Protocols to Strengthen & Pain Proof Your Back

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday

[Music]

life I'm Andrew huberman and I'm a

professor of neurobiology and

Opthalmology at Stanford school of

medicine today we are discussing how to

build a strong pain-free back having a

strong pain-free back has numerous

advantages not the least of which is

you're not in pain as well as the fact

that you can carry out your daily

activities any exercise or Sports you

might play interaction with family

members like picking up a kid leaning

down to get things out of a cupboard or

reaching up to get things out of a

cabinet without any pain and back pain

is one of those things that even if

minor and certainly if severe severely

impedes our ability to do most

everything even to just sit still or lay

still and one of the things about pain

in particular back and neck pain is that

it also has an effect on our emotional

self it makes us more irritable it makes

any activity even the mundane activities

that much more distressing to carry out

so during today's discussion we will

talk about how to amarate pain however

pain as a general topic was already

covered on this podcast with an expert

guest Dr Shawn Mackey who's a medical

doctor at Stanford he's actually the

director of our pain clinic and on that

episode which we provide a link to in

the show note captions he talks about

the various ways to address pain

everything from pain medication to

epidurals to electrical stimulation

and importantly the biopsychosocial

model of pain whereby our thoughts and

our perceptions about pain actually

influence the severity and the duration

of that pain so if you're interested in

pain and the treatment of pain per se I

highly recommend that episode today we

will certainly talk about ways to deal

with back pain ways to reduce it and

perhaps even eliminate it alt together

but we are also going to talk a lot

about how to pain proof your back and

how to build a really strong back not

just for pulling things because the back

muscles are involved in pulling things

but also just for generating a really

strong stable core strong spinal

Erectors making sure that your pelvis

and your spine are interacting correctly

that your shoulders neck and Spine and

pelvis and even your lower Limbs and

feet are working together in the proper

manner to make sure that you have the

strongest and most pain-free back

possible so what I'm going to do is

first I'm going to describe a bit of

back anatomy and physiology I'm going to

talk about the neuromuscular components

as well as the spinal and disc

components I promise even if you don't

have a background in biology I'm going

to make this all very accessible to any

and all of you and then I'm going to go

into the 10 or 12 specific things in

particular six things that take very

little time that require no equipment no

purchase of anything whatsoever and

involve a very minimal time investment

that will allow you to build a really

strong pain-free back what's covered are

protocols from three of the world's for

foremost experts in back pain but also

back strengthening and building

resilience into the back so they include

a medical doctor expert in back

strengthening and Rehabilitation a PhD

researcher who has spent decades

researching The Spine and ways to

strengthen the core and Spine and a

world-class PhD physical therapist who

is expert not just in the spine but in

fact in the movement Rehabilitation and

strengthening of the entire body they

are the MD Dr Shawn Miller

the PHD Dr Stuart Mcgill and also the

PHD Dr Kelly starett I provide links to

them and resources that they provide in

the show note captions and indeed I plan

to host all three of them separately on

the huberman Lab podcast as expert

guests in the not too distant future

before we begin I'd like to emphasize

that this podcast is separate from my

teaching and research roles at Stanford

it is however part of my desire and

effort to bring zero cost to Consumer

information about science and science

related tools to the General Public in

keeping with that theme I'd like to

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Aero press.com huberman today's episode

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huberman okay let's talk about the back

