How To Get Extreme "Okinawan" Strength, 3 Ways To Fix Low Back Pain & The Best Core Exercises With Stu McGill

Hey, hey, hey. I gotta pour myself my. My chocolate hot drink for the day. This is Ben Greenfield, by the way. It's the afternoon, and I like to drink relaxing things in the afternoon. I'm not a coffee guy, so I'm drinking some. Some Rishi and a little bit of dark chocolate and some stevia. Here, pour this. Pour this bad boy into my cup before I tell you what we're about to listen into today and take a sip. Amaze bombs. It's even foamy. Hey. Extreme Okinawan strength. One of the best books on low back pain and core stability that I've read in a very long time. Three of the best ways to fix low back pain, the best core exercises, a whole lot more. I got the world's leading expert on low back strength and fixing low back pain on the podcast today. His name's Stu McGill. You're going to love him, trust me. In this episode of the Ben Greenfield.

Fitness show, if we take a thin willow branch, we can bend that back and forth, and it doesn't build up cumulative stress. It's not an issue. But if you took a thick branch and even bent it once to the same amount of bend, it would shatter, because the stress in a round tube, which is your spine, is a function of its diameter. So great trainers not only create great hardware in people's bodies, but great software. And it's those default software patterns that allow people to move in a resilient, confident way all day long throughout life.

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Hey, folks, it's Ben Greenfield here. I get a lot of questions about, of all things, the back. People ask me about the immune system, and they asked me about erectile dysfunction, and they asked me about putting fat in your coffee. But gosh, one of the questions is way up there is the back, how do you fix back pain? How do you decode back pain? And are crunches really all that bad? And how can you get good torso strength without throwing your back out? And how can you keep your glutes turned on, unquote? And is there A way to fix your back without going into a chiropractic dock over and over again. And so I decided it was high time that I got one of, if not the world's leading low back experts on the podcast to clear up all the confusion and the clutter about your back and about your spine. And his name is Dr. Stuart McGill. He's been a professor of spine biomechanics at the University of Waterloo for over 32 years. He's got well over 200 different scientific journal papers that he's authored. He's mentored over 40 graduate students, and he's a consultant that provides expertise to individuals, to professional athletes, to various government agencies, corporations, legal firms, teams, you name it. Specifically when it comes to low back health, and specifically when it comes to a scientific and even, as we'll describe in today's show, a quantifiable approach to low back health and the elimination of low back pain. Now, as I usually do, because Stu's gonna be a wealth of resources for you guys. Anything that we talk about or bring up, including Stu's fantastic books, he's got some really good ones, including a brand new one called the Gift of Injury. And we'll fill you in on that one. Just go to BenGreenfieldFitness.com McGill, that's M C, G I L. And when you go there, I will provide links to everything that you are about to discover. So straighten up in your chair if you're sitting in one of those fancy low back supporting chairs and tune in because we're about to take a deep dive into your back. Stu, welcome to the show, man.

Oh, thanks very much, Ben. Good afternoon to you.

Yes, sir. And you know what? Before we even started our recording today, now this is hot on my mind. I gotta ask you because I'm very curious. I was kind of throwing a few different therapies at you. We're talking about chairs and decompression belts and foundation therapy and all these things. And you said that your approach to everything is that you quantify and that you're one of the few guys out there who actually quantifies any of these modalities that are out there when it comes to management of or elimination of or strengthening of the low back or low back pain. What do you mean by that? Like, how do you actually quantify whether or not something's working when it comes to your back?

Well, that's a great start. As a professor, I ran several research operations. The first one was what we called the in vitro laboratory. We would Take real cadaver spines from different animals and humans. And if, you know, we can't get 50 identical humans, but we could get 50 identical animals. And there's not a medical question that is asked where animals aren't involved in some way, shape or form because they add control to the initial level of investigation. So we would load spines and create specific injuries. So we would learn very specifically what is required to create a certain type of disc herniation or bulge, or how you fracture an implant or tear ligaments, et cetera, et cetera. The second laboratory that we ran in tandem was what we called the in vivo laboratory that was a equipped to measure loads in real people and stress in the different tissues. So we would measure the three dimensional motion of their spines, we would build a virtual spine in the computer, their own customized three dimensional anatomy which we would acquire from their MRI slices that we'd build up their own bodies and then their virtual spine would move. As they moved their own spine, we would detect it and then drive their virtual spine. And then as their, their brain activated muscles to perform different tasks. And sometimes the tasks were very simple, sometimes they were world class performance. We've measured, as you know, top athletes in many different sports, the muscle activation was sensed through sensors called electromyographic electrodes.

Emg.

Emg, exactly. And then we use those signals to drive their virtual muscles. Then we could measure muscle forces, ligament loads, disc and vertebra loads. And finally we got to some very high level estimates of things like spine stability. And if I was to say to you, how stable is that bridge you're building in a hurricane? If you're an engineer, that would be quite a feat of engineering to put a number on that. Well, that was what we endeavored to do to actually measure spine stability. So we're not hand waving about it. And if you want me to explain the three major elements that determine spine stability, I'd be willing to do so. The third level of evidence over those 30 or so years came from the clinic where we would see patients and we would say, all right, these are tests now that we think are going to stress different tissues and we're going to see if they indeed replicate your pain or take your pain away. We're going to measure stability and see if we can come up with new muscle patterns, motor patterns, movement patterns, exercise regimens, different rest break periods. That was very much part and parcel with this new gift of injury book to see how we can then advise people. The fourth element was the proof. Does this indeed work? Then we would do Population studies, we used military groups, police, firefighters, different sports teams, and we would try interventions to see if, A, we could reduce the risk of future back pain, and B, what was the efficacy of different approaches for those who already had different types of back pain? And there is no such thing as back pain. It's like saying to someone, oh, can you give me an exercise for arm pain or head pain? You know, we wouldn't tolerate this. So we always had to subcategorize pain down into pain by different movements, different loads, or different tissues, or whatever the categorization rubric was. But anyway, that's. That's it in a nutshell. And that's how our operation worked to try and become the primary investigator of these different things. In other words, we didn't go to other people and ask their opinion. We just did the primary work.

