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

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. (www.backfitpro.com/about-us/) where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.
We discuss:
0:00:00 - Intro
0:00:30 - Peter’s experience with debilitating back pain
0:14:11 - Anatomy of the back: spine, discs, facet joints, and common pain points
0:24:48 - Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more
0:31:30 - Why the majority of back injuries happen around the L4, L5, and S1 joints
0:37:20 - How the spine responds to forces like bending and loading, and how it adapts do different athletic activities
0:45:12 - The pathology of bulging discs
0:48:33 - The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more
0:59:36 - The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types
1:12:46-The significance of strength and stability in preventing injuries and preserving longevity
1:25:33-Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns
1:37:08-Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain
1:46:59-Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro
1:56:08-When surgical interventions may be appropriate, and “virtual surgery” as an alternative
2:05:48-Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more
2:11:21-Tarlov cysts: treatment and surgical considerations
2:13:34-The evolution of patient assessments and the limitations of MRI
2:18:40-Pain relief related to stiffness and muscle bulk through training
2:26:49-Advice for the young person on how to keep a healthy spine
2:39:24-Resources for individuals dealing with lower back pain
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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
Learn more: peterattiamd.com
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Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies. For a full list of our registered and unregistered trademarks, trade names, and service marks, please review our Terms of Use: peterattiamd.com/terms-of-use/

[@PeterAttiaMD]

In this episode, we discuss: <a href="#" class="seekto" data-time="0">0:00</a>:30 - Peter’s experience with debilitating back pain <a href="#" class="seekto" data-time="14">0:14</a>:11 - Anatomy of the back: spine, discs, facet joints, and common pain points <a href="#" class="seekto" data-time="24">0:24</a>:48 - Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more <a href="#" class="seekto" data-time="31">0:31</a>:30 - Why the majority of back injuries happen around the L4, L5, and S1 joints <a href="#" class="seekto" data-time="37">0:37</a>:20 - How the spine responds to forces like bending and loading, and how it adapts do different athletic activities <a href="#" class="seekto" data-time="45">0:45</a>:12 - The pathology of bulging discs <a href="#" class="seekto" data-time="48">0:48</a>:33 - The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more <a href="#" class="seekto" data-time="59">0:59</a>:36 - The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types <a href="#" class="seekto" data-time="72">1:12</a>:46-The significance of strength and stability in preventing injuries and preserving longevity <a href="#" class="seekto" data-time="85">1:25</a>:33-Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns <a href="#" class="seekto" data-time="97">1:37</a>:08-Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain <a href="#" class="seekto" data-time="106">1:46</a>:59-Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro <a href="#" class="seekto" data-time="116">1:56</a>:08-When surgical interventions may be appropriate, and “virtual surgery” as an alternative <a href="#" class="seekto" data-time="125">2:05</a>:48-Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more <a href="#" class="seekto" data-time="131">2:11</a>:21-Tarlov cysts: treatment and surgical considerations <a href="#" class="seekto" data-time="133">2:13</a>:34-The evolution of patient assessments and the limitations of MRI <a href="#" class="seekto" data-time="138">2:18</a>:40-Pain relief related to stiffness and muscle bulk through training <a href="#" class="seekto" data-time="146">2:26</a>:49-Advice for the young person on how to keep a healthy spine <a href="#" class="seekto" data-time="159">2:39</a>:24-Resources for individuals dealing with lower back pain

[@BrianCarroll1306]

kzbin.info/www/bejne/hmm8mo2FaLR6oM0

[@AlbertManiscalco]

Can you do an episode dedicated entirely to the fascia system? I just came from my general practitioner and there’s still a lot of misconceptions about the new research. I had major blunt trauma to my fascia when I was 18 and I’m still having issues from it at 48. most doctors if you say to them “I have referred pain”look at you like you’re a liar or you have two heads, so you have doctors doing their patients a disservice because they don’t even understand all the progress that has made in the last 10 to 15 years. My general practitioner literally tried to tell me that there aren’t any major discoveries about the body left anymore, just refinements, so there’s major education that needs to happen for general practitioners, and the general public on this subject

[@cognac1969]

Fascial treatment for low back pain (acute or chronic) provides greater relief and lasts longer. @@AlbertManiscalco

[@RelentlessCuriousity]

Peter You should take his courses.

