Episode 8 – Dr. Stuart McGill – Back Pain in Cyclists & Triathletes

In this Episode:

• Dr. Stuart McGill
• Common Themes for Cyclists’ Back and Hip Pain
• Strength Training: Overtraining and Neurological Training
• Dysfunction
• Transference and Transition
• Injury
• Conclusion

Show Notes:

1:17 –

Dr. Stuart McGill

• Menachem has learned from him for the past decade
• Researches the back and spine and has over 300 research articles at this point
• Started Back Fit Pro
  • Facebook and Instagram handle and website
• Works with Dr. Joel and Dr. Ed and they travel the world and teach the McGill method
  • Assess
  • Come up with hypothesis
  • Work with each individual athlete
• Menachem’s Book Recommendations:
  • Low Back Disorders – 3rd edition
    • Really good, updated content
  • Ultimate Back Fitness and Performance – 6th edition
  • Back Mechanic – Secrets to a Healthy Spine Your Doctor Isn’t Telling You
  • Gift of Injury with Brian Carrol
    • Strength athletes’ guide to recovering from back injury
• Retired from University of Waterloo a couple of years ago
• Now lives North of Toronto

6:24 –

Common Themes for Cyclists’ Back and Hip Pain

• Sitting in a vehicle for more than two hours

• • Especially with a forward flexed spine and vibrations, makes risk for injury much higher
• It depends
  • “It’s really the most accurate way we can conceive any answer for a human” – Dr. McGill
  • Linkage = body
    • It must follow several rules (scientific code) that the body should live by
  • The art of good coaching, training, therapy, etc. – it’s what makes us different that makes us so interesting
  • The science from the code combined with the art that always makes the answer it depends
• Asymmetry
  • Studies: hip symmetry/motion and hamstring length/tension
    • Those with bigger asymmetries in those two features tended to experience first episode back pain sooner than the symmetric
  • After a while, you recognize the cluster of syndromes around different sports
    • Common syndromes around cyclists and triathletes
      • Many get hurt in the weight room, not on the bike
        • Manifests and limits their ability to ride well
        • Happens through poor technique or poor programming
        • Replace deadlifting or squatting where the full load has to go from the shoulders down through the spine to the hips
          • If you substitute a back squat with a waist belt you can really tune the challenge to the legs, which cyclists need
            • They need a stiffened core and very powerful legs
• Cycling is much more a challenge for the thighs
  • Big load on quadriceps and hamstrings, but not so much gluteal muscles
  • Typical cyclists have frog legs
    • Front squat is probably closer to being on a bike than a back squat
• All training enhances the mechanical, physiological, AND neurological
• Back and hip pain tend to create an inhibition of the gluteal muscles
  • Chronic hip pain – FAI – common in cyclists and squatters
  • Back pain would tend toward gluteal inhibition but also tend to get psoas facilitation
  • Cara Lewis
    • As you extend the hip, and if you become gluteal inhibited, the hamstrings takeover, so as you extend the hip through extensor torque, the hamstrings pull the femoral head into interior impingement with a sheer
    • When the gluteal muscles drive hip extension, they glide the femoral head posteriorly in the acetabulum away from the FAI, so it’s better
  • Cyclists must flex spine over the bike and crouch down to reduce windage
• Squatmax MD
  • Put belt on and connect to load on chair
    • As they stand up you can do front squats or back squats
      • Load is free floating and projected down, not on a cable
        • Eliminates a constraint of motion and destreses the joints
• Overtraining (for endurance athletes)

• • They really fail to let their body adapt
    • Figure out what tissues you’re working with and what the mechanism of injury is so that they can adapt
    • They will all adapt at different rates because: it depends
• Insufficient Core

• • Stiffness in the bike frame is similar to stiffness in the core
    • You’re leaking energy if either of these things are unstable

20:29 –

Strength Training: Overtraining and Neurological Training

• Back, hip, and knee pain were the common complaints of cyclists for many years
• #1 complaint from cyclists is overtraining
• “I find that most cyclists and triathletes are doing way too much training – especially long distance” – Menachem
• Force creates motion, but stiffness controls motion

• “I get a clipboard – and I’ll say write down everything that you need to be the world’s best cyclist or triathlete or whatever it is” – Dr. McGill
  • Very specific strengths, stiffnesses, flexibilities and non-flexibilities, endurances, tissue resilience, etc.
    • Okay now let’s measure these things – are they sufficient?
      • “Let’s go choose a tool out of our toolbox – in the strength and conditioning world – so that we can enhance that for you as an individual, and you in your sport” – Dr. McGill
• Somewhere between 33 and 35% of your pedaling power should come from the glutes 
• Menachem commonly sees a decrease in the ability of the internal obliques to fire for cyclists
• Dominance of hamstring muscle for hip extension is at the expense of gluteal power
  • Mechanism is more neurological

