打造强健无痛的背部 | Stuart McGill博士

欢迎来到Huberman实验室播客，我们在这里讨论科学与基于科学的日常生活工具。我是Andrew Huberman，斯坦福大学医学院神经生物学与眼科学教授。今天的嘉宾是Stuart McGill博士。

Welcome to the Huberman Lab Podcast where we discuss science and science based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Doctor. Stuart McGill. Doctor.

Stuart McGill是滑铁卢大学脊柱生物力学杰出教授。作为拥有三十余年教职的学者，McGill博士既研究过伤者脊柱也分析过健康人群，开发出治疗脊柱损伤疼痛及优化任何人脊柱生物力学的方法。他发表了超过250篇相关领域同行评审论文，堪称真正的世界级权威。本期节目中我们将探讨脊柱解剖结构及常见背痛根源。

Stuart McGill is a distinguished professor of spine biomechanics at the University of Waterloo. As a professor for more than three decades, Doctor. McGill has analyzed the spines of injured people as well as healthy people and develop methods to treat spine injuries and pain, as well as to improve spine biomechanics in anybody. He has authored more than two fifty peer reviewed research articles on these topics, making him a true world expert. During today's episode, we discuss spine anatomy as well as the common sources of back pain.

我们还将讨论关于背痛成因与不同治疗方式的争议观点。正如您将很快了解到的，背痛既无单一明确诱因，也不存在万能解决方案——但McGill博士清晰指出：每个人都可通过特定方法强化背部并缓解疼痛。他详细讲解了自我诊断背痛的具体方法，这对理解该做什么及避免什么至关重要，无论是应对疼痛还是运动与日常生活中的应用。

And we discuss some of the controversies as to the origins and different treatments for back pain. As you'll quickly learn, there is no one specific source of back pain nor is there one specific solution to back pain, but as Doctor. McGill spells out very clearly, there are things that anyone and everyone can do in order to strengthen their back and to reduce the amount of pain they may be experiencing. He explained some specific ways to self diagnose your back pain, which of course is critical for understanding what specific things to do as well as to avoid in dealing with any pain and as it relates to applying in sport and in everyday life. Doctor.

McGill博士与我亦探讨了背痛治疗领域的若干激烈争议。我们谈及所谓的疼痛生物心理社会模型，该理论指出疼痛可能源自情绪、睡眠不足、脊柱大脑等身体特定部位的多重因素，以及这些因素如何交织形成我们所感知的疼痛，并引导出特定治疗方案。McGill博士堪称背部生理解剖、疼痛根源与治疗领域的活体百科全书，能如此详尽清晰地向其学习实属难得机遇。

McGill and I also discuss several of the avid controversies within the field of back pain and the treatments for back pain. We talk about the so called biopsychosocial model of pain, which points to the various sources that pain can arise from everything from emotional to lack of sleep, to specific locations in the spine and brain and elsewhere in the body. And the ways those mesh together to give us what we call pain as well as to direct us towards specific treatments for pain that tend to be especially Doctor. McGill is a true encyclopedia on the topics of back physiology and anatomy, sources of back pain and treatments for back pain. So it's truly a special opportunity to be able to learn from him in such immense detail and in such a clear and actionable way.

听完本期节目，您将对背部解剖生理及其与健康/疼痛的关系形成系统认知。当然，您还将掌握应对背痛、预防疼痛及强化背部的多种方法——不仅针对运动锻炼，更能让您在任何年龄都能无痛自如地进行日常活动。节目开始前我想强调：本播客独立于我在斯坦福的教学研究工作，但符合我向公众免费提供科学知识的初衷，在此特别感谢本期赞助商。

By the end of today's episode, you will have a quite thorough understanding about the anatomy and physiology of the back as it relates to a healthy back to back pain. And of course, you'll have various remedies for dealing with back pain, preventing back pain, and for strengthening your back for all sorts of different kinds of movement, not just for exercise and sport, but also to move through your daily activities pain free and with ease and mobility at any age. Before we begin, I'd like to emphasize that this podcast is separate from my teaching research roles at Stanford. It is however, part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast.

首期赞助商Helix Sleep提供根据个人睡眠需求定制的床垫枕头。我曾在多个播客强调优质睡眠是身心健康与表现的基础，而关键之一就是确保床垫符合您的独特睡眠需求。这具体意味着什么？

Our first sponsor is Helix Sleep. Helix Sleep makes mattresses and pillows that are customized to your unique sleep needs. Now I've spoken many times before on this and other podcasts about the fact that getting a great night's sleep is the foundation of mental health, physical health, and performance. Now, one of the keys to getting a great night's sleep is to make sure that your mattress is suited to your unique sleep needs. What does that mean?

只需登陆Helix官网完成两分钟测试，回答诸如'您习惯仰卧、侧卧还是俯卧？''夜间容易发热还是发冷？'等问题——无论您是否清楚这些答案，Helix都将为您匹配理想床垫。

Well, if you go to the Helix website, you can take a brief two minute quiz and it asks you questions such as, do you sleep on your back, your side, or your stomach? Do you tend to run hot or cold during the night? Things of that sort. Maybe you know the answers to those questions, maybe you don't. Either way, Helix will match you to the ideal mattress for you.

对我来说，最终选择了Helix公司生产的DUSK床垫。大约三年半前我开始使用DUSK床垫，这绝对是我有生以来睡得最好的时光。如果你想通过定制符合你独特睡眠需求的床垫来改善睡眠，请访问helixsleep.com/huberman，完成简短的两分钟睡眠测试，Helix将为你匹配理想床垫。现在Helix提供高达30%的折扣并赠送两个免费枕头。重申一次，访问helixsleep.com/huberman即可享受7折优惠和两个免费枕头。

For me, that turned out to be the DUSK mattress made by Helix. I started sleeping on a DUSK mattress about three and a half years ago, and it's been far and away the best sleep that I've ever had. So if you'd like to sleep better by sleeping on a mattress that's customized to your unique sleep needs, go to helixsleep.com/huberman, take that brief two minute sleep quiz and Helix will match you to a mattress that's ideal for you. Right now Helix is giving up to 30% off mattresses and two free pillows. Again, that's helixsleep.com/huberman to get 30% off and two free pillows.

本期节目由BetterHelp赞助播出。BetterHelp提供持证治疗师的在线专业心理咨询服务。我坚持每周进行心理治疗已超过三十年。最初并非自愿——这是允许我继续上学的条件，但很快我就意识到心理治疗是整体健康极其重要的组成部分。

Today's episode is also brought to us by BetterHelp. BetterHelp offers professional therapy with a licensed therapist carried out entirely online. I've been doing weekly therapy for well over thirty years. Initially, I didn't have a choice. It was a condition of being allowed to stay in school, but pretty soon I realized that therapy is an extremely important component to overall health.

优质心理治疗主要提供三大价值：首先是与真正值得信赖的人建立良好关系，能坦诚讨论你面临的问题；其次是治疗师应提供情感支持或针对性指导；第三是专业治疗应带来深刻洞见，不仅帮助你理解情感生活和人际关系，更能厘清自我认知与职业/学业目标的关系——这意味着卓越的治疗还应激发积极行动。

There are essentially three things that great therapy provides. First of all, great therapy consists of having good rapport with somebody that you can really trust and talk to about the issues that you're dealing with. Second of all, that therapist should provide support in the form of emotional support or directed guidance. And third expert therapy should provide useful insights, insights that allow you to better understand not just your emotional life and your relationship life, but of course also your relationship to yourself and to career goals and school goals. Meaning excellent therapy should also inspire positive action.

BetterHelp能轻松帮你找到产生共鸣的专业治疗师，获得上述所有益处。若想尝试BetterHelp，访问betterhelp.com/huberman可享首月9折优惠。再次提醒：betterhelp.com/huberman。本期节目还由冥想应用Waking Up赞助，该应用提供数百种引导冥想课程、正念训练、瑜伽休息术等内容。

BetterHelp makes it very easy for you to find an expert therapist with whom you really resonate with and that can provide the benefits that I just described. If you'd like to try BetterHelp, you can go to betterhelp.com/huberman to get 10% off your first month. Again, that's betterhelp.com/huberman. Today's episode is also brought to us by Waking Up. Waking Up is a meditation app that offers hundreds of guided meditation programs, mindfulness trainings, yoga nidra sessions, and more.

我15岁开始练习冥想，这深刻改变了我的生活。近年来使用Waking Up应用进行冥想练习，发现它能极好地保持练习持续性。我和众多用户喜爱这款应用的原因在于其丰富的冥想选择——时长各异的课程既能保持新鲜感永不厌倦，又能随时探索自我新知，即使每天仅有两三分钟也能坚持练习。我还特别喜欢进行10-20分钟的瑜伽休息术（或称非睡眠深度休息），它能恢复身心活力，又不会像传统午睡后有些人会感到的困倦。

I started practicing meditation when I was about 15 years old and it made a profound impact on my life. In recent years, I started using the Waking Up app for my meditations because I find it to be a terrific resource for allowing me to really be consistent with my meditation practice. What I and so many other people love about the Waking Up app is that it has a lot of different meditations to choose from, and those meditations are of different durations. So it makes it very easy to keep up with your meditation practice, both from the perspective of novelty, you never get tired of those meditations, there's always something new to explore and to learn about yourself, and you can always fit meditation into your schedule, even if you only have two or three minutes per day in which to meditate. I also really like doing yoga nidra or what is sometimes called non sleep deep breaths for about ten or twenty minutes, because it is a great way to restore mental and physical vigor without the tiredness that some people experience when they wake up from a conventional nap.

若想尝试Waking Up应用，请访问wakingup.com/huberman获取30天免费试用。重申：wakingup.com/huberman可享30天免费试用。现在有请Stuart McGill博士。

If you'd like to try the Waking Up app, please go to wakingup.com/huberman, where you can access a free thirty day trial. Again, that's wakingup.com/huberman to access a free thirty day trial. And now for my discussion with Doctor. Stuart McGill. Doctor.

Stuart McGill博士，欢迎您。

Stuart McGill, welcome.

谢谢您，先生。

Thank you, sir.

很高兴您能来。我是您作品的忠实粉丝，看过您很多其他内容，读过您的书，今天很期待讨论如何打造强健有韧性的背部、背痛的原因及缓解方法。或许更大的问题是这些因素如何影响活动能力和功能性，不仅在运动中，也在日常生活中。那么作为开场，我想问一个很多人关心的问题。

Great to have you here. I'm a big fan of your work. I've watched a lot of your other content, read your books, and I'm excited to discuss today what makes for a really strong, resilient back, what causes back pain and how to relieve it. And perhaps the bigger issue is what all of that allows for in terms of mobility and functionality, not just in sport, but in everyday life. So to kick things off, I'd like to ask a question that I think is on a lot of people's minds.

大多数人除非感到疼痛，否则不会想到自己的背部。那么背痛是什么引起的呢？

Most people aren't thinking about their back unless they have pain. So what causes back pain?

您一开始就问了个简单问题。在尽可能精确定义前，我先说明背景。背痛是一种症状，我们暂时换个话题说说腿痛。你能想象问别人‘能否给我一个针对腿痛的锻炼或预防策略’吗？

You start with the easy questions. Let me give context before I define it as tightly as I can for you. Back pain is a symptom. So let's just change the topic for a moment and talk about leg pain. Can you imagine asking someone, well could you give me an exercise or a prevention strategy for leg pain?

好，这样铺垫一下。我们讨论的是有上百种不同成因和机制的症状。所以现在需要进行相当全面的评估和理解，以确定背痛类型，再匹配适当的干预措施。今早我刚听了您和安迪·加尔平的新播客。

Okay, so that sets the stage a little bit. We're talking about a symptom for which there's a 100 or more different pathways and mechanisms there. So we've got to have a fairly comprehensive assessment now and understanding to focus on the type of back pain and then matching an appropriate intervention. I was listening to your new podcast with Andy Galpin this morning. The Podcast.

《表现播客》，对。他说要遵循‘三个I’原则：收集信息、解读信息、然后干预。这里也是同样的思路，当然这适用于所有医疗状况。

The Perform Podcast, yeah. And he said, I'm going to try and follow the three I's. And it was, I think gather information, interpret the information, and then intervene. So it's the same kind of deal here. And of course that's pan medical condition shall we say.

基于这个背景，我会这样回答：什么导致背痛？基因上膛，环境扣动扳机，而个体周围的社会心理环境则影响他们对疼痛的反应。我们可以从这三个方面来剖析。

So with that context, I'm going to answer it like this. What causes back pain? Genetics loads the gun, exposure pulls the trigger, and then the psychosocial milieu around the individual influences how they respond to the pain. So there's a start, we can break it down in those three categories if you wish.

当然。当你提到‘基因上膛’时，我立刻想到的是，根据我的个人经历，我的右肩比左肩略低一些——除非我刻意注意姿势。我父亲也有同样的情况。而且你会发现，我某一侧脚踝搭在另一侧膝盖上会更容易些。跑步时我的一只脚会比另一只更倾向于内翻。这些都是很细微的差异。

Sure. So when you say genetics loads the gun, what comes to mind, because it's my experience is that I have a right shoulder that sits a little bit lower than my left shoulder, unless I'm mindful of that. My dad has the same thing and I can, you know, put an ankle on my other knee a bit more easily on one side versus the other. I tend to pronate one foot a little bit more than the other when I run. These are subtle things.

这些差异不一定会导致背痛，但我猜测很多情况要么是发育性过度使用（比如特定运动项目造成的）——我是右脚优势者，玩过很多滑板，所以用右脚蹬板，用右脚踢足球等等。但假设基因确实起了作用，造成了某种倾向性。如果我告诉你这些（就像刚才那样），当我说‘我右下侧偶尔会疼痛’时，你会立刻想到某种干预措施吗？毕竟我已知这种不平衡是由基因和可能的生活经历共同造成的。

They don't necessarily result in back pain, but I'm guessing that a lot of that is either developmental overuse particular sport, I'm regular footed, I skateboarded a bunch. So I push with my right foot, I kick a soccer ball with my right foot, those sorts of things. But let's assume that genetics played some role, created some bias. If I were to tell you that, which I just did, would then you immediately think to a particular intervention if I told you, okay, you know, I have a little bit of lower right side pain, which I occasionally do. I know I've got this imbalance that was loaded by genetics and presumably experience as well.

你的第一反应会是探究疼痛的特定根源，还是更重要的——直接想到某种治疗方案？或者我们需要更深入分析：我的行为模式、骨骼结构是纤细型还是粗壮型？在调查类别下，你认为还应该提出哪些问题？

And would your mind immediately go to a particular origin of that pain or perhaps even more importantly, a particular remedy to that pain? Or do we need to drill a little bit deeper and really understand more about what I do, what I don't do, if I'm more thin set or heavily set at the level of bone structure. You know, what are some of the other questions one would ask in the investigate category?

我的思路不会非此即彼，而是会兼顾两者。我会用这个比喻开启对话：我们来聊聊犬种吧，毕竟我们都爱狗。

My thought would not go to one or the other, but it would go to both. And I'd start that conversation with this analogy. Let's talk about breeds of dogs. We both love dogs.

如果

If

我对你说要训练两只狗参加灵缇赛——一只是灵缇犬，一只是圣伯纳犬。你觉得结果会怎样？无论怎么训练或调整，圣伯纳永远不可能在灵缇赛道上表现良好，最终只会得到一只受伤的圣伯纳。

I said to you we're gonna take two dogs and we're gonna train them for the greyhound track. One's a greyhound and one's a Saint Bernard. How do you think you're going to make out? The Saint Bernard, no matter how you train it or condition it, will never make it to the performing on a greyhound track. You're gonna end up with a broken St.

所以宏观上首先要承认先天差异。现在让我们具体到脊柱问题：观察个体的基础解剖结构很有意思——就像刚才分析犬种那样。想象我拿一根细柳枝反复弯曲，它不会积累应力损伤。

Bernard. So there's a little bit of a start from a big perspective. But now let's drill down and talk about spines. It's interesting when you look at the basic anatomical structure of an individual, we just did that with dogs. Imagine if I took a thin willow branch, I could bend that willow branch back and forth over and over, and it wouldn't accumulate stress.

但如果我拿同样的柳树枝条，像工字梁一样从上到下施加压力，它只会弯曲断裂。所以它能承受弯曲循环，但无法承受压缩。现在我要把这根柳树枝换成更粗的木棍。当我弯曲木棍一次，它就碎裂了。换句话说，厚度和径向直径越大，弯曲时的应力就越大。

But if I took that same Willow branch and loaded it top to bottom, like an I beam, it would just bend and break. So it supports bending cycles, but it doesn't support compression. Now I'm going to change that Willow branch into a thicker stick. And I bend the stick once and it shatters. In other words, the thickness and radial diameter being larger means the stress is bigger in bending.

然而，如果我们压缩同样的木棍。它能承受巨大的压缩力。这里有个关于脊柱的生动例子：有位连续仰卧起坐世界纪录保持者，能做数千个。根据我刚才说的，你的预测是什么？

However, let's compress the same stick. It can bear tremendous compression. So there's a very fast example on spines. There's a fellow who has the world record in consecutive sit ups, Thousands of them. Given what I've just said, what's your prediction?

你认为他是个脊柱粗壮的壮汉？还是个体型纤细、脊柱如柳枝般柔韧的人？

Do you think he has a big strong fellow with a thick spine? Or do you think he's a very slender man with a willowy thin spine?

他是个柔韧如柳的家伙，能不停地在地面上上下弯曲。

He's a willowy bendy guy who can just keep bending up and down off the ground.

