Protocols to Strengthen & Pain Proof Your Back

welcome to the huberman Lab podcast where we discuss science and science-based tools for everyday [Music] life I'm Andrew huberman and I'm a professor of neurobiology and Opthalmology at Stanford school of medicine today we are discussing how to build a strong pain-free back having a strong pain-free back has numerous advantages not the least of which is you're not in pain as well as the fact that you can carry out your daily activities any exercise or Sports you might play interaction with family members like picking up a kid leaning down to get things out of a cupboard

or reaching up to get things out of a cabinet without any pain and back pain is one of those things that even if minor and certainly if severe severely impedes our ability to do most everything even to just sit still or lay still and one of the things about pain in particular back and neck pain is that it also has an effect on our emotional self it makes us more irritable it makes any activity even the mundane activities that much more distressing to carry out so during today's discussion we will talk about how to amarate

pain however pain as a general topic was already covered on this podcast with an expert guest Dr Shawn Mackey who's a medical doctor at Stanford he's actually the director of our pain clinic and on that episode which we provide a link to in the show note captions he talks about the various ways to address pain everything from pain medication to epidurals to electrical stimulation and importantly the biopsychosocial model of pain whereby our thoughts and our perceptions about pain actually influence the severity and the duration of that pain so if you're interested in pain and the

treatment of pain per se I highly recommend that episode today we will certainly talk about ways to deal with back pain ways to reduce it and perhaps even eliminate it alt together but we are also going to talk a lot about how to pain proof your back and how to build a really strong back not just for pulling things because the back muscles are involved in pulling things but also just for generating a really strong stable core strong spinal Erectors making sure that your pelvis and your spine are interacting correctly that your shoulders neck and

Spine and pelvis and even your lower Limbs and feet are working together in the proper manner to make sure that you have the strongest and most pain-free back possible so what I'm going to do is first I'm going to describe a bit of back anatomy and physiology I'm going to talk about the neuromuscular components as well as the spinal and disc components I promise even if you don't have a background in biology I'm going to make this all very accessible to any and all of you and then I'm going to go into the 10 or

12 specific things in particular six things that take very little time that require no equipment no purchase of anything whatsoever and involve a very minimal time investment that will allow you to build a really strong pain-free back what's covered are protocols from three of the world's for foremost experts in back pain but also back strengthening and building resilience into the back so they include a medical doctor expert in back strengthening and Rehabilitation a PhD researcher who has spent decades researching The Spine and ways to strengthen the core and Spine and a world-class PhD physical therapist

who is expert not just in the spine but in fact in the movement Rehabilitation and strengthening of the entire body they are the MD Dr Shawn Miller the PHD Dr Stuart Mcgill and also the PHD Dr Kelly starett I provide links to them and resources that they provide in the show note captions and indeed I plan to host all three of them separately on the huberman Lab podcast as expert guests in the not too distant future before we begin I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford

it is however part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the General Public in keeping with that theme I'd like to thank the sponsors of today's podcast our first sponsor is arero press arero press is like a French press but a French press that always bruis the perfect cup of coffee meaning no bitterness and excellent taste Aero press 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

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waking up.com huberman to try a free 30-day trial again that's waking up.com huberman okay let's talk about the back the back for many people simply means the spine the Bony stuff that runs down your middle now of course your spine doesn't just run down your middle you've got your cervical spine up near your neck don't ever forget that your neck is the upper part of your spine you've got the thoracic spine which is essentially through you know in insects we think of the thorax remember that from biology class in middle school or high school but

through your region here you know basically down from the neck through the chest and then you've got your lumbar spine which is the part right below that and then you have the sacral spine which is the area of the spine that is in the pelvic region and then of course there's the bottom region of that which is called the coxic spine which is the very lowest part of the sacral region of the spine now of course that's the Bony stuff and if you've ever seen a spine on a you know a skeleton of any kind

or a drawing of a skeleton you know that it's a bunch of segments it's a bunch of bony segments it's important to understand that the back is made up not just of bony stuff but it's got stuff in between which are the discs the discs are the soft tissue that sit between the vertebrae right the vertebrae of the bones and those discs have some durability to them they're they're not easily squished but they can be squished that is they can move they're a soft tissue that allows for mobility of the Bony stuff so you've got

basically bone disc bone disc bone disc bone dis and it's those discs that allow for movement of the spine from side to side and it actually allows for some compression along the length of the spine as well what sometimes today I'll refer to as vertical compression but actually vertical isn't the correct anatomical term so in anatomical terms we talk about anterior posterior we talk about rostral coddle which is just different language for anterior posterior I'm going to try and avoid using fancy nomenclature as much as possible but the point here is that those discs allow

for movement of the vertebrae but keep in mind that the vertebrae and the discs have a whole down the middle they look like donuts basically they're not perfectly round like donuts but for the time being just think of them as Donuts right some are bony donuts and others have more pliability to them but there's a hole down their middle why well within that hole is a long snake like piece of the nervous system called the spinal cord which is the neural stuff the neurons now within the spinal cord it's not just neurons nerve cells okay

neurons means nerve cells it's also glea which are another cell type that provides yes support to the neurons but also do some really important things on their own like clearing out of metabolic waste they actually regulate communication between neurons if you've ever heard that the Gia are just glue and that's actually the Latin translation of Gia glue it implies that they're not doing much actively that they're just sort of a passive participant keeping things together the glea are really doing important things as well but keep in mind that the spinal cord is this long snake

like process of the nervous system that extends down through the vertebrae and down through the discs or if you prefer you can think about the long snake like process of the spinal cord and then around it all along its length you have bony vertebrae disc bony vertebrae disc bony vertebrae disc going all the way from the neck region down to that coxic region within the pelvis now the thing about neural tissue is it's very soft it's very fragile and one of the reasons we have vertebrae is to give the spinal cord some rigidity and protection

from damage and that's really important because the spinal cord this long tube of neural tissue that sits inside of the vertebrae and the discs it's central nervous system tissue CNS tissue and as CNS tissue it does not regenerate after injury okay maybe a tiny bit in certain conditions and in very young people but if the spinal cord is damaged typically there's a lot of scar tissue that forms but there is no renewal of the neurons that are damaged so it's very important that the spinal cord be protected which is one of the reasons why it

is encased by those vertebrae and the discs now the other thing to understand is that the spinal cord is indeed a snake-like extension out the back of the brain so the brain and spinal cord make up what we call the central nervous system the CNS we just talked about that a moment ago but now I want you to think about the brain your brain of course is encapsulated within the skull the cranial Vault there are only two pieces of your brain that reside outside of the cranial Vault they are your neural retinas that line the

back of your eyes I know many of you have heard me say this before but it's so cool that I can't help but share it again and again which is that you have two pieces of your brain literally your central nervous system that were extruded out from the cranial Vault during development while you were in utero this happens in the first trimester when you were in embryo that line the back of your eyes like a pie crust and those Linings of the back of your eye like a pie crust are made up of three layers

of neurons and a bunch of GAA and they are your neural retinas they are two pieces of brain that literally look out into the world and are activated by what by light by sunlight by edges and objects by the photons in the outside world and that's what gives rise to Vision so starting at the front of your head and working down through the spinal cord we can do this very quickly to give you a complete picture you've got your neural retinas that line the back of your eyes they are central nervous system they are brain

they communicate with the rest of your brain through the optic nerves then you got your brain you got the brain parts that respond to hearing the brain parts that allow you to think imagine learn remember Etc and then at the back of the brain you have the brain stem and then extending out from the brain stem you have the spinal cord this tube like neural structure that extends down through the vertebrae down through the discs all the way to your pelvic region now why am I telling you all this Neuroscience if we're talking about strengthening

the back why am I talking about the spinal cord why am talking about neurons in the brain well just as your brain has the cranial Vault your skull to protect it your spinal cord has the vertebrae to protect it and the discs to protect it but the discs allow for some movement of the spinal cord in fact quite a bit of movement if you just lean forward in your chair you lean back arch your back or you twist to the side your spinal cord is actually twisting in that way okay this would be Ain to

your brain actually moving within the skull it can move a little bit but it doesn't move nearly as much as your spinal cord does so your back has of course many functions it's there to stabilize your body it's there to provide stiffness in order to be able to move your limbs in very Dynamic ways we're going to talk about back and core stiffness as such a key feature of having a strong back when you hear the word stiffness you probably think well that can't be good I don't want a stiff back ah but you actually

want to be able to generate rigidity within your core and spine in order to move your limbs to throw a ball or to do a martial arts Punch or to even dance gracefully or even just move up some stairs without falling so basically when we talk about the brain and spinal cord as extending down through the vertebrae and through the discs we're doing that to set up the other piece of this whole story which is that the neurons that reside in the spinal cord in particular what we call the ventral spinal cord which if we're

going to imagine this in kind of more real world terms they're sitting in the part of the spinal cord it's kind of on your front Okay that that's facing uh the front of the world there are neurons there called motor neurons neur the motor neurons themselves what we call the cell bodies reside in the spinal cord in the so-call ventral Horn of the spinal cord you can look this up if you like although you don't need to know that and they extend little wires that we call axons out to the muscles and through the release

of neurotransmitters they allow our muscles to move our flexors to flex like our bicep our extensors to extend like our tricep could think quadricep hamstring calf abdominal muscles all the movement of those muscles is controlled by neurons that reside within the spine cord some of the movements that we generate are unconscious movements especially movements that are required for breathing although you can consciously take care of your breathing as well right you can breathe unconsciously you're always doing that even in sleep or you can take conscious control of your breathing you can generate limb movements consciously

or you can generate limb movements unconsciously typically once you know how to walk and you get up and you walk across the room you're not thinking right foot Left Foot Right Foot left foot all of that's handled by motor neurons and what are called Central pattern generators in the spinal cord and to some extent the brain stem but the commands for specific deliberate movements that you're thinking about especially when you're trying to learn a movement or you're trying to be very deliberate in a movement those come from what are called upper motor neurons in the

brain they communicate with lower motor neurons which then communicate with the muscles okay so that's one neural outflow pathway from spinal cord out to muscles some of it's conscious some of it's unconscious and then there are the neural Pathways from skin from the tendons and insert of the muscles onto bone within the muscles that register how much stretch are on our muscles and those are the soall sensory inputs that come into the dorsal part of the spinal cord the part that is facing toward our back and that sensory information tells our spinal cord which then

informs our brain whether or not our limbs are extended too far and about to snap or whether or not a muscle is loaded too heavy and is about to be pulled off the bone and in that case the brain and spinal cord have these magnificent mechanisms to shut down the neurons so that you know we drop the load so that we don't overwhelm the muscle and rip it off the bone or we don't stretch our limbs too far now keep in mind that the neurons within the spinal cord that communicate with muscles or the neurons

that innervate as we call it the skin or the tendons or different parts of the body and go into the spinal cord those little wires those axons literally leave the spinal cord and they go out into What's called the peripheral nervous system now a big source of pain in back pain is when those nerve Roots as they're called they're little bundles okay bundles of nerves are sometimes called fices sometimes called nerve Roots the nomenclature kind of depends on where you are in the nervous system but I'll call them nerve roots or bundles of nerves those

bundles of nerves are sometimes impinged on they're physically pressed on by say a bulging what's also called a herniated disc the discs can sometimes bulge out from the side of the spine a little bit too much okay Maybe by compression from the overlying vertebrae maybe from some inflammation we'll talk about the various sources today and often times the source of back pain or neck pain or even pain in the pelvic region is because of a compression of the nerve roots that are going into and out of the spine okay so when we talk today about

back pain and when we talk today about building a strong back we need to focus on two major themes one is the extent to which those nerve roots are free and clear of any physical pressure from say Hern ated discs from compressed vertebrae from inflammation in those regions maybe all three and what we're really trying to do when we talk about relieving back pain often is creating space creating room for those nerve roots to travel in and out of the spine for those messages to come in from the periphery the skin the tendons the muscles

