Music. Nation podcast. I'm your host, Dr. Steve Nosworthy. The views and opinions of guests on this podcast are their own and may differ from my own. But as always, I try to be respectful of other people's opinions, even when we might disagree. My guest today is Dr. Stort McGill. Dr. McGill is a professor emeritus at the University of Waterloo in Ontario, Canada, and a world-renowned lecturer and expert in spine function, injury prevention, and rehabilitation.
Dr. McGill has written more than 200 scientific publications on the topics of lumbar function, low back injury mechanisms, and the investigation of tissue loading during rehabilitation programs. He's received several awards for his work, including the Volvo Bioengineering Award for Low Back Pain Research from Sweden and is a recipient of the Order of Canada, the second highest merit award in the nation.
Dr. McGill has been an invited lecturer at many universities, has delivered more than 200 addresses and 70 keynotes to societies around the world. He has written four books and contributed 32 chapters to others. He's sat on the editorial boards of many journals in the physical medicine and rehab space and recently has appeared as a guest on other podcasts with Andrew Huberman, Peter Atiyah, and Mark Bell.
As a consultant, he has provided expertise on assessment and reduction of the risk of low back injury to government agencies, corporations, professional athletes, and sports teams of all varieties. Most recently, he accompanied Team Canada to the Paris Olympics. When Dr. McGill agreed to join me for a conversation, I was determined to not simply recreate other interviews he had done, by asking him about the causes of low back pain.
Rather, we delved into his career, his personal and professional philosophies on health and fitness, and he shared several inspiring stories about both professional athletes and regular people that he has worked with, and how he derives deep satisfaction from helping people change their lives. And yes, I felt compelled to ask him about his iconic mustache. Let's get to the interview. This is a question I've asked you before, and I think it bears repeating.
You are very well known for certain things. Um, the example I gave you before was, you know, people here, I'm a chiropractor. They, they think they have me figured out. They pigeonhole me into what, whatever their impression is of, of a chiropractor in my knowledge and expertise goes well beyond that. Uh, and, and to me in talking to you, um, it's quite clear that your expertise goes beyond biomechanics and, and simple low back pain.
So i'd like you if you would just comment on, what what is the main difference between, the common persona that people think of you like when they hear the name stew mcgill or they listen to you talk what's the difference between that impression or that image of you and your impression of yourself? Maybe that's an unfair way to ask it, but nevertheless, there's the question. Wow. Yeah. Well, I don't know what impression I have of myself.
I think the variation that you're describing of some people who hear my name and have an impression is that they're internet educated or social media educated versus having spent time with me either here at BackFit Pro or just at a conference. When I was a professor, I used to find the most valuable experience of going to a conference was going and have dinner with a group of students or with other professors.
That's when the real work and understanding of individual viewpoints is acquired and honed. So would it help to summarize what I did at the university and it may if anyone's interested stimulate them to look at what.
Was performed and maybe why i have some of the opinions that i have that extend beyond biomechanics yeah i think that would be very helpful and i'd like to also if we can both remember to come back to this for you to you know maybe point out a couple of things that a couple of things about yourself that most people wouldn't come to know if all they knew was you on the internet like watching, watching a podcast interview or watching, uh, there's videos of, of you out there, uh,
you know, doing an assessment with certain people or, you know, showing someone how to do a proper pull up or for example. So, you know, start with that. Like, what did you actually do at the university? And then maybe lead into, here's a couple of things that people don't know about me and my background and it can be anything. It could be professional. It could be personal. Okay. I started at the university, as I said, as a professor in 1986, and I just had one question.
And this would bother people a little bit because normally a new professor has to have a hypothesis. You write that into a grant, you submit that grant, and this is the hypothesis that I'm going to test and I want money for. Yeah. Well, I was never like that. My question was, how does the spine work? It's not a hypothesis. It's just a question. How does the spine work? So over the years, a few colleagues would have fun with me and they say, oh, McGill, you're such a spine slut.
You will do anything with anybody at any time as long as you can learn something more about the spine. So if I would work with a surgeon and attend surgery or work with a team, study the injury patterns.
I would be invited to the team's training camp and I would meet with the medics and we'd be sitting up in the stands there and we would have the idea, we're watching all these players, we were discussing them and I'd say, good, get out a piece of paper and let's write down our hypotheses being who will be hurt and where by the end of the season. Put it in the envelope and that's going in your desk. And that doesn't come out till the end of the season.
And let's see how good we really are if we think we can predict injury by watching them move. So, you know, just fun things like this. How does the spine work? Anyway, the first laboratory that we started in 86 was equipped to measure internal loads in the living person. So we would film them three-dimensionally moving. And then the big step was the virtual spine.
So the computer technology was just at the point where we could take CT scans or MRI scans, which are serial slices, stack them, and then recreate that individual's spine, their musculature, the ligaments, the discs, etc. That was called the virtual spine.
The instrumentation measured the spine curve, the external mechanics of load on their hands and working through link segment dynamics, figuring out the external mechanics, the loads on the spine, and then using electromyography of electrodes around the body, figuring out muscle force, stiffness, stability, etc. Etc., allowed us to measure the stress concentrations on the actual tissues. Interestingly enough, in most people, the stress concentrations was where the pain was coming from.
Not at all, but in most, which was fundamental. Then I realized I didn't know the injury processes, so we took cadavers and we would apply the loads to the spines and the various tissues of the cadaver. So we learned very precisely what are the pathways to disc herniation? How do you fracture an M plate?