the back for many people simply means

the spine the Bony stuff that runs down

your middle now of course your spine

doesn't just run down your middle you've

got your cervical spine up near your

neck don't ever forget that your neck is

the upper part of your spine you've got

the thoracic spine which is essentially

through you know in insects we think of

the thorax remember that from biology

class in middle school or high school

but through your region here you know

basically down from the neck through the

chest and then you've got your lumbar

spine which is the part right below that

and then you have the sacral spine which

is the area of the spine that is in the

pelvic region and then of course there's

the bottom region of that which is

called the coxic spine which is the very

lowest part of the sacral region of the

spine now of course that's the Bony

stuff and if you've ever seen a spine on

a you know a skeleton of any kind or a

drawing of a skeleton you know that it's

a bunch of segments it's a bunch of bony

segments it's important to understand

that the back is made up not just of

bony stuff but it's got stuff in between

which are the discs the discs are the

soft tissue that sit between the

vertebrae right the vertebrae of the

bones and those discs have some

durability to them they're they're not

easily squished but they can be squished

that is they can move they're a soft

tissue that allows for mobility of the

Bony stuff so you've got basically bone

disc bone disc bone disc bone dis and

it's those discs that allow for movement

of the spine from side to side and it

actually allows for some compression

along the length of the spine as well

what sometimes today I'll refer to as

vertical compression but actually

vertical isn't the correct anatomical

term so in anatomical terms we talk

about anterior posterior we talk about

rostral coddle which is just different

language for anterior posterior I'm

going to try and avoid using fancy

nomenclature as much as possible but the

point here is that those discs allow for

movement of the vertebrae but keep in

mind that the vertebrae and the discs

have a whole down the middle they look

like donuts basically they're not

perfectly round like donuts but for the

time being just think of them as Donuts

right some are bony donuts and others

have more pliability to them but there's

a hole down their middle why well within

that hole is a long snake like piece of

the nervous system called the spinal

cord which is the neural stuff the

neurons now within the spinal cord it's

not just neurons nerve cells okay

neurons means nerve cells it's also glea

which are another cell type that

provides yes support to the neurons but

also do some really important things on

their own like clearing out of metabolic

waste they actually regulate

communication between neurons if you've

ever heard that the Gia are just glue

and that's actually the Latin

translation of Gia glue it implies that

they're not doing much actively that

they're just sort of a passive

participant keeping things together the

glea are really doing important things

as well but keep in mind that the spinal

cord is this long snake like process of

the nervous system that extends down

through the vertebrae and down through

the discs or if you prefer you can think

about the long snake like process of the

spinal cord and then around it all along

its length you have bony vertebrae disc

bony vertebrae disc bony vertebrae disc

going all the way from the neck region

down to that coxic region within the

pelvis now the thing about neural tissue

is it's very soft it's very fragile and

one of the reasons we have vertebrae is

to give the spinal cord some rigidity

and protection from damage and that's

really important because the spinal cord

this long tube of neural tissue that

sits inside of the vertebrae and the

discs it's central nervous system tissue

CNS tissue and as CNS tissue it does not

regenerate after injury okay maybe a

tiny bit in certain conditions and in

very young people but if the spinal cord

is damaged typically there's a lot of

scar tissue that forms but there is no

renewal of the neurons that are damaged

so it's very important that the spinal

cord be protected which is one of the

reasons why it is encased by those

vertebrae and the discs now the other

thing to understand is that the spinal

cord is indeed a snake-like extension

out the back of the brain so the brain

and spinal cord make up what we call the

central nervous system the CNS we just

talked about that a moment ago but now I

want you to think about the brain your

brain of course is encapsulated within

the skull the cranial Vault there are

only two pieces of your brain that

reside outside of the cranial Vault they

are your neural retinas that line the

back of your eyes I know many of you

have heard me say this before but it's

so cool that I can't help but share it

again and again which is that you have

two pieces of your brain literally your

central nervous system that were

extruded out from the cranial Vault

during development while you were in

utero this happens in the first

trimester when you were in embryo that

line the back of your eyes like a pie

crust and those Linings of the back of

your eye like a pie crust are made up of

three layers of neurons and a bunch of

GAA and they are your neural retinas

they are two pieces of brain that

literally look out into the world and

are activated by what by light by

sunlight by edges and objects by the

photons in the outside world and that's

what gives rise to Vision so starting at

the front of your head and working down

through the spinal cord we can do this

very quickly to give you a complete

picture you've got your neural retinas

that line the back of your eyes they are

central nervous system they are brain

they communicate with the rest of your

brain through the optic nerves then you

got your brain you got the brain parts

that respond to hearing the brain parts

that allow you to think imagine learn

remember Etc and then at the back of the

brain you have the brain stem and then

extending out from the brain stem you

have the spinal cord this tube like

neural structure that extends down

through the vertebrae down through the

discs all the way to your pelvic region

now why am I telling you all this

Neuroscience if we're talking about

strengthening the back why am I talking

about the spinal cord why am talking

about neurons in the brain well just as

your brain has the cranial Vault your

skull to protect it your spinal cord has

the vertebrae to protect it and the

discs to protect it but the discs allow

for some movement of the spinal cord in

fact quite a bit of movement if you just

lean forward in your chair you lean back

arch your back or you twist to the side

your spinal cord is actually twisting in

that way okay this would be Ain to your

brain actually moving within the skull

it can move a little bit but it doesn't

move nearly as much as your spinal cord

does so your back has of course many

functions it's there to stabilize your

body it's there to provide stiffness in

order to be able to move your limbs in

very Dynamic ways we're going to talk

about back and core stiffness as such a

key feature of having a strong back when

you hear the word stiffness you probably

think well that can't be good I don't

want a stiff back ah but you actually

want to be able to generate rigidity

within your core and spine in order to

move your limbs to throw a ball or to do

a martial arts Punch or to even dance

gracefully or even just move up some

stairs without falling so basically when

we talk about the brain and spinal cord

as extending down through the vertebrae

and through the discs we're doing that

to set up the other piece of this whole

story which is that the neurons that

reside in the spinal cord in particular

what we call the ventral spinal cord

which if we're going to imagine this in

kind of more real world terms they're

sitting in the part of the spinal cord

it's kind of on your front Okay that

that's facing uh the front of the world

there are neurons there called motor

neurons neur the motor neurons

themselves what we call the cell bodies

reside in the spinal cord in the so-call

ventral Horn of the spinal cord you can

look this up if you like although you

don't need to know that and they extend

little wires that we call axons out to

the muscles and through the release of

neurotransmitters they allow our muscles

to move our flexors to flex like our

bicep our extensors to extend like our

tricep could think quadricep hamstring

calf abdominal muscles all the movement

of those muscles is controlled by

neurons that reside within the spine

cord some of the movements that we

generate are unconscious movements

especially movements that are required

for breathing although you can

consciously take care of your breathing

as well right you can breathe

unconsciously you're always doing that

even in sleep or you can take conscious

control of your breathing you can

generate limb movements consciously or

you can generate limb movements

unconsciously typically once you know

how to walk and you get up and you walk

across the room you're not thinking

right foot Left Foot Right Foot left

foot all of that's handled by motor

neurons and what are called Central

pattern generators in the spinal cord

and to some extent the brain stem but

the commands for specific deliberate

movements that you're thinking about

especially when you're trying to learn a

movement or you're trying to be very

deliberate in a movement those come from

what are called upper motor neurons in

the brain they communicate with lower

motor neurons which then communicate

with the muscles okay so that's one

neural outflow pathway from spinal cord

out to muscles some of it's conscious

some of it's unconscious and then there

are the neural Pathways from skin from

the tendons and insert of the muscles

onto bone within the muscles that

register how much stretch are on our

muscles and those are the soall sensory

inputs that come into the dorsal part of

the spinal cord the part that is facing

toward our back and that sensory

information tells our spinal cord which

then informs our brain whether or not

our limbs are extended too far and about

to snap or whether or not a muscle is

loaded too heavy and is about to be

pulled off the bone and in that case the

brain and spinal cord have these

magnificent mechanisms to shut down the

neurons so that you know we drop the

load so that we don't overwhelm the

muscle and rip it off the bone or we

don't stretch our limbs too far now keep

in mind that the neurons within the

spinal cord that communicate with

muscles or the neurons that innervate as

we call it the skin or the tendons or

different parts of the body and go into

the spinal cord those little wires those

axons literally leave the spinal cord

and they go out into What's called the

peripheral nervous system now a big

source of pain in back pain is when

those nerve Roots as they're called

they're little bundles okay bundles of

nerves are sometimes called fices

sometimes called nerve Roots the

nomenclature kind of depends on where

you are in the nervous system but I'll

call them nerve roots or bundles of

nerves those bundles of nerves are

sometimes impinged on they're physically

pressed on by say a bulging what's also

called a herniated disc the discs can

sometimes bulge out from the side of the

spine a little bit too much okay Maybe

by compression from the overlying

vertebrae maybe from some inflammation

we'll talk about the various sources

today and often times the source of back

pain or neck pain or even pain in the

pelvic region is because of a

compression of the nerve roots that are

going into and out of the spine okay so

when we talk today about back pain and

when we talk today about building a

strong back we need to focus on two

major themes one is the extent to which

those nerve roots are free and clear of

any physical pressure from say Hern ated

discs from compressed vertebrae from

inflammation in those regions maybe all

three and what we're really trying to do

when we talk about relieving back pain

often is creating space creating room

for those nerve roots to travel in and

out of the spine for those messages to

come in from the periphery the skin the

tendons the muscles Etc up into the

brain because the brain needs that

information to know where our limbs are

still needs to keep us safe as well as

the nerve Pathways traveling out of the

spine that control our musculature for

deliberate movements unconscious

movements and so on and so much of what

you'll hear about today when thinking

about how to build a really strong

pain-free back is about creating the

kind of stability around the spine so

that we can engage in the different limb

movements that we need to but to do so

in a way that doesn't create compression

of those nerve Pathways now with all

that said it's really important to also

understand that not all of back pain is

neural in nature now technically all

pain is neural in the sense that it's a

perception okay if you listen to the

episode with Dr Shawn Macky which

includes a deep description of the

biopsychosocial model of pain it will

tell you or I'll just tell you now that

indeed pain involves a lot of different

things it involves psychology it

involves prediction it involves history

it involves inflammation it involves a

lot of things and yes ultimately it's

neural it is the firing of nerves that

create the perception of pain and your

perception of pain is also the firing of

neurons in your brain and spinal cord

however what you'll also learn today is

that there are many things that you can

do including creating stability of your

feet your toes believe it or not the

position of your pelvis your neck your

chin all these things as well as the

spinal erector muscles in your lower

back as well as your abdominal region

your so-called core all of those things

combine to create a millu for the spine

and back to function at its best so if

now you're getting overwhelmed you're

thinking my goodness we have to learn

about the entire body's physiology and

anatomy in order to understand back pain

and strengthening to some extent that's

true but really all we've said so far

and all you need to know or keep in mind

that is is we have the vertebrae the

Bony segments that surround the spinal

cord in between those we have the discs

the soft tissue that also have a hole

through them the spinal cord travels

through that so that the vertebrae can

move so that we have some pliability and

Mobility our spine forward flexion so

