Back Pain
Back pain affects most people at some point. Huberman discusses evidence-based approaches for both treating and preventing back pain, drawing heavily on the work of Dr. Stuart McGill, a world expert in spine biomechanics.
Understanding Back Pain
The Biopsychosocial Model
Back pain isn’t purely mechanical:
| Factor | Influence |
|---|---|
| Biological | Disc issues, muscle strain, nerve compression |
| Psychological | Fear, catastrophizing, stress amplification |
| Social | Work demands, support systems, disability context |
Your thoughts and beliefs about back pain actually influence its severity and duration.
When to Seek Professional Help
Certain symptoms require immediate evaluation:
- Numbness or weakness in legs
- Bladder/bowel dysfunction
- Pain after significant trauma
- Pain that wakes you from sleep
- Unexplained weight loss with pain
- Pain that doesn’t improve after several weeks
These may indicate serious underlying conditions.
Spine Types: Willow vs. Redwood
Dr. McGill’s concept:
| Spine Type | Characteristics | Implications |
|---|---|---|
| Willow | Thin, flexible, high ROM | More mobility, less stability |
| Redwood | Thick, stable, lower ROM | More stability, less flexibility |
Your spine type affects which activities suit you:
- Willows may need more stability training
- Redwoods may need to respect their movement limits
- Neither is better—they’re different
Self-Assessment
Wrap your hand around your wrist:
- Fingers overlap easily = likely willow type
- Fingers barely touch = likely redwood type
The McGill Big Three
Dr. Stuart McGill’s core stabilization exercises:
1. Curl-Up (Modified)
Not a sit-up—protects the spine:
- Lie on back, one knee bent, one straight
- Hands under lower back for support
- Lift head and shoulders slightly (chest leads, not chin)
- Hold for 10 seconds
- Switch legs and repeat
2. Side Plank (Progression)
Build stability through progressions:
- Start with modified side plank on knees
- Progress to standard side plank
- Keep hips lifted, body straight
- Avoid hip sagging
- Build up to 10-second holds, multiple sets
3. Bird Dog
Trains anti-rotation stability:
- Start on hands and knees
- Extend opposite arm and leg simultaneously
- Keep spine neutral (don’t rotate)
- Hold briefly, return to start
- Alternate sides
Daily Spine Hygiene
Morning Caution
The spine is more vulnerable right after waking:
- Discs are hydrated and expanded overnight
- Highest risk of disc injury in first hour
- Avoid loaded flexion immediately after waking
- Wait 30-60 minutes before heavy lifting
Movement Variety
- Avoid sustained postures (sitting too long, standing too long)
- Change positions frequently
- Walk regularly
- Use standing desk intervals if desk working
Lifting Mechanics
- Keep load close to body
- Maintain neutral spine
- Hip hinge rather than spinal flexion
- Brace core before lifting
- Turn whole body rather than twisting
What Makes Back Pain Worse
| Factor | Problem |
|---|---|
| Prolonged sitting | Disc pressure, muscle deconditioning |
| Poor sleep posture | Spine stress overnight |
| Fear-avoidance | Deconditioning, prolonged recovery |
| Repeated flexion | Disc stress (especially when loaded) |
| Over-stretching | May destabilize hypermobile spines |
Exercise Considerations
Generally Helpful
- Walking
- Swimming (spine-neutral strokes)
- Core stabilization (McGill Big Three)
- Controlled resistance training
- Maintaining overall fitness
Case-by-Case
- Running (depends on condition)
- Heavy deadlifts (excellent when healthy, risk when injured)
- Yoga (some poses help, some harm—depends on individual)
- Stretching (may not be appropriate for all)
Sleep Positions
Position affects spine loading overnight:
| Position | Consideration |
|---|---|
| Side sleeping | Generally well tolerated; pillow between knees helps |
| Back sleeping | Good if spine stays neutral; may need knee support |
| Stomach sleeping | Often aggravates back pain |
Experiment to find what works for your body.
The Pain-Fear Cycle
Pain → Fear of movement → Avoidance → Deconditioning → More pain
↑___________________________________________________|
Breaking this cycle:
- Gradual return to activity
- Education about spine resilience
- Building confidence through controlled movement
- Professional guidance when needed
Related Pages
“The spine is resilient, but it requires proper care. Most back pain is not from one big event but from accumulated poor habits. The McGill Big Three should be foundational for everyone.” — Andrew Huberman