Monday, October 24, 2016

Arches And Orthotics

Picture from article Scientific Reports
I've often been asked by my patients about whether they need orthotics. The following article I read will explain some of the research behind orthotics on how they can affect your running rather than just my opinion.

Each time we land on our arches when we run, energy is stored in our arches. This is free energy that doesn't require anything to activate. The researchers wanted to measure wanted to find out specifically how much energy is lost if they restricted the arch with orthotics.
Orthotic that was used
The researchers made two types of custom orthotics. One completely blocked the arch from collapsing while the other allowed the arch to compress (or collapse) halfway. Only runners who did not use orthotics were recruited for their study. The runners ran on a force plate treadmill. The shoes had sensors inside which measured energy expenditure.

In order to have a baseline measurement, the runners ran in just the shoes (that were similar for all runners, pictured below) first followed by the same shoes at the same speed while testing the home made orthotics.

Picture from Scientific Reports

The runners tested the orthotics while walking as well as running.While walking, there was virtually no difference in energy expenditure. However, while running significant energy loss occurred.

In the orthotics that blocked all compression, researchers measured an energy cost of six percent (or less efficient by six percent) while the orthotics that allowed for 50 percent compression lost four percent.

Before you throw away your orthotics (if you're wearing them) the authors suggested don't throw them out yet as many runners get custom made insoles to prevent injury. They felt this is more important than saving energy without the orthotics. In fact the authors were very diplomatic and said that "We don't want to say orthotics are good or bad."

Likewise, if you are considering wearing orthotics (but may not need them), then maybe you shouldn't especially if you wanna run faster.


Stearne SM, McDonald KA et al (2016). The Foot's Arch And The Energetics Of Human Locomotion. Scientic Reports 6, Article number: 19403. DOI: 10.1038/srep1940.

Thursday, October 13, 2016

2 Pairs Of Under Armour Running Shoes

UA Charged Bandit 2 (L) and UA Speedform Slingshot (R)
My patient Marie came to our clinic last week to see me on how she was going with her training for the New York City marathon she was going to participate.

She had also brought along a few pairs of her running shoes to show me and we talked about running shoes for her race. The pair she'd chosen seemed rather heavy and clunky so I suggested the pair she was wearing then looked more suitable. She said that the UA Speedform Slingot she was wearing was more suitable for 5 km and below runs. She seemed a little hesitant about wearing them for the marathon as she thought she'll require more cushioning for the race.

She took them off and showed me and I actually tried them on and said that these are the kind of shoes I'd run with usually. I explained  why and then suggested she try them for a longer run. She then said she would try and get me a pair as she was sponsored by Under Armour.

So today Marie and Wilfred Mong, Brand Communications Manager from Under Armour came to our clinic and passed me 2 pairs of Under Armour shoes to try. The same pair Marie is now going to use for her New York City marathon the Speedform Slingshot and the Charged Bandit 2.

A big thank you to Marie and Wilfred.

Here's a closer look

Sunday, October 9, 2016

Can Exercise Be Good For Your Back Pain?

I never really had low back pain before, not before my accident anyway. It's a different story after my accident, although thankfully it's more of an ache occasionally than back pain now actually.

I seem to get back ache when I see too many patients in a row now. I used to be able to go through an entire day without needing a break. Now on a long day I often give myself two half hour breaks. In fact when I was started working again after my accident, my wife would schedule a 30 min break for me after I see four patients and made sure I rested. I started working two hours a day, three, then four and and so on. Now I usually won't see patients for longer than seven hours at a time.

I see patients 2 times a week at Physio Solutions now and often go without a break. I always take a bus there and run home when I'm done. Every single time my back is sore/ achy I still run because my back always feels better during and after the run.

You must be thinking, how can this be? Can exercise alleviate back pain?

Here's the strange thing, I was worried too when I first had back ache after seeing patients at Physio Solutions and was wondering if I should still run home. I ran anyway and within the first three minutes, my back started feeling better. Each time I had back ache and ran I had same result, my back always felt much better.

But I can't just tell my patients with low back ache/ pain to just go running, I have to be able to justify and explain why running (or other exercise) helps.

So I was rather pleased when I came across the following article (Belavy et al, 2016).

The authors wanted to understand what kinds if sports and exercise could be beneficial for the intervertebral disc (IVD) and they did a review on IVD adaptation with loading and exercise. They also examined the impact of specific sports on IVD degeneration in humans and acute exercise on disc size.

2 levels of the vertebrae and disc
Here's a summary of what the authors found.

Our human spine likes dynamic, axial loading at slow to moderate speeds. This means that loading forces that are performed regularly for longer time periods that are dynamic (not static) but not rapid and of a magnitude up to approximately those seen in jogging/ running are likely to result in positive adaptations to the IVDs.

High impact loads, explosive movements, extreme ranges of movement as well as sedentary behaviour, disuse and immobilisation are likely detrimental to the IVD.

Static or very rapid loads, magnitudes that are too low (e.g. lying) or too high (lifting in flexion) are not beneficial to your IVDs. Yes sitting is bad for you as I've written before and also too much bed rest.

