McGill and Spine Models

Stuart McGill using Dynamic Disc Models to Share His Knowledge

Stuart McGill on Back Talk Doc podcast.

Professor McGill of backfitpro sharing is knowledge using Dynamic Disc Models to teach.

TRANSCRIBED FROM VOICE TO TEXT so some errors exist below.

Sanjiv Lakhia DO (00:00:05):

When I started the podcast back talk doc, about two years ago, I had two goals in mind. First, obviously, I’m biased. I love where I work and I wanted to feature all the talents and services we offer at Carolina neurosurgery and spine associates. And largely I’ve done that. We’ve had great interviews with some of the best surgeons and the entire region in the country talking about things like minimally invasive spine surgery spinal stenosis. I’ve been able to interview many of my partners who are physiatrists as well where we’ve talked about regenerative medicine injections, and we’ve had multiple episodes on the rehabilitation data approach to back pain. So I’ve been very proud and pleased to offer that to all you listeners out there. My other goal though was to try and attract thought leaders in the space of spine care from across the country and the world. And folks I’m super excited today to say that we are accomplishing that goal in the moment today. I’d love to welcome to the show. Probably the world’s most renowned back mechanic spine. Biomechanic Dr. Stewart McGill Stu, welcome to the show.

Pro. Stuart McGill (00:01:14):

Well, thanks so much, Sean GE and a good day to you as John to John as well.

Sanjiv Lakhia DO (00:01:19):

Yes. And also my friend and colleague, Dr. John Lecher is joining us for a conversation today. Originally Steve, when we talked, we’re kind of tiling this show fact or fiction regarding spine care and back pain. But I have a feeling with three spine nerds like us as could go in any direction. But I want to introduce you to the listeners. You are, I’m not understanding you’re literally a living legend in the field of back rehabilitation. Particularly when I mentioned to the physical therapy team in our group, everyone was really pleased to hear that you volunteered some time to speak with us, but for those potential patients out there, or just people who aren’t familiar with you, I’m gonna take a brief moment and kind of go over your background. So Dr. Mcgill is a distinguished professor, EMTI spine bell mechanic at the University of Waterloo.

Sanjiv Lakhia DO (00:02:13):

He’s been a professor there for 30 years and explored low back mechanics of both intact humans, both normal and injured people and harvested tissues where specific injuries are created and analyzed. He’s been the author of many scientific journal papers. Last I recall almost 200 peer review published articles, maybe more he’s mentored over 40 graduate students. And his work has received several international awards, including the Volvo by engineering award for low back pain research in 1986. And most recently the order of Canada as a consultant, he’s provided expertise on low back injury to various government agencies, many corporations and legal form firms, professional and international athletes and teams worldwide. And Dr. Mcgill’s regularly referred special patient cases from the international medical community, for opinion. So folks he’s, he’s, he’s an expert. He’s also an author and I’ve been deep-diving into his work.

Sanjiv Lakhia DO (00:03:12):

So the first one I have here is you know, with my green screen here, that’s gonna show up back my and this is a fabulous book put together. Actually, I wasn’t aware of it until John mentioned it to me to take a look at, for my own back. And it’s been a wonderful resource. Other ones is Ultimate Back Fitness and Performance. Then I also have Low Back Disorders, evidence-based prevention and rehab in my physical therapy team provided for me. So they are definitely heavy, heavy into your work. He sat on numerous editorial, Bo boards for journals like the journal of spine clinical biomechanics and the journal of applied biomechanics. As I said, an author and he is also put together the book gift of injury, which is a very, very interesting read. And he is, a married gentleman with two children and lives in Ontario and really just an authority in the world of back pain. Stu, did I leave anything out that you think people should know about you?

Pro. Stuart McGill (00:04:14):

I was, I, I was thinking of a very smart answer that you might have to censor, so we won’t start off that way. <Laugh>

Sanjiv Lakhia DO (00:04:21):

Okay. Fair enough. There. But really, you know, it’s, you’ve dedicated your life. I mean, you’re literally, this is your focus and it’s so appreciated for those of us in clinical medicine, that there are people who have put in the work in the laboratory. And one of the things on this podcast I’ve been able to look at all different types of angles and approaches to how you treat back pain. And what you really add in terms of value, add to the show is a scientific background on how you’ve literally investigated a lot of them, the thoughts about the way things should be and, and put evidence behind them or, or kind of disprove ’em. And it’s very much appreciated it cuz in the world of back pain, it can be a black box, I guess it’s like we can go down pathways and not get the results we’re looking for. You know, I, I think the question I wanna lead off within our fact versus fiction before we get into that, I wanna let John, I think he’s got a very good question and we were talking about it before he came on referencing how you kind of made a decision to get in this clinical space. So John I’ll let you lead with that question as an opening question for Dr. Mcgill.

John Lesher, MD, MPH (00:05:31):

Sure. Thanks, I was just basically really interested in how, or, or was there a, a Sentinel event or something that went on in your early career or life where you said, gosh, the studies that I’m doing and the research that I’m doing, I need to apply this directly more to patients to help in their assessment and then guide them through the rehab journey. So I’m just curious, was there, was there a spark that really got that going in your career?

Pro. Stuart McGill (00:06:02):

Yes and no, this this might surprise you. I never intended to become this clinician. I never intended to see patients. I was a scientist and started off in the lab laboratory, just asking a simple question. How does the spine work? That was it. And I would be invited to orthopedic meetings or neurology meetings. And the medics would approach me afterwards and say, what you just showed in terms of mechanism is something that we haven’t thought about. Would you see a patient that’s being a bit difficult right now, a challenge for us? And I said, no, I’m not a clinician. And they said, don’t worry. We are. But we would like you to come and see this patient and, and show us what you see. So that was the start of that. And very reluctantly I, I went, but I realized not having gone through the medical school training, although, you know, I, I took all the engineering courses and, and but, but quite a number I’m obviously medical anatomy and physiology and those kinds of things.

Pro. Stuart McGill (00:07:11):

But I, I hadn’t been through the clinical realm. In other words, here’s how you can do back assessment and you have 15 minutes and then in another 15, you’re gonna see the next patient. I didn’t have any of that. So the next seminal event was the Dean came to me and said, I’d like you to start an experimental research clinic here at the university. Well, I didn’t, I wasn’t familiar with the 15 minute model. I asked the question, how long do I need to be with a patient to understand the mechanism of their pain, why they’re in pain, what’s missing. And I decided, I think I need two hours to see a patient to start, that process. I have to listen to them and understand what are all the impediments that have prevented them from getting better with all of the other clinicians that they’ve seen because if I don’t deal with that right off the bat, I will fail too.

Pro. Stuart McGill (00:08:16):

And then listening to their story, I would generate hypotheses. Hmm. I think I could, that I could test this and test this to prove and, and manipulate things and, and get insights into these various pathways. And then I needed a little bit of time to try it with them. Can I immediately modulate their pain? Can I make it worse? Can I make it better and probe it? Do you know John, after the first year I ch and by the way, when we started that my medical colleagues said two hours, what are you gonna do with a patient for two hours? And by the end of the first year, we changed that to three hours. And I still, to this day book three hours to see a patient to really understand the mechanism of their pain and get an understanding of how we’re going to organize a strategy to address it. So, tho those are two seminal events, I guess, to use your words and, but never did I ever think 30 years ago I would be a clinician.

