By Alex Earl, DC DACRB DNSP
This week on the Health Restoration Blog, we are breaking down THAT Huberman Back Pain Podcast which recently came out. This episode was published and shared by the esteemed Stanford Neuroscientist, Andrew Huberman, MD.
If you’d like to watch the Huberman Lab’s Protocols for Strengthen and Pain Proof Your Back, you can do so by clicking here.
(If you missed last week’s article on The 10 Dos and Don’ts of Tendon Rehab you can read it here)
Who is Andrew Huberman, MD?
Andrew Huberman, Ph.D. is a renowned neuroscientist and tenured professor of neurobiology at Stanford University. He is the director of the Huberman Lab, which specializes in studying brain function, behavior, and neural plasticity.
Dr. Huberman is widely known for his expertise in neuroscience and his ability to communicate complex scientific topics in an accessible manner. His podcast, “Huberman Lab,” provides evidence-based insights on health, fitness, and cognitive performance.
His recent episode, “Protocols to Strengthen and Pain Proof Your Back,” highlights practical strategies for improving back health through neuroscience-informed protocols.
With over 200 episode on his podcast to date, Andrew Huberman has become one of the most trusted sources of medical, health, fitness and longevity in the world.
But did everything that he stated on his episode reflect the current level of understanding around back pain?
In short, I aim to highlight several of the misconceptions and omissions from the Huberman back pain episode from my perspective as someone who specializes in back pain.
What did Huberman Back Pain Episode get RIGHT?
While it might be easy to target the things I feel Andrew Huberman got wrong, I think it’s important to highlight what he did get right. In all fairness to him, he did what many people (including myself) rarely do – attempt to tackle the behemoth that is back pain.
With so many treatment options for back pain, and even stronger opinions about how to “properly” recover from back pain, this episode was never going to please everyone.
But you know what they say, “There is no clear path to success, but there is to failure – which is the pursuit of pleasing everyone.” I first heard that on the Tim Ferriss Podcast a few years ago.
The first thing that he does well to explain is the overall decrease in all cost mortality that exercise and physical fitness does for us. Included in the increase in physical activity, is the relative reduced risk of spinal health issues.
In fact, I found it quite odd that the Huberman back pain episode referenced the BioPsychoSocial (BPS) Model of Care early on in the episode, only to then follow the rest of the episode with an outdated biomedical take on back pain.
Another important aspect of back pain is what to do when it hits you with a vengeance. His advice to remain active, avoid complete rest and continuing to perform mild movements is consistent with the current literature. In fact, one of the worst things to do when you have an acute episode of back pain is to stay in bed for an extended period of times, such as days or weeks.
Lastly, I would also like to point out that stronger people are (typically) more resilient. Therefore, the stronger one gets, the more likely they are to experience some form of back pain along the way. The goal is not to be pain free, but the goal is to improve strength.
The way Huberman back pain episode describes improving strength is a positive takeaway that will result in thousands (if not millions) of people being more active today than they were before listening to the podcast.
Personally, I’d love to see more back pain patients participating in strength training programs even if they have a history of a “bad back.” The juice is worth the squeeze there.
What did Huberman Back Pain Episode get WRONG?
More stability does not mean less pain.
After reading and listening to Pr. Peter O’Sullivan for the past several years, I’ve come to realize a few things about back pain that even my fellow rehab chiropractors don’t understand.
For instance, the role of “stability” in back pain. There are countless courses, books, online programs and chiropractic “gurus” talking about the importance of improving spinal stability.
On the Huberman back pain episode, he makes logical arguments and has clever engineering analogies, but is that an evidence-based argument? In short, there is no evidence that improving spinal stability will result in a reduction of back pain.
Strengthening the back muscles is also not the “end all be all” of spinal health.
On the Huberman back pain episode, the famous “McGill Big 3” exercises for low back strength are brought up. As a student of the esteemed Stu McGill, Phd, I can say that I have learned so much about the spine from him more so than anyone else in my educational experience.
I’ve learned more about people and their behavior from Pr. Peter O’Sullivan, William Miller, and Stephen Rollnick.
Furthermore, the exact opposite is also not true. On the Huberman Back Pain episode, he describes how back pain can be the result of a weak core.
Back pain is NOT caused by a “weak core.” Weak “core” muscles do not cause back pain. In fact, when I had a nasty back situation a few years ago, my core was engaged the entire time. It was a safety mechanism. It was tense and contracting even during simple, small movements that normally don’t require a stiff abdominal brace, such as grabbing a mug for coffee.
One of the earliest signs of a pretty severe back issue is through the contraction of the abdominal muscles. The tighter, more engaged the abdominals, the more intense the back situation is, typically. That’s why one of our first go to strategies for back pain patients is oftentimes relaxation techniques, such as breathing.
This approach allows the abdominals to relax and the reduction in overall tension allows the back muscle to relax as well.
Back pain is not related to one’s posture.
Posture is a hotly contested topic in the chiropractic profession. Some providers make a big deal of posture, oftentimes making specific exercise recommendations to alter or change the patient’s posture entirely. Other providers, like me, don’t really make a big deal about static posture. It can change in an instant!
So for me, I believe the over-emphasis on one’s posture was a big miss from the Huberman back pain episode. I understand the point that he tries to make, but it just isn’t consistent with any of the literature on the topic of posture.
In fact, researchers have looked at posture as a predictor for back pain, and cannot find a causative etiology for those patients. Perhaps this is a case where correlation does not equal causation? Because one has poor posture and back pain means the two factors are mutually exclusive data points. Posture does not cause back pain.
