Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
62: Make McGill Make Sense
2.1k Plays1 year ago
Welcome to episode 62 of the Movement Logic Podcast. In this episode, Sarah and Laurel discuss the recent interview of Dr. Stu McGill on Dr. Peter Attia’s podcast, The Drive. This interview has sparked a lot of internet commentary, so we’re breaking it down for you into what we’re calling Make McGill Make Sense.
You will learn:
- Who are McGill and Attia, and why Attia is interviewing McGill
- McGill’s rigid (pun intended) views on powerlifters vs yogis and what each group should and should not do
- Why McGill “doesn’t believe” in non-specific low back pain, a well documented and researched phenomenon
- How the biopsychosocial model of pain doesn’t exist in his world view
- Why his fearmongering and moralizing approach to movement has been so successful
- How and why he leans into storytelling vs data around low back pain
And more!
Sign up here to get on the Wait List for our next Bone Density Course in October 2024!
Links:
Episode 29 The Cues We Use Part 1
Episode 31 The Cues We Use Part 2
Episode 34 The Cues We Use Part 3
Episode 45 Injury and Safety in Strength and Yoga
Episode 54 Alignment Dogma: Spine
https://peterattiamd.com/stuartmcgill/
https://rheumatology.org/patients/joint-replacement-surgery#
Lancet Study age of hip replacements
Evidence for an Inherited Predisposition to Lumbar Disc Disease
Recommended
Transcript
Trigger Warning & Episode Introduction
00:00:00
Speaker
Hi everyone, Sarah here. Laurel and I just wanted to let you know that there is discussion of suicidal ideation in this episode. Okay? Enjoy the show.
00:00:12
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist, Dr. Sarah Court. With over 30 years combined experience in the yoga, movement and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up to date and cutting edge tools, evidence and ideas to help you as a mover and a teacher.
00:00:48
Speaker
Welcome to season four and episode 62 of the Movement Logic Podcast. I'm Dr. Sarah Court, physical therapist, and I'm here with my co-host, Laurel Beaversdorf, strength coach, and yoga teacher. Hello.
Dr. Stu McGill's Interview Controversy
00:01:01
Speaker
In today's episode, we're going to discuss a recent interview of Dr. Stu McGill by Dr. Peter Attia on his podcast, The Drive. Now, you may have already heard about this interview or seen clips on Instagram accounts, including the Movement Logic Tutorials account, also talking about this interview.
00:01:18
Speaker
because there have been a lot. We first heard about this interview from a few sources. One of Laurel's students in Tennessee tagged her in a comment on Atiyah's Instagram page. And then our friend and movement logic collaborator, Trina Altman, tagged me in it. And Laurel was like, we have to drop our planned episode and talk about this interview instead. And I was like, hell yes, we do.
00:01:39
Speaker
If you don't know McGill, he is a very polarizing figure. In essence, people either love him or hate him and neither group is willing to budge. So there've been a lot of drags of this interview on social media with the inevitable comments section, arguments. And our goal with this episode is instead of that, to give you a more thorough picture of McGill himself,
00:02:02
Speaker
And what is it that makes him such a provocative figure?
Exploring McGill's Provocative Views
00:02:05
Speaker
The interview is very long. It's almost three hours. But there are some essential themes that McGill adheres to throughout. So we've picked four clips for you that highlight these themes. And we're going to present and discuss them through the lens of make it make sense. Or as we're calling this episode, make McGill make sense. We'll also discuss McGill and Atiyah's backgrounds, the placebo slash nocebo effect,
00:02:30
Speaker
the role of group dynamics and the pressure of performance and the potential impact of McGill's very rigid position, pun intended, sort of, or the main person with back pain who might listen to this interview and then draw some not especially helpful conclusions of their own around what they should do to get out of pain based on McGill's advice. But before we get into it, let's read one of our testimonials from our bone density course.
Stacy Jackson's Testimonial & Rehab Progress
00:02:58
Speaker
And we're just so proud of it and people are very excited to be in it and we wanna share that with you. Laurel, do you have one? Yeah, this one was from early on from Stacy Jackson. She's still going strong in the course. She writes, I just wanted to share that these past two weeks doing this course has helped my hip rehab in so many ways. The barbell has a way of exposing my hip compensations when I do a squat so I can make the corrections I need.
00:03:26
Speaker
When I use kettlebells, I don't really feel when I'm compensating. I thought that was a pretty cool insight because Stacey's been in the live classes and she's been adding her thoughts and questions into the Facebook group, posting on social media about her rehab process and about how barbelling has become a pretty important part of that. So super cool to hear from Stacey.
00:03:50
Speaker
So so if if you don't know Stacy, she had a hip replacement about four months, roughly, I don't remember exactly, but about four months before we started the program. And I was her PT for her some of her early rehab for that. She's also very she's, you know, she's been a yoga teacher and movement teacher, she's lifting, she's very self motivated and self driven. And so we discussed while we were rehabbing, like would the timing of the program work for her?
00:04:18
Speaker
And I'm really glad you picked that one because it gives evidence that is completely contrary to McGill's approach to everything, which is I looked at the individual person. I know her really pretty well. I've known her for a while. She's here in Los Angeles. I've worked with her a few different times. And I knew her history of movement. I knew what she was capable of. And I saw the speed of her recovery, which was really solid.
00:04:48
Speaker
And so we together thoughtfully came to the conclusion that she could do the program. This wasn't me picking out some random person who had just had a hip replacement that I knew nothing about and being like, yeah, sure, do some barbells. I'm sure it's fine. You won't have any problems.
Barbells & Hip Compensations
00:05:02
Speaker
She definitely had to do some modifications in the beginning, which is entirely appropriate, but it was, it was actually kind of a perfect continuity for her as she was coming out of the more rehab phase to get back into the strengthening phase and beyond.
00:05:16
Speaker
She is now, I mean, beast mode. I don't even know if that describes it accurately. She's gotten so strong. Her husband also comes into the clinic and he's like, oh man, Stacy's buying more barbell equipment. I'm like, get used to it, friend.
00:05:33
Speaker
You're not suffering because of this. Actually, it's going to make your life better as well. So I don't know what you're complaining about. Yeah. And the good news with barbells is that when you have to buy more equipment, it's usually just a set of plates. And those plates are not nearly as expensive as one kettlebell. Right. And those plates are going to be used in lots of different lifts just to make whatever lift you need to make heavier, heavier. So once you get started with the barbells, the add-ons are much easier than other equipment.
00:06:03
Speaker
and cheaper. Since I bought my first stash of stuff, I haven't bought anything else. I'm getting close to needing to get 35-pound plates. Yeah, you are. I don't have to. I can still use literally everything I have and get enough, but that was over a year and a half ago at this point. There's an initial output, but then after that, it's not an expensive way to stay strong. We're telling you about this because we are going to be launching the second cohort of our bone density program
00:06:32
Speaker
later this year in October. And so the important thing is there is a discount code if you are interested in this course, but there's only one way to get the discount code and that is to get on the wait list. So there is a link in our show notes to get on the wait list for the discount code. I say you should do it. Even if you're like, you know what? I don't really think I'm interested in this. Who knows where you'll be come October. Maybe you will be, and you won't want to be like, oh shoot, I heard about this discount code back in March. And I was like, not for me.
00:07:01
Speaker
So that's the one way to get the only discount on the course and the lowest price for this year coming up. So even if you are already on our regular mailing list, you want to sign up for this discount code as well, because the regular mailing list is not going to get it. Did I say all the things I was supposed to say about that? You said all the things. All the things said. All right, let's get back to business.
Introduction to Dr. McGill & Dr. Attia
00:07:24
Speaker
I'm going to start with sort of introducing who McGill and Atiyah are.
00:07:28
Speaker
If you've never heard of him, Dr. McGill is considered one of the foremost experts on the spine and specifically the low back. He received a bachelor's in physical education from the University of Toronto, a master's of science in anthropology from Ottawa University. I had never heard of that. That sounds interesting. And a PhD in kinesiology from Waterloo University. He was a professor of kinesiology at Waterloo for over 30 years, during which time
00:07:56
Speaker
he published hundreds of research papers using his experimental research clinic. These papers fell into two basic categories. The first was assessing and diagnosing mechanical sources of back pain from live patients, so things like disc herniations, synosis, cysts, and so on. And then the second was testing cadaver tissues to see how they respond after hundreds or sometimes thousands of iterations of the same movement.
00:08:21
Speaker
and then drawing conclusions around the mechanical ways we can injure live tissue from those cadaver studies.
00:08:28
Speaker
And we talk about one of those studies in episode 54, one of our alignment dogma episodes about the spine and quite a bit about the problems around basing your conclusions about live bodies based on cadaver bodies. So we will link to that episode in the show notes for you as well. McGill has written several books. He has held numerous academic positions and he has a CV that goes on for
00:08:53
Speaker
dozens, literally dozens of pages. In short, he has dedicated his entire life and career to figuring out the mechanical sources of back pain and teaching patients and clinicians how to do the same. And there's also something called the McGill method, which is a set of three exercises that he prescribes for his patients who he believes need to build up their trunk stability. And we're going to talk about those exercises a bit later on. But I think it's fair to say that McGill is at heart an engineer and a mechanic. His first book is called Back Mechanic.
00:09:22
Speaker
And as such, he does not appear to integrate any of the biopsychosocial model of pain in his work. Sarah, can you tell us a little bit about what the biopsychosocial model is?
Biopsychosocial Model of Pain
00:09:33
Speaker
I would love to. And it's going to come up later as well. So when we talk about people's experience of pain, we think about it in three categories.
00:09:42
Speaker
to try to qualify, not quantify necessarily, but qualify what aspects are actually creating this pain sensation for them. So the bio part is McGill's focus, right? The actual mechanical tissue damage that may or may not be happening. The psycho part is the pathways that change in your brain and in your spinal cord and your peripheral nerves when you start to have pain and how are you
00:10:11
Speaker
personally set up to handle it? Have you had many recurrences of this pain? Is it connected to a trauma experience that you've had? What is the psychological component? What are the aspects that are making your pain either worse or better? Can I say something? Please. Is it also the psychological aspect? Is it also about your beliefs about pain? Absolutely. Yeah. And what you believe your pain means? Yep.
00:10:39
Speaker
for what you can and can't do, but also your future. Yes, absolutely. And this is where the fear part can come in really, really strongly for people. And my job is to help them like dial down the fear. The social component has to do with it sort of blends a little bit with the psychological component, because it's like, well, what is your support system? How are you able to manage with your pain? Do you have
00:11:03
Speaker
community that you can be with? Do you have resources to help you manage your pain? Are you able to do the things you need to do? Right? And so Atiyah gives to McGill multiple opportunities to talk about any of this stuff. And instead, McGill just takes a totally, you know,
00:11:22
Speaker
Yeah, there is a total and utter absence of any discussion around pain science, beliefs about pain.
00:11:35
Speaker
And also a total absence of any type of discussion around the limitations of what an individual can do, the importance of our society's attitude toward pain.
00:11:54
Speaker
discussion is very narrowly confined to really talking an enormous amount about anatomy. So it's video, the entire episode is video and you can watch it on YouTube, where McGill is pointing to different models to show how, you know, the anatomy of the spine tells the story of injury to a certain extent, like he kind of shows you the terrain or the territory so that you can understand
00:12:23
Speaker
what these different injuries mean specifically. And then there's a lot of discussion around biomechanics and forces and the way that forces can impact those tissues. But literally nothing about the role that beliefs and society's influence play other than the personal anecdotes shared by Atiyah mostly
00:12:51
Speaker
where he does, like you said, Sarah, convey these different aspects of his experience that I mentioned were absent, but McGill addresses none of them and immediately wants to talk about
00:13:09
Speaker
exactly what the mechanism, this is a word you're gonna hear a lot, what is the mechanism for the pain? So he wants to always point back to the anatomy of the body and specifically name exactly what has gone wrong. He's an engineer, this is what engineers do. They go into a machine, the body's not a machine, and they look for the specific problem so that they can diagnose it and then develop a specific solution.
