Tuesday, December 22, 2009

More Presents


Had a very nice surprise today thanks to one of my patients.

Got a special delivery by courier these 2 books I've been meaning to buy but can't seem to find them in Singapore.

Once A Runner - described as one the best ever books written about running by Runners World magazine and Born To Run about a tribe of ultra runners and a great race the rest of the world has no idea of.

Thank you once again PJ.

Present From Oakley


Got an early Christmas present from Oakley.

My 2nd pair of Jawbones, black this time with vented lenses (as compared to my 1st pair in white). Also see this Jawbone review.

Great peripheral vision.

Thursday, December 17, 2009

Taking Stock Of Your Season


Most of you would have finished your races for the year and taking some well earned time resting, spending time with your loved ones and perhaps going on a holiday to recharge your batteries.

One thing I always did during the off season while I was still racing was to reflect and review what I did so I could learn from it.

Here is where your training logbook will come in handy if you have been keeping track of your training. I looked at how consistent I was with my training, where I slacked off and how (if it affected) my training and racing subsequently.

Most of us are limited with the time we have to train and even more limited with the time we have to rest and sleep. No prizes for guessing that having a family, demanding job, and training is time consuming. Be sure to look out for where and when you fell ill as this is probably your body trying to tell you that you need to rest.

All of us want to succeed when we toe the line for our goal race, but bear in mind this requires a different path for all of us. Did you feel tired or burned out the last few months? Over or under trained? What works for someone else may not work for you. The SEA games in Laos will have its closing ceremony tomorrow and I've seen different athletes achieve their results with vastly different training. So take the time to really reflect on your 2009 season; it will help make 2010 a better one.

Enjoy your off season, especially all our Team Singapore athletes returning from Laos and congratulations for a job well done.

Sunday, December 13, 2009

Pain In Your Neck

Sports Solutions quoted in today's (131209) Sunday Times Lifestyle section page 10 & 11. Go take a look.

We've just been told that we cannot use their headlines (Singapore Press Holdings) or photos, if we do we have to pay them a yearly fee per article (so I've taken out the photos and changed the title of the article) so you'll have to look in the paper.


We've even be slapped with an "investigation fee" if we refused to pay the yearly fee for each article.

Sunday, December 6, 2009

Lose Weight By Stepping

Have a look at today's Sunday Times Lifestyle section page 11 and you'll see Sports Solutions quoted. Here is the link to the article.

I've just been told that if we (Physio and Sports Solutions) use their headlines or their photos (Singapore Press Holdings) we have to pay them a yearly fee so I've taken out the photos and changed the title so you'll have to look for it in the papers.

We've even been slapped with an "investigation fee" if we refused to pay a yearly fee for each article.

Wednesday, December 2, 2009

Day Of Your Race


Alright folks, here's the final post on the marathon preparation.

Try to eat a decent breakfast and give yourself 2-3 hours to digest it. It's real early I know, but you're gonna need it.

This is personal but I find that if I find a quiet spot before the race and just spend 5 minutes reviewing my race plan and visualize the race it helps me focus and be calm.

Remember my post on the fact you do not need a long warm up in the heat. Well, it's still pretty humid though cooler at this time of the year and you've got a long way to run so you don't have to have a lengthy warm up. Watch the elites, even they don't really warm up a lot, they too will be saving their energy for later in the race.

Start slow (about 6-10 secs slower than your goal pace) so you can preserve some of your glycogen stores for later and finish finish strong

Sometimes it helps to think of each 5km as a lap to break down the distance into more manageable bits. That way you don't have to stress about the number of kilometres. Or you can sing songs in your head to make the distance go by quicker.

Drink early and often (but don't over drink). Here's when all the practice of taking nutrition on the run will pay off.

He (or she) who strives will succeed. When the going gets tough, there is light at the end of the tunnel if you keep your hopes up.

All the best for your race.

*Picture of Singapore Flyer taken before the race.

Saturday, November 28, 2009

The Last Week Before Your Marathon



Chill out as much as possible in the last few days before your big race. Yes, you've done all the hard training earlier and it's now down to the last week. So don't be afraid to rest more now.

Reduce the outside stresses in your life especially from work. Try to have all your work projects under control.

Decline politely all invitations to any late nights out and so on. Try to stay off your feet as much as possible in the last few days.

For those of you collecting your number tags, fon't spend too much time at the expo after collecting your race entry pack. Now is not the time to check out the latest running shoes or energy gel flavor.

You can carbo-load but don't fat load, especially in the last 3 days leading up to the race. And remember this, since you have already been tapering and thus expending less calories you don't really have to eat more than usual.

Stay tuned for one more post just before race day.

*Picture from Flickr

Sunday, November 22, 2009

2 More Weeks


You're down to the last 2 weeks before your marathon. Go with what you know. Meaning even if your best buddy or a well meaning colleague shows up dispensing advice, don't try aything radical. Especially in the last week leading up to your goal race. Stick to your own training plans and what you've been practicing.

Be at ease doing what you've been used to rather than trying something new and then worrying how it will affect you.

If possible, run at the same time as the start of your marathon. Yes, that's a real early start for most of you. Well, the good thing is your body's rhythm-including your all important bathroom routine will be in sync once race day arrives.

The more times you can do this the better, try at least the last 3 days before your race. Back when I was still racing, my swim training starts at 5.30am. In order to be early, I had to get up at 4.30am, leave my place by 4.50am and ride my bike there. The good thing is that none of the early starts at most races fazes me since I was already up even earlier than most races. You can do it! You just need some practice.

Remember to start tapering. You can tone down to 70% of what you've been doing this week and probably 40-50% of your regular mileage in the last week leading up to your race. Run a dress rehearsal of not more than 12km in your race outfit and shoes at your race pace. Do a similar run in the last week but only up to 5 km. Picture yourself out on the course (if you can't get on the course) running strong and relaxed. This run will help you lock in your race pace and let you get some decent effort in.

Before you go to bed each night, visualize yourself running smooth and strong and crossing the finishing line showing a new personal best time.

Til my next post, take care and rest well.

*Picture from Flickr by Brian Gudas Photography

Sunday, November 15, 2009

3 Weeks To Go


Yes, for those of you running in the Standard Chartered Singapore marathon on 6/12/09. This is probably the most critical phase of your training. Most of you would have done your last long run 3 or 4 weeks out, so if you haven't don't try to cram it in. Doing more than you are used to will hurt rather than help your race (especially so if you are attempting the full 42km).

Select the shoes, socks and race clothes that you'll wear for your race. Try them out a few times before the race to ensure that you do not get any chafing or blisters.

Even if you are feeling great, resist the urge to increase your training. Draw strength from the hard work you have put in and have confidence in what you have been doing.

If possible, start doing some of your runs on the race route. Get used to the pancake flatness (well most of it anyway). The lack of variation in a flat course means you will be using the same old muscles the whole race and you need to get ready for this.

Practice drinking with the sports drinks and energy gels you intend to refuel with during your race. For those with finicky tummys, you should be using the same sports drink that will be available on the race course.

Stay tuned as we share more tips for running your best marathon in our next post.


Monday, November 9, 2009

Glucosamine, Chondroitin & MSM


I've had many of my patients ask me if they need to be taking any supplements. Some even tell me they swear by their daily glucosamine and chondroitin pills -the 2 supplements favored by most runners. My patients were all really convinced the supplements worked until I tell them the published evidence.

