tag:blogger.com,1999:blog-24686440792359915632024-03-19T18:55:03.484+08:00Running SolutionsFormer national triathlete and Sports Physiotherapist Gino Ng, shares his racing and training experiences. He's focusing on running tips for now but will also include swimming and cycling advice. Visit this blog if you'd like sporting tips and inspiration.Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.comBlogger801125tag:blogger.com,1999:blog-2468644079235991563.post-56033161020926475842024-03-17T15:38:00.069+08:002024-03-17T16:21:08.643+08:00Knees Out Or Knees In When You Squat?<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTZpIDlIPHpDHOwKoLsn8b1E-4vrYpweFIAUPZUIowdrlWavz10FlL06BzoaOZsKRPOHS4VNbA8ni4Flsd0EyRHUxY7IdZKPOavQAw9Jy1YXv97WtlMvRWwfIYdzXGjpbFjNTsKRLeDsHf9dUvqpiNVjjEsxQjm5AlB7FJCT8rFm0HEsbwsGWcCySRFoQ/s1921/out%20vs%20in%20squat.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1921" data-original-width="1920" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTZpIDlIPHpDHOwKoLsn8b1E-4vrYpweFIAUPZUIowdrlWavz10FlL06BzoaOZsKRPOHS4VNbA8ni4Flsd0EyRHUxY7IdZKPOavQAw9Jy1YXv97WtlMvRWwfIYdzXGjpbFjNTsKRLeDsHf9dUvqpiNVjjEsxQjm5AlB7FJCT8rFm0HEsbwsGWcCySRFoQ/s320/out%20vs%20in%20squat.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Out (left) versus in (right)</td></tr></tbody></table>Here is a post that will perhaps change the way you squat. It depends on what area you want to work on. Previously, some <a href="https://weloverunning.blogspot.com/2022/12/bluetooth-hands-free-physiotherapists.html" target="_blank">physiotherapists</a> and <a href="https://physiosolutions.blogspot.com/2020/08/no-physical-contact-when-treating.html" target="_blank">personal trainers</a> hated me for saying that you can <a href="https://weloverunning.blogspot.com/2020/02/who-says-your-knees-cannot-come-forward.html" target="_blank">let your knees move forward</a> when you <a href="https://weloverunning.blogspot.com/2022/05/quads-and-squats.html" target="_blank">squat</a>. Most, if not all, <a href="https://physiosolutions.blogspot.com/2020/08/no-physical-contact-when-treating.html" target="_blank">personal trainers</a> teach their clients that it is taboo to let your knees move forward while <a href="https://weloverunning.blogspot.com/2023/10/optimal-exercise-form-is-not-always.html" target="_blank">squatting</a>, They get their patients or clients to stick their bums out instead.<div><br /></div><div>Those same <a href="https://weloverunning.blogspot.com/2022/12/bluetooth-hands-free-physiotherapists.html" target="_blank">physiotherapists</a> and <a href="https://physiosolutions.blogspot.com/2020/08/no-physical-contact-when-treating.html" target="_blank">trainers</a> may be aghast if I suggest squatting with your knees pointing in (gasp!) or pointing out. </div><div><br /></div><div>The author recruited 14 males and 18 females for the squatting study (Chiu et al, 2024). Using 3D motion cameras and force platform meausures, normal squats required hip extensor, adductor and lateral rotator net joint movements (NJM). The gluteus maximus muscle exerts hip extensor and lateral rotator moments. The adductor magnus (pictured below) exerts hip extensor and adductor moments. Both muscles combine meet hip demands contributing to hip extensor NJM.</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_qDUZcj3PVzkgdIFx3IcY42mswkQv5_tmnh3D-ZUreGAohVAMcn61ytg6LF1E4RYWLJqv1EQjXiBXlAw-lbkIkheeW2rH8EHjmZcVYejeLxmuvZ-vnU27rDVDEAFcTYxB8C5xnJBEJh6g5Cr6tdfJ77w6NFzSwwi1-VhKBnfFqkcMaIEMaxxbDUXq96w/s1920/Adductor%20Magnus.