Dr. Stuart McGill Interview on Back Pain Relief by Ian Hart

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Ian: Alright, so, here we are! This is Ian Hart, co-creator of Back Pain Relief4Life and I’m here with Dr. Stuart McGill. He is the professor of Spine Mechanics at the University of Waterloo in Ontario Canada and he is one of the most sought after experts and consultants and author for back pain relief performance and his books and DVD’s can be found at http://backfitpro.com/ – Welcome, and thank you Dr. McGill.

Dr. McGill: Yea, Thank you, Ian.

Ian: Alright so, there are a few questions I want to ask and a lot of these questions are pertaining to everyday questions I get from clients and also fitness professionals. The first thing is why is back pain such a monstrous epidemic nowadays and is the spine more vulnerable today as say, 40 years ago?

Dr. McGill: (laughs) Starting with the easy questions first. I don’t know the answer to that, Ian. However, if we go back even to the ancient Roman scrolls and Egyptian art, we see pictures of people expressing their back pain and trying different mechanical postures and movements to try and deal with it. So, its not something new that’s for sure. However, I think with the advent of personal computers and how people’s jobs have changed so radically – I know even my role as a professor has changed radically over the years where virtually everything I do, from the administrative point of view through the teaching is done by a computer – and we’re all sitting much more and longer and some of us elect to engage in fitness programs because of this generally sedentary lifestyle. We go very hard in that one hour training session and then for the other 23 hours were quite sedentary and that regimen in and of itself is problematic.

Ian: So that sitting down all day could potentially lead to people’s backs getting worse throughout their lives as they sit down at desks?

Dr. McGill: Yea there’s no question. Yep. Sitting for a long period of time is quite stressful for the back for quite a number of reasons.

Ian: Ok. You also brought up people engaging in exercise programs. Now a lot of people are scared when they have back pain to engage in exercise and sometimes they just don’t do anything because of the pain in their backs. When is it appropriate to exercise? Which exercises should… and obviously this can be a complicated question but in general, what exercises should people stay away from, and what exercises will help strengthen the lower back, core, etc?

Dr. McGill: Ok. Well I’m just going to clarify a few things there because you started the question as talking or referring to back pain which is a generic malady should we say. And here’s the thing: there is no good instruction for someone with back pain on what they should do and what they shouldn’t do. It’s very much dependent on the person. So if we go back to more general principles, we could say avoid the mechanical cause of your back pain. So
people when they think about it in terms of motions, postures and loads they should be able to identify motions, postures and loads that exacerbate or make their pain worse. They should also be able to identify motions, postures and loads that are tolerable. So the exercises that they should do are the ones that are tolerable, but address their deficits and ones they should avoid and ones that make their pain worse. So that’s the answer from a generic point of view. But, if we were going to get specific you would have to use examples of specific categories of that pain. So let’s take a 30-year-old person who works in an office but are quite keen to keep their fitness and appearance and that sort of thing. So once a day they go to the gym and have a good training session. It probably bothers them that the slob that sits beside them at work, who never trains or works out, never complains about their back pain. And here’s the funny paradox that is quite unique to backs. Pain in that 30-year-old office worker, is most probably discogenic pain (pain from the disk). Pains in other periods in the lifecycle come from different tissues and mechanisms. That would be a good generalism to characterize that type of person. The person who never trains or works out, never builds up any cumulative trauma or more specifically delamination in the discs of their back so they remain pain free. But then again, their work capacity is very low so they couldn’t go out and go for a run or a lifting session or whatever; they just couldn’t take it. However, the person who does train – and they train, probably with too much of a flexion bias, you know too many sit ups and too many full motion crunches, etc. maybe too much stretching – they start the delamination process in their discs so that when they go back to work and sit for a few hours, that becomes a very painful enterprise. If they didn’t work out they would probably have less pain. That’s the craziness of all of this but I’m certainly not advocating don’t train – quite the opposite. It’s the way that you train so that you don’t build up cumulative stress in any one area of the body and keeping the back in balance is one of the key principles to reducing not only back pain but throughout the body.

