Out (left) versus in (right) |
Sunday, March 17, 2024
Knees Out Or Knees In When You Squat?
Sunday, March 10, 2024
The Most Efficient Way to Run (According To Science)
It's a long review paper, key findings in the pictures attached. Let me highlight some of the important points. The paper does lend some support for increasing your cadence or step rate to improve running economy as this increases leg stiffness and reduces vertical oscillation. When you watch some runners run, you can see that they tend to 'bounce' up and down while running, that is vertical oscillation.
Initial Contact |
Mid stance |
During Mid Stance phase, decreased trunk flexion and reduced vertical oscillation may be associated with improved running economy. Increased vertical and leg stiffness may also be associated with lower energy cost.
Toe off |
At the Toe Off phase, if trunk flexion and ankle plantarflexion are reduced, running economy may be improved.
Those metioned above are just he key findings which I have summarised. However, there are many more details and applications in the paper itself. You can read the free paper here.
I have previously written before on running cadence and running form if you wish to read further.
Reference
Van Hooren B, Jukic I, Cox M et al (2024). The Relationship Betwen Running Biomechanics And Runnng Economy : A Systematic Review And Meta-Analysis Of Observational Studies. Sports Med. DOI: 10.1007/s40279-024-01997-3
Summary |
Can Your Sports Bra Restrict Your Breathing?
Sunday, March 3, 2024
What Time Do You Eat Dinner?
Picture from Yahoo |
I do not know for sure what time most Singaporeans have dinner, but 3 in 5 Americans normally have dinner after 9 pm (Farsijani et al, 2023).
Our bodies are much better at digesting and processing nutrients during the day and powering down and resting at night. So eating close to bedtime can cause a whole range of issues. There are studies linking late night eating to heartburn while others demonstrate how it can affect your sleep quality. As you know, Singaporeans already do not have enough sleep.
There are also recent studies that link late night eating with increases in body weight and the risk of diabetes. When you limit your calorie intake 3 to 4 hours before bedtime, it can help with blood sugar control and weight management (Vujovic et al, 2022). This is likely linked to the circadian clock which reduces the energy we use after a meal in the evening.
Again in America, early dinners seem to gaining popularity among Americans of all ages. 5 pm is the fastest growing time slot for dinner reservations while bookings for 8 and 9 pm are falling.
Surprisingly, many Gen z-ers are embracing this early bird lifestyle. Americans between the ages of 15 to 34 are getting more sleep each night (9 hrs 12 mins) over the last decade if you look at data from the U.S. Bureau of Labor Statistics.
I am surprised to say that the youths (Americans at least) today are more well rested than I thought, possibly because these youths are ditching late night drinks in favor of . Less daily commuting in this era of remote work enables them to sleep in, while an increase in venture capital for sleep tech definitely helps too.
When you limit your calorie intake 3 to 4 hours before bedtime, it can help with blood sugar control and weight management (Vujovic et al, 2022). This is likely linked to the circadian clock which reduces the energy we use after a meal in the evening.
Eat early, sleep early that seems to be what the research is telling us to ensure good health .
References
Farsijani S, Mao Z, Cauley JA et al (2023). Comprehensive Assessment Of Chrononutrition Behavirs Among Nationally Representative Adults: Insights From National Health And Nutrition Examination Survey (NHANES) Data. Clin Nutri. 42(10): 1910-19-21. DOI: 10.1016:/j.clnu.2023.08.007
Vujovic N, Piron MJ, Qian J et al, (2022). Late Isocaloric Eating Increases Hunger, Decreases Energy Expenditure, And Modifies Metabolic Pathways In Adults With Overweight And Obesity. J Clin and Transl Report. 34(10): 1486-1498. DOI: 10.1016/j.cmet.2022.09.007
Sunday, February 25, 2024
Ulnar Nerve Entrapment
Left ulnar nerve |
The ulnar nerve arises from the brachial plexus at C8-T1 and travels down the inner part of the upper arm through the arcade of struthers (pictured below).
At the elbow, the ulnar nerve travels just behind the bony part on the inner part of the elbow. This is also know as the "funny bone" when you can get sensations of pins and needles after bumping the area.