Etc up into the brain because the brain needs that information to know where our limbs are still needs to keep us safe as well as the nerve Pathways traveling out of the spine that control our musculature for deliberate movements unconscious movements and so on and so much of what you'll hear about today when thinking about how to build a really strong pain-free back is about creating the kind of stability around the spine so that we can engage in the different limb movements that we need to but to do so in a way that doesn't create

compression of those nerve Pathways now with all that said it's really important to also understand that not all of back pain is neural in nature now technically all pain is neural in the sense that it's a perception okay if you listen to the episode with Dr Shawn Macky which includes a deep description of the biopsychosocial model of pain it will tell you or I'll just tell you now that indeed pain involves a lot of different things it involves psychology it involves prediction it involves history it involves inflammation it involves a lot of things and yes

ultimately it's neural it is the firing of nerves that create the perception of pain and your perception of pain is also the firing of neurons in your brain and spinal cord however what you'll also learn today is that there are many things that you can do including creating stability of your feet your toes believe it or not the position of your pelvis your neck your chin all these things as well as the spinal erector muscles in your lower back as well as your abdominal region your so-called core all of those things combine to create a

millu for the spine and back to function at its best so if now you're getting overwhelmed you're thinking my goodness we have to learn about the entire body's physiology and anatomy in order to understand back pain and strengthening to some extent that's true but really all we've said so far and all you need to know or keep in mind that is is we have the vertebrae the Bony segments that surround the spinal cord in between those we have the discs the soft tissue that also have a hole through them the spinal cord travels through that

so that the vertebrae can move so that we have some pliability and Mobility our spine forward flexion so your chin closer to your belly extension your chin back and away from your belly sort of arching of the lower back you can twist to side to side to some extent you have all that stuff and through the middle is the spinal cord and the brain and then you have sensory information going into the spinal cord from the body from the muscles from the skin and then you have motor commands going out the bottom of the spinal

cord so literally traveling out past those vertebrae and discs out to the muscles to control those muscles for involuntary and voluntary movement if you can understand that and you can Envision it just a little bit even just a little bit you're going to be able to think about all of the various protocols that we talk about next in the most functional way meaning as you learn about and hopefully incorporate the various protocols for strengthening and pain proofing your back that you'll occasionally think back to okay it's my spinal cord that I'm bending in my lower

back region I'm allowing the discs to kind of move forward and they likely are kind of bulging out a little bit they're not necessarily herniating let's hope not but they're bulging a little bit in that direction then back in the other direction and if you happen to have herniated that is bulging discs which many people do in fact I've had that I've got a sort of an L3 a kind of Lumbar 34 bulge that got activated a few years ago I'll tell you what allowed me to very quickly fix that permanently with no medication no

surgery whatsoever and it was extremely debilitating there's some simple movements that one can do if done in the proper direction and in the proper way that can allow you to push that bulged that herni disc back under or I should say closer to the spinal cord okay moving it from the kind of bulging out from between the vertebrae to closer again toward the center point of the spine by doing that one can take pressure off of the nerve roots that are traveling out to the muscles and in from the skin and other sensory information coming

into the spinal cord and allow yourself relief from back pain and then by building up stability in the abdominal region the lower back region you can create a nice firm core that will allow you to protect all of that with plenty of space so the nerve roots are not impinged and then of course by focusing on some of the stabilizers that exist really distal which means far from all of that further from all of that such as the feet literally how you position your feet the ability to spread your toes believe or not as a

way to provide support for your back not just when doing exercise but also at rest there are some things you can do about neck positioning strengthening of the front of the neck strengthening of various muscles again that involves no equipment whatsoever that allows you to have a pain-free strong back both at rest and during movements of different kind different Dynamic sport movements like tennis or golf Etc as well as if you're into it resistance training if you're putting yourself under heavy loads all of that painfree and moving through life with a tremendous amount of mobility

and versatility now before we get into the specific protocols and exercises for strengthening and pain proofing your back it's worth mentioning something that really was first told to me by Dr Stuart McGill again he's going to be a guest on this podcast Dr Stuart Mill is a world expert in spine physiology and anatomy and he's worked with a lot of athletes but his work is not specific to athletes it's really for the everyday person as well and in discussions with Stu he raises some really important points first of all if you have back pain you

need a proper assessment and diagnosis it's really possible for me in this format to try and diagnose your back pain or for you to try and diagnose your back pain that would just be irresponsible of both of us there's just so many things that are specific to each circumstance for instance some people get back pain or neck pain or both because of overuse of certain motor patterns maybe they are Avid golf players and they're always swinging a certain way with one foot forward that's typically the way it works and they built up some strength in

certain Pathways both muscular strength and neural strength but they have a weakness in the opposite side muscles and nerves and they need to rehabilitate those in order to eliminate the back pain other people have an injury right they have a spinal compression injury they don't just have a herni disc they have a ruptured disc often time ruptured discs need surgery I don't want to give the impression that all back pain can be resolved without surgery there are cases where surgery is necessary okay so it's very important that if you have severe back pain or persistent

back pain and you're not able to alleviate it with non-surgical methods that you talk to a back expert perhaps even a surgeon there are cases for epidurals for painkillers for you know different types of rehabilitative approaches but Dr Stu Mill has also pointed out that there are a number of things that any and all of us can do by just self assessing that I think are appropriate for today's discussion that relate to whether or not we are likely to have a thick spine or a thin spine okay this isn't a psychological feature at least not

to my knowledge but if you look at different body types you know what in the old days used to be called the Ecto endo and momor body types okay this nomenclature isn't used quite as much anymore but just to kind of return to it the ectomorphic body phenotype is one in which people are typically kind of light Bon meaning thinner wrists smaller knees smaller ankles so not really thick bones and thick wrists so as the ectomorph these are people that tend to be pretty thin sometimes referred to as people that have you know very low

body fat less muscle mass although that's not always the case just think lighter thinner skeleton versus myomorph which tend to be people with kind of thicker wrists thicker knee joints have a thicker overall and then endomorph which was at the time used to describe people that are carrying more body weight in the form of body fat I don't know how often the endomorphin type um language is used anymore but what Dr stmill has pointed out is that people in general tend to be more ectomorphic or myomorph they tend to be more thick through the Torso

or thin through the tors so they tend to have thinner wrist or smaller wrists as compared to their age matched sex matched counterparts okay but in general so these are generalizations people who have thicker wrists generally are going to have thicker spinal segments okay in terms of the circumference of the spinal segments and discs whereas people with smaller wrists smaller joints smaller ankles are going to have thinner spine so thinner vertebrae thinner discs between them and so on now neither is good or bad they are just different and they create a situation where people have

different needs in order to build a strong pain-free spine so for instance people who have thick spinal segments so these are people who tend to be more Barrel chested thick through the Torso maybe thicker wrists and ankles and knees have thicker spinal segments and therefore may not need quite as much buildup of the musculature around their spine in order to handle vertical loads okay compression along the spinal length because they have those big thick spinal segments and discs it's not to say that they don't need to do any spinal strengthening they do but they are

generally going to be very stable along the I'm calling it the vertical axis but along the length of the spine those people perhaps not surprisingly are not going to be as Mobile in terms of the twisting and bending of the spine meaning spine Mobility along the different axes apart from that vertical axis that I was referring to along the length of the spine but twisting and bending is going to be harder for them now at the opposite extreme you're going to have people with smaller RIS smaller ankles smaller knees and they in general are going

to have a thinner spine meaning vertebrae and discs that are smaller in circumference and they are not going to have the capacity to sustain as much vertical compression along the length of the spine as somebody with thick spinal segments but they are going to be more quote unquote bendy if you will now that doesn't always mean more flexibility what I'm referring to here is a capacity or a potential for the ability to generate movements in which the spine is twisting from side to side with more ease than would be the powerlifter so imagine at the

extremes the thick torso and spine of the powerlifter of the shot putter somebody like that versus the spine of say the yoga teacher the dancer they have these smaller wrists smaller pelvis smaller knees Etc but they're going to have more ability to twist themselves their spine so imagine just kind of like bending over to the side a little bit while looking up the spine is going to do that very easy easily as compared to the person with a thicker torso in spine these two distinctions and here I'm really making them polarized distinctions and in reality

there's a whole distribution of thick spine very thick spine moderately thick spine thin spine ultra thin spine and so on but at these two extremes you can start to imagine that each of those spines each of those backs probably has different requirements in order to make it strong and pain prooof depending on the activities that those people are engaged in now of course a thin spine person can decide to powerlift that can be very good for them and indeed one of the things that somebody with a thin spine should do according to Dr Stu Mill

and I'll reiterate this several times today is build up the musculature around the spine so that they can stabilize that otherwise bendy spine along both the vertical and side to side axis so they don't injure it they want to make it strong as well as the person with the thick spine who can tolerate heavy loads around one axis but maybe needs to generate more mobility of that spine so that they don't go reaching for glass up in the cupboard and all of a sudden they have compression of a nerve root coming out the spine because

they just Twisted it to the side by about 5 to 7° both groups have specific needs meaning specific protocols that they can emphasize to a greater or lesser degree in order to strengthen and pain prooof their spine so while we can't do an assessment of spinal pain and your exact needs for your particular body type in this kind of format through the tunnel of the internet you can take a look at yourself or just think about yourself and think oh do I tend to have thicker wrist knees elbows Etc am I more of a you

know kind of thick torso person or do I tend to be someone who's more Li who's more you know small wristed somebody who can move from side to side with a lot of ease but probably can't handle as much what I was calling vertical load along the length of the spine and some people have a kind of mixed phenotype not purely Ecto not purely myomorph I can say that about myself I have fairly long limbs in fact I have like almost sort of like Gibbon arms I have this kind of really long reach so more

kind of um ectomorphic um arms and at the same time I have a short torso and I am fairly thick through the circumference of my torso I've always been like that even before I started doing any kind of resistance training my legs are somewhere in between okay so I don't have small knees or small ankles they're kind of moderate in that way my wrists and my arms probably a bit more ectomorphic not strong ectomorphic phenotype but then my torso is a short torso and it's kind of thick through the circumference that's just the way that

my genetics landed me into the world you have genetics that landed you into the world in a particular way you can take a look at these kind of external phenotypes about joint size and kind to do an assessment just thinking about it and by doing that you'll be able to know which protocols which we're about to talk about you may want to emphasize or deemphasize in order to best strengthen and pain prooof your back so a good analogy that Dr Stuart McGill offers when thinking about this thin spine versus thick spine thing is if you

think about a willow tree which has essentially a a thin trunk and thin branches relative to say an oak tree or redwood tree the willow tree trunk and branches can bend to quite a considerable degree without breaking so it's just very bendy from side to side but they are thin and they can't sustain a lot of vertical pressure a lot of loads from top to bottom or else they'll simply collapse they might not snap to the point of breaking but they will definitely Bend to the point of not being able to bend back as opposed

to the trunk and branches of a full-grown oak tree or redwood tree which are very thick and very strong and can sustain a lot of loads from top to bottom along this vertical axis but if they Bend even just a tad too far from one side to the next they're going to snap and essentially break off so while that analogy isn't a perfect one to explain the situation with thin spines versus thick spines I think it gives you a mental image of the general situation for which some people who have the more Willow like spine

probably need to build more musculature around the spine in order to stabilize it but probably don't have to do quite as much work in order to generate more side to side flexibility as opposed to people who have a thicker spine who probably don't need to do quite as much work to develop the musculature of the spinal Erectors of the abdominals it's not to say they don't need to develop those at all they do but that they don't need to do quite as much work to build the musculature around the spine in order to stabilize it

for vertical loads but they perhaps want to do more work aimed at generating more flexibility in these planes of motion from side to side and at different angles you know relative to the vertical axis and again most people don't fall at either extreme of Willow like or Redwood like most people are going to fall somewhere in the middle and as I mentioned before many of us including myself have a sort of combination of more Thin musculature and Thick musculature depending where in the body you look I'd like to take a brief break and acknowledge our