Ian: Great! That actually leads to my next question, which is: why are crunches and why is spinal flexion or repeated spinal flexion deleterious to the spine and what should be opposing the spinal flexion (or you said if too much stress on one specific spot could cause pain). What should someone do as opposed to crunches or…

Dr. McGill: Yup, I understand your question. I’m just going to define for your listenership what flexion is versus flexion effort or moment. Flexion movement Is what your spine goes through when you do repeated sit-ups – you bend the spine forward over and over and over again. That is different from flexion challenge or flection torque. If you’re familiar with doing say a push up or a “stir the pot” kind of exercise, that is still very challenging to the abdominal muscles and yet no flexion movement takes place. So that’s what people don’t recognize. Is the difference between using your abdominals and creating flexion effort versus flexion motion.
Flexion motion with compressive load is an injury mechanism. We’ve proved this over and over again, that if you keep bending the spine under compressive load over and over again, you will work the nucleus (the center gel of the disc) through delaminations that will slowly accumulate. Now, I don’t want to get ahead of myself but you can make a note for later, that that’s in a person specific of itself. Heredity does make a difference there. But nonetheless that combination of flexion motion with compressive load from muscle activity will slowly lead to back pain versus if that same person was to avoid repeated curve ups where there bending the spine or repeated sit up and replace those with exercises like stir the pot – which is basically a push up posture, where the elbows are placed on a big gym ball and they swirl there arms around – and stir the pot is a good name because that’s what it looks like. That is a terrific abdominal challenge but the spine isn’t actually bending and that does several things. Now the tolerable training volume in that particular individual grows. If you keep doing flexion motion using the sit up example, the person will actually wear or work on the discs of their back more than the actual muscle. So they’re wearing out the joints before they wear out the muscle. Well your objective is the opposite. You want to spare the joints and really train the muscle underneath. So you can see how exercises like say doing a push-up and a walk out with the arms or pushing exercises or stir the pot are all very abdominal muscle intensive yet they spare the joints underneath, therefore increasing the tolerable volume. So you get more development of athleticism and less pain. So you see it’s back pain type specific to answer that question.

Ian: Ok. Perfect. I think that got the point across. Now when is bed rest appropriate if ever for back pain? We hear all the time, I still hear it to this day, Doctors saying just rest; don’t do anything for your back. When is it appropriate for bed rest?

Dr. McGill: Well, that’s an excellent question because like most of my answers there’s a time and a place. And what I mean by that is, those people that are listening to this who have experienced the real sharp stabbing back pain and there about 30 years old. That’s discogenic back pain. When the person gets locked up and it’s just absolute murder with they will describe its like knives going into their backs. Probably laying in bed rest for half a day is advisable. However, the trick is to as you are laying, trying to find a position that resolves this very acute sharp attack. So if it is of the type, say the person was bending over and tying their shoe or they sneezed and that threw their back out, that is a flexion based disc bulge, and it’s trapping in their root and creating that real knife pain. When they’re laying in bed, if they can lay on their tummy and work into a position where they could put one fist under their chin while there laying on their tummy, they would find that they could then stand up, work themselves onto their hand and knees, side step out of the bed, get to an upright position, and they would find that would enable them to really shorten the duration of bed rest so they could get moving once again. The funny thing is, disc bulges that create those very sharp acute attacks can be worked back into the center of the disc reducing the bulge, if the right combination of positions and loads are generated in the back.

Ian: OK

Dr. McGill: Ian, may I just say one more thing to answer your question. I think the other part, when Docs say well, just try bed rest for back pain, that has been shown to not work well at all. We’re not talking about the stabbing sharp attacks. Now that’s just someone who is just getting worn out from there back pain so there solution is to just go to bed and that’s just a spiral.

