53:38.120 | So there's an idea there.

01:53:41.340 | In my own life, it's a habit.

01:53:45.320 | I walk after every meal.

01:53:47.760 | I walk before I go to bed

01:53:49.000 | and that's my time with my wife and my dog.

01:53:52.060 | And it's our routine.

01:53:53.620 | And it is, even when we travel in the winter,

01:53:57.900 | we drive South, we break up the drive and we do our walks

01:54:01.800 | and it keeps us pain-free.

01:54:04.800 | If I say, it doesn't matter who you are,

01:54:07.120 | if you sit all day, chances are you will cause pain.

01:54:12.120 | I can talk about damage, which is interesting.

01:54:14.520 | We've probably loaded more spines

01:54:19.040 | than any other laboratory in the world.

01:54:21.360 | I think that's a fair thing to say.

01:54:23.260 | If we put a cadaveric spine,

01:54:27.440 | that is what we call a virgin spine.

01:54:29.460 | In other words, it came from a young donor,

01:54:31.480 | it wasn't traumatized.

01:54:33.360 | So there's no pre-existing cumulative damage to it.

01:54:37.560 | If you put it in a sitting posture,

01:54:39.520 | you cannot create new injury.

01:54:42.100 | So if a person has never had back pain,

01:54:45.800 | and I can give you an example.

01:54:47.080 | You know the person that they're probably overweight

01:54:49.780 | and all they do is sit.

01:54:51.320 | It's so unfair, they don't have any back pain.

01:54:53.440 | And then their colleague is much more fit.

01:54:55.360 | They go to the gym every day, they have back pain

01:54:57.880 | and they think this is so unfair.

01:55:00.380 | But what they didn't realize is,

01:55:02.480 | they are not training wisely at the gym.

01:55:05.600 | They are probably going far too hard

01:55:10.240 | in a short period of time with too much intensity

01:55:12.640 | and they're creating a little bit of micro trauma.

01:55:14.440 | So now they just made sitting painful.

01:55:17.120 | So do you see what I mean?

01:55:19.160 | You can't injure the spine sitting

01:55:22.280 | if you have no pre-existing injury.

01:55:24.080 | But if you have pre-existing delamination of the collagen,

01:55:27.960 | an old disc bulge, sitting for a long time

01:55:30.580 | will then make it painful.

01:55:32.260 | - If ever there were two exercises

01:55:35.260 | that bring to mind notions of back strengthening

01:55:40.260 | and potentially back pain,

01:55:43.260 | it's the deadlift and the squat.

01:55:46.840 | What are your thoughts on deadlifts and squats

01:55:50.980 | as a function of one's age, one's perhaps phenotype,

01:55:56.220 | ecto, endo or mesomorph or any other factors

01:55:59.920 | that would lead you to say, yes, deadlift and or squat.

01:56:04.920 | No, don't deadlift and or squat.

01:56:07.880 | Or maybe you should deadlift and or squat.

01:56:11.680 | - Okay, those who know me know it could be

01:56:15.800 | any of those three options.

01:56:17.480 | At the highest level, every exercise is a tool

01:56:24.540 | and it's a tool to reach a specific goal.

01:56:26.840 | So in our world of limited capacity,

01:56:29.280 | when a person is fresh coming out of back pain

01:56:32.640 | or they're training to really achieve something physically,

01:56:36.600 | have they defined the goal

01:56:39.440 | and have they chosen the best tool

01:56:41.820 | to keep as much capacity as they can

01:56:45.840 | for training other things that really matter?

01:56:48.720 | The deadlift is an extraordinary exercise.

01:56:53.880 | And as you know, I don't know of anyone

01:56:56.780 | who's been involved with more world-class deadlifters

01:57:01.780 | than myself through the back pain relationship.

01:57:07.380 | So on one hand, I can say, well, I love the deadlift.

01:57:12.100 | And on another hand, I can say, I hate the deadlift.

01:57:14.940 | I can tell you, Andrew, that if you take the clients

01:57:19.260 | who ask for consults now and they're under 30 years of age,

01:57:23.640 | I will say half of them will say in their interview with me,

01:57:27.740 | it started with the deadlift.

01:57:29.920 | So I would say that is getting onto the category

01:57:32.620 | of an epidemic.

01:57:34.200 | And yet I will still tell you, I love the deadlift.

01:57:38.260 | So there's a lot of variables here, a lot of moving parts.

01:57:43.260 | The deadlift is a tremendously

01:57:47.220 | neurologically dense exercise.

01:57:51.140 | Whether you're lifting a light weight or a heavy weight,

01:57:55.640 | I love these bodybuilding charts that say,

01:57:59.920 | oh, well, to do a deadlift, it lights up the erector spinae,

01:58:03.360 | the glutes and the quads perhaps.

01:58:05.560 | Every single muscle of the body should be involved

01:58:08.120 | at a deadlift, every single muscle.

01:58:09.920 | There are no agonists and antagonists.

01:58:12.480 | Every muscle, the full fascial complex will be tightened up

01:58:16.680 | to take the slack out, to pull a bar from the ground.

01:58:20.400 | That's a good deadlift.

01:58:21.640 | That's what minimizes the risk of injury.

01:58:26.080 | And as you know, competitive deadlifters

01:58:28.500 | will actually put on a exoskeleton

01:58:31.380 | of even more fascial stiffness.

01:58:34.040 | It's called a lifting suit.

01:58:35.980 | But not everybody obviously is in that category.

01:58:39.940 | Now, I'm going to talk about one of the most potent pathways

01:58:46.420 | to disc herniation.

01:58:49.500 | So we have the disc from an anatomical point of view.

01:58:52.620 | It's a gel core wrapped with layer upon layer,

01:58:56.940 | concentric layers of collagen fibers

01:58:59.780 | that in order to get a disc bulge or a disc herniation,

01:59:03.580 | they needed to delaminate and the gel nucleus,

01:59:07.580 | when it's pressurized under a heavy bend,

01:59:10.780 | will seek the weak spot between these fibers,

01:59:14.900 | work through the delamination and create a disc bulge.

01:59:18.820 | Now, there's been several recent studies now

01:59:23.820 | that have done assays, investigations

01:59:28.700 | of the harvested nucleus in a disc surgery.

01:59:33.000 | More than half the time, that harvested nucleus

01:59:36.460 | contained fragments of broken end plate.

01:59:39.500 | Broken end plate comes from excessive compression.

01:59:43.780 | And then you go into the history of the person.

01:59:46.080 | Oh, well, maybe they fell on ice

01:59:48.140 | and they pile-drived their back.

01:59:49.660 | There's a candidate mechanism

01:59:51.580 | to create small fractured bits of end plate.

01:59:55.980 | But then they will say, no,

01:59:58.500 | this whole disc herniation story,

02:00:01.980 | it started with a deadlift two years ago.

02:00:05.060 | My back got a bit tweaky after that.

02:00:06.860 | I kept deadlifting and whatnot.

02:00:08.700 | And then they find the fragments of bone.

02:00:11.260 | So more than half of that harvested nucleus

02:00:14.700 | shows evidence of an overload and compression.

02:00:17.780 | When you put that together with the history,

02:00:21.380 | and again, it's not the fault of the deadlift.

02:00:24.180 | It's the fault of the progression.

02:00:28.700 | There are some trainers who will take a person

02:00:31.060 | from an unfit state through to lifting in a deadlift

02:00:35.300 | twice their body weight in half a year.

02:00:38.700 | When you look at the stimulus to bone growth,

02:00:41.460 | it takes a lot longer than half a year.

02:00:43.260 | And when you look at the characteristics

02:00:48.260 | of really successful deadlifters,

02:00:51.300 | they're not young men and women.

02:00:52.900 | They are people who've trained their body over many years

02:00:58.020 | to get that density of bone,

02:01:00.140 | because that really is the weakest link in a deadlift

02:01:03.940 | as far as back injury goes.

02:01:07.340 | So there's something to consider, first of all.

02:01:11.700 | Let's go back to the back pained person now.

02:01:16.340 | And there are some people who do not perform an assessment

02:01:19.180 | and they say, "Oh, if you've got back pain,

02:01:20.860 | the symptom of back pain, do deadlifts."

02:01:23.020 | Well, hold on a second.

02:01:25.140 | One of the first things we do after we've assessed them

02:01:32.460 | is to try and get rid of the cause

02:01:34.300 | that almost always involves teaching them

02:01:37.260 | how to bend at the hips

02:01:38.780 | and not stressing and creating concentrations in the spine.

02:01:42.060 | It's called a hip hinge.

02:01:43.260 | Then we may put a load in their hands

02:01:47.340 | and then we have to assess their hips

02:01:49.700 | to determine whether the hips have shallow sockets

02:01:53.180 | or deep sockets.