What really causes spondylolisthesis? And as it turns out, it's a little bit of anatomy with the set angle, plus the cycles of load, plus the brittleness of the bone, etc. Then I realized, boy, all of these people are coming into the experimental research clinic and, I'm reading the radiology reports, but there's no link back to the mechanical causation pathway. So we developed a radiology suite.
I acquired some money and we got x-ray machines, micro-CT, ultrasound for living people, etc. Then the dean asked me, well, okay, hot shot, not using those words, but that's what he meant. And why don't you start seeing patients and test your science to see how good it is? So I started the experimental research clinic. But remember, I didn't have the constraints of traditional medical training or funding models.
The patients would come in and I set aside two hours to assess them and give them my opinion as to what is going on. And then that will inform what they should and shouldn't do. You know, Steve, after the first year, I changed that to three hours. Well, this was unheard of. My medical colleagues said, what are you going to do with people for three hours?
Who's going to pay for that? Anyway, the other unique feature of that was we followed up with every single patient we ever saw in the history of that clinic. We know exactly our efficacy score for the different categories. You know, is it discogenic pain? Is it neural arch pain? Is it pain exaggerated because of the fear that they have of losing their job and now having five mouths to feed at home?
You know, all of the subcategories. The next pillar that we used, and I developed being a spine slut, remember, was I realized as I saw patients, clusters were forming. I was paying attention. And so why was it gymnasts? Had quite a common presentation as they were coming in. Crossfitters had just started. Why are they coming in with, again, it was almost always discogenic pain. And then in my work with in different sports, I would see how come this baseball team has zero stress fractures?
The next baseball team has four spine stress fractures. It wasn't the game. It was the strength coach who was causing the stress fractures in their back, not realizing the mechanism and that biological capacity has a finite bound. And you just can't keep bending the pars, which is the bone that was stress fracturing in their back, back and forth over and over and over again, because eventually it will crack. And if you keep going, it will fracture.
So that came from our study of, uh, from, uh, study in clusters. We, uh, won an award. Actually, we had the longest longitudinal study of the Toronto police force, the ETF. And, you know, the things that we learned, you know, where is the most dangerous place in terms of musculoskeletal injury for an elite SWAT team police officer. And people will think, oh, well, it's rappelling down a building or, you know, a hostage situation. No, it's the weight room.
And interestingly enough, the ones who push themselves to have the highest level of fitness had the highest injury rate. So, you know. And you would almost expect that, right? Because you're, I mean, by nature, you're pushing the band or it. Yeah. Yeah. You and I would, but not some of the strength coaches. They always think, oh, being stronger is always better.
Strong is always better. No, it isn't. There is an optimum for enhancing resilience as a police officer, as there is for every single athlete. Oh, I would love to drill down on this idea of what is optimal strength. Do you have a sense of that, Of course, do share. Right now, I am perceiving that because of the internet, there's a lot of people who are jumping on the bandwagon, get stronger, get stronger, get stronger, do Olympic lifts, and that kind of thing.
I'm old enough that I've seen quite a number of true Olympic lifters. And I've followed them through until they're, well, I've got one guy who's in his 80s. Do you think he's the most capable 80-year-old right now? I imagine that kind of training takes a toll. Well, that particular one is on a walker. His shoulders are shot, his knees are shot, his hips are shot. Now, I'm not saying that I may not be there myself, but, you know. Optimal strength is one that suits your body frame, first of all.
There are some people, through the right choice of their parents, they can carry a lot more strength and they're going to be fine. There are others who will never carry that strength without paying the price to their joints. There are some who move well and can utilize that strength, and there are others who are someone put a V12 engine into a jalopy and it tore up the rest of the frame. So we're starting a little bit with genetics there.
What are the demands of their life? Is the strength sustainable? And I will say this, and again, people will disagree, but that's fine. The stronger the person is, the less of their life they will carry that. Now, I'm talking about extremes, people who come here as back pain patients, and I'll say, what's your goal? And they say, I want my next deadlift record.
And they're 33 years old, they've got an inflate fracture, a disc bulge, maybe more, sore hips, torn labrum, and they're saying, I want my next. And I'll say, who's paying you a million dollars for the next world record? Not world record, sorry, your next personal best, which is done in your basement. And they look at me and I'll say, let me ask you something. And say they're a 56-year-old. And I'll say, how old are your kids? Oh, I got a 30-year-old son.
Yeah, do they have kids? He says, yeah, just had our first grandchild. I said, how about this? Would it grab you if you could be the best rocking 80-year-old on this planet, playing with your grandson, I'm taking them fishing, et cetera. And they stop and think and they really pause. And they say, well, I've never really thought about it that way before.
And I said, well, on your current path, if you want your next personal best, the chance of you being that very capable, sufficiently strong 80-year-old diminishes. And uh that rocks them a little bit and then if i can get them to buy in a a lifespan longevity kind of a goal, we have a much better chance of improving their health that's sustainable. That is not maximum strength. It is sufficient strength. But I've given you that it is a context given their frame, their injury history.
How successful are we to adapt some base robustness now, given their injury history, to get them through to that? So I can't give you, unless we have a person with us, great, we'll assess them and we will establish what sufficient strength means for them. But of course, there are some generalizations. If the person has, and I know where you're headed with this, you want generalizations and darn, you're going to force Stu to give them to you.
But what our research showed us over the years, there are some baseline things that Most people, if they can do this, they're sufficiently strong. And I go back to, you know, when I was working in the NHL, National Hockey League, I think over the course of three or four seasons, we had five sportsman's hernias with different teams. Do you know? And that's a torn internal oblique or external oblique abdominal wall muscle.