Ian: Perfect. Thanks for clarifying that. Now there’s a ton of surgery going on too with back pain and I always feel, my personal belief is that it should be a last resort, but it seems like sometimes it’s not the last resort. When do you find that it’s appropriate for surgery as a relief or as a help to eliminate back pain?

Dr. McGill: (laughs) Well if you’re sticking with the back pain definition then I would say never, absolutely never. Now if I could expand that idea of back pain and say well, was this subsequent trauma? Did they fracture their spine in a car accident or something like that? Then is a case to justify back spine surgery. Or if they have unrelenting pain down their leg. So it’s no longer really back pain but it’s radiating pain, clearly a nerve route is trapped. All conservative approaches to pain management have been tried and failed. They’ve lost bowel and bladder control. These are all markers to justify a surgical consult. However, if they have been given the diagnoses of Degenerative Disc Disease and they have more than one level in their back involved – so they have flattened discs at more than one level – then surgery is a very very poor choice and their just rolling the dice now. The chance that a surgeon would be able to go in and cut out their pain, when they have multiple levels involved and several sources, has been shown to be… well a surgical disaster. And these are the kinds of patients that I have to deal with.

You know what’s so interesting about this Ian, is that statistically the studies show that those who go in for back surgery for non-descript back pain, while they roll the dice some will become very incapacitated afterward and some will become quite improved. But, after 10 years everybody’s evened up. So if they let nature take its course, and better yet if they understood the cause of their pain and dealt with it through people who understood their movement patterns, addressed the deficits to put their body back into balance and dealt with there back pain that way, generally speaking they’ll do quite well. When I hear, “ Oh I tried all this physical therapy, I saw my trainer, etc. Then it didn’t get better, in fact it got worse.” I would have to say, “ you saw the wrong physical therapist and the wrong trainer but, if you saw the right ones, who understood the source of your pain then they could have designed a better program for you. Even if they didn’t do anything there even up after 10 years. Back pain has a natural history to it, you don’t hear of 80 year-olds as a rule complaining about back pain. You do occasionally but generally they complain about other things. When you talk to them, they might say “Oh yea, I had a bad back when I was 30, 40 and 50 but I grew out of it.”

Ian: Now that’s a good point you brought up because in reading Dr. Sorno’s book “Healing back pain”, he talks about the psychosomatic issues with it and you talk about this is your book, “Low Back Disorders.” How much of it has to do with emotional factors? I think he was stating that between 30 and 60, there’s a lot of stress and emotional issues. How much is psychosomatic and how much is physical?

Dr. McGill: Well, there’s no question that a positive attitude – and that’s what Dr. Sarno really promotes, a positive attitude will help. But, I will say it absolutely is not the cure and if the person’s pain is real and its coming from damaged tissue from repeatedly poor movement patterns or bad lifting patterns or whatever it happens to be, no amount of positive attitude will help that individual. Now let me give you the opposite side of that argument. I’ve had many patients like this but I’ll give you an example of this one to illustrate. This fellow was a very solid citizen in the community. He wasn’t faking his back pain. His doctors – and he saw several – told him, “we don’t understand your pain and the pain must be in your head.” He was eventually sent to a pain clinic and their solution was to load him up on narcotics – demerol and the like. And they had him write down his pain. “Oh is your pain a 6, a 2, an 8?” So he could document his pain throughout the day, which was absolutely the wrong thing to do because, he focused on his pain. I saw him and he said, “doc I hear you’re different but, they tell me the pain is in my head, but it can’t be it’s too real. However, if it is in my head, I must be crazy and I don’t deserve to live and if you can’t take my pain away, I’m going to put a bullet in my head.” This is a real situation. Being driven to suicide, being told that the pain is in their head and all they had to do is take a psychosomatic or psychophysical kind of approach. The fact of the matter is, when that person has shown motions, postures, loads and how to put their body back into balance and their pain subsides; they’re able to have a good nice sleep; they’re able to eat well; and they’re able to tolerate good training activity once again. All of these things will strengthen them again – not only their body but their mind. A good night’s sleep won’t rob them of the softness that they get mentally. All of a sudden they’ll be able to handle the rigors and challenges of daily life but, it started by started by taking their pain away not by telling them they have to get used to it.

