Muscle for Life with Mike Matthews - Dr. Stuart McGill on the Real Causes of Back Pain (and How to Fix It)

Episode Date: January 18, 2019

Back pain is the bane of athletes everywhere. About a third of adults deal with it at some point, and that number is even higher for us fitness folk. To make matters worse, the cause of back pain, and low-back pain in particular, is rarely obvious and notoriously difficult to diagnose. It also often strikes out of nowhere, lingers for a while, and then suddenly vanishes for no apparent reason. Or not—sometimes it sets in the for long haul. All this mystery, confusion, and frustration has made low-back pain a reliable honeypot for Internet profiteers, fake doctors, and supplement shysters who aren’t bothered one bit by cashing in on people’s pain. That’s why I wanted to talk to one of the most respected, experienced, and knowledgeable experts in the world on spinal health and function—Dr. Stuart McGill—to help cut through the noise and get an honest, practical, evidence-based take on treating back pain. Dr. McGill has spent over 30 years studying the mechanics of the spine and what causes back pain and how to safely and effectively treat it, has published several books including The Back Mechanic, and through his work has helped tens of thousands of people prevent and eliminate back pain without invasive surgery. In this interview, Dr. McGill and I start more or less from square one and then dive into the nitty gritty details and address a whole host of questions I get asked fairly often, including . . . -Is back pain always caused by structural damage? -Can you have structural damage without pain? -How do different forms of exercise affect the health of your back? -How common is degenerative disc disease? -What can people do to self-diagnose and heal their back pain? -When is surgery a good idea and when it is unnecessary? -And more. The bottom line is by the end, you’ll know more about the real science of back pain than 95% your fellow lifters (and more than many doctors and personal trainers). 6:28 - Does back pain mean good or bad structural damage? 16:24 - Can there be structural damage without pain? 25:16 - How does mechanical stimulation damage tissue and correlate to pain? 32:38- What options did the clinicians give your client? 36:49 - What are your thoughts on back surgery? 42:36 - What should back surgeons prove to their patient before recommending back surgery? 45:35 - What is a scenario that requires back surgery? 50:07 - Is deadlifting and squatting safe for the spine? 58:59 - What is the goldilocks zone for squatting and deadlifting? 1:10:51 - Where can people find you and your work? Want to get my best advice on how to gain muscle and strength and lose fat faster? Sign up for my free newsletter! Click here: https://www.muscleforlife.com/signup/

If I hand you a sheet of paper and I say, write down the things that don't hurt your back, and now write down the things that do hurt your back, and if they can come up with a list of activities that fit both of those boxes, chances are 95% of the time you will not need surgery. surgery. Hey everybody, Mike Matthews here from Muscle for Life and Legion Athletics, and welcome to another episode of my podcast. This one is about back pain, which is the bane of athletes everywhere. About a third of adults out there have to deal with back pain at some point. And that number is even higher for us fitness peoples. To make matters worse, the cause of back pain and low back pain in particular is rarely obvious and notoriously difficult to diagnose, even for experts and specialists. Back pain also often strikes out of nowhere, lingers for a while, and then vanishes suddenly for no apparent reason.

Or not. Sometimes it just sets in for the long haul. Now, as you can imagine, all of this mystery, confusion, and frustration has made back pain and low back pain especially a reliable honeypot for internet profiteers, fake doctors, and supplement shysters who are not bothered one bit by cashing in on people's pain. And so that's why I wanted to talk to one of the most respected, experienced, and knowledgeable experts in the world on spinal health and function, Dr. Stuart McGill, to help cut through the noise and get an honest, practical, evidence-based take on treating back pain. Now, in case you are not familiar with him, Dr. McGill has spent over 30 years now studying the mechanics of the spine and what causes back pain and how to safely and effectively treat it. He has published several

books, including The Back Mechanic, which I highly recommend. And through his work, he has also helped tens of thousands of people eliminate back pain without invasive surgery. In this discussion, Dr. McGill and I start more or less from square one, and then we start diving into the nitty gritty details and address a whole host of questions, some of which I get asked fairly often, including, is back pain always caused by structural damage? Can you have structural damage without pain? How do different forms of exercise affect the health of your back? How common is degenerative disc disease? What can people do to self-diagnose and heal their back pain? When is surgery a good idea and when is it unnecessary and more? The bottom line is by

the end of this podcast, you are going to know more about the real science of back pain than 95% of your fellow lifters and more than many doctors and personal trainers as well. This is where I would normally plug a sponsor to pay the bills, but I'm not big on promoting stuff that I don't personally use and believe in. So instead, I'm just going to quickly tell you about something of mine, specifically by flexible dieting cookbook, The Shredded Chef. Now, this book has sold over 200,000 copies in the last several years and helped thousands of men and women get the bodies they really want, eating the types of food they really love, which is why it has over 700 reviews on Amazon with a four and a half star average. So if you want to know how to build your best

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So if you want to take Audible up on this offer and get my book for free, then simply go to www.bit.ly.com slash free T-S-C, And that will take you to Audible. And then you just click the sign up today and save button, create your account. And voila, you get to listen to The Shredded Chef for free. All righty. That is enough shameless plugging for now, at least. Let's get to the show. Professor McGill, thanks for taking the time to come on the show. I really appreciate it. Oh, thanks, Mike. I'm looking forward to this chat. Yeah, me too. You are one of the often requested guests. That's actually why I reached out, because I ask people here and there, hey, who should I have on the show?

And you are somebody that many people have brought up. So here we are. Oh, fabulous. you are somebody that many people have brought up. So here we are. Uh-huh. There he was. So obviously, I want to get you on to talk about the types of things that you talk a lot about, and specifically to address a few different things that I'm often asked about that I have done my best to inform myself on and to give people solid practical advice on, but I am not at your level of understanding of these things. So I thought it'd just be a great opportunity to hear your thoughts and hear in some cases, your, your advices to people who are running into certain issues,

particularly revolving around back pain. And well, I guess we could say joint pain, but particularly with back pain, how it relates to certain exercises and surgeries and so forth. Yeah, terrific. So the first thing that I want to get your thoughts on is how pain and we can stick with the back or just joints in general, doesn't necessarily mean structural damage because that is one of the first things, of course, that people assume if they tweak something in the gym or just have some sort of chronic condition that there must be some sort of structural problem. And if they could just fix that, and again, the fix would have to be a structural kind of mechanical fix, the pain would go away. Well, Mike, that's a huge question. I can only take a spine position on this because that's really where my expertise lies. So let's talk about does back pain always mean structural

