Cover photo

Sunday, 7 February 2016

Better version of "My Plate"

Precision Nutrition's eating guidelines for clients - By John Berardi, Ph.D.

The USDA has ditched the Food Pyramid and introduced MyPlate, a new graphic that shows a supposed “balanced diet”.
But are the recommendations on MyPlate designed for the health of the individual or the health of the food industry?
Dr. John Berardi discusses the short-comings of MyPlate and offers an alternative: The Precision Nutrition Plates.
These simple graphics show our suggestions based on nutritional science, our own research, and the success of thousands of real-world clients.
A few months back, the USDA ditched the iconic Food Pyramid in favor of a new design. In a bold and exciting move (please note the sarcasm), they took the food out of the pyramid and…placed it on a plate.
Here’s the new graphic:

Some praise the new design for its relevance — after all, most of us do put our food on plates before we eat it — and say the plate provides a good teaching tool for building our own plates at mealtime.
Of course, not everyone is happy. The biggest opponents are critical of its content, as not much has changed with the food choices since the 1990s. (We’ll get into some additional criticism in a minute.)
But before universally praising or condemning the plate, we should quickly talk about two things:
  • Why was the plate created in the first place?
  • What is it supposed to accomplish?

Why MyPlate?
Is MyPlate supposed to represent the ideal eating strategy for everyone? Is it an improvement on the way the US eats now? Is it a strategy for weight loss or a diet for optimal health?

To answer these questions, I turned to the official website for the MyPlate campaign, www.ChooseMyPlate.gov. According to their site, the image is designed:
“…to remind Americans to eat healthfully; [not] to change consumer behavior…”
It doesn’t seem like they’re not aiming too high with MyPlate. Instead, they’re just “reminding Americans to eat healthfully.”

Of course, that implies that Americans already know how to eat healthfully. Current obesity and food spending trends indicate otherwise. It also implies the USDA itself knows how to eat healthfully. I’m not sure about that either. (We’ll get into the science of that part in a minute.)

Finally, it implies that “healthfully” has a definition. I don’t think it does. The term seems so vague that it can mean anything to anyone. Want to lose weight? Surely that’s healthy. Build muscle? Healthy too, right? Drop cholesterol? Healthy. Combat type II diabetes? Healthy. But can one set of recommendations accomplish all those healthy things at the same time? Probably not.

Instead of getting into a debate about semantics, let’s talk about responsibility. Here’s a quote from Agriculture Secretary Tom Vilsack:
“We’re not telling people what to eat; we are giving them a guide… We’re not suggesting they shouldn’t have a cookie or dessert. That’s not what it’s about.”
I get the guide concept. But given the rapidly rising obesity levels in North America, shouldn’t someonestart telling people to eat fewer cookies? Honestly, Tom?
All other criticisms aside for now, why can’t our most high-profile government food agency sack up and tell people to eat less empty-calorie food? I suspect it has to do with the USDA’s conflicted mission.

Who does the USDA work for?

It’s no secret the USDA has to balance all kinds of interests.
Sure, they’re trying to help spread the idea of healthy eating across the US. However, we’d be naive to ignore their other mission: to ensure the “health” of the food industry.

This is where conspiracy-minded folks go crazy. When food and profit are used in the same sentence, some people get uncomfortable. I urge you to take a gentler perspective. If the food industry isn’t profitable, it stops existing. If the food industry stops existing, a good portion of the world’s 6.7 billion people don’t get food.

So damning “big corporations” gets us nowhere. The USDA’s job of ensuring both our people and our food industries are “healthful” is an important, albeit thankless one. Any recommendations of any kind are likely to piss off someone, whether consumers or industry.

When healthy people and healthy business are at odds.
I appreciate the difficult task the USDA faces. Trying to make everyone happy and healthy is a daunting challenge, especially in cases where the recommendations that might make people healthier may run counter to recommendations that might make industry healthier.