Ian: Now that leads to my next question actually, when you brought up the medication point. A lot of people are going to doctors and they’re getting Celebrex and there are a few others out there. Can you just give me your thoughts on pain medication for back pain and is that ever necessary, and what’s that doing to the body?

Dr. McGill: I’m really not qualified to talk about meds, but I can certainly give you my own
opinions on them. Celebrex may help some arthritic conditions, there’s no question about that. But for the more common causes of back pain, again, there are more better should we say, physical methods and our job is to get the people off their pain meds.

Ian: Ok. Fair enough.

Dr. McGill: I can think of an example you didn’t mention Methocarbamol, which is a muscle relaxant. So many docs give muscle relaxants for back pain. The best muscle relaxant is posture change. If a person is bent over and in a flexion entasia, because of back pain no amount of muscle relaxant will shut the muscle off. But if you can get them to change their posture, you can get them to shut their muscle off and they’ll say, “oh, you’re absolutely magical, you just took my muscle pains away.” That was through changing their posture so they didn’t have to support their back against the loads of gravity.

Ian: That a great point. Now my next question is another question that I think the general population is maybe mislead or they have a bad understanding of how everything works. When they go to get MRI and they’re given feedback on their MRI, would you say that’s a good indication of their current situation of the spine, discs, nerves, etc. and what can an MRI really give you in terms of feedback and where your spine health is?

Dr. McGill: Ok, well I think there are two questions in there. Generally speaking most people would be better without an MRI. Some people would say that’s responsible. However, the picture of the anatomy very rarely helps. You will have some docs that will say, “well I can’t see anything on the MRI and therefore your pain is not real or I don’t understand it, it must be in your head, go away.” Or they will look at the next MRI and it will look absolutely awful and all kinds of things could be possible pain candidates, and yet the person doesn’t have much pain. Here’s the concept that would help people understand. As you age, there’s no question that the discs will slowly dry out and lose water content and flatten. Say a person did damage one of their discs or vertebrae, with a say they had an end plate fracture during a lifting injury. So that joint is now flattened. Over the next ten years they will have a load intolerance. When they have poor form when they lift, they’ll increase their back pain, when they sit too much, they’ll increase their back pain, etc. But after about ten years their pain will start to go away and yet the MRI through this whole ten year period, has looked and worse and worse. First it shows a flat disc, then it shows sclerotic bone growth, then it shows arthritic spurs are starting to grow around that unstable segment, then the facets start to atrophy and glow on the MRI etc, etc, etc. After ten years it’s a terrible looking MRI and yet the term we use the pain has burned out. After ten years the arthritis has fused up the joint naturally. There’s no more motion left in the joint. The bone spurs have grown over the whole thing. So as I said, the MRI looks awful, but the joint is now stabilized. Guess what’s happened to their pain? It’s all gone. So that’s why the MRI doesn’t correlate with the pain. Now if you’re going to have surgery, the surgeon needs to know what he’s going to cut out or alter to try and change the pain generator. That’s when the MRI is used. So once the person has been identified as a really good risk with a high probability of a favorable surgical outcome, then has the MRI to guide the surgeon on what he may have to go around, what he may have to really alter. But again, his risk versus reward, the reward increases when there’s one thing that the surgeon knows he can go in and alter. But if there’s more than one, you’re now just really rolling the dice just hoping that he gets the one that’s the major pain cause. But anyway, that may help people interprets their MRI’s. And one other thing that I’ve written a lot about in my books, and I chide the radiological community for is the radiologist never see the patient. So when they see the MRI’s they look at some peculiarities and just state what the peculiarities are. But who’s the person who makes the links between the MRI findings and the actual patient? It’s not the radiologist because they never see the patient. So there’s a missing link in the whole medical process to really obtain the information so I ask every patient that I see – they have to bring their full set of medical images. I never look at the medical images until I examine them. And then from the results of my exam where I’ve already identified motions, postures, and loads and tissues that are all pain generator candidates, then I look at the MRI and say “ah, well that makes sense. There’s edema in that bone, that’s a bone bruise that is accounting for why they can’t
tolerate compression. Or they might have a shear intolerance and I’ll look and say, “oh yeah there’s an open, very dynamic, very open shear instability in the spine.” But this is all done afterwards; but that’s not typical medical practice at all.

