Modern Wisdom - #081 - Dr Stuart McGill - Why Do Our Backs Hurt?

Episode Date: June 17, 2019

Dr Stuart McGill is a professor emeritus at the University of Waterloo and a world expert in back pain. Dr McGill has worked with some of the best athletes in the world across pretty much every sport you can imagine as a spinal specialist, so if anyone can give us some advice about how to cope with back pain, it's him. On today's episode expect to learn why backs are so problematic, how much of back pain is due to lifestyle choices or training methodology, how much of an impact desk work is having on our spinal health and why recovery from a back injury can be so slow and hard to define. Massive thanks to The Protein Works for sponsoring this episode, check out their full range here - https://bit.ly/TPWChrisWillx Extra Stuff: Buy Dr McGill's Book Back Mechanic - https://amzn.to/2ILv037 Check out Dr McGill's Website - https://www.backfitpro.com T-Nation CrossFit Article - https://www.t-nation.com/training/doctors-view-of-crossfit Follow Dr McGill on Twitter - https://twitter.com/drstuartmcgill (but don't expect a response) Check out everything I recommend from books to products and help support the podcast at no extra cost to you by shopping through this link - https://www.amazon.co.uk/shop/modernwisdom - Get in touch. Join the discussion with me and other like minded listeners in the episode comments on the MW YouTube Channel or message me... Instagram: https://www.instagram.com/chriswillx Twitter: https://www.twitter.com/chriswillx YouTube: https://www.youtube.com/ModernWisdomPodcast Email: https://www.chriswillx.com/contact Learn more about your ad choices. Visit megaphone.fm/adchoices

Hi friends, welcome back to Modern Wisdom. My guest today is none other than Dr. Stuart McGill. He is one of the world's leading researchers into back pain. He's worked with top flight athletes in pretty much every sport in the world from power lifting to CrossFit, NFL, NHL, Gymnast, Yogi's and even MMA. When world squat record holder Brian Carroll shattered his sacrum and his L5, Dr McGill was the guy who we went to to not only get in pain free, but to also take him back to fitness so that he could re-break his own squad record.

So my point is that if anybody understands how the complex system that is the spine works, it's Dr. McGill. Today we're talking about why spines are so problematic, how we can mitigate the effect of office work and being sedentary or sat down for most of the day, what Dr. McGill's thoughts are on CrossFit as a training methodology and for spinal health, his favourite rehab exercises including the genesis of the legendary Big 3 for back and so much more. I'm certain that this is going to be an absolute hit with a lot of people who suffer with back pain or know someone who does, so very fortunately I have linked up with the protein works to incentivise you to give the episode a little share.

I massively appreciate all of the support that I get and I you to give the episode a little share. I massively appreciate all of the support that I get and I wanted to give something back to those of you who helped to spread the message of the podcast. So listen to the first 30 seconds and you can find out how you can win over a hundred pounds of free protein work supplements. All you need to do is just listen, fuck it, I'll stop talking. Dr Stuart McGill, take it away. Ladies and gentlemen, welcome back. This episode is brought to you by the Protein Works. I'm very happy to be supported by them again for this episode.

They're given away over a hundred pounds of supplements and all that you need to do to enter is share this episode. I'm absolutely certain it's going to be a massive help to a lot of people, so find a friend that you think would be interested, fire it in a group chat or feel free to post on your socials. All you need to do is then send me a screenshot at Chris Willex on whatever social media you want. Find me a screenshot, tag me in your share and I will pick someone over the next week and I'll announce that before next Monday. But on to today's guest, Dr Stuart McGill, we are getting fully spinal today, aren't we? How are you? Welcome to the show. Well, I'm well, Chris. How about you? I'm fantastic. Thank you. I've

been looking forward to this episode for as long as I can remember posted it in the gym, Facebook group asking if they had any questions. So we've got crowd-sourced questions about spinal health. It's going to be a good one today. So first off, I guess I posted in the group a perfect example, posting the group and a lot of people had questions. Why is it that for people who take care of their health and fitness, spines are so problematic? Well, Iines are so problematic. Well, I could go so many ways with that question, but I think it's because it's so difficult

to do things without a robust back. Think of all the things we do, they all involve the back. So I guess that's why they're problematic, but I can be a bit more specific. And that is if we sub-categorized spines and people, we would converge on common patterns. And if we did a little bit of pattern recognition, we'd notice some real cause and effect. some real cause and effect. For example, athletic groups are really fun to study. There are certain athletes in sport where they just clearly have an underperforming core. They spend a lot of time on other parts of their body, but the demands on their spines

simply outpace the foundation that they've built and they end up with either injury or pain or compromise performance or any of those. But in the general public, why are spines so problematic? Look at our lives. You know, I started as a professor 34 years ago. Computers weren't even invented yet. We would spend time walking down halls meeting with our colleagues and doing our clinic work and our lab work. Within those 32 years, something happened.

I became a computer operator. Students no longer wanted to come to office hours. They would send an email and I'd say I don't do emails Which he better come and we'll have some hands on but you know it was just I became a computer operator now that is You know I had a good back but sitting all day gave me back pain. So this is why I think it's back pain. So this is why I think it's problematic to use your words. And then the solution became, well, now you've become a slave to your chair and your computer for eight or 10 hours. Now you're going to blow out all of the stress one hour at the gym. So let's compound the biological

perturbation here and people would start treating their spinal joints because they were locked up all day at the computer like ball and socket joints, but they're not. Biologically, they're an adaptable fabric made of collagen strands held together with a ground substance, and they follow different rules. So, you know, there's all kinds of other downsides to sitting a lot. Your hips get stiff. Well, mobile, powerful hips are one of the secrets of skillful athletic performance and spine sparing strategies. So are people undoing the chronic adaptations and stress in their hips when they go to the gym? Sometimes they do the opposite. I guess the final bit, and this is coming a bit randomly in a thought pattern

between my ears, very few people these days get a competent and thorough assessment of the mechanism of their back pain. So they willy-nilly try untargeted therapies and their spines remain problematic to really answer your question. So if a person has a back issue and they have a thorough, competent assessment, so they understand very precisely what the pain trigger or mechanism is, they then have a road map to guide a strategy to remove the cause, and secondly, to build a foundation to be pain-free and as functional and fit as they want to be. So it's a bit of a long-winded answer, but those are some random thoughts as to why spines are problematic.

Well, I guess first and foremost, spines are a complex system, right? There's a lot going on with your spine. It runs for a lot of your body. There's a lot of interactions going on there. So it wouldn't ever be a single, a single answer. One of the things definitely, one of the questions I've got down, what you have used on workplace ergonomics, you know, you've already touched on it. The sedentary nature of us being sat. Is it simply that we're sat for a long period of time, or is it that we're stationary? Is a standing desk a solution for this? What are your thoughts on the ergonomics of workplaces? Well, I have several thoughts. I wrote an opinion piece quite a number of years ago for the journal called ergonomics.