00:13:37
Speaker
This approach often just hasn't been shown to work so well on biological tissue inside a very complex organism like the human body and in complex phenomena like pain, because there's often not one mechanism. And if there is one thing causing it,
00:13:57
Speaker
The implications of that one thing causing it cause a cascade of other possible sources or causes of pain, right? So if I've got something broken in my body and it's causing me to experience pain, what then does that do to the way I think about my injury, my pain? Anyway, I just want to say there's just an overemphasis in general.
00:14:21
Speaker
from Atiyah in his work as a health and longevity optimizer. And then I'm hearing a lot from McGill as well. There's this big optimizer energy where they'll really use a lot of personal anecdote and lean heavily into the mechanics or the biomechanics of these issues.
00:14:39
Speaker
which is just one way of many of overemphasizing individual issues and overemphasizing the biological aspect of pain. This leaves out two thirds of what we would want to consider around pain. To talk a little bit about his interviewer, McGill is a guest on a podcast called The Drive, which is hosted by Dr. Peter Attia. Attia is an MD who received his medical degree from Stanford University.
00:15:07
Speaker
and he trained at Johns Hopkins as a general surgeon and at the NIH as an oncology surgeon.
00:15:13
Speaker
I'm not sure where he's practicing at the moment, if at all, but he's known for his focus on longevity and teaching strategies and tactics, you know, hacks to live longer and healthier. He's the author of a book called Outlive the Science and Art of Longevity, which he calls the operating manual for longevity. His podcast, The Drive has over 50 million downloads and focuses on the applied science of longevity, extension of human life and wellbeing.
00:15:40
Speaker
He features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer's disease, cancer, mental health, and more. So why does Atiyah have McGill on his show? Well, we find out pretty quickly because Atiyah himself had several debilitating back pain incidents in his early twenties. He blames his back pain incidents on the fact that he was doing weight training with no formal instruction.
00:16:07
Speaker
But then there's some weird stuff where it's like it was every time he got off his bike that his back hurt. So anyway, this is personally an interesting topic to Atiyah. We know this because he talks about himself quite a bit in the episode. But we also know that most people will experience some sort of low back pain at some point in their lives. So considering that Atiyah is focused on healthy longevity, it makes sense.
00:16:28
Speaker
that he put McGill on his show. But can I just say something? Please. Something that I found kind of troubling about the way that the sort of impetus for this entire discussion was framed was like, okay, Atiyah's got this personal story. So he's bringing McGill on to share his expertise, but
00:16:50
Speaker
positioning this expert within the broader story of Atiyah, because it's Atiyah's podcast. He shares this personal anecdote of several incidences of quite debilitating back pain that he experienced while he was, I believe, late teens into what would probably be pre-med and then med school.
00:17:13
Speaker
so every three years or so. And he begins the story by talking about how he was an untrained power lifter. So he's lifting really heavy weights and didn't really know what he was doing. So he starts the story with that. Then he goes on to describe, I believe, three bouts of pain which were so severe that it prevented him from being able to do the things that he wanted to do. And he was laid up for several weeks.
00:17:41
Speaker
So here's where we have the post hoc fallacy where because this thing happened first, it then follows that it caused the other things that happened after it. What's implied is that because Atiyah lifted heavy barbells and didn't really know what he was doing, he suffered these debilitating bouts of back pain.
00:18:05
Speaker
I find this really problematic because for one thing there's no evidence given in the story that it was found to be that the heavy lifting caused the back pain and there would actually be no way to prove that.
00:18:18
Speaker
There would be no way to prove that. Like, how would you go back in time and go like, oh, see, it was this incidence where I lifted the barbell in this way that caused me to have this debilitating back pain three years later. Second of all, in the story, I think there were two points in the story where he's getting off of his bike and he hurt in his back starts hurting.
00:18:40
Speaker
So from that it would seem almost more logical to say that it was bike riding that caused the back pain but even that's not even that's not a even a remotely good explanation for where this pain came from because this type of pain was probably something that was in the making for a while. Yeah. Right. And so the.
00:18:59
Speaker
body basically just reached a threshold where the brain started to output pain because it was you know there was there was this point at which the brain was like you really need to stop doing whatever you have been doing over the course of however many years because things aren't right right that's kind of what pain is it's like a request for change it's a it's a warning signal right.
00:19:18
Speaker
So how would he then be able to say that it was the heavy lifting that caused the back pain? But this is kind of the conclusion that they implicitly draw from the linear storytelling that Atiyah takes us through.
00:19:35
Speaker
which is that first I lifted heavy weights as a teen, didn't really know what I was doing. Then I had a bunch of pain. And what's assumed is that the heavy lifting caused the pain. But my question is, OK, he's in high school, probably very high performing kid. He's going to med school, right? Eventually, so he's in pre-med. How was he sleeping during all of this? What were his relationships like? They literally completely leave out everything else that may have contributed
00:20:03
Speaker
to the injury and pain, not to mention genetics. What does his dad's back look like? What does his mom's back look like? But it's amazing that they're both so very certain about the cause. Well, it's why they're so happy to talk to each other for three hours. Each of them is reinforcing the other's core beliefs.
00:20:23
Speaker
Yeah, exactly. And this is a running theme with Stu in what he exudes as a speaker. He is never uncertain. There isn't even a remote hint of uncertainty in this entire episode where he isn't sure he knows. Right. And you know what, I would like to say about that specifically. Sorry to break in, but the big thing that doesn't really come up very much is he's not a medical doctor. He has a PhD.
00:20:53
Speaker
He's not a clinician. And one of the things that changed the most for me when I became a physical therapist is I became a lot less certain about everything because you learn that there is no certainty. So the fact that he has this sort of arrogant confidence throughout that he knows exactly what's wrong with everybody and he's going to be able to fix them all is just to me, just highlights the fact that he, in some of these cases has no business doing what he's doing.
00:21:19
Speaker
Let's maybe get into some of our clips so that we can hear the man.
Yoga, Deadlifts, and Movement Fears
00:21:23
Speaker
So this first clip is when Atiyah wants to talk about load, specifically in the context of flexion and extension and what happens to the spine. So again, very much this biological focus.
00:21:38
Speaker
But now let's talk about load in the context of flexion and extension, where you now do have within the disc, it's not just pure compression. It's actually, again, if you're in, so maybe just even explain to people, flexion is bending forward, extension is going back. So now if you have an axial load in that position, which you could easily have if you're deadlifting something or squatting something,
00:22:07
Speaker
any given disc in that, especially in that lower spine region can be under compression and tension at the same time, correct?
00:22:15
Speaker
Absolutely. I have a little bit of a story on that, Peter. It's so interesting when I say I'm asked to give a lecture to a group of radiologists and they describe very well all the subcategories of disc bulges and disc deformations and that kind of thing, but they've never been taught what the applied load nor the adaptation was. So let me paint a little picture here of the deadlifter.
00:22:45
Speaker
A deadlifter almost always gets a posterior disc bulge, as you may know. So a deadlifter is under tremendous compressive load, and if they, say, get to the bottom of where the hips run out of room, now the femur collides with the pelvis, and thereafter the rotation takes place in their low back.
00:23:09
Speaker
because the nucleus is under such enormous compressive pressure, remember this model, I had to bend it forward to get the nucleus to squirt back. So you're creating a center of hydraulic effort. Now, let's consider a person who's adapted their spine to do yoga. This is why I say, please never mix up deadlifts and yoga.
00:23:39
Speaker
If you adapt your spine to be very flexible, you adapt the type X collagen holding the type one and type two, the heavy grisly collagen and then the elastic collagen, all those fibers together. A power lifter wants them to be stiff and tough. They even wear an exoskeleton of a lifting suit to have even more stiffness and toughness.
00:24:05
Speaker
But the yoga master, that would be the kiss of death. They want nice, pliable, flexible spines. They soften the ground substance holding the collagen together. So when they bend forward, in contrast to the disc bolts going backwards, the front of the disc now buckles under.
00:24:25
Speaker
Impression. So when a power lifter, typically now, of course there are very odd cases that are the exceptions. The power lifter bends forward and crushes the disc bulge posteriorly.
00:24:41
Speaker
But when the yoga person or very flexible spine, when they bend backwards, the collagen under compression buckles. So one gets a disc bulge from extension and the other gets a disc bulge from flexion. Isn't that interesting? And it all depends on how they adapted their spine. But my final point in all of that is don't mix up the adaptation schedules. So if you want to be a powerlifter,
00:25:09
Speaker
strain, your hip mobility, shoulder mobility, but torso stiffness. Try not to, throughout the day, do a lot of bending versus the yoga master. Please stay away from the very heavy loads.
00:25:29
Speaker
What? Yeah. So what you guys didn't see while we were listening to that is that Laurel and I were just making faces at each other that I can only describe as what the fuck faces like it just it's just so okay. Let me let's unpack this.
00:25:46
Speaker
Let's unpack this. I want to start by talking about the mechanics of the disc bulge that he describes and why, in his opinion, yoga practitioners should not deadlift. And our first big theme, which I'm going to call McGill fearmongers movement.
00:26:02
Speaker
So he's saying that if a power lifter gets a disc bulge, it's usually posterior lateral, right? Back in a little bit to the side because they run out of hip mobility and then they have to do a posterior pelvic tilt. Oh no, it's a butt wink, which puts the pressure on the anterior disc. It's the model we all learned. You push on one end, the jelly and the jelly donuts squirts out the back, right? Fine. I'm not here to fight about that. I got bigger fights. So this is the accepted model for disc herniation.
00:26:30
Speaker
PS, most disc bulges are poster lateral for everyone, not just lifters. And I think it actually partly has to do with the fibers of the annulus of the disc are weaker posteriorly than they are anteriorly, but don't quote me. I don't know that for sure. And then the other thing is that recent research shows that pretty much everybody goes into a posterior pelvic tilt in a deadlift, even if it's not visible to the observer. So it's not just a hip mobility issue.
00:26:56
Speaker
Yeah, the pelvis is anteriorly tilting at the hip joint, and then posteriorly tilting at the lumbar sacral joint past a certain degree of range of motion at the hip joint. The pelvis will posteriorly tilt at the lumbar sacral joint, resulting in lumbar flexion. This has been shown to be the case before 90 degrees at 90 degrees, beyond 90 degrees of hip flexion. In any hip flexion,
00:27:23
Speaker
exercise. So squat, deadlift, good morning, Romanian deadlift. It's happening no matter what. So listen to the way that they use mechanical terms like the disc will experience compression on the anterior side and
00:27:44
Speaker
Tension on the posterior side, right? That's a T is like lead into the question and it's like these words when they land on the lay Person's ears sounds scary. Absolutely. Oh the disc is being compressed and it's experiencing tension and that immediately in the lay person's mind is something that they Worry will hurt their disc. But these are just ways of Naming applied the way you can apply force right so a commercial load
00:28:14
Speaker
Pushing force tension is a pulling force right and so these forces. Compression and tension are neither good nor bad they're neutral and in the case of dead lifting they could be beneficial right because forces.