In some earlier studies, there seemed to be some evidence supporting the use of glucosamine (but not chondroitin, or MSM etc). Yes, that means you do not need anything else in your tablet or pill except glucosamine. But most if not all of those studies were sponsored by the companies who made the tablets.

Based on recent studies however, researchers looked the effects of glucosamine and/ or chondroitin on joint spaces in the knees of 572 subjects with known (x-ray evidence) osteoarthritis in their knees. At the end of the 2 year follow up, there were essentially no differences between the subjects who received a placebo (or dummy) tablet and those who received glucosamine and/ or chondroitin. It was a double blinded study, meaning both researchers and subjects didn't know who were getting the dummy tablets and who were getting the real deal.

So what's my take on this. For all those who are currently taking them and feel that they work, please carry on. If not you may feel uneasy stopping anyway. For those who are thinking of starting, well, you have the evidence before you.

Reference

Sawitzke AD, Shi H, Finco MF et al (2009). The Effect of Glocosamine and/ or Chondroitin Sulphate on the Progression of Knee Osteoarthritis. International Society of Sports Nutrition.



Sunday, November 1, 2009

Do More Bicyclists Lead To More Injuries?


Not necessarily so, if research from a well-established body is true. Bicycle-riding patterns in the United States and Europe were studied and what was found was when the number of cyclists on the road increases, the likelihood of accidents declines. This surprising result is known among its researchers as the “safety in numbers” effect, and has been repeatedly documented. (This is true. When I ride in a huge group on Saturdays, we do get more respect from drivers.)

This particular post's topic was what the New York Times discussed just a few days ago on 291009.

Why is this so, you may wonder? How can more cyclists mean fewer road accidents? The author of a Californian study thinks that adaptation in motorist behavior seems to be the reason rather than people cycling obeying traffic laws. In other words, when more cyclists ride on the roads, car drivers become used to them and respond appropriately.

There is a catch of course, In the early stages of increasing bike ridership, more accidents may occur, since drivers will not yet be used to the influx of bicycles (and many of the cyclists will not be used to cycling in heavy traffic).

Well this is what I've noticed here in Singapore. While I do not have hard facts to back me me up, a personal observation of mine is that in the last few years, there seems to be an increasing number of cyclists on our roads. I'm not sure about the rate of accidents but if it's true than of course less injuries from accidents are great, but I do see more cyclists getting sports injuries..... that will probably be another post.

Like many other increasing number of cyclists here in Singapore, I too ride to work at Sports Solutions daily, both for health reasons and also to do my part to go green. (Actually, it is also because I get really impatient waiting for the bus). So all you drivers out there, do look out for us cyclists on the roads.

Here's the link to the New York Times article.

*Picture by Getty Images

Wednesday, October 28, 2009

The Human Body Is Built For Distance


Sorry I haven't written in a while, our 2nd clinic Sports Solutions has been keeping me busy... and stressed so far. Anyway, the topic for this particular post was actually "given" by one of my patients and a very frequent participant in our weekly running club sessions (on Thursdays).

I first read about this topic last year when I was made aware of a book "Born to Run" by Christopher McDougall, based on the Tarahumara Indians of Mexico, a tribe unknown to the rest of the world but are capable of running extraordinary distances in nothing but thin-soled sandals. This was what led me to write about 2 of our more popular topics on March 14 this year "  Do High Tech Running Shoes Work "and "Pain Free Running" on March 17.

The article -which is the title of this week's post was published in the New York Times on 261009 and this patient sent me a link to this article. Go ahead and have a read, we humans are really made to run.

Ask our participants at our running club, many of them have been told by their doctors and surgeons not to run, but are now running again. Give us a ring to let us know if you are coming (63331211 or 62236078). Here's too more running.


*Photo by Luis Esocobar, The New York Times

Saturday, October 24, 2009

Sports Massage Available This Weekend!

We have sports massage available this weekend for the runners participating in the Nike Human Race today and North Face Run. Having a sports massage after your race hastens your body's recovery process. Call us at 63331211 to book your appointment.

Friday, October 23, 2009

Running Club @ Sports Solutions





It's been a great start to our first days at Sports Solutions. Thank you for all the support that we've received!

We are unique as we offer Sports Physiotherapy, Sports Massage, Sports Nutrition, Strength and Conditioning, Sports Psychology and Sports Rehab all under one roof.

Our running club now starts at Sports Solutions, 108 Amoy Street. Call us at 62236078 to let us know that you'll be joining us on Thursdays at 630pm.

Tuesday, October 20, 2009

Sports Solutions Opens

For all our patients who have been waiting patiently for us, our second branch, Sports Solutions will open to see patients from tomorrow 21 October 2009!

We have named it differently as it has a sports rehab space/ gym that we will be able to use to return our patients back to sports and /or after their injury or operations.
Of course we will also have physiotherapy and sports massage therapy services there as well.

There will also be strength and conditioning, sports psychology and sports nutrition services available upon request as well. Please contact us if you have any questions.

Sports Solutions is located at 108 Amoy Street, Singapore 069928. Tel 6223-6078. Fax 6223-6079.

Monday, October 12, 2009

Excessive Kneads


If the picture looks familiar, you are right, it has been taken from yesterday's Sunday Times (111009) Life section, page 9.

As the article pointed out, there are no published studies showing that too many massages are bad. However, let me share a true experience from the 2004 Athens Olympic Games. Our Team Singapore medical team consists of only a doctor and 2 physiotherapists (only) for the whole Team Singapore contingent. Besides looking medical and sports injuries' needs of the athletes, all three of us had to double up and do sports massage for the athletes as well (since we don't have a sports massage therapist with us).

One of our swimmers (who shall remain anonymous) insisted of receiving 3 sports massages a day (even after the competition). If it was before the competition and if time permits, I'll say no problemo. And if the swimmer came back with a medal, I'd say alright I'll do it (after the competition as well). But the swimmer was really quite far away from even making the finals so I said to the swimmer "if you get 3 sports massage sessions a day, does that mean you will swim 3 seconds faster?"

The swimmer stormed off and didn't speak to me for a few days. What I am trying to say is that yes, sports massage does have some benefits (if done properly and at the right time), but 3x a day? Through my experience of working with athletes, I know that some prefer (and can handle) a sports massage close to their really important events (1 or 2 days before). Others prefer 4-5 days before their big event. Now, every athlete is different and have different preferences. You all know that you shouldn't wear new shoes, running shorts, vests, etc before your race, well same for sports massage, nothing new or nothing you aren't familiar with.

One other comment though, caught my attention. The comment was made by a principal physiotherapist at a local hospital --"a massage using non-professional and forceful techniques can lead to problems such as nerve damage and cerebrovascular accidents such as stroke and bruising".

Personally, I feel that there is no justification at all for that comment made by the principal physiotherapist. Especially if you come to our clinic, our staff all all extremely well trained and experienced. If you search the current scientific databases, there is currently no documented or published evidence (in Pubmed, PEDRO etc) of such claims. A cerebrovascular accident or stroke involves arteries inside the cranium (or skull),so unless the massage therapist performing the massage fractures the cranium and so disrupts the blood supply, there is virtually no chance of a stroke happening.

As for nerve damage, it would really take quite a fair bit of force to inflict any "damage" to our nerves as nerves are actually quite hardy.

*Picture ST Photo: Terence Tan

Wednesday, October 7, 2009

Does Exercise Increase Damage To Your Joints?


Most runners may have heard or read in some way or another through inaccurately written articles that too much exercise may be harmful to their joints. Most of the general community perception is similar too, that too much running or exercise are mostly harmful to joints. Well, all runners (and other athletes) will be real pleased to know that exercise does not cause osteoarthritis (OA) but might actually help to prevent it.