And think of the office where you can organize it in a way to reduce stress. You can adjust heights the way you sit and these kinds of things. But then I would say, well, is there such a thing as an ideal posture? And I think we would both converge that no, there isn't. The ideal posture is one that frequently changes because you migrate stress concentrations in your body through posture change. So that, that's a little bit of a myth. There are many jobs, by the way, that you can't do ergonomics with. Can you imagine a farmer, a forest or a fisherman, a lumber? A bus driver, a miner. Very few can do ergonomics. All they have is limited in many jobs for sure,

and even some of the foundational principles of ergonomics may not be appropriate for certain people in certain jobs. In that, there is no ideal. The ideal is a moving target, and that's just the biological reality of it. If you were to prescribe a cadence of movement from seating to standing or from if someone was to potentially be able to do their work, let's say they were able to do some calls, they were able to walk while they were on a call perhaps with a hands-free kit or something like that, is moving as frequently as possible whilst obviously not completely degrading your ability to do the work on your laptop or your computer. Is that optimal? Is it to move as much as possible and vary the posture?

Well, you're on the right track. Now, I think you've gone from one extreme to the other, saying move as much as possible. But I would say move more, absolutely. So as great cook, who many of your listeners will know, I think he coined the phrase move well and moved often, and there's a lot of wisdom to that. Now, what is optimal will be very specific to the person, for sure They're aged, they're past injury, history, all of these factors. There's no substitute. You've got to get up out of the chair and move for. You think of every system in the body and every single one of them thrives on movement for optimal health. But that optimum is between not too much and not too little. So moving as often as

possible, you're going to need to sit down to have a rest if you do that. Yeah, yeah, but but you know what I mean. Biology has a tipping point and there's such a thing as too much, just as there's such a thing as too little. The trick of it all is to find that medium. Totally. I certainly can appreciate it. And as you were saying earlier on the reason that I laughed at when you were talking about people trying to offset a sedentary work lifestyle with intense training, is that that is the avatar of the person that I was for quite a while. I presumed that a step counter was really the only only for like my

mum and my dad, like I don't need to bother myself with a step counter because I'm going into the gym and I'm knocking out a thousand calorie, 1500 calorie session in, you know, between an hour and two hours, five, six times a week, and, you know, I'll do a little bit of foam rolling before I start. And that's, like, I don't need to bother about that. Like, that'll undo my, any issues. And at the beginning of last year, I had quite a bit of bad back pain, which I'm still rehabbing through at the moment. And an MRI, at the beginning of this year showed two bulging discs, L5 S1 in a Schmoles node. That you know what caused that. It has a very precise cause. Please elaborate. Well, a Schmoles node,

you weren't born with it, you you it. Now, a schmoral's node consider the vertebra as a barrel. So the side of the barrel is cortical bone and the top and bottom of the barrel that interfaces with the disc is a cart lagging as plate. That's called the end plate. When you lift heavy and you exceed your biological tolerance, that end plate bulges and it will get a little crater that forms in it. It's actually a fracture and that's caused by very high pressure in the nucleus, which comes from lifting heavy. So at some point you lifted heavy to the point where you created that small fracture. Now, I've had two of them in my life. One was hardly noticeable, and the other one was quite to symptomatic for a couple of years.

But then what happens is the disc loses a little bit of height. Now, you can imagine letting a little bit of air out of your car tire. The tire then starts to bulge a little bit of height. Now, you can imagine letting a little bit of air out of your car tire. The tire then starts to bulge a little bit, and it gets a bit sloppy on the road. That's exactly what happens to that joint in the spine now. You lose a little bit of height, and if you keep bending, the collagen is no longer turgid that forms the disc. It's not a ball and socket joint. It's actually strands of collagen kind of glued together, if you want to think of it now, with a ground substance. It's basically, it's a biological goo. Now, that goo can be adapted to be softer, which will

allow you to have a lot more mobility, like, say, you did a lot of yoga, or you exposed your back to high loads without a lot of mobility, that goo actually gets more gooey. And it becomes more resilient to higher load. So as you keep lifting, and if you believe in, well, I have to squat as deeply as possible and that kind of thing, and you have a little butt wink at the bottom. It now becomes a bit more problematic following that, Schmarrerles node or that emplaced fracture. And the collagen will keep adapting to that deep squat mobility

by becoming less gooey, shall we say, in the ground substance. It will delaminate and then you will get a disc bulge. So it's a combination of loaded flexion and it's accelerated by lifting too heavy in the first place. So quite often it starts off with a heavy deadlift and then goes on to repeated loaded flexion. How close am I on that? Pretty, pretty damn close. I was going to repeated loaded flexion. How close am I on that? Pretty damn close. I was going to ask you.

I'm bang on, aren't I? Yeah, you're too bang on. I was going to ask you another question. I've not told you about my training history. If I was to present you with the particular symptoms that I've just explained to you now, what methodology would you predict that I'm following? Crossfit.

100% right. Yeah, I know. I see them all the time. Why is it? So I read and I will be linking in the show not below an article, the article slash interview that you did with T-Nation. Yeah. And it was on the, I guess, the common injuries that are associated with Crossfit and a biomechanical breakdown of that. There will be a lot of Crossfiters who will be listening. There will also be some powerlifters and weightlifters and some endurance athletes as well. But I would be interested to hear if you could give an explanation of what are the typical injuries and why that you see them

with CrossFit, your assessment of the injury to methodology relationship. Yeah, well, it's a fabulous question, but injuries cluster around specific sports and specific training methods, and there's a reason for it. It's the chronic exposure. So, physical exposure to the body causes adaptations. Now, that adaptation can be good or it can be bad, but you load the body and the body will adapt. So that's the beginning opening principle. If you go back to that t-nation article, I think it was in the title of the first paragraph. I have a love, uh, hate relationship with CrossFit. I mean, I absolutely love CrossFit for the culture, for the support of community. I love it. If I was younger, I would have been in there 100%. Uh, but now let's get into the biological adaptation. And then I can give you a solution.

So CrossFit combines adaptations to stimulate mobility. And then the next exercise is asking you to have a tougher collagen. Let me give you an example. So if you start out a routine with 10 burpees, you are creating a high mobility in the back without much load. So burpees on their own are probably not going to create too much challenge to the adaptation process. You're teaching the spine to be a bit more mobile, but it doesn't pay the price because there's no load.

Then the next routine is repeated Olympic lifts. Now we have a problem. If you work with the Olympics, they are grooving perfect movement patterns. It's a highly technical lift. There's no margin for bad form. So CrossFit tries to create an indurable athlete, a power athlete, and a mobile athlete. That's very, very difficult to do in terms of biological adaptations. So by programming 10 Olympic lifts, you know the form is going to deteriorate. Now you're migrating stress.

The first two reps might be all right. And interestingly enough, I don't get many Olympic lifters in as back pain patients. They have to go and see the knee and shoulder guys. Those are the joints that the Olympic lifters are having trouble with. Not really, they've got quite healthy lowbacks. And they'll have very stiff. Well, they lock them into much more of a neutral position because the mobility is at the hips. And they're actually a speed power athlete. They're very, very quick.