00:28:32
Speaker
can cause adaptations to occur that are positive, right? Increase in bone density, increase in ligaments, stiffness, tendons, stiffness, muscles, strength, all of these things would make your body tougher and better capable of resisting forces. Just to go back to what he was talking about, the power lifter versus the yoga person. So he says that a person who has adapted their spine to do yoga, they have
00:28:56
Speaker
He goes into the types of collagen and whether it's been more malleable and that that results in these people getting their disc herniations out the front, these mechanical changes. I want to say something that's actually very telling and it's an enormous leap in logic. He's describing a yoga practitioner practicing yoga and softening the ground substance. This is what happens when we warm up something that's viscoelastic
00:29:33
Speaker
lengthen more readily because they're viscoelastic, right? He's describing what happens whenever anyone warms up through exercise, which is that ground substance softens, but he uses then this acute change in soft tissue to extrapolate out a chronic change in soft tissue, as in because yoga practitioners experience acute changes to the ground substance of their connective tissues,
00:29:42
Speaker
it has less resistance
00:30:03
Speaker
This then means that the change is now somehow chronic and they should never deadlift a heavy load because their viscoelastic tissues will experience too much creep and won't hold themselves together. This actually makes no sense. No sense. There's no logical way to try to connect his idea about softening ground substance in the moment of practicing yoga and then some
00:30:30
Speaker
tissue incompetency for lifting heavy loads. I don't see it. Right. Well, he's saying that this this softening is a permanent change when it's not. It's not. That's why we warm up for exercise. This is why he thinks that yoga people should not deadlift and power lifters should not bend over much during the time. When I heard that part, I was like,
00:30:50
Speaker
I was like, Oh, so I guess someone else has to tie their shoes. And then he actually later tells a story of an NHL hockey player that he treated, who now has to have someone else tie his skates because McGill doesn't let him bend over anymore. And this is this is terrible, terrible, terrible advice. There's also a moment where, you know, after they set up the Atea story, and they're like, Yeah, it was all your heavy lifting when you were in your late teams and didn't really know what you do that resulted in your bouts of
00:31:18
Speaker
low back pain with zero evidence to show that that was actually the case or like to explain how they know that. At one point in the episode, Gil's like, yeah, you probably hurt your back by bending over to unlock your bike. Right. So then he also wants to attribute it to the bending of unlocking a bike too. Somehow there's just this
00:31:42
Speaker
Inability to not attribute back injury, back pain to flexion. And this is something that I almost feel like this is a defining rule that really defines the brand of Stu McGill. Yes. Flexion is the worst possible thing. And that's, in fact, not at all true.
00:32:00
Speaker
as we now know with lots and lots of research. And, you know, it also feels like McGill doesn't really know anybody who does yoga. Like maybe 30 years ago he did when like a lot of yoga people were only doing yoga and he's looking around thinking, wow, these people are unstiffening themselves or whatever conclusions he was drawing. But he's also, he's very sort of derogatory in his language choices about people who talk about mobility. You know, he uses the term yoga master, which feels very outdated.
00:32:28
Speaker
later on when he's talking about someone that he's never even seen in person, but Atiyah is describing their, you know, deconditioning. He's like, oh, I bet, I bet she's a mobility monster. And I just, I find it like personally very offensive. Yeah, he takes, he takes a similarly condescending approach to my ears, to both people who are into performing extreme ranges of motion as some might be with yoga, asana practice, and people who are into lifting heavy loads.
00:32:58
Speaker
And here's the thing, unless you're an elite athlete, right? In which case he seems to have no issue moralistically speaking with their choices, right? If you are a professional boxer who probably, you know, has a very high likelihood of experiencing
00:33:18
Speaker
some type of dementia later on in your life from the exercise that you do. He has no qualms about that, right? He has no qualms about people who regularly get kicked and hit in the head or that do Muay Thai fighting where I'm sure the injury rates of Muay Thai fighters are probably several times more per however
00:33:44
Speaker
many hours of training than a powerlifter. This is borne out that powerlifting is actually extremely safe. Here's the deal. Stu also says very early on in the episode, and I don't know that he means this in the case of all data, but that he's only really interested in treating the people who come to him in his clinic, and he doesn't pay that much attention.
00:34:07
Speaker
to data. But why is Stu takes such a condescending approach to the lay person who likes to do yoga or heavy lifting, but then seems to almost worship the elite athlete who subjects their body to extreme forces, extreme trauma, such as the Muay Thai fighter. If you listen to the episode, you'll hear what I'm saying. He's
00:34:29
Speaker
basically just lost in a fugue state, appreciation and wonder for like the striking force of Muay Thai fighters. And then he'll occasionally also then say something along the lines of, you know, yoga master or mobility monster, and then chuckle and ha ha ha, you'll pay for that later type of tone in his voice. I don't know who he's appealing. I mean, I do know who he's appealing to, which is I, I believe probably overwhelmingly
00:34:58
Speaker
an audience of people who are having their beliefs reinforced by McGill, who see him as an authority. And probably there's some type of, this is just my opinion, right? What's coming through overwhelmingly is this like, we're tough, we're elite, we're athletes, we're the best in our field, we know the answers, we don't experience uncertainty, we lead with confidence, we know exactly what's wrong, we're gonna go in and we're gonna fix it and we're gonna make you better.
00:35:27
Speaker
And it's utterly lacking in the gray, in the uncertainty, in these attitudes of inquiry, these attitudes of curiosity about, well, maybe I don't actually know it all. And maybe there's more to this story. And maybe there's a lot going on in this person's life that I can't see and measure. Yeah, there's a lot of contradictory expression that he does throughout this episode. He does sort of worship athletes. And then at the same time,
00:35:57
Speaker
He makes fun of how poorly trained this one athlete is who's at the end of his career and comes to him. It's very bizarre. It's patronizing and it's fear-based. His whole thing is basically preserve the spine at all costs.
00:36:16
Speaker
because that's the most important thing. But at all costs means don't do these movements. Don't do these movements. Don't lift if you're bendy and don't mobilize if you're stiff and that then now all that's doing is creating a whole new host of issues around
00:36:33
Speaker
not moving because bodies like to move is the thing right you know there are so many studies that that reinforce the fact that there is no correlation between disc bulges stenosis and pain directly right so he's fear mongering this completely natural process
00:36:50
Speaker
because we are organic material. Our tissues gradually break down over the course of our lives. It's just kind of what happens. We can do lots and lots of things to slow it down and to improve things like our bone density, our muscle mass, things like that, but it boggles the mind.
Questioning Fear-Based Deadlift Advice
00:37:06
Speaker
This is the part also that blew my mind. Atiyah just leaves it when he says like, yoga people, don't deadlift, power lifters, don't bend over.
00:37:15
Speaker
He doesn't ask for clarification, like, are you saying that flexible people should not lift weights because they're flexible? He doesn't ask about training variability, load variability, resilience, all of these things. And when I first listened to this, there was, I was kind of just so blown away that there was no follow up about, you know, at best, this very old fashioned idea about, you know, how people should
00:37:38
Speaker
know, take the best care of their bodies. A lot of McGill's defenders on social media have jumped in and said like, you know, he's not saying don't strength train, he's just saying don't deadlift. But let's get real. This is a person who has a lot of reach. He's putting out this completely nocebic message about deadlifts like the he
00:37:56
Speaker
I don't understand why he hates deadlifts so much, but he does. And he thinks they're the worst possible thing out there. I'm like, well, then you're telling somebody to bend over and pick something up and don't do it with your back. I'm like, that's a fucking deadlift. Anyway, the layperson listening is not thinking like, oh, well, he's only saying deadlift, so I should go out and strength train otherwise. They're just scared of heavy lifting in case they get hurt. And this is rampantly true. I see it all the time in the clinic. I actually just yesterday,
00:38:25
Speaker
got someone to work with a 15 pound barbell for the first time that I started working with them in November. And I have had this goal in mind since then. But I had to ramp so slowly up to it because they were convinced
00:38:39
Speaker
that they were going to hurt themselves. So that is the message that's out there. And this interview is just cementing that message, which is, in my opinion, completely unethical. During the interview, Atiyah gives him a chance to clarify again. He says, Atiyah says, well, we don't want to give people the impression that they shouldn't lift weights. But McGill does not respond in any meaningful way. He just kind of tells another story about how he saved somebody. Yeah. There's a problem too, which is that
00:39:05
Speaker
Like you're pointing out, Sarah, which is they're painting heavy lifting in this very dangerous light. And they never actually define what they mean by heavy or what they are proposing would be dangerous in terms of the magnitude of heaviness. They're just saying heavy. So when someone who doesn't know a lot about strength training, they hear heavy and they think anything bigger than a pink dumbbell.
00:39:34
Speaker
Yeah. Anything heavier than 10 pounds, right? And so they're immediately actually turned off by any type of strength training. And so they have painted strength training in a dangerous light. But what is mind-boggling to me is that the CDC and the WHO recommend two times a week strength training for the prevention of disease
00:39:54
Speaker
And the data shows that strength training, including heavy strength training like powerlifting, is incredibly safe when compared to soccer or even running. But they're on here making it sound like it is so threatening. Now, this kind of reminds me of Andrew Huberman, big optimizer energy.
00:40:17
Speaker
around health and longevity, and he calls himself a science communicator, bridging the gap between science and making it more accessible for the regular person to understand. Well, here's what happens with Andrew Huberman. Probably the single most important thing anyone could do to preserve their health and the health of the population as a whole is get vaccinated.
00:40:38
Speaker
But any time Andrew Huberman even mentions vaccine, he makes sure he mentions it in the context of autism. Even though there are mountains and mountains of research showing that there is no connection between vaccines and autism. That vaccines are incredibly safe and they save millions and millions of lives.
00:41:00
Speaker
This is kind of what I'm hearing from Tia and McGill, which is that we're gonna paint strength training, which is something that is so important for our health and longevity that these two enormous super data-driven organizations like the WHO and the CDC are recommending that literally everyone do it twice a week. And they're painting it in this negative light. And I find this reprehensible because they are being so unclear.
00:41:29
Speaker
And they both have doctor in front of their name, which just solidifies it for in a lot of people's minds that like, oh, well, he's a doctor. He must be saying something, you know, that I that's right. All right. So this is the rest of that thought.
00:41:44
Speaker
What is the pathologic response to the anterior bulging of the disc? Because when you have that posterior bulge, I guess we should have mentioned this earlier, and I guess it's worth stating, the spinal cord stops quite high up. The spinal cord does not run down the entire canal. It stops around L2. So for most of the people experiencing lower back pain vis-a-vis a herniation,
00:42:09
Speaker
that fortunately, the herniated disc is not hitting your spinal cord, it is hitting the nerves that emanate from it. But again, there's so much real estate in that area. It's insane, right? Because you don't just have the nerve roots, you have the dorsal roots, you have all of these other tiny little nerves that are going to the facets and to the disc and to the vertebral bodies that's running musculature. Into your genitals and
00:42:38
Speaker
everything that's important, of course. That's absolutely correct, and I learned that the very, very hard way. Yeah. But tell me about the end. I'm laughing, again, I'm laughing with the subjects here, not the person.
00:42:55
Speaker
Yeah, no, no, it's, yeah, we could tell some stories if we weren't on the air. And so the, tell me about the manifestation clinically of the anterior herniation in that very flexible person who's presumably greatly lacking in any spinal stability.
00:43:14
Speaker
There probably won't be too much. They will go along with their merry life and be flexible. The anterior bulge is not, as a rule, picking up any nasty nerve root compressions. And on the grand scheme, Peter, it's probably a nonclinical issue for them.
00:43:40
Speaker
Now, do those people still... It's still anyone with a lift, you know, they were in an emergency situation now, they've come across a car wreck, someone is in the car and if they don't get them out, the car is going to explode. So, we will all be placed into these situations at some point in our life and whether or not we have the physicality to deal with them is another issue. But anyway, that's the downside of that particular
00:44:07
Speaker
adaptation and lifestyle, perhaps. Okay, so I just need to lay this out. Apart from the weird part where they start talking about how some of the nerves in the lower part of your spine have to do with your genitals, which has nothing to do with anything. But ha ha ha, let's talk about penises. To me, this is his sort of second big theme, which is McGill moralizes around movement modalities. So I just needed to I heard that. And I was like, Okay, wait a minute, I just need to lay this out for myself. So he says,
00:44:36
Speaker
Yoga people should not do deadlifts because they are not adapted for them. But then he also says, oh, yoga people, so unfortunate that they do not have the strength to lift a car off a person when the time comes. Don't do this thing. Oh, it's so unfortunate that you don't do this thing because life will call on you and you will be unable to step up to the challenge.
