Dr. Stu McGill - Low Back Pain Insights and Rehabilitation
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[00:00:00] Dr. Stu McGill is one of the preeminent people in the world in the area of low back pain. And we're very, very grateful and fortunate that he's going to spend some time with us as far as his journey to become one of the best in the world in low back pain. And I think it's really important to that in these times we need to become really, really good at something.
And Dr. McGill has done that definitely. So I'm going to bring Dr. McGill on here. Dr. McGill, thank you so much for spending time. I'm very grateful. I know everyone watching this is very grateful to hear your words of wisdom that, you know, what you've seen over the years. And also what, what is actually coming down the pipeline.
So could you give us a sort of a brief overview of your own journey as far as how you basically created this focus in on the low back? Uh, okay. Well, good morning, Ken, and [00:01:00] good morning to, uh, Uh, the, the viewers, um, you know, it's been just a fabulous history with Swiss and, uh, in typical Ken Kanakan style, you've figured out how you're going to continue to, uh, provide the fabulous service that you you've done in, in, in this way, and I can hardly wait to get back to the live, uh, Swiss meetings, the, uh, personalities that you attract.
The panel discussions, the ability to go and shake hands and have a coffee with the superstars you bring in is just unparalleled in the world. So I'm, there's a little plug for the Swiss and this fabulous community that you've, uh, you've built. put together. Well, my story, I mean, I don't want to harp on that for for too long.
In some ways it was an accident and in some ways it's attitude in that life gives you opportunities and [00:02:00] you at that time have a choice. You can walk away from them or you can make the most of them. So I through a lot of opportunities, I was never really supposed to finish high school. I was going to be a plumber and through A series of events.
I met the right people. I had the right mentors, the right encouragement. And I, I said yes to things. And, uh, sooner or later I ended up as a PhD student in the spine biomechanics lab at university of Waterloo. And they, uh, you know, in those days they said, well, would you consider being a faculty member and that kind of thing?
And, and so the question I started out with was how does the back work? And it was simply that question and then people I'd be speaking at orthopedic conferences and sports conferences and whatnot, and they would say, Could you see a patient with us? And I say, Well, I'm not a clinician, but I can tell you what I've [00:03:00] learned about spine function and injury mechanisms and pain pathways and that kind of thing.
And, uh, yeah. Slowly, I morphed into this, uh, clinician and medical schools would invite me to come in and teach their, their fellows and surgeons. And, uh, the ball just kept, uh, rolling and I ended up, uh, working with and training with some. Just superstar names in the spine world and learned how to integrate their tools with our science.
And, uh, that was the, the, the story. Uh, so I, you know, uh, it was a matter of moving my family to different locations at different parts of my career as we would work, uh, with different clinicians and, uh, University clinics and whatnot. But anyway, that's the story. And and the, uh, some [00:04:00] of the, uh, athletes would, uh, or through their coaching staff or their team doctors would say, Would you see this particular athlete and, uh, working with these, uh, Extraordinary people.
You know, I've really learned that the human condition is a rainbow. It is such a broad spectrum, as you appreciate, and when you work at the extremes, you know, wouldn't a car mechanic just love to work with an Indianapolis or a Formula One? Car team, they just learned so much and I got to drive the absolute Ferraris in the athletic world and you realize what the human is capable of and some of the training tricks, uh, et cetera, and then bring all that.
back down to the poor person who comes in, who's suffering with back pain and everyone else has, has been unsuccessful. So that's been part of the journey as well, but it's been [00:05:00] a lot of fun, as you know, now you, you, when did you end your professorship at university of Waterloo? And then you've started over.
When did you start your own company back up fit pro? Well, uh, I retired about five years ago now, and, uh, I just see patients up until COVID here at BackFit Pro HQ. And we've got quite a facility here. In fact, my clinic here is bigger than the one we had at the university. I've got more equipment, more things, uh, more space than I ever had at the university.
But, uh, Uh, so I retired. Uh, I actually started Backfit Pro probably about 20 years ago. And, uh, we would travel the world, uh, about once a month actually, uh, somewhere in the world and deliver our courses and try and train some of our own clinicians that we could refer [00:06:00] to and, and that kind of thing. But, uh.
I don't know if that answers that particular, uh, question. And, and could you explain, um, your, your program as far as, you know, you were teaching live and now you also have online, which I, I, you know, when we got on the call here, I didn't realize that it's now online, which is fantastic because now we have access to see all that.
Could you explain the process that you have? Yes, uh, as we would teach, we would go and put on a clinical course suite, and it might last three or four days, and we'd have to fly in to do it, and I had my teaching assistants with me and all that kind of thing. It was a bit of an on road rock show in a way.
And, uh, but you know, it was hard to fly to Australia, for example, your jet lagged and, and, and, uh, you got to come home and catch up on the work you missed and all the rest of it. And, and we were on the road for, uh, in various forms for over 25 years. And I [00:07:00] think we only ever missed three months in that.
Um, anyway, uh, along came COVID, which shut all travel down. So we put the, uh, three courses online. And I, I didn't know how it was going to work. We now have 60 hours of specialty training to become a specialist in back pain. Uh, and we have a lot of trainers who take it all the way through to surgeons who are taking the courses as well, full spectrum.
