Sunday, October 22, 2017

SS Turns 8!

Our clinic celebrated our 8th anniversary yesterday. A big thank you to all our families, staff, friends and patients for all your support all this while. We wouldn't have done it without all of you.

Our goal has remained the same all this while. To make our patients better quicker. "As long as we're happy and enjoy treating our patients, it's not really work."

Here's to many more years to come!

Monday, October 16, 2017

Hamstring/ Calf Pain? Treat Your Back

Now here's a nasty hamstring injury
I was looking through some of our past articles in our Physio Solutions blog and came across this article on how treating the lower back helps with hamstring injuries.

Here's a good reason why this is so. This article written way back in 2004 addressed the issue of hamstring and calf strains in older footballers in particular (but can also be in runners, triathletes etc).

I came across many of Dr John Orchard's articles back when I was doing my post graduate physiotherapy studies in 2003. This particular article suggested that a possible mechanism of higher occurrences of hamstring/ calf strains in older athletes may be due to your lumbar spine (or lower back) issues.
See where L5 nerve root is, (disc is next to it in white)
He suggested that the L5/ S1 neve root segment may be more prone to irritation and compression under the lumbosacral ligament due to disc degenerative changes. Dr Orchard notes that the L5 nerve root has the "most tortured path through the lumbosacral canal" before going over the sacrum to join the sacral plexus (or nerve roots).
The lumbosacral ligament further lessens the L5 space 

He suggested that it is likely that the location of a larger lumbosacral ligament is clinically more significant in older athletes due to degenerative disc changes (or slipped discs).

Due to possible L5 nerve root entrapment, some older athletes may have regular hamstring/ calf  and nerve muscle and tendon injuries. This happens when the L5/ S1 segment loses disc height (due to a slipped disc).

Space for the L5 nerve root is thus reduced (under the lumbosacral ligament) and may cause back pain and/ or hamstring and calf muscle/ tendon injuries.

So now you know why we treat your lower back when you have a hamstring or calf injury, especially when treating just the hamstring or calf doesn't improve your condition.

This is especially so when you saw from last week's post on how the hamstrings are closely related to the thoracolumbar fascia.


Orchard JW, Farhart P et al (2004). Lumbar Spine Region Pathology And Hamstring And Calf Injuries In Athletes: Is There A Connection? BJSM. 38(4): 502-504.

Sunday, October 8, 2017

How Your Hips Are Connected To Your Shoulders

Yes, our shoulders are connected to our hips! Definitely if you refer to work done by Tom Myers in his Anatomy Trains book.

If you look at the picture above, you can see that the right hamstrings through its fascial attachments are linked to the buttocks then through the thoracolumbar fascia across to the opposite (left) rib cage, shoulder and arm.

If I say it simply, it means your hamstrings actually attach to your arms! Or if I put it in a different way, your arms don't end at your arms. They end at your legs.

Another look at the connection
So supposing you have a rotated/ and or unstable pelvis (or hip), this can affect your shoulder and change the biomechanics in your shoulders and cause pain.

So in order to treat your shoulder pain, I'm not really crazy if I assess your hips before I look at your shoulder.

Just ask Bertrand, without really assessing his shoulder pain, I made his shoulder better just by taping his hip. 

Now when you come and see us in our clinics, you know why we look at your hips first if you have shoulder pain.

Saturday, September 30, 2017

How To Prevent Fading In Your Next Marathon

Rachel showing her exaggerated "float" phase of the run
You were running really well in your key marathon. You've trained very well, started conservatively despite feeling great hoping to have a strong negative split. You've hit all your target times at each 5 km split that you've written down on your hand.

To your greatest horror, you start to tire in the final miles of the race. Your dreams of a personal best begin to fade too.

What was the fade due to? Was it dehydration? High core temperature or low blood sugar? Apparently, none of the usual suspects according to a paper that studied 40 marathon runners immediately before a race and within three minutes of them finishing the race.

The best predictor of the runners fading was in fact muscle damage.

With each stride you run, your quadriceps and calf muscles contract "eccentrically" (lengthen instead of shorten). The muscles shorten when you push off, but they lengthen whilst you are in mid air in the double swing (or floating phase). See picture below.

This causes an accumulation of microscopic damage to your muscles. It's this eccentric contraction that causes delayed onset of muscle soreness (or DOMs).

The above mentioned study of the marathon runners showed that the eccentric contractions can literally hobble you during the race. Runners whose pace dropped more than 15 percent from the beginning to the end of the race had levels of creatine kinase and myoglobin (both are by products of muscle damage measured in blood tests) 53 and 112 percent higher than the runners who managed to maintain a steadier pace.

When I read the paper, my first thoughts was that the runners who faded did not train enough as those who didn't. However, the researchers suggested that age, running experience and training were not significant enough to explain the differences.

The authors suggested three ways to prevent fading in your next marathon.

Doing your long run close to your target marathon pace is crucial to get your muscles stronger. A 30 km run at or close to your target race pace three to four weeks before to simulate the effort will lessen the chance of muscle damage in the race.

Due to the "repeated bout effect", it will be harder to trigger as much muscle damage once they have recovered. You will need to run harder or faster to trigger similar damage.

The second way to increase your ability to withstand eccentric muscle damage is with weight (or resistance) training. Eccentric lunges and squats of at least 80 percent of the heaviest weight you can lift will help prevent damage to your muscles. Do the weight training twice a week during your training cycle and cut back to once a week when you are tapering for the race.