your chin closer to your belly extension

your chin back and away from your belly

sort of arching of the lower back you

can twist to side to side to some extent

you have all that stuff and through the

middle is the spinal cord and the brain

and then you have sensory information

going into the spinal cord from the body

from the muscles from the skin and then

you have motor commands going out the

bottom of the spinal cord so literally

traveling out past those vertebrae and

discs out to the muscles to control

those muscles for involuntary and

voluntary movement if you can understand

that and you can Envision it just a

little bit even just a little bit you're

going to be able to think about all of

the various protocols that we talk about

next in the most functional way meaning

as you learn about and hopefully

incorporate the various protocols for

strengthening and pain proofing your

back that you'll occasionally think back

to okay it's my spinal cord that I'm

bending in my lower back region I'm

allowing the discs to kind of move

forward and they likely are kind of

bulging out a little bit they're not

necessarily herniating let's hope not

but they're bulging a little bit in that

direction then back in the other

direction and if you happen to have

herniated that is bulging discs which

many people do in fact I've had that

I've got a sort of an L3 a kind of

Lumbar 34 bulge that got activated a few

years ago I'll tell you what allowed me

to very quickly fix that permanently

with no medication no surgery whatsoever

and it was extremely debilitating

there's some simple movements that one

can do if done in the proper direction

and in the proper way that can allow you

to push that bulged that herni disc back

under or I should say closer to the

spinal cord okay moving it from the kind

of bulging out from between the

vertebrae to closer again toward the

center point of the spine by doing that

one can take pressure off of the nerve

roots that are traveling out to the

muscles and in from the skin and other

sensory information coming into the

spinal cord and allow yourself relief

from back pain and then by building up

stability in the abdominal region the

lower back region you can create a nice

firm core that will allow you to protect

all of that with plenty of space so the

nerve roots are not impinged and then of

course by focusing on some of the

stabilizers that exist really distal

which means far from all of that further

from all of that such as the feet

literally how you position your feet the

ability to spread your toes believe or

not as a way to provide support for your

back not just when doing exercise but

also at rest there are some things you

can do about neck positioning

strengthening of the front of the neck

strengthening of various muscles again

that involves no equipment whatsoever

that allows you to have a pain-free

strong back both at rest and during

movements of different kind different

Dynamic sport movements like tennis or

golf Etc as well as if you're into it

resistance training if you're putting

yourself under heavy loads all of that

painfree and moving through life with a

tremendous amount of mobility and

versatility now before we get into the

specific protocols and exercises for

strengthening and pain proofing your

back it's worth mentioning something

that really was first told to me by Dr

Stuart McGill again he's going to be a

guest on this podcast Dr Stuart Mill is

a world expert in spine physiology and

anatomy and he's worked with a lot of

athletes but his work is not specific to

athletes it's really for the everyday

person as well and in discussions with

Stu he raises some really important

points first of all if you have back

pain you need a proper assessment and

diagnosis it's really possible for me in

this format to try and diagnose your

back pain or for you to try and diagnose

your back pain that would just be

irresponsible of both of us there's just

so many things that are specific to each

circumstance for instance some people

get back pain or neck pain or both

because of overuse of certain motor

patterns maybe they are Avid golf

players and they're always swinging a

certain way with one foot forward that's

typically the way it works and they

built up some strength in certain

Pathways both muscular strength and

neural strength but they have a weakness

in the opposite side muscles and nerves

and they need to rehabilitate those in

order to eliminate the back pain other

people have an injury right they have a

spinal compression injury they don't

just have a herni disc they have a

ruptured disc often time ruptured discs

need surgery I don't want to give the

impression that all back pain can be

resolved without surgery there are cases

where surgery is necessary okay so it's

very important that if you have severe

back pain or persistent back pain and

you're not able to alleviate it with

non-surgical methods that you talk to a

back expert perhaps even a surgeon there

are cases for epidurals for painkillers

for you know different types of

rehabilitative approaches but Dr Stu

Mill has also pointed out that there are

a number of things that any and all of

us can do by just self assessing that I

think are appropriate for today's

discussion that relate to whether or not

we are likely to have a thick spine or a

thin spine okay this isn't a

psychological feature at least not to my

knowledge but if you look at different

body types you know what in the old days

used to be called the Ecto endo and

momor body types okay this nomenclature

isn't used quite as much anymore but

just to kind of return to it the

ectomorphic body phenotype is one in

which people are typically kind of light

Bon meaning thinner wrists smaller knees

smaller ankles so not really thick bones

and thick wrists so as the ectomorph

these are people that tend to be pretty

thin sometimes referred to as people

that have you know very low body fat

less muscle mass although that's not

always the case just think lighter

thinner skeleton versus myomorph which

tend to be people with kind of thicker

wrists thicker knee joints have a

thicker overall and then endomorph which

was at the time used to describe people

that are carrying more body weight in

the form of body fat I don't know how

often the endomorphin type um language

is used anymore but what Dr stmill has

pointed out is that people in general

tend to be more ectomorphic or myomorph

they tend to be more thick through the

Torso or thin through the tors so they

tend to have thinner wrist or smaller

wrists as compared to their age matched

sex matched counterparts okay but in

general so these are generalizations

people who have thicker wrists generally

are going to have thicker spinal

segments okay in terms of the

circumference of the spinal segments and

discs whereas people with smaller wrists

smaller joints smaller ankles are going

to have thinner spine so thinner

vertebrae thinner discs between them and

so on now neither is good or bad they

are just different and they create a

situation where people have different

needs in order to build a strong

pain-free spine so for instance people

who have thick spinal segments so these

are people who tend to be more Barrel

chested thick through the Torso maybe

thicker wrists and ankles and knees have

thicker spinal segments and therefore

may not need quite as much buildup of

the musculature around their spine in

order to handle vertical loads okay

compression along the spinal length

because they have those big thick spinal

segments and discs it's not to say that

they don't need to do any spinal

strengthening they do but they are

generally going to be very stable along

the I'm calling it the vertical axis but

along the length of the spine those

people perhaps not surprisingly are not

going to be as Mobile in terms of the

twisting and bending of the spine

meaning spine Mobility along the

different axes apart from that vertical

axis that I was referring to along the

length of the spine but twisting and

bending is going to be harder for them

now at the opposite extreme you're going

to have people with smaller RIS

smaller ankles smaller knees and they in

general are going to have a thinner

spine meaning vertebrae and discs that

are smaller in circumference and they

are not going to have the capacity to

sustain as much vertical compression

along the length of the spine as

somebody with thick spinal segments but

they are going to be more quote unquote

bendy if you will now that doesn't

always mean more flexibility what I'm

referring to here is a capacity or a

potential for the ability to generate

movements in which the spine is twisting

from side to side with more ease than

would be the powerlifter so imagine at

the extremes the thick torso and spine

of the powerlifter of the shot putter

somebody like that versus the spine of

say the yoga teacher the dancer they

have these smaller wrists smaller pelvis

smaller knees Etc but they're going to

have more ability to twist themselves

their spine so imagine just kind of like

bending over to the side a little bit

while looking up the spine is going to

do that very easy easily as compared to

the person with a thicker torso in spine

these two distinctions and here I'm

really making them polarized

distinctions and in reality there's a

whole distribution of thick spine very

thick spine moderately thick spine thin

spine ultra thin spine and so on but at

these two extremes you can start to

imagine that each of those spines each

of those backs probably has different

requirements in order to make it strong

and pain prooof depending on the

activities that those people are engaged

in now of course a thin spine person can

decide to powerlift that can be very

good for them and indeed one of the

things that somebody with a thin spine

should do according to Dr Stu Mill and

I'll reiterate this several times today

is build up the musculature around the

spine so that they can stabilize that

otherwise bendy spine along both the

vertical and side to side axis so they

don't injure it they want to make it

strong as well as the person with the

thick spine who can tolerate heavy loads

around one axis but maybe needs to

generate more mobility of that spine so

that they don't go reaching for glass up

in the cupboard and all of a sudden they

have compression of a nerve root coming

out the spine because they just Twisted

it to the side by about 5 to 7° both

groups have specific needs meaning

specific protocols that they can

emphasize to a greater or lesser degree

in order to strengthen and pain prooof

their spine so while we can't do an

assessment of spinal pain and your exact

needs for your particular body type in

this kind of format through the tunnel

of the internet you can take a look at

yourself or just think about yourself

and think oh do I tend to have thicker

wrist knees elbows Etc am I more of a

you know kind of thick torso person or

do I tend to be someone who's more Li

who's more you know small wristed

somebody who can move from side to side

with a lot of ease but probably can't

handle as much what I was calling

vertical load along the length of the

spine and some people have a kind of

mixed phenotype not purely Ecto not

purely

myomorph I can say that about myself I

have fairly long limbs in fact I have

like almost sort of like Gibbon arms I

have this kind of really long reach so

more kind of um ectomorphic

um arms and at the same time I have a

short torso and I am fairly thick

through the circumference of my torso

I've always been like that even before I

started doing any kind of resistance

training my legs are somewhere in

between okay so I don't have small knees

or small ankles they're kind of moderate

in that way my wrists and my arms

probably a bit more ectomorphic not

strong ectomorphic phenotype but then my

torso is a short torso and it's kind of

thick through the circumference that's

just the way that my genetics landed me

into the world you have genetics that

landed you into the world in a

particular way you can take a look at

these kind of external phenotypes about

joint size and kind to do an assessment

just thinking about it and by doing that

you'll be able to know which protocols

which we're about to talk about you may

want to emphasize or deemphasize in

order to best strengthen and pain prooof

your back so a good analogy that Dr

Stuart McGill offers when thinking about

this thin spine versus thick spine thing

is if you think about a willow tree

which has essentially a a thin trunk and

thin branches relative to say an oak

tree or redwood tree the willow tree

trunk and branches can bend to quite a

considerable degree without breaking so

it's just very bendy from side to side

but they are thin and they can't sustain

a lot of vertical pressure a lot of

loads from top to bottom or else they'll

simply collapse they might not snap to

the point of breaking but they will

definitely Bend to the point of not

being able to bend back

as opposed to the trunk and branches of

a full-grown oak tree or redwood tree

which are very thick and very strong and

can sustain a lot of loads from top to

bottom along this vertical axis but if

they Bend even just a tad too far from

one side to the next they're going to

snap and essentially break off so while

that analogy isn't a perfect one to

explain the situation with thin spines

versus thick spines I think it gives you

a mental image of the general situation

for which some people who have the more

Willow like spine probably need to build

more musculature around the spine in

order to stabilize it but probably don't

have to do quite as much work in order

to generate more side to side

flexibility as opposed to people who

have a thicker spine who probably don't

need to do quite as much work to develop

the musculature of the spinal Erectors

of the abdominals it's not to say they

don't need to develop those at all they

do but that they don't need to do quite

as much work to build the musculature

around the spine in order to stabilize

it for vertical loads but they perhaps

want to do more work aimed at generating

more flexibility in these planes of

motion from side to side and at

different angles you know relative to

the vertical axis and again most people

don't fall at either extreme of Willow

like or Redwood like most people are

going to fall somewhere in the middle

and as I mentioned before many of us

including myself have a sort of

combination of more Thin musculature and

Thick musculature depending where in the

body you look

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SL huberman so now let's discuss the

