Ep. #365: Dr. Stuart McGill on the Real Causes of Back Pain (and How to Fix It)

Mike : [00:00:26] Hey, everybody, Mike Matthews here from Muscle For Life and Legion Athletics, and welcome to another episode of my podcast. This one is about back pain, which is the bane of athletes everywhere. About a third of adults out there have to deal with back pain at some point and that number is even higher for us “fitness peoples”.

To make matters worse, the cause of back pain and low back pain in particular is rarely obvious and notoriously difficult to diagnose, even for experts and specialists. Back pain also often strikes out of nowhere, lingers for a while, and then vanishes suddenly for no apparent reason or not, sometimes it just sets in for the long haul.

[00:01:19] Now, as you can imagine, all of this mystery, confusion and frustration has made back pain and low back pain especially, a reliable honey pot for internet profiteers, fake doctors, and supplement shysters who are not bothered one bit by cashing in on people’s pain. And so that’s why I wanted to talk to one of the most respected, experienced, and knowledgeable experts in the world on spinel health and function, Dr. Stuart McGill, to help cut through the noise and get an honest, practical, evidence-based take on treating back pain.

Now, in case you are not familiar with him, Dr. McGill has spent over 30 years now studying the mechanics of the spine and what causes back pain and how to safely and effectively treat it. He has published several books, including The Back Mechanic, which I highly recommend and through his work he has also helped tens of thousands of people eliminate back pain without invasive surgery.

[00:02:35] In this discussion, Dr. McGill and I start more or less from square one, and then we start diving into the nitty-gritty details and address a whole host of questions, some of which I get asked fairly often, including is back pain always caused by structural damage, can you have structural damage without pain, how do different forms of exercise affect the health of your back, how common is degenerative disc disease, what can people do to self-diagnosis and heal their back pain, when is surgery a good idea and when is it unnecessary, and more.

The bottom line is, by the end of this podcast, you are going to know more about the real science of back pain than 95 percent of your fellow lifters and more than many doctors and personal trainers as well.

Mike : [00:05:23] Professor McGill, thanks for taking the time to come on the show, I really appreciate it.

Dr. McGill: [00:05:28] Oh, thanks, Mike. I’m looking forward to this chat.

Mike : [00:05:31] Yeah, me too, you are one of the often requested guests, that’s actually why I reached out, because I asked people here and there, “hey, who should I have on the show?” And you are somebody that many people have brought up. So here we are.

Dr. McGill: [00:05:43] Fabulous. [Laughing]

Mike : [00:05:46] So obviously, I want to get you on to talk about the types of things that you talk a lot about and specifically to address a few different things that I’m often asked about that I have done my best to inform myself on and to give people solid practical advice on, but I am not at your level of understanding these things, so I thought it would just be a great opportunity to hear your thoughts and in some cases, your advice to people who are running into certain issues, particularly revolving around back pain, well, I guess we could say joint pain, but particularly with back pain, how it relates to certain exercises and surgeries and so forth.

Dr. McGill: [00:06:33] Yeah, terrific.

Mike : [00:06:34] So the first thing that I want to get your thoughts on is how pain – and we can stick with the back or just joints in general – doesn’t necessarily mean structural damage because that is one of the first things, of course, that people assume if they tweak something in the gym or just have some sort of chronic condition, that there must be some sort of structural problem and if they could just fix that – again, the fix would have to be a structural kind of mechanical fix – the pain would go away.

Dr. McGill: [00:07:05] Well, Mike, that’s a huge question, I can only take a spine position on this because that’s really where my expertise lies. So let’s talk about, “does back pain always mean structural damage?” Can I just reframe the question a little bit that way?

Dr. McGill: [00:07:23] Perfect. 

Mike : [00:07:24] Okay, well, as I said, that’s a huge question, and I’ll start off by saying, yes, it’s true, there may not be structural damage, but I’m going to have to riff back and forth and take different viewpoints to really cover the waterfront on this one. We have to quantify damage, pain, and give it some interpretation so we can discuss this. And it’s really important because it impacts the listener’s behavior, you’ve already identified it, “what should they do if they have pain, and do they have to do something that is a structural intervention?”

But it also really affects behavior of clinicians, you know, coaches, physios, chiropractors, sportsmen, docs, etcetera, who interpret pain patterns and then they’ve got to decide whether the pain is muscular or it might be tissue-based, might be behaviorally based, so the context of all of this really matters. So if there is pain, you might find this controversial, we usually do find some level of tissue disruption.

We have a little bit of a different or unique perspective from our work over the years of running the Spine Clinic and the two laboratories, we created damage, measurable damage, in spine tissues, and then we imaged them, so we did this on cadaveric spines, so the imaging, whether its C.T., x-ray, MRI, is really poor at picking up the damage. But then we had the advantage of dissecting the spines after, and all of a sudden we saw all sorts of microdamage that had gone unrecognized in the scans.

So this really questions the assumption that, “well, there’s no quantifiable damage,” but then I’m going to take another view on this and talk about the biological tipping point, because now we have to say, “is that damage good or is it bad?” So think of a bodybuilder who trains, they actually at a micro level, you can think of it as damaging the muscle at the ultrastructural level and the tissue adapts and gets stronger and hypertrophies, so that kind of damage you would say is good.

Well, let’s take a powerlifter now who does deadlifts or heavy squats, you’ll notice the bodybuilder typically trains, say, three days a week and then each day of rest between the training days and the days of adaptation, that’s when they adapt and get stronger, but a powerlifter or a strong man type of athlete really couldn’t do that. They might do heavy deadlifts or heavy squats on one day and then they have to take five days off because it takes that long for the micro fracturing that’s occurred under the endplate in their spine due to that heavy load.

It takes five for the new calcium and magnesium ions to really scaffold in with the chemical bonds and get a good hold. So you see a radiologist might say, “you’ve got sclerotic inflates,” not realizing that that person is a highly trained powerlifter and that damage is actually a positive adaptation and in fact, they couldn’t be strong and, you know, deadlift 500 pounds or squat 1,000 or whatever it is, without that kind of cumulative damage that triggered the appropriate tissue adaptation.

But, you know, we just discussed a tipping point, “is it good or is it bad?” I need to know a lot more details about the person, the exposure, the load, the volume, the rest cycles to really blend the art and science to give a very specific direction to a person. But the next viewpoint I’ll take is one where distal pain might be from a central disc bulge. So say a person has been told they’ve got piriformis pain because they’ve got a radiating pain into their deep buttock muscle or their right toe is on vacation or it’s heavily numb when they workout at that gym – I’m just recalling a specific patient, this patient came to me, they had very nasty foot pain.

