Product Review - The Ultimate Pullup Program by Meghan Callaway

              Earlier this month I was touched when my fellow Canadian friend and colleague Strength Coach Meghan Callaway messaged me and asked me to review her new pull-up program "The Ultimate Pull-Up Program." Ever since I discovered her work a couple years ago I’ve became a big fan of her serious, no-nonsense approach to strength training and nutrition as well as her authentic personality. So, towards that end, when she asked me to review her program I was excited and could not say no.

Side note: before anyone says anything NO I am not an affiliate of Meghan’s and as such I am not getting any money from this.

The program consists of four progressive phases that start with very regressed versions of pullups and progress to (and even beyond) regular pullups. If you follow Meghan on social media you’ll see her doing some very advanced (and by her admission sometimes crazy) progressions of pullups and other exercises, some of which are included in the program as bonus content.

What amazed me about the program was the level of detail Meghan put in to describing each of the exercises and the various cues she uses to ensure proper performance as well as the amount of progressions and regressions available for each exercise. One of my hesitations in recommending people to do specific programs comes down to whether or not they can do the exercises properly but Meg has this taken care of.

One of the biggest themes in the book is that of creating full body tension in order to do pull ups as opposed to the traditional focus on just treating it as a back & arm exercise. This concept was first taught to me by my friend and mentor Dr. Stuart McGill and he learned it from the popular kettlebell expert & strength coach Pavel Tsatsouline.

As I was reading the book I also thought to myself that it makes a good overall strength training program for pullups and for progressing bodyweight exercises in general. I’ve often said bodyweight exercises can be quite effective but past a certain point you can only do so many reps of pushups & bodyweight squats before they quickly hit a point of diminishing returns.

            Overall I quite enjoyed the program and enjoyed reading it. I will definitely be taking a lot of these principles and applying them to my own training and that of the patients and clients that I work with.

The only two things I would have liked to have seen included in the program are

1) Some tips for fat loss for larger clients who may struggle to do pullups (or bodyweight exercises in general) due to their weight. Obviously being a bigger powerlifter I am biased.

2) Exercises and guidance for people who may lack the mobility to perform pullups (or any of the other exercises) properly.

I might be wrong – but I do feel the program is more intended for healthy people who are already working out and have a good base of fitness. Some of the exercises may not be recommended for people due to certain injuries and/or medical issues.

            All in all I think Meghan’s Pullup Program is one of the most well thought out and well written programs I’ve ever read and if you’re an avid gym goer who wants to improve your pullups I highly recommend it. The program is available at this link and will be available for a discount launch price until Friday at midnight. 

What to look for in a personal trainer or strength coach

            At the start of every year many people make resolutions to lose weight, start exercising, and improve their health & lifestyle. Some people may hire a trainer or coach to help them with their exercise & nutrition routines.

            Spending the vast majority of my time in the physical therapy world I am quite often given the task of recommending good gyms/trainers to some of the people whom I work with.

            As someone who’s trained myself for a lot of years I believe having a knowledgeable trainer or coach can save you a lot of time & hassle. At the same time personal trainers aren’t regulated like doctors or physiotherapists are and as such it’s difficult to know who to trust.

            In this article I give you a (non-exhaustive) list of what you should look for in a trainer or strength coach before hiring. For the sake of not making this a long article I’m not including some of the more basic “common sense” ones such as trainers showing up on time, not texting on their phone, and being professional.

Disclaimer: Some may argue that trainers & strength coaches are different professions. I’m just overlapping them for simplicity purposes. I’m not including coaches of specific strength sports (i.e. powerlifting, olympic lifting, strongman) or coaches of physique sports (i.e. bodybuilding, bikini, figure) in this article.

With that out of the way here are some of the traits you should look for in a fitness professional…

1) They should ask you about your medical history

This is the biggest thing right here. If you go in for an initial session and your trainer doesn’t ask you about your medical history, your injury history and your medications than you should immediately ask for a refund and head out the door.