00:44:57
Speaker
I don't even know. It's not gaslighting. I don't know what it is. It's beyond gaslighting. Miguel's like, I can't help you if you don't help yourself. And if you're making poor choices, young lady, you're just going to have to accept the consequences. I mean, the mental gymnastics of this. And this is, again, where I'm like, this is not a clinician because why is he not prioritizing helping these yoga people? If he thinks what they're missing is stiffness, why isn't he telling them to get stiffer?
00:45:22
Speaker
Well, because their body has entered into a chronically soul state with their ground substance in a permanently. So there's no hope. Oh, my God. OK. His rhetoric revolves around warnings, not encouragements. Right. There are virtually no encouragements in this entire episode from Stu McGill, apart from follow my rules. Right.
00:45:51
Speaker
He's all about subtraction.
00:45:54
Speaker
I don't actually get the feeling that he's particularly interested in yoga people, but I think I'm wrong because a lot of yoga people are big followers of Stu Magill. You hear a lot of Magill wisdom espoused in the yoga community. I don't know if it's because they're learning directly from him or from people who have learned from him, but there is a terrible amount of flexion, fear-mongering in the yoga community.
00:46:22
Speaker
And I know of several who have named McGill as being a source of information that they've gotten ideas around what they shouldn't be doing from. But I don't get the sense that McGill is terribly interested in yoga people. I think he's way more into
00:46:36
Speaker
you know, the idea of elite athletes and working with athletes. You know, his audience, at least a Tia's audience, I would venture to say, and I might be totally wrong about this, that it's a largely male leaning audience, that in general, I've noticed that amongst a certain type of man, group of, you know, men, that there's this negative attitude toward yoga. They love to denigrate yoga, practicing yoga is something that is
00:47:04
Speaker
pointless, a waste of time, ridiculous, injury is definitely not going to like get you ripped and like buff and super strong and just kind of just a stupid waste of time thing to do. I don't know that this is where Stu's somewhat dismissive slash patronizing slash, he seems particularly condescending around yoga people is what I'm trying to say. I don't know that he is, you know, rhetorically appealing to
00:47:32
Speaker
the audience that he knows he's speaking to. I have no idea what his true attitudes are. And no one has any idea about what anyone's true attitudes are or beliefs are about anyone, really. We would be mind reading at this point. But my takeaway from the rhetoric is that Stu is largely about warnings, not encouragements, subtraction, not addition.
00:47:54
Speaker
and that he just doesn't think that much of a lay person's attempt to do any type of exercise that he doesn't deem, quote unquote, safe, which he doesn't really tell us what that is. He's just anything that involves heavy loads and big ranges of motion he seems to just not be on board with. Yeah.
00:48:14
Speaker
Do you want to talk about the McGill Big Three exercises or the McGill Method or the Big Three? Sure. Yeah. You can YouTube McGill Big Three and get some visual representations of this, but there are three exercises. I believe the first one
00:48:31
Speaker
that he describes in the episode is the partial curl up. I might be according to Stu just totally butchering this, but this is the shape, right? Basically, your knees are bent, your feet are flat on the floor, your arms underneath your lower back, you're curling up and you're holding that.
00:48:45
Speaker
isometrically okay the second one is side plank, which you can do on your knees with or with your legs straight, I believe, and you're on your forearm, I believe, according to the McGill big three and then the third one is bird dog so you're on hands and knees you're reaching, for example.
00:49:02
Speaker
your right arm forward, your left leg back. So those are the three exercises that he connects to adaptations that would result in increased trunk stiffness, which I find implausible. And to be completely fair, honestly, I just don't want to give any detractors of our point of view any ammo in this at all.
00:49:23
Speaker
When Atiyah asks him about the big three and he phrases it like, you know, these are the exercises that everybody should do, McGill immediately says, no, they're not for everyone. So he stays on point with that, which these are the exercises for people that he believes need more truncal stiffness. And this is the way they're going to do it. To prove his point, both Mick Jagger and Usain Bolt do bird dogs.
00:49:48
Speaker
Yeah, he does a lot of name dropping, which is an appeal to authority while making zero connection as to any evidence he has for why Usain Bolt and Mick Jagger are doing those exercises, right?
00:50:02
Speaker
He sort of drops that in there so that we connect the dots and think, oh, they must be doing those exercises because those exercises make them as famous as performers as they are. Exactly. Somehow, that would be the connection that would probably be made unless Stu went in and said, now, I know they do these exercises. I don't actually know why, but hey.
00:50:26
Speaker
just FYI, they do them. And that would be kind of funny, you know, if he said it like that. He was like, by the way, I'm going to name drop. It's fine to name drop, but don't leave it hanging in a way that your audience is probably because of the way human minds work, connect those famous people's names to the efficacy of the exercise. That's called appeal to authority. I find it implausible that the McGill big three would lead to trunk stiffness.
00:50:51
Speaker
and or stability because I actually don't understand how Stu is using these words stiffness and stability. What does he mean by stiffness? Because when I think stiffness, I think of alterations that happen structurally and mechanically to the property of tissues like bones can get stiffer.
00:51:11
Speaker
tendons and other soft tissues can get stiffer and muscles get stiffer. And typically, in order to make these tissues stiffer, we actually have to stress them above a threshold. And for bones, it's high. For muscles and for soft tissues, it's maybe not as high, but it's at least above 70% in terms of magnitude, 70% of a 1RM. I find it implausible that the McGill Big 3
00:51:35
Speaker
would constitute 70% of a 1RM for anyone except someone who would be quite deconditioned, especially that partial curl up and especially the bird duck. Maybe the side plank for a while. But here's the deal. I actually think that is it plausible in your mind, Sarah, as a clinician that maybe the way that these isometrics function to reduce pain, the reason they help people feel better
00:52:01
Speaker
Short-term and he describes he has reports from people that they've experienced Relief for as much for as long as an hour after doing the big Gil big three, right? Isn't it true that? Isometrics can act as an analgesic to pain right? So they're doing isometric exercises
00:52:18
Speaker
He wants it to be that they're increasing trunk stiffness, but I don't think that these exercises sufficiently stress the tissues that we need to stress to result in a change in structural and mechanical properties of the tissues of the trunk. Now, the other thing he uses a lot of times is trunk stability, but here's the deal. So balance and stability are kind of related concepts. He doesn't talk a lot about balance, but he talks about stability. So balance is your ability to maintain equilibrium, right, when stationary or moving.
00:52:47
Speaker
So you don't fall over basically stability refers to any structures ability to resist change or disruption to equilibrium so this encompasses the ability to maintain control and prevent excessive movement or deviation from a desired position.
00:53:04
Speaker
And so this can involve muscle strength, coordination, joint integrity, and neuromuscular control.
The Big Three Exercises: Efficacy Debate
00:53:12
Speaker
Fine. But what he seems to be implying is that stability is actually neutral.
00:53:19
Speaker
And yet, you can be stable in any spinal position. You can be stable, for example, in crow pose. And when you reach the ability to resist perturbation, you might be able to balance in crow pose. You can be stable in a side bend. You can be stable in a rotation. You can be stable in a back bend. But McGill uses stability, actually conflates it, I believe, with another concept, which is neutral.
00:53:46
Speaker
So he says we're doing these exercises to increase trunk stiffness, to maintain trunk stability. But what I think he's using these exercises for in the way that I think they function is probably as analgesics to pain, to reduce acute bouts of pain for people. I'm no doctor, but this is what I've heard.
00:54:04
Speaker
And these exercises, while they might promote a neutral position within an isometric hold, don't actually guarantee that someone is going to be able to resist perturbation while doing anything. What it's actually encouraging them to do, I think, through the way that he promotes these exercises and the narrative around them and the fear mongering that he uses, is it encourages people to be afraid of leaving neutral. That's not actually stability.
00:54:34
Speaker
Fear of leaving neutral is not stability. I would argue that it said the opposite of stability. Yeah, absolutely I mean your point about the isometrics and the analgesics makes absolute sense because He then goes on to say, you know They report that they don't have pain for an hour and then I tell them, you know You're gonna do this exercise three times a day, right? So, you know, he may be promoting some strength building for some D condition per people for a while he never at any point values
00:55:03
Speaker
range of motion and stability together. He's got some stuff messed up in his neck and he's like, my neck is bulletproof because I strengthened it in this, again, neutral position supposedly. He did chin tucks and I don't know what. He's like, I can't turn it, but it doesn't hurt. That's his big thing.
00:55:25
Speaker
You've messed yourself up this much. You were taking away the right for you to actually move through your life and move through the world in a way that is going to be actual longevity, actual resilience. And instead, we're going to create this very, very narrow space of almost no movement at all. And you're just going to tense up in that position. And that's your exercise. And you do not get to leave that place. It's really about bracing.
00:55:54
Speaker
Yes. It's not really about stability. It's about bracing. So at the one hour and five minute mark, McGill compares findings of a study done using the big three and they're testing efficacy of pain relief in one. But then on another one, they're studying the efficacy of performance enhancement in athletes. I believe there were two groups, college athletes and grad students in the same study. And so he's looking at how the big three is able to enhance
00:56:23
Speaker
performance by enhancing trunk stiffness. And he notes that the intervention actually didn't have much effect on athletes, but that on grad students, which I presume are non-athletes, he states that a six-week intervention increases trunk stiffness, I believe probably in some type of athletic maneuver. Now, this makes sense to me because
00:56:48
Speaker
If the non-athletes are more deconditioned than the athletes, which we can assume that they are, of course, doing relatively low load isometrics might constitute enough of a stimulus over the course of six weeks, especially if it's somehow being progressively loaded, to result in structural and mechanical change to tissues.
00:57:12
Speaker
But the athletes would, in fact, require a much higher stimulus because they're already at a higher baseline of conditioning than some light load isometrics would be able to provide for them, like the partial abdominal curl, side plank, and bird dog. Stu then goes on to wax poetical about the different fighting styles of Muay Thai fighters and enters into his fugue state about how the big three in another study improved their strike force
00:57:41
Speaker
He namedrops McJagger and Usain Bolt in this part. Meanwhile, there's absolutely no dialogue, no pushback or questioning from Atiyah about that initial study he references. He kind of just leaves it hanging. He's like, we found that it didn't really make a much difference in athletic performance.
00:57:58
Speaker
But then we found that it helped these Muay Thai fighters. He says nothing about the initial study that he names and how it didn't make a difference in college athletic performance. And then it all just morphs into a long and passionate speech about fighting and how famous fighters, in so many words, float like a butterfly, sting like a bee, and how rock stars like Mick Jagger and Bolt do the big three. And there's just so many amazing leaps and logic where basically it's like whatever people put in the,
00:58:26
Speaker
caption of a post of a funny story or a booyah comment, they're like, I'm just going to leave this here. McGill just kind of says things in this, I'm just going to leave this here type of a way. But I have so many questions like McGill, why do you think it didn't have any effect on the professional athletes, but then it did have an effect on the Muay Thai fighters and tell us about how these studies were conducted. And we get none of that. For someone who has done so much research,
00:58:53
Speaker
He really likes to misrepresent the data. And we're going to see that later on, just in the way that he speaks about it. And he interprets the data in ways that reinforce his story. And his story consistently is don't move your spine, stiffen, like, you know, in his words, stiffen your trunk, make everything rigid, isometric contraction right where you are. Do not ever lose, leave this place. If you're a bendy person,
00:59:23
Speaker
Don't try to now add load to this, God forbid. And if you're a power lifter, don't ever move from this pose. And that's his like, like his basic tenet is neutral spine is the only place to be. Tighten your muscles around your neutral spine. Now you don't have pain. What else do you want? Oh, you want to move? That's not my problem. I got you out of pain because I didn't let you move in ways that irritate your pain. So yeah, the more I talk to you about
00:59:53
Speaker
Stu's M-O, and the more I compare that to the language that he's using, he's an engineer, right? Oh, yeah. He's often using language like stiffness and stability, but he's, I believe, who am I? To say this, I think he's misusing these terms. I agree. I think he's using them incorrectly. I think what he really means is brace. Yeah.