[@geoffreyquaile4383]

Don't discount unperceived stress and back pain. From experience, I had about 5 years of progressively worse lower back pain including disc issues with the debilitating butt and lower leg nerve pain. During this time I sought help from PT, massage, acupuncture, and bone crackers. While offering some temporary relief nothing really fixed my issues. During this phase of my life (31-36 years old) my mother was dying from cancer. The day she passed, I was in a medium "background" phase of pain (not acute). Over the next week this pain dissipated and I have yet to suffer acute back episodes since (I'm rounding 60). I subscribe to Dr. McGill's big 3 with variations to keep basic core strength. When I get lazy on the core, I will have occasional muscle back pain (usually when installing snow tires), but I'm relatively bullet proof if keeping the core strong. In sum stress (not recognized in my case) is a mysterious influence that the medical community does seem connect with enough.

[@lookswhatsnew8951]

This is one of the best podcasts I've heard and so valuable for advancement of knowledge and shows the lack of knowledge by many physicians and trainers. Dr mcGill is a gift to humanity.

[@Re3iRtH]

This podcast didn't show what you stated clown

[@fitnesssoup7553]

It's rather remarkable how many physicians, therapists and other medical "professionals" are so incredibly ignorant about the body and it's treatment. This is particularly true with the spine. 😅 Most of them aren't particularly good in the region where I live and I've been to some that are considered to be very good. Many times patients are more knowledgeable than they are.

[@dravrahamrosenzweig]

@@fitnesssoup7553 dont shit yourself poossie

[@waakdfms2576]

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

[@6681096]

Terrible back problems from early '20s to '40s until I found McGill. Get his book "back mechanic", maybe his video, but definitely how to's he did with Jeremy Ethier on KZbin. I run, lift, and play basketball with no issues.

[@user-jg6jy2cc2j]

How did you fix your problem

[@waakdfms2576]

@@user-jg6jy2cc2j I followed the McGill "big 3" and also his advice for "virtual surgery," which was the most difficult thing ever because I rely on my exercise activities for systemic and nervous system regulation, so this was hugely challenging for me....but it made perfect sense and avoided gigantic medical bills and even more recovery time. Also, I'm very flexible and have always done lots of stretches, but I totally "stopped stretching" per his advice for herniated discs, and I could see that I had been continually aggravating my sciatic nerve and prevented it from cooling down. There's so much more in his Back Mechanic book which contains essential details to narrow down your own specific problem and how to best address it. Best of luck to you.

[@deekana]

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

[@toddsmith9598]

McGill is a global treasure. A life-saver. I love that man.

[@robertbaillie2948]

WOW! learned more from Stuart in this podcast than all my prior research combined. He gave me such a good understanding of my back and the evolution of my issues. Can't thank you enough Peter, you always have the best and brightest in their field.

[@micahkirn6756]

You two have made the biggest impact on my life concerning health and longevity. I had debilitating back pain from 2 herniated disks in my 20's. I was told surgery, chiro, massage, acupuncture, and stop lifting. I discovered mcgill through Dr. Aaron at squat University. I lift more than ever and haven't had a single sciatic or disk issue in 2 years.

[@swimraces]

This was hands down one of the best Drive episodes. McGill was an authority on the lumbar spine 20+ years ago when I was at Osteopathic school and here he shows why. Well studied, deep insight and clear, practical explanation. Kids, devote your life to learning something in depth in both theory and application, and this is what is looks like. Great discussion!

[@angelapolly1]

Thank you for putting this material out. It's very timely for my brother who has been suffering with lower back pain. He's a hard HVAC worker and needs his back. I sent him this and hope he'll listen (I'm listening to share in case he doesn't find the time and will share what I learn also). I appreciate you so much, Dr. Attia.

[@bw6078]

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

[@Dynamicdiscdesigns]

Appreciate the mention and the use of our anatomical models. Wonderful interview.

[@fahada1921]

No way!! Stuart Mcgill. Seriously I was gonna request you to do any type of content regarding back pain and especially lower back pain as I’m dealing with a herniated disc. As it’s getting more common these days. I freaking love you Peter 😁 Thanks a lot and can’t wait to watch this.