Well, here is the good news, there is actually no strong evidence supporting the fact that regular exercise can cause harmful effects in normal joints (i.e. joints without any pre existing injury) according to a review of studies published in the article cited below.

The review paper was a joint effort between German and American researchers that looked for a relationship between exercise and osteoarthritis which found none, except in elite athletes in sports where they incurred knee injuries. In fact for comparisons between runners and matched controls (who didn't run), the runners were found to have lower rates of OA compared to their sedentary counterparts.

The researchers found that there was a higher likelihood of elite athletes sustaining sports injuries leading to an increased risk of OA in the damaged joints. Count me in, I've had 3 knee operations between 2002-2003 when I was still training and racing. (Thank the good Lord, it was really difficult, but I managed to get back to training and racing at my previous levels and have had no problems ever since). Guess that's where pain free running helps. More info here.
The researchers concluded that for most other people though, vigorous, low-impact exercise is beneficial for both physical and mental benefits.

So, if you do not have any prior existing injury, keep running and exercising. If you do, there's always pain free running.

Reference
Hunter DJ and Eckstein F (2009). Exercise And Osteoarthritis. The Journal Of Anatomy 214(2): 197-207.

* In the picture above of a body composition DEXA scan, the brighter areas in lthe ower limb bones correlate to stronger bones.

Tuesday, September 29, 2009

Should You Be Training Like The Caveman


More on our caveman folks. Alright, before you carry on reading, I must say that this particular post has got no research or scientific backings. They are just what I feel personally. Now that you know, I will let you know a foolproof way to achieve running success. In short, to enable you to run faster and stronger.

The secret - run as hard as fast as long as it seems right. I guess I can call it a back to basics sort of training, sort of like the caveman.

If the caveman had a training program it would probably have just 2 words - run hard. Or else no dinner. Worse if the caveman was running away from say a fierce lion, the outcome would be disastrous if he wasn't quick enough.

In an age where there are so many gadgets and recommendations to help with our training like GPS, heart rate monitors, mileage advice (how many miles you should log a week), supposedly better running shoe technology, fuel belts, lactate and V02 testing etc. You can even run against your friends, track their training etc with the Nike+ devices (I've never tried it tho').

I am sure that in the era of the caveman, he definitely didn't have all these gadgets and our caveman had no trouble covering more than 10 miles a day tracking down their dinner.

My uncle was the person that got me started on running. I remember when I was just a 10 year old kid my uncle Simon used to bring me running with him. I didn't know what pace or distances we ran. I just tried my best to follow him, to keep up with my uncle. Definitely didn't know what sort of times we clocked on our runs. Later in secondary school (high school for our American readers) when I began running longer, further and faster I still "just ran" even when I started winning track and cross country races.

Now we have running experts, coaches and exercise physiologists saying we should train at this particular pace, run intervals, and long runs etc.

Well, here is the good news. Running can be as simple or as complicated as we make it. You want the graphs, charts, bells and whistles, etc go ahead and use all the available technology. Want to go the old school, stripped-down, and bare bones version? Just run.

*Picture from Flickr

Monday, September 21, 2009

Eating Like A Caveman Part II


I first read about the Paleolithic diet back in 2005. In his book "The Paleo Diet for Athletes, the author Loren Cordain states that the Paleo diet will make you fitter and healthier. The author also calculated that Paleo man got 55% of their calories from meat (more protein than what is currently recommended) but the Paleo diet also contains much more fiber, calcium, vitamins, iron, folate and essential fatty acids, but much less sugar, salt and saturated fats than we now get from our current diet. The meat from Paleo man's era were also not burgers or anything like the Atkin's diet.

To the author, grains were the original fast food back then as it is fairly cheap, easily obtained and overly processed (humans first began cultivating grains about 10,000 years ago). Moreover, grains have a lot less nutrients than fresh fruits and vegetables. Since most of our current available grains were only available in the last 10,000 years, our Paleo ancestors ate no bread, pasta, pancakes, kuay tiao, bee hoon or rice as these "modern" grains were not available then. Cordain believes that we live healthiest when we consume a diet similar to what early (or Paleo) man ate as even now our digestive systems are not adapted to process grains properly.

I was rather skeptical upon reading this as I had been brought up on a diet of pasta, bread and rice especially (since I am from Singapore where it's fried rice paradise).

Well, this is what Joel Friel, renown triathlon, multisport and cycling coach who has written "The Training Bible" series of books on cycling, triathlon etc had to say. He first tried the diet to actually proof Cordain wrong. In Friel's first two weeks, he felt terrible but by the third week, he felt strong enough to increase his training by 50% and another 50% on the fourth week and since then he's been a true believer.

Friel explained in great detail on how to get the best carbohydrates before, during and after training or races. He is especially particular about the post exercise or post race period breaking it into 3 separate stages where you eat/ drink fruits and fruit juices to potatoes and sweet potatoes and finally to the last stage where you mix carbs and protein.

According to Cordain, the Paleo diet will likely increase your protein and fat consumption while lowering your carbohydrate intake slightly. But since your carbs are mostly coming from fruits and vegetables, you will have a lot more micronutrients. Protein is from lean meats with low saturated fat levels and from fish (with high levels of healthy omega-3 fats) and fats from canola, walnut and olive oil (which is healthy monosaturated fat).

I feel like having a big greasy burger for lunch after this with my favorite fries especially since I'm no longer racing. But after writing all that, I think maybe I should have steam vegetables instead.....

Reference

Loren Codain (2005). The Paleo Diet for Athletes: A Nutritional Formula for Peak Athletic Performance. Published by Rodale Inc

*Picture from Flickr.com

Saturday, September 19, 2009

We're Open This Weekend

Yes, we are open for sports massage on this Hari Raya long weekend on Sunday 200909 and Monday 210909. Please call us to make an appointment especially if you have been training hard and need a sports massage.

Sunday, September 13, 2009

Should I Be Eating Like A Caveman?


Or should I stick to the more popular but unhealthy western diet like burgers, pizzas, and french fries etc?

Most of us know that too much of the typical western diet leads to numerous chronic diseases. But would a Paleolithic hunter-gatherer diet do better? A what diet you say? A Paleolithic diet (also known as Stone Age diet) is one that is similar to what our pre agricultural hunter-gatherer ancestors (or caveman) ate before. The Paleolithic era is one that is nearly 2.5 million years ago.

The Paleolithic diet consists of foods that can be hunted and fished, such as meat and seafood, and that can be gathered, such as eggs, insects, fruit, nuts, seeds, vegetables, mushrooms, herbs and spices. This diet included more low fat proteins, healthy fats and much less carbohydrates than most of us eat today.

A group of researchers decided to find out, feeding 9 healthy, non-obese volunteers a Paleo diet for 10 days (no grains, dairy & legumes). The protocol was designed to ensure the volunteers did NOT lose weight, which would have influenced results.

The results? Compared to their prior diets, the volunteers experienced significant reductions in blood pressure and plasma insulin. Moreover, there were large, significant reductions in total cholesterol, LDL, and triglycerides. All this in just 10 days. Impressive or what?

Stay tune as I will discuss in my next post on how the Paleo diet can help in your training and racing.

