Here is an excerpt from the article:

 

However, what I tend to see happening with this method is people get bored of their meal plan, and those freer meals essentially turn into these all out binge meals, often called “cheat meals”. This can still work, once the calories aren’t too outlandish on those binge meals, but what generally happens is that those binge meals are all out binges. This method is also hard to adjust intuitively, as you effectively have to redesign your meal plan every time you want to lower/higher calories as you are effectively eating a meal plan designed with specific calories/macros in mind, and to adjust these calories/macros you thus have to adjust the whole meal plan. So adjusting this method effectively ends up looking like what you would do in Tier 3.

While this method can work, and some people do quite enjoy it as it gives both structure and flexibility, I tend to not recommend it, as the risk of binge eating is high (although not guaranteed), but also because micronutrient deficiencies are more likely to occur when you eat the exact same thing every single day. Obviously you can set things up better, but most people aren’t willing or don’t know how to set up a diet that actually achieves all of the macro and micro needs, and this method ends up looking so much like Tier 3 without the flexibility that Tier 3 brings, I just don’t think it offers as much of a return on investment as it should. However, some people find this method very helpful for controlling their portions and thus hitting their calorie/macro needs."

 

Is it safe to squat if you have “bad knees”?

Often, we encounter individuals who believe certain movements are off limits due to pain or other sensations (e.g. crepitus/popping/cracking) that they have experienced. This is especially true of middle-older age adults who may have signs of arthritis, but also of younger adults who have experienced knee pain.

Resistance training, including squatting movements, is generally a good recommendation for such individuals.

Why?

1️⃣Exercise may lead to reductions in pain, which may or may not be the primary complaint.

2️⃣Increased muscle strength generally leads to reductions in the exertion required during common activities of daily living (e.g. stair climbing), meaning that you have a greater reserve of strength for the things that you’d like to be able to do.

3️⃣Exposure to movements perceived to be harmful and/or challenging can help to develop self-efficacy, reduce threat and fear-avoidance, which can support both improvements in pain and function.

4️⃣Low muscle mass/strength is a poor prognostic factor for health & longevity, and squatting exercises are effective, versatile and widely accessible. 

To conclude, resistance training is likely a good idea for individuals struggling with function secondary to knee pain. Squatting variations are one potential tool that could be safely used as part of that resistance training approach. As always, the specific variation, loads used and relative intensity prescribed should be tailored to the individual, so don't just assume "squatting" means working up to a 3RM on back squats. If sit-to-stands are appropriate for the individual at that point in time, then that's still productive training.

 

Prinold and Bull (2016) suggested an increased risk in shoulder injury from the performance of supinate chin ups (as shown). In particular, they discussed risk of shoulder impingement.
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For those unaware, impingement is a term typically used to describe a point at which multiple tissues come together. In this case, this refers to a reduction in the subacromial space and/or compression of the supraspinatus tendon.
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However, to suggest that such an exercise increases risk would first require us to have clear evidence of this mechanism of injury (i.e. that impingement is to be avoided, due to being injurious). In fact, we don’t. This thought process has been challenged for a while now.
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This simple version of the story would lead one to believe that you could simply surgically decompress the subacromial space and/or debride the acromion, both of which have been done for a long time. Despite surgery for shoulder impingement being very popular, it actually shows no benefit versus sham/placebo surgery (Karjalainen et al. 2019).
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This is a clear example of where our simple stories about pain and injury fall apart. Things can “make sense” while still being incorrect, which is why it’s important to rely on research evidence to inform practice.
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The thing is, patients believe in the story told. They believe that if the pressure is released, they can be pain-free. Therefore, regardless of whether it’s a real or sham surgery, the outcomes are the same (i.e. the actual surgery itself isn’t actually doing anything).
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While it is interesting to consider the kinematics of various movements, we have to be careful about concluding that they cause pain/injury and telling people not to do them. I am unaware of any evidence that has attempted to quantify the risk of injury associated with *any* particular resistance exercise, so it’s a good idea to think twice before telling people what they should avoid. There may be reasonable suggestions, of course (e.g. don’t squat on a Swiss ball...).

 

t’s easy to be the overcautious trainer, as I have been there myself, but I think elevating the threat associated with resistance training is likely to be a net negative. It may facilitate nocebo effects, fear-avoidance behaviour, and ultimately limit participation in resistance training. Do not want.

"4 years ago, I weighed 21stone. Moving was a chore and pain was a normal part of life. A list of injuries culminated in surgery on my left knee to repair & rebuild cartilage and severe muscle damage, 2 hip reconstructions and two herniated discs which were by far the worst injury I will ever have. Specialists gave me a long list of what not to do & what to avoid. All of them told me avoid the gym. However, against their advice I started in the gym and got myself down to 15 stone. A lot of excess weight was gone but the pain was always there. My body was weak, I couldn’t train my legs without hurting myself, I had to be very careful picking almost anything up for fear of putting out my back. I lived my life wrapped in cotton wool.⠀
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Gary's honest & open approach to life is what made me seek out his services. My goal was to be pain free and be able to start building muscle in my legs & back, to build the foundation I badly needed. 1 year later, the pain & issues I was so used to with my back and hips are gone. I came to accept it as normal, he showed me how to change that. He taught me so much but teaching me to manage my body and to ditch the "broken" mentality was vital. Having a sore back shouldn’t debilitate me - if it was another part of my bod, I'd ignore it and push though, not wrap myself in cotton wool.⠀
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You could not meet a more understanding and brilliant person to work with. I am in college full time, while working 3 other jobs. Gary’s simple solutions helped me balance my life much better than I was doing, and it isn’t all about hitting number in the gym and on the scale.⠀
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Finally, I lost my Father 3 years ago and it's still something I struggle with. Gary never judged me for it and did what he could to understand how I felt each week, giving me a safe place to vent about how I felt/how it affected me, even taking the time to text me on the day of my Dad's anniversary to see how I was doing. This an outstanding service that will benefit any person who accesses it no matter what their goal."

 

 

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The resources listed are simply resources that are likely to be educational and thought-provoking. It does not mean that we endorse every point made by any of the authors listed in either this newsletter or any of those to follow.

 

Book: Meditations - Marcus Aurelius