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1784" data-original-width="1920" height="297" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_qDUZcj3PVzkgdIFx3IcY42mswkQv5_tmnh3D-ZUreGAohVAMcn61ytg6LF1E4RYWLJqv1EQjXiBXlAw-lbkIkheeW2rH8EHjmZcVYejeLxmuvZ-vnU27rDVDEAFcTYxB8C5xnJBEJh6g5Cr6tdfJ77w6NFzSwwi1-VhKBnfFqkcMaIEMaxxbDUXq96w/s320/Adductor%20Magnus.jpg" width="320" /></a></div><div>When squatting with hip in lateral rotation (feet pointing outwards), there was smaller hip extensor, lateral rotator and larger hip adductor NJM than normal squats. This loads the adductor magnus.</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCfgUIkK2KYq91R2CAsU5HnQMIKzGGx8GylXwO4UavpdRyid58WIdmjl1sbYMXgtlI3Ub8FRI2w8qfL5HcqdDOTBDq2Rs8n_NQiGwL2Hm-655tuCplTcRqP_4HeMHm5lHPRy48jRuyKYkvqaNxUj8ddho1nP08qtDNIK33E6zVOboyieunw8u8bNt1IGc/s1400/adductor-magnus.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1105" data-original-width="1400" height="253" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCfgUIkK2KYq91R2CAsU5HnQMIKzGGx8GylXwO4UavpdRyid58WIdmjl1sbYMXgtlI3Ub8FRI2w8qfL5HcqdDOTBDq2Rs8n_NQiGwL2Hm-655tuCplTcRqP_4HeMHm5lHPRy48jRuyKYkvqaNxUj8ddho1nP08qtDNIK33E6zVOboyieunw8u8bNt1IGc/s320/adductor-magnus.jpg" width="320" /></a></div><div>Medial rotation squats (feet pointing inwards) had smaller hip extensor and adductor NJM and larger hip lateral rotator NJM than normal squats. This loads the gluteus maximus.</div><div><br /></div><div>Likewise if you stick your bum out when you squat, you are engaging more of your bum (Gluteus Maximus) muscles. If your let your <a href="https://weloverunning.blogspot.com/2009/08/ladies-your-knee-pain-may-be-coming.html" target="_blank">knees</a> move forward when you squat, you are definitely using your thigh (quadricep) muscles. If you want to increase hip adductor (adductor magnus) work, squat with your knees out. It just depends on what muscles you want to engage or work harder. Try it yourself.</div><div><br /></div><div>There is definitely no real need to restrict forward <a href="https://weloverunning.blogspot.com/2009/08/ladies-your-knee-pain-may-be-coming.html" target="_blank">knee</a> movement when you squat. It's one of the biggest training myths ever. You can add squatting with your knees pointing inwards and outwards to the list of myths as well. </div><div><br /></div><div>This information should 'challenge' some old school "perfect squat" gurus.</div><div><br /></div><div>Reference</div><div><br /></div><div>Chiu LZF. "Knees Out" Or "Knees In"? Volitional Lateral Versus Medial Hip Rotation During Barbell Squats. J Str Cond Res. 38(3): 435-443. DOI: 10.1519/JSC.0000000000004655.</div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-49372150194564114572024-03-10T11:08:00.093+08:002024-03-10T14:47:07.597+08:00The Most Efficient Way to Run (According To Science)<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghOufUUBSprUWJ1OWMq0ferlTf3IryjIgdqUvze8MwfTG0UEiSg5lTs7NEwHwSeL5e90Fe_VILYXrk3sVbRjeWVdt0Pf7SUKS57Ssp4J994C1o14X6YeF_Gy_XmueesQbQUVAFx8z9utwJLDSjWldEDo3dljSSCOJ9u5HLMwBULZkSLxZn7CyIONDq6Qo/s1072/Run%20efficiently%20post.