When we met uh we would go back then and look at their fitness scores every single one of them not one of them could hold a side plank for a minute now you're asking me what is an nhl player doing who is at that level of physical ability and they can't hold a side plank they're terribly, out of whack, out of balance in their physical training. Anyone who could hold a side plank for a minute, we never did. Now, this is anecdotal. There's only five cases, but it's a hypothesis.
So my colleague at the university, Jack Callahan, he would take back pained people and normal people and then just measure their side plank. Those who had longer side planks could stand longer without back pain. In other words, the people who are getting back pain. Now, again, is that causation or is it correlation? I think it's probably a little bit of both. But anyway, I know, Steve, you're asking me for generalizations. Most people should be able to hold a side plank for a minute,
and that should be symmetric between sides within 5%. Because if they're asymmetric, that increases their risk of future back pain as well. Now, We get into the discussion, have I ever measured a professional golfer who is symmetric right and left on the side plank? And the answer is no, I never have. But every single pro golfer who comes to see me has a back pain history playing a highly asymmetric sport.
And by the way, if I had a professional baseball pitcher, would I demand and expect and have the goal of symmetry? Absolutely not. They're an asymmetric elastic athlete. So, do you see how the nuance of all of this just continues and continues, but you want some generalizations? So, it would be, now, maybe your shoulder is sore, and that is the reason why you can't hold a side plank. It's not a spine or a core endurance issue.
So we might have to do a side laying lateral leg hover as a surrogate for the measure of, is it as good as a side plank? No, it's not. It's a surrogate. Anyway, does that help? Yeah, no, that's helpful. And it leads my brain down a couple of different avenues. Yesterday... The very first thing you said in this part of the conversation was a lot of it has to do with genetics and, say, body style.
I showed my dad a video of the guy recently breaking the world deadlift record, you know, 1,000 plus pounds. And I made a comment to him. My wife was there. And I made a comment like, these guys are all built the same way. If you look at high-level powerlifters, strongmen, there's a phenotype that lends them to that type of capacity. Obviously, training becomes very important. And you can go to the other extreme and you look at Kenyan runners.
You're not going to expect them to deadlift tremendous amounts of weight. And so I totally understand that body habitus, your phenotypic expression, how thick are your joints and your bones, and maybe we can make some correlations with ligament and tendon strength as a result of that. So I totally understand, totally get that. But what I want as a professional is I want, and maybe we'll never get there, but I want a set of basic guidelines.
Like one of my great interests, because of the types of people that I work with who are, as I mentioned before, tend to be the sickest of the sick, not with disease, but with dis-ease and dysfunction. And many of them have lost what I call exercise tolerance. They've either had to greatly reduce their physical activity to match their performance and recovery capabilities. Some have given up on exercise altogether because at least they perceive that anything they do is problematic for them.
And so I, as a clinician, I'm always asking myself, number one, when is the right time to get this person into an activity or an exercise program? And I do make a distinction between those two things, activity versus exercise. And how do I blend that with my understanding of their, what I call their metabolic tipping plan?
And that's their ability to basically perform and recover as perhaps dictated by their inflammatory state, their energy metabolism systems, and a couple of other things that we could throw in there as well. And so the question is always, where's the starting point and how quickly can we progress them? Because as you said, one of our prior conversations, like, you know, there's, there's an infinite ability. No, I'm sorry. There's a limited ability to perform and recover.
And when someone's injured, that goes down. And I see the same thing from a metabolic standpoint to the point where people are so metabolically compromised and deranged that even, you know, walking a block is challenging for them or doing their household chores is challenging for them. And so I'm always trying to, trying to develop for myself and then to share with colleagues, how do we, how do we get someone into an exercise and activity program for the benefit of their whole body health?
And, uh, I, I shared with you before that when I started thinking this way, one of the very first things that I adopted was the McGill Big Three, just as almost what I call a low load preparatory phase of training where I might have somebody spend six weeks every other day doing the McGill Big Three and doing some shoulder girdle stabilization exercises.
And watching how they can perform and recover and handle that tells me a lot about how quickly I can progress them into, say, gravity dependent exercises. And then full body exercises, whether it's as simple as an air squat or a thruster with nothing in their hands, for example. And so I know I keep harping on this, like, what are the basics?
What are the baselines? Because for me in my world, if I can find that lowest common denominator and then progress people from there to some semblance of sufficient strength, sufficient mobility, sufficient flexibility and so on, then I'm doing the best that I can clinically to help these people live a good life 10, 15, 20 years down the road from wherever it is that we're starting from.
I don't know if that helps you clarify what my thought process is, or I don't even know if there's a question in there, Stu. Well, I can riff on the topics that you brought up. And that was a great essay that you just wrote, by the way. Well, you know, you started out talking about phenotypes, and I just have so many friends in this whole area. Chances are I know the person that you're talking about who set the deadlift record. But, you know, I've learned so much from someone like Ed Cohn.
And if anyone's in the powerlifting world, they will know the name Ed Cohn. And Ed is just built to lift. But, you know, incredible strength of mind and personality and all the rest of it. And he's absolutely very different from a Kenyan runner. One of my good friends is Shane Benzie, who wrote the book Lost Art of Running, and he has spent years living in Kenya, working with, coaching, and studying the Kenyan runners. And you're absolutely right.
