00:00all right team we've got a very
00:03episode of keeping it real this week
00:06my guest is a gentleman by the name of
00:08dr stuart mcgill and he is one of the
00:11if not say one of the most he is
00:13arguably the best in the world
00:16at helping people rehabilitate back
00:20he has multiple books he's
00:23very well published he has rehabilitated
00:25some of the world's greatest athletes
00:28myself included not that i'm one of the
00:30world's greatest athletes but he helped
00:34and this might be news to many of you
00:37but last year actually in 2021 i
00:41and then subsequently herniated three
00:43discs in my lower back
00:46and it was dr mcgill that helped put me
00:50put me on the road to recovery and i
00:52haven't talked about it because i wasn't
00:54quite sure how the story was gonna end i
00:56wasn't sure the story i was going to
01:00i told that story i wanted to be sure
01:03that i was giving you guys the absolute
01:07so we're going to kick off my story
01:14manage chronic pain rehabilitate back
01:19with this show with dr stewart miguel so
01:22i really hope you enjoy it
01:25all right we are back with dr stuart
01:28mcgill professor emeritus at the
01:30university of waterloo and chief
01:34of backfit pro doc welcome to the show
01:36thank you so much for being on it's my
01:38pleasure jillian nice to see you again
01:41you too i know you have a lot going on
01:43today um you're in very high demand
01:46uh but the the first thing i would love
01:49for you to tell people about
01:51is your backstory i mean you are the
01:54most well respected professional
01:57in rehabilitating the spine um everybody
02:01in my line of work all the greatest
02:02athletes in the world know that you are
02:04the god the the golden god the gold
02:08but how did you i never even asked you
02:13this guy what what prompted that
02:16well if you asked my high school
02:18teachers that question they wouldn't
02:23but um i've always been interested in
02:28i did a phd in spine biomechanics and
02:32then became a professor and scientist
02:35and as a young professor i just started
02:37out asking one question and it was so
02:39simple how does the spine work
02:41so we would uh devise different
02:44experiments to probe people
02:47with and without back pain and try and
02:49understand the mechanisms how on earth
02:52do we have this flexible rod that allows
02:55us to tie our shoes and dance and really
03:00uh the next task is a young mom picking
03:04her baby out of a crib and the flexible
03:06rod doesn't work anymore it would
03:08collapse under the weight so now she has
03:10to stiffen that rod to allow it to bear
03:13load so it's this really interesting
03:16part of the body with so many changing
03:20we were the first to analyze stability
03:24and what a person needs to do in a
03:27healthy way to transition from doing a
03:30deadlift or picking up their child and
03:32and then as i said to use a mobility
03:35example like tying your shoe
03:37or uh dancing so i started out with a
03:41laboratory where we measured the stress
03:43distributions on people and then i
03:46realized i don't know
03:50and injury pathways come together so we
03:53then created a cadaver lab where we
03:56would apply the stresses that we
03:58measured in people and then made them a
04:01little bit excessive in terms of motions
04:03and loads and different postures and
04:05what not and then we saw very
04:07specifically what injuries occurred with
04:13i would be asked to go to medical
04:16and my medical colleagues
04:18neurologists and surgeons and what i
04:20would say you just described a mechanism
04:24that may apply to this very challenging
04:26patient that we have would you see a
04:28patient with us and i will say no i i'm
04:30a scientist i'm not trained to see
04:33people and they said don't worry come
04:35and we will be with you and we all
04:38realized that i looked at back pain from
04:41a very different point of view
04:46i was asked to see patients and and you
04:48know this nowhere on the internet is
04:53uh site that you go and get an
04:55appointment with professor mcgill it's
04:57all word of mouth and and if if
05:01you know i'm i'm not well known outside
05:04of the you know elite athletes and and
05:06the celebrities like yourself
05:09uh to get entertainment
05:12well and i and i and that's why i had to
05:15right and we're going to get to that at
05:17the end um we're going to get to how you
05:22someone like and in this case the man
05:24himself dr stewart mcgill because it is
05:27that serious that you do
05:29um and i speak from personal experience
05:32which you guys all just heard my story
05:36doc one of the things i find
05:42someone like me with all the knowledge i
05:44have in all the access i have
05:46was still fell prey to bad advice and
05:50then i was even able to find
05:52and i don't want to scare anyone i just
05:54i would like your thoughts on what we
05:57was even able to get to some of the best
06:02physical therapists um
06:14that the information because the
06:16information is only as good as the
06:18interpreting that information you know
06:21that's really that is what is so scary
06:24is not only can people not get help
06:26you know how do you know the help you're
06:31like what how often do you see that like