For example, one of the most important healthy-eating messages – eat less – seems to run counter to a fundamental healthy-business message: buy more food.
So how does the USDA’s new MyPlate deal with the tension? Well, they tackle it admirably. Bravely, in fact. They tell people to “eat less” and to “avoid oversize portions.” I’m sure that created a bunch of industry blowback and resentment.

The only problem is that the “prescription” is so general and subject to interpretation that I’m not sure how much of an impact it has really made. Eat less than what? What exactly are “oversized portions”?

There also seems to be a hidden message in the new MyPlate guidelines, it’s as if the USDA is encouraging folks to “eat some of everything.” Some fruits, some veggies, some processed grains, some unprocessed grains, some protein, and some dairy. With every meal.

While this can be viewed as a positive message in promoting dietary variety, I’m not sure we should strive for “some of everything” with every meal. Further, it’s easy to see the marketing abuses that come next.

Here’s part of a statement released by USA Rice Federation President and CEO Betsy Ward,
“Grains comprise a large portion, signaling that USDA recognizes the importance of grains such as enriched white rice and whole grain brown rice in the diet.”

Huh. I wonder how that will play out.

The MyPlate recommendations pretty much support the promotion of just about any food. Nice for the food industry, not so awesome for minimally informed food consumers.
Where’s the nutritional science behind MyPlate?
I’m not a conspiracy theorist, so I don’t want to overplay the sometimes unhealthy relationship between the food industry and USDA. In addition, I’m not such a know-it-all to suggest that I have access to all the considerations important to the USDA.

One thing I do have access to, however, is the science. Because of this, it’s clear that science isn’t the only force at work when creating the MyPlate recommendations. Here are a few examples.

Too much dairy
“Dairy” continues to be singled out as its own food group. Yet millions of people cannot digest it well (lactose intolerance), are allergic to it (milk protein allergy), or choose not to drink it because of concerns with pasteurization and homogenization, as well as the appearance of potentially harmful hormones and antibiotics in dairy foods.
So why does dairy have its own group when all other sources of protein – everything from beans to seafood to nuts to meats – are lumped together?
Apologists might say it’s because of the calcium. However, why not create a calcium-rich group that also includes the sometimes more bio-available, non-dairy sources like green leafy vegetables or alternative options such as fortified nondairy milks?

Where’s the water?
Water is a nutrient. So why isn’t water represented anywhere on the graphic? Why is the only visible beverage dairy?
It all makes me wonder if maybe the dairy lobby has a stronger influence than the water lobby. (Just something to think about.)

Where are the healthy fats?
Where are the healthy fats like fish oils, olive oils, and other plant-based oils? In my opinion, the absence of healthy fats is the biggest oversight with the current MyPlate presentation.

Epidemiological studies are rock-solid. There are immense benefits from consuming a diet that includes a moderate amount of healthy fat, in the right balance. Indeed, if the American plate included more monounsaturated and omega-3 fatty acids – and likely fewer grains – we’d see a large decrease in the number of people suffering from hypertension, heart disease and stroke.

So, why are healthy fats not even mentioned?
Could the grain lobby have a stronger influence than the avocado lobby? (Again, something to think about.)

These are my biggest criticisms of the MyPlate recommendations. However, I do have a few other nitpicky things.

The difference between fruit juice and fresh fruit
The MyPlate recommendations suggest that any fruit or 100% fruit juice counts as part of the Fruit Group, and that canned and dried fruits are equivalent to fresh fruit.

Unfortunately, the differences between fruit juice, dried fruit, and fresh fruit are huge. They’re almost different foods in terms of digestion, absorption, and nutrient profile. (For the record, fresh fruits are much, much better.) So why are they all lumped together? Probably because it’s good for the food processing industry.

The difference between vegetable juice and fresh vegetables
The recommendations suggest that any vegetable or 100% vegetable juice counts as part of the Vegetable Group. Same problem. Vegetable juice (especially the store-bought kind) and vegetables are very different, with vegetables being superior.

High carbs for everyone?
Finally, the recommendation for grains and fruit with every meal suggests that a higher carbohydrate diet is ideal for everyone. Diabetes statistics suggest otherwise. So do body type and activity differences between people.