These are not Ed Cohn. These are elastic, tuned elastic athlete with beautiful upright postures, tuning the elastics to store and recover energy to enhance efficiency. You know, nothing to do with Ed's athleticism and a totally different definition of sufficient strength. But both are world class at what they do. But I'm going to go back to a patient who I saw yesterday. Just a lovely fellow. And he came to me and he said, I used to be over 600 pounds.
And he came and he was 300 pounds and not a tall man. But what a lovely personality. And, you know, I tried to understand what the pathway was leading him to becoming 600 pounds. And he, you know, had a challenge with the pandemic and, okay, I can understand what happened and allowed him to become a prisoner of his room. And he could lay in bed and walk to his computer and go to the toilet. And then he became a prisoner of that room.
But he started to work with one of my grand old friends who used to be on our Olympic team. A fantastic strength power athlete, but he now has debilitating back pain. And I think what you were talking about with some of your people, they are an extremely low level and they're extremely fearful and they've given up on exercise because it's always hurt. So I'm trying to give a background now for the challenge that I had yesterday.
And here is this fellow, he's lost 300 pounds, half his body weight, but he's still 300 pounds through caloric deficit. He can't go any lower. His metabolism is so slow, he's got to do some physical activity to change and reset the caloric expenditure side of the equation. So, can he walk? Yes. Well, we did some walking training. Again, from my experience of the Kenyan runners, can we use some elastics now and some body positioning so we can walk pain-free?
Still 300 pounds. That's hard on your ankles and your hips and your knees, et cetera. But the key is intervals. And I think this speaks to your question of how do you start dosing this? you said they can only walk for a block. Great. Walk to the end of the room and back and do it every 15 minutes. So the lower level that the person is starting from, the principle of graded exposure is try and have a shorter interval, smaller dose more often.
And then as they start to gain a little bit of capacity, the dose becomes larger, but so does the time between the exposures. And in the extreme, you can become Ed Cohn. And even though he was by far the best deadlifter in the world, he really only trained once, maybe twice a week, but he spent that much time between the exposures because of the intensity of them. So that is a little bit of a scientific principle in this idea of graded exposure.
Do you know, sorry to jump in here, but you know Marty Gabala at McMaster? I know Marty well. Yeah. So I interviewed Marty last year. We have a mutual friend, a guy I went to chiropractic school with, and he was the one, I don't think he coined the phrase, but he was the one that introduced me to the idea of exercise snacking. Well, Marty really is considered the father of HIT by intensity interval training. Yeah.
Yeah. Yeah. In fact, to this day, my interviews with him are some of the best, the most downloaded and listened to episodes in my, uh, in my Funkmandation podcast. Yeah. Yeah. No, Marty's fabulous. Yeah, he certainly is. Uh, sorry. And I know I interrupted your train of thought. I just wanted to bring his name into it. back to you. Well, and then you mentioned bird dogs. And I was thinking yesterday, okay, first of all, my client needed permission to do physical things.
He was petrified that with his body and its current condition that he might create an injury and more pain because he came to me with back pain. But it really was spine hygiene or movement competency showing him how to squat. So that same style of shortstop squat that we talked moments ago with that elderly woman at the medical school, I showed him. And yeah, but we expanded it with him. We did the shortstop squat. And then I said, now reach across your body and touch my hand over here.
And he reached out. Oh, yeah, that causes pain. I said, why did it cause pain? He said, I don't know. And I had to remind him yet again that your pain is caused when your spine gets out of position. How do we keep position? You're going to reach across, but turn your hips. Put a pointer on your rib cage, a pointer on your pelvis, and those stay together. It doesn't cause pain, does it?
No, it doesn't. Why hasn't anyone shown me that before? So I got him to do a shortstop squat, reach across, turn the hips, push his hips back a little bit further, pull his hips through, square up, and relax. Let all of the control go. Just relax and hover. He says, yeah, that didn't cause pain. This was monumental in changing his opinion of movement being something to fear versus movement being liberating and now allowing me to accomplish that.
So that was the first step, giving him permission to move, but also showing him a technique not to trigger his specific pain mechanism. Then we got down and we did bird dogs. It was a challenge getting down and then to do a bird dog because his shoulders were also an issue. Okay, well, there's bird dogs and then there's bird dogs. And here's where the expertise came in. I showed him how to do a bird dog, and his arms were way out in front of him. He says, oh, my shoulders are sore.
I said, get your hands underneath your shoulders, your knees underneath your hips, and lift your tail. Okay. Did a bird doggies. Well, that hurts my shoulder that he's supporting 300 pounds with. I said, good. Grab the ground with your hands and try and pull your hands to your knees. Now, you with your training knows what I just did with his back. We turned on the lower traps, trapezius, not trapezius, lower trapezius, serratus anterior, and a little bit of lats.
And all of a sudden I got the, I tricked him into a shoulder stability pattern. So now his shoulder didn't hurt. And I said, now push the earth away. And now do the bird dog trying to pull the stance heel of your hand towards your knee, took his pain away. So, you know, that was important because it now gave him another tool to really integrate this goal of he's got to have some caloric utilization now because he's maxed out. He's so calorie deficit.
His reset is now 300 pounds. He wants to get to 200. But anyway, it was such a wonder. And I called him, as I always do, the next day. So this, what's today? Thursday. I saw him Tuesday. So I called him yesterday. And he says, yeah, on the verge of tears, I haven't had any pain. I gave him a lumbar to put in his low back. So the person who drove him here, he is almost five hours through the snow. And I said, yeah, I didn't have any pain in my drive home.
So it's just figuring out his mechanism and giving him permission to move and then showing him a few tools so that he realizes, wow, this doesn't hurt me. I'm safe. And it's what I need now to meet my goal, which him, he still needs to lose another hundred pounds. But that is the.
