Why Do Our Backs Hurt? | Dr Stuart McGill

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 #backpain #rehab #crossfit - Listen to all episodes online. Search "Modern Wisdom" on any Podcast App or click here: iTunes: https://apple.co/2MNqIgw Spotify: https://spoti.fi/2LSimPn Stitcher: https://www.stitcher.com/podcast/modern-wisdom - I want to hear from you!! Get in touch in the comments below or head to... Twitter: https://www.twitter.com/chriswillx Instagram: https://www.instagram.com/chriswillx Email: [email protected]

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Chris Williamson?

  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 powerlifting to CrossFit, NFL, NHL, gymnasts, yogis 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 him pain free, but to also take him back to fitness so that he could re-break his own squat record. So my point is that if anybody understands how the complex system that is the spine works,

• 0:45Chris Williamson?

  it's Dr McGill. Today, we're talking about why spines are so problematic, how we can mitigate the effects 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 three 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 wanted to give something back to those of you

• 1:29Chris Williamson?

  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 £100 of free protein work supplements. All you need to do is, well, just listen.

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• 3:12Chris Williamson?

  Fuck it, I'll stop talking. Dr. Stuart McGill, take it away.

• 3:31Chris Williamson?

  Ladies and gentlemen, welcome back. This episode is brought to you by The Protein Works. I'm very happy to be supported by them again for this episode. They're giving away over £100 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 that you need to do is then send me a screenshot at Chris Willems on whatever social media you want. Find me a screenshot or tag me in your share and I will pick someone over the next week and I'll announce that before next Monday. But on to today's guest, Dr. Stuart McGill.

• 4:14Chris Williamson?

  We are getting fully spinal today, aren't we? How are you? Welcome to the show.

• 4:19Speaker 04

  Well, I'm well, Chris. How about you?

• 4:22Chris Williamson?

  I'm fantastic, thank you. I've been looking forward to this episode for as long as I can remember. Posted it in the gym Facebook group, asking if they had any questions. So we've got crowdsourced questions about spinal health.

• 4:38Speaker 04

  All right.

• 4:40Chris Williamson?

  It's gonna be a good one today. So first off, I guess, I posted in the group, a perfect example, posted in the group and a lot of people had questions. Why is it that for people who take care of their health and fitness, spines are so problematic?

• 4:56Speaker 04

  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 subcategorized spines in people, we would converge on common patterns. And if we did a little bit of pattern recognition, we'd notice some real cause and effect. For example, athletic groups are really fun to study.

• 5:36Speaker 04

  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 compromised 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.

• 6:17Speaker 04

  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." "You 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 problematic, to use your words.

• 6:58Speaker 04

  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.

• 7:36Speaker 04

  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.

• 8:20Speaker 04

  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 roadmap 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.

• 9:05Speaker 04

  So it's a bit of a long-winded answer, but those are some random thoughts as to why spines are problematic.

• 9:10Chris Williamson?

  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 answer. One of the things, definitely, one of the questions I've got down, what are your views 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?

• 9:47Speaker 04

  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.

• 10:27Speaker 04

  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 forester, a fisherman, a lumberman? A bus driver, a miner. Very few can do ergonomics. All they have is the skill to move their body in ways that do not create stress concentrations to the point of pain. So ergonomics is limited in in 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

• 11:06Speaker 04

  there is no ideal. The ideal is is a moving target, and that's just the biological reality of it.

• 11:14Chris Williamson?

  If you were to prescribe a cadence of movement from seating to standing or from if someone was to potentially be able to do their work, 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 or your computer is that optimal? Is it to move as much as possible and vary the vary the posture?

• 11:47Speaker 04

  Well, you're on the right track. No, I would. I think you've gone from one stream 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, their age, their past injury history, all of these factors. So there's no, no, no, there's no substitute. You've got to get up out of the chair and, and move for, uh, you, you, you think of every system in the body and every single one of

• 12:31Speaker 04

  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.

• 12:45Chris Williamson?

  Yeah, yeah, yeah.

• 12:46Speaker 04

  But, but you know what I mean. The, the biology, uh, has a tipping point. And, uh, there's such a thing as too much, just as there's such a thing as too little. The, the, the trick of it all is to find that medium.

• 13:00Chris Williamson?

  Totally. I certainly can appreciate. 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, for quite a while. I presumed that, uh, a step counter was really the only, only for like my mom 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, I don't need to bother about that.

• 13:41Chris Williamson?

  Like that'll undo my, uh, 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, uh, two bulging discs in L5S1 and a Schmorl's node. Um, that

• 14:00Speaker 04

  You know what caused that?

• 14:03Speaker 04

  It, it has a very precise cause.

• 14:07Chris Williamson?

  Please elaborate.