02:01:54.060 | In other words, what's the hip range of motion

02:01:55.660 | that will allow you to pick a bar off the ground?

02:01:58.540 | There are many people

02:01:59.460 | who shouldn't be picking heavy bars off the ground.

02:02:02.340 | When you look at the size of an Olympic,

02:02:06.660 | I call them cookies, but a 45 pound plate, I suppose,

02:02:10.060 | that was arbitrarily chosen.

02:02:12.700 | In fact, it was actually chosen

02:02:14.300 | that if someone dropped the bar on the ground,

02:02:17.300 | your head could fit between the bar and the ground.

02:02:20.020 | That was where that original size of the cookie came from,

02:02:22.600 | is my understanding of it.

02:02:24.020 | - People lifting alone quite often, is that why?

02:02:26.480 | - Oh yeah.

02:02:27.380 | Well, there's lots of YouTubes of those injuries,

02:02:29.200 | but anyway.

02:02:30.040 | - Yeah, that's something that I both encourage

02:02:33.920 | and discourage people from searching for

02:02:36.840 | because it can scare you appropriately,

02:02:38.440 | but it's also can be traumatizing to see.

02:02:40.720 | - Right.

02:02:41.560 | So now we've put together the idea

02:02:44.120 | of what anatomy do they have in the hips

02:02:48.460 | and where's the tipping point

02:02:50.260 | in picking something off the ground.

02:02:52.440 | We may start to progress the hip hinge

02:02:57.440 | into a loaded situation

02:02:59.380 | if the person doesn't have compressive load triggers

02:03:02.360 | to their back pain pattern.

02:03:04.440 | I doubt we'll be pulling a bar off the ground though.

02:03:07.000 | We will elevate the bar and put it on blocks.

02:03:09.160 | So if you come to BackFit Pro and you look at our rack

02:03:13.280 | that has 1,300 pounds there available to lift if you wish,

02:03:18.280 | they pull off pins.

02:03:20.560 | In other words, we're matching the height of the pull

02:03:24.020 | to their biomechanical optimum in the beginning.

02:03:28.100 | And then we have to decide is the deadlift the best tool

02:03:33.100 | to get them to their goal?

02:03:35.340 | You know, I did the podcast with Peter Attia

02:03:38.660 | and Peter had a little section on the deadlift

02:03:43.140 | and he asked me the same question,

02:03:45.180 | but he just told me his personal story of conflict

02:03:49.760 | and whether he should be deadlifting.

02:03:51.140 | You know, he's had a couple of spine surgeries

02:03:53.140 | as a younger man when, you know,

02:03:54.860 | none of us knew better in those days, I suppose.

02:03:57.660 | And my answer was to him and a lot of people took it

02:04:01.340 | and we got a lot of blowback on this,

02:04:03.740 | that it was a generic answer for deadlifts and it wasn't.

02:04:07.300 | It was an answer for him where I started to talk about,

02:04:09.500 | well, maybe for yourself, why don't we walk backwards

02:04:13.260 | up a hill in a monster walk style

02:04:15.560 | and you will feel the quads burning?

02:04:18.020 | How many squats and deadlifts do you really need to do?

02:04:21.300 | And then urology comes into this.

02:04:24.380 | You walk backwards up a hill, say it's about 50 yards.

02:04:28.220 | Your quads are burning.

02:04:29.540 | Then walk down to the bottom of the hill

02:04:31.140 | and walk forwards up the hill.

02:04:33.360 | The brain says, I'm perceiving exhausted quads.

02:04:37.620 | Let's go get the next in the hierarchy, your glutes.

02:04:40.640 | It's a fabulous stimulator to glutes.

02:04:43.500 | So there you go.

02:04:45.100 | I've just found a better tool

02:04:46.540 | for a person who has limited capacity.

02:04:49.420 | Deadlift was not the way to go.

02:04:52.120 | They're gonna walk backwards up a hill

02:04:53.460 | and then they're gonna walk forward

02:04:54.660 | and really feel tremendous exhaustion

02:04:58.300 | if that's how they get their jollies.

02:05:00.300 | And if that's what we need in the athleticism

02:05:02.820 | to keep them going and building robustness.

02:05:05.460 | - What are your thoughts on glute ham raises?

02:05:07.780 | I'm a big fan of Nordic curls and glute ham raises

02:05:10.140 | for the posterior chain.

02:05:11.620 | To me, a glute ham raise, folks can look it up,

02:05:14.220 | is basically a deadlift into a leg curl,

02:05:18.420 | into a hamstring leg curl,

02:05:19.980 | except that your feet are,

02:05:21.540 | instead of being on the floor for the deadlift part,

02:05:24.940 | you've rotated yourself 90 degrees

02:05:28.360 | so that the feet are effectively at the wall, right?

02:05:31.380 | And from the bottom position

02:05:32.820 | up to the parallel to floor position,

02:05:35.060 | that's more or less a deadlift, right?

02:05:36.900 | Stiff-legged or partially stiff-legged deadlift.

02:05:39.500 | And then the rest of the way is the Nordic curl

02:05:42.200 | or the leg curl.

02:05:43.040 | To me, that seems like almost the perfect exercise

02:05:45.140 | for the posterior chain, hamstrings and glutes,

02:05:48.020 | which is why I do them regularly.

02:05:49.860 | What are your thoughts about them for back strengthening

02:05:52.460 | and for people that are trying to avoid back pain,

02:05:55.660 | both in the present and in the future?

02:05:58.740 | - It's exactly the same answer that I gave you for deadlifts.

02:06:01.700 | A, it depends, and B, is it the best tool to reach the goal?

02:06:04.940 | That is an auxiliary exercise.

02:06:07.460 | It's not a deadlift.

02:06:08.500 | It's just challenging a part of the chain involved

02:06:13.220 | in the full chain that's required for a deadlift.

02:06:18.140 | If I go back to some of the criticism

02:06:21.740 | after that original deadlift statement,

02:06:25.980 | there was a lot of older fellows who were saying,

02:06:28.780 | you know, I love the deadlift.

02:06:30.240 | When I stop deadlifting, my back pain actually increases

02:06:34.100 | and deadlifting keeps the bogeyman away.

02:06:38.500 | I get it.

02:06:39.540 | Okay, that was the right tool for them,

02:06:42.300 | but I can tell you about the characteristic of those people.

02:06:46.400 | They will be somewhat unidimensional

02:06:48.460 | in their athleticism.

02:06:50.020 | I will bet you dollars to donuts.

02:06:52.380 | Actually, donuts are getting more expensive now,

02:06:54.540 | so that's a poor analogy.

02:06:56.700 | That worked when I was a kid.

02:06:58.420 | But anyway, ask them to throw a football.

02:07:01.900 | Ask them to swing a golf club.

02:07:04.020 | I'll bet you the ones who say deadlifts are good

02:07:06.820 | for their back pain won't do well

02:07:08.940 | in either of those activities.

02:07:10.860 | So it's a very unidimensional.

02:07:13.180 | - Because they can't generate that kind of twist and snap

02:07:15.640 | with the throwing a football, for instance,

02:07:19.140 | like the stiffening up of the body

02:07:21.580 | at precisely the right moment

02:07:23.980 | and the relaxing of the arm kind of flicking and spiral.

02:07:27.900 | - A deadlift is not a pulsing strength.

02:07:29.460 | It's a grinding strength.

02:07:31.180 | And again, if you want neurology to adapt, to create,

02:07:36.180 | you know, again, I know people don't like when I do this,

02:07:41.080 | but when I, I love athletic examples

02:07:44.300 | and I learn so much because it's like a car mechanic

02:07:47.360 | working on a McLaren and then a dump truck,

02:07:50.940 | which carries heavy load, and then a Baja racer,

02:07:53.940 | which is incredibly endurable because it shows you

02:07:56.620 | in terms of engineering and automotive technology

02:08:00.060 | what is possible.

02:08:01.180 | So when you work with a great athlete,

02:08:02.880 | you learn what is humanly possible.

02:08:05.300 | So something like a deadlift,

02:08:06.820 | it teaches the nerves to carry electricity.

02:08:10.300 | When you measure a very good deadlift, it is an exhausting,

02:08:15.300 | but think of it, what is strength?

02:08:18.220 | Strength starts with this thought,

02:08:20.820 | and now you have to densify that thought.

02:08:23.540 | Then you have to densify the pulse train

02:08:27.420 | down through the nerves,

02:08:28.460 | and you've got to teach the nerves

02:08:29.860 | to carry that amount of electrical pulse.

02:08:32.340 | Then you've got to teach the muscles to utilize it.

02:08:34.940 | So in terms of grinding strength capacity,

02:08:38.540 | a deadlift is pretty good,

02:08:40.060 | but does that have to do with most people with back pain?