[@youdontknowwhoiam5097]

2 hours and 45 minutes, are you stupid?

[@glennsorokan9608]

Been following Dr. McGill for a decade plus. Genius. His work is so important. Thank you Peter.

[@raifps5091]

Doctor Stuart McGill’s book helped me totally eradicate horrible back pain I had for 2 years. I will forever be grateful to him 🙏🏻

[@pumpkinpie82]

The timing of this is impeccable. Thanks to both of you!

[@janehodges8057]

Hi, a PT of 23 years here, great interview, but want to let people know that there are really good PTs out there who specialize in back pain, many of his stories are the same for me and my colleagues, so happy to hear him comment on posture and mechanics, that's what we teach all day long!!!

[@tallndorky]

As a PT what is your opinion on Dr. McGill’s statement about not mixing yoga and deadlifting? As a middle aged rock climber that started weightlifting this year I’m very concerned about this.

[@kasunkandauda4593]

Not a PT, just a regular guy on the internet. I was very concerned about that too. I think maybe it has to do with stability. Yoga can be done in many ways, and I think he wants to warn against pushing end ranges of the joints. That’s to be differentiated from mobility, which is a controlled range of motion.

[@Flow_with_G]

As a Pilates and yoga instructor, as well as a low-back pain patient and currently taking Dr. McGill's courses: If the spine needs stability and stiffness but you remove it through stretching/yoga, you create more instability. Every case is different and it depends on the specific patient and injury. It's like with the spine extension/traction tables. Would you stretch a spine that needs stiffness? No. I've been stretched by PTs for lower back pain. It made me worse. Couldn't even walk the next few days. But again it depends on each case. After a thorough assessment you determine what the specific person needs. Not just yoga for everyone type of statements. My understanding is that it's a continuum. Generally speaking, you can't have both: a heavy-lifting spine and a very mobile spine. The yoga master can't be the Olympic champion in weight/powerlifting. There is no free lunch in physiology (I think Andy Galpin's words if I remembercorrectly). Two opposite adaptations. But we could try to get the best balance of both. This balance would be different for each individual.

[@ExerciseLab]

@@tallndorky while I can't speak for McGill, I think what he's getting at is that while both spinal mobility and stability are needed, certain populations like elite deadlifters need a lot more of one than the other (stability >> mobility). However, since most of us aren't elite deadlifters, I think pursuing a balance between the two makes sense. McGill's point is that if your priority becomes deadlifting strength, you shouldn't be regularly taking your spine to end ranges (potentially creating laxity) by doing yoga.

[@6681096]

​@@Flow_with_GGreat comment. As others have commented one should be wary of really pushing the end range of movement particularly if you're also going to lift heavy weights. Make sure you have some control when you're getting near the end range and also at times add in some bands or isometric resistance to your stretches.

[@fabig1507]

Dr Attia, I enjoy all your podcasts but this one was the best for me. I can personally relate with this topic. When I was 40yrs old, I encountered 2 episodes of back pain. It lasted for so long almost 2 wks, laying in bed, unable to walk or sit; holding the pain because I had no health insurance. Later on I had a MRI and learned I have congenital spinal stenosis L5-S1. When my pcp suggested me to avoid any type of exercise I cried, because I loved exercise. I took a break, I learned the proper technique, stretching exercises and I went back to exercises, (training for life) It has been 10 years since and I feel strong and healthy. Thanks to God It makes me appreciate the life, the human body and all the things we take from granted. Thank you for everything you do.

[@Hon1355]

Thank you, Great interview. I wish you'd have touched on lower back pain in women during peri menopause and menopause and role of hormones in disc degeneration and lower back pain. There aren't enough research and attention to this at all! Maybe in future episodes?

[@abzer030]

Thanks for this Peter, I have a suspected disc bulge and I’m suffering and this is giving me additional options that I didn’t have before listening to your podcast. Greatly appreciated. Cheers

[@Dailyfunctionalprogramming]

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

[@kelleyjensen2644]

Love McGill! Great choice, Peter. Just finished Back Mechanic and my 18 months of sciatica is nearly gone!

[@warrenstringham415]

The dude is hands down the best in the business when it comes to back pain.