damage? Can I just reframe the question a little bit that way? Perfect. Perfect. Okay. Well, as I said, that's a huge question and I'll start off by saying, yes, it's true. There may not be structural damage, but I'm going to have to riff back and forth and take different viewpoints to really cover the waterfront on this one. We have to quantify damage, pain, and give it some interpretation so we can discuss this. And it's really important because it impacts the listener's behavior. You've already identified it. What should they do if they have pain? And do they have to do something that is a structural intervention? But it also really affects behavior of clinicians, you know, coaches, physios, also really affects behavior of clinicians, you know, coaches, physios, chiropractors, sports med docs, etc., who interpret pain patterns, and then they've got to decide whether the pain is

muscular or it might be tissue-based, it might be behaviorally based. So the context of all of this really matters. So if there is pain that you might find this controversial, we usually do find some level of tissue disruption. We have a little bit of a different or unique perspective from our work over the years of running the spine clinic and the two laboratories. We created damage, measurable damage, in spine tissues, and then we imaged them. So we did this on the cadaveric spines. So the imaging, whether it's CT, x-ray, MRI, is really poor at picking up the damage. But then we had the advantage of dissecting the spines after, and all of a sudden, we saw all sorts of micro damage that had gone unrecognized in the scan. So this really questions the assumption that, oh, well, there's no quantifiable damage. But then I'm going to take another view on this and talk about the biological tipping point,

because now we have to say, is that damage good or is it bad? So think of a body builder who trains. They actually, at a micro level, you can think of it as damaging the muscle at the ultra structural level and the tissue adapts and gets stronger and hypertrophies. So that kind of damage you would say is good. Well, let's take a powerlifter now who does deadlifts or heavy squats. You'll notice the bodybuilder typically trains, say, three days a week, and then each day of rest between the training days are the days of adaptation. That's when they adapt and get stronger. But a powerlifter or a strongman type of athlete really couldn't do that. They might do heavy deadlifts or heavy squats on one day, and then they have to take five days off because it takes that long for the

micro fracturing that's occurred under the end plate in their spine due to that heavy load. It takes five days for the new calcium and magnesium ions to really scaffold in with the chemical bonds and get a good hold. So you see a radiologist might say, oh, you've got sclerotic end plates, not realizing that that person is a highly trained power lifter and that damage is actually a positive adaptation. And in fact, they couldn't be strong and, you know, deadlift 500 pounds or squat a thousand or whatever it is without that kind of cumulative damage that triggered the appropriate tissue adaptation. But, you know, we just discussed a tipping point. Is it good or is it bad? I need

to know a lot more details about the person, the exposure, the load, the volume, the rest cycles, to really blend the art and science to give a very specific direction to a person. But the next viewpoint I'll take is one where distal pain might be from a central disc bulge. So say a person has been told they've got piriformis pain because they've got a radiating pain into their deep buttock muscle, or their right toe is on vacation, or it's heavily numb when they work out at the gym. Well, I'm just recalling a specific patient. This patient came to me. They had very nasty foot pain. In fact, they couldn't stand the weight of a summer bed sheet on their toes. There was a surgeon who had offered to amputate the person's foot.

Then he became frustrated and they finally sent him off to a pain clinic who loaded him up on opioids. And then they said, no, your pain is really from emotional issues. Well, this patient was really suicidal. He was a very psychologically solid citizen. And some doc had told him he had emotional issues. And he said, well, if the pain is in my emotions, that means I must be crazy. I don't deserve to live, doc. I'm telling you what, I'm giving you a week to help me do something about this pain. I know you're different, but if you can't, I'm ending it. I can't, it's more emotionally disruptive to me to think that I'm crazy than this terrible pain I feel in my foot. Well, we do a fairly

thorough assessment. It revealed that he had a nerve trap at his fourth lumbar disc, and it was a very peculiar type of trap. You know, consider a person with an ACL deficient knee. A clinician would do a drawer test and find out if the knee was lax and whether or not that aberrant movement would trigger knee pain or symptoms that they're complaining of. Well, when we do the same type of shear instability test up and down his spine, we find a slightly flattened L4 disc. So the radiologist might call it degenerative disc disease, which is an absolute fallacy. But the loss of height means that disc is a little bit sloppy. It's lost its stiffness. It's like letting a little bit of air out of your car tire. The car

now drives a bit sloppily on the road. And when he did specific movements, very specific movements, there was a shearing micro movement across the disc that had lost a little bit of height and it trapped the nerve root going down to his right foot. We showed him a muscle bracing strategy that was a bit unique for him, but we found it very quickly and it immediately stiffened the joint and took the nerve trap out of it. So the clinicians that had seen him, no fewer than a dozen, all declared he had nothing wrong. He had no structural damage at all because that type of damage couldn't be seen in a static image, whether it was an MRI or a CT. But when you watched his spine move through video fluoroscopy, which is a real-time moving x-ray,

you would watch the spine and the segments, one vertebra move with respect to the other, and then at the instant of that nerve trap, the joint would shear just a couple of millimeters, and that's what trapped the nerve. So there's another example where normal imaging and the diagnostic triage would assume there was no tissue damage when in fact there was, in fact, quite extensive damage. I had a patient just last week who came in complaining of when she moved her back a certain way, it triggered a headache and face numbness. And then she got neck pain and back pain and leg pain. Anyone would reasonably conclude that she had a bit of a bizarre psychological overtone to all of this. But then when we did

a thorough exam of tension in her neural tract, I pulled it one way, say towards her head. It caused many of the symptoms I just described. And then I did it again with no pain. Then I pulled the neural track codly down towards her feet, away from her head. First cycle, all of those triggers, she reported. And then the second cycle and third cycle, all the pain was gone. So as it turned out, she had nerve friction. There was no visible tissue damage. And it turned out a little bit later, all this nerve friction was actually caused by her just starting off now with ankylosing spondylitis. So all this was missed by all of the clinicians who told her you don't have any structural damage. And my students over the years know me well enough that if you can't find the pain trigger,

you better go look again, because there's usually something that is the trigger. And then, of course, central processes can modulate the pain intensity and whatnot. To keep going with this idea, let's turn that question completely around. You said, does pain always need structural damage? Well, can there be net damage with no pain? Absolutely, there can. Take the disc. So your spinal disc, when you're a young person with no history of physical overload, there are no nerves inside the annulus or the disc.