Bulging Discs are not a good predictor of back pain
On the Huberman back pain episode, he describes disc bulges putting pressure on the local spinal nerves, which he alludes is the cause of the back pain. In reality, the bulging disc which compresses the nerve causes neurological symptoms, not pain.
Furthermore, we have seen a wide variety of back pain patients in over 9+ years of patient care. We have seen some patients who were unable to walk, had to lie down on the floor, and couldn’t move at all. When imaging results came back, they have some of the smallest findings recorded.
We have also seen some patients who walked in, performed all our functional testing, and only complained of back pain in certain movements and under certain loads. When the imaging report came in, we were all surprised at the size of the disc herniation found on MRI. In fact, several times we called the radiologist to confirm it wasn’t a typo.
This just goes to show that the size of the disc herniation or bulge does NOT accurately predict the overall intensity and severity of back pain.
What did Huberman Back Pain Episode Leave OUT?
The Huberman Back Pain episode provides a comprehensive overview of back health protocols, focusing primarily on exercise, movement, and strengthening strategies.
However, the Huberman back pain episode does not delve deeply into crucial aspects like stress management, sleep quality, nutrition, and the psychological impact of anxieties, fears, and worries on back pain. Addressing these factors is essential, as they can significantly influence pain perception and recovery. Incorporating stress reduction techniques, sleep optimization strategies, and psychological support into a back pain protocol ensures a more holistic and effective approach to rehabilitation.
Pain, but especially back pain, is incredibly complex. It’s not always complicated, but complex. It involves several aspects of external and internal factors.
In the functional rehab chiropractic industry, we refer to back pain as “multifactorial”, meaning it consists of a combination of several independently related factors. Slept on the couch last night? You might wake up a bit more sore than usual. Get into a bit of road rage on the way to an important work meeting? Your back might be a bit more sensitive to the normal motions you go throughout the day.
Are these reasons to STOP living life? Of course, not. But they are important data points when discussing back pain.
My Poll Analogy
On the Huberman back pain episode, the concept of pain was never address.
Pain can be confusing, misleading and not an appropriate indication of reality. Its like the polls!
Especially since it’s an election year here in the United States, polls are everywhere. Did you see the East Tunafish University Poll showing Biden leading Trump by 86%? Yeah, me neither.
It’s dangerous to avoid the polls, as many politicians would argue.
It’s dangerous to avoid pain, as pain tells us something about our environment!
It’s equally dangerous to be guided by polls.
It’s equally dangerous to be guided by pain.
Back pain is rarely caused by damaged spinal structures.
The Huberman back pain episode highlighted a lot of the misconceptions surrounding tissue damage and pain.
Pain is a terrible guide.
At our office, we tell new patients that we are not afraid of pain. We respect it, but we are not afraid of pain.
For whatever reason, this instills a level of confidence in them that we won’t be reckless or irresponsible with them during a potentially scary health situation.
In fact, this helps calm down patients who fear that the more intense the back pain feels, the worse the damage must be in their spine.
We remind patients that pain can be misleading all the time. For example, a papercut can be a really painful experience for a short period of time. But is there a significant amount of tissue damage that should realistically cause that intensity of pain?
Real Life Case Study: “Help! I’m in Florida and I hurt my back!”
Recently a potential new patient called our office in dire need. He had just landed in Florida and was really hurting. His back started hurting right before taking off in the airplane and it was really hurting him when we spoke on the phone. In fact, the call switched over to a FaceTime chat and I could see him lying on the tile floor in his hotel. What a frustrating experience to start your vacation!
I couldn’t let him suffer for 4 days without giving him some form of guidance and support. So, I was able to figure out which movements provoked his symptoms, to which he wasn’t thrilled to experience!
But by finding what did increase his discomfort, we were able to rule in several positions and movements that did relieve his pain. It might be surprising to most of you, but the best approach was to focus on his breathing.
By shifting his focus from over-contracting his abdominal muscle to expanding his belly during deep inhalation, we were able to slow his heart rate down, lower his blood pressure, and actually start to experience some relaxation.
Once he was able to, we needed him to get up off the floor and walk around. This was the hardest part! It took him a few minutes to go from laying down to standing up, but he did it!
From there, we were able to give him a few movements to help alleviate his discomfort so that he could sleep that night.
He woke up the next day and had this to report:
“Hi! I was able to roll over some of my mini arches, and I was to go significantly further after I had 25 or so. I then tried to stand, which was hard but I was able to get there with some help. Sleeping was actually much better than expected and I’m now doing some more back arches and I’m moving around a lot better already.”
Summary:
So there you have it! These are all my thoughts about the Huberman back pain episode recently hitting the interwebs. I highly recommend you listen or watch the episode and take the good action items he discusses on the show. He’s a got a lot of good things to say that most MDs, PhDs don’t initial come out and support. Overall, it was a good attempt at a complex topic. I would love to hear a conversational style podcast between him and Pr. Peter O’Sullivan down the road. That would probably break the internet!
Do this next!
- Share this Article with a Friend or Family member who listened to the Huberman Back Pain Episode. They must get this info!
- Text “BACK PAIN” to our office at (630) 765-0575. We send you our FREE LOW BACK PAIN GUIDE as quickly as possible. Some people have shared that they’ve drastically improved their back pain in as little as 24 hours with the tips, tricks and guidance in this FREE Report!
- Keep an eye out for next week’s article!
Alex Earl
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