In fact, they couldn’t stand the weight of a summer bed sheet on their toes. There was a surgeon who had offered to amputate the person’s foot. Then he became frustrated and they finally sent him off to a pain clinic who loaded them up on opioids. And then they said, “no, your pain is really from emotional issues,” well, this patient was really suicidal, he was a very psychologically solid citizen and some doc had told him he had emotional issues and he said, “well, if the pain is in my emotions, that means I must be crazy.

I don’t deserve to live, doc, I’m telling you what, I’m giving you a week to help me do something about this pain. I know you’re different, but if you can’t, I’m ending it. I can’t. It’s more emotionally disruptive to me to think that I’m crazy than this terrible pain I feel on my foot.” Well, we do a fairly thorough assessment, it revealed that he had a nerve trap at his fourth lumbar disc and it was a very peculiar type of trap, you know, consider a person with an ACL deficient knee, a clinician would do a drawer test and find out if the knee was lax and whether or not that aberrant movement would trigger knee pain or symptoms that they’re complaining of.

Well, when we do the same type of shear and stability test up and down the spine, we find a slightly flattened L4 disc, so the radiologist might call it degenerative disc disease, which is an absolute fallacy, but the loss of height means that disc is a little bit sloppy, it’s lost its stiffness, it’s like letting a little bit of air out of your car tire of the car now drives a bit sloppily on the road, and when he did specific movements, very specific movements, there was a sheering micro movement across the disc that had lost a little bit of height and had trapped the nerve root going down to his right foot.

We showed him a muscle bracing strategy, it was a bit unique for him, but we found it very quickly and it immediately stiffened the joint and took the nerve trap out of it. So the clinicians that had seen him, no fewer than a dozen, all declared he had nothing wrong, he had no structural damage at all because that type of damage couldn’t be seen in a static image, whether it was an MRI or a C.T.

But when you watched his spine move through video fluoroscopy, which is a real-time moving x-ray, you would watch the spine and the segments, one vertebra move with respect to the other, and then at the instant of that nerve trap, the joint which shear just a couple of millimeters and that’s what trap the nerve. So there’s another example where normal imaging and diagnostic triage would assume there was no tissue damage when in fact, there was, in fact quite extensive damage. I had a patient just last week who came in complaining, when she moved her back a certain way, it triggered a headache and face numbness and then she got neck pain, and back pain, and leg pain.

Anyone would reasonably conclude that she had a bit of a bizarre psychological overtone to all of this, but then when we did a thorough exam of tension in her neural tract, I pulled that one way, say, towards her head, it caused many of the symptoms I just described, and then I did it again with no pain. Then I pulled the neural tract coddly down towards her feet away from her head. First cycle, all of those triggers she reported, and then the second cycle and third cycle, all the pain was gone.

So as it turned out, she had nerve friction. There was no visible tissue damage. And it turned out a little bit later all this nerve friction was actually caused by her just starting off now with ankylosing spondylitis. So all this was missed by all of the clinicians who told her, “you don’t have any structural damage,” and my students over the years know me well enough that if you can’t find the pain trigger, you better go look again, because there’s usually something that is the trigger and then, of course, central processes can modulate the pain, intensity, and whatnot.

To keep going with this idea, let’s turn that question completely around, you said, “can this pain always need structural damage?” Well, can there be net damage with no pain? Absolutely there can. Take the disc, so your spinal disc, when you’re a young person with no history of physical overload, there are no nerves inside the annulus or the disc. Now, people will cite papers and say, “well, the outer third of the annulus is innervated.” No, it isn’t.

That’s only in people who’ve died and they look at their spines and they measure the ingrowth of nerves because a normal, healthy disc contains such high hydraulic pressure throughout the day inside the nucleus that it kills any nerves or internal sprouting of arteries or veins, etcetera. It’s a very pristine kind of a disk. But over time, with a little micro-damage to the endplate and whatnot, there’s a little bit of loss of disc height, a little loss of pressure, now all of a sudden, nerves and vascular sprouting can take place and nerves start to grow into the disc from the outer layers growing inwards.

So now you’re actually developing the hardware to sense pain, but the very first time that person is getting a disc bolt growing, they don’t have the hardware to sense pain. So there is damage accumulating and there’s no way for them to link pain. So all of a sudden, one day they do something a bit odd and they report, “it felt like a knife went into my back.” Well, actually, they’ve been building up that cumulative trauma, perhaps for years, perhaps for whatever length of time, and then, you know, there are subsets of this type of hydraulic behavior and pain.

When you go to bed at night, you’re shorter than when you get up in the morning because your disks are hydrophilic and they suck up fluid. Well, interestingly enough, when you study that cosmonaut and astronaut program, those people grow a couple of inches, the first 24 hours they’re in space and many of them have back pain that they have to take painkillers for. We see exactly the same thing in people who lay in bed longer than eight hours, their spine continues to grow. Think of the last time you had the flu and you laid in bed too long, your spine is screaming.

So now let’s take an intervention, you might have someone who says, “it’s not good to lay in bed, get up and walk around, and let’s do some precision-based exercise prescription.” And then another person clinician comes along and does some cognitive behavioral therapy where they say, “look, let’s just get moving, get out of bed, and get a move on.” Do you see how they both achieved exactly the same thing? Because in that particular example, getting out of bed and squeezing some of the fluids out of their back, mechanically distressed their disc and reduced the pain, so both interventions were linked through mechanics and dealt with their pain.

You know, I quite often don’t see this great divide between cognitive approaches and precision exercise approaches because sometimes they both converge on the same thing. Then another type of evidence that I hear people cite, “well, back tissues heal within 8 to 12 weeks.” So you might have structural damage, but if you have pain lasting longer than three months, there is some other reason for you to have pain. Well, I’ve used this when I’ve been called as an expert witness in court cases, for example, where someone is claiming that this person doesn’t deserve their disability pension or whatever because they have long-lasting pain and therefore it must be more neaurally driven.

Wait a second, you could break your leg and the leg would heal, and it would actually be stronger in the bone than the non-fractured side and so the pain goes away, but that’s not fair to do to a spinal joint. When a disc becomes a bit damaged and a bit flattened, the load sharing among the tissues now change, so in two years, the facets have become arthritic and they become secondary pain generators, the ligamentum flavum will thicken up quite possibly and start causing some stenosis driven pain. The point is there’s a cascade of change that’s unique to the spine.

It was first discussed by Professor Kirkaldy Willis, he wrote a whole book about it called Managing Low Back Pain. So the pain follows this cascade and then all of a sudden the images, you know, are you looking at a wound or a scar? Is the feature that you’re looking at on MRI images, is that 30 years old or was it done yesterday, and is it still a fresh pain generator? So you see, there’s a lot of wonderful uses, but misuses of this whole argument that pain exists without damage.

