Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D. (#287 rebroadcast)

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Sep 1, 2025

Stuart McGill, a distinguished professor emeritus and chief scientific officer at Backfitpro, dives deep into the intricacies of lower back pain. He discusses the anatomy of the spine and challenges the notion of nonspecific pain, emphasizing the need for targeted assessments. With compelling case studies, he reveals successful strategies for treatment, highlighting exercises that build strength and stability. McGill stresses the importance of understanding body mechanics and offers invaluable advice on maintaining a healthy spine, encouraging listeners that relief is achievable.

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ANECDOTE

Peter Attia's Recurrent Back Crisis

Peter recounts three major low-back flares between ages 21–27 culminating in a year-long episode that required surgery.
He later discovered a 5 cm free disc fragment at L5–S1 causing S1 radicular pain that explained his severe symptoms.

INSIGHT

Disc Damage Transfers Load To Facets

Loss of disc stiffness shifts load to facet joints, producing shear and accelerated facet degeneration.
Building muscular girdle stiffness can arrest shear and compensate for lost disc integrity.

INSIGHT

Disc Injury Invites Painful Nerve Ingrowth

Healthy discs lack blood vessels and nerves because intradiscal pressure prevents ingrowth.
Disc injury allows vascular and neural ingrowth, increasing pain sensitivity until the disc eventually fibroses and quiets.

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.

We discuss:

Peter’s experience with debilitating back pain [3:00];
Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:30];
Why the majority of back injuries happen around the L4, L5, and S1 joints [30:45];
How the spine responds to forces like bending and loading, and how it adapts to different athletic activities [36:00];
The pathology of bulging discs [43:00];
The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [45:45];
The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:00];
The significance of strength and stability in preventing injuries and preserving longevity [1:08:00];
Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:15];
Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:29:45];
Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:38:30];
When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:30];
Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:15];
Tarlov cysts: treatment and surgical considerations [2:00:00];
The evolution of patient assessments and the limitations of MRI [2:02:00];
Pain relief related to stiffness and muscle bulk through training [2:06:45];
Advice for the young person on how to keep a healthy spine [2:14:00];
Resources for individuals dealing with lower back pain [2:25:15]; and
More.

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