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="630" data-original-width="1072" height="188" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghOufUUBSprUWJ1OWMq0ferlTf3IryjIgdqUvze8MwfTG0UEiSg5lTs7NEwHwSeL5e90Fe_VILYXrk3sVbRjeWVdt0Pf7SUKS57Ssp4J994C1o14X6YeF_Gy_XmueesQbQUVAFx8z9utwJLDSjWldEDo3dljSSCOJ9u5HLMwBULZkSLxZn7CyIONDq6Qo/s320/Run%20efficiently%20post.jpg" width="320" /></a></div>I came across a recently published (6/3/24) systematic review on what is the most efficient way to run, according to science (Van Hooren et al, 2024). 51 studies were reviewed in this systematic review.<p></p><p>It's a long review paper, key findings in the pictures attached. Let me highlight some of the important points. The paper does lend some support for increasing your <a href="https://weloverunning.blogspot.com/2023/11/is-there-ideal-running-cadence-rate.html" target="_blank">cadence</a> or step rate to improve running economy as this increases leg stiffness and reduces vertical oscillation. When you watch some runners run, you can see that they tend to 'bounce' up and down while running, that is vertical oscillation. </p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5zS3OaZ_Iic1vwM7Yx4hoCpclUHYgPEU8MQgA6u5bIENXWD2L5Rg-_k97IqrvWzri4DyapvC2sBpr6-Fc6IdJsLBP1D_-4s1z9CMScKLslSYzCGpoojfGP2gzVVRholzR9lGUPZet5uao-PQF5HJNB_07XQxx2Cx581DAju3zdqzPyOjcjidnZS9mxsc/s1080/Initial%20Contact.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="987" data-original-width="1080" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5zS3OaZ_Iic1vwM7Yx4hoCpclUHYgPEU8MQgA6u5bIENXWD2L5Rg-_k97IqrvWzri4DyapvC2sBpr6-Fc6IdJsLBP1D_-4s1z9CMScKLslSYzCGpoojfGP2gzVVRholzR9lGUPZet5uao-PQF5HJNB_07XQxx2Cx581DAju3zdqzPyOjcjidnZS9mxsc/s320/Initial%20Contact.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Initial Contact</td></tr></tbody></table>At Initial Contact (or foot flat) phase, higher <a href="https://weloverunning.blogspot.com/2023/11/is-there-ideal-running-cadence-rate.html" target="_blank">cadence</a> (step rate) may be associated with a lower energy cost of running. Decreased trunk flexion and knee flexion during swing phase may also be associated with better running economy.<p></p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-4RQWeKDSVDiuSKxAqWtTdjDbvJUGsNa_CPimIx8wNRRvSmEhUR5PJ4EhYPQtB9SzpKkmRm8hx7_bCCc_YklYZ7Kz117jJJ9kTaZhJ5A5y8qmHMN6f1xW2impw4WwpduJquuGP3mQRbIYB0bqWTxSg9k89SJMIig5SnphyphenhypheniNmyWxlAUEA17uSSK1O0D0/s1080/Mid%20Stance.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="982" data-original-width="1080" height="291" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-4RQWeKDSVDiuSKxAqWtTdjDbvJUGsNa_CPimIx8wNRRvSmEhUR5PJ4EhYPQtB9SzpKkmRm8hx7_bCCc_YklYZ7Kz117jJJ9kTaZhJ5A5y8qmHMN6f1xW2impw4WwpduJquuGP3mQRbIYB0bqWTxSg9k89SJMIig5SnphyphenhypheniNmyWxlAUEA17uSSK1O0D0/s320/Mid%20Stance.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Mid stance </td></tr></tbody></table><p>During Mid Stance phase, decreased trunk flexion and reduced vertical oscillation may be associated with improved running economy. Increased vertical and leg stiffness may also be associated with lower energy cost.</p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_0oXbV1Dh6slYgMWULUjcrhcGzJ2CHgce_y5xfqhl71-_Vm7nH0zy4BGIalkwUaL1KC-9M8xkrcv34Nq59gQXh5AvPUHcIZzKF6A98MGcrS6bVFUFmkFruLvXhMTdJT3spfWaI1bL86YKCxvPyb8QOfNquT6NSfDG-QinpD57CQXCnV_z0li1e4ebHOI/s1080/Toe%20Off.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="982" data-original-width="1080" height="291" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_0oXbV1Dh6slYgMWULUjcrhcGzJ2CHgce_y5xfqhl71-_Vm7nH0zy4BGIalkwUaL1KC-9M8xkrcv34Nq59gQXh5AvPUHcIZzKF6A98MGcrS6bVFUFmkFruLvXhMTdJT3spfWaI1bL86YKCxvPyb8QOfNquT6NSfDG-QinpD57CQXCnV_z0li1e4ebHOI/s320/Toe%20Off.