They have good pulsing on and off. They relax to catch the on and off. They relax to catch the bar and the snatch and all of these kinds of things. But let's get back to the CrossFit programming. The first two lifts might be fine. The third one now, you're starting to get a little bit tired. You're polluting the perfect movement muscle memory of an Olympic lift. So do you see to be a great Olympic lifter? You would never pollute it when you're tired,

but CrossFit's a different sport. It is an endurance and look, I get the sport. There's lots of sports that aren't necessarily the best for your long-term athleticism. That's just, I have a lot of MMA athletes. I don't think that's a particularly healthy thing to do for your body, but it's a sport nonetheless, and they come to me asking for help.

So of course, I get CrossFit athletes as well, and it's my job to try and adapt their body to be resilient, but we have to make a compromise here. But that's the nature of the programming. So somewhere you have to be between stiffening the spine collagen through repeated load exposures, heavy load exposures, but you can't move your back. You know, that's the difference. So on rep one and two, you might be fine on the Olympic lift, but rep eight, nine, and

ten are pretty not very nice in terms of the bending stresses. And it's at that point where things fall off the rails in terms of biological adaptations and the collagen starts to the fibers. Not the fibers necessarily, but the ground substance between them start to loosen up. And the fact of the matter is the nucleus will slowly work its way through the delaminating collagen and get a dis bulge. So every sport has its pattern, shall we say, and that certainly is. Now, if I could offer this, and I think in that article, I did offer a solution at the end, and it comes from, let's take the good things from CrossFit and mitigate the things that are not so good in terms of biological adaptation.

And Dan John, if you've, have you ever heard of Dan John out of the US? They call them the quirky uncle or something of training. He's a fabulous fella. We're both the same age. We're both in our middle 60s. We have somewhat of the same background and whatnot. But Dan is a really wise guy. He's very clever in that he can say magnificent things in just a few words.

But Dan's solution to the burpee Olympic lift routine would be to do kettlebell swings with a goblet squat, for example. So there would be a wonderful substitute in a CrossFit program to mitigate the biological adaptations that are going to lead to tissue breakdown. Isn't that it? Isn't that an interesting one to think about? So from a biological adaptation point of view, both of those involve a hip hinge, they involve strength, endurance, and they're telling the body to adapt in a consistent way, which is not so with burpees and Olympic lifts. Anyway, there's just a thought for you. But you mentioned other athletes as well, like power lifters, for example. They have a slightly different cluster of patterns for back injury.

But generally speaking, they too begin with end plate fractures and the schmarrows nodes. But here's the difference. Let's take bodybuilding where you train on Monday to tear down muscle at the micro level. Tuesday, you rebuild the muscle in the kitchen and in bed. In other words, while you're resting, and Wednesday, you go again and you repeat the process. Power lifters, when you examine, and I've worked with some of the grand old women and grand old men of powerlifting the very successful ones The crossfitters would consider them under trained because a very heavy

Strong power lifter might do heavy squats on Mondays and take five days off in other words They allowed all the micro fracturing at this is at the micro level now, down at the level of the bone osteones or the bone cells. They are damaged. There's no question. But is that damage a good thing or a bad thing? For cross fitter, it would be a bad thing because the cross fitter says, oh, on my day off, I only ran 5K.

Wait a second. That's not a day off. That's more cumulative. So it's crazy to keep stimulating the body to adapt. And then you know, you don't take the day off to allow the adaptation, but the power lifter has a much more wise biological adaptation schedule. They'll do heavy squats or say it's a pull from the from the ground, a deadlift, for example, and then they take five days off. Now, let's discuss the adaptation of bone. Bone is a piezoelectric material, and what that means is when you stress a bone, it builds an electric charge.

That electric charge attracts free ions of calcium and magnesium, and it blues it or chemically bonds it to where the fracture is or the high stress. But it takes five days for those new ions of basic bone building material, calcium, magnesium and whatnot to scaffold on before they break it off again. But what does the cross fitter do? They train the next day and they break off the adaptation that they were trying to create. So do you see the same micro damage in a power lifter is a good thing. It stimulated adaptation, but they were wise enough to let the biology over the next five days really build substantial bone strength. That's not typically

the way a cross-fitter would train. It's just more is better and they don't allow sufficient adaptation. So these are all very interesting philosophical things to discuss in terms of creating robustness to load and better athletic performance. But, you know, I get it. I get CrossFit, I get why you do it. As I said, I would have been there if it was 40 years ago as well. However, I've learned quite a bit about biology in the meantime. And that's why these training, you know, it may not be so much the poor exercises sometimes. It may just be the not paying enough attention to the adaptation schedules of some of these things. And, you know, that's just pure programming.

So any organization could change their programming and create a more robust athlete. I think there's certainly in the CrossFit community, there is a addiction to training that classes would tend to run when they choose to. Wednesday, Thursday, off, Friday, Saturday, Sunday off, which means that you're going to be training even if you're just like a RX class athlete or even a scaled class athlete, you're going to be doing five days of training per week. Now, you're not going to be pushing the same sort of loads in terms of percentages, frequently as a powerlifter, but you're going to be doing a normal for a lot, and I do, I get what you mean, the fact that a rest day for anyone who follows Zach George, UK athlete, you'll see his

active recovery days that he does on a Thursday, which will be like a 40 minute e-mom of rowing wall balls and burpees. And that's his active recovery day, but it'll be a pace that would be in any other normal athlete. It just happens to be that he's a little bit of a freak. So, yeah, the fact that that's considered a rest day by CrossFit is when you look at it in the cold light of days, and probably to other sports as well, especially powerlifters, but then on the flip side from the kind of cultural perspective, CrossFit is the look across, in our gym, We have a crossfit area, weightlifting area,

bodybuilding area, and a powerlifting area. So there's like every different species of strength athlete is kind of moving around in the same place and some endurance guys as well. And the Crossfit is a look over at the powerlifters and see that they're sat down for five minutes in between lifts and they'll be sort of thinking, giving them shit.

And then the powerlifters will be looking at the crossfit as well and they're brightly coloured shorts with like doing millions of wraps and burpees and going out and running in the rain and stuff and they'll be giving them shit and it's interesting. It's very interesting dynamic. I think you'd probably quite enjoy observing from a bird's eye view if you could access the CCTV. Chris, that's my world. I see it every day.

So I don't need to see it anymore. I won't send you the stream. All right. But I, of course, I know exactly what you're talking about. Look, my job is to try and understand these mechanisms. And then when a person has pain, mitigate them, it's so interesting. You know, years ago, I would see someone on the way to a back injury.

And you know, you're almost always right, not always, but almost always right. And but I learned it's almost impossible to motivate the uninjured. So if they haven't got back pain yet, who am I to go over and give them any advice? Unfortunately, we have to let them learn the hard way and then all of a sudden they're motivated to listen and hopefully we can come up with something that will address the mechanism a bit.