protocols that allow you to strengthen

your back the first three of these

Protocols are the so-called McGill's big

three named after Dr Stuart McGill who

again has done a tremendous amount of

work in the research and practical realm

and has developed a number of different

protocols for strengthening and

depainting the spine but has distilled

down three specific protocols that

everyone I spoke to in the PT community

in the MD Community for those that

specialize on spine and in the sports

Community as well as people who don't

play sports but are simply interested in

having a healthy spine for sake of daily

Mobility all agree are extremely useful

for everybody to carry out now the one

caveat is that Stu Mill himself has told

me that he doesn't want the big three to

be viewed as the Beall end all of back

strengthening and Pain Relief by no

means is it exhaustive to do just the

big three so I'm also going to include a

bunch of other protocol calls that are

gleaned from other practitioners and

that Dr McGill often offers himself in

his books and I'll certainly put links

in the show note captions to his books

and again he'll be a guest on this

podcast but for sake of clarity and

simplicity The Big Three are as follows

the first is called the curl-up the

curl-up is in many ways a replacement

for the situp most people are familiar

with ab crunches and sit-ups where you

lie down typically people will bend

their knees although not always they'll

often put their hands behind their head

or on their chest and then they'll

essentially sit up to contract the

abdominals turns out that if you have

back pain and even if you don't that is

probably the least efficient and perhaps

even the worst thing that you can do for

your back pain and if you think about

the discs that sit between those

vertebrae remember those soft tissue

discs that allow for some mobility of

the spine well if you Happ have a disc

that's bulging even slightly that is

it's herniating it's getting pushed out

from between the vertebrae and it's

impinging on a nerve and there's some

pain

if you are crunching you can imagine

that's essentially bringing the

vertebrae together in the front of that

sandwich that is vertebra disc vertebrae

and what it's going to do is it's going

to have that disc bulge out even further

it's going to herniate even further and

impinge on those nerves even further so

what's required in a situation where you

want to strengthen the back or try and

eliminate or reduce pain of the back is

a way in which you can strengthen the

abdominals because the abdominals and

the abdominal wall is very important for

stabilizing the spine and you want a

stable spine that's a very important

point but you want to do it in a way

where you're not adding to the

herniation of the disc in any way so the

curl up is an excellent exercise for

people who have back pain and who don't

have back pain to strengthen the

abdominal wall and it's done as follows

you lie down you put one knee up meaning

one leg is bent the other leg is

extended you put your hand both hands

below the lower portion of your back so

in the arch of your back and you

actually want to maintain the arch of

your back that's one of the reasons your

hands are there the head is in a neutral

position okay so your chin isn't tucked

toward your chest the chin is in a

neutral position and this is important

your tongue is on the roof of your mouth

this is something I talked a little bit

about in my description of neck

exercises in a previous video we're

going to get back to this but tongue on

the roof of the mouth often puts the

head into a safe default position it

also allows for breathing in particular

nasal breathing to be done very easily

so you got your tongue on the roof of

your mouth the mouth is typically closed

and then what you do is you raise your

elbows off the ground and then while

maintaining that small of the back

you're going to just raise your upper

chest you're going to lead with the

upper chest not with the chin and head

although of course the head will follow

you're going to raise the upper chest

meaning raise the upper torso so the

head's going to move forward and you're

going to Exhale and contract the

abdominals for anywhere from 8 to 10

seconds okay so you get a very strong

contraction of the abdominals but you're

not doing a full situp you're only

coming up maybe about I don't know

somewhere between 5 to 10° so your back

is coming up the head is coming up and

the chin is not moving towards the chest

it's staying in a neutral position

you're going to repeat that so meaning

you're going to go up contract for 8 to

10 seconds you're going to contract the

abdominal walls if you want to Exhale

you can usually get a stronger

contraction of the abdominal walls and

then you're going to go back down and

relax on the floor maybe rest 10 to 30

seconds maybe a minute and then repeat

okay so that's the basic movement and

then you would switch to the other side

meaning you're then going to extend the

leg that was bent you're going to bend

the other leg and you're going to repeat

in terms of sets and repetitions

typically the best way to do this is to

do anywhere from three to five sets

starting with 10-second contractions

done five times for the first set so it'