Scientific reality he needs caloric exposure now maybe in the beginning what you did was you removed both a physical as well as a uh like a perceptual block to making that next step right you asked me earlier where's the misperception of of me people say oh mcgill's biomechanical never considers the psychosocial, full biopsychosocial rubric of pain. And anyone who comes here says, wow, that's the most biopsychosocial assessment and intervention I've ever seen.
So, again, there are people on the internet who. They haven't contributed to the science. And so, again, social media, they want to gain exposure by misrepresenting other people, I suppose. I would imagine that when, you know, I approached this interview with you with the express intent of not doing just another Stu McGill interview where all we did was talk about back pain, you know, because I knew. It's been refreshing and fun.
Yeah, well, I knew that there was more to you and more to your expertise, and that's really, you know, what I wanted to bring out.
You know as you were talking about this gentleman and, I'm sure it's more multi-dimensional than this but being confined to his room and being that large he had such a high mechanical load on his spine but being confined to such a small space and unable to really move all that much he would have fallen into such states of disuse atrophy, and it made me think about, And I'll bring this up particularly, like in another month I'll be flying to
California to teach a weekend seminar on, we call it brain chemistry, but it's about a lot more than that. And I usually start the entire weekend seminar by bringing docs through kind of like the different developmental stages from infancy to adulthood, so to speak. You can just, if you'll bear with me here for a second, and I think anybody who either has children or has spent time around infants will recognize this. You know, babies come out of the womb and they're completely spastic.
They're, you know, all over the place. They can't control their eyes. They can't control their head. They're just moving spontaneously. And as the brain begins to develop, the first thing it learns to control is the eyeballs. That's like literally the first motor system that begins to mature. And because the ocular motor system is linked to the vestibular system and to the intrinsic spinal muscles, the next thing that develops is some semblance of cervical stability.
And those get yoked together to the point where just even after four or five weeks of life, a baby can see something across the room and turn their eyes and their head to look at an object of interest. And then as they continue to develop beyond that, And that stabilization of the spinal structure, which at this point doesn't have any curvature to any great extent, and I should say it's a big C curve, it doesn't have a cervical or a lumbar lordosis.
And as these core systems develop, we get the cervical lordosis, stabilization progresses caudally, and now we get stabilization of the pelvis.
This gets combined with the ability to turn over sit up then they can stand then they can walk they then they can run and from a neurological standpoint this this creates the platform from which all higher cognitive functions develop like there's a reason why most children don't start talking until a certain age like the the motor system has to develop before we can acquire language in most cases, right? There's always outliers and that may be actually a sign of a problem.
But, and maybe this is the bias of a chiropractor talking. I look at the spine and spinal integrity in many ways as being foundational to health and wellness. I think it's a critical part. And it's not just because it's what allows us to move and explore our environment and to do things, say, with the grace and beauty of a ballerina or an elite gymnast. The influence of the spine and capacity of that to neurological health is scientifically undeniable.
And even if we go into the, you know, the, maybe the clouded history of chiropractic and its origins, you know, back before chiropractic became known as a back pain modality, people in the early 1900s went to chiropractors because their guts didn't work. You know, they had indigestion or they weren't sleeping. I mean, chiropractic in its origins was a true healthcare discipline. And then we got pigeonholed into back pain and neck pain, which is fine, and it still serves a purpose.
But I love talking to people like you because you see things differently. Your experience is different. And everything that you just walked me through in terms of meeting people where they are and treating them as individuals and working to remove barriers to allow them, to have basic functionality.
I look at that and go, if I can get, if I can get someone to go through that process and open their mind to the possibility of doing new and different things, I know that I'm going to have a great result with them. It doesn't mean they're going to be a hundred percent and I can't guarantee when that's going to happen, but I, I look at, um. I look at motion and movement as a key component of health, wellness, and fitness for so many different reasons, but the spine is integral.
And I think we can track that all the way back to how neurological systems are designed. And I could just keep going on, but I'll probably get lost in my own thought process. But what's your response to those things that I just shared from my perspective? Well, again, I'm so enjoying this. I was jotting down a few things as you triggered them and as you spoke. So I'm just going to go back to the client that I spoke of a couple of days ago who was and continues to be trapped in his body.
So yes he still has a goal of losing weight but why what is the real root of all of that and it came out working with him he says i just want to socialize i want to go out and meet people and he's just starting to now and you know your heart i'm trying not to cry now as i not now but when i was with him and just to, you know, receive what he was giving me. And as I said, he had the most lovely personality, good looking guy. I can hardly wait for him to get out.
And, you know, again, I mentioned this started with the pandemic and you realize for some people that was. Such a challenge. I loved it. I hate to gloat. You know, my daughter was living in Australia. She came home. My son, who's lived in the U.S. his whole adult life since he was 18, he came home. I lived with my adult kids for half a year. It was the most beautiful thing for me. And yet, here was my patient yesterday who lost his 20s, he said to me.
And, you know, so this is a huge thing that, yes, losing the weight, becoming physical gives him back himself as a social being. And so, you know, then you started to talk about the ontological development and how, first of all, the eyes start to move and whatnot. And another old friend of mine, Pavel Kolej, the person who has really developed this idea of DNS, dynamic neuromuscular stabilization, which is really based on ontological development.
And he's really opened my eyes to the progression of the gaining of ability and how sometimes an adult with pain, it's wise to take them back to some of those people refer to them as primitive or child development principles and reestablish those. Absolutely. And I get it. And then you talked about chiropractic, which I don't know if you're aware.