Be sure to practice downhill running if your race has downhill sections. Running downhill causes lots of eccentric contractions, a sure fire way of triggering muscle damage. Experiment with your stride to find the best way of descending as lightly as possible to minimize the muscle damage.


Del Coso J, Fernandez De Velasco D et al (2013). Running Pace Decrease During A Marathon Is Positively Related To Blood Markers Of Muscle Damage. PLoS One. 8(2): e57602. DOI: 10/1371/journal.pone.0057602.

Saturday, September 23, 2017

FFTT - Floss Band, Foam Roller, Trigger Ball And Taping

Underwrap? To explain fascia?
It's been a few months since we had our last floss band course. i was told by Jane we had eight previous courses so far.

After the last course Jane mentioned to me that many people have asked about the benefits and especially differences between using the Floss band, foam roller, trigger ball and taping.

She told me my new task was to effectively address how FFTT - floss band, foam roller, trigger ball and taping can be effective (or not depending on how you use them) in treating myofascial pain, addressing adhesion/ knots in fascia and improving range of motion.

Talking about fascia
We spent lots of time on the anatomy of fascia. After explaining how to effectively move fascia, we went on to the practical part of the course. Demonstrations using the floss band, foam roller, trigger ball were shown.
Marc helping with the foam roller demo
For the taping bit, I just showed the class pictures. You've got to come to our Kinesio Taping course if you want to learn the taping techniques.

Let me also mentioned that other than Kinesio TapingFunctional Fascial Taping (or FFT) using rigid sports tape too can influence fascia.

Functional fascial taping for the knee
Ron Alexander who used to treat the Australian Ballet dancers developed the technique while working with the ballet dancers.  If you've attended the course, you will know how much you need to "gather" or pull the tape. In Kinesio Taping, the ability of the Kinesio tape to recoil does the work for you.

Once again, chapeau to Jane, Danny and Ekina for coming to get the place ready and for helping me to pack up too. I wouldn't have gotten ready in time to teach without their help. Please contact them at Sanctband Singapore if you are keen to find out more.

Thank you also all the physiotherapy students, physiotherapists, Terrance Yap from Atlas Chiropractic, the teachers from Nanyang Junior College and the rest who attended the course today. Hope you found it useful.
Getting Tang from NYJC to march
The physiotherapy students and their discussion
Gek Han deep in thought
Gurmit comfy on the floor

Friday, September 22, 2017

KInesio Taping For F45 Trainers

Demonstrating how it's done
By special request, our clinic organized a special "Introduction to Kinesio Taping" session for F45 trainers from Holland Village and Novena.

The trainers from both F45 have had their fair share of injuries and have some basic knowledge of taping. They were very keen on the session and thought it would be great to get some pointers.
Explaining "recoil"
Of course the session touched on understanding concepts rather than just dishing out recipes on how to tape. That's always how we organize these sessions and the actual Kinesio Taping Level 1-2 courses.

Please contact us if you're interested to learn more.

Saturday, September 16, 2017

Today's Straits Times Article On Hydration

Straits Times article 160917 page C13 under Sport section
Every morning when I pick up the newspapers, I'll usually turn to the sports section first. Today, I happened to look at the article on the training plan for those planning to run the Singapore marathon at the end of the year. "Right hydration integral to a successful race". I thought the article was well written. Fairly straight forward and simple to understand. Also mentioned that over drinking water can lead to hyponatremia.

Wrote about about sports drinks. Though you need to know that sports drinks cannot replace or even maintain your sodium levels during exercise or racing.

Just wanted to point out that the two percent loss of body weight (through sweating) during endurance exercise/ racing affecting your performance may not be totally accurate.

I wrote about it before earlier in the year that latest published research suggest that current hydration guidelines may well be wrong.

Two published studies on cyclists and elite male marathoners (including Haile Gabreselassie during 13 major city marathons) showed that weight loss up to three percent did not slow the runners down nor decreased the cyclist's power output.

In fact Gabreselassie lost 9.8 percent of his body weight during the 2009 Dubai marathon and still won the race in 2:05:29 hours! All drinking by the elite runners were ad libitm (or at their own time and pleasure).

Yes I do agree that the quoted study was done on elite runners. How does that apply to us in super humid and sunny Singapore?

My own thoughts are that the sports drink companies definitely recommend us to drink to much. I wrote before that I definitely drink less than my fellow team mates and competitors. From the time I started running cross country as a twelve year old kid to when I was racing triathlons. Even now during my weekly group bike ride. Most of the other cyclists carry two or more water bottles while I survive the three hour ride on one.

In fact I often had a side stitch after drinking while running cross country as a kid. That also deterred me from drinking too much then.

Of course this does not mean you try not to drink at all in your next long run/ ride and especially your next race. What I'm suggesting is that you at least give it a try in your next few long bike or run sessions.  Everyone is different. Try to get through those long sessions drinking as little as you can. You might be pleasantly surprised that you may not need as much fluid as you think.


Beis LY, Wright-Whyte M, et al (2012). Drinking Behaviours Of Elite Male Runners During Marathon Competition. Clin J Sport Med. 22(3): 254-261. DOI: 10.1097/JSM.0b013e31824a55d7.

Wall BA, Watson G et al (2015). Current Hydration Guidelines Are Erroneus: Dehydration Does Not Impair Performance In The Heat. BJSM. 49(16): 1077-1083.