02:08:44.700 | A few years ago, the professional golf community,

02:08:50.100 | led by a few personalities, got into heavier lifting.

02:08:55.900 | Now, this was rather odd.

02:08:57.500 | If you go back to the old days of Jack Nicklaus

02:08:59.780 | and Gary Player and Arnold Palmer,

02:09:01.420 | do you think they lifted heavy weights?

02:09:03.860 | And I think Arnold Palmer is still playing.

02:09:06.180 | - I mean, some of those guys back when were known

02:09:08.600 | for having a few alcohol drinks,

02:09:12.260 | plus smoking cigarettes on the course.

02:09:17.260 | - But my point is, the more you deadlift,

02:09:20.460 | the less you will be able to throw a football and play golf.

02:09:24.860 | So if your goal in life is to be generally able

02:09:29.860 | to enjoy a really diverse array of activities,

02:09:35.600 | be careful on the tools that you choose.

02:09:38.260 | So going back to the pro golfers of, say, 15 years ago,

02:09:44.580 | when a few of them got into Olympic lifting,

02:09:47.140 | which is heavy hip mobility,

02:09:49.820 | down to the deep squat for the snatch,

02:09:51.720 | and tremendous shoulder mobility and deadlifts,

02:09:56.720 | not one of them, to my knowledge,

02:10:00.980 | and I know some of them intimately well,

02:10:03.220 | hit the ball further.

02:10:06.200 | But they ended up with sore knees and disc bulges.

02:10:09.620 | Essentially, really heavily compromising their careers.

02:10:14.660 | And then a few of them,

02:10:15.900 | and I've worked with quite a number of them,

02:10:18.280 | have now backed off that heavy lifting,

02:10:21.400 | and they have less pain, far more resilience.

02:10:24.220 | And I think they're gonna be playing a lot longer for it.

02:10:26.440 | So I know that's gonna create some controversy,

02:10:29.420 | but so be it.

02:10:30.320 | - Well, that's okay.

02:10:31.160 | I mean, I've gone on record saying that I'll do,

02:10:34.160 | and genuinely do, heavy hack squats,

02:10:38.380 | hack machine squats, leg extensions,

02:10:40.760 | those kinds of things,

02:10:41.600 | alternatives that, for me, have just led to,

02:10:44.760 | you know, progressively more of what I'm looking for,

02:10:47.320 | run training legs, and back, of course, lower back.

02:10:52.320 | And I do glute ham raises,

02:10:54.540 | and I can do all of those without pain.

02:10:57.200 | I don't know the last time I ever did a deadlift.

02:10:59.760 | I was never particularly strong in the deadlift,

02:11:01.500 | but if you're telling me that avoiding deadlifts

02:11:03.920 | as I get older, heavy deadlifts, that is,

02:11:06.480 | is going to help me avoid back and hip pain,

02:11:09.740 | then, you know, I'm all for avoiding heavy deadlifts.

02:11:13.480 | - If you want, first of all,

02:11:15.240 | I don't put you in the category of high risk

02:11:18.160 | for osteoporosis, which is mineral loss from your bones

02:11:20.960 | through genetics, and way under the tipping point

02:11:25.960 | in terms of load stimulation.

02:11:27.880 | So I'm not worried about that for you.

02:11:30.560 | So if I was, that would justify

02:11:33.960 | a heavier loading regimen for now.

02:11:36.800 | But as alternatives, a rear leg elevated split squat.

02:11:41.800 | You can do it just with body weight,

02:11:44.440 | or consider this, interlace your fingers,

02:11:47.720 | put them behind your head, become a peacock,

02:11:50.880 | lift your chest up, now do the split leg

02:11:55.520 | rear elevated squats, like lunge squats,

02:12:00.000 | and you're potentiating the erector spinae

02:12:04.120 | and the whole stabilizing mechanism

02:12:06.160 | by pushing up and resisting.

02:12:07.920 | Do you see how- - Do I need

02:12:09.120 | to flare my elbows back?

02:12:11.160 | - You can do, yeah. - Okay.

02:12:12.600 | - Now, do you see how that just stimulated

02:12:14.760 | your whole upper body?

02:12:16.120 | And the more you push- - The more traps,

02:12:18.280 | everything lined up. - Right.

02:12:19.120 | And you just lit up your whole erector spinae.

02:12:21.360 | We did all of that without a heavy bar.

02:12:23.800 | You could do a goblet squat, hold it in front.

02:12:28.120 | Now the whole body takes a more upright attitude.

02:12:32.140 | It's more knee load.

02:12:33.280 | If you want more knee load and less back and hip load,

02:12:36.200 | or a back squat, you add more hip and low back load

02:12:40.440 | and you take some off the knees.

02:12:41.880 | So you can band the knees.

02:12:44.280 | We can really play jazz on this

02:12:46.760 | to optimize the best variant

02:12:49.160 | to get optimal reward with minimal risk.

02:12:53.000 | And that will change as you recover from the back injury.

02:12:57.680 | It will change with age.

02:12:59.680 | It will change with other comorbidities.

02:13:03.320 | Oh, my neck's a bit sore.

02:13:04.460 | You've dinged up your shoulder,

02:13:05.480 | or whatever the case may be.

02:13:06.880 | Single leg step-ups would be another example.

02:13:13.600 | Now you've added a balance challenge.

02:13:16.120 | As you get older, your risk will not be mitigated

02:13:20.320 | by deadlifts because the biggest risk

02:13:22.720 | as you get older is falling.

02:13:25.280 | That will really change your life

02:13:28.440 | as it does in many people.

02:13:30.520 | Do you have the agility and neural dexterity

02:13:34.440 | that when you stumble,

02:13:35.760 | can you get your foot out ahead of the center of mass,

02:13:40.520 | which is now ahead of the base of support,

02:13:41.960 | so you're gonna fall.

02:13:42.900 | You gotta get that quick.

02:13:44.080 | So it's hip power, quick.

02:13:45.440 | Rest the fall and really mitigate against catastrophe,

02:13:51.360 | which is that fall.

02:13:54.460 | So do you see how that changed?

02:13:55.760 | But can I just finish off with one thing?

02:13:57.360 | And I wanna talk about deadlifts and capacity as well.

02:14:01.120 | And again, it's a lesson that we learn from elite athletes.

02:14:06.120 | When we have an athlete whose goal it is

02:14:09.000 | to set a world record,

02:14:10.240 | be it in deadlifting or squatting or whatever,

02:14:13.040 | they can't train maximum deadlifts and squats

02:14:17.420 | two or three times a week.

02:14:18.940 | It is just too exhausting.

02:14:22.240 | And the recovery period required between training sessions

02:14:25.820 | becomes so long,

02:14:27.600 | they actually lose the peak of the training progress.

02:14:31.540 | So we do it through auxiliary exercise.

02:14:34.520 | So when I think of someone like Brian Carroll,

02:14:36.780 | you know, again, this is all sort of content validity

02:14:40.120 | types of arguments.

02:14:41.460 | I get it.

02:14:42.300 | But until someone produces a few more winners,

02:14:45.900 | I'm going to stick with the way our science has shown to go.

02:14:51.900 | If you train and really push,

02:14:56.900 | you know, you're talking about training at 85%.

02:15:01.320 | Well, are you gonna set the world record

02:15:03.240 | if you only train at 85%?

02:15:05.200 | Probably not.

02:15:06.700 | But if you go to 100%,

02:15:09.080 | you've gotta take a couple of weeks off.

02:15:11.080 | So instead you do some auxiliaries

02:15:14.880 | like Brian used heavily the belt squat machine,

02:15:19.040 | which you can really train hips, legs, et cetera,

02:15:24.040 | tremendous power,

02:15:26.520 | but it doesn't take or exhaust

02:15:28.360 | the whole upper body and back system.

02:15:30.480 | Or you're not loading the spine or compressing the spine.

02:15:32.920 | That's right.

02:15:33.760 | Because you just can't do it.

02:15:37.520 | So if you see why, you know,

02:15:42.120 | it's very difficult for me without knowing the person,

02:15:45.960 | knowing what the goals are,

02:15:47.100 | knowing what their future risks are.

02:15:49.560 | Is it a bone mineral density issue?

02:15:53.080 | Or is it their knees are getting a bit cranky now?

02:15:56.160 | Or whatever the,

02:15:57.300 | I have to choose the most efficient tools.

02:16:01.940 | Occasionally it's a deadlift.

02:16:05.520 | But I also told you that right now,

02:16:07.940 | there's too many young people influenced by social media

02:16:11.800 | who are trying to set,

02:16:13.200 | oh, I'm gonna set a personal best in deadlift.

02:16:16.440 | Not really knowing how to densify the neural drive,

02:16:20.080 | take out all the slack.