Sanjiv Lakhia DO (00:09:20):

Great. Wow. I mean, that speaks to, you know, if someone as well studied, researched as you, and you’re speaking to a two to three-hour evaluation, I think that just really illustrates for people how complex things can be. And, and even more than that, how important it is to listen to someone’s story when they come in with back pain versus a cookie-cutter approach. And John and I do get 15 minutes <laugh> to evaluate a patient and make a determination about how to positively influence their trajectory with their back. So what you do as, as a physician is we break up that two-hour evaluation over subsequent, multiple visits, and at least try and get the ball rolling in the positive direction. And then have, you know, we’re fortunate in our group, in the Carolinas, we have numerous physical therapists who are very well educated, a lot of them follow your teachings and your methods about evaluation and looking at spine triggers and things like that. So so that’s fantastic. Thank you for sharing that I wasn’t aware of. That’s kind of how you got, you kind of got <laugh> holding whether you wanted to or not,

Pro. Stuart McGill (00:10:29):

Right? Yeah.

Sanjiv Lakhia DO (00:10:30):

Yeah. Fantastic. All right. So today’s topic, we’re gonna do fact versus fiction. I thought this is a great kind of way to shape this. I did this sort of paradigm a few episodes ago with one of my partners about lumbar epidural injections and going through your back mechanic books do one thing I will say is you are not afraid to take a position <laugh> and, and I like that, right? I like that. And, and typically I think the reason you’re not afraid is cuz you’ve done the work and the research to back it up. So the first question is we kind of hit this off is, and, and I’m trying to, I’m gonna try and go through some topics that not necessarily hot topics, but there is some debate out there and there’s gonna be people who would conflict with what, what we may or may not say, but let’s get right to it. Fact versus fiction. Number one, most back pain is a result of herniated bar diss.

Pro. Stuart McGill (00:11:24):

I would say most back pain of the people who you are seeing in your clinic. And there it’s disabling pain sufficient to miss work. For example, I wouldn’t say herniated discs, but I would say certain Lee, the majority of them have disc disruption, which changes the mechanics of the joint off slow offload stress from some tissues onto others. And the rest of it. So sorry about that. That’s fine. You can spot the professor. I know what you’re thinking, but in any case, so disc D arrangement I would say is involved in the majority, but you know, Sanji the, in the assessment, if it’s thorough enough, will always give you the answer. So if you were to start with what activities cause the pain and what activities take the pain away, then let’s just do a little bit of pattern recognition at the base level.

Pro. Stuart McGill (00:12:24):

If someone said to you, you know, sitting at the computer for 20 minutes, really ramps up my pain. But if I go for a fast walk for 15 minutes, my pain goes away. All right, there is a very disco type of pattern, but then the person comes in the next one is 65 years of age and they give you exactly the opposite pattern. They say, you know going for a walk for 15 minutes, I have to sit down to get back pain relief. So we’re out of the discogenic joint and stability phase. And now the joint is stiffened. It’s got a bit gnarley with some arthritic bone growth and what-not, and more into the stenotic categories that you mentioned earlier. And, and so those very simple patterns putting them together. Would you say that the disc is still part of the pain?

Pro. Stuart McGill (00:13:17):

Well, it might be, and it certainly was 30 years prior in that person’s life, but now their patterns have changed. So there you go in, in terms of we would then do provocative testing. We would apply loads in compression, in sheer and in bending torsion, tension and see what exacerbates their pain or takes their pain away. Specific postures, sit in a chair, upright. Does this cause your pain? And let’s say the person says no good slouch. Oh yeah. There’s my familiar pain! And not only that, my right great toe just started to buzz a little bit. All right. Well, we’re, we’re starting to slice and dice down here. So the next pass is to become actually tissue-specific, let’s load that particular tissue off camera we were talking about spondylolisthesis and not to preempt that discussion, but again, there’s a pattern to those kinds of patients that we put together to come up, not only in activity-based diagnosis and understanding of their pain mechanism but now we get to actual tissues. So anyway, that would be the mechanical approach that would lead us to understand whether it is a disc herniation and what type or subcategory of herniation it is, or are we far down the cascade?

Sanjiv Lakhia DO (00:14:52):

Yeah, that’s great. And I kind of started off with that question cuz I wanted people listening to get a little bit of insight into how you organize your evaluation. And the other piece of it is we all know that there’s a certain degree of degenerative dis changes that are associated with aging. And you look at research stuff that shows a certain percentage of the population’s gonna have abnormal MRI and may not have symptoms. But I felt as I go along in my career, there were times where I feel like I might over-interpret that sort of information and other times under interpret it. And what you’re talking about it sounds like is, you know, you look at the whole person as an osteopath. That’s kind of how we looked at things in medical school was looking at alignment and movement patterns and such, and then I kind of got away from it. So, you know, we like to say we treat patients not MRIs. And I think what you might be saying is that we treat patients and we really understand their MRI and try and figure out mechanistically what’s going on, John. Is that kind of how you look at things to when you’re doing your evaluations with people and interpreting their MRIs?

John Lesher, MD, MPH (00:15:59):

Yes. It’s much more of a comprehensive approach and just actually Dr. Mcgill, I’m always impressed when I read or listen to some of your work on how you interpret MRIs and how you will pick up on things that are not at all discussed the radiologist, but if you know the clinical background of their pain, the, the findings really give you a much diverse or a much more colorful and comprehensive picture of what’s going on.

Pro. Stuart McGill (00:16:28):

Yes. Do you wanna comment about that, John,

John Lesher, MD, MPH (00:16:31):

Just with regards to, you know, just, for example, Schorl nodes in certain parts of the spine or anterior aspects of the endplates really are not commonly discussed by radiologists, but then you, you know, you listen to a person’s history and you know, they’re a, they’re a weightlifter who’s loading their back repeatedly with heavy loads or in a manual labour task where they’re doing a lot of forward flexion with a sledgehammer or heavy equipment. And then you’re saying, well, gosh, there could be something there based on this based on what you’re doing regularly.

Pro. Stuart McGill (00:17:09):

Yes. I, I get a little bit disturbed when see a clinician and even before they’ve seen the patient walk in the door, they have the MRIs up on the screen and they’ve decided whether they’re going to intervene. And yet the sclerotic bone that they might be seeing, or the endplate fractures incomes, the old champion power lifter or the world’s strongest man, those sclerotic changes are adaptations to heavy load. It’s a good thing. <Laugh> and, and, you know, Sanjiv to your point talking about degenerative discs and you follow a person through their cascade, the more degenerated some people get, the less pain they have because the pain wasn’t, the degenerated disc, the pain was when the discs are to first lose its tur. Now the person was getting micro movement. So if I could take, if I may take a pelvis with three lumbar discs visible here, there’s L five L four and L three. L three and five are normal.

