287 ‒ Lower back pain: causes, treatment, and prevention of lower back injuries and pain

Understand L.Hays teachings out of her bookled: heal your body the infos about spine meanings and add the bloodtype diet.. Do adequate exercises and learn about yourself who you are indeed..psychologically but also physically..
🎉❤🎉

"Couldn't make it better", 'course not, God made us😊

Professor McGill you are a saint. Thank you for being compassionate and such an amazing practitioner.

That story made me cry an saved my life, thank you

McGill is the G of addressing low back issues. After going to MD’s, Chiros, Acupuncturists, massage therapists etc. for LBP, I read his book and watched his videos. I still have some LBP but way less than before. The big 3!! Let’s go!

Can someone add the links to the big 3?

This was awesome. I’m about to turn 25 and have been in back pain for five months ever since a powerlifting squat injury. Slowly getting on the right track after months of stubbornness and arrogance.

Finding Dr. McGill was a miracle for me as a 66-year-old with chronic back pain and herniated discs since age 25 (equestrian, bodybuilding, gymnastics, track and field, long distance runner, etc., etc.). I can now manage my symptoms and do the things I want/need to do. I am also encouraged by your own story, Dr. Attia, of triumph over back issues. Thank you for this most excellent interview....you both are the greatest.

Great podcast. As a person with hEDS and 2 years out from l5-s1 herniated disc related to Eds, I continue to strive to strengthen and stabilize my core. I was told o don’t have all the chronic pain with other joints is because I have been so active in strengthening my supporting muscle. It is great to get confirmation I am on the right track. Thanks for this podcast.

This is great! Please both of you collaborate with Rachel Zoffness!!! Ezra Klein of NYT did a great interview with her but I’d love to see her interviewed by Dr A, AND she and Dr McGill seem to have so much in common in how they treat patients yet from very different disciplines.

What are these thee exercises names?

Psalms 139:14 by King David
14 I will praise thee; for I am fearfully and wonderfully made: marvellous are thy works; and that my soul knoweth right well. KJV

HIS design of us is wonderful and marvelous. That should literally make you fear his awesomeness. Evolution is a scientific establishment lie like the pLandemic. Scientists must go along with the narrative and never question it if they want to be gainfully employed.

Dr. McGill is the GOAT for spine injury rehab and recovery.

Where are the links to the separate videos of the 3 exercises that he mentioned in the video around the hour mark? Can’t find them in the show notes - are they only for paying members?

I can respect what Dr. McGill is doing and I do like that he mentions empowering people with pain. I also respect his approach with reassuring the patient he had that the pain is not just "in his head," as we know this has a significant and negative effect on one's psyche. 

First hand experience is a very powerful tool that can help overcome situations like back pain and I use that same approach of empowerment with clients of mine if they have tweaks or come in with back pain. But we do differ on the notion that Dr. McGill is very mechanics focused and I employ the biopsychosocial model of pain management much more heavily. I don't see any mention of that model specifically in the transcript but if I missed it someone say so.

Anyways my point is, Dr. McGill shares stories of patients, which while powerful in their own right can be directly contrasted with stories where a mechanism is not the focus and pain goes away. Take my story for example.

Just the other day I was front squatting and on the first rep of my third set it felt like one of the vertebrae in my lower back slid over the vertebrae below it. That's unlikely to be what actually happened but it's the best way I can describe. At the moment it didn't feel great and luckily I could stand the weight up and re-rack it. 

Now I didn't focus on the mechanism or go into the "big 3" or even worry about bracing my core. I actually did the exact opposite. I stayed calm and relaxed taking my spine through various positions, hinging, rounding, extension, lateral flexion, rotation while standing, bent over and in deep squats. I then was able to do some large range of motion empty barbell RDLs and squats with and without lumbar flexion. I stayed mobile, and finished my workout using machines. I didn't catastrophize about the "slip" feeling or anything. I stayed calm the whole time. This feeds into the psychological component and fear of pain and or pain provoking movement that is often seen in those who progress from acute, to subacute, to chronic pain and disability - fear.

Over the next 2 days, no "big 3," no NSAIDs, no heat pad, no massage, nothing but a calm state of mind and staying active. Day 3 squatted 315 for sets of 3, and day 4 back to deadlifting 400+ without pain.

So my point is we can all share anecdotal experiences of ourselves or others we've worked with if we're in the field of healthcare. Why should the model of mechanics and "spine protection" be the one to follow? We have research investigating prevalence of disc bulge/herniation across age groups and rates of pain occurrence in people with disc bulges/herniations. 