06:34for you to be the only one that caught
06:36that i had an mri looked at by three
06:41how is that possible
06:43well every person that comes here
06:46follows that storyline
06:49no one has a back pain primary issue and
06:52then says oh i'm going to phone up
06:53miguel and get an appointment
06:55i only see the failures so when a
06:58clinician be it a surgeon or a cairo or
07:00a physio gets a patient better
07:05i will never see those people i only see
07:10at that point what we do is a very
07:15now the assessment that i did with you
07:17was probably something unlike you've
07:22and the analogy i use is can you imagine
07:24taking your car and saying my car isn't
07:27functioning properly and the car
07:28mechanic says oh good with
07:30non-functioning cars we change the
07:32engine so if you go to a certain kind of
07:35clinician you get the intervention or
07:41thing that they are trained to do
07:43whether or not that matches you but it
07:46makes so much more sense i hope that the
07:48car mechanic would say we're going to
07:50run some diagnostics hone in on the
07:52problem and then we have a good chance
07:56but the average public doesn't get a
07:59thorough assessment in the traditional
08:02health care system there's no billing
08:04and i will take in some people sometimes
08:09three hours of investigating and probing
08:12first of all a very in-depth interview
08:15to understand and perform pattern
08:17recognition the nature of the pain what
08:20activities cause it what activities take
08:24um tell me about their job and their
08:26family life what are the impediments
08:28systemic in your life that have caused
08:29you to fail previously and it might be
08:33their unawareness of what the mechanism
08:36and then i explain it to them with
08:39precision and many of them will say you
08:42thank you for not treating me like a
08:44five-year-old you're the first person
08:46that has ever shown me and explained to
08:49what my pain mechanism is and then given
08:52me a movement hack or a strategy to
08:55start winding down the pain
08:57so it's not a cure it is a strategy to
09:04tissue the language of of cells is force
09:08and pressure as you know
09:11in order to create adaptation for
09:14robustness to get your strength and
09:17load-bearing ability back again the
09:19things necessary for a good life
09:21you stimulate those through appropriate
09:24mechanostimulation or the appropriate
09:27exercise but then that's all governed by
09:30a tipping point not too much and not too
09:32little you know every system in biology
09:35has a tipping point consider vitamin d
09:38a nutritional supplement if you don't
09:40have enough vitamin d you're sick
09:42so we expose you to more vitamin d
09:47too much vitamin d then becomes a poison
09:51in other words there was a tipping point
09:53and it's a great art and science to know
09:55where these tipping points are and the
09:57assessment always shows us where that is
10:04language that the cells understand and
10:07will respond to to create optimal uh
10:10adaptation and get your
10:12mojo back for a good life
10:15and let me just say to anybody listening
10:17thinking i can't figure this out
10:19uh we're going to guide you to dr
10:22mcgill's books in particular the back
10:24mechanic and his website where there are
10:26videos that walk you through all of this
10:29so don't don't panic we would not give
10:31you something that was not accessible
10:34doc one of the things i learned
10:37is that in going through all you know
10:39before i was able to get to you know the
10:41ct scan the emergency room the mris the
10:44the epidurals all of the things that i
10:47there was someone with a story
10:49even the kid that delivered my bed
10:51because i was laying on the floor looked
10:54at me and he's like you've hurt your
10:5630 year old kid and he's like
10:58i herniated two discs
11:00everybody has a story and i came to
11:04some ridiculous uh statistic it's like
11:0685 of people will suffer with back pain
11:11um am i right in that number
11:17we we get into subcategories of back
11:19pain and i think what you're describing
11:21is what we would call disabling back
11:23pain and that means disabling sufficient
11:26that you now lose a day from work or a
11:29period of time from work that is
11:31disabling back pain and the 80 percent
11:37everyone like i went for a tooth
11:39cleaning you know even after you you
11:42know when you got me functioning enough
11:45and even the woman cleaning my teeth the
11:48hygienist was like oh my god
11:50i suffer i suffer and everyone talks to
11:52me about living with this horrendous
11:54chronic pain and it devastates me
11:59that they're not getting the information
12:00they need they're not getting the advice
12:01to rehabilitate themselves and in fact
12:03they're probably getting very bad
12:06that's making the problem worse
12:10i wanted to ask you what are some of the
12:12most common back injuries you see
12:15and some of the most common causes of
12:19i'm going to start that answer with
12:26genetics loads the gun
12:29exposure pulls the trigger
12:32psycho social influences
12:45let me give you an example may i give an
12:47example of each one of those and then
12:49yeah because i'm trying to exactly yes