Higher carb diets are fine for those active folks with good glucose tolerance. But for folks who don’t exercise much, or who are experiencing early signs of impending type 2 diabetes – like a huge percent of the American population – a higher carb diet is the absolute worst eating plan to follow. Yet I suspect the grain lobby wouldn’t stand for any mention of eating fewer carbohydrates.

Did MyPlate get anything right?
While the new MyPlate recommendations are simply too watered down, too generalized, and too supportive of the food industry at the expense of consumer health, it’s important not to completely discredit it.

Compare MyPlate to a plate dominated by processed snack foods and French fries, served with a jumbo soda and MyPlate gets a huge win. After all, half of it is filled with veggies and fruits.

Also, simply including some protein with each meal, as MyPlate suggests, would benefit most people. I also like the idea of using a “protein” label instead of “meats and beans” as it better indicates all the food choices that fall into that group.

Lastly, prior food guides have encouraged a diet dominated by grains, and this model proposes to at least bring grain consumption back in line with other food groups. It also gets people thinking about eating more whole grains versus processed ones.

Yes, there are some good things about MyPlate.
Yet if you’re going to ransack the Food Pyramid and recreate a new set of healthy eating recommendations, why piss around with vague generalities and half-measures? (I shudder to think of how much time and money was spent on creating the MyPlate recommendations.) Why not come up with something really meaningful?

Introducing the Precision Nutrition plates
Instead of just sitting back and criticizing, we decided to come up with some plate-based recommendations of our own.

You’ll notice that each recommendation includes a few key components:
  • what to eat (and drink)
  • when to eat it
  • how much to eat

Because exercise plays a big role in daily energy expenditure and nutrient tolerance, we decided that one plate isn’t enough. Instead, we need two plates.

Precision Nutrition’s Anytime plate
The first is an “Anytime” plate. The Anytime plate recommendations are for those who either don’t exercise — in which case, they’d follow these recommendations exclusively — or for those who do exercise, in which case, they’d eat Anytime meals for every meal outside the post-exercise period. (More on this in a minute.)

What’s on the PN Anytime Plate
As you can see, most of the plate is full of nutrient-dense, high fiber, low-calorie vegetables. Protein helps with appetite control, maintaining lean mass, and optimizing the metabolism. Healthy fats offer myriad benefits. The drink of choice is water or tea.

We suggest you choose smaller plates if you’re a smaller person and larger plates if you’re a larger person. And we highly recommend putting down the fork when you’re 80% full, not when the plate is empty.

We recommend minimizing starchy carbs until after exercise, which is when the body uses them most effectively. And we suggest choosing whole (less-processed) foods, with local and organic selections when possible.

Precision Nutrition’s Post Workout plate
The second plate we submit is the “Post Workout” plate. The Post Workout plate recommendations are for those who perform intense exercise. Eat a Post Workout meal soon after your intense exercise sessions only.

What’s on the PN Post Workout Plate
This plate helps us take advantage of the body’s metabolic response to exercise. It includes starchy carbohydrates and protein, which are great during times of increased glucose tolerance (during the post-exercise period). We also advise a mix of vegetables and fruits.

You’ll notice there isn’t much fat here. A higher fat meal post-workout slows the digestion and the assimilation of protein and carbohydrate. So we recommend getting most dietary fat during Anytime meals and most dietary carbohydrates during PW meals. Keep in mind we’re not suggesting you avoid fat. Just minimize added fat.

Notice that the Post Workout portion is slightly larger, as we add a small side dish of starchy carbohydrates on top of a full plate of protein and fruits/veggies. Of course, one should use smaller or larger plates based on body size.

In terms of food selection, the Post Workout plate is still based on whole, unprocessed foods, with local and organic selections when possible.

For the plant-based eater
Although plant-based eaters (i.e. vegans) make up only 1-2% of the population, they’re some of the most nutritionally conscious and proactive individuals. That’s why we decided to come up with a plant-based plate with the help Ryan Andrews, a long-time plant-based eater.