Reference

Frasetto L et al, (2009). Metabolic and Physiologic Improvements from Consuming a Paleolithic, Hunter-gatherer Type Diet. European Journal Of Clinical Nutrition. 63: 947-955

*Picture taken from Flickr.com

Wednesday, September 9, 2009

Aqua Based Rebabilitation- Reported by Red Sports

You've seen it here on 300409, the Straits Times covered it on 130609 (http://www.straitstimes.com/STI/STIMEDIA/pdf/20090613/ItsASplash.pdf).

Red Sports published it on their site (http://redsports.sg/2009/09/03/aqua-based-rehabilitation-deep-water-running/) on 030909.

We have classes twice weekly, please contact us if you are keen on learning it.

Friday, August 28, 2009

Ladies, Your Knee Pain May Be Coming From Your Hips


How many of you ladies have knee pain? Well, you may be interested in this then. I have seen quite a few women runners/ triathletes the last couple of weeks, both elite and recreational with knee pain in the clinic. And guess what? Majority of my patients knee pain came as a result of weakness in the hips. Yes, some of them do have contributing factors coming from the knee itself, but the main cause was the hip weakness. So the hip weakness basically led to knee pain.

Well, you do know that at Physio and Sports Solutions we are really good at treating the cause of your pain rather than just treating the pain itself. So besides treating the patients' knee pain, the main thing was to explain the rationale of the treatment plan to them and then teach them how to specifically strengthen the hip muscles.

The strange thing is I've actually noticed this trend quite a while earlier from treating previous patients. So I was really pleased to find an article that was published earlier this year that confirms what I thought.

The study had 19 female runners with knee pain and a separate control group of another 19 female runners as well without knee pain. The group of women with knee pain had greater average hip internal rotation range and reduced hip muscle strength compared to the other group.

The authors concluded that it is the abnormal hip mechanics and decrease strength levels rather than the difference in hip shape and structure of women (as compared to men) that caused their knee pain.

So ladies, if your knees are causing you grief while running, please come in and see us and we will treat the cause of it to prevent it from coming back. And then you can run, pain free of course.


Reference

Souza RB and Powers CM (2009). Predictors of Hip Internal Rotation during Running: An Evaluation of Hip Strength and Femoral Structure in Women With and Without Patellofemoral Pain. Am J Sp Med. 37(3):579-587.

Tuesday, August 18, 2009

Strength Training Makes You Eat Less


Alright folks, latest update on my post last friday regarding Time magazine's article on The Myth About Exercise.

Remember that the writer claimed that you tend to be hungry and eat more after you exercise and hence, exercise is not effective in promoting weight loss.

Well, the latest research show that a strength training workout (or weight training session) does not increase your calorie consumption after your workout. If you include the calories burned while exercising, the exercise session actually results in a lower net calorie consumption.

So all you personal trainers reading this can now tell this to your patients/clients to reassure them.


Reference

Ballard, TP et al (2009). Effect of Resistance Exercise, With or Without Carbohydrate Supplementation, on Plasma Ghrelin Concentrations and Post exercise Hunger and Food Intake. Metabolism. Aug 58(8): 1191-1199.

Friday, August 14, 2009

The Myth About Exercise


That's the front page headlines of this week's Time magazine. The writer says that while exercise may be good for you, it will not help you lose weight, it's watching what you eat that really counts.

I can already hear some of you groaning-"what??? All my exercise was done in vain." Well, this is what the writer of the article 'Why Exercise Won't Make You Thin' attempts to tell us why exercise is unnecessary for weight loss.I do not agree with him, and here's why.

The writer claims that working out is ineffective in promoting weight loss because exercise makes people hungry. So you tend to eat a lot more after you exercise, worse still he says that after exercising he indulges in some junk food (to reward himself) because he deserves it. He thinks that exercising is a waste of time and he stops eating desserts and didn't gain weight. This he thinks is evidence enough that by eating less you can lose weight.

The few articles he quoted did seem to support what he wrote, but there are many many more articles that don't support what he wrote at all(which he didn't include).

Those of you who've tried dieting know that yes you do lose weight fairly easily and quickly but you do know that the weight comes back super quick once you stop. Moreover, your metabolic rate slows down while you are dieting and after a while the weight loss will plateau.

If you eat more than what you use (in terms of calorie expenditure), you will gain weight. If what you use (especially if you exercise) is more than what you eat, then you will lose weight. This is the way I explain to my patients/ friends when they asked me for advice on losing weight. So even if you ran an hour on the treadmill and reward yourself with a plate of fried kuay tiao or brownie (or fill in your own favorite), then you probably won't lose much weight.

So, what have I gotta do to lose weight? well, you combine exercise with clever eating and do it on a long term to lose weight and keep the weight off. Come talk to us if you need any advice on this.

Plus there are other good reasons to exercise, please also see this and this.
This Time magazine article is probably what most people will read and think that they don't have to exercise. Certainly, not the best read for our increasing numbers of overweight children as well. Please tell your friends that it's not true.

Please email me if you want a copy of the Time article.

Friday, August 7, 2009

Risk Of Osteoporosis In Male Cyclists



Now that I've gotten your attention, the picture of the CT scan on the left shows a healthy tibia (shin bone) while the one on the right shows one that is osteoporotic.

Now, here's the very surprising news that I read from this article recently. In their study, the researchers found that the group of serious male cyclists had greater rates of osteoporosis when compared to a group of control subjects. That's very surprising as women are more usually prone to having osteoporosis as compared to men.

The very exact reason why cycling is an excellent exercise also has its dramatic drawback because of its low weight bearing nature. Less weight bearing means less loading on your bones and joints (that's why it's good), but it also means that it doesn't stress your bones enough to stimulate it. Our bones need a certain degree of weight bearing stress to stimulate it to regenerate to form new and stronger bone. Hence, some degree of weight-bearing is not only good for the bones but also necessary.

In this study, the serious male cyclists (rides 7-22 hours a week and 9.4 years of racing experience), had lower body fat, more muscle and greater calcium intake compared to an age and weight matched control group. However, they also had 2.5-3 times greater rates of osteoporosis and osteopenia (near-osteoporosis).

So what's a biker gotta do about this, you'll ask? The researchers didn't offer any advice, but it'll be fair for me to suggest that a modest amount of running and/ or strength training in a standing position (hence weight bearing) will probably do the trick. Want something more challenging, try rock climbing.


Reference

Smathers, AM et al (2009). Bone Density Comparisons In Male Competitive Road Cyclists and Untrained Controls. Medicine & Science In Sports & Exercise. Feb; 41(2): 290-296

Tuesday, July 28, 2009

Tuning In


Ever wonder why all commercial gyms seem to be blasting music all the time? Well, studies have confirmed what most gym users already know. Listening to your favorite tunes can boost your capacity for exercise.

The researcher that has done work in the area of music and exercise for over 20 years is Dr Costas Karageorghis from Brunel University in Great Britain.

He recommends exercising to songs with a beat of 120 to 140 beats/minute and says his subjects have improved performance by up to 15 percent while listening to songs such as: "I Like the Way You Move" by Bodyrockers, and "Mercy", by Duffy.
Those who like music from the 80's did better listening to: "The Heat is On" by Glenn Frey, "Don't Stop Me Now" by Queen, or "Dancing Queen" by Abba.

In addition, moderate exercisers said that while listening to their favorite songs reduced their perception of hard work - although for those exercising at a higher intensities, this was not the case (notice that all the elite runners at races never race with music).

Now you realize why lots of runners listen to music while running these days.

I've even seen some tune-in during races, though that's discouraged by many events and running organizations. The reason being that you may not be aware of other runners in the race causing you or them to fall. Please be careful if you do run with music. You need to be aware of traffic if you're running outdoors and other runners around you.


