Protocols to Strengthen & Pain Proof Your Back
Summary
This episode covers the anatomy of the spine and the neuromuscular systems that support it, then presents specific, evidence-based protocols for building a strong, stable back and reducing or eliminating back pain. The protocols are drawn from three leading experts: spine researcher Dr. Stuart McGill, rehabilitation MD Dr. Sean Miller, and physical therapist Dr. Kelly Starrett. All exercises require no equipment and minimal time investment.
Key Takeaways
- McGill’s Big Three (curl-up, side plank, bird dog) form the foundational protocol for back strengthening and pain relief — requiring no equipment and taking as little as 5–10 minutes.
- Traditional sit-ups and crunches are counterproductive for anyone with disc issues, as they increase disc herniation and nerve impingement.
- Spinal stiffness is desirable — the ability to generate rigidity in the core and spine is what allows safe, powerful limb movement.
- Spine type matters: people with thicker spines (larger joints, barrel chests) need more mobility work; people with thinner spines (smaller wrists, more flexible) need more muscular stabilization.
- Disc herniation can often be reversed without surgery or medication using directional movement protocols (e.g., McKenzie-style extension for lower back bulges).
- Hanging from a bar with toes touching the floor for 10–30 seconds can decompress the spine and relieve nerve impingement pain.
- Tongue on the roof of the mouth positions the head neutrally during exercises and facilitates nasal breathing.
- Making a fist during exercises like the side plank and bird dog activates stronger neural contractions throughout the body.
- Pushing the floor away from you — not just lifting a limb — is as important as the movement itself in all three Big Three exercises.
- Back pain has a biopsychosocial component: thoughts and perceptions about pain influence its severity and duration.
Detailed Notes
Spine Anatomy Essentials
- The spine consists of bony vertebrae separated by soft intervertebral discs, running from the cervical (neck) to the coccygeal (tailbone) region.
- The spinal cord — central nervous system tissue — travels through a hole in the center of each vertebra and disc, protected by the bony column.
- Spinal cord tissue does not regenerate after injury; protection of the cord is a primary function of the vertebral column.
- Motor neurons in the ventral (front) spinal cord send signals out to muscles; sensory neurons carry information from the skin, tendons, and muscles back in through the dorsal (rear) cord.
- Nerve roots (bundles of nerves exiting the spinal cord) are a primary source of back pain when compressed by a bulging or herniated disc, inflamed tissue, or compressed vertebrae.
Spine Types: Thick vs. Thin
- People with thicker wrists, larger joints, and barrel chests generally have thicker spinal segments — more tolerant of vertical (compressive) loads but less mobile in twisting/bending.
- People with smaller wrists, smaller joints generally have thinner spinal segments — more mobile and flexible but more vulnerable to compression loads.
- Willow vs. oak analogy (from Dr. McGill): the willow bends easily but collapses under vertical load; the oak handles vertical load but snaps if bent sideways.
- Thin-spine individuals should prioritize building musculature around the spine for stabilization.
- Thick-spine individuals should prioritize spine mobility work to avoid nerve impingement from lateral or rotational movements.
McGill’s Big Three
1. The Curl-Up
A safer alternative to the sit-up for strengthening the core without increasing disc herniation.
Setup:
- Lie on back; one knee bent, one leg extended flat
- Place both hands under the lower back arch — maintain the natural arch throughout
- Tongue on roof of mouth; mouth closed; head in neutral (chin not tucked)
Movement:
- Raise elbows off the floor
- Lead with the upper chest (not chin or head) — lift only 5–10°
- Exhale to intensify abdominal contraction
- Hold for 8–10 seconds, then lower and rest 10–30 seconds
Sets and Reps (descending pyramid):
- Set 1: 5 × 10-second holds
- Set 2: 4 × 10-second holds
- Set 3: 3 × 10-second holds
- Continue down to 1 hold
- Switch legs and repeat
Common mistakes: Tucking chin to chest; doing a full sit-up motion; not maintaining lumbar arch.
2. The Side Plank
Loads one side of the spinal musculature at a time; targets obliques and lateral stabilizers.
Progression (start here):
- Lie on side, knees bent at ~30–40°, feet stacked
- Plant forearm/fist on the floor; make a fist to activate neural drive
- Push the floor away, raise hips to create a straight spine
- Hold 8–10 seconds, lower, rest, repeat
Progression steps:
- Knees bent → straighten legs with top foot placed slightly in front
- Add a rotational roll toward the floor (chest toward ground) and back
- Work toward a full front plank position
Sets and Reps:
- 2–3 sets of 3 × 10-second holds per side (beginner)
- Progress to 5-4-3-2-1 descending pyramid
Common mistakes: Letting hips sag; not pushing the floor away; rolling the torso instead of staying square.
3. The Bird Dog
Strengthens lower back, upper back, and shoulder stabilizers through contralateral extension.
Setup:
- Start on all fours (hands and knees)
- Extend one arm forward (in a fist) and the opposite leg backward simultaneously
Key form points:
- Spine stays parallel to the floor — no lateral tilting
- Do not raise the arm too high or arch the lower back
- Aim for one long, rigid line from fist to foot
- The planted hand and knee must push the floor away throughout
- Pointed or slightly flexed toe on the extended leg is acceptable; avoid kicking the heel too high
Sets and Reps:
- 3–5 repetitions of 8–10 second holds per side
- Descending pyramid (5-4-3-2-1) over multiple sets
- Can alternate sides each set or complete all sets on one side first
Progressions:
- Draw small boxes or circles with extended fist and/or foot
- Move extended fist and foot simultaneously in box pattern
- Reach back with extended fist to tap the extended knee, then re-extend
Common mistakes: Raising the arm or leg too high; tilting to the stabilizing side; losing floor-pushing tension.
Protocols for Pain Relief
Spinal Decompression Hang
- Grip a sturdy overhead bar with both hands
- Allow the spine to lengthen, but keep toes or heels lightly touching the floor (not a full dead hang)
- Do not twist
- Hold 10–30 seconds, release, walk briefly, repeat 2–3 times
- Mechanism: reverses compressive forces on discs, creating space for nerve roots
- Caution: Avoid if you have glaucoma or elevated intraocular pressure (inversion increases eye pressure)
Directional Movement for Disc Herniation
- For a posterior disc bulge (the most common lower back herniation), gentle extension of the lumbar spine (e.g., lying prone and pressing up onto elbows or hands) may push the disc material back toward center, reducing nerve impingement.
- The direction of relief must match the direction of herniation — this is why proper diagnosis matters.
- Dr. Huberman reports personally resolving an L3-L4 disc bulge using directional movement with no surgery or medication.
Additional Stabilization Concepts
- Foot and toe positioning: Spreading the toes and proper foot placement contribute to spinal stability, both during exercise and at rest.
- **