With the rise of obesity and other health conditions it’s more and more common that trainers encounter clients who have various medical conditions and are taking medications. Some medications and medical conditions require special adjustments to the exercise program to be done safely. If your trainer doesn’t ask you these questions they’re just playing with fire.

Side note: I may get flack for this but I believe that training diseased populations (i.e. heart disease, osteoporosis, cancer, hypertension) should be left to people who have the requisite training (i.e. CSEP – CEP, CSPS, Kin or Physical Therapy degree) AND have worked with these populations AND keep up to date on the research.

2) They should ask you what your goals are and tailor the program towards your goals

The fitness industry is full of trends ranging from aerobics to bodybuilding to functional movement to kettlebells to CrossFit to powerlifting. While these all have a time & a place when done and programmed correctly I’ve seen too many trainers force their goals and their philosophy on clients. Your trainer should ask you what your goals are. If you ask your trainer “how is this helping my achieve my goal” and the trainer doesn’t have an answer than that’s a problem.

Side note: sometimes to achieve specific goals your trainer/coach may ask you to do things that you may not like to achieve your goals. For example if your goal is to lose weight your coach may recommend reducing soda consumption.

3) They should give you an individualized program

The major principles of training – specificity (SAID), overload, and fatigue management apply to everyone and almost every training program will include some squatting, hip hinging, pushing, and pulling (short of any medical or injury issues). That said training still needs to be individualized in terms of training volume, training frequency, exercise technique and exercise selection.

Training needs to be individualized to provide the most effective program with the lowest risk of harm. Some people can’t do certain exercises properly or painfree. Some people are really deconditioned and won’t tolerate a lot of training volume right off the bat.

As such a trainer or coach should be able to develop a program that’s customized to your needs, not a cookiecutter program or even worse the exact workout that your coach uses for him/herself.

Along with this a trainer should be able to modify your program if you’re tired, sick, sore, get injured, have pain with a certain exercise etc. Your trainer should be asking you questions like “How do you feel today?”, “How did you feel after the last workout?”, and “Did you get a good sleep last night?”

4) When performing exercises the trainer should be walking around, observing from different angles and coaching you to perform the exercise effectively

One of the important lessons I learned from Stu McGill is to observe an exercise from all angles and put the work into coaching. A trainer should be doing the same – not just counting reps or cheerleading.

Side note: some exercises and some people require more coaching than others. If you’re doing a simple exercise (i.e. seated calf raise) and/or you’re someone with good body awareness than you may not need as much coaching as someone else doing a more advanced exercise.

5) Your workouts should be progressive and have a direction. They shouldn’t be random.

A concern that I have with some training plans is that the workouts are incredibly random from day to day and don’t have a planned direction. The training principle of SAID – Specific Adaptation to Imposed Demand and the principle of Directed Adaptation state that training needs to be geared in a specific direction to achieve a specific goal.

For instance fat loss training needs to be built around maintaining a calorie deficit and preserving (or potentially increasing in some cases) lean muscle mass.

In another example building strength in certain lifts requires low rep training (for the most part, not all the time) in those lifts to build neural efficiency & technique and also requires higher repetition training to build hypertrophy in the muscles that support those lifts.

As such workouts can (and should) have some variety in terms of set & rep ranges and exercises but they should all be tailored a specific goal. If your training consists of 3x15 one week, hitting a 1 rep max the next week, and doing 5x5 the next week than chances are your training is so random that you aren’t going to be able to spend enough time to achieve one goal.

Following with that your trainer should be tracking your workouts to make sure that you’re progressing appropriately.

6) Your trainer shouldn’t be basing the effectiveness of your workouts based on how much you puked or how tired you are.

A concern that I have with the popularity of extreme workouts is that people base their effectiveness off of how tired they are or whether they puke or not. I am of the belief that the occasional *ss-kicking session is OK as long as it’s done safely – but if you leave each workout super sore, in a pool of sweat, and/or feeling like you’re going to puke than you need to consider working with someone different.