Karageorghis, C et al (2008). Psychological Effects of Music Tempo during Exercise
Int J Sports Med 29: 613-619

Sunday, July 19, 2009

No Need For A Long Warm Up In The Heat


Consider the following scenario. Current temperature is 35 degrees celsius (95 degrees Fahrenheit) and 95% humidity just before the start of the race. You see many people warming up by running ahead of the start line, some doing striding while others are mentally rehearsing for the race. Being nervous, you proceed to do the same, running to warm up as well. Then you notice someone just chilling by the side waiting for the announcer to ask the starter to give the go ahead for the race to begin. When the call comes, this guy just stands up, takes his place and starts with the rest when the gun goes. Later you find out this same guy wins the race easily and you go - hey wait a minute, this guy didn't even warm up, he just showed and ran and won the race. Am I doing something wrong here, Did I warm up too much?

Research actually shows that too much warm up before your race can hurt your performance especially so in hot and humid conditions. Consider the following study. The subjects in the study performed the test after no warm up, 10-min or 20-min warm up in hot conditions (35 deg celsius). Plasma lactate (lactic acid levels) was significantly higher after active warm up. The longer active warm up resulted in a greater increase in temperature and was associated with a decrease in performance in the heat. The researchers showed that a long warm up in hot weather is more likely to diminish performance than improve it.

Ever encountered similar weather conditions while racing? This is very common in Singapore, especially the humidity. And this is the problem, it's not the heat, it's the humidity. Moist air slows down your body's ability to cool itself through sweat, so even though you sweat a lot, it is not evaporated since the air is too moist.

Well, now you know there's no need for a long warm up in the heat. It's nice when there is research to back up your common-sense feelings. So it's okay to chill.


Reference

Bishop, D and Maxwell, NS (2009). Effects of Active Warm up on Thermoregulation and Intermittent-sprint Performance in Hot Conditions.J Sci Med Sport Jan;12(1):196-204.

Tuesday, July 14, 2009

Got DOMS?


This is what one of my patients who had DOMS did with his pain (cupping), hope you didn't do the same.

DOMS or delayed onset of muscle soreness is a condition where you have muscle pain, soreness or stiffness that is usually worse 2-3 days after exercise, hence the word delayed, and the pain usually subsides over the following few days.

Certain activities are more likely to cause DOMS. Those that require your muscles to forcefully contract while lengthening (eccentric contractions) seem to cause the most soreness. Ever took part in a race where there were lots of running downhill? Then you should know the feeling in your legs a couple of days later. Other examples of eccentric contractions are going down stairs or lowering your barbell slowly during weights. I've also seen patients/ athletes who had DOMS at the beginning of a new an exercise program (especially a new gym/ weight program), after a change in sports activities, or after prolonged or higher than usual intensity efforts.

DOMS is different from the muscle pain or fatigue you experience during exercise. The onset of pain from DOMS always occurs 2-3 days after the cessation of exercise. This helps differentiate it from more acute injuries such as a muscle rupture or sprain.

The soreness will go away on its own after a few days. There are a few things you can do to help. Icing or contrast baths (hot/cold) seems to help although no clear evidence proves they are effective. I had severe DOMS in my legs after my first half marathon race about 12 years ago and tried contrast baths and they didn't seem to help much. Gentle stretching of the affected muscles has also been recommended although there is again no real published evidence found.

There is some evidence that massage seems to help alleviate DOMS by about 30%, but it had no effects on muscle function.

Wanna know what seems to work? My personal experience suggest that performing reduced intensity and low volume exercise will increase blood flow to the affected muscles and often reduce pain. Pedaling on low resistance on a stationary bike is ideal as you don't have to worry about traffic (if you ride on the roads). An easy swim or just walking in waist or chest height water works well too. Wearing compression garments will help reduce it as well. These above mentioned strategies do have some support in the research.

Can you prevent it? Szymanski (2003) suggests the repeated-bout effect as a way of reducing DOMS. This is a progressive adaptation to eccentric exercise. If you perform repeated bouts of lower intensity eccentric exercise 1-6 weeks before your key event,it will help reduce DOMS and exercise induced muscle damage. Thus, a gradual introduction of eccentric exercise, over a period of weeks, is encouraged.

References

Herbert,RD and De Noronha, M. (2007). Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews. Issue 4. The Cochrane Collaboration.

Szymanski, D. (2003). Recommendations for the avoidance of delayed-onset muscle soreness. Strength and Conditioning Journal 23(4): 7–13.

Zainuddin, Z et al (2005).Effects of massage on delayed-onset muscle soreness, swelling and recovery of muscle function.Journal of Athletic Training.Jul-Sep;40(3):174-80.

Friday, July 3, 2009

Oakley Jawbone


Yes this is the latest Oakley sunglasses to reach our shores. I was fortunate enough to get an opportunity to try them out before they are released officially in Singapore.

You may wonder why Oakley's latest release is named Jawbone but once you have a pair in your hands you'll understand why. This is due to its new, unique way of enabling the user to change lenses.

Unlike most other Oakley models which require you to first "yank" the lens out before snapping in another. For the Jawbone, you just flip out the hinged nose piece, open the lower "jaw", remove the lens and it's done. Real simple and no less secure. I may have mastered changing lenses for my Pro M and Radar models, but I always had trouble changing lenses with the Flak Jacket and Half Jacket models, just ask the staff at Oakley Singapore, they'll be able to confirm this.

So how do it go? Well, here's the verdict. The ear stem is slightly shorter than the Radar model, but still maintained a good grip around the head. This also means it will not get in the way of your helmet straps while riding. The vented lenses were great due to it's hydrophobic coating which true to its word prevented fingerprints, sweat, road grime and water from leaving marks or streaks behind which can hinder vision.

This particular color was a little loud for me, but other than that I have no complaints whatsoever especially with its superb lens clarity.

Wednesday, July 1, 2009

Can't Post Pictures

Have written up a couple of posts, but can't seem to attached the pictures. Have been trying since last saturday. It seems every one else is having the same problem on blogspot as well. Will put post up as soon as problem is resolved.

Sunday, June 21, 2009

Let's Talk about Wimbledon


Some trivia about Wimbledon, which is probably much better know for its aces than races. Aces or races, you'll ask? There's Wimbledon, the world's leading tennis tournament staged by the All England Lawn Tennis and Croquet Club which was founded in 1868. But I'm sure not many of you know that there's also a close connection between tennis and cross-country running .

Both sports were "born" in the same town, Wimbledon, England, 10 miles south of London. One sport has exploded into a world wide TV spectacular with huge summer crowds, big prize money (£12, 550,000 this year), high status, champagne and of course its famous strawberries and cream. The other is virtually unchanged - lonely, muddy and under appreciated, just like the way it was.

The first open cross-country race took place on the Wimbledon Common on December 7, 1867 while the first modern tennis championship was started about a mile away a decade later on July 9, 1877. That first Wimbledon Common race was probably the progenitor of road racing and marathon races as we know them today.

Thanks to the BBC, Wimbledon tennis was the first sport to be broadcast on radio and world wide TV. More than 800 million viewers follow the event on TV while more than 400,000 spectators attend the 2-week long tournament which remains the only Grand Slam event still played on grass.