12:53let's start with genetics there are
12:56uh features of each of us
13:01very receptive to a certain kind of
13:04exercise stimulus but it's a poison for
13:06the next so i'll start with a dog
13:08example can you imagine training a saint
13:10bernard to win at the greyhound track
13:13it's not possible you will break the dog
13:16so if i was to look at someone with a
13:18very heavy skeletal structure can you
13:22imagine bending a thin willow branch
13:24back and forth over and over again no
13:26stress no problem so if that person did
13:30sit-ups as an example chances are that
13:33won't create stresses like a thin willow
13:36branch but if you took a thicker branch
13:38and bent it it would shatter immediately
13:41so do you see why a thicker heavier
13:46doesn't do well with sit-ups whereas
13:48they might do well if they were of a
13:50more slender spine so that's just an
13:52example the hip sockets you'll remember
13:54on you i measured your hip uh sockets
13:58just externally by by moving your knee
14:01around the hip socket so i knew right
14:04where you were best able to get out of a
14:07chair should your knees be together or
14:09your knees apart and remember when you
14:11were on all fours and i asked you to
14:12rock your pelvis back to your heels we
14:15found the pain immediately and we also
14:18found immediately a strategy for you to
14:20take your pain away but but no one would
14:23ever have come up with that without
14:27i've got to assess jillian and really
14:29get at her specific pain trigger so
14:32there's a little bit on the genetics
14:38loads motions postures activities create
14:43stress so you can imagine if i was doing
14:47and i'm not picking on yoga yoga can be
14:49very helpful for certain people for
14:51certain things or it can be the polar
14:57i expose uh one person to yoga
15:00they might get stretch reflexes
15:03uh a false sense of uh whether that is
15:07helping or hurting and then the next
15:08person says oh and i do yoga that's kind
15:10of like jujitsu i want to submit enough
15:13i'm going to tap out
15:15so do you see how the exposure
15:20is governed by this tipping point some
15:23people are very very resilient to
15:25certain loads some people are very very
15:28resilient to bending etc that's just the
15:31the way it is but don't cross the
15:34the the the final bit the psychosocial
15:37bit can you imagine if we took an addict
15:40let's take an a a person who's an addict
15:49exercise so hard you're crossing the
15:52tipping point and in fact we isolate it
15:54down to riding the elliptical they go
15:57into the gym and they ride the
15:58elliptical for 45 minutes every day and
16:04i know what's causing your back pain
16:06uh it is that overexposure to
16:10riding the elliptical now that's not a
16:12bad thing it was just overexposed and
16:14she will say i have to do it because if
16:16i don't it's my stress reliever i'll
16:18come home and murder my husband and kids
16:20so i have to do it and then also and
16:23then i recognize that pattern as an
16:25addict of exercise and i'll say good
16:28if you go and have surgery the mechanism
16:31of how the surgery will work is
16:34for the first time it forces to you to
16:36rest it is an intervention on your
16:39uh addiction rather than the knife
16:42cutting your pain out if i've isolated
16:44the the type of pain that it is
16:49oh and i'll say i'll tell you what
16:51let's perform virtual surgery and i'm
16:54very dramatic about it i go over and i
16:56touch her on the shoulder like i'm
16:58nighting you know a night you've now
17:00been knighted there is your surgery now
17:03if you have surgery you're not going to
17:04the gym to ride the elliptical tomorrow
17:06what will you do post-surgical which
17:08you're going to be forced to do anyway
17:10you will rest you will uh
17:13get up go for a pee short walk sit down
17:17but it's a graded re-exposure and it is
17:21the perfect way to re-adapt your tissues
17:25once again to allow them to wind down
17:27their pain sensitivity and now build up
17:30their robustness once again
17:32so there is an intervention
17:35on a psychosocial issue that was causing
17:39that particular client to fail time and
17:42time again so do you see how
17:45understanding the pathway to pain
17:48is required and everybody's pathway is a
17:51little bit different so when you ask me
17:53what's the common cause
17:55i know we both know what your pathway
17:58was we know what other people's pathways
18:01are and we arrange the
18:03uh approach the treatment approach in
18:06two stages number one
18:08wind down the cause of pain if you
18:10stubbed your toe every day your toe
18:12would become very angry and all i have
18:14to do is touch your toe and you would
18:17when i first saw you your back was
18:19ramped up and everything that
18:22everything you did caused pain the first
18:25thing we had to do was to figure out
18:27four jillian michaels
18:32you didn't have a chronic pain you had
18:35many acute episodes over and over again
18:38not your fault unbeknownst to you but
18:40once we were able to point that out we
18:42were able to wind it down the second bit
18:46what does jillian michaels now need
18:50restore her athletic her fabulous
18:53athletic mojo number one get the hips
18:56moving again transfer the load and