Yeah, it's an interesting approach. Basically injuring the spines of unfortunate little mice, among other things, and seeing what actually works. A lot of times you'll see folks will say, well, this worked in such and such an athlete. There'll be a lot of cases of n equals 1, or, this worked to fix my back pain, therefore you should try it. I don't run into a lot of people who are actually quantifying in the way that you quantify. And I actually wanna ask you in a little bit about some of the things that you found through that quantification, because there's a lot of popular things out there that people do that I'm curious whether or not you found actually worked. But before we dive into that, you mentioned the three major elements that influence spine stability. I'm assuming that none of those are those giant leather belts that you wear at the gym when you lift weights.

Well, actually they are. Yeah, that would be part of it. Do you want me to talk about those three very briefly and I'll work that belt comment in for you.

Sure.

Okay. Well, the first one is the spine is a flexible rod. Now, it allows you to dance and move and throw a baseball and swing a golf club and do all these fun things. But if you're a power lifter and you're going to squat £1,000, you must have virtually almost zero movement in that flexible rod because that flexible rod will collapse. So the role of the muscles is to act as a guy wire system supporting the front, the sides and the back to allow that flexible column to bear hundred, well, half a ton of compressive load. So a belt that the weight lifters and power lifters wear add to the stiffness. There's no question that that extra stiffness allows them to bear a few more pounds without buckling and even micro buckling at the very low level.

Now, just to interrupt you real quick, that doesn't mean that that's a belt that should be used as a crutch. That would be something you'd use when subjecting the spine to an unnaturally high load. That's not something one would wear throughout the day or as a regular practice at the gym.

Right.

And the reason I ask that is I'm under the impression that. That you lose the ability to stabilize.

Precisely. I actually wrote legislation for several companies and a couple of government agencies on belt wearing, administrative belt wearing. Do you remember years ago you would go into Home Depot and you would see all the guys wearing belts?

Yeah. The guys on the forklifts are sitting there slouched over with a belt on.

At one time was a mandatory condition for employment and we were quite involved in, in that. So of course that is not what we're talking about because there's on average. It's not justifiable for the average working guy. It's not really justifiable for guys at the gym either. Unless they are trying to push their bodies to lift a heck of a lot of load or they want to set a record. There's no question that the belt will help you bear a few more pounds. But the downside of it is if a person's starting to get back pain and they, they keep doing the thing that's causing the pain, but now they are wearing a belt thinking that they're protected. What we do know is the injury if they're wearing a belt is actually more severe. And that makes perfect sense. So address the cause and the belt in that situation is probably not the cure.

Okay, got it. So when it comes to the three major elements that influence spine stability, the belt isn't one of those elements. But the belt provides the same type of stability that one of those elements would.

Yes, that's correct. So the muscles acting as a guy wire system all around the spine is principle number one. But let's forget about the belt. Now I'm just giving you the three principles. So the muscles need to activate and that's why when we develop spine stabilization exercises, we treat all of the muscles acting like a fine orchestra as they all play together to ensure we call sufficient stability. So if you're just bending over to pick up your two year old, you don't need maximum stability and stiffness, but you need enough control. Just enough. Now, if you're walking and you've got a sore back, you may need to add a little bit more stiffness. And we would cue that clinically, but that would be a low level of tuned stiffness. But again, if you were lifting a couple hundred kilos in a deadlift, you'd want obviously a lot more stiffness. So that's the first element. The second element is what we call proximal stability to unleash distal athleticism. Consider this for a moment. I'm sure the listeners know what a pec major is, the bench press muscle. So distally or on the other side of the ball and socket joined to the shoulder, that muscle attaches to the humerus of the arm. So it flexes the arm around, but it also connects to the rib cage proximally or closer to your core. So if you were to push a door or push an opponent in a, in a combative situation, the muscle that, that single joint muscle, it swings your arm around inflection, but it also collapses your ribcage towards the arm. So that's not a very effective push. But if you were to stiffen down the core, 100% of that muscle activity is directed to swinging your arm around. So, you know, when we hear Venus Williams grunt when she serves the tennis ball, that, if you know what I mean by that, super drives the stiffness in her core through the grunt so that more miles an hour are on her arm and eventually to the tennis racket to get a few more miles an hour on the ball. So proximal stability, it's very important. You can't even walk if you don't have an appropriately stiffened core. You can imagine a child at, at the neurology ward at the children's hospital who has a paralyzed quadratus lumborum on one side. Say it's on the right side. They could leg and swing their left leg and walk, but when they stood on their left leg to swing their right leg, the pelvis on the right side drops down because that lateral stability and holding up the pelvic floor and the spine is. It's with the hip musculature on the stance side, but also quadratus lumborum on the other. So you see, you can't even walk if you don't have proximal stiffness to allow your legs to move and transmit the hip generated power to the legs.

Okay, so before we move to number three, we basically have the proximal stability. And this would be elements such as strengthening the quadratus lumborum. And some of those elements around the spine.

In fact, every muscle is important. That plays a role.

Yeah, okay. Yeah. And I know you have a few exercises to do that I wanted to ask you about. And the number. The first one was the actual ability of the spine to flex properly.

No, it was to bear load. See, it's a flexible rod. Now, if you're. If your spine was like a femur, like a stiff, rigid bone, you could load it in compression and it wouldn't collapse. But it's more like a stack of oranges. So if you loaded a book on the top of a stack of oranges, they'd all fly up. Unless you stiffened all of those oranges together by putting guy wires around them or wrapping them in duct tape or something like that. That would give them stiffness.

Okay, got it, got it. And then what's number three?