Picture by Conor Jones |
The ulnar nerve supplies the sensation and muscles to the 5th and half the ring finger. Symptoms are related to degree of irritation of the nerve. They start off intermittent in nature and may only come on at night after the nerve has been stretched for a longer time.
Pins and needles, aching or tingling in the little and/ or ring finger will be the common symptoms. This is what my patient felt. If the irritation persists, the symptoms may become constant and progress to numbness in the 5th and/ or ring finger and ultimately weakness in the hand.
As the ulnar nerve exits the bony tunnel, it goes into the flexor carpi ulnaris muscle. Follwing that at the wrist, it travels superficially to the flexor retinaculum and passes into Guyon's canal.
R wrist |
Picture from Medical Art Library |
Knowing the exact site of nerve irritation during an accurate clinical examination will help decide what needs to be done for treatment. Some doctors send their patients to do a nerve conduction test, but I personally find that an upper limb tension test (with radial nerve bias) done correctly does a much better job. Others may do ultrasound imaging to help diagnosis. Do not confuse it with thoracic outlet syndrome.
Just remember not to have a steroid/ cortisone injection.
*Ulnar nerve entrapments are commonly seen in cyclists, golfers, weightlifters and construction workers.
References
Kong G, Brutus JP, Vo TT et al (2023). The Prevalence Of Double- And Multiple Crush Syndromes In Patients Surgically Treated For Peripheral Nerve Compression In The Upper Limb. Hand Surg Rehabil. 42(6): 475-481. DOI: 10.1016/j.hansur.2023.09.002
Raut P, Jones N, Raad M et al (2022). Common Peripheral Nerve Entrapments In The Upper Limb. Br J Hosp Med. 83(10): 1-11. DOI: 10.12968/hmed.2022.011
Sunday, February 18, 2024
Does Strength Training Help Runners Prevent Injuries?
Monday, February 12, 2024
Weak Core, Tight Hamstrings And Weak Glutes?
A patient came in this past week with low back pain and was told by another physiotherapist that she had a weak core, hamstrings and weak glutes and that was why her back hurts.
Now, I do not agree with that. Actually studies show that back extensor strength is more important than flexor (abdominal) strength when it comes to low back pain (Lee et al, 1999).
Like I wrote previously, the idea for the need of a strong core was first introduced by Paul Hodges (Hodges and Richardson, 1998) when he published his article on the Transverse Abdominis (TA) muscle. His research compared the timing of TA and Multifidus in people with low back pain (LBP) for 18 months or more against healthy subjects with no LBP.
Hodges suggested that the TA was likely to be the main cause of LBP as it is the most important and deepest muscle in the abdomen. It looks and works like a corset to stabilise the back.
This article made the allied healthcare/ fitness industry conclude that the TA was a trunk stabilising muscle that was very important to strengthen for those with LBP. Patients who had LBP had weaknesses in their TA which led to instability in the spine.
Similarly with 'tight' hamstrings (Halbertsma et al 2001) and weak glutes. This female patient of mine can deadlift 90 kg. Her glutes are not weak nor are her hamstrings tight.
You can put all those myths to rest. Your low back pain is not caused by a weak core, tight hamstrings nor weak glutes. Stengthening your back extensors will be a much better option than the previously mentioned.
References
Halbertsma JP, Goeken LN, Hof AL et al (2001). Extensibility And Stiffness Of The Hamstrings in Patients With Nonspecific Low Back Pain. Arch Phys Med Reh. 82(2): 232-238. DOI: 10.1053/apmr.2001.19876
Hodges PA and Richardson CA (1998). Delayed Postural Contraction Of Transversus Abdominis In Low Back Pain Associated With Movement Of The Lower Limb. J Sp Disorders. 11(1): 46-56.
Lee JH, Hoshino Y, Nakamura K et al (1999). Trunk Muscle Weakness As A Risk Factor For Low Back Pain. A 5-year Prospective Study. Spine (Phila Pa 1976). 24(1): 54-57. DOI 10.1097/00007632-199901010-00013