没错。完全正确。他必须是这样的。这是基因决定的起点。

Bingo. Bingo. He has to be. There's no option. So there's a start on the genetics.

不是人人都能当进攻截锋，也不是人人都能成为体操运动员，甚至不是所有人都能忍受坐在椅子上当电脑操作员。这是个再普通不过的例子。

Not everybody can play offensive tackle and not everybody can be a gymnast or not everybody can simply tolerate sitting in a chair being a computer operator. There's a very mundane example for you.

关于柳枝与粗树干这个例子，我能请教个问题吗？我们能否通过躯干厚度、手腕粗细或脚踝周长来判断自己更偏向柳枝型还是红杉型？按理说观察自己、了解自己就该明白。比如我躯干短，前后厚度较大，从小就这样，但手腕周长不算小也不算特别粗。我曾养过斗牛獒，它常盯着我看，我知道它心里在想：安德鲁，我的手腕可比你的粗多了。

Could I ask you a question about the Willow versus thicker trunk example? Can we look to torso thickness or wrist thickness or ankle circumference as a way to assess ourselves as to whether or not we are likely to be more willowy or Redwood like. I mean, should be obvious just by looking at ourselves, knowing ourselves. But for instance, I have a short torso, I'm kind of thick through the torso front to back, I always have been since I was a kid, but in my wrist, the wrist circumference isn't small, but isn't huge. I had a bulldog mastiff and he would often look at me and I knew in his mind, was thinking, My wrists are really thick compared to yours, Andrew.

我就知道他是这么想的。他的前臂壮得像码头工人。当然他这辈子从没干过任何活。实际上，斗牛犬的人生目标就是尽可能少干活。不过我有些朋友膝盖粗壮，有些关节较小，脚踝更纤细。

I knew that's what he was thinking. He had forearms like a longshoreman. And of course he had never done any work whatsoever. Actually, goal of the Bulldog is to do as little work as possible in life. But I have friends who, you know, have thick knees, some have smaller joints, smaller ankles.

我们能否通过观察这些外围特征，在不进行影像检查的情况下对脊柱状况做出大致评估？

Can we make some general assessment about our spine without imaging it by looking at some of these peripheral markers?

当然可以。膝关节宽度、髂嵴间距（即骨盆宽度）、髋部宽度等都是反映骨骼整体粗壮程度的替代指标。没错，这是个很好的参考标准。但遗传因素和脊柱柔韧性还涉及更多方面，椎间盘形状也很关键。

Absolutely, yeah. So the knee width, the bi ileo crystal width, which is the width of your iliac crests, hip width are all surrogates to indicate general heaviness of the skeleton. So yes, that's one good marker. But there's more to the story for genetics and how bendy a spine can be. The shape of the disc matters.

比如观察顶级高尔夫球手群体，会发现他们的脊柱椎间盘——如果做MRI横断面扫描——呈更接近卵圆形的形状。而承重能力强的人，椎间盘形状更像利马豆，我们称之为利马豆形椎间盘。

So if you take on average a group of top golfers, you'll notice that their spines, that the disc shape, if we were to cut through, which is a transverse scan on an MRI, the discs are more ovoid. If you take someone who can bear a lot of compressive load, the discs look more like a lima bean. And that's called a limacon shaped disc.

当然，这些椎间盘从脊柱顶端到底部都是重复排列的。

And of course the discs are in repeating fashion throughout the spine, top to bottom.

正确。

Correct.

椎间盘是软组织，使骨节段（椎骨）能够活动。

And the discs are the soft tissue that allow for mobility of the vertebrae, the bony segments.

没错，它们确实是关节，但并非球窝关节，实际上是由层层胶原纤维构成的网状结构。我们也可以详细讨论这一点。

Exactly, they are the joints, but they're not a ball and socket joint, they're actually a fabric of layer upon layer of collagen fibers. And we can talk about that as well.

多么精妙的适应性设计啊！想想看，要让一堆坚硬的骨骼能够弯曲，就必须将其分割成若干节段，就像项链上的珠子那样。而在这些‘珠子’之间，需要填充某种既柔韧又能被压缩的组织——这样它既能灵活弯曲，又能在垂直方向上被挤压变窄。

What a beautiful adaptation, right? Take a bunch of bony, if you wanna be able to bend a bone, right? You need to break it up into segments, kind of like beads on the necklace. And then in between those beads, put some pliable yet, I guess a tissue that you can still compress. So it's both pliable and it squeeze down and become more narrow in the vertical direction.

它还能在一定程度上单侧受压变形。

And it can also squeeze down on one side or the other to some degree.

是的，我们进化出了椎间盘结构，确实没有比这更完美的构造了。有人问为什么脊柱不采用球窝关节？想象一下把五个橙子叠起来，每个之间用球窝关节连接。要控制每个橙子——移动一个就得控制所有其他的——这需要多大的协调性啊。

Yeah, we evolved discs and there really is no other better architecture. People say, well, why don't we have ball and socket joints in our spine? And the reason is this. Can you imagine stacking five oranges, one on top of the other, And then you could make them mobile by putting a ball and socket joint in between them. The amount of control that you would need on every single orange, you move one orange, you have to control all the others.

这根本不可能完成。我在课堂上给学生做过实验：用四个咖啡罐，每个之间放个网球，前后左右各系一根绳子让四名学生拉着。

It's mission impossible. We would, I would do an experiment with students in my lectures. I would take four coffee cans and put a tennis ball between each coffee can. And then I would put a rope at the front and the back of each coffee can, and then one on the side. And I had four students take those four ropes.

再让另外四组学生分别控制相邻咖啡罐的绳子。当我喊‘现在让脊柱前屈’时，前面的学生轻轻拉动，但最顶端的必须比下层多用点力，再下层又递减。相反方向的学生则要按顺序放松绳子。接着我说‘现在稍微扭转一下’。

And then I took another four students who had the ropes on the next coffee can and then on the next coffee can. And then I'd say, okay, group, flex the spine forward. So the students on the front would pull a little bit, but the guy on top had to pull more than the next coffee can, and then the next coffee can a little bit less. Vice versa, the people on the other side had to pay out the rope in sequence. And then I would say, okay, now let's twist a little bit.

可想而知这根本难以控制。后来我取出网球，换成泡沫橡胶制成的圆盘状椎间盘模型——瞬间整个系统就稳定了。因为人体以刚度作为控制参数，泡沫橡胶会形成缓冲：当运动出现偏差时，它会自动增加阻力。

Anyway, you could imagine it was impossible to control. And then I took out the tennis balls and I put in what was a disc, a big round cylindrical piece of foam rubber. All of a sudden that added stiffness. So now, because the body uses stiffness as the control parameter, Now we've added control in that the foam rubber would create a buffer. And as the deviation in motion occurred, the foam rubber would add more resistance.

这是一种自动控制系统。汽车上的减震器就是这样工作的，它包含弹性元件和阻尼器，但主要是弹性元件在起作用。我们稍后会讨论刚度和稳定性，正是这些特性真正实现了控制功能。这就是为什么我们会进化出椎间盘。

So it was an automatic control. And that's what a shock absorber does on a car. It has an elastic element plus the damper, but it's the elastic element. And we're gonna talk about stiffness and stability, I hope, that really creates the control. So that's why we have evolved discs.

这种结构效率极高。我可以弯腰系鞋带，但如果要提着沉重的购物袋回家，就需要那根柔性杆保持足够的刚度以免坍塌。或者像古人可能需要扛着猎物回家，这时椎间盘就能以非常经济的方式提供必要的刚度，同时不会像球窝关节那样产生应力集中。这是进化必需的结构。此外，脊柱除了由椎骨和椎间盘组成的柱体外，后方还有两个被称为关节突关节的构造，它们负责引导运动。

It's highly efficient. I can bend the spine to tie my shoe, but if I have to carry home these days, heavy shopping bags, I need stiffness of that flexible rod so it doesn't collapse. Or years ago I might have been carrying home an animal for dinner and I needed those discs to provide the stiffness in a very economical way and in a way that didn't create stress contribution, concentrations the way ball and socket joints would. So that's an evolutionary necessity. Also when we look at spines there are the column of vertebra with the intervening discs, but behind them there's two more joints and those are called facet joints and they guide motion.

这些关节突关节具有不同角度。开放角度允许你进行扭转动作。想象一下如果高尔夫球手的关节角度是这样的封闭状态，他们就无法完成挥杆扭转。

Those facet joints have a variety of angles. They can have open angles which allow you to twist. So if you took a group of golfers, could you imagine if they had facet angles like this, you can't twist.

也就是说关节突角度过于接近，或者说夹角太小。

So facet angles that are too close together, basically, or just a small angle.

如果关节角度朝向后侧排列，就无法完成扭转。你会发现职业高尔夫球手群体中，所有人都具有开放型的关节突结构。

If the angle is orientated for an aft, you can't twist. And you won't find if you're dealing with a group of professional golfers, you'll find they all have open facet joints.

这是遗传决定的吗？

Is that genetic?

百分之百是遗传决定的。有趣的是，当关节突呈我描述的开放状态时，后仰动作会导致关节像屋顶瓦片那样相互挤压。这会给称为椎弓峡部的骨骼带来压力，比如体操运动员就容易出现典型的峡部裂骨折（脊椎滑脱症），导致该节段脊柱轻微移位。我刚完成一位职业网球选手的康复治疗，他就是在发球时追求过度动作幅度导致同样损伤——教练为了增加发球速度，要求他做出过度的后仰动作。

It's absolutely 100% genetic. Now interestingly enough, when you arch back, when the facet joints are orientated open as I'm describing, when you arch back one pushes hard on the other like shingles on a roof. That stresses a bone called the pars bone and gymnasts, for example, get a very typical fracture pattern called a spondylolisthesis, which is a fracture of that bone and then the spine shifts a little bit at that joint. Just finishing rehabbing a pro tennis player who had the same thing after they tried to have too much range of motion in their serve. The coach gave them excessive extension to try and put more miles an hour on the ball.

但这并不适合脊椎，最终导致了应力性骨折。

But it didn't suit the spine and they ended up having a stress fracture.

我是说，可以公平地说，如果我们天生柔韧性好，比如我妹妹，她的手指可以轻松向后弯曲，她的肩部伸展能力也很强——对于那些不熟悉肩部伸展的人来说，想象你背靠栏杆站立，栏杆大约在腰部上方，双手平行放在上面，手臂紧贴身体。然后，双脚离栏杆大约一两只脚的距离，你可以弯曲膝盖，手臂就会向后伸展。

I mean, it fair to say that if we can if we are naturally flexible, for instance, like my sister can, you know, like her fingers can bend back really easily, her shoulder extension, which I guess for people that aren't familiar with shoulder extension, know, she can, like, let's say you're leaning up against a railing with your back to the railing. The railings is just, let's just say is just above lower back height and you can put both hands on it parallel. So your arms are close together, like very close to the torso. And then, and people don't do this quickly because you can tear something or injure something. But then with feet about, I don't know, a foot or two away from that bar, you can do a knee bend and basically the arms go back behind you.

碰巧我的肩部伸展能力还不错，这是天生的。我并不特别灵活，但这就是我的身体结构。我有一些朋友无论如何都做不到这一点。

Like I happen to have a fair degree of shoulder, just natural shoulder extension ability. I'm not particularly flexible, but that's just how I'm structured. I have some friends that can't do that to save their life.

没错。

Right.

但我不会认为自己超级灵活。我妹妹比我更灵活一些，我们显然是亲姐妹。那么像她这样天生柔韧性好的人，如果目标是避免疼痛，是否应该避免某些活动？就像你说的圣伯纳犬在灵缇犬赛道上跑步，我们都可以享受休闲活动，但当然不想受伤。

But I wouldn't consider myself hyper flexible. My sister is a bit more flexible, we're related obviously. So would people like her or people that tend to be pretty flexible naturally, would they be wise to avoid certain activities if their goal is to remain pain free? I mean, you talk about the St. Bernard running on the Greyhound Track, you know, we all can enjoy things recreationally, but of course we don't want to injure ourselves.

那么天生柔韧性好的人是否应该避免某些运动和活动？反过来，天生关节僵硬、脊椎粗壮的人是否也应该避免某些活动？

So is somebody who's naturally flexible, should they avoid certain sports and activities? And conversely, somebody is naturally stiffer, thicker spine, thicker joints, should they avoid certain activities?

这是个很大的问题，需要考虑更多变量。但我要说的是，当我们帮助运动员或普通人康复重返工作岗位时——他们都是职业运动员——我们会考虑所有这些因素。就像你描述你妹妹后仰的动作，A)我知道她的椎间盘饱满，充满液体以允许椎间盘活动。B)我也知道如果我们从侧面看X光片，可以看到她的棘突后部结构。

That's a huge question and there's many more variables to consider. But I will say that when we are rehabilitating an athlete or just a person to get back to work, they're an occupational athlete. We take all of this into consideration. So as you were describing your sister arching back, A) I know she has plump discs, discs that are full of fluid to allow the mobility to take place in the discs. I also know that if we looked at an x-ray from the side, you know the posterior spinous processes.

当你用拇指沿着一个人的背部中线向下滑动时，会感觉到脊柱中央的骨性突起。这些是棘突。当人直立时，各棘突间会有较大间隙。而当背部后伸时，这些间隙会逐渐闭合直至棘突相接触——我们称之为'棘吻现象'。这让我想起俄罗斯传统的卧推技术。

If you run your thumb down the midline of a person's back, will feel the bumps of bone up the middle of the spine. Those are the posterior spines. She will have a large space between each one when she's standing upright. So when she extends back, those spaces will come together and eventually the spines, what we call it kissing spines. And it takes me back to some of the old Russian techniques for bench press.

他们进行卧推时会保持极大的背部反弓，其他人看到后会说'我要模仿这种卧推技术'，因为这样能调动更多背阔肌力量、保持背部刚性，产生不同的力量矢量，实际上能对杠铃施加更有效的力。但人们没意识到，当一个人能做到极大反弓时，他们的棘突间距本就宽大。如果你的棘突间距不足却强行模仿，就会挤压棘间韧带（这些韧带本就位于棘突间隙中），从而引发一系列新问题。所以对某些人是力学优势的动作，对另一些人反而是力学劣势。

They would bench press with a huge arch in their back and then other people would say, Oh, I'm going to try and mimic that particular bench press technique because it allows you to get much more force out of latissimus dorsi, a stiffer back, and you get a different force vector and actually more effective force on the bar. They didn't realize that when we work with a person who has a huge arch, they have big spaces between those spinous processes. And if you don't have those big spaces, you are going to crush the interspinous ligaments, which naturally are between those spaces. And you will now fire off a whole set of new problems. So what is a mechanical advantage for one person is a mechanical disadvantage for another.

明白了吗？这些都至关重要。再说回椎间盘——它是由层层胶原纤维构成的复合结构。典型椎间盘约80%是I型胶原蛋白，这种胶原提供刚性强度。

Do you follow? So all of this matters. Going back to the disc being a fabric of layer upon layer of collagen strands. Typically the disc is about 80% type one collagen. That is the stiff strength collagen.

另外约20%是具有弹性的II型胶原蛋白。而III至X型胶原则负责将这些纤维结合在一起——这里存在更大的遗传变异性。所以有些人能做大量卷腹动作，他们不仅脊柱纤细，还具有特殊的结合型胶原来维系这些纤维结构。

About another 20% is elastic collagen type two. But there's types three through 10 that bind those collagen fibers together. That's where there's a much greater degree of genetic variability. So there are some people who can get away with doing many sit ups. They have a slender spine and they have the type of binding collagen that holds all those fibers together.

如果我想拆解衬衫纤维使其分层，就需要反复施加应力应变。面料的抗拉强度取决于纤维间的结合物质——这些结合纤维正是遗传差异所在。因此就连一个人对反复弯曲训练的耐受程度，某种程度上也由父母决定，包括脊柱尺寸和III至X型胶原的构成比例。

But if I wanted to work these fibers of my shirt apart, get them to delaminate, I would create repeated stress strain reversals. The resistance of that fabric depends on the stuff holding the fibers together. So there will be binding fibers there. That's where the genetic variance lies in many people. So even there, the person's resilience to repeatedly doing a bending drill is determined by your parents to some degree, both in the size, the collagen type three through 10 makeups.

正如大家所知，我服用AG1已超十年。很高兴他们赞助本期播客。明确说明：我并非因赞助而服用AG1，而是因为我长期服用才促成这次合作。事实上自2012年起我每天坚持服用1-2次。当今关于营养学的信息众说纷纭，但以下几点已形成普遍共识：

As many of you know, I've been taking AG1 for more than ten years now. So I'm delighted that they're sponsoring this podcast. To be clear, I don't take AG1 because they're a sponsor, rather they are a sponsor because I take AG1. In fact, I take AG1 once and often twice every single day, and I've done that since starting way back in 2012. There is so much conflicting information out there nowadays about what proper nutrition is, but here's what there seems to be a general consensus on.