What’s on the PN Plant-Based Plate
A wide variety of non-starchy vegetables, combined with a protein source and healthy fat, should dominate the plant-based eater’s plate, just like the Anytime meal above.

We recommend including smaller amounts of minimally processed fruit and starches to meet energy needs. And, as with all meals, regardless of timing or type, adjust plate size and total intake to body size and energy needs. And stop eating at 80% full.

Science + real world results = the perfect plate recommendations

We suggest that the Anytime and Post Workout plates above are more useful than MyPlate for real people, especially those who exercise. These plates are based on solid scientific data and — perhaps most importantly — on the real-world eating experiences (and long-term success) of thousands of clients.

Monday, 7 December 2015

Exercises To Stop Doing Forever

Exercises To Stop Doing Forever
8 Gym Moves You Should Stop Doing Forever

Some exercises are dangerous, others are simply a waste of your limited and precious time, the worst are both. Bro science may tell you something different, but there are certain moves that force your body into unnatural positions, where you'll potentially do more harm than good. Here are eight exercises you shouldn't bother doing in the gym, why not, and what you can do instead.

Barbell Vertical Row

There’s a saying in strength coaching that there’s no such thing as bad exercises, just bad execution, and while that is true to extent, the upright row is top of the list of exceptions. 

The problem It's two-fold: firstly it puts your shoulder, elbow and wrist into an awkward position, leading to the shoulder being loaded internally. This makes the muscles and ligaments much more liable to both acute and chronic injury. The second problem is that the exercise isn’t hugely effective anyway. 

Alternative Cable row to chin, snatch grip high pulls




Decline Sit-Up

If you’re trying to hit your abdominal muscles and build a six-pack, this move is designed to do that. But it also trains your hip flexors hard, and that's bad news for your lumbar spine.

The problem With most sit-up variations, and declines especially, the overuse of the hip flexors and the shearing force on the spine exacerbates the bad posture and lower back issues from all the sitting you do.

Alternative: Plank, Anti-rotational exercises, hand walk-outs, Turkish get-ups.



Tire Flips

There’s a difference between sport and training. Training is about building health and strength, sport is about points. Tire flipping is popular for one reason: it looks badass, and in recent years it’s escaped the realm of sport (ie strongman), and made its way into the gyms and bootcamps.

The problem While it looks badass, in terms of the health of your back and biceps it’s just bad. The lower and upper spine is well rounded at the start of the lift when you’re working the hardest, and the arms are holding large loads with the elbows slightly flexed, putting your biceps at a greater risk of strain or tear than the majority of alternatives.

Alternative Deadlift, cleans, snatches, kettlebell swings

Behind The Neck Press

In an ideal world the behind the neck press would be a safe and effective shoulder builder. The thing is, it’s not an ideal world. Desk work, driving and bad posture all take their toll on the shoulders, which makes things complicated for this move.

The Problem Having chronic poor posture and overly tight pecs and lats — that's 99% of gym goers out there — changes how your muscle around the shoulder joint function, and reduces your healthy range of motion, something which the behind the neck press needs a lot of.

Alternatives Dumbbell see-saw press, dumbbell press, kettlebell press

Leg Extensions

This quad isolation exercise is popular because a) you can do it sitting down watching the gym’s TV, and b) because bodybuilders seem to like it — and who doesn't want a bit more muscle?.

The problem The quadriceps muscles weren’t designed to work on their own, and leg extensions apply forces across the knee that it wasn't built for, affecting function and potentially leading to damage in the joint. Added to this, they don’t really make you stronger in the real world.


Alternatives Split squat, lunges. Both huge quad builders that also improve whole-leg function as well.

Triceps Kickback

These are the poster boy of a whole host of isolation exercises that are so way down the list of priorities that, for most, they’re just best forgotten. They aren’t dangerous, they’re just pointless.