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to strengthen your back the first three of these Protocols are the so-called McGill's big three named after Dr Stuart McGill who again has done a tremendous amount of work in the research and practical realm and has developed a number of different protocols for strengthening and depainting the spine but has distilled down three specific protocols that everyone I spoke to in the PT community in the MD Community for those that specialize on spine and in the sports Community as well as people who don't play sports but are simply interested in having a healthy spine for sake

of daily Mobility all agree are extremely useful for everybody to carry out now the one caveat is that Stu Mill himself has told me that he doesn't want the big three to be viewed as the Beall end all of back strengthening and Pain Relief by no means is it exhaustive to do just the big three so I'm also going to include a bunch of other protocol calls that are gleaned from other practitioners and that Dr McGill often offers himself in his books and I'll certainly put links in the show note captions to his books and

again he'll be a guest on this podcast but for sake of clarity and simplicity The Big Three are as follows the first is called the curl-up the curl-up is in many ways a replacement for the situp most people are familiar with ab crunches and sit-ups where you lie down typically people will bend their knees although not always they'll often put their hands behind their head or on their chest and then they'll essentially sit up to contract the abdominals turns out that if you have back pain and even if you don't that is probably the least

efficient and perhaps even the worst thing that you can do for your back pain and if you think about the discs that sit between those vertebrae remember those soft tissue discs that allow for some mobility of the spine well if you Happ have a disc that's bulging even slightly that is it's herniating it's getting pushed out from between the vertebrae and it's impinging on a nerve and there's some pain if you are crunching you can imagine that's essentially bringing the vertebrae together in the front of that sandwich that is vertebra disc vertebrae and what it's

going to do is it's going to have that disc bulge out even further it's going to herniate even further and impinge on those nerves even further so what's required in a situation where you want to strengthen the back or try and eliminate or reduce pain of the back is a way in which you can strengthen the abdominals because the abdominals and the abdominal wall is very important for stabilizing the spine and you want a stable spine that's a very important point but you want to do it in a way where you're not adding to the

herniation of the disc in any way so the curl up is an excellent exercise for people who have back pain and who don't have back pain to strengthen the abdominal wall and it's done as follows you lie down you put one knee up meaning one leg is bent the other leg is extended you put your hand both hands below the lower portion of your back so in the arch of your back and you actually want to maintain the arch of your back that's one of the reasons your hands are there the head is in a

neutral position okay so your chin isn't tucked toward your chest the chin is in a neutral position and this is important your tongue is on the roof of your mouth this is something I talked a little bit about in my description of neck exercises in a previous video we're going to get back to this but tongue on the roof of the mouth often puts the head into a safe default position it also allows for breathing in particular nasal breathing to be done very easily so you got your tongue on the roof of your mouth the

mouth is typically closed and then what you do is you raise your elbows off the ground and then while maintaining that small of the back you're going to just raise your upper chest you're going to lead with the upper chest not with the chin and head although of course the head will follow you're going to raise the upper chest meaning raise the upper torso so the head's going to move forward and you're going to Exhale and contract the abdominals for anywhere from 8 to 10 seconds okay so you get a very strong contraction of the

abdominals but you're not doing a full situp you're only coming up maybe about I don't know somewhere between 5 to 10° so your back is coming up the head is coming up and the chin is not moving towards the chest it's staying in a neutral position you're going to repeat that so meaning you're going to go up contract for 8 to 10 seconds you're going to contract the abdominal walls if you want to Exhale you can usually get a stronger contraction of the abdominal walls and then you're going to go back down and relax on

the floor maybe rest 10 to 30 seconds maybe a minute and then repeat okay so that's the basic movement and then you would switch to the other side meaning you're then going to extend the leg that was bent you're going to bend the other leg and you're going to repeat in terms of sets and repetitions typically the best way to do this is to do anywhere from three to five sets starting with 10-second contractions done five times for the first set so it' be 10sec hold then relax 10-c hold then relax doing that five times

maybe four times but five would be ideal that would be one set and then on the next set you're going to do four repetitions meaning four 10-second holds with rest in between and then on the next one three on the next one two and the next one one 10c hold or so these are just rough guidelines you certainly don't have to do quite as long holds as those if you can't do those you don't have to do all of those sets if you find you're fatiguing one of the advantages however of doing these brief 10-second

holds and really focusing on the contraction of the abdominals hard or as hard as you can and then releasing is that as opposed to doing a long hold just trying to hold as long as you can and building a lot of endurance in the abdominals when you repeatedly contract a neuromuscular connection you build the pathways you basically allow the pathways that can engage those strong muscular contractions to a greater degree than if you're trying to just statically hold that particular position for a very very long time like 30 seconds or 60 seconds or longer okay

now there are a bunch of different variations of the curl up you can do the curl up with the extended leg elevated slightly to make it harder you can do the curl up with your elbows positioned closer to the ceiling so you're you're really lifting your elbows and arms far off the the ground as opposed to having them just hovering right above the ground there a bunch of different variations of these we include links to a few short videos in the show note caption so you can see the different variations of the curl up has

me doing these on the floor in my uh typical street clothes so you don't need to get into workout gear to do these and I should mention that the curl up is something that you can do every day if it occurs to you and if you have the time it's something that you would certainly benefit from doing every day but it's also something that even if you do once or twice a week for for even just a couple of sets you're going to see some benefit in terms of strengthening your back and probably relieving some

pain of your back as well the other terrific thing about the curl-up is if you have back pain and doing the curl-up doesn't aggravate it you are most certainly doing things to strengthen the musculature around the back that's going to help you avoid more back pain as you work through the different rehabilitative practices that hopefully you're doing with a PT or with a excellent MD who specializes in back pain relief as the pain dissipates you're going to be building up the musculature of the abdominals that's going to then further protect your spine especially if you're

one of those people that has a thinner spine that needs more muscular support around the spine in order to support it just as a final note about the curup two of the most common errors that people make when doing the curl up is to make it more like a situp and generate a chin to chest movement first and let the chest follow you really want the chest to lead and keep the head in a neutral position tongue on the roof of your mouth try and breathe through your nose and if you find that you can't

do the big exhale as you bring it up to the top don't worry about it it's perfectly fine to hold your breath as you come up and then just maybe release a little bit of air to enhance the uh intensity of that abdominal contraction the second exercise in the mill big three is the side plank I confess and I don't know why I hate doing side planks I don't know why I hate doing side planks I just hate doing side planks which tells me I should do side planks so I've started doing some side planks

recently after talking to Dr Mill I'm fortunate that right now I don't have back pain I haven't for a while I'll talk about how I alleviated my back pain but I spend a lot of time as a 48-year-old thinking about having a strong spine being able to jump off things and land with confidence all the sorts of things that set one up for both healthspan and lifespan as has been taught to us by Dr Peter AA some of you may know Dr Peter AA because he's been a guest on this podcast he wrote The Incredible

Book outlive and he talks about how having a strong spine having the ability to break Falls by virtue of training your ability to jump down things and step down things with confidence is essential to offset the aging process so I've decided I'm going to do side planks I'm going to embrace the uh spine strengthening exercises that Stu Mill has put forward as the big three and that includes side planks so how do you do side planks well most people think that a side plank is just getting on your side essentially on the floor then putting

one arm down and stacking your feet on the other side and trying to make yourself as stiff as a plank as you possibly can and while that is C only one way to do it most people find that they are going to get the most in terms of strengthening their spine and preventing back pain and maybe even alleviating back pain if they build up through a set of incremental steps making sure that the form on each of the steps is absolutely perfect so the way to really start doing side planks and if you think you

can already do side planks to assess whether or not you're doing them properly is to start with knees slightly bent so maybe at about a 30 or 40° angle so you're on your side your knees are bent the feet are stacked you're of course going to push one arm down although many people find that putting their hand in a fist as opposed to a flat hand is going to be best I don't know if U most of you are aware of this but anytime that we generate a fist in either hand it sets in motion

a number of different neural Pathways that allow for a firmer contraction of muscles not just within the fist but elsewhere in the body okay if um you've ever heard the great teachings of Pavo susulan who I hope to have on this podcast as a guest he's talked about how if you were say to try and squeeze a metal bar or think about just trying to give your friend the firmest handshake you possibly can you're having that handshake squeeze competition if you make a fist with your other hand you're actually going to be able to generate

a harder contraction of the shaking hand okay of the squeezing hand and this is because of the way that we have these bilaterally U wired uh nerve to muscle connections and the fact that neural activation on one side is related to neural activation on the other side and so forth but basically what you're going to do for the side plank in order to generate the strongest and most efficient side plank for strengthening and hopefully depainting your back is to get on the side Bend those knees put the hand down in a fist position okay then

you're going to push the hips off the ground so the upper body is indeed in a plank position then you're going to raise the hips up and you're going to have to put some considerable effort into pushing the floor away from you that's really the key here pushing the floor away from you now if you find that you can do that and you can hold that position for a good 8 to 10 seconds with a strong degree of rigidity so you're not quaking and you're not feeling as if the hips want to collapse down to

the floor something you really want to avoid especially if you already have some back pain or even a subtle back injury you want to make sure that your your spine is straight okay and that those hips come off the ground and you're really in a plank position right no Bend if you find that you can do that and it's fairly straightforward for you well then feel free to then extend your feet out further put the top foot on top of the other foot and out to the front Okay so you're not stacking the feet right

on top of one another we just shoe on top of shoe but you've got or foot on top of foot if you're doing this Barefoot or in socks but you've got one foot in front of you for some stability and then you're generating that long side plank pose and holding that for 8 to 10 seconds then pause for 10 maybe 30 seconds if you have to and then repeat again again all that part of one set just as we talked about for the curl up previously so you're working through the progression from bent legs to

straightening your legs if the top foot is placed in front of the other foot with legs straight and that's something that you can do for say anywhere three to five repetitions of those 8 to 10 second holds which make up one set well then you have the option to make the whole thing more difficult by doing a sort of roll forward where you actually take the part of your shoulders which is on the side of your free arm so the hand that is not pressing into the floor and you rotate forward so that your chest

is now aiming toward the floor maybe not to a full push-up position but maybe close and then back again to the side plank what you're doing there is you're activating some of the musculature that is for rotation of the spine okay and as you do that you're getting closer and closer to a front plank and of course front planks are also an excellent way to generate spine stability most people can do a front plank by resting on their forearms why start with a side plank well there are a lot of different reasons for that but

what you'll realize is that when you're doing a side plank you're actually only really loading half of the spine maximally the other half of the spine is not being loaded maximally because it's the side of the spine that's that's up and of course that's a reason why you want to do these on both sides of your body right so what's the sets and repetition scheme that's going to work here well if you're like me and you loathe doing side planks and you find that they do take a lot more effort than perhaps you would like