be 10sec

hold then relax 10-c hold then relax

doing that five times maybe four times

but five would be ideal that would be

one set and then on the next set you're

going to do four repetitions meaning

four 10-second holds with rest in

between and then on the next one three

on the next one two and the next one one

10c hold or so these are just rough

guidelines you certainly don't have to

do quite as long holds as those if you

can't do those you don't have to do all

of those sets if you find you're

fatiguing one of the advantages however

of doing these brief 10-second holds and

really focusing on the contraction of

the abdominals hard or as hard as you

can and then releasing is that as

opposed to doing a long hold just trying

to hold as long as you can and building

a lot of endurance in the abdominals

when you repeatedly contract a

neuromuscular connection you build the

pathways you basically allow the

pathways that can engage those strong

muscular contractions to a greater

degree than if you're trying to just

statically hold that particular position

for a very very long time like 30

seconds or 60 seconds or longer okay now

there are a bunch of different

variations of the curl up you can do the

curl up with the extended leg elevated

slightly to make it harder you can do

the curl up with your elbows positioned

closer to the ceiling so you're you're

really lifting your elbows and arms far

off the the ground as opposed to having

them just hovering right above the

ground there a bunch of different

variations of these we include links to

a few short videos in the show note

caption so you can see the different

variations of the curl up has me doing

these on the floor in my uh typical

street clothes so you don't need to get

into workout gear to do these and I

should mention that the curl up is

something that you can do every day if

it occurs to you and if you have the

time it's something that you would

certainly benefit from doing every day

but it's also something that even if you

do once or twice a week for for even

just a couple of sets you're going to

see some benefit in terms of

strengthening your back and probably

relieving some pain of your back as well

the other terrific thing about the

curl-up is if you have back pain and

doing the curl-up doesn't aggravate it

you are most certainly doing things to

strengthen the musculature around the

back that's going to help you avoid more

back pain as you work through the

different rehabilitative practices that

hopefully you're doing with a PT or with

a excellent MD who specializes in back

pain relief as the pain dissipates

you're going to be building up the

musculature of the abdominals that's

going to then further protect your spine

especially if you're one of those people

that has a thinner spine that needs more

muscular support around the spine in

order to support it just as a final note

about the curup two of the most common

errors that people make when doing the

curl up is to make it more like a situp

and generate a chin to chest movement

first and let the chest follow you

really want the chest to lead and keep

the head in a neutral position tongue on

the roof of your mouth try and breathe

through your nose and if you find that

you can't do the big exhale as you bring

it up to the top don't worry about it

it's perfectly fine to hold your breath

as you come up and then just maybe

release a little bit of air to enhance

the uh intensity of that abdominal

contraction the second exercise in the

mill big three is the side plank I

confess and I don't know why I hate

doing side planks I don't know why I

hate doing side planks I just hate doing

side planks which tells me I should do

side planks so I've started doing some

side planks recently after talking to Dr

Mill I'm fortunate that right now I

don't have back pain I haven't for a

while I'll talk about how I alleviated

my back pain but I spend a lot of time

as a 48-year-old thinking about having a

strong spine being able to jump off

things and land with confidence all the

sorts of things that set one up for both

healthspan and lifespan as has been

taught to us by Dr Peter AA some of you

may know Dr Peter AA because he's been a

guest on this podcast he wrote The

Incredible Book outlive and he talks

about how having a strong spine having

the ability to break Falls by virtue of

training your ability to jump down

things and step down things with

confidence is essential to offset the

aging process so I've decided I'm going

to do side planks I'm going to embrace

the uh spine strengthening exercises

that Stu Mill has put forward as the big

three and that includes side planks so

how do you do side planks well most

people think that a side plank is just

getting on your side essentially on the

floor then putting one arm down and

stacking your feet on the other side and

trying to make yourself as stiff as a

plank as you possibly can and while that

is C only one way to do it most people

find that they are going to get the most

in terms of strengthening their spine

and preventing back pain and maybe even

alleviating back pain if they build up

through a set of incremental steps

making sure that the form on each of the

steps is absolutely perfect so the way

to really start doing side planks and if

you think you can already do side planks

to assess whether or not you're doing

them properly is to start with knees

slightly bent so maybe at about a 30 or

40° angle so you're on your side your

knees are bent the feet are stacked

you're of course going to push one arm

down although many people find that

putting their hand in a fist as opposed

to a flat hand is going to be best I

don't know if U most of you are aware of

this but anytime that we generate a fist

in either hand it sets in motion a

number of different neural Pathways that

allow for a firmer contraction of

muscles not just within the fist but

elsewhere in the body okay if um you've

ever heard the great teachings of Pavo

susulan who I hope to have on this

podcast as a guest he's talked about how

if you were say to try and squeeze a

metal bar or think about just trying to

give your friend the firmest handshake

you possibly can you're having that

handshake squeeze competition if you

make a fist with your other hand you're

actually going to be able to generate a

harder contraction of the shaking hand

okay of the squeezing hand and this is

because of the way that we have these

bilaterally U wired uh nerve to muscle

connections and the fact that neural

activation on one side is related to

neural activation on the other side and

so forth but basically what you're going

to do for the side plank in order to

generate the strongest and most

efficient side plank for strengthening

and hopefully depainting your back is to

get on the side Bend those knees put the

hand down in a fist position okay then

you're going to push the hips off the

ground so the upper body is indeed in a

plank position then you're going to

raise the hips up and you're going to

have to put some considerable effort

into pushing the floor away from you

that's really the key here pushing the

floor away from you now if you find that

you can do that and you can hold that

position for a good 8 to 10 seconds with

a strong degree of rigidity so you're

not quaking and you're not feeling as if

the hips want to collapse down to the

floor something you really want to avoid

especially if you already have some back

pain or even a subtle back injury you

want to make sure that your your spine

is straight okay and that those hips

come off the ground and you're really in

a plank position right no Bend if you

find that you can do that and it's

fairly straightforward for you well then

feel free to then extend your feet out

further put the top foot on top of the

other foot and out to the front Okay so

you're not stacking the feet right on

top of one another we just shoe on top

of shoe but you've got or foot on top of

foot if you're doing this Barefoot or in

socks but you've got one foot in front

of you for some stability and then

you're generating that long side plank

pose and holding that for 8 to 10

seconds then pause for 10 maybe 30

seconds if you have to and then repeat

again again all that part of one set

just as we talked about for the curl up

previously so you're working through the

progression from bent legs to

straightening your legs if the top foot

is placed in front of the other foot

with legs straight and that's something

that you can do for say anywhere three

to five repetitions of those 8 to 10

second holds which make up one set well

then you have the option to make the

whole thing more difficult by doing a

sort of roll forward where you actually

take the part of your shoulders which is

on the side of your free arm so the hand

that is not pressing into the floor and

you rotate forward so that your chest is

now aiming toward the floor maybe not to

a full push-up position but maybe close

and then back again to the side plank

what you're doing there is you're

activating some of the musculature that

is for rotation of the spine okay and as

you do that you're getting closer and

closer to a front plank and of course

front planks are also an excellent way

to generate spine stability most people

can do a front plank by resting on their

forearms why start with a side plank

well there are a lot of different

reasons for that but what you'll realize

is that when you're doing a side plank

you're actually only really loading half

of the spine maximally the other half of

the spine is not being loaded maximally

because it's the side of the spine

that's that's up and of course that's a

reason why you want to do these on both

sides of your body right so what's the

sets and repetition scheme that's going

to work here well if you're like me and

you loathe doing side planks and you

find that they do take a lot more effort

than perhaps you would like either

psychologically or physically then for

me what I've been doing is one set

consists of three 10c holds I've been

doing these with knees bent although

I've now progressed to the point where I

can do one foot over the other and

resting that top foot um across the

bottom foot so leg straight doing that

for three 10-second holds to make up one

set and doing that for two or three sets

on one side of my body two or three sets

on the other side of my body so slightly

different than as I described for the

curl up where it was descending

repetitions where you know the first set

you're doing five 10c holds next one 4

10sec holds next one 3 2 1 for the side

planks I don't like them enough that I

just prefer to do two or three sets of

three 10-second hes on each side

although I'm starting to enjoy them just

enough that I might progress to the kind

of what's called reverse pyramid where

you go five five 4 3 2 1 this sort of

thing increasing the number of sets and

again I have a link in the show note

captions that shows you how the side

planks are done in these different

variations I should mention that the

most common mistake was side planks is

letting the hips sag so if you don't

push the floor away from you enough if

you're not stable enough through the

foot contact with the floor or the leg

contact with the floor if you're doing

these with knees bent even if you go to

leg straight and you consider yourself

very very strong in the side plank if

the hips start to Sag you can imagine

based on what you now know about back

Anatomy right the spinal cord being this

um kind of snake like extension out the

back of the brain with the vertebrae as

segments and the discs in between them

if that's sagging well especially if you

have an issue with a disc bulge and some

impingment on one of those nerve Roots

either coming into or out of the spinal

cord you're going to get into some

trouble meaning it's going to cause some

pain or at least some aggravation so the

goal is to get that spine really

straight as you're doing the side planks

regardless of whether or not you're

doing that with knees bent or you're

doing it with legs straight in fact

that's the reason I went through all of

that Anatomy earlier so that as you're

doing these exercises whether or not

it's the big three or the other

protocols I'll talk about you can really

Envision the major components of the

spine that are getting engaged okay it's

not just about the abdominals and the

obliques and the lower back of course

it's about all of that that's what

you're exercising but you're also

getting the neural engagement within the

spine you should think about the

vertebral segments the discs the fact