The third one has a more direct relationship with pain. When people hurt a joint, it becomes slightly unstable so that there's micro movements there. So consider a knee joint. If someone damages the ACL ligament of the knee, the doc or the clinician will do a drawer test. They pull the lower leg forward and they'll see a little micro movement in the knee. And if that causes pain, the person will say, ouch, that you just hurt my knee. So shear load in a joint shows you how much micro movement or instability there is in a joint. So when someone gets a disc bulge or they crack an end plate or something like that, which is quite common, the disc loses a very slight bit of height. Now imagine letting a little bit of air out of your cart. The car is a little bit sloppy on the road now, and that's what happens to that particular level in the spine. You get a little micro movement. And we have clinical tests to detect this. But if we teach a person an appropriate stiffening strategy by turning on their abdominal wall, just again, you tune it to take the pain away, engineer or stiffen out the micro movements, and their pain is gone. So let me give you an example. Take a person and they. They are standing upright, and they just go up on their toes and bounce down onto their heels. And that's a. That's an impact load of about 1 1/2 times body weight down the spine. Some people will say, oh, that just caused my pain. That was a bonafide pain trigger. Then we would say I would poke my fingers into their oblique abdominal wall. Not in front by the navel, but around a bit more towards each side. And I'd say push my fingers out a little Bit. Now repeat the heel bump. And they might say, oh, doc, you're amazing. You just took my pain away. No, we didn't. We stiffened out the micro movement. So it was a one to one. But the patient may very well say, you know what, that pushing my fingers out caused me a compressive penalty because turning on the abdominal wall adds a bit of compression to the spine. And say, you know what, that just increased my back pain. Now you've just proven that the tolerance of the spine for compression isn't there yet. So you've got a little bit of healing to do before you can take advantage of that stiffening pattern to engineer out the micro movements. But anyway, there are the three major explanations from someone who's measured spine stability is. And in a nutshell, it helps you control pain. If you have, allows you to walk, run, cut, play tennis, it allows you to dance and move under control, and it allows you to bear load down a flexible rod. It's non negotiable and it's absolutely essential for every human.

Okay, so you have. I know, because it's pretty popular and you run into these online sometimes the Stuart McGill big three back exercises. Is it safe to say that if someone were to do those three exercises each day, and I want to ask you what those are in a second, that they would, that they would address most of those parameters that you just talked about? Is that why you designed those big three exercises?

Yes, absolutely.

Okay, so what are they?

Well, I'll just give a little bit of a backdrop. Now. We didn't really invent any of them. Those were the three exercises that kept bubbling up to the top. When we tried to find exercises that ensured spine stability, provided the stiffness to achieve the three reasons that I just mentioned earlier. And they spared the spine. They were easy on a person's back who their back is a little bit tender. It's a little bit sensitized now. And the fourth thing that we've just, we would hear sprint coach and gymnastics coaches and some professional strength and conditioning coaches in NFL football. They would say, you know what? After doing those exercises, the guys can run a little faster, they can cut a little bit harder. And we were experiencing the same thing. Patients would say, you know what? I don't have pain for an hour after doing them. When we investigated the mechanism, it turns out that neurologically you add a little bit of stiffness to your core, to your spine for on average about an hour or so after you've done that session. And it's very helpful for some people and obviously not helpful at all in others. But that's how those three exercises bubbled up. The first one for the back is the bird dog. You go onto your hands and knees. You extend one leg and one arm and hold it for 10 seconds. And then you sweep the floor with your hands and knee, just about the shoulder and ball and socket joint. So it's also to create that movement engram. And there's all sorts of little features that people don't realize because the exercises are so simple. For example, it activates the right side latissimus with the left side glute maximus. That's exactly how you walk. It's how you run. There's pairings of muscles that go together, and they're called PNF patterns. And these exercises incorporate these patterns naturally in them. And say you have a client who's just had knee replacement or hip replacement. They can't get down onto their hands and knees. So we have regressions of the exercise forms. They can do a bird dog standing at the kitchen table, for example. For the side, there's the family of side planks. Both feet are not stacked. That was a mistake, and I can tell you the story about how that occurred if you want.

So you don't stack one foot on top of the other. For the side planks.

We were asked by the American College of Sports medicine in the 90s to put together their spine stabilization program. They were late in the production of the book. You know the protocol for prescribing exercise. I forget the name of the textbook now. But anyway, we'd submitted all of our figures, and their artist was drawing the three basic forms of the exercises. And for the side plank, the editor said, oh, we're behind. Just trust us. The artist will draw properly. The artist drew the feet together, and that's how it became the standard. It was a pure editorial mistake. And ever since then, because everybody does.

Like the easy version, right? Hey, if you're in the back of the room and you're embarrassed, you don't stack your feet together because that's considered to be too easy, Right?

Right. But the top foot should be in front because that allows the person to transition from a side plank, roll over their toes to a front plank and then roll over to the other side. And it allows you to really progress the exercise with progressions. But there's some young kids on the. On the Internet, you know how they are. They, oh, McGill, you don't know what you're talking about. The feet should be stacked. And I said, look, Kid who's the guy who wrote that program in the first place. And I know it was an editorial mistake on how that was.

Darn Whipp snappers. Yeah, interesting. Okay, so we've got the side plank, the opposite arm, or the bird dog. What's the last one?

And the last one is what we call the modified curl up for the front. So here the person lays on their back. Now, in some Pilates schools, for example, they instruct people, flatten your back to the floor, imprint it to the floor. That actually stresses the discs. If you keep the natural curves, the spine is more tolerant of load in the average person. So we say put your hands palms down under the lumbar region of the spine. Support that natural curve. Now bend one knee. And the reason that you bend one knee is it takes the stress off the neural system. It takes a little bit of load off the sciatic nerve roots, et cetera. Just again, on average, to de stress, the pain triggers a bit and then slightly raise the head and shoulders, and the operative word there is slightly. Then you hover your head and shoulders just an inch or so off the ground, and people will be surprised how difficult that is. Then lift the elbows up. Then after that, of course, we can switch over to things like stir the pot and progress from there. But there's the beginning of stabilization exercises. The big three, very tolerable. And people, people look at them and think they're simple. And they're surprised to hear that some of the top athletes, even some of the top powerlifters of the world, find they enhance performance by improving the core stiffness and unleashing their hips for a better hip hinge, etc.