• 14:09Speaker 04

  Well, a Schmorl's node, you weren't born with it. You, you developed it. Now, Schmorl's node, uh, is 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 cartilaginous plate. That's called the end plate. Uh, when you lift heavy,

• 14:31Speaker 04

  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 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.

• 15:15Speaker 04

  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, with a ground substance. 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

• 16:01Speaker 04

  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 Schmorl's node or that end plate 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.

• 16:40Speaker 04

  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?

• 16:55Chris Williamson?

  Pretty, pretty damn close. I was going to ask you-

• 16:57Speaker 04

  Bang on, aren't I?

• 16:58Chris Williamson?

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

• 17:11Speaker 04

  CrossFit.

• 17:12Chris Williamson?

  Hundred percent right.

• 17:14Speaker 04

  Yeah, I know. I see them all the time.

• 17:17Chris Williamson?

  Why is it? So I read, I read, and I will be linking in the show notes below, an article, the article slash interview that you did with T Nation.

• 17:24Speaker 04

  Yeah.

• 17:25Chris Williamson?

  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 CrossFitters who will be listening. There will also be some, some powerlifters, some weightlifters and some endurance athletes as well. But I would be interested to hear if you could give a, an explanation of what are the typical injuries and why do you see them with CrossFit? Your assessment of the injury to methodology relationship?

• 17:56Speaker 04

  Yeah, well, it's a fabulous question, but injuries cluster around specific for sports and specific training methods. And there's a reason for it. It's the chronic exposure. So, uh, 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, I, I think it was in the title of the first paragraph, I have a love, hate relationship with CrossFit.

• 18:35Speaker 04

  I mean, I absolutely love CrossFit for the culture, for the supportive community. I love it. If I was younger, I would have been in there a hundred percent. But now let's get into the biological adaptation and then I can give you a solution. So.

• 19:00Speaker 04

  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, if you work with the Olympics,

• 19:45Speaker 04

  there are grooving, perfect movement patterns. It's a highly technical lift. There's no margin for bad form. So CrossFit tries to create an endurable athlete, a power athlete and a mobile athlete. That's very, very difficult to do in terms of biological adaptations. So by programming 10 Olympic lifts, you know the form is going to deteriorate. Now you're migrating stress. The first two reps might be all right. And, and interestingly enough, I don't get many Olympic lifters in as back pain patients. They have to go and see the knee and shoulder guys.

• 20:26Speaker 04

  Those are the joints that the Olympic lifters are having trouble with. Not really, they've got quite healthy low backs.

• 20:34Chris Williamson?

  And they'll be very stiff.

• 20:37Speaker 04

  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, 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 seem to be a great Olympic lifter? You would never pollute it when you're tired.

• 21:20Speaker 04

  But CrossFit's a different sport. It is an endurance. And look, I get the sport. You know, there's lots of sports that that aren't necessarily the best for your long-term athleticism. That's just, you know, 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.

• 21:59Speaker 04

  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 10 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,

• 22:44Speaker 04

  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 disc bulge. So every sport has its

• 22:59Speaker 04

  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, have you ever heard of Dan John out of the US? No. They call him the quirky uncle or something of training. He's a fabulous fellow. We're both the same age. We're both in our middle 60s. We have somewhat of the same background and whatnot.

• 23:39Speaker 04

  But Dan is a really wise guy, and he's very clever in that he can say magnificent things in just a few words.

• 23:50Speaker 04

  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.

• 24:16Speaker 04

  Isn't that, 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, there's just a, a thought for you. But you mentioned other athletes as well, like powerlifters, for example. They have a slightly different cluster of patterns for back injury, but generally speaking, they too begin with

• 25:00Speaker 04

  end plate fractures and Schmarles 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. Powerlifters, when you examine, and I've worked with some of the grand old women and grand old men of powerlifting, the very successful ones, you, the CrossFitters would consider them undertrained because a very heavy

• 25:41Speaker 04

  Strong powerlifter might do heavy squats on Mondays and and take five days off. In other words, they allowed all the micro fracturing at the, this is at the micro level now. Down at the level of the bone osteons or the bone cells. Um, they are damaged, there's no question, but is that damage a good thing? Or a bad thing for a CrossFitter, it would be a bad thing because the CrossFitter 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.

• 26:23Speaker 04

  But the powerlifter has a much more wise biological adaptation schedule. They'll do heavy squats or or say it's a pull from the, from the ground. Um, a deadlift, for example, and then they take five days off. Now let's discuss the adaptation of bone. Um, 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 glues 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.

• 27:07Speaker 04

  Calcium, magnesium and whatnot to scaffold on before they break it off again. But what does the CrossFitter do? They train the next day and they break off the adaptation that they were trying to create. So do you see the, the same micro damage in a powerlifter 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 CrossFitter 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

• 27:50Speaker 04

  to load and better athletic performance. But, you know, I, I, I get it. I get CrossFit. I, 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, the, the, the training, you know, it may not be so much the, the poor exercises sometimes, it may just be the, um, not paying enough attention to the adaptation schedules of some of these things. And, you know, that's just pure programming.