02:16:21.920 | So when they grip the bar,

02:16:24.680 | the final squeeze of the bar actually gets the bar moving.

02:16:28.960 | They're breaking it from the floor with,

02:16:31.420 | they're so stiff throughout their body

02:16:33.080 | and they don't know this yet.

02:16:35.320 | And they end up with a back injury

02:16:40.880 | and those are long lasting.

02:16:43.460 | They're hard to recover from.

02:16:45.800 | - You've talked about the so-called biblical training week.

02:16:49.080 | I love this.

02:16:50.800 | It's something that I plan to adopt for myself.

02:16:54.160 | It's not too far off from what I do now,

02:16:55.900 | but it's distinctly different enough

02:16:58.560 | that I'm excited because it's going to require

02:17:02.140 | some psychological adaptation, physical adaptation.

02:17:04.840 | Tell me, what is the biblical training week

02:17:07.840 | and why is it so useful?

02:17:11.820 | - It is the underlying philosophy of how I train now.

02:17:16.240 | It wouldn't have appealed to me

02:17:17.760 | when I was in my 20s and 30s.

02:17:19.620 | In those days, it was all about strength, power,

02:17:24.620 | looking good, impressive, et cetera.

02:17:28.120 | But my joints aren't what they used to be.

02:17:33.540 | My training has evolved with my age.

02:17:38.200 | So the name training, biblical training week

02:17:42.660 | came from the idea that every major religion

02:17:45.740 | has a Sabbath day, a day off.

02:17:48.260 | And when I was a kid and working with my dad,

02:17:52.500 | you didn't do any work on Sunday.

02:17:54.620 | And that was his day of allowing all the cumulative work

02:17:58.480 | during the week to adapt and settle out.

02:18:02.140 | So it's a very wise thing to do.

02:18:07.860 | There's six days to train.

02:18:10.120 | In its basic form, two days a week, I strength train.

02:18:15.320 | Two days a week, I work on the things

02:18:18.840 | that are a bit sticky and not moving very well

02:18:21.860 | because I'm getting older and I have a few injuries.

02:18:25.520 | So those are the mobility days.

02:18:28.560 | Two days a week, I work on my ticker,

02:18:31.480 | cardiovascular system, things to challenge my heart,

02:18:37.220 | et cetera.

02:18:38.760 | There's more caveats to all of this.

02:18:41.520 | So I live in a rural setting most of the time.

02:18:44.760 | We heat our cabin.

02:18:49.240 | I live in most of the days of the week by wood.

02:18:52.240 | So I have to split firewood.

02:18:53.880 | If I split firewood, I've checked all the boxes.

02:18:57.080 | It's cardiovascular training, it's mobility training

02:18:59.640 | and it's strength training.

02:19:00.580 | So it's also a lot of power.

02:19:02.560 | So I've done my training for that particular day.

02:19:05.920 | But I wouldn't split wood two days in a row.

02:19:08.640 | I wouldn't strength train two days in a row.

02:19:10.360 | I wouldn't mobility train two days in a row.

02:19:12.680 | So that's another caveat.

02:19:14.080 | Don't do the same thing two days in a row

02:19:16.720 | and allow the soreness to really develop into something.

02:19:21.480 | Another thing that suits me well is routine.

02:19:26.000 | I try and go to bed at the same time,

02:19:27.680 | get up at the same time.

02:19:29.080 | So those are the basic tenets

02:19:32.880 | of the biblical training week.

02:19:34.800 | The components of each.

02:19:36.720 | You know, I've had some neck trauma, some shoulder trauma.

02:19:40.440 | I broke my hip, I'm hip replaced.

02:19:42.400 | These are the things that I focus on

02:19:46.040 | for strategic mobility.

02:19:48.360 | The strength training is a little bit of bodybuilding,

02:19:53.800 | a little bit of strength and patternings.

02:19:56.000 | So patterns of a squat, a lift, a lunge,

02:20:01.120 | a push, a pull, et cetera.

02:20:05.040 | And so I don't run because of my hips,

02:20:07.080 | but in the summertime, I will swim, kayak, canoe,

02:20:11.400 | but I'll put a bit of beef into it, a bit of effort.

02:20:16.240 | I ride my bike.

02:20:17.760 | In the winter, I cross country ski.

02:20:19.720 | Shovel snow is a big part where I live, et cetera.

02:20:24.680 | So those are the, oh, by the way,

02:20:29.800 | I do do the big three six days out of seven.

02:20:33.800 | And I didn't really discuss that of why they're essential.

02:20:38.800 | We didn't invent those exercises, but we measured.

02:20:42.360 | We were one of the few groups in the world

02:20:43.960 | who actually measured spine stability in a quantitative way.

02:20:48.400 | Doing the big three was the most efficient way

02:20:51.560 | to guarantee spine stability,

02:20:53.900 | but spare the spine while you're doing it.

02:20:55.880 | Well, some people will say,

02:20:56.800 | well, why are you sparing your spine?

02:20:58.180 | It allows me to have capacity,

02:21:00.120 | the limited capacity to do other things.

02:21:02.500 | So why would I waste them all on core training?

02:21:05.580 | The other thing is we live in a linkage.

02:21:09.720 | So the spine is a flexible rod.

02:21:13.040 | There's no coincidence that either end of your core

02:21:16.180 | is a ball and socket joint, the shoulder and the hips.

02:21:19.480 | If I wanted to push you or an object,

02:21:23.160 | a heavy door perhaps at the university

02:21:25.400 | or at a shopping mall, say I could bench press 300 pounds.

02:21:29.700 | Well, I can't anymore, but say I could.

02:21:31.940 | The bench press muscle is the pec major.

02:21:34.500 | Let's look at the architecture of the pec major.

02:21:37.520 | The pec major crosses the shoulder joint,

02:21:39.920 | distal to the shoulder joint,

02:21:42.400 | to where it connects on the upper arm bone, the humerus.

02:21:46.480 | The muscle contracts and creates the desired push.

02:21:49.600 | But proximal, it connects to my rib cage.

02:21:53.700 | Look what it does.

02:21:54.660 | It collapses my torso into my shoulder,

02:21:58.760 | which is an energy leak that is anti-push.

02:22:03.320 | But if I can use core control and core stiffness

02:22:06.520 | and lock down proximally,

02:22:08.880 | 100% of that muscle activity

02:22:11.060 | now goes distally to the athleticism.

02:22:14.040 | So you may have heard the expression,

02:22:16.280 | a stronger core makes you stronger throughout your body.

02:22:19.640 | Well, how does that work?

02:22:20.960 | I've just explained to you

02:22:22.540 | that when you create proximal control and stiffness,

02:22:26.360 | it directs the athleticism distally.

02:22:28.900 | If you want to wiggle your finger quickly,

02:22:30.500 | you had to stiffen your wrist.

02:22:31.820 | If you want to wiggle your arm quickly,

02:22:34.340 | you had to stiffen your upper arm, et cetera.

02:22:37.000 | So the mother of all proximal stability is your core.

02:22:42.000 | In exactly the same way, a heavy equipment operator,

02:22:45.280 | using a backhoe, the first thing they do

02:22:47.420 | is they put down the stabilizers,

02:22:49.180 | which are posts that go into the ground

02:22:50.980 | and lift the tires off the ground to stabilize the tractor

02:22:54.340 | so that now the arm can be the athlete pulling earth.

02:22:58.660 | Failure to stabilize,

02:22:59.980 | you're just pulling the tractor around.

02:23:02.380 | So core stability is essential for ability and performance.

02:23:07.380 | It's arresting all little micro movements.

02:23:13.940 | We're all shrinking.

02:23:15.140 | You will notice this probably over the next decade.

02:23:18.660 | The disc height is now shrinking

02:23:20.940 | and there's gonna be a little bit more micro movement

02:23:23.040 | in the discs.

02:23:24.060 | - Is there anything that can be done to offset the shrinking?

02:23:26.660 | - Not that I know of.

02:23:28.120 | - People will ask whether or not hanging

02:23:29.780 | or anti-gravity boots.

02:23:31.860 | - Oh, well, I've measured that.

02:23:33.220 | Yes, it will increase disc height for 15 minutes

02:23:38.220 | and then gravity and the hydrostatic pressures

02:23:45.860 | will cause the fluid flow.

02:23:48.140 | And the fluid flow,

02:23:48.980 | there's a little bit through laterally through the disc,

02:23:53.020 | but most of it comes through the end plates.

02:23:54.700 | So from the vertebral body into the nucleus of the disc

02:23:59.300 | and you can draw fluid in under tension,

02:24:03.060 | but the hydrostatic pressure

02:24:05.140 | overrides the osmotic pressure in gravity

02:24:08.100 | and then the discs lose all the fluid.