For instance: Herniated discs are very common, with an estimated 20-30% of the general population, or 66.5-99.8 million US citizens, having at least 1 herniated disc, majority of which occur in the low back, lumbar area due to humans walking upright (Orief et al., 2012). In a great systematic review performed by Brinjikji et al. (2015), the authors looked at the incidence of symptomatic and asymptomatic degeneration in 3110 individuals, with ages ranging from 20-80 years old. Brinkikji and colleagues analyzed the data from 33 articles, 32 used MRI, 1 used CT, and found 37% of the 20 year age group, 52% of the 30 year age group, 68% of the 40 year age group, 80% of the 50 year age group, 88% of the 60 year age group, 93% of the 70 year age group, and 96% of the 80 year age group had disc degeneration, while 30 %, 40%, 50%, 60%, 69%, 77% and 84% of each respective age group also showed signs of bulging discs that were also asymptomaticIn a vast majority of cases, herniated and bulging discs are harmless (Dydyk et al., 2021), and should be no cause for alarm if they are noted in a radiographic image like an CT scan or MRI, especially if no back pain is experienced prior to the knowledge of its existence (Steffens et al., 2013). 

Evidence reports that in most back pain related cases, the percent of which is accurately attributed to herniated discs is between 1-3% (Dydyk et al., 2021). Of those 1-3% of cases in which a herniated disc is the root cause of one's back pain, the prognosis is oftentimes very promising, with most cases resolving or improving substantially within a few weeks (Dydyk et al., 2021). Moreover, Disc herniations are very likely to heal on their own through conservative treatment such as exercise (Chui et al., 2015), the reasons for this are currently not well understood, however, there is some evidence that dehydration of the jelly like center results in re-absorption, thus healing the disc (Orief et al., 2012).

Lastly in Steffens et al's review, the authors mention a study by (Jarvik et al., 2001), found that disc herniations were not predictors of future back pain episodes in individuals with a prior history of back pain, and the authors make note of 2 more studies (Boos et al., 2000; Elfering et al., 2002) that found no meaningful associations between disc degeneration or herniation and back pain (Steffens et al., 2013). Further, another study cited by Steffens and colleagues, conducted by (Hellum et al. 2012), found no association between disc bulge and low-back pain or disability.

So all of this is to say, how can we point towards the mechanical model of back pain when a fair amount of evidence (this isn't even scratching the surface btw) points towards the mechanical side not being a primary or even reliable predictor for back pain? 


References:

Boos, N., Semmer, N., Elfering, A., Schade, V., Gal, I., Zanetti, M., Kissling, R., Buchegger, N., Hodler, J., & Main, C. J. (2000). Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity. Spine, 25(12), 1484–1492.

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. 

Chiu, C.-C., Chuang, T.-Y., Chang, K.-H., Wu, C.-H., Lin, P.-W., & Hsu, W.-Y. (2014). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation, 29(2), 184–195

Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2021 July 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.

Elfering, A., Semmer, N., Birkhofer, D., Zanetti, M., Hodler, J., & Boos, N. (2002). Risk factors for lumbar disc degeneration: a 5-year prospective MRI study in asymptomatic individuals. Spine, 27(2), 125–134.

Hellum, C., Johnsen, L. G., Gjertsen, Ø., Berg, L., Neckelmann, G., Grundnes, O., Rossvoll, I., Skouen, J. S., Brox, J. I., Storheim, K., & Norwegian Spine Study Group (2012). Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 21(4), 681–690.

Jarvik, J. J., Hollingworth, W., Heagerty, P., Haynor, D. R., & Deyo, R. A. (2001). The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine, 26(10), 1158–1166

Orief, T., Orz, Y., Attia, W., & Almusrea, K. (2012). Spontaneous Resorption of Sequestrated Intervertebral Disc Herniation. World Neurosurgery, 77(1), 146–152. 

Steffens, D., Hancock, M. J., Maher, C. G., Williams, C., Jensen, T. S., & Latimer, J. (2013). Does magnetic resonance imaging predict future low back pain? A systematic review. European Journal of Pain, 18(6), 755–765

Rogan Next for Stuart !

Where are the 3 excerscises? Peter said that he will link them. Anybody knows?

Peters questions were perfect

Ahh Dr. McGill is a LEGEND ❤ My only wish is that I found him in time to help my father

Finally an interview that does Prof McGill justice. I suffered back pains for years and his books are paramount to my recovery journey. And it gotta be Peter Attia that does the interview. Thank you a million!

Great thank you, very interesting. It would be great if you could talk to other specialists like Peter O'Sullivan, Lorimer Moseley or Greg Lehman for a different view on those very important matters. Thank you for all the great work, loved your book.