Now, this curl up move, and by the way, for those of you listening in, just go to BenGreenfieldFitness.com McGill and I'll put photos of each of these exercises. If you had trouble wrapping your head around how those actually go. But the curl up exercise, it's like a crunching motion. And you see a lot of people say, I believe. And I may be misquoting him there, but I think, Paul, check who I had on this show a couple of times. I believe I've even seen him say, this is this idea. And Paul, if you're listening, I'm sorry if I'm misquoting you on this, but some people talk about how the back is like a credit card. You're not supposed to bend it over and over again. Yet this curl up exercise that you recommend seems to be bending back over and over again. Are you on board with this idea that you're not supposed to do, say like crunches because those damage the spine.

The word is it depends. Now we can have a really interesting discussion that could take the rest of the podcaster, or it can be three sentences. It's up to you. But here it is sort of in a nutshell. It depends on the person. If they have a history of back pain and you assess them and you determine that their pain triggers are flexing their spine forward, it doesn't make sense to do full curl ups. You will cause them back pain. If they've never had back pain and they don't do a lot of flexing in other exercises, it's probably not a big deal. So there's a start of the discussion. But now there's no such thing as an ideal exercise for everyone. And let's start with this idea that anatomy matters. If we take a thin willow branch, we can bend that back and forth and it doesn't build up cumulative stress. It's not an issue. But if you took a thick branch and even bent it once to the same amount of bend, it would shatter because the stress in a round tube, which is your spine, is a function of its diameter. There's a guy in Brazil who's on YouTube and he does. I forget how many thousands of sit ups in a row in. In a little bit of a. Sit ups and curl ups and in a. In a. I don't know why he was doing it, but he was. And you know, some kids on the Internet once again said, look, what do you think of this McGill? This guy's. And I said, well, I don't really even need to see him. I can tell you that he will be a small, slender guy because he has a willow branch for a spine, no problem. But if you take an NFL offensive tackle who by definition has a thick spine, you will find that they will cause stress points in their discs by doing full curls much faster than a slender person. So there's just an example of how because of our architecture and anatomy, different people have different exercises. The exercises are just tools, Ben, as you know, and you have to match them tool with the best risk reward. But, you know, then I'll be asked to consult with say a jiu jitsu team or a mixed martial arts gym. And well, you know, there's some, some very interesting groups in jiu jitsu, which is a lot of flexion to train and guard and, and put on submissions and whatnot. It's a lot of spine flexion. Well, they might wake up in the morning, put their hands, palms down onto the floor, and do two or three hundred and curl ups and whatnot, which is fine till we're about 22 or 23 years of age. And then a few of them, because they come to consult with me, I know this. Their backs start to get painful to the point where they can't train anymore. And they are now out of competition. Well, we've restored a few top level careers by saying, stop doing the curl ups and instead do the stir of the pot. So you get on your toes and you plank and have your elbows on a, on a gym ball. Now swirl the ball around in little circles. Now it gets really interesting. When you do a curl up, you activate the abdominal wall to about 60% of maximum neural drive. So you're only training at 60%. When you do stir the pot and you roll the ball forward, or you do a push up and you walk out forward with your hands, you can now drive the abdominal wall to 100% with a neutral spine. There's no curveball.

So. So if you're, if you're traveling, for example, say you're like waiting for an airplane or, and you don't have access to a big old stability ball, you would get into a push up position. And maintaining that planked push up position, walk your hands as far out in front of you as possible.

Well, within reason, because you will now drive your abdominal wall to 100% of a maximum neural drive. That's 100% strength effort if you keep walking forward. So if you're untrained, you're going to tear something. But if you're well trained, you now see the difference. You can do a thousand curl ups@60% or you can do a few walkouts to 100% neural drive. And what a difference to your athleticism and some of these Jiu Jitsu fighters. Then come back to me and say, you know, I had no idea the curl ups were inhibiting my performance because I was only training at 60%. We now do your exercises, our back pain is gone and we're training at 100%. And we kick and punch harder.

Is this related to this concept that you talk about? Because I've seen this in articles you've written before of Okinawan strength. You have this concept called Okinawan strength. Is what you just described what you're referring to, or is that something else?

Else? It's something else, actually. I'd be happy to.

Yeah, I'm very curious about that. What exactly is, I assume it goes beyond just like eating rice and fish.

Yeah. Well, Okinawa is a small island south of Japan, and it's a. It's actually a base for the US Navy, but. And Marines, I believe. But anyway, Okinawa has a very interesting martial arts culture, and one of the positions of strength to bear a lot of load in Okinawan karate is a little bit of you stand and you adopt a little bit of a horse stance, as it's called. So slight flexion at the hips, slight flexion at the knees. And do you know in American culture, when you go to the gym and you see the males walking around and we call it being very chest proud with the flared lats? You know the.

You're talking to a former bodybuilder. I. Absolutely.

Okay. Bingo. So, you know the chest proud. Now, interesting. When we walk, measure someone setting up in a squat, like a high bar back squat or something like that, if they get too chest proud, they actually lose some of their strength. So one exercise we might give them is an Okinawan posture. Now, I'm going to try and do this over the magic of the Internet. I'm going to make a small hole with my lips, I'm going to purse my lips, and I'm going to blow through the very small hole if you get the object of what I'm doing. And as I'm blowing through the small hole, I'm in a horse stance. I'm pulling my rib cage down. It is the opposite of the chest proud chest lift. I'm actually pulling my chest down, and I'm creating a full torso compression. Now, this is called, in the Okinawan sense, putting on the iron shirt. Now, if I was to take a 2x4 and start to whack you in different places of your body, I must not find a soft spot. Well, you might find one, but that's illegal. But don't allow a soft spot in your body. You put on the iron shirt. Pavel Satsulin, the girl Russian kettle master, good friend of mine, he talks about breathing behind the shield. These are all nuances of what I'm calling in this position of Okinawan strength. So is it for everybody? No, it's not. But it's a very good tool for the people who lose strength because they're too chest proud. Some secretaries, for example, when they sit at their computer and when you ask them to sit up, they extend their spine at the thoracolumbar junction. They don't know how to use their hips quite properly. And you say, put your thumb where your back pain is, and they Put their thumb right in the middle of their back. And there would be a candidate for a mild form of Okinawan strength training. But anyway, there's a little bit of a start to the whole explanation.