Well, I can put my hand in the air and say that my rehab was a second thought up until the point at which rehab was all that I could do. Like when I was still able to train rehab took a back seat and last year when my back went for a front of a better term, that was when I decided to really pay a lot of attention to my rehab. Now I did, but then over the space of a month last summer, flew for 60 hours, did a powerlifting meet in Hawaii, went and trained CrossFit with Michael Casu in Texas,

and then came back to the UK and just started all over again. And the same thing happened. I've been sat on planes, cramped up, pretzled up into all manner of different different postures, and then the same thing happened again. So... So you earned your pain? I have, oh yeah, I really did. I mean, it's just, it's one of those things. Another interesting point on that in terms of the injury giving people the motivation to do their rehab was when I had an MRI scan at the beginning of this year. So I'd been working after, back end of last year, sort of five months or so, working quite hard on my rehab, but was seeing an upper limit in terms of my recovery.

I then saw the MRI scan this year. Now I know that there is a very tenuous link between pathologies that present on scans and pain that presents a lot of people who do strength sports would present some sort of abnormality if you were to show them an MRI. But many of them may not have pain and some people with pain may not present on an MRI. But for me to see the fact that there was something

actually there, it wasn't just pain, this kind of nebulous, weird, ephemeral thing in the back of my mind, to see that there was something actually there that had been caused that was the cause of my pain and also the cause of my due to my training, that really hit home. And the last few months have really stepped up how much I've taken care, how consistent I've been with the big three and a bunch of other things as well. It's the MRI was a real kind of like whoa moment. Well, MRIs, if they're used properly

are absolutely fabulous in your case in point. And I argue the statement that MRI evidence does not link to pain. In fact, I would argue the opposite. The problem is an MRI image shows anatomy. And I don't know how old you are, but say you're 30 31. Yeah, you can't fool me, Stu knows, but anyway, if what I'm looking at on your MRI is 31 years of life. Now, some of the features that are on the MRI are old wounds. Sorry, old scars, they don't cause pain anymore. Some of them will be fresh wounds.

Now, a radiologist has no way of knowing which are wounds and which are scars. What is painful and what is not. However, if you proceed the MRI session with a thorough assessment of the person, you know exactly what you're going to see on the MR. So you can do a thorough assessment of the person, you know exactly what you're going to see on the MR. So you can do a thorough assessment and you know the pain is coming from whatever structures and plates, you know, compromised nerve roots, sake, well, the act joints or whatever. The assessment will reveal those sources

and then you go look at the MRI scans and you'll get pretty close to a one-to-one match. So I wouldn't blame the MRIs of not being linked to pain. It's the system that prevents them from being linked to pain. So they become quite powerful after you've already seen the person, but here's the thing. The radiologist has no idea whether that person is a cross-fitter, a powerlifter, or a sedentary worker at a 10-hour a day computer job. And what I mean by

that is, I've seen athletes who bring in their MRI reports. And the report says, Oh, they've got degenerative disc disease. And then I look at the MRIs and I say, that's a power lifter spine. That's not an MR. Those are sclerotic end plates. That's what that's the bony calis that a power lifter has developed and adapted over 20 years of heavy lifting. But the radiologist had no idea whether that was an adaptation to heavy exposure. So now that's healthy. That's exactly what the power lifted needed to set a world record. So do you see my issue when I hear that MRIs are not linked, it's the system and the fact that radiologists I don't think radiologists should be allowed to write a report.

They've never seen the person, so they have no context. Now they're good at looking for cancers, tumors and things like that, but in the world of back pain, that's extremely rare. So to link it to physicality, you've got to know the person first. And then we can interpret the MRIs and they can be very helpful for people who are a bit stubborn in the response to therapies. So, I mean, you're a perfect case in point. I mean, these people who argue, oh, it's a psycho, psycho, psychological issue that people will start to obsess over their MRI. Wait a second. You just

gave an example of you just got psychological relief and understanding that you do have something there. It's not something to ignore. It's time to get on it and treat it and get your health back. So it all boils down to just being a good human being and telling the truth, respecting that the patient you're dealing with is not a five year old, there are 31 year old athlete who needs to know a strategy to get rid of their pain and get back to what they love, which is training CrossFit with their friends and I get it 100%. Yeah. I mean, you're totally correct. I was in the gym today watching some of the guys throw down doing a class work, doing

a competition qualifier, and I'm thinking, ah, like, I wish that I could go back in there and do that. But previously before the MRI, I'd have probably been like, oh, my back feels okay today. Like, oh, boys, can I just join in? And then that would be me, throw it like, I'll just go, oh no, no, no, no, it's fine. Like, my back, it'll just be a thing.

But then you write, the MRI really hit home with regards to the fact, no, no, no, no, no, no, hang on. Like, your spine is something that you're going to need for more than just satiating the CrossFit hunger for the next, however long that's your methodology, it's something that you're going to have to have, functioning effectively for the rest of your life. So take some time, focus on the rehab and work on that and then slowly begin to build things back in, which is currently

now the strategy and has been for a while. And it's working, I take it. So it is, specifically, I want more the listeners with my particular pathology in my back. There's some oddities that I can't quite work out and perhaps once I, we get off the call, I might be able to explain them to you. But yeah, there's some, there's some interesting things. However, since I've focused a lot more, since I've taken more care about it, I have seen a, the plateau that I spoke about before the MRI has now been pushed through. And the only real thing which has changed

has been compliance with the rehab plant. Yeah, what people don't realize is just because the pain is gone one day, it doesn't mean their back is healed. And this is the mistake. The underlying adaptations still need to continue to build that robustness back again. So if you've got a disc bulge, it's time to get the loss of stiffness back into the disc, actually done by the stabilization exercise and whatnot. And that's, I hate that word because it doesn't mention what specific exercises they should be, but nonetheless, mentioned what specific exercises they should be, but nonetheless, you do have to honor that history because there's some physical therapists these days who say, oh, well, just because you have

a back pain, there's no evidence of tissue damage. And again, I would argue very vehemently against the opposite. I see the damage and I've created it in the clinic and laboratory and we document it and we know what to look for. Most radiologists have no idea what to look for and whether they're looking at wounds or scars. So again, just because you're out of pain, behave, and organize a proper adaptation schedule and really enhance the chance for being successful at gaining your athletic robustness once again. I got you. So we've touched one of the things that you come up with a lot is the relationship between stiffness and flexibility in the spine. Would it be

possible to have Yogi who's also a power lifter? No. See one of the interesting things is this I spoke to Dr. Quinn Henneck, Dr. Physical Therapy for Juggernaut Training Systems about a a year ago. And he was talking about what he referred to as mobility myths. So we were going through the typical tools and approaches that people use that you see in a gym, the static stretching, the thetheragon, the vibrating foam roller, the dynamic stretching, the PNF, and all these different things. And he was talking about the mechanisms that actually occur when these things happen. But I certainly know that in Strengthsport, at least in the UK, in my experience, I see a lot of static stretching.

There's a number of subscription services that you can get that focus exclusively on static stretching as a way to enhance mobility and to improve your range of motion, but it sounds like you potentially might be doing more damage than good with something like that. Well, that wasn't your question. You asked me, could they be a powerlifter in any of you? Let me say why I said that very emphatically. Have you built a world champion powerlifter? No. Do you know one with loose hamstrings? No. No. Yeah, they don't exist.