Those of you who have ran cross-country races here in Singapore or any where else know the deal. To be a good runner over the course, you have to negotiate terrain that is usually up or down, slanted perhaps but seldom flat. Whilst running in your racing flats, you 'll be able to feel every ridge, root and rock under the slippery leaves. The course will often present a new challenge at every turn, which demands a total combination of balance, aerobic fitness and leg strength. All this can add benefit to your character. My first real running race was a cross-country race. This is how I gradually built my strength up -training and running over cross-country which later paved the way to me finding success racing on the track and roads and later in triathlon as well.

Our only "real" cross-country course in Singapore is Macritchie Reservoir, which over the years has been landscaped to make it less "wild" and more runner friendly. At the Wimbledon Common though, it has remained an undeveloped public park where you can easily run 20 miles on the 1140 acres without retracing steps.

Tennis and cross-country running both have great history and tradition, but are at absolute ends of the spectrum. One is entirely formalized and structured, the result of modern rule-making. The latter is completely unstructured, almost primeval, more of a participant sport with few spectators who certainly don't go to be seen.

While I will definitely watch the "live" telecast of the tennis matches beginning tomorrow, I prefer to be running cross country. I am moving, I am free, there are no lines, no fences, no boundaries or schedules.

Sunday, June 14, 2009

Aqua Based Rehabilitation - You Saw It Here first

Yes you did. Yesterday's Straits Times (130609 page c32) had a report called Water way to fitness. Please see the link here).
Our post -Aqua Based Rehabilitation (Deep Water Running) was published on 30th April this year (Check it out here).

We have classes weekly, please contact us if you are keen on learning it.

Tuesday, June 9, 2009

You Spin Me Right Round Baby Right Round


No, this write up is not about the 80's song by Dead or Alive made famous again in the show "The Wedding Singer". Rather, I am talking about riding your bike and spinning your pedals round.

It's well documented that part of Lance Armstrong's key to success is an unusually fast cadence while cycling- about 110 rpm (revolutions per minute). The rationale behind is this- spinning faster requires less muscle effort, so you fatigue less and recover faster, especially while climbing. It works for Lance, but will this style work for the rest of us? Well, what works best is finding what is most the most efficient cadence for yourself.

First and foremost, you have to have an efficient riding position before you learn how to pedal in smooth circles. For me, I use a goniometer (measuring tool) to ensure the cyclist has a saddle height that leaves his/ her knees bent between 25-35 degrees when the pedal is farthest away from the saddle. In addition I also drop a plumb line with pedals horizontal at the front of the knee cap to bisect the pedal axle. This is to achieve an optimal position for power transfer. For the actual pedal stroke it is better to "lift and pull back" with each pedal stroke and not push the pedals down. This can be achieved with strong core and hip flexor muscles. Please also see this).

Bear in mind that riding smaller gears and spinning faster than what you are used to will feel uncomfortable at first. It takes a while before it becomes natural. Try the following drills.

On your next ride, shift to a low gear and experiment with different cadences, 85, 95, 110 rpm, spinning a few minutes at each. If you ride 20 rpms faster than what you are normally used to, riding at your usual cadence will feel easy. You ideal maximum cadence is when you are spinning fastest with you form intact - no bouncing up and down in the saddle.

Single leg pedaling will teach you how to apply power through the whole pedal stroke (and not just on the down stroke). It's better to do this on a relatively traffic free road if you do not have a trainer at home. Do 30 secs on each leg, building to 2 mins, with equal rest time.

But don't let this technique become your cardinal rule. Sometimes you still need to shift to a heavier gear and go - especially if you want to accelerate instantly. Like when you buddy attacks and you want to follow, or when you are doing the attacking.

* Picture of Lance taken by Aized on Stage 6 in Adelaide, Tour Down Under 2009

Wednesday, June 3, 2009

Hyponatremia at Sundown Marathon


What's that again you say? Hyponatremia means having low levels of sodium (or salt) in your bloodstream (<135 meq per litre).

At least 3 runners were known to be affected judging from the data my friend collected as part of his research from runners who participated in the 84km Sundown marathon last Sunday.

How serious is this? Well, there was one death from hyponatremia in the 2002 Boston marathon. Thankfully, there were no fatalities from this race. Most runners are aware of the dangers of dehydration, but not many are aware of the dangers of over hydration.

Usually, athletes who participate in marathon distances and above, half ironman distances triathlons and above are most at risk.

Sodium (or salt) is a very important electrolyte that is involved in muscle contraction and has a role in moving water through your cell walls and distributing it throughout your body. When you sweat, you lose salt and water, and if you sweat a lot, you can deplete your body's sodium stores. If you drink too much water and do not have enough enough sodium (or salt) in the body, the water cannot move from the gut to the blood stream so the water remains in your tummy.

A common complaint among athletes is that they have drank a lot yet still feel thirsty. They feel bloated, their tummy is swollen and they have a upset stomach. More severe symptoms can include cramps, giddiness, disorientation, vomiting, diarrhoea, convulsions, swelling in the brain and even death in severe cases. Trust me on this, I had most of the previous mentioned symptoms and even spent 2 days in the ICU in a Hong Kong hospital when I had hyponatremia while taking part in a 100km run in November 2000.

Some interesting numbers for your consideration. Sweat contains 2.25-3.4 grams of salt per litre. In a long race, you can easily sweat 1 litre an hour, so in a 12 hour race that can add up to 27-41 grams of salt. A general rule of thumb is that you should consume 1 gram of sodium per hour in a long event. You should also increase your salt intake in the days leading up to the event (try 10-25 grams of salt per day pre race). Now, those of you who know me know why I always sprinkle extra salt on my french fries and why I'm not afraid of eating chips. Well, now that I'm not training like before, I'd better not go crazy with my salt intake.

To get just one gram from sports drinks alone, you will need to drink 2.8 litres of Gatorade. Do you think you can drink that much for the duration of your race? Not many of us can. Even if you drink sports drinks (instead of water), it is quite likely you will sweat out more salt than you can drink, especially on a hot day. You will probably need to replace your salt specifically.

Hope this helps with your next long training session or race.

References

 Almond CSD et al, (2005). Hyponatremia among runners in the Boston Marathon. New Engl J Med. 352: 1550-1556.

Noakes, T (2002). Hyponatremia in distance runners: fluid and sodium balance during exercise. Curr Sports Med Rep. 1: 197-207.

Wednesday, May 27, 2009

Am I Watching The Match?


Some of my patients asked if I was gonna be watching the UEFA Champions League final tonight? Of course I will be. Have been spoilt for choice over what to watch recently, there's cycling (Giro'd Italia), French Open tennis all live in the evenings, and there's NBA in the mornings (although I haven't been able to watch much because of work of course). And of course tonight's dream final between Barcelona and Manchester United. Two of the most supported teams trying to win the most prestigious club competition at the Stadio Olimpico in Rome.

With all the attention on soccer the past few days, I happened also to come across an interesting British paper attempting to find key characteristics that distinguish between successful and less successful soccer players and teams (professional footballers from 1973-74 vs 2003-04).

The results are as follows, a significant increase in average height in present day players but no significant changes in body weight, body mass index or BMI and reciprocal ponderal index (RPI). RPI is the cube root of body weight divided by height to determine obesity.

Goalkeepers, central defenders and strikers were taller, heavier and older than players in wider positions. Midfielders and wider players were also found to have lower BMI and RPI than central players. Players from the more successful teams (top 6 in table) were also taller, more muscular and younger. This trend was even more obvious in the most recent season studied (2003-04).