And, uh, what we do is provide a foundation on how the spine works, how it becomes injured, various pathways to pain, various things that are impediments in people's lives that have prevented them from recovering and beating their pain with other clinicians. So it's quite a broad spectrum. Then we get into how to perform An assessment that [00:08:00] reveals the precise cause of their pain.
Now, the pain might be multifactorial, but in most people, you can figure out what motions, postures, and loads trigger their pain and then how they respond to that, then you, you have to understand those mechanisms and deal with them. Then. We show them how to avoid the cause. You've got to wind down the pain sensitivity first.
And this is a real challenge for a lot of trainers. They lose the ability to change their client's life because they can't retain them. They can't turn that back pain client who's disabled into a client they can work with. So to retain the back pain client, you've got to reduce the pain sensitivity.
Initially, which means remove the cause. Then you have to know enough from the precision diagnosis that you've done, and it's in the physical world. These are [00:09:00] motions, postures and loads. What volume of load, uh, Crosses the tipping point to make the pain worse versus building the foundation in their body for resilience.
That resilience and pain, uh, tipping point is, uh, it has an expertise to it. You know, again, I'll go back to the race car example. Uh, you've got to know how much your equipment can take, how much horsepower can you. Put through that transmission to win without breaking, and it's the same analogy with, uh, with people anyway.
And then the final part of the course is now you've been successful at winding down their pain. What are the tricks that the world's best athletes use to not cross their tipping points? but achieve world class performance out of their bodies. And there's a lot of science and I'll say art in that. And we both know great clinicians [00:10:00] have the clinical art skills plus the scientific foundation to guide them through to, uh, create that resilience and, uh, performance, uh, in a person.
So those are the courses. They're online. And at the end of it, uh, if they're interested in becoming certified, which many of them request, then they take the certification exam, which is, uh, written and, uh, with, with a live person online in front of one of our instructors. And then we have the master clinician level, uh, of which I personally trained.
So I identify these people who have the gift. They can see movement, they can, they can read a person and then, uh, make sure they have the skills to, uh, well, the benchmark is I want to work with them with 20 patients and they have to get 18 of them better, so I need a 90 [00:11:00] percent success rate if they're going to be someone that I refer to at that highest level of master clinician.
Wow. That, that is unreal. That's such a brilliant idea. To have that assessment system so that you feel comfortable and confident That, you know, the person is, is capable of dealing with that. You know, it's just, wow. I, I didn't realize that. So that's an amazing, amazing process. Um, go ahead. No, I'll let you drive the bus.
I've learned when Ken speaks, Stu listens. So one of the things that, you know, and please clear this up because I mean, a lot of people say. You know, I did the, you know, the McGill three and I still have back pain and I went, Oh my God, it's way more than just doing, you know, three exercises. Can you talk a little bit about that?
Right. It must be [00:12:00] frustrating for you. Well, well, well it is. And you know, I'm asked to do media interviews and, and whatnot. And, and men's health, for example, uh, they, they would ask for a quote every month. for for a number of years, and I'd say, well, I can't really answer that question. It's much more complex than that.
Oh, just give us the three exercises. So, you know, you're, you're put into a box. And so people think, well, if I just do these exercises, uh, somehow my back pain is going to go away. But let's say I've got a sore thumb. Do you think I could bend my thumb back and forth and put more load into it? My thumb pain is going to go away.
No. Cool. Take away the, the, the hammer that every day I hit my thumb with and wind up the pain, stop hitting it with a hammer and my thumb will get better. So the, the process is you have to assess to figure out what the mechanism of their pain is. Now it might be [00:13:00] a bulging disc. Uh, they are. Training improperly at the gym with poor form, and they are replicating the mechanism that causes a disc bulge.
Now, it might be simply a matter of changing the way you lift and bend and even getting on and off the toilet and in and out of your car, which accumulates throughout the day, or you have a desk job. You're a computer operator and you sit for eight hours. No one can sit for eight hours and expect three exercises is going to take their back pain away.
So our clinicians are trained to unravel the factors and variables that are conspiring together to create this pain. And, uh, they create a strategy. That is workable and doable for the person that they can wind their pain down. But that's different for everybody. Now, then we all live in a linkage. [00:14:00] Uh, this linkage follows certain scientific laws.
So just consider a backhoe, you know, a tractor with a hole on the back is an articulated linkage. The first thing they have to do is put down the stabilizer bars, uh, to lift the back tires off the ground and lock it into the ground. Well, that creates. Proximal stability. So now the arm can be very athletic and dig earth.
So if I want to do a push, I might push a heavy door. I might be lifting a child out of a crib or I might be. I was just talking to one of our athletes yesterday who's fighting on a UFC card in a couple of weeks. He's got to get ready and create. proximal stiffness. So a one arm punch or pull, you've got to lock the core because if you do a bench press and develop a pec major, for example, distally to the shoulder joint, the pec major flexes the shoulder and [00:15:00] creates the punch.
Everyone understands that, but they forget that proximally that same muscle, its action is to bend the ribcage towards the shoulder. So if I can bench press a few hundred kilo, well, A few hundred pounds, whatever, anyway, maybe Ken could, I wouldn't, but anyway, that bench press muscle on distally, it flexes the arm, but proximally it bends the shoulder.
The net is zero. I can't deliver a punch, but if I lock down proximally 100 percent of that effort is now directed distally. So one of the laws of the linkage is you have to have proximal stability and control to unleash distal athleticism. If you violate that, you, you, you will be in pain and you will be, uh, poor performing, um, but there's so many other linkage, uh, laws as well.
