My Reflections on Dr. Peter Attia & Dr. Stuart McGill’s Conversation on Back Pain

Recently, Dr. Peter Attia hosted Dr. Stuart McGill; one of the most cited researchers in the back pain world, on his podcast. First, I want to acknowledge both of them:

• Dr. Attia, for his passion in exploring longevity and his willingness to share his own personal experience with back pain.

• Dr. McGill, for his decades of dedication to the mechanical aspects of spinal health and for bringing clarity to concepts many struggle to grasp.

Their conversation was insightful and valuable. And, like any good conversation, it also left space for further expansion.

Points of Agreement

• MRI results vs pain: They highlighted the incongruence between scans and lived pain. This is an important acknowledgement that pain is more than mechanical.

• Strategy matters: McGill’s focus on designing strategies for specific mechanical insufficiencies is powerful. I echo this: people need tailored roadmaps, not generic prescriptions.

• Practical coaching: I appreciated examples like teaching an elderly client how to get off the toilet. These moments show how the way we move shapes independence and quality of life.

Where I See Room for Expansion

• Personal experience ≠ universal truth: Dr. Attia described his three episodes of back pain as his “PhD” in the subject. While lived experience is invaluable, he runs the risk of projecting his own story onto all patients. It takes a great degree of personal awareness as a practitioner to remember that not everyone's journeys are the same. What has worked for him, is likely to not work for the next person. This is the back pain conundrum.

• Beyond the spine itself: McGill described the spine brilliantly as a flexible rod requiring stiffness and mobility. Yet missing from the discussion was the pelvis as the spine’s base, and the role of the feet in optimising spinal forces. When the lower limb structures don’t move well, spinal forces increase dramatically. Engineering and mechanics is a very valuable way to look at back pain, and through this lens needs to be acknowledgement of concepts like centre of mass motion (L4/5) within its base of support (feet).

• Mind and body are not separate: Both men acknowledged psychosocial factors but didn’t deeply explore them. Thoughts, emotions, trauma, and nervous system regulation profoundly shape the pain experience. Mechanics matter, but so does mindset, emotional safety, and nervous system tone. We need strategies for the whole of the person, not just for the vertebrae between L1-5.

• Pain as invitation: Dr. Attia’s own story reveals a pattern of pushing his body beyond boundaries. From my perspective, his pain, on all three occasions, was an invitation to explore why he felt the need to continually push himself. Stabilisation after the fact is great, but has he really learned what was on offer during those experiences ? Only time will tell.

A Broader Frame

I deeply respect Dr. McGill’s caution around surgery and his “virtual surgery” concept to encourage rest. But here too, I would expand: instead of simulating rest, can we explore why someone feels unsafe to rest in the first place?

This is where my work with Bulletproof Backs comes in. My approach doesn’t separate mind and body, because they aren’t separate. By combining mechanical strategies with mental, emotional, and nervous-system strategies, we empower people to not just cope, but truly heal.

Closing

The Attia–McGill conversation was a gift to the back pain field. It sparked debate, highlighted important truths, and invited us to look deeper. My hope is that we continue expanding this dialogue, bringing mechanics, movement, mindset, and emotions into the same room. This is what truly holistic back pain rehabilitation is about.

Because when we do, back pain stops being a life sentence, and becomes an opportunity for personal transformation of the most beautiful kind.

—
Marion McRae
Founder, Bulletproof Backs™

Watch the conversation here