So you could get into. Because this sounds very similar. I know, because I asked you about his name and you're familiar with it. Dr. Eric Goodman has this program called Core Foundation Training. One of the moves in there is, I believe he calls it a supine decompression, may be the one I'm thinking of. It's in a plank position and you imagine you have like an X crossing from your right elbow to your left hip, left elbow, the right hip, your knees are pressed together very hard, and you're basically planking as though you're trying to crunch your whole body together. But it's an isometric contraction that you're holding as hard as possible, almost like you're compressing in the way that you've just described. You can hold it for maybe five seconds before you become fatigued. Is that the type of thing that you're talking about?

Yeah, that one I'm not quite familiar with. I'm much more familiar with Pavel and his organization called Strength First. And the hard style of plank is what they might call it. So you take a plank physician, that's a elbows on the floor, on your toes, and you pull your elbows down towards your feet while you're supported in that bridging position. Is that somewhat the same?

Very, very, very similar. Almost identical, except I think in Dr. Goodman's, your knees are on the ground and pressed together very hard rather than being in a full plank position.

Got it. Well, that certainly is not decompressing the spine. It will be adding compression, but nonetheless, it sounds very similar. And yeah. Is that an exercise your grandmother should be doing? Probably not, but is it helpful for some? Yeah, it will be helpful for some. So there you go.

You'd be surprised. A lot of bad grandmas are listening to this show.

You know what, I take that back. I. I was working with this woman at an MMA gym not too long ago, and she was pushing the prowler and I just had to compliment her on her form and her hip drive. And she looked at me, she says, yeah, I'm a 66 year old grandma, you know, And I said, well, good for you. I. I'm sorry. Well, I'm in my 60s myself and I'm past that, I think.

Well, speak. Speaking of 60 year old grandma, this will be a great segue. You talk about sex and treating and fixing low back pain related to sex. A lot of people complain of low back pain when they have sex. What's the link between low back pain and sex? And why have you written about that, particularly aside from the fact that it's great clickbait online?

Yeah, it really is. Well, let me set the stage for you on this, being an American, and you will get what I mean by that last comment in just a second. If you go to any primary care clinician, they will say to you, we have couples that come to us and say, we're now celibate because the last time we had sex, we knackered our back so badly, we are now fearful of the back pain and we're not having sex anymore. So they will say that's not an uncommon situation. And yet there is no guideline that exists for clinicians. They don't know what to do. They're clueless. Now, there was one manual that we found that said, if you have painful sex, try spooning. Well, me being me, I had to go to an undergraduate student and said, what's spooning? So anyway, as it turns out, spooning is not a good idea. You're bending the spine. And that quite often replicates the pain trigger. So one of my graduate students, Natalie Sidorkowitz, a very brave woman, decided that she would work together on this. And it took us two years to do all the ethics groundwork, because, as you can imagine, there's no mother or father who wants to hear that their students, their children might be asked to partake in a study like this at the university. And this would never have been done in a million years in the US people are terrified they'd lose their national funding and etc. But our President got behind this. Our chief medical officer got behind this because of the magnitude of the problem that exists. It was a real thing. So we weren't allowed to recruit any personnel, students, or faculty from the university. They all had to be at arm's length. But we had couples. And they came into the laboratory. They were instrumented with full instrumentation. The men were instrumented by one of our male assistants and females by a female assistant.

I know where this is going.

Yeah. And then they did. They had sex in several different positions, different motions, and we were measuring stress on the joint. So. And just a little bit of a funny aside on that. So we're in the laboratory, the lights are dimmed down, and Natalie and I were sitting behind a curtain, actually, so we couldn't actually see them. But, you know, you hear all the sounds and that kind of thing. But on our computer screens, their bodies are being recreated in infrared. So you've seen the movie Avatar. We used exactly the same instrumentation because real actors were driving those avatars. Well, the avatars were themselves performing different sex positions anyway. And then we would see all the signals of the muscles activating and the joints moving on our screens. Then all of a sudden, all emotions stopped and the muscles got quiet. And then we heard them giggle. And then we saw their abdominal muscles start to vibrate as they began to gig. Giggle. And then we called out and said, are you two okay? And they said, yeah. We velcroed ourselves together. We didn't quite get the instrumentation right on the first time, and we had to go back and redesign it. But that was a little bit of a fun vignette, I suppose. But anyway, then we created an atlas. So we were able to show different positions and techniques and what spared different joints. So now. Now clinicians have access to the atlas. They test the person who has back pain. Are you tolerant of flexion or extension or compression or whatever it happens to be? And if you are, then you go to this place on the chart and you say, that's a position for you that won't trigger that specific back pain trigger. So some general rules in if the person who has back pain is on the top, they are responsible for the motion and probably should be using their hips, not their back. And if it's the person on the bottom, they should try and use different pillows and whatnot and buttress their hips and spine into a position that's resilient for their particular pain trigger.

Interesting. Did you publish this anymore?

Oh, yeah, It's. It's been published. And now, you know, when you publish academically, first we had to show the male side of things, and then the EMG and then the spine loads and then the females, and then you have to do different validation studies and all that kind of thing. But the main atlas either just has come out in a family medicine journey journal or it's just about to. I'd have to ask Natalie.

Oh, fascinating. So this is pretty new.

Oh, it's very new. Oh, yeah. This is world leading. Natalie, when she presented it at the International Society for Study of the Lumbar Spine. That's the top orthopedic spine meeting in the world. She won the prize for the top study a couple of years ago.

If you have any links, send them to me and I'll put them in the show. Notes for folks. It's like Stu McGill's Kamasu.