Uh, you know, years ago at the university, uh, I would, uh, [00:16:00] say there was some big football player in the back row who'd be monkeying around and just wouldn't settle down trying to talk up a girl beside him or whatever. And I'd say, you know, Cool it while I'm talking and, and they won't pay attention until you say, come on down.
Let's have an arm wrestle, have an arm wrestle in front of the class. They're going to have an arm wrestle with the old man and they are bad there. Oh yeah. And they're a football player who's been on the pipes a little bit and I'll come down and I use every dirty trick in the book. Ken, I, I hook up and then the first thing I do is paralyze the nerve on the back of their hand.
And then I, I roll them a little bit and then I put my elbow on my hip and I lift them off the table. They don't realize that I just did it with my hips, not my arm. And then I hook up and, and then I just lock everything. And then I force their weakest joint into an eccentric contraction, and then I get them to smile.
I'll tell a little bit of a [00:17:00] joke, like, you know, it's killing me, but I don't let it show. And I'll say, when are you going to start? And, and you know, every dirty trick. And as soon as I can get them to smile, I unleash out of my hip and now I used to be able to do that 20 years ago. If I do it now, the, someone in the audience would be offended that, Oh, McGill is B, you know what I mean?
And, uh, but when you teach it that way, then all of a sudden. I achieved three goals. Number one is he shuts up. He is never going to clown around in my class again and everyone else is on alert as well because they don't want to come down to the front and have a personal lesson in arm wrestling. But it also gave me a wonderful scientific forum.
To discuss all of the science that I used, all the dirty tricks that I used to either beat pain or create pain, optimize performance. It's neurology, it's psychology, it's humor. You know, if you can break, get someone to [00:18:00] smile, as you know, you just broke the neural drive. Of strength, right? Gotta have a game.
You gotta have a game face, but it was a wonderful way to teach if the students understood the method in the madness, but it made a wonderful lecture. So it was, it was the ability to take a, you know, a negative situation. I had to get this fella to stop disrupting the class, but turn it into a lesson for everybody.
But, uh, anyway, I don't know if that. Is, uh, times are changing, but I mean, it's also very useful because you, you literally, you know, number one, don't, don't get into an argument with someone understands, you know, kinesiology at the highest level, you know, applied biomechanics because they're, they understand leverages.
And how are you?
You know, it's so interesting when I go to some of the [00:19:00] UFC camps and, uh, you know, there's some fantastic camps that get fighters ready and, uh, They have their specialty coaches. They have a striking coach. They have a wrestling coach, but some of the, uh, BJJ Brazilian jujitsu coaches are the most modest looking people you'd ever see in your life.
I know there's this eye doctor who's a Brazilian, uh, jujitsu specialist. And, you know, he looks like such a calm, modest fella. Boy, you don't want to get him going, he'll give you a lesson then and just boa constrict you to death. Uh, so yeah, you'll learn that the great ones, uh, have all the tricks, but having said that go and learn from them.
Yes. Yes. You know, and that's the interesting thing, you know, don't go in with the attitude that you already know how to do it or, you know, I think a lot of people walk in and they try and you've, you've been, you've been teaching long [00:20:00] enough that you'll always have a number of individuals. Yeah. That think that they should be up on stage.
You know, and instead of opening up your mind, it was some concepts that they may not heard. And it's like, you know, being, being that, like, I mean, being teaching at the highest level, academic level, you know, and you've, you've worked with so many, you know, yasic troll wiki, who's done some amazing work out of Yale.
And you've inspired so many different people to carry on, you know, Dr. Ed Cambridge, you know, to, to, to raise that level. Um, and, and, and I think that's the power of a really, really good teacher. And most people, you know, people come up to me all the time and they say, you know, you're not a real doctor. And I said, I agree.
I'm not, there's only one true doctor and it's a PhD because the Latin term for doctor is teacher. And most people don't understand that. So you're teaching people and that's the big gift that you have is that you teach them on how they need [00:21:00] to change their life. How to get off the toilet. You know how to stop training.
You know, I asked you a couple of years ago, you were nice enough to come up to the powerlifting contest to watch Ken and I compete. And I asked you a question. I said, you know, is your secret sauce that you just get these guys to stop squatting heavy for, you know, a number of weeks and you go, yeah, the bone has to heal.
And most people don't realize that, you know, you, you're stopping the pain generator as you can actually help build resilience. Is that one of the major things that people really need to understand is just stop doing things that are, that is causing the pain? Yes. Well, we show what many of the pain pathways are, and as you know, they cluster around sports.
So you mentioned the sport of power lifting. Uh, there's two or three major pathways when you're under heavy load squatting and, and dead lifting and that kind of thing. And one is the [00:22:00] nucleus. Of the disc pressurizes under that very high load and the end plate of the disc. I actually have some models here from dynamic disc designs.
And so there is obviously a sacrum, but the nucleus pressure. It's a gel gets pressurized under that fantastic compression of taking the load and watch as I pressurize the nucleus. It, it can put a lot of stress, radial stress up on the end plate, and the end plate is just a cartilage plate. People think it's bone, but it isn't.
