Dr. Stuart McGill: Build a Strong, Pain-Proof Back

High-Level Overview

Andrew Huberman sits down with Dr. Stuart McGill, distinguished professor emeritus of spine biomechanics at the University of Waterloo, who has spent some four decades loading spines in the lab and rehabilitating everyone from office workers to world-record powerlifters, NHL players, and pro golfers. The conversation starts with a deceptively simple question, "what causes back pain?", and McGill's answer sets the tone for everything that follows: back pain is a symptom with a hundred or more possible pathways, and the only way to fix it is to find the specific mechanism in the specific person. From there the two cover spine anatomy and genetics, how McGill assesses pain, why injury is so costly, the biopsychosocial side of pain, the deadlift debate, the famous McGill Big 3, practical tools like lumbar supports and split-up walks, and the "biblical training week" McGill uses to stay fit and pain-free in his late 60s.

The tone is conversational, story-driven, and practical. McGill teaches through analogies (willow branches, dog breeds, coffee cans with tennis balls, a backhoe's stabilizers) and anecdotes from elite athletes, and he is happy to court controversy, especially about deadlifts. Huberman brings his own back history and training routine into the discussion, which keeps it grounded. The conversation moves from anatomy and genetics, to assessment and rehabilitation, to training philosophy and specific exercises.

The Discussion Explores:

• "Genetics loads the gun": McGill's three-part model of back pain: genetics, exposure, and the psychosocial context around a person.
• Spine architecture: why thin "willowy" spines tolerate bending and thick spines tolerate compression, why we have discs instead of ball-and-socket joints, and how disc shape and facet angles differ between people.
• Stress and the tipping point: every system needs stress to adapt, but crossing the tipping point builds cumulative damage.
• Assessment over generic advice: how McGill provokes pain to find its mechanism, then removes the cause and desensitizes.
• Injury is asymmetric: borrowing from Nassim Taleb, why avoiding injury and protecting joints matters more than chasing intensity.
• The biopsychosocial side of pain: trauma, sensitization, fibromyalgia-like patterns, and McGill's "virtual surgery" approach.
• Deadlifts, squats, and alternatives: why McGill both loves and worries about the deadlift, and what he uses instead.
• Daily tools and the biblical training week: the Big 3, lumbar supports, dosed walking, posture changes, neck work, "swordplay," and a weekly Sabbath.

Deep Dive into Main Ideas

Back Pain Is a Symptom, and Genetics Loads the Gun

McGill begins by reframing the question. Asking what causes back pain, he says, is like asking for one exercise to fix "leg pain." There are more than a hundred different pathways and mechanisms, so the first job is a thorough assessment that narrows down the type of pain before matching an intervention. He compares it to the approach Andy Galpin described on Huberman's performance podcast: gather information, interpret it, then intervene.

His summary model is memorable: "Genetics loads the gun, exposure pulls the trigger and then the psychosocial milieu around the individual influences how they respond to the pain." To illustrate the genetic part, he uses dogs. Train a Greyhound and a St. Bernard for the Greyhound track and, no matter how well you condition the St. Bernard, "You're going to end up with a broken St. Bernard." People are no different: not everyone can play offensive tackle, be a gymnast, or even tolerate sitting at a computer all day.

Willow Branches, Redwoods, and Why We Have Discs

McGill explains that spine shape determines what kind of load a person tolerates. A thin willow branch can bend back and forth endlessly but buckles under compression, while a thick stick shatters when bent but bears tremendous compression. The world record holder in consecutive sit-ups, he notes, is a slender man with a willowy spine. Huberman asks whether we can guess our own type, and McGill says knee width, the width of the iliac crests, and hip width are all decent surrogates for how heavy a person's skeleton is. Disc shape matters too: top golfers tend to have more oval discs, while people who bear heavy compression have discs shaped more like a lima bean. Facet joints, the small guiding joints behind each vertebra, also vary; professional golfers all have open facet angles that allow twisting, which McGill calls "absolutely 100% genetic." That same openness can stress the pars bone during back-arching, which is why gymnasts (and one pro tennis player he rehabilitated after a coach pushed excessive extension in their serve) can develop stress fractures.