[@rainrider]

Excellent interview and resources! Thank you so much for hosting it!

[@matiassanchez9563]

Listening to Stuart, seeing how much he enjoys what he does, is trully inspiring.

[@mandihaase2744]

This is by FAR my favorite episode of the Drive Podcast. Thank you both Dr. McGill and Dr. Attia for all you do to help people live up to their full potential. ♥

[@joboehm4576]

Thank you, thank you Dr Peter Attia and Dr McGill🙏

[@Madmad722]

I love this man, respectfully!! Dr. Stwart Mcgill is a impressive scientist. I have studied all his books!

[@Carras02]

This is the deep dive we all needed. Glad you stepped up to the task! Stuart is phenomenal!!

[@jenniferzinetti]

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

[@Jibcutter]

Dr. McGill is such a great communicator.

[@lezlieobrien]

Stuart McGills name is not mentioned anywhere, not the title or description.

[@richardnorris7948]

At <a href="#" class="seekto" data-time="134">2:14</a>:19 Peter asked what are the things on MRI that a radiologist can miss. McGill‘s answer was completely off the mark. He focused on missing cervical instability, but that’s not something a radiologist misses. That’s just simply a limitation of static imaging. Or the failure of the ordering physician to get a flexion extension film. Much more commonly, there are findings that are mis-represented or underrepresented on the MRI due to the recumbent position that it’s taken in with a bolster under the knees, flexing the hips. This severely under represents bulging discs. As was discussed,lumbar flexion increases the pressure on the disc and brings out the bulge, but in the MRI you’re lying flat on your back, the lowest pressure on the disks. The other thing that is misrepresented is spinal stenosis. The bolster under the knees causes flexing of the hips opening up the neural foramina, thus minimizing the true extent of the stenosis. It’s important to remember that the MRI report is simply a description of what the radiologist sees, and while the MRI tells the truth, it’s not the whole truth and nothin,g but the truth. You can’t just go by the report. You have to know enough about the limitations of the imaging in order to interpret it in a clinical setting.

[@ManambeLavaka]

Great points. Similarly, they’ll often ask for an X-ray with flexion but the X-ray tech will just ask you to bend forward normally. Anyone who has struggled with back pain for years and has worked to mitigate their own pain will often default to a hip hinge instead of actually rounding the spine. X-ray comes back with nothing abnormal when you can actually have sponylolisthesis/retrolisthesis. Long story but the imaging is not the end all be all. I had to learn all this from, Dr. McGill and then guide the spine specialist doctor for years until they finally started agreeing with my own self diagnosis. Crazy.

[@Re3iRtH]

I'm a board certified diagnostic radiologist and that question is nonsense. Do you think someone with 15 years of training would miss a finding that a lay person would see? People on the internet are something else

[@Re3iRtH]

​@@ManambeLavakaA radiology tech and radiologist are slightly different.. about 13 years of training different :)

[@didactica9326]

@@ManambeLavakagood job! Sometimes our instinct about our own bodies is spot on. Imagine that!

[@chrislongdc]

I had a 70 y.o. female patient with sever sciatica for 3 months. After x-rays and looking at her MRI. She had a grade 1 spondylolisthesis at L4, and Grade 2 at L5. Looking at her MRI her spine otherwise looked amazing for her age, turns out she took care of herself very well, exercised and ate healthy. She wanted me to really move the spine. Based on her MRI (how healthy her bones and other discs looked) I was confident that we could make some movement safely so I side postured her! It clunked loudly and she was dancing at her granddaughters wedding that weekend. She still comes to me every week for gentle routine adjustments and is still exercising, cleaning and performing ADL with just a constant ache at her left SI. An aches she'll have the rest of her life but much better than debilitating pain.

[@simoskazakos98]

I think it was one of the best podcasts of stuart mcgill. It's really wonderful when the host of a podcast knows the right questions to navigate the conversation.

[@Dynamicdiscdesigns]

agree, absolutely packed full of insights and knowledge. The length of time of this podcast helped him be more thorough ⏲

[@paulwitt8186]

"Never mix up deadlifts and yoga" <a href="#" class="seekto" data-time="2600">43:20</a> 🤯🤯 This is enlightening. I have been doing Pilates and yoga in my routine with deadlifts thinking the two things complement each other. Might need to rethink this. Always learn something new and actionable on these podcasts.