I hope this article gives you an idea of what to look for when hiring (or referring to) a trainer or strength coach. If you are having a hard time finding one in your area message me on Facebook or at my email ericccbowman90@gmail.com and I’ll do my best to help you to find one.

What to look for in a rehab professional

            As a powerlifter (and hopefully soon to be CSCS) who works in the health & fitness industry I cringe whenever I see powerlifters & strength coaches asking other powerlifters and coaches for injury & rehab advice. Your coach may be great at preparing you for the platform but unless they went to PT/Chiro/RMT/ATC school and have a solid understanding of pain science & the evidence they likely aren’t the people you should be seeing.

            That said I see a lot of powerlifters, strength coaches, and athletes in general who are reluctant to see a rehab professional as they may doubt the professional’s ability. In addition some (not all) rehab professionals aren’t very knowledgeable when it comes to weight training or athletics. This can make it difficult to find a good professional to work with.

            The purpose of this article is to provide a (non-exhaustive) list of things to look for in a rehab professional.

1) They don’t run you through an assembly line

I understand that I will piss a few people off by saying this but <30 minute assessment times & 10 minute (or less) treatment times for patients are ridiculous. These bookings, in most (but not all) cases, fail to provide adequate time to adequately assess, reassess & treat patients.

Bottom line – you should be looking at clinics that provide 40-60 minutes per assessment and at least 15-20 minutes per visit.

2) They understand pain science and the biopsychosocial model

Many rehab professionals are educated in the postural-structural-biomechanical model of thinking. This model basically claims that all pain is due to postural, structural, and biomechanical faults. The problem with this theory is two fold.

First of all many of the “biomechanical” faults that therapists & chiros cite (e.g. trigger points, joints being out of place, upslips/downslips/rotated innominates, hypermobile/hypomobile segments) either can’t be reliably assessed and/or don’t correlate well with pain.

Secondly, through decades of research, we know that pain is more complex and can be influenced by biological, psychological, and sociological factors.

Bottom line – if you ask your therapist about the biopsychosocial model & pain science they should be able to give you a half decent answer as to what they are.

3) They should understand lifting and athletics

If you’re not an athlete or someone who lifts weights feel free to skip this part.

One of the gripes I hear about PTs & chiros from strength coaches, trainers and lifters is that many of them don’t understand lifting weights or athletics and are overly cautious with their restrictions. You hear this all the time. “Don’t squat it’s bad for your knees.” “Don’t deadlift it’s bad for your back.” “Use light weight and do lots of reps.” “You’ll never run again.” The list goes on and on.

Now I will be the first to say that certain injuries and certain medical conditions can make certain exercises unsafe. But working with a rehab professional who understands how to train effectively & safely and also understands athletics will give you the most bang for your buck.

Side note: Your therapist may not have done every single sport or activity that you do but they should at least understand the general demands of each activity.

4) They should give you a thorough assessment & ask you about your general health, not just your aches & pains

One major concern I have with some (again not all) rehab professionals is when they start doing manual therapy and other techniques without giving you a thorough assessment and asking about your medical history to rule out red flags.

Some medical conditions – such as cancer, rheumatoid arthritis, osteoporosis, and others can make manual therapy techniques (and certain modalities) unsafe. As such your PT/chiro/RMT/ATC whoever should be asking you about your general health & ruling out red flags to make sure treatments can be done safely.

Side note: Sometimes as a patient you may have to do things you don’t like – such as taking a temporary break from training, modifying your training volume, and/or doing rehab exercises to help get better. But, at the end of the day you should be able to ask your therapist “how is this helping me achieve my goals?”  

5) They should be good at communication

“People don’t care how much you know until they know how much you care.” – Attributed to many people

Communication is key. As a patient you should feel like your story is being listened to and that your therapist is working towards your needs & goals. I’ve heard it said, both in PT and doctor’s clinics, that patients have less than 15-23 seconds to speak before they get interrupted. In my practice I open (almost) every assessment with “tell me your story” and let them have the floor. I found this gave me more useful information and insight into their condition than anything else did. As Peter O’Sullivan said “you won’t remember tick boxes but you’ll never forget a patient’s story.”