The authors also mentioned that running and upright endurance sports are either beneficial or at least not detrimental to the IVD. However, sports like elite swimming, baseball, weightlifting, rowing and equestrian riding are more likely to lead to IVD degeneration.

I was very surprised to see elite swimming on the not beneficial list. During the tumble turns, loading direction and speed of loading will be in torsion and/ or extremes of range. Amateur swimming is more likely to be at the very least less detrimental to the IVDs, but it is unclear whether it will be beneficial for the IVDs.

Come talk to me if you need to find out more. I have a compression fracture in my L1 and a fractured skull after my bike accident.


Belavy D, Albracht K et al (2016). Can Exercise Positively Influence The Intervertebral Disc?Sports Med. 46:473-485. DOI:  10.1007/s40279-015-0444-2.

*Many thanks to Elizabeth Boey who got me the article. Email me if you want a copy of the article.

Sunday, October 2, 2016

The Benefits Of Exercising Before Breakfast

Picture by Evan Bench from Flickr
How many of you don't eat anything before you exercise first thing in the morning? While I was still actively training I never went training first thing in the morning on an empty stomach. Definitely wouldn't be able to finish the session.

I still try to ride close to three hours most Saturday mornings and still cannot imagine not eating anything before the ride too.

So I was pretty surprised when I read that the benefits of exercising in a fasted state (up to 90 mins in the study) will significantly reduce the chance of you putting on weight if you've been eating like there's no tomorrow.

A group of healthy young men were recruited by researchers for their six week study. They were fed a diet of 50 percent fat and 30 percent more calories than what they had been consuming overall. What's more, some of the men agreed not to exercise during the six weeks (this is the control group).

The rest of the subjects were assigned to two exercise groups. Both groups did the same identical, supervised exercise four times a week in the mornings.  They ran and cycled at a strenuous intensity. Two of the exercise sessions were 90 mins, two were 60 mins.

One of the exercise groups ate a hefty carbohydrate rich breakfast before exercise and continued to ingest carbohydrates (in the form of sports drinks) during the exercise.

The other exercise group fasted before exercising and drank only water during the exercise.The second group did make up by eating similar amounts to the first exercise group later in the morning.

After six weeks the group that did no exercise put on an average of six pounds. What was worse was they had developed insulin resistance - their muscles were no longer responding well to insulin and had difficulty getting glucose out of their bloodstream efficiently.

Extra fat was stored between their muscle cells too. This insulin resistance and muscles stored with fat are metabolically unhealthy conditions that can be precursors of diabetes.

The first exercise group also gained weight, half as much as the control (non exercise) group. They too had become more insulin- resistant and were storing fat in their muscles.

Only the second exercise group did not gain weight and showed no signs of insulin resistance. They burned fat that they ingested more efficiently too.

The authors suggested that exercise training is more effective if have haven't eaten before exercise compared to eating a carbohydrate rich breakfast to stimulate glucose tolerance if you are on a high fat, high calorie diet. They explained that exercising in a fasted state (usually possible before breakfast) encourages the body to burn a greater percentage of fat (instead of carbohydrates) for fuel during vigorous exercise. Since you are utilising fat, you will not store it in your muscles.

This fasting group also had increased levels of a muscle protein that helps with transporting glucose in the bloodstream thus helping to regulate insulin sensitivity.

Exercising in a fasted state helped fight the two bad effects of eating a high fat, high calorie diet. Plus it prevented them from gaining weight.

Before you proceed to embark on your training sessions on an empty stomach do take note of the following caveats. Fasting before your race definitely won't work. You run the risk of "hitting the wall" during your workout since carbohydrates are easier for muscles to utilise than fat while exercising. The benefits more not be similar if you exercise at a more leisurely pace and for less duration.

A good time to adopt such a practice to fast before exercise is probably during the upcoming festive season (yes, it's already October, the year has flown by) where you indulge in more fat and calories than anytime of the year. Bear in mind the researchers detected that only three days of a extremely high fat and high calorie diet can lead to increased blood sugar levels and insulin resistance, potentially increasing your risk for Type 2 diabetes.

Running on a treadmill or cycling on the stationary bike in the gym is definitely safer if you plan to ride more than the 90 minutes (done in the study). You definitely don't want to bonk and fall while riding outside.


Van Proeyen K, Szlufcik K et al (2010). Training In The Fasted State Improves Glucose Tolerance During Fat-rich Diet. J Physiol. 588(21): 4289-4301. DOI: 10.1113/jphysiol.2010.196493.

Saturday, September 24, 2016

Full Again Today For The Floss Band Course

Just about to start
After a break of over two months, Sports Solutions hosted the Floss band course again today. As you can see from the picture above we were really filled.

There were lots of physiotherapists in the class today (at least half of the whole group I was told) and I spent a bit more time explaining the rationale for using the Floss bands while not neglecting the members of the public who did not have a anatomy background.

After all the explanations it was time to start flossing.
Flossing the knee
Flossing Jialing's lumbar spine

Many thanks as usual to Amy, Danny and Jane for setting up the place again while I was still treating patients. They do such an excellent job organising the course, registering the participants, setting up the place, providing the Floss bands etc while I just show up and teach.