Unfortunately, I think some clinicians are motivated to say, “the pain is due to a psychological mechanism or a central neural mechanism,” and they may not be correct, but that’s the default because they haven’t done a thorough assessment. So at the end of the day, this whole issue is really addressed by taking the time and doing a thorough assessment of that person. The megatrend in medicine these days is towards precision medicine. Look at any disease, any cancer, know what you’re dealing with and address it with a very targeted kind of intervention.

The final thing I’ll say about this is if you take the average person with the average bad back, there’s a big margin of safety, you don’t have to be that precise, so the average clinician will get the average back pain person and they don’t have to be that precise. However, when you get a difficult patient where the margin of safety or the margin of error now is razor-thin, they can’t take too many cycles of load without pain or more tissue disruption. Now, this is what separates the average clinician from the master of the craft, who does the very thorough assessment, really understands the mechanism.

Mike : [00:22:59] That’s a fantastic summary. And it really does highlight that point because, again, I hear it, people just reaching out to me here and there where all I know is their backs hurt, it’s usually in the context of working out, and they’re worried that, you know, because Dr. Google says that their spine is now broken and should just be – every vertebrae should be fuzed now, but no, they’re just concerned where, “Hey, I have this pain, does this automatically mean that there’s something seriously wrong?”

And it’s interesting, a couple of those anecdotes that you shared with the trapped nerve, I’m sure there are a lot of people that are dealing with problems like that, that the cause is completely different than what they think and again, like you said, it requires someone like you, it requires a real specialist who is going to go beyond just the standard protocol that works for most people that are right in the middle of the curve.

Mike: [00:25:18] How does mechano stimulation play into this, in terms of damage to different types of tissues and how that can correlate to pain?

Dr. McGill: [00:25:26] Yeah, what a fabulous question, and I enjoyed just listening to the whole line of logic you created there, because too many people think getting back pain is really the kiss of death and, you know, no wonder they go to a therapist who gives them ultrasound, and then they go to the next therapist who’s asking them questions about their family, and then they go to someone else and they get some goofy core exercise and, you know, keep finding that nothing really works and no wonder they get despondent about all of this. [Laughing]

Mike: [00:25:55] Yeah, unfortunately, I have a friend in the gym whose wife went through that process. It sounds like to some degree, multiple surgeries, I mean, ultimately, she may have been working with great people, I’m not sure, but I just would hear about it second hand of, from one person to the next and trying this and trying that in constant pain and …

Dr. McGill: [00:26:16] Well, I will bet not once, did she get a thorough assessment that informed her of the mechanism of her pain, and that’s why I wrote my book Back Mechanic, it takes the person through a self-assessment of their pain triggers and then based on the self-assessment, it then shows them what to not do because they have to first stop the cause to wind down the pain, sensitivity, and then what they should do to build the foundation for pain-free activity and whatever that goal is, you know, if they want to play golf or even set another record in powerlifting.

If I can just tell the story about mechano stimulation, I don’t know if you’re familiar with the book I wrote called  Gift of Injury with Brian Carroll. Brian was a champion powerlifter, he was the only guy that I know of who had lifted or squatted over 1,000 pounds in national and international competition over 50 times over the years, so that’s quite a track record.

Mike: [00:27:16] That’s insane. You just have to have big balls to ever even step underneath weight like fact, let alone unrack it. It’s pretty superhuman.

Dr. McGill: [00:27:29] It’s astounding. If you’re off millimeter, you just get crushed because you cannot correct 1,000 pounds on your back. People don’t realize the precision of that maneuver. But nonetheless, Brian came to me with a split sacrum, split front to back. L5 was heavily damaged, his bottom vertebra, and then the two discs were heavily, heavily compromised. They looked just horrible. In fact, we show it in the book at the beginning. I said, “I think I can get you out of pain,” but then he said, “oh, great, I want to set the next world record again,” and then I remember saying to him, “if you were my son, I think I would just enjoy not having pain.”

And a few surgeons had told him, you know, he may never get out of pain and whatnot. But with this massive fracture, what I did was I took a cadaver, I loaded it with a heavy deadlift type of load, we created the split sacrum, but then I did kyphoplasty. So what a surgeon would do is mix up some bone cement, inject it into the vertebra, and it would set and give an internal casting, if you will, of the vertebra, so the idea was to bear load.

So they do this on people with osteoporosis fractures and things like that. But I couldn’t get the endplate to seal, so the disc kept leaking through cracks in the fracture even though the bone was stabilized. So I said to Brian, “I don’t think that’s going to work, we’re going to do some bone stimulation,” which we had some knowledge of from mechano stimulation.

So some people think, “their body is in this state of deterioration.” Some goofball clinician who should know better told them they had degenerative disc disease. There is no such thing, they don’t have a disease, and they’re not degenerating. Quite the contrary, their body is in that continual state of adapting and healing. It’s just no one had shown them how to facilitate that healing process.

Mike: [00:29:37] That’s interesting. That’s a key point, actually, for people listening – because, again, that’s a common concern and I hear it fairly often, mostly from people, I would say, in the 40 plus crowd, and understandably so, because it’s something you just hear about and they just assume just that, that no matter what they do, pretty much everything in their bodies falling apart, their metabolism’s falling apart, their lean mass is falling apart, their joints are falling apart.

Dr. McGill: [00:30:05] Please, we’ve got to get [laughing] clinicians and radiologists to stop using these so destructive terms such as degenerative disc disease. Let me get back to Brian because it will show you the power of understanding the mechanism and then when you target the so-called damage with precision intervention, magic happens all over again. So Brian had this massive fracture. I’m just going to explain how bone heals.

So if you took a long bone, saying in your forearm, and you bent your forearm until the tensile side of one of the arm bones would fracture in tension. So bone, when you stress it, is a piezoelectric crystal. It develops a charge where the strain is the highest. That charge sucks and attracts free ions of calcium and magnesium, the fundamental building blocks bone, and then it scaffolds in to grow bone around the area of the highest stress. So with Brian, I knew there was no real surgical way to close in the fracture so we filled it in by doing bone callusing.

He would stimulate the bone by doing, say, a suitcase carry with a kettlebell, and then he would take five days off and let the scaffolding take place. Now, can you imagine an athlete of his caliber, I said not do that for a year? Now, he was professional enough that even though the pain went away very quickly, I gave him a few simple stabilization exercises that are described in Back Mechanics and he would do the carry and the load and the walk once every five days. If you look at the MRI image of a couple of years later, you won’t see the fracture. It’s all filled in, the discs of remodeled, and the vertebra has remodeled. That’s the power of mechano stimulation. So the body is trying to heal itself, it just needs to be guided the right way just a little bit.

Mike: [00:32:15] Wow, that’s amazing.

