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Dr Stuart McGill17 June 2019

Why Do Our Backs Hurt? - Dr Stuart McGill - #081

0Frameworks
18Insights

Insights & moments

The myth-busts, hot takes, explainers, and tools worth keeping.

Myth Buster· 3

Myth Buster08:00

There's No Such Thing as an Ideal Posture

McGill debunks the idea of a single 'correct' posture, arguing the goal is frequent posture change to migrate stress concentrations around the body. He notes many physically demanding jobs (farming, fishing, forestry) have no ergonomic fix available — the real skill is moving the body in ways that avoid stress concentrations.

  • There is no single ideal posture — the 'ideal' is one that changes frequently
  • Static posture 'solutions' don't migrate stress away from any one tissue
  • Many jobs (farmer, forester, fisherman, lumberjack, bus driver, miner) can't be ergonomically optimized — workers rely on skillful movement instead
  • The prescription isn't 'move as much as possible' but 'move more,' echoing Gray Cook's 'move well and move often'
  • Optimal movement frequency is highly individual, based on age and injury history

Is there such a thing as an ideal posture? I think we would both converge that no there isn't — the ideal posture is one…

Stuart McGill · 08:30
#ergonomics#posture#movement#workplace
Myth Buster32:00

MRIs Don't Fail to Predict Pain — the System Reading Them Does

McGill pushes back on the popular claim that MRI findings don't correlate with pain. His argument: an MRI shows anatomy accumulated over a lifetime — some findings are old healed 'scars,' others are fresh 'wounds' — and a radiologist with no context about the patient can't tell which is which. But if a thorough physical assessment precedes the scan, the clinician already knows what the MRI should show, and the match becomes close to one-to-one.

  • An MRI shows anatomy built up over the patient's whole life, mixing old healed 'scars' with fresh 'wounds'
  • Radiologists writing reports without ever seeing the patient have no way to distinguish painful pathology from harmless old adaptation
  • A prior thorough physical assessment lets the clinician predict what the MRI will show, producing close to a one-to-one match with pain source
  • McGill has seen athletes' MRI reports labeled 'degenerative disc disease' that were actually a powerlifter's healthy, adapted sclerotic endplates
  • Radiologists shouldn't write reports without ever seeing the patient — they're good at spotting tumors, but back pain context requires knowing the person

MRIs, if they're used properly, are absolutely fabulous... I would argue the opposite — the problem is an MRI image shows anatomy, not pain.

Stuart McGill · 32:00

I don't think radiologists should be allowed to write a report — they've never seen the person, so they have no context.

Stuart McGill · 34:30
#mri#diagnosis#back-pain#assessment
Myth Buster39:30

No World-Champion Powerlifter Has Loose Hamstrings

McGill challenges the assumption that more flexibility is universally good, pointing out that elite powerlifters rely on tight, elastic hamstrings to generate recoil in the pull, while elite yogis he's treated as patients often struggle to stand up from a bodyweight squat. He argues most sports need athletes positioned somewhere between these extremes, tuned specifically to their sport's demands rather than maximized for mobility.

  • No world-champion powerlifter has loose hamstrings — tight hamstrings provide elastic tension essential to the pull
  • Powerlifters even add elastic knee wraps and suits to increase stiffness and elastic recoil further
  • Yogis McGill has treated as patients can do deep squats but often struggle to stand back up unaided, showing a strength deficit
  • Athletes like rugby players or CrossFitters need to sit somewhere in the middle of the mobility-stiffness spectrum, not at either extreme
  • Elite jumpers/dunkers also have tight, spring-like hamstrings rather than loose ones

Have you built a world-champion powerlifter? Do you know one with loose hamstrings? Yeah, they don't exist.

Stuart McGill · 40:30

They can do wonderful squats, their bottom can go right down and touch the ground, but they have difficulty doing the bodyweight squat to stand…

Stuart McGill · 41:30
#mobility#stretching#powerlifting#yoga#myth

Hot Take· 1

Hot Take83:00

"I Don't Know a Master of the Craft Who Lives on Social Media"

Asked about engaging with fans on Twitter, McGill states flatly that he doesn't do social media at all, arguing that true mastery and constant social media presence are incompatible. His daughter manages any online content instead; he only answers email.