18:58motion responsibility to the hips
19:01recognizing we have to look after that
19:04little oyster that was
19:06three you had three oysters in a
19:08fracture that you fixed on me yeah yeah
19:10it's a three three disc herniations
19:18and i i mean i i i'm afraid to say it
19:21out loud but like i do everything you
19:23tell me i'm extraordinarily
19:28but i am have been pain free for
19:34beautifully i haven't tried
19:36anything like sprinting i don't do
19:40any of the rotation stuff we talked
19:43i mean i thought i was my life was over
19:46i thought my whole world was over well
19:48it's time after this podcast let's get
19:51together again and we are reassess where
19:56and then we're going to create an
19:58inventory of what you want
20:00and then we build uh within a time frame
20:03a very patient evidence-based plan to
20:08keep adapting and getting you back to
20:10love and life completely
20:12and on that note we are going to take a
20:15quick break and we will be right back
20:17with dr stuart mcgill
20:23you know you've answered some of my next
20:26questions about treatment right
20:28treatment if you get injured
20:30but i made a series of mistakes that you
20:32stopped immediately the minute we began
20:36um and i wonder if you see these
20:38mistakes often one of which was
20:41oh well if you have a herniated disc you
20:43know surely you need to decompress the
20:48oh my god i made things so much worse or
20:55i screwed everything up so much worse
20:58trying to attack the problem
21:01and instead of doing exactly what you
21:03told me to do which was chill the f out
21:05and then figure out what was causing
21:09what do you what are some of the things
21:13um that are so dangerously wrong
21:16uh upon getting injured uh and
21:20you know i was even given the wrong
21:21doses of medication i was given so much
21:23flexural i couldn't see my phone
21:27it's dark i was blind i was literally
21:29blind i was like oh my god i can't i
21:31can't see my phone um you know what
21:34is it rushing into surgery is it is it
21:37taking the wrong medication is it taking
21:40matters into their own hands is it
21:42seeing the wrong professionals because i
21:44i just worry i know if i can make it
21:49i know so many people are making the
21:52you know without getting the proper help
21:54what are some of the things you see that
21:55we should absolutely never do when we
21:59the answer doesn't exist in a generic
22:01sense that works for everybody the
22:03answer is always we have an individual
22:06in front of us it depends on the
22:09circumstances of that particular
22:10individual even if we can converge on
22:13the right approach we haven't even
22:15discussed the dose and where that
22:17tipping point is and where too much or
22:19too little is so it's quite an art and a
22:24most people when they
22:27they get an understanding of these
22:30typical pathways to pain so that they
22:34recognizing patterns in their own body
22:38then we guide them through a
22:39self-assessment which uh we we assess
22:42their ability to bear compression to
22:44bend to to twist to extend
22:49to go for a walk how far can you walk
22:52can we change the way you walk can we
22:54add more swing or less arm swing
23:00once we've defined those motions
23:02postures loads activities that cause the
23:05pain to ramp up we create movement hacks
23:08do you remember the day i showed you how
23:10to tie your shoe in a way that didn't
23:14now you didn't realize that it was a
23:16combination of a lunge
23:19putting your foot up on the bench rather
23:21than sitting on the bench and then
23:23sitting on the bench and bending forward
23:27uh disc bulges but we created a movement
23:32stayed upright moved your hips down to
23:34your uh shoe with a um
23:38a modified lunge and all of a sudden we
23:42so i i keep coming back to this idea
23:46just go chapter by chapter and it will
23:48guide you through it there's a whole
23:49chapter on how do you find a good
23:52uh clinician is surgery for you it's
23:56it's all algorithmic for example if if
23:59you see a surgeon and right away they
24:01haven't done a thorough assessment and
24:03they start saying whether they're going
24:04to operate or not i suggest
24:09if you ask the surgeon how many of these
24:12procedures have you done and could i
24:15speak with a couple of your previous
24:17patients and if they say no i would not
24:22there's a series of checks and balances
24:26to reduce the risk and enhance
24:31chance for a better outcome and it just
24:33guides the person through then we go
24:35into the assessment and we go into
24:40brush your teeth without triggering pain
24:43so many people come in as you know and
24:45they say you know all i did was sneeze
24:46and i threw my back out what happened
24:49and we'll say okay here's if you sneeze
24:52this way you've just bulletproofed your
24:56well no and and now talk about the
25:02understands why they do something and
25:05they get a knife shoved in their back
25:08you know it it it it breaks down the
25:12mentally strongest people going it's
25:15torture you never know when the bogeyman
25:18is going to come and slam a knife in
25:20your back so it turns the person into a
25:23just a hapless victim
25:25but once they learn what