• 28:33Speaker 04

  So any organization could change their programming and create a more robust athlete.

• 28:39Chris Williamson?

  I think there's certainly in the CrossFit community, there is a addiction to training. That classes would tend to run Monday, Tuesday, Wednesday, Thursday off, Friday, Saturday, Sunday off, which means that you're going to be training, even if you're just like a, 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 an awful lot. And I, I do, I get what you mean. The, the fact that a rest day for, 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

• 29:23Chris Williamson?

  EMOM of rowing wall balls and burpees. And that's, that's his active recovery day, but it'll be at a pace that would bin 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 CrossFitters is when you look at it in the cold light of day is and probably to other sports as well, especially powerlifters. But then on the flip side, from the kind of cultural perspective, CrossFitters look across at the, in our gym, we have a CrossFit area, weightlifting area, bodybuilding area, and a powerlifting area. So there's like every different species of of strength athlete is kind of moving around within the same place and some endurance guys as well. And

• 30:06Chris Williamson?

  the CrossFitters will look over at the powerlifters and see that they're sat down for five minutes in between lifts and they'll, they'll be sort of thinking, giving them shit. And then the powerlifters will be looking at the CrossFitters wearing their brightly colored shorts with like doing millions of reps and burpees and going out and running in the rain and stuff. And they'll be giving them shit. And it's, it's interesting. It's very, a very interesting dynamic. I think you'd probably quite enjoy observing from a bird's eye view if you could access the CCTV.

• 30:32Speaker 04

  Yeah, Chris, that's my world. I see it every day. So I don't need to see it anymore.

• 30:39Chris Williamson?

  I won't, I won't send you the stream.

• 30:41Speaker 04

  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, and give them any advice? Unfortunately, we have to

• 31:26Speaker 04

  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.

• 31:39Chris Williamson?

  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 backseat. And last year, when my back went, for want 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 Kazew in Texas and then came back to the UK and just started all over again. And the same thing happened. I'd been sat on planes, cramped up, pretzelled up into all manner of different, different postures. And then the same, the same thing happened again. Um, so.

• 32:23Speaker 04

  So you earned your pain.

• 32:25Chris Williamson?

  I have, oh yeah, I really did. I mean, it just, it, it's one of those things. Another interesting point on that in terms of, um, the injury, giving people the motivation to do their rehab was when I had an MRI scan at the beginning of this year. So I'd been working after back end of last year, sort of five months or so, working quite hard on my rehab, but was seeing an upper limit in terms of my recovery. I then saw the MRI scan this year. Now I know that there is a very tenuous link between pathologies that present on scans and pain that presents, a lot of people who do strength sports would present some sort of abnormality

• 33:06Chris Williamson?

  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, the cause of my pain and also the cause of my, the, 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.

• 33:48Speaker 04

  Well, MRIs, if they're used properly are absolutely fabulous and you're, you're a case in point. And I, and I argue the statement that, uh, MRI evidence does not link to pain. In fact, I would argue the opposite. The problem is an MRI image shows anatomy. And I don't know how old you are, but say you're 30.

• 34:11Chris Williamson?

  Thirty one.

• 34:12Speaker 04

  Thirty, thirty one. Uh, yeah, you can't fool me. Stu knows, but anyway. If, if, uh, 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. Uh, sorry, old scars. They don't cause pain anymore. Some of them will be fresh wounds. Now, a radiologist has no way of knowing which are wounds and which are scars. What is painful and what is not. However, if you proceed the MRI session with a thorough assessment of the person, you know exactly what you're going to see on the MR.

• 34:55Speaker 04

  So you can do a thorough assessment and you know the pain is coming from whatever, uh, structures, endplates, you know, compromised nerve roots, uh, sequeleac joints or whatever. The assessment will reveal those sources and then you go look at the MRI scans and you'll get pretty close to a one-to-one match. So I wouldn't blame the, uh, MRIs of not being linked to pain. It's the system that prevents them from being linked to pain. Uh, so they become quite powerful after you've already seen the person. But here's the thing, the

• 35:36Speaker 04

  radiologist has no idea whether that person is a CrossFitter, a powerlifter, or a sedentary worker at a 10-hour-a-day computer job. And what I mean by that is, uh, I, I've seen athletes who bring in their MRI reports and the report says, oh, they've got degenerative disc disease. And then I look at the MRIs and I say, that's a, that's a powerlifter's spine. That's not an MR. That, those are sclerotic endplates. That's what, that's the bony callus that, that a powerlifter has developed and adapted over 20 years of heavy lifting. But the, but the

• 36:16Speaker 04

  radiologist had no idea whether that was an adaptation to heavy exposure. So now that's healthy. That's exactly what the powerlifter needed to set a world record. So do you see my issue when I hear that MRIs are not linked? It's the system that, and the fact that radiology, 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.