6) They should be evidence based & value continuing education

This is a no-brainer. If your therapist doesn’t value continuing education and making themselves better chances are he/she is more likely in it for the money than to help you.

7) They shouldn’t make you dependent on passive treatments

I’m sure I’ll also get some flack for this one but here goes….

Patients like passive treatments (e.g. modalities, manual therapy). The patients don’t have to do anything and they provide a short term (often placebo) benefit. While the odd modality is supported for the odd condition and manual therapy does have a place – if a therapist doesn’t give you some active methods to manage your pain (be it exercise, education, or both) that is problematic.

Side note: during my time in clinical practice I had times where I had to solely passive treat certain patients as they were in such pain they couldn’t tolerate much (if any) volume of exercise. But I made it known to the patients that this was a temporary thing.

I hope this article gives you some insight for choosing a therapist. If you have trouble finding a therapist email me at ericccbowman90@gmail.com and I’ll see what I can do. Tune in next week for “What to look for in a fitness professional.” 

A Review of Core Stability Training in Rehab: Facts, Fallacies and Future Directions

Updated May 5, 2018

               Over the last two decades one of the most popular forms of exercise in the health and fitness industry is core stability training. While the fad is slowly starting to die off a bit you can still go to many PT clinics or gyms and see people being told to pull their bellybutton in when doing exercises.

                I’ll confess, as a former student and current friend of McGill’s, the whole core stability concept (particularly the TVA/MF focus) has been a big thorn in my side for many years.

                So where did this start? Where did we go wrong? That’s what I will explain in this article.

                Before we get started I’d like to provide a definition of stability as stability means different things according to different people. The term stability has many meanings attached to it including control of movement, balance, stiffness or absence of movement, or structural stability. Webster’s definition of stability is

“ 1:  the quality, state, or degree of being stable: as

•       a :  the strength to stand or endure :  firmness

•       b :  the property of a body that causes it when disturbed from a condition of equilibrium or steady motion to develop forces or moments that restore the original condition

•       c :  resistance to chemical change or to physical disintegration”

ORIGINS OF CORE STABILITY – PANJABI

In the early 1990s a researcher named Panjabi first defined the concept of the neutral zone as “A region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column^1,2.”

Panjabi proposed that a smaller neutral zone meant a joint was more stable. Panjabi recognized 3 contributors to spinal stability….

•       Active subsystem: Spinal muscles

•       Passive subsystem: Spinal column

•       Control subsystem: Neural^1,2

THE RESEARCH FROM AUSTRALIA ON THE INNER CORE

                In the mid to late 1990s Paul Hodges, Carolyn Richardson and other researchers compared people with and without low back pain (LBP) to see how fast their core muscles activate in response to various arm and leg movements. What they found was that the transverse abdominnis (TVA) and multifidus (MF) were slower to activate in people with LBP compared to people without LBP. No other muscles were activated differently between groups³.

                These studies created the idea that there is an inner core consisting of TVA, MF and the pelvic floor that contracts independently of the outer core. TVA was thought to increase spinal stability through its attachment to the thoracolumbar fascia. Drawing in or abdominal hollowing co-contracts the TVA and MF and increases intra-abdominal pressure³.

                A 1997 study by Peter O’Sullivan et al showed that core stability exercises improved outcomes in people with spondylolisthesis compared to GP care⁴. Hides et al showed that training the inner core decreased the risk of developing LBP⁵.

                As such it became believed that TVA and MF issues cause LBP, that everyone with LBP needs core stability exercises and that the inner core muscles are the most important muscles in spinal stability and low back health. Boom!! A new trend is born. Core stability exercises are still the most prescribed intervention for LBP.