• To change a cyclist’s engram and get their gluteal muscles back into priority is very difficult and almost impossible in some very highly trained cyclists
  • Let’s deal with the mechanisms of their back pain and try to create what we can

31:28 –

Dysfunction

• “If it’s a feature of some of the great cyclists then I don’t know if I would call it a dysfunction” – Dr. McGill
• Do monster walks pushing through the knee backwards up a hill
  • Cyclists should feel fatigued and quadricep soreness
  • Then they should turn around and go downhill
    • They need hip extension but they can’t get it through the knees and quads anymore, so the brain goes to the glutes, which tricks athletes to change form due to fatigue
      • “Now you’ve just created a very powerful engram to combat the fatigue-induced dysfunction – as you called it” – Dr. McGill

37:06 –

Transference and Transition

• “A cyclist is an entirely different animal from a triathlete” – Dr. McGill
• Triathlon: “transference of athleticism”
  • Swimmers are very good in the pool, but they don’t have that dexterity in gravity
  • “The first out of the pool very rarely wins the triathlon” – Dr. McGill
    • Because they can’t run or absorb forces as well on the bike
  • “The ones who win the triathlon would come out of the pool middle” – Dr. McGill
    • To swim you need a floppy foot and ankle, and to run on a bike you take all the stiffness out of your foot and get it to the pedal
    • The best runners pretune the stiffness like a kangaroo
      • They can’t relax – they have to turn on their muscles so there’s a certain elongation of a spring and then they add a muscle pulse onto that loaded spring and push-off onto the next phase of the gait cycle
    • “The very best runners have tuned elasticity and they store and recover elastic energy – the ones that stretch it all the way have to use far too much eccentric/concentric muscle” – Dr. McGill
• “The trick is the transition” – Dr. McGill
  • For a swimmer who doesn’t have stiffness – I’d give them stiffness training
  • Foot Ricochet – “nervous kid in school” – taps foot on ground – creates engram of stiffness
  • You need to pre-activate muscles and tune them very precisely so that they act as a spring
  • Ask a swimmer to jump rope or pogo

44:01 –

Injury

• Most common (back) injuries for cyclists are joint instability and disc bulges
  • Disc bulge: from training in the weight room

• You need a lot of motion and high load
• Deadlifting can disrupt the endplate so that the fibers of the collagen where they connect to the bone (Sharpey’s fibers) pull off the bone at the micro level
• Role of Discs in the Back

• • Endplate = top quadrant of the disc
  • Top and bottom of vertebrae are a cartilaginous plate
  • If a person deadlifts above their capacity a disc can bulge
  • Shock absorption occurs inside the vertebrae, not in the discs
• “We’re one of the few people who have quite a high success rate in rebuilding power-lifters who have done that type of damage to the bones” – Dr. McGill

• • Use bone callusing technique
    • “Gift of Injury”
      • Brian Carrol – very heavy split fracture in sacrum (L5)
    • Have to allow new bone to scaffold in
• “Injuries are very very specific and they need very specific stimuluses” – Dr. McGill
• Mechanostimulation – every tissue in your body responds to load
  • Anabolic response – if the load is below the tipping point
  • Catabolic response – if the load exceeds the tipping point
  • “Cumulative trauma builds up and if you don’t rest you’re gonna have a much bigger issue” – Dr. McGill
• There’s a “U-shape” to the loading of the tissues of the spine
  • Too little and too much
  • Injuries tend to happen to cyclists in the weight room because there’s a lot of shearing force from being in that crouched position and then trying to put a bar on their back or deadlift from the floor
    • You need to build up and be consistent

55:13 –

Conclusion

• How can people find you?
  • Backfit pro on Instagram and Facebook
  • Backfitpro.com
  • Books
    • Back Mechanic: people who have back pain and want to get out of it
      • Pay attention to the details
    • Ultimate Back Fitness and Performance: people out of back pain who want to start to train again
    • Gift of Injury: specifically for strength athletes who are out of back pain and want to start to train again
    • Low Back Disorders: heavy-read for medics or geeks 🙂
      • 3rd edition: has sections on preventing or reducing risk; spine hygiene; creating proximal stability and distal mobility