And that can have a little micro fracture. And do you see the white nucleus coming up through into the vertebral body? So that creates a little bit. of, uh, bone damage. And it doesn't show on MRIs unless it does, but you have to really know what you're looking for. And you, you know, you've mentioned the name Brian Carroll in the, uh, intro, [00:23:00] uh, Brian, uh, as you know, I don't know if you do, but he set the all time world squat record a couple of months ago.
He squatted 1000s. 306 pounds, never been done before. But, uh, when I first saw Brian in 2013, and I think, you know, the story, uh, he had a split sacrum and, uh, this isn't a fracture in the sacrum it's in L5, but it's very similar. So I'm going to pull a plug out. And, uh, this model is they're all by dynamic.
disc designs, which really captures the biofidelity. So the nucleus is dyed chromium blue. If you look into that hole there, I'm going to see if I can capture it. I'm going to squeeze. Can you see the nucleus squirting up into the vertebral body through that end plate fracture? So now. With Brian, we used a technique called bone callusing, where we, um, now I learned this from the [00:24:00] space program and studies done on turkey wings and how you densify the, uh, calcified mineral matrix inside the vertebral, uh, body.
Um, do you want, can I divert into a keep going, keep going. on on how bones heal. Yes, please. Please. Okay. If I bend a long bone, my forearm like this, this surface goes into tension and this surface goes into compression. And, uh, if I create a little stress crack, uh, the body The bones are piezoelectric. So this is the signaling of how bones heal.
If I bend a piezoelectric material, like a lithium crystal or a quartz crystal, remember in, in, in summer camp, you'd get two crystals and you'd rub them together like that at night and lightning would shoot through the quartz crystal. [00:25:00] Okay. That's a piezoelectric, uh, material. crystal. Your bone is crystalline as well.
So as you bend it, it creates an electric charge at the level of the highest strain. Now, um, what that does is that electric charge draws in free ions of calcium, magnesium and, uh, various salts and whatnot that build the bone and they put a callus on the bone break and they actually build that break stronger than the virgin, uh, bone.
So it's a piezoelectric mechanism, but here's the rub. A lot of guys train these micro fractures and there's in their spine when they're power lifting and they'll, they'll, they'll stimulate, they'll train. And then they're doing a deadlift in two or three days again. That's insane. They didn't understand the mechanism.
They created the piezoelectric charge. It draws in the new, uh, ions. [00:26:00] It creates a little bit of a callus. And then in two days, they train and they break the callus off. What you have to do with bone callusing is, it's a minimum of a five or six day turnover. So, you know, you go to Swiss and you talk to Ed Cohn and, and some of the great ones, Brian Carroll, and, and you'll say, you know, how often did you train heavy squats and deads?
And they say once a week. And the average kid thinks you're under trained. What an idiot. No, they understood the science of heavy training. You stimulate a heavy piezoelectric uh, driver to the adaptation and then you allow a full five days for all of the metabolites to now form a callus. So when you train in another six days, it's stuck on and it's, it's already formed in here and you don't break it off.
So bone callusing is you stimulate. Train, [00:27:00] take five days off, repeat for a year. So that's the professionalism of people like Brian Carroll, who everyone said you're finished and yet he was so professional. He had a world record, came with a fractured sacrum, uh, really heavily fractured L5 and over that next year, he did bone callusing.
And the big three and started with some loaded carries. And then, uh, after he became pain free and rebuilt the foundation of his back again, you know, my job was done. No one knew how to build strength better than Brian. He'd already been there. But he then built himself back and he, he, as I said, he squatted 1, 306 unbelievable.
Yeah. So, you know, there's an example of the confluence of really understanding the science and [00:28:00] then putting it into practice. And if you have that expertise, you know, I, I mean, the number of power lifters that we've seen over the years to deal with bone injury, like I'm describing and yeah, you've got to organize your time off and look, we, we don't train to get strong while we're training, we're training to stimulate adaptations.
Right. And if you don't allow that adaptation to occur, the training is actually a poison because it's cumulative damage. And you have the only documented, uh, injury. I remember I used to train with them, Bobby Wilson out of, uh, Popeyes, and you actually watched a spontaneous, uh, compression fracture on, um, uh, on the MRI, can you talk about what happened there to Bob?
Yeah, this was going back to the late [00:29:00] 80s. So I started as a professor. My first Ph. D. student was Jacek, uh, Holowicki is, Holowicki is how you would say it in Polish. The Americanization is Jalowiecki. But anyway, you know who I'm talking about. Um, Jacek was a power lifter, uh, came from Poland. And he immediately smashed the Canadian powerlifting record.
It was fabulous. I think he weighed at what, 185 and he bench pressed 540 pounds raw. And that, that record lasted for 20 years or something. So, uh, Jacek. Uh, and I, we started going to Popeye's, which was the heavy powerlifting gym. It was the, it's not the Popeye's of today. It was a grungy, you know, it was an iron pit back in the day and some of the greatest powerlifters trained there.
So me being the, uh, geek, uh, said, let's. Really see what's going on with the vertebra when [00:30:00] guys are lifting several hundred pounds and the long and short of it was one. And by the way, we used video fluoroscopy, so this is a real time moving x ray machine and we watched the vertebra deform and squeeze and bend and all this kind of stuff.
No one had ever done this before with extreme loads. Really? Yeah, no, no one had ever watched. But anyway, uh, and and, you know, Jacek was such a brilliant engineer. It took us about a year to digitally enhance those images. I mean, we're going back to the eighties and to see, uh, a micro movement of one millimeter of one vertebra relative to another and about half a degree of rotation.