Yeah, you're right. So, yeah, I mean, the strongest powerlifter has to have tight hamstrings. It's non-negotiable. So there you have it. Now a powerlifter needs to fight their mobility to get down into a proper deadlift pole. There has to be elastic tension in their body to assist the muscles in the poll if you're going to win the worlds. So, you know, you can't, they wear elastic knee wraps, elastic suits to add even more

stiffness to allow even more elastic recoil. So I mean, but we're going for the extreme here. Is that healthy or is that a great athlete, or is that what you want? I mean, that's debatable. But let's go to the other end. Have you ever worked with a, I mean, I've had yogis who are on the TV,

teaching yoga, yoga as patients. I can't really think of too many who are strong. In fact, they can do wonderful squats. Their bottom can go right down and touch the ground, but they have difficulty doing a body weight squat to stand back up again. Is that so? Oh yeah.

Now, somewhere people want to be in the middle. You know, yogis aren't out there on the rugby field, nor is the power lifter. So that rugby player somewhere in the middle, the cross fitter has to be somewhere in the middle. And that's the expertise of, first of all, the dumb luck of choosing your parents, and then being as clever as you possibly can

in creating the right adaptation. I'll ask you some other questions. The NBA championships are on right now. You see a lot of people dunking basketballs. Do you think they have loose hamstrings? No. I'm one of the few who've measured them. No, they're tight. They bounce off springs. So, you know, you went to this dark place of saying, oh, there's stretching programs to create more mobility. Be careful now. Go through the great athletes you've measured and tell me who has unlimited mobility.

They don't. They're elastic athletes. They're wound up springs. So, you know, you can go through the spectrum from the throwers to the golfers to the tennis players through to the Olympic weight lifters. I'm talking about elastic athletes here. What a mistake it is to stretch away that elastic athleticism. Is that the way it works? Is it a other two counter to each other? You've got stretching and then you've got progressive overload.

You've got loading and those two are they about as antagonistic as you can get. Yeah, you're talking extremes. Maybe in some people. But again, my world is elite athletes. I have to tune the machine. I'm tuning elasticity. I'm tuning facial trains. I'm tuning muscle pulses. I would be very judicious in whether or not we would stretch them away with a static stretch. So we might do a static stretch, say, for a rower, who now has a lot of posterior anular disc stress. They've just done a rowing session in a boat or on an herb, and I would say, good, lay on your tummy and just breathe. Now, there is a static stretch for a rower.. Now I might do a thoracic extension stretch to give them more elasticity so they're sliding

up the slide on the seat on the boat. They go into compression and the catch and then the hips and knees start to extend and then their spine as they sit tall gets a little bit of a whip as their hips explode and really Womp you can hear that elastic storage and recovery in in the fastest boats so You know Look at the people who throw a baseball 110 miles an hour Are they heavily mobile? Well, they are asymmetrically mobile on one side

But they have a hell of an elastic, you know, the first elastic across their hips, the second one across the front of their chest and the third one in their in their wrist. You put those three elastics together and you can throw 110 miles an hour. If you don't, and all you have is mobility, you won't throw a ball very, do you know yogis who can throw 110 miles an hour? Do you know a powerlifter who can throw 110 miles an hour. Have you measured the great golfers? How strong are they? Have you tried? Well, I've measured them. How, how, how, how much effort have you ever tried to hit a golf ball a long way?

Yes. Okay, you noticed it didn't go very far. No. Yeah, it goes further when you don't try. So when you have a muscle pulse of about 40 to 50 to 60 percent, that is the sweet spot for speed. Because when a muscle contracts, it creates force, it also creates stiffness. If I maximally contract my bicep, I can't punch you. I've got to really, boom, I got to let it go.

When I measure the guys who hit the hardest in the MMA leagues, like the UFC, for example, do you think it's the guys with a great big muscles? No, they push their punches. It's the guy who can snap, bam, that hits the hardest. So it's a neural priming of a spring that is then released. We've got a lot to talk about in terms of optimal athleticism. So let's be a little bit careful now when we talk about static stretching to enhance injury resilience and athletic performance and athletic performance because in the great athletes, and I'm not talking about duffers here. I'm talking about world class people.

Be very careful with stretching. If it's good enough for them, then, it's definitely good enough for us. You touched on a couple of interesting sports there, baseball and golf specifically. I've always wondered what the physiology of an athlete who has such a unique type of movement as their flagship of what their athleticism is built around. Are there some odd abnormalities, especially with someone like a baseball picture,

maybe less so than someone I guess who's an arm wrestler that would only ever focus on like a very, very, you see these arm wrestlers who have one huge arm that's much bigger than the other one. What's the sort of structure that you would see on golfers and on baseball pitches and people like that? Well, first of all, they're highly asymmetric athletes. people like that. Well, first of all, they're highly asymmetric athletes. So they're not going to pass a screen for symmetry, but nor would you want them to. Yeah. You know, they're attuned elastic asymmetric athlete. I don't really know what more you want me to say on this. know what more you want me to say on this. I can give you all kinds of tests. I mean, it's so interesting when we look at the facial linkage, for example, through the arm down the right side of the body to the seos muscle, for example, and how I can tighten the sois by internally and

externally rotating the arm through the shoulder, and you can palpate the sois tendon, beginning tight, and then releasing by doing this. So there would be an example of a highly tuned thrower, for example, who has a beautiful elastic tuned chain. If you didn't have that body type, you won't throw very fast. And if you didn't adapt it, you probably wouldn't throw very fast either. So it's a combination of things. And there's all kinds of things with lever ratios and tendon lengths and all kinds of things. I mean, a sprinter looks like a sprinter for a reason, right? They have a lot of lardosis in their low back and you don't need much calf muscle, but you need a pre-turned pelvis to get the power production and hip extension out the back to run. If you plant your foot ahead of your pelvis, you're actually slowing down.

All the power has to be out of the extensor range of the foot behind the pelvis. But by the same token, they're not in the UFC kicking people in the head. The fighters have flat backs because they have to pre-turn their pelvis to kick high. So again, we can talk about all of these adaptations and what you get from your parents and what makes a good athlete and how you tune them. But I'd be very careful with discussions of stretching and all understood.

I wanted to move on to the big three. There will be a lot of people listening who are familiar with them. I'd love to hear the story of why those movements were chosen and what the mechanisms are that they're actually working on. Right. Well, around it would have been about 30 years ago. We were starting to create different back injuries on cadavers in the lab. When you damage a disk, you lose a little bit of disk height. Now, there's micro movements occurring at that joint.

Now, you can't see them on an MRI, for example, because it's only under dynamic load that these things are created. But if a person says, you know, I've got right-sided back pain and then a little bit later, my right heel goes on fire. And then later on in the day, I get some left-buttic pain. Well, there's an example where the pain triggers are migrating around the back and radiating down the legs.

It tells you that there's little micro movements in the joint. It's not a stable pain, in other words, from a single disc bulge that has the same pattern that just shrinks and grows. So we were looking for ways to stiffen out those micro movements. And we assessed all kinds of exercises, but they had to have several criterion. Number one is they had to guarantee stability.