无论你是杂食、肉食、素食或纯素食者，公认原则是应主要摄入未加工/轻加工食品——这样既能吃饱又不会过量，同时获取充足的维生素、矿物质、益生菌等身心必需的微量营养素。我个人选择杂食并尽量以天然食材为主，但坚持每天服用1-2次AG1的原因在于：它能确保我获取全部营养素，所含适应原还能帮助应对压力。这本质上是种营养保险，用于补充而非替代优质食物。通过早晚各一份AG1，我能满足所有基础营养需求。和众多使用者一样，我在精力、消化、睡眠等多方面都感受到显著改善。

Whether you're an omnivore, a carnivore, a vegetarian, or a vegan, I think it's generally agreed that you should get most of your food from unprocessed or minimally processed sources, which allows you to eat enough, but not overeat, get plenty of vitamins and minerals, probiotics, and micronutrients that we all need for physical and mental health. Now, I personally am an omnivore and I strive to get most of my food from unprocessed or minimally processed sources, but the reason I still take AG1 once and often twice every day is that it ensures I get all of those vitamins, minerals, probiotics, etcetera, but it also has adaptogens to help me cope with stress. It's basically a nutritional insurance policy meant to augment, not replace quality food. So by drinking a serving of AG1 in the morning, and again in the afternoon or evening, I cover all of my foundational nutritional needs. And I like so many other people that take AG1 report feeling much better in a number of important ways, such as energy levels, digestion, sleep, and more.

市面上许多营养补充剂都针对特定效果，而AG1则是基础营养品，旨在全面支持身心健康。若想尝试AG1，可访问drinkag1.com/huberman获取特别优惠——订购即赠五包旅行装及一年份维生素D3K2。重申一次：drinkag1.com/huberman。除非某人立志成为某项运动的世界级运动员，这种情况下他们或许该关注自身基因是否与该运动匹配。

So while many supplements out there are really directed towards obtaining one specific outcome, AG1 is foundational nutrition designed to support all aspects of well-being related to mental health and physical health. If you'd like to try AG1, you can go to drinkag1.com/huberman to claim a special offer. They'll give you five free travel packs with your order plus a year supply of vitamin D3K2. Again, that's drinkag1.com/huberman. Unless somebody is seeking to be a world class athlete in something, in which case they should probably pay attention to their genetics and see whether or not it lines up well with a given sport.

当然也有例外——那些基因条件明显不适合某项运动的人却达到了世界级水平。但这类案例极其罕见。对于以娱乐为目的的大多数人，比如脊柱较粗壮的高尔夫/芭蕾爱好者，或体型纤细的举重初学者，他们是否该选择特定活动来增强抗疼痛能力和表现力？比如纤细者是否该强化脊柱周围肌肉以弥补脊柱单薄？

Although there have been, you know, exceptions where people who were incredibly genetically, let's just say biased toward not being able to perform well in a sport have nonetheless succeeded in performing at a world class level. But those are exceedingly rare exceptions. For most people who want to do things recreationally, like the heavier set person with a thicker spine who wants to golf or do a, you know, or do ballet perhaps, or the thinner willowy person who wants to get into power lifting, for instance. Are there certain things that they should each consider and embrace as activities in order to make themselves more resilient, more pain resilient and more apt to have higher performance? For instance, would the willowy person, so to speak, do well to build up some of the musculature around the spine to compensate for the thinness of that spine?

而脊柱粗壮者是否该设法增强椎间盘柔韧性？

And would the person with the heavier or thicker spine do well to try and encourage more pliability of their discs somehow?

答案是肯定的，但有严格限制。首先需要说明：人体每个系统都需要压力刺激才能保持最佳状态——心血管系统、肌肉骨骼系统、内分泌系统乃至心理系统都需要压力来激发适应性强化。

The answer is yes, but it's a very limited yes. So if I can set the stage and give some context here. Every system in the body requires stress for optimal health. Think of the cardiovascular system, the musculoskeletal system, the endocrine system, even the psychological system. It needs stress to create adaptation for robustness.

但绝不能突破临界点。否则就会积累某种创伤——无论是心理层面的情绪创伤，还是细胞组织层面的持续压力。因此我们必须明确这些临界点，设法拓展适应范围但绝不逾越。在此前提下，才能讨论不同运动对人体各部位的压力适配性。

But you cannot cross what's known as the tipping point. Because if you do, you start building cumulative trauma of some form, whether it's emotional trauma psychologically or it's cumulative stress at the tissue level, at the level of the cell. So we have to talk about those tipping points. We've got to define where they are, try and expand them, adapt them, but don't cross them. So with that context now, we can talk about a person's suitability for the stresses on different parts of their body associated with different sports.

我们可以探讨适应发生的速率、所需的减负休息周期——这些都受基因影响。动作执行方式会改变压力分布。举个有趣例子：奥运会标枪项目领奖台上的选手们体型几乎一模一样。

We can talk about the rate at which the adaptation occurs, the amount of deloads and rest that are required. All of these things are genetically influenced. The way that they perform the movement is going to move the stress concentration. Here's an interesting demonstration for you. If you go to the Olympics and look at the podium winners of a javelin thrower, they look identical.

你觉得游泳选手会和标枪选手长得像吗？当然不会。

Do you think the swimmers look like the javelin throwers? No, they don't.

但他们看起来很像。

But they look like each other.

但他们看起来很像。台上的人

But they look like each other. The people on

在结构上看起来非常相似。

the podium look very similar in structure.

是的。让我再举一个非常生动的例子。想象一项对运动员有三种截然不同要求的运动——铁人三项。选手需要先游泳一段距离，然后骑自行车，最后跑步。

Yeah. Let me just give another very poignant example of that. Consider a sport that has three very separate demands of the athlete. Consider a triathlete. The triathlete has to swim a certain distance, then they bike a certain distance, and then they run a certain distance.

你见过有人从湖里或泳池里第一个出来，结果赢得铁人三项吗？不可能。适合水中快速游动的鱼型身材——脚踝需要更灵活以模仿鱼鳍，躯干更长——

Have you ever known a person who comes out of the lake or the pool, whatever it is, first winning the triathlon. It doesn't work that way. What suited them to be a fish? Fast in water. They have to be somewhat floppy in the ankles because they're creating a fish's fin, longer in the torso.

想象一个力量举选手做蝶泳的样子，肯定不太美观。然后他们骑上自行车时需要核心绷紧。不知道你是否了解自行车设计，当然你肯定懂，车架刚性是高价所在。

Consider a power lifter performing a butterfly stroke. It wouldn't look very pretty. Then they get on the bike where they have to stiffen to stiffen the core. I don't know if you know bike design, well, I'm sure you do. You're paying for stiffness of the frame.

这就是顶级选手——

That's what a really elite-

原来不知道这个。

did not know that.

是的。所以当人踩踏板时，车架不会弯曲，因为那样会导致能量流失。你花钱买的就是一个非常坚固的车架。这样你施加在曲柄上的每一分力都能推动你前进，而不是被浪费在弯曲车架上。同理，骑手也会与自行车紧密锁定。

Yeah. So when a person pushes on the pedal, the frame doesn't flex because that would be an energy leak. You pay for a very stiff frame. So every ounce of force that you apply to the crank handle to propel you forward propels you forward instead of being wasted and bending the frame. The same way the cyclist will lock in on the bike.

他们会用双腿夹紧鞍座，握紧把手，收紧核心肌群，这样当通过髋部和腿部发力时，力量就能完全转化为推进力，而不是消耗在弯曲他们柔韧的身体上。这与游泳运动员的神经学和力学机制截然不同。现在说说跑步。最高效的跑者通过调谐弹簧储存并释放弹性势能。

They'll squeeze the saddle between their legs, lock into the bars, lock their core down so that when they create power through the hips and through the legs, it's transferred to the power. It isn't transferred to bending their willowy body. That is very different from the neurology and the mechanics of a swimmer. Now let's run. To run, the most efficient runners store and recover elastic energy in tuned springs.

推荐阅读肖恩·本齐的《失落的跑步艺术》，他研究了肯尼亚跑者如何像袋鼠那样，在每一步中储存并释放弹性势能。袋鼠跳跃时比单纯依靠肌肉的离心-向心收缩更高效。这又与游泳运动员完全相反，是高度调谐的刚性系统。铁人三项第三赛段最高效的跑者会预先绷紧肌肉。

A wonderful book to read is The Lost Art of Running by Shane Benzie, who studied the Kenyan runners and how they store and recover elastic energy with each stride, almost the same way as a kangaroo would. A kangaroo is more efficient when it hops versus plotting along using eccentric concentric muscle contraction. So again, the polar opposite of a swimmer. It's a very tuned stiffness. The most efficient runners for the third leg of the triathlon pre stiffen.

他们的肌肉会预先收缩。这样当脚触地时，弹性元件已经开始储能，并能免费获得回弹力。但如果弹簧未调谐，肌肉只是被动拉伸——这在游泳环节很有利——想象玩弹簧单高跷。如果你腿部完全松弛，就会瘫软在地，只能靠肌肉的向心-离心收缩发力。

They have a pre contraction of the muscle. So when the foot hits the ground, they're already storing the elastic elements and they get that back for free. But if the springs were not tuned and they'd stretched away their muscles just to be passive elements, which serves them very well in the swimming element, Think of doing a pogo jump. So you're just pogoing through the ankles now. If you had no tone in the legs, you just flop into the ground and you would have to use concentric eccentric muscle contraction.

但若过度绷紧，你就会像铁块般无法跳跃。只有调谐恰到好处时，才能获得美妙的共振和完美的弹跳。肌肉收缩时会产生力量，但人们往往忽略它同时在调节刚度。如果我最大限度收缩肌肉，反而会无法移动。

But if you stiffened too much, you're now a piece of iron and you won't be able to jump either. But you'll get a beautiful resonance, a beautiful pogo when you have the tuning just right. So when a muscle contracts, it creates force. We all know this, but people don't appreciate you're also tuning the stiffness. If I maximally contract my muscles, I can't move.

因此运动员既要调节肌肉刚度（如果是冲击型运动员），又需要脉冲式放松。今天播客前我们讨论过迈克·泰森的发力机制——他先脉冲蓄力，再放松以获得拳头接近对手时的末段加速度。而当拳头击中对手时，他会瞬间硬如花岗岩。能稍微体会这种感觉真是震撼至极。

So athletes have to tune muscle if they're impacting athletes, but they also have to pulse and relax. Pulse. We're talking about Mike Tyson before the podcast today and the mechanics of how he pulses and then he's got to relax to get closing velocity of the fist to the opponent. And then when his fist hits the opponent, he turns to granite. And it is just such an awesome experience to to feel that a little bit.

与精英运动员共事，感受他们的运动天赋，然后剖析他们如何做到这一点，这是我生命中的一大乐趣。这其中包含许多内容，但那位铁人三项运动员给我们的启示是：你不可能擅长所有事情。运动能力与遗传因素总是存在权衡，当然还需要通过适当的训练来优化并通过技术展现这种天赋。有些运动员身体非常松弛，有些则非常紧绷。

It's one of the joys of my life working with elite athletes to feel their athleticism, but then dissect it down as to how they do it. So there's a lot in that, but that lesson from the triathlete really shows us how you can't be good at everything. There's always a trade off with athleticism and the genetic part, and then, of course, in the appropriate training to optimize and express that genetic gift through technique through technique. So some athletes are very loose. Some athletes are very tight.

有些运动员极具弹性。如果你不是弹性型运动员，就无法将高尔夫球击出330码。你会发现那些能打出330码的高尔夫球手，他们的力量测试成绩并不突出。他们拥有完美调谐的弹性身体。如果你接触过足够多这类运动员，几乎一眼就能辨认出来。

Some are very elastic. You won't hit a golf ball three thirty, yards if you're not an elastic athlete. You'll notice if you measure a golfer who can hit 330 yards, they don't test very strong. They have a beautiful tuned elastic body. You can almost see it if you've worked with enough of them.

他们的肌肉有一种流畅感。皮肤之下是筋膜网络。那些能以每小时110、115、120英里速度投掷棒球的人也是如此，但这时你会看到一种高度不对称的弹性效应。

There's a smoothness to the muscle. So underneath the skin is a fascial net. Someone who can throw a baseball 110, 115, 120 miles an hour will be the same, but now you have a very asymmetric elastic effect.

我知道你有充分理由避免一概而论。但考虑到大多数观看此内容的观众可能并不立志成为精英运动员——我肯定不是——我们能否至少做一两个普遍性建议，说明每个人如何通过训练多样化或避免某些训练类型来预防背痛和受伤？比如我们以三种主要体型为例（当然现实并非如此简单）：经典的瘦长型（外胚型），关节细小，身材修长；

So I know that you low then avoid generalizations with good reason. But given that most people listening to watching this are probably not aiming to become elite athletes, I know I'm certainly not. Can we safely make at least one or two generalizations about what we each and all can do to try and avoid, let's say back pain and injury by either diversifying our training or avoiding certain types of training. For instance, let's take the three major phenotypes. And this is obviously not how the world works, but the classic, ectomorphic phenotype, very thin, very willowy, small joints, long and lithe, or lithe.

健壮型（中胚型），肌肉发达；以及所谓的胖型（内胚型），骨架较大，可能携带更多体脂肪等（实际体质可能混合其他类型）。根据你的理论，我想一个基本原则是：避免那些与自身先天体型倾向极端不符的运动，比如身体不够柔韧就不要每周做七天瑜伽。但我也想到相反观点：正因不够柔韧才应该多练瑜伽以提升柔韧性。

The mesomorph thicker, more muscular, and then the so called endomorph, the more heavier set, maybe even carrying some extra body fat, etcetera. Don't You really know what's under there. They could fall into either of the other two phenotypes. I could imagine based on everything that you're saying that a good rule of thumb would be avoid the types of activities that are outside of your natural genetic propensity based on body type, at least in the extremes, like if you're not very bendy, don't do seven days a week of yoga, okay? But I could also imagine the opposite, which is if you're not very bendy, do seven days of yoga, because that's going to allow you to become more bendy.

再比如天生像铅球运动员体型的人（中胚或内胚型），可能成为出色的力量举选手。我高中时就见过这样的同学——体育课第一次举重就能推起315磅。但如果他们的目标是全面健康（我认为大多数人的目标）：能在机场提行李不气喘、能弯腰取物、抱孩子、进行庭院劳动等，也许他们反而不该专注力量训练。

Or the person that is naturally shaped more like a shot putter, let's say the mesomorph or endomorph, and you could say, well, there'd be great power lifter. I mean, I knew kids like this in high school, you know, PE class, they're like, okay, weight training today, none of us had done weight training. And then the kid, you know, lies down and, you know, and pushes, you know, three fifteen, you're like, oh goodness, you know, like that's wild. But maybe they shouldn't be weight training. If their goal is to be all around fit to be able, which I think is the goal of most people to be able to, you know, carry some luggage at the airport without, you know, having to stop every once in a while and suck for air, to be able to, you know, lean down and grab something out of a cabinet, you know, you know, pick up a kid, you know, do some hard labor in the yard, you know, move some logs and things like that.

目标是日常活动不受伤、不会次日酸痛到需要康复治疗。虽然你反对笼统建议，但我们是否应该有意识地针对自身弱点训练以平衡潜在失衡？还是应该扬长避短，完全不触碰弱势领域？

To be able to do stuff without getting injured, without being so sore in the following days that you feel like you need extensive rehabilitation. So again, I know you like to avoid generalizations, but should we make it a point to train against our predisposition in order to offset the imbalances that would otherwise occur? Or would we be wise to lean into our strengths and just not touch stuff that taps into our weaknesses?

我理解这个问题。答案是我不知道。但我知道人们会说，这位教授在回避问题，而我不会那样做。所以我要告诉你我如何找到答案——通过评估。

I understand the question. The answer is I don't know. But I know people will say, well this professor, he's avoiding question and I'm not going to do that. So I'm gonna tell you how I find the answer. And it's through assessment.

顺便说一句，我很高兴我们回到背痛这个话题，因为这是我真正的专业核心。我们的评估非常全面，首先我会简单询问对方：告诉我你的故事。有些人当我让他们讲述故事时，却从未提及疼痛。他们会谈论家庭生活，以及不得不继续工作的压力，因为他们有两四个孩子在上学。

And I'm glad we're getting back to back pain by the way, because it's my real, the cornerstone of my expertise. Our assessment is very comprehensive. It starts out by me simply asking the person, Tell me your story. And some people never tell me about their pain when I ask them to tell me their story. They will be telling me about their family life and the pressures that they have to still go to work because they have two kids in school or four kids in school.

可能会告诉我他们的激情所在，或是他们的人生目标。这些目标就是回答你问题的起点，安德鲁。我们都知道有些人不适合某些职业，比如我自己——高中职业顾问曾对我父亲说：'麦吉尔这孩子学术上不太行，该去读技校。'

Might tell me about the passions that they have. Or they might tell me about their goals. So the goals are the beginning of answering your question, Andrew. We all know people who aren't suited for a certain occupation or they aren't suited or they, I'll take myself for example. I had a high school careers counselor tell my father, well, McGill, he's not really suited academically, he should go to trade school.

于是我就报了管道工学校。

So I registered for plumbing school.

不，只是觉得'哎呀'——显然你没走这条路。不是说读管道学校对所有人都是坏选择，但在你这儿走了完全不同的方向。

No. Just went oops because clearly that's not the way you went. Not to go into plumbing that going to plumbing school would be a bad decision for some, but in your case, went a very different direction. Well,

我觉得当管道工我也能胜任。但重点在于：目标是什么？在评估中，我会关注对方的学习风格，思考如何指导他们，最后才深入分析他们的疼痛细节。

I I think I would have been okay as a plumber. Sure. But anyway, my point in that is what are the goals? Then the assessment, I'm paying attention to the person's learning style, how are we going to coach them? And then we get down to the details of their pain.