The problem This is down to how muscles function and the angle and leverage of the weight. Muscles tend to be weak at the extremes of their action, and in a kickback when the arm is out straight and your tricep is in a weak position the weight’s leverage on your arm is at its greatest. This means that not only do you have to use those tiny pink dumbbells to do them, even on a very light weight you'll likely use poor form and fatigue quickly.

Alternative Pretty much every heavy pressing movement such as close grip bench press, push up variations.


 Smith Machine Squats

Many coaches refer to the smith machine as an "expensive coat rack", and with good reason. Using a smith machine for anything confines you to a movement path, and that straight-up-and-down-no-matter-what means you can get away with using poor form.

The problem The machine can’t take account of your body's individual mechanics. In an ideal world the barbell should go straight up and down in a squat, but being confined to this path actually means you use fewer stabilising muscles, moving unnaturally and working in all sorts of odd directions. This increases injury potential.

AlternativeBarbell and dumbbell front squats, unloaded squats, goblet squats



Monday, 11 May 2015

A Doctor's View of CrossFit

An Interview with Dr. Stuart McGill

A-doctors-view-of-crossfit
NEW
LEAD PHOTO CREDIT: CROSSFIT OCEAN ISLE BEACH

Here's what you need to know...

  1. CrossFit is the fastest growing fitness pursuit, but some of the things participants do are questionable from a health standpoint.
  2. According to Dr. Stuart McGill, the spine is most at risk when it's flexed and loaded with high compression and when it extends while still bearing the high compression.
  3. Fatigue from heavy, high-rep lifts can cause deterioration of lifting form leading to a higher incidence of disc bulges and herniation.
  4. Dr. McGill says CrossFit could improve by making a few simple changes, like decreasing the number of reps required on Olympic lifts.

The Fittest on Earth... For a Year

Gym
Like it or not, CrossFit is here to stay, and in a big way. With over 10,000 CrossFit facilities and counting, it's become the household name in fitness.
And every year the CrossFit Games brings in hundreds of thousands of competitors to determine who "the fittest on earth" will be.
So what's next for CrossFit? Maybe cleaning up some of the issues that will make fittest-on-earth contenders debilitated-for-life later on down the road.

Notes From A Physical Therapist

Dr John Rusin
As a sports performance physical therapist, CrossFit has been on my professional radar for years. Both CrossFit athletes and facilities have sought my services.
One of the biggest misconceptions I hear is that all CrossFit athletes are chronically sidelined with debilitating injuries. This isn't accurate and the reason for the spike in physical therapy may surprise you.
Good physical therapists are movement specialists and coaches above all else. The focus in my professional work with high-level athletics such as CrossFit has gravitated more towards injury prevention and pre-habilitation than traditional rehab.
Screening, evaluating, and preventing future injuries makes up a majority of my cases with CrossFit athletes over the past few years. Just as with any other competitive sport, there will always be an influx of chronic and traumatic injuries. That's part of the game.

Does CrossFit Hurt People?

Ring Dips
I only have so much anecdotal evidence behind my claims that CrossFit may be one of the most debilitating forms of training.
While research is incomplete, it's important to justify or refute these claims regarding CrossFit-specific injury rates as the world's fastest growing athletic specialty continues to grow.
This is a tall task. To set the record straight, I spoke with one of the top thinkers in biomechanics to get his perspective on CrossFit.

Insights From Dr. Stuart McGill

Dr. Stuart McGill is considered one of the world's top spinal specialists and researchers.
He's been sought out by corporations, the government, elite athletes, and professional sports teams for his expertise in injury prevention, programming, and rehabilitation.