Now, people will cite papers and say, oh, well, the outer third of the annulus is innervated. No, it isn't. That's only in people who've died and they look at their spines and they measure the ingrowth of nerves. disc contains such high hydraulic pressure throughout the day inside the nucleus that it kills any nerves or internal sprouting of arteries or veins, etc. It's a very pristine kind of a disc. But over time, with a little micro damage to the end plate and whatnot, there's a little bit of loss of disc height, a little loss of pressure. Now, all of a sudden, nerves and vascular sprouting can take place and nerves start to grow into the disc from the outer layers growing inwards. So now you're actually developing the hardware to sense pain. But the very first time that person is getting a disc bulge growing,

they don't have the hardware to sense pain. So there is damage accumulating, and there's no way for them to link pain. So all of a sudden, one day, they do something a bit odd, and they report, oh, I felt like a knife went into my back. Well, actually, they've been building up that cumulative trauma, perhaps for years, perhaps for whatever length of time. And then, you know, there are subsets of this type of hydraulic behavior and pain. When you go to bed at night, you're shorter than when you get up in the morning because your discs are hydrophilic and they suck up fluid. Well, interestingly enough, when you study the cosmonaut and astronaut program,

those people grow a couple of inches the first 24 hours they're in space. And many of them have back pain that they have to take painkillers for. We see exactly the same thing in people who lay in bed longer than eight hours. Their spine continues to grow. Think of the last time you had flu and you laid in bed too long, your spine is screaming. So now let's take an intervention. You might have someone who says, it's not good to lay in bed, get up and walk around, and let's do some precision-based exercise prescription. And then another person, clinician, comes along and does some cognitive behavioral therapy where they say, look, let's just get moving, get out of bed and get a move on. Do you see how they both achieved exactly the same thing? Because in that particular example, getting out of bed and squeezing some of the

fluids out of their back mechanically de-stressed their disc and reduced the pain. So both interventions were linked through mechanics and dealt with their pain. You know, I quite often don't see this great divide between cognitive approaches and precision exercise approaches, because sometimes they both converge on the same thing. Then another type of evidence that I hear people cite, oh, well, back tissues heal within 8 to 12 weeks. So you might have structural damage, but if you have pain lasting longer than three months, there is some other reason for you to have pain. Well, I've used this when I've been called as an expert witness in court cases, for example, where someone is claiming that this person doesn't deserve their disability pension or

whatever because they have long lasting pain and therefore it must be more murally driven. long-lasting pain, and therefore it must be more neurally driven. Wait a second. You could break your leg, and the leg would heal, and it would actually be stronger in the bone than the non- fractured side, and so the pain goes away. But that's not fair to do to a spinal joint. When a disc becomes a bit damaged and a bit flattened, the load sharing among the tissues now change. So in two years, the facets have become arthritic and they become secondary pain generators. The ligamentum flavum will thicken up quite possibly and start causing some stenosis-driven pain. The point is there's a cascade of change that's unique to the spine. It was first discussed by Professor Kirkcaldy Willis. He wrote a whole book

about it called Managing Low Back Pain. So the pain follows this cascade. And then all of a sudden the images, you know, are you looking at a wound or a scar? Is the feature that you're looking at on an MRI images, is that 30 years old or was it done yesterday and is still a fresh pain generator? So, you see, there's a lot of wonderful uses but misuses of this whole argument that pain exists without damage. Unfortunately, I think some clinicians are motivated to say, oh, the pain is due to a psychological mechanism or a central neural mechanism, and they may not be correct. But that's the default because they haven't done a thorough assessment. So at the end of the day, this whole issue is really addressed by taking the time and doing a thorough assessment of that person. The mega trend in medicine these days is towards

precision medicine. Look at any disease, any cancer, know what you're dealing with and address it with a very targeted kind of intervention. The final thing I'll say about this is if you take the average person with the average bad back, there's a big margin of safety. You don't have to be that precise. So the average clinician will get the average back pain person better, and they don't have to be that precise. However, when you get a difficult patient where the margin of safety or the margin of error now is razor thin, they can't take too many cycles of load without pain or more tissue disruption. Now, this is what separates out the average clinician from the master of the craft who does the very thorough assessment, really understands

the mechanism. Yeah, I mean, that's a fantastic summary. And it really does highlight that point because, again, I hear it, people just reaching out to me here and there where all they know is their back hurts. It's usually in the context of working out and they're worried that, you know, because Dr. Google says that their spine is now broken and should just be, uh, every, every vertebrae should just be fused now, but no, they're, they're just concerned where, hey, I have this pain. Does this automatically mean that there's something seriously wrong? And it's interesting, a couple of those anecdotes that you shared with the trapped nerve and where

that I'm sure there are a lot of people that are dealing with problems like that, that the cause is completely different than what they think. And again, like you said, it requires someone like you, it requires a real specialist who is going to go beyond just the standard protocol that works for most people that are right in the middle of the curve. Hey, before we continue, if you like what I'm doing here on the podcast and elsewhere, and if you want to help me help more people get into the best shape of their lives, please consider checking out my VIP

one-on-one coaching service. Now, my team and I have helped thousands of people of all ages, circumstances, and needs. So no matter how complicated or maybe even hopeless you might think your situation is, we will figure out how to get you the results you want. Every diet and training program we create is 100% custom. We provide daily workout logs and we do weekly accountability calls. Our clients get priority email service as well as discounts on supplements and the list goes on and on. To learn more, just head over to legionathletics.com slash coaching. And if you like what you see, schedule your free consultation call. Now there's normally a wait list to work with our coaches and new slots do fill up very quickly. So if this sounds even remotely

interesting to you, head over to legionathletics.com slash coaching now and schedule your free consultation call. And let's see if our program is a good fit for you. How does mechanostimulation play into this in terms of damage to different types of tissues and how that can correlate to pain? Yeah, what a fabulous question. And I enjoyed just listening to the whole line of logic you created there because too many people think getting back pain is really the kiss of death. And no wonder they go to a therapist who gives them ultrasound and then they go to the next therapist who's asking them questions about their family and then they go to someone else and they get some goofy core exercise and you know they keep finding that nothing really works and no wonder they get despondent about all of this yeah unfortunately i have a friend in the gym whose wife went through that process it sounds

like to some degree um multiple surgeries and And I mean, ultimately, she may have been working with great people. I'm not sure, but I just would hear about it secondhand of from one person to the next and trying this and trying that and constant pain. And well, I will bet not once did she get a thorough assessment that informed her of the mechanism of her pain. And that's why I wrote my book, Back Mechanic. It takes the person through a self-assessment of their pain triggers. And then based on the self-assessment, it then shows them what to not do because they have to first stop

the cause to wind down the pain sensitivity. And then what they should do to build the foundation for pain-free activity and whatever that goal is. If they want to play golf or even set another record in powerlifting. If I can just tell this story about mechanostimulation. I don't know if you're familiar with the book I wrote called Gift of Injury with Brian Carroll. Brian was a champion powerlifter. He was the only guy that I know of who had lifted or squatted over a thousand pounds in national and international competition over 50 times over the years. So that's quite a track record.