I've done some fairly seminal investigation of the chiropractic manipulation, etc. And I can give an example there of we had a national level gymnast come into the clinic for back pain. Well, remember now, we just don't assess them. We put on full instrumentation and measure them while they're doing things. And it was a bit curious. They said, you know, I also have a pain. And they appointed laterally to their oblique wall. And they say, it's just nagging right there.
And we put our electrodes right over it. And then we tried to get them to relax and that muscle wouldn't relax. In other words, the motor units and neuromuscular compartments in the abdominal obliques isn't one. In other words, the external oblique is not a muscle. The external oblique has many neuromuscular compartments within. The area where they said is always sore, it never relaxed. It was a local area of a spasm in their muscle. Well, then we had a chiropractor manipulate them.
Within 300 milliseconds, now this is going to inform a short loop reflex within 300 milliseconds that spasm was about a half so it was you know this controversy does spinal manipulation affect neurology distal in the body that's a huge question well there was a pretty powerful piece of evidence that wasn't near the spine that was around in the abdominal wall. And yet that neurology and whatever was the source of that spasm, a short loop reflex was stimulated and changed immediately.
So where the spindles stretched and created a control-alt-delete, shall we say, to that pattern, that would be my hypothesis and that's all it is. Maybe I'm wrong. But anyway, the implications of that. Of distal influence is huge. And then you got on to talking about the dexterity of these engrams. And just to go back to myself, I'm only using this as an example. But again, at my age, and I have to face the fact that I'm not going to become more physical, I'm only going to become less.
And every day when I get dressed, I typically would stand on my left leg, put my right leg into my underwear first and in my left, just a habit. It's what I do. Well, now I reverse it. I put my left sock on first. I try and do everything in reverse. And then I will stand. Do you know the stork in karate, and I'll just stand in the stork. Can I hold it, lock it, and don't fall? Then I go in and brush my teeth. I'm right-handed, very right-handed.
I'm going to brush my teeth with my left hand. Man, I have to really work my brain to brush my teeth left-handed. So I play these games just living life, challenging myself in balance, neurological dexterity, uh, et cetera. So I, I don't know if that helps or, or it doesn't. And to that last point, like from a, from a neurological standpoint, particularly, um, you know, you see this a lot that, that people get older and they get concerned about their cognitive capacity.
And so they, they become experts in crossword puzzle or Sudoku and, and they do the same thing over and over and over again. And, um, you know, one of the things that we teach practitioners in our brain seminars is that, well, I guess it's no different than in physical training. Like if, if I hired a personal trainer who was good at their job, they would put me through a battery of tests, find out where I'm weak and train me where, where I am weak.
They wouldn't have me just keep doing the things that I'm already good and strong at because my interest is general physical capacity and preparedness, like I don't want to be an Ed Cohen. I'm certainly not a Kenyan runner. I want baseline capacity across multiple domains that we might include in the word fitness. And it's the same thing with the brain. If all you do is Sudoku puzzles, you get really good at these number puzzles, but you might learn, you might lose some language capacity.
And so from a brain standpoint, it's important to do things that you're not good at, like brushing your teeth with your off hand or getting dressed in a different order. Like you said, left leg first instead of right leg first. These things are helpful. And, you know, any one thing like that might not be all that great. But if you do a bunch of those things, then they sum up over time to put yourself in a position where your brain is better off somewhere in the future to do that.
The other thing that I wanted to point out when we were talking earlier that came to my mind about neurological development, when we're kids, we move through life three-dimensionally.
We hop we skip we jump we tumble we twist we turn we roll and then we become adults and we basically sit up and down and we move predominantly straightforward and we lose to some degree the capacity to generate and tolerate rotational movements or you know you were talking about the gentleman and obviously he would have other challenges but sometimes just the ability get down on the floor and get back up again, which we could train, for example, with some version of a Turkish getup,
which I think is a fabulous exercise. But I quite often think about how much we lose because of the connection between movement and neurological and cognitive health. How much do we lose when we stop doing the things that we used to do all the time and naturally when we were children? And if you were to look at all the athletes that you work with.
Do you see any correlations? Like you've talked about golfers who swing in one direction all the time, pitchers that throw in one direction all the time. They practice these asymmetrical movement patterns. But then we have gymnasts, for example, that do flip and twist and turn. And it seems just by me watching their routines that they tend to do it to the right and to the left.
Do you see from your observation do you see any patterns that emerge um and i don't want to constrain your thoughts just to like injuries but any comment i think you have would be useful but do you think do you see any difference between sport practitioners where multi-dimensional, and angular movement and the impact on their body is different than someone who's just a repetitive single motion sport practitioner. I think I know where you're coming from with that question.
And do they end up in a different place when they're 70 years old? Is that the question? That's part of it. Yeah. I don't know except to say that if they were an impact or a collision athlete, they are in a very different place. Also, if they were a high-level gymnast, I don't see many of them at our age where they're as physical as we are. But of course, it's a biased selection in that they're coming to me with back pain. Chances are, you know, I had an NFL linebacker here not too long ago.
He was in his 30s and he had two knee replacements and two hip replacements. In his 30s. Yeah. Well, late 30s. Couldn't get off the floor. You know... I, I, I've had another, uh, very, uh, household name, shall we say, uh, from the NFL. And, and he said, oh, Dr. McGill, if I was, uh, if I'd known it was going to hurt this bad, I never would have done it. Oh, you know, the, the accolades and that he has received in his life.
