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

**Peter Attia** (0:11)
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Welcome to a special episode of The Drive. For this week's episode, we would like to re-broadcast one of our most popular episodes, a conversation with Stuart McGill that first aired in January of 2024 Stuart is a world-renowned spine biomechanist who spent more than three decades as a professor at the University of Waterloo, where he founded an experimental research clinic devoted exclusively to solving back pain puzzles. He's also the author of the self-assessment guide, Back Mechanic and other seminal texts on spine health. I want to re-broadcast this episode as low back pain touches almost everyone at some point in life. Stuart's frameworks provide a clear roadmap for assessment, rehab and long-term spine resilience. Since this episode originally aired, I have referred many of my patients to it, and without exception, those who have stuck with the protocols that Stu put in place, have experienced a significant relief from their lower back pain. In this conversation, we discuss why Stuart rejects the idea of non-specific low back pain and insists on a truly individualized assessment before any therapy begins. The most common movement triggers, prolonged sitting, flexion, shear, heavy lifting, and how mapping your triggers guides effective rehab. Stuart's big three core stability exercises, the modified curl up, the side plank and the bird dog, and the right way to scale them for both pain relief and performance. How proximal stiffness lets you transmit force efficiently, boost athletic power and plug the energy leaks that invite injury. When heavy lifting is helpful, when it's harmful and why chasing enough strength often beats chasing lifetime PRs for long-term spine health. Simple daily habits, walking, posture tweaks, hip hinge practice that calm flares quickly and keep the spine resilient for decades. So, without further delay, please enjoy or re-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** (3:33)
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** (3:58)
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** (4:06)
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. And this doc knows me well enough. He said, let's run the experiment. We're doing it for three months, I'm living Peter Attia's life.
And then I love to work hard physically and finish it off with a beer, which of course, six days out of seven, I'm denying myself of that. But long story short, I have my blood done again in two weeks and we'll see if this three months experiment has paid off. He says, no, it's in your genetics, you're not going to move the marker. But my sister says, oh no, you will. She did. Anyway, thanks and no thanks. But I think I'm sleeping a little bit better. I think I'm a little more mentally sharp, but we'll see over the next hour if that's true.