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Toe off</td></tr></tbody></table><p>At the Toe Off phase, if trunk flexion and ankle plantarflexion are reduced, running economy may be improved.</p><p>Those metioned above are just he key findings which I have summarised. However, there are many more details and applications in the paper itself. You can read the free paper <a href="https://link.springer.com/article/10.1007/s40279-024-01997-3#citeas" target="_blank">here</a>.</p><p>I have previously written before on running <a href="https://weloverunning.blogspot.com/2023/11/is-there-ideal-running-cadence-rate.html" target="_blank">cadence</a> and running <a href="https://weloverunning.blogspot.com/2022/02/does-good-running-form-make-you-run.html" target="_blank">form</a> if you wish to read further.</p><p>Reference</p><p>Van Hooren B, Jukic I, Cox M et al (2024). The Relationship Betwen Running Biomechanics And Runnng Economy : A Systematic Review And Meta-Analysis Of Observational Studies. Sports Med. DOI: 10.1007/s40279-024-01997-3</p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6nKCHrgNpuOWsx_ED2oO9gEl6xoevtgrWKUHHM2T8704u4SD9AQTrbwICfsrlufhFzKZMWoBSob1zW_JcX9QN9v-If12t-i_PAVGYeJpI3C9GPvW4SkrmoZfGFqvSzmpJnEKUXhVtuyy1RaiJ8pUnLqBX0tAVjKzEJ801RdxuhcTHcZHAInVODJgIVyw/s1021/Efficient%20Running.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1021" data-original-width="940" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6nKCHrgNpuOWsx_ED2oO9gEl6xoevtgrWKUHHM2T8704u4SD9AQTrbwICfsrlufhFzKZMWoBSob1zW_JcX9QN9v-If12t-i_PAVGYeJpI3C9GPvW4SkrmoZfGFqvSzmpJnEKUXhVtuyy1RaiJ8pUnLqBX0tAVjKzEJ801RdxuhcTHcZHAInVODJgIVyw/s320/Efficient%20Running.jpg" width="295" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Summary</td></tr></tbody></table><br /><p><br /></p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-90371866675373414162024-03-10T08:08:00.002+08:002024-03-10T11:11:39.070+08:00Can Your Sports Bra Restrict Your Breathing?<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFqBG6pyoUYdrDwhF6FWEYYvM-t8bMHsDVHrRKFR3HtW07ac69vstRBWNJMG7AaRo60clbsRjfLh57ylil-0kGVsb4QggGqRFXZ_0n_nbEEehKn36m8WY8gfun9mbvAtbdcNeDhd74BW6W_97QFBDXs891HOQU2zajlmTva3sWDiflRsN5Uh_BdustGnQ/s1080/Sports%20bra.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1080" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFqBG6pyoUYdrDwhF6FWEYYvM-t8bMHsDVHrRKFR3HtW07ac69vstRBWNJMG7AaRo60clbsRjfLh57ylil-0kGVsb4QggGqRFXZ_0n_nbEEehKn36m8WY8gfun9mbvAtbdcNeDhd74BW6W_97QFBDXs891HOQU2zajlmTva3sWDiflRsN5Uh_BdustGnQ/s320/Sports%20bra.jpg" width="320" /></a></div>Excellent <a href="https://physiosolutions.blogspot.com/2024/03/is-your-sports-bra-restricting-your.html" target="_blank">post</a> by <a href="https://weloverunning.blogspot.com/2019/05/raising-two-kids-and-two-clinics.html" target="_blank">Aized</a> on whether your sports bra can restrict your breathing when you exercise in our <a href="https://physiosolutions.blogspot.com/2024/03/is-your-sports-bra-restricting-your.html" target="_blank">Physio Solutions blog</a>. Have a read <a href="https://weloverunning.blogspot.com/2019/05/raising-two-kids-and-two-clinics.html" target="_blank">here</a>.<p></p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-6873807584027093472024-03-03T08:18:00.040+08:002024-03-03T10:21:27.045+08:00What Time Do You Eat Dinner?