Pro. Stuart McGill (00:18:26):

L four is now started the, a degenerative cascade. It’s lost its stiffness, just like a knee that has strained knee ligaments. It’s lost its stiffness. And if you do a drawer test, you will get laxity instability. So let’s do the equivalent of a drawer test on a spine. L four, as I’ve already said, has lost its stiffness. I’m just gonna apply a torque. Do you see where the majority of the motion is occurring? It’s at the unstable joint now. It might, might look perfect. And you would never see that instability until you did an instability test, or perhaps you could do some radiological stills, you know, a full flexion, full extension or whatever it happens to be. But anyway, over time and, and look at the work that the facets are, are experiencing at that level of L four L five, not at L four.

Pro. Stuart McGill (00:19:20):

So when you see the gnarly facets four or five years later at only one level that was because of the micro-movement that was occurring due to that original loss of, of Bisk tur through injury or damage. None of that’s visible on the Mr. And over time that joint will get a little bit gristly and gnarly. And so the radiologist is very concerned about a degenerative change at that level in, in, in 10 years, the pain from that level, it’s all gone, but that’s the worst looking joint. But you know, we see this in whiplash patients as, as well through videofluoroscopy the joint that looks normal, the person will take their neck through the range of motion. And all of a sudden, somewhere in the mid-range sees five on C6 might have a heavy sheer translation, and the person goes, ah, and then keeps on going. The pain was associated with a micro-movement invisible on the Mr.

Sanjiv Lakhia DO (00:20:26):

Now that’s a great point. And it’s interesting. It occurs to me, that many of our neuro spine surgeons will have a suspicion or intuition that a patient has instability in their low back and from a kind of insurance model. There are certain criteria you have to meet to, for the patient to be appropriately approved for the surgery. And we have limitations on what you just illustrated. You know, we can image in a sagittal plane and look for spinal instability. We actually have one of the few groups that have a Flexx MRI. But of course, you can do dynamic plane films, but that’s just one plane of movement. And really putting that model up on the screen was awesome. I mean, you, it shows how micro-movements can occur in any direction and be a pain trigger. Now I know that jumping to lumbar fusion is probably not the first thing that comes to your mind, and it kind of feeds into my second fact versus fiction kind of statement or question for you, Dr. Mcgill fact versus fiction. Number two, most back pain is lifelong regardless of treatment

Pro. Stuart McGill (00:21:34):

Fiction. Usually, it’s very difficult for me to be absolute on anything. And I don’t mean to avoid the question but we’re dealing with people and, and that’s, that’s the truth. So I’m gonna say a fiction usually. When I ran the experimental clinic, we followed up with every patient that we ever saw in the history of the clinic. I don’t know of another clinic in the world that has done that. And of course we had failures, but what we did do was we ran with idea. There’s no such thing as nonspecific pain, it’s all very specific. And when we subcategorized people we would then through the follow up learn who got better and who didn’t did they comply? Did they do what we ask them to do? What was it that we gave them to do? Was there a match between that, what test results did we have?

Pro. Stuart McGill (00:22:38):

In other words, I can now better answer your question on, is the pain going to have the likelihood of being lifelong or not? If now one more statement, every patient that we saw at the experimental clinic was a failure. No one said, oh, I’ve got fresh back pain. We’re gonna go off to the experimental clinic. We got the people who’d already seen at least 10 different clinicians and they had failed. So right now their clinical success projection was zero. So let’s, that’s where we’re starting from. They have zero chance of getting better and they are your lifelong patients. Would you believe that if they were told you’ve tried everything, you’ve been to the osteopath, the physio, the physiatrist, you’ve been a pain clinic, you’ve done cognitive behavioral therapy, et cetera. You’ve, you’ve done it all. And the last option for you is surgery.

Pro. Stuart McGill (00:23:39):

If that was your subcategory and you followed the program that we gave to wind down your pain, sensitivity through spine hygiene and moving with competency, according to your triggers, et cetera, build a foundation to move with proximal stability and appropriate mobility throughout the linkage, et cetera, following the philosophy in a two year follow up 95% reported that they were glad that they never had the surgery. So there’s a statistic there. That’s an impressive one, but now I can get into the less impressive categories. If a patient was categorized with flexion intolerance. So remember the person was just had of the sitting test, they sit upright and they say, no, I don’t really have any symptoms sit slouch. Oh yeah, there are my symptoms. So there is a test reflection intolerance P 8% of them in the two-year follow-up reported excellent outcome, meaning that they needed no further intervention and they were happy with their lives.

Pro. Stuart McGill (00:24:45):

So that’s less than half. If the person said or, or was categorized with flexion plus compression intolerance, compression intolerance is a tough one because there’s not too much rehab you can do in terms of adapting your tissues with a load stimulus we’re down to with 33 per percent, within two years, chance of them saying, ah, I we’re, I’m very fine with life, but if they had flex and extension motion intolerance, they had a 80% success rate in saying that I, we, I had an excellent outcome. I don’t need any further intervention. Those were the people attending our clinic. Now I go into the athletic cases because as you’re aware to this day, I still, our subspecialty, I suppose, is dealing with world-class athletes, people who push their bodies to the N degree. I can name many worlds records players players in your professional leagues, the NFL, the NBA the UFC, the fight league NHL hockey who have now come back and are playing at previous levels, or even better levels for proving that their pain and disability sufficient for them to lose millions of dollars in salary and all the rest of it that they got back to set world records or play their professional sport again.

Pro. Stuart McGill (00:26:23):

So it’s not a lifelong sentence, but of course it’s context in case specific. If, if, if you’ve been in a car wreck and, and heavily compromised, and a surgeon has really had to be magical to get you back together, you know, the chance that you’re gonna be back power lifting again is, is not very high. So of course it’s it’s case specific, but there’s a little bit of, I hope encouragement for listeners.

Sanjiv Lakhia DO (00:26:50):

Yeah, exactly. And I would say for those listeners out there, who, before you try and slam Dr. Mcgill or us for saying all back pain, a hundred percent of the time can be cured. I think what you’re really trying to say is with a, a purposeful, systematic approach most maybe nonmalignant back pain has an opportunity to improve. And you’ve definitely done some research and data to document some outcomes which are encouraging. But it does lead me to my next question in terms of surgery. So fact versus fiction back pain with radiculopathy. So for layman that’s let’s say pain radiating down your leg with some associated weakness. Maybe you can’t get your toes up. Numbness is a clear indication for surgery. And I’ll, I’ll bring that specific question up because in our world, in the medical spine world, that is for at least for physiatrists, that’s when our, our alarm bell goes off and we’re thinking much more about do we need to get our neurosurgical colleagues involved? And I know the devil’s in the details for sure. But John, you agree, that’s when you see a patient that comes in, who has some motor weakness in their leg and it’s, you know, associated with numbness and intractable pain that your, your awareness level is a little bit higher about whether or not the patient needs surgery.

John Lesher, MD, MPH (00:28:10):

Yes. especially if it’s progressing or moving pretty quickly.

Sanjiv Lakhia DO (00:28:15):

So I wanna get your thoughts, Dr. MCGI and this may not be a, I mean, as all of these, these aren’t black and white answers, there’s a lot of context that needs to be involved and, and so forth. But we’d love to hear your thoughts on that type of situation.