But anyway, One of the lifters became injured while we were filming, and we actually watched the injury occur. So just, uh, at one joint, if I went back to this model here, just at one joint, uh, it was L34. [00:31:00] So this one, the athlete bent forward and the spine moved like a garden hose. Each joint took up its responsibility to flex.
And then the spine buckled just at that one joint. It did. That just, did you see what I mean? And that, that stressed, uh, the tissues at that one joint. And, uh, you know, it was a horrible thing. Uh, the lifter had done, or had experienced exactly the same injury before. So it was a motor control problem. He didn't have sufficient stiffness.
So, you know, when a, when a power lifter takes air, locks the core and sits back with the hip. Uh, they use that strategy to build more proximal stiffness because here we have a flexible column. Uh, how insane would God have to be if he was an engineer or she was an engineer to say, let's take a flexible rod and put half a ton of [00:32:00] compression load on it.
Of course, it's going to bend and buckle. So, uh, anyway, that's it. So the lifter uses the stiffness strategy. And then, you know, what does the weight belt do? What does the lifting suit do? They all add stiffness, uh, to the core to add more hip power transmission through the stiffened core up to the shoulders and the bar and et cetera.
But anyway, uh, he was better in, in a few months and was, uh, back to lifting again, but the moral of the story, or, you know, I said in, at the beginning of this, Uh, throughout my career, when we saw an observation like that, that was just, no one had ever seen that before. It was an absolute gold mine. But then my brain said, why did it?
And it was, it wasn't a crush injury. It was an injury where it was a motor control screw up. The brain [00:33:00] allowed a single joint to bend and buckle, uh, that took us into the world of spine stability. And we said, Hey, who are the world's experts at this time? Well, there really weren't any. We're back in the late eighties.
And so we said, all right, we're going to become the world's experts in measuring spine stability. So Jacek again, brilliant engineer, just as you would measure the stability of a bridge. We used exactly the same techniques to measure the stability in the spine. And then we had to measure the neural response, why some people's brains organize perfect stiffness through the core, uh, why they take air, why they use, uh, lifting belts, what are the movement and the muscle activation patterns that assure sufficient stability.
And, and it really drove 20 years. Wow. You know what it's. And [00:34:00] it's so inspiring because you fulfilled an area that was so missing and low back pain, basically one of the most prevalent injuries in the world. You know, everyone basically experiences at one time, I think it's like 80 percent of the population will experience it.
And, you know, to talk about that, a lot of people unfortunately get a diagnosis of, you know, from a physician that, you know, they did an MRI and you have a disc herniation. And they think that their entire life is over and they can't do anything. They can't lift anything anymore because they have a disc herniation and it's unrecoverable, you know, unfortunately it's, that's that bad myth, like squats are bad for the knees.
You know, you have a disc herniation, you shouldn't pick anything up. Can you talk a little bit about that, that possibly there are strategies that you can recover from a disc herniation? Well, the proof of the pudding is, uh, I'm just going back to Two Olympics ago. [00:35:00] I think I had over 40 individual athletes in that Olympics from different countries, and most of them will have had disc herniations.
So, uh, don't tell me that it's a life sentence. I've got right now, three, maybe four, uh, Athletes, fighters in the UFC, all active with, uh, disc bulges. Uh, you name the sport and, uh, I got on the pro tennis tour, a pro golf tour, uh, NHL, um, uh, Was it two years ago? There was the World Series, the Stanley Cup, and the Super Bowl.
So three, I had players in every single one of those, in the Stanley Cup, in the Super Bowl, and, uh, in the World Series. I had two in the World Series of baseball. Uh, final games. And, uh, don't tell me that, uh, substantial back injury that [00:36:00] failed all other clinicians is not, uh, unrecoverable. Now, having said that, do I have success with everybody?
And the answer is of course not. But please don't rush to surgery because you've got a disc bulge. Uh, and you think you've done everything and now someone says, well, the last thing for you is surgery. Uh, it may very well be, uh, you know, I wrote a book back mechanic and there's a whole chapter on there to help you decide on whether surgery is a risk you want to take because it's not guaranteed.
But, uh, anyway, no, it's, don't worry, uh, uh, prematurely that, uh, this is a life sentence. Well, and I think people feel that way. And I always believe that you should start with the least invasive. And go to the most invasive and least invasive is that, you know what? Just get someone that understands back injuries, which a lot of people don't.
And the different things that you [00:37:00] can do, but even just starting with the foundation, take away the pain generators, you know, that's so important. I'm going to do something here because I know your audience has a lot of, uh, uh, trainers and coaches in it, but if someone is suspected of having a disc bulge, it's as simple as this.
Do an assessment. Don't guess. So take your client, have them sit on a stool and have them sit upright and then say, Do you have a symptom at the at this incident? Chances are they'll say no. Good. Pull up, grab the seat pan and pull up 20 pounds per side. Did that increase your pain? And they might say no.
And I'll say, good, lock your head and neck, but slouch down, drop your chest and roll your pelvis down. Oh yeah, there's my pain. Okay. I just proved it was a combination of emotion and load that caused your pain. Now get off the chair. Now watch carefully. Do you see the person went right into their pain?[00:38:00]
Versus, look, it's weightlifting 101, brother. I, if my knees are together, I can't bend forward over the lever of my knee without flexing my spine either. But if I spread my knees apart, get my feet underneath me, suck some air, bend forward through my chest and pull my hips through, did that cause you pain?