Dr. McGill: [00:32:16] Oh, and just to put the icing on the cake, he then went to the Arnold’s, you know, the competitions in Columbus where they have bodybuilding, and powerlifting, and weightlifting, and some CrossFit games, and all that sort of thing, he went and won the Arnold’s the following two years. Squatting, by the way, well over 1,000 pounds once again. So, there you go.

Mike: [00:32:37] That’s awesome. That’s a great success story, because before he came to you, what were other people telling him his options were? You had mentioned briefly that it was like, “you might be in pain for the rest of your life,” and I’m sure they were saying, “you could forget about squatting anything ever again.”

Dr. McGill: [00:32:55] Yeah, your life is basically over because he defined himself as a world champion powerlifter. He came out of a surgical consult with the doc, not really giving him any hope, just more despair, and really inappropriate wording of his diagnosis. Brian sat in his car with a semiautomatic pistol in his lap, wondering whether to pull the trigger, and that’s chapter one of the gift of injury book. So that’s where it starts. It was kind of fun because he held my feet to the fire on that one.

When I first said to him, “I think we can get you out of pain, but I would advise you to find other things to do than to try and set the world record again, given this massive fracture history,” but he said, “no, I want that next record,” and I said, well, “if you get the record, we’ll write a book about it.” So he helped my feet to the fire and came back to me a couple of years later and said, “okay, let’s do the book.” But the thing about Brian was, I had no idea, the man can write. So that first two-page, I’ll send you the book if you can give me the address, but boy, it is emotional, but that’s where the book starts. His life was over and he came and rebuilt his physicality because that’s who he was. He fought his way back.

Mike: [00:34:11] Yeah, that’s so cool. And just for everybody listening, in case you haven’t caught, it’s The Gift of Injury is the name of the book for anybody who wants to.

Dr. McGill: [00:34:17] It’s just Gift of Injury, there’s no “the”. You know, Mike, we’ve done this with many UFC fighters, hockey players, NFL players, I mean, that’s what we do, we restore a lot of athletic careers, not always, we do fail as well, but this is facilitated by understanding the nature of the tissue damage so that we can create mechano stimulation. People will argue, “well, the cognitive-behavioral approach is very important,” and it may very well be, but so often I can’t distinguish between the two because to steal a person’s dream really affects their physicality.

To tell someone that they have a degenerative disease when in fact they do not, the clinician was too intellectually lazy or their profession has not evolved. I mean, I’m really sending out some heavy indictments here, you know, and people blame it on the opioid crisis – who gives them the opioids? [Laughing] It’s clinicians who are failing in providing an intervention to address the very specific pathway of that person’s pain.

Mike: [00:35:32] Well, they can’t all be you, I guess.

Dr. McGill: [00:35:34] Well, that’s why I wrote the book. I never wanted to write the book. You know, I’ve written medical textbooks for clinicians, but, gosh, they’re awful. I even hate reading them [laughing] they’re far too heavy, but you know, some savvy lay people would say, “I picked up your medical textbook, could you possibly write one for the lay public?” so that’s Back Mechanic came about. But I’ll tell you, it took me five years to write that book. It was such a struggle to maintain the integrity of truth.

In other words, the publisher said, “the title has to be Five Easy Steps to Cure Your Back Pain,” and I said, “that’s a lie, it doesn’t exist, and I’m not writing the damn book.” And I said, “no,” so the book is 19 chapters, but what it does, it gives a systematic approach to assessing the person’s pain triggers, you know, do you get it when you bend a certain way, or sustain a certain load, or do you get it after driving your car, or sitting at your computer, do you get it after walking for 20 minutes, or simply when you go upstairs? If you can name a specific activity that makes your pain worse and then another activity that takes your pain away, there is hope, it’s just a matter of quantifying the mechanisms that make the pain better and worse and building on those.

Mike: [00:36:48] I like that, that’s a great framework with which to view it. I’m curious now if we can segway into your thoughts on back surgery for people. I think I can guess, but I think it’s worth talking about.

Dr. McGill: [00:37:02] [Laughing] You know, well there’s a whole chapter in Back Mechanic on that. The vast majority of back pain should not be operated on. Period. Why does most surgery, when it does work, why does it work? Well, sometimes changing the anatomy works, but the surgeon better be darn sure that the tissue they’re going to change is the pain generator.

Sometimes it isn’t, even though on the MRI it might look as though it’s a bit odd if you can prove, and it’s very easy to prove by the way, that the pain is from another level, you know, that that surgery is going to fail. But here’s the interesting thing that I hope if anything, your viewers or listeners who are told, you know, “you’ve tried all these things, nothing works, surgery is the last thing,” it is not. Surgery often works because it’s forced rest. Now, think of what I just said. I will get a patient who comes in and says you know, “I have to go and …”

Mike: [00:38:00] That’s kind of a scary thought, honestly.

Dr. McGill: [00:38:02] Well it is, some of them are addicted to exercise. So they’ll say, “I have to ride the elliptical for 20 minutes every day, otherwise I’ll murder my husband,” or something like that. And I’ll say, “fine, I’m going to play a game with you. I’m going to call it virtual surgery.” [Laughing] And I make a big deal of it, I make them kneel down on one knee and I touch them on the shoulder with a wooden dowel or maybe a kettlebell or something like that, and I’ll say, “there, you’ve just had surgery.”

Now, you cannot go to the gym tomorrow and ride the elliptical, you will spend intervals in bed, you’re going to get up and go to the toilet, and over the next few weeks, I’m going to give you a progression to restore some basic function, and then once the pain is gone, we’re going to rebuild the deficits in your body so that you can do the things that you want to do again. Now, I’m not going to cut you.

I am going to play that game of virtual surgery and you’re going to recover like a post-surgical patient. When we do this, and we were very unique in our clinic because all of those patients we saw over the years at the university, we followed up with every patient. If on follow up we ask the question of those who were told they had no option but surgery left, doing the plan in the book, 95 percent of them avoided surgery and we’re happy for it.

Mike: [00:39:24] Wow.

Dr. McGill: [00:39:24] So we then stepped them through a set of questions that they must check the boxes. If they cannot check the boxes, don’t get surgery. So, you know, the surgeon has to show the person the cause of their pain. If the surgeon can’t show them the cause of their pain, they mustn’t have surgery because the cause will remain and then they’ll be back in six months, “oh, I reherniated my operated disc,” or, “the joint above now has a disc bulge on the same side.” And then I have to hear some tale of woe from a patient who is now an opioid addict and it was iatrogenic, it was caused by their clinicians.

