Protocols to Strengthen & Pain Proof Your Back

Welcome to the Huberman Lab podcast where we discuss science and science based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology 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, interactions 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 most mundane activities, that much more distressing to carry out. So during today's discussion, we will talk about how to ameliorate pain. However, pain as a general topic was already covered on this podcast with an expert guest, Dr. Sean 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 altogether. 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, 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 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. Sean Miller, the Ph.D. Dr. Stuart McGill, and also the Ph.D. Dr. Kelly Starrett. 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 to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is AeroPress. AeroPress is like a French press, but a French press that always brews the perfect cup of coffee, meaning no bitterness and excellent taste. Aeropress achieves this because it uses a very short contact time between the hot water and the coffee, and that short contact time also means that you can brew an excellent cup of coffee very quickly. The whole thing takes only about three minutes. I started using an AeroPress over 10 years ago and I learned about it from a guy named Alan Adler, who's a former Stanford engineer who's also also an inventor. He developed things like the Aerobi Frisbee. In any event, I'm a big fan of Adler inventions and when I heard he developed a coffee maker, the Aeropress, I tried it and I found that indeed it makes the best possible tasting cup of coffee. It's also extremely small and portable, so I started using it in the laboratory when I travel, on the road and also at home. And I'm not alone in my love of the Aeropress coffee maker. With over 55,000 five star reviews, Aeropress is the best reviewed coffee press in the world. If you'd like to try Aeropress you can go to Aeropress.com Huberman to get 20% off. Aeropress currently ships in the USA, Canada and to over 60 other countries around the world. Again, that's Aeropress.com Huberman Today's episode is also brought to us by Joovv. Joovv makes medical grade Red Light Therapy devices. Now, if there's one thing I've consistently emphasized on this podcast, it's the incredible role that light can have on our biology. And of course I'm always telling people that they should get sunlight in their eyes as soon as possible after waking on as many days of their life as possible for sake of setting circadian rhythm, daytime mood, focus and alertness, and improve sleep. Now, in addition to sunlight, red light and near infrared light has been shown to have positive effects on improving numerous aspects of cellular and organ health, including faster muscle recovery, improved skin health and wound healing, even improvements in acne or that is removal of acne, reducing pain and inflammation, improving mitochondrial funct, and even improving vision itself. What sets joovv apart and why it's my preferred red light therapy device is that it has clinically proven wavelengths, meaning it uses specific wavelengths of red light and near infrared light in combination that trigger the optimal cellar adaptations. Personally, I use the Joovv handheld light both at home and when I travel. It's only about the size of a sandwich. It's very convenient to use. I also have a Joovv whole body panel and I use that about three or four times a week. If you would like to try Joovv, you can go to jo ovv.com huberman Joovv is offering an exclusive discount to all Huberman Lab listeners with up to $400 off select Joovv products. Again, that's Joovv. J-O-O-V-V.com Huberman to get $400 off select Joovv products. Today's episode is also brought to us by Waking Up. Waking up is a meditation app that offers hundreds of guided meditations, mindfulness trainings, yoga, NIDRA sessions, and more. I started meditating over three decades ago and what I found in the ensuing years is that sometimes it was very easy for me to do my daily meditation practice. I was just really diligent. But then as things would get more stressful, which of course is exactly when I should have been meditating more, my meditation Practice would fall off with Waking Up. They make it very easy to find and consistently use a given meditation practice. It has very convenient reminders and they come in different durations. So even if you just have one minute or five minutes to meditate, you can still get your meditation in, which research shows is still highly beneficial. In addition to the many different meditations on the Waking up app, they also have Yoga Nidra sessions, which are a form of non sleep deep rest that I personally find is extremely valuable for restoring mental and physical vigor. I tend to do a Yoga Nidra lasting anywhere from 10 to 20 minutes at least once a day. And if I ever wake up in the middle of the night and I need to fall back asleep, I also find Yoga Nidra to be extremely useful. If you'd like to try the Waking up app, you can go to wakingup.com huberman to try a free 30 day trial. Again, that's wakingup.com 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 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 coccyx 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, 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 are the bones. And those discs have some durability to them. 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, disc. 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, caudal, 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 hole 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 glia, 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 a metabolic waste. They actually regulate communication between neurons. If you've ever heard that the glia are just glue, and that's actually the Latin translation of glia, glue. It implies that they're not doing much actively, that they're just sort of a passive participant keeping things together. The glia 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 coccyx 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 vertebra 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 glia. 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've got your brain. You've 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 I 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 akin 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 the front of the world. There are neurons there called motor neurons. The motor neurons themselves, what we call the cell bodies, reside in the spinal cord, in the so called 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 spinal 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 insertions of the muscles onto bone within the muscles that register how much stretch are on our muscles. And those are the so called sensory inputs that come into the dorsal part of the spinal cord, the part that is facing toward our back. And that sensory information is, 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 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 fascicles, 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 oftentimes 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, herniated 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, et cetera, 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 Mackey, 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 milieu for the spine and back to function at its best. So if by now you're getting overwhelmed and you're thinking, oh, 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 of 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 bulge, that herniated 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 it 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, et cetera, as well as, if you're into it, resistance training, if you're putting yourself under heavy loads, all of that pain free 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 McGill 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 impossible 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 are 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 herniated disc, they have a ruptured disc. Oftentimes 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 McGill 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 mesomorphic 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 boned, meaning thinner wrists, smaller knees, smaller ankles, so not really thick bones and thick wrists. So that's the ectomorphs. These are people that tend to be pretty thin. Sometimes referred to as people that have very low body fat, less muscle mass, although that's not always the case. Just think lighter, thinner skeleton versus mesomorphs, 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 endomorph phenotype language is used anymore, but what Dr. Stumagill has pointed out is that people in general tend to be more ectomorphic or mesomorphic. They tend to be more thick through the torso or thin through the torso. 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 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 spines, 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 wrists, 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 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, et cetera, 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 easily as compared to the person with a thicker torso and 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 proof, 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 McGill, 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 a 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 to the side by about 5 to 7 degrees. Both groups have specific needs, meaning specific protocols that they can emphasize to a greater or lesser degree in order to strengthen and pain proof 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 wrists, 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 lithe, 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 mesomorphic. 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 ectomorphic 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 how 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 de emphasize in order to best strengthen and pain proof 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 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 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. I'd like to take a brief break and acknowledge our sponsor, AG1. By now, most of you have heard me tell my story about how I've been taking AG1 once or twice a day every day since 2012. And indeed that's true. I started taking AG1 and I still take AG1 once or twice a day because it gives me vitamins and minerals that I might not be getting enough of from whole foods that I eat, as well as adaptogens and micronutrients. And those adaptogens and micronutrients are really critical because even though I strive to eat most of my foods from unprocessed or minimally processed whole foods, it's often hard to do so, especially when I'm traveling and especially when I'm busy. 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They'll give you five free travel packs with your order, plus a year's supply of vitamin D3K2. Again, that's drinkag1.com 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 depaining 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 McGill himself has told me that he doesn't want the Big Three to be viewed as the be all 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 protocols 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 sit up. 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 happen to 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 vertebrae, 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 hands, 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 sit up. You're only coming up maybe about, I don't know, somewhere between 5 to 10 degrees. 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'd be 10 second hold, then relax. 10 second 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 ten second 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 into 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 really lifting your elbows and arms far off the ground as opposed to having them just hovering right above the ground. There are a bunch of different variations of these. We include links to a few.