Sunday, March 26, 2017

Anatomy Trains Course

The three amigos 
Aized and Sham did the Pediatric Craniosacral Therapy course two weeks ago, while Reggie, Ting Jun (TJ) and I attended the Anatomy Trains workshop this weekend.

TJ has been at the course for the past four days and since Reggie and I did the first two days last year, we came only for the third and fourth day this year.

It was good to have done a little last year and then review some the concepts while adding on to it this time around.

Here are some pictures from the course.

Theory 
More theory

TJ has the best view for this practical
At the end of the course the presenter was saying "if all of you go in to see and patients tomorrow and wonder what you need to do then I've done my job. "

He was challenging us to look at and treat our patients with a whole new perspective instead of trying to treat our patients the same way we've done.

This has been a most interesting and stimulating course. It ties in nicely with many of the things we already do with fascia while treating our patients.

Well, I'll share what I've learnt with the rest of our team and we'll all be looking to treat our patients and make them better quicker.

Saturday, March 18, 2017

Mirror Mirror On The Wall

Rachel training while waiting for her patients
When you go to a gym, one of the first things  you notice is there are mirrors almost everywhere. And you see lots of people training in front of the mirrors. In theory, the mirrors are there to ensure you hold correct and proper form during exercise. Can mirrors really be helpful?

Previous studies showed mixed results about using mirrors for exercise. Some studies show workout benefits, some no effects while others show negative effects depending on the specific task and experience level of subjects.

Currently, there is a lot of evidence showing that external focus leads to better performance than internal focus while performing physical tasks. Let's say you're shooting a basketball on the free throw line. Focusing on the rim rather than the movement of your wrist will get you better results. One reason is external focus (focusing on the rim) allows well-practiced movements to take place on auto pilot. This is more efficient than trying to directly control wrist action (internal focus).

A group of researchers studied the role of mirrors in attentional focus by getting subjects to do two series of tests. One involved flexing the elbow as hard as possible (single joint movement). The other test involved jumping as high as possible (multi joint movement).

In both cases, tests were done four times under the following conditions. Internal focus, external focus, neutral and finally with a mirror.

To sum up, external focus was best for both series of tests, while internal focus was worse. Using mirrors were no different (statistically) from the neutral condition.

So for both tasks, the mirror didn't really matter. Perhaps while doing resistance type training with heavier weights, mirrors may be helpful for maintaining symmetry of movement or correct form. What is important is that external focus trumps internal focus.

Runners take note that a previous study found that focusing on your form or your breathing (internal focus) results in worse running economy than if you focused on the surroundings (external focus).

References

Halperin I, Highes S et al (2016). The Effects Of Either A Mirror, Internal Or External Focus Instructions On Single And Multi-joint Tasks. PLOS One.
http://dx.doi.org/10.1371/journal.pone.0166799

Schucker L, Hagemann H et al (2009). The Effect Of Attentional Focus On Running Economy. J of Sports Sciences. 7(12) : 1241-1248. http://dx.doi.org/10.1080/02640410903150467.

Saturday, March 11, 2017

Stress Fractures In Teenage Female Runners

Icing the shin
The Singapore National School's competitions are usually held between March and late May every year since 2009. And it's that time of the year again where we see many patients in our clinics with shin splints. Mostly adolescent and teenage girls and the occasional boy.

Why are girls more susceptible to shin splints and stress fractures? Well, some new data shows that if teenage female athletes don't eat enough to support their training, there will be complications regarding their subsequent training and health.

The study tracked 323 female athletes at Stanford University in 16 different sports including cross country running. Bone scans and questionnaires were used to assess the runners based on the components of the "female athlete triad" consisting of "low energy availability, with or without disordered eating, menstrual dysfunction and low bone mineral density. "

Risk status were calculated based on an article published in the British Journal of Sports Medicine  in 2014. Have a look at Figure 4 in the article if you're keen to know more about the calculations.

Looking only at the cross country runners (47 runners) data, half the runners were classified as low risk, and three of those later developed stress fractures.

Sixteen of the runners had moderate risk and 50 percent of these developed stress fractures within a year. These girls were about four times as likely to get injured compared to the low risk group.

Seven runners were in the high risk group and five of them developed stress fractures. They were nearly six times as likely as the low risk group to get injured.

Well, if you're thinking like me, not so good news for the girls if you're a runner and in the moderate to high risk group.

The researchers suggested the following guidelines for female athletes in the moderate to high risk group. The athletes need to ensure they're getting enough calories to support their training along with calcium and Vitamin D. Their menstrual function, bone health and nutrition needs to be monitored on an ongoing basis.

Higher risk athletes may have to consider using low impact cross training more often in their weekly routine. Good sleep and recovery are important too.

Stress fractures occurred mostly in the foot for the low risk athletes, probably as a consequence of biomechanics and jumping sports (due to higher forces).

In the higher risk categories, many of the stress fractures were in the sacrum, pelvis and femoral neck (where the bones tend to be softer). These areas may be due to weakened bone rather than biomechanical forces.

So all the doctors, physiotherapists, physical education teachers, coaches, heads of departments and administrators in charge of female teenage athletes reading this post, please take note.

Reference

Tenforde AS, Carlson Jl et al (2017). Association Of The Female Athlete Triad Risk Assessment Stratification To The Development Of Bone Stress Injuries In Collegiate Athletes. AJSM. 45(2): 302-310. DOI: 10.1177/0363546516676262.

Friday, March 3, 2017

Current Hydration Guidelines May Well Be Wrong

Picture by richseow from Flickr
We've been told in the past by articles, journals and research scientists that if you lose more than 2 percent of your body weight (through sweating) during endurance exercise/ racing your performance will be affected.

Moreover, advertisements from Sports drinks companies keep harping on the fact the you need to drink up or else you get dehydrated.

However, some recent studies (as well as anecdotal evidence from the world's top distance runners) suggest that it may be possible to lose more than 2 percent of your body weight (from sweating) with little or no loss in your performance.

Research scientists from New Zealand's High Performance department have suggested that previous published dehydration studies were conducted in "relatively windless environments (i.e. wind speed less than 12.9km/h) with participants being aware their hydration status." They stated that such conditions do not simulate real race conditions.

In their own (albeit) small study of 10 cyclists, they found that weight loss of up to 3 percent did not slow down the cyclists nor their power output decrease in a 25 km time trial.

Another study on elite male marathoners examined their drinking behavior during 13 major city marathons. Haile Gebreselassie was found to have lost 9.8 percent (and that's a lot) of his body weight during the 2009 Dubai Marathon and still won in 2:05:29 hrs. All drinking by the elite runners were ad libitum (or at their own time and pleasure).

Granted the above study was done on elite runners. Does that even apply to mere mortals like us?Especially in hot and super humid Singapore.

Here are my own thoughts. From the time I started running cross country as a twelve year old kid, I've noticed that I tend to drink less than my team mates and other competitors. And definitely less than what the Sports drinks companies recommend. In fact I often had a side stitch after drinking. That also deterred me from drinking too much then.

So despite what you've heard or read before, at least give it a try in your next few long bike or run sessions. Try to get through those long sessions drinking as little as you can. You'll be pleasantly surprised that you may not need as much fluid as you think.

References

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

Wall BA, Watson G et al (2015). Current Hydration Guidelines Are Erroneus: Dehydration Does Not Impair Performance In The Heat. BJSM. 49(16): 1077-1083. http://dx.doi.org/10.1136bjsports-2013-092417.