Thursday, October 31, 2019

Never Give Up!



Chapeau to  Ronald Susilo. This guy just keeps on going and going. After suffering many potential badminton career ending injuries while at the top of his game, he has always managed to bounce back.

After winning the Japan Open Grand Prix and then beating World Number One Lin Dan at the 2004 Athens Olympics with a torn shoulder labrum, he went under the knife.

More heartbreak followed after coming back from that when he tore his achilles tendon at the World Badminton Championships in 2005.

Yet he persisted. Tragedy again at the 2007 Sea Games when he tore his right forearm muscles playing against Vietnam. Again he managed to bounce back and we went to our second consecutive Olympics together in Beijing in 2008.

His wife sent him to Sports Solutions in this 
Even after retiring from national duty, he kept playing after he started coaching. And subsequently ruptured his patella tendon while tearing his ACL and medial meniscus at the same time. He needed 2 operations after this. Attaching the patella tendon first before repairing the ACL almost a year later.


And now this right shoulder again .....

Well, Ronald we've done this together too many times before. But I know you'll be back once more. You can do this!! Want to be a champion? Passion for the sport and persistence is what you'll need. Lots of it.


In the picture below, you see me celebrating and more excited than Ronald Susilo himself after he defeated Lin Dan in the 2004 Athens Olympics.

Yes, I used to sit on court with him and his coach every time he played.

Monday, October 28, 2019

Does Weight Training Stunt Growth In Young Adolescent Kids?

14 yo Miles with Dad Ving Henson at The Pit
I remember clearly being told by my teammates as a young runner at twelve that I should never do weights as it would stop me from growing taller.

This misconception about weight training often comes from fellow teammates, well meaning parents, physical education teachers and even some coaches. Actually, the sport your child participates in (sprinting, jumping or contact sports) will generate greater forces than training in the weight room.

This widely held belief that weight training especially when performed during puberty/ adolescence stunts growth still persist in the present day. Due to this, young athletes and children should only perform body weight exercises and not do any training with barbells, kettlebells or even dumbbells.

Fret not if you're a parent or teacher of a young athlete. There is simply no evidence to support this belief at all. Many studies have looked into this topic and found that weight training has no negative impact on skeletal growth. It will not stunt growth.

Actually, studies show consistent findings that young subjects have increased strength, speed and power, while losing weight, gaining muscle and stronger bones. There is also a reduction in injury rates. Good news for parents if your child keeps getting injured. This is especially true even when the young subjects have not reached puberty.

So it makes very little sense from a bone stress point of view if you stop your child from going to the gym but allow them to participate in sports.

So how soon can your child start weight training? We do not have any suggestions from any local authority but the Australian Strength and Conditioning Association suggest that a child can start weight training at six years old. As long as he/she can follow clear instructions and understand the dangers when training.

If you do send your child/ athlete for weight training, make sure the learn the correct techniques by a good strength coach who has experience working with young athletes. Remember, don't force the young athletes if they are not keen.


References

Barbieri D and Zaccagni L (2013). Strength Training For Children And Adolescents: Benefits And Risks. Collegium Antropologicum. 37(2): 219-225.

Faigenbaum AD and Meyer GD (2010). Resistance Training Among Young Athletes: Safety, Efficacy And Injury Prevention Effects. BJSM. 44(1): 56-63.

Falk D and Dotard R (2019). Strength Training In Children. Harefuah. 158(8): 515-519.


After seeing 14 yo Miles training above, my 9 yo was inspired to do the same


Friday, October 18, 2019

Is Your Running Style Causing Your Running Injury?

How's my running gait?
I saw a patient yesterday who was training for the upcoming Singapore marathon. He started having knee and heel pain after doing a long run of 22 km over the weekend. Upon assessment, he definitely demonstrated a greater contralateral (or opposite) pelvic drop (CPD), indicating Gluteus Medius muscle weakness.
Picture A- Injured runner with CPD and right hip adduction 
Last week we discussed whether doing clam shell exercises was still relevant for someone with Gluteus Medius muscle weakness. Turn's out that this week's post is related to that.

The referenced study (Bramah et al, 2018) investigated and identified certain faulty running gait patterns that contribute to running injuries. In all, 108 runners were studied, including 72 injured runners and 36 healthy runners in the control group matched for age, height and weight.

None of the injured runners received any prior treatment for their injury. Those with an increase with more than 30 percent in training volume were also excluded from the study. The control group of runners ran at least 30 miles (or 48 km) a week.