Mike: [00:40:07] Wow. I wish I would have done this interview just a month or so ago. I’m just thinking of my buddy’s wife. I mean, ultimately, it may have – she had a fusion done and so far she’s okay, she’s doing her recovery. It may have been necessary, I don’t know, I’m not saying that the people she worked with didn’t know what they’re doing, but it’s just …

Dr. McGill: [00:40:30] Why did she need the fusion, do you know? Was it a disc bulge or flattened disk?

Mike: [00:40:36] You know, I don’t even know. I try not to bring it up too much with her because, you know, I didn’t want it to always be about – because I know that she was pretty much always in pain, funny enough, she also is into working out and she didn’t like taking breaks, but anyway, I spoke to her a little bit here and there about it, but I didn’t want to every time I see her, “Hey, how’s your back doing,” you know what I mean? I tried to talk about other things, but no, I don’t know anything technically about what was going on. I just know the type of pain she was dealing with.

Mike: [00:41:04] I wish trainers would have conversations with their clients about programming and biology and that more is not better. They train to create adaptations, but the adaptations don’t take place while they’re training. The adaptations take place in the kitchen when they’re eating and in bed when they’re resting. So they train to create the adaptations, but what so many people do is they neglect the adaptation side of the equation and they just add more stimulus, more stimulus, more stimulus, and accumulate measurable biological, and I’ll get right out there and use the word damage, not allowing the natural adaptation process to use the damage in a positive way and cause positive adaptations and strengthen their body. More is not better.

Mike: [00:41:58] Yep, yep. I write and speak about that quite often. I mean, we see that just kind of in life in general, right? It’s always go, go, go more, everything is better, we always have to have more and everything is kind of wired for just never-ending growth. That’s what we need and it needs to be never-ending output, forget about quality, forget about rest. I understand how you can get kind of caught in that, but like you were saying, with some people, it takes probably more discipline for them to actually give their body enough rest than to just go in the gym and work out like crazy all the time.

Dr. McGill: [00:42:36] Absolutely. [Laughing]

Mike: [00:42:38] I’m curious, just getting back on the back surgery, what are some of those other boxes? So one is that the surgeon has to show you where the pain is coming from, what are some of the other things on a checklist?

Dr. McGill: [00:42:48] Well, some surgeons start moving up the ladder and they’ll say, “well, you need a double level fusion.” If you need a double level, fusion, I’d run the other way. There’s something else that’s going on that’s caused all this and the first level of businesses to understand the cause and make sure you get rid of that first. If the surgeon is in a rush and is impatient with the patient discussing things like the cause and “what exactly is it? What’s wrong with me?”

If the surgeon won’t answer those questions, you better run the other way, always get a second opinion. But here’s the million-dollar question. If I hand you a sheet of paper and I say, “write down the things that don’t hurt your back and now write down the things that do hurt your back,” and if they can come up with a list of activities that fit both of those boxes, chances are 95 percent of the time you will not need surgery.

So there is a huge exercise, a huge question with a huge payoff. Work on the things that don’t cause you pain and build on them, get rid of the things that do cause you pain. So you can imagine a younger person, they can deadlift a 100 kilo or you’re American. So 220 pounds, right?

Mike: [00:44:08] Yes, or 225, the standard couple of forty-fives on the bar.

Dr. McGill: [00:44:13] Perfect, there you go, “backfit pro here, sponsored by a lethal sore in kilos. 

Mike: [00:44:16] Professional. [Laughing]

Dr. McGill: [00:44:19] Yeah. Anyway, so deadlift 100-kilo in the gym at night, but sitting in front of the computer ramps up their back pain and causes the right calf to go numb. 20 minutes in front of the computer causes that. But if they can get up and go for a walk for 10 minutes, all those symptoms go away. There is a specific pain pattern. We know the cause of that. We know exactly what to do.

Now let’s contrast another person who, say is my age, they’re in their mid-60s, but sitting gives them relief and walking now gives them a numb foot and back pain, so it’s the precise opposite pain pattern than the younger person that I just described. They would require – we know the cause of that one as well, but they have quite a different strategy but a precision strategy to address and build on the things that don’t cause pain and somehow make the things that do cause pain tolerable. Anyway, those are some examples that I hope to illustrate for your listenership that once they’re guided with an understanding of the mechanism, they get so much more precise in learning how to build their tolerable life and get back to doing the things that they want to do.

Mike: [00:45:37] Yeah, that’s fantastic. Out of curiosity, what is a scenario that requires surgery?

Dr. McGill: [00:45:45] If a person has been traumatized with high energy impact, like a car collision, for example, and they’ve got a very broken pelvic ring, really, really damaged sacroiliac joints, for example, they can’t bear any load at all, they can’t even walk, there would be an example. Another one might be where someone has a really nasty disc bulge, it’s really trapped and nerve root, it’s unrelenting, we can’t get the nerve to slide, once again with neurodynamics, there has been a steroidal cocktail injection, very precisely injected at the pinch point, most of the time they’re not precisely injected, but anyway say they were, and still you couldn’t get a nerve slide and it’s gone on for a couple of months.

There is a really good risk to take, it’s targeted, you know exactly what you’re dealing with, go in there. But the next question is: what caused that disc bulge in the first place to trap the nerve root? And if the surgeon doesn’t show the person, which almost all the time they fail to do that, then the person might come back in a few months saying, “I’ve re herniated my disc,” now we’re into second surgeries and now the risks suddenly went way up of an optimal outcome.

Mike: [00:47:09] Interesting. Interesting. Well, I think I would take that personally as good news if I were dealing with back pain, because just given …

Dr. McGill: [00:47:19] This is just a series of good news stories, it’s so terrible, what’s going on? [Laughing]

Mike: [00:47:26] But it’s also very positive, your message is very positive and you also are providing people a solution, even if it’s: get your book, get educated, go through the self-assessment, find out what’s going on, where at least it gives them something that makes sense other than just, “well, I don’t know.” I have not been in that situation myself, fortunately, I’ve not had any real acute injuries with weightlifting.

I’ve aggravated my SI joints, I’ve had some biceps tendonitis, I’ve had some little things that I’ve been able to just work through, but if I were in that situation, I could see how it would be easy to assume that the surgeon must know what they’re doing right, or maybe even get two opinions and maybe they happened to both be wrong, but they’re consistently wrong and so you assume that, “well, that’s what these people do, so I guess that’s what I got to do,” if it were me, if I weren’t to have come across someone like you and your work, I could see how it is just kind of, “what else can I do? I guess I roll the dice.”

Dr. McGill: [00:48:26] Well, it is so empowering, both physically and psychologically for a person to realize,” wow, that’s how I can tie my shoe pain-free for the first time.” No one showed them that you cannot sit in a chair and reach forward and tie your shoe if that happened to be their particular pain trigger. But if they stood up and put their shoe on top of the seat pan of the chair, put one foot up on the stool, and now they do a lunge, they are tall, they guide their pelvis towards the target, down towards the seat pan where their shoe is, and they bend their supporting leg, they can not stress the tissue, the very specific tissue that was causing the pain. No one showed them how to move.