either psychologically or physically then for me what I've been doing is one set consists of three 10c holds I've been doing these with knees bent although I've now progressed to the point where I can do one foot over the other and resting that top foot um across the bottom foot so leg straight doing that for three 10-second holds to make up one set and doing that for two or three sets on one side of my body two or three sets on the other side of my body so slightly different than as I described for the

curl up where it was descending repetitions where you know the first set you're doing five 10c holds next one 4 10sec holds next one 3 2 1 for the side planks I don't like them enough that I just prefer to do two or three sets of three 10-second hes on each side although I'm starting to enjoy them just enough that I might progress to the kind of what's called reverse pyramid where you go five five 4 3 2 1 this sort of thing increasing the number of sets and again I have a link in the

show note captions that shows you how the side planks are done in these different variations I should mention that the most common mistake was side planks is letting the hips sag so if you don't push the floor away from you enough if you're not stable enough through the foot contact with the floor or the leg contact with the floor if you're doing these with knees bent even if you go to leg straight and you consider yourself very very strong in the side plank if the hips start to Sag you can imagine based on what you

now know about back Anatomy right the spinal cord being this um kind of snake like extension out the back of the brain with the vertebrae as segments and the discs in between them if that's sagging well especially if you have an issue with a disc bulge and some impingment on one of those nerve Roots either coming into or out of the spinal cord you're going to get into some trouble meaning it's going to cause some pain or at least some aggravation so the goal is to get that spine really straight as you're doing the side

planks regardless of whether or not you're doing that with knees bent or you're doing it with legs straight in fact that's the reason I went through all of that Anatomy earlier so that as you're doing these exercises whether or not it's the big three or the other protocols I'll talk about you can really Envision the major components of the spine that are getting engaged okay it's not just about the abdominals and the obliques and the lower back of course it's about all of that that's what you're exercising but you're also getting the neural engagement within

the spine you should think about the vertebral segments the discs the fact that those nerve Roots need to run in and out of the spinal cord outp pass the Bony and disc material and to do that without impingement so as you do these movements can be very beneficial to think about the different anatomical features of the back including spinal cord vertebrae discs nerves Etc but mainly those and as you're doing that you'll not just be strengthening your back you'll also be strengthening your learning of neuroanatomy so the last of Stu Mill's big three again Stu

kind of cringes every time people say okay it's just Mill's big three and that's back strengthening and Pain Relief and he always just kind of I can tell it pains him uh no pun intended because he knows and it's true that there's a lot more involved in strengthening and pain proofing the back but always good to have a great place to start a simple place to start and something that's really tractable without equipment or any cost and so we're very grateful that Stu was willing to kind of resist his temptation to be um Beyond nuanced

and thorough which he always is and offer us the curl-up the side plank which we've covered and now the third which is the bird dog the bird dog as some of you may know is where you get into all fours on the ground you extend one arm forward and you extend the opposite one leg backward okay so if you're down on all fours and you extend your right hand in front of you you're going to extend your left leg behind you now there are a couple key things about this one is again have the extended

hand in a fist why because you want to generate a strong neural contraction so that you don't forget and in fact facilitate keeping your upper body parallel to the floor so no tilting from side to side as best you can and you also want the neural activation to allow you to then Engage The Lift of the leg in a way that's also very strong and stable okay so nothing floppy no leaks as they say a key point is to make sure you don't raise the leg too high you're not trying to Arch your lower back

in fact what you want to do is raise the hand in front of you generate that fist it can even just be out in front of your your eyes at first maybe a little bit higher and then the leg that's extending toward the back feel free to either point the toe toward the ground or if you want to extend the toe a little bit like you're doing a little bit of calf raise in the air right pointing your toe that is that's fine too but don't get that heel up too high or even the upper

thigh up too high that you're getting a really big arch in the back the idea is to Envision one long line between the extended arm and fist all the way back across the midline because it's to the opposite leg and to the foot behind you again it's about creating a strong stable reach a strong stable lift of the foot but not too high and this is very important with the hand that remains planted and the knee that remains planted pushing the ground away from you okay that's as important as is the lifting of the arm

the clasping of the Fist and the raising of the leg in all of these movements the pushing of the ground away from you the resistance to gravity is as important as whatever movement you happen to be doing again this is a terrific movement for strengthening the spine that most people can do because you're only working one half of the musculature on either side of the spine okay there's of course activation of the musculature on the other side to some degree in order to balance things out but by emphasizing only one half of the musculature a

you can really focus on the contractions again you can really put a lot of Mind into the pushing the the floor away you can put your mind into where fist is and your foot is and of course you can generate the kind of hard contractions that are really going to strengthen those lower back muscles as well as the upper back and shoulder muscles that are required for generating stability of the spine again that's really what this is all about again it's going to be maybe three to five repetitions of 8 to 10 second holds for

one set done for repeated sets maybe for a descending number of repetitions where you're going five holds four holds three holds two holds one hold all of that being done repeatedly and with the greatest amount of of intensity and focus so that those nerve Pathways can be engaged over and over again very easily generating a lot of strength of contraction that then of course carries over into your exercise activities and even just your passive activities throughout the day and even stability of the spine while at rest which is something that we're going to talk about

more as we get into some of the other protocols now of course with the bird dog exercise you also need to train the opposite side of your body so after doing say two to five sets of those two to five repetitions of eight to 10 second holds on one side you're going to want to switch to the other side and do the same thing or you could alternate you could do right hand extended left leg extended do one set then switch to the other side left hand extended or I should say left fist extended uh

right leg extended do those repetitions call that one set and then shift back to the other side and so on and so forth really depends on how much time you have how frequently you're doing this throughout the week again right now I'm striving to do all of stum Mill's big three at least once a week maybe twice a week I know many of you will say oh that's pretty wimpy you know you should be doing this every single day or five times a week well I have a busy schedule just as many of you do

and it's something that I'm trying to incorporate more and more typically at the end of a workout although some people decide to do this at the beginning of a workout right now fortunately I'm not dealing with any back pain knock on wood but it's something that for many people who have back pain they find that if they do it this at the beginning of a workout it allows them to then move into the workout warmed up and to avoid a lot of the back pain they would otherwise experience with that said I want to be

very clear that if any of these movements exacerbate your back pain then you should definitely avoid doing them and of course if you have back pain you should be working with a licensed professional to figure out how to treat that back pain you may very well need pain meds Andor surgery I don't know because I don't know your specific circumstance but for most people who are just trying to strengthen their back who perhaps are dealing with a little bit of nagging back pain The Big Three are often very very accessible meaning they don't exacerbate back

pain and in many cases they alleviate it sometimes partially sometimes completely there are a lot of wonderful anecdotes out there of people who have benefited from doing the big three in all of those categories now again we have a link in the show note captions showing how the bird dog exercise is done there are a couple of variations that you can do to make it harder one is to draw boxes with the extended Fist and the extended foot that's actually a coordination issue too for some people so some people choose to do a box with

their hand maybe they do it clockwise then they do it counterclockwise some people choose to do the hand and foot moving in a box together meaning simultaneously sometimes they'll alternate foot then hand this sort of thing any kind of movement that you're doing with the extended Fist and or foot is going to add some degree of difficulty to this but you want to make sure that if you're going to add those movements those progressions that you're keeping the pushing away way of the floor constant throughout and that you're keeping your torso parallel to the floor

as you go now when I say parallel I realize that as you do an extension of one fist or the other fist as you kick out that back leg it's going to be near impossible for most people to stay perfectly parallel to the floor what you're trying to do however is to make sure that you're not rolling from one side to the next you're trying to make sure that you don't get tilted onto the stabilizing shoulder hand side okay so that's what's really important you can also if you really want to make it difficult you

can start to take the extended hand fist that is and reach back and then touch the knee that was a few seconds ago extended so you can do that in kind of a kind of reaching back touching the knee then ex re- extending the leg you do that for one side both sides Etc again there are a number of different progressions that um I do in the video I must say these are challenging for me especially doing more than three sets after you've contracted your muscles really hard in the way that you're supposed to for

these exercises in the three you're not going to have the sort of fatigue that you experience after sprinting or after doing heavy deadlifts or something of that sort but it's a certain kind of fatigue that prevents you from performing the movements properly and so the whole point here is to perform the movements properly to build a pattern what sometimes called an engram but basically it's an activation pattern of nerve to muscle and the resulting limb movements that allow you to do the movements perfectly so don't be in a big rush to do tons of this

stuff right out the gate be in a rush to do as much of it it as you can perform properly and consider it a progression and something that you're going to keep up not just for a week not just for a year but it's something that you're going to do for the rest of your life even if that means doing it just once a week or once in a while learn the movements properly that's the most important thing and of course I'd be remiss if I didn't mention the common mistakes that people make when they

do the bird dog one is people often raise that front fist way too high okay they're reaching for the sky or they're kicking way too high in the back they're generating a sort of bow shape from extended fist to Extended back foot that's not good you really want to raise these things up as stiff straight levers while also maintaining as much as you can parallel to the floor stance and pushing the floor away this is about generating strength of contraction and I know the word sounds bad but rigidity it's about generating stiffness in the spinal

muscles and in the abdominal muscles and in the upper back muscles and the other muscles that are requ requ ired for this and when I say stiffness I don't mean a lack of ability for the muscles to move once you're in sport or once you're about your daily activities what I'm talking about is an ability to generate a really firm muscular contraction so that those nerve pathways are strong so that you can stabilize the spine in any number of different dimensions and planes and orientations as you embark on your daily activities sports activities Etc that's

what all of this big three stuff is about it's about strengthening the musculature of the abdominals of the lower back of the shoulders and everything that connects it neurally again these are Pathways it's something that I should have said earlier and didn't which is we often experience pain in a given location like lower back pain or pain in the lower back and down the hip into the leg but pain is always the consequence of a pathway being irritated or a pathway being activated and in order to strengthen the components around the back to strengthen the

components of the back to avoid pain you want to work Pathways and so the big three that stum migil has developed is really about generating the kind of muscular strength and stability the neuromuscular activation patterns and doing it in a way that is generally safe for most people to perform to get the strongest and most painfree back possible and what I just described might sound like a lot of exercise it's actually something that if you decide to just include one or two sets of each of those curl up side plank bird dog you could complete

in anywhere from 5 to 10 minutes again if done once a week or twice a week whereas a warm up before you know weightlifting or at the end say a cardiovascular training session maybe even while watching TV or listening to a podcast or something of that sort it actually doesn't take that much time at all and of course doesn't require any equipment and it can be done essentially work or street clothes I'd like to take a quick break and acknowledge one of our sponsors plunge plunge makes what I believe is the best self-cooling cold water