That's insane. You just have to have big balls to ever even step underneath weight like that, let alone unrack it. And it's pretty superhuman. It's astounding. Think of, yeah, if you're a one millimeter, you just get crushed because you cannot correct a thousand pounds on your back. People don't realize the precision of that maneuver. But nonetheless, Brian came to me with a split sacrum, split front to back. L5 was heavily damaged, his bottom vertebra, and then the two discs were heavily, heavily compromised. They looked just horrible. In fact, we show it in the book at the beginning. get you out of pain. But then he said, oh, great. And then I want to set the next world record again. And then I remember saying to him, if you were my son, I think I would just enjoy not having pain. And a few surgeons had told him, you know, he may never get out of pain and whatnot. But with

this massive fracture, what I did was I took a cadaver, I loaded it with a heavy deadlift type of load. We created the split sacrum, but then I did a kyphoplasty. So what a surgeon would do is mix up some bone cement, inject it into the vertebra, and it would set and give a internal casting, if you will, of the vertebra. So the idea was to bear load. So they do this on people with osteoporosis fractures and things like that. But I couldn't get the end plate to seal. So the disc kept leaking through cracks in the fracture, even though that the bone was stabilized. So I said to Brian, I don't think that's going to work. We're going to do some bone stimulation, which we had some knowledge of from mechanostimulation. So, some people think, oh, their body is in this state of deterioration. Some goofball clinician,

who should know better, told them they had degenerative disc disease. There is no such thing. They don't have a disease and they're not degenerating. Quite the contrary. Their body is in the continual state of adapting and healing. It's just no one had shown them how to facilitate that healing process. That's interesting. That's a key point, actually, for people listening. Because, again, that's a common concern. Because again, that's a common concern and I hear it fairly often, mostly from people I would say in the 40 plus crowd and understandably so because it's something they just hear about and they just assume just that, that no matter what they do, pretty much everything in their body is falling apart. Their metabolism is falling apart. Their lean mass is falling apart, their joints are falling apart. Please, we've got to get clinicians and radiologists stop using these so destructive terms such as degenerative disc disease. Let me get back to Brian because it will show you the

power of understanding the mechanism. And then when you target the so-called damage with precision intervention, magic happens all over again. So Brian Recall had this massive fracture. I'm just going to explain how bone heals. So if you took a long bone, say in your forearm, and you bent your forearm until the tensile side of one of the arm bones fractured. It would fracture in tension. So bone, when you stress it, is a piezoelectric crystal. It develops a charge where the strain is the highest. That charge sucks and attracts free ions of calcium and magnesium, the fundamental building blocks of bone, and then it scaffolds in to grow bone around the area of the highest stress. So with Brian, I knew there was no real surgical way to close in the fracture. So we filled it in by doing bone callusing. He would stimulate the bone by doing, say, a suitcase carry with a kettlebell,

and then he would take five days off and let the scaffolding take place. Now, can you imagine an athlete of his caliber? I said, now do that for a year. Now, he was professional enough that even though the pain went away very quickly, I gave him a few simple stabilization exercises that are described in Back Mechanic, and he would do the carry and the load and the walk once every five days. If you look at the MRI image of a couple of years later, you won't see the fracture. It's all filled in, the discs have remodeled, and the vertebra has remodeled. That's the power of mechanostimulation so the body is trying to heal itself it just needs to be guided the right way just a little bit wow that's amazing oh and and and just to put the icing on the cake he then went

to the arnold's you know the uh competitions in uh columbus where they they have bodybuilding and powerlifting and weightlifting and some CrossFit games and all that sort of thing. He went and won the Arnold's the following two years. Squatting, by the way, well over a thousand pounds once again. So there you go. That's awesome. That's a great success story because before he came to you, what were other people telling him his options were? You had mentioned briefly that it was like, yeah, you might be in pain for the rest of your life. And I'm sure they were saying you could forget about squatting anything ever again. Yeah, your life is basically over because he defined himself as a world champion powerlifter. He came out of a surgical consult with the doc, not really giving him any hope, just more despair and really inappropriate wording of his diagnosis.

Brian sat in his car with a semi-automatic pistol in his lap, wondering whether to pull the trigger. And that's chapter one of the Gift of Injury book. So that's where it starts. It was kind of fun because he held my feet to the fire on that one. When I first said to him, I think we can get you out of pain, but I would advise you to find other things to do than to try and set the world record again, given this massive fracture history. But he said, no, I want that next record. And I said, well, if you get the record, we'll write a book about it. So he held my feet to the fire and came back to me a couple of years later and said, okay, let's do

the book. But the thing about Brian was I had no idea the man can write. So that first two page, I'll send you the book if you can give me the address at the end. But boy, it is emotional. But that's where the book starts. His life was over and he came and rebuilt his physicality because that's who he was. He fought his way back. Yeah, that's so cool. And just for everybody listening, in case you haven't caught, it's The Gift of Injury is the name of the book for anybody who wants to. It's just Gift of Injury. There's no other one. Okay, so Gift of Injury.

You know, Mike, we've done this with many UFC fighters, hockey players, NFL players. I mean, that's what we do. We restore a lot of athletic careers. Not always. We do fail as well. But this is facilitated by understanding the nature of the tissue damage so that we can create mechanostimulation. People will argue, oh, well, the cognitive behavioral approach is very important. And it may very well be. But so often I can't distinguish between the two because to steal a person's dream really affects their physicality. To tell someone that they have a degenerative disease when in fact they do not. It's only the clinician was too intellectually lazy or their profession has not evolved. I mean, I'm really sending out some heavy indictments here.

You know, people blame it on the opioid crisis. The opioid crisis, who gives them the opioids? You know, it's clinicians who are failing in providing an intervention to address the very specific pathway of that person's pain. Well, they can't all be you, I guess. Well, that's why I wrote the book. I never wanted to write the book. You know, I'd written medical textbooks for clinicians, but gosh, they're awful heavy. I even hate reading them. They're far too heavy.

But, you know, some savvy lay people would say, oh, I picked up your medical textbook. Could you possibly write one for the lay public? So that's how Back Mechanic came about. But I'll tell you, it took me five years to write that book. It was such a struggle to maintain the integrity of truth. to maintain the integrity of truth. In other words, the publisher said, oh, the title has to be five easy steps to cure your back pain. And I said, that's a lie. It doesn't exist. And I'm not writing the damn book. And I said, no. So the book is 19 chapters, but what it does, it gives a systematic approach to assessing the person's pain triggers. You know, do you get it when you bend a

certain way or sustain a certain load, or do you get it when you bend a certain way or sustain a certain load? Or do you get it after driving your car or sitting at your computer? Do you get it after walking for 20 minutes or simply when you go upstairs? If you can name a specific activity that makes your pain worse

and then another activity that takes your pain away, there is hope. It's just a matter of quantifying the mechanisms that make the pain better and worse and building on those. I like that. That's a great framework with which to view it. I'm curious now if we can segue into your thoughts on back surgery for people who I think I can guess, but I think it's worth talking about. Yeah. Well, there's a whole chapter in back mechanic on that. The vast majority of back pain should not be operated on period. Why does most surgery,

when it does work, why does it work? Well, sometimes changing the anatomy works, but the surgeon better be darn sure that the tissue they're going to change is the pain generator. Sometimes it isn't, even though on the MRI, it might look as though it's a bit odd. If you can prove, and it's very easy to prove, by the way, that the pain is from another level, you know that that surgery is going to fail. But here's the interesting thing that I hope, if anything, your viewers or listeners who are told, you know, you've tried all these things, nothing works. Surgery is the last thing.