Pro. Stuart McGill (00:28:29):

Very rarely do we jump to that conclusion quickly. We almost always run an experiment and the experiment is called virtual surgery. So we perform some tests and we create the radiation that you’re describing, whether it’s a numbness down, a specific neural tract, whether it’s mechanical, crosstalk and tension from one nerve to another, or, or is it, is it a, an open Fisher disc bulge if it’s an open Fisher disc bulge? No. Do virtual surgery prove to the patient that if they sit like this at the computer for four hours chances are that pressure from that specific disc bulge on that specific nerve root is going to get worse and worse and worse. But if we teach them, well, maybe we have to do a hip exam. And we learn from the hip exam that when they turn the pelvis, now I’m flexing the hips and they have a, a sh an anatomy to their hip sockets that that causes them to back off the hip impingement.

Pro. Stuart McGill (00:29:44):

And they’re right back into the hydraulic pressure to increase the size of the dispel, spread your knees apart, get your feet underneath you. Ah, that took the pressure off the hips. Now I can sit with it in, in that position more comfortably. Now, every hour stand up, reach for the ceiling and twice a day, lay on your tummy for five minutes, do not do a McKenzie prone, pushup, just lay and breathe and relax your back. Does that take the numbness out of your foot? And if they come back in a week and say, you know, that those, those radiating symptom are starting to disappear. Fabulous. Let’s keep it going. So my point is oh, and I should say that this works very well for patients who we let’s say they are exercise addicts. Let me paint a picture here. A stay-at-home mom, two young kids comes in and says, you know I have to go to the gym every day and ride the elliptical for 45 minutes.

Pro. Stuart McGill (00:30:51):

Otherwise I stressed out and I, you know, I’m gonna murder my husband and my kids. And, and I’ll say, good, we’ll go have the surgery then. But you do realize that tomorrow, if you have the you’re gonna lay in bed and you’re going to get up and go for a pee and you’re going go and lay down in bed again, and you’re going to progressively reintegrate movements and all the rest of it. But if you go right back to the same patterns, you have a great chance of herniating. So you are going to have to change the way that you move, become more efficient. And in, in purposefully stimulating the adaption that you need in your body to become robust again, why don’t we do it now? Let’s perform virtual surgery. And I’m very dramatic about it. I’ll say, you know, I’m like, I’m knighting you. There you are. You’ve had your virtual surgery now behave like a postsurgical patient. And that when I said that 95% figure, that’s where that came from. Performing virtual surgery works 95% of the time. If they fit the category of they haven’t been traumatized, there’s no heavy tissue damage from impact. Or do you know what I mean? Or, you know, we’re not dealing with anything. That’s a red flag.

Sanjiv Lakhia DO (00:32:08):

You clarify. So when you’re saying virtual surgery, are you essentially implying rest and gentle modification for a period of time?

Pro. Stuart McGill (00:32:17):

I’m suggesting that they behave like a postsurgical patient starting now.

Sanjiv Lakhia DO (00:32:22):


Pro. Stuart McGill (00:32:23):

So we show them the cause of their pain mechanic and, and our assessment will show that and reveal it to them. And then we coach them on if this is how they get out of the chair and they have, we’ll just use that posterior open Fisher, disc bulge, subcategory of patient. If their first movement is into even more flexion to get out of the chair. And no one showed them that if they spread their knees, get their feet underneath them, suck a little bit of air lead with the chest, flex through the hips and pull the hips through. Ah, now I’ve just stopped. I’ve arrested the hydraulic effort that causes the discal to grow. Would you like to see another model of this? I can show you with precision, if you like.

Sanjiv Lakhia DO (00:33:11):

Yes, I’d be fabulous. Cuz that’s, that’s our big, common mechanism of pain.

Pro. Stuart McGill (00:33:15):

All right. So here, these are all made by dynamic designs, which I have no business relationship with. I will point that out. However, they have based a lot of these models on our work over the years that we’ve documented. So let’s look into the disc from the top here and we see the nuclear gel and the collagenous fibers forming the fabric, the fabric of the disc, not it’s not a ball and Socka joint. It is actually a fabric. Now, if I wanted to laminate the fibers of my shirt, which is a fabric, I would create stress, drain reversals, back and forth, and the fibers would laminate and create a tear. So the disc has to have some denomination. So the fibers pull apart and then the pressurized nucleus will work its way under great pressure through the denominations. So that’s typically caused by a combination of flexion movement plus load.

Pro. Stuart McGill (00:34:18):

If you just have flexion movement, no real issue. Belly dancers, for example, can do all kinds of gys, but they’re not under load. And they adapt a very mobile anus and ground substance structure in the collagen fibers, but they don’t herniate, but it’s not the spine. You wanna put a lot of load on because of the laxity, in any case, I’m now going to show that there has been a denomination that’s occurred, and this is exactly what you would see in the surgical case. Bloody invagination growth of, of nerve endings and vascular structures along the delamination. So now we have a posterior lateral lamination and you can see it as a red mark at the end of my finger there. So now I’m going to squeeze the spine to simulate compression. I’m compressing the incompressible hydraulic fluid of the nucleus, and I’m going to allow it to flex forward, watch the fied site.

Pro. Stuart McGill (00:35:21):

And I’m gonna squeeze is, and I’m going to drive the hydraulic pressure posterior. And now you see the disc bulge. Mm-Hmm <affirmative> there is the nerve root. So now I can see when I put them into a all fours position, I rock them back and now I’m gonna pull her head down. I’m gonna pull the nerve roots up, watch this nerve root under my thumb. I pull it right into the offense. Do you see it moving right here? Yeah. And then I might straighten the leg and pull it the other way. So I can tell exactly whether that disc bulge is oh, over hooking or under hooking, the dispo that will correlate almost all the time with the inic lean that you see in the disc herniation pattern, they will be leaning away, but it doesn’t predict the side. It predicts whether the D the disc is under or over hooking the nerve root and in the neurodynamic tests, as you’re migrating the spinal cord cranially and coly, you will figure out with great precision. A lot about that mechanic. Now what’s the antidote. Now we’re going to squeeze the spine, but I’m not gonna allow it to flex. In other words, I’m creating a equal H pressure on the wall of the anus. Watch the whole disc is going to squeeze down. Yes.

Sanjiv Lakhia DO (00:36:45):


Pro. Stuart McGill (00:36:46):

Nothing comes out posteriorly. So it’s as simple as if I had an orange seed being Carolina boys. You’re a little north of the orange groves, but anyway, you know what I mean? If you squeeze an orange seed and I want to squeeze it out that way, I had to bias the pressure and how it goes every single time. Yes. But I lock it in place as I drive the hydraulic pressure straight down through the middle. So it’s, it’s hydraulics. And if I can get outta the chair now, not going into flexion, hydraulic pressure driver to the open Fisher, but I, you follow what I, yes. Did in that coaching of the patient now pull the hip hips through and you know, typically that person will say, you know, I get relief. When I, when I go for a walk, I go for, I get relief. Even when I carry my groceries. No kidding.

Sanjiv Lakhia DO (00:37:41):

Yeah. I, I really love the, the cue you have for them, the sniff, like, and when you do that, you can feel some core activation. There is that, is that what you’re trying to do?