  • McGill has a strong conviction that mastery of a craft and being active on Facebook/Twitter don't go together
  • He personally does zero social media beyond occasionally checking email
  • His daughter handles any content posted under his name online
  • Chris agrees, framing heavy social media use as antithetical to being genuinely excellent at something

I have a very strong conviction that if you're a master of the craft you can't do Facebook and Twitter — those two don't go…

Stuart McGill · 83:00
#social-media#mastery#hot-take#focus

Explainer· 7

Explainer03:00

Why Even Fit, Health-Conscious People Get Bad Backs

McGill explains why spines are so commonly problematic even among people who train hard: athletes often have an underperforming core relative to their sport's demands, and modern sedentary work has turned everyone into 'computer operators' whose hips and spinal joints stiffen from sitting, then get abruptly overloaded at the gym. He argues most people never get a proper assessment of their actual pain mechanism, so they chase generic, untargeted fixes.

  • Athletic injuries often trace to an underperforming core relative to sport-specific demands on the spine
  • Modern work has shifted from movement (walking halls, hands-on labs) to hours of sitting at a computer
  • Spinal joints aren't ball-and-socket joints — they're an adaptable collagen fabric that follows different rules than muscles
  • Sitting all day stiffens the hips, which undermines mobile, powerful hips needed for spine-sparing athletic performance
  • Very few people get a thorough, competent assessment of their specific back pain trigger before trying random therapies

They're not biologically ball and socket joints — they're an adaptable fabric made of collagen strands held together with a ground substance, and they follow…

Stuart McGill · 05:30
#back-pain#ergonomics#sedentary-lifestyle#assessment
Explainer12:00

How Heavy Lifting Actually Creates a Schmorl's Node and Disc Bulge

McGill walks through the precise mechanical cause of Chris's own back pathology: lifting heavy enough to exceed biological tolerance causes the vertebral end plate to bulge and micro-fracture, forming a Schmorl's node. This is followed by loss of disc height and, if compounded by repeated loaded flexion (like deep squatting), a progressive disc bulge — a pattern he links directly to CrossFit-style training.

  • A vertebra's end plate (cartilage cap where bone meets disc) bulges and micro-fractures under nucleus pressure from heavy lifting
  • After that fracture, the disc loses height, becoming looser — like a tire losing air
  • Repeated deep flexion (e.g. deep squats) makes the disc's collagen 'goo' more mobile and eventually causes delamination and bulging
  • The typical sequence: heavy deadlifting first, then repeated loaded flexion compounds the damage
  • McGill correctly predicted, from symptoms alone, that Chris's training background was CrossFit

So it's a combination of loaded flexion and it's accelerated by lifting too heavy in the first place... quite often it starts off with a…

Stuart McGill · 14:30

CrossFit 100%.

Stuart McGill · 15:00
#disc-bulge#schmorls-node#spine-anatomy#injury-mechanism
Explainer16:00

The Biomechanical Reason CrossFit Injures Backs (and a Fix)

McGill explains why CrossFit programming — pairing high-mobility, low-load movements like burpees directly with repeated Olympic lifts — creates a biomechanical trap: form degrades on later reps of a fatiguing set, migrating stress into the spine at exactly the point mobility has been primed and load is highest. He proposes substituting kettlebell swings with a goblet squat (a suggestion from Dan John) as a lower-risk alternative that still trains the same hip-hinge, strength-endurance pattern.

  • Burpees prime spinal mobility without load; Olympic lifts then demand high load with 'no margin for bad form'
  • By reps 8-10 of a fatiguing Olympic lift set, form deteriorates and bending stress spikes right when mobility is already primed
  • Olympic lifters themselves rarely present with back pain — their injuries cluster at knees and shoulders because they stay locked in a stiff, neutral spine
  • CrossFit's dual goal of endurance, power, and mobility athlete is biologically very hard to reconcile in one program
  • Dan John's suggested fix: substitute kettlebell swings with a goblet squat for the burpee/Olympic-lift pairing — same hip-hinge and strength-endurance stimulus without the same adaptation conflict

I have a love-hate relationship with CrossFit... I absolutely love CrossFit for the culture, for the supportive community.