Please contact them at Sanctband Singapore if you wish to attend the course or get the Floss bands.

Friday, September 16, 2016

Earth Runners Huraches/ Running Sandals Review

My Earth runners huraches
More than a year ago Mike Dally, founder of Earth Runners contacted me and asked if I was keen to review a pair of his earth sandals. I wrote back and said that I would be most happy to try a pair and mentioned that I live in Singapore.

Mike simply wrote back and asked for my size and mailing address. I requested for the Alpha X-11 mm which was a bit thicker and were more moldable. Mike added he was sending me the conductive leather laces.

The sandals were "zero drop" (same thickness between heel and the forefoot). There was a strap between the big and second toe and buckle on the outside the secure the sandal.

What was interesting was that I noticed there was a copper grounding insert flushed with the Vibram outsole. I later read that they were there to offer electrical conductivity  (or earthing). This is to offer the primal experience of walking/ running grounded to the earth. You can read more about the concept of earthing here. The copper inserts did not bother me at all while walking or running.
Copper inserts
I've waited a long time to write this as I wanted to wear the sandals in a bit before commenting. Mike Dally told me to take my time as most of the reviewers feedback was the longer they'd worn the sandals the more comfy they feel.

I first wore them mostly at home for up to a couple of hours at a time. I found that the leather straps (even though they were very soft) tend to cut into my first web space between my big and second toe. I felt slightly more discomfort over the base of the second toe. Otherwise I had no issues at all with walking. The buckle at the side tightened without any difficulty at all.

I've began to wear them more recently as my older boy has been wanting to ride his bicycle. He can ride well but is afraid to stop as his feet can't touch the ground yet.

Lending a helping hand
So almost every single morning he's been asking to ride so I just wear my earth sandals with normal ankle socks and run alongside him steadying him when the need arises.

How does the sandal feel while running? If you've run in minimalist shoes, then you'll understand when I say they have a fair ground feel. They were nice to run in after you've broken them in and gotten used to them. They offer more than ample protection for the running that I do. If you have black toenails like me, then they will be very much appreciated since there's nothing for you to jam your toes against.

For the fashion conscious, hey look real cool with its raw genuine hurache appearance and you can wear them pretty much everywhere else.

Thanks Mike for a great pair of running sandals.

Sunday, September 11, 2016

Can Antihistamines Decrease Muscle Soreness?

I still shave/ wax my legs. Not as often as before, but I still try to keep them hair free.

Ever since my racing days, I've been making sure my legs are free of hair. Why is that so you should be asking?

In the event of a bike crash and the resulting abrasions, the wounds are easier to clean if there is no hair on the skin.  From time to time I need to take Clarityn (which is a relatively mild antihistamine) for my hives that result from the ingrown hair.
Easier to clean the wounds with no hair
I sometimes use Clarityn for mild allergies as well. Piriton (or chlorphenamine) is stronger, but it makes me very drowsy.

So I was surprised to read that taking a single dose of antihistamines can help lessen delayed onset of muscle soreness (or DOMs) after a hard workout.

After a hard workout, blood flow to your muscles remain elevated for a while. Histamines (part of your body's immune response) play a role in triggering this post exercise blood flow, which may be linked to inflammation and subsequent repair of muscle.

The researchers' aim was to investigate if blocking histamines with antihistamine medication would reduce post exercise blood flow, reduce inflammation and increase muscle damage and DOMs.

The subjects had to run downhill on a 10 percent grade for 45 minutes after taking the antihistamine medication (control group didn't take). Blood flow, inflammatory markers, pain sensitivity, perceived soreness and strength were measured for three days.

Results showed that blood flow to the legs was reduced by 29 percent an hour after exercise in the antihistamine group. There were however no differences in markers of inflammation.

Creatine kinase (used to determine muscle damage) levels were very different. This seems to supports the idea that blocking histamine receptors resulted in increased muscle damage.

The control group (didn't take medication) was 19.3 percent weaker the day after the hard workout compared to the group that took the antihistamines (7.8 percent weaker).

Before you rush to the nearest pharmacy to buy some Clarityn, do bear in mind that the results were a little more complex after you examine them closely.

This is very similar to what I wrote a few weeks earlier about the balance between recovery and adaptation.

The researchers themselves do not know exactly why this is so. It is possible that the antihistamine medication make you feel less pain and soreness (even if there was more damage in your muscles).

This makes antihistamines a double edged sword. They may make you more prone to muscle soreness even though you may not feel it.

If, however you want an edge to reduce next day soreness and strength loss when you have back to back races or games then taking antihistamines may help.

If you interfere with the recovery process to make yourself better soon (or recover faster), do you then risk delaying the repair or adaptation process? It is a short term versus long term trade off.


Ely MR, Romero SA et al (2016). A Single Dose Of Histamine-receptor Antagonists Prior To Downhill Alters Markers Of Muscle Damage Andd Delayed Onset Muscle Soreness. J Appl Physiol.
DOI: 10.1152/japplphysiol.00518.2016.