02:24:10.380 | So it's a 15 minute effect.

02:24:14.340 | - I feel like every tissue in the body

02:24:17.500 | has been the target of an attempt

02:24:21.180 | to either restore its more youthful state

02:24:25.220 | or somehow augment its, I don't know,

02:24:30.340 | resilience over time.

02:24:31.880 | So these days we hear a lot about FDA approved treatments

02:24:36.260 | using so-called platelet rich plasma,

02:24:38.820 | PRP injected into the knee or PRP injected into an ovary

02:24:41.960 | or PRP injected into whatever tissue it is

02:24:45.340 | that people are attempting to restore youthful state to.

02:24:49.460 | Is there any evidence for any compounds

02:24:52.660 | or injectable drugs that can restore

02:24:57.000 | the tensile strength and thickness to the discs?

02:25:01.260 | - I haven't seen any evidence of PRP doing so.

02:25:04.820 | Now, I didn't condemn PRP throughout the body.

02:25:09.540 | I swear by it for stubborn muscle tears.

02:25:13.520 | - Interesting.

02:25:14.360 | - In one example, ball and socket articular joints.

02:25:18.160 | There's no question, not all the time,

02:25:24.720 | but it can make a measurable difference,

02:25:28.560 | but not injected into the disc.

02:25:30.900 | So I just need to give a little bit of a context to this now.

02:25:36.060 | If we take someone's disc who's never been traumatized,

02:25:41.060 | so they're a young person,

02:25:43.080 | they can expose their spine to mobility,

02:25:47.740 | be it yoga or ballet or whatever,

02:25:49.980 | and they will probably increase

02:25:51.620 | the range of motion and mobility.

02:25:53.940 | They can strength train and toughen the collagen

02:25:56.820 | and the end plate and build some bone.

02:25:59.300 | And in other words, they can do both, Andrew.

02:26:02.440 | They can increase the constituent strength

02:26:07.440 | of the various parts and they can create mobility.

02:26:13.720 | But once you have an injury to the disc

02:26:17.180 | and you lose a little bit of disc height,

02:26:18.720 | the world changes.

02:26:20.400 | It's not so easy to adapt those full range

02:26:23.360 | of athletic abilities anymore.

02:26:25.480 | So now you're forced to make a compromise.

02:26:28.680 | Most people, we can get them to do one or the other.

02:26:32.200 | They can maintain mobility to play golf

02:26:34.800 | after a disc injury,

02:26:36.360 | or they wanna pop up on a surfboard.

02:26:39.680 | That's their thing in life.

02:26:40.860 | They just wanna be able to surf.

02:26:42.440 | I'll say, good, we can manage.

02:26:47.080 | It's no longer adapting.

02:26:48.440 | We can manage you to achieve that,

02:26:51.760 | but you're gonna have to back off the deadlifts

02:26:53.740 | and some of the strength exposures

02:26:56.760 | because they will just further compromise

02:26:59.300 | the disc height of a damaged disc.

02:27:02.320 | And we can do the opposite.

02:27:04.400 | If you wanna strength train and bear a load,

02:27:06.640 | you're gonna have to give up the mobility.

02:27:09.200 | So that game, that dance with the devil,

02:27:11.960 | that comes after the back injury.

02:27:14.160 | So I think the question was a little bit about adaptation.

02:27:17.800 | If you haven't experienced disc damage yet,

02:27:22.820 | you have a lot more leeway to adapt your spine.

02:27:26.240 | After that, it becomes a game of management

02:27:29.200 | and encouraging an athletic ability.

02:27:33.520 | You become a little bit more unidimensional.

02:27:35.640 | And if you want a little bit of everything, okay,

02:27:38.540 | but you have to be very modest.

02:27:40.180 | You just have to try and achieve sufficient mobility,

02:27:44.160 | sufficient strength to do whatever,

02:27:46.600 | just to get through life.

02:27:47.800 | And it's a bit of a dance.

02:27:49.960 | So I don't know if that gives a bit of a context.

02:27:52.960 | - That's perfect.

02:27:53.800 | - Yeah. - Yeah.

02:27:54.760 | - Could you walk us through your biblical week training

02:27:59.480 | with some examples of what one could select

02:28:02.120 | from the buffet of training options?

02:28:04.200 | - Right, I think I can.

02:28:06.280 | So let's say today I'm going into our clinic gym

02:28:11.280 | and I will start with doing the big three.

02:28:15.120 | So I will do bird dogs and I'm gonna work on good form.

02:28:19.080 | And then I'm gonna put some dynamicism into it.

02:28:21.480 | I don't lift the leg so much.

02:28:24.120 | I push the heel away.

02:28:25.680 | And it really causes you to lock the core

02:28:28.800 | to create the proximal stability.

02:28:30.760 | And then pushing the heel away

02:28:32.680 | really engages the glutes and hamstrings.

02:28:35.280 | Then I draw small squares.

02:28:36.720 | I square out with the hand and foot

02:28:38.420 | down towards the midline and up.

02:28:40.600 | So now I'm creating a little bit of a disassociation

02:28:44.720 | through the ball and socket joints with I want,

02:28:46.960 | which is what I want, with the core control.

02:28:52.920 | So that is translatable.

02:28:55.640 | We did an experiment with the Pensacola Fire Department,

02:28:58.240 | by the way, where those firefighters who were trained

02:29:02.760 | with a coach who explained why they were insisting

02:29:07.600 | on certain exercise forms,

02:29:09.460 | we measured them doing fire ground tasks

02:29:13.400 | before the training sessions.

02:29:15.000 | In other words, we measured them putting up a fire ladder,

02:29:18.360 | advancing a loaded fire hose,

02:29:19.840 | which is a tremendous reactive push, as you know,

02:29:23.100 | picking open an elevator door,

02:29:25.400 | chopping a hole in a burning roof.

02:29:27.580 | Then half of the group trained

02:29:29.920 | with this attention to exercise form.

02:29:33.260 | And we explained the principles to them.

02:29:35.400 | And then the other half of the firefighters

02:29:38.840 | had trainers who were more like cheerleaders,

02:29:42.720 | trying to get them to do more reps and encouraging them.

02:29:45.520 | Both groups got fit.

02:29:48.280 | And then we measured them all again out on the fire ground.

02:29:51.360 | Remember now, we never trained them

02:29:53.040 | how to do the fire ground tasks.

02:29:55.240 | They went back to the fire ground.

02:29:57.320 | Those who trained with the cheerleader types of,

02:30:00.320 | oh, just do more reps, had more known injury markers.

02:30:05.200 | Do you know valvular collapse of the knee

02:30:07.320 | is a very strong predictor of future risk

02:30:09.880 | of ACL injury being one of them.

02:30:11.640 | So there would be an example of that.

02:30:16.400 | Sagittal plane spine motion under load.

02:30:18.960 | I mean, every study that surveils groups

02:30:21.480 | who have to bend down through their spine

02:30:24.120 | and pick up more load has a much higher incidence.

02:30:26.560 | A Bill Maris' study showed 10 times the risk factor

02:30:30.440 | to having a disc injury if you do that.

02:30:34.420 | So I will then do side planks, rolling side planks.

02:30:39.420 | I will do a variety of abdominal exercises,

02:30:45.520 | the modified abdominal curl that you're familiar with,

02:30:48.040 | and I'll do some glute bridges.

02:30:51.500 | Then I'll do them one-legged

02:30:53.840 | and I'll get the arm involved and cross body.

02:30:56.560 | I may put a kettlebell on my belly

02:31:01.760 | and do some hip thrusts that way, but a very mindful way.

02:31:05.160 | I'm focused my brain on squeezing the glutes,

02:31:08.560 | pushing the feet away, et cetera.

02:31:12.080 | Then I will probably stand up and do the strength patterns.

02:31:15.880 | So I'll go over and do pushes.

02:31:18.960 | Now, consider a pushup, which rather than me load heavy

02:31:23.960 | with a bench press or something like that,

02:31:28.680 | I'll do pushups, you know, the clapping pushup

02:31:30.800 | where you dynamically explode up, clap, and go down.

02:31:34.400 | I'll do a variety of those,

02:31:36.280 | very dynamic power generating pushes.

02:31:39.440 | Then I'll do some pulls.

02:31:41.920 | I probably won't do a row with a barbell,

02:31:45.040 | but I'll do an inverted row pulling on a TRX,

02:31:48.400 | pronated grip, pulling into hammer grip,

02:31:50.440 | power breathing and exploding.

02:31:52.140 | Really trying to get some power into it.