Now, we were measuring spine stability, so we could measure which exercises created spine stability and which were called spine stabilizers, but they really weren't. So, we started out at that level, and then we chose exercises that had a high reward low risk. In other words, maximum stiffening, stabilizing, controlling attributes, but minimal spine load. So, the exercises that kept bubbling up to the top were the ones like the bird dog, the side plank, and the curl up. So consider the bird dog. You can do a Roman chair extension, if you like, but it's double the spine load. So that didn't fit sparing your back.

That's why we backed off and went opposite arm, opposite leg. Then other advantages started to emerge. You know, it's a natural PNF pattern across pattern across the back. And then we would hold for 10 seconds. We learned that one because you clamp down the capillary bed in the muscle and the muscle becomes acidic quite quickly. And you oxygenate and rebalance the pH of the muscle just by sweeping the floor with your hand in knee after 10 seconds and out you go again. So, you know, there are people say, well, I hold my bird dog 30 seconds and I say, great, I hope you enjoy the pain. It didn't, it wasn't consistent with the science. So we just put layers and layers of investigation and science to try and come up with the best exercises for guaranteeing stability in a spine-sparing way and then programming them

in a way to reduce the risk of being unsuccessful. Then recently with athletes, a strange thing happened. And then recently with athletes, a strange thing happened. First of all, your listeners need to understand the principle of proximal stability for distal athleticism. So consider, if I was to, I say I could bench press 200 kilo. I can't, but say I could. There's my bench press muscle, my pec major. So distally to the shoulder joint, it flexes my arm around. That's its distal effect, but it's proximal effect. If I just contract my pec major,

proximally it bends my ribcage towards my shoulder joint. So one creates a push and the other leaks it away. Do you see the difference? Now, if I create proximal stiffness first, I harden my core, I stiffen my body proximally, now 100% of that muscle activity goes to the push because I've arrested the energy loss or the energy leak if people want to call it that or the eccentric contraction, approximately. So now we had to create more proximal stiffness. So we took moitai fighters and we trained them with the big

three and then we trained others, well, not we didn't train any one group, no differently, they were the control group. But again, we converged and found that once they create more proximal stiffness, they actually had a higher closing velocity with their fist and foot for arm strikes and hand strikes, and they hit harder. So the more proximal stiffness you have, the faster you can run, cut, and change direction, the harder you strike a bag that's

instrumented, for example, et cetera, et cetera, et cetera. So when athletes say, you know, you've heard a few quite famous athletes recently, say, you know, I got my back better and I'm back on the course or the arena, whatever it is, because I worked on my core. And this idea of proximal stability is, it's not a myth. It absolutely unleashes faster tennis serves, throws, punches, kicks, running speed, directional change, et cetera.

Guess what? Those three exercises also bubbled up as being quite superior. Now, they won't take you to the Olympics, that's for sure. And then we, well, that was my book, Ultimate Back Fitness and Performance, to write progressions that would then keep the theme going

of arresting micro movements, proximal stiffness, and stiffening appropriately, the flexible rod of the spine for more load bearing if that's what the athletes need. Anyway, those were put together for the sport and for the athlete, but that's where those exercises came from and that's how they worked through the evolution over the past 30 years. But as you know, they're just a small part of the whole back pain puzzle. Yeah, for sure.

One of the things that I think is interesting when we talk about that is that, certainly for me, I actually find an immediate relief when I do the big three. Right. So it's not just that there is an over-time adaptation, the genuinely actually feels like there is some sort of relief to my lower back discomfort when I do them. Which I think is really interesting. Do you want to know why? I certainly do. If there was any man in the world for me to tell me why it's you. That's that's well. Well, we measured a residual neural stiffness. So when you do those exercises, your brain remembers them and your core stays a little bit stiffer.

In some people that lasts about 20 minutes and some people that lasts up to two hours. Now, why does it work on you? It's because I will bet you've got a little bit of not only do you have a disc bulge, if you have an inflate fracture or a small snow, you will have lost a little bit of height on that joint. Now, it's lost a bit of height, it's a little bit of sloping, you've got micro movements. Doing the big three adds a neural stiffness to the barrel of muscle around that joint that's lost a bit of stiffness. You're arresting the micro movements and you feel better.

Good timing. Yeah. Anyway, that's that we've measured that and you'll notice that's why some athletes who play professional football, for example, start every game and every training with the big three. That's the warm up. They are faster and they're also more pain-resilient. It's part of their warm up, yes, absolutely. Now if I can give you one more hint, Chris, since you're getting a immediate relief and a

resilient period after doing the big three, do them twice a day, do them mid-morning, do half the volume mid-morning, and then the other half mid-afternoon. And that will give you two periods of respite throughout the day and accelerate your wind down of the pain sensitivity. You should read a book called Back Mechanic. This is all in Back Mechanic, by the way. I have, I have got it, I've got it from, from our coach. I've got it from our coach. It's going to take me a little bit of time to get through, but links to Back Mechanic and all of Stuart's, Dr. McGill's other books will be in the show notes below if you are interested. One of the questions that I had in our members group actually, when I posted the fact that I was going to speak

to you in was, what's the progression on from the big three? I think someone had been doing them for quite a while and was feeling like they were topping out at the degree of overload or the degree of hard work that they were doing with them, and they wondered what was next. Okay. Well, the answer to the question, I need a context for the person. For example, for many people who just want no pain, optimal health, play with their kids, maybe around a golf, and a little bit of adult activity on Friday night, whatever. If that's what they want,

then they're done. All they need is the big three. That is sufficient. There's this idea on the internet that people need to keep striving for their personal best, etc. A lot of people will be shortening their athletic career by keep trying to push, push, push. So there is a concept of sufficient athleticism, sufficient stability, sufficient strength, sufficient mobility, and that is where their optimal health will lie. However, it's not going to get you to the peak of the CrossFit games or the Olympics or anything else. So, if I was preparing the average fighter for a three-rounder in the UFC, so that's five minutes on, one minute off, that's your work rest schedule.

I would then say, let's do stir the pot. So, they're doing their feet are on the ground, and their elbows are on a gym ball. And now they stir through the elbows for five minutes. And they can have one minute off times three. So if you think you're ready for a little progression, there's a there's a little bit of a calibration for you. That must be so uncomfortable. That must be absolutely torturous. That's fine. No, no, don't give me that. You're across from here. That's what you live for. Yeah, get comfortable being on the road. That's what it's all about.

That doesn't say, well, I'll wait and see. I will post it in the members group and the guy who asked the question, I'll see if he can do the five minutes, five minutes on one minute, off time three. Oh, I've got plenty of other tortures for you if you want, but you know, it's interesting. I have an acquaintance, we'll call them, who is a very, very successful person. I'm sure if I revealed his name, most of your listeners would know of the person I'm talking about.