• 36:55Speaker 04

  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 um, issue that people will start to obsess over their MRI. Wait a second, you just gave an example of, you just got psychological relief in understanding that you do have something there. It's not something to ignore. It's time to get on it and treat it and get your health back.

• 37:36Speaker 04

  So it all boils down to just being a good human being and telling the truth. Uh, respecting that the patient you're dealing with is not a five-year-old. They're a 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%.

• 38:03Chris Williamson?

  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 wish that I could go back in there and do that. But previously, before the MRI, I'd have probably been like, oh, well, my back feels okay today. Like, oh, boys, can I just join in? And then that would be me, throw like, I'll just go, oh, no, no, no, it's fine. Like, my back, it'll just be a thing. But then, you're right, the MRI really hit home with regards to the fact, 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.

• 38:48Chris Williamson?

  Take some time, focus on the rehab and work on that and then slowly begin to build things back in, which is currently now the strategy and has been, has been for a while.

• 38:59Speaker 04

  And it's working. I take it.

• 39:01Chris Williamson?

  So it is specifically, I won't bore the listeners with my particular pathology in my back. There's some, 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 plan.

• 39:35Speaker 04

  Yeah. What, what people don't realize is just because the pain is gone one day, it doesn't mean their back is healed. And this is the mistake. The underlying adaptations still need to continue to build that robustness back again. So if you've got a disc bulge, it's time to get the, uh, loss of stiffness back into the disc, actually done by, with stabilization exercise and whatnot. And that's, I hate that word because it doesn't mention what specific exercises they should be. But nonetheless, um, you do have to honor

• 40:17Speaker 04

  that history because, you know, 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. Uh, and I've created it in, in the, 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, uh, again, just because you're out of pain, behave and

• 40:54Speaker 04

  Organize a proper adaptation schedule and really enhance the chance for being successful at gaining your athletic robustness once again.

• 41:07Chris Williamson?

  I get you. So we've touched, one of the things that you come up with a lot is the relationship between stiffness and flexibility in the spine. Would it be possible to have a yogi who's also a powerlifter?

• 41:21Speaker 04

  No.

• 41:26Chris Williamson?

  See, one of the interesting things is this, I spoke to Dr. Quinn Hennick, Doctor of Physical Therapy for Juggernaut Training Systems about a year ago, and he was talking about what he referred to as mobility myths. So we were going through the typical tools and approaches that people use that you see in a gym, the static stretching, the Theragun, the vibrating foam roller, the dynamic stretching, the PNF, and all these different things. And he was talking about the mechanisms that actually occur when, when these things happen. But I certainly know that in strength sports, at least in the UK, in my, my experience, I see a lot of static stretching. There's a number of subscription services that you can get that focus exclusively on static

• 42:09Chris Williamson?

  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.

• 42:21Speaker 04

  Well, that wasn't your question. You asked me, could they be a powerlifter and a yogi? Oh, let me say why I said that and very emphatically. Have you built a world champion powerlifter?

• 42:32Chris Williamson?

  No.

• 42:33Speaker 04

  Do you know one with loose hamstrings?

• 42:37Speaker 04

  Yeah, they don't exist. So, yeah, I mean, the strongest powerlifter has to have tight hamstrings. It's non-negotiable.

• 42:46Speaker 04

  So there you have it. Now, a powerlifter needs to fight their mobility to get down into a proper deadlift pull. There has to be elastic tension in their body to assist the muscles in the pull 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,

• 43:28Speaker 04

  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 bodyweight squat to stand back up again.

• 43:43Chris Williamson?

  Is that so?

• 43:44Speaker 04

  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 powerlifter. So that rugby player is somewhere in the middle. The CrossFitter 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 mean, 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?

• 44:25Chris Williamson?

  No.

• 44:26Speaker 04

  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 weightlifters. I'm talking about elastic athletes here. What a mistake it is to stretch away that elastic athleticism.

• 45:08Chris Williamson?

  Is that the way it works? Is it a, are the two counter to each other? You've got stretching and then you've got progressive overload or you've got loading? And those two, are they about as antagonistic as you can get?

• 45:23Speaker 04

  Yeah, you're talking extremes.

• 45:25Chris Williamson?

  Yeah.

• 45:28Speaker 04

  Maybe in, in, in some people, but again, my world is elite athletes. I have to tune the machine. I'm tuning elasticity, I'm tuning fascial trains, I'm tuning muscle pulses.

• 45:46Speaker 04

  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 annular disc stress. They've just done a rowing session in a boat or on an ERG. 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.