Related:  Back to McGill

Dr. McGill has made enough groundbreaking advancements in his field to carry an opinion backed by science that speaks volumes.
I had the chance to get his take on CrossFit. Here's what he had to say.
Dr. Rusin: Is CrossFit inherently dangerous?
Dr. McGill: My expertise is in back injury, so that is the perspective from which I view controversial topics such as this. For the record I have a love-hate relationship with CrossFit.
I don't think "dangerous" is the right word, but certainly "injury risk" is appropriate and it facilitates discussion of practices that influence injury risk, injury mechanisms, and injury rates.
A major component of CrossFit is Olympic lifting. Olympic lifting must find the lifter. Not the other way around given the special anatomical gifts needed to lift with efficiency and injury resiliency.
The flexibility required in the hips and shoulders in many cases is a gift from your parents. No matter how much stretching is attempted, some will never have the hip and shoulder socket anatomy to deep squat and support a bar overhead. But they will try, and their compromised form will create substantial injury mechanisms.
The majority I see are spine disc bulges and vertebral end plate fractures. Most of these fractures are undetected by radiologists reporting on MRI, CT, and x-ray scans.
Overhead Squat
Dr. Rusin: What can the average CrossFit coach without a strong background and focus on the Olympic lifts do to identify at-risk athletes while also keeping their clients and athletes safe?
Dr. McGill: This is a difficult challenge for any coach. Anyone can play basketball with little risk but this cannot be said for the Olympic lifts.
The next issue is that programming within a CrossFit routine can be problematic.
World-class Olympic lifters train with very few reps – usually just singles and doubles. They have also learned to never miss a lift, never lift when fatigued, and never compromise form.
They do not create muscle memory polluted with fatigued patterns. This approach creates faster gains in performance and less injury.
I have known several Olympic lifters over the years who are unanimous in stating that their back injury was tuition. It taught them never to lift with compromised form again. One went on to set multiple world records.
Dr. Rusin: What are the most common causes of injury?
Atlas Stone
Dr. McGill: The spine's discs are quite tough and resilient to high load when they're not bent but remain in a neutral posture. Second best is when they are flexed and then loaded, but they must not move.
Think of flexing the spine when picking up an atlas stone and the spine is curled over the stone and lifted with extension at the hips – the spine stays locked.
The injury bogeyman appears when the spine is flexed and then loaded with high compression, and then it extends while still bearing the high compression.
Here, high reps of these bending movements while under the high loads from the bar slowly delaminate the collagen fibers that form the outer rings of the disc.
Eventually the cumulative effect is the gel-like nucleus of the disc seeps through the delaminations causing a disc bulge. We have performed dozens of experiments over the years to prove this.
Dr. Rusin: It's well accepted that placing the spine in a flexed position under daunting loads is a bad thing. But don't Olympic lifters endure the same types of stresses as CrossFit athletes executing Olympic lifts within programing or WODs?
Dr. McGill: This is the distinction between the real Olympic lift competitors and CrossFit athletes.
The high repetitions and deterioration of lifting form from fatigue in CrossFit athletes causes a higher incidence of disc bulges and herniations. I rarely have to deal with these injuries in the Olympic athletes – typically they have healthy backs but succumb to shoulder, knee, and hip injuries.