He says the measure and the predictability of one's success is how willing they're, how willing are they to tolerate to discomfort? That is in a nutshell, what he says will separate those. Anyway, I'm sure there's other things as well, but that would have been his. And there's CrossFit tool. So do you see why I love it and I hate it? Yeah, absolutely. There's a quote in James Clears, a Tommy Cabot, to book which came out this year, James is a habit expert. I'm not sure if you've read it yet, but if you haven't, and if you've got time to read something you're looking for for a holiday read highly recommended my favorite book of 2019 I had James on the podcast about three months ago and he's he really is is the real deal

And he went and interviewed the coach of a One of the Chinese weightlifting teams coaches and he asked him the question he's weightlifting team's coaches and he asked him the question, what makes the difference between the guys who are good and the guys who become the absolute best and the coaches answer was that it is the people who can put up with the boredom of doing the same thing day in day out and what he identified there was that I think a lot of normal athletes like myself look at someone like Matt Fraser or Adele Beckham or whatever it might be and think well That person must never get bored their training must always be fantastic for them

Anthony Joshua you see him he is the sort of person who's quite forthcoming about his training online is Training diaries and stuff like that. You see him training a lot, and he think he must, he must just turn up to training and love it every single day. And the coach of this particular weightlifting team said that's not the case at all. He's like, there's days when my athletes turn up and they don't want to be there. They don't want to, they don't want to have to do yet another set of pulls from blocks or whatever it might be.

They don't have to do more back extensions, but they do. And they go through it. And he said that the difference is the person who is able to turn up and follow the program and just stick to the plan and grind through those days. I thought that was really, really interesting and illuminating. I agree. I'm glad. I'm glad. As well, the other thing that I really liked about that was that it it put the power for someone to change their athletic ability in their hands. It's like, look, if the best cross-fret on on the planet, Matt Fraser gets boards training and he works through it,

then it's exactly the same for you. He doesn't have some superhuman level of motivation. He just grits his teeth and does the work. I thought it was nice. Yeah. Well, I don't know Matt Fraser, but he has to be of that type. But for that cloth. Yeah. I wanted you to tell the listeners the story behind the gift of injury if you could. Well, that was a book. It's co-authored by Brian Carroll. So the story is this, I knew the name Brian Carroll. I'd never met him, but he held several records in powerlifting. You know, he'd squatted well over 1100 pounds. He'd

squatted over a thousand pounds over 50 times an international competition, so he'd been around the block. So I knew the name and I knew some of those statistics. I got a phone call one day and he said very politely, this is Brian Carroll, a professor. Professor, I've heard my back would you see me? And I said, well, yes, and he came up. And he was not moving well. And I thought, wow, this is one of the best squatters. And he has difficulty getting in and getting in and out of a chair. And it seemed as though he'd lost his discipline. Anyway, within not too long, within an hour, I would say, he was starting to move without triggering his back pain. And I said, and then I never put a person's images up on the view box early in a consult. I really try and understand the person who they are, their personality, and

then I assess them for their physical pain triggers, and only then, while I look at the images, and when I looked at the images, I was quite horrified. He'd split his sacrum front to back. L5 was heavily fractured, and the discs were, if I use the word obliterated, that would be quite accurate. Now, what does that look like on an MRI? Is it just like... Well, if you get the book, you'll see, because we put that image, that MRI in the book. Anyway, so we started to talk and he was starting to move a little bit better. way. So we started to talk and he was starting to move a little bit better. But he had to humble himself right back to getting the movement patterns right and some very, very basic patterns, athletic patterns. And then he said, in our conversation, he said, well, do you

think I'm going to get out of pain because the surgeons I've said, seen that they said, I'm done. I'm not even going to get out of pain. I've done so much damage to my back. And I said, well, I don't know, but let's, let's, here's my best effort and my best suggestion on what to do. Well, believe it or not, he was out of pain in about three weeks, just learning how to avoid the triggers. But he said something very curious to me. He said, well, I'm going to get out of pain. And when I get out of pain, I want my world record

back. And I said to him, I said, well, and obviously, I'm a lot older than he was. And I said, well, if you were my son, Brian, I'd give you this advice. I said, let's work on getting you out of pain. But I would seriously consider doing something else with your life. I mean, let's work on getting you out of pain, but I would seriously consider doing something else with your life. I mean, this is a pretty compromised spine to build you back to set a world record again is, but he said, no, I want to do that. And I said, all right, well, if we do it, we'll write a book together. So that was the story behind the book called Gift of Injury. He did get out of pain, he did start training again, he did bone calisthen, which is you stimulate the bone and he did things like say a mildly loaded carry and he would take five days off to allow the scaffolding of the bone to occur, the adaptation that I

described earlier. Then he did that for a year, so he bone-callist for a year, and then he started to get back into training his strength back again, which he spent another year or two doing, and he came back and won the Arnold's, and then he came back and won it the year again. So I think he only lifted what was at 1174 pounds, something like that. Then we show the MRIs of his back three years later, once he'd been through. His L5, first of all, the fracture in the sacrum had completely filled in.

L5 had remodeled under the chronic load and it was square once again. The discs were looking pretty good. I mean, they weren't flawless, of course. But anyway, he has zero pain. He has zero pain to this day and he's still training and does the odd competition and he's one of the old boys on the block. So we started writing the book and I thought it was really going to be his story, sort of a very personal story of triumph and all of that. Well, I we would write it together and I found out he can write. I had no idea. And as he wrote, we couldn't stop. We'd sit at his kitchen tape. He was in Florida, by the way, 2000 miles away. But I'd go down and we, we'd write for a bit. Now we'd go fish off

his dock for a while and have a beer. And then we'd do some more writing. And eventually the thing got done. And then that sounds like the most lovely process for writing a book. Have a bit of chat, go go fishing, have a beer, chill out, barbecue, write a bit more book, and then before you know it, you've made a book. That was it, but then we, I don't want you to take this the wrong way, but we sort of fell in love with one another. Now, you know, I, you know, he's an outstanding fellow and he's just an ace and We've become and and so often you know if you go get any clinical training at all They teach you to don't get emotionally involved with a patient

You know, I cannot do that every single patient I ever with, I have to get to the emotional level with them. If we're going to change their life, these are huge things. And anyway, you know, I become friends with, I would say almost every patient I ever see. I need them to tell and relate to me like they've never done with anyone else before. We've got to get at the bottom of all of this. Anyway, it turned into a wonderful relationship and then we couldn't stop writing. Then the book became a manual for strength athletes regaining their strength, athleticism, off of back injury.