25:28caused the knife in their back and they
25:30have a strategy to eliminate that cause
25:34they now become confident and their
25:37whole psychology changes so that the
25:39next time they have pain
25:41what they do is a self-analysis and say
25:44what principle did i just violate let me
25:47repeat that right now
25:49but i'm going to do it right aha i did
25:52it with no pain now they're confident
25:54they're empowered and their their whole
25:57demeanor changes and they're off to the
26:01doc um let's get into
26:03the back mechanic i obviously have the
26:06book and reading it you know sometimes i
26:08was like okay whoa that's a little
26:10technical and then i had you to explain
26:12it to me and then i said you doc you
26:14know what about a video series and you
26:16were like i did all that so
26:19can you tell everybody right how do we
26:22to you so we've got the book the back
26:24mechanic and that's the one you would
26:25recommend because you have you know
26:27several i of course bought them all and
26:28then you were like no no start on the
26:31but is that where we would start people
26:34and then provided they're like i can't
26:35i'm not a reader i have add where do we
26:38find the video series and god forbid i
26:40know you said you were mostly retired
26:43but are you still seeing patience and if
26:45so how do people find you so let's start
26:48which book where do we get the videos
26:51and then if we need you
26:55i wrote my first book for clinicians i
26:58wrote the book for doctors in the year
27:03and i never expected in a million years
27:05the lay public would read it but some
27:07savvy people did read it and they said
27:09wow that this has really helped would
27:11you write a book for the lay public and
27:13so that's where back mechanic uh came
27:16from it's a very difficult book to read
27:18because the publisher said can you write
27:20a book with the title fix your back in
27:223z steps and i said no i can't that's a
27:25uh it requires an assessment it's a lot
27:28more the book is 17 chapters but if you
27:32and and i know this statistically as
27:36um if you fall into the category that
27:39you've tried everything and the last
27:40hope for you is surgery if you've been
27:42told that and you follow back mechanic
27:4695 percent avoid surgery and in a
27:49two-year follow-up they are glad that
27:51they did so we would do those follow-ups
27:54with readers and patients at the
28:00obviously do not have the ability uh
28:02there are some days i get 200 requests
28:04from around the world to see people it's
28:06not possible so what i did was i trained
28:13how to perform a thorough assessment of
28:16anatomy mechanics neurology psychology
28:21with precision on the pain triggers of
28:26people can go to our website
28:30click on the entry portal for
28:33people with back pain so that you're a
28:35doc and you're going in or you're a
28:38and then you will see
28:40um the lists of the clinicians we've
28:46that uh will give you that assessment
28:49and a plan on what to do to get better
28:55i think i've covered off
28:57everything that you are asking for there
28:59yeah the books and what a person can do
29:04but are there suffering
29:06yeah so there's two back mechanic comes
29:09back mechanic is a book and you can buy
29:14on amazon for example there's a video
29:16enhanced back mechanic and it has videos
29:20that bring each chapter alive so
29:22when you're doing a self-assessment it
29:25guides you through so i'm i'm with
29:28patients showing how to conduct the
29:30assessment and then how to get the
29:32movements uh right for the movement
29:34hacks do you remember how we just rolled
29:37over in bed without pain the first time
29:39i saw you it was impossible that the
29:41thigh pains that you were getting
29:43through nerve friction the oysters in
29:47the the herniated nucleus had such an
29:51inflammatory soup around them you you
29:54but yet we found a strategy so you could
29:57roll over a straight leg with a little
29:58bit of core bracing and you did it
30:01without a pain trigger that was
30:03empowering for you right away i saw the
30:05look in your face and and it was at that
30:09i knew you were going to be successful
30:13and you became empowered
30:16so you got me to stand for the first
30:18time i was like oh my god i'm upright
30:24uh then we show people how to stand and
30:27and not have pain on and off the toilet
30:29in and out of their car tying their
30:31shoes brushing their teeth etc
30:33then we add strategic mobility to get
30:37the body loosened up strategically uh
30:40and uh we go from there so that's the
30:43video enhanced back mechanic that is a
30:46must-have a must-have and i could
30:49literally keep you for hours but i know
30:52you have uh more people to speak to more
30:57um but i know this will not be the first
31:01work together in this way and doc you
31:04know i'm so indebted to you i'm so
31:05grateful for everything you did for me
31:08i am just so grateful to to share you
31:10with the world because i had no idea
31:14no idea this kind of pain was possible
31:17and it you feel like your life is over
31:20literally jillian the respect in the fan
31:22club goes two ways thanks for all you do
31:25thank you doc all right i'll be in touch