• 46:29Speaker 04

  And then their spine, as they sit tall, gets a little bit of a whip as their hips explode and really whomp. 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... Uh, and all you have is mobility. You won't throw a ball very, do you know yogis who can

• 47:12Speaker 04

  throw a hundred and ten miles an hour? Do you know a power lifter who can throw a hundred and ten miles an hour? Have you measured the great golfers? How strong are they?

• 47:21Chris Williamson?

  I'm not sure.

• 47:22Speaker 04

  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?

• 47:29Chris Williamson?

  Yes.

• 47:30Speaker 04

  Okay, you noticed it didn't go very far.

• 47:32Chris Williamson?

  No.

• 47:33Speaker 04

  Yeah, it goes further when you don't try. So when you have a muscle pulse of about forty to fifty to sixty 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, in the MMA leagues, like the UFC, for example, do you think it's the guys with the great big muscles? No, they push their punches. It's the guy who can snap, bam, that hits the hardest. So it's a neural priming of a spring that is

• 48:17Speaker 04

  then released. Uh, 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. Because in the great athletes, and I'm, and I'm not talking about duffers here, I'm talking about world-class people. Um, be very careful with stretching.

• 48:44Chris Williamson?

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

• 49:27Chris Williamson?

  baseball pitchers and people like that?

• 49:31Speaker 04

  Well, first of all, they're highly asymmetric athletes.

• 49:35Speaker 04

  So they're not going to pass a screen for symmetry, but nor would you want them to.

• 49:41Chris Williamson?

  Yeah.

• 49:43Speaker 04

  You know, they're a tuned elastic asymmetric athlete. Uh, I don't really know what more you want me to say on this.

• 49:53Chris Williamson?

  I didn't think it would be anything else.

• 49:55Speaker 04

  Yeah, I can give you all kinds of

• 50:00Speaker 04

  tests. I mean, it's so interesting when we look at the uh, fascial linkage, for example, through the arm, uh, down the right side of the body to the psoas muscle, for example, and how I can tighten the psoas by internally and externally rotating the arm through the shoulder and you can palpate the psoas tendon, uh, can try, be getting tight and then releasing by doing this. So there would be an example of a highly tuned thrower, for example, who has a beautiful elastic tuned chain. If, if you, you didn't have that body type, you, you won't throw very fast. Um, and if you didn't adapt it, you probably wouldn't throw

• 50:41Speaker 04

  very fast either. So, you know, it's a combination of, uh, things and there's all kinds of things with lever ratios and tendon lengths and all kinds of things. I mean, a sprinter looks like a sprinter for a reason, right? They have a lot of lordosis in their low back and uh, you know, you, you, you don't need much calf muscle, uh, but you need a, a pre-turn uh, pelvis to get the power production and hip extension out the back to run. Um, if, if you plant your foot ahead of your pelvis, you're actually slowing down. All the power has to be out of the extensor range of the foot behind the, the pelvis. But, uh, by the same token, they're not in the UFC kicking people in the head. Those, the fighters have

• 51:25Speaker 04

  flat backs because they have to pre-turn their pelvis to kick high. So, you know, again, uh, we can talk about, uh, all of these adaptations and, and what you get from your parents and what, what makes a good athlete and how you tune them. But, uh, I'd be very careful with discussions of, uh, stretching and.

• 51:48Chris Williamson?

  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.

• 52:07Speaker 04

  Right. Well, around, it would have been about 30 years ago, we were starting to create different back injuries on cadavers in the lab. And when you damage a disc, you lose a little bit of disc 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 buttock pain. Well, there's an example where the pain triggers

• 52:49Speaker 04

  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,

• 53:30Speaker 04

  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

• 54:11Speaker 04

  to emerge. You know, it's a natural PNF pattern, a cross 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 and 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 said, 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

• 54:54Speaker 04

  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. First of all, your listeners need to understand the principle of proximal stability for distal athleticism. So consider if I was to, say I could bench press 200 kilo. I can't, but say I could. There's my bench press muscle, my peck major. So distally to the shoulder joint, it flexes my arm around. That's its

• 55:37Speaker 04

  distal effect. But it's proximal effect. If I just contract my peck major, proximally it bends my rib cage towards my shoulder joint. So one creates a push and the other leaks it away. Do you see the difference? Yeah. 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 proximally. So now we had to create more proximal stiffness.

• 56:21Speaker 04

  So we took Muay Thai 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, etc., etc., etc. So when athletes say, you know, you've heard a few quite famous athletes recently say,

• 57:03Speaker 04

  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, etc. 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, my book, Ultimate Back Fitness and Performance, to write progressions that would then keep the theme going

• 57:46Speaker 04

  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.

• 58:19Chris Williamson?

  Yeah, for sure. One of the things that I think is interesting when we talk about that is that... Certainly for me, I've, I actually find an immediate relief when I do the big three.

• 58:32Speaker 04

  Right.

• 58:33Chris Williamson?

  So it's not, it's, it's not just that there is an overtime adaptation that genuinely actually feels like there is a, some sort of relief to my lower back discomfort when I do them.

