McGill vs Barbell Medicine – Brian Carroll Interview

Last week I scheduled my first interview on this channel. I’ve been uploading videos regularly for 2 and a half years and had a consistent process of locking myself in the gym or my room and not coming out until I had something to upload. This process typically involved a few hours of walking around in circles, heavily caffeinated and talking to myself, before setting up the camera and bumbling through 90 minutes of awkward delivery. Editing out all of the “umss” and “errs” along with the wet mouth noises and fumbled words would reduce an hour down to 12 or 15 minutes of watchable video.

It wasn’t a clean process but, dammit, it worked.

You can imagine the thought of filming an hour plus interview with one of the best equipped lifters in history left me a little hesitant. But I sucked it up, remembering that the only way through is forward. I’m glad I did, as the end result was just over an hour of back and forth with a legend of his sport, someone who could give insight into how this journey is supposed to go, having already completed it himself.

Brian Carroll was the first man to break 1300lbs in a squat (1306lbs, to be exact) and did so after devastating injury to his lower back. This was of special interest to me, since I spent a decade trying to undo the damage of a low back injury I suffered in my late teenage years. There was a time where I thought 405lb deadlifts were a thing of the past and here’s a guy who broke the all-time squat record when his initial prognosis was “keep lifting and end up in a chair”.

I’m certainly biased in this interview, since the methods I used to piece myself back together came directly from Brian and his co-author on “The Gift of Injury”, Dr. Stuart McGill. I’ve since made several videos on the exercises and approach used by Dr. McGill, ranking them as highly important for the average lifting population due to A.) the lack of attention paid by most lifters and resources, B.) the likelihood of injury over a long and ambitious lifting career and C.) the essential role of a strong midsection in increasing efficient movement patterns and increasing performance. It just seemed to fit a worldview I had been building for the last 20 years.

My injury specifically came from my formative years when deadlifts were maximal and frequent. It had been pointed out to me that my back rounded excessively during but was dismissed as unimportant by a few trainers and peers I considered strong. I sure as hell wasn’t going to take weight off the bar if I didn’t need to, so I shrugged and said, “nah, it’ll be fine”. I was also lacking in just about every technical cue that a seasoned deadlifter might lean on to increase performance: I had no sense of where my hips were or where the bar was, no sense of how the movement should start or finish and no sense of how the upper back and midsection worked to maintain stiffness and increase force transfer.

After years of meager progress in the deadlift, my midsection was about as rigid as a bowl of pudding.

Of course, I didn’t realize this until 5 or so years after my first injury. It happened when I was 19, when years of hanging on my erectors and jerking the bar to lockout culminated with an unforgettable wet ‘POP’. I felt it 6 inches above my waistline in the dead-center of my spine; it was merely just gross at first but it slowly intensified until I couldn’t sit, stand or lie down without excruciating pain. This lasted for several weeks and the pain didn’t subside for several months.

Then I came back, got stronger and set a new run of PRs until….. ‘POP!’, it happened again. Repeat a dozen or so times between 2006 and 2016. I stopped getting mad, it eventually just seemed like a normal part of the process.

To save you the long, boring details of my comeback journey, I was lucky and stumbled across a seminar that demonstrated my near-700lb deadlift was built off a midsection made of pudding. I took the lessons from that seminar and the very similar protocols recommended by McGill and started learning how to build stiffness in my abdominals and use that stiffness to prevent unnecessary movement. At this point, I am 5 years out from my last low back episode and pulled an all-time PR last week, pain and symptom free. I consider it no accident that a stiffer midsection coincided with both an end to injury AND a dramatic improvement in deadlift ability.

I talked with Brian about a lot of topics: equipped lifting, internet culture, influences, etc. But the clip I published that garnered the most attention was the philosophy around the McGill method and how it conflicted with it’s detractors, namely Barbell Medicine.

I had heard there was disagreement but, surely, those in the scientific community don’t resort to attacks when experts come to different interpretations of the same data! After all, evaluating studies made around something like pain and injury in competitive lifters must be anything but straightforward, right? Wrong. The disagreement quickly became hostile, the way you might expect with Physics professors responding to flat-earthers.