疼痛性质是什么？是早晨起床时发作？与特定活动相关？还是与某些动作、姿势或负重有关？疼痛会变化吗？要尝试精确描述。

What's the nature of the pain? Is it when they get out of bed in the morning? Is it associated with a certain activity? Is it associated with certain motions, postures or loads? Try and hone does the pain change?

疼痛最初是出现在背部一侧，然后到了下午就转移到左臀了吗？还是说会一直延伸到右脚趾？所有这些症状都在告诉我疼痛的稳定性，为我提供了评估方向的线索。然后我们再进行具体评估。

Does it start out on one side of the back and then later in the day it's in the left glute? Or does it go down to your right toes? All of things, these things are telling me about the stability of the pain. It's giving me clues on what I'm going to assess. Then we go and assess them.

我们首先进行所谓的诱发测试。我会有意诱发他们的疼痛。如果能成功诱发，说明我抓住了机械性病因。如果诱发不了，那就不是机械性问题。好的，这现在给了我一些信息。

And it begins with what we call provocative testing. I'm purposefully provoking their pain. If I can provoke their pain, I've nailed the mechanic. If I can't provoke it, it's not mechanical. Okay, well that tells me something now.

现在我逐渐明白了：我知道他们的职业，知道他们想从事什么运动。我对该运动项目的体能要求和心理要求都有足够了解。他们是否具备从事该职业或运动所需的条件？

So now I'm starting to see, I know what their job is. I know what sport it is they want to do. I know enough about that job in sport that I know the physical demands. I know the psychological demands. Do they have what's required of the job or sport?

接着我会进行测试。如果触发了他们的疼痛，那就有问题了。因此我们必须非常针对性地设计训练方案，因为人的训练承受力是有限的，受伤时承受力会更低。

And then I test that. If it triggers their pain, we have a problem. So now we have to focus the trainings very specifically because people do not have infinite training capacity. They only have so much. And when you're hurt, have even less.

所以我们专注于那些能产生改变的关键点，使他们有能力达到我们确定的具体要求。虽然这个解释有点冗长，但我知道如何通过这个路径来制定训练方案。既然我们已经识别出他们疼痛路径的特殊性——可能是某种联动机制在起作用。举个例子，如果让一群加拿大冰球运动员使用椭圆机，他们表现会很差，因为这项运动的特点导致球员髋部容易僵硬。

So we try and focus on things that are going to make a difference to enable them to have the ability to meet those specific demands that we've identified. So do you see how it's a long winded answer, but I know how to get there to know how to train them. So now that we've recognized the very specific nature of their pain pathway, and it may be something that's going through the linkage. In other words, when they run, I could give you an example of if we put a group of Canadian hockey players on an elliptical trainer, they don't do very well because typical of the sport, the hockey players tend to get stiffer in the hips. It's the way they are.

他们滑行时保持微屈姿势，沉重的冰鞋和护具都压在腿上，导致髋部越来越僵硬。使用椭圆机时，髋部活动度不足，脊柱和骨盆会随着椭圆机每转一圈而扭动。如果原本就有动作诱发的背痛，椭圆机就会加重症状。而另一组髋部灵活的人...

They skate a little bit flexed and they carry all the heavy skates and heavy equipment down the legs. They get stiffer in the hips. When they go on the elliptical, their hips don't have the range of motion and their spine and pelvis gyrates with every rotation on the elliptical trainer. The elliptical gives them back pain if they already have motion triggered back pain. We take another group who has mobile hips.

在椭圆机上表现就很好，压力不会传导到背部。现在你明白为什么我知道哪类人适合椭圆机，哪类人不适合了吧？比如我给某些人做侧向剪切测试（其实就是熊抱姿势），当我用腋窝扣住他们肩膀时，会把他们的骨盆往我这边拉。

They do very well on elliptical trainers. The stress doesn't go into their backs. So now do you see why I know why one group does well with ellipticals, the other group does not. I know why one group who they, I'll give them a lateral shear test, which is basically a bear hug. I pull their pelvis towards me as I hook down their shoulder in my armpit.

我正在横向剪切他的脊柱。如果这触发了他的疼痛，那就对了。前几天有个职业冰球运动员，我给他做了横向剪切测试，他右侧腰部突然一阵剧痛。这完全复现了他的疼痛症状。我精准地找到了问题机制。

So I'm shearing their spine laterally. If that triggers their pain, exactly. I had a pro hockey player the other day, I gave him the lateral shear test and he had a right sided flash of pain going around his right flank. It exactly replicated the pain. I just found with precision the mechanism.

好，怎么解决？我把手指伸进他的斜肌，说：把我的手指推出去。结果他用力过猛。他说：哦不，这样更疼了。好吧，稍微收着点劲。

Okay, what's the antidote? I put my fingers into his oblique muscles and I said, push my fingers out. And he did it too hard. He says, Oh no, that hurts even more. Okay, dial it back a bit.

调整我们想要达到的效果。稍微对抗我一下就行。我重复了之前引发症状的测试，现在症状消失了。现在我更清楚该怎么做了。他当时在做Pallof推举。

Tune what we're trying to achieve here. Fight me just a little bit. I repeated the formerly offensive test, the symptom was gone. So now I'm getting more precision on knowing what I need to do. He was doing the Pallof press.

Pallof推举是个长力臂训练。通常用绳索或弹力带横向施加负荷，增加力臂长度，你必须抵抗这个力

The Pelloff press is a long lever exercise. So you take a load usually with a cable or a band that's held laterally and you increase the length of the lever, which you have to resist

因为要把重量从身体推出去。

because it's punch it out from the body.

对。你尝试时会导致身体扭转，同时给脊柱带来巨大剪切力。这正是引发他疼痛的原因。所以我们取消了Pallof推举——这个动作目前会复现他的症状。但如果是NHL球员，应该能做Pallof推举。

Yeah. You try and it it it's causing you to twist, but it also creates a tremendous sheer load on your spine. That was triggering his pain. So we took out the Pell Off press, which for him right now is replicating his symptoms. But if you're playing in the NHL, you should be able to do a palov press.

明白吗？嗯。是的。这是职业冰球运动的基本要求，但他现在做不了。所以这决定了我们后续的训练方案。

You follow? Yep. Yeah. It's it's a requirement of the rigors of professional hockey, but he can't do it now. So this is informing the programming that we're going to do.

如果某人在特定动作中感到疼痛，比如久坐后站起来时，

So if somebody has pain in a given movement, say standing up, after they sit for too

长时间坐着后，

long, a

比如某种髋部铰链动作、硬拉或深蹲，或者跑步时，他们是否应该思考当下或之后哪个具体动作让疼痛最剧烈？因为通常疼痛会在我们进行某项活动后出现，但在活动过程中疼痛却被抑制了——这本身就是一个有趣的现象，或许值得探讨一下原因。我们总以为是血流、温度等因素，但显然远不止于此。

particular style of hip hinge, deadlift or squat, or when they run, for instance, would it be wise for them to, you know, think about the exact movement that makes the pain the worst in the moment that they're doing the movement or afterwards? Because oftentimes pain will arrive after we engage in a certain activity, but during the activity that pain is shut down, which by the way, an interesting phenomenon in its own right, and you know, might be worth some mention as to like, couple of the reasons why that that occurs. We always think, oh, blood flow, it's warm, but clearly, it's it's more

远不止如此。确实如此。毫无疑问。

It's much more than that. More than that. Yeah. For sure.

假设我跑步时膝盖疼，我是否应该避免引发疼痛的步态并调整方式？在我看来这是合理的选择。

Let's say I've pain in the knee when I run. Should I avoid running in that gate that causes pain and work around it? Seems to me that would be the logical choice.

没错。来找我们的人大多有背痛问题。最初我们会避免疼痛动作。可以根据需要从神经学、生物力学或心理学角度讨论。

Right. Every person that comes to us comes with back pain. So initially we avoid it. We can have a neurological discussion if you like. We can have a biomechanical discussion or we can have a psychological discussion.

我们可以选择任一框架来分析。如果疼痛导致敏感化——以脚趾踢到东西为例：第一次踢到会疼，但痛感很快消失；如果每天重复踢到，敏感度就会提升，到最后甚至不用踢到，只需轻轻触碰那个敏感区域就会引发过度反应。

We can take it in the framework of any of those if we like. If the pain is causing a sensitization, I'm gonna use the example here of stubbing your toe. You stub your toe once, okay, well it hurts a bit and the pain goes away fairly quickly. But if every day you stubbed your toe, you would increase the sensitivity so that you don't have to stub it anymore. All you have to do is lightly touch that sensitized and you are going to have a maladaptive heightened response.

如果我们持续让脚趾承受疼痛，它就永远无法好转。所以我们必须开始一个基于组织也基于神经系统的脱敏放松过程。因为每个来找我们的人都带着疼痛，我们努力寻找绕过疼痛的方法。比如，坐着会引发他们的疼痛。通过坐姿测试我们发现，如果他们懒散地坐着，就会引发疼痛。

So if we keep creating pain on that toe, it will never get better. So we have to start a desensitization wind down, which is tissue based, but it's also neurologically based as well. And so because everyone comes to us with pain, we work very hard to hack our way around it. So let's say sitting, causes their pain. All right, we'll find out that when, we do a sitting test, if they sit slouched, causes their pain.

当他们坐直时，疼痛就消失了。所以我会给他们一个我现在正好在用的腰部支撑。昨天我坐飞机五个小时来见你，这个支撑让我在飞机上坐着时不会背痛。因为如果我蜷缩着坐五个小时，背部会不舒服，到了酒店就不想散步和训练了——而这些正是我们需要做的，以创造低于临界点的压力来优化健康。制定康复计划也是同样的道理。

When they sit upright, their pain goes away. So I will give them a lumbar support which I'm just happening to use now. I had to sit on an airplane for five hours yesterday coming to see you and this allows me to not get back pain on the airplane while I'm sitting. Because if I sit flexed for five hours, I will have a grumpy back and I won't feel like when I get into the hotel to go for a walk, which is, and train a bit because that's what we have to do to create a stress below the tipping point to optimize health. So it's the same thing in putting together the program.

首先，找出病因并尝试消除它。我们会花大量时间教授脊柱保健知识：教他们如何髋部铰链或深蹲，如何弓步，如何安全地到地面，如何在不扭转脊柱引发疼痛的情况下滚动身体，而是利用球窝关节活动。

First of all, know the cause and try and eliminate it. So we'll teach them, know, we spend a lot of time with spine hygiene. We teach them how to hip hinge or squat. We teach them how to lunge, how to get to the floor. We teach them how to roll without twisting their spine into pain, but using their ball and socket joints.

我们教他们像婴儿那样爬行，这样可以避免躯干扭转——以他们目前的状态，扭转会刺激敏感的疼痛触发点。

We teach them how to do a baby's crawl, which eliminates the torso twisting, which in their current state will offend the sensitized pain trigger.

对成年人来说，趴下来做婴儿爬行一定很让人谦卑吧。

It must be humbling for adults to get down and do a baby's crawl.

让世界纪录保持者的运动员重新学会谦卑确实很有意思。你知道，我曾训练过深蹲世界纪录保持者布莱恩·卡罗尔，我们还合著过一本书，所以可以提他的名字。

It's so humbling to take a world record holding athlete and humble them right back. As you know, I've had the current holder of the world's all time record squat, Brian Carroll. Brian and I have written a book together so I can use his name.

深蹲纪录是多少？

What's the squat record?

1306磅。如果你能相信的话。平行下蹲。平行下蹲。没有其他人做到过。

Thirteen oh six pounds. If you can believe that. Down to parallel. Down to parallel. No no other human has has done that.

那是四年前的事了。至今无人能复制。

That was four years ago now. No one's replicated it.

他穿那种弹性举重服吗？是的，他穿了。

Does he wear one of those elastic lifting suits when Yeah, he does so

他穿上了一套增加刚度的外骨骼，但我想回到那个令人谦卑的时刻——一个已经在两个不同重量级别保持深蹲世界纪录的人。而我却要教他如何从马桶上站起来，这又是另一个故事了。我们现在都对此一笑置之，但这就是疼痛造成的后果。疼痛扭曲了他的动作模式，他忘记了如何深蹲，尽管他保持着世界纪录。这就是疼痛对神经记忆的腐蚀性影响。

he's putting on an exoskeleton of stiffness, but I wanna come back to how humbling it was to have someone who already held world records in squatting in two different weight categories. And I had to show them how to get off the toilet, but that's another story. And we both laugh at this now, but that was what pain had done. Pain had corrupted his movement patterns and he forgot how to squat, but he held the world record. That's how corruptive pain is to the neurological engram.

我们可以讨论抑制和促进等各种机制。我很乐意展开这个话题，因为我知道在座的是谁。

And we can talk about inhibition and facilitation and all of the things. I mean, I'd love to have that conversation because I know who I'm sitting with.

神经层面的影响令人着迷。当他完成那个惊人的深蹲重量时，他是从标准深蹲架上取下杠铃后退步吗？还是那种杠铃悬挂在两个挂钩上，然后他从那里取下的？

The neural aspects are fascinating. When he does that incredible squat poundage, does he take the bar off a standard squat rack and then walk it back? Or is it one of those ones where the bar is suspended from two hooks and then he takes it from there?

没错，那次特定举重是从一个整体结构上直接举起的，不需要后退步。

Yeah, so that particular lift was lifted off a monolith where he didn't have to walk it out.

所以他把它取下来。于是它就挂在钩子上，然后那些钩子

So he takes it off. So it's hanging from hooks, then the hooks

被移开了。

are brought away.

我这么问是因为听起来他针对一两个特定平面上的动作进行了优化，仅此而已，因为单肩扛着一千多磅走路本身就是一项壮举。

Reason I ask is it sounds like he's optimized for one very specific movement in a couple of, you know, a couple of planes and nothing else because walking with a thousand plus pounds on one shoulders is also a feat in of itself.

好吧。呃

Okay. Well

你就像是在倒退着走。

You're shuffling backwards as it were.

行吧。你不打算放过我，这没关系。我曾与参加壮汉比赛的选手合作过，他们能扛着一千磅的重量行走。这叫超级牛轭。我们另一位客户保持着IPF（国际力量举联合会）的世界威尔克斯分数，他们不是从整体巨石上举起的。

Alright. You're not letting me off the hook, which is fine. So I've worked with competitors who compete in strong men and they can carry and walk with a thousand pounds on their shoulders. It's called the super yoke. Another client of ours who held the World Wilkes score in the IPF, International Powerlifting Federation, where they do not lift out of a monolith.

他们从深蹲架上取下杠铃后必须后退。如果你躯干没有足够的侧向力量和控制力，这时候就会受伤。不是在深蹲过程中，而是在后退时。所以这是完全不同的力量表现。你说从整体巨石上举起需要不同于IPF风格的力量分配和运动能力，这非常敏锐——IPF要求从架上取下杠铃并后退。

They take the bar off a squat rack and they have to step back. And that is, if you don't have enough lateral strength and control in your torso, that's when you become hurt. Not during the squat, it's during the walkout. So it's a it's a very different feat of strength. So you're very astute to say lifting from a monolith is a different athleticism and strength distribution than an IPF style where they lift off a rack and have to walk it out.

所以你正单腿站立。想象一下，一千磅的重量沿着你的脊柱中线下压，冲击骨盆，然后当你右脚后撤时，这股力量会斜向穿过骨盆传导至支撑腿。这需要巨大的力量来保持摆动腿侧的骨盆平台稳定——这就是核心力量的重大体现。

So you're standing on one leg. So can you imagine a thousand pounds coming down your axial spine, down your midline, it hits your pelvis and then it has to shear across the pelvis and go down the stance leg as you're stepping back with the right. So it requires tremendous strength to hold the pelvic platform up on the swing leg side. And so that is a tremendous core strength component.

所以这种情况下最好别用柳木脊柱。不，你得像缪尔森林的红杉那样结实。

So best not be carrying a Willow spine for that one. No. You wanna be like a Muir Woods, Redwood

嗯，你得像我们的客户布莱恩·萨姆纳那样强壮。我和布莱恩合作很多年了。

Well, you wanna be built like Blaine Sumner, who's another one of our clients. I've worked with Blaine for quite a number of years.

我喜欢用犬种来类比。我爱看犬展，虽然只看过几次——不是为了看狗狗们花式表演，那完全吸引不了我。顶级犬展最棒的部分是去竞技场后方，那里聚集着所有不同品种的犬只。

I love the analogy to dog breeds. I love going to dog shows. I've only done it a few times, not to actually see the prancing around of the dogs. That doesn't interest me at all. Best part about a really excellent dog show is you go back behind the arena where all the different breeds reside.

你能看到最优秀的爱尔兰猎狼犬、英国斗牛犬等等排成一列。数百种不同品种，让你真正见识到基因的极端表现——不仅是结构上的，还有性情上的。比如斗牛犬们性情上的相似之处。

So you can see the lineup of the finest Irish Wolfhounds, the finest English bulldogs, etcetera. Right. You know, hundreds of different breeds. And you really get to see these genetic extremes, not just of structure, but of temperament. And you get to see the similarity and temperament of the bulldogs.