Let's see if we can find any interesting matchups to see where the game will be won in tonight's game. With injuries and suspension affecting the Barcelona defense, 22-year-old Gerard Pique (1.91m, 85kg) will most likely be tasked with keeping 24-year-old Cristian Ronaldo (1.85m, 75kg) quiet. More incentive for Pique is the fact that he will be facing the team he used to play for and he will be out to prove Manchester United was wrong in letting him go.

At the other end it will be Lionel Messi (21 years, 1.70m, 67kg) versus Patrice Evra (28 years, 1.75m, 75kg). Evra will have his hands and legs full to keep Messi in check as Messi can turn the game in a flash if given too much freedom with his superb movement, tricks, pace and vision.

In central midfield Xavi Hernandez (29 years, 1.68m, 66kg) will have a key "head to head" confrontation with Michael Carrick (27 years, 1.83m, 70kg). The tall, athletic Carrick against a diminutive, dynamic Xavi will showcase a clash in styles. Carrick will have additional defensive duties as Darren Fletcher is suspended besides trying split the Barca defence with pinpoint passes or penetrating runs. Xavi's role mirrors that of Carrick as he is just as crucial in attack as defence for Barcelona.

Let the match begin.

Reference
Journal of Sports Science 2009 27(5): 419-426

Photo taken from www.soccernet.com

Sunday, May 24, 2009

What Time is It?


It's French Open Time. For all you tennis fans out there, the French Open kicks off tonight. It looks like an intriging two weeks up ahead as the French Open is billed as the most challenging among all the grand slams. Why most challenging, you may ask? Well, it's a time when the ubiquitous power games on both the men's ATP and women's WTA tour take a back seat to strategy, guile and court craft. The rallies are long, matches longer and only the mentally tough can win the utimate prize. Hosted in Paris at the Stade de Roland Garros, one of the most romantic cities in the world, the French Open runs from 24th May to 7th June this year.

I'd still say the big favorite for the French Open remains Rafael Nadal. How can you pick against arguably the greatest clay court player in the history of tennis who'll be gunning for a record setting 5th consecutive title (to overtake Bjorn Borg).

Well, there's Roger, some will no doubt say. Roger Federer accomplished what no other player this year has, he played spectacularly to beat Nadal in straight sets last Sunday to win the ATP Masters Madrid Open (see photo above). For Federer to beat Nadal is rare enough as he'd lost their previous five finals (previously all matches head to head is 13-6, in Nadal's favor, 9-1 on clay, including 11-4 in finals). But to do so on clay is an enormous achievement for Federer.

However, before you start to think that the tide has turned and that Federer has regained his status as the man to beat, it must be pointed out that the last time Nadal lost a final on clay, it was also to Federer, in Hamburg 2007, and only a few weeks later, he went on to beat Federer in the final of the French Open. Moreover, at this Madrid Open which is a new clay court event on the calender this year, it obviously has a faster surface than Paris (which suits Federer's game more) and cannot be compared with the French Open.

Nadal came into last Sunday’s final less than 24 hours after spending a record- breaking 4 hours 3 minutes on court in the semis against Novak Djokovic. The match is believed to be the longest best-of-three sets singles match on the ATP World Tour in the Open Era (since 1968). Not to take anything away from Federer, who played an excellent clay match against his fiercest rival. He was able to take advantage of Nadal’s heavy legs and prolific unforced errors. He kept a cool head, which has not always been the case for the Swiss maestro recently. He truly earned the win and will now head into the French Open next week with buckets of confidence.

Nadal mostly staggered through that match. His legendary focus on big points was absent. He went 0/4 on break points against Federer in the match and saved neither of the two break points Federer had against him. Nadal's backhand was often short and tired looking and he could not find his range on the forehand wing. Federer, who obviously noticed that Nadal was struggling with his movement, used the drop shot to great effect. His tactics were simply exceptional throughout the match. Besides these two great players, other challengers in the men's field will include Novak Djokovic, Fernando Verdasco and maybe Andy Murray.

For the ladies, the draw looks wide open with a few likely ones challenging for the honors. Svetlana Kuznetsova, Jelena Jankovic, Elena Dementieva, Vera Zvonareva and Ana Ivanovic are the usual suspects though the latter and who is a former World No 1 and defending champion hasn't been playing well recently. After losing in the 3rd round at the Australian Open, Ana has managed only 2 quarterfinal appearances to date so far and pulled out of the Madrid Open last week with a knee injury. The Williams sisters Venus and Serena haven't done so well in Paris recently, but you can never count them out especially in grand slam events. My guess for the win? Dinara Safina, yes Marat's little sister, who is having a super stellar season so far. The current World No. 1 was runners-up at this year's Australian Open (and also last year's French Open). She's the one in ominous form recently and has won back to back clay court titles in Rome and Madrid.


Who will I be rooting for? Rafa of course. I had the honor of taking a picture with him at the Beijing Olympics last year and he was really humble and obliging. But, here's the clincher, Rafa has never lost in Paris, going 28-0 in Paris since first winning there in 2005. He has never even been pushed to a 5th set there so far. In fact, he didn't lose a single set in last's year's run to the title. This year will will be tougher though given he has a tough draw. But in Paris, he's still the man to beat.



Tuesday, May 19, 2009

Eating on the Fly


On the just concluded queen stage 10 (longest stage of 262km) of the ongoing Giro d' Italia (a 21 day cycling stage race otherwise known as the Tour of Italy), the riders in the picture on the left are seen getting their feed bag to get some much needed nourishment so they can do well on this particular stage. 262km in a day? How many of us have ridden that far in a week recently, let alone in a day?

Unless you've been living on another planet, most of you will be aware of the tremendous importance of carbohydrates (CHO) for sporting performance. Much of the published emphasis has been on replenishing CHO stores after training or competition.

There is however, emerging evidence that CHO feeding during exercise offers significant benefits. There is no way the riders can get away with not eating during that stage where they ride 262km. In fact, they have to eat a lot before, during and after the stage. For the rest of us mortals who ride or train much less, eating on the go (while training or exercising) may be just as critical.

Consider the following study where investigators attempt to find out what the impact of eating during a 75 minute training ride at 80% VO2 max on CHO stores in the body and also protein oxidation. In the first trial, the cyclists took 125 grams of glucose while riding, while in the second trial, no glucose was ingested. Sweat and urine metabolites were also analyzed to see how much protein was being oxidized during exercise ( to track to see if your muscle tissue is being broken down to fuel your exercise).

Results showed that feeding on the glucose reduced liver glycogen stores by 12% and muscle glycogen usage by a whopping 16%. The impact on protein utilization was more significant, glucose feeding resulted in a two-thirds drop in protein oxidation.

Hence, it is clear that by ingesting CHO during training, it offers significant benefits to endurance athletes (more so since the athletes studied were not low in CHO stores before the study). Not only does it spare muscle glycogen stores, it also reduces the loss of muscle tissue via protein oxidation.  This may be especially useful for endurance athletes who struggle to maintain muscle mass during periods of high volume training or competition.

So more reason to eat on the go for your next long run or ride.


Reference 

Int Journal Sport Nutr Exercise Metab Aug 2005; 15(4) : 350-365

Tuesday, May 12, 2009

Shin Splints Or Stress Fracture?



I've seen quite a few of my patients recently with shin pain so I thought I'd write about it. This condition can usually be caused by any activity that involves running, jumping or even extended periods of walking. Patients usually present with pain at the beginning of exercise. During the initial phase, the pain may disappear during the warmup or after 15-20 minutes of exercise, but returns for several hours after exercise. In the more severe cases, pain is usually present during training and aggravated during daily activities like walking, squatting or climbing stairs. There is often pain at rest as well. The pain is often described as a dull, aching discomfort of varying degrees of intensity.