<p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYcJiKASIfAdj7mSA_yL-IO9QvpMRRqVcospMkpJPtCgcgCRg20UQsGHIY99u8UM57CuMOEnr7HwljqUM7GST-NOPzNE2Ndm7TRIPlz0jlEzF19JlrN2iM2GMOS_-JphB2XAQKsMUfYW172P1vPHZFKoMM4r28W3cWjO7B_XKb5eILslxtgBlzkWIY8po/s630/Early%20Dinner.webp" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="420" data-original-width="630" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYcJiKASIfAdj7mSA_yL-IO9QvpMRRqVcospMkpJPtCgcgCRg20UQsGHIY99u8UM57CuMOEnr7HwljqUM7GST-NOPzNE2Ndm7TRIPlz0jlEzF19JlrN2iM2GMOS_-JphB2XAQKsMUfYW172P1vPHZFKoMM4r28W3cWjO7B_XKb5eILslxtgBlzkWIY8po/s320/Early%20Dinner.webp" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture from <a href="https://sg.news.yahoo.com/best-time-day-eat-dinner-104500915.html" target="_blank">Yahoo</a></td></tr></tbody></table>My patients are usually shocked when I tell them that I normally have dinner by 6 pm. My family usually has dinner at around 6 pm (plus minus 10 minutes). </p><p>I do not know for sure what time most Singaporeans have dinner, but 3 in 5 Americans normally have dinner after 9 pm (Farsijani et al, 2023).</p><p>Our bodies are much better at digesting and processing nutrients during the day and powering down and resting at night. So eating close to bedtime can cause a whole range of issues. There are <a href="https://pubmed.ncbi.nlm.nih.gov/16393212/" target="_blank">studies</a> linking late night eating to heartburn while others demonstrate how it can affect your <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215804/?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosfinishline&stream=top" target="_blank">sleep quality</a>. As you know, <a href="https://www.todayonline.com/singapore/singapores-sleep-deprived-millennials-snooze-longer-weekends-habit-worrying-sign" target="_blank">Singaporeans</a> already do not have enough <a href="https://weloverunning.blogspot.com/2016/12/if-only-you-know-power-of-sleep.html" target="_blank">sleep</a>. </p><p>There are also recent studies that link late night eating with increases in body weight and the risk of <a href="https://weloverunning.blogspot.com/2017/09/how-singapore-can-solve-our-diabetes.html" target="_blank">diabetes</a>. When you limit your calorie intake 3 to 4 hours before bedtime, it can help with blood <a href="https://weloverunning.blogspot.com/2013/07/sugar-and-not-fat-causes-diabetes.html" target="_blank">sugar</a> control and <a href="https://weloverunning.blogspot.com/2023/06/exercise-versus-diet-for-losing-weight.html" target="_blank">weight management</a> (Vujovic et al, 2022). This is likely linked to the circadian clock which reduces the energy we use after a meal in the evening.</p><p>Again in America, early dinners seem to gaining popularity among Americans of all ages. 5 pm is the fastest growing time slot for dinner reservations while bookings for 8 and 9 pm are falling.</p><p>Surprisingly, many <a href="https://weloverunning.blogspot.com/2023/04/the-millenial-and-generation-z-strength.html" target="_blank">Gen z-ers</a> are embracing this early bird lifestyle. Americans between the ages of 15 to 34 are getting more sleep each night (9 hrs 12 mins) over the last decade if you look at <a href="https://data.bls.gov/PDQWeb/tu" target="_blank">data</a> from the U.S. Bureau of Labor Statistics. </p><p>I am surprised to say that the youths (Americans at least) today are more well rested than I thought, possibly because these youths are ditching <a href="https://news.gallup.com/poll/509588/americans-view-moderate-drinking-unhealthy.aspx" target="_blank">late night drinks</a> in favor of . Less daily commuting in this era of remote work enables them to sleep in, while an increase in venture capital for <a href="https://news.crunchbase.com/startups/inside-supermoon-capitals-big-dreams-for-its-sleep-tech-focused-fund/" target="_blank">sleep tech</a> definitely helps too.