• 58:47Speaker 04

  Yep.

• 58:47Chris Williamson?

  Which I think is really interesting.

• 58:49Speaker 04

  Do you want to know why?

• 58:50Chris Williamson?

  I certainly do. If there was any man in the world for me to tell, to tell me why, it's you.

• 58:55Speaker 04

  Yeah, 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, it lasts about 20 minutes and some people it 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 implant fracture or a Schmorl's node, 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 sloppy and 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.

• 59:46Chris Williamson?

  Good timing.

• 59:47Speaker 04

  Yeah.

• 59:47Chris Williamson?

  That's a.

• 59:48Speaker 04

  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 session with the big three.

• 1:00:03Chris Williamson?

  That's their warm up.

• 1:00:04Speaker 04

  They are faster and they're also more pain resistant. 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.

• 1:00:39Chris Williamson?

  I have, I have got it. I've 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're 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.

• 1:01:17Speaker 04

  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

• 1:02:01Speaker 04

  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.

• 1:02:46Chris Williamson?

  That must be so uncomfortable. That must be absolutely torturous, that final.

• 1:02:51Speaker 04

  No, no, no, don't give me that. You're a CrossFit. That's what you've lived for.

• 1:02:56Chris Williamson?

  Yeah, get comfortable being uncomfortable, yeah.

• 1:02:58Speaker 04

  That's what it's all about.

• 1:03:01Chris Williamson?

  That, um, that doesn't, well, I'm, I'll, I'll wait and see. I will post it in the members group and the, the guy who, uh, who asked the question, I'll see if he can do the five minutes, five minutes on, one minute off times three.

• 1:03:13Speaker 04

  Oh, I've, I've got plenty of other tortures for you if you want, but you know, it's, it's interesting. I have a, uh, an acquaintance, we'll call him, who is a very, very successful person. I'm sure if I reveal his name, most of your listeners would know of the person I'm talking about. He says, the measure and the predictability of one's success is how willing they're, uh, how, how willing are they to tolerate discomfort?

• 1:03:46Speaker 04

  That is in a nutshell, what he says will separate those. Anyway, that I'm sure there's other things as well, but that, that would have been his, uh, and, uh, there's, there's CrossFit to it. So do you see, you see why I love it and I hate it?

• 1:04:01Chris Williamson?

  Yeah, absolutely. There's a, a quote in James Clear's Atomic Habits. It's a book which came out this year. James is a habit expert. I'm not sure if you've read it yet, but if you, if you haven't, and if you've got time to read something, you're looking for a holiday read, highly recommended. My favorite book of 2019.

• 1:04:17Speaker 04

  Oh, beautiful.

• 1:04:18Chris Williamson?

  I had James on the podcast about three months ago and he's, he really is, he's the real deal. Um, and he went and interviewed the coach of a, one of the Chinese weightlifting team's coaches. And he asked him the question, what makes the difference between the guys who are good and the guys who become the absolute best? And the coach's answer was that it is the people who can put up with the boredom of doing the same thing day in, day out. And what he identified there was that I think a lot of normal athletes like myself, look at someone like Matt Fraser or, uh, Adele Beckham or whatever it might be and think, well,

• 1:05:02Chris Williamson?

  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, his training diaries and stuff like that. You see him training a lot and you think he must, he must just turn up to training and love it every single day. And the coach of this particular weightlifting team said, that's not the case at all. He's like, there's days when my athletes turn up and they don't 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 won'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.

• 1:05:46Chris Williamson?

  I thought that was really, really interesting and illuminating.

• 1:05:50Speaker 04

  I agree.

• 1:05:52Chris Williamson?

  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, if the best crossfitter on the planet, Matt Fraser, gets bored training and he works through it, then it's exactly the same for you. He doesn't have some superhuman level of motivation. He just grits his teeth and does the work. I thought it was nice.

• 1:06:19Speaker 04

  Yeah, yeah. Well, I don't know Matt Fraser, but he has to be of that type. There's no option.

• 1:06:27Chris Williamson?

  Yep. I wanted you to tell the listeners the story behind the gift of injury, if you could.

• 1:06:35Speaker 04

  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 1,100 pounds. He'd squatted over a thousand pounds over 50 times in international competitions. So he'd been around the block. So I I knew the name and I knew some of those statistics. I got a phone call one day and he he said very politely, this is Brian Carroll, Professor. I've I've hurt my back. Would you see me? And I said, well, yes. And he came up and

• 1:07:20Speaker 04

  he he was not moving well. And I thought, wow, this is one of the best squatters and he has difficulty getting in getting in and out of a chair. And it 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 I never put a person's images up on the view box early in the consult. I really try and understand the person, who they are, their personality. And and then I I assess them for their physical pain triggers. And only then will I look at the images.