Pro. Stuart McGill (00:37:52):

I think several things neurologically it is a pull become so victimized and they have this despair from their pain. You know, the person who comes into their office, no one comes in and say, Hey, doc, I’ve got back pain. No, that’s never an extensor proud pattern. It’s defeated. They’re beaten. I’ve got back pain, feeding the flexion, hydraulics to make the posterior Fisher that I just showed you grow even more, who owns the world. And, you know, these are all just little psychological games that we’ll play. And they’ll say, well, what do you mean? And I’ve, I said, I’ve just shown you that you can now reduce the pressure. You can reduce the numbness of your feet by planking on the wall and allowing your hips to drift towards the wall. Now stand tall and you own the world. You’re now, now in control, swing your arms from the shoulders, get a little bit of natural nerve flossing going.

Pro. Stuart McGill (00:39:01):

And that sniff is a little bit of, I own the world a little bit. So that’s the start of the psychological empowerment that they now have con some control over their, their back pain. It also stacks the mass. So mechanically we can palate the person’s rector spine. A and you’ll find that they’re taught their compressing, chronically their back pain. They might have a compartment syndrome in fascia with the muscle, just chronic muscular pain when they move it’s sharp pain. But then if we can get them to stack their mass, they can feel those muscles just shut down. We didn’t give them a dose of methocarbamol or muscle relaxants. We simply got them to stand. So the sniff might feed that posture as well. The, it, it does a lot of things. Your statement of it then activates the core muscles, which form a Guidewire system to stiffen the rod. So this micro movement that I showed you earlier, yes, we have a loss of control. The body uses stiffness and joint stiffness to control movement. It is now lost its control, but we make up for that by adding a little bit of muscular bracing with the core muscles as you do very well. So do you see the sniff does? Yeah. Many, many things.

Sanjiv Lakhia DO (00:40:37):

This is great. And I honestly don’t even remember the question anymore. I’m just so engaged with what you’re talking about. It’s awesome. This is, well,

Pro. Stuart McGill (00:40:44):

You, you phenomenal. They are, they are, they, they, they are so empowering for a patient to transition from, okay. You know, there’s this movement in their now don’t always tell the patient the truth, keep encouraging them that their back isn’t fragile. They’re going to be okay. And we don’t do that. We show the person what their particular pain pathway is, and then give enough education or wherewithal that they can now control it and create the adaptations to, to get some robustness back and, you know, Sanji. So many of them say, thank you. You’re the first person, the first doc who hasn’t treated us like a five year old, we get it. And you know, the person might be a car mechanic. If I, if I show them a lever arm or, you know, if I’m gonna pull on a door, I’m going to pull a door and I’ll say, did you ever play basketball in high school? Good. Show me a drop step. You’re boxing out shack. O’neal they know how a drop step is good. Grab the door. And now you’re pulling the force vector right through your spine, but drop step, take a step back. Oh, doc, I just opened up the heavy steel door for the first time, without any back pain. They’re a car mechanic. They understand <laugh>,

Sanjiv Lakhia DO (00:42:11):

I’ll just take a moment here to, to plug your back mechanic book. And for those who wanna pick up a copy, he, you also offer with the accompanying videos, which I did, and they’re excellent. And you go over a lot of these things, you know, Dr. Mcgill’s covering a lot of his concepts in a fairly quick manner right now, but a, if you wanna take a deeper dive and we’ll link to the we’ll link to his books in the show notes for the podcast and the the videos on YouTube you just touched a little bit on the core on a segue into this concept kind of fact, versus fiction here, Dr. Mcgill, a strong core is more important than back and leg flexibility in preventing back injuries. And specifically what I’m getting at with this question here. Number one is I wanna open the door for you to discuss and share with people who aren’t familiar with your big three. And then I also want your opinion on the idea of particularly the hamstrings, because a lot of, a lot of people are told they have very tight hamstrings and that if your hamstrings locked it’ll create a flex moment about the L five S one disc. When you try and you try and hip hinging, you just can’t do it. So hamstring stretching is an integral part of re rehabilitative exercise programs for lower lumbar disc herniation. So a couple of points there that I wanna pick your brain on.

Pro. Stuart McGill (00:43:34):

Well, there’s much to unpack there. I’ll, I’ll try and be efficient. First, the assessment shows whether they have tight hamstrings or tight sciatic nerves mimicking and being perceived by the patient as a tight hamstring. I would say that more often than not, it is the nerve don’t stretch a tight sciatic nerve. It will become even tighter. So here’s a person who comes into the office and they say, well, I’ve been working on my hamstrings. I’ve been stretching them for, for a year. I haven’t gotten any better. Oh, good. Let’s do some neurodynamic testing on that nerve. And we’re also going to you, you know, the, the expert, the expertise that we put into a straight leg rates, we palpate the two heads of hamstrings. We raise the leg and we feel where the muscles become engaged. But if they say, oh, no, I’m tight.

Pro. Stuart McGill (00:44:32):

And you can clearly palpate the muscles aren’t tight yet. And now get your finger right up into the Popel FASA and really play guitar strings on the sciatic nerve. They’ll say, oh yeah, that’s, that’s causing my back pain sun. You have a tight sciatic nerve. You do not tight hamstrings. So please stop stretching them. And what we’re going to do now is try some nerve mobilization. Once we’ve figured out what it is that’s causing the tight nerve, whether it’s a disc bulge or an arthritic bone spur a tar off cyst or whatever the case may be. So there’s a little bit of a start on the hamstrings. Now, the next thing it is on the performance side, do you think Michael Jordan has tighter, loose hamstrings

Sanjiv Lakhia DO (00:45:16):

Tight? Oh, I guess it’s tight.

Pro. Stuart McGill (00:45:17):

Yeah. But look at every leper in the NBA, that’s the spring that they jump off. Wow. and I I’ve measured quite a number of them. Okay. So be careful now how much you want to slacking off a hamstring, but let’s go to the opposite end of the spectrum. There are those people with pathologically tight hamstrings and they create the syndrome exactly. As you described, it is so tight. It bends the pelvis, which bosses the spine into flex and stress to the point where it is the cause of their back pain. So, you know, again, the, the answer is, it depends, but the assessment always shows you the way forward on how to approach this perceived tight hamstring idea.

Sanjiv Lakhia DO (00:46:08):

That’s great. John, I want to let you jump in. I don’t wanna hog all of his attention. Do you have anything to offer on that or, or any questions are coming to your mind?

John Lesher, MD, MPH (00:46:18):

No. As far as the assessment on, on that, I, I commonly see the same thing. It’s is this a muscle issue or is it a nerve issue? No, that was it. I, one of the things I was gonna, it kind of P backs onto the question is just flexibility and general. And this is a, a generalization I’ll see, in my clinic, my female patients want to become more flexible where they need more stability. And it’s my <laugh> male patients who want to get stiffer or stronger where they may need a little bit more mobility. So Dr. Mcgill, I was just curious if you see patterns like that as well.