当然存在个体差异：有些更欢快，有些更沉稳。梗类犬本身就独具魅力。正如你之前关于领奖台的比喻，同品种间的性情相似度高于跨品种，但品种内部仍有差异。我之所以现在提起这个，是因为如果你观察这些动物的运动方式——光是走路姿态，是否喜欢踏步时屈爪，或者步态差异...我虽没有专业术语描述，但视觉系统能识别出它们确实以不同方式移动，即便步速相同。再看人类，高矮胖瘦，体型各异。

And of course there's variation, some of them are a bit more jolly, others more stoic, you know, the terriers are magnificent in their own right. And as you pointed out earlier with respect to the podium, more similar to each other within breed than across breeds in terms of temperament, but there's variation within breed. The reason I bring this up and the reason I bring this up now is that if you look at the movement of those animals, even just the way they walk, whether or not they enjoy a flexion of the paw as they stride, or whether or not they tend to stride differently, I don't have language for this, I'm not an expert in this, but I have a visual system that works and I can see that they may move differently. They actually walk differently even at the same pace. And then you look at human beings, shorter, taller, medium, more lithe, more heavyset.

令人惊讶的是，我们竟忽略了同物种内运动方式的巨大差异，尽管我们已被归类。那么当有人走进你的实验室——或者说诊所实验室时，你会抛开疼痛因素，专门观察他们进房间的移动方式吗？

And it's amazing that we don't take this into consideration that we all move very differently even within species, but that we've been into these groups. So when someone walks into your laboratory as it were, your cliniclaboratory, do you Are you paying attention to how they move into the room irrespective of pain?

百分之百确定。我们会为客户安排时间。我上午看一个，下午看一个，每次预约三小时。所以我知道他们什么时候来，只要可能，我会看着他们下车。

A 100%. We time the clients. I see one in the morning and one in the afternoon and they're three hour appointments. So I know when they're coming. I watch them get out of the car if I can.

那时评估就开始了。但回到狗的话题，我姐姐是兽医，她丈夫也是，女儿正在接受兽医培训。所以我们经常讨论这些。

And that's when the assessment starts. But just to go back to the dogs, my sister's a vet. Her husband's a vet. And her daughter's in vet training. So we have these conversations all the time.

你知道吗？她已经对那只狗进行了评估，预测它在打针或直肠检查时会如何反应，包括不同品种的狗甚至猫，哪些需要戴口套，因为她通常能准确判断谁会咬人。有趣的是，狗会受主人影响，她通过观察主人就能预判狗的行为。所以关于狗行为的心理社会视角，绝对值得探讨。

Do you know she's already made an assessment of that dog on how it's going to behave when she injects it or has to do a rectal exam or whatnot and what dog or breed, and even in cats, which ones she's going to muzzle because she's usually right on who's going to get bet. Yeah. And interestingly as well, it's how the dog feeds off the owner and she can look at the owner and usually determine how the dog is going to behave. So talk about the psychosocial view around dog behavior. Absolutely.

回到你关于人走进来的问题。我治疗过短跑金牌得主吗？有的，奥运冠军。银牌得主也有，几乎所有类型的运动员都接触过。

Going back to your question when a person walks in. So I've had goal have I had a gold medalist in sprints? Yes, I have from the Olympics. I've had a silver medalist. I've had just about every athlete that you can.

然后街上随便走进来一个人，都说背痛。想象一下优秀短跑选手的形象——你认为他们的下背部是平坦的，还是有明显前凸（腰椎过度伸展）？现在说说短跑选手，他们应该是什么样？

And then a person walks in off the street, all with back pain. In your mind's eye, conjure up the image of a good sprinter. Do you think they have a flat lower back or do you think they have a lot of lordosis, which is an extension hollow in their low back? A sprinter now. What what will they have?

我记得看到迈克尔·约翰逊短跑时身体挺得很直。

I recall seeing Michael Johnson sprinting very upright.

没错。

Yes.

所以当我想到直立姿势时，要么是下背部平直，要么是下背部略微拱起，你知道，就是这种

So when I think upright, think either flat lower back or a little bit of an arch in the lower back, you know, this kind

对。他是两百米选手对吧？两百和

of Yeah. He was two hundred meters, wasn't he? Two and

四百米。我记得他同时参加两百米和四百米。

four hundred meters. I think he was a two hundred and four hundred.

他

He

确实是。这很罕见。能同时在两个项目夺金的人。

was. Which is unusual. Someone that could win gold in both.

好吧，我现在想到一些短跑选手，那些100米的男女运动员。你会发现他们的腰椎前凸比短跑选手的背部弧度更明显。他们有个低...我来解释一下跑步机制。当你跑步时，有个质心。你需要让脚底发力点位于质心后方才能推动前进。

Well, I'll I'll think of some of the sprinters now, the 100 meter men and women. They you will find they have a lot more lordosis than the arch in the sprinters. They have a low And what that does, I'll just explain the running mechanics here for a minute. So if you're running along, you have a center of mass. You have to bias the force under your feet behind the center of mass to propel you forward.

因为如果发力点在质心前方，实际上是在制动，这样可赢不了金牌。所以落脚点必须在质心后方。接着你有极短时间产生伸展脉冲然后收腿。如果脊柱腰椎前凸能让骨盆预先旋转，就能在质心后方通过伸展范围产生更大爆发力。如果是平背状态就难了，这会缩短你作为短跑选手将脉冲转化为推进力的作用范围。

Because if it's in front of the center of mass, you're actually breaking, which wouldn't win you a gold medal. So footfall has to occur behind the center of mass. And then you get a very brief period of time to create an extensor pulse and then recover the leg. If you can pre turn the pelvis with a lot of lordosis in the spine, you get much more power development behind the center of mass through the extensor range. If you have a flat back, it's difficult now, you've just shortened up the range that you can pulse into propulsive force as a sprinter.

他们转动身体的弓部。是的。但你会注意到短跑选手很难踢高。所以，你看，我观察这些格斗运动员的不同形态。如果你看那些能高踢回旋踢的人，他们的背部往往更平直。

They turn the bow of the body. Yeah. But you'll notice it's very difficult for a sprinter to kick high. So you'll, you know, I look at these different forms in the combat athletes. If you look at someone who can kick high in a roundhouse, they will tend to have a flatter back.

因此，格斗运动员的背部往往更平直。回到跑步者身上，你会注意到迈克尔·约翰逊和那些长跑运动员的脊柱更平直。他们更挺直，调整着储存和恢复弹性能量的能力，而短跑选手从起跑器出发，靠的是马力，是向心和离心肌肉的脉动。总之，既然你提到跑步，跑步的风格、项目就是个例子。跑步并非千篇一律。

So combat athletes tend to have a flatter back. Going back to the runners, you'll notice that the Michael Johnsons and the more, the runners with more distance have a flatter spine. They're more upright and they're tuning that ability to store and recover elastic energy where the sprinter out of the blocks, it's horsepower, it's concentric and eccentric muscle pulsing. But anyway, there would be an example since you mentioned it with running, the style of running, the event. Not running isn't running.

跑步差异很大。再看看短跑选手和万米选手的领奖台得主，身体结构截然不同。

Running is very different. And again, look at the podium winners of the sprinters versus the 10,000 meters. Very different architecture.

我想稍作休息，感谢我们的赞助商之一Element。Element是一种电解质饮料，包含你所需的一切，不含任何多余成分。这意味着电解质、钠、镁和钾的比例恰到好处，但无糖。我和播客中的其他人多次讨论过适当补水对大脑和身体功能的关键重要性。研究表明，即使是轻微脱水也会显著降低认知和身体表现。

I'd like to take a brief break to thank one of our sponsors, Element. Element is an electrolyte drink that has everything you need and nothing you don't. That means the electrolytes, sodium, magnesium, and potassium in the correct ratios, but no sugar. Now I and others on the podcast have talked a lot about the critical importance of hydration for proper brain and bodily function. Research shows that even a slight degree of dehydration can really diminish cognitive and physical performance.

获取足够的电解质对你的身体和大脑发挥最佳功能也很重要。电解质、钠、镁和钾对你体内所有细胞的功能至关重要，尤其是神经元或神经细胞。为了确保我获得适当的水分和电解质，我早上醒来时会将一包Element溶解在约16至32盎司的水中。这是我早晨的第一件事。在进行任何体育锻炼时，尤其是在出汗多、流失水分和电解质的热天，我也会喝溶解了Element的水。

It's also important that you get adequate electrolytes in order for your body and brain to function at their best. The electrolytes, sodium, magnesium, and potassium are critical for the functioning of all the cells in your body, especially your neurons or nerve cells. To make sure that I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of Element in about 16 to 32 ounces of water when I wake up in the morning. And I drink that basically first thing in the morning. I also drink Element dissolved in water during any kind of physical exercise I'm doing, especially on hot days if I'm sweating a lot and losing water and electrolytes.

如果你想尝试Element，可以访问drinkelement.com/huberman，拼写为drinklmnt.com/huberman，购买任何Element饮料混合包即可获得免费样品包。再次强调，那是drinkelement.com/huberman领取免费样品包。我很喜欢这次对话的方向，因为体型和形态存在巨大差异。我相信现在每位听众都在思考，哦，我的脊柱更倾向于修长型、较细还是较厚，那种柔韧性，或者你所说的垂直堆叠恢复力，哪种脊柱更具优势。这让我回到一个问题：我们每个人能做些什么来打造最强壮的背部，同时减少疼痛倾向，假设我们目前还没有疼痛，对吧？

If you'd like to try Element, you can go to drinkelement.com/huberman, spelleddrinklmnt.com/huberman to claim a free Element sample pack with the purchase of any Element drink mix. Again, that's drinkelement.com/huberman to claim a free sample pack. I love where this conversation is going because there's tremendous variation in body shape and form out there. And I'm certain that by now everybody listening is starting to think about, oh, am I more likely to have a willowy spine, a thinner spine or a thicker spine, the kind of pliability, or what you called vertical stacking resilience that one spine or the other would have. And it brings me back to this question of what can we each and all do to try and create the strongest back as well as limit the propensity for pain, assuming we don't have it yet, okay?

所以我想说我介于中间，既不是特别灵活，也不像壶铃那样，处于两者之间。因此，在我的训练周中，我特意安排三次抗阻训练、三次心血管训练，一次长、一次中、一次短的心血管训练。举重训练旨在以平衡的方式为我建立或保持力量，每个人的需求都不同。换句话说，没有偏向于耐力、力量或爆发力等特定结果。我认为大多数人可能想要类似的东西，因为他们希望能够应对生活中的各种需求。

So I would say I'm kind of in the middle, I'm neither extremely live nor am I shaped like a kettlebell, kind of somewhere in between. So for me, I make it a point across my training week to include three resistance training sessions, three cardiovascular training sessions, one long, one medium, one short cardiovascular session. The lifting sessions are geared toward building or maintaining strength in a balanced way for me, everyone is going to have different requirements. In other words, nothing is skewed toward one particular outcome like endurance or strength or power. And I think most people probably want something similar because they'd like to be able to meet the various demands of life.

我之所以这样构建即将提出的问题，是因为当人们开始自我评估时，这个问题会再次浮现：我们是否应该通过加强某种特定训练来弥补自身弱点？如果是的话，这对脊柱意味着什么？您之前说过——我非常喜欢这个观点——我必须在此并始终将其归功于您：人体所有系统都需要压力才能获得更好的健康状态。最佳健康状态。谢谢您，为了最佳健康。

So I frame the question I'm about to ask that way, because as people start to assess themselves, the question arises again, should we try and compensate for our weaknesses by emphasizing a certain style of training a little bit more? And if so, what does that look like for the spine? You said earlier, and I love this quote, and I wanna make sure I'd attribute it to you now and going forward that all systems in the body require stress for better health. Optimal health. Thank you, for optimal health.

假设某人身材较瘦、柔韧性较好，那么增强核心肌群（不仅是腹肌，还包括斜肌和下背部肌肉）以增加脊柱稳定性是否明智？而那些躯干较厚实、脊柱关节较粗壮的人，是否应该加强瑜伽等柔韧性训练来提升灵活性？

So assuming that somebody has a thinner stature, they're more bendy, would they be wise to build up the muscles of the core, not just the abdominals, but the obliques and the lower back muscles, you know, all around the spine in order to give it more stability? And would the person who has a thicker torso, thicker spine, thicker joints do well to emphasize some additional yoga training, some additional, anything that allows them to be more bendy.

我要回归到他们因疼痛求诊的事实。我们将通过全面评估找出疼痛诱因。确实，大多数人并不追求极限表现——他们又不是为了一千万美元报酬去投掷快球。他们只想享受生活。

I'm going to go back to the fact that they're coming to me with pain. We are going to figure out through the thorough assessment what triggers their pain. Most people, it's true, don't want ultimate performance. They're not being paid $10,000,000 to be able to throw a fastball or something like that. They want to enjoy life.

假设他们热爱高尔夫。我的职责是让他们恢复足够强健且无痛的状态，能去打休闲高尔夫。因此他们脊柱是否柔韧现在已无关紧要。我会分析他们的基础挥杆动作，用最简单的二分法来看。

Let's say they love golf. My job is to get them sufficiently robust and out of pain to go and play recreational golf. So it becomes a moot point now, whether they have a willowy spine or not. I will look at their basic golf swing. If I can divide that up, just binary.

有些人属于我们所说的'扭转者'——髋部活动度不足，主要靠脊柱扭转。这在高尔夫中称为X因子。他们通过这种方式储存和释放弹性势能，这本质上是种弹性运动表现。

Some people are what we call twisters. They don't have a lot of hip mobility and they twist their spine. So it's called the X factor in golf. And they store and recover elastic energy. Again, it is an elastic athleticism.

但下一位患者不属于扭转型，而是旋转型。他们拥有我们所说的'快速髋部'——髋部旋转时脊柱承受的扭力较小。通过测量发现，当他们击球时若出现100%的暴力侧向挤压，而这正是疼痛诱因时，我们会限制其在击球时只做到95%的侧向挤压，这样就能避开临界点。

But the next person isn't so much a twister, they're a turner. They have what we call quick hips. So their hips turn and their spines don't sustain as much twist. And then we measure, well, when they impact the ball, if they have a 100% violent lateral crunch, and then we measure them and assess them and that turns out to be their pain trigger, what we do is we don't allow them to go to a 100% in lateral crunch at impact, they go to 95%. And that just moved them off the tipping point.

如此一来他们既不会'踢到脚趾'，也不会撞上疼痛敏感区，而是始终保持在脱敏状态。

So they're not stubbing their toe or slamming into the pain sensitizer. They just stay off the desensitizer now.

稍微回溯一下，但要确保我这样做是有目的的。你需要知道是什么引发了疼痛，才能尝试定位它

So backtracking a little bit, but making sure that I'm doing that with purpose. You need to know what generates the pain in order to It try and localize the

一切都归结于评估

all comes back to the assessment.

但目标不是重复任何会导致疼痛的动作

But then the goal is not to repeat whatever creates the pain.

正确

Correct.

也许我理解的是，目标是接近疼痛的边缘但不触及它，不做出会重现疼痛的动作，而是将动作推进到不引发疼痛的极限，然后思考不稳定、虚弱或生物力学缺陷如何导致疼痛。好的，现在我明白了

Perhaps what I'm hearing, the goal is to get near the proximity of the pain, but not go there, not generate the movement that recreates the pain, but, you know, take the movement as far as one can without creating the pain, and then think about where the instability or weakness or biomechanical failure is contributing to the pain. Okay, so now I understand

为什么。我想补充一点，不想打断你，这是个好时机，安德鲁。接下来我们要讨论暴露量的问题。记住那个临界点，我们可以对他们的旧痛采取一定程度的进攻

why. If I can just add one, I don't wanna interrupt, this is a good juncture, Andrew. Then we get into the volume of exposure. So remember the tipping point, we can have somewhat of an offense to their former pain,

但是

but

如果我们适度进行，这是另一个关键。所以与其说是选择训练项目，不如说是控制训练量，然后安排休息期或减负期。简单来说，我现在想到一个运动员。实际上，我收到了一封邮件。不，那不是邮件。

if we do it sparingly, that's another key. So it isn't a matter of selecting the exercise sometimes as much as it is controlling the volume and then having a period of time off or a deload or whatnot. So it may simply be, I've I've got a an athlete that that comes to mind right now. In fact, I I got an email. It wasn't an email.

那是一条WhatsApp消息。哦，我刚赢了。她今天参加国际比赛。他们每天都比赛。但在让她恢复时，关键在于我们必须做这些曾经引发疼痛的动作，但要控制训练量。

It was a WhatsApp message. Oh, I just won. So she's at an international tournament today. And they play every day. But in getting her back, it was a matter of we have to do these things that were former pain triggers, but control the volume.

再以格斗运动员为例。柔术需要大量脊柱活动度。通常柔术运动员过度使用脊柱活动度时会感到疼痛。我们的做法是限制他们的训练。换句话说，他们掌握了柔术技巧，但不需要每天都挑战极限范围，因为如果这样做，他们会疼得无法训练。

You can think of, again, combat athletes. Jujitsu requires a lot of spine mobility. And typically Jujitsu athletes get pain when they use too much spine mobility. What we do is we limit their training. In other words, they have the skill of jujitsu, but they don't need to push the end range every day because if they do, they're in so much pain they can't train.

所以我们减少训练量。我可以给你讲职业橄榄球员的故事。他们在大学时最强壮。进入NFL后，他们的身体就承受不了高强度力量训练了。他们不再像以前那样深蹲和硬拉。

So we back off the volume. And I could tell you stories about professional football players. They were their strongest when they were in college. Their bodies can't take the heavy strength training once they get into the NFL. They don't squat and deadlift what they used to.

他们他们他们限制了动作幅度。他们减少了对抗训练。比赛方式改变了，和人们想的不一样。

They're they're they're they're they're limiting the depth. They're pulling off blocks. The game changes and it's not what people think.

