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

Peter Attia

Sep 1, 2025

Episode description

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.

We discuss:

Peter’s experience with debilitating back pain [3:00];
Anatomy of the back: spine, discs, facet joints, and common pain points [14:15];
Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:30];
Why the majority of back injuries happen around the L4, L5, and S1 joints [30:45];
How the spine responds to forces like bending and loading, and how it adapts to different athletic activities [36:00];
The pathology of bulging discs [43:00];
The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [45:45];
The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:00];
The significance of strength and stability in preventing injuries and preserving longevity [1:08:00];
Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:15];
Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:29:45];
Empowering patients through education and understanding of

Episode description

View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

We discuss:

Peter’s experience with debilitating back pain [3:00];
Anatomy of the back: spine, discs, facet joints, and common pain points [14:15];
Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:30];
Why the majority of back injuries happen around the L4, L5, and S1 joints [30:45];
How the spine responds to forces like bending and loading, and how it adapts to different athletic activities [36:00];
The pathology of bulging discs [43:00];
The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [45:45];
The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:00];
The significance of strength and stability in preventing injuries and preserving longevity [1:08:00];
Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:15];
Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:29:45];
Empowering patients through education and understanding of

Mindsip insights from this episode:

Aim for sufficient strength to protect joint health

For long-term joint health, it's better to pursue "sufficient strength" for life's demands rather than chasing maximal deadlift personal bests, which can cause cumulative micro-damage to the spine.

#joints

#strength

Embrace arthritis for spinal stability and pain reduction

A degree of arthritis can be beneficial for an aging spine as it naturally adds stiffness to a previously unstable joint, which can ultimately reduce or eliminate pain.

#arthritis

#pain

Recognize limitations of static MRIs in diagnosing dynamic instability pain

A static MRI can appear normal while a person is in debilitating pain because it cannot detect dynamic instabilities, like a "clunk" or shear motion during movement, which are the real source of pain.

#MRI

#pain

Avoid mixing yoga and deadlifts to prevent injury

Training for extreme flexibility (like in yoga) and training for stiffness (like in powerlifting) create conflicting spinal adaptations that increase the risk of injury.

#yoga

Self-assess pain triggers with Back Mechanic for tailored recovery

Instead of seeking generic fixes, the book "Back Mechanic" guides you through a self-assessment to identify your specific pain triggers and provides a tailored strategy for recovery.

#back-pain

#recovery

Recognize inflammation as essential for healing after disc injury

The acute inflammatory response following a disc injury, while painful, is a crucial process where the immune system cleans up extruded material, and using anti-inflammatories might hinder this beneficial long-term healing.

#healing

#inflammation

Understand how damaged spinal discs increase pain sensitivity

A damaged spinal disc, having lost its internal pressure, unfairly adapts by growing new nerves and blood vessels into the tissue, making it even more sensitive to pain.

#pain

#regeneration

Reconsider Big Three core exercises for individual flexibility needs

The famous "Big Three" core exercises are specifically for building stability and are not a universal prescription, as they can be inappropriate for individuals who are already too stiff.

#exercise

#flexibility

Identify and stop micro-insults to resolve chronic back pain

Most so-called chronic back pain is actually a series of repeated acute injuries throughout the day, and the pain resolves once these micro-insults are identified and stopped.

#back-pain

Peter Attia

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