It is not. Surgery often works because it's forced rest. Now, think of what I just said. I will get a patient who comes in and say, you know, I have to go and ride. That's kind of a scary thought, honestly. Well, it is. They're addicted. Some of them are addicted to exercise.

So they'll say, I have to ride the elliptical for 20 minutes every day. Otherwise, I'll murder my husband or something like that. And I'll say, fine, I'm going to play a game with you. I'm going to call it virtual surgery. And I make a big deal of it. I make them kneel down on one knee and I touch them on the shoulder with a wooden dowel or maybe a kettlebell or something like that. And I'll say there, you've just had surgery. Now, you cannot go to the gym tomorrow and ride the elliptical. You will spend intervals in bed. You're going to get up and go

to the toilet. And over the next few weeks, I'm going to give you a progression to restore some basic function. And then once the pain is gone, we're going to rebuild the deficits in your body so that you can do the things that you want to do again. Now, I'm not going to cut you. I'm going to play that game of virtual surgery and you're going to recover like a post-surgical patient. When we do this, and we were very unique in our clinic because all of those patients we saw over the years at the university, we followed up with every patient. If on follow-up, we asked the question of those who were told they had no option but surgery left, doing the plan in the book,

95% of them avoided surgery and were happy for it. So we then stepped them through a set of questions that they must check the boxes. If they cannot check the boxes, don't get surgery. So, you know, the surgeon has to show the person the cause of their pain and the surgeon can't show them the cause of their pain. They mustn't have surgery because the cause will remain. And then they'll be back in six months. Oh, I reherniated my operated disc or the joint above now has a disc bulge on the same side. So anyway, and then I have to hear some tale of woe from a patient who's now an opioid addict. And it was iatrogenic.

It was caused by their clinicians. Wow. Wow. I wish I would have done this interview just a month or so ago. I'm just thinking of my buddy's wife. I mean, ultimately, she had a fusion done, and so far, she's okay. She's doing her recovery. It may have been necessary. I don't know. I'm not saying that the people that she worked with didn't know what they're doing, but it's just- Why did she need diffusion? Do you know? Was it a disc bulge or a flattened disc? I don't even know. I tried not to bring it up too much with her because I didn't want it to always be about- Because I know that she was pretty much always in pain. Funny enough,

didn't want it to always be about, cause I know that she was pretty much always in pain. Funny enough, she also is into working out and she didn't like taking breaks. And, but anyway, I spoke to her a little bit here and there about it, but I didn't want to, every time I see her, Hey, how's your back doing? You know what I mean? I tried to talk about other things, but no, I don't, I don't know anything technically about what was going on. I just know that the type of pain she was dealing with. I wish trainers would have conversations with their clients about programming and biology and that more is not better. They train to create adaptations, but the adaptations don't take place while they're training. The adaptations take place in the kitchen when they're eating and in bed when they're resting. So they train to create the adaptations. But what

so many people do is they neglect the adaptation side of the equation and they just add more stimulus, more stimulus, more stimulus and accumulate measurable, and I'll get right out there and use the word damage, not allowing the natural adaptation process to use the damage in a positive way and cause positive adaptations and strengthen their body. More is not better. Yep. Yep. I write and speak about that quite often. And I think it's, I mean, we see that just kind of in life in general, right? It's always go, go, go more. Everything is better. We always have to have more and everything is kind of wired for just never ending growth. That's, that's what, that's what we need.

And it needs, there needs to be never ending output. Forget about quality, forget about rest. I understand how you can get kind of caught in that. But like you were saying with some people, it takes probably more discipline for them to actually give their body enough rest than to just go in the gym and work out like crazy all the time. Absolutely. I'm curious, just getting back on the back surgery, what are some of those other boxes? So one is that the surgeon has to show you where the pain is coming from. What are some of the other things on a checklist? Well, some surgeons start moving up the ladder and they'll say, oh, well, you need a double level fusion.

If you need a double level fusion, I'd run the other way. There's something else that's going on that's caused all this. And the first level of business is to understand the cause and make sure you get rid of that first. If the surgeon is in a rush and is impatient with the patient discussing things like the cause and what exactly is it, what's wrong with me, if the surgeon won't answer those questions, you better run the other way. at what's wrong with me. If the surgeon won't answer those questions, you better run the other way. Always get a second opinion. But here's the million dollar question. If I hand you a sheet of paper and I say, write down the things that don't hurt your back and now write down the things that do hurt your back. And if they can come up with a list of activities that fit both of those boxes,

list of activities that fit both of those boxes, chances are 95% of the time you will not need surgery. So there's a huge exercise, a huge question with a huge payoff. Work on the things that don't cause you pain and build on them. Get rid of the things that do cause you pain. So you can imagine a younger person, they can deadlift a hundred kilo or you're American. So 220 pounds, right? Yeah. Or 225 standard, a couple of 45s in the bar. Perfect. There you go.

Our back fit pro here is sponsored by Aliko. So we're in kilos. Professional. Professional. Yeah. Anyway, so deadlift a hundred kilo in the gym at night, but sitting in front of the computer ramps up their back pain and causes the right calf to go numb. 20 minutes in front of the computer causes that.

But if they can get up and go for a walk for 10 minutes, all those symptoms go away. There is a specific pain pattern. We know the cause of that. We know exactly what to do. Now let's contrast another person who, say, is my age. They're in their mid-60s. But sitting gives them relief, and walking now gives them a numb foot and back pain. So it's the precise opposite pain pattern than the younger person that I just described.

They would require, we know the cause of that one as well, but they have quite a different strategy, but a precision strategy to address and build on the things that don't cause pain and somehow make the things that do cause pain tolerable. Anyway, those are some examples that I hope illustrate for your listenership that once they're guided with an understanding of the mechanism, they get so much more precise in learning how to build their tolerable life and get back to doing the things that they want to do. Yeah, that's fantastic. Out of curiosity, what is a scenario that requires surgery? If a person has been traumatized with high energy impact, like a car collision, for example, and they've got a very broken pelvic ring, really, really damaged sacroiliac joints, for example, they can't bear any load at all. They can't even walk.