01:00:17
Speaker
I teach you how to brace your core so that you don't leave whatever position it's in. Yeah. I think that's exactly right. All right. Well, let's see an example of McGill in action.
01:00:32
Speaker
What, you know, when I exercise today, I don't care about the performance. I care about the preservation and longevity of my body for whatever number of years I have left. So this is really where I think stability matters. It's, you know, what are the exercises I need to be doing? What are the exercises my patients need to be doing?
01:00:57
Speaker
so that as we age and we walk up the flight of stairs or carry something heavy, we don't hurt ourselves because we don't have that core stability that can resist the deformation that's going to allow energy to seep out of the system. Well said.
01:01:20
Speaker
A story was coming to mind as you were saying that. I'll be giving a lecture or teaching a class and I'll show some data from an elite athlete. And there will be therapists and clinicians in the room who say, we don't deal with elite athletes. We deal with the elderly or we deal with sick people. And I think
01:01:47
Speaker
What are you thinking? I'm showing you what the human body has the potential to do and your arrogance won't allow you to learn what is possible. And I'm gonna give you a very emotional, I hope I can get through this, a very emotional story to show the arrogance that exists among some of our colleagues.
01:02:13
Speaker
Occasionally, medical groups, a hospital or whatever will ask, would you come out and assess three patients in our auditorium in front of all our medical staff? I was at this facility, it was in Europe, and they brought out, the first person was a rugby player, fair enough, and I had 20 minutes and declared what I thought was going on.
01:02:33
Speaker
The next one was a woman in her early 70s clearly distraught. You could look at her posture, her carriage, she was defeated by the world. And she came onto the stage and I said, can you tell me your story? And she said a little.
01:02:53
Speaker
few sentences. And then she said, but the therapist says that I have to leave my home now. When I get off the toilet, I'm a bit unsteady and she's afraid I'm going to fall on the floor. I can't get off the floor by myself and I'm just going to lay there and no one will discover me. I have to leave my home. She started to cry at this point, Peter. She said, what's going to happen to my cat and all this sort of stuff?
01:03:20
Speaker
And I said, really, would someone please bring me out of school and this will be our simulated toilet. So an assistant brought in a stool onto the stage. I said, okay, pretend that's the toilet and the seat. She turned and had no idea how to move and just sort of plopped and collapsed on the toilet. And then I'm just going to turn this down because I want you to see my lower body kinematics as we're moving here.
01:03:49
Speaker
And then I said, would you get up off the chair? And I can't remember whether she was wearing a skirt or pants pants, I think it was, but nonetheless, knees together, and she just sort of collapsed. And I had to help her. She was going to collapse onto the floor. And so I said, I want you to humor me now. You're my mirror. When I coach, I try and use minimum words. I said, do this with your hands.
01:04:19
Speaker
What's your kneecap between your thumb and your hands as you slide your hands down? Good. Now, I want you to be a leaning tower.
01:04:29
Speaker
being tower four and backwards and played with the curve of your back. Do you have any pain now? She said, no. And I said, watch my shoulders. You're shrugged. I want you to anti shrug. She did that. Perfect. And now I've said, pull your hands off your thighs by pulling your hips through. Don't lift with your back. Pull your hips through. See, she had it done in three repetitions. That was not her pattern. And I said, okay.
01:04:58
Speaker
Think of what we've just done and sit on the toilet." And I said, whoops, spread your feet apart. And there she went, slid her hands down. And now I said, then she put her knees together. And I said, now stand up. She was going right back to the incompetent movement that caused her inability and disability before. I said, spread your knees apart and pull your heels underneath you. Sniff some air.
01:05:27
Speaker
Now lean forward and do what you now know how to do. And she did a perfect squat. Do it again. And then by the third repetition, big smile came on her face. It was the emotional part. I said, what's up with you? She said, I don't have to leave my home, do I? I said, no.
01:05:51
Speaker
Do you know many of those heart-baked surgeons and clinicians started to cry as well? For the first time, they realized all I did was teach her weightlifting 101.
01:06:04
Speaker
Remember how this story started with the arrogance of some of our colleagues who say, I don't want to hear stories about elite athletes. I deal with old people or sick people. And that's why they continue to not have the skillset to help their people. All I did was learn from the best windlifters in the world, people who know how to move load, learn what the efficiency was and turn it into a hack to change a person's life.
01:06:36
Speaker
I just want to say he describes what I do every day. He's just, that's physical therapy and he's acting like it's some sort of mind blowing. Nobody's ever seen this before. It's just another enormous leap in logic where we're supposed to go. The surgeons and clinicians in this audience, many of them must be terribly arrogant because on multiple occasions, Gil has showed research on elite athletes and some of them.
01:07:05
Speaker
have failed to see the relevance to their population that they serve, which are non-elite or non-athletes, right? People who are maybe older, sicker. Why would Stu then tell a story about teaching a sit to stand as a example of some type of anything related to it, elite athletic performance and the capability of the human body?
01:07:36
Speaker
I mean, sure, a sit-to-stand is a squat. I volunteered in a rehab ward in a hospital where people were coming out of surgery and saw almost every single occupational therapist and physical therapist in that room at some point teaching sit-to-stands.
01:07:58
Speaker
I mean, this is not something that you need to show research on elite athletics to drive home. I'm sorry, Stu, you needed to pick a different example anecdote because that one didn't go as well with the point you were trying to make. But I think the point you're actually trying to make is that you are the benevolent Jesus in this story, the healer, the person that people come to to be saved.
01:08:27
Speaker
The medical establishment is the devil. They're arrogant. They don't understand. They refuse to want to help because they're so arrogant. And yet you assume that no one in the room has ever tried to teach a sit to stand.
01:08:50
Speaker
and everyone's crying because you did this miraculous thing, I find that assumption terribly condescending. And also, you threw in there that you've studied with the best strength coaches in the world. I find the way that you represent yourself, I'm sorry, pretty arrogant. Is this what he's seeing as arrogance of doctors who don't want to hear about elite athletes because they deal with old people and sick people?
01:09:20
Speaker
Okay. Assuming that's what he's coming up against. Is that arrogance or is that just a lack in clinical application in thinking? Isn't the whole point of McGill being there to help the clinicians bridge this gap so that they can apply it and explain to them that regardless, if you're an elite athlete or an older person getting up and down off of the toilet, the mechanics of a squat, the mechanics of a sit to stand are essentially the same.
01:09:48
Speaker
or how about you bring in statistics of their community to show them, rather than bringing in statistics of people that they have no, doctors are busy.
01:10:00
Speaker
And I'm not, this is not an excuse for why they can't bridge the gap between an elite athlete and an older person. But when you're presenting, if I'm presenting about people with breast cancer, I'm not bringing in statistics on prostate cancer. You knew the group you were coming into. So, and you clearly have very little respect for them. So why don't you just take that lack of respect and just, you know, dumb it down for the dummies.
01:10:22
Speaker
And in a lot of the medical community, people are not necessarily as versed in movement as medicine, motion as lotion, but it is starting to change. We're seeing more and more doctors that are prescribing physical therapy over surgery, but McGill expects them to be expert in the thing that he's coming to lecture about and then dismisses their lack of comprehension as arrogance. Now, this may not be the part that our listeners care the most about, but one of the things that I hate
01:10:52
Speaker
is when we will dismiss entire professions when the truth is a lot more nuanced. The way that he positions himself in this story is what makes me the twitchiest. Yeah. Basically what we have here is a very high pressure situation where this woman is brought to the presuming stage in front of, I don't know how many dozens or hundreds of doctors and clinicians
01:11:22
Speaker
to be evaluated and helped by Stu. So she's under an enormous amount of social pressure to respond well to Stu's intervention. This type of healer moment happens a lot in high demand groups. I'm not suggesting this was a cult or anything like that.
01:11:46
Speaker
However, I will say that Stu has big guru energy in addition to big optimizer energy. This type of healer moment happens a lot in high demand groups and it's often used in systems of control because witnessing others being healed creates a powerful emotional experience which Stu was very forthcoming about.
01:12:09
Speaker
It reinforces shared beliefs and values among those watching or listening to this podcast. The leader who performs the healing is seen, of course, as an authority or expert
01:12:23
Speaker
And this, of course, then enhances their credibility and influence. The display elicits emotional response and faith. Seeing someone healed in public can make people see stew in this completely new light. Like, wow, we've heard he could do this, but we just saw it with our own eyes. And this creates a powerful psychological bond.
01:12:45
Speaker
It enhances loyalty and commitment. Now, none of the listeners of this podcast were actually in this audience, but Stu just put them there. Public displays of healing attract attention and they generate publicity, attracting new followers, new supporters. And this is incredibly effective for people seeking to expand their influence or
01:13:09
Speaker
sell something. Now, in addition to this being a device of high demand groups, and we know that we can't trust the outcomes from high pressure situations like this, because the question now should remain in everyone's head. Did this woman actually end up having to go to the nursing home? We don't know, but what we do know is that what Stu did was create an opportunity for her to do motor performance of a sit to stand.
01:13:38
Speaker
Now, if you've listened to our episodes on queuing, I believe from season two, season two, we have a three part plus bonus series on motor learning. You know the difference between motor performance and motor learning. So Stu got this woman to do motor performance of a sit to stand to a stool on a stage. This actually tells you very little about whether or not she
01:14:04
Speaker
learned the motor skill, or if she will be able to repeat it in the context of her home, which is paramount to motor learning. We need to be able to do the motor skill in multiple different contexts, not just a high pressure social situation where we're being spotlighted on a stage for everyone to watch. So check out those episodes, which we're going to link in the show notes, our three part plus bonus series on motor learning.
01:14:33
Speaker
But at any rate, this intervention, we don't actually know if it caused the positive outcome for the individual, quote unquote, healed. We just, we don't know. We only know that the story is compelling, that it elicits an emotional response, and that Stu has positioned himself as a healer.
01:14:59
Speaker
And a healer who in a David Goliath-like situation also just knocked those arrogant Western medicine clinicians down to size by helping this poor defenseless old lady use the pot. Now listen, I also find this very public display of an older woman's very private moment, the reenactment of it, struggling to sit down on a toilet, juxtaposed with Stu's bravado
01:15:29
Speaker
and self-righteousness, frankly, oddly discomforting. He's publicly making an example of a woman in her most vulnerable moment and rescuing her with his elite strength training skills.
01:15:45
Speaker
To me, it reads... Go ahead. It reads as such a grandiose story in the way he is actually attempting to position himself within it. This is a story about Stu. Yes. I think it's great if he actually helped her.
01:16:06
Speaker
By the way, he could have humbly shared the story of how teaching a woman a sit to stand was actually the most effective intervention for her and how it prevented her from going to the nursing home. And he knows for sure that it did prevent her from the nursing home and he shares this with us. He could have done this without the evil clinicians versus Jesus Stu spin.