Stuart McGill · 16:30

Dan's solution to the burpee/Olympic-lift routine would be to do kettlebell swings with a goblet squat — that would be a wonderful substitute to mitigate…

Stuart McGill · 21:30
#crossfit#injury-mechanism#programming#olympic-lifting
Explainer23:00

Why Powerlifters' Rest Days Build Bone and CrossFit's Often Don't

McGill contrasts powerlifting and CrossFit recovery schedules through the lens of bone's piezoelectric adaptation: bone generates an electric charge under stress that attracts calcium and magnesium ions to reinforce the fracture site, but this scaffolding takes about five days to bond. Powerlifters who take five days off after a heavy lift let this adaptation complete; CrossFitters who train the next day (even calling a 5k run a 'rest day') repeatedly break off the adaptation before it forms.

  • Bone is piezoelectric — stress generates an electric charge that attracts calcium/magnesium ions to the damaged site
  • That mineral scaffolding takes roughly five days to bond before the next load can be applied
  • Powerlifters' heavy-lift-then-five-days-off pattern is actually a sound adaptation schedule, even though CrossFitters might call it 'undertrained'
  • CrossFit's near-daily training (including 'active recovery' like a 5k run) repeatedly interrupts the bone-building window
  • The same micro-damage can be a good adaptation stimulus or a chronic injury driver depending purely on the recovery schedule

It's crazy to keep stimulating the body to adapt and then you don't take the day off to allow the adaptation.

Stuart McGill · 24:00
#bone-adaptation#recovery#powerlifting#crossfit#programming
Explainer44:30

Why Maximal Muscle Contraction Actually Slows You Down

McGill explains the counterintuitive physics of striking and swinging power: a fully clenched, maximally contracted muscle also becomes maximally stiff and therefore slow. Elite performers — from golfers to MMA fighters who hit hardest — operate at roughly 40-60% muscle contraction, using a neurally 'primed spring' that releases rather than a muscle that's locked rigid.

  • Maximally contracting a muscle creates both force and stiffness — stiffness kills speed
  • The hardest-hitting MMA/UFC fighters aren't the most muscular — they're the ones who can 'snap' with a released, unclenched strike
  • A muscle contraction around 40-60% is the sweet spot for generating speed
  • This explains why trying too hard to hit a golf ball far often produces less distance, not more
  • Elite throwers/hitters rely on stacked elastic elements (hips, chest, wrist) rather than raw mobility or raw strength

If I maximally contract my bicep I can't punch you — I've got to really let it go. It's a neural priming of a spring…

Stuart McGill · 45:30
#athletic-performance#biomechanics#power#elasticity
Explainer53:00

A Stiffer Core Made Muay Thai Fighters Hit Harder — Here's Why

McGill explains the principle of 'proximal stability for distal athleticism': stiffening the core and trunk first prevents energy leaking away through the ribcage or shoulder, so more force transfers into the limb doing the work. In a study, Muay Thai fighters trained with core-stability work showed a measurably higher closing velocity and harder strikes than an untrained control group.

  • Contracting a muscle like the pec can either push (distal effect) or 'leak' energy by bending the ribcage toward the shoulder (proximal effect)
  • Stiffening the core proximally first stops that energy leak, so more force reaches the limb doing the striking or pushing
  • In a controlled study, Muay Thai fighters trained with proximal core stiffness had faster fist/foot closing velocity and hit harder than an untrained control group
  • The same proximal-stiffness principle drives faster running, cutting, direction change, tennis serves, throws, punches and kicks
  • This is the real mechanism behind athletes who say 'working on my core' got them back to elite performance

The more proximal stiffness you have, the faster you can run, cut and change direction, the harder you strike a bag.

Stuart McGill · 54:30
#core-training#athletic-performance#muay-thai#biomechanics
Explainer56:30

The Neural Mechanism Behind Immediate Back Pain Relief From Core Work

McGill explains why Chris feels immediate relief from certain core exercises rather than only long-term adaptation: they create a measurable 'residual neural stiffness' where the brain keeps the core slightly stiffer for anywhere from 20 minutes to two hours afterward. For someone with a lost-height joint from an end plate fracture or Schmorl's node, that added neural stiffness arrests the small joint micro-movements causing pain.