Oh no, that's magical. And some of them will start to cry. No one has ever shown me. How to get up off the toilet without causing my pain. And I said, you've never been to a trainer that knows weightlifting 101 and showed you how to move in a way that didn't trigger your pain. And not only that, he just showed you how to train pain free.
You don't have a disc bulge anymore that is going to be disabling to you. You just needed the knowledge through that simple assessment. And, and you think about most, [00:39:00] and I, and I'm saying this seriously now, most of the pain pathways In the back, people can say, You know, if I do this activity, it causes my pain.
If I sit at the computer for so long, or if I go for a long walk, or if I play a game of tennis, or if I simply bend down and tie my shoe, my foot goes to sleep. Every single one, they can say and give you clues on specific motions, postures and loads. Well, what's, who, who owns motions, postures and loads? Is it the family doc?
They haven't a clue. Is it the, you know, Who owns it? It's trainers. The savvy movement specialist who can see those motions, postures, and loads that offend the pain and then have enough assessment tools. Uh, now they can create a strategy as I just did. I just used weightlifting 101 to come up with a movement pattern.
And if it's a baseball player, go down and play shortstop. Play with the [00:40:00] curve of the back. Make it sweet. Take the pain away. Now, instead of lifting With your back, it's a different thought. Pull your hips through. Oh, pain's gone. So,
Brilliance is in the simplicity. And I think that's the most important thing. And people don't realize it's the small things that is causing the pain, the pain generators. And if you do that, getting out of a chair, You know, 20, 30, 50 times a day, you're always going to be recreating that. And I think the brilliance of what you've done is you've gone all the way back to what is generating it.
And let's, even though it's small, accumulated, it makes an enormous difference, an enormous difference. That's, that's the right way to summarize it. I'm just going to show this little model again by Dynamic Disk Designs. Um, you can see the liquid nucleus in the middle, which is a [00:41:00] hydraulic structure. Now, if you, Train poorly, do a lot of loaded twisting, a lot of flexion, bending under load, you, this won't happen if you don't do it with load.
So, so just swing a golf club, for example, won't do it. But if you lift heavy and then swing a golf club and you lift heavy in a way that creates stress concentrations, um, the, the collagen fibers. This isn't a ball and socket joint. They slowly delaminate. So you can see a little bit of a delamination. Can you see the red mark at the end of my finger at the back of the disc there?
Now watch, I'm going to bend the disc forward. As I squeeze, can you see the delamination opening up there and the gel coming out? Now I'm going to mitigate that. I'm going to stack the spine tall and I'm going to squeeze. Okay. Notice nothing comes out the back, even though the whole disc is bulging and [00:42:00] taking load.
So that just explained the mechanism of what I just did. Here's the flawed person, knees together, having to bend forward. They just created, and then on MRI, if I flex them, we would see the disc bulge. If I then laid them on their tummy, The disc bulge is gone. I've done this with radiologists on necks. Put your head this way, hold it for five minutes.
They've got a disc bulge, post your lateral on the right side of C4. And then I say, all right, let's go the other way and hold this position. And then we MRI them in, in 10 minutes and the bulge is gone. So that would be the disc bulge caused by an open fissure. in the disc. So do you think doing physio movements with more motion is going to address that particular pain pathway?
No, that's what caused it. Now you get the next person who they have, uh, more of a muscularly based issue and the range of motion might be the [00:43:00] perfect therapy for them. But if, if the assessment doesn't reveal with precision, what the mechanism is, What is poison to one is the next person's therapy and vice versa.
Wow. You know what? This has been so inspirational. Thank you for spending the time explaining all these things. Cause I think a lot of people. They live with this, you know, diagnosis, you know, that they have to live with this for the rest of their life and they don't have to. But the challenge being is that who do you go to?
Cause I mean, chiropractors really don't understand this, you know, to the best ability. And same thing with physiotherapists and the, you know, uh, medicine doesn't think of it. They use their modalities, medication, uh, or surgery. And so that's the challenge that we end up with is that, you know, the trainers and the strength coaches can walk into this world.
stay within their scope of practice because their modality is exercise, but even lifestyle changes. And that's what [00:44:00] you've created this whole system. So I really, you know, I really want to emphasize that anyone that's interested in, um, becoming, you know, outstanding in this area, because there's more than enough people that have low back pain, you know, that's the gyms are closed.
But we can still work with people. You can work with people one on one when the gyms reopen, you know, the hopefully that you'll be able to rebuild it. But in the meantime, they can take your course and become educated and to understand the language. And I, you know, doing all these interviews, something very apparent has come about is that All the different strength coaches and the doctors and the therapists, they've all said the same thing.
The trainers and strength coaches that are out there have to learn the language of medicine. You have to understand the, the language as far as injuries, pain generators, the nervous system. And that way us as a health professional can talk to you in those terms instead of trying to give [00:45:00] you some weird little metaphor to try and get you to get it.
And I think you, you delve heavily that in your course, correct? That let's educate you on what actual the spinal and the muscles and the neurology is. but then also the deficits and then terminology and the names of it. So you can have an intelligent conversation with another health professional. Am I correct saying that?