[@adamsussman1469]

what was approximate timestamp on that comment?

[@paulwitt8186]

@@adamsussman1469 43:20. There are references to yoga and deadlifts throughout, including when Dr. Mcgill talks about how many lifelong deadlifers and yoga practitioner's eventually need surgery. Peter did a great job talking about his struggles with the desire to perform deadlifts vs the risk of injury. At 41, I struggle with this same issue as I'm sure many do. Dr. Mcgill really did a great job talking about the long term risks of heavy compound movements. A lot of us watching will really need to reflect after watching this. How important is hitting that deadlift PR really?

[@jeremydrake101]

Ok but are we talking level 11 power yoga and 1 rep max deadlifts? Or can I do some basic vinyasa and 15-20 rep with bands. I think he’s saying don’t go in to elite directions. Surely a yogi should do deadlifts every now and then haha

[@jeremydrake101]

Ok but are we talking level 11 power yoga and 1 rep max deadlifts? Or can I do some basic vinyasa and 15-20 rep with bands. I think he’s saying don’t go in to elite directions. Surely a yogi should do deadlifts every now and then haha

[@jeremydrake101]

Ok but are we talking level 11 power yoga and 1 rep max deadlifts? Or can I do some basic vinyasa and 15-20 rep with bands. I think he’s saying don’t go in to elite directions. Surely a yogi should do deadlifts every now and then haha

[@themostselfishman]

Absolutely fantastic. These deep, informative dives paired with your range is why your program is the best.

[@MorethanGUNZ]

McGill is such a gem. After all these years and clients, he still loves what he does and is making a huge impact.

[@BambiWantsRevenge]

Talking about the unfair development of nerves in a damaged disc - to go one further, after a herniation/damaged disc, during the repair process (which I have never seen explained so well as in this video), there is a risk for infection to get in - especially with Modic Endplate damage. Herniated/Damaged Disc + Endplate damage/microfractures can easily = bone infection. Which, it turns out, is what was causing my back pain of around 4 years. I have just finished the treatment (MAST: Modic Antibiotic Spinal Therapy) through an Infectious Disease Specialist and am blown away by how much it has worked! I feel like a normal person again. This video has been so incredibly helpful with the next stages of my healing process - because my poor facet joints and lower back muscles have been turned on 24/7 for 4 years. I'm now doing a deep dive into Stuart's website and advice.

[@CriticalThinking88]

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

[@2000triathlete]

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

[@mathieuguillet4036]

Love your series, Doctor! These are some of the best guidelines for overall health available.

[@miCorazonSuCasa]

I suffered from back injuries for years. I am grateful to Stuart McGill for making the effort to share his expertise. I do not know what I would have done if this beacon had not shown in my life.

[@kengreeff]

I thoroughly enjoyed this episode, I love how animated and knowledgeable Stuart is.

[@thdjjfsfh]

Holy Moly, you guys have no idea how useful this podcast is for me.

[@richardvasquez2327]

Thank you both for all you do❗️Hoping more so called professionals are disrupted by Dr. McGill’s wisdom yet open to learn, listen, hear and HEAL🙏🏻

[@finukai]

Fist of all thank you for the amazing work you do. It's really something that Dr McGill shout outs the impact the work you do has had in his life. I do have a question related to the "don't mix Yoga and Deadlifts", I was puzzled by this statement. Historically on the training you recommend for longevity there are core strength, regular strength (which may include deadlifts and similar repetitive movements), and flexibility (yoga like movements), how do we interpret this mismatch between flexibility and strength? Also in other episodes Dr Andy Galpin mentioned the feasibility of having really strong athletes with good flexibility. The intention of this question is how do we understand the statement as we may all need some strength and flexibility? How do we come up with the proper mix?