</p><p>When you limit your calorie intake 3 to 4 hours before bedtime, it can help with blood sugar control and weight management (Vujovic et al, 2022). This is likely linked to the circadian clock which reduces the energy we use after a meal in the evening.</p><p>Eat early, sleep early that seems to be what the research is telling us to ensure good health . </p><p><br /></p><p>References</p><p>Farsijani S, Mao Z, Cauley JA et al (2023). Comprehensive Assessment Of Chrononutrition Behavirs Among Nationally Representative Adults: Insights From National Health And Nutrition Examination Survey (NHANES) Data. Clin Nutri. 42(10): 1910-19-21. DOI: 10.1016:/j.clnu.2023.08.007</p><p>Vujovic N, Piron MJ, Qian J et al, (2022). Late Isocaloric Eating Increases Hunger, Decreases Energy Expenditure, And Modifies Metabolic Pathways In Adults With Overweight And Obesity. J Clin and Transl Report. 34(10): 1486-1498. DOI: 10.1016/j.cmet.2022.09.007</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-86669964866258446592024-02-25T08:38:00.017+08:002024-02-25T09:42:08.689+08:00Ulnar Nerve Entrapment<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO8QBhfyuG3oeos2dcc1QUJmxeljFa6ddR317oBj2jDbMMJWywRQbhV3YDekfA8TNmlsguzTt3URoX56_uBkwUmxw8WvDb5XIPlNj2GkoWawq5j54iFdngSSa4KOVevfxjsEaKtCD5TbridRytAvlJWDeUhXepjPojnmpOzMhMEGJHRO5fXV6m3pSK_YY/s346/L%20ulnar%20nerve.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="203" data-original-width="346" height="188" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO8QBhfyuG3oeos2dcc1QUJmxeljFa6ddR317oBj2jDbMMJWywRQbhV3YDekfA8TNmlsguzTt3URoX56_uBkwUmxw8WvDb5XIPlNj2GkoWawq5j54iFdngSSa4KOVevfxjsEaKtCD5TbridRytAvlJWDeUhXepjPojnmpOzMhMEGJHRO5fXV6m3pSK_YY/s320/L%20ulnar%20nerve.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Left ulnar nerve</td></tr></tbody></table>My patient who is a <a href="https://weloverunning.blogspot.com/2010/11/team-singapore-asian-games-athlete-has.html" target="_blank">Team Singapore</a> cyclist came in with a case of ulnar nerve entrapment on Friday. Ulnar nerve entrapment* is the second most common nerve condition happening in the upper limb after carpal tunnel syndrome.<p></p><p>The ulnar nerve arises from the brachial plexus at C8-T1 and travels down the inner part of the upper arm through the arcade of struthers (pictured below).</p><p>At the elbow, the ulnar nerve travels just behind the bony part on the inner part of the elbow. This is also know as the "funny bone" when you can get sensations of pins and needles after bumping the area. </p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvC8PH1va1G4x0WqMXsDhezHmUxjd7gXpl-TFPnBscHRqSaG-pctMkyLL7Lsk7Cz6yFY5LxhKZIumi2yBcAv5PrwoyfpLs7m_g1O6qv-rGDLPgwmKAwRhngmXbU0U6zUCl4tW-K6iB0BRFX1j-_4PXytGPySrS7fjiivPY6nc_AyfOtKqe3bFLEftq0hE/s900/Ulna%20nerve.