02:31:57.580 | Then I will go to probably a split lunge,

02:32:04.440 | rear elevated foot squat, lunge squat,

02:32:09.380 | with the techniques that I showed you,

02:32:11.680 | hands interlaced behind my head,

02:32:14.560 | peacocking high, pushing back, pulling forward,

02:32:18.240 | and now doing the lunge squat.

02:32:20.240 | So that's challenging my balance,

02:32:23.440 | the whole extensor chain strength, et cetera.

02:32:28.440 | I might do some bilateral squats with my hips.

02:32:33.280 | I've broken my ankle.

02:32:34.680 | I do heel elevated squats, usually with a banded knee.

02:32:38.720 | And sometimes I just use my brain

02:32:40.560 | and try and spread the floor.

02:32:42.800 | Then I get into the auxiliaries.

02:32:44.480 | So I broke C4.

02:32:45.680 | I have to, yeah, not a good thing.

02:32:49.520 | - Playing football.

02:32:50.520 | - Hockey.

02:32:51.360 | - Hockey.

02:32:52.180 | - Head down into the boards, classic.

02:32:54.040 | Anyway, I can't really do shearing exercises

02:32:59.040 | where I push against resistance

02:33:02.200 | that will get my neck a bit cranky.

02:33:04.760 | So I take out the shear, I get tall,

02:33:08.480 | I push my tongue hard to the roof of the mouth,

02:33:11.680 | and I grimace.

02:33:12.600 | So now I've activated all the flexors

02:33:14.800 | and I put my hands underneath

02:33:16.160 | and I just push up isometrically and I control that.

02:33:20.040 | So there's no shear anymore,

02:33:21.280 | but I've really started to build the flexor family.

02:33:25.080 | - Keep your neck strong.

02:33:27.000 | - It's important for me.

02:33:29.000 | Yeah, now put your chin poking, retract.

02:33:32.680 | Now push up, you got it.

02:33:35.160 | That's it.

02:33:36.000 | Push your tongue.

02:33:37.240 | Yeah, don't go crazy.

02:33:39.240 | And add a little bit of endurance to that.

02:33:41.600 | I appreciate the neck work that you do though,

02:33:43.880 | which I-

02:33:44.720 | - I have a four-way neck machine, but I don't require one.

02:33:46.960 | I've actually found that taking a plate

02:33:50.000 | and wrapping it in a towel, lying on one side,

02:33:52.640 | making sure to hook my foot under the wrench

02:33:54.800 | and stabilize with my other hand on the ground,

02:33:58.200 | and then just gently doing repetitions.

02:34:00.560 | Jeff Cavalier from Athlean-X

02:34:02.040 | has a great set of videos on this,

02:34:03.960 | where he really spells out the dangers

02:34:05.540 | of things like neck bridges.

02:34:07.560 | They can be done, but there's a risk there

02:34:10.840 | that probably outweighs the potential benefits

02:34:13.160 | for most people.

02:34:14.700 | But every once in a while, I can't help myself,

02:34:16.360 | and I do some bridges, 'cause I really enjoy them.

02:34:19.240 | - If you're a wrestler at University of Iowa,

02:34:22.160 | you've been doing it for a good while,

02:34:24.140 | you're probably okay doing neck bridges.

02:34:26.520 | - Yeah, I get teased for saying this too often,

02:34:28.580 | but the value of having a strong neck

02:34:31.480 | is just hard to overstate.

02:34:33.720 | You don't have to have a big neck,

02:34:35.120 | but a strong neck for sake of stabilizing

02:34:37.560 | the whole shoulder girdle, excuse me,

02:34:39.600 | during pressing and pulling lifts,

02:34:42.840 | for posture, for feeling like your head

02:34:47.680 | is stably placed on your body.

02:34:49.360 | - Think of every pulling motion.

02:34:51.240 | Where does it start?

02:34:52.440 | The trapezius originates off the neck.

02:34:56.160 | Stack that flagpole and really get those muscles

02:35:00.240 | ready to pull.

02:35:02.400 | It requires a stiff, strong neck.

02:35:05.280 | - Yeah, absolutely.

02:35:06.120 | So every strong puller.

02:35:07.200 | - Yeah, as the dog was alive,

02:35:09.780 | he had the larger neck in the house.

02:35:11.600 | But again, it's not about building size into the neck.

02:35:16.500 | It's really that strength and stability

02:35:18.960 | that I just think translates to so many things

02:35:21.240 | that are valuable.

02:35:22.440 | Anyway, I'll finish out my strength routine

02:35:24.680 | with some more auxiliaries.

02:35:26.480 | People laugh at this, I call it sword play.

02:35:29.000 | The amount of athletic gain that we've achieved

02:35:32.120 | with sword play.

02:35:33.160 | I take an iron bar, like the old wieder dumbbell weight,

02:35:38.160 | it'll be an iron bar about that long,

02:35:40.800 | and I'll put maybe a two pound weight on the end.

02:35:43.960 | And then I grab it and I do figure eights over here,

02:35:48.160 | over here, over here, around there.

02:35:50.640 | You wouldn't believe I have professional hockey players

02:35:55.160 | in the NHL who say, wow, those figure eight sword plays,

02:35:58.840 | my wrist shot, my slap shot have, tour tennis players.

02:36:03.140 | I've never had such power and finesse off the racket

02:36:06.600 | because of that sword play exercise.

02:36:08.520 | - Yeah, this is interesting.

02:36:10.360 | I love older exercise books.

02:36:13.360 | And recently I came across one called "Heavy Hands."

02:36:16.940 | This must be from the '70s.

02:36:18.840 | And the entire book was centered around people

02:36:22.200 | being encouraged to carry some dumbbells during exercise,

02:36:25.080 | not all the time, and doing some lunges,

02:36:26.680 | or walking uphill and getting the weights out

02:36:29.040 | from their body.

02:36:29.880 | And I was kind of chuckling about it on the one hand,

02:36:34.320 | pun intended, but at the same time,

02:36:37.680 | we know based on a number of really good studies

02:36:39.980 | using neuroimaging and functional scoring

02:36:42.480 | of neural system function as one ages,

02:36:46.960 | that the innervation of some of the distal muscles

02:36:49.760 | and the fine control of the digits,

02:36:53.760 | the fingers and toes and toe spreading and things like that,

02:36:58.240 | even calf size and atrophy are fairly reliable markers

02:37:04.360 | of the extent to which there's been degeneration

02:37:08.360 | of the upper motor neuron pathways,

02:37:11.520 | other brain areas or not.

02:37:13.740 | So the idea of keeping the nervous system

02:37:17.280 | and neuromuscular connectivity youthful

02:37:21.400 | by "heavy hands" or maybe ankle weights,

02:37:24.920 | provided they're not going to induce injury,

02:37:26.800 | makes a lot of sense.

02:37:28.160 | Weighting the most distal portion of our body

02:37:30.860 | in order to generate adaptations,

02:37:34.000 | I think is going to be something that returns

02:37:35.980 | to the kind of modern sphere of fitness and longevity.

02:37:40.980 | - May I give you a couple of comments?

02:37:43.560 | - Please.

02:37:44.400 | - That was fabulous.

02:37:45.680 | It's so much fun when I see someone getting out of their car

02:37:49.080 | and walking up to the clinic door

02:37:52.720 | and I can see the muscle wasting on their calf

02:37:55.080 | and they'll say, "Oh, I have to get out my EMG

02:37:58.240 | nerve conduction velocity scores here."

02:38:02.280 | I said, "Are you kidding me?

02:38:03.440 | You telling me the doc needed to do EMG conduction velocity

02:38:06.800 | and all I had to do was look at your leg?"

02:38:08.760 | We know exactly the nerve roots that are deficit

02:38:11.560 | 'cause I know exactly what serves those muscles

02:38:13.840 | that have wasted.

02:38:14.960 | I mean, it's crazy how technology has made so many people

02:38:19.960 | oblivious to the signs that we all show.

02:38:26.120 | That was my first comment.

02:38:27.360 | But the second one was going back to the old time books.

02:38:29.900 | I collect a lot of those actually.

02:38:32.260 | I have quite a library of the old time strength books

02:38:34.680 | from some from the 1800s,

02:38:36.720 | the old Inchbook of Strength and oh, they're fabulous.

02:38:39.840 | Indian clubs.

02:38:42.600 | Are you familiar with Indian clubs?

02:38:44.080 | So it's a wooden club

02:38:45.680 | that looks like a bowling pin basically.

02:38:47.960 | But some of the old style Indian clubs were this long.

02:38:51.520 | Well, there's a great manual strength athlete

02:38:55.840 | that not too many people have heard of, John Brookfield.

02:38:59.060 | He lives in North Carolina, Pinehurst, North Carolina.

02:39:02.320 | In Pinehurst, there's a sculpture of very heavy steel

02:39:06.720 | that John bent with his bare hands

02:39:08.680 | to make this sculpture with.