[@user-pu8mk2fw8p]

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

[@Alekosssvr]

Agree with a lot of this. Messed up my back a while back. Could lift weights but nothing that stressed my back, e.g. squats, deadlifts. After a special spinal reactivation program which involved twisting bending movements while in an unbalanced stance I was agle to get back to trainig and deadlift 220Kg at an age of 54. Also, focused breathing exercises are very beneficial in the short term. I was able to apply this method right after a full-blown lumbago event. Normally this would put me down for at least 3-4days. But after about 2 hours of foucsed breathing the lumbago miraculously dissapeared!

[@konstantinl6131]

Here it is! Was wondering all the time why there was almost no content on back pain that is on of the most common symptoms in population. Great episode.

[@kidagave1]

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

[@franciscoalarcongalarce8688]

Wooow!! 🎉🎉 what a crossover !! Very happy to see Dr. Mcgill here with you Peter, I'm a Physical Therapist too and He has been my mentor since I was a student, his books are amazing !! Really life changers. Thanks Peter for this interview 🧠

[@my_screenname007]

<a href="#" class="seekto" data-time="77">1:17</a>:55 That story made me happy cry an saved my life, thank you!! So thankful I got to watch this video!

[@andrewpratt3861]

This was an incredibly insightful episode. Dr. McGill is such an earnest and intelligent person that it was as much of a pleasure to hear his stories as it was to learn from his expertise in the field. Dr. Attia, I'm very grateful to you for making this information available to the public where only certain elite athletes and wealthy people could access such a high level of understanding from practitioners like this. I did want to address one moment in the podcast where Dr. McGill was asked to give advice to someone in their 20s and 30s and it was apparent that he has had some negative interactions with young people who would not listen to advice or even express interest in modifying behavior. I am a 30 year old and I'm incredibly interested in learning more about how to properly take care my body and, if not avoid certain behaviors, at least be aware of their impact as I age for the sake of longevity and healthspan. I was a bit disappointed that we didn't dig a bit deeper with that question, but I totally understand where that feeling of futility comes from.

[@michaelhagood4648]

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

[@DZMYQD]

I'm 32 and currently 6 months in to my 3rd significant bout. I'm hoping it'll be my last because PT and Prednisone couldn't help this last time. Thanks for this podcast, I don't know if I'll ever be "better", but it's nice to hear that people can figure out their pain.

[@patrickpoulin8554]

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

[@dant.6364]

You sound like you are on the right track now. Best of luck!

[@davidalcantara8122]

As an engineer turned spine physician, I really resonate with McGill’s statements toward the medical system. I really want to spend an hour or two with a patient to figure out their pain mechanisms, but like he says, our interventions are a crapshoot. So in reality, you take limited information, then shoot your shot, kinda like in House MD. If your intervention works as intended, you just made your diagnosis. Thankfully, obvious pathology is obvious. The ones in the realm of nonspecific low back pain are the tough ones while the ones with non organic factors are practically impossible to treat with our current toolset.

[@cwong6204]

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

[@cwong6204]

By the way, I listened all the way to the end even though I’ve never had real back pains (some stiffness after sitting too long, but that doesn’t count). I find this information very interesting because I work on prevention - doing exercises in good posture and form, and the proper training to increase stability/mobility.

[@littlebeebs1]

I admire Dr. McGill so much! He is very kind and forthcoming with his knowledge and helpful advice.

[@paulmcmahon99]

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

[@catcan221]

Ha. I too was 27 with my first back injury. I had a skiing accident and years of disc pain and sciatica. However, yoga has been my lifesaver. My surgeon was the one who said to do it for strength, balance and mobility. I did stop now and then and back pain would come back. Once I got back to regular yoga, strengthening my core and all my hip and back muscles, the pain would cease.

[@jake1783]

Did you have surgery? And how far down did your sciatica go?

[@reformedknight7506]

I cannot say one chapter is more interesting that the other . Truly amazing podcast with big expert , who is also enthusiastic and loves to help people .

[@BaddykidStarcraft]

Peter, great job asking the right questions

[@watchdogdb]

Best show to date Mr Attia. Even someone like Peter, who went through medical school, was an accomplished endurance athlete, who promotes working out with weights, who is also familiar with DNS, didn't know about the nuances of the spine/disks that is in about minute <a href="#" class="seekto" data-time="1920">32:00</a>. That's not knock on Mr. Attia, it should however be a lesson that everyone should do their own learning and be responsible for themselves.