Pro. Stuart McGill (00:46:56):

Absolutely. Yeah, yeah. That that’s you’ve been in the clinic. You’ve spent your time. I, I see that there are some people who say, well, okay, I’m, I’m going to go to yoga class to deal with my back pain now it, it, it may be E that some of the asanas in yoga are wonderful for them, but it may be that the very next one is creating more laxity. When it’s the micro movements that’s causing their pain. And what they’re doing is they’ll, they’ll get a 20 minute jolly. They fired a stretched reflex feels good for 20 minutes, but then an hour later they’ve got the same feeling back, oh, I think I better pull my knees to my chest again, or whatever it happens to be. Yeah. And we’ll say, stop all that. And what we’re going to give you a replacing alternative every time you wanna pull your knees to your chest, I suggest you lay on your tummy, the floor and take 10 deep breaths.

Pro. Stuart McGill (00:47:51):

Now tell me how you are after three days. And you know, what the result of that is surprisingly to them sometimes for the first time now they say, you know, I can sit a little bit longer before my toes go numb or whatever the case may, but this excuse me, tuning of the body to make it resilient. If the person is really training to be more mobile. Terrific, great. And, and they love going to the yoga studio and, and whatnot. I, I, I’m gonna give a plug for a friend right now. I have a friend who’s a Yogi, Bernie Clark, Bernie Clark wrote a series of books. One was called your body, your yoga. Another one was called your spine, your yoga. And he guides the teachers and the through self assessments of their anatomy and their mechanics to determine how they’re going to do certain yoga, asanas, or poses to create the desired effect of resilience and performance.

Pro. Stuart McGill (00:49:06):

And not more pain. You, you, you follow the logic and, and people are, are all different. As, as you know, you know, you look at the shape of hip sockets, which are yes, you got them from your parents. But if you look at the shape of hip sockets around the world and the incidents of orthopedic disease, based on that hip socket, it follows haplo groups and genetic groups. For example, where’s the highest rate OFI in Caucasian Europe. It’s the Celtic nations. It’s the Irish and the Scots who have the highest rate OFI. They’ve got the congenitally deepest hip sockets picking things up off the floor. And I’m not saying every Irishman has a deep hip socket. I’m not saying that at all. I’m just saying the population average what’s the polar opposite in, in an orthopedic incidence sense of FAI and D hip sockets.

Pro. Stuart McGill (00:50:06):

Well, it’s the dysplastic hip hip dysplasia. Where’s the highest rate of hip dysplasia across Caucasian Europe. I’m not talking about Asia because that, that has a different distribution of pools within it. The epicenter is Poland. The highest rate of hip dysplasia, who has the shallows hip sockets. It’s the poles where do the Olympic lifters come from? People who have to deep squat with weight over their head. So you’re starting to see form and function here a little bit. Now, I’m not saying every poll has a dysplastic hip, not at all. I’m just saying it is evidence to link different characteristics joints with function, tolerance ability. So there are some people who are made for yoga and they’re not made to be on a power lifting platform and vice versa. So now we get into recognizing these different types and feeding their bodies with the appropriate distribution of mobility and flexibility and stiffness and control and load bearing.

Pro. Stuart McGill (00:51:16):

So if I took a spine, which if you took a spine out of you and we just had this osteo ligamentous spine, and I put it on a table it would collapse with a out five pounds. That’s all your spine will take. Now, this spine has some load bearing ability because I’ve added stiffness. I’ve put a wire rod up the middle to give it compression. Now I’m gonna take some compression away and you see it collapses right away. So if I’m a, a wet noodle and a very flexible person, and I have to a hundred kilo in each hand and I don’t create a very stiff controlling girdle or Guidewire system, my spine will buckle. And we’ve done experiments to, to prove that, but you know, how many strong men and I’ve worked with people who compete in world’s strongest, man, you know, do you think they do sit-ups and spine mobility work?

Pro. Stuart McGill (00:52:15):

No, they, as you pointed out, they do stiffening exercise to get that flexible garden hose of the spine to bear tons of load. You know, if I stacked up five oranges and put a book on the top, it would fly apart. But if I put guidewires on all of those oranges, particularly on the end of toothpick, this was experiments that I used to do with students. Those are called transverse processes, by the way, with vertebra, they create stability and bigger moment arms. And it it’s, it’s called oiler stiffness if you’re an engineer. But that’s the role of the abdominal muscles. So in the most mild forms, Sanji, we might sniff to activate those muscles and create more robustness for load. We might go through to muscular bracing. We might go all the way through to VE Salva maneuvers. You know, the person who deadly a thousand pounds will suck up about 80 70 to 80% of ti volume in their lungs.

Pro. Stuart McGill (00:53:18):

And then they compress down with their pecs and lats, and they create a hydraulic pressurized cylinder to allow that spine to be now a rigid H beam I beam. Wow. Anyway, so do you see how we’ve really have to have a good conversation now as to what we’re trying to engineer in this person’s body and the distribution of stability and mobility. And, and if I could take this one piece further, now, we live in a linkage, this linkage with all of the joints. I’m gonna ask you to wiggle your finger as fast as you can stiff you, did you notice you had to stiff in your wrist, because if you don’t stiff in your wrist, you can’t wiggle your finger as asked. So this is the law of the linkage in order to create distal athleticism, you had to create proximal stability. If I want to create a punch, I’m going to train a offensive tackle now for the defensive for the offensive line in the NFL.

Pro. Stuart McGill (00:54:23):

And they’re gonna box out the if they, they train bench, press say a pushing exercise. The tech major, the bench press muscle is a uni muscle crossing the shoulder joint distal to that joint. It creates the arm flex, which is the desired athleticism. But look what that same muscle does approximately it attaches to the ribcage. It bends the ribcage. It’s an energy leak. It’s a performance. <Laugh> de-evolution if you, if you wanna. So that same muscle on one side of the joint creates a desired action. And on the other side, it creates a collapse. So I engineer out in the linkage with proximal stability. I lock my core. Now a hundred percent of that bench press muscle gets expressed as distal athleticism. So now let’s go to some of the world class athletes take someone. Well, I I’ve measured some of the fighters who hit the hardest in this fight league, the us C the big strong fellas with big muscles.

Pro. Stuart McGill (00:55:32):

You would be surprised in that. They probably don’t hit the hardest because they push their punches. It’s, it’s quite a slower motion versus the one who pulses muscles and they pulse. And then relax to increase the closing velocity because strong muscles also have high stiffness. You have to let the muscle relax to let it go quickly. And then when they hit the contact point, they have a second pulse of muscle. So it’s boom, boom. They hit you with their whole body, as it turns to stone. And that characteristic of the muscle pulse is what is so, so important in this tuning of stability and mobility to create athleticism. You know, let’s go to a running example. Do, do, do you think well, Sain both, everyone knows that as a name, do, do, do you think he did a lot of core stabilization work?

Pro. Stuart McGill (00:56:30):

You can look it up his training programs on YouTube. He had to. Yeah, because without creating proximal stiffness, when the hip muscles explode, the desired athleticism is to propel LA femur through the extensor range, but those same muscles also connect to the pelvis. And if those muscles aren’t stiffened, approximately they just bend the spine. Oh, look out, I’m gonna fire my glutes. And you just, Ooh, <laugh> every time he’d be doing this down, the, the, the sprint track. So you engineer out all that proximal motion, make it stiff to get 100% of the power transfer to the distal side of the ball and socket joint, which is the hip and the shoulder. So now, you know, it, it, it almost ties up our questions about hamstrings. Yeah. And you know, the, the, it’s no coincidence that our core, our spine has a ball and socket joint on either end the only location in the body.