He explains why evolution chose discs rather than ball-and-socket joints with a classroom demonstration: four coffee cans separated by tennis balls, each controlled by students pulling ropes, proved impossible to coordinate. Replacing the tennis balls with foam rubber discs added stiffness, which automatically resisted deviation. The body, he says, uses stiffness as its control parameter, much like a car's shock absorber. Each disc is layer upon layer of collagen, about 80% stiff type I collagen and about 20% more elastic collagen, with types III through X binding the layers together. That binding collagen is where much of the genetic variation lies, and it explains why some people can do thousands of bending repetitions while others delaminate their discs.

McGill adds that one person's advantage is another's injury. Russian powerlifters bench pressed with a huge arch, and others copied them without realizing those lifters had large gaps between their spinous processes. People without those gaps crush the ligaments between them. "What is a mechanical advantage for one person is a mechanical disadvantage for another."

Every System Needs Stress, but Not Past the Tipping Point

Asked whether people should train with or against their body type, McGill offers a principle Huberman says he wants to attribute to him from now on: every system in the body, cardiovascular, musculoskeletal, endocrine, even psychological, requires stress to adapt and become robust. The catch is the tipping point. Cross it and you begin building cumulative trauma, whether emotional or at the tissue level. The goal is to find the tipping point, expand it, and never cross it.

He illustrates how specialized bodies become with the triathlon. The best swimmers are floppy in the ankles and long in the torso, the best cyclists lock their core down like a stiff bike frame, and the best runners pre-stiffen their muscles to store and recover elastic energy like a kangaroo (he recommends Shane Benzie's book The Lost Art of Running). No one who exits the water first wins the triathlon. Muscle contraction creates force, but it also tunes stiffness, and elite athletes like Mike Tyson pulse and relax, then turn "to granite" at impact. Golfers who hit 330 yards and pitchers who throw above 110 miles an hour tend to be elastic athletes who don't test especially strong. The lesson is that there is always a tradeoff.

Assessment: Provoke the Pain, Then Remove the Cause

McGill's answer to the generic question of how to train is that he doesn't know until he assesses the person. His three-hour assessments begin with "tell me your story, which reveals goals, pressures, and learning style. He then asks about the pain in detail: when it happens, with which motions, postures, or loads, and whether it moves. Then comes provocative testing. If I can provoke their pain, I've nailed the mechanic. If I can't provoke it, it's not mechanical."

His examples are precise. Canadian hockey players with stiff hips often get back pain on elliptical trainers because their pelvis and spine gyrate to make up for limited hip motion, while people with mobile hips do fine. One NHL player's flank pain was reproduced exactly by a lateral shear "bear hug" test, and the pain disappeared when McGill had him gently brace his obliques against his fingers. The culprit in his training was the Pallof press, a long-lever exercise that shears the spine, so it was removed for now.

Once the mechanism is known, the first step is to stop triggering it, because repeatedly provoking pain sensitizes the system, like stubbing a sore toe every day until a light touch hurts. McGill teaches "spine hygiene": hip hinging, squatting, lunging, getting to the floor, rolling without twisting, even a baby's crawl. He describes having to teach Brian Carroll, the holder of the all-time squat record of 1,306 pounds, how to get off a toilet without pain, calling it evidence of how corruptive pain is to movement patterns. Later, volume becomes the lever: golfers might stop at 95% of their lateral crunch at impact instead of 100%, and jiu-jitsu athletes limit how often they push end range.

Injury Is Asymmetric: Protect Your Joints

Huberman shares a friend's intensity rule for non-competitive exercisers: about 85% of workouts at roughly 85% effort, 10% at 90 to 95%, and 5% or fewer all-out. He notes that his own injuries almost always happened when someone invited him to a workout and competitive spirit took over. McGill is sympathetic but says it depends heavily on age and history: a 65-year-old pushed to 85% may need five days of rest, whereas training at 50% might need only one. He shares that he fractured his spine two years earlier after hitting a rock on a snowmobile at 100 miles an hour, and that even before that he could only ride hard for a season after months of preparation.

