Tuesday, May 3, 2016

Too Much Lactic Acid Causes "Crystals" To Form In Your Muscles?

*What a load of  sh--!
One of my massage therapist asked me today if it's true that with too much exercise, lactic acid can form crystals in your muscles? His friend had been been told by a massage therapist that "crystals" can form in his muscles with too much running and no sports massage to "break the crystals."

This is the 3rd time in two weeks someone asked about this. The first two were my patients.

Apparently they had gone to this particular massage place and were told by the massage therapist there that if "the crystals" in the muscles were not "broken up" it's bad for them and they can't run well. The massage therapist(s) then WhatsApp their patients an article to read.

Now I find this really ludicrous to say the least. I've addressed this issue before. Massage does not flush lactic acid from your muscles.

Any textbook on Exercise Physiology (or you can check online) will explain that you can only accumulate lactic acid in your muscles during intense exercise (e.g. while racing or running intervals). As there is not enough oxygen available, a substance called lactate is formed. Our bodies then try to convert this lactate to energy without using oxygen.

However, this lactate or lactic acid can build up faster in your bloodstream than you can use it. The point where lactic acid starts to build up is called the "lactate threshold." So if you run just below your lactate threshold you won't fill the "burn" in your muscles.

That is what interval training is all about - trying the raise your lactate threshold so you can run at your race pace longer without incurring oxygen debt (or that burning sensation in your muscles).

This "burn" you feel is temporary. Once you slow down and/ or stop exercise, your body can then easily convert the lactic acid to energy. After a short while there isn't any more lactic acid in your muscles. The "burning" sensation in your muscles happen only during intense exercise.

The soreness you sometimes feel in your muscles a day or two (especially if you've pushed too hard) isn't from the lactic acid accumulation in your muscles. It's most likely delayed onset of muscle soreness or DOMs.

Back to my conversation with my colleague. He then said that his friend said that after a massage session there "to break his crystals" he normally can't run for three days! That's how sore he got. More likely how brutal or how heavy handed the massage therapist was.

When I was still racing, I get sports massage done so I can train/ run long and hard the next day and the day after and after. That's what the sports massage is supposed to do. Helping me to recover better so I can run long and run hard every day if possible. As an athlete, that's what I want to do. If I have to rest three days after a sports massage how do I get my training done?

So be very wary if your massage therapist or even physiotherapist tells you that that you need to "get your crystals broken" or that you need to flush the lactic acid out of your muscles.

*Thanks to my patient for forwarding the article to me.

Saturday, April 30, 2016

Full House Today (Again)

Full house ....waiting to start
I didn't expect the Flossing course to be full today as earlier in the week Jane told me that there were still vacancies and asked if I could share the brochure on our clinic's Facebook page.

But it was filled just like the course two weeks ago and we even had families and friends of course attendees dropping by.

Explaining how it works
Hey whose bones are these?
Time to demo
Amy, Jane and Danny Sanctband were early as usual setting up the place while I was still seeing patients, a big thank you to them.

Next course will be on 14/5/16, please contact Sanctband Singapore to sign up.

Calm before the start

Thursday, April 21, 2016

Your Running Style Definitely Changes When You're Tired

Picture by richseow from Flickr
"I'm a fore/ mid foot runner, I don't land on my heels etc". I often get responses like this from my patients who are runners when I ask them if they have changed their running style recently.

To which I will reply, "How about when you're tired?"

I remember when I was still racing triathlons the official race photographer will email pictures of the race and I'll be quite amazed by the transformation. Often the smooth stride at the start of the run is often reduced to a not so pretty shuffle near the end of the race - (exception is when I'm sprinting or trying to out sprint another competitor at the end).

Is that the same for you as well? Well, I looked through pictures of my school boy track races I used to run, my stride looked pretty good all the way, but that's for track races (which are much shorter) and many moons ago (I was much younger then).

Most research so far has focused on fresh (and not fatigued) runners usually on a treadmill. Not much use then when your running style tend to fall to pieces when you get tired.