There would be an example. Another one might be where someone has a really nasty disc bulge. It's really trapped a nerve root. It's unrelenting. We can't get the nerve to slide once again with neurodynamics. There has been a steroidal cocktail injection, very precisely injected at the pinch point. Most of the time, they're not precisely injected, but anyway, say they were, and still, you couldn't get a nerve slide, and it's gone on for a couple of months. There is a really good risk to take. It's targeted. You know exactly what you're dealing with. Go in there. But the next question is, what caused that disc bulge in the first place to trap the nerve root? And if the surgeon doesn't show the person, which almost all the time they fail to do that,

then the person might come back in a few months saying, oh, I've re-herniated my disc. Now we're into second surgeries, and now the risk suddenly went way up of a, an optimal outcome. Interesting. Interesting. Well, I mean, I think that's, I mean, I would take that personally as good news if I were dealing with back pain because just, just given, Oh, Mike, this is such a series of good news stories. It's so terrible what's going on. that makes sense other than just, well, I don't know. I mean, this, because I would, I would think I've not been in that situation myself. Fortunately, I've not had any real acute injuries with weightlifting. I've aggravated my SI joint. I've had some biceps tendonitis. I've had some little things that I've been able to just work through. But if I were in that situation,

I could see how it would be easy to assume that the surgeon must know what they're doing, right? Or maybe you even get two opinions and maybe they happen to both be wrong, but they're consistently wrong. And so you assume that, well, that's what these people do. So I guess that's what I got to do. If it were me, if I weren't to have come across someone like you and your work, I could see how it is just kind of what else can I do? I guess I roll the dice. Well, it is so empowering, both physically and psychologically for a person to realize, wow, that's how I can tie my shoe pain-free for the first time. No one showed them that you cannot

sit in a chair and reach forward and tie your shoe if that happened to be their particular pain trigger. But if they stood up and put their shoe on top of the seat pan of the chair, put one foot up on the stool, and now they do a lunge. They are tall. They guide their pelvis towards the target, down towards the seat pan where their shoe is, and they bend their supporting leg, they can not stress the tissue, the very specific tissue that was causing the pain. No one showed them how to move. Now, after a while, do they need to do that? Is that a life sentence? No, it allows you to calm down the sensitivity and let this great natural healing capacity work. But you know, if you hit your thumb with a hammer all day long, after day three, your thumb's going to be just lightly touch your thumb and you'll scream,

well, this is the condition of some people's backs. Take the damned hammer away, let your thumb settle. And then all of a sudden, now, can you imagine I'm hammering my thumb? And now some clinician says, oh, let's do exercises for your thumb. Are you kidding me? It's screaming right now. I'm not, I don't have any ability to do exercise, but take the hammer away. Let it settle. Now let's cleverly start using the thumb in the way that will cause the adaptation process of natural healing.

Yeah, that's great analogy. Or in the case of your previous patient, why don't we just, let's just cut the thumb off. Let's just cut the foot off. Yeah, it's astounding. Let's switch gears here and talk about deadlifting and squatting. What are your thoughts on the safety, specifically, obviously, with the spine of deadlifting and squatting? Well, you probably know me well enough to know the first two words out of my mouth are, it depends. You know, I often say, you know, I love squats and deadlifts and I hate squats and deadlifts. It all depends on the context. So on one hand, they can reduce the safety of that person in breaking to pain or

precisely the opposite. They can build a more robust system, but it's all governed by the concept of the biological tipping point. Every system in your body has a tipping point. Think of vitamin D. There's an easy one. If you don't have enough vitamin D, you're sick. If you have too much, it's poison. There is a sweet spot right at the tipping point. There is a sweet spot right at the tipping point. Now let's get back to deadlifts and squats. Another concept is exercises are simply tools. Now, what's the goal of the exercise?

If you can name what the goal is, and then you can say, well, the best tool I have in my trainer's toolbox is a squat, then okay, that's your best tool. But if I said, what about pushing a car? Wow, all of a sudden now, we've got a different load profile through the body. We've got frontal plane strength with sagittal plane strength. We're on one leg, we're pushing, we're getting foot athleticism. So there's an example where I might have a real discussion about programming and how it's all set up before I can get into something like specifically deadlifting and squatting. And then I need to ask questions like, what volume are we talking about? What load?

What other exercises are you doing? What's your work life? Are you a fisherman? Are you a construction worker? Are you a truck driver? Are you a computer jockey? What's your injury history? What's the rate of progression in terms of the end plates of your spine? The great squatters and deadlifters are hitting records usually, but not always,

in their late 30s and early 40s because it took that long to build that bone mass that will allow them if they are into high volume. What is the rest schedule to facilitate optimal tissue adaptation? Then my thought goes to, let me watch you deadlift and squat. What's your training form like? Because we both know deadlifting, it's an incredibly technical exercise. And if trainers would realize that, and then, you know, I'll get a patient in and she's a stay-at-home mom. And she tells me, you know, all my troubles started when I started deadlifting. And then I'll say, well, show me what you've been doing. And then she tells me she's only been training with the trainer for three

months and that trainer's got her lifting her body weight from a deficit position after three months. That trainer caused her back issues, definitely damaged her tissues. No question about it. So they violated the tipping point. If I was to talk about squats, again, what's the goal? Well, what's a squat? Are we talking in front squat, a back squat, or an assisted squat with bands? Now, you know, I broke my hip as a younger fella. I've been hip replaced. I was first told to have my hips replaced when I was 45.

So I'd been through heavy lifting and all that sort of thing. But what I did was I learned this from an Olympic lifter, world record holder from Poland who told me, just do one squat a day. It will keep you preserving your deep squat ability, but it's not enough volume to really pick the scab and make your heavily arthritic hips painful. And then I started to use a kind of a squat. If you can imagine this, I would put heavy green bands. So every trainer knows what a green band is for, you know, that you might use with heavy barbell lifting. And I would hang them on a overhead chin-up rack, And I would hang them on a overhead chin-up rack.

And then I'd wrap them around my wrists and descend into a deep squat. So by the time I got down into the full deep squat, my body weight was taken up mostly through my arms and upper body to the elastics overhead. Then as I started to ascend, I would add more and more conscious muscle activity and really preserve the motor control of a good squat. Well, I do that today still as part of my daily routine. And it keeps me out of pain. It keeps me really quite functional for being an old guy. And here's a final thought. Think of both squats and deadlifts. They're exercises where both feet are planted on the floor. Then I will measure a really strong squatter and deadlifter who have back pain because they don't have matched frontal plane strength. So they've got beautiful strength in the sagittal plane, good back strength and whatnot. But when I put them on one leg and they have to take a step and pivot and might be

playing a pickup basketball game, and then I see their spine bend as their pelvis drops on the swing leg side. They can't, they don't have sufficient frontal plane strength because not once in their programming did they address it. They did more squats, more deadlifts, and the whole deficit would have been addressed with a suitcase carry. So where's the carry part of your programming? What do you mean? Well, let's try that. Let's start off with some side planks. Then we're going to start doing some suitcase carries. And then all of a sudden they'll come back and say, you know what? My back pain is gone and I'm hitting my bests that I've never hit before in squats. That's really interesting. It makes perfect sense, but it's just very interesting.