that those nerve Roots need to run in

and out of the spinal cord outp pass the

Bony and disc material and to do that

without impingement so as you do these

movements can be very beneficial to

think about the different anatomical

features of the back including spinal

cord vertebrae discs nerves Etc but

mainly those and as you're doing that

you'll not just be strengthening your

back you'll also be strengthening your

learning of neuroanatomy so the last of

Stu Mill's big three again Stu kind of

cringes every time people say okay it's

just Mill's big three and that's back

strengthening and Pain Relief and he

always just kind of I can tell it pains

him uh no pun intended because he knows

and it's true that there's a lot more

involved in strengthening and pain

proofing the back but always good to

have a great place to start a simple

place to start and something that's

really tractable without equipment or

any cost and so we're very grateful that

Stu was willing to kind of resist his

temptation to be um Beyond nuanced and

thorough which he always is and offer us

the curl-up the side plank which we've

covered and now the third which is the

bird dog the bird dog as some of you may

know is where you get into all fours on

the ground you extend one arm forward

and you extend the opposite one leg

backward okay so if you're down on all

fours and you extend your right hand in

front of you you're going to extend your

left leg behind you now there are a

couple key things about this one is

again have the extended hand in a fist

why because you want to generate a

strong neural contraction so that you

don't forget and in fact facilitate

keeping your upper body parallel to the

floor so no tilting from side to side as

best you can and you also want the

neural activation to allow you to then

Engage The Lift of the leg in a way

that's also very strong and stable okay

so nothing floppy no leaks as they say a

key point is to make sure you don't

raise the leg too high you're not trying

to Arch your lower back in fact what you

want to do is raise the hand in front of

you generate that fist it can even just

be out in front of your your eyes at

first maybe a little bit higher and then

the leg that's extending toward the back

feel free to either point the toe toward

the ground or if you want to extend the

toe a little bit like you're doing a

little bit of calf raise in the air

right pointing your toe that is that's

fine too but don't get that heel up too

high or even the upper thigh up too high

that you're getting a really big arch in

the back the idea is to Envision one

long line between the extended arm and

fist all the way back across the midline

because it's to the opposite leg and to

the foot behind you again it's about

creating a strong stable reach a strong

stable lift of the foot but not too high

and this is very important with the hand

that remains planted and the knee that

remains planted pushing the ground away

from you okay that's as important as is

the lifting of the arm the clasping of

the Fist and the raising of the leg in

all of these movements the pushing of

the ground away from you the resistance

to gravity is as important as whatever

movement you happen to be doing again

this is a terrific movement for

strengthening the spine that most people

can do because you're only working one

half of the musculature on either side

of the spine okay there's of course

activation of the musculature on the

other side to some degree in order to

balance things out but by emphasizing

only one half of the musculature a you

can really focus on the contractions

again you can really put a lot of Mind

into the pushing the the floor away you

can put your mind into where fist is and

your foot is and of course you can

generate the kind of hard contractions

that are really going to strengthen

those lower back muscles as well as the

upper back and shoulder muscles that are

required for generating stability of the

spine again that's really what this is

all about again it's going to be maybe

three to five repetitions of 8 to 10

second holds for one set done for

repeated sets maybe for a descending

number of repetitions where you're going

five holds four holds three holds two

holds one hold all of that being done

repeatedly and with the greatest amount

of of intensity and focus so that those

nerve Pathways can be engaged over and

over again very easily generating a lot

of strength of contraction that then of

course carries over into your exercise

activities and even just your passive

activities throughout the day and even

stability of the spine while at rest

which is something that we're going to

talk about more as we get into some of

the other protocols now of course with

the bird dog exercise you also need to

train the opposite side of your body so

after doing say two to five sets of

those two to five repetitions of eight

to 10 second holds on one side you're

going to want to switch to the other

side and do the same thing or you could

alternate you could do right hand

extended left leg extended do one set

then switch to the other side left hand

extended or I should say left fist

extended uh right leg extended do those

repetitions call that one set and then

shift back to the other side and so on

and so forth really depends on how much

time you have how frequently you're

doing this throughout the week again

right now I'm striving to do all of stum

Mill's big three at least once a week

maybe twice a week I know many of you

will say oh that's pretty wimpy you know

you should be doing this every single

day or five times a week well I have a

busy schedule just as many of you do and

it's something that I'm trying to

incorporate more and more typically at

the end of a workout although some

people decide to do this at the

beginning of a workout right now

fortunately I'm not dealing with any

back pain knock on wood but it's

something that for many people who have

back pain they find that if they do it

this at the beginning of a workout it

allows them to then move into the

workout warmed up and to avoid a lot of

the back pain they would otherwise

experience with that said I want to be

very clear that if any of these

movements exacerbate your back pain then

you should definitely avoid doing them

and of course if you have back pain you

should be working with a licensed

professional to figure out how to treat

that back pain you may very well need

pain meds Andor surgery I don't know

because I don't know your specific

circumstance but for most people who are

just trying to strengthen their back who

perhaps are dealing with a little bit of

nagging back pain The Big Three are

often very very accessible meaning they

don't exacerbate back pain and in many

cases they alleviate it sometimes

partially sometimes completely there are

a lot of wonderful anecdotes out there

of people who have benefited from doing

the big three in all of those categories

now again we have a link in the show

note captions showing how the bird dog

exercise is done there are a couple of

variations that you can do to make it

harder one is to draw boxes with the

extended Fist and the extended foot

that's actually a coordination issue too

for some people so some people choose to

do a box with their hand maybe they do

it clockwise then they do it

counterclockwise some people choose to

do the hand and foot moving in a box

together meaning simultaneously

sometimes they'll alternate foot then

hand this sort of thing any kind of

movement that you're doing with the

extended Fist and or foot is going to

add some degree of difficulty to this

but you want to make sure that if you're

going to add those movements those

progressions that you're keeping the

pushing away way of the floor constant

throughout and that you're keeping your

torso parallel to the floor as you go

now when I say parallel I realize that

as you do an extension of one fist or

the other fist as you kick out that back

leg it's going to be near impossible for

most people to stay perfectly parallel

to the floor what you're trying to do

however is to make sure that you're not

rolling from one side to the next you're

trying to make sure that you don't get

tilted onto the stabilizing shoulder

hand side okay so that's what's really

important you can also if you really

want to make it difficult you can start

to take the

extended hand fist that is and reach

back and then touch the knee that was a

few seconds ago extended so you can do

that in kind of a kind of reaching back

touching the knee then ex re- extending

the leg you do that for one side both

sides Etc again there are a number of

different progressions that um I do in

the video I must say these are

challenging for me especially doing more

than three sets after you've contracted

your muscles really hard in the way that

you're supposed to for these exercises

in the three you're not going to have

the sort of fatigue that you experience

after sprinting or after doing heavy

deadlifts or something of that sort but

it's a certain kind of fatigue that

prevents you from performing the

movements properly and so the whole

point here is to perform the movements

properly to build a pattern what

sometimes called an engram but basically

it's an activation pattern of nerve to

muscle and the resulting limb movements

that allow you to do the movements

perfectly so don't be in a big rush to

do tons of this stuff right out the gate

be in a rush to do as much of it it as

you can perform properly and consider it

a progression and something that you're

going to keep up not just for a week not

just for a year but it's something that

you're going to do for the rest of your

life even if that means doing it just

once a week or once in a while learn the

movements properly that's the most

important thing and of course I'd be

remiss if I didn't mention the common

mistakes that people make when they do

the bird dog one is people often raise

that front fist way too high okay

they're reaching for the sky or they're

kicking way too high in the back they're

generating a sort of bow shape from

extended fist to Extended back foot

that's not good you really want to raise

these things up as stiff straight levers

while also maintaining as much as you

can parallel to the floor stance and

pushing the floor away this is about

generating strength of contraction and I

know the word sounds bad but rigidity

it's about generating stiffness in the

spinal muscles and in the abdominal

muscles and in the upper back muscles

and the other muscles that are requ requ

ired for this and when I say stiffness I

don't mean a lack of ability for the

muscles to move once you're in sport or

once you're about your daily activities

what I'm talking about is an ability to

generate a really firm muscular

contraction so that those nerve pathways

are strong so that you can stabilize the

spine in any number of different

dimensions and planes and orientations

as you embark on your daily activities

sports activities Etc that's what all of

this big three stuff is about it's about

strengthening the musculature of the

abdominals of the lower back of the

shoulders and everything that connects

it neurally again these are Pathways

it's something that I should have said

earlier and didn't which is we often

experience pain in a given location like

lower back pain or pain in the lower

back and down the hip into the leg but

pain is always the consequence of a

pathway being irritated or a pathway

being activated and in order to

strengthen the components around the

back to strengthen the components of the

back to avoid pain you want to work

Pathways and so the big three that stum

migil has developed is really about

generating the kind of muscular strength

and stability the neuromuscular

activation patterns and doing it in a

way that is generally safe for most

people to perform to get the strongest

and most painfree back possible and what

I just described might sound like a lot

of exercise it's actually something that

if you decide to just include one or two

sets of each of those curl up side plank

bird dog you could complete in anywhere

from 5 to 10 minutes again if done once

a week or twice a week whereas a warm up

before you know weightlifting or at the

end say a cardiovascular training

session maybe even while watching TV or

listening to a podcast or something of

that sort it actually doesn't take that

much time at all and of course doesn't

require any equipment and it can be done

essentially work or street clothes I'd

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some of the other protocols for