And he would have given all that up not to have the pain that he, that he has now. But again, these are, are one of us. There are some very, very successful, uh, athletes. I, I gave a lecture actually, uh, to the NFL, uh, probably five years ago, just before the pandemic on, uh, returning the NFL player to civilian life.
And the challenge, because we know that every year you play in the NFL, and I forget whether this has been updated or not, but it was something like every year you play is two years taken off your life, statistically. And is that playing above a certain level is like collegiate or professional? No, this was in the NFL. So every year that you played in the NFL, it took a certain amount of time, a substantial amount of time, statistically, from your allocated years for your age group.
Aside from these impact-type activities, are there any other physical activities that you see that are inconsistent with goals of longevity and quality of life? Well, look at every high-level sport and athlete. Do any of them outlive the rest of them? So you're saying pretty much anything to the extreme? Right. It's a toll on your body.
And there are some people who train like Olympic athletes, and they're a computer operator, not realizing that if they don't go quite as hard now, they will have most likely a longer health span. Some of them are just way too extreme for a variety of reasons. But anyway, that's my observation now of watching these people for over 40 years like you. And you recognize patterns.
When I go to a medical meeting, which occasionally I will go to as an invited speaker now, and all the speakers sit at a table, and what do we talk about at lunch and dinner? Well, I remember the last time the dermatologist who came in and gave an overview of dermatology and what they'd learned over 40 years, he says, well, I love public hot tubs. They keep me in business. And then, you know, the orthopedic, there might be a spine surgeon or a hip
surgeon. And, you know, he can predict who's sitting in his waiting room. There's a pattern there that they've noticed. people who do certain things increase their risk of becoming a patient for that particular. Yeah. You know, we all know these kinds of things. And I don't know if that. No, no, I mean, it's, it's, I think it speaks to the idea, like, I'll go back to what I was saying before, like, if, If you asked, let's say you take 15, 20 people off the street and ask them,
you know, what are the best examples of fitness? You're going to get a variety of answers that all fall to the extremes, right? The Kenyon runner, the extreme VO2 max, the extreme strength athlete. I would argue that neither of those two extremes represent true fitness. I think fitness is multidimensional, uh, in the sense that it probably encompasses strength, speed, power, endurance, agility, mobility, cardio respiratory capacity.
Um, and you know, for me personally, just before you get too far ahead of me, Steve, can I interrupt and ask you something? Yeah. This is a really interesting conversation that I've had with a lot of different coaches and health professionals. Who is the best athlete? And is there a sport that you would link to being the best athlete? And you're not talking about skill, you're talking about... I might be. You might be. I might be. But that was a simple question. What and who is the best athlete?
So, to start my line of logic on that and how I've answered that question in the past, if you take a long-distance runner, they have a unidimensional athleticism. If you are a swimmer and you are a world record swimmer, and I've worked with a number of world record swimmers, they are unidimensional athletes. Are they the best basketball player? No. And one of the examples that I would use there is the sport of being a triathlete, obviously dominated by endurance.
And when you're on a bike, it's endurance power. Is the person who wins the first leg of the event, which is the swim.
So their athleticism in other words a great swimmer will beat all of the uh triathlete swimmers however to be a swimmer you need to be a fish uh it is a great advantage to have loose joints big floppy big feet act like flippers with a loose ankle joint that's the kiss of death to run where you need to the elasticity to store and recover elastic energy and, and basically be a kangaroo or a bunny rabbit in, in, in terms of the most matched athleticism.
Because if you look at the best runner, they won't be able to swim. Uh, you know, again, I'm talking generalizations of course. There are, there are those triathletes touched by the hand of God who really have the ability to do all of these things. So those kinds of sports, to me, are not the best athletes. Those are the unidimensional athletes, and they're really good at one thing. Yeah. I've asked this of docs who are in the Olympic program for their country.
So they're exposed to a lot of different sports. And then when they're, the Olympics only occur once every four years. So they're doing things that are usually associated with very high level sports teams and that kind of thing. If you look at a basketball player, a basketball player has to have pretty much of it all. They are agile. They can change direction quickly. They have beautiful hand-eye coordination. They have game savviness and sense strategy.
A certain amount of endurance, a certain amount of strength, a certain amount of speed from an all-around perspective, that's pretty good. Some of the uh nfl football players before they get too banged up. I was placed on the head of an nhl hockey player who skating is is uh interesting, it's not running it's not ground-based yeah um anyway there's a there's a thought for some of the best athletes, shall we say. Who's your, what's your favorite type of athlete to work with?
And that can either be sport-based or maybe both. Comment, sport-based comment mindset. Well, this will surprise you. I'm not a sports fan. In other words, I would never choose to watch sport. Never. That's my life. And the only time I watch sport on TV is if one of my clients or patients is on the screen.
And I think it was three years ago in the Super Bowl, which is the, uh best players in in the nfl i had one guy in the world series i had a patient and then in the nhl stanley cup i had a patient so all in one year all in one year yeah it was uh interesting do i have a favorite the answer is no my favorites are the ones where i get the internal satisfaction action of changing their life. So either I was able to get them out of pain and they were.
Satisfied that they'd done their best and now they're ready to retire. Or, wow, I'm here in BackFit Pro HQ. There's several posters around the walls here. Thank you for adding a few years to my career. Thank you for adding a couple more records. So those are ones that I felt satisfied with, shall we say. And I'm not saying I can help everybody because I can't. But anyway, I don't have a favorite sport. I will say this. I'm a little bit mesmerized by anyone who's really good at what they do.