Related:  4 Most Damaging Types of Training

But CrossFit compounds the risk further. Olympic athletes toughen the collagen in their spine discs by only training mobility in the ball and socket joints.
CrossFit athletes must perform exercises like burpees. Performing ten burpees before ten snatches replaces disc toughness with flexibility and softness in the matrix holding the collagen fibres together, resulting in a more potent injury risk scenario.
Many athletes have, and will, pay the price with years of back pain misery.
Spine
Dr. Rusin: So CrossFit-specific programming can be risky for lower back health. By now, don't coaches and programing coordinators over at the CrossFit HQ know this?
Dr. McGill: While attending the CrossFit competition at the Arnold Classic, one thing really stood out: the lifting technique was just awful.
I did not see one competent lift. Not one! And things only got worse with each rep and set. (I will note that I have consulted before with some CrossFit gyms and there are some very competent lifters.)
No corrections from the coaches, only encouragement to continue lifting. The injured athletes went down to the medical tent where I saw very strange and, in my view, inappropriate chiropractic and physical therapy approaches being administered.
Dr. Rusin: What were they doing?
Rock Tape
Dr. McGill: They were putting athletes into flexion positions and applying manual technique to their back muscles making the situation worse.
The clinicians appeared not to understand the mechanisms causing the athletes pain – they had disc pain.
I suspect athletes think injury will not happen to them, and that lifting form during fatigue is not going to catch up to them, but maintaining good form is that important.
Dr. Rusin: How do CrossFit athletes compare to other elite level athletes you've worked with?
Dr. McGill: I'm not able to answer the question, "Who are the greatest athletes?" But I can address the training and whether or not it creates the best athleticism in the individual.
The programming based on going to failure with speed and high load will shorten the athletic window of many of these people. But can I say anything different for MMA, American football, and many other sports?
Training to compete in the CrossFit Games is about creating a very special competency, but our work shows it does not create the best transfer. I don't know how transferable it is to other activities and sports.
Running
Fitness variables compete with one another. For example, one cannot train for maximum explosive power and still train for endurance.
It's not possible to enhance the fast twitch mechanisms for maximum speed and strength while enhancing fatigue resiliency by challenging the slow twitch metabolism. But this contrast does not necessarily lead to injury – only a poorer specialized athlete.
Dr. Rusin: So are you saying that CrossFit-specific programming can hinder an athlete's potential athletic development in sports other than CrossFit?
Ball Throw
Dr. McGill: The programming within CrossFit will only create a better CrossFit competitor. There are better ways to build a faster running back in football, a better rower, a better Olympic lifter, etc. Decreasing the volume of reps is just one variable, among many, that would need optimizing.
Some will argue that some CrossFit events requiring torso-bending power such as the seated overhead medicine ball throw creates athletic competency.
Dr. Rusin: I have argued that the GHD medicine ball toss is one of the single most risky movements in CrossFit, period. So, does the ball toss create any athletic competency?

Related:  Does CrossFit Lead to Injury?