• 1:08:03Speaker 04

  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.

• 1:08:18Chris Williamson?

  Now. What does that look like on an MRI? Is it just like?

• 1:08:21Speaker 04

  Well, if if you get the book, you'll see because we put that image, that that MRI in the book. Anyway, so we started to talk and he was starting to move a little bit better. And 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 I've said, seen, they they said, I'm done. I I'm not even going to get out of pain. I've done so much damage to my back.

• 1:09:00Speaker 04

  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, 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, my world record back. And I said to him, I said, well, and obviously I'm a lot older than he was. And I said, well, if you were my son, Brian, I'd give you this advice. I said, let's work on getting you out of pain, but I, I, I would seriously consider doing something else with your life. I mean, this is a pretty compromised spine to build you back to, to set a world

• 1:09:40Speaker 04

  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, uh, the book called Gift of Injury. Um, he did get out of pain. He did start training again. Uh, he did bone callusing, which is you stimulate the bone and he did things like, say, a mildly loaded carry. And then he would take five days off to allow the scaffolding of the bone to occur, the adaptation that I described earlier. Then, uh, he did that for a year. So he bone

• 1:10:20Speaker 04

  calloused for a year. And then he started to get back into, uh, 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, uh, I think he only lifted, what was it? 1174 pounds, something like that. Um, then we show the MRIs of his back three years later, once he'd been through his L5. Uh, first of all, the fracture in the sacrum had completely filled in. Uh, L5 had remodeled under the chronic load, uh, and it was square once again. Uh, the discs were looking pretty good. I mean, they weren't flawless, of course.

• 1:11:02Speaker 04

  But anyway, he has zero pain, he has zero pain to this day. And he's still, uh, training and does the, uh, 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, I, we, 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 table. He lives in Florida, by the way, 2,000 miles away. But I'd go down and we, we, we'd write for a bit and then 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.

• 1:11:47Chris Williamson?

  And then my son. That sounds like the most lovely process for writing a book. Have a bit of a 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.

• 1:11:59Speaker 04

  That, that was it. But then we, we, we, I, 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, I, I, you know what I mean by that. Well, you know, he's an outstanding fella and uh, he's just an ace and uh, we've become, and, and so often, you know, i- if, 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 deal with, I have to get to the emotional level with them. If we're going to change their life, this is, these are huge things.

• 1:12:42Speaker 04

  And anyway, uh, you know, I, I've become friends with, 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. So then the book became a manual for strength trainers or, or strength athletes regaining their strength athleticism off a back injury. So 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?

• 1:13:22Chris Williamson?

  No, no, I don't.

• 1:13:23Speaker 04

  Oh, okay. Well, I can send you a copy. But anyway, then, as I said, we showed the before and after MRs of the mechanostimulation. That we did, that he did and read adapted his back. So.

• 1:13:38Chris Williamson?

  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 reheard 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.

• 1:14:07Chris Williamson?

  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.

• 1:14:49Chris Williamson?

  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 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, I'm going to go back and be better than I ever was.

• 1:15:13Speaker 04

  The, the, this is the, I, I love hearing what you've just said, because this is the difference. You were talking earlier about that, that one percenter who becomes the world champion. It's the ones who are willing to endure. When, when you work with someone like Brian Carroll, the strength of character to basically put a car on your back and then squat.

• 1:15:37Speaker 04

  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, we've worked together actually in, in rehabbing some other champion powerlifters. Um, sorry, these are patients who keep calling in.

• 1:16:03Chris Williamson?

  God damnations.

• 1:16:05Speaker 04

  Yeah. If, uh, uh, say you've got a powerlifter who wants to squat a thousand pounds. They've never done it before. Um, 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 1,050 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, a game of mind and physical adaptations, neural adaptations and all the rest of it. It's a really complicated enterprise that,

• 1:16:49Speaker 04

  that a lot of people don't, 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, uh, carry it through all the way to the end.

• 1:17:03Chris Williamson?

  Yeah. Yeah. It's a, it's a really, a really fascinating story. And I love every time that I hear that story about Brian. I absolutely love it. I'm very, very excited to get stuck into the book as well. I appreciate.

• 1:17:13Speaker 04

  Why don't you have him on your podcast? You hear it from the horse's mouth. He's a, he's a fabulous man and a good storyteller and, and.

• 1:17:22Chris Williamson?

  Would you be able to do an introduction?

• 1:17:23Speaker 04

  Of course.

• 1:17:25Chris Williamson?

  Absolutely. Well, listeners, you've heard it here first. I might be speaking to Brian Carroll sometime soon. Wouldn't that be cool? That'd be a cool second part.

• 1:17:31Speaker 04

  I'm sure Brian would love to. He's a lovely fellow.

• 1:17:35Chris Williamson?

