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cover of episode #287 ‒ Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D.

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

2024/1/29
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Stuart McGill: 本期节目深入探讨下背痛的各个方面，包括解剖结构、疼痛机制、治疗方法和预防措施。McGill教授强调找到损伤和疼痛之间的因果关系，并通过案例说明了如何通过评估和运动疗法来改善下背痛。他还介绍了“麦吉尔三大核心练习”及其原理，并讨论了手术的指征和时机。 McGill教授认为，慢性背痛通常是多次急性损伤累积的结果，而非持续性疼痛。他强调了核心稳定性的重要性，以及如何通过增强核心肌肉力量和稳定性来预防和治疗下背痛。他还分享了在评估和治疗背痛时的一些技巧和经验，例如如何通过改变运动模式来缓解神经痛，以及如何判断手术的必要性。 McGill教授还谈到了背痛患者的心理创伤，以及如何通过赋能和教育来帮助他们克服心理障碍。他认为，理解疼痛的机制是关键，通过正确的评估和治疗，大多数患者都可以避免手术。 Peter Attia: 分享了自己多年来遭受下背痛的经历，并与Stuart McGill教授一起探讨了背痛的各个方面。Attia医生也分享了自己对力量训练和核心稳定性的认识，以及如何平衡力量训练和避免损伤。他与McGill教授一起讨论了MRI检查结果的局限性，以及如何通过评估和运动疗法来改善下背痛。

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Peter Attia and Stuart McGill discuss Peter's history of lower back pain, highlighting recurring acute episodes followed by radicular pain and occasional discomfort. They delve into the anatomy of the back, including the spine, discs, facet joints, and common pain points, emphasizing the interplay between flexibility and stability for optimal function.
  • Lower back pain can stem from issues with discs, facet joints, or other anatomical structures.
  • The spine's design balances flexibility for movement and stiffness for load-bearing.
  • Discs act as biological fabrics, providing efficiency but susceptible to delamination under stress-strain reversals.
  • Facet joints guide motion and can become thicker and more painful after disc injuries.
  • Instability in the spine can lead to increased stress on facet joints and subsequent pain.

Shownotes Transcript

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. 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 [3:30];
  • Anatomy of the back: spine, discs, facet joints, and common pain points [14:45];
  • Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:45];
  • Why the majority of back injuries happen around the L4, L5, and S1 joints [31:00];
  • How the spine responds to forces like bending and loading, and how it adapts do different athletic activities [36:15];
  • The pathology of bulging discs [43:15];
  • The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [46:00];
  • The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:15];
  • The significance of strength and stability in preventing injuries and preserving longevity [1:08:15];
  • Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:30];
  • Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:30:00];
  • Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:39:00];
  • When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:45];
  • Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:30];
  • Tarlov cysts: treatment and surgical considerations [2:00:15];
  • The evolution of patient assessments and the limitations of MRI [2:02:15];
  • Pain relief related to stiffness and muscle bulk through training [2:07:00];
  • Advice for the young person on how to keep a healthy spine [2:14:15];
  • Resources for individuals dealing with lower back pain [2:25:30]; and
  • More.

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