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of motion safely I want to talk about two protocols that one can use to alleviate back pain that many people find beneficial now all this goes back to this thing about vertebrae dis vertebrae right that's the alternating sequence along the length of the spine and again the vertebrae are bony tissue so it's hard stuff the discs are a softer all right it's got some durability to it but it's a softer tissue but it allows for pliability of the spine because it's a soft tissue so imagine an Oreo cookie something that um I'm not a fan

of eating um I don't like the way they taste and I'm told uh they're probably not good for us but in any case if you like Oreos or you don't it's a good analogy here where you've got the two cookies and the cream Center so the two cookies are analogous to the vertebrae here and the cream Center is analogous to the disc if you squeeze the cookies evenly from top to bottom the cream Center is going to move out towards all sides along the full circumference right so all the white stuff is going to move

towards the edges more or less equally if you squeeze just on one side right the cream filling is going to move out toward one side if you squeeze on the other side cream filling and move out toward the other side and of course if you were to crush the cookies from top and bottom or even just the top cookie or the bottom cookie the cream filling is going to go up and through that will be equivalent to the rupturing of the disc along that Dimension okay why am I mentioning this well as I said before

a lot not all but a lot of back pain has to do with compression or impingement of nerves at some point along a pathway sometimes multiple points along a pathway and one of the most common sources of back pain is when those discs are bulging they're herniating and they're impinging on a faasle of nerves a bundle of nerves so two of the things that many people find beneficial when they're experiencing back pain are first if you can find a bar or something that you can hang from but don't worry you're not going to have to

actually hang in a full dead hang position if you don't have the strength for that or even if you do the idea here is to get your arms overhead onto a bar you're holding on to the bar and your legs are going to drape down and your toes are going to be in contact with the floor so we're not talking about a dead hang here okay which actually requires that you engage some muscles that can actually aggravate back pain what you're doing here is you're going to hold on to the bar you're in more or

less a hang except that your toes are supporting you or your feet or sometimes your heels are supporting you what you're trying to do is get lengthening of the spine basically what you're doing is the opposite of pressing down on those spinal discs and you're going to do that for anywhere from 10 to 30 seconds you're not going to twist okay you could imagine how twisting of the spine could be bad depending on where the Bulge is and which nerves are being impinged what you're trying to do is just create length along the spine to

relieve some of that disc bulging which is impinging on the nerves again without knowing the source of your back pain it's impossible to know whether or not this will help or it won't but many people get some degree of Pain Relief by doing this of course you need to be cautious in how you do it you don't want to hang for a long time if you don't have the strength to do that while trying to find the distance to the floor with your toes you're going to want to progress toward this very carefully but this

is something that many people find beneficial it's also the kind of logic behind you know inversion tables and these um kind of look more like um kind of chair apparati where people uh have designed chairs that then can invert so that people can relieve some of the pressure on their spine I've personally never tried those inversion chairs I did used to have an inversion table that I had out on my deck in the morning and I like to you know lock my ankles in and and invert on that thing it was kind of fun keep

in mind if you're going to do any kind of inversion you are going to generate intracranial pressure if you're somebody and I feel obligated to say this because I'm a vision scientist and I worked on glaucoma for a number of years which is intraocular pressure if you have glaucoma or you're predisposed to glaucoma you're going to increase ocular pressure if you're inverted in that way or anyway so keep that in mind you would want to avoid that in those cases but for many people just generating some degree of lengthening of the spine by hanging from

a bar or from some other physical object that's sturdy while keeping your toes or your feet or your heels in contact with the floor so you're just kind of lightly touching there so you can keep that going for anywhere from 10 to 30 seconds and then just kind of relax let go you walk around a little bit and then repeat doing that two or three times many people experience some degree of pain relief from doing that for all the reasons that now should be logical and obvious to you based on your understanding of spine anatomy

and physiology that we talked about earlier and the general theme of just trying to relieve compression that is herniation of the discs now what about reversing herniation of the discs okay so this is something I'm very familiar with and I have an anecdote here that of course just relates to my experience so it certainly doesn't carry over to everybody but it's an experience that I've shared with a number of people who've also experienced lower back pain to some degree of success and the story goes as follows a few years ago when I was in Seattle

giving a talk I decided to go to the gym that morning and I did an exercise which was not a deadlift it wasn't anything spinal really it was kind of a reverse bench dip that I do for my triceps I've always enjoyed doing these I've always um been able to do these completely painfree but that morning I got ambitious and I put a couple um plates on my lap in order to do them and I don't know exactly when it happened but as I was doing these bench dips with the weight on my lap something

felt like it quote unquote went in my back something something felt off I I don't know what happened but it felt like a little kind of like a little pull or something of that sort and when I stood up felt okay and then as I started to walk around a little bit more and went through my workout I thought uhoh something happened back there this is not good and what essentially was happening is I was experiencing pain on my kind of lower and mid right side of my back down the hip so intense pain at

the hip socket and down the leg kind of what some people might describe as classic s Attica or something similar to that I thought oh goodness this is not good as the morning progressed I was having a harder and harder time not walking walking was okay but if I sat down and then I need to stand up it was incredibly painful and I thought oh no this is it I really did something bad to my back so much so that I was literally bent over at about 20 or 30 degrees walking back to the Space

Needle in Seattle cuz we were giv the talks um up in the one of the rooms there I don't know if it was the top room one of the rooms at the Space Needle and I could barely walk up to the Space Needle I was just you know hunched over it was miserable now eventually what happened was I was able to fly home I was in a ton of pain I started reaching out to colleagues of mine that work on the back that understand pain they were suggesting painkillers I personally like to avoid taking painkillers

unless I have to take them and I basically don't take them I might take an aspirin every once in a while but I really like to avoid taking painkillers that's just me I don't judge those that need painkill but basically in talking to Medical colleagues I thought okay maybe I'm going to need a corticosterone shot maybe I'm going to need to just weight it out and keep in mind that a lot of back pain does relieve itself if people just wait it out and avoid the movement or movements that caused or exacerbate that back pain

this is something really important to know a lot of back pain will just relieve over time but I wanted to stay active so I started reading online as one does and I even started doing some abdominal strengthening exercises at the time I wasn't aware of the curl-up and instead what I was doing was some crunches so I was doing sit-ups which you guessed it made things way way worse for the obvious reasons it was actually causing more of bulging of the discs that were impinging on those nerves bulging out the I guess it would be

the back side of the back the posterior side of the back at the time I didn't really understand dis anatomy and vertebral anatomy in a way that would tell me that the sit-ups were going to cause that problem but they were making it worse and worse eventually I cross P with a PT who said absolutely stop doing any abdominal crunching just stop you're making it much much worse he explained to me that the discs were bulging at about the L3 L4 region you look up where that is and then it was impinging on the nerve

which was causing the pain both in the back at the hip socket down the leg what did he suggest I do he suggested that I do essentially the opposite of a situp basically that I lie down on the floor with toes extended legs together and then do essentially a push-up while keeping my hips in contact with the floor so you might think of this kind of as an up dog or a cobra pose in yoga um although not so much extending the head looking up at the ceiling but keeping the head in a neutral position

and then doing anywhere from 8 to 10 repetitions of those and then holding the final repetition for as long as I could until I started to Quake a little bit and then relaxing onto the floor what was remarkable is that from the very first set of those that I did I started to experience some degree of pain relief not total pain relief but some degree of pain relief and what he suggested I do and what of course I did was to do those essentially Cobra push-ups or I don't know really what to call them again

it's hips in contact with the floor toes pointed back legs straight pushing back essentially what he was having me do was to try and work that disc bulge back into the more vertical alignment of the spinal column I realize that's not the exact nomenclature so all you pts and chyros and physios are probably cringing at this point but for the common listener what we were trying to do was get the cream of the Oreo cookie from stopping to squeeze out from the back of from between those cookies and back under those cookies so to speak

and what I found and this was just remarkable was that within two maybe three days the pain was almost completely gone almost completely gone which was to me just staggering no pain medication I mean prior to this I was thinking oh goodness I'm going to need corticosteroid injection I'm going to have to take pain meds I might even need surgery I mean I was compl completely debilitated now of course we don't have the control experiment where I didn't do these exercises and I did nothing so we don't know how fast it would have relieved itself

had I just done nothing so that's an important caveat to all of this and again this is just my experience but the reason I'm sharing this experience is not because I necessarily think that you should be doing these same exercises to relieve a disc bulge and the pain that results from it but to give you a sense of how the disc bulging and the impingement on the nerve is very often the cause of back pain and you want to absolutely avoid doing anything that exacerbates that disc bulge so in my case it meant avoiding doing

any crunching because that would send the cream from between the two Oreo cookies further and further out impinging on the nerve more and more and more creating more and more pain rather to try and push things back by doing a spinal extension by doing creating an arch in the lower back by doing these essentially uh Cobra push-ups from the floor and when talking with this PT again and telling him gosh the back pain is essentially removed this is amazing I'm back to exercising walking running in the very same week he said yes indeed some people

have so much back pain that they can't even do the Cobra type push-up they need to just go to a wall and actually just put their hands on the wall standing about six inches or so away from the wall and then just push their hips towards the wall okay yeah I acknowledge kind of an odd visual there but pushing their hips towards the wall while keeping their you know arms bent and their torso you know anywhere from 6 to 12 in from the wall and then eventually progressing to be being able to do these Cobra

type push-ups or up dogs whatever you want to call them on the floor I again will provide a link in the show note captions of how these are done I found these to be tremendously beneficial not just when I have back pain because yes indeed couple years later I did something else in the gym I wasn't training particularly heavy and that same L3 L4 thing started again and I started doing these right away and it resolved it right away okay so clearly it works for me but one of the things that's really been key for

me is to understand that I have a propensity for a disc bulge a herniation in that region I now know what direction the disc bulge goes therefore which exercis is to avoid because they exacerbate that herniation of the discs and which exercises to emphasize because they help alleviate the herniation of that disc and this is why a little bit later I'm going to talk about some of the protocols that you can incorporate into your resistance training things like posterior chainwork like glute ham raises Nordic curls and things of that sort that if you're like me

and you're prone to slight herniation of the discs in the direction towards the posterior side right that it's very important to build up the musculature that surrounds those discs so that one can avoid herniating them further so again this is my experience you if you have back pain I would hope not but if you have back pain it might be a herniation toward the anterior side of your spine right it might be herniation in the direction of spine flexion and so therefore you need to do different exercises the point is that you need to understand

what the origin of the pain is but I also offer this story because I've known several people one of whom is in my family who experienced back pain fought they need to get corticosteroid injections actually got those injections got some degree of pain relief which is not surprising but then the pain came back okay it turns out they had a herni disc in the same kind of area and general category of posterior you know cream of the cookie going out the back right towards the back as I did thought that my anecdote about the herni

disc and these you know push-ups and these wall push-ups and pushing one's pelvis towards the wall was kind of goofy and you know wasn't really Medical but what's very interesting is when they then traveled to Europe to Scandinavia for the summer living there their Scandinavian and spoke to a physician there the instruction from that MD that physician was not to do corticosterone injections or to get surgery but you guessed it to do exactly the same exercise izes that the PT in the United States suggested to me now why do I raise this well the last

thing I want to do is get into a debate online about whether or not one profession like PT or Cairo or MD Etc is better than the other I realize there's a range of talents there are mediocre Terrible Bad excellent and superb practitioners in all these categories by the way um that's clear uh to me and hopefully to everybody else right you can't look at an entire field and say good or entire field and say bad there's going to be a range of quality of practitioners in any of those fields but when it comes to

back pain we are at an interesting point in history where depending on where you are in the world depending on the traditions of the medical practice in the area in which you live certain forms of relieving back pain are going to be looked at as more esoteric than others so that's the other reason I offer this anecdote this family member of mine and a couple friends who've experienced back pain of a similar nature have all now Incorporated these um Cobra push-ups uh up dog type approaches to some degree of success or another it is true

that one of them had a badly enough herniated disc that they did need surgery so surgery sometimes is needed of course but it's been remarkable to me to see how much I and others can relieve their back pain and strengthen the particular areas and aspects of the body that then can avoid further back pain and I'm quite happy to say that I've had essentially zero back pain now that I've Incorporated the right rehabilitative exercises as well as the right strengthening exercises which include The Big Three that we talked about before and the ones I'm going

to talk about next I realize that when a lot of people hear about back pain they immediately think of sciatica and somebody who's always carried his wallet in his back right pocket I'm often told hey you're going to get sciatica if you carry your wallet in your back right pocket um well I always take my wallet and put it in my front right pocket when I sit down or at least I try to remember to so I don't think that's the cause I'm certainly somebody who's had quote unquote sciatica now sciatica's most commonly thought of