02:39:10.680 | Yeah, he'll take heavy rebar and bend it

02:39:13.440 | and put on strength shows with his hands.

02:39:17.400 | He's a fabulous fella too, by the way.

02:39:19.300 | He's got a set of Indian clubs.

02:39:23.360 | I can hardly pick one up,

02:39:24.720 | but he just picks up this Indian club

02:39:26.560 | and it was from some famous guy from the 1800s

02:39:28.840 | and somehow he got the Indian clubs

02:39:31.000 | and they're about this long,

02:39:31.920 | but he could just get them and play swordplay

02:39:36.160 | with very heavy Indian clubs.

02:39:38.720 | There's actually a good friend of mine.

02:39:41.280 | He's an Australian fellow, Andrew Locke.

02:39:43.200 | I don't know if you've ever heard of Andrew Locke.

02:39:45.760 | And Andrew has collected kettlebells

02:39:48.760 | and Indian clubs from the old timers.

02:39:51.640 | He's got quite a lovely collection in Melbourne,

02:39:54.280 | where he's from in Australia.

02:39:56.180 | But they're wonderful exercises.

02:40:00.400 | - And none of these things require fancy equipment.

02:40:03.040 | One could imagine just grabbing ahold of some either-

02:40:06.840 | - Well, an iron bar.

02:40:07.680 | - Yeah, an iron bar.

02:40:08.980 | Yeah, I really think there's something

02:40:11.520 | to this loading of the distal limbs cautiously, right?

02:40:16.520 | Properly, but there's something there

02:40:19.480 | in terms of keeping the neural pathways healthy and alive

02:40:22.560 | because we know they atrophy with age.

02:40:24.040 | And that explains in part the calf muscle atrophy,

02:40:27.320 | which as you point out is a well-known clinical marker

02:40:31.080 | for neurodegeneration.

02:40:32.700 | - Well, simply things,

02:40:34.840 | and you can certainly comment about this.

02:40:37.000 | I try and do things with my opposite hand.

02:40:39.280 | So today I'm just gonna brush my teeth,

02:40:40.640 | comb my hair with my opposite hand.

02:40:42.800 | Now don't ask me to throw a ball because I'm a moron,

02:40:45.740 | but if I'm splitting firewood, okay, it's 10 reps this way,

02:40:50.080 | 10 reps that way.

02:40:51.160 | And that's all in an attempt to keep my brain

02:40:56.720 | as movement competent and dexterous as possible.

02:41:01.720 | - Well, certainly when I resistance train,

02:41:03.280 | if I'm doing anything standing,

02:41:05.040 | I make it a point to stagger my stance.

02:41:09.160 | - Yes.

02:41:10.760 | - And at the same time to make sure

02:41:12.640 | that my belly button is pointing forward

02:41:14.600 | so that I generate some anti-rotation effort

02:41:18.980 | so that most of my abdominal work

02:41:20.840 | can be placed within the workout for other things.

02:41:23.720 | I do some pikes and some direct abdominal work as well

02:41:26.800 | in the roll-up and things of that sort

02:41:28.920 | that you've recommended.

02:41:30.240 | But I find that from a coordination standpoint

02:41:35.240 | and especially from a balancing the musculature

02:41:38.800 | and the strength on both sides of the body,

02:41:40.800 | this is extremely important.

02:41:42.140 | And I know this because after years of skateboarding

02:41:44.560 | where you push with one leg, that was when I was younger,

02:41:47.800 | boxing where I'm traditional stance as opposed to Southpaw,

02:41:52.400 | you start getting into all these imbalances

02:41:55.480 | that goes way beyond anything aesthetic.

02:41:57.920 | I mean, the aesthetic stuff is my concern in certain people,

02:42:00.620 | but it was more of the feeling

02:42:01.520 | that I could turn to my right very easily

02:42:03.360 | without pain turning my left.

02:42:04.560 | I felt stiff and it was just an imbalance

02:42:06.400 | in some of the muscles controlling anti-rotation.

02:42:11.080 | So I think that weaving a symmetric stance,

02:42:14.600 | weaving the requirement for symmetric balancing

02:42:19.320 | of the musculature on both sides of the midline

02:42:21.880 | just makes all the sense in the world to me,

02:42:25.200 | especially if one is going to be a regular exerciser,

02:42:27.640 | which hopefully people are.

02:42:29.520 | - Well, if I can convince you

02:42:31.300 | to consider the biblical training week,

02:42:34.120 | all of that fits into your mobility days.

02:42:36.960 | Yeah, let's talk about those

02:42:37.840 | 'cause you talked about the strength days.

02:42:39.080 | What about the two days of mobility?

02:42:41.360 | - Well, given my history, I do thoracic spine extension.

02:42:45.800 | I do a little bit of neck work, hip mobility,

02:42:48.820 | but again, I have a certain capacity there

02:42:51.500 | that I can't overdrive.

02:42:54.040 | And then once I've done the targeted ones,

02:42:56.880 | I just go through the motion of every joint

02:43:00.760 | and don't add load.

02:43:03.840 | And then I will do the footwork.

02:43:06.660 | So with my background, I'll do a little bit of shadow boxing.

02:43:09.560 | I'll play traditional southpaw, et cetera.

02:43:14.560 | - If you could just repeat the cardiovascular days

02:43:18.200 | since in the-

02:43:19.040 | - It depends on the time of year.

02:43:20.800 | I really like to be outside.

02:43:23.480 | So if it's winter time and I, for some reason,

02:43:28.080 | couldn't go for a cross-country ski that day or whatnot,

02:43:30.960 | I will ride a stationary bike in the clinic.

02:43:34.680 | I'd prefer not to, but I will.

02:43:37.160 | If it's summertime, I'm riding outside.

02:43:39.720 | And I could kayak, swim, canoe,

02:43:44.720 | just go to the hills and walk with Tico, my dog, hard.

02:43:51.640 | And that might be my cardiovascular that day.

02:43:55.760 | And going back to the genetics,

02:43:58.200 | which is how we started this podcast,

02:44:01.300 | have you ever had your athletic panel done

02:44:05.400 | from a genetic base?

02:44:06.880 | In other words, they look at your genes

02:44:08.680 | and determine what you're genetically good at

02:44:11.240 | and what you're genetically horrible at.

02:44:13.280 | Do you know that?

02:44:14.280 | - I mean, I know a few things that I'm horrible at.

02:44:17.600 | - But you haven't had it tested genetically?

02:44:20.060 | - No.

02:44:20.900 | I have.

02:44:22.120 | And they gave me a panel of 10 athleticisms.

02:44:26.320 | Now, interestingly enough,

02:44:28.080 | if I didn't have my athletic panel

02:44:30.200 | and you just asked me to check,

02:44:31.760 | am I good at this or am I bad at it?

02:44:34.360 | And check somewhere in between,

02:44:35.840 | I would have got every single one 100% right.

02:44:38.560 | - Interesting.

02:44:39.400 | - Yeah, so I know my abilities and it aligns 100%.

02:44:42.840 | In other words, I'm ultra,

02:44:45.080 | which is the highest for grip strength.

02:44:47.440 | I always knew that, you know, they're a pair of hands,

02:44:50.840 | but if I got my hands on you in football,

02:44:52.440 | you weren't getting it.

02:44:53.280 | You know what I mean?

02:44:54.100 | I've always had a very good grip strength.

02:44:56.180 | So genetically that came through as ultra.

02:44:58.240 | And the other thing I was ultra at

02:44:59.840 | was I can be quick for the first 35 milliseconds, boom.

02:45:03.880 | If you want something done like that,

02:45:05.760 | I can usually pop it, you know.

02:45:08.140 | When I was playing hockey,

02:45:10.720 | typically it's a 45, 50 second anaerobic blast.

02:45:16.680 | And you sit down for three minutes,

02:45:18.280 | there's two more shifts,

02:45:19.120 | and then the coach taps you on the helmet

02:45:21.160 | and I'm still breathing heavily.

02:45:22.640 | And my two line mates, they're ready to go again.

02:45:25.360 | I was terrible at recovering

02:45:27.040 | from an athletic anaerobic blast.

02:45:30.320 | Guess what?

02:45:31.160 | I'm the worst possible genetic category

02:45:33.120 | for recovery of heart rate.

02:45:37.360 | And I, you know, I've worked with

02:45:39.680 | some of the best heart rate recovery people

02:45:43.780 | and I'm hopeless at it.

02:45:46.120 | - I have a feeling I'm naturally inclined

02:45:48.560 | to do endurance work

02:45:50.280 | because once I start running distance,

02:45:52.220 | I can just run and run.