Now, after a while, do they need to do that, is that a life sentence? No. It allows you to calm down the sensitivity and let this great natural healing capacity work. But, you know, if you hit your thumb with a hammer all day long after day three, you just lightly touch your thumb and you’ll scream. Well, this is the condition of some people’s backs. Take the damned hammer away, let your thumb settle, and then all of a sudden now, can you imagine I’m hammering my thumb and now some clinician says, “let’s do exercises for your thumb?” Are you kidding me? It’s screaming right now, I don’t have any ability to do exercise.” But take the hammer away, let it settle, now let’s cleverly start using the thumb in the way that will cause the adaptation process of natural healing.

Mike: [00:50:02] Yeah, or in the case of your previous patient, “let’s just cut the thumb off, let’s just cut the foot off.”

Dr. McGill: [00:50:08] Yeah, it’s astounding.

Mike: [00:50:09] Let’s switch gears here and talk about deadlifting and squatting. What are your thoughts on the safety, specifically obviously with the spine of deadlifting and squatting?

Dr. McGill: [00:50:19] Well, you probably know me well enough to know the first two words out of my mouth are, “it depends.” You know, I often say, “I love squats and deadlifts and I hate squats and deadlifts,” it all depends on the context. So on one hand, they can reduce the safety of that person in breaking to pain, or precisely the opposite, they can build a more robust system, but it’s all governed by the concept of the biological tipping point. Every system in your body has a tipping point, think of vitamin D, there is an easy one, if you don’t have enough vitamin D, you’re sick. If you have too much, it’s poison.

There is a sweet spot right at the tipping point. Now let’s get back to deadlifts and squats. Another concept is exercises are simply tools. Now, what’s the goal of the exercise? If you can name what the goal is and then you can say, “well, the best tool I have in my trainers toolbox is a squat,” then, okay that’s your best tool. But if I said, “what about pushing a car?” Wow, all of a sudden now we’ve got a different load profile through the body, we’ve got frontal plain strength with sagittal plane strength, we’re on one leg, we’re pushing, we’re getting foot athleticism, so there’s an example where I might have a real discussion about programming and how it’s all set up before I can get into something like specifically deadlifting and squatting.

And then I need to ask questions like “what volume are we talking about? What load? What other exercises are you doing? What’s your work life? Are you a fisherman, are you a construction worker, are you a truck driver, are you a computer jockey? What’s your injury history? What’s the rate of progression in terms of the endplates of your spine?” The great squatters and dead lifters are hitting records usually, but not always in their late 30s and early 40s because it took that long to build that bone mass that will allow them, if they are into high volume.

“What is the rest schedule to facilitate optimal tissue adaptation?” then my thought goes to, “let me watch you deadlift and squat. What’s your training form like?” Because we both know deadlifting is an incredibly technical exercise and if trainers would realize that and then, you know, I’ll get a patient and she’s a stay at home mom and she tells me, “you know, all my troubles started when I started deadlifting,” and then I’ll say, “well, show me what you’ve been doing” and then she tells me she’s only been training with the trainer for three months and that trainers got her lifting her body weight from a deficit position after three months.

That trainer caused her back issues, definitely damaged her tissues, no question about it. So they violated the tipping point. If I was to talk about squats again, what’s the goal? Well, what’s a squat? Are we talking front squat, a back squat, or an assisted squat with bands? Now, you know, I broke my hip as a younger fella, I’ve been hip replaced. I was first told to have my hips replaced when I was 45, so I’d been through heavy lifting and all that sort of thing. But what I did was, I learned this from an Olympic lifter, world record holder from Poland, who told me, “just do one squat a day.

It will keep you preserving your deep squat ability, but it’s not enough volume to really pick the scab and make your heavily arthritic hips painful.” And then I started to use a kind of a squat, if you can imagine this, I would put heavy green bands so every trainer knows what a green band is, that you might use with heavy barbell lifting, and I would hang them on an overhead chin up rack, and then I’d wrap them around my wrists and descend into a deep squat so by the time I got down into the full deep squat, my body weight was taken up mostly through my arms and upper body to the elastics overhead.

And then as I started to ascend, I would add more and more conscious muscle activity and really preserve the motor control of a good squat. Well, I do that today, still as part of my daily routine, and it keeps me out of pain and keeps me really quite functional for being an old guy [laughing]. And here’s a final thought, think of both squats and deadlifts, they’re exercises where both feet planted on the floor, then I will measure a really strong squatter and deadlifter who have back pain because they don’t have matched frontal plane strength, so they got beautiful strength in the sagittal plane, good back strength, and whatnot, but when I put them on one leg and they have to take a step and pivot, like they’re playing a pickup basketball game, then I see their spine bend, as their pelvis drops on the swing leg side.

They can’t. They don’t have sufficient frontal plane strength because not once in their programming did they address it. They did more squats, more deadlifts lifts, and the whole deficit would have been addressed with a suitcase carry. “So where’s the carry part of your programming?” “What do you mean?” “Well, let’s try that. Let’s start off with some side planks, then we’re going to start doing some suitcase carries,” and then all of a sudden they’ll come back and say, “you know what, my back pain is gone and I’m hitting my best that I’ve never hit before and squats.”

Mike: [00:56:08] That’s really interesting. It makes perfect sense, but it’s very interesting.

Dr. McGill: [00:56:13] You’ve been really thoughtful in these questions, I must say [laughing].

Mike: [00:56:17] I like to give it some thought, when I have people like you, who are willing to take their time, I try to make the discussions as interesting for both me and you, and also as beneficial to the listeners as possible. And again, in this case, I was fortunate in that these were questions that I get fairly often, so I’d say that my listeners probably did the work for me there, but you’ve been sharing a lot of really, really great wisdom and some very practical stuff, too, which is fantastic.

To that point, actually, I have a question, back to the deadlifting and the squatting in terms of safety for the average person who doesn’t have any major issues, I think it goes without saying that if performed correctly – let me also give the context of, and really I’m just talking about most of my readers, and listeners, and followers. Again, like I told you before we got on the recording here is, I have a lot of people in their 30s and 40s, fair amount in their 20s as well, everyday people, in most cases, no major injuries or issues, who want to get fit.

They want to be strong and they want to have above-average musculature and they’re going to be in the gym three to five hours a week and in most cases, that probably is going to involve, if we’re talking, squatting and deadlifting a few heavier sets of each per week auto-regulated somewhere in the rep range of, let’s say, four to six, or maybe six or eight, or eight to ten, that’s kind of where most people are at, at least who reach out to me.