strengthening the back which largely

center around building strength into the

stabilizing muscles and parts of the

body that allow the spine to move

through different planes of motion

safely I want to talk about two

protocols that one can use to alleviate

back pain that many people find

beneficial now all this goes back to

this thing about vertebrae dis vertebrae

right that's the alternating sequence

along the length of the spine and again

the vertebrae are bony tissue so it's

hard stuff the discs are a softer all

right it's got some durability to it but

it's a softer tissue but it allows for

pliability of the spine because it's a

soft tissue so imagine an Oreo cookie

something that um I'm not a fan of

eating um I don't like the way they

taste and I'm told uh they're probably

not good for us but in any case if you

like Oreos or you don't it's a good

analogy here where you've got the two

cookies and the cream Center so the two

cookies are analogous to the vertebrae

here and the cream Center is analogous

to the disc if you squeeze the cookies

evenly from top to bottom the cream

Center is going to move out towards all

sides along the full circumference right

so all the white stuff is going to move

towards the edges more or less equally

if you squeeze just on one side right

the cream filling is going to move out

toward one side if you squeeze on the

other side cream filling and move out

toward the other side and of course if

you were to crush the cookies from top

and bottom or even just the top cookie

or the bottom cookie the cream filling

is going to go up and through that will

be equivalent to the rupturing of the

disc along that Dimension okay why am I

mentioning this well as I said before a

lot not all but a lot of back pain has

to do with compression or impingement of

nerves at some point along a pathway

sometimes multiple points along a

pathway and one of the most common

sources of back pain is when those discs

are bulging they're herniating and

they're impinging on a faasle of nerves

a bundle of nerves so two of the things

that many people find beneficial when

they're experiencing back pain are first

if you can find a bar or something that

you can hang from but don't worry you're

not going to have to actually hang in a

full dead hang position if you don't

have the strength for that or even if

you do the idea here is to get your arms

overhead onto a bar you're holding on to

the bar and your legs are going to drape

down and your toes are going to be in

contact with the floor so we're not

talking about a dead hang here okay

which actually requires that you engage

some muscles that can actually aggravate

back pain what you're doing here is

you're going to hold on to the bar

you're in more or less a hang except

that your toes are supporting you or

your feet or sometimes your heels are

supporting you what you're trying to do

is get lengthening of the spine

basically what you're doing is the

opposite of pressing down on those

spinal discs and you're going to do that

for anywhere from 10 to 30 seconds

you're not going to twist okay you could

imagine how twisting of the spine could

be bad depending on where the Bulge is

and which nerves are being impinged what

you're trying to do is just create

length along the spine to relieve some

of that disc bulging which is impinging

on the nerves again without knowing the

source of your back pain it's impossible

to know whether or not this will help or

it won't but many people get some degree

of Pain Relief by doing this of course

you need to be cautious in how you do it

you don't want to hang for a long time

if you don't have the strength to do

that while trying to find the distance

to the floor with your toes you're going

to want to progress toward this very

carefully but this is something that

many people find beneficial it's also

the kind of logic behind you know

inversion tables and these um kind of

look more like um kind of chair apparati

where people uh have designed chairs

that then can invert so that people can

relieve some of the pressure on their

spine I've personally never tried those

inversion chairs I did used to have an

inversion table that I had out on my

deck in the morning and I like to you

know lock my ankles in and and invert on

that thing it was kind of fun keep in

mind if you're going to do any kind of

inversion you are going to generate

intracranial pressure if you're somebody

and I feel obligated to say this because

I'm a vision scientist and I worked on

glaucoma for a number of years which is

intraocular pressure if you have

glaucoma or you're predisposed to

glaucoma you're going to increase ocular

pressure if you're inverted in that way

or anyway so keep that in mind you would

want to avoid that in those cases but

for many people just generating some

degree of lengthening of the spine by

hanging from a bar or from some other

physical object that's sturdy while

keeping your toes or your feet or your

heels in contact with the floor so

you're just kind of lightly touching

there so you can keep that going for

anywhere from 10 to 30 seconds and then

just kind of relax let go you walk

around a little bit and then repeat

doing that two or three times many

people experience some degree of pain

relief from doing that for all the

reasons that now should be logical and

obvious to you based on your

understanding of spine anatomy and

physiology that we talked about earlier

and the general theme of just trying to

relieve compression that is herniation

of the discs now what about reversing

herniation of the discs okay so this is

something I'm very familiar with and I

have an anecdote here that of course

just relates to my experience so it

certainly doesn't carry over to

everybody but it's an experience that

I've shared with a number of people

who've also experienced lower back pain

to some degree of success and the story

goes as follows a few years ago when I

was in Seattle giving a talk I decided

to go to the gym that morning and I did

an exercise which was not a deadlift it

wasn't anything spinal really it was

kind of a reverse bench dip that I do

for my triceps I've always enjoyed doing

these I've always um been able to do

these completely painfree but that

morning I got ambitious and I put a

couple um plates on my lap in order to

do them and I don't know exactly when it

happened but as I was doing these bench

dips with the weight on my lap something

felt like it quote unquote went in my

back something something felt off I I

don't know what happened but it felt

like a little kind of like a little pull

or something of that sort and when I

stood up felt okay and then as I started

to walk around a little bit more and

went through my workout I thought uhoh

something happened back there this is

not good and what essentially was

happening is I was experiencing pain on

my kind of lower and mid right side of

my back down the hip so intense pain at

the hip socket and down the leg kind of

what some people might describe as

classic s Attica or something similar to

that I thought oh goodness this is not

good as the morning progressed I was

having a harder and harder time not

walking walking was okay but if I sat

down and then I need to stand up it was

incredibly painful and I thought oh no

this is it I really did something bad to

my back so much so that I was literally

bent over at about 20 or 30 degrees

walking back to the Space Needle in

Seattle cuz we were giv the talks um up

in the one of the rooms there I don't

know if it was the top room one of the

rooms at the Space Needle and I could

barely walk up to the Space Needle I was

just you know hunched over it was

miserable now eventually what happened

was I was able to fly home I was in a

ton of pain I started reaching out to

colleagues of mine that work on the back

that understand pain they were

suggesting painkillers I personally like

to avoid taking painkillers unless I

have to take them and I basically don't

take them I might take an aspirin every

once in a while but I really like to

avoid taking painkillers that's just me

I don't judge those that need painkill

but basically in talking to Medical

colleagues I thought okay maybe I'm

going to need a corticosterone shot

maybe I'm going to need to just weight

it out and keep in mind that a lot of

back pain does relieve itself if people

just wait it out and avoid the movement

or movements that caused or exacerbate

that back pain this is something really

important to know a lot of back pain

will just relieve over time but I wanted

to stay active so I started reading

online as one does and I even started

doing some abdominal strengthening

exercises at the time I wasn't aware of

the curl-up and instead what I was doing

was some crunches so I was doing sit-ups

which you guessed it made things way way

worse for the obvious reasons it was

actually causing more of bulging of the

discs that were impinging on those

nerves bulging out the I guess it would

be the back side of the back the

posterior side of the back at the time I

didn't really understand dis anatomy and

vertebral anatomy in a way that would

tell me that the sit-ups were going to

cause that problem but they were making

it worse and worse eventually I cross P

with a PT who said absolutely stop doing

any abdominal crunching just stop you're

making it much much worse he explained

to me that the discs were bulging at

about the L3 L4 region you look up where

that is and then it was impinging on the

nerve which was causing the pain both in

the back at the hip socket down the leg

what did he suggest I do he suggested

that I do essentially the opposite of a

situp basically that I lie down on the

floor with toes extended legs together

and then do essentially a push-up while

keeping my hips in contact with the

floor so you might think of this kind of

as an up dog or a cobra pose in yoga um

although not so much extending the head

looking up at the ceiling but keeping

the head in a neutral position and then

doing anywhere from 8 to 10 repetitions

of those and then holding the final

repetition for as long as I could until

I started to Quake a little bit and then

relaxing onto the floor what was

remarkable is that from the very first

set of those that I did I started to

experience some degree of pain relief

not total pain relief but some degree of

pain relief and what he suggested I do

and what of course I did was to do those

essentially Cobra push-ups or I don't

know really what to call them again it's

hips in contact with the floor toes

pointed back legs straight pushing back

essentially what he was having me do was

to try and work that disc bulge back

into the more vertical alignment of the

spinal column I realize that's not the

exact nomenclature so all you pts and

chyros and physios are probably cringing

at this point but for the common

listener what we were trying to do was

get the cream of the Oreo cookie from

stopping to squeeze out from the back of

from between those cookies and back

under those cookies so to speak and what

I found and this was just remarkable was

that within two maybe three days the

pain was almost completely gone almost

completely gone which was to me just

staggering no pain medication I mean

prior to this I was thinking oh goodness

I'm going to need corticosteroid

injection I'm going to have to take pain

meds I might even need surgery I mean I

was compl completely debilitated now of

course we don't have the control

experiment where I didn't do these

exercises and I did nothing so we don't

know how fast it would have relieved

itself had I just done nothing so that's

an important caveat to all of this and

again this is just my experience but the

reason I'm sharing this experience is

not because I necessarily think that you

should be doing these same exercises to

relieve a disc bulge and the pain that

results from it but to give you a sense

of how the disc bulging and the

impingement on the nerve is very often

the cause of back pain and you want to

absolutely avoid doing anything that

exacerbates that disc bulge so in my

case it meant avoiding doing any

crunching because that would send the

cream from between the two Oreo cookies

further and further out impinging on the

nerve more and more and more creating

more and more pain rather to try and

push things back by doing a spinal

extension by doing creating an arch in

the lower back by doing these

essentially uh Cobra push-ups from the

floor and when talking with this PT

again and telling him gosh the back pain

is essentially removed this is amazing

I'm back to exercising walking running

in the very same week he said yes indeed

some people have so much back pain that

they can't even do the Cobra type

push-up they need to just go to a wall

and actually just put their hands on the

wall standing about six inches or so

away from the wall and then just push

their hips towards the wall okay yeah I

acknowledge kind of an odd visual there

but pushing their hips towards the wall

while keeping their you know arms bent

and their torso you know anywhere from 6

to 12 in from the wall and then

eventually progressing to be being able

to do these Cobra type push-ups or up

dogs whatever you want to call them on

the floor I again will provide a link in

the show note captions of how these are

done I found these to be tremendously

beneficial not just when I have back

pain because yes indeed couple years

later I did something else in the gym I

wasn't training particularly heavy and

that same L3 L4 thing started again and

I started doing these right away and it

resolved it right away okay so clearly

it works for me but one of the things

that's really been key for me is to

understand that I have a propensity for

a disc bulge a herniation in that region

I now know what direction the disc bulge

goes therefore which exercis is to avoid

because they exacerbate that herniation

of the discs and which exercises to

emphasize because they help alleviate

the herniation of that disc and this is

why a little bit later I'm going to talk

about some of the protocols that you can

incorporate into your resistance

training things like posterior chainwork

like glute ham raises Nordic curls and

things of that sort that if you're like

me and you're prone to slight herniation

of the discs in the direction towards

the posterior side right that it's very

important to build up the musculature

that surrounds those discs so that one

can avoid herniating them further so

again this is my experience you if you

have back pain I would hope not but if

you have back pain it might be a

herniation toward the anterior side of

your spine right it might be herniation

in the direction of spine flexion and so

therefore you need to do different

exercises the point is that you need to

understand what the origin of the pain

is but I also offer this story because

I've known several people one of whom is

in my family who experienced back pain

fought they need to get corticosteroid

injections actually got those injections

got some degree of pain relief which is

not surprising but then the pain came

back okay it turns out they had a herni

disc in the same kind of area and

general category of posterior you know