Yeah, it's interesting. Can I can talk to, uh, a car mechanic or an orthopedic surgeon, but I use the same analogies. and vernacular and lexicon, and it's so interesting that so many of the patients will say, you know, thank you. You're the first person who hasn't treated me like a five year old. I understand what you're talking about.
And I use the models just as I do in the courses. Uh, I use lots of medical imaging, uh, lots of case studies. And, uh, I don't know what [00:46:00] it is where, where. Certain people treat their, their patients and clients like five year olds, but, uh, stop it and show them the biological truth and, uh, people are then partners in their own, uh, recovery for the first time they understand what they should do and why they should do it, how often they should do it, the intensity, what they expect to feel, what are the benchmarks for the next stage of progression, et cetera.
And, uh, our job is only to empower the people to heal themselves, but we do that with the knowledge and, uh, skill. Wow. And you know, it's, you know, I always ask, you know, the, uh, presenters, you know, what's something that they could do on Monday morning. You know, after they see this video, you know, and I would definitely, you know, um, recommend people actually sign up for your course because you've already built a network, you built an educational system, and you're one of the few individuals that it's [00:47:00] actually built a network of high level.
Like the whole thing is that just because you took a weekend course doesn't mean you're good at it. It just means that you're competent and you went through it and you may or may not understand it. But you, you, you level up, you know, you have different levels of core competency in that area. And what type of advice would you give a strength coach or personal trainer after seeing this video?
What would you recommend? I say, you know what, just sign up for the course. Hell, I'm going to sign up for the course. I didn't realize you had it online. Yeah, well, I, I, I can't really come up with anything different than that, and that's the sole reason why we created it. We had to train our own experts and, uh, many of them will say that, and the, the, the other thing that people don't realize is patients come to our website and the website refers them to their local clinician.
Who is either McGill method certified, or they're a master clinician. There are, uh, many [00:48:00] master clinicians, plus some certified, uh, who are the, the trainers, who are full time. Just referrals from the website. It's all passive. They are full time, uh, busy with, uh, people. Uh, coming now. Uh, it's interesting. Some of the trainers will say, Oh, what do I do?
I've just got this person with X, Y and Z. And I said, that's out of your wheelhouse. You refer that onto a master clinician now. But the nice thing is the master clinician then refers them back and says, Okay, here's the program. I need you to execute. So it's a wonderful family. We call it the BackFit Pro family, and every few months we have a family Zoom where they all come in from around the world.
We present case studies to one another. They all meet one another, and they'll say, Oh, you live in Amsterdam. Well, I'm here in Belgium. And could I send you this cyclist? And do you know what I mean? So it's with a very nice [00:49:00] referral network. within the system, but the rider is, they all have this special spine expertise.
And, uh, if they don't, my name's on it, they have to be good now. Also, do you refer someone to say a chiropractor that they may need some, um, say the joint is dysfunctional to restore motion. Do you also work with individuals like that? Well, our initial, uh, assessment, uh, sometimes there are things that I can't deal with.
I'll give you some examples. Uh, I might find a metastasized tumor. That's why they have central low back pain. We're the first people to discover it. So obviously they have to be referred and they go back starting with their family doc usually, but I find some people or I have to refer them immediately to the emergency room.
I've just found a [00:50:00] descending aorta aneurysm. They're ready to blow, and that's why they have back pain. The pattern didn't fit. So I knew I had to delve a little bit deeper to find it. Or, you know, I, I know that the pattern isn't quite fitting. There's some sort of comorbidity that I'm not finding out. The other thing we do can is we follow up with everybody.
No one gets off the hook and sent away, they are contacted again. Well, we found several cases of say, uh, Lyme's disease. Now, okay, this pattern doesn't fit. It is worth it for you to go have the Lyme disease test. Sure enough, they've got it. Go get treated for it. And not only did their back pain mitigate, but their comorbidities, uh, did as well.
Or someone who we measure in the assessment, they've got friction on the nerve roots. Or it might be a unidirectional friction. They've also got, uh, Ehlers Danlos syndrome, which is a, a [00:51:00] hypermobility to their joints. One of the, uh, features of that is the nerves become gooey as they descend through the, uh, foramens and, and the central canal.
And that's what we measure in the assessment. Uh, so there I refer them to a book. on adhesive, uh, arachnoiditis as an example, but if they've got, uh, and, and again, I'm such a specialist. If they come in with back pain and they say, I've got neck pain too. I say, I'm not the neck guy. I'm confident in the low back.
I'm not the world's best in the neck, but here's who I'm going to refer you to. If you're in central us, I refer you to, to, uh, Um, uh, Skaggs, um, Clayton Skaggs, uh, as you know, he was the medical director of a little baseball team called the St. Louis Cardinals , but, you know, he's now the director of, uh, the Central Institute for Human Performance.
He is a, he's a Cairo originally and, but so much more in his [00:52:00] training. But if you've got a, a funky neck, I send you to Clayton Skaggs. Um, if you're a player in a certain sport, I've got my Rolodex as I call it. I'm still old fashioned enough to have one. Uh, so I've got clinicians around the world and coaches, like I, I mentioned Ken with firefighters as an example, uh, around the world.