What people who quote the research tend to miss is that Hodges et al’s research was cross sectional. As such we can’t tell if core muscle delays are a cause or consequence of pain. Pain can affect muscle activity and prospective research hasn’t found an association between baseline TVA function and LBP development⁶.

                In addition the average delay in muscle activation was 20-50 ms across studies which is negligible. Some researchers have questioned the legitimacy of measuring MF via surface EMG as there is potential for crosstalk from the erector spinae. In addition some research has shown activation delays in other core muscles in people with LBP⁷.

STUART MCGILL AND THE GLOBAL APPROACH

                In 2003 McGill et al measured the role of each muscle in spine stability and found that each muscle contributed fairly equally to spinal stability across various tasks⁸. His research also showed that drawing in decreased the activity of the outer core muscles and as such removed many stabilizing muscles from the equation⁹.

                By contrast bracing (or stiffening all of the muscles in your core) contracts all muscles and has been shown to increase TVA and MF activity, increase spinal stability, and increase ability to respond to perturbations when compared to drawing in⁹. A recent study found efficacy for bracing exercises in LBP¹⁰.

                Side note: some studies that claim to use bracing actually use hollowing or drawing-in.

                However, most tasks (including lifting up to 70 lbs) require 4-8% core muscle maximal voluntary contraction for sufficient spinal stability. This level of core muscle activity can be generated naturally and reflexively without bracing unless you have a spinal cord injury or other neurological condition⁹.  

                Bracing does increase compressive forces on the lumbar spine¹¹ and as such it may be appropriate for higher load tasks (ie heavy strength training) but it is “overkill” for day to day tasks.

PAIN SCIENCE AND THE BIOPSYCHOSOCIAL APPROACH

                Through the work of researchers such as Peter O’Sullivan, Kieran O’Sullivan and others we know of the link between psychosocial factors and LBP.

                A myriad of psychosocial factors are associated with the transition from acute to chronic LBP including stress, anxiety, depression, hypervigilance, fear avoidance, kinesiophobia, and catastrophizing^12,13.

                Some studies have also shown that some people with chronic low back pain have hyperactivity of their core muscles. The notion that the lumbar spine is unstable may cause these maladaptive beliefs and behaviours and may cause more focus on protection of the spine^12,13.

RECENT RESEARCH

                Studies in 2012 and 2014 have shown that core stability exercises were not superior to general exercise in improving outcomes^14,15. One important thing to note is that the general exercise protocols in many studies often included general core exercises (ie planks, birddogs etc). A study in 2017 showed core stability exercises provided better outcomes at 3 months compared to general exercise but no measures were made at 6 & 12 months and a 2018 review showed that core stability exercises were more effective than general exercises ^16,18.

                A 2013 systematic review found no correlation between changes in TVA and MF activation and clinical outcomes in people with LBP⁶. A 2017 paper showed that spinal stability in people with back pain didn’t significantly change after performing a motor control program or a general exercise program¹⁷.

PRACTICAL IMPLICATIONS

                Core exercises by themselves are not necessarily evil – it just depends on how they’re marketed. If they’re used as a means of movement and exercise that’s tolerated by the individual (assuming they are well tolerated) than that’s OK. If you say “you need to get your core working to keep your spine stable” you are more than likely delivering a nocebo effect.

                Drawing in in isolation (i.e. when lying on your back & lifting your legs/arms up) is OK but isn’t advisable when doing advanced core exercises, heavy lifting, or balance exercises.

To summarize this long article

•       Core muscle activity can be altered in people with LBP but it’s relevance to spine stability and LBP is questionable

•       The TVA and MF aren’t any more important to core stability than any other muscles

•       Exercises designed to focus on the TVA and MF haven’t produced any more favourable outcomes in LBP than general exercise

•       Doing draw-in exercises in isolation is OK but drawing in shouldn’t be used when doing advanced core exercises, lifting, or balance exercises

•       Bracing is appropriate when extra stability is needed (ie lifting heavy loads) but shouldn’t be used for day to day tasks

•       The belief that “your spine is unstable” may (in theory) cause issues like fear avoidance, hypervigilance and guarding which are associated with chronic LBP

References

1.          Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5(4):383-389; discussion 397. http://www.ncbi.nlm.nih.gov/pubmed/1490034. Accessed September 27, 2017.