Ian: Ok. Thanks for clarifying that. Now the next question…

Dr. McGill: I have to tell you, you’re really wise in asking these questions, you’re hitting exactly the right issues. You’ve been around this before. (laughs)

Ian: Yea. I mean, I really appreciate you clarifying these things because, there are so many myths out there and that everybody’s confused about back pain and doctors are more confused sometimes than the patient. And I wanted to make sure you touched on those things because you’re the expert and you know and you’ve seen so much and you’ve researched so much that it’s hard to dispute what you’re saying. Right?

Dr. McGill: My wife would argue with you. She still thinks I’m an idiot. But in any case… (laugh)

Ian: that’s alright though; it’s always going to be that way.

Dr. McGill: You know what, your right.

Ian: You’re right, same issues here. Now I had a consultation today and I see this often. The lady said, “I had a car accident 6 months ago (or 6 months previously) and then 6 months later I had sciatica and she somehow linked it with the accident 6 months before. How much does trauma play into back pain, how much is it genetics and where are the statistics and what is the research saying when it comes to these issues?

Dr. Stuart McGill: Okay you will not find a single good source out of the research literature to answer that question. The only way you can answer that is to spend a good number of years and having a lot of applied and practical experience such as dealing with people and see who does well with certain approaches and whose traumatized and who was not, and doing the science yourself so you really understand the various links that exist. So it is up to someone who has lot of experience I think to put up all together to answer that question you will not find an answer in a single book.

Ian: OK.

Dr. Stuart McGill: However, let’s start the genetics component of your question. Let me give you an example: not everybody is designed to play golf. Consider a rod which will be the spine and you are going to twist that rod now, if you had a thick rod or a thick tree trunk and tried to twist it, you would shatter it. But if you had a thin rod or a narrow very thin tree, you could twist it and it wouldn’t break and the reason is, you would not create high stress. So a thick rod creates a lot more stress than a thin rod for the same amount of bend shall we say or twist.

Ian: Right.

Dr. Stuart McGill: So, if a person has a very slender spine – and I see this in a lot of the professional golfers – they may look like bigger on the outside, but when you look at their x-rays and or MRI’s generally speaking they have a slender spine and open facet joints and what not. So in other words, genetics played a role in determining what mechanical variables their spine will tolerate. Now let’s take that same golfer’s spine and put that in an NFL (at middle linebacker), they will not survive. Because the very features of the spine to be good at golf are the antithesis of those that will allow you to survive playing middle linebacker. Those people need big, thick spine with Limacon-shaped discs that can bare the compressive stresses of getting banged around in the NFL, but don’t ask those guys to play golf. So you see golf is just about being strong the linebackers that would be playing on the PGA tour, but you can’t find those guys who can hit a golf ball very far.

Ian: Right, Right!

Dr. Stuart McGill: You see the difference? So this is why genetics, predisposes us all as to what activities build us up versus which activities tear us down. And that would be different between individuals. But when you have been looking at it after 30 years, you start to get an idea of why every – and I rather unique in my career if you talk to the average family doc and say well how many PGA tours or how many olympic medal sprinters have you looked at or rowers, or whatever. They probably would have to answer and say, None! But I am a bit lucky and that I see a number of these different people and when you see enough of them you start to see patterns emerged and those patterns tell a story in terms of genetics.