  • Targeted core exercise creates 'residual neural stiffness' — the brain keeps the core stiffer afterward, lasting 20 minutes to 2 hours depending on the person
  • A joint that has lost height from an end plate fracture or Schmorl's node becomes 'sloppy,' producing micro-movements that cause pain
  • The added neural stiffness arrests those micro-movements, producing real, immediate symptom relief — not just a long-term training effect
  • Doing the relief-inducing exercise twice a day (split between mid-morning and mid-afternoon) compounds the respite and speeds the reduction in pain sensitivity over the day
  • Professional athletes across sports use this kind of core-priming work as part of their in-game and pre-training warmup for this reason

We measured a residual neural stiffness — when you do those exercises your brain remembers them and your core stays a little bit stiffer... in…

Stuart McGill · 57:00
#back-pain-relief#core-training#neuroscience#mechanism

Story· 1

Story64:30

The Gift of Injury: Brian Carroll's Comeback From a Shattered Spine

McGill recounts treating world-record powerlifter Brian Carroll, whose sacrum was split front to back, L5 heavily fractured, and discs 'obliterated.' Despite surgeons telling Carroll he'd never be pain-free, McGill got him out of pain in three weeks, then spent years rebuilding him through bone remodeling and progressive loading until he won the Arnold's and returned to elite competition pain-free. The collaboration became the book 'Gift of Injury.'

  • Carroll had split his sacrum front to back, a heavily fractured L5, and 'obliterated' discs
  • McGill assesses the person and movement patterns before ever looking at imaging
  • Carroll was out of pain in about three weeks just by learning to avoid pain triggers
  • McGill's advice was to consider a different path, but Carroll insisted on chasing his world record again
  • Recovery involved a year of bone-callusing (mildly loaded carries with 5 days rest between) before returning to strength training
  • Follow-up MRIs 3 years later showed the sacrum fracture fully filled in and L5 remodeled square again; Carroll has zero pain and still competes
  • The book was written collaboratively at Carroll's kitchen table in Florida, alternating writing sessions with fishing trips

He'd split his sacrum front to back, L5 was heavily fractured, and the disks were if I used the word obliterated that would be quite…

Stuart McGill · 00:00

I said well if you were my son Brian I'd give you this advice. I said let's work on getting you out of pain, but…

Stuart McGill · 67:30
#back-injury#powerlifting#rehab#case-study#gift-of-injury

Q&A· 2

Q&A61:00

What Actually Separates Elite Performers: Tolerance for Discomfort, Not Motivation

In response to a listener question about the mindset needed for injury recovery, McGill and Chris discuss the idea (echoed from a Chinese weightlifting coach cited in James Clear's Atomic Habits) that top athletes aren't distinguished by superhuman motivation but by their willingness to tolerate discomfort and grind through boredom day after day, even elite athletes like Matt Fraser.

  • McGill cites a successful acquaintance's view that willingness to tolerate discomfort is the single best predictor of success
  • Chris references a James Clear anecdote: a Chinese weightlifting coach said the gap between good and best athletes is tolerance for boredom of repetition, not raw talent
  • Even elite athletes like Matt Fraser reportedly don't love every training day — they grit their teeth and stick to the plan anyway
  • This reframes injury recovery motivation: it's not about waiting to feel inspired, it's about grinding through the plan

The measure and the predictability of one's success is how willing they are to tolerate discomfort.

Stuart McGill · 61:30

He doesn't have some superhuman level of motivation, he just grits his teeth and does the work.

Chris Williamson · 64:00
#mindset#motivation#rehab#discipline
Q&A79:30

How Dr. McGill Trains His Own Back Now, in His Mid-Sixties

Asked what he personally does beyond the Big Three, McGill describes how his own training has shifted over the decades: less load and more targeted mobility now versus more load and hip-hinge focus in his 30s-50s, plus specific work to manage a broken-neck history and prioritizing fall-recovery leg power as he ages.