Pro. Stuart McGill (00:57:31):

But if we had ball and socket joints, you know, I have a, I have a spine here from a whale. And it’s interesting when you look at the mammals in the oceans, they have a ball, one socket joint in their, in, in the big tail that drives the flues. There’s the ball, and there’s the socket. And, but we don’t have a ball in socket. We’ve evolved this stiffened disc. Could you imagine if we had ball in socket joints, the muscles, we would have to have controlling those ball and sockets up our torso, but the spine with discs give a defined stiffness, the neutral zone, and the final stiffness of each joint allows us to have a slender spine and be athletic. And

Sanjiv Lakhia DO (00:58:18):

Yeah, it occurs to me several years ago, when I was doing martial arts in our black belt training the instructor to break the boards, which were getting thicker and more complex, the teaching was never about the force with the hand. It was all about stability through the trunk, looseness relaxation with the extremity until the very last moment with the rotation and then using the breath. And it wasn’t about, and there were guys who were much bigger than me, stronger must who couldn’t do it. And then there’s people smaller than me, younger than me, kids who are accomplishing it with the same kind of mechanism. And I’m, I’m wondering, I’m sitting here thinking if it’s a similar concept to what you’re describing about how you generate the power through core stability to get that distal <affirmative>

Pro. Stuart McGill (00:59:09):

I never met Bruce Lee. I wish I did his one inch punch. Now we did measure some accomplished athletes performing that, and it is exactly as you just described Sanji. So you would take a contact on, say a, a device to measure the impact, and then you stiffen the core and it’s just a hip turn. That’s what is the one inch punch? Now, when you put motion, pivot off the rear foot, put motion and then boom, snap with the appropriate muscular pulse at the end. Now all hell inferior is unleashed. It’s no longer just it’s a one inch punch plus <laugh>, but this is the hallmark of the great athletes. And a again, I’ve, I’ve measured so many of the great ones, you know, this, they don’t test to be the strongest in the weight room or on the power lifting platform.

Pro. Stuart McGill (01:00:12):

They are the ones who can muscular force. And when we measure the timing of those, and sometimes it was six times faster than the graduate students who were members of our laboratory could produce wow, six times faster. This is what creates and, and, you know, yeah. I talk to some strength and conditioning coaches. And I, I point out, you know, with some graphical data, why this person is so great. And then I say, okay, how many of you, you are training the speed of muscle on, on set. And we, and the room goes silent.

Sanjiv Lakhia DO (01:00:57):

Well, look, this has been incredibly informative, and I want to be respectful of your time and energy, but I won’t let you off the hook with a one last kind of question that I know you’ve been asked by numerous other during numerous inner interviews, but it is worth asking again, because it’s such an important concept. John, would you agree that in your clinic, probably the most common mechanism from a history perspective for people who hurt their back is bending over of some type. Yes. Sure. Yeah. So then that leads to the final kind on effect versus fiction people with back pain should avoid flex or bending when they’re lifting.

Pro. Stuart McGill (01:01:42):

It depends.

Sanjiv Lakhia DO (01:01:43):

Yes. I love it.

Pro. Stuart McGill (01:01:44):

So, you know, it’s so context specific. If the person has this open Fisher that creates a disc bulge to grow and pinch the nerve root when they flex for a period of time sitting or they’re gardening and pulling weeds with that method and that causes their symptoms to elevate the answer is perform a hip pinch, which every good Amer Americans should know baseball, the short stop posture, carry the weight down the arms, grab the knees hard and watch some of the movements. Now I’m going to tune my back. There’s a flex back. There’s an extended back. I’m going to find the perfect resilience somewhere in the middle. And then I’m going to activate my lats and my packs and watch I’m gonna pop up. I just drifted my shoulders down, away from my arms. Now I can grab a bar and pull my hips through. So I’m not bending the knees to lift. I’m pulling my hips through, which is an entirely different coaching instruction. So I’ve bent over, but I didn’t in a way that caused that open Fisher to grow. I, I moved in a way to actually vacuum it in. So it was actual therapy. I might, that would be to pick up my child.

Pro. Stuart McGill (01:03:16):

If I dropped my keys on the ground, I could sniff, turn this leg stiffened to my body, into a baseball bat. I’m gonna push the heel away and over. I go pull my hip through. I bent over. I picked up the key off the floor. Did I flex well? I did, but I didn’t cause the flexion stress on my back now let’s take, so that open Fisher disc bulge is consistent with the pattern of a person who trains at the gym with weights. The next client has never touched a weight. They are into yoga. They love flexibility. When you look at their discs, their plump, they have lots of motion when they bend forward the compression side of the disc buckles because it’s soft, it’s compliant and now they get a disc bulge, anteriorly, not posteriorly. In other words, bending forward through their spine takes the, or disbel away off the nerve root.

Pro. Stuart McGill (01:04:26):

So do you see how it depends? And it’s so hold in the details. Yeah, it, it, it is. And you know, I know people get on the internet and criticize ohia. You don’t like, you know, I did a podcast with Martin. Who’s the current world, strongest man. And Aaron Porsche from squat university. We did that about a month ago and we went through the mechanics of the ATLA stone lift. The ATLA stone can be a 400 pound round ball of cement and the athletes flex right over and pick up the 400 pound ball off the floor. And they’ll say the, the, the chatter on the internet from people who have never measured these, these beasts who pick up these, these balls and they say, well, they’re flexing their backs and they don’t break their backs. But again, the devil is in the details. The ball is between their feet.

Pro. Stuart McGill (01:05:27):

400 pounds is less than half of their deadlift weight. So they’re only picking up half of what they would normally pick up on, on a, on a of barbell. And then they pull the bar into their laps and they curl their spine around the stone. So their spine and their stone becomes one. They do not have the hydraulic motion causing the denomination of the fibers. They just lock their spine inflection. So that’s, that’s right for most people. And another thing that people don’t realize to get into some of the mechanics, Martin has doubled the moment arm of his back muscles. Then the three of us, meaning that if you look at the line of action of the extensor muscles that extend and pull the spine up, his are double the distance. He’s got double the wrench handle. So if he picks up 400 pounds, you realize there’s only half the load transferred from the muscles onto his back.

Pro. Stuart McGill (01:06:33):

Then me, he picks up 400 pounds with half the weight on his back because he’s got double the moment arm of his muscles. So muscle hypertrophy plays a, a, a huge role in this. So, you know, I can, I can go on and on with the, the nuances of why the answer is, it depends. And some people are confused over flexion. Well, flexion is a motion. It’s a kinematic, but flexion is a torque. It’s a kinetic, what kind of flex are you talking about? So, you know, the, the golfers lift and the short stop squat, those are kinetic flexion lifts, but not kinematic. So there’s a lot of nuances that we have to get through here.

Sanjiv Lakhia DO (01:07:15):

I, I appreciate that. Definitely wanted to give you space to comment on that.