Yeah. Aren't these, you've been really thoughtful in these questions, I must say. Yeah. I like to give it some thought before when I have people like you are willing to take their time. I try to make the discussions as interesting for both me and, uh, and, and you, and also as beneficial to the listeners as possible. And so again, in this case, I was fortunate in that these were questions that I had, uh, I get fairly often. And so I'd say that my listeners probably did the work for me there, but, um, I mean, I really, yeah, mean, yeah, you've been sharing a lot of really, really great wisdom and some very practical stuff too, which is fantastic. To that

point, actually, I have a question on back to the deadlifting and the squatting in terms of safety for the average person who doesn't have any major issues. I think it goes without saying that if performed correctly, and let me also give the context of, and really I'm just talking about most of my readers and listeners and followers. Again, like I told you before we got on the recording here, is I have a lot of people in their 30s and 40s, fair amount in their 20s as well, everyday people, in most cases, no major injuries or issues who want to get fit. They want to be strong and they want to have above average musculature. And they're going to be in the gym three to five hours a week. And in most cases,

that probably is going to involve, if we're talking squatting and deadlifting, a few heavier sets of each per week, auto-regulated somewhere in the rep range of, let's say, four to six or maybe six to eight or eight to 10. That's kind of where most people are at, at least who reach out to me. And so for those people, I think it's fair to say that there's nothing inherently wrong with doing that, which that might sound silly to you. But again, I mean, I understand where this is of people reaching out to me because they hear things like just black and white, oh, squatting and deadlifting are terrible for your spine. And yeah, you can get away with it when you're young, but over time, you're just going to be causing yourself more and more problems. That's what people hear often. Well, I mean, I don't know what more I can say other than recognize there's a biological tipping point. And what will tear you down if you violate the tipping point can just as easily enhance your robustness if you're on the positive side

of the tipping point. But you modulate the tipping point by things like having good form, etc. Are there any other, I would say, like, again, for the average person, I think of CrossFit, right? And I think of people who have written me. And in some cases, the workouts are reasonable. In many cases, they're very unreasonable, in my opinion, where you have high volume, you know, AMRAP, squatting and deadlifting multiple days a week. And I'll just tell people, don't do that. Just don't.

Where is that Goldilocks zone for the average person? What do you feel would be a reasonable prescription for squatting and deadlifting? Okay. If you threw in Olympic lifting, I'd have a little bit more wisdom to talk about CrossFit and that kind of thing. But if you're going to stick with squats and deadlifts, you know, I was working with a group of elite rowers earlier in the week. It was interesting. We were having discussions about reducing the risk of injury. I said, at this time of the year, what do you really want to do? Are you really trying to create a physiological base for aerobic training?

But most of them are masters rowers. They only row a kilometer in their race. How big an aerobic base do they need? So we had this discussion where why don't you try on the ergometer to give perfect strokes, really focus and groove the muscle memory of perfection. And at the first indication of you breaking form, you stop and you rest. Now, I'd like you to repeat that. And all of a sudden, they started to get into natural intervals of only two or three minutes. Well, what's a race? It's like

four minutes. Wow, all of a sudden, they were starting to really get much better scores. Where did I get that from? That came from the world of Olympic lifting. There's no Olympic lifters that I know of who are true Olympians who train sets of 10 lifts. I'll just back up one second here to talk about adaptation. So I talked about bodybuilders adapting muscle. They train for one day and it's the day of rest afterwards that the muscle grows or they create the changes and the development that they're seeking. The strength athlete, the real strong man and power lifter might train heavy squats or deads and then take five days off because they're developing that heavy bone that

they're going to need. But when we take the Olympic lifter, they are one of the few athletes who adapt while they are training because they're laying down muscle memory patterns. You've got to be extremely explosive to rip the bar off the ground keep the upward momentum going as you snap under the bar for the catch if you're say doing a snatch so there's a hell of a sequence of muscle on muscle off etc now getting stronger won't quite possibly help them to lift more it's much more getting perfect muscle memory of the pulse relaxation, pulse into catch sequence. So now if I use that to go back into dead lifting, if you can get perfect form with the first lift, fabulous. You've created a successful memory.

Now let's do rep number two. Perfect. You've got a a perfect lift now let's go to rep number three oops we've got a little bit of slop going on there we shut it down now i've got two stories that will probably knock your socks off what i'm asking all your viewers to do now if they're worried about this is go watch the youtube of the latest World's Strongest Man competition. So WSM 2018. It was in Mogadishu, Africa this year. One of the events was squatting 750 pounds on this machine for reps. How many reps can you do?

So some of the guys started finishing at 12 reps. I think the winner got 17 reps. That's absurd. Yeah, but watch the rep before the failure. And now you're going to see it every single time. The rep before they failed, they lost spine stiffness. Their hips shifted just a little bit. Their pelvis might have come forward just a little bit. Now, what happens there is fatigue slowly eats away at good form. And as soon as the brain senses that instability and loss of stiffness, because the body uses stiffness to control movement, the fuse box comes on and shuts down neural drive. So, they didn't run out of strength on rep 17. They got unstable in rep 16. And then the

motor control system shut it down. So if you want to define your strength really quickly, lose form. So now though that they'd be far wiser to keep good form, to keep squeezing out reps. And that's universal among strength expressions, doing reps. So I hope that little story gives you some wisdom in how many reps. I think it's a key point, right? To just maintaining the safety of the exercises. I mean, of course, everybody hears that, but like you've said, these are technical movements. And I've, I've again, written about this and spoken about this at length is that point of often people in the muscle building space, they think of just muscle failure, right? And okay. You don't, a lot of people know that you don't necessarily want to go to muscle, muscular failure on your heavier lifts, but I like to also, I think that's fine. If you're

talking like a biceps curl or something. I mean, you could, you could take your biceps curl to muscular failure pretty often and not have to worry about it. Uh, but with your more technical lifts to look at it more as technical failure, which is that point where your form starts to slip and being very aware of how you are moving. And it's not just about getting the bar to move any which way. It's about getting it to move properly and getting the sequencing in your body correct. And at that point where if that starts to disappear, even if you feel like you have the strength to continue the rep or finish the rep or even get another rep, let's say, let's say you do finish a rep

and you felt like, okay, that was getting a little bit sloppy. Just end the set there. Even if you feel like, well, I could just squeeze out another couple reps and get really close to that point of muscular failure. So you just progressed now from a bodybuilder to a true strength athlete, organizing the motor control and driving the weakness out of the body. And you've just hit the nail on the head. Can I tell one little story that's