Left untreated, it can progress to a stress fracture in your tibia (or shin bone). Which is exactly what happened to one of my patients.

The picture shown above is the x-ray of my patient's stress fracture. The arrow depicts the callus formation of thickening of the bone indicating a stress reaction in the bone. Usually a bone scan is needed to detect a stress fracture as an x-ray only picks up the callus formation (about a month later) as the bone is healing.

The term "shin splints" refers to pain along your tibia and this is usually caused by too much pulling of your muscles along their attachments along the bone. Research has shown that it is usually the tibialis posterior and soleus muscles that causes this condition. With repeated pulling (or stress), this causes the shin bone to be irritated and pain results. That is why this condition is also known as medial tibial stress syndrome. Milder cases are treated fairly easily. Most physiotherapists will ask their patients to rest, ice the painful area, change footwear and modify your training routine to prevent shin splints from recurring. The cause of your pain should be addressed rather than just treating the shin pain alone.

Most of the time shin splints occur from overuse. It is commonly seen in athletes who suddenly increase their duration or exercise intensity of training. Overpronation is often listed as one of the common causes of shin splints. Now if you've been following our blog article Pain Free Running or running with the Physio or Sports Solutions team, then you will be happy to know that you can run pain free and even avoid getting shin splints. Our athletes with shin splints or stress fractures often do their rehabilitation in the pool as well to maintain their fitness.

I have had stress fractures in both legs before, early in my racing days, when I was just competing in track and field events. This was before I started competing in triathlons of course. I know exactly how frustrating it can be not being able to run. Will be most willing to help if you need any advice on this.

Please read this for more on shin splints.

Reference
Thacker SB, Gilchrist J, Stroup DF and Kimsey CD (2002): The prevention of shin splints in sports: a systematic review of literature. Medicine and Science in Sports and Exercise 34: 32-40.

Thursday, April 30, 2009

Aqua Based Rehabilitation (Deep Water Running)



If you've ever wondered how our injured national athletes still keep most of their hard gained fitness, read on.

Their pool based water work is often the key to a quick return. For those not injured, the swimming pool can also be used as a great training tool in addition to your other workouts. Look closer at the 2nd picture and you may recognize some of our badminton players who have been to the last 2 Olympics- Ronald Susilo, Kendrick Lee, Xing Aiying and Li li etc. Our Singapore badminton team went to the pool once a week at least during periods when they were training at their hardest so they can train in a setting with little or no impact to minimize injuries with yours truly leading the session in the water with them.

Now, this is not a typical swim training session like you might think. As most land based athletes are not good swimmers, I often use aqua running techniques (or deep water running) to produce a valuable training effect for them. It would take a far longer time to get them to be of a good swimming standard to get the same effect from swimming and since time is a precious commodity in sports rehabilitation hence the use of deep water running. Moreover, most of these athletes or patients are involved in some land based or running sports, so swimming offers less transferable benefits or movements that are similar to their land based activities.

Done right it is a full body workout involving the legs, arms, shoulders and core muscles.It is also a good alternative to pounding the streets day after day. A study comparing a group doing deep water running versus another group road running found both training programmes produced similiar improvements in V02 max levels.
Water is about 773 times more resistant than air, so it can strengthen all key running muscles. Water is also isokinetic, meaning the water resists you as much as you resist it. The harder you move your arms or legs through the water, the more drag force or resistance you encounter. What's more challenging? Doing the workout without a flotation device or belt. I often get my athletes to do the entire session without one to push them harder.

The pool is a very good and versatile environment for rehabilitation work and training for athletes and patients. By including this session, you can allow for injured athletes or patients to recover quicker and allow others to undertake higher intensity land based training. It will not do the aqua training technique justice for me to describe how you do it in just a few short sentences, please contact us know if you need more advice on this. Physio Solutions conducts deep water running classes, give us a ring to find out more.

References
Davidson, K (2000). Deep Water Running Training Improve V02 max in Untrained Women. Journal of Strength and Conditioning Research. 14 (2) 191-195

Dowzer, CN and Reilly, T (1998). Deep Water Running. Sports Exercise and Injury. 4: 56-61

Sunday, April 19, 2009

Boston Marathon



In case you didn't know, tomorrow is Patriot's Day(a public holiday) in Boston. For New Englanders, Patriots' Day remains special for it is the anniversary of the beginning of the American Revolutionary War with battles between British troops and the Minute Men of Concord and Lexington, Massachusetts.

For runners, Patriots' Day has become synonymous with the Boston Marathon or, as locals often refer to the day, Marathon Monday. One of the country's oldest athletic clubs, The Boston Athletic Association (BAA) was formed on March 15, 1887 with the support of politicians, sports enthusiasts and entrepreneurs to "encourage all manly sports and promote physical culture" (quote from its 1890 yearbook constitution).

In 1897, the BAA put on a 24.5 mile race that only 10 out of the 15 runners that attempted finished. That little event grew to become the Boston Marathon today, the crown jewel of the BAA and some say the running world as well. The first woman to run was Roberta Gibb in 1966, she had to hide in the bushes before the start of the event. Women were finally allowed to run in 1972 and of the 8 that started, Nina Kuscsik won (and all 8 finished).

This is the only marathon for non elite runners that requires you to qualify before you can participate. Trying to qualify for the Boston Marathon is the holy grail (the most sought after and most difficult goal) for many runners. Getting into Boston has become an honor, almost like qualifying for the Olympics at the "normal people" level.

All the best for all those taking part.

Tuesday, April 14, 2009

Look Ma No Hands


One of my favorite riders Mario Cipollini shown here winning the 2002 World Cycling Road Race Championships in the picture above. What does super Mario have as a advantage over his fellow sprinters? Besides his abundance of fast twitch muscle fibers, his strong core muscles are his best kept secret. Even Lance Armstrong spends extra time working on his core muscles so he can be more stable and hold his time trial position longer in the quest to get mere seconds over his competitors. 

Why this topic, you may wonder? Well, many of our patients this past fortnight are cyclists, triathletes preparing for a cycling stage race in Thailand at the end of the month. Hence, I've decided to do a topic on this as it benefits all athletes and even patients who don't play sport and yet have low back pain.

Consider some research done on cyclists on whether a torso (or trunk) stabilization device would reduce metabolic cost of producing cycling power - increasing cycling efficiency and lower energy expenditure for the same cycling power output. All this translated means cycling faster using less energy. The cyclists were tested on a cycle ergometer at different power outputs, different pedal cadences with and without torso stabilization. The results show that with a stable torso, submaximal cycling power was reduced (increase in cycling efficiency was seen), meaning cycling faster with less effort. This reduction was also related to pedaling cadence. Greatest reduction was seen at lower pedaling rates where pedaling force was greatest.

The researchers concluded that implications of this study are significant for cyclists. High cadence pedaling appear to increase efficiency by reducing the amount of energy required to stabilize the upper body while cycling. Cyclists with greater core stabilty will have an advantage over those with weaker stabilzing muscles. (My patients reading this now should realize why I spent so much time teaching you how to use your deep, core muscles).

I'd like to point out that you need to learn how to activate your core muscles without activating the superficial muscles and still be able to transfer them to your sport or activity. I know for a fact that many of our patients have been taught wrongly despite having 'learnt' it before from previous physiotherapy, Pilates or other core classes. Please come talk to us if you have any questions.

Reference
Canadian Journal of Applied Physiology Aug 2005 30(4) : 433-41