01:16:25
Speaker
In theory, he could. I don't think he actually could. I think that's so much of his MO. And we actually see this exact same scenario in one of the later clips that we're going to talk about that, to my mind, actually borderlines on, I would call it abuse, but he's not a clinician. So he has no ethical guidelines that he could be abusing.
01:16:46
Speaker
which is part of the problem. So there's some more of Stu. And, you know, my feeling is in this case, Jesus should not be taking the wheel. OK, we're going to go on to our next clip, which is yet again, here comes Stu saying you can do some things, but you can't do all of the things.
Lifting, Longevity, and Injury Risks
01:17:07
Speaker
Let's talk a little bit about that, because I have to tell you, Stuart, I'm a bit conflicted personally and I'll explain why.
01:17:15
Speaker
I obviously have no desire to do anything that I deem stupid anymore, right? So my days of gritting through painful anything are long over. I know the difference between discomfort that is worth pushing through and pain that is not. When I think about in particular squats and deadlifts, I'll tell you where, especially around the deadlift, which is
01:17:40
Speaker
an exercise I really, really enjoy where I feel conflicted. On the one hand, I feel like
01:17:48
Speaker
Now that I'm so tuned in to how to do this movement correctly, it's a really wonderful audit for my stability system. Again, I'm embarrassed to tell you how much I didn't know when I was deadlifting. At no point did I understand the importance of tension in the arms, intra-abdominal pressure,
01:18:10
Speaker
you know, the variability in foot pressure on the ground, like none of that stuff, right? It was just pure brute force stupidity. Today, as I know those things, it allows me to modulate force and to, on a good day, kind of push the envelope a little bit in what I perceive is safe. So on the one hand, I think, yeah, I should be deadlifting my whole life. Not, I don't need to deadlift 400 pounds anymore, but I should be deadlifting because it's this great audit.
01:18:39
Speaker
And on the days that I don't feel it, I back off. And then on the other days, I say, Peter, you don't need to do this anymore because honestly, you can still get the same or nearly the same activation for all of the muscles involved using other movements, single leg movements in particular, where you don't have a fraction of the axial loading. And yeah, you might need to do two exercises instead of one. But at the end of the day,
01:19:07
Speaker
there's a lower risk approach to get it. In other words, deadlifting is valuable, but you have a narrow operating window in which you can potentially hurt yourself. I continue to go back and forth on this, Stuart, and as such, here I am telling you, I still will go
01:19:28
Speaker
periods of my life where I'll deadlift every week and then I'll take three months off feeling like I don't want to push it. How would you advise a middle-aged person or even a non-middle-aged person who's sort of thinking through this particular issue? I've never encountered any evidence, Atiyah, to suggest that deadlifts are somehow
01:19:54
Speaker
more dangerous than any other type of lift. Sarah, have you seen anything along those lines? There are multiple studies, in fact, that suggest that deadlifts can be beneficial for people with low back pain. Yeah. I mean, any exercise compared to any other exercise has been shown to be equally
01:20:16
Speaker
efficacious and ineffectual. There are no superior exercises for low back pain. But what he's suggesting, what Atiyah is suggesting is that there is an additional elevated inherent risk to deadlifting above and beyond other strength exercises. And I don't know that I've seen anything along the lines. I think that the zeitgeist is that deadlifts are scary. Yes.
01:20:40
Speaker
But is there actual evidence showing that there's a higher prevalence of injury that results from deadlifts? First of all, we have one major glaring problem, which is that it is incredibly difficult to show causality with an injury because injuries don't happen in a moment unless it's something like a traumatic injury. If you hurt yourself deadlifting,
01:21:05
Speaker
Okay, but my dad threw his back out by sneezing. Do you really think that the sneeze caused him to throw his back out? No. Everything leading up to that did and probably genetics and stress and not sleeping enough or whatever it is, the same could be said for people who experience pain after they deadlift.
01:21:27
Speaker
Well, there's absolutely no way to set up a study to prove that deadlifts are more dangerous than any other exercise. That's why there's no research that shows it. But to your point, everywhere you look, deadlifts are bad for your back. When we started our bone density program, there were definitely people who were like, is my back going to be okay with deadlifts? Because my understanding is that deadlifts are bad for your back and I should do RDLs instead. And they seem to have picked the deadlift
01:21:58
Speaker
to represent all the evils of weightlifting. It almost feels arbitrary. Why did they not pick the back squat? Why did they not pick back extension exercises where you're starting a V and then you lift yourself up into ... Do you know what I'm talking about? You know what? I had a theory two nights ago as I was falling asleep. It came into my head as many
01:22:22
Speaker
of my best thoughts do, that I wonder if the name deadlift is responsible for the negative.
01:22:30
Speaker
the negative narrative around it. You lift and you be dead. You dead. Well, my mom for a while was calling it the dead weight exercise, which- Yeah. Well, I think that's what it's supposed to mean is that it's this dead, inertial, heavy object that you're supposed to lift from the floor in that resting- Not that you're going to die from it. It's not resting on top of your shoulders before you begin the lift. It's literally sitting
01:22:55
Speaker
completely inert. There's so many times where they make claims that I've never encountered any evidence to support. And what I think instead what they're doing is they're reinforcing what they believe, but maybe more so what their audience believes. Who is listening to me? What do they believe? And how can I tell them what they expect to hear in a way that endears them to me more? Yeah. Well, here's the rest of that nonsense.
01:23:27
Speaker
Again, I have so many thoughts going through my mind. It's interesting when we have a back pain, 50 year old coming here and I'll say, what are your goals? Oh, I want to set a personal best in deadlift. And I said, really? Okay. Um, let me tell you some stories. Let's, let's, let's talk about Ed Kohn. Do you know Ed Kohn? I sure do. I was with Ed a couple of weeks ago. I'll tell you a funny story about him if you like in a minute, but anyway,
01:23:55
Speaker
And when he would set a personal best, he'd take a couple of months off afterwards to set a personal best is so demanding of your body. There are actually
01:24:10
Speaker
If you said a true personal best, most people experience micro fracturing just underneath the end plate of the trabecular bone. If you look at the great strength athletes, they train deadlift. And again, if you go to our website, look at the testimonials at the bottom, the number of world class deadlifters who are on there. So
01:24:36
Speaker
I've worked with quite a few of these people through their injuries.
01:24:41
Speaker
Now, those micro fractures would be a good thing or a bad thing. The professional power lifter will take a week off. They train heavy deadlifts or squats once a week because it takes a week for the bone callus to not only attach through the chemical electro attraction, but to really scaffold on takes a week. If you deadlift in another three or four days, the way some trainers, they might deadlift a client three times a week.
01:25:10
Speaker
that allows those micro fractures to accumulate until finally you've got a full-blown end plate fracture or whatnot. So these are the people that come here. And then I say, how about this for a goal? Do you have kids? Yeah, do you have grandkids? Yeah.
01:25:27
Speaker
How about this? And I've since learned about your Centurion Decathlon, which I love, by the way. I'll say, would you rather, as your goal, have the ability to play with your grandchildren on the floor when you're 80 and get off the floor and pick them up?
01:25:46
Speaker
And they pause for a minute and they'll say, yeah, I like that goal. I said, well, you can't have both. If you think you're going to continue having deadlift personal bests, you will have artificial hips, all of these other things, because how many old power lifters do you know? Do you really want to be like that group of athletes?
01:26:14
Speaker
So I can talk them into changing their long-term goals. Now is the time to get on the program and make sure you get there. If that's the case, we eliminate deadlifts.
01:26:28
Speaker
A few of the things that just jump out to me in this once more just logic dead zone where he's saying, you know, a power lifter takes a week off after deadlifting, but some people deadlift three times a week. You're not trying, nobody is trying to deadlift their personal best. The heaviest thing they can lift one time and one time only. Nobody is doing that three times a week. No trainer.
01:26:53
Speaker
is taking someone through that three times a week. You might still be doing deadlift movements, but maybe you're doing it with a lightweight.
01:27:01
Speaker
Maybe you're doing it with body weight only. Maybe you're combining it with other movements. I don't know a trainer in the world who would say, you know what I should do with this 50-year-old person is work on their deadlift PR three times a week. So his argument is just complete fallacy. It makes no sense at all. And then he's also talking about, oh, well, those people get these end plate fractures. I'm like, I'm sorry. I thought the power lifters doing deadlifts were the ones getting the disc herniations. What is the thing, the inevitable future that all of these people
01:27:31
Speaker
end up with.
01:27:45
Speaker
looked at with some research on CrossFitters. And what they found was that the rate of injury amongst CrossFitters was higher the longer someone had been doing CrossFit, which means that the rate of injury was highest amongst the most conditioned CrossFitters. And I think that we could probably extrapolate out to say that you're probably more likely to be injured if you are in the category of elite athlete.
01:28:14
Speaker
because there are non insignificant
01:28:18
Speaker
stressors, there are non-insignificant risks that you are regularly placing on your body to perform at the level that you are performing at as an elite athlete. I mean elite athletes put their bodies through a lot to be able to be competitive. The fact that McGill has the platform that he has and the fame that he has
01:28:46
Speaker
He is attracting elite power lifters. And they're coming to him with their injuries. What is happening here might be that McGill is going, I see a lot of injured elite power lifters, therefore lifting heavy weights is dangerous. When in fact, what's possibly the problem is that these are elite athletes, not that they're doing something that is inherently
01:29:11
Speaker
dangerous. And we should also link Adam Meakin's post in the show notes where he lists off a number of old power lifters who are still PR-ing. And yeah, he lists off, I don't know, like 10 power lifters over the age of 50 men and women. So we'll link that post in the show notes. He says, do you know, McGill is like, do you know any old power lifters? And this post is like, yep, there's a whole bunch of them.
01:29:40
Speaker
as evidenced by the fact that there is an age group devoted to that group of people. There wouldn't be that age group if there were no power lifters who are older. Again, all of these claims are made evidence free. They're just kind of thrown out there like meat into the ocean of sharks for the sharks to just gobble up like yum, yum, yum, yum, yum, yum, yum. Thank you for confirming my beliefs.
01:30:10
Speaker
Thank you for helping me strengthen my bias.
Tribalism in Fitness Beliefs
01:30:13
Speaker
Deadlifts are bad. Lifting heavy is dangerous. Yes, this is why we believe you, oh teacher Stu. This is why we trust you. This is why we are on your side. This is why we will surround and protect you as the believers that we are. And so we enter into this
01:30:31
Speaker
state of tribalism where McGill continues to be able to say the things that he says because he's surrounded by people who support him in his statements. He's incapable of
01:30:47
Speaker
hearing or responding to or refuses to hear or respond to criticism. There's lots of research to criticize Stu's statements, but he doesn't seem to really bother too much with that. Not at all. Very specifically, he says some things here that are actually incorrect. This is not even an opinion statement on should you be bracing or should you be bending. He presents numbers that in a way that seem legitimate
01:31:15
Speaker
in particular in ways that if you're a lay person and you're not used to sort of analyzing the way that data is presented, they might not be able to suss out that it's kind of super questionable. So like, for example, Laurel, here's a question for you. Let's say you hurt your thumb really badly doing a handstand and you went to a hand specialist and they said to you, oh my God, this is so crazy. I see this exact problem all the time.
01:31:41
Speaker
would you think, oh wow, so many people are hurting their thumbs doing handstands? You kind of would, right? Because you went to this person and they said they see it all the time. Yeah, and then therefore I might go, oh, handstands must be dangerous. Dangerous for my thumbs. I shouldn't do handstands. Because this person sees a lot of people who hurt their thumbs in handstand.
01:31:59
Speaker
Right. And a bit before this clip, McGill says, oh, wow, yeah, people are going crazy on deadlift magnitude. You should see how many of them I am seeing here in my clinic. But you're doing the math wrong. It's not how many of the people that come to your back pain clinic are deadlifters. That's not the statistic. It's how many people who deadlift are getting back pain. And it's way, way less.