I've got, and, and, you know, Ken, I don't care what their medical shingle says. I don't care whether they're a chiro, a physio, an osteopath, a medical doctor, or whatever. I don't care. All I know is they've demonstrated to me that they have that skill. With whatever it is, I'm sending them for and, you know, I, I think of the over the years, the number of medical meetings that I've gone to and Swiss and everything else, and you just meet the world's experts in medicine.
[00:53:00] And, uh, you know, I remember, uh, I, I was next up on the podium as they brought in this low back expert, but the guy before me was the rheumatoid arthritis expert. And I just had sitting there at the lunch table with him and, uh, you know, he just very quickly looked at this person's hands. And, uh, And he looked at the redness in the knuckles and he said, yeah, that's, uh, I think we should assess this.
In other words, what the Great Ones do is pattern recognition. And as soon as that person walks through the door of the dentist, even before they open their mouth, that dentist has already done pattern recognition to know if this person, if they can't take care of their clothes, what do you think their teeth are going to look like?
Wow. Do you know what I mean? And you see, you see the puffy face syndrome. If someone comes into me and [00:54:00] they have back pain that starts when they walk, sitting down takes their pain away. And I see, uh, purple legs. Uh, I see a puffy face. Uh, the pattern starts to fit. And then if it's a man, I'll say, um, do you have a rectal dysfunction?
They said, yeah, how'd you know? And I said, because you've got vascular congestion and I know what I'm going to see in their back or I can watch an NBA player come through my front door. They're almost seven feet tall. They have to duck underneath. They come up and I can see the pain in their eyes. I'm probably looking at an underhook nerve root.
So, do you know what I mean? The patterns, if you've been in the game and you. see people and you can read them. You can see these syndromes and every expert will say exactly the same thing. As soon as the person walks. So you interviewed Joel, I understand. [00:55:00] Well, Joel, if you, if you go to Joel's facility, Joel is a trainer, but the second you walk through his door, he's already seen what kind of shoes are you wearing?
How'd you dress? How did you walk? Do you have an antalgic list? What are your eyes focused on? What kind of learner are you? What's your, what's your lexicon? How am I going to coach you? Do you know what I mean? It just starts the second you lay eyes on them. And, uh, those are the people we look for in our, uh, to, to become a McGill clinician.
Wow. You know what? Amazing, amazing time with you, Dr. McGill. You know, you're always inspiring. What I really appreciate is that you take complex issues And you make it easy, real life to understand regardless of the educational level. And, but you also have an action of this is what you can do, not just theory.
You know, we've been through enough theory, uh, courses, but how do you apply this into real world [00:56:00] situations to relieve pain, to optimize function? And it always comes with the simple things, and then you can branch out. On that I want to thank you for your time. It was just such an incredible time, you know chatting with you I look forward that when things open up and the border opens up and we get the band back together and You know, we can do a live swiss symposium and we'll uh be enjoying ourselves again Um, but thank you so much and I really inspire everyone to Definitely take your course because I mean, there really is nothing out there and especially trainers, you know, whenever I do any presentations, there's always people there that ask me, you know, what do you do for sciatic nerve or frozen shoulder?
And I'm like, you've kind of outgrown. Your profession of just training people. Now you're trying to fix people. This is probably one of the premier opportunities, especially since you have it online now that you can learn to be, you know, an exercise clinician that you can work with people [00:57:00] specifically in the low back.
And that's even more brilliant. It's not the entire body. The low back is just so complex and just to be able to do that. So thank you for putting that course together and, and putting it online, you know, to allow everyone, you know, access and, you know, I'll definitely put, you know, all the different links to, uh, to the materials and then also your books and they're, they're amazing.
I have all of them. Appreciate that Ken very much. Uh, and if you will allow me to say. Uh, I stopped going as a professor and a scientist to biomechanics meetings, a lot of the scientific meetings because I found that the topics never changed, and it was someone who's invented a new technology to measure the same old issue.
And I just got tired of it. The best meetings I have ever attended [00:58:00] are Swiss hands down. You are able to bring together people who done it, the world's strongest people, the biggest bodybuilders, the fastest men and, and, and, and women, uh, just fabulous, fabulous people. And, uh, Than the scientific geeks like myself and, uh, it was an absolute festival.
For me and just go, just walk down the hall and I'd see a lot of my old friends and, and simply that, uh, created a lot of referrals for me, the old contacts and then sure enough, we're, we're going, I just was talking to Ed Cohn, uh, uh, last week as a matter of fact, and, and we met at Swiss. You know, Bill Kazmaier and I, we, we met originally and got our start World's Strongest Man at Swiss, [00:59:00] uh, JL.
I think I, uh, Holdsworth, uh, the first time I ever met him was at Swiss. Um, yeah, so many, uh, of the, uh, personalities anyway, and you've always been so gracious with the, uh, the, uh, meals and the get togethers we have at Swiss, it is hands down. The best meeting I've ever, uh, been to. That means a lot to me, you know, especially coming from you, because, you know, I hold you in such high esteem, and, you know, to get, you know, that, um, kind words, it really means a lot, you know, to my heart.
And, uh, you know what? I look forward to seeing you soon again at, uh, the Live Swiss, and, um, hopefully we can, uh, inspire more people to, uh, really, really raise the level and, uh, really become good at what they're doing. And I think that's what people are going to be really looking forward to. So again, I thank you.
Okay. Can't wait. Can can't wait anyway. Take [01:00:00] care, brother. Great to see you. You too. Thank you. Bye bye. Bye.