确实，如果目标是保持长期健康或运动生涯，不总是挑战疼痛和极限是有智慧的。我有个在健身界很有成就的好友说，保持一生健康的最佳方式之一就是持续训练、适度努力训练（我们可以讨论他的具体建议，我很想听听你的想法），并尽可能避免受伤。我们常忽略这点，总听到要坚持训练和努力突破，但避免受伤同样关键。

And well, and there's some wisdom to to not pushing into pain and extremes all the time if the goal is to have a long arc of fitness or athletic career. A good friend of mine who's very accomplished in the fitness community, He says, one of the best ways to get and stay in excellent shape your entire life is to train consistently, train reasonably hard, and we can talk about what his recommendation is, I'd love your thoughts. But as best as one can to not get hurt. You know, we forget about this. We hear so much about training consistently and pushing hard, but the not getting hurt part is is key as well.

这是他关于训练强度的建议。我能和你分享一下并听听你的想法吗？

Here's his recommendation on intensity. Can I share it with you and just get your thoughts?

是的，我注意力持续时间很短。我能只增加附加值而不受伤吗？伤害是极度不对称的。你知道纳西姆写的那本书吗？

Yeah. I have a short attention span. Can I just add added value Don't to get hurt? Hurt is tremendously asymmetric. Let me Do you know the book by Nassim?

哦，纳西姆·塔勒布。《反脆弱》，对。

Oh, Nassim Taleb. Nassim Taleb. Antifragile. Yeah.

没错。啊，《反脆弱》。他引用了我们的研究，还引用了我写的《腰背疾病》作为反脆弱医学的例子，很有意思。

Yeah. Oh, and antifragile. He quotes our work. He quotes my low back disorders book as an example of antifragile medicine. Interesting.

总之，从经济学角度和塔勒布讨论时，如果我给你100美元投资，获得50%收益会变成150美元，但50%亏损就只剩50美元。损失50美元带来的痛苦远大于获得50美元的快乐。

Anyway, when you talk to Taleb in an economic sense, if I gave you a $100 to invest, if you had a 50% gain, you'd end up with $150. If you had a 50% loss, you'd end up with 50. It's much more hurtful to lose 50 than the relative jolly you would get of gaining 50.

是的，这背后有神经科学依据，当然也有心理学因素，特别是关于我们如何重置强化阈值的神经机制。

Yeah, there's some neuroscience, certainly some psychology, but certainly some neuroscience to support that in terms of how we reset our kind of a reinforcement threshold.

没错。伤病同样具有这种不对称性。训练时冒险加压，短期内可能提升一点韧性或表现，但更可能搞砸一切——伤病造成的损害是极不对称的。所以我们指导运动员时，会极力避免伤病，就因为后果的不对称性。

Right. And so it is so asymmetric with injury. Training, if you push is taking a risk. You might gain a little bit in short term resilience or short term performance, but you have a chance of really screwing things up and an injury is really asymmetrically harmful. So when we work with people and athletes, we really try and avoid injury because of the asymmetry of the consequence.

伤病很糟糕，这是我想说的第一点。第二点是人们刻苦训练时总谈论肌肉灼烧感，却忽视关节。长寿的秘诀就是别搞坏关节——肌肉可以高强度训练，它具有适应性和复原力。

Injury's bad. That's the first part that I wanted to say. The second part is people train hard and they feel the muscle burn and they talk about muscle, but they don't talk about their joints. And the key to long life is don't mess up your joints. You can train hard and build muscle, but muscle is adaptive and resilient.

关节可没那么多。如果你年轻时因训练过度而损伤关节，你会发现，哦，我当初那么高强度训练是为了在70、80岁时依然强壮。结果却是膝盖疼痛，再也无法跪地，只能扶着椅子或墙壁爬行。

Joints are not so much. And if you start messing those up when you're younger by training too hard, you'll find that, Oh, I was training at this intensity because I wanted to be strong when I'm 70 and 80. They'll find that no, their knees ache. They can't get down on their knees anymore. They have to crawl up a chair or a wall.

非常可悲的画面。

Very sad picture.

确实如此。别搞坏你的关节。这是首要原则，脊柱显然也是其中一部分。但年轻时高强度训练需要智慧，别只盯着肌肉效果。

It is. Don't mess up your joints. So that's an overarching principle of which the spine is one obviously. But that's some wisdom with training intensely when you're young. Don't base the outcome on muscle.

要为关节着想。

Think about the joints.

不，这对每个人都是绝佳建议。他的建议（顺便说，这不是针对竞技运动员，而是普通锻炼者）是：全年85%的训练应控制在最大强度的85%左右。无论阻力训练还是有氧训练，单次训练时长按目标设定，但不要竭尽全力，而是以当日主观极限的85%为准。全年10%的训练可达到90-95%强度，剩下5%甚至更少的训练才全力以赴——用尽洪荒之力，随你怎么形容。

No, it's excellent recommendations for everyone. His suggestion, and by the way, this is not for competitive athletes, this is just for exercisers, if you will, is to make 85% of one's workouts across the year at about 85% of maximal intensity and output. So still constraining the total length of a session to whatever the goal of that session is, whether it's resistance training or cardiovascular training, but to not go all out, to go at 85% of one's kind of subjective understanding of what all out on that day would be on that day. To make 10% of one's workouts across the year at somewhere between 90 to 95% intensity of what one could generate that day. Again, 100% all out being subjective for that day and then 5% or even less of their workouts all out, Everything you could possibly give, leaving it all on the mat, whatever phrase one prefers.

我喜欢这个建议，因为它能保持克制，同时让人意识到训练强度。这样我们就不会因为一夜好眠、多喝了一杯咖啡、正好播放的热血歌曲，或是当天有人加入训练引发的竞争心态而伤害自己。事实上，我回顾自己训练受伤的经历，几乎都是因为有人邀我一起锻炼，我们陷入了竞争状态。虽然我不是好胜心强的人，但那天你拼尽全力，两周后（甚至两天后）就得处理伤病，你会想：老天，这真的值得吗？

And I like that recommendation because it keeps things in check and it also creates an awareness of how intense one is training. And it allows us to not let the great night's sleep or the extra cup of coffee that we had, or the great song that happens to be playing or the competitive spirit that's arising because someone joined you that day or asked you to join a workout to take you into the domain of harming yourself. In fact, I can look to the times when I've been injured training and almost always it's because somebody invited me to join their workout and we got into a little bit of a competitive spirit. And I'm not an ultra competitive person, but you push yourself to a 100% on that day. And two weeks later, you've got something you're dealing with or two days later, you've got got something and you go, god, was that really worth it?

我认为除非是竞技运动员在比赛日，否则很可能不值得。

And I think unless one is a competitive athlete and that's competition day, it's probably not worth it.

没错。我对你刚才描述的整体情绪非常理解。但我认为这更多是个体差异问题。你可以对年轻人严格要求，就像某些教练所做的那样，他们也能取得成功。年轻人反应快，恢复也更快等等。

Right. Well, I'm very sympathetic to the overall sentiment of what you just described. But I think it's much more individual than that. You can take a younger person and drive them quite hard as some trainers do, and they have success. A young person responds, they recover faster, etcetera.

如果你对65岁的人这样做，会发现他们恢复得没那么快。他们需要更多的减负和休息日。所以如果达到85%强度，就意味着需要五天休息。这显然不明智。如果只到50%，中间只需休息一天。

You try doing that to a 65 year old and you'll find that they don't recover as quickly. They need many more deload and rest days. So if you go to 85%, you just committed to a five day rest. Well, that's not wise. If you went to 50%, you only need one day of rest between.

明白如何调整和优化了吗？就像我们说的运动员逐渐减量训练。以我为例，直到两年前，我冬季都会疯狂玩雪地摩托。两年前我在湖面上以100英里时速撞上岩石，脊椎骨折。你现在能认出教授了。

So do you see how you play and you optimize this? And it's like what we call tapering down an athlete or, you know, in my life I have seasons, up until two years ago, I rode snowmobiles hard in the winter. Two years ago, I hit a rock at a 100 miles an hour on a lake. I fractured my spine. You can spot the professor.

那曾是我的激情所在。所以我每年八月开始训练，为激烈驾驶雪橇做准备。安德鲁，我无法全年都这样，会受伤的。

So that was my passion. To So my training would start in August. Every year I'd get into shape to ride sleds fairly aggressively. I couldn't do it all year Andrew. I'd become injured.

所以我会有三个月准备期，然后尽情享受。当然现在不这么做了。讲这个故事是想说明：我需要的信息远不止'好，85%'这么简单。20到25岁时或许可行，但50岁时肯定不行。

So I would have a cycle of three months getting ready and then really have some fun. But obviously I don't do that anymore. But my point in telling that story is I need much more information than just, okay, 85. You may get away with that when you're 20 to 25. I don't think you're gonna get away with that when you're 50, as an example.

在为客户优化表现时，有时需要保留大量余量，因为你希望隔天训练。如果连续两天都达到85%强度，绝对不行。明白我的意思吗？这取决于年龄、伤病史、基因、体型等各种因素。

As we optimize performance in our clients, sometimes you gotta leave a lot of gas in the tank because you want to train every other day. Certainly if you do two days in a row, 85%. There's no way. So do you see what I mean? It depends on their age, their injury history, their genetics and their body type and all the rest of it.

我们究竟在把什么推到85%？是跑步距离？还是硬拉重量？后者可是相当重的。

What are we actually pushing to 85%? Is it a distance on a run? Is it a deadlift weight? That's pretty heavy.

是的，我在思考强度问题，意思是，在阻力训练中，假设一个人能用特定重量完成六次重复动作，但如果被枪指着脑袋，他们就能完成九次。

Yeah, here I'm thinking about intensity, meaning, well, for resistance training, let's say that one could complete six repetitions at a given weight, but if they had a gun to their head, they could complete nine.

对。

Right.

好吧，那么你现在做六次。重申一下，这是粗略估算，对吧？六次，也许七次，可能在第七次重复时稍微偷点懒。如果是跑步，比如我每周日的惯例是长距离慢跑，但这里的'慢'其实有点主观。

Okay. Well, then you're doing six. Again, this is crude calculations, right? But six, maybe seven, maybe cheating a little bit on that seventh repetition. If it's a run, and like for me on Sundays, typically there's a long slow jog, but the slow in that component is a little bit subjective.

所以我是在稍微超出舒适区地努力，还是保持在巡航速度？

So am I pushing a little bit harder than I'm comfortable or am I hitting kind of a cruising pace?

对。

Right.

好的，对我来说85%的最大强度就是保持巡航速度并偶尔稍微提速，但在全力训练日（如果有的话），就是所谓的'长距离慢跑'——不过我正在尝试提高这个'慢'的速度。这确实很主观，但我们每天都能判断自己是否突破了舒适区。我不太依赖心率监测器之类的东西，我依赖的是自己的持续性。这就是我三十多年来保持全面健康的方法。

Okay, so 85% of max intensity for me would be staying at cruising pace and occasionally bumping up the speed a little bit, but on all out day, if it happens to be one, then it's long, quote unquote, slow distance, but I'm trying to increase the speed of what I'm referring to as slow. So again, this is all very subjective, but we know on a given day, whether or not we're pushing past our comfort zone or not. And I'm not somebody who relies heavily on heart rate monitors and things like that. What I rely on is my consistency. This is the way that I've decided to stay in all around shape for, you know, more than three decades.

我觉得自己体态还不错。虽然我不是顶尖运动员，永远不会成为房间里最强壮的人，也没有最好的耐力、速度或爆发力，但我确信自己能很好地应对大多数运动。而且我没有疼痛，对此我心存感激。我认为这是因为我已经养成了一种态度——我不想称之为节制，而是调节。

I feel like I'm in decent shape. I'm not a great athlete, I'll never be the strongest person in the room, or have the best endurance, or the most speed or explosiveness, but I'm pretty sure I can keep up with most things pretty well. And I don't have pain. And I feel very grateful to not have pain. And I think it's because I've adopted a stance of, I don't wanna call it moderation, but of modulation.

嗯，我很感谢你所说的一切。在我的世界里，每个人都有过背痛的经历。关键是要让直觉——我们从评估中收集的信息——来指导我们如何：A.帮他们缓解疼痛；B.建立基础韧性，也就是调整他们的身体，实现策略性灵活性和稳定性。现在我们还没讨论的是不同类型的疼痛及其如何影响我们为他们制定终身训练方案。你曾和某人做过一期播客，我记不清名字了，但那是关于疼痛的播客。

Well, I appreciate all what you've said. In my world, everyone has a back pain history. It's always, just let the gut, the information that we gather from the assessment that guides our decision on how we're going to A, get them out of pain, build some base resilience, which is tuning their body, strategic mobility, strategic stability. Now, one thing we haven't talked about is various types of pain and how yet that impacts on how we're going to approach their programming for life. You did a podcast with somebody, I can't remember what their name was, but it was a pain podcast.

当时你在阐述一个观点：如果他们的疼痛机制本质上是记忆印痕的改变。他们在事件发生时遭受了创伤，或者可能有性虐待史之类的。但我几乎总能识别出这类人。当我开始用手触碰他们时，会感觉到——这里还存在感知能力吗？而他们会退缩。

And you were developing this idea that if the mechanism of their pain was really part of the changed engram. They were traumatized at the time of the event, or maybe it was a history of sexual abuse or whatever. But I can detect that person almost always. I'll start to put my hands on them to feel, oh, there any intelligence here? And they recoil.

这是受虐者的典型反应。当你把这些反应综合起来，就知道问题比脊柱某处受伤要深刻得多。嗯。

That's an abused person. That's a very characteristic response. So you start putting together some of these reactions and you know that there's something deeper than an injury to a part of their spine. Mhmm.

对，我们请过肖恩·麦基医生。

Yeah. We had doctor Sean Mackie.

就是他。

That was it.

没错，肖恩·麦基医生是斯坦福大学疼痛科室的负责人。

Yeah. Yeah. Doctor Sean Mackie is our head of the essentially the pain division at Stanford

是的。

Right.

医学院。他既是医学博士又是哲学博士，是生物心理社会疼痛模型的坚定支持者，现在讨论这个模型对我们很有意义。顾名思义，该模型融合了心理因素，当然也包括生理因素，我记得它指出了七种或更多应对疼痛的途径，其中一些涉及对情绪状态、压力水平和睡眠的考量。我是说，所有这些显然都在疼痛及疼痛康复中扮演着角色。

School of Medicine. He's an MD and PhD, and he's a big proponent of the biopsychosocial model of pain, which probably makes sense for us to discuss now. As the name suggests, it incorporates psychological elements, it incorporates, of course, physiological elements, and it points to, as I recall, seven or more sort of paths to dealing with pain, some of which include thoughts about one's emotional state, stress level, sleep. I mean, all of these things clearly play a role in pain and rehabilitation from pain.

没错。顺便说我很喜欢那期播客，因为它与我们发现和实践的内容高度一致。如果一个人只是因为机械性超出临界点而出现组织损伤，我们会制定策略避免他们以加重损伤的方式活动或负重，尽可能让损伤自然愈合。

Right. I love that podcast by the way because it's so consistent with what we've found and what we do. If a person has, it was just a mechanical exceeding of their tipping point, and they now have some tissue damage. We address that by creating a strategy that they don't move or load in a way to stress that. And we allow the injury to heal if we can.

我们还需要讨论椎间盘是会自我适应还是需要人为管理，这是另一个非常有趣的话题。但无论如何，我们正在通过策略性活动度与稳定性训练来调整他们的身体，进行核心锻炼，释放髋肩活动度等，这将取得合理程度的成功。而且我们能明确知晓疗效——因为我们会对每位患者进行独特随访来确认治疗效果。

And we should talk about whether the disc adapts or you have to manage it. But that's another very interesting topic to get into. But nonetheless, we are tuning their body with strategic mobility and stability, giving them core exercise, unleashing their hips and shoulders, etcetera. And we will have a reasonable level of success. And we know by the way, what our success is because uniquely we follow-up with every patient we see to know if we were successful or not.

但现在我们面对的是另一种情况。我能举出很多例子来展示这个光谱：也许这个人遭遇了车祸幸存下来，但身旁的母亲却去世了。于是他们背负着巨大的情感创伤和负罪感。或许事故发生时他们正在打瞌睡——当时是他们在驾驶。

But now we have that person. And I can think of many examples just to give a spectrum. Perhaps the person was in a car accident, they survived, but the person beside them who might have been their mother died. So now they're carrying a hell of a lot of emotional trauma, guilt, trauma. Maybe they nodded off at the time of the accident, they were driving.

巨大的心理压力。或许他们还遭受过性虐待之类的事情。这些经历重塑了他们的大脑神经回路。所以现在他们来就诊时，疼痛模式完全不符合常规。当我们对其不同组织进行物理加压测试时，反应会不断变化且极不稳定。

Tremendous psychological stress. Maybe they were sexually abused or whatever. That rewires their brain. So now they come in and the pain pattern doesn't fit. We do physical stressing of their various tissues and the reactions, they change, they're variable.

这些反应完全不符合预期。他们大脑感知疼痛的方式已被重塑。如果我们采用传统方案，仅仅提高其体能和运动能力，根本不会奏效。我们无法突破这种适应不良的反应模式，必须彻底改变方法。

They're not what they should be. The way that their brain perceives the pain has been rewired. If we give them the traditional approach of giving them more fitness and ability, it won't work. We can't break through that maladaptive response. We completely change.