[@karlmcmanus4816]

I absolutely love listening to Dr McGill . I was on my hands and knees for close to a month . I was given an unlimited prescription for pain killers by my former family doc . I used Dr McGill’s book - back mechanic to get back on my feet and stronger than ever . I might be wrong but I’m fairly certain with the level of spinal hygiene I have now . I will never have back pain again

[@user-kx7nt4wp1z]

Also it’s amazing how well mentally Peter handled very severe prolonged injury - much more so because he loves exercise. The 2 back surgeries, and all that led to it, id have a very hard time staying mentally well enough to work

[@sandraweber]

Massage therapist here...almost all of my clients come from "I've seen the best neurosurgeon, I've had muscle relaxers, nerve blocks, chiro, pt, had a personal trainer, had botox for migraines...still in pain...no practitioner is touching them. A few lifestyle modifications, good bodywork, strengthening where needed, nutrition/supplementation as needed, and they are good to go!! Great interview. You'll never agree with everything someone says, if you do, you're in a cult. The big picture is that the standard of care will not help most of the population in pain.

[@warrenstringham415]

if you're in the US, you're a client there and not a patient. The goal is to make you come back and get you hooked on pills.

[@Dr.G9]

Such a great podcast, I'm 33 years old and I had low back surgery for a disk herniation. More medical professionals should listen to these kind of conversation.

[@thomassmyth65]

Im ten minutes into this podcast and i can relate to all this, pain, sciatica, small and big occurrences, its been 20 plus years for me, im really looking forward to the rest of this. Sciatica in my knee is probably the most uncomfortable ive experienced so far

[@albertoverenzuela5641]

Amazing talk. As a young physician, very encouraging to keep learning. And specially as a biped animal good advice to take.

[@raulvh23]

Great information in this episode. Thanks a lot for the details and dip explanations. Very much appreciated!

[@premiermovement6614]

Yessss so pumped to see these guys together!

[@martine5716]

Thank you for explaining everything I've wanted to know for 4 years now. I'm 51 and have a grade 2 degenerative spondylolisthesis. I can absolutely attest that strength training and isometric holds will keep pain at bay. I'd just started weight training when I was diagnosed. I still back squat and have replaced deadlifts with RDLs. I still bench but because I'm short and pinch my nerve root in extension, I now place my feet up on the bench. Doing it that way definitely makes sure you engage your core otherwise you get the wobbles! Pinching that nerve is absolutely horrifying! The pain is excruciating and I basically can't walk for 5 or so hours which is scary even when you know what's going on. I have a prevention mindset though. My choice was lift weights, nerve block or surgery. I will take exercise over the other two any day. Thank you again🙏❤️

[@dr.johnhemingson7170]

Find a Gonstead Chiropractor for your spondy. I have seen tons of people with spondys and have dramatic results when handled specifically

[@bonozil]

Thank you so much for this video, both of you are AMAIZING

[@aliciar.2016]

Thank you both for your time and outstanding information. It is extremely helpful and desperately needed information. God bless you.

[@SamE2109]

This was a magical interview. Thank you

[@robertdelorme8779]

This was fantastic!! Thank you Peter and Stuart!!!

[@gailkapusta1342]

omg that story made me cry. i felt my life was going this way.Thank you.

[@jlimbird]

Kudos on a great podcast/video. And it is true sometimes you do not need to look at your MRI (or report) and just get on with it..... 72 and just rode 130 mi/11,000ft of gravel in the last 7 days with the following lower back MRI In October.... 1. Severe central canal stenosis at L4-L5 due to disc disease and muhilobulated synovial cyst lormation in the dorsal epidural space. 2. Severe bilateral lateral recess slenosis at L3-L4 and L4-L5 3. Up to severe neuroforaminal stenosls and iacet degeneraton detailed above. Core and Movement are key.....

[@FrankRS-ww7pp]

So enlightening. Thank you!

[@ellenvolkomer269]

AMAZING! GRIPPING! THank you for such an informative, interesting, entertaining discussion.