Well, I'm not the only person wondering if you running stride changes when you're tired. A small group of 14 habitual forefoot runners who typically ran about 30 miles (48 km) a week were studied. They ran to exhaustion (average of 15 minutes) while researchers took detailed measurements of their stride at both the start and end of the run.

There were significant changes even after only 15 minutes. Eight out of the 14 runners studied were landing farther back toward their heels by the end of the run. The ankles and knees were more flexed during the gait cycle suggesting that this may give a little more shock absorption when the ankle and calf muscles get too tired to provide sufficient shock absorption.

This shows that our running stride gradually changes as we fatigue, regardless of whether you start off heel striking, mid foot or forefoot striking.

Hence the authors suggest this can be a problem running in minimalist/ barefoot inspired type running shoes as your muscles fatigue during a long race and your land on your heels without sufficient cushioning. I've previously written that will reduce overall impact forces

You can of course gradually increase your mileage in your minimalist/ barefoot inspired type running shoes to increase your strength and build up fatigue resistance as I've previously written that your own muscles and tendons and a good running technique will reduce overall impact forces.


Jewell C, Boyer KA and Hamil J (2016). Do Footfall Patterns In Forefoot Runners Change Over An Exhaustive Run? J Sports Sciences. 22: 1-7. DOI: 10.1080/02640414.2016.1156726.

Saturday, April 16, 2016

The Flossing Technique At Sports Solutions

All ears
After seeing patients in the morning and the early afternoon, I had > 30 minutes to get ready to teach others how to use the Floss bands. Fortunately, Amy, Danny and Jane from Sanctband arrived very early to get ready. Chapeau to them.

After explaining how the bands work, it was time to floss.

Putting to practice what they learnt
We had 20 people who came today. The course is organized by Sanctband Singapore and held at Sports Solutions. The next course is in 2 weeks. Please contact Sanctband  if you're keen to attend.

Concentrating ....
A big thank you to Amy, Danny and Jane today.

Tuesday, April 5, 2016

Exercise Is Not The Path To Strong Bones

This recently published New York Times article  definitely caught my attention. The author writes that "exercise is not the path to strong bones." In fact the author says that "exercise has little or no effect on bone strength."

The author then proceeds to discuss studies that showed increased bone density in subjects as a response to jump and weight training. However she wrote that "those studies failed to find anything more than a minuscule exercise effect - on the order of 1 percent or less, which is too small to be clinically significant."

So of course I went to look at the article she mentioned and it turns out I had written about that published study last year.

I looked up the article again. Here are my thoughts.

Consider that we reach peak bone mass at the end of puberty after which the normal course of ageing involves a steady loss of bone that is almost impossible to stop or prevent. This makes the 1 percent pretty important in my opinion. If you consider a decade or a lifetime of 1 percent effect instead of a single year, now that would be truly significant.

Hence when we treat patients with osteoporosis or patients who are osteopenic, just maintaining or slowing the loss of their bone mass is considered successful. Especially when this translates to a lower fracture risk.

What I also got from another article is that our bones do not get strong only because of weight bearing exercise. Two other important factors are jarring impacts and resistance training. Both make a big difference to the hip and spine - specific areas where bone density is most vulnerable.

Well, if you're a runner you can rejoice then since runners get repeated jarring impacts with each step you run. Turns out the authors found that runners have similar bone density to strength trained subjects, Cyclists have lower bone density since they not have have jarring impacts and if they do not strength train.

So don't stop running, strength training or your weight bearing exercises.


Hinton PS, Nigh P et al (2015). Effectiveness Of Resistance Training Or Jumping-exercise To Increase Bone Mineral Density in Men With Low Bone Mass: A 12-month Randomized, Clinical Trial. Bone. 79: 203-212. DOI: 10.1016/j.bone.2015.06.008.

Rector RS, Rogers R, Reubel M, Widzer MO and Hinton PS (2009). Lean Body Mass And Weight-bearing ActivityIn The Prediction Of Bone Mineral Density In Physically active Men. J Strength Cond Res. 23(2): 427-435. DOI: 10.1519/JSC.0b013e31819420e1.