01:32:27
Speaker
because those people, you're not seeing them. They're not coming to your very specialized back pain clinic. And as I said before, there's a lot of studies that suggest deadlifts are actually beneficial for back pain. So that's just one way that he provides a very incorrect association of how many people are hurting themselves with deadlifts. And then he goes on to say this thing about people getting joint replacements that I want to play.
01:32:52
Speaker
Let's go get any one of our colleagues who are orthopedic surgeons. Tell us who you're replacing the hips of. Well, 50-year-old Caucasian women who have done yoga for 30 years, okay, and men around 50 who've done deadlifts all their life. Who are you not? The middle of the road moderates.
01:33:20
Speaker
He does incredibly end this story with like, well, it's more, we're all here to be called upon. Are you ready to receive the call? So when he claims,
01:33:33
Speaker
that if you asked any orthopedic surgeon, who are you doing hip replacements on? Oh, it's 50 year old women who do yoga, 50 year old men who deadlift. This is bullshit. It's literally incorrect. There's a study from the Lancet that we will link to in the show notes where they looked at over 60,000 patients who had undergone a total hip replacement between 1991 and 2011 and the mean age
01:33:56
Speaker
was 69.4 years. So about 70 years old is how old most people were. 15% were aged between 50 and 60 and 15% were older than 79. So it's most, it's not 50 year olds, it's 70 year olds. So it's just incorrect. Apparently Stu himself also has a hip replacement. I don't know, I have a hip replacement. I did a lot of yoga. Yoga did not create the environment where I needed a hip replacement. My anatomy did.
01:34:26
Speaker
And there are a lot more people out there doing yoga who don't need hip replacements than there are who do need hip replacements. So he cherry picks information. He wraps his story around it and twists it in a way to just bolster
01:34:44
Speaker
this constant message of fear movement, fear range of motion, fear the deadlift.
Critiquing Individual Responsibility in Health
01:34:54
Speaker
It's the world's scariest Jesus. Do you have anything else you want to say about this clip before we move on? Yeah. It's just bringing me back to this big optimizer energy where the world's scariest Jesus is really the tagline for guru energy, colon, the world's scariest Jesus.
01:35:15
Speaker
But then we've got big optimizer energy, which is one of the tenants of optimization in the health and wellness world is that
01:35:26
Speaker
it all falls on the individual, right? It all falls on the individual and the choices that the individual makes. And so Stu leans heavy into the types of movement choices you should be making, both moment to moment in terms of the position your spine is in at any given moment, don't bend during the day, but also in terms of exercise
01:35:48
Speaker
format choice, don't do yoga, and also load selection, don't lift heavy. And so these are all choices that an individual could make. And if they make the wrong choice, ha, you dumb fool. And he kind of chuckles, and it becomes this sort of condescending moment where he's like, okay, go ahead, you'll pay for that later, right? But meanwhile, injury
01:36:12
Speaker
pain are influenced by so many sociological factors and genetic factors and systemic factors like hypermobility, obesity, access to healthcare, access to food, the way you were raised and how exercise was either promoted or not.
01:36:41
Speaker
These are all things that Stu and Atiyah never want to talk about because they can't sell you a back fit pro certification for that. They can't sell you on their narrative. It's very much a carefully positioned narrative with a very specific perspective to make sure that you don't ask tough questions.
01:37:09
Speaker
All right. So our last clip is another story from McGill, but this time this is, this is a clip where I believe a Tia kind of tease him up to talk about this psychological component of the biopsychosocial model.
Psychological Impact of Low Back Pain
01:37:28
Speaker
He doesn't say those words exactly, but he's talks about the psychological impact of low back pain. And yet again, McGill just sidesteps it.
01:37:38
Speaker
Atiyah throws him a nice ball where he could say, yes, absolutely, that is part of it and people should seek treatment from blah, blah, blah, blah, blah. Instead, Miguel completely, either on purpose or just because he doesn't know any better, completely misinterprets what Atiyah is saying and just uses it to tell another story about how he saved someone from their back pain. There we go. Let's pivot for a moment to talk a little bit about
01:38:08
Speaker
the amount of psychological trauma that exists in the patient with lower back pain. I'm thinking very specifically even about some of my own patients or friends who have been in the throes of lower back pain.
01:38:29
Speaker
If nothing else, Stuart, I take a great degree of comfort from the injury, the third injury that I had, the one in 2000, because it lasted so long and because it was so debilitating and because I'm here today without pain.
01:38:47
Speaker
My confidence around small recurrences is so high that I don't tend to awfulize about it and work myself up. But I have great empathy for a person who doesn't have that knowledge and instead
01:39:06
Speaker
I don't know how to help someone sometimes because I can't tell what is mind and what is body at this point. And I suspect that there's a significant interplay. So can you speak more about this phenomenon and what those of us who want to help these patients can do? I am certainly much more conscious of the point you're making now than I was 30 years ago. Absolutely.
01:39:35
Speaker
But before Stu launches into an impassioned speech, he says, I'm certainly much more conscious of the point that you're making now than I was 30 years ago. Can we just name the point we think Atiyah was making? I think the point Atiyah is making is that there are other components going into your pain that are not mechanical. Fear is one of them. Yeah. And that. Tasktrophizing is one of them, right?
01:40:06
Speaker
conscious that there are things that he may not be able to help his patients with that are beyond not the scope of his practice, because that's certainly within the scope for him as a medical doctor, but beyond his experience or his specialty, let's say.
01:40:22
Speaker
He's saying, I lived it. I walked the walk. I went through it. And I came out on the other end going, you know what? It's not as scary to me anymore because I've made it through. And so whenever there are little things that crop up for him pain-wise, he doesn't immediately go down the rabbit hole of like, oh my god, my life is over. So he's grown in terms of when we talk about the biopsychosocial model for pain science. He's done some learning.
01:40:50
Speaker
about the role that psychology plays. And he's asking McGill, what is your experience with this, essentially, right? Yep. And then McGill does this. I'm going to start with a little story. But this happens very often.
01:41:11
Speaker
You mentioned earlier how MRIs don't show you the mechanism of pain and I can give all kinds of reasons why. But let's take this patient. He came to see me and he said, hi doc, I hear you're different. I've got this pain. I've been everywhere. I went to the pain clinic. They gave me narcotics and now they say the pain is in my head.
01:41:41
Speaker
I can live with the physical pain. I cannot live with someone telling me the pain is in my head, because that means I'm crazy. And if I'm crazy, I don't deserve to live. You've got two weeks, and in two weeks, I'm blowing my brains out. Now, there's a heavy psychosocial challenge, and a little bit of a story of what the system does to people.
01:42:09
Speaker
And it's not unusual for someone to come here suicidal. So I said, all right, you don't appear to have pain right now. And he says, no, I don't. And I said, okay, what causes your pain? And he said, well, it's when I do a certain movement that I get a flash of pain and it feels like someone has broken a beer bottle and have ripped open my hamstring muscles. It's awful. And I said, oh,
01:42:38
Speaker
kick, can you show me the pain? And he said what you want me to show you how I create the pain. And I said, it's the only chance I have to understand it. I said, you've been to 15 different clinicians. Has no one ever asked you to show them the mechanism of your pain? Has anyone ever touched you? He says no.
01:42:59
Speaker
I said, well, it's the only way I know. Peter, I put on my instrumentation, which was muscle EMG over the torso, the glutes, et cetera. We put on this fine motion monitor, 3D motion spine monitor. And then I said, all right, let's see what causes this. So he stood there and he did a very weird thing. And he said, all right, well, here you go. And he wound himself around in a circle like this. And when he got to 10, tucked that center,
01:43:28
Speaker
Now, at that time, I heard like a little cavitation, little paw come out of his back. And that was the wrap of the sciatic nerve. And he was in a bad way. You know, I laid him on a table, tried to give him a bit of decompression. And he went home and I said, I know exactly what the mechanism of your pain is. Here's what you should do over the next three days, but I want you to come back. But promise me, you aren't going to do anything silly.
01:43:58
Speaker
Remember what the threat was hanging over us. He said, I promise I called him that night. I called him the next day just to make sure. Then he came back and I said, I know exactly what your mechanism is.
01:44:11
Speaker
As, and here's what the data showed, as he was winding himself around, he was using muscle. Muscle is stiffening and stabilizing, it's centrating of the joints. And as he got to top dead center, he shut all his muscles off, he completely relaxed, and then there was a little sheer translation or a clunk. And that's what we heard. And that's what scrapped the sciatic route. I said, okay, you have no pain.
01:44:39
Speaker
Push my fingers out. Harder. Good. Hold that. Now talk to me and keep talking to me with that controlling. And we poached them through this in a minute. Very simple. I said, oh, keep the tone now. And we're going through. And as he came to top dead center, you could see him. Ah, ah, ah, ah, ah, ah. I said, we're there. Do it again. Hold on. Keep control. He didn't clunk.
01:45:09
Speaker
Now it took him about four months to wind down the ache, but he never had another clunker attract. It was really striking how when he mentioned like there's a strong bio, no, there's a strong psychosocial, like immediately after saying this guy was going to go home and if he didn't have a solution in two weeks,
01:45:33
Speaker
blow his brains out. Stu's mention of psychosocial. And then he kind of quickly changed the subject. And then at the very end of the clip where he mentions like, imagine the psycho and then he stops. Anyway, like he can't go there. He literally can't go there. But everything is resolved from this adjustment that he gives this person. Yeah, I have I have so many problems with this story. I have so many problems with the story. Number one. Stu McGill is not a medical doctor.
01:46:04
Speaker
He's not a clinician of any kind. He has no business taking on mental health of his client, not his patient because he's not a doctor, his client.
Ethical Concerns in McGill's Approach
01:46:16
Speaker
Clinicians are mandatory reporters of suicidal ideation and any kind of suspected abuse. If this was my patient, I am mandated, I would have my license removed if I did not report
01:46:29
Speaker
that this patient told me that he was suicidal. But here comes Stu, who says, never mind all that. The medical system failed him. Time for cowboy Stu to give it a whirl. Now, look, obviously the patient had a bad experience in the pain clinic and they did a poor job of explaining pain science to this man, or they did a fine job of explaining it to him, but he didn't understand it. We don't know.
01:46:53
Speaker
He obviously did not get a physical exam, which means he did not go to a PT or a Cairo or an OT. But that's not even how McGill interprets the psychological component that Atiyah is asking about. In McGill's world, the psychological aspect of pain is caused by the failure of the medical community to accurately diagnose, because you can always come up with a mechanical reason for back pain. And so the psychological distress
01:47:22
Speaker
is because they have been failed by the system, right? And it's not that there isn't a mechanical component, often there is, but he so much enjoys being this non-traditional outside of the Western medical world, you know, savior, and he tells these dramatic stories to drive home that point.
01:47:46
Speaker
Because let's just devil's advocate this for a moment. Let's say in this story, he had the man do the movement. It reproduced his pain. And then McGill didn't find any way to relieve his patient's pain after he turned it on, having him repeat the movement. And then the guy went home. He's in pain. He's even more demoralized. Here's yet another person who has failed him. And he decides, you know what? I'm moving up my suicide schedule. I'm doing it tomorrow.
01:48:13
Speaker
Now, I don't know if this counts as McGill playing God, but I think it's pretty close. And at no point, this is the full extent. When McGill says, I certainly know more about this than 30 years ago, this appears to be the full extent of what he understands. At no point does he say, and also I discussed how chronic pain works, because in his mind, chronic pain is psychological pain only. And he sort of talks about this earlier in the episode. He says it's a link between
01:48:42
Speaker
It's a self-invented link between pain and the low back, whereas acute pain is pain that has a mechanical source. And these two things never overlap, but this is completely inaccurate because one of the things that we know about chronic pain is that it can occur from what was originally acute pain. In the medical world, chronic pain is categorized by the length of time that it's been going on.