2.          Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992;5(4):390-396; discussion 397. http://www.ncbi.nlm.nih.gov/pubmed/1490035. Accessed September 27, 2017.

3.          Hodges PW. Is there a role for transversus abdominis in lumbo-pelvic stability? Man Ther. 1999;4(2):74-86. doi:10.1054/math.1999.0169.

4.          O’Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine (Phila Pa 1976). 1997;22(24):2959-2967. http://www.ncbi.nlm.nih.gov/pubmed/9431633. Accessed September 27, 2017.

5.          Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine (Phila Pa 1976). 2001;26(11):E243-248. http://www.ncbi.nlm.nih.gov/pubmed/11389408. Accessed May 27, 2017.

6.          Wong AYL, Parent EC, Funabashi M, Kawchuk GN. Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to nonspecific low back pain? A systematic review. J Pain. 2014;15(4):377.e1-35. doi:10.1016/j.jpain.2013.10.008.

7.          McGill S. Ultimate Back Fitness and Performance (6th Edition-2017) - Backfitpro. 6th ed. BackFitPro Inc.; 2017. http://www.backfitpro.com/books/ultimate-back-fitness-and-performance-6th-edition-2017/. Accessed September 27, 2017.

8.          McGill SM, Grenier S, Kavcic N, Cholewicki J. Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol. 2003;13(4):353-359. http://www.ncbi.nlm.nih.gov/pubmed/12832165. Accessed September 27, 2017.

9.          Grenier SG, McGill SM. Quantification of lumbar stability by using 2 different abdominal activation strategies. Arch Phys Med Rehabil. 2007;88(1):54-62. doi:10.1016/j.apmr.2006.10.014.

10.        Aleksiev AR. Ten-Year Follow-up of Strengthening Versus Flexibility Exercises With or Without Abdominal Bracing in Recurrent Low Back Pain. Spine (Phila Pa 1976). 2014;39(13):997-1003. doi:10.1097/BRS.0000000000000338.

11.        McGill SM. Low Back Disorders: The Scientific Foundation for Prevention and Rehabilitation. Champaign, IL: Human Kinetics; 2002.

12.        O’Sullivan P. Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Man Ther. 2005;10(4):242-255. doi:10.1016/j.math.2005.07.001.

13.        O’Sullivan P. Common misconceptions about back pain in sport: Tiger Woods’ case brings five fundamental questions into sharp focus. Br J Sports Med. 2015;49(14):905-907. doi:10.1136/bjsports-2014-094542.

14.        Wang X-Q, Zheng J-J, Yu Z-W, et al. A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain. Eldabe S, ed. PLoS One. 2012;7(12):e52082. doi:10.1371/journal.pone.0052082.

15.        Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2014;15(1):416. doi:10.1186/1471-2474-15-416.

16.        Coulombe BJ, Games KE, Neil ER, Eberman LE. Core Stability Exercise Versus General Exercise for Chronic Low Back Pain. J Athl Train. 2017;52(1):71-72. doi:10.4085/1062-6050-51.11.16.

17.        Shamsi M, Sarrafzadeh J, Jamshidi A, Arjmand N, Ghezelbash F. Comparison of spinal stability following motor control and general exercises in nonspecific chronic low back pain patients. Clin Biomech. 2017;48:42-48. doi:10.1016/j.clinbiomech.2017.07.006.
18.       Gomes-Neto M, Lopes JM, Conceição CS, Araujo A, Brasileiro A, Sousa C, Carvalho VO, Arcanjo FL. Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis. Phys Ther Sport. 2017 Jan;23:136-142. doi: 10.1016/j.ptsp.2016.08.004. Epub 2016 Aug 18.