Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D.

**Peter Attia** (0:11)
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My guest this week is Stuart McGill. Stuart holds the title of Professor Emeritus at the University of Waterloo, where he has dedicated 40 years of overseeing his laboratory and research clinic dedicated to advancing the understanding of back pain. Currently, he serves as the Chief Scientific Officer of Backfitpro, where he specializes in evaluating complex cases of lower back pain from across the globe. He has authored 245 scientific articles and multiple textbooks.
I wanted to have Stuart on for the obvious reason that very few people listening to this will have not had their lives impacted by lower back pain, even if it's just a short bout that lasts for only a few days. And sadly, many of you have had far greater impact resulting from lower back pain, lower back pain that has perhaps plagued you for many years. In this episode, we do a deep dive into all things that pertain to lower back pain. We begin by discussing the anatomy of the lower back and how the spine works, the pathophysiology of back pain, and where people can have issues as it relates to their back.
We talk about why Stuart believes there is no such thing as non-specific back pain and why he is so adamant about finding a causal relationship between an injury and pain. And by injury, I mean a physical reason for the pain, not necessarily an acute injury that resulted in it. Talk about ultimately why people who are experiencing back pain should be empowered to do something about it. In other words, Stuart really believes that nobody should suffer endlessly because of back pain.
I'm very excited about this episode because I know even just looking at the relatively small sample population of my patients, I know this is a topic that many people will find value in. And if you're not finding value in it today, it might be a podcast you want to come back to when you do experience lower back pain, though I hope that never happens.
Lastly, this is an episode where Stuart shows off a variety of models and positions to better explain what we're covering in the conversation. So while the show notes will have all of the images, this may be an episode you want to watch on video. So without further delay, please enjoy my conversation with Stuart McGill.
Hey Stuart, thank you so much for joining me today. Wish we were doing this in person because there's so much I'd love to get into, but I have a feeling we're going to be able to do a pretty good job remotely. And I get the sense that you're very well versed at communicating your ideas in two dimensions rather than three. So great to make your acquaintance today.

**Stuart McGill** (3:51)
Same here, Peter. I've been looking forward to this day for quite a long time.
At some point, I'm going to thank you for writing your book. You are one of the few people on this planet who, A, I allowed and B, I did change my behavior. So thank you very much for that. Let's see where we go today.

**Peter Attia** (4:15)
You're going to leave me hanging with that. I'm curious to know what it was. Were you a smoker who somehow stopped? No, I'm kidding.
What was it?

**Stuart McGill** (4:23)
Well, a couple of years ago, my family doc right now is one of my former students. This may bring a smile to your face. I don't remember this, but apparently when he was an undergrad and he asked me to write the letter of recommendation for medical school, I told him, of course I'm going to write this because one day I'm going to need a good doc when I'm an old man. Well, wouldn't you know? Anyway, so we did my blood and I was just on the edge of what the cardiology association is saying, needing Crestor or Lipitor or something like that.