01:49:07
Speaker
among other things, but he only allows for repeated acute bouts, which I think is why he doesn't believe in nonspecific low back pain. But then he doesn't explain how you could possibly know the difference. And if he can give a mechanistic explanation, he doesn't seem too concerned about seeing if there's anything else going on that might be related. Yeah, he doesn't believe in nonspecific low back pain. Meanwhile, there's substantial evidence supporting the existence of nonspecific low back pain.
01:49:37
Speaker
which is characterized by pain in the lower back that does not have a specific identifiable cause, such as what you could glean from imaging, such as herniated discs, spinal stenosis, or structural abnormalities. Instead, it often arises from a combination of factors which could include muscle strain, ligamentous injury, and psychosocial factors.
01:50:04
Speaker
And yet, McGill is basically a non-believer in the existence of this well-studied explanation for low back pain, which is that there is no mechanism. The other thing too is he says that the people told him that the pain is in your head.
01:50:22
Speaker
Right? Which, when you hear the pain is in your head, okay, of course you feel like you're being gaslit, but in actuality, pain is an output from the brain. Pain is a perception that is outputted from the brain. The issue is not in your tissues. The tissues send sensory data via nociceptors and other receptors to the brain and the brain then interprets that.
01:50:48
Speaker
to output pain. So it's not incorrect to say the pain is in your head, but you have to be very careful from my understanding how that's communicated to a patient because it can very easily sound like you're being gas lit. Right. But he basically is like, well, but that's just not a thing. Pain isn't in your head. It's in your body.
01:51:04
Speaker
Yep. There's a mechanism and I'm going to find it. There were also some pieces. There was a lot that I did not like in this interview. And I also gathered a grab bag of other things that I hated about this interview that I thought I would highlight quickly and Laurel, if there's any of these that you also
01:51:18
Speaker
disliked for any reasons, you're welcome to also jump in, or if you have any other that I don't mention. But my first one is something that he calls virtual surgery, which Laurel, you will not be surprised to discover has nothing to do with actual surgery. Because what McGill believes is that most back surgery is ineffective. And actually, he's not wrong. There's a lot of studies now around the number of back surgeries performed that do not relieve people's back pain. So he's not incorrect about that.
01:51:48
Speaker
What he thinks is the valuable part of his surgery is the forced rest. And so he tells people here, I am anointing you. He uses the word anoint. I'm anointing you. You have gone through virtual surgery.
01:52:04
Speaker
what i want you to do now is go lie down for three days and then you're going to do my protocol or whatever but why he doesn't just call it required rest i didn't like that another one that i didn't like and this is a little bit of a deep cut for like the pts and the otis and the clinicians who are listening
01:52:20
Speaker
This one's just weird. He claims there are no assessment codes for diagnosing back pain. And there are literally so many, Laurel, and there are so many that are really specific. There's non-specific low back pain. There's back pain with radiculopathy. There's herniation. There's so many.
01:52:38
Speaker
And so I don't know what he's going on about, except to make himself yet again the hero of these people who've been filled by the medical system because they're not getting any correct assessment. Or maybe it's different in Canada, I don't know. But it's just a very weird thing to say, and also it's wrong. Here's another thing I didn't like. We know from research that tissue damage on MRI, that there's no direct correlation to pain.
01:53:03
Speaker
but McGill's issue with MRs is not that they, it's that they don't show movement mechanism, right? They're not moving images and that's why they're no good except for the occasions when he has had athletes come in with year after year of MRs and then he can point to a specific year and say, oh, that's the year you started doing deep squats, immediate tissue injury, must be why, no possible other explanation. I mean, I know he's not a clinician, but that's not even scientific.
01:53:32
Speaker
Here's another thing. He says that it's better to have, after an acute injury, it's better to have inflammation and suffer the pain for two weeks because your body needs it, right? There's a lot of sort of, stop being a baby. Experience your pain. Like there's a lot of moralizing through this episode for a person who actually spends so much time trying to get rid of people's pain. And yet he's also totally against Atiyah taking drugs for his pain and says he just needs to lay on his belly and breathe. You don't fucking know that.
01:54:00
Speaker
This is my first curse. I've been holding that in. He just constantly contradicts himself. Like, you know, power lifters shouldn't bend over, but then he talks about cross training athletes.
01:54:11
Speaker
for exercises that aren't covered by what they're doing because that's what they need, but you stupid layperson, you should not cross drain anything. It's really impossible to make sense of what he's talking about. Do you have any other little small moments before we get onto the one big problem? There's a lot of qualities of McGill that rub me the wrong way, but I could misinterpret and pretend to be able to read his mind and pass judgment on him in ways that would be actually quite unfair.
01:54:41
Speaker
I personally find it very difficult to listen to two men talk about health in a way that is placing sole responsibility on the individual
01:54:55
Speaker
and fail to mention psychosocial factors that might also be at play because it is just so deeply individualistic. All right, so there's a really big elephant in the room, and I'm going to address it in a moment. Before we do, I just want to review our big McGill themes. Theme number one, McGill fearmongers movement, right? A lot of fearmongering language.
01:55:18
Speaker
McGill moralizes movement modalities. He seems to hold a sort of a dim view of certain people who do certain kinds of movement or strengthen without mobility or mobilize without strengthening. Rather than educating, McGill misinterprets medical data. It's baffling because he's done so much research, but he literally does not know how to present statistics.
The Need for Updated Views on Lifting for Women
01:55:38
Speaker
And worse, he shows no apparent interest in updating his approach or his understanding based on new research, which is not the mark of a scientist.
01:55:49
Speaker
and McGill manipulates via melodrama because everyone who comes to him has been failed by the system and he is their savior. But here is the actual biggest problem. It is unethical that he is discouraging the exact demographic who need to lift heavy from lifting heavy. And this demographic is women or people who've exclusively or mostly done yoga, Pilates, bar,
01:56:19
Speaker
type of exercise, low load, women who are menopausal or perimenopausal. This is the number one group who need strength training, heavy lifting, progressive loading, impact for building and maintaining muscle mass, bone density, balance, stamina, self-confidence, and longevity.
01:56:45
Speaker
Atiyah gives him the opportunity to correct his Yogi's shouldn't weight lift stance, and he breezes right past it. So if you didn't hear me, I'll say it again. It is unethical that he does not update his stance to include this. And if by some, I don't know how, chance he doesn't know, because he doesn't seem to bother much with new research, it is unethical
01:57:10
Speaker
that he has not continued to learn about his field. But again, here's the thing. Since he's not a clinician, he's not bound by a code of ethics like clinicians are. He's free to be you and me. But I believe, and so do a lot of people, with great power comes great responsibility. He has a lot of power.
01:57:31
Speaker
And I don't know if he's just unwilling to change or doesn't see any reason to, or is he just like an aging politician who won't step down because they refuse to admit it's not their time anymore? Yeah, there's a big elephant in the room, too. Another one, the friend of the first one. This entire episode, the call to action at the end was basically to go check out Stu's BackFit Pro Course for Clinicians, where
01:57:57
Speaker
you will be taken through an incredibly demanding process where you will learn to find the mechanism. You will learn to do assessments that get at the mechanism for why someone has pain. If this is what Stu is selling, it makes sense that he is marketing with the, what did you call it? The big themes, right? His big themes are a way to
01:58:27
Speaker
basically convince people, sell to people, right? So of course you need to fear monger movement because movement is dangerous, movement causes the damage, and you're gonna get at the mechanism for that. You're gonna identify that it was in year three of playing hockey that the person did deep squats and ended up with the herniated disc. I don't know if that's what you're gonna do in Backfit Pro, but by God, you're gonna find a mechanism.
01:58:54
Speaker
McGill moralizes movement modalities because movement is dangerous. You see, because it causes damage because that's the mechanism. There must be a cause. There must be a mechanism. McGill misinterprets medical data. Of course he does because he would never be able to sell this course if he actually interpreted it correctly and shared that with the people listening.
01:59:15
Speaker
Why would they then want to buy this backfit pro knowing that there's often no mechanism there is such a thing as Non-specific low back pain. It's well researched and finally McGill manipulates via melodrama the more emotional the better the more stirring the better Because people want to feel something They don't want to think too hard, right?
01:59:39
Speaker
And they want to believe that there are good guys and that there are bad guys. Of course, it all makes sense at the end when a T is like, oh, maybe I'll take your course. Oh, that sounds good. Oh, tell me more. OK, Lincoln show notes. Now, Sarah, we sell something too, right? We do sell something. It's true. Basically, I'm not saying that people who sell things are shady, right? Not at all.
02:00:06
Speaker
But Sarah and I speak on, I like to think that we try to peel back the curtain on what's going on underneath, right? Including what's going on with movement, what's going on with movement science, with body science, but also what's going on with the way it's being delivered.
02:00:28
Speaker
And how can we interpret this? And how should we think about it? And are we doing this to sell bone density course? Perhaps. True. But we're certainly not telling people things that aren't supported by evidence to get them to be afraid to the point where they're going to give us money. It seems so obviously shady to me. And I don't think it is so obvious, though, because I think Stu is actually a really smooth operator. He's very charismatic.
02:00:59
Speaker
Right? He knows how to hold your attention and tell a story. I also don't think he's like an evil guy either. No. Right? I think that he's definitely caught up in his own bias and he's been very successful and he's reached a stage now where he is protecting a legacy.
02:01:16
Speaker
for him to go backwards and be like, wow, I was wrong a lot. And I said a lot of things that might've actually been unhelpful. I don't see it happening. And I can't say I fault him because I don't know how I'm going to be when I'm his age, right? Maybe I'll do the same thing and I'll double down. That's very human to do.
02:01:33
Speaker
You know, Stu's a human and he's probably helped a lot of people. He's definitely helped a lot of people. There's no doubt. And he's done a lot of really good research and he's made a name for himself because of the excellent work that he's done to a large extent. I think we get into trouble when we don't speak truth to power. So Sarah and I are not big names.
02:01:55
Speaker
We're little fish. We're little fish, right? But we have people who listen to us and who care what we think. And we think it's important that when there's someone in our field who's saying things that might potentially make people that are also listening to us afraid of things like strength training, that we need to speak up. And so this is what this episode is about. Basically, we see so many women afraid to lift weights.
02:02:25
Speaker
That's our area, right? We coach women to lift weights in order to make themselves stronger. And what we don't like to see is when women are afraid to lift weights because someone in a position of authority in so many different clever ways is suggesting that it's bad for them. With our bone density, of course, what we're trying to create is a community essentially for women or people who identify as women that is outside of the
02:02:56
Speaker
very, very heavy constraint of the patriarchy. This has nothing to do with anything, but I'm real tired of seeing two white men talk to each other. Immediately, there are blind spots there. There are things that listen to what they're not saying. It's hard to do, but listen to what they don't talk about because of their position perspective as people who are incredibly privileged
02:03:23
Speaker
at the danger of now having created a podcast episode that is almost as long as the original interview. We hope you enjoyed this episode.
02:03:34
Speaker
You know, I would really like to encourage people, even though I made a lot of jokes about not wanting to listen to it anymore, if you haven't listened to it. I do think it's worth it, just in the sense that you can then come up with really good arguments to use on your social media page when the McGill sycophants say, but that's not what he's saying. You can check out our show notes for lots and lots of links.
02:04:03
Speaker
to all of the different references we mentioned in this podcast. If you appreciate the time and energy that Laurel and I put into these episodes, you can express that appreciation by subscribing, by rating, and by reviewing our podcast anywhere that you get your podcasts. And Laurel, I'll see you in two weeks. See you in two weeks.