Friday, January 12, 2018

Drill Bit Left In Ankle After Operation

11:42 am -before treatment
Have a look at the picture above. My patient came to our clinic with "problems" in his right ankle. He fractured the ankle in 2010, had pins and plates inserted (but the surgeon did not suggest physiotherapy after that).

He resumed running and football after that and subsequently needed an ankle reconstruction last year as another surgeon told him all his ligaments were now torn and the ankle unstable. Again there was no referral for physiotherapy after this second operation.

One year later, he still had lots of pain in his ankle and lack of range of motion. He saw another surgeon for a second opinion and the MRI was inconclusive. He underwent another operation and in the operating theater, the surgeon found a bone spur in front and a broken-off drill bit left behind! Yes, you read correctly, a broken-off drill bit from the earlier operation ??!!!

Finally, this third surgeon he saw referred him for physiotherapy.

11:55 am 
Well, it took me about 13 mins to change his right ankle if you look at the time difference between both pictures. Actually it was less because I treated his left leg too, before re-assessing him.

Now if we put both pictures together, you can definitely see the difference.

See the difference?
Having a difficult time before or after your operation? Come and see us in our clinics. We'll definitely be able to help you get better.

Sunday, January 7, 2018

Job Done

It was raining cats and dogs this morning when we returned for Day 2 of the re-certification of the Kinesio Taping Instructors course. This was the last re-certification course available for this period for Instructors as there had already been courses in Albuquerque, Prague and in Brazil in the past 2 months.

Being the model for Graceann
The other Instructors present had become familiar faces and we discussed different teaching strategies. It was good for me to meet the other Instructors in Asia as previously I'd only done the re-certification courses in Albuquerque and Venice. We watched some videos and had the practical sessions to clear our doubts.
Getting my cert from Graceann
My 2 students before and now fellow Instructors
Well, my certification will qualify me to teach for the next 3 years til end 2020. And the next course I'll be teaching will be at Sports Solutions on 3rd-4th February 2018. You can sign up for the February course here.

Next course will be on June 16th-17th 2018.

Here's my cert

Saturday, January 6, 2018

Day 1 Of Kinesio Taping Instructors Recertification (CKTI) In Hong Kong

Study time

3 years have gone by since Venice and here I am in Hong Kong doing my Kinesio Taping re-certification for Instructors. This is my 3rd re-certification after Albuquerque in 2011 and Venice in 2014.

My name tag
Dr Kenso Kase was unfortunately not present this time and since there are some changes to the course, we spent the whole day with Dr Graceann Forrester (who originally certified me as an Instructor in 2010) going through the new slides while sharing some laughs of course.

Going through the slides with Graceann
Graceann did a really good job explaining the new slides and changes.

Graceann at the break
Stay tuned for day 2 of the Instructors re-certification.

Sunday, December 31, 2017

Weather Change Make Your Bones and Joints Ache?

Raining cats and dogs 
In the past when I was still a very junior physiotherapist, I'll often have patients (in the hospital) who tell me when it gets cold, their joints and/ or bones will ache or hurt. Not that I don't believe them but I'll often think to myself, hmmmm really, how cold can it get in Singapore?

Later while treating patients overseas (where it can get much colder than Singapore), the patients there tell me the same thing. They say right before the weather turns cold, their previously injured or arthritic bones/ joints will hurt.

So is that true or just an old wives' tale? Can the ache in your bones and joints predict the change in weather?
Raining all the time here at Sports Solutions the past week
A recently published study looked at medical records of 11,673,392 outpatient visits, dwarfing other studies that previously looked at whether an increase in humidity, rainfall or barometric pressure can bring on pain.

The researchers matched the dates of the visits to local weather reports and found that 2,095,761 of the cases occurred on rainy days. After controls applied for age, sex, race, various chronic medical conditions including rheumatic arthritis, they found more visits for bone and joint pain during dry days than wet days.

The authors concluded that the weather does not cause joint pain but that patients attribute joint pain to the weather when it's raining.

I can hear those of you reading this protesting already. Yes, I personally agree there are flaws in the way this study is conducted. In the real world, many patients complain that they can't get a same day appointment with the doctor when they feel pain in their joints. Even if they did get a same day appointment, the doctor will tell them it's the "weather causing their pain".

Personally I don't get any pain in my back or skull (fortunately) after my accident, before the weather changes or in cold weather.

BUT, I've definitely noticed that if I'm coming down with a fever and especially if my stomach is feeling uncomfortable either from indigestion or feeling bloated, my previously fractured L1 lumbar spine will definitely ache. Visceral manipulation (mobilization of the organs) helps that. I will cover that in another post.


Jena AB, Olenski AR et al (2017). Association Between Rainfall And Diagnoses Of Joint Or Back Pain: Retrospective Claims Analysis. BMJ. 359:j5326. DOI: 10.1136/bmj.j5326.

Friday, December 15, 2017

This Is No Bull .....