as tingling pain or numbness or some combination of the three in maybe a little bit in the lower back in the glute region in the hip and down the leg especially now relieving sciatica involves a number of different approaches and I'll probably have to do an entire episode about sciatica and other nerve pathway pain specifically but for the time being a lot of sciatica is caused by exactly the sorts of things that we were talking about thus far the herniation of the disc the bulging of the disc and the impingement on the nerve and when

that bulging AKA herniation is occurring within the lower lumbar region of the spine often times it will impinge on a nerve or nerves that innervate the various regions I just described so the glutes the hip down the leg and sometimes will activate pain tingling or numbness in areas which are not innervated by that nerve there's something called referred pain where you're experiencing pain in one part of the body due to an impingement or disruption of a neural pathway or other pathway or inflammation elsewhere in the body so we're not going to do a deep dive

on sciatica right now suffice to say that a lot of the symptoms of sciatica fall under the umbrella of what we're talking about today which is back pain and strengthening the back in a way that can help you avoid back pain and indeed sciatica as well much of what I just spoke about in terms of my own experience with lower back pain could be thought of as sciatica because there was a lot of pain in the hip I almost felt as if the hip socket was in pain and there was some um pain not shooting

down the leg but kind of in the outer uppermost thigh for me some people experience it all the way down to their toes even numbness tingling or pain within the foot so it really depends on the degree to which those neural pathways are impinged but the principles are the same which are if you are experiencing lower back or related pain in the hip the leg the buttocks Etc you really want to figure out is there a bulging also called a herniated disc if so which direction is the herniation likely occurring is it out toward the

back of the spine is on one side you really want to understand where that herniation and bulging is occurring so that you can do the proper exercises to work that bulging to push essentially what I'm referring to in analogy as the pushing back of the cream between the two Oreo cookies back between those two Oreo cookies so that you can give some relief from the impingement on those nerve roots that are no doubt causing the flare up of back pain or what some people experience and call sciatica okay so thus far we've largely been talking

about different structural features of the back things like vertebrae which are bony the discs Etc that can impinge on nerves and cause pain and while pain is certainly neural there are a number of things that exist from literally toe to head that allow our back to move through the various planes of motion in the ways it needs to to carry out daily living to carry out Sport and that if we strengthen certain things even very distal very far from the spine we can allow for more mobility of the spine strengthening the spine and indeed even

pain relief within the spinal Pathways now the protocols we're about to discuss were shared with me with Dr Shawn wheeler sha wheeler is a medical doctor who has an incredible knowledge of back pain back relief and back strengthening by no means can I exhaustively cover all of the knowledge that he shared with the world I'll provide links to some of his work in the show note captions I intend to bring him onto the podcast as a guest but the Hallmark of the protocols I'm about to share with you you is the following we have muscles

that are constantly actively engaged in order to stabilize our spine which again is a good thing you want a stable spine and we have muscles that are not actively engaged but for which we can engage them either voluntarily or we can train them to be more engaged when we're not thinking about it so involuntary engagement but we have an entire set of musculature that is constantly actively engaged in order to stabilize our spine which again is a good thing and we have musculature that can potentially stabilize our spine if we focus on it if we

consciously decide to so what I'm about to describe are some simple protocols in fact very simple protocols that you can do in order to create more spine stability and in fact you can do these anywhere the first involves strengthening the muscles in the front of the neck now this is something that I do believe most everybody should be doing anyway why well most people nowadays are starting to take on a c shape not just rounding the lower spine but the chin is starting to move toward the chest and of course this is because most everybody

is texting or on a laptop much of the time okay this is not an exaggeration if you look at people walking around now they are tilted forward at the chin they are essentially taking an inch or two off their height they are potentially creating pain elsewhere in the body maybe even in the neck itself and what I'm about to describe is a way in which you can very easily strengthen the muscles in the front of the neck without adding size to the neck because I know a lot of people don't want to add size to

their neck I've talked elsewhere about strengthening the muscles on the side of the neck and in the back of the neck this is something that I do believe is important especially for people that are doing a lot of heavy weightlifting who are broadening their shoulders or who already have broad shoulders also just from a sheer aesthetic perspective nothing looks weirder than a little head and neck placed on broad shoulders okay but more importantly than any athetic matters is that if the musculature of the neck is weak you have a weak upper spine which is not

a good thing from the perspective of avoiding pain and not a good thing from the perspective of safety let alone posture breathing Etc I've talked about that elsewhere I'll provide a link in the show note captions to some of the simpler exercises for strengthening the neck that you can do without equipment in the meantime for sake of strengthening and pain proofing the back it's very clear that strengthening the muscles of the front of the neck can be very beneficial this is something that not just Dr Wheeler but also steuart McGill have been proponents of and

the simplest way to do this without any equipment is to Simply put your fists underneath your not your chin but on the two sides of your jaw so on either side of your chin if you're just listening that's where my voice is going like this and then with your tongue on the roof of your mouth and breathing through your nose you're just going to do a 10-second static contraction where you're going to try and move your chin down against the resistance of your fists underneath your jaw okay so you're going to go push down there

again tongue on the roof of your mouth feel free to exale exhale as you do this you might want to do this for three or four repetitions of 10c static contractions and then just relax you could do that for anywhere from two to five sets very easy to do what you're doing is you're generating strength in the muscles of the front of the neck and some nearby musculature it has the tendency to then put you into a default position at a distance from your chest okay so this is different than strengthening the muscles on the

back of your neck which will of course help to keep your your chin out and and away from your chest but when one does this there are a number of different benefits improved Airway passage so as many of you know I'm a big proponent of nasal breathing unless you need to breathe through your mouth both during sleep and sometimes during exercise but certainly at rest so strengthening the muscles of the front of the neck again I'll provide a link to this in the show note caption very easy to do it takes barely any time you

can do it anywhere and it has a number of different benefits for strengthening and pain proofing the spine next is to focus on strength of your feet and your toes Yes you heard me correctly why are we talking about feet and toes when we're talking about back strengthening and alleviating back pain well your feet are the foundation of your entire body they're carrying you around all day long and it's very clear that the stronger your feet are the healthier the rest of your body is going to be it's not to say that the rest of

your body will be healthy if you just focus on foot strength that's certainly not the case but strengthening your feet has many many benefits it's something that I've been focusing a lot on in the last couple of years and it's made a huge difference in terms of eliminating shin splints when I run it's made a huge difference in terms of alleviating a certain amount of lower back pain although you heard the anecdote about how I largely did that through other mechanisms earlier basically strengthening your feet is an allaround terrific thing to do how do you

do this well some people opt to get very wide toebox shoes some people will even run in those um shoes where the individual toes are look like they're in a glove I don't own those shoes I do have a slightly wider toebox shoe for running and I've really benefited from that but basically what anyone can do and you don't need to purchase any shoes or anything like that is to try and see if you can spread your toes out from one another so that none of them are touching on both feet many people find that

they are able to do that some people including myself found that they could do that on one foot not the other and it just took a couple of weeks of working at it and strengthening those neural Pathways learning how to activate those neural pathways through concentration to be able to spread my toes on both feet this might sound a little silly to some of you but being able to spread your toes on both feet actually says a lot about your ability to activate distal neural Pathways or I should say neural Pathways to distal parts of

your body there's a bunch of interesting data about how that correlates with some metrics of Aging or lack of Aging I'm going to cover that in a future podcast but some people find that they can't spread their toes out and they need a little bit of help from toe spreaders yes there are commercially available toe spreaders that take the form of these kind of um stocks that you can put between um your toes these are rubber stocks that then spread the toes it can be a little bit uncomfortable at first but then you get better

at it help you learn to spread your toes you certainly don't need those things you could even just take some you know paper towel or or tissue paper or something of that that's that's firm and put it between your toes and that will help you learn to spread your toes I'm not suggesting you walk walk around all day with tow spreaders although some people actually do that but basically what you're doing is you're creating the ability to activate the neural Pathways that that allow you excuse me to spread your toes I know this might sound

silly but if you do this you're going to find that you're walking your stance when you're stationary and certainly if you do any kind of running or cycling you're going to find that all of those things are going to benefit in addition there is benefit to strengthening your toes this is something that I'm only now starting to explore um one way you can do this is by sitting in a chair Barefoot spreading your toes as much as possible and then seeing whether or not you can lift each toe independently I'm not at the point where

I can do that yet I'm still trying to learn how to um lift my big toes independent of my other toes again all this is learning how to activate neural Pathways to distal parts of your body that serve as stabilizers for the arch of the foot for the foot itself for the ankle for the shin that carry over to spine stability and a strong spine I know it seem seems kind of wild that we're talking about the feet and Toes spreading to benefit your back but all of these things relate to one another up and

down the chain of activation involved in Walking In running and certainly if you're involved in any other sports but also just standing around so don't underestimate the power of learning to spread your toes and learning to move your toes independently and then of course there's a whole set of exercises that you can find online of how to actually strengthen the individual toes with bands and things of that sort pretty advanced stuff most people aren't going to do that but if you're willing to explore that stuff it's clear that there are a lot of benefits and

again there's some exciting literature starting to emerge about the benefits of toe strengthening and toe spreading and all that stuff as it relates to believe it or not neurocognitive longevity I know it sounds wild but this is actually a literature that's starting to pick up some weight so it's one that I'm paying attention to and that uh I'm certainly going to cover in a future podcast Okay so we've got strengthening the neck we've got toes spreading at a minimum making sure that you can spread all your toes move them independently that would be great what's

that going to do that means that when you're standing at rest that you're creating a stable base for yourself when you're walking when you're running and certainly when you're lifting or you're playing any sports you're creating the most stable base for yourself possible when I say stable base I don't just mean because the toes are spread I mean because if you can activate the musculature to spread those Toes or if they're passively in that spread toe position not touching one another you're going to be activating some of the musculature that's I guess for the typical

person we think of this as in the arch of the foot and the top of the foot and running up to the front of the shin that's going to create the most stability for your lower limbs your upper limbs your pelvis and your spine okay now in discussions with Dr Wheeler and discussions with Dr starett and discussions with Dr Stu McGill all of them really emphasize that when doing resistance training that bracing the body by essentially not doing a big belly breath but filling the body with air so that you essentially create a firmness within

the abdominal walls and the spinal Erectors and the obliques so this would be essential in a squat type movement or other types of movements that's beneficial during resistance exercise to create the most stable canister of you the most stable activation of the musculature around the spine to avoid injury and also to lift the greatest amount of weight there's a number of different mechanical advantages and safety advantages that are afforded when we do that this was also something that I discussed with Dr Andy Galpin when he did his series on exercise physiology with us again we

find a link to that in the show note captions now that bracing that filling of the body with air and that bracing of the abdominals and the musculature essentially that runs like a belt around the midsection to make yourself strong and stable during those movements that's all fine and good but it turns out that when we're at rest when we're just standing around we actually want to do the opposite we actually want to relax that musculature and belly breathe now I've done an entire episode about breathing and the difference between belly breathing versus breathing where

the chest lifts or a combination of both but we can keep this very simple you can do yourself a great favor by trying to remember that when you're at rest you're just standing around maybe you're seated or standing and working or you're talking or something of that sort that you're ideally nasal breathing unless you're speaking or eating or something of that sort and you are belly breathing okay so you're actually relaxing the abdominals as you inhale and the belly is moving out and then as you exhale the belly moves in so that's the ideal pattern