  • In his 30s-50s his body thrived on more load and more strength work; now it's less load and more targeted mobility
  • He does neck stability work (not much neck mobility) due to a prior broken neck, plus thoracic extension work
  • He now allows a bit more lumbar mobility through his low back than he would have in earlier decades
  • He prioritizes leg strength and hip power specifically for the ability to catch a stumble and arrest a fall — a key factor in maintaining independence with age
  • His prescription is always context-dependent: what's right for him would be entirely wrong for a younger person or different athlete

The most important thing is having the ability to recover from a fall — make sure that if you stub your toe you have hip…

Stuart McGill · 81:00
#aging#personal-routine#self-experimentation#training-longevity

Tool· 2

Tool60:00

"Stir the Pot": McGill's Progression for Athletes Ready to Advance Past the Basics

When asked what comes after mastering the foundational core exercises, McGill describes calibrating progressions to the athlete's actual sport demands — using the example of an MMA fighter preparing for a three-round bout by matching the exercise's work-rest interval (5 minutes on, 1 minute off, times three) to the fight's real time structure.

  • Progression choice depends entirely on the person's context — age, sport, and injury history — there's no universal 'next step'
  • For a UFC three-round fighter (5 minutes on, 1 minute off), McGill prescribes 'stir the pot' (feet on ground, elbows on a gym ball, stirring) matched to that exact work-rest interval
  • The principle: match the progression's duration/intensity profile to the athlete's actual competitive demands, not an arbitrary harder version

If I was preparing the average fighter for a three-rounder in the UFC — that's five minutes on, one minute off — I would then…

Stuart McGill · 60:00
#exercise-progression#mma#programming#core-training
Tool58:30

McGill's Recommended Books: Back Mechanic and Gift of Injury

Chris highlights two of McGill's books as direct resources for listeners dealing with back pain: 'Back Mechanic,' a practical self-help guide, and 'Gift of Injury,' co-written with powerlifter Brian Carroll, which combines his comeback story with the science and programming behind his recovery.

  • 'Back Mechanic' is McGill's practical guide for people managing their own back pain
  • 'Gift of Injury,' co-authored with Brian Carroll, blends narrative, science, and programming for strength athletes rebuilding after serious back injury
  • Both books are available on Amazon UK and via McGill's site, backfitpro.com

You should read a book called Back Mechanic.

Chris Williamson · 58:30
#books#resources#back-pain#recommendation

Takeaway· 2

Takeaway59:00

"Sufficient Athleticism" Is a Real Goal — Not Everyone Needs to Peak

McGill argues that most people don't need to keep chasing personal bests; there's a legitimate training target of 'sufficient' stability, strength, and mobility for a pain-free, functional life, and pushing past that point can actually shorten someone's athletic career. He contrasts this with the much higher, more punishing standard required to compete at the CrossFit Games or Olympic level.

  • For many people, pain-free function and casual activity (playing with kids, occasional golf) is a complete and sufficient goal
  • There is a real concept of 'sufficient athleticism' — sufficient stability, strength, and mobility — where optimal health lies
  • Constantly chasing a new personal best can shorten someone's athletic career rather than extend it
  • This standard is explicitly not what's required to reach the CrossFit Games, Olympics, or elite competition

A lot of people will be shortening their athletic career by keep trying to push, push, push. There is a concept of sufficient athleticism.

Stuart McGill · 59:30
#training-philosophy#longevity#goal-setting
Takeaway76:00

Telling a Patient Their Back Is 'Fragile' Can Be Right or Dangerously Wrong

McGill criticizes the blanket physical-therapy trend of telling every back pain patient 'your back isn't fragile, just carry on' without first assessing who they are. A go-getter CrossFitter needs to be held back and told to respect fragility during healing; a movement-averse, anxious patient needs the opposite message — reassurance that they're more robust than they think.

  • Some physical therapists now tell every back pain patient their back 'isn't fragile' regardless of who they are or what caused the pain
  • A CrossFitter/go-getter type doesn't need encouragement to push — they need the brakes pumped and to be told to respect their healing timeline
  • A movement-averse, catastrophizing patient needs the opposite: reassurance and evidence that they're more robust than they believe
  • The right message depends entirely on assessing the individual first — there is no universal script

There's a time and a place to tell a person your back is fragile — and for a crossfitter you've got to hold them back.

Stuart McGill · 77:00
#patient-communication#back-pain#physical-therapy#individualization