Best I can tell at this point, the disagreement is a philosophical one, with the Barbell Medicine guys focusing on de-stigmatizing lifting as a potentially dangerous endeavor to the general population. McGill’s method seems to emphasize preventing or rehabilitating injury, part of which is to avoid things that hurt after an episode. I’ve seen this referred to as ‘fear mongering’ multiple times on the BBM side, which leads me to believe that they are assigning a blanket recommendation for novice and elite lifters alike in order to increase participation in lifting by sedentary people. I have quite a bit more reading to do before I commit to that analysis but, if true, I have a bit to say about it.

Apparently another point of contention is that McGill’s role in spine biomechanics led him to reject the notion of ‘non-specific’ back pain, which is something that Barbell Medicine upholds through the evidence cited through pain research. McGill asserts that there is a root cause and it can be connected to lack of stability created by weak or deconditioned musculature. My first impression of ‘non-specific’ pain is that it’s a cop out for not being able to accurately diagnose a problem. Even if it is purely neurological or not otherwise connected to injury, that is still a physical mechanism that can potentially be measure, just not by our current ability. Labeling pain as ‘non-specific’, especially in a field where participants routinely subject their spine to maximal loads, seems….. lazy.

Recommending hurt lifters not ‘catastrophize’ injury and return to normal activity asap might give a better result over the aggregate, at least if the cost is off-set by higher enrollment of sedentary people into barbell programs. But if that’s the limit of your recommendations then you have immediately displaced individual lifters who have actually experienced trauma. A main point of disagreement likely resides in how many of these lifters are represented in the population. After 2 decades of talking to the highest performers in strength sports, I believe this type of trauma occurs at some point in most of those who A.) have been around for more than a decade and B.) strive to compete at a high level. I believe the number is certainly greater than what the BBM crew believes.

It brings up some interesting questions. As a thought experiment, we can ask other body part receives a diagnosis of non-specific pain when it interferes with sports performance. Knees? Hips? Shoulder? Of course not, so what makes the spine different? I’m sure that Barbell Medicine has an answer and I plan on sniffing that out with more reading.

Another question would be why there is so much dismissiveness around the model of stiffening the spine by increasing strength and endurance in the abdominal muscles. In every other facet of sports, we see unstable joints as being a risk for injury in a worst case scenario. The best case is that it simply just limits efficiency and hinders performance. Every other sport sees preventing these weaknesses before they happen as making just good sense. Why would this not apply to the thing that houses the spinal cord and exists as the lever through which all force transfers onto external objects?

Yet another question would be in regards to the mantra that ‘the body is resilient and it adapts to stress’ as the platform for the ‘it’ll be fine’ approach. Does it adapt? Every time? We can accept that a population involved with some type of regular labor would be better off long-term than a population of sedentary loafs like the cruise-ship residents in Wall-E. But can we predict whether someone who exists in the labor group will enjoy stronger joints and increased quality of life or if the stress will eventually make them a candidate for back surgery or a knee replacement? No. No we cannot.

This applies to garbage men and roofers just as it applies to Olympians and NFL players. Some members of Olympic weightlifting teams had long, dominant careers followed by an active retirement, while some got so chewed up from the same stress that they simply couldn’t continue. The stress that makes dense the bones and tendons of an arm wrestler is the same that leads to spiral fractures in the humerus and full bicep tendon ruptures. All of training is a balance between stress and recovery and, when it comes to our structures, shit often goes sideways. Individual competitors need more than a blanket lecture about not making pain more than it is.

There’s a lot more to be done here, like a deep dive into the pain studies that Barbell Medicine cites and a discussion as to how much weight they should get (I have a special distaste for those who over-represent their ability to draw conclusions from formal academic studies). Brian has sent me copies of his books with McGill and agreed to do another talk once I’ve digested them. Until they come, I plan on scouring every inch of the BBM forums until I can faithfully repeat their ideas back to them. I plan on revisiting this topic at that point so that I can give it the attention it deserves.

Until then, I feel completely confident in telling every lifter reading this that their midsection isn’t strong enough and they should probably do some curl-ups.

6 thoughts on “McGill vs Barbell Medicine – Brian Carroll Interview”

  1. “My first impression of ‘non-specific’ pain is that it’s a cop out for not being able to accurately diagnose a problem. Even if it is purely neurological or not otherwise connected to injury, that is still a physical mechanism that can potentially be measure, just not by our current ability. Labeling pain as ‘non-specific’, especially in a field where participants routinely subject their spine to maximal loads, seems….. lazy.”