cream of the cookie going out the back

right towards the back as I did thought

that my anecdote about the herni disc

and these you know push-ups and these

wall push-ups and pushing one's pelvis

towards the wall was kind of goofy and

you know wasn't really Medical but

what's very interesting is when they

then traveled to Europe to Scandinavia

for the summer living there their

Scandinavian and spoke to a physician

there the instruction from that MD that

physician was not to do corticosterone

injections or to get surgery but you

guessed it to do exactly the same

exercise izes that the PT in the United

States suggested to me now why do I

raise this well the last thing I want to

do is get into a debate online about

whether or not one profession like PT or

Cairo or MD Etc is better than the other

I realize there's a range of talents

there are mediocre Terrible Bad

excellent and superb practitioners in

all these categories by the way um

that's clear uh to me and hopefully to

everybody else right you can't look at

an entire field and say good or entire

field and say bad there's going to be a

range of quality of practitioners in any

of those fields but when it comes to

back pain we are at an interesting point

in history where depending on where you

are in the world depending on the

traditions of the medical practice in

the area in which you live certain forms

of relieving back pain are going to be

looked at as more esoteric than others

so that's the other reason I offer this

anecdote this family member of mine and

a couple friends who've experienced back

pain of a similar nature have all now

Incorporated these um Cobra push-ups uh

up dog type approaches to some degree of

success or another it is true that one

of them had a badly enough herniated

disc that they did need surgery so

surgery sometimes is needed of course

but it's been remarkable to me to see

how much I and others can relieve their

back pain and strengthen the particular

areas and aspects of the body that then

can avoid further back pain and I'm

quite happy to say that I've had

essentially zero back pain now that I've

Incorporated the right rehabilitative

exercises as well as the right

strengthening exercises which include

The Big Three that we talked about

before and the ones I'm going to talk

about next I realize that when a lot of

people hear about back pain they

immediately think of sciatica and

somebody who's always carried his wallet

in his back right pocket I'm often told

hey you're going to get sciatica if you

carry your wallet in your back right

pocket um well I always take my wallet

and put it in my front right pocket when

I sit down or at least I try to remember

to so I don't think that's the cause I'm

certainly somebody who's had quote

unquote sciatica now sciatica's most

commonly thought of as tingling pain or

numbness or some combination of the

three in maybe a little bit in the lower

back in the glute region in the hip and

down the leg especially now relieving

sciatica involves a number of different

approaches and I'll probably have to do

an entire episode about sciatica and

other nerve pathway pain specifically

but for the time being a lot of sciatica

is caused by exactly the sorts of things

that we were talking about thus far the

herniation of the disc the bulging of

the disc and the impingement on the

nerve and when that bulging AKA

herniation is occurring within the lower

lumbar region of the spine often times

it will impinge on a nerve or nerves

that innervate the various regions I

just described so the glutes the hip

down the leg and sometimes will activate

pain tingling or numbness in areas which

are not innervated by that nerve there's

something called referred pain where

you're experiencing pain in one part of

the body due to an impingement or

disruption of a neural pathway or other

pathway or inflammation elsewhere in the

body so we're not going to do a deep

dive on sciatica right now suffice to

say that a lot of the symptoms of

sciatica fall under the umbrella of what

we're talking about today which is back

pain and strengthening the back in a way

that can help you avoid back pain and

indeed sciatica as well much of what I

just spoke about in terms of my own

experience with lower back pain could be

thought of as sciatica because there was

a lot of pain in the hip I almost felt

as if the hip socket was in pain and

there was some um pain not shooting down

the leg but kind of in the outer

uppermost thigh for me some people

experience it all the way down to their

toes even numbness tingling or pain

within the foot so it really depends on

the degree to which those neural

pathways are impinged but the principles

are the same which are if you are

experiencing lower back or related pain

in the hip the leg the buttocks Etc you

really want to figure out is there a

bulging also called a herniated disc if

so which direction is the herniation

likely occurring is it out toward the

back of the spine is on one side you

really want to understand where that

herniation and bulging is occurring so

that you can do the proper exercises to

work that bulging to push essentially

what I'm referring to in analogy as the

pushing back of the cream between the

two Oreo cookies back between those two

Oreo cookies so that you can give some

relief from the impingement on those

nerve roots that are no doubt causing

the flare up of back pain or what some

people experience and call sciatica okay

so thus far we've largely been talking

about different structural features of

the back things like vertebrae which are

bony the discs Etc that can impinge on

nerves and cause pain and while pain is

certainly neural there are a number of

things that exist from literally toe to

head that allow our back to move through

the various planes of motion in the ways

it needs to to carry out daily living to

carry out Sport and that if we

strengthen certain things even very

distal very far from the spine we can

allow for more mobility of the spine

strengthening the spine and indeed even

pain relief within the spinal Pathways

now the protocols we're about to discuss

were shared with me with Dr Shawn

wheeler sha wheeler is a medical doctor

who has an incredible knowledge of back

pain back relief and back

strengthening by no means can I

exhaustively cover all of the knowledge

that he shared with the world I'll

provide links to some of his work in the

show note captions I intend to bring him

onto the podcast as a guest but the

Hallmark of the protocols I'm about to

share with you you is the following we

have muscles that are constantly

actively engaged in order to stabilize

our spine which again is a good thing

you want a stable spine and we have

muscles that are not actively engaged

but for which we can engage them either

voluntarily or we can train them to be

more engaged when we're not thinking

about it so involuntary engagement but

we have an entire set of musculature

that is constantly actively engaged in

order to stabilize our spine

which again is a good thing and we have

musculature that can potentially

stabilize our spine if we focus on it if

we consciously decide to so what I'm

about to describe are some simple

protocols in fact very simple protocols

that you can do in order to create more

spine stability and in fact you can do

these anywhere the first involves

strengthening the muscles in the front

of the neck now this is something that I

do believe most everybody should be

doing anyway why well most people

nowadays are starting to take on a c

shape not just rounding the lower spine

but the chin is starting to move toward

the chest and of course this is because

most everybody is texting or on a laptop

much of the time okay this is not an

exaggeration if you look at people

walking around now they are tilted

forward at the chin they are essentially

taking an inch or two off their height

they are potentially creating pain

elsewhere in the body maybe even in the

neck itself and what I'm about to

describe is a way in which you can very

easily strengthen the muscles in the

front of the neck without adding size to

the neck because I know a lot of people

don't want to add size to their neck

I've talked elsewhere about

strengthening the muscles on the side of

the neck and in the back of the neck

this is something that I do believe is

important especially for people that are

doing a lot of heavy weightlifting who

are broadening their shoulders or who

already have broad shoulders also just

from a sheer aesthetic perspective

nothing looks weirder than a little head

and neck placed on broad shoulders okay

but more importantly than any athetic

matters is that if the musculature of

the neck is weak you have a weak upper

spine which is not a good thing from the

perspective of avoiding pain and not a

good thing from the perspective of

safety let alone posture breathing Etc

I've talked about that elsewhere I'll

provide a link in the show note captions

to some of the simpler exercises for

strengthening the neck that you can do

without equipment in the meantime for

sake of strengthening and pain proofing

the back it's very clear that

strengthening the muscles of the front

of the neck can be very beneficial this

is something that not just Dr Wheeler

but also steuart McGill have been

proponents of and the simplest way to do

this without any equipment is to Simply

put your fists underneath your not your

chin but on the two sides of your jaw so

on either side of your chin if you're

just listening that's where my voice is

going like this and then with your

tongue on the roof of your mouth and

breathing through your nose you're just

going to do a 10-second static

contraction where you're going to try

and move your chin down against the

resistance of your fists underneath your

jaw okay so you're going to

go push down there again tongue on the

roof of your mouth feel free to exale

exhale as you do this you might want to

do this for three or four repetitions of

10c static contractions and then just

relax you could do that for anywhere

from two to five sets very easy to do

what you're doing is you're generating

strength in the muscles of the front of

the neck and some nearby musculature it

has the tendency to then put you into a

default position at a distance from your

chest okay so this is different than

strengthening the muscles on the back of

your neck which will of course help to

keep your your chin out and and away

from your chest but when one does this

there are a number of different benefits

improved Airway passage so as many of

you know I'm a big proponent of nasal

breathing unless you need to breathe

through your mouth both during sleep and

sometimes during exercise but certainly

at rest so strengthening the muscles of

the front of the neck again I'll provide

a link to this in the show note caption

very easy to do it takes barely any time

you can do it anywhere and it has a

number of different benefits for

strengthening and pain proofing the

spine next is to focus on strength of

your feet and your toes Yes you heard me

correctly why are we talking about feet

and toes when we're talking about back

strengthening and alleviating back pain

well your feet are the foundation of

your entire body they're carrying you

around all day long and it's very clear

that the stronger your feet are the

healthier the rest of your body is going

to be it's not to say that the rest of

your body will be healthy if you just

focus on foot strength that's certainly

not the case but strengthening your feet

has many many benefits it's something

that I've been focusing a lot on in the

last couple of years and it's made a

huge difference in terms of eliminating

shin splints when I run it's made a huge

difference in terms of alleviating a

certain amount of lower back pain

although you heard the anecdote about

how I largely did that through other

mechanisms

earlier basically strengthening your

feet is an allaround terrific thing to

do how do you do this well some people

opt to get very wide toebox shoes some

people will even run in those um shoes

where the individual toes are look like

they're in a glove I don't own those

shoes I do have a slightly wider toebox

shoe for running and I've really

benefited from that but basically what

anyone can do and you don't need to

purchase any shoes or anything like that

is to try and see if you can spread your

toes out from one another so that none

of them are touching on both feet many

people find that they are able to do

that some people including myself found

that they could do that on one foot not

the other and it just took a couple of

weeks of working at it and strengthening

those neural Pathways learning how to

activate those neural pathways through

concentration to be able to spread my

toes on both feet this might sound a

little silly to some of you but being

able to spread your toes on both feet

actually says a lot about your ability

to activate distal neural Pathways or I

should say neural Pathways to distal

parts of your body there's a bunch of

interesting data about how that

correlates with some metrics of Aging or

lack of Aging I'm going to cover that in

a future podcast but some people find

that they can't spread their toes out

and they need a little bit of help from

toe spreaders yes there are commercially

available toe spreaders that take the

form of these kind of um stocks that you

can put between um your toes these are

rubber stocks that then spread the toes

it can be a little bit uncomfortable at

first but then you get better at it help

you learn to spread your toes you

certainly don't need those things you

could even just take some you know paper

towel or or tissue paper or something of

that that's that's firm and put it

between your toes and that will help you

learn to spread your toes I'm not

suggesting you walk walk around all day

with tow spreaders although some people

actually do that but basically what

you're doing is you're creating the

ability to activate the neural Pathways

that that allow you excuse me to spread

your toes I know this might sound silly

but if you do this you're going to find

that you're walking your stance when

you're stationary and certainly if you

do any kind of running or cycling you're

going to find that all of those things

are going to benefit in addition there

is benefit to strengthening your toes

this is something that I'm only now

starting to explore um one way you can

do this is by sitting in a chair

Barefoot spreading your toes as much as

possible and then seeing whether or not

you can lift each toe independently I'm

not at the point where I can do that yet

I'm still trying to learn how to um lift

my big toes independent of my other toes

again all this is learning how to

activate neural Pathways to distal parts

of your body that serve as stabilizers

for the arch of the foot for the foot

itself for the ankle for the shin that

carry over to spine stability and a

strong spine I know it seem seems kind

of wild that we're talking about the

feet and Toes spreading to benefit your

back but all of these things relate to

one another up and down the chain of

activation involved in Walking In

running and certainly if you're involved

in any other sports but also just