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="675" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvC8PH1va1G4x0WqMXsDhezHmUxjd7gXpl-TFPnBscHRqSaG-pctMkyLL7Lsk7Cz6yFY5LxhKZIumi2yBcAv5PrwoyfpLs7m_g1O6qv-rGDLPgwmKAwRhngmXbU0U6zUCl4tW-K6iB0BRFX1j-_4PXytGPySrS7fjiivPY6nc_AyfOtKqe3bFLEftq0hE/s320/Ulna%20nerve.jpg" width="240" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture by <a href="https://twitter.com/ConorJones921/status/1622265190153682950" target="_blank">Conor Jones</a></td></tr></tbody></table>As the ulnar nerve crosses the elbow, it passes through a bony tunnel and up to 2 other potential points for blockage making it vulnerable to pressure or stretching. Prolonged periods of sleeping with the elbow bent can also cause over stretching of the nerve. My patient hurt her ulnar nerve after riding for a few hours in a new position after changing her handlebars. Riding for a few hours on bumpy roads did not help. She had also fractured both her clavicles (R followed by L in the last few months). This is also known as the cubital tunnel syndrome.<p></p><p>The ulnar nerve supplies the sensation and muscles to the 5th and half the ring finger. Symptoms are related to degree of irritation of the nerve. They start off intermittent in nature and may only come on at night after the nerve has been stretched for a longer time. </p><p>Pins and needles, aching or tingling in the little and/ or ring finger will be the common symptoms. This is what my patient felt. If the irritation persists, the symptoms may become constant and progress to numbness in the 5th and/ or ring finger and ultimately weakness in the hand.</p><p>As the ulnar nerve exits the bony tunnel, it goes into the flexor carpi ulnaris muscle. Follwing that at the wrist, it travels superficially to the flexor retinaculum and passes into Guyon's canal. </p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivmQGQLDXZA1ksAsnVyD5WVTocr4-1vrqEbDinxWFUxg5kX_tLC3mHI2f1WuNLPZdFZJSGb6YZ4E82BSbyGVi4yw0FtMyMaCiH1PTrCnfihv9Q2eyNQqzlAhFDpyiQ6-8ZzHfKT2VbJWzi1A60AVZr6a8HOqT1PArJy2GtgQMt3lp0uq88oznlTEPqLFM/s330/Guyon's%20canal.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="246" data-original-width="330" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivmQGQLDXZA1ksAsnVyD5WVTocr4-1vrqEbDinxWFUxg5kX_tLC3mHI2f1WuNLPZdFZJSGb6YZ4E82BSbyGVi4yw0FtMyMaCiH1PTrCnfihv9Q2eyNQqzlAhFDpyiQ6-8ZzHfKT2VbJWzi1A60AVZr6a8HOqT1PArJy2GtgQMt3lp0uq88oznlTEPqLFM/s320/Guyon's%20canal.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">R wrist</td></tr></tbody></table>Guyon's canal is formed by 4 borders (pictured above). The roof is the palmar carpal ligament, the floor being the transverse carpal ligament, the ulnar (inner) border is the pisiform and the radial (outer) border is hook of hamate. If the nerve is irritated at the wrist it is known as Guyon's canal syndrome.<p></p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggEpT9DCil51-MhMDeNLbCE8NpLvFZdWAV0cSyjlA3f0rfi-WJ5Z06mjYCMIu22OEiVWNYuSH0dkqJQleyVTRsFd9QaqUZfGoMH6591HL1_Qjy2bLqB6bcrHVNtIE96rIr5JFfvZNOJlHNnufwkSd0PzVIMzJXu_hb5bwheqrqom4ZCbIhr0uXyCsHiWc/s800/hand-muscles-2.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="800" data-original-width="800" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggEpT9DCil51-MhMDeNLbCE8NpLvFZdWAV0cSyjlA3f0rfi-WJ5Z06mjYCMIu22OEiVWNYuSH0dkqJQleyVTRsFd9QaqUZfGoMH6591HL1_Qjy2bLqB6bcrHVNtIE96rIr5JFfvZNOJlHNnufwkSd0PzVIMzJXu_hb5bwheqrqom4ZCbIhr0uXyCsHiWc/s320/hand-muscles-2.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture from <a href="https://medicalartlibrary.com/hand-muscles-hypothenar/" target="_blank">Medical Art Library</a></td></tr></tbody></table>The flexor carpi ulnaris and inner half of flexor digitorum profundus muscles are innervated by the ulnar nerve