    This shows you have little understanding of the nature of pain, specifically the more updated biopsychosocial model. You are looking at it through the antiquated biomechanical model. You can have pain without injury, and you can have injury without pain. Non-specific simply means there are multiple factors that contribute, not a single ‘physical mechanism’ like you are claiming. Reducing it to a “physical mechanism” isn’t helpful–yes, we live in the physical world and everything we deal with is technically physical or an experience emerging from a physical process, but you don’t treat fear or other emotional issues ‘physically’, its dealt with through communication and learning.

    You appeal to other sports as if those aren’t also affected by poor models of pain/injury.

    You reduce BBM’s argument to “…a blanket lecture about not making pain more than it is.” That is not what they’ve done, as far as I’ve seen, and I don’t follow them closely.

    This statement really shows your bias and inability to understand the hierarchy of empirical data “I have a special distaste for those who over-represent their ability to draw conclusions from formal academic studies”.

    Going to be honest here: I have followed you more closely than I have followed BBM, but this article has really turned me off. I don’t think I can accept your authority on this anymore, regardless of your experience. I appreciate that you are willing to look into and discuss this more, that’s good, but man, maybe you should have done the research first before arguing against a strawman.

    1. Ben, your surface level regurgitation of BBM talking points leads me to question what your involvement is, either in formal academic study or handling highly competitive athletes. You had a perfect opportunity to sway me towards a point of view or make clear things I may have missed, but instead wrote several paragraphs that amounted to “you don’t understand and you’re wrong” (in the same smug affectation that bleeds through most BBM content, no less).

      The thing that makes the vitriol here so silly is that this whole argument amounts to nothing of substance. BBM has never said McGill’s methods don’t work and their recommendations for how to come back from injury aren’t substantially different. It all boils down to an esoteric argument about 2 models for evaluating pain in the low back that doesn’t feature expert consensus and doesn’t dramatically change how injuries are treated! Trying to build a career over absolute minutiae is not uncommon dick-swinging for those trying to establish authority in formal science arenas (especially the medical field) and is why I expressed skepticism at those who over-represent their ability to draw conclusions from studies. In the field of health and performance, IT HAPPENS ALL THE TIME.

      As I write this, I’m experiencing regret over committing to this shit-show of a topic.

      The entirety of lifting culture is built around fixing and preventing weaknesses in order to increase performance and prevent injury. It’s literally the programming backbone of all elite lifters. There have been many pieces written about the performance, rehab and injury prevention by means of exercises that strengthen the rotator cuff, stabilize the knee and balance the hip because lack of attention in those areas correlates with injury and it’s really damn common. It’s non-controversial until a ‘biomechanicalist’ recommends the same approach to common maladies in the low back. To dismiss an appeal to build stability in what is objectively one of the biggest and most common weak points in the general lifting population (which also happens to be the primary conduit of all human force transfer) out of a fear of ‘catastrophizing’ is fucking stupid.

      I understand the difference between the models and I recognize the potential role ‘psychosocial’ factors can play. What I struggle with is the degree to which we assume ‘psychosocial’ factors are dominant and how those assumptions should change when making recommendations for a formerly sedentary accountant who just started lifting vs a 15 year vet who is chasing records, despite a laundry list of issues.

      “You can have pain without injury…” which assumes that an athlete experiencing pain may not be injured. How many elite athletes experience pain without injury compared to the gen pop? Would you say it’s common? Would you say it’s in line with the 90% non-specific back-pain numbers that BBM likes to cite? What about the opposite ends of the spectrum? Plenty of athletes are successful because their standard of what ‘hurt’ is is much higher than normal people. What about the lifters who refuse to stop, rely on cortisone shots and opiates and who eventually wear themselves down to nothing in the process? Does this model take them into account?

      NFL players, gymnasts, rodeo clowns are all separate from the gen. pop. because impact and stress is a day to day occurrence, which means instance of pain is tightly correlated with ACTUAL STRUCTURAL DAMAGE and lifters are often guilty of pushing through barriers without having built sufficient stability in antagonists and stabilizers and, yes, their goddamn midsection.