  I, I would love to hear where his minds are. Again, you know, as some of the listeners, and I'm sure a lot of people will be tuning in, seeing your name, uh, seeing the particular topic that we're talking about and thinking, I want to hear, I want to frame my mind about injury in the right way. I want to have the mindset which is going to be optimal to help me progress my injury. 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.

• 1:18:09Speaker 04

  It's huge.

• 1:18:11Chris Williamson?

  Yeah.

• 1:18:11Speaker 04

  It's huge, you know, but I'll just pick up on that because in particular in your country, there's, there's, 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, your back isn't fragile, you know, to just carry on and keep doing the, whatever it is you're doing and whatnot. And I say, well, hold on a second. There are different types of people. If you get a CrossFitter and you say, well, just carry on, the person who's a CrossFitter is a go getter to start with.

• 1:18:47Chris Williamson?

  Yeah.

• 1:18:48Speaker 04

  And they don't need to be encouraged to keep going for it.

• 1:18:51Chris Williamson?

  No, no, no, no. For the love of God, pump the brakes.

• 1:18:54Speaker 04

  Yes. Thank you. For the love of God, pump the brakes. And but the next person who has this idea, well, you know, they, they are magnifying every little ache and pain. And, you know, they've had a good fart and they're calling the doctor. It's, it's, so there's a time and a place to tell a person, yeah, your back is fragile. And for a CrossFitter, you've got to hold them back and let biology adapt the robustness to the tissues that you can't see the fractures, the micro fractures on the MRI, but they're there. And it takes

• 1:19:35Speaker 04

  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, 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

• 1:20:04Speaker 04

  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.

• 1:20:22Chris Williamson?

  Yeah. Um, I appreciate that you have athletes ringing you because you need to, you need to deal with some people who might be in a little bit of back pain, Dr. McGill. So I'm, uh, I'm going to, I'm going to try and, 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 pot as one potential extra. If you were to have, um, the next closest exercises that were the close runners up for the big three, were there any? Or would there be any that are your staple favorites for a broad cross section of athletes?

• 1:21:02Speaker 04

  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, uh, 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, uh, program than it would be for you. Or I've got a, uh, an Olympic class swimmer or, you know, race car driver. It doesn't matter. So you see, the answer is, is very much a moving target. Um, for myself, for example, uh, I, I do some,

• 1:21:41Speaker 04

  uh, things well beyond the big three that for my body at this stage in my life, I have zero pain. I feel fabulous. Uh, I'm reasonably athletic for my age. Um, but I've had a lot of trauma as well. So what I would do would be very different than, than what you would do. Now this might surprise some people. Um, whereas my body would have thrived on more load and more strength in my thirties, forties and maybe early fifties, believe it or not, now it's less load and more mobility. And you'll find that people go through this progression. Uh, so two days a week now,

• 1:22:22Speaker 04

  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, uh, 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. Uh, in, in former decades, I would have, uh, carried more load, been more, um, cognizant of the perfect hip hinge. Now I've backed right up on the load and I get just a little bit more lumbar mobility.

• 1:23:05Speaker 04

  Um, uh, my hips, uh, yes, um, I, uh, mobility, uh, 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?

• 1:23:39Chris Williamson?

  Absolutely.

• 1:23:40Speaker 04

  And then I, I will give you the decades, um, honoring the past injury history, um, uh, et cetera, to come up with what the best progressions, uh, beyond the big three would be. But there's a, a little bit of a, a start on the discussion.

• 1:23:57Chris Williamson?

  I got you. But Dr. McGill, I, I can't thank you enough for coming on. It's been absolutely fantastic. I'll make sure that links to back mechanic, uh, 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 an email, once we're done, I'll make sure to add that as well. If there's any.

• 1:24:18Speaker 04

  Yeah. Well, the books, the books are on amazon.uk or amazon.co.uk, whatever it is.

• 1:24:25Chris Williamson?

  Yeah.

• 1:24:26Speaker 04

  Um, and, uh, but they're also on our website, backfitpro.com.

• 1:24:32Speaker 04

  If people are needlessly suffering with with their their backs.

• 1:24:39Chris Williamson?

  I understand it's I'm 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 Well X 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.

• 1:24:59Speaker 04

  No, I don't. I have a I have a very strong conviction that if you're a master of the craft, you can't do Facebook and Twitter.

• 1:25:07Chris Williamson?

  Ah, I see.

• 1:25:10Speaker 04

  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.

• 1:25:32Chris Williamson?

  I understand.

• 1:25:33Speaker 04

  Far too busy for that.

• 1:25:35Chris Williamson?

  Well, you are cut you're cut from a similar cloth to us, Dr. McGill. It's it's one of those things where I think a lot of people would benefit from taking a more ascetic route that 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 a we're part of the same camp, but I'm going to I'll stop pontificating. Today's been great. Dr. McGill, thank you so much for your time.

• 1:26:01Speaker 04

  Thanks, Chris.