现在可能只需要进行脱敏治疗。说出来你可能觉得好笑——我们可能会用羽毛轻刷他们的后背，而他们会说：'对，就是这个动作会引发我的疼痛。'真的吗？

Now it might be just to desensitize them. You'll laugh at this. We might get a feather and brush it over their back. And they say, Oh yeah, that triggers my pain. Really?

是的。哦，我现在开始头疼了。好吧。所以我们必须想出他们能做些什么而不引发那种适应不良的反应。可能就是那个。

Yes. Oh, now I'm getting a headache. Okay. So we have to come up with what can they do without triggering that maladaptive response. And it might be that.

最简单的动作，传入和传出神经的所有信息进入那个记忆痕迹，原本会引发疼痛，我们现在找出不会引发疼痛的动作，然后通过重复慢慢脱敏，从不引发疼痛。然后我们扩大这个动作范围。你听说过纤维肌痛，这是一个有点笼统的术语，但像闪光灯、突然吓到某人，他们走在街上，有人从商店出来以某种方式吓到他们。这会引发剧烈的疼痛反应。我们用非常温和的方式，做不会引起疼痛的事情，并尝试慢慢将这个记忆痕迹扩展为无痛的。

Simply the most simple of movements where the afferent and eference, all the information going into that engram, which is formally triggering pain, we now figure out what it is that doesn't trigger pain and then slowly desensitize it with repetition, never triggering pain. And then we expand that repertoire. So you've heard of fibromyalgia, which is a little bit of a catchall term, but a flashing light, surprising someone, they're walking down the street and someone comes out of a shop and surprises them somehow. And that triggers off this massive pain response. We do that with very gentle love, doing the things that doesn't cause pain and try and slowly expand that engram into a pain free one.

有些人参与所谓的'工作强化'训练。这通常由保险公司资助。如果你有顽固的背痛，我们现在会让你做你的工作。我们开始时每天一小时。如果你是砌砖工，你要砌砖一小时。

There are those in what's called work hardening. It's usually funded by insurance companies. So if you have intransigent back pain, we are now going to get you to do your job. We start out with an hour a day. You're a bricklayer, you're gonna lay bricks for an hour.

明天你要砌一小时十五分钟。偶尔他们有一些成功，或者有一些非常糟糕的失败。那个人会说，我不能再做四个小时的砌砖工作了，即使这只是我工作的一部分。所以他们现在被踢出项目，因为他们被称为'不配合'。换句话说，他们心理上有问题，他们崩溃了。这些人就是我们看到的。

Tomorrow you're gonna lay for an hour and a And occasionally they have some success or they have some really miserable failures. And the person says, I cannot do another day of bricklaying for four hours, even though it's only a portion of my job. And so now they get kicked out of the program because they're called a noncompliant. In other words, there's something psychological wrong with them and they're shattered. Those are the people we see.

所以这些人，不要谈论生物心理社会方法。我知道我有时被贴上生物力学家的标签，被认为忽视了所有心理社会因素，但这些是从来没有读过我们工作的人，他们不知道。所以我真的很感谢你提出这个问题，因为我不常被问到这个观点。但我知道，以你的背景，你会理解这一切。

So these are, don't talk about the biopsychosocial approach. I know I get labeled sometimes as the biomechanist and I ignore all the psychosocial, but these are people who've never read our work and they don't know it. So I really appreciate you bringing this because I'm not often asked this perspective. But again, I know with your background, you'll appreciate all of this.

是的，神经系统确实参与产生运动和来自肌肉及本体感觉的反馈。正如你所描述的，神经系统创造了我们的疼痛感。正如Mackie博士指出的，正如你所强调的，疼痛有一个情感成分，控制疼痛或产生疼痛的神经回路在某种程度上涉及所有这些因素的汇合。我感谢你愿意深入这个生物心理社会模型的疼痛并承认它，因为我认为在生物力学和疼痛，特别是背痛这个领域，人们，在某些情况下你被贴上只认同一种特定治疗模式或框架的标签。

Yeah, surely the nervous system is involved in generating movement and feedback from the muscles and proprioception. And as you're describing the nervous system creates our sense of pain. There's an emotional component to it, as Doctor. Mackie pointed out, and as you're reinforcing, and the neural circuits that control pain or give rise to pain involve the confluence of all of these things at some level. And I appreciate that you're willing to go into this biopsychosocial model pain and acknowledge it, because I think all too often in this space of biomechanics and pain and back pain in particular, people, you in some cases get labeled as only subscribing to one particular pattern of remedy or one particular framework.

这根本不是真的。根本不是。事实上，我甚至要说，这实际上是其他人对你和你的工作施加单一视角的反映，而不是你的工作本身具有单一视角。我知道你通过相当复杂的棱镜来看待背痛和背部康复问题。所以谢谢你触及生物心理社会模型。

And that's simply not true. It's just not true. In fact, I'll go so far as to say that that's actually a reflection of other people placing a singular lens on you and your work, as opposed to your work having a singular lens. I know that you look at things through the rather complex prism that is back pain and back rehabilitation. So thank you for touching into the biopsychosocial model.

我们会在节目说明中附上那期与麦基博士对谈的链接，因为他对此进行了深入探讨。我们确实非常详细地覆盖了那个模型。有件事你曾对我说过，我特别想强调：选择特定训练方式（不仅是运动项目选择，还包括训练风格，比如大重量抗阻训练vs耐力训练、长跑或长泳）的人，有时会培养出某种——我们该怎么称呼——人格风格或反应模式，这可能独立于他们最初的本性。当然这些因素永远无法完全割裂。

And we'll put a link in the show note captions to that episode with Doctor. Mackey, because he went into this in some depth. And so it is the case that we've covered that model in pretty extensive detail. There's something that you said to me once that I really wanna make sure we highlight, which is that people who embark on a particular style of training, not just sports selection, but style of training, like resistance training with heavier weights versus endurance training, running longer distances or swimming longer distances, will sometimes cultivate a certain, what should we call it, personality style or reactivity style that is probably independent of who they started off as. I mean, you can never separate these things completely.

可以说，心理耐力强的人会选择耐力运动，性格更具爆发力的人（这里我扮演心理学家）会选择需要速度和爆发动作的运动。但反过来可能也成立：当我们越多从事需要神经系统产生特定动作模式（如爆发动作、耐力或力量）的活动时，我们某些心理和情感层面的特征也会被放大。我知道这未必有详细的同行评议研究支持，至少我不了解。但根据你与从事不同活动的普通人群以及运动员打交道的经验——别忘了我们之前关于犬种培育的讨论——

I mean, we could argue people who have a lot of mental endurance pick endurance sports, or people that are rather ballistic in their personality, here I'm playing psychologist, pick sports with a lot of speed and ballistic motion involved. But perhaps the reverse is also true, that the more we engage in activities for which the nervous system is required to generate a particular pattern of movement, like ballistic movement or endurance or strength, that we exacerbate certain aspects of our mental self, our emotional self as well. I realize this is not the stuff of detailed peer reviewed studies necessarily, or at least I'm not aware of them. But in your experience, working with a variety of different people from the general population who engage in different activities, as well as athletes who engage in very different activities. And let's keep in mind the discussion we had earlier about dog breeds.

犬类不仅根据身体表型和动作被选择，还根据性格类型，对吧？比如性情。你观察到耐力跑者有哪些广泛特征？相比力量型运动员或短跑选手，他们在其他活动中是否表现出更强心理耐力？或者他们在心智生活的其他领域可能较弱但更突出？

They are selected for not just based on physical phenotype and movement, but also personality type, right? Temperament. What sort of broad correlations have you observed in say endurance runners? Do they have more mental endurance for other activities versus say strength athletes or sprinters? Do they tend to have less but tend to excel in other domains of their mental life?

你说得对，这方面确实缺乏可靠科学依据。但经过四十年与人打交道、观察表型极端案例后，我确实有些观点。这来自执教经验：如果一个运动员天生神经爆发力强——反应快、爆发强但持久性差——几乎可以说（虽然我讨厌贴标签），

You're right in that I haven't seen good science to back up this whole issue. But after working with people for forty years and seeing the extremes of the phenotype, I I do have some opinions on this. And it comes from coaching. So if you take an athlete who has by nature, they're very explosive neurologically, they're quick, they're explosive, but they can't do it for very long. It's almost, and I hate using this label, but it's just a way to describe it.

他们存在注意力缺陷。我自己就被诊断过。所有高中老师都会告诉你：'麦吉尔注意力不集中'。当然可能只是我对他们讲的内容不感兴趣，脑子在想别的，但我确实有一定程度的注意力缺陷。

They have attention deficit. Now I've been told I have this. Every high school teacher would have told you, Yeah, McGill, his attention deficit. Now maybe it was just, I wasn't interested in what they were talking about. My brain was thinking about something else, but I think I do have a certain degree of attention deficits.

如果话题无法吸引我，我就会思考更重要的事。运动员爆发力越强，你能有效指导他们的时间窗口就越短；爆发力越弱，指导时间就越长。这是我的观察。

If someone's not holding my attention, I'm thinking of something that's more important. The more explosive the athlete is, the shorter the time you have to coach them that they're present with you. The less explosive they are, the more time you have to coach them. So I will say that.

这非常有趣。我已经想到几个自我实验：比如在特定季节增加耐力训练，观察这与写作或准备播客时的心理专注力/耐力的关联。当然，既然我对结果有了预期，可能会产生偏差。但如果是旨在改变心理状态或行为的自我实验，这种偏差或许没那么重要。

I find that really interesting. And I can think of a number of self experiments that I'd like to embark on of, you know, including more endurance training at particular times of year and seeing how that correlates with mental focus and endurance for say writing or preparing podcasts, things of that sort. But of course, now that I have some sense of what the answer could be, I'd be biasing the outcomes. But if it's a self experiment and the goal is simply to shift one's mental life or behavior, then I don't know that it matters that much.

我可以讲个小故事吗？比如我可能会接到一位教练的电话，假设是NBA教练，他会和医疗团队一起说：我们有个球员，现在每场打18分钟，你能帮忙吗？这球员有背伤史。你能帮我们把他的上场时间提升到27分钟吗？然后我就会开始调查了解这名球员。

Can I go with a little anecdote there that you I'll may get a call from a coach, say an NBA coach, and it'll be with their medical staff and they'll say, we have this player, They play eighteen minutes a game? Can you help? And they have a back pain history. Could you help us to get them to play twenty seven minutes a game? And then I'll investigate and understand the player.

接着我可能会问教练一个问题：是什么让观众愿意买票进场看球？他们会反问：你什么意思？我就说：就是我们正在讨论的那个球员。那球员上场的18分钟就像魔术般精彩，因为他们充满活力，爆发力十足。

And then I may ask a question to the coach. What puts paying bums in the seats in the stadium? And they'll say, Well, what do you mean? And I said, Well, it's that player that we're talking about. That player is magical for the eighteen minutes that they play because they're sparky, they're explosive.

如果我们训练他们，利用其可塑性生理和神经特点进行训练，让他们能坚持27分钟，你就会发现这是在用爆发力做交换。你不可能同时拥有极高的最大摄氧量和最强爆发力，这是相互冲突的机制。一个是追求速度和爆发力的快肌纤维机制，另一个则是持久性的生理机制。

If we train them and they have a plastic physiology and neurology that we can train so that they can last twenty seven minutes, you realize that you're trading off the explosiveness. You cannot have a really high VO2 max and be maximally explosive. They're competing mechanisms. One's a fast twitch mechanism for speed and explosiveness. And the other one is an endurable physiology.

你只能二选一。所以你真要牺牲那种爆发力吗？这在备战格斗运动员时尤为明显。如果他们是神经爆发型选手，你设计的比赛和训练必须确保他们第一回合就能取胜。如果第一回合没赢，他们就会体力耗尽。

And you trade one for the other. So do you really want to compromise that explosiveness? And you see this when you're on a team getting a combat athlete ready. If they are neurologically explosive, you design the fight and the training that they pretty much have to win in the first round. And if they don't win in the first round, they're going to gas out.

他们的对手则专门训练如何熬过第一回合，在第二回合发力。这是两种完全不同的训练方向。从心理角度比较这两类运动员，如果你观察得够多，我想你会同意我的观点——指导方式必须拆解成易于消化的小模块。这无关智力高低，

The person who is preparing to compete against them is training to survive the first round and then come on in the second. So they're training endurance. To compare those two different athletes from a psychological point of view, and if you do it enough, I I I think you'll come to agree with me and you'll notice that there is how you coach them. It has to be in short consumable bites. And it's not that they're any more or less intelligent.

他们完全能理解。但你必须把握时机，用词精炼。明白我的意思吗？执教风格会因此发生很大变化。

They get it. But you have to be on cue and choose your words, be efficient. Do you see what I mean? The coaching style changes quite a bit.

你认为当人感到疼痛时，是否应该培养既能直面疼痛又不加剧它，与之共处而非逃避的能力？人们该如何看待自身疼痛并与之相处？这就是我问这个问题的原因。

Do you think that if somebody has pain, that they should have the capacity both to like lean into and push into the pain, not exacerbate it, but to, you know, sit with it and feel it as opposed to just avoiding it. How should people think about their own pain and how to work with it? That's the reason I'm asking.

没错，这要看情况，就像跳舞一样。我可以给你举些例子。我的《背部力学》书中有一章专门讲手术，讨论你是否应该接受手术。我们这样做是因为，如你所知，在大学里的实验诊所里，我们对每位接诊过的患者都进行了跟踪随访。

Right. It depends and it's a dance. So I can give you some examples. One chapter in my Back Mechanic book is called well it's about surgery and should you have surgery? We did this because as you know, in our experimental clinic at the university, we followed up with every patient we ever saw.

我们会先评估他们，然后将他们细分到不同类别。如果有人被告知：你已经尝试过所有方法——看过脊椎按摩师、物理治疗师、整骨医生，进行过手术咨询，甚至看过心理医生等等，但全都失败了。基本上你已经被训练成失败者了。这时我们会尝试一个叫'虚拟手术'的疗法。

We would assess them and then we would sub categorize them into different bins. If a person was told, you've tried everything, you've been to the chiropractor, you've been to the physical therapist, the osteopath, you've had a surgical consult, you've been to the psychologist, etcetera. And you failed every single one of them. So basically you've been conditioned to fail. We tried a process called virtual surgery.

现在我要定义这类人群：你已尝试所有方法，最后被告知手术是唯一选择。这就是我们要讨论的特定人群。我会说：好吧，你可以去赌一把做手术。显然他们大多都不愿意。

So I'm defining the group now. You've tried everything and you've been told the last thing for you is surgery. That's the subcategory of people that we're now gonna talk about. And I'll say, fine, you can go and roll the dice and have surgery. Most of them don't want it obviously.

然后我会说：但我们要做的是尝试虚拟手术。我会把这个过程搞得很有仪式感，像册封骑士那样——轻拍他们的肩膀说'这就是你的手术'，同时直视他们的眼睛，然后递给他们这样东西。

And I'll say, but what we're going to do is try virtual surgery. And I make a bit of a production out of it. I anoint them like a knight. I touch them on the shoulder and I say, that's your surgery. And I'm looking into their eyes And now I give them one of these.

此刻我们正进行灵魂对视。你已经做过手术了，接下来要像术后患者那样行动。明天是你术后恢复第一天，你要卧床休息，每两三小时起床小便一次，进行短距离挪步。后天我们再逐步增加活动量等等。

We're looking into each other's soul now. You've had surgery. You're gonna behave like you've had surgery. Tomorrow, your first post surgical recovery day, you're going to lay in bed, relax, get up for a pee every two or three hours, have short little shuffles. The next day we'll add a little bit more, etcetera.

我们会给你制定优质的术后康复计划，然后开始战略性调整身体状态：先稳定性、灵活性，远早于力量训练之前就逐步加入耐力训练，最后修正动作模式等等。如果患者本身有运动成瘾——就像你描述的那种性格的人，他们在面谈时会告诉我'我必须每天在椭圆机上骑40分钟，否则就会想杀了老公孩子'，当然这是夸张说法，但他们会用这种表达来强调运动是他们的减压方式。

We give you a post surgical recovery program, a really good one. And then we start tuning the body strategically, stability, mobility, eventually adding a little bit of endurance long before strength and then getting the movement patterns, etcetera. If the person was an exercise addict as well, so you can imagine the person who has the personality that you're describing, they tell me in the interview, you know, I have to ride the elliptical for forty minutes every day because if I don't, I'm going to murder my kids and my husband because that's my stress relief. Not literally, but that's what they'll say is painting the get

就是那种离不开跑步机的人。对吧？或者说运动成瘾者。

the person on the treadmill. Right. Or exercise.

好的。他们之前和每位临床医生都达成了协议。但在我这儿行不通，因为我只在乎结果。我的职责是不择手段让他们康复，所以我必须控制局面。

Okay. So they've won that negotiation with every previous clinician. Well, they're not gonna win it with me because all I care about is outcome. My job is to get them better by whatever means. So I have to tame that.

手术在多数情况下有效，因为它强制休息。对运动成瘾者实施手术迫使他们休息并逐渐脱敏。我们模拟手术并实施。现在来看证据：我们对每位患者进行了两年随访，95%避免手术但接受虚拟手术的患者对此感到庆幸。

Surgery works in a lot of cases because it's forced rest. Surgery for that exercise addict forced them to have rest and allowed them to desensitize. So we fake it and we do it. Now for the evidence. We followed up with every patient and in a two year follow-up, ninety five percent of those people who avoided surgery but did the virtual surgery were glad that they did.