And so for those people, I think it’s fair to say that there’s nothing inherently wrong with doing that. Which that might sound silly to you, but again, I understand why people are reaching out to me because they hear things like, just black and white, “squatting and deadlifting are terrible for your spine,” and, “yeah, you can get away with it when you’re young, but over time you’re just going to be causing yourself more and more problems.” That’s what people hear often.

Mike: [00:58:30] Well, I mean, I don’t know what more I can say other than, recognize there’s a biological tipping point and what will tear you down if you violate the tipping point can just as easily enhance your robustness if you’re on the positive side of the tipping point. But you modulate the tipping point by things like having good form, etcetera.

Mike: [00:58:55] Are there any other – I would say again, for the average person, I think of Crossfit, right? And I think of people who have written me, in some cases the workouts are reasonable, in many cases they’re very unreasonable, in my opinion, where you have high volume, you know, AMRAP, squatting, and deadlifting multiple days a week, and I’ll just tell people, “don’t do that. Just don’t do that.” Where is that Goldilocks zone for the average person? What do you feel would be a reasonable prescription for squatting in deadlifting?

Dr. McGill: [00:59:33] Okay, if you threw in Olympic lifting, I’d have a little bit more wisdom to talk about Crossfit and that kind of thing, but if you’re going to stick with squats and deadlifts – you know, I was working with a group of elite rowers earlier in the week. It was interesting, we were having discussions about reducing the risk of injury. I said, “at this time of the year, what do you really want to do? Are you really trying to create a physiological base for aerobic training?” But most of them are master rowers, they only row a kilometer in the race. How big an anaerobic base do they need?

So we had this discussion where, “why don’t you try on the odometer, to give perfect strokes, really focus and groove the muscle memory of perfection. And at the first indication of your breaking form you stop and you rest. Now, I’d like you to repeat that.” And all of a sudden they started to get into natural intervals of only two or three minutes. Well, what’s a race? It’s like four minutes. Wow, all of a sudden, they were starting to really get much better scores. Where did I get that from?

That came from the world of Olympic lifting. There’s no Olympic lifters that I know of, who are true Olympians, who train sets of 10 lifts. I’ll just back up one second here to talk about adaptation. So I talked about bodybuilders adapting muscle, they train for one day and it’s the day of rest afterwards that the muscle grows or they create the changes and the development that they’re seeking.

The strength athlete, the real strong men, a powerlifter, might train heavy squats or deads and then take five days off because they’re developing that heavy bone that they’re going to need. But when we take the Olympic lifter, they are one of the few athletes who adapt while they are training because they’re laying down muscle memory patterns. You’ve got to be extremely explosive to rip the bar off the ground, keep the upward momentum going as you snap under the bar for the catch, if you’re, say, doing a snatch. So there’s a hell of a sequence of muscle on, muscle off, etcetera.

Now, getting stronger won’t quite possibly help them to lift more, it’s much more getting perfect muscle memory of the pulse relaxation, pulsing to catch sequence. So now if I use that to go back into deadlifting, if you can get perfect form with the first lift, fabulous. You’ve created a successful memory. Now let’s do rep number two. Perfect, you’ve got a perfect lift. Now let’s go to rep number three. Whoops, we’ve got a little bit of slop going on there, we shut it down.

Now, I’ve got two stories that will probably knock your socks off. What I’m asking all your viewers to do now, if they’re worried about this, is go watch the YouTube of the latest world’s strongest man competition, so WSM 2018, it was in Mogadishu, Africa this year. One of the events was squatting 750 pounds on this machine for reps. How many reps can you do? So some of the guys started finishing at 12 reps. I think the winner got 17 reps.

Mike: [01:03:04] [Laughing] That’s absurd.

Dr. McGill: [01:03:06] Yeah, but watch the rep before the failure. And now you’re gonna see it every single time. The rep before they failed, they lost spine stiffness, their hips shifted just a little bit, their pelvis might have come forward just a little bit. Now what happens there is: fatigue slowly eats away at good form and as soon as the brain senses that instability and loss of stiffness, because the body uses stiffness to control movement, the fusebox comes on and shuts down neutral drive.

So they didn’t run out of strength on rep 17, they got unstable in rep 16, and then the motor control system shut it down. So if you want to define your strength really quickly, lose form. So now, they’d be far wiser to keep good form, to keep squeezing out reps and that’s universal among strength expressions, doing reps. So I hope that little story gives you some wisdom in how many reps.

Mike: [01:04:16] I think it’s a key point, right? Just maintaining the safety of the exercises. I mean, of course, everybody hears that, but like you’ve said, these are technical movements, and I’ve again, written about this and spoken about this at length, is that point, often people in the muscle-building space, they think of just muscle failure, right? And a lot of people know that you don’t necessarily want to go to muscular failure on your heavier lifts, I think that’s fine if you’re talking like a biceps curl or something, I mean, you could take your biceps curl to muscular failure pretty often and not have to worry about it.

But with your more technical lifts, look at it more as technical failure, which is that point where your form starts to slip and being very aware of how you are moving, and it’s not just about getting the bar to move any which way, it’s about getting it to move properly and getting the sequencing in your body correct and at that point, where if that starts to disappear, even if you feel like you have the strength to continue the rep, or finish the rep, or even get another wrap, let’s say you do finish a rep and you felt like, “okay, that was getting a little bit sloppy,” just end the set there, even if you feel like, “well, I could just squeeze out another couple reps” and get really close to that point of muscular failure.

Dr. McGill: [01:05:37] So you just progress now from a bodybuilder to a true strength athlete organizing the motor control and driving the weakness out of the body, you’ve just hit the nail on the head. Can I tell one little story that’s kind of fun about this whole issue?

Mike: [01:05:54] Please do.

Dr. McGill: [01:05:54] Do you know who Ed Coan is?

Mike: [01:05:56] Yeah, of course.

Dr. McGill: [01:05:57] Yeah, so everybody in the powerlifting world knows Ed Coan, he’s a good friend of mine and as you know, people revere him and refer to him as that goat, the GOAT, the greatest of all time. When Ed set the powerlifting records, I mean, he was 25 percent higher in total load than the next competitor and this is at the world level.

Mike: [01:06:23] That’s like Tiger Woods stuff when he was in his prime.

Mike: [01:06:27] It was better than that. I think back to some of the old Olympic sprints, you know, when Carl Johnson was breaking the 10-second barrier, it would be like the next competitor running 12.5 seconds and Carl Lewis wins gold at running at 10 or, you know, 9.98 or whatever it is, people don’t realize how fabulously beyond Ed Coan was in his prime. But now listen to Ed tell the same story about deadlifts and how did he become so strong?