Dr. McGill: I would argue that each individual only has a defined amount of training capacity. A much better set of exercises could be programmed to achieve the athletic competency without using up so much of the available training capacity.
Again, the programming is not designed to allow maximum athletic development while reducing the injury risk. The point is, risk could be mitigated, and athletic variables increased with more thought directed at programming.
Dr. Rusin: One of your recent studies – relevant to this discussion of fitness and injury risk – revealed that fitter police and firefighters got hurt sooner.
Dr. McGill: We tested several hundred firefighters together with a police SWAT team for athletic variables: biomechanical, physiological, range of motion, endurance – a robust battery of tests.
Firefighter Pistol Squat
Then we followed the firefighters for three years and the police for five. The results were the same: the fitter ones got hurt more.
Then we analyzed the injury mechanisms – the majority of injuries did not occur on duty but rather in the weight room, and they were training in the style of lifting to failure and compromising form.
The guys who trained more moderately were slightly less fit, but they were sufficiently fit, and more injury resilient. This just shows that programming matters.
Dr. Rusin: In your view, what's the most positive aspect of CrossFit that we can all learn from?
Dr. McGill: Of course, I see many positives. In CrossFit, I see people rallying around physical activity that may not otherwise become involved. When I was younger, I would have loved this – the tougher the challenge, the better.
In high school and college I trained for strength and size, then later for specific athleticisms involving speed and strength. But then I had to tone down the intensity as the mileage on my body was showing with pain and slower recovery from injury and training.
By my early 50s I made a conscious decision to make it to retirement with as much remaining athleticism as possible. Now I look around and see my contemporaries who still have their joints – and they were not the ones who thought intense training when they were younger would give them good fitness through the lifecycle.
This is only achieved with moderation.
But having stated that, I am equally dismayed by many of the students at my university who are so soft and untrained that they will suffer the health consequences of being physically weak.
If I could influence them, I would coach them in movement competency then send them to CrossFit; but a CrossFit facility concentrated on proper movement and science-based programming methodology, of course!
Injury
Dr. Rusin: What would you do if you could run CrossFit for a day?
Dr. McGill: That's a fair question and the right question for anyone who wants the right to voice an opinion. It puts it in perspective.
From a programming point of view, I would reduce the number of reps of Olympic lifts. Perhaps modify programming to singles or doubles at the beginning of a sequence. But there would need to be a way to test competency.
I would not add volume to an event that had an inherent risk for tissue damage, like the Olympic lifts, or the seated med ball throw up and over the roman chair. In fact I would drop that event as it steals resiliency from the lifts.
Actually, if reps were required, I would ban it. The laws of human motion with injury resiliency begin first with proximal stiffness enhances distal athleticism, and secondly, generate power at hips, not the spine. This will create a more competent and injury resilient athlete.
Ball Toss
Dr. Rusin: So we have a list of things that you would omit from CrossFit-style programming. Are there any additions that you'd like to see in CrossFit?
Dr. McGill: Some more variety in the events to include obstacle courses, and more endurance holds, like a new military plank hold. These would maintain the mental toughness element that is a wonderful feature of CrossFit.
Interestingly this seems to be the direction of the Spartan races and Tough Mudder events. The natural team-building that occurs is wonderful. No wonder participation is growing among police, firefighter, and military groups.
We're just publishing a study where we trained a group of firefighters with a program of substantial repetitions and weights but we did not coach form – the emphasis was on completing the reps. This will sound familiar to the CrossFit community.
In a second group we had a coach insist on good form for every rep, stopping when form broke, and continually correcting.
Burpees
Both groups enhanced their fitness. However, we tested their movement competency in high-demand firefighting tasks following the training sessions. The coached group moved with more competencies and fewer injury mechanisms. The high-rep, go-to-failure, form-compromising group had more injury mechanisms in their movements.
From this perspective, transference of movement skill to other events, together with fitness, required a disciplined training approach. Our data showed that performing more reps without focusing on technique did not transfer as well to other activities, while the disciplined movement form approach did.
CrossFitters interested in being better athletes with fewer injuries will be interested in this – and adjust their programming approach as a result.
Dr. Rusin: This could clean up the high incidence of injuries secondary to CrossFit programming and participation. It may broaden the scope of what CrossFit could be capable of for the transfer of athleticism into other sports.
Dr. McGill: Variety of events would absolutely assist in better transference of athleticism to other sports, and reduce injury risk.
Some strongman events would better test grip strength, frontal plane strength and isometric endurances that are lacking in many CrossFit routines. This would require the CrossFit executives to expand the brand.
Adding movement competency judging to CrossFit would reduce injury risk. Some events are currently judged for example achieving the chin to bar – but this is to count reps based on a performance metric. Judging the lifts for form and skill would be best, but difficult to administer.
Dr. Rusin: While I agree it would be great to have a metric for movement competency and execution, doesn't it all start at the foundation of coaching?
Deadlift
Dr. McGill: Coaches need a lot of training. I am so disappointed when I hear coaches yelling at an incompetent lifter to keep trying for more reps with awful form. This is common on YouTube clips and is poor press for CrossFit.
A great coach assesses their athletes for injury history, body type, current athleticisms, and training goals, then creates a program while training best technique. A poor coach beats a client up and makes them sore.

Related:  The Future of CrossFit Training

Dr. Rusin: That is one of the biggest misconceptions I see all over the fitness industry: the assumption that overly hard training methodology that routinely puts an athlete into the ground will produce optimal results when compared to more intelligently and goal-oriented programming.
There's a big difference between programming a movement to be "hard" and programming to be "challenging."
Dr. McGill: Absolutely. Clearly some people do not have the competency to pull a bar from the floor. They should be pulling from blocks. I suspect that incorporating this modification would reduce a lot of CrossFit lifting related injuries.
Dr. Rusin: So how can we protect our CrossFit athletes?
Ropes
Dr. McGill: No athlete can stay in peak fitness for very long without becoming sick or breaking down. The combat sports have instituted commissions to reduce the number of fights or to monitor a fighter before reinstating their competition status.
Legislation to limit training volume for cricket bowlers (similar to baseball pitchers) in Australia is another example that these approaches reduce injury rates while preserving high performance.
Some equivalent institutional or legislative mechanism from the CF head office would assist serious CrossFit athletes.