The injuries the injured runners had were patella femoral pain (PFP), Iliotibial Band Syndrome (ITBS), Medial Tibial Stress Syndrome (MTSS or shin splints) and Achilles Tendinopathy (AT). The injuries were selected as they are most prevalent among runners.

All the injured runners showed a greater contralateral (or opposite) pelvic drop (CPD), demonstrating Gluteus Medius muscle weakness. They had a more extended knee and dorsiflexed ankle (heel striking) at initial contact and a forward trunk lean at the midstance phase of running. These patterns were consistent across each of the four injured groups.
Contralateral pelvic drop
CPD was found to be the most important variable predicting whether the study participants were healthy or injured. For every 1 degree increase in pelvic drop, there was a 80 percent increase in the odds of getting injured.
Injured runner (L) heel striking, forward trunk lean vs normal
Those who had more knee extension makes the patella (kneecap) more vulnerable to lateral tilting and displacement. This may affect knee joint contact areas and increase stress when the foot strikes the ground. If a runner heel strikes with the knee extended, their center of mass is further away from their foot. This leads to an increase in knee joint loading and a increase "braking" forces (imagine applying brakes on while you're running).

Those with a forward trunk lean may have weakness around the back and gluteal muscles as shown by previous studies. The injured runners with PFP and ITB problems had more hip adduction than other runners. More female runners were also found to more hip adduction compared to male runners.

So make sure your Gluteus Medius muscles are strong enough so that you will be less likely to have a running injury.


References

Bramah C, Preece SJ Nimh G et al (2018). Is There A Pathological Gait Associated With Common Soft Tissue Running Injuries? AJSM. 46(12): 3023-3031. DOI: 10.1177/0363546518793657

Lessi GC, Dos Santos AF et al (2017). Effects Of Fatigue On Lower Limb, Pelvis And Trunk Kinematics And Muscle Activation. J Electrom Kinesiol. 32: 9-14

Thursday, October 10, 2019

Clam Shell Exercises?

Clam shell exercises?
My patient came in complaining of knee pain after running. She had seen another physiotherapist who after treating her knee, prescribed clam shell exercises for her to do as well. But she still had knee pain after running and climbing stairs despite doing them regularly.

How many of you have been asked to do clam shell exercises to make your Gluteus Medius (or hip) muscles stronger? If you have, maybe you need not bother any more.

Latest research (Moore et al, 2019) shows that clam shell exercises do not activate your Gluteus Medius as much as you think.
Right Gluteus Medius muscle
The Gluteus Medius muscle is very important for female runners, especially if they have knee pain. You can treat their knees but their pain will not go away until you have addressed the weakness  in their Gluteus Medius muscle.
View from the back, Left Gluteus Medius
In that small study, three sets of six common lower limb exercises were performed by ten healthy adults after a short warm up. They did single leg squats, single leg bridging, hip abduction (lifting) in side lying, clam shell exercise in side lying, running man exercise (simulates running motion of running one leg at a time) and resisted hip abduction-extension exercise.

The participants had electromyography or EMG electrodes to measure muscle activity attached to all three parts of the Gluteus Medius muscle (in front, middle and posterior).

Results showed that clam shell exercises were not effective in activating any part of the Gluteus Medius muscle. Highest levels of overall activity were seen in the single leg squat, single leg bridging and the resisted hip abuction-extension exercise.

Other than the knee, you need to know that weakness in your Gluteus Medius can also contribute to pain or problems in your Achilles. Make sure you are doing the strengthening correctly.



Reference

Moore D, Pizzari T et al (2019). Rehabiliation Exercises For The Gluteus Medius Muscle Segments: An Electromyography Study. J Sp Rehab. DOI: 10.1123/jsr.2018-0340.

Tuesday, October 1, 2019

Head, Neck And Jaw

Taking turns for a quick assessment
After Aized and Rachel attended Fans of the hip last week, Reggie and I attended the Head, Neck and Jaw course yesterday and today. This is the next course offered after we did the Shoulders and Arms course earlier in April this year.

Reggie, the center of attention
Wow, time really flies, it's already October today.

It was a really interesting course looking at everyone's head, neck and into their mouths. Yes, you read correctly, we got to stick our fingers inside each other's mouths.
All five different necks
We learnt about the Masseter and Temporalis which are on our face and skull, we also learnt how to treat the Medial and Lateral terygoids, which are inside our mouths and how they connect to the neck.

Showing me my Lateral Pterygoids
Yes, we got right into each other's mouths.
Medial , Lateral Pterygoids
Back to work tomorrow. And if you need to get your head, neck or jaw treated .....