when it rests the exact opposite of the pattern that you want when you're actively engaging all that musculature for sake of exercise and stability especially when you're engaging in weight training under loads so that places us at strength in the front of the neck toes spreading and strengthening of the feet belly breathing at rest and then there's a kind of fun one that's something that I've been incorporating a lot because frankly I'm not a big fan of doing abdominal work it's just not something that I really enjoy doing in the gym or elsewhere but I

know that it's important to have a strong abdominal wall it's important to have strong abdominals generally and yes occasionally I'll grab onto a bar and I'll do a set of Pikes I actually enjoy Pikes you know bring my ankles up to my hands and doing that trying to stop there doing LS sits things like that I'll do those every once in a while but what I found to be very beneficial and that is more kind of realworld related in the sense that it activates the musculature of the abdominals you can train your abdominals while doing

things that more closely mimic what you do in real life is to actually stagger one's stance while doing certain forms of resistance training okay so not during deadlifts not during squats or anything of that sort but let's say during dumbbell curls for the biceps rather than stand with feet parallel standing with one foot in front of the other making sure that they are wide enough apart in the lateral plane as we'll call it okay so far enough away on either side of your belly button so that you're stable Little Bend in the knees and then

making sure that your belly button is still facing Direct directly forward this is really key not twisting the Torso but making sure that your belly button is facing directly forward and doing curls one arm then the other arm one arm then the other arm then switching to a stance in which the other foot goes forward and the other foot goes back again make sure that you're not in a CrossCountry skier position with the feet very close to your midline because if they are you're not going to be stable so make sure that they're far enough

away from your belly button on either side that there's a bend in your knees so that you're stable and then doing curls that way can also do this for any kind of triceps exercise like an overhead triceps extension those are mainly the exercises in which one could apply this although there are a few others maybe for back work maybe for shoulder work although I think parallel stance is probably best for that and certainly for leg work so what are you doing if you do curls or overhead triceps extension in this way with one foot forward

then the other foot forward what are you doing well if you deliberately insist meaning force yourself to keep your belly button facing exactly forward and for that reason sometimes it's helpful to do these in front of a mirror what you're doing is you're generating anti-rotational forces you're requiring that your upper body not twist while you're lifting these loads and what that does is it trains the obliques it trains components of your abdominals and to some extent it's training components of your lower back although not so much as it is the obliques the abdominals that are

anti-rotation that are preventing your body from twisting while you're carrying out these movements and in doing so you're also mimicking the way that a lot of movements are carried out in daily life because if you think about it it's pretty uncommon that you're going to be lifting things with one arm with feet parallel I mean it happens okay there are times when feet are parallel and we're lifting something up with both hands there are times in which you do something similar to kind of the stance that you would be in for a dumbbell curl you

know with feet parallel in the gym or a tricep extensions with feet parallel but more often than not as we move through life one or the other feet is positioned in front of the other and you know we're reaching something or lifting something or we're pulling something those are the patterns that exist more typically in daily life and those are the patterns of movement that typically people hurt themselves while doing you know they reach down to get something out of a cabinet they'll reach into the back and they'll twist a bit to grab something in

the back and that's when their back will go or they're reaching overhead to grab something and they're twisting as they reach with one arm so I've certainly found and this was supported by again all of the experts that I spoke to that staggering one stance while performing resistance training typically curls or overhead tricep extensions there aren't many other things that lend themselves well to this so those are the two that I'm really focusing on doing that while insisting that is forcing yourself to keep your belly buttons facing completely forward okay not tilting to the side

either way that can really help strengthen the abdominals through the use of what's called anti-rotation this is also what you're going to experience if you ever take a yoga class and you do a pose where you know it's arms overhead Like a Warrior 2 pose or a warrior one pose and they'll say make sure that your belly button is facing completely forward that you're not twisting to the side too much this is also what the instructor will tell you in a Pilates or a yoga class very often in certain movements where there's a tendency to

kind of um relax or sag into a twisted upper torso of course there's some yoga and pilates movements that require that you twist your upper torso but that's not what we're talking about here this is when they tell you keep your belly button facing forward you're generating anti-rotation forces not just of the abdominals but as the abdominals connect to the pelvis and of course all of that is providing stability for the spine and then if you run down the legs in your mind that is and you think about your feet with those nice spread toes

and the activated um musculature on the base and the top of your feet and running up the front of your shin and your calves you can really imagine how you're creating the most stable positioning on the floor stable positioning of the spine no wonder that the spine is not only going to experience less shearing stress less pain but you're also in a position position to create a nice strong chain of activation from the nerves and muscles from the base of the floor all the way up to your neck because you're already strengthening your neck okay

so in terms of protocols thus far we've covered stum Mill's big three then we talked a little bit about things you can do to relieve pain so this was the hanging from a bar with the toes touching the ground right as well as the kind of up doog or Cobra exercises and then we talked about five or six things that one can do including strengthening the neck spreading the toes strengthening the feet Etc in order to generate strength and stability distal to the back and thereby to strengthen and pain prooof the back now we're going

to cover four final protocols to strengthen your back pain prooof your back and allow you the greatest degree of Mobility both for sake of Mobility during exercise and in daily living the first of those four protocols is going to be to activate and strengthen and in some cases Des spasm the medial glute which is a muscle that most people don't think about the medial glute is involved in stabilizing the hips as you walk as you run okay so it's going to prevent the pelvis from moving from side to side it's one that when it weakens

or when you have trouble activating it can lead to some forms of what is perceived as lower back pain so if you reach to your lower back and you feel these kind of like two kind of like almost like nodules at the top of your pelvis a lot of people will experience pain in and around that region or maybe even as a kind of a like a belt um of pain around that area more or less and in some not all cases but in some cases that's due to lack of medial glute activation or in

some cases it's due to spasming of musculature in that region it's really hard to tell unless you're being assessed by an expert which one it is again that's not what we're here to do what I am here to do is to provide you a protocol that I've found to be tremendously beneficial for relieving the sort of lower low back pain and the kind of pain that even extends into the top of the glutes that many people experience especially if you've been sitting a lot if you've been driving a lot flying a lot if you find

yourself doing a lot of hip hinging exercise like squats and then you travel so you're sitting on a plane for a while and you don't um pay mind to really stay in a you know flatb or um arched back position by the way if you're somebody who has disc bulging in that direction that we talked about before and can benefit from doing those Cobra poses or kind of up dog you know push-ups if you travel or drive or you're seated a lot for work I and many others find it really beneficial just take a towel

and just roll it up and put it so you maintain the arch in your lower back so you're not rounding in your seat that can be really useful and it makes perfect sense if you think about it given what we were talking about before with the squeezing out of the cream of the Oreo cookie in that direction you want to make sure that you're not rounding your lower back too much keeping it straight or a little bit arched is going to be beneficial not overly arched but straight or a little bit arched and a you

know a rolled up towel or something of that sort that you can put in your lower back can really be helpful for that now the protocol here is to essentially activate and Des spasm the medial glute this is actually a protocol that I learned from Jeff Cavalier long before I ever met him or he was on the podcast which he's been on the podcast Jeff cavaliere has a YouTube channel called athleen X which has tons of zeroc cost protocols for resistance training for cardiovascular training he just provides so much useful information again zero cost I've

actually paid for his programs no he didn't ask me to say that he doesn't pay me to say that over the years I've paid to use various programs from athlex and they've benefited me tremendously I've customized them a bit for myself but in any case love the work he does grateful to call him a friend extremely grateful that he was a guest on this podcast we'll Pro provide a link to the episode that he did talking about exercise and exercise physiology and nutrition in the show note captions in any event the protocol here is to

activate and some cases Des spasm the medial glutes which can be done in a very straightforward way where you lie on your side essentially like you were going to do a side plank so you've got your elbow and your forearm on the ground making that fist you would imagine you'd go into a side plank except no you're going to keep the lower leg the leg that's in contact with the floor against the floor you're going to take the leg that's on top you're going to point the toe down okay so you're not bridging up into

a side plank you're just resting on the floor on your side you take that top leg point the toe down you bring that toe out in front of you touch it to the floor and then you're going to bring your heel back you're going to extend it not overextend it but extend it as far as you can with your heel pointed toward the back wall and up towards the ceiling so you're trying to maintain that downward pointed toe effort okay then you're going to lower it again touch bring it all the way back up you're

going to do that for maybe five 10 repetitions and then on the final repetition you're going to hold it there in that raised position not as long as you can but probably anywhere from 10 to 20 seconds depending on how much strength you have in your medial glutes to be able to do that and if you like you can also take your hand on the side of the foot that you're raising okay so if you're lying on your left side you're going to take your your right hand and you're going to take your thumb and

put it right at the top of your glutes and you'll feel when the leg is fully extended back with the heel towards the back wall and ceiling you'll feel the muscle activate there and you can kind of push against it what are you doing when you do this you're activating the medial glute you're in some cases Des spasming the medial glute and some of the musculature around there and many people find that they get considerable pain relief of that low low back region when they do this exercise you of course would want to switch to

the other side even if you're not experiencing pain on the other side and do the same thing for the opposite side so lying on your right right hand side taking then your left leg pointing the toe down putting in front of you bringing it back doing multiple repetitions of that and then holding it in a static hold while feeling that medial glute get activated and then taking some rest this is the sort of thing that you can do if you're experiencing low low back pain to see if it provides some relief many people find it

does provide that relief if of course it exacerbates your pain please stop doing it you never want to exacerbate pain in any kind of way but many people find that it relieves the pain in that low low back region and it does so not just during the exercise but in the minutes and hours following you may need to repeat this a couple times per day you may need to adjust your other activities including exercise it really depends on the severity of your back pain and injury the nature of it Etc however it's something that many

people including I also include in our regular routines I'll sometimes do this as part of a warm up on leg day I'll sometimes do this just while you know watching TV or something which I don't do terribly often but I'll just take a couple of minutes literally just 2 minutes or 3 minutes and I'll do a couple sets of these on either side just to maintain that neuromuscular activation of the medial glute some people I would say most people are not very good at activating that medial glute region if you're somebody who is being conscientious

and doing a lot of posterior chain work such as Kabal swings on a regular basis you're doing glute ham raises which I'm a huge fan of I'll do an entire video about posterior chain and why I'm such a big fan of glut ham raises unfortunately you need a specialized piece of equipment to do them or Nordic curls such a big fan of Nordic curls glut ham raises etc for all sorts of reasons strengthening the back strengthening the posterior chain making sure you can still generate power in the pelvic region lower back region while maintaining posture

especially as you age all of that I'll talk more about those in a future episode of The hubman Lab podcast but the point is this many people just fail to get activation of the glutes in a way that supports their lower back and allows them to strengthen their back to the extent that they would otherwise and much of the time it's not just a failure to activate the glutes because of course there are many ways to activate the glutes there are all sorts of exercises you can read about online but a failure to activate the

medial glute muscles in particular that people need to overcome by strengthening those nerve to muscle Pathways and of course I'm talking about activation of the medial glutes and Des spasming of the medial glute which is really what happens when you hold that medial glute contraction for some period of time then afterwards you allow some relaxation in those neural pathways that is often again not always but often the cause of that low low back pain so if you have low low back pain and it's safe for you to perform this exercise I encourage you to give

it a try again it requires no equipment it's very easy takes almost no time and at least for me and many others that I've spoken to it has been tremendously helpful in relieving that lower back pain by Des spasming the medial glute and at the same time allowing for nerve to muscle activation of the medial glut such that the medial glutes can be active when they need to in order to stabilize the pelvis and allow for the strongest possible pelvic spine interface okay so the next protocol is one that you can do essentially anywhere it