Yeah, well, it kind of is like that, but there's a very concatenated atlas in back Mechanics. So in the last chapter we actually have a few pages on sex technique and mattress selection and all that kind of stuff. And you might find this funny. Not funny, but interesting. Ben and I don't know if you want to go here. Never in a million years would. I thought I would say the word orgasm in public, but it was so interesting. We were the first, we didn't know this, we were the first to measure the male orgasm response in with full instrumentation. And the Kinsey Institute, which is the repository of sexual health and science in the US they're not even allowed to do this kind of work. And now they're partnering with us because we obviously were doing it and they were most interested in it. But what was so interesting in the male response is in some men it's almost non existent. There's not much muscle activity that goes on. In other words, they're not really at risk of hurting their backs.

Even the guys who aren't drunk, huh?

Yeah, that. There you go. You see, there's the next level of study. So you'd be a good scientist, you just cascade into the next one. But in contrast to that, there are some men who put their spine in a fully deviated position and then contract their gluteal muscles and abdominal wall 100%. So now let me ask you, put your spine in a deviated posture and encrunch your muscles to 100% effort. You see how you can hurt your back and it's no wonder. So to show those particular candidates what it is that's causing their back pain and really violence pain triggers. So when you educate them, I mean I can talk about coaching transference, which would also be very interesting for your readership or listenership, but just to finish this off, coach them well, show them what causes the pain and then show them what to do as an alternate. And most people get it and you know, they say thank you. You're the first person who hasn't treated us like a five year old. That's all we needed to know. And they're back to enjoying life again.

Interesting. You are, you are officially the first guy to ever utter the word orgasm on the Ben Greenfield fitness podcast. You know, I'm actually kidding.

Back pain cells.

Yeah, yeah, we've, we've, we've broached everything from THC enemas before sex to, to stem cell injections into the. So you're definitely not the first guy to bring up orgasm. We're sick.

Safe.

The listeners know when to put earmuffs on the kids. Now, what about this concept of coaching transference that you mentioned would be interesting to the listeners? What are you referring to?

Yeah, absolutely. So there are, again, Facebook discussions on back pain and that, oh, you might not want to say to your client or to your patient what's causing their back pain. And don't mention they have a herniated disc or something like this, because they will become fearful and fearful of movement and all this kind of thing. And I so disagree. And I have data that I'll just describe now to give some perspective on this, we took the Pensacola Fire Department down in Pensacola, Florida, and broke them up into three training groups. One group trained exercise. You know, the kind of exercise where you do a whole pile of burpees. Burpees. And then you stand up and you might do a whole pile of Olympic snatches. Well, the interesting thing about that is you're trying to adapt the spine two different ways that don't add up. It's inconsistent. When you do burpees, you're building flexibility into the spine. You're loosening the collagen of the disc, which is fine, but that's if you want to be flexible, but you can't be flexible or. It's very rare for a person to gain the ability to have a lot of spine movement and then bear a lot of load. In Olympic lifts, the Olympic lifters, they lock their backs and they pull with their hips. But when you do the Olympic lifting, now you're compressing the back, and it's better to have stiffer collagen. That's more load resilient. And then when you do 10, you start getting tired and you break form and you start creating stress risers in the back. But nonetheless, group number one didn't get coached on the actual movements. They were coached and encouraged just to keep doing repetitions, do another repetition. Okay. Group two did what we called the movement matters training. They had coaches from. Well, it's now called exos. It used to be called athletes performance.

Yeah, that's Mark Verstegens. I used to do consulting for exos for their supplement display.

Yeah, fabulous. And Mark has good coaches. They know what they're doing. So they coached the second group of firefighters in. Oh, watch your frontal plane knee movement, valgle collapse while you're doing a lunge. In other words, that is a predictor of ACL injury. Sagittal plane spine motion is a predictor. Of getting back pain under high loads, for example. So they coached, they didn't use that language, but they would say, you know, watch your knee, keep your spine in the natural curve when you're under this load. But they never measured them doing firefighter tasks. Then when they were measured doing their firefighter tasks after the study was finished, those who just did the fitness training for more reps had more injury movement markers when they were doing their firefighting tasks. Those who are coached on good fundamental movement in the gym, but never coached on how to do firefighting tasks, when the study was over and they went back to firefighting tasks, they completed the tasks with less stress on their bodies. That was the first study ever that proved good coaching is transferable to the activities of daily life. So if there's any trainers who think their professionalism isn't absolutely a necessity, there they go. There's the first evidence they have.

So, so basically, by somebody listening in to you, for example, coach on this podcast, how to do that Okinawan strength exercise, they aren't just gonna get better at the Okinawan strength exercise. That's potentially something they could take out with them to, let's say, well, Home Depot, to be able to lift the box better or the tennis court to be able to swing a racket with correct spinal stabilization.

Exactly. It's transfer with them. So being a professional coach, not it's not a matter of beating people up and getting them to do more reps. You can do that if you like, but it's the way that you're coaching that turns out to be so, so important.

Gotcha.

Can I just mention a ton this.

Go ahead.

Again, this won't be for the coaches, but more of the, for the lay public. Movement is a function of your hardware. So that's the strength of your muscles and the strength of your bones and joints to carry the loads and that kind of thing. That's why you train, you harden your body. But the second thing about training is you're changing the software. You're creating muscle memory patterns. These are called muscle engrams. So you don't think to, you fire off an engram or you run the computer tape and your body just runs the tape until you stumble or something. And you need your brain to fix that and recover. So training is also about developing these, these engrams. So if you're a stay at home mom, you've got a two year old, no, you've got a one year old and it's two o' clock in the morning and you walk down to the bedroom and you pick the baby up out of the crib at 2:00 in the morning, you go to your default endgame. Graham, how good was your trainer in teaching you how to lift and doing a few practical, everyday lifts as well so that they've grooved that into the software pattern. Do you follow what I mean? So great trainers not only create great hardware in people's bodies, but great software. And it's those default software patterns that allow people to move in a resilient, competent way all day long throughout life.