I am a Pilates teacher and I worked with people who were in pain and were so tight . there is such a belief that stretching is the answer. I stopped them doing static stretching and worked with them to activate the muscles worked on posture balance strength stability and core and they were pain free

Hi, I just wanted to get some things off my chest. I have had chronic back pain since I was 13 so for about 7 years now. I was diagnosed with Scoliosis and immediately had to get a back brace. I wore it religiously (18 hours a day) for 4 years, but I had enough at that point. I hated it so much and felt like it had been years since I could relax and get a good night's sleep. I stopped wearing the brace knowing that it was very likely that I would need spinal fusion surgery. My back kept getting worse in the level of curve and pain. Eventually, I needed surgery so I got it. Well since then the pain has kept going. The pain is very different from before but it is hard to explain. I have gone to 3 physical therapists, many chiropractors, a few acupuncturists, pain psychologist, and did bio-feedback. These all had their ups and downs but my pain has improved since the height of it after the surgery. Now I have just given up on having a pain-free life (and having a happy life but this video is about back pain so we won't get into that). I have read like 5 books on pain and watched some videos I am not sure if this video will be any different (I have not watched it yet). But I hope there is something in this video that at the very least gives me enough hope for a less painful life that I can find the willpower ( and think it is finically worth it) to try and find some treatment. Because I have not been to a doctor in a long time and now I just hate everything there is about the medical stuff.

Link to the 3 exercises?

hasn't helped at all with my sciatica. wish it did.

Talking about the unfair development of nerves in a damaged disc - to go one further, after a herniation/damaged disc, during the repair process (which I have never seen explained so well as in this video), there is a risk for infection to get in - especially with Modic Endplate damage. Herniated/Damaged Disc + Endplate damage/microfractures can easily = bone infection. Which, it turns out, is what was causing my back pain of around 4 years.

I have just finished the treatment (MAST: Modic Antibiotic Spinal Therapy) through an Infectious Disease Specialist and am blown away by how much it has worked! I feel like a normal person again.

This video has been so incredibly helpful with the next stages of my healing process - because my poor facet joints and lower back muscles have been turned on 24/7 for 4 years. I'm now doing a deep dive into Stuart's website and advice.

Where are the links to the big 3?

Brilliant, thank you gents.

This was great, especially the big 3 and the boxer imitation. Ali was on point lol, thanks gentlemen

The back guru and helper to millions. A complete pleasure to watch this podcast in it's entirety. I started out listening to it on my phone then took Peter's advice and decided for this one it maybe best to watch it and watch it I did. Thanks for interviewing Mr McGill.

What an engrossing podcast!! I listened to its entirety in the airport, then had to immediately rewatch it at home to get all the visuals. Then I bought his book, and I can't wait to get into it. Amazing job, fellas!

This was a magical interview. Thank you

I spend a fair bit of time thinking about what to do to age well because of problems I see with my parents that I'd like to avoid. Dad has had a lot of back problems for years, so I'll pick up a copy of Back Mechanics, give it a read, then pass it on to him for his upcoming birthday. Thanks for the information. Hopefully this will be of some benefit for him.

I’m scheduled for a hemilaminectomy in 4 days…Jesus. Now what do I do????

I miraculously stumbled upon Dr. McGill’s classic textbook as part of my personal trainer continuing education. What a fortunate choice! I’ve learned so much from Dr. McGill, and that knowledge forms an unimaginable important foundation for everything I do. I work mostly with seniors, so the story of the old lady that Dr. McGill mentioned is even more relatable for me. Dr. Attia and Dr. McGill conversing is such a treat for us. Can’t believe we are this lucky to be able to receive this information for free. Thank you docs!

Mentioned in the video are the three most important exercises. Will there be links to explanatory videos about these three exercises?

What an awesome interview! Some of it over my head yet you both break it down so well.
When he said all the specialists couldn’t think of a way to improve their body system I thought how fearfully and wonderfully we are made by a loving and amazing God. Others may be accidental explosions of unknown matter to eventually somehow work from ape to human but I was designed for excellence by a creator

Thanks for that great interview. Can you speak more about sleep positions with bad backs? My pain is worse when I wake up after sleeping the night in bed

This was a great interview. A lot to take away about my LBP. Also, he's a great interview!

So great. I’m gonna have to listen to this 2 or 3 times.

This guy is incredibly knowledgeable!!!!

Are you kidding me? Almost 3 hours with the "back pain specialist" and no mention of interventional spine procedures or regenerative treatments? If I were a patient listening to this I would think that either you do exercises or have surgery for your lumbar issues. Nothing in between? Most of the treatments these days fall in between PT and surgery. Of course movement patterns are important and they need to be corrected, but try to do that in somebody with a hot disc or an acute radiculopathy - good luck with that! I take my skills and interventional diagnostic methods any day over the physical exam diagnosis, even that of Stuart McGill's. And by the way, almost all disc fragments, once they separate from the mother-disc, will resorb and disappear. Almost nobody has to have surgery for disc fragments - epidural steroid or epidural growth factor infusions do the trick. Sorry to be the party pooper here, but this podcast is incomplete at best.

Absolutely mesmerizing….thank you, Peter for finding this guy….and I am now a Yoga practitioner who after hearing this interview has done his last dead lift!

Anyone know a similar figure to McGill for knees? Been working through knee issues for years, and the medical system hasn't been any help with so far. I'd love treatment of the underlying issue or even a 50 hour course rather than muddling through it myself..

Loved this interview!!!

Exceptional podcast. I've been dealing with the same issues as you described, so this really hit home.