It was a much thicker, bigger book than we ever expected. So it's the story plus a lot of the science and then the programming at the end. Do you have a copy of it? No, no, I don't. Okay, well, I can send you a copy. But anyway, then, as I said, we show the before and after MR's of the mechanos stimulation that we did, that he did, and adapted his back. So I think, so hearing that story, for me, the first time that I heard it was quite a while ago on a podcast you did for human OS, and then re-heard it again during my research for this episode on squat university, every time that I hear that story of just how much damage was done to Brian Carroll's back, and then the level of competition that he wanted to get himself

back to and subsequently did, there's an unbelievable contrasting effect with my injury, which has been at the forefront of my sort of training mind for the last year, and maybe for many of the listeners as well. They have that particular niggle, that particular pain, that back pain that just doesn't seem to go away or doesn't seem to get, they get disheartened with their rehab or it's not happening fast enough or why is this particular injury been? Why is this curse been given to me and me alone, why is this my trouble to my burden to bear, so to speak, hearing that story of just how bad Brian's back was when he arrived to where he managed to get himself to is for me incredibly inspirational, not just that it shows that it can be done and stuff like that,

but just that he has the mindset of a person who will be in a situation where he's a obliterated part of his back and is going not only do I want to get pain free, but once I'm pain free, I'm going to go back and be better than I ever was. I'm going to go back and be better than I ever was. I love hearing what you've just said, because this is the difference. You were talking earlier about that one percenter who becomes the world champion. It's the ones who are willing to endure. When you work with someone like Brian Carroll, the strength of character to basically put a car on your back and then squat. If you're one

millimeter out of line of drive, you can't correct that. You're going to get crushed. So first of all, to have the strength of mind to to will your body to do such a thing. And you know, in his rehab and we've worked together actually in rehabbing some other champion powerlifters. Sorry, these are patients who keep calling in. Yeah, if say you've got a powerlifter who wants to squat a thousand pounds. They've never done it before. The first part of it is conditioning their mind that it's possible. So what we'll do is we'll take the target load, say a thousand pounds and we'll add 50. So we'll put one thousand and 50 pounds on their back and they do a one inch squat. So already now the mind is there. They've handled it. They know what it feels like. And then the physicality takes over. So it's such a game of mind and physical adaptations, neural adaptations, and all the rest of it. It's a really complicated enterprise that a lot of people don't appreciate.

But there's a little bit of a perspective on the character of a person who can do that with their body and then carry it through all the way to the end. Yeah, it's a really fascinating story. And I love every time that I hear that story about Brian, I absolutely love it. I'm very, very excited to get stuck into the book as well. Well, why don't you have him on your podcast? You hear it from the horse's mouth. He's a fabulous man and a good storyteller. Would you be able to do an introduction?

Absolutely. Of course. Absolutely. Well, listen, as you've heard it here first, I might be speaking to Brian Carroll sometime soon. Well, that'd be cool. That'd be a cool second part. I'm sure Brian would love to. He's a lovely to. I would love to hear where his mind's at

Again, you know as some of the listeners and I'm sure a lot of people will be tuning in seeing your name Is seeing the particular topic that we're talking about and thinking I want to hear I want to frame my mind about injury In the right way. I want to have the mindset which is going to be optimal to help me progress my injury. It's one of the things that the physio that's helping me with my rehab says it's that making sure that you're in the right mindset is a large part of the battle. It's huge. Yeah. It's huge, you know, but I'll just pick up on that because in particular in your country, there's been a little bit of a transformation in physical therapy where some, if a person comes in with back pain, without even assessing the patient, they'll say,

oh, well, your back isn't fragile, you know, you just carry on and keep doing whatever it is you're doing and whatnot. I say, well, hold on a second. There are different types of people. If you get a cross-fitter and you say, well, just carry on, the person who's a cross-fitter is a go-getter to start with. And they don't need to be encouraged to keep going for it. No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,

no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no And, you know, they've had a good fart and they're calling the doctor. It's... So, there's a time and a place to tell a person, yeah, your back is fragile and for a cross-fitter, you've got to hold them back and let biology adapt the robustness to the tissues that... You can't see the fractures, the micro fractures on the MRI, but they're there. And it takes time versus the next person who just is a little bit more on the movement adverse side of the spectrum. Yes, you are a little bit more robust than you think. Let's prove it. Let's try a few things and show them some good mechanics.

Once they've mastered the good mechanics, load them, make sure the mechanics are preserved and all of a sudden they've just broken through and there. Wow, I'm training now. I'm pain free. Now I just have to organize the progression in a way that isn't too greedy. I'll respect the time process of the adaptation and build them back. So, you know, it's different strokes for different folks, that's for sure.

Yeah, I appreciate that you have athletes ringing you because you need to deal with some people who might be in a little bit of back pain, Dr. Miguel, so I'm going to, I'm gonna try and call it there. If there was one final question that I had, we've touched on it already, and you mentioned about stirring the part as one potential extra, if you were to have the next closest exercises that were the close runners up for the big three, Were there any, or would there be any

that are your staple favorites for a broad cross section of athletes? Well, I'm not trying to avoid the question, but of course, the answer depends on the assessment and the person who's in front of you. Are we talking about the American record holder power lifter for men over 75. Now, I just gave you a lot of information. So that would be an entirely different program than it would be for you. Or I've got an Olympic class swimmer or race car driver, it doesn't matter.

So you see the answer is very much a moving target. For myself, for example, I do some things well beyond the big three that for my body at this stage in my life, I have zero pain, I feel fabulous. I'm reasonably athletic for my age, but I've had a lot of trauma as well. So what I would do would be very different than what you would do. Now, this might surprise some people whereas my body would have thrived on more load and more strength in my 30s, 40s and maybe early 50s. Believe it or not, now it's less load and more mobility. And you'll find that people go through this progression. So two days a week now, I work on things

that are a little bit stiff and stuck. So, you know, I've broken my neck, I do a little bit of neck work, more stability work, not too much neck mobility, but more stability. Thoracic extension, I'm turning into a little old man, so I have a little bit more thoracic spine mobility through my low back. In former decades, I would have carried more load, been more cognizant of the perfect hip hinge. Now I've backed right off on the load and I get just a little bit more lumbar mobility. My hips, yes, mobility, certainly leg strength and leg and hip power is important. As you get older,

the most important thing is having the ability to recover from a fall. Make sure that if you stub your toe, have hip power to get your foot out in front of you to arrest the fall. These are the things that will keep your life going for a longer period of time. Anyway, so do you see how I have to give a context to this? Absolutely. And then I will give you the decades honoring the past injury, history, etc. to come up with what the best progressions beyond the big three would be. But there's a little bit of a start on the discussion. I got you. Dr. McGill, I can't thank you enough for coming on.

It's been absolutely fantastic. I'll make sure that links to back mechanic, the gift of injury and all of the other resources that we've talked about this evening will be in the show notes below. If you fire anything over in email once we're done, I'll make sure to add that as well if there's any additional resources. Well, the books are on Amazon.uk or Amazon code.uk, whatever it is. And but they're also on our website, backfitpro.com if people are needlessly suffering with their backs. I understand. It's absolutely certain that will have helped a lot of people today. If you

have any questions or any comments as per usual, feel free to get at me at Chris Wellex on all social media. I'll also make sure that Dr. McGill's Twitter is linked on there and if you want to hassle him on there and tweet things at him and see if don't tweet things at him. No, I have a very strong conviction that if you're a master of the craft, you can't do Facebook and Twitter. Uh-huh, see. Those two don't go together. I don't know a master of the craft who lives on social media, so I don't do social media. However, my daughter does put up content, but I have zero ability to answer. Now, I do have an email, but that's as far as I'm going. I'm afraid. I understand. I'm far too busy for that stop. Well, you're cooked from a similar class to us, Dr. McGill.

It's one of those things where I think a lot of people would benefit from taking a more ascetic route that you have. If you have things that you want to be very good at in life, social media is an antithesis of pretty much everything as far as I'm concerned. So we're part of the same camp but I'm gonna stop pontificating. Today's been great Dr. McGill thank you so much for your time.

Thanks Chris. Thank you.