You need to make these patterns almost subconscious.

Yes. If the word from a neuroscience perspective is create default engrams, that the person.

That default angles how you spell. How are you spelling engrams?

E, N, G, R, A, M, S. So the engram for walking, for example, isn't in your motor cortex. It lives in your spinal cord. So there are some people who will get a spinal cord shock, say a whiplash or, or some trauma like that, and they have problems walking. And the docs and the physios haven't realized that they may not have a hardware problem. Their engram was corrupted with the violence to their spine.

Interesting.

Oh, yeah. So the relearn how to walk is as much about resetting that new default engram or correcting the perturbed one that was perturbed. And you know, it's so interesting how those engrams can be protected, can be perturbed by emotional upset, physical upset. It's very different forms of fibromyalgia. For example, movement triggered general pain can be a function of corrupted engrams.

Wow, this is so interesting. All right, I got a couple other questions before.

We should save that for another podcast then, but. Yeah, that we could have. I wish we were in person. This is a beer and peanuts conversation.

Yeah, well, maybe. Maybe someday. Which city are you in again?

I don't live in a city. I'm about three hours north of Toronto up in Ontario, Canada. I'm looking out at feet of snow here.

Yeah. And I don't get up there much. Okay, another question for you. We have a ton of listeners who are chronic repetitive motion athletes. They're like triathletes or marathons. And I see this over and over again. People say they've got their SI joint is locked. Their SI joint is locked up. They gotta go to the chiro and get it unlocked. Or they do like this self unlocking mechanism. They'll get off of YouTube or like in, you know, Kelly Starrett's book or whatever. And Then their SI joint gets locked again. They blame all their low back pain and limited range of motion on this SI joint issue. What's your take on this whole SI joint thing?

Well, I'm gonna start with a phrase once again, that I hope you're not tired of, but the word is it depend SI joint's really interesting. Let me just start off with this perspective. There are some people who say the SI joint is bomb proof. It doesn't move, and it's not an issue. Forget about it. And my thought when I hear that is I think they just have limited experience and expertise. I'm going to tell you a personal story you may or may not know. I've had hip replacement after some substantial trauma, but years ago, I had hip and back pain, and I went to a chiropractor, and they laid me on my side, and with my hip as arthritic as it was, they couldn't do a manipulation of what they told me was a stuck SI joint. It was locked up, right? So they got up on my iliac crest and they jumped up on it and squished it down. In other words, they cracked open my SI joint by squeezing my iliac crests quite, quite heavily. Okay, Now, I had a loose SI joint. I had to crawl for a week. I was in excruciating pain in my pelvic ring. So you need a certain amount of integrity in the pelvic ring, which are the two iliad bones with the pubis symphysis at the front and the two SI joints with the sacrum in the middle. Now, there is a little bit of movement and flexibility there. So when you do a split lunge and your right leg goes forward, your right ilium mutates backwards or posteriorly, and your left ilium, as your left leg goes back, it mutates the other way. So you do get a little bit of movement and laxity in the SI joints. If you get too much, you have a lot of pain. These are athletes, like tennis players and squash players, who've done way too many split lunges, and they've opened up the movement in their SI to the point that it's painful. But anyway, there's a little bit of a personal perspective on SI joint pain. And, you know, if it's lost, it may or may not cause pain. And if it's too loose, it will cause excruciating pain as well.

But so, in other words, like, if you're constantly getting your SI joint adjusted, you may be creating laxity, when in fact, what you should be doing, perhaps is working on some of the stability exercises that you talked about earlier.

Precisely. Precisely.

Okay.

Yeah, that makes sense. So we have tests for testing the SI joints. And one. One of them, because of my personal experience, was we manually squeeze the iliac crests. And does that cause SI joint? Then we pain. Then we squeeze the greater trochanters and see if that causes pain. Then we repeat it while the person is loaded and walking, and we can reveal whether there's a pain sensitivity there. And then we have other tests that directly load the sacrum and the pelvic ring to see. But anyway, having said all of that, when a person says they have a locked SI joint, you know what we find? Quite often it's not the SI joint at all. It is a dynamic disc bulge. And they bend a certain way. They get a little bit of a irritating bulge that immediately they get a sense as though someone put a knife into their SI joint. But it was a radiating symptom from a sciatic root. And that sciatic nerve root that comes from the disc in the lumbar spine goes right. Right by what they perceive as the sacroiliac joint behind the hip joint and then down the thigh. So sometimes when I hear someone say, you know, my SI joint just got locked up as I moved, or I flushed the toilet, or I bent down to pick up a penny off the ground or whatever, SI joints don't really come on like that. That's much more of a discogenic disc bulge kind of a symptomatology. And then over that slowly winds down, and then they're quite fine again and again. A sacroiliac joint does not wind down in two weeks. It takes months and even sometimes a couple of years for that pelvic ring to stiffen up once again. And it takes a lot of stabilization exercise and stop doing whatever the cause is. So the character of the pain reveals whether it's discogenic or true si. So if it's si, si, it's very slow to recover. But if it's a sharp pain in the SI joint and then it's gone in two weeks again, that's probably much more likely a disc sciatic nerve root genesis.

Okay, got it. One other question that I know is near and dear to the hearts of our listeners, because we got a bunch of biohackers out there hanging upside down like bats, yoga trapezes and inversion tables and even the badass gravity boots. I own them all. I've used them. I actually kind of like the way I feel after I get off an airplane, for example, and I've been sitting for six hours on a flight or in airports and I want to decompress, unquote the spine or hang or invert. What is your opinion on inversion for either low back pain or self traction or even just a preventive measurement?

You know, I'm going to start with that, with the two words once again.

And that is depends.

Yeah, it depends. It really does. We've measured.

Yeah, I beat you to the punch that time.