Energy drinks from Cold Storage
When I was doing my National Service in the army, some of my platoon mates who were having issues with their fitness would frequently load up with "energy drinks" such as Red Bull. Especially in the morning before physical training and/ or Standard Obstacle Course (SOC) training sessions. They definitely did before the SOC tests too.

I'll ask them why and they'll say that it gives them a "boost" to be able to finish the training strongly or pass the test. Some of them will also mix Red Bull with alcohol when they book out on Fridays so they can party the rest of the night away.

Later while studying in university, I found out some of my classmates did the same when cramming for an exam or writing a paper. A published paper found that 51 percent of college students consumed at least a bottle of energy drink a month.

So I'm sure you would have seen, heard or perhaps even tried some of the above. Well, if energy drinks such as Red Bull is your drink then you may want to read on.

Sure, the energy drinks may give you a temporary boost, but it can also give you a whole lot of other problems. Previous studies show that they can mess with your sleep, make you gain weight and increase your blood pressure. They can also lead to substance abuse, mental health problems, higher risk of developing diabetesdental problems and even kidney damage.

Energy drinks are advertised to boost/ improve energy, stamina, athletic performance and even your concentration. Similar to sports drinks (Gatorade, Powerade, 100 Plus etc), the target consumer market for energy drinks are adolescents and young adults.

Energy drinks typically contain lots of sugar, high fructose corn syrup, artificial sweeteners, caffeine, certain vitamins, minerals and non nutritive stimulants (such as guarana, ginseng, taurine, L-carnitine, inositol, yerba mate and D-glucuronolactone).

An average 500 ml can of energy drink contains about 54 grams of sugar, way above the recommended 36 grams for men. You've read here that it is through consuming excessive sugar that causes you to get diabetes.

According to the article referenced below, some energy drinks reviewed contained as much as 207 mg of caffeine (recommended daily allowance for adults is 400 mg/ day, 100 mg/day for adolescents). When you consume more, you may feel anxious, depressed or even harbor suicidal thoughts.

Excessive caffeine along with other stimulants such as taurine, guarana and ginseng can also affect your blood pressure.

The authors concluded that current evidence suggest that health risks outweigh any short term perks or benefits you may experience from energy drinks.

Now you know.


Al-Sharr L, Vercammen K et al (2017). Health Effects And Public Health Concerns Of Energy Drink Consumption In The United States: A Mini-Review. Frontiers in Public Health. 31 August 2017. DOI: 10.3389/fpubh.2017.00225.

Heckman MA, Sherry K et al (2010). Energy Drinks. An Assessment Of Their Market Size, Consumer Demographics, Ingredient Profile, Functionality, And Regulations In The United States. Comp Reviews in Food Sci Food Safety.  29 April 2010. DOI: 10.1111/j.1541-4337.2010.00111.x

Now, that's a lot of Red Bull in there
I took the picture above and below while riding to my previous clinic a few years ago thinking I may one day use the pictures. Glad I can use the pictures now.

A closer look

Saturday, December 9, 2017

Early Christmas Present From Oakley

Oakley Jawbreaker
Here's my early Christmas present from Oakley. A pair of Jawbreaker sunglasses. It does seem a little big as you can see from the picture above, but then it also means you get more protection.

Vented lenses means it won't fog up so easily. I really like the fact that peripheral vision is great too.

Many thanks to Joey from Oakley.

Here's another look
Please also see this post on the Jawbreaker.

Monday, November 27, 2017

Stretching Your Muscles? Or Stretching Your Brain?

Kids stretching before gong fu classes
We've written before that just one static stretch of 30 seconds can reduce your maximum strength. Hence, I've questioned whether it improves your sporting performance or help prevent exercise related injury.

Here's another interesting thought. Does stretching makes one more flexible because repeated stretching alters the mechanical properties of the muscles, tendons and joints you are stretching?

Or stretching causes you and your muscles to tolerate more tension when you stretch? You become more flexible or can reach further because your brain tells you that you can and not because you've altered the mechanical properties in the joint.

This was exactly what researchers were wanting to know when they pooled data from 26 studies that measured the mechanical properties of the joint, muscles and tendons after stretching programs of between three to eight weeks.

Participants in those 26 studies stretched at least twice a week, average total stretching time slightly less than 20 minutes each week.

I was surprised (and I'm sure you'll be too) when the results appear to support the second theory as only very small changes were seen in the mechanical properties measure. Participants did get more flexible and were willing to tolerate greater tensile forces while stretching.

Bear in mind that the stretching period was only eight weeks. The authors point out that weight training over similar duration show increase in neuromuscular strength gains but no change in size of the actual muscles. The same may be true for stretching, neural changes first followed by physical changes.

Some readers will undoubtedly say that don't worry about whether is the the physical muscle changing or neural changes. As long as flexibility improves.

As written earlier, we do not know for sure if stretching improves your sporting performance or helps prevent injuries, but the general consensus is that regular stretching may be beneficial in the long term.

Freitas SR, Mendes B et al (2017). Can Chronic Stretching Change The Muscle-tendon Mechanical Properties? A Review. Scan J Med Sci Sports. DOI: 10.1111/sms.12957