Pro. Stuart McGill (01:07:18):


Sanjiv Lakhia DO (01:07:20):

Well, it’s been terrific. This has been extremely informative and really love your passion and how you’ve dedicate your whole life towards really understanding what’s happening. Like for myself, I’ve learned, I need to do a better straight leg race. <Laugh> like, I certainly don’t have the level of detail that you described there when evaluating patients. And I know John is doing some of your training as well as we look to up level our game when we take care of patients. Before I let you go, though, I always like to have my guests share a little bit about their daily routine, so to speak. I’m, I’m a bit of a health and wellness nut. So I always like to add things in and would love to hear just kind of how you keep yourself healthy, both mentally, physically, and, and enjoy your life.

Pro. Stuart McGill (01:08:10):

Yeah. well, I appreciate that question, son GE for a lot of reasons, I left the university five years ago, primarily when I signed on to be a professor almost the better part of 40 years ago now, do you know, computers weren’t even invented? We didn’t even have a computer in the lab. 40 years ago, everything was done on strip chart recorders and analog devices, et cetera. And then computers took over and then towards the end, students would say, oh, can’t I meet you on a virtual meeting on the computer for office hours? Do I actually have to, you know, get my body down to your office? And you know, how I teach, I teach with my hands and getting them to feel it, and you know, let’s go to a patient and I’m, we’re, we’re gonna workshop this. And I, I couldn’t stand it. And my health was in decline sitting at a computer. So I said, I’m, I’m done now. And I retired and now I moved three hours north of the, the unit so I can get a decent winter. And I’m healthier now than I’ve been since I was in my twenties. And I live what I call the biblical week. So here it is, there’s seven days in a week. And by the way, this is the foundation of the teachings of every single major religion. And that’s why I call it biblical week.

Pro. Stuart McGill (01:09:40):

I do physical labor. I heat with wood. I chop my own fire wood. So there, the shovel, snow, all of these things are built into my daily routine. But two days a week, I do dedicated strength and power training. Two days a week, I’ve had a lot of a injuries I’ve broken my neck. I’ve fractured ribs really had some substantial and it broken my hip. In any case I have to do some mobility when I was 30. I didn’t need any mobility. God gave it to me, but now I need strategic mobility. So two days a week, I’m very strategic. I work on things that are a little bit stuck. My ribcage, my neck my hips, et cetera, two days a week, I work on cardiovascular, my, my ticker. So I’ll have a, so if I chop firewood, I just accomplished all three, for sure.

Pro. Stuart McGill (01:10:33):

If I get a free day, I but if I don’t, I will either I’ll go for a swim or a bike ride or a ski. I’ll be in the clinic here and I’ll do some mobility work or some strength work if I haven’t had that in, but the magic of it all, and the way to stay pain free is one day a week is rest. Don’t do anything. Hmm. That’s the day that your body at the apps. So all the stimulation that you’ve done all week long now, let it adapt. And the other thing too is say, I am doing a heavy day on the chainsaw. I don’t two days a row and I, it then it’s training or I I’m a passionate Snower. I don’t, I never do two days in a row. And so I, I, I feel fabulous anyway. That’s the other thing is it’s funny. People talk about wait and die. So I have a weight and I weigh myself once a week and my target is 180 pounds. If I’m under 180, I can drink all the beer I want, I can eat chocolate. I can do whatever. I like if I’m 180 1, I don’t do any of that. And so what’s my diet never cross 180.

Sanjiv Lakhia DO (01:11:51):

That’s great. Thank you for there’s a

Pro. Stuart McGill (01:11:53):

Little daily wisdoms

Sanjiv Lakhia DO (01:11:55):

You know, a bit of almost like a personal side to yourself about, about your routine and your rest day. And, you know, I’ve shared with my listeners, I just graduated from the Andrew wild integrated medicine to your fellowship program. And we talk about, we talk about the importance of kind of mind, body and soul. And one other thing I would add, just listening to you, you have a unique sense of humor, which I think really comes across the interactions terrific teacher. I can imagine being a student in the lab with you, and I’m sure John as well appreciates that. And we can recognize that and honor that. So I wanna thank you for your contributions to the spine field. Those of us who are down the trenches, we lean on that type of research to help us improve the quality of life for our patients and frankly for ourselves. So John, anything you wanna add for him before we let him get outta here and probably do something more important than talk to us?

John Lesher, MD, MPH (01:12:49):

Yeah. I just wanted to ask more on a, on a lighter note with regards to your mustache, have you ever gone full handle bar or, or full man shoe or we, we have to have a little bit of fun, right? Humor.

Pro. Stuart McGill (01:13:01):

Yeah. If, if you know what the logo for our company is, it’s the the, the mustache and glasses. And I shaved my, my daughter, who’s almost 30 now, but she would be maybe seven or eight years old. She said, dad, and I’ve always had either of ear or some kind of facial hair. I never shaved. And she said, dad, I’ve never seen you without a mustache. So I shaved it and it was awful. I walked by the president of the university. He didn’t know me. I mean, I’ve known this guy for <laugh>. I see him every day. People didn’t know who I was. And then they would pick me up at the airport to do a you know, a lack or something. And they’d say, well, just they’d some graduate student will say, well, we were just told to look for the mustache and you’ll know it when you see it, you know, this was before the internet. And anyway so I have to have the mustache for the logo and I, yes, I have shaved a beard and left a big longly handle bar, but I can tell you it’s pure wife repellent, and I can only hold out a week or so. So I have to behave <laugh>.

John Lesher, MD, MPH (01:14:08):

Yeah. Thanks for sharing that. Thank you. This has been truly a privilege. We it’s women

Pro. Stuart McGill (01:14:14):

Don’t find this particularly attractive. I can tell you that

Sanjiv Lakhia DO (01:14:18):

<Laugh>, you know, this for both clean shaving <laugh>

John Lesher, MD, MPH (01:14:21):

Yeah, yeah, yeah. Well,

Sanjiv Lakhia DO (01:14:23):

No, it’s been, it’s been an honor. Thank you for your time. And I hope we can, in some manner, stay in touch. And when you’re in the Carolina, as you’ve definitely look us up and love to host you introduce you to people in our group and really give you more exposure for your teachings and, and the contributions that you’ve made. So thank you so much for your time. We really appreciate us too

Pro. Stuart McGill (01:14:43):

Well, Sanji and John, thank you so much for your support of what we do and your in getting this out to helping the people who deserve it so much.

Sanjiv Lakhia DO (01:14:56):

Yeah. And we’ll definitely link to your company’s website some of the books that you have and educational materials for people. And please send me if you have any other contact information that you’re comfortable putting in the show notes and things. We’ll definitely add that for people to reach out if they wanna get hold of you.

Pro. Stuart McGill (01:15:14):

Yeah. the best thing is the backfit website. And by the way, if we have patients who are unable to get to you in the Carolinas we do have a network of clinicians who are listed on our website. And I hope to see one or both of you on that in, in the, not to distant future. And then the website will feed some patients to you as well. But

Sanjiv Lakhia DO (01:15:42):

Terrific. All right, guys, I’ll, I’ll let you go. And thank you both for your time today and blessings for great rest of the week for both of you

Pro. Stuart McGill (01:15:51):

And same to you. Bye.

Sanjiv Lakhia DO (01:15:53):

Take care. Bye bye.

John Lesher, MD, MPH (01:15:54):



Stuart McGill Playlist