If this person is the best spine surgeon, I want to hang out with them. I want to see how they think. I want to know their habits. I want to know their skills. Um i have some people who live in the the small town of gravenhurst here who are fabulous at what they do they might be a musician uh they might be a nature artist uh they might be a canoeist, I'm going to seek them out. Yeah. So I love mastery. And it goes way beyond sport.
I remember, here's a funny story that it's rather oblique and you might enjoy it, though. When I was a PhD student, I was going to quit. And the reason I was going to quit was I was terrified of public speaking. It was so difficult for me to go to a medical conference or a biomechanics science meeting and tell them what I'd been working on. And even though I was the expert at what I had done, it was so difficult for me. And I was going to quit.
And I remember 1983, the University of Waterloo hosted the world's biomechanics conference.
And uh there was a very famous spine surgeon there named harry farfan and i went to lunch with dr farfan and he said oh that was a good speech you gave and he asked me a few questions about my work and he said so where are you headed next and i said professor farfan or dr farfan i i i'm struggling i i don't know if i'm going to continue with this and this will surprise a lot of people because I made my life living speaking.
And he said, well, I'll tell you what. He says, that was a good talk you gave today. Just keep doing it. And if you ever screw it up, they'll never ask you back again. And your problem is solved. Problem solved. And that was what I needed to hear at that time. And I fought through it. But I'll tell you, even today, when people ask me to come and give a talk And it doesn't matter if it's in front of 10 graduate students or 10,000 people at the National Safety Convention.
Yeah. My knees are shaking. You know, it's funny you say that because in the last 15 years, I've taught thousands of doctors of all persuasions. You know, I would do roughly, depending on the year, before COVID, I was doing probably 15 to 18 three-day weekend seminars a year. And even now, even after 15 years of teaching, the first 10 minutes, I'm nervous. And then, you know, just kind of get into the flow and you forget what you're doing.
And now you're just talking to a bunch of colleagues and then the rest of the weekend is fun. But those first 10 minutes for me, always nerve wracking. Same. Yeah. Well, I'm glad to hear that I'm not, I'm not alone. Well, listen, I never goes away. No, it doesn't. I know that you have some snow shoveling to do. So I do. I have one question I would like to end on, and you can choose to answer this or not. You've got to tell me about the mustache.
Your mustache, it's so iconic. It's even part of your brand. Well, it is. And the story behind that was I was always, I had a mustache since, or a beard actually from high school. That's probably the only thing I was good at in high school, but in any case.
Um and then uh my daughter who would have been a very young girl maybe four or five years of old age she and and i'd always had a beard usually a beer full beard in the winter and then just a mustache in the summer and she said dad i've never seen you without a mustache why don't you shave it off see what you look like i thought for maybe 30 milliseconds so i went and shaved it off.
And i i i was kind of surprised there's a couple of photos they're rare and uh i went to work the next day and i i walked by my colleagues who i've worked with for years they just walked by no one recognized me and then a couple would say oh my god and uh anyway uh in those days the internet was just starting. And I'd be flying to different places like you. I was somewhere in the world every month for 25 years.
And usually a graduate student or someone would be assigned to pick me up at the airport. And what was the instruction? Because there was no internet. They didn't know what I looked like. They were just a senior student. And usually the instruction was, Look for the mustache. You'll know it when you see it. But people were so upset that when I showed up without a mustache, they said, well, that's not Stu McGill. That's not what we paid for.
So I realized, darn, I'm kind of stuck with this and that my wife hates it. Does she really? Oh, yeah. She hates facial hair and whatnot, but I don't know. It is what it is by now, I guess. I've grown a full beard a couple of times in my life, and I always ask my wife, what do you like better, shaved or not shaved or goatee or whatever? And her answers are so noncommittal that it drives me bananas. It drives me nuts. So anyways, like I said, your mustache is so iconic.
I know there's got to be more stories about the mustache, but maybe we'll save that for a different time. I would love— Do you want to hear one that just came to mind since you said that? Of course. I was coming into Dublin Airport in Ireland, and you know how they swab different things as you're coming in. And the woman who did it just said, just a moment, and two burly guys came, and one came under each arm and took me back to this room.
And they said, sir, is there anything you want to tell us? And I said, no. And they said, okay, why do you have explosives on your hands? And I said, no idea. And do you know then that they went through my mustache and were getting molecules of TNT? And then they heard my accent and they said, oh, you're Canadian. And I said, yes. And they said, have you been around firearms? And I said, yes. I cleaned my guns two weeks ago. Two weeks ago. And there was residue off my guns and gun oil, I guess.
And it was still in the pores of my hands. And I washed my hands a lot because I washed my hands between every single patient. But there you go. I had gunpowder residue and they picked up a molecule. That's how good those machines are. Yeah. Well, I'm going to have to grow some facial here and go test out that theory. Yeah. Careful what you touch. That's right. Well, Stu, this has been a hoot. I really appreciate it. I know you're a busy man and your time is valuable.
So thanks for taking time to talk to me and to talk to our community. I would like to propose that maybe we do this once a year. Well, let's, let's see how it goes. Maybe next time I can come out to the rock. There you go. Yes. We'll come out and I'll, and I'll, I'll share my, uh, my favorite fish and chips place and a brew pub. No, to hell with that. Let's go out and catch one. Oh, there you go. We'll, we'll, we'll have it on the back porch even better. That sounds, that sounds awesome.
Stu McGill. Thank you, sir. I appreciate your time. Dr. Noseworthy. Thank you so much. I've enjoyed every second. Music.