Yeah, it depends. And we've measured the length of people's spines and hydration of the disc and that kind of thing with 15 minutes of upside down inversion from boots, interestingly enough, there's no question the discs become unloaded and they suck in fluid. So when you stand up, you're actually taller and you've got a new imbibe ation of fluid in the nucleus of the disc. Now that's all gone within 15 minutes of walking around. So is that good or bad? I don't really know. You've given the disc a little bit of nutrition, I suppose, but have you opened up the disc space as well? It's all gone after 15 minutes. But let me continue on with this it depends discussion. Isn't it interesting that, you know, it's really difficult after you measure these things to come down to a hard answer. And I'm not trying to evade any of the answers, but what I have learned is when you give people the biological information, they can usually make their own best decisions. That's what I'm trying to do with these things. But consider instead of hanging upside down, which by the way, for some older people, traction for the spine, on average, that's the one group that it is shown to have a little bit more efficacy at reducing back pain. So these are the ones who say, you know, after I walk for 10 minutes, I'm starting to get leg pain and that kind of thing. So traction can assist, but it's much better when they figure out what the cause is and then reduce the cause at the same time. But then hanging upside down, it creates pressure in your eyeball and cerebral fluid pressures and whatnot. That may not be the best for everybody, but here's a very interesting perspective on this. If you're a young guy, which I know you are, and you're on an airplane and you just want to press your back after, perhaps just go lay on your tummy and then lay on your tummy, suck in air and as you exhale, imagine your low back falling through your Stomach into the table. Just slowly work the lordotic curve back into your back. After you've been sitting on the airplane and we've measured this, if you have a little bit of a disc bulge, that is a mechanism that vacuums it in and allows it to decrease its size ever so slightly.

Interesting. So one more time. You lay on your stomach. You lay on your stomach, you suck the air, and then you just let the low back kind of melt into.

The ground as you exhale. Absolutely.

As you exhale. So you're not doing this whole Okinawan strength. Extreme contraction. This is more of a relaxation.

Yeah, that's entirely different. So just lay on the floor and breathe in and let your low back fall to the floor as you exhale. That adds a relaxation to the spine, but it restores the lordotic curve. And in some people, and there's a few nuances to this. For example, you need 70% of the disc height remaining or more. And if you do that, it is possible that the disc bulge gets vacuumed in. Now, if you want to super drive that just a little bit, have someone pull on your legs while you're laying prone and exhaling and relaxing. Now, in some people, if they have a lot of spine instability, they'll say, oh, stop. That makes my back feel sick. But if the person has a little bit of a disc bulge, but they have sufficient spine stability when you pull on their legs, they'll say, ah, I love that. And then you can give their legs a little bit of a shake and put a tiny bit of motion into their lumbar spine. And that even that. That accelerates the return of the nucleus and shrinking of the disc bulge even faster. But there will some be some people who say, oh, you know, I. I just can't stay in this prone position. I'm kind of locked in flexion after getting off the table. Well, try this. Turn your head ever so slightly on the ground and push your eyebrow down into the floor. Two pounds. And then I'll say, you know, that that made all the difference in the world. And all you did was added a little anterior chain stiffness, and now all of a sudden, you made it tolerable. So do you see how there's. There's nuances and nuances and nuances to all of this?

Yeah. I'm gonna try it, though. The next time I'm at the airport, I'm gonna try this. I'll get some stranger to lay down on my legs. That shouldn't be too hard. And I'll keep folks posted on What I experienced. Because that's something I feel a lot when I get off the plane.

Yeah. But hey, me too. We're both road warriors.

Yeah. That's how you discover a lot of these fixes, huh? You mess yourself up and you throw out your own back having sex or getting some chiropractic doc to stand on your iliac spine and then you gotta turn around and find these crazy exercises. So it's the unfortunate part of living in the trenches.

It isn't unfortunate. That's the joy of being a professor.

That's true.

Yeah, it absolutely is. It's been a wonderful career just to experiment and play, ask questions, confirm what is right, what is wrong. Surprise yourself. Oh, it's been wonderful.

Yeah.

Yeah.

And you know, for those of you listening in, I have taken notes and I've got links to all of Stu's books, but also this new book, the Gift of Injury, which I'd actually like to give Stu, if you're game. I'd love to get you back on the show sometime because I know you helped some powerlifter who went from 1,100 pound squats and 800 pound deadlifts to completely being out of the game, basically fight his way back and you fix this guy. And then from what I understand, you co wrote a book with him, this Brian Carroll guy. So I might have to have you guys back on the show and have you two tag team a show with me.

We'd love to. And Brian is such an engaging personality, but he had a horrific back injury and we did what we called bone callousing to fill in the fractures and the damaged discs and he remodeled back to quite a normal looking spine to win the Arnold's amazing ago. So there's proof of the point. We've done that with many different athletic careers, but this was one that we documented all the way through and showed how we did it. So.

Yeah, well, you may be getting contacted by some listeners I know who deal with debilitating low back pain who want to reach out to you. So I'll put a link to your website on there as well as this book. And I can tell you what, tonight, maybe as a warm up for my workout, I'm going to try these big three exercises. I may also try this, this stir the pot exercise in your hard style plank. And for any of you others who are listening in who want to try some of these exercises and let me know how they go for you, I'll put links to them all over at BenGreenfieldFitness.com McGill and you can also go over there to leave your comments and your questions and your feedback and I'll try and get everything sorted for you as much as possible. So BenGreenfieldFitness.com McGilch Stu, this has been a lot of fun and again, I agree. We'll have to perhaps hook up and have a fireside chat sometime up there in Ontario. If I can make it out there, I'll hop on a plane and of course get off the plane, have someone lay on my legs in the airport while I'm on my stomach and then I'll hop in a car and head over to you.

Ben, it sounds fabulous. And I you've got the reputation. You do. You're very good at it. So good on you, sir.

Hey, thanks man. Well, all right, folks, I'm Ben Greenfield along with Dr. Stuart McGill signing out from BenGreenfieldFitness.com have an amazing and hopefully pain free week.

You've been listening to the Ben Greenfield Fitness podcast. Go to BenGreenfieldFitness.com for even more cutting edge fitness and performance advice.

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