He then brings in Nassim Taleb, whose book Antifragile cites McGill's low back disorders book. A 50% loss hurts far more than a 50% gain helps, and injury works the same way: training hard offers a small gain with a risk of lasting harm. His second point is that people talk about muscle but forget their joints. "The key to long life is don't mess up your joints." Muscle is adaptive, joints much less so, and people who train too hard when young can find at 70 or 80 that their knees ache and they can't get down on the floor.

The Biopsychosocial Side of Pain and "Virtual Surgery"

Referencing Huberman's episode with Stanford pain specialist Dr. Sean Mackey, McGill pushes back on his reputation as a pure biomechanist. When pain comes from a mechanical injury, tuning the body with strategic mobility and stability usually works. But some patients have been through trauma, such as a car crash that killed a family member or sexual abuse, and their brain has been rewired so that the pain pattern doesn't fit. McGill says he can often tell when someone has been abused because they recoil when he first touches them. For these people, standard fitness approaches fail. Instead his team finds movements that don't trigger pain, sometimes as gentle as brushing a feather across the back, and slowly expands that repertoire with repetition, never triggering pain. He contrasts this with insurance-funded "work hardening programs that push injured workers, like bricklayers, to do more each day and label them non-compliant" when they fail.

For patients who have failed every therapy and have been told surgery is their last option, McGill uses "virtual surgery." He touches them on the shoulder like a knight, tells them they've now had surgery, and gives them a full post-surgical recovery plan: bed rest the first day, short walks, then gradual stability, mobility, endurance, and only later strength. Surgery often works, he explains, because it forces rest, especially for exercise addicts. In their two-year follow-ups, 95% of those who chose virtual surgery over real surgery were glad they did.

He also observes, while admitting he hasn't seen good science on it, that explosive athletes tend to have short attention spans and need coaching in short, efficient bites. When an NBA team asked him to help an explosive player last 27 minutes instead of 18, he asked the coach whether that would trade away the very explosiveness that sells tickets.

Deadlifts: An Extraordinary Exercise With a Growing Problem

McGill says he both loves and hates the deadlift. It is "tremendously neurologically dense," involving every muscle in the body to take the slack out before the bar leaves the floor. Yet about half of his clients under 30 tell him their back pain started with the deadlift, which he calls close to an epidemic. Recent studies of disc material removed during surgery found fragments of broken end plate more than half the time, a sign of excessive compression. The problem, he says, is progression: some trainers take unfit people to deadlifting twice their body weight in six months, while bone adapts far more slowly. Successful deadlifters are people who have built bone density over many years.

For people coming out of back pain, his team teaches the hip hinge first, assesses hip socket depth, and pulls from elevated pins rather than the floor. He clarifies that his earlier advice to Peter Attia, walking backward up a hill instead of deadlifting, was meant for Attia specifically. He adds that heavy deadlifting builds "grinding strength" that can reduce the pulsing, elastic strength needed to throw a football or swing a golf club. Pro golfers who took up heavy Olympic lifting and deadlifts hit the ball farther but ended up with sore knees and disc bulges, and many have since backed off. For older adults, he notes that the biggest risk is falling, which deadlifts don't protect against; hip power and agility do.

His alternatives include the rear-leg-elevated split squat with fingers interlaced behind the head and chest lifted ("become a peacock), goblet squats, single-leg step-ups, and, for elite lifters, auxiliary work like the belt squat, which Brian Carroll used heavily. Huberman shares that he does heavy hack squats, leg extensions, and glute-ham raises without pain and rarely deadlifts; McGill says glute-ham raises get the same it depends" answer, since they are auxiliary exercises rather than a deadlift.

The McGill Big 3 and Core Stiffness

The Big 3 are the bird dog, the curl-up, and the side plank. McGill says his group didn't invent them but was one of the few in the world to measure spine stability quantitatively, and these were the most efficient way to build stability while sparing the spine. He does them six days out of seven. Sparing the spine matters because people have limited training capacity, and he'd rather save it for other things.