Do you know he never missed a lift in practice? You create muscle memories as a winner. Your brain doesn’t know what a losing, fatigued, spent-out muscle memory – in science, we call it the engram. The engram is that movement tape, but Ed had perfect movement tapes because that’s all he ever trained. And so he didn’t set world records in his basement like so many kids do. He set world records when he needed to and he hadn’t really done that before in practice.

All he did was perfect patterns, never missing a rep or a lift. And when he was getting tired, he would interval train and he’d back off and let those adaptations take place. Anyway, there’s a little bit of wisdom and some nice stories from the pros. Another friend is, Bill Kazmaier, world’s strongest man for the first three years and I had to give – I didn’t have to, I had the great privilege of awarding a lifetime achievement at a conference I was at to Bill Kazmaier and I told the story:

I measured some of the techniques that Bill used when he was younger and competing to train the neuromuscular compartments of his erector spinae, “so, Bill, how did you get that fabulous back strength that you developed to set the world record and raw powerlifting and all this sort of thing?” You know, because I knew his techniques challenging the motor units near muscular compartments and getting them written down in the engram in his move tape up and down his spine, and then he said, “Stew, I only knew what worked.”

And that was my introduction to giving him the award. It’s been a fabulous back and forth for where a guy like me would measure in the laboratory and in the clinic, what the mechanisms were and how you would go about creating optimal strength, and then we have the world’s strongest man who was just doing it, [laughing] and he’d do it because he knew it worked. And that’s one of the greatest synergies where science just synergizes with practice to make the magic unleash itself.

Mike: [01:09:17] That’s great. That’s a good lesson for people. Really, the key takeaway there is that importance of it. I liked it also forces – it invites you to take a longer look at what you’re trying to achieve in your training and not being so myopic and so focused on, “well, you gotta beat-,” You know, I like the idea of going into each workout, trying to do a little bit better than the last one.

I guess it depends on your programming, but if you’re following – again, I’m helping mostly kind of everyday normal people just getting fit, I don’t work with the type of people that you work with, so generally speaking, it makes sense if you’re relatively new and you’re following a kind of simple strength, kind of autoregulated program, try to get better each workout, but there is that bigger picture where, okay, so even if you didn’t beat last week’s workout, maybe you were a rep shy of last week’s workout.

But if every rep was as perfect as they can be, I mean, maybe if you were to put yourself on camera, okay, maybe it’s not 100 percent perfect, but you’re using good form as well as you can, you are as technically perfect as you can be, and you are working to increase that level of technical perfection, that’s also a form of progression, even though you might be stuck at a certain weight and a certain number of reps for a few weeks, it’s just, there are different scorecards, it’s not all just about load and in volume.

Dr. McGill: [01:10:43] Fabulous summary.

Mike: [01:10:44] OK, well, I think this is a great point to just wrap up actually, I think we’ve touched really on everything, all the important stuff that I wanted to ask you. Let’s wrap up with where people can find you and your work, and you’ve mentioned a couple of your books throughout, so if you wanted to mention anything else there, if you have something new you’re working on, or just reiterate like, “here, anybody listening, if you’re dealing with back pain or if you don’t want to have to deal with back pain, this is what I want you to check out,” or “this is where I want you to go.”

Dr. McGill: [01:11:15] Well, thanks for that, Mike. Our website is backfitpro.com, It’s just how it sounds, back fit pro. My books are there, I wrote them for a reason. It’s to guide people through self-assessment and give them a fairly precise roadmap on what to stop doing that’s causing their pain and then how to build a foundation for pain-free activity. Then I’ve got a couple of other books for strength athletes, I’ve got the Gift of Injury written with Brian Carroll, which we never thought it would be a strength guide, but that’s what it turned out to be, so it’s the story of his recovery and then a general text on enhancing strength.

And then I have another book called Ultimate Back Fitness and Performance, it is much more broad on developing athleticism, in terms of endurance and speed, and power and agility, and all that kind of thing, being very respectful of that person’s history with back difficulties. And then I have my clinical textbook, that unless you’re a clinician, it would be very nasty to read through.

But anyway, there’s quite a number of podcasts available on there and articles and it gives people guidance on what to do, and it’s also for clinicians, by the way, there are two portals coming in and people who want, or are interested in attending some of our clinical courses on how to assess back pain, we have a trainer’s weekend for those wanting to retain their clients with back pain and not losing them and certainly don’t create new back pain for people as well.

Mike: [01:13:08] That’s great, backfitpro.com, that’s like the central hub, it sounds like, to everything.

Dr. McGill: [01:13:12] You know, it’s funny, Mike, I’m not a social media person, in fact, I really have some difficulties with what goes on Facebook, and Instagram, and some of these things, and then I see some of the advice and guidance by people who’ve not created one Olympic medal in their lives. It’s very concerning to me. Nonetheless, that’s about the extent of my Internet activity.

Mike: [01:13:37] Yeah, I’m with you. I’m on social media. Ironically, before we jumped on this, I was putting together a plan. I’ve resolved to be more involved in social media, although I don’t like it personally and actually don’t even use it personally outside of my work, really. And I think that the world might be a better place if it were just banned. But as a lot of people use it and it is very popular, I was like, “okay, it’s stupid for me to completely neglect it.”

That’s me being harsh to myself, I don’t mean to say that to you, but that that’s me looking at it going, “I think there’s an opportunity.” I produce a lot of educational content, that’s what I enjoy doing, I can repurpose a lot of that, I can do it in a way that I feel would be – what I’m not interested is trying to get attention, I don’t care about that, but if I can use social media in a way to just help educate people and help spread around a lot of the other stuff that I’m doing, like the podcasts, and the articles, and the books, and the videos, and blah, blah, blah, then that’s interesting to me.

And it may not be necessarily the “best strategy” for like, “hyper-growth” and trying to become Insta famous, but I don’t care about that. If I can do it in a way that I feel is in line with like, “why am I even doing this,” then that works for me. So you have obviously a ton of wisdom to share, so at some point, if you ever are interested, maybe that’s a reason why you would consider being a little bit more involved in it, in that, it is a very easy way to just spread information and if you have good information to spread, well, that’s a win-win.

Dr. McGill: [01:15:08] Well said and point noted. [Laughing]

Mike: [01:15:12] [Laughing] But I do understand where you’re coming from, but anyways, that’s great, so backfitpro.com. And I want to thank you again, Professor, for taking the time, this is a great discussion and I know that a lot of people are going to find it very helpful because you have answered a lot of questions. And now I have something I can send people to, “that’s a great question here, check out this interview,” that’s going to happen often now.

Dr. McGill: [01:15:35] Thank you very much, Mike. You’re good at what you do, so keep it going, and best of luck through it all.