02:45:53.600 | And then eventually it just feels like

02:45:55.480 | the stopping comes from, you know, I don't know,

02:46:00.160 | some nagging little injury or something like that,

02:46:02.480 | or pain as opposed to anything stopping me

02:46:05.440 | from continuing to run,

02:46:06.680 | which is unfortunate because I tend to like

02:46:08.440 | the shorter workout type stuff.

02:46:10.920 | But it brings us back to what we were talking about earlier,

02:46:13.480 | trying to do a balance of those and everything in between.

02:46:18.160 | I love the biblical training week.

02:46:19.660 | And given that currently I've been doing

02:46:21.500 | three days of resistance training total per week

02:46:24.440 | and three days of cardiovascular training,

02:46:26.600 | all it requires is shifting one each of those days

02:46:30.280 | toward mobility training,

02:46:31.500 | still taking the full day off each week.

02:46:33.240 | - Make sure you take that day off.

02:46:35.180 | You will be less painful with your joints, I predict,

02:46:41.000 | when you're going into your 60s and 70s

02:46:43.640 | and knock on wood, having a blast when you're 80.

02:46:48.320 | - That's the plan.

02:46:50.200 | Well, I've certainly had a blast today, Dr. McGill.

02:46:53.280 | This has been amazing.

02:46:54.640 | I mean, you've given us such a wealth of knowledge

02:46:57.900 | about the back, its anatomy, neurology,

02:47:01.280 | the sources of pain for those that have back pain,

02:47:04.440 | avenues to relieve back pain,

02:47:07.080 | avenues for people to stave off back pain,

02:47:09.440 | including the big three, but not limited to the big three.

02:47:11.960 | You also gave us a wonderful window

02:47:13.680 | into the precision with which you approach assessment.

02:47:18.680 | And during the introduction

02:47:20.180 | and also in the show note captions,

02:47:22.280 | I mentioned and linked to the many clinicians

02:47:25.300 | that you've trained all over the world

02:47:27.600 | so that if people want to try and access

02:47:30.520 | direct coaching and rehabilitation, they can do that.

02:47:34.820 | I also really appreciate the books you've written,

02:47:38.000 | and we linked to that as well, "Back Mechanic."

02:47:41.180 | And I really just appreciate your devotion

02:47:43.520 | to public education through your own channels,

02:47:46.500 | through your students, the many, many, many

02:47:49.960 | peer-reviewed papers that you've published.

02:47:51.880 | I mean, I can't overemphasize this enough.

02:47:54.120 | You have a vast number of high-quality,

02:47:57.660 | peer-reviewed publications in these areas.

02:47:59.600 | And it's just wonderful to sit across from somebody

02:48:02.960 | who's devoted their professional life

02:48:05.440 | to this really important area

02:48:06.920 | that so many people confront,

02:48:08.280 | whether or not they be athletes or conventional exercisers

02:48:11.520 | or just people who are experiencing some pain

02:48:13.240 | or want to get in shape or all of the above.

02:48:15.560 | So on behalf of myself and everyone listening and watching,

02:48:19.160 | I just want to extend a really deep,

02:48:22.000 | heartfelt, and genuine thank you.

02:48:24.620 | Thank you so much.

02:48:26.040 | - Well, thank you, Professor Huberman.

02:48:28.820 | You know this, but I'm going to mention this

02:48:33.920 | for the listeners.

02:48:34.960 | You have done a great deed in changing the behavior

02:48:39.960 | of many people, myself included, and my family.

02:48:45.620 | It's not the easiest thing to do

02:48:51.460 | because there's always the critics,

02:48:53.520 | but you have done a tremendous service.

02:48:56.420 | And I thank you for that as well.

02:48:58.500 | And I thank you personally because you've improved my life.

02:49:02.360 | And hopefully I'll have a few more years to enjoy it,

02:49:05.120 | but thank you.

02:49:06.040 | - Well, thank you for those words.

02:49:08.880 | It's a labor of love for me,

02:49:11.440 | and that's extremely gratifying to hear.

02:49:14.140 | And God willing, I'll be in your kind of shape at your age.

02:49:18.200 | Let's do this again.

02:49:19.640 | - I would love it.

02:49:20.480 | Thanks.

02:49:21.300 | - Thank you for joining me for today's discussion

02:49:23.320 | with Dr. Stuart McGill.

02:49:25.000 | To learn more about his work,

02:49:26.200 | as well as to find a link to his excellent book,

02:49:28.600 | "Back Mechanic, The Step-by-Step McGill Method

02:49:31.640 | to Fix Back Pain," please see the show note caption.

02:49:34.760 | Also in the caption, you'll find a link to backfitpro.com,

02:49:38.600 | which is Dr. McGill's website,

02:49:40.400 | where he has links to specific practitioners

02:49:42.500 | you can work with if you're experiencing back pain.

02:49:45.240 | If you're learning from and/or enjoying this podcast,

02:49:47.640 | please subscribe to our YouTube channel.

02:49:49.720 | Please also subscribe to the podcast

02:49:51.440 | on both Spotify and Apple.

02:49:53.080 | That's a terrific zero-cost way to support us.

02:49:55.540 | And on both Spotify and Apple,

02:49:56.880 | you can leave us up to a five-star review.

02:49:59.020 | Please also check out the sponsors that I mentioned

02:50:01.000 | at the beginning and throughout today's episode.

02:50:03.320 | That's the best way to support this podcast.

02:50:05.740 | If you have questions for me or comments about the podcast,

02:50:08.660 | or topics or guests you'd like me to consider

02:50:10.480 | for the "Huberman Lab" podcast,

02:50:12.040 | please put those in the comments section on YouTube.

02:50:14.560 | I do read all the comments.

02:50:16.400 | For those of you that haven't heard,

02:50:17.520 | I have a new book coming out.

02:50:18.720 | It's my very first book.

02:50:20.340 | It's entitled "Protocols,

02:50:21.760 | An Operating Manual for the Human Body."

02:50:23.880 | This is a book that I've been working on

02:50:25.080 | for more than five years,

02:50:26.220 | and that's based on more than 30 years

02:50:28.560 | of research and experience.

02:50:30.120 | And it covers protocols for everything from sleep,

02:50:33.160 | to exercise, to stress control,

02:50:35.640 | protocols related to focus and motivation.

02:50:38.080 | And of course, I provide the scientific substantiation

02:50:41.480 | for the protocols that are included.

02:50:43.560 | The book is now available by presale at protocolsbook.com.

02:50:47.440 | There you can find links to various vendors.

02:50:49.800 | You can pick the one that you like best.

02:50:51.600 | Again, the book is called

02:50:52.520 | "Protocols, An Operating Manual for the Human Body."

02:50:55.920 | If you're not already following me on social media,

02:50:58.080 | I am Huberman Lab on all social media channels.

02:51:00.940 | So that's Instagram,

02:51:02.240 | X, formerly known as Twitter,

02:51:03.960 | Threads, LinkedIn, and Facebook.

02:51:06.200 | And on all those platforms,

02:51:07.640 | I discuss science and science-related tools,

02:51:09.820 | some of which overlap with the contents

02:51:11.320 | of the Huberman Lab podcast,

02:51:12.760 | but much of which is distinct

02:51:14.120 | from the contents of the Huberman Lab podcast.

02:51:16.400 | Again, that's Huberman Lab on all social media channels.

02:51:19.760 | If you haven't already subscribed

02:51:21.000 | to our Neural Network newsletter,

02:51:23.000 | our Neural Network newsletter

02:51:24.400 | is a zero-cost monthly newsletter

02:51:26.120 | that includes podcast summaries,

02:51:27.960 | as well as protocols in the form of brief PDFs

02:51:30.640 | of one to three pages,

02:51:32.020 | where I spell out the specific do's,

02:51:33.920 | and in some cases do nots,

02:51:35.140 | but mostly do's related to things like

02:51:37.120 | how to optimize your sleep,

02:51:38.720 | how to regulate your dopamine levels.

02:51:40.760 | There's a protocol for neuroplasticity and learning,

02:51:43.720 | as well as protocols for fitness,

02:51:45.840 | which we call the Foundational Fitness Protocol,

02:51:47.700 | includes everything sets, reps, cardiovascular training.

02:51:50.200 | Again, all available, completely zero cost.

02:51:52.440 | You simply go to HubermanLab.com,

02:51:54.640 | go to the menu tab, scroll down to newsletter,

02:51:57.080 | and provide us your email.

02:51:58.200 | But I should point out,

02:51:59.240 | we do not share your email with anybody.

02:52:01.480 | Thank you once again for joining me for today's discussion

02:52:04.200 | with Dr. Stuart McGill.

02:52:05.640 | And last, but certainly not least,

02:52:08.120 | thank you for your interest in science.

02:52:10.400 | [upbeat music]

02:52:12.980 | (upbeat music)

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

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