      In a sport defined by self-taught lifters with limited instruction and with ample instances of athletes worn to dust, I fail to see how we gain anything by assuming that the approach of a lifter who is experiencing pain isn’t in need of some correction, especially given that the recovery protocols don’t really vary.

      “You reduce BBM’s argument to “…a blanket lecture about not making pain more than it is.” That is not what they’ve done, as far as I’ve seen, and I don’t follow them closely.”

      That was a non-argument. I don’t even understand the point of you having typed this. I scoured through a few forum sections where they responded directly to questions about McGill and the standout phrases (when Baraki wasn’t dismissing the questions of forum members altogether) were ‘catastrophizing’ and ‘fear mongering’. You could have clarified how I may have misinterpreted that, but you didn’t.

      “This statement really shows your bias and inability to understand the hierarchy of empirical data “I have a special distaste for those who over-represent their ability to draw conclusions from formal academic studies”.”

      I do. It happens all the time in these fields, especially over absolute minutiae when it allows you to brand yourself. Studies are flawed, data is imperfect, a lot has to be interpreted (which is why there is disagreement among experts). When I hear someone spend 30 minutes talking about a study without acknowledging sources of error or limitations (which are goddamn guaranteed in this field), I check out, they aren’t doing due diligence to the science and are probably selling something. Again, you had an opportunity to engage with my point but instead left it at, “you don’t understand”.

  2. Hi Alex!

    I think you should check out Jared Powells on the shoulders of giant episode where Greg Lehman and Andrew Lock debate over low back pain.

    You should not dismiss the psychosocial factors even in athletes, there is a lot to dig in there. Yes it may be that athletes know what pain feels like and are not as twitchy but they are still human and they are still affected by what they have learned about pain, or what they are feeling. They might get distressed about pain, when a competition is coming up because they might get worried that they won’t be able to participate and they are hurt and that will amplify their pain response.

    I think you are making a bit of a misrepresentation on the evidense based movement, it does not dismiss anectode and experience it just is not held at a too high of regard compared to empirical evidence. And when there is no higher evidence available experience has to be used. The flawed data argument has to be applied to experience as well, i mean how can you know that it is exercise x that is working and not just time doing it’s thing with regression to mean or that it was actually load management that helped i.e deloading a joint while doing bird dogs etc.

    There was actually a case being made for nonspesific shoulder pain, seeing at it too is very hard to accurately point out the tissues at fault for pain, but it seems that the new definition is subacromial shoulder pain, because it a offers bit more context.

    1. Thanks for that, I’m actually checking it out as we speak.

      What you said isn’t unreasonable, though it doesn’t address the ENTIRELY different relationship career lifters have with pain than the gen pop or recreational lifters (see: widespread nsaid and narcotic abuse to push through pain in order to perform).

      It still doesn’t explain why psychosocial factors would be the only reason for back pain in lifters.

      1. Nice to see that you’re open to discussion on the topic Alex.

        I am not saying that psychosocial factors are the only factors in pain, in athletes or even in sedentary gen pop. But i do think that they can never be fully disregarded as pain tends to be really complex and variable even in the same person depending on their enviroment, past beliefs, mood and whatever. And the psychosocial factors even contribute to biological factors as excessive phycological stress tends to slow down healing etc.

        When it comes to nsaids and narcotics i am not sure that it differs that much from gen pop, if you look at how low back pain tends to managed overall. But i could be mistaken because i have not really delved into athletes use of nsaids and narcotics.

        I don’t think that bbm is disregarding bio when discussing pain, i’m pretty sure they have said something in the words of “bio still matters but it is a question of how much it matters”.

        If you’re still interested Lehman wrote a short open access paper on lumbar flexion earlier this year called “getting out of neutral: the risks and rewards of lumbar spine flexion.”

    2. Jesus, that was unwatchable. Even if I agreed with anything Lock said, his filibusters and awkward shit talking made him a terrible debater. I skipped through big parts but didn’t hear Lehman make a convincing case (aside for pointing out some of the conflicting conclusions from biomechanists). He did conced repeatedly that the research is lacking, which gains him favor in my eyes; lack of discussion of research quality is one of my biggest gripes with the absolutist statements that come from BBM. If they had a more competent sparring partner, this could have been an extremely productive conversation.

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