Ian: Right, okay. Now on to one big topic of strength and conditioning people and also, people just the general population is deadlifts. Many people in the general population don’t or they have a fear of their back let’s say. So when they do a deadlift and they feel those muscles working they say and think..they feel their back, they think it’s pain. Now, what types of deadlifts or when is a deadlift appropriate for just a general population?

Dr. Stuart McGill: So these are people who have never had back pain..or have a back pain history?

Ian: People with yeah back pain history.

Dr. Stuart McGill: Well first thing I have to do is determine what they tolerate and as they have tolerate compressive load on their back, then I’ll say alright when you are candidate to do higher load exercises, which is a deadlift. The next investigation I would perform is what type of hips do they have? Do they have shallow, hip sockets or acetabulums? Or are they deep? Now if they are deep, chances are they should not be deadlifting from the floor; they should be picking up with a dead weight that.. has been elevated a little bit on some blocks.

Ian: Right.

Dr. Stuart McGill: So you see once again it depends on what the shape of their hips are, as to what style of deadlifts I would consider. I then manipulate some of the stylistic features of a deadlift to try and shore-up whatever weaknesses it was that we detected. One example of that would be as the person is setting up for the pose so they gone into the deadlift, they have hip-hinged, they have a neutral spine, now the trick would be to really stiffen their whole spine so they will grab the bar with a double overhand grip, not a reverse hand grip.

Ian: Okay.

Dr. Stuart McGill: And the first thing they do is as they’re grabbing the bar quite robustly, they try and twist the bar by engaging the lats and what that does it stiffens the entire back all the way down to the sacrum. So by bending the bar in external rotation, that stiffens the whole back. Now, if you set up in what is called the “lifters wedge”, so a nice stiffened wedge, you’ve grab the bar, you’ve bent the bar, you’ve stiffened your hips you’re spreading the floor, all of these pre-stiffening conditions, then simply squeezing the bar harder picks it up off the ground. You follow?

Ian: Gotcha! yeah.

Dr. Stuart McGill: yeah. Now do not lift with your back at that point. Instead, slide the bar up – and I don’t know whether its below the knee at this point or above, it depends on again how you set up an individual person, but as they squeeze and externally rotate and then grip it in to the ground with their feet externally rotate and spread the floor through the hips, they don’t lift with their back – the instruction is simply pull your hips through and that acts as a cam about the hips so there is no possibility of any shear loads working into the back, etc. And as long as they tolerate compression, you should have a very successful deadlift for that person with a history of pain.

Ian: Perfect.

Dr. Stuart McGill: The last can I say one more thing about this whole issue Ian?

Ian: Sure.

Dr. Stuart McGill: And that is we never did ask the question “Was the deadlift the very best tool for addressing what you are trying to achieve?”

Ian: Right.

Dr. Stuart McGill: In other words, could we have, see deadlifting generally uses up a lot of capacity at the back. If you have a good deadlifting session, generally there is not much capacity to do to much more. However, if we didn’t use it all up on deadlift and we took a heavy two inch manila rope or 1 and 3 quarter inch manila shipping rope and you simply grip into the ground put a big weight onto the end of that rope – say 30 meters away, or 30 yards away for you americans – and then hold that rope in hand over hand, you’re going to develop balance between grip strength, back strength, hip strength, hamstring strength, etc.

Ian: Right.

Dr. Stuart McGill: And then you might say okay, well now I am getting some good endurance on really balancing the posterior chain. Or maybe you might want to do some sled dragging exercises that are not quite so intensive in terms of using up that deadlift capacity. So that is the second part of the question. Not only are there are all sorts of tricks that we can use to make the deadlift not only more tolerable but more of an exercise developing athletics prowess, but also ask the question: is the deadlift the only tool in our toolbox that we can use or is there something better to get the job done.