是的，这回答了问题。就是遵循临床医生的建议。这又回到运动倾向性的话题——人们倾向于某种运动方式，从而回避其他形式，参与特定活动而忽略其他。我知道这么说会惹麻烦：我们70%的训练应该顺应自身倾向，30%则逆向而行。但我确实倾向于这个比例，对吧？

Yeah, that answers the question. It's follow the advice of the clinician. It gets back to this issue of predisposition to move a certain way, to therefore avoid other forms of movement, to engage in certain activities, but not other activities. I realize that I'll get in trouble if I say, you know, 70% of the training that we do should be in line with our predisposition and 30% should be counter current to that. But I'm kind of veering towards numbers more or less like that, right?

比如在神经系统相关的机器学习算法中，我们知道难度系数大约应控制在15%的问题或挑战。这些认知或体能挑战应该导致非伤害性失败。答错率约15%时，最有利于跨领域学习。明白吗？

I mean, we know for instance, in the machine learning algorithms that relate to learning in the nervous system, that a rough, this is a rough estimate of difficulty should be about 15% of questions or challenges. So these could be cognitive challenges or physical challenges should lead to failures, non injurious failures. Right? Getting the answer wrong about 15% of the time tends to optimize learning across a number of different domains. Okay.

这适用于所有领域吗？语言、数学、舞蹈？不，但对多数领域成立。

Like is that true for everything? Is it true for language, math, dance? No, but it's true for a lot of things.

这个论点经常被引用。但如我所说，我做过研究也跟踪过病例，我的观点是有依据的。我们首先提供消除疼痛的工具。从生理角度这很重要，从心理角度我们赋予了患者力量。

That's an argument that's used a lot. And I However, as I said, I've done the work and I've done the follow-up and I have an opinion for a reason. We start out by giving them the tools to not have pain. From a physical point of view, that's really important. From a psychological point of view, we've just empowered that person.

他们现在掌握了主动权，因为他们从未有过这些工具。作为神经科学家，他们既不了解疼痛的真实机制，也没有调节或脱敏策略。但现在他们精确知道哪些动作、负荷和活动会引发疼痛，也清楚哪些对抗措施真正有效。他们开始走向最小化疼痛的生活。

They are now in control because they never had the tools. A, they didn't understand what the real mechanism of pain was, so they had no strategy to down regulate it, if I'm a neuroscientist, or to desensitize it. But now they know with some precision what the moves, the loads, the activities are that cause their pain. They know the counterpoints, what actually are beneficial for their pain. And they begin this life of having as little pain as possible.

现在回到临界点问题，所有系统都需要压力。但最初我们无法跨越临界点，这正是你问题的核心——何时开始施加些许痛苦？有些人开始得太早。

Now I go back to the tipping point and all systems need stress. But in the beginning, we cannot cross the tipping point. And that's really the essence of your question. When do we start pushing them now to allow a little bit of pain? Some people start it way too early.

我们不会。我们知道临界点在哪里。在建立足够的安全边际前，我们会持续培养无痛训练能力。之后才开始利用这个安全边际——能否增加训练量让他们重返工作或运动？

We do not. We know where that tipping point is. And we keep building the training capacity of being pain free until we have a margin of safety. Now it's that margin of safety that we start to play with. Can we expand the volume of training and get them ready to go back to work or to go back to their sport?

或许他们只想休闲打高尔夫。我们讨论过这点。最终我们会逼近临界点，那时就需要重新对话：记住目标是什么。

Or maybe they just want to play recreational golf. We've talked about that. Eventually, we're going to go to the point where they're we're butting up against the tipping point now. Now we have another conversation. Remember what the goal is.

对你而言，创造硬拉个人记录或每周打五次18洞有多重要？换成三次能接受吗？经过一年无痛生活后，他们心态已变，人生轨迹不同了。

How important is it for you to set a personal best and deadlift or to play 18 holes of golf five days a week? Would you settle for three? And and now they've they've had a year of no pain. Their life has changed. They're mentally in a different place.

他们会自己得出答案。我已不是18岁，55岁的我有两个小孙子，盼着75岁还能陪他们打球。

They have their answer and they converged on it themselves. I'm not 18. I'm 55 years of age. I've got two young grandkids. I'm looking forward to playing golf with them when I'm 75.

看到我们如何引导他们接受适度痛苦了吗？那更像是年轻人的心态。虽然仍有战士精神留存，但多数人随年龄增长变得柔和。回想我自己年轻时也进行高强度训练。

So do you see how when we bring them through that way, accepting a certain amount of pain, that's that's more of a younger person's outlook. There's still some warriors left. A lot of us soften up as we get older. But I just think of my own journey. I trained heavy as a kid.

记得父亲曾问：为什么要这样？你会缩短运动生涯。虽然我本就没有职业生涯...但他是对的。如今我的训练方式已彻底改变。

And I remember my dad saying, Why are you doing this? You're really shortening your athletic career. Not that I had one, but you know. And he was right. And now my training has totally changed.

但如你所知，我没有任何疼痛。我的身体状态依然相当好。

But as you know, I have no pain. I'm still fairly physical.

是啊，你67岁还能保持这么好的体型。真的，状态非常出色。对于只听音频不看视频的听众，我建议你们去看看YouTube视频顶部的信息卡。我是说，斯图活动自如，你体态也很好，这个状态放在任何年龄都算得上优秀，更别说67岁了。

Yeah, you're in great shape at 67. Yeah. Just remarkable shape. For those listening and not watching, I encourage you to take a look at the top card of the YouTube video. I mean, Stu moves around great and your posture is great and you're in awesome shape for any age, much less 67.

这说明你的方法确实有效。

So that's a testament to your methods.

嗯，重点是年轻时可以适当突破极限。但现在你已经没有这个能力了。如果我感到疼痛，这种疼痛会持续好几天，而不只是一小时。

Well, point was, it's okay to push when you're younger. You don't have the capacity to push now. If I go into pain, I'm in pain for a few days, not an hour.

所以你变得谨慎了。

So you're cautious.

是的。老年人都会面临这个阶段。

Yeah. And older people will get to that point.

我想请教你关于麦吉尔的三大训练动作。我知道你一向不愿给出笼统建议，但人们总需要些具体方法来强化背部、预防疼痛。我们做过一个包含这三大动作的视频，会在节目说明里附上链接——视频里我演示了这三大动作，虽然可能不够标准。其实应该请你来纠正我的动作姿势，我们随时可以重拍。不过那个视频基本展现了三大动作的要领：鸟狗式、卷腹和侧平板支撑。

I'd like to ask you about McGill's big three. I know that again, you loathe to impart generalizations on but at some point you realize that people need something to do to work with in order to try and quote unquote pain proof their back or reinforce their back. So we did a video that included the big three, we'll provide a link to those in the show note captions where I perform the big three, probably not perfectly, admittedly. I should have invited you to critique my form and we can always shoot another one of those, but I think it captures the big three well enough. The bird dog, the roll up and the side plank.

对。

Right.

旨在增强脊柱周围的力量和稳定性，预防背部疼痛，或在某些情况下帮助康复背部疼痛。大量用户来信反馈，表示‘三大训练’对他们帮助极大。因此我想明确一点：尽管你谨慎地表示‘三大训练’并非解决所有人背部疼痛的万能方案，但它们确实帮助了非常非常多的人预防甚至康复背部疼痛。如果要在‘三大训练’基础上增加第四个动作，你会选什么？

Designed to build strength and stability around the spine and to stave off back pain or in some cases, rehabilitate back pain. An enormous number of people wrote to us and commented how much the big three have helped them. So I just want to make sure that it's clear that despite the fact that you are appropriately reluctant to say that the big three is the solution to everything in terms of back pain for everyone, they have helped a large, large number of people avoid, and in some cases rehabilitate back pain. If you were to add a fourth exercise to the big three, what would it be?

取决于评估结果。

Depends on the assessment.

假设某人脊柱柔韧度较高，希望增强脊柱稳定性。他们需要为特定目的提升脊柱刚性。

Let's say somebody has a willowy spine and they want more spine stability. They want to be able to generate more spine rigidity for whatever purpose.

还有哪些疼痛诱因？

What other pain triggers?

患者有单侧下背部疼痛。久坐后起身时，患侧会感觉僵硬并有疼痛放射至腿部。

They have a lower back pain on one's that's unilateral. And when they sit too long and then stand up, it feels like that side is locked up and there's some pain shooting down the leg.

明白了，这是机械性背痛伴有神经症状（疼痛放射至腿部）。患者年龄多大？

Okay, so they've got mechanical back pain, They've got neurological involvement if it's shooting down the leg. How old are they?

五十出头，可能在四十多岁或更年长。好的。这是一个

Early fifties, maybe in their forties or older. Okay. It's a

很大的范围。所以他们会有一些椎间盘源性疾病。关节存在紊乱，这会导致神经以某种方式反应。

big range. So they will have some discogenic disorder. There's there's a disorder of the joint and it will be causing the nerve to react in such a way.

当他们走一小段路，十到十五分钟后，通常会感觉好些。

And when they walk a bit, ten-fifteen minutes, they tend to feel better.

啊，明白了。所以他们的脊柱较年轻，因为椎间盘源性疾病在年轻人中更常见，久坐是致病途径。散步是缓解途径，但随着年龄增长这种情况会反转。

Ah, okay. So they have a younger spine because discogenic disorders are more common among younger people and sitting is the causative pathway. Going for a walk is the relieving pathway, but that will switch over when they get older.

是这样吗？

Is that right?

是的。久坐会变成缓解方式，而行走则成为疼痛加剧因素。不过，我需要更精确地了解具体机制。如果涉及神经方面的问题，我需要知道原因。什么会加重症状？

Yeah. Sitting becomes a relief and walking then becomes the exacerbator of their pain. Well, again, I need to know with some precision what the pathway is. But if they have neurological parts, I need to know why. What makes them worse?

所以我可能会让他们在椅子上坐直，抓住椅座并向上拉。我在增加压力。这会引发更多神经放射痛吗？如果是的话，说明他们有点不耐受压迫。好，那么现在我必须选择本质上非压迫性的锻炼方式。

So I might have them sit upright in a chair, grab the seat pan of the chair and pull up. I'm adding compression. Does that cause more nerve radiation? If it does, they've got a little bit of compression intolerance. Okay, so now I have to choose an exercise that is not compressive by nature.

如果我移动神经，也就是在伸展他们腿部的同时，让他们抬头，这样可以从上方释放整个脊髓和所有神经根，同时从下方牵引。换句话说，就像用牙线清洁一样。如果这个动作引发疼痛，说明存在神经摩擦；如果是牵拉性紧张，则是神经张力问题。这两种疼痛机制截然不同，需要采取不同的处理方式。

If I move the nerve, so if I extend their leg at the same time, ask them to look up, it releases the whole spinal cord and all the nerve roots from above and it pulls it from below. In other words, it flosses it through. If that causes pain as they're doing it, they've got nerve friction. If they do it and it's tensile tension, then it's nerve tension. So these are very different mechanisms of their pain and they require different approaches.

现在你明白为什么我对下一个练习仍持谨慎态度了吗？可能是为了松动神经，也可能是通过胸椎伸展来增加胸椎活动度，从而让他们在坐立时减轻负荷。想象站立时，你可以触摸竖脊肌，它们可能是松弛的。但当你前伸下巴，这些肌肉就会激活。

So do you see why I'm still hedging on that next exercise? It might be mobilizing the nerve. It might be giving them more thoracic spine extension through a thoracic and now they've taken the load off when they sit and stand. So you can imagine standing, you can palpate your erector spinae muscles and they might be relaxed. You poke your chin and those muscles come on.

但抽筋只发生在单侧，如果是肌肉问题，很可能与此无关。这仍然是典型的椎间盘源性症状——存在膨出或某种机械性异常，我们需要进一步确认。我可能会建议'多走路'，但不要一次性走太久。

But the cramp was on one side and if it was muscular, that's probably not related to this. That's still a very discogenic sign. There's a bulge or there's something off that's mechanical that we will determine. I might just say, Walk more. But not in a single dose.

我在《背部力学》中详细解释过：与其一次性步行一小时，不如分三次进行每次二十分钟的步行。连续步行一小时会增加疼痛风险，而二十分钟步行能确保无痛。所以要分段进行。

And again, I've described all of this in Back Mechanic. Instead of walking an hour in one dose, have three twenty minute walks. Walking for an hour increased the risk of getting pain. Walking for twenty minutes guaranteed you have no pain. So do it in three doses.

这样就能确保成功。我可能会增加一个练习，但会非常策略性地安排。

You've just guaranteed success. So I might add another exercise, but I might program it very strategically as well.

你对倒立牵引台和反重力靴这类脊柱减压设备有什么看法？

What are your thoughts on inversion tables and anti gravity boots and things to de load the spine?

没错。根据我们的研究，确实会通过牵引实现脊柱减压，但通常由专业临床医师操作。原因在于——以你刚才描述的年轻人为例，当他们俯卧呼气时，允许腰部自然下沉到治疗台，增加腰椎前凸（我们在实验室测量过这个现象）。

Right. Well, again, if you follow our work, we do do deloading of the spine through traction. It's usually applied by one of our trained clinicians. And the reason for that is, let's take that younger person again, as you just described, maybe laying on their tummy. As they exhale, they allow the low back to sink into the table, increasing the lordosis, which is, we measured this in the lab.

如果患者存在后侧椎间盘膨出伴裂隙（这是较常见的情况），这种手法能将膨出的椎间盘吸回。若疼痛立刻沿腿部减轻，我会建议俯卧位，让他人沿治疗台平面以每腿5-6磅的力度牵拉双腿。当下一位患者进来喊痛时，我们就开始即兴发挥——这就是治疗的艺术。

If they have a posterior disc bulge with an open fissure, which is probably one of the more common ones, that maneuver vacuums in the disc bulge. If that immediately reduces the pain down their leg, I would say lay prone and have someone pull on your legs along the plane of the table, five or six pounds per leg. Now the next person comes in and say, Oh, that hurts. Well, now we play what we call jazz. This is the art of therapy.

我正在研究如何对足部施加旋转扭矩。没有任何减压治疗台能做到这些，它们缺乏艺术性，更像粗暴的锤击。要真正应对疑难病例（记住，没人背痛时会主动说'我要去找米格尔'）...

I'm playing with how we're going to apply a twisting torque to their feet. No decompression table does all of this. It doesn't have the art. It's more of a brutal hammer. And to really get difficult people, because remember, no one has back pain and says, oh, I think I'll go see Miguel.

现实并非如此。我们接诊的都是经历过10次其他治疗失败的患者，真正的疑难杂症。

It doesn't work that way. We only get the ones who've failed 10 previous attempts. The difficult difficult

其他所有疗法都试过了。

Every other treatment.

不，我们必须掌握诀窍，必须具备专业技能。

No, we've got to know, we've got to have some skills here.

我根据你的书开始练习'三大项'后，右侧下背部偶发疼痛确实改善了。我还发现自己在各种推举中变得更强，但最显著的效果是跑步时——躯干能保持更直立，双腿像蹬自行车般流畅摆动，仿佛拥有用不完的耐力。

Well, started doing the big three on the basis of your book and it certainly has helped my lower right side back pain that occasionally flares up. I also noticed I've gotten stronger in various lifts, but the most salient consequence has been when I run, I feel like my torso can stay more upright as I can kinda cycle my legs underneath me, like I'm pedaling on a bike. And I feel like I have endurance for days.

这正是应有的感受！你改善了躯干圆柱体功能。横膈膜在圆柱体内上下运动实现肺通气。若缺乏这种运动型横膈膜，跑步时腹肌和斜肌就不得不代偿呼吸功能，这会让你精疲力竭。

That's exactly what you should feel. So you've improved the cylinder. So the diaphragm pumps up and down inside the cylinder to allow you to lung ventilate. If you don't have that athletic diaphragm you're in training your abdominal muscles, the oblique muscles, to the breathing effort while you're running. It wears you out.

这还会影响你的脊柱。所以你需要这些肌肉形成一个束带来支撑整体。根据你的病史，我怀疑你现在可能有点椎间盘突出。

It also compromises your spine. So you need those muscles to form a girdle and hold it all together. Now I know enough of your history that I suspect you will have a little bit of a disc bulge now.

确实有。我做过全身扫描。对，就是...你知道，为了好玩吧，大概这就是我的娱乐方式。确实有个，我想是L3、L4节段一侧的突出，和我一直以来的疼痛模式完全吻合。

I do, yeah. I had a whole body scan. Right. For just, you know, for fun, I guess is the sort of thing I do for fun. And indeed there's a, I think it's like an L3, L4 bulge on one side, which is fully consistent with the the pattern of pain that I've had.

对。而且多年来我都刻意避免做眼镜蛇式这类动作。

Right. And I've managed to avoid for a number of years now doing cobra type pose, these kinds of things.

眼镜蛇式并非对所有人都有效，但它对某些类型的椎间盘突出有很强的回纳作用。很高兴它对你有用，而且你找到了这个方法。对某些人它会有效，但对另一些人可能会加重疼痛。我们有测试方法来判断。

The cobra doesn't work for everybody, but it is a powerful vacuuming in of certain types of disc bulges. So I'm glad it works for you and you found it. And it will work for some others or it will make the pain worse than some others. And there's tests for figuring that out.

我注意到如果旅行时需要长时间坐着，第二天再做任何髋部铰链动作训练时，疼痛就会复发。

I noticed if I travel and it forces me to sit for long periods of time, and then the next day I train with any kind of hip hinge movement, it flares up again.