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.

Friday, September 2, 2016

Michael Phelps Does Cupping For Recovery. Should You?

You've seen the tell tale signs all over his back and shoulders during the Rio Olympics. Strange, dark purplish circular marks were seen on Michael Phelp's body.

These are the marks after cupping is done. Cupping (thought to be an ancient Chinese recovery technique) is supposed to help recovery and increase mobility.

Glass cups are put on the skin to create suction (using either heat or air), pulling the skin slightly up and away from the underlying muscles. The suction usually lasts only a few minutes, it then causes the capillaries just beneath the skin's surface to rupture. This causes the obvious eye-catching bruises that you see.

The Chinese practitioners believe this can balance the flow of Qi (energy) and blood to wherever it is stagnant or deficient due to soft tissue imbalances from over training or traumatic injuries.

You can expect to feel some mild discomfort (from the tugging of the skin) but it's mostly relaxing once you get used to it. Your skin may feel a little sensitive afterwards. The cupping can be repeated again after the marks from the previous session have dissipated, which usually take a few days.

There's no doubt many athletes, coaches and trainers believe in cupping for recovery even if there isn't any clear and convincing evidence that it is better than myofascial release, massage, taping or using your pressure ball/ foam roller. 

Even my dad believes in cupping. I remember helping my dad do cupping on his back at home as a teenager. I had to put glass cups after using a lighter to set fire to a piece of cotton ball that he'd soaked with some Chinese herbs. I definitely had no knowledge of what it was back then.

If you're looking for scientific proof for cupping, a meta-analysis of 135 controlled trials suggest that more research is needed although there appears to be no negative effects.

The athletes may be feeling better because of a placebo effect. Still, a placebo effect can be beneficial at the Olympic level as Michael Phelps will attest.

My dad? He comes to our clinic for treatment when needed now.


H Cao, X Li and J Liu (2012). An Updated Review Of The Efficacy Of Cupping Therapy. PLos One. 7(2): e31793. DOI: 10.1371/journal.pone.0031793.

Rozenfeld E and Kalichman L (2016). New Is The Well-forgotten Old: The Use Of Dry Cupping In Musculoskeletal Medicine. J Bodywork Mvt Therapies. 20(1): 173-178. DOI: 10.1016/j.jbmt2015.11.009.

Friday, August 26, 2016

Can Watermelon Juice Make You A Better Athlete?

You've read from our blogs about drinking coconut water, green juices, lemon water etc. I am sure that  when it comes to our health or getting a competitive edge, we are always eager to try something new but evidence-based.

Guess what I read in a recent article? L-citrulline supplementation appears to help VO2 max levels and high intensity exercise performances. In real food form, watermelons are the best natural sources of L-citrulline.

In the published study, ten cyclists were given either L-citrulline, L-arginine or placebo tablets over a period of three seven-day cycles. On day six and seven, the subjects completed a moderate and intense cycling test.

Only the subjects taking the L-citrulline tablets had improved their VO2 max, time to exhaustion and maximum power during a 60 second all out sprint. There were no changes in performance in the L-arginine or placebo group.

Now, before you run out and eat/ drink all the watermelons you can, here are some of my personal thoughts.

The sample size (10 athletes) in the study was relatively small. Recreational cyclists were used in the study so the results may be different in elite athletes. So great news if you're a recreational athlete.

For elite athletes however, probably you may want to wait for more studies to be replicated to make sure the results are valid.

The subjects in the study were given L-citrulline tablets. You'll need to drink about 2.5 litres of watermelon juice to get the same dose of L-citrulline used in this study. And probably have to go the the toilet pretty soon after.


Bailey SJ, Blackwell JR et al (2015). L-citrulline Supplementation Improves O2 Uptake Kinetics And High -intensity Exercise Performance In Humans. J App Physiol. 119(4): 385-395. DOI: 10.1152/japplphysiol.00192.2014.

Sunday, August 21, 2016

Do Compression Garments Help While Exercising? Or Only With Recovery?

Picture I retook with my iPhone 6 from Alex Hassentein/ Getty Images
Allyson Felix just missed another gold medal in Rio earlier in the week, finishing second in the 400 meters after losing to a dive by Shaunae Miller of the Bahamas.

Last night, she just won her 6th gold medal at the Olympics in the Women's 4 x 400 m relay, the most ever by a woman in track and field.

Five of her gold medals have come in relays. Her individual gold came in the 200 meters in 2012.