takes almost no time and it's a wonderful one because it allows for stretching of the soaz muscle right the muscle that is easy to say and hard to spell soaz it's PSAs right I think the p is generally silent you'd say soaz muscle um the soaz muscle is involved in connecting the spine to the pelvis okay it also has an interaction with the diaphragm that's really important this muscle that's important for breathing and many people have tightening of the soaz tightening of the hip flexors but being able to stretch the soaz muscle is something that

provides a ton of relief to the tightness that one can experience from sitting too much from being in a hip hinge position too much especially if you're doing heavy hip hinge work and then you're sitting or driving a lot and many people also just carry a lot of stress in their midsection and relieving or stretching the soas can be very beneficial okay there's a lot about this that could be said in fact I'll probably do an entire episode about soas and fascia okay I know there's a lot of requests to talk about fascia but it's

far too much to get into now here's the protocol that I do believe everyone can benefit from I don't care how bendy you are how rigid you are how big you are how live you are how slim you are this is a wonderful exercise it just feel so good and it allows you to afterwards be in a long spine posture to really feel opened up at the hips if you will now I'm using yoga type language but I think you understand what I mean and it is a great stress reliever as well which is essentially

to do what looks like a Warrior 2 position in yoga so you're essentially doing a lunge okay where you're going to Lunge with one leg back and the other leg forward of course that's a lunge and then you're going to take the hand on the same side as the leg that's extended behind you reach that toward the ceiling okay and then you're going to rotate pinky clockwise okay the other way to think about this is to put the palm of your hand parallel to the ceiling if you're doing it outside parallel to the sky okay

so you're going to get into the longest lunge that you safely can for you okay that's going to differ for everybody and then you're going to raise the arm on the same side as the leg that's extended backward and you're going to go parallel Palm to the sky or to the ceiling this will provide a stretch all the way or you should feel a stretch all the way from your wrist down past your hip and possibly even into the foot that's behind you now Dr Stuart McGill showed me this um I've certainly done Warrior 2

pose in yoga classes and when I've done yoga at home from time to time I wasn't new to raising an arm overhead while stretching in a lunge position but Dr Su Mill was the one who really emphasized that by putting the Palm parallel to the sky to the ceiling and twisting a bit so that you're turning that pinky toward I would say the best way to describe this is to turn that pinky toward your head okay not away from your head but toward your head while still maintaining a flat palm and reaching as much as

you can and extending all the way from the heel of that back foot all the way up to your palm that you're getting stretching not just of the soas but they also getting activation of some of the neurofascial aspects going from Palm all the way to heel that provide some relief that is some relaxation of the musculature that otherwise is providing tension of the spine pelvic interface and that can allow for better posture longer spine and at the same time strong spine positioning after you do the exercise and of course you want to do this

on both sides now I realize that many of you are just listening to this you're not watching this but even for those of you that are watching on YouTube it's very difficult since I'm seated behind a desk to show you the proper form of this exercise which is why we've provided a link to a visual of this exercise in the show note captions that you can go look at otherwise but hopefully it's clear to you it's basically a lunge front leg slightly bent at the knee back leg perhaps slightly bent but extended behind you so

you're in a lunge position arm on the same side as the extended leg raised overhead pum Palm parallel to the ceiling okay with arm extended and turning your wrist a bit so that your pinky is more or less trying to point towards your head although most people including myself probably don't have the flexibility to do that all the way so that your pinky is pointed towards your head I encourage you to experiment with this a little bit until you feel that stretch all the way from hand down to heel it feels really good to do

you can hold it for anywhere from 5 to 10 seconds you can exhale or inhale doesn't really matter you can just breathe normally the point here is that you're getting a terrific stretch of the soaz you then switch to the other side get a terrific stretch of the other side soas and after you move out of this pose you will definitely feel as if you sort of have quote unquote lengthen the spine you know the extent to which you have lengthen the spine isn't clear what more likely has happened is that you have some relaxation

and perhaps even some lengthening between the spine and pelvic connection so then you can sit upright nice straight spine and you're not being pulled forward by that tighten soas that connects the spine to the pelvis okay so that's sort of the simplest way that I can describe all that it's a wonderful exercise to do you can do it in an airport you can do it when you get home you can do it when you get out of the car it's one of those things that provides a ton of relief in terms of kind of stress

and compression and C shaping of the spine from sitting that most all of us are doing too much of these days and as Dr Stu Mill will explain when he comes on the podcast it also provides some both activation and relaxation of the nerve to fascial to muscle interface that's so critical for having a strong and pain-free spine okay so the final protocol I want to share with you today believe it or not is purely mental it's purely cognitive it doesn't involve any movement what it does involve is developing an awareness of your movement patterns

As you move through your daily life including exercise but not limited to exercise what do I mean by this well based on what I told you at the beginning of today's episode and throughout today's episode you are now armed with knowledge about the different components of back Anatomy the vertebrae the discs the nerves the muscles and how those relate to one another and how bulging that is herniating of the discs or I would hope not but even rupturing the of the discs or inflammation at a particular spinal segment or maybe tonic static contraction at the

level of the neck or lack of strengthen the feet how that could create back pain how that could limit back Mobility how that could limit overall Mobility so the final protocol of today's episode is for you to really pay attention to any pain you might happen to have in your back region and any kind of limitation you have in terms of its ability to manage loads or to generate the kinds of movement that you need for your life what do I mean by this well if you're somebody who has a lot of lower back stiffness

lower back pain you might ask yourself okay when I drive when I sit even if I use a standing desk what is the position of my feet are they directly underneath my pelvis am I rounding my back if you're somebody who has a lot of pain in your low to midback and you find just by way of observation that you're rounding your back a lot of the time either because you're texting or typing maybe you need to take a towel roll it up and put it in your lower back region maybe you need to just

spend a little bit more time each day not all day but a little bit of time being consciously aware of maintaining a little bit of lower back arch or maybe even a straight back if you can't arch your back in that way if you're somebody who's standing at your standing desk or even just talking to friends or family members do you always lean to one side do you always relax to one hip is that because you're not activating the medial glute on one side more than the other or either or is it because you know

you tend to stand with one foot in front of the other or you're not maintaining enough toes spread or you don't have the strength in your feet to kind of stabilize yourself are you relaxed with your breathing and letting your belly go out when you're not exercising these are the sorts of things that once you start to observe and by the way you don't have to become neurotically self- observant all the time about your back and your breathing in your foot position that's not what we want okay that is absolutely not the goal here but

if you're experiencing back tightness or shoulder tightness you should ask yourself are you you know constantly like thumbs pointed in shoulders rolled forward are you doing enough pulling exercises to balance out all the pushing exercises you might be doing like push-ups and shoulder presses and bench presses make sure you're balancing the back musculature and the shoulder and chest musculature these kinds of things are extremely valuable to pay attention to because oftentimes the origin of your back pain or the origin of your sciatica or the origin of your neck pain and tension is something that can

be fairly simply remedied it doesn't necessarily mean you have an injury maybe you have a small degree of dis bulging and if so what direction is that bulging is it toward the front of your spine the side is it the back and if so what are you going to do to adjust it are you going to do you know one or two sets of those Cobra push-ups each day are you going to put that you know towel rolled up behind your back in order to make sure that that bulge doesn't increase further are you going

to avoid doing a lot of crunching in the gym many of you are going to need to avoid doing crunching and finding other ab exercises like the rollup to do in order to still strengthen your abdominals which is so important for stabilizing the spine and having a strong pain-free back but you don't want to generate more forward rolling and bulging of the discs out the back of the spine for all the reasons that are now obvious to you so this final protocol is one that I could go on for hours about but really it's for

you to think about for just a couple of minutes for a couple of days and just pay attention to your movement patterns how you stand at rest how you breathe at rest whether or not you're using best possible posture or whether or not you're using postures and patterns of overuse in your daily life and in sport these things can really build up some strong imbalances in neuromuscular activation patterns that over time can translate into pain and even if they don't translate into pain can translate into a weakened back system or put more appropriately a weakened

body system where you know you're always sagging one shoulder or you're not breathing properly because your chin is always towards your chest these kinds of things now today's episode is certainly not geared towards fixing every aspect of your posture your movement patterns strengthening your back and removing your back pain however I will say that thanks to the information that's out there from the peer-reviewed literature and from these fabulous practitioners again MDS pts folks even in the Chiropractic Community I say even because oftentimes they take a lot of heat from people in the other communities but

again there's a range of quality of practitioners in all these different domains they've really started to explore these different aspects of back strengthening and removing pain from the back in ways that sure they come to the table through different lenses of training right some are going to talk about laser therapy and by the way we didn't cover that on purpose there's a little bit of evidence but it's not super strong for laser therapy for the back okay there I just upset all the people are into laser therapy we'll get into that in a future episode

sure there's evidence that Pilates that yoga walking has been shown to be tremendously beneficial for back pain there's wonderful evidence for any and all of those different practices what I've tried to focus on today were prot protols that practitioners who spent most if not all of their careers thinking about strengthening the back and pain proofing the back generally agree on okay I realize there isn't going to be Universal consensus but they generally agree that Stu Mill's big three the curup the side plank the bird dog they generally agree that strengthening the stabilization muscles and Pathways

from feet up to hips and all the way to shoulders and top of the head including the neck including breathing in a particular way while relaxed while not exercising again those would be belly breaths ideally through the nose unless you're talking or you're eating making sure that your abdominals are strong not just from crunching but that you're activating the obliques that the muscles between your ribs are strong something that can really benefit from anti-rotation work so that you can generate a stiff stable spine which is great provided you can do that when you want to

voluntarily and then you can relax and you can move about your days still in great posture is still in a strong position but without having to brace all the time which is obviously something you don't want to have to do as you move through your life and having a number of different stretches that allow for lengthening of the spine we talked earlier about hanging from a bar with feet touching the ground so that you can create some space to alleviate hopefully some of the disc bulge to nerve impingement that might be causing pain that you

might want to do those Cobra type push-ups or those up dog type movements that can provide some kind of pushing back of the cream between the two Oreo cookies that I use as an an analogy for the discs and the spinal segments these are the sorts of things that most all of the data and most all of the experts in the field generally agree on and so I've offered them to you today in the form of this list of protocols there are about a dozen of them I realize again we have links to examples of

them in video form in the show note captions I certainly don't expect that everybody's going to do all of these every day that's by no means the expectation think of these more or less as a buffet of things that you could explore and experiment with depending on whether or not you have back pain in which case please proceed towards them with a lot of caution please remember also that I am not saying that epidurals painkillers surgery and other methods for treating back pain are not useful I am certainly not saying that those certainly have their

place and yet I would say many people if not many or even all adults could certainly benefit from thinking about how their back interfaces with their pelvis their legs their feet their neck and vice versa and thinking about how to strengthen that entire system by creating a strong core a strong lower back generating the proper movement patterns and doing so through protocols like the ones I described today that don't take a lot of time require zero equipment they're essentially zero cost except for the minimal time investment required and that have been shown time and time

again to lead to a stronger pain-free back if you're learning from Andor enjoying this podcast please subscribe to our YouTube channel that's a terrific zeroc cost way to support us in addition please subscribe to the podcast on both Spotify and apple and on both Spotify and apple you can leave us up to a five-star review please check out the sponsors mentioned at the beginning and throughout today's episode that's the best way to support this podcast if you have questions for me or comments about the podcast or topics or guests you'd like me to consider for

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with anybody I'd like to thank you once again for joining me for today's discussion all about how to strengthen and pain prooof your back and last but certainly not least thank you for your interest in science [Music]