[@Ptomsett49]

This was the best episode of the podcast I’ve seen in 5 years of listening and watching. Thanks to you both for what you do. Can we have the same for joint health pls? 😂

[@breathless66]

Your story is incredible and I am so grateful you told it from beginning to end. I am more prepared for neurosurgeon. Such good info from you both

[@drnancystanley]

Excellent! As a physical therpaist for 45 years just saying keep looking for answers!

[@sylgo]

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

[@smedleyjefferson1450]

For me, what overcame my chronic lower back pain was 48 hour calorie restriction (up to 600 calories a day). - 24 hour CR inadequate, combined with physical therapy. Do 48 CR twice a week, 2 days CR, 2 days normal eating cycle

[@Gustoking37]

There is something in what you saying .. I find over eating doesn’t help so this makes sense!

[@pryme2013]

Fantastic video. Never hit fast forward once. As someone who has abused my back for 30 years in the gym and can see 50 without looking too far forward, this video was very informative. Like Peter, deadlift was my favorite exercise to perform and I have reluctantly had to almost completely eliminate it along with back squats, due to the accumulated wear and tear over the last 30 years. I’m glad I catalogued a lot of lifts over the years because I already use them when I feel nostalgic and want to go back and relive those moments and I’m sure it’ll get even more pronounced as I get older. Too bad KZbin wasn’t a thing earlier on. Never had an mri but I’m sure it doesn’t look great.

[@TruthFreedomTV]

I had an emergency laminectomy due to cauda equina syndrome. The symptoms of CES came on quickly after a hard workout with kettlebells. I was doing a kettlebell swing and felt a pop. But since the pain wasn't too severe and the mentality "no pain, no gain" was so deeply ingrained in me, I kept pushing till the end of my set. I had never had any back pain before that time. It was an intense week, culminating in me losing feeling in both my legs, from my hip down, which landed me in the ER. Took me a year to learn how to walk again without a walker. I want from being a professional dancer to almost being paralyzed. I still have nerve damage from my hips to my feet but at least im walking again. Now im looking for a workout program that will help me stay strong 💪

[@metemad]

Bravo Peter! Great guest. Being a power lifter I have been reading Stuart’s books and watching his videos.

[@darrellstyner0001]

Wow, who knew 2 hours and 45 mins. about back pain could be so riveting. I've suffered from lower back pain on and off for over 30 years. I'd given up on being able to do much about it, but now have some hope that it can be addressed with the right exercises. Looks like I need a copy of Back Mechanic.

[@judyfalcone4542]

Absolutely just what I needed, both of you just brilliant

[@szghasem]

Yet another sought after expert. Thanks for this gem Peter !

[@ST-pp3fk]

Outstanding content. Thank you so much to both of you.

[@okayesthntr]

What an amazing interview. Thank you so much.

[@jeffreylang330]

Had back pain for years and recovered. So many great tips . Avoid surgery at all costs unless you have hard neurological findings. Unfortunately over past three years developed the unilateral neck pain without radicular symptoms that is very painful and bothersome . Woukd love to get Dr McGill’s take on neck issues now

[@donaldmorrill1636]

Awesome interview Peter! I went shopping for sciatica pain mitigation ten years ago that led me to McGill’s 2nd textbook, “Low Back Disorder”. After studying, highlighting, and bending pages I learned a lot. Flossing my nerve was helpful, but ultimately I needed a L5 S1 laminectomy for the exact reasons you got back surgery.

[@jeffreyharrison4045]

Amazing episode! Thanks so much Peter!

[@shredit_nyc]

Having trouble finding the video references to the "big 3" in the video description. The bird dog and side plank are well known exercises, but I'm still a bit fuzzy on the modified curl up.

[@KevinFlowersJr]

Your not the only one. I combed the show notes on Peter Attia's website and still couldn't find them. Guessing they just forgot to add them

[@CharlieCurrie-tx7es]

Thank you so much for this episode. Very informative. Did you post the videos of the big 3 exercises? I don’t see them in the description. Thanks!

[@annapleetmd]

It's crazy Dr. Attia, your story of your lower back pain in your early 20s is identical to my own experience. Was a competitive gymnast as a child (never had any injuries), suddenly had such intense episodes of excruciating pain years later in my early 20s that at times I was "stuck" in bed and couldn't walk for days at a time. Years later, I still feel mild pain and cannot fully understand it. Excited to finish this episode