Why am I writing about Allyson Felix? Other than being one of my favorite runners, she is also one of many athletes in the Rio Olympics wearing compression sleeves (see picture above) while competing.

You too would have seen many athletes wearing them while training or racing. I've written about compression garments before way back in 2009.

Newly published studies suggest they definitely do help muscles recover significantly after exhausting exercise. The compression garments can aid the the movement of blood through muscles after exercising, when blood flow would otherwise be slow.  This increase in circulation may help reduce inflammation and muscle aches.

To provide such benefits, the compression garments must be quite tight, which some people may find uncomfortable. They must be also be worn for several hours after exercising/ racing, even if they become unpleasantly damp and stinky.

However, they do have certain downsides that may cause some of us not to wear them. Most recent studies indicate that compression garments do not boost blood flow through muscles during exercise, most probably because the movement of blood when we are exercising is already at its peak.

Even though many athletes report that exercise feels easier when they wear compression garments, these athletes performed similarly whether they wear the compression garments or not.

The authors concluded that compression garments has small effects on short duration sprints, running at VO2 max, as well as time trial performances (Born et al, 2013).

Like I wrote before  I've never raced with compression garments, I've only worn them after hard training so I can recover and train again the next day.

Maybe Allyson Felix didn't have to wear her calf compression sleeves after all ......


Born DP, Sperlich B et al (2013). Bringing Light Into The Dark: Effects Of Compression Clothing On Performance And Recovery. Int J Sp Physiol Perf. 8(1): 4-18. DOI: 10.1123/jisppp.8.4

Engel FA, Holmberg H and Sperlich B (2016). Is There Evidence That Runners Can Benefit From wearing Compression Clothing? DOI: 10.1007/s40279-016-0546-5.

*Here's another look at Allyson Felix's compression sleeves - took the picture with my iPhone 6 from the original by Cameron Spencer/ Getty Images.

Saturday, August 13, 2016

Too Much Recovery May Slow You Down

*You did great Jo!!!
You've read that it's best to do a recovery ice bath after your training session, eat within 30 minutes of your exercise to replenish your glycogen stores, get a massage etc.

Well, you'd better stop that. Are you kidding me? Isn't that what Michael Phelps, Joseph Schooling and all the other top athletes do after training? And you're asking me not to do that?

Well, don't be recovery-obsessed, not while you're in training anyway.

Exercise and training are all about adapting to stress. However, the more time you spend "forcing" recovery, the less chance your muscles have to build up strength and endurance.

Researchers are discovering that when you try to recover quickly (from training) by removing the signals of stress (from your exercise/ training), you may be helping only short term recovery. This will also reduce the signals needed for your muscles to adapt.

While the researchers are suggesting that you still need to recover from training, but you just need to plan and periodize recovery the same way you would plan and periodize your training.

Meaning, you don't have to achieve optimal recovery after every training session. Some fatigue and soreness is acceptable and even necessary at certain times in your training program.

However, during high quality training sessions and especially during competition, an increased focus on recovery (and not adaptation) is needed.

So here are some general guidelines. Most often your recovery strategies should be targeted towards the longer term.

During base training/ pre season or easy workouts, adaptation to training stress is fine. You want some fatigue and soreness (or "inflammation") because this is part of the muscular adaptation process. Using ice immersion post training will often interfere with the adaptation process leading to less than optimal adaptations.

Ice immersion can and should be used during competitions especially if you're racing in a few events a few hours later (like Phelps and Schooling during the Olympics) or over a few days. It is also time to eat real god food to recover, get your massage sessions in etc.

You'll probably have to figure what works best for you as different recovery strategies work differently for everyone. Some prefer a massage while others prefer ice baths.


Halson SL, Bartram J et al (2014). Does Hydrotherapy Help Or Hinder Adaptation To Training In Competitive Cyclists? Med Sci Sports Ex. 46(2):1631-1639. DOI: 10.1249/MSS.0000000000000268.

Roberts LA, Raastad T et al (2015). Post-exercise Cold Water Immersion Attenuates Acute Anabolic Signaling And Long-term Adaptations In Muscle To Strength Training. J Physiol 593(18) : 4285-4301. DOI: 10.1113/JP270570.

*I used to swim with and treat Jo Schooling way back in 2005-2007 when we were both swimming at the Centre of Excellence under coach John Dempsey. He used to kick my butt in the pool even when he was ten years old. Great job on winning Singapore's first ever gold medal at the Olympics. So very happy and proud of you!