kind of fun about this whole issue? Yeah, yeah, please do. You know who Ed Cohn is? Yeah, of course. Oh, yeah. So everybody in the powerlifting world knows Ed Cohn. He's a good friend of mine. And as you know, people revere him and refer to him as the GOAT, the G-O-A-T, the greatest of all time. When Ed set the powerlifting records, I mean, he was 25% higher in total load than the next competitor. And this is at the world level. It would be like- That's like Tiger Woods stuff when he was in his prime. seconds and Carl Lewis wins gold at running at 10 or, you know, 9.98 or whatever it is. People don't realize how fabulously beyond Ed Cohn was in his prime. But now listen to Ed tell the same story about deadlifts and how did he become so strong? Do you know he never missed a lift in practice. You create muscle memories as a winner. Your brain doesn't

know what a losing, fatigued, spent out muscle memory, or in science, we call it the engram. The engram is the movement tape. But Ed had perfect movement tapes because that's all he ever trained. And so he didn't set world records in his basement like so many kids do. He set world records when he needed to. And he hadn't really done that before in practice. All he did was perfect patterns, never missing a rep or a lift. And when he was getting tired, he would interval train it. He'd back off and let those adaptations take place. Anyway, there's a little bit of wisdom and some nice

stories from the pros. Another friend is Bill Kazmaier, world's strongest man for the first three years. And I had to give, I didn't have to, I had the great privilege of awarding a lifetime achievement at a conference I was at to Bill Kazmaier. And I told the story. I measured some of the techniques that Bill used when he was younger and competing to train the neur record in raw powerlifting and all this sort of thing. You know, because I knew his techniques, challenging the motor units on your muscular compartments and getting them written down in the engram in his movement tape up and down his spine. And then he said, Stu, I only knew what worked. And that was my introduction to giving him the award. I only knew what worked. And that was my introduction to giving him the award. It's been a fabulous back and forth for where a guy like me would measure in the laboratory, in the clinic, what the mechanisms were and how you would go about creating optimal strength. And then we

have the world's strongest man who was just doing it. And he knew it because he knew it worked. And then we have the world's strongest man who was just doing it and he knew it because he knew it worked. And that was, that's one of the greatest synergies where science just synergizes with, with practice to make the magic unleash itself. That's great. No, that's just, that's a good lesson for people. I mean, that really the key takeaway there is that importance of it. I like that also forces, it gives you, it invites you to take a longer look at what you're trying to achieve in your training and not being so myopic and so focused on, well, you got to beat, you know, I like the idea of going into each workout, trying to do a little bit better than the last one. I guess it depends

on your programming, but if you're following, again, I'm helping mostly kind of everyday normal people just getting fit. I don't work with the type of people that you work with. So generally speaking, it makes sense if you're relatively new and you're following a kind of simple strength, kind of auto-regulated program, try to get better each workout. But there's that bigger picture where, okay, so even if you didn't beat last week's workout, maybe you were a rep shy of last week's workout, but if every rep was as perfect as they can be, I mean, maybe if you were to put yourself on camera, okay, maybe it's not 100% perfect, but you're using good form as well as you can. You are as technically perfect as you can be, and you are working to

increase that level of technical perfection. That's also a form of progression. Even though you might be stuck at a certain weight and a certain number of reps for a few weeks, there are different scorecards. It's not all just about load and volume. Fabulous summary. Okay. Well, I think this is a great point to just wrap up. Actually, I think we've touched really on everything, all the important stuff that I wanted to ask you. Let's wrap up with where people can find you and your work. And you've mentioned a couple of your books throughout. So if you wanted to mention anything else there, if you have

something new you're working on or just reiterate like here, anybody listening, if you're dealing with back pain or if you don't want to have to deal with back pain, this is what I want you to check out or this is where I want you to go. Well, thanks for that, Mike. Our website is backfitpro.com. It's just how it sounds, BackFitPro. My books are there. I wrote them for a reason. It's to guide people through a self-assessment and give them a fairly precise roadmap on what to stop doing that's causing their pain and then how to build a foundation for pain-free activity. Then I've got a couple of other books for strength athletes. I've got The Gift of Injury written with Brian Carroll, which we never thought it would be a strength guide, but that's what it turned out to be. So it's the story of his recovery and then a general text on enhancing strength.

And then I have another book called Ultimate Back Fitness and Performance. It is much more broad in developing athleticism in terms of endurance and speed and power and agility and all that kind of thing, being very respectful of that person's history with back difficulties. And then I have my clinical textbook that unless you're a clinician, it would be very nasty to read through. But anyway, there's quite a number of podcasts available on there and articles. And it gives people guidance on what to do. And it's also for clinicians, by the way. There are two portals coming in and people who want or are interested in attending some of our clinical courses on how to assess back pain.

We have a trainer's weekend for those wanting to retain their clients with back pain and not losing them and certainly don't create new back pain people as well. That's great. Backfitpro.com. And that's like the central hub, it sounds like, to everything. You know, it's funny, Mike, I'm not a social media person. And in fact, I really have some difficulties with what goes on on Facebook and Instagram and some of these things. And when I see some of the advice and guidance by people who've not created one Olympic medal in their lives, it's very concerning to me. Nonetheless, that's about the extent of my internet activity. Yeah, I'm with you. I'm on social media.

I actually, ironically, before we jumped onto this, I was putting together a plan. I've resolved to be more involved in social media, although I don't like it personally. And I actually don't even use it personally outside of my work really. And I think that the world might be a better place if it were just banned. But as a lot of people use it and it is very popular, I was like, okay, I need to, it's stupid for me to completely neglect it. That's me being harsh to myself. I don't mean to say that to you, but that's me looking at it going. I think there's an opportunity. I produce a lot of educational content. That's what I enjoy doing. I can

repurpose a lot of that. I can do it in a way that I feel would be what I'm not interested in is trying to get attention. I don't care about that. But if I can use social media in a way to just help educate people and help spread around a lot of the other stuff that I'm doing, like the podcasts and the articles and the books and the videos and blah, blah, blah, then that's interesting to me. And it may not be necessarily the quote unquote best strategy for like hyper growth and trying to become Insta famous, but I don't care about that. If I can do it in a way that I feel is in line with like, why am I even doing this? Then that works for me. So, I mean, you have obviously a ton of wisdom to share. So at some point, if you ever are interested, maybe that's a reason why you could, you would, you would consider being a little bit more involved in it in that it is a very easy way to just spread information. And if you have good information to spread, well, that's a win-win. Well said and point noted.

But I do understand where you're coming from. But anyways, that's great. So backfitpro.com. And I want to thank you again, Professor, for taking the time. This is a great discussion. And I know that a lot of people are going to find it very helpful because you have answered a lot of questions that I get. And now I have something I can send people to. I could say, that's a great question here. Check out this interview. That's going to happen often now. Thank you very much, Mike. It's, um, you're, good at what you do. So, uh, keep it going and, uh, best of luck to it all. Hey there, it is Mike again. I hope you enjoyed this episode and found it interesting and helpful.

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