Friday, April 1, 2016

Pepsi Light Dumbell?

Taken online with my Iphone 6 from AlmapBBDO
If you're thinking April Fool's you are absolutely correct.

The picture was circulated by an ad agency (AlmapBBDO) in Brazil. Turns out the bottle isn't real and there are no plans to create one according to a spokesperson from PepsiCo.

If PepsiCo eventually does manufacture the two litre dumbell lookalike bottle, it'll be a good advertisement for them but a nightmare for gym goers trying to lose weight. What I suggest is to fill the bottle with water or sand instead. Now that would be good for a workout.

Perhaps Gatorade (a brand owned by PepsiCo) would be more suitable to manufacture it.

Happy April Fool's Day.

Saturday, March 26, 2016

How Much HIIT Is Beneficial?

Picture by Irving Henson from The PIT
A young lady I spoke to in the clinic today told me she has been attending HIIT (or high intensity interval training) sessions recently and gotten injured. (HIIT involves alternating very intense bouts of exercise with low intensity recovery exercise. It can be done in the gym with weights or on the bike or running set times or distances).

Being on the slightly plump side, she was tempted by the many benefits promised by the trainer conducting the HIIT sessions and the fact that she could lose weight and become stronger quickly whilst spending little time training.

Sounds too good to be true?

Considerable evidence definitely exists to support a role for low volume HIIT as a potent and super time efficient training method for inducing both central (cardiovascular) and peripheral (skeletal muscle) adaptations that are linked to improved health outcomes (see references below).

HIIT is designed to briefly strain your body to its limits. And these short bursts of very intense exercise lead to beneficial physiological changes similar to those much longer duration workouts. How much or how little do you need is still debated.

Leading interval training researcher Professor Martin Gibala found that 30 seconds worth of sprint intervals (four to six repeats of all out efforts three times a week) in young active but trained males produced just as good results as endurance training (subjects rode continuously for 40-60 mins five times a week). This is also known as theWingate Test. The subjects generally hated the process though.

This is also known as the Wingate Test. I clearly remember doing this while I was a young physiotherapy student in our Exercise Physiology lessons. It's extremely demanding and may not be safe, tolerable or appealing for some individuals. Definitely not for the faint hearted.

With a less taxing program in which subjects did 60 seconds interval (HIIT) training at 90 % effort (10 reps), the subjects found it more bearable although they had to do more repetitions (10x) to get the same benefits as the 30 seconds all out effort (Gibala et al 2012).

Here's another workout that may be more palatable. Dr Gibala studied a group of obese/ overweight group of men and women on a program of 20 seconds of all out intervals followed by a recovery of two minutes.

They started with a 2 minute warm up on a stationary bike, followed by 3 x 20 seconds of all out sprints with two minutes recovery followed by a three minute cool down. A grand total of three minutes of intense work per week within a total training time of 30 minutes. Results were very encouraging as he subjects become fitter and improved their health (their VO2 max increased by 12%).

And if you find even 20 seconds of all out effort too difficult, there's the 30-20-10 workout which "only" requires 10 seconds of sprinting.

My take? Clearly, despite its many benefits, HIIT is not suitable for everyone, especially if you're just starting on an exercise program. As I've written before, we live in an instantaneous society now where we want results at the snap of a finger. Train don't strain is still important, or you risk a visit to your physiotherapist or doctor soon.


Burgomaster KA, Howarth KR et al (2008). Similar Metabolic Adaptations During Exercise After Low Volume Sprint Interval And Traditional Endurance Training in Humans. J Physiol. 586(1): 151-160.

Gibala MJ, Little JP et al (2012). Physiological adaptations To Low-volume, High-intensity Interval Training In Health And Disease. J Physiol. 590(5): 1077-1084. DOI: 10.1113/physiol.2011.224725

Gillen JB, Percival ME et al (2014). Three Minutes of All-out Intermittent Exercise Per Week Increases Skeletal Muscle Oxidative Capacity And Improves Cardiometabolic Health. PlosONe. DOI: 10.1371/journal.pone.0111489.