Ian: Okay, that makes a hundred percent sense. Now as we come to the end of the interview, I’d like to ask you. Someone suffering from back pain, what are three action steps you would tell them to take to get them on a journey for at least?

Dr. Stuart McGill: Find out the cause of your pain and if someone can guide you, it will reveal itself. What I mean by that is pay attention as to what activities cause pain and then try and figure out what motions, what loads, repetitions, what time of the day, what features cause the pain and isolate them and then stop doing it. So that is number one.
Number two, would be to have an assessment from a competent individual who understands how not only the back works but the entire body linkage, because sometimes stiff hips is the real culprit in this particular person.

Ian: Right.

Dr. Stuart McGill: Or maybe it’s a bad knee that they every time have work around that knee and that is propagating through the linkage into the hips, and the back and the shoulders. Maybe when they put a bar on their back they don’t have enough shoulder or thoracic spine mobility so that now manifests as a bending stress on their low back, so that assessment is critical. So now you know what the cause is, and now you know what to not do, that’s huge. Too many people just jump in right away. Here are your corrective exercises and here’s your workout problem. But they forgot those first two steps to really eliminate the cause. Now the third element which most people get is a progressive training program that stays within the person’s tolerance and really addresses the deficits. Now it has a chance to work because they’ve eliminated – you know its like picking a scab, they’ve stopped picking the scab allowing that to heal now and address the deficits, as I’ve said of this progressive program. So I don’t know if I that’s three, it sort of is.

Ian: Yeah that works perfectly. The next question, the final question that I’m going to ask you is with all that said those three steps, what could someone do right now and I know this is going to be specific to each individual, but is there anything that could someone do right now that is going to provide them some relief or any exercise or something that they could do right this instant?

Dr. Stuart McGill: Well I’m gonna be smart and say read my books.

Ian: All right.

Dr. Stuart McGill: But to be a bit more directive on that… Again Ian, it depends on what is causing the pain. Again to that posterior or disk post, the discogenic 30 year old, simply laying on their tummy and placing their hands flat to the ground, but stacking them underneath their chin, and just lay like that for 5 minutes. And see if that helps or hurts, – it’s going to do one of the two. And does that take you into direction that is helping your back? Or does it take you into direction that’s making you worse? But there’s a nice little test right away to see if that is going to help you and it is something you can do right now to change the pain that you experience.

Ian: Okay great. Now as we close here I wanted to ask, are there any presentations that you are going to be featured in or anything that you can kind of let us know where you going to be, if someone wants to see you or see where you’re presenting?

Dr. Stuart McGill: Well there is if folks were to go to the backfit pro website, that’s www.backfitpro.com, there is a little tab at the top of the website that says Courses and Clinics. And if you click on that you will see the public ones that people can sign up to go to (I do a number of private ones obviously there close to public but the public ones are listed on that website). The next two years I think are listed but there mostly in the US, there are a few in Canada and a few in Europe. I think for 2015 there is going to be a couple in Asia and Australia and what not.

Ian: I really appreciate you’re doing this and again, everybody can go to backfitpro.com correct?

Dr. Stuart McGill: Yes.

Ian: And they can purchase books, DVDs and then also see presentations that you are at.

Dr. Stuart McGill: Yes.

Ian: All right. And is there any last thing that you would like to tell the people who are suffering with back pain or anything you would like to add to this?

Dr. Stuart McGill: I think I probably talked enough. They’re fed up of me.

Ian: Alright Dr. McGill. I appreciate it and I will talk to you soon and send you the link to this interview.

Dr. Stuart McGill: You are welcome. Thank you very much Ian.

Ian: Have a great night!

Dr. Stuart McGill: Yeah good luck to you.. Bye!

Ian: Bye.

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