He explains why a strong core makes the whole body stronger. The pec major attaches to the arm on one end and the ribcage on the other, so without a stiff torso, pushing collapses the chest into the shoulder, an "energy leak." Lock down the core and all the force goes to the limbs. He compares this to a backhoe putting down its stabilizers before digging. Huberman reports that since doing the Big 3, his occasional lower right back pain has improved, his lifts have gotten stronger, and he runs more upright with better endurance. McGill says that's exactly what he should feel, since the core forms a cylinder around the diaphragm.

Practical Tools: Lumbar Supports, Dosed Walking, Posture Changes

Several simple tools come up. McGill used a small inflatable lumbar support on his five-hour flight and gave Huberman one; a rolled-up towel works too, in lectures, restaurants, or cars, even if it draws funny looks. For walking, his rule is "Don't walk to pain. If 40 minutes brings pain but 20 doesn't, walk 20 minutes three times a day and you've guaranteed" an hour of pain-free walking. People with disc-related pain should keep changing posture, for example sitting for 20 minutes, standing for 30, and walking for 10 using a sit-stand desk. McGill walks after every meal and before bed with his wife and dog.

On sitting, he offers a surprising lab finding: loading a healthy, never-injured cadaver spine in a sitting posture does not create new injury. Sitting becomes painful when there's pre-existing damage, like collagen delamination or an old bulge, which is why a fit gym-goer who trains too hard may hurt when sitting while a sedentary colleague doesn't. For people whose pain is relieved by extension, lying face down while someone gently pulls on each leg can draw a posterior disc bulge back in (McGill says the maneuver "vacuums in" the bulge). Inversion tables and hanging increase disc height for only about 15 minutes before gravity reverses it, and he has seen no evidence that PRP injections help discs, though he swears by PRP for stubborn muscle tears and it can help in ball-and-socket joints. Once a disc is injured, he adds, people generally have to choose between mobility and heavy strength rather than having both.

The Biblical Training Week and McGill's Own Routine

McGill's training philosophy is named for the Sabbath: one full day off each week so the week's work can adapt and settle, as his father practiced when McGill worked with him as a kid. In its basic form, he strength trains two days, does mobility work on two days, and does cardio on the others, with the Big 3 six days out of seven. Huberman plans to adapt his own three-lifting, three-cardio week by converting one of each into a mobility day.

A strength session starts with the Big 3 done dynamically (pushing the heel away in the bird dog and drawing small squares with hand and foot), then glute bridges and hip thrusts, clapping push-ups, explosive inverted rows on a TRX, split squats, and heel-elevated squats. Because he broke a vertebra in his neck playing hockey, he trains his neck flexors isometrically by pressing his tongue to the roof of his mouth and pushing up against his hands. He finishes with "swordplay": figure eights with a bar weighted at one end, which NHL players credit for more powerful shots. Huberman connects this to research showing that distal muscles and calf atrophy are markers of neural decline, and McGill agrees, noting he can often read nerve-root problems just by looking at a patient's calves. McGill also brushes his teeth and splits wood with his non-dominant hand to stay coordinated. Mobility days include thoracic extension, neck and hip work, moving every joint without load, and shadow boxing. Cardio is outdoors when possible: cross-country skiing, cycling, kayaking, swimming, or hard hill walks with his dog.

He also recounts a genetic athletic panel that matched his self-assessment exactly: "ultra" grip strength and very quick first movements, but the worst category for heart rate recovery.

Conclusion

Dr. Stuart McGill's central message is that there is no single fix for back pain because there is no single back pain. Genetics shapes what each spine tolerates, exposure determines whether it gets pushed past its tipping point, and psychology shapes how the pain is felt and resolved. The path forward is to identify the specific movements, postures, and loads that trigger a person's pain, stop provoking them, build spine stability with tools like the Big 3, and then slowly and carefully expand capacity. Along the way, he urges respect for joints over muscle, caution with fast deadlift progressions, dosed walking, frequent posture changes, and a weekly day of rest. Whether you're recovering from pain or trying to avoid it, the episode offers both a framework for thinking about your own body and a set of concrete, low-risk habits to stay strong and mobile into your 70s and 80s.

This is a summary of "Dr. Stuart McGill: Build a Strong, Pain-Proof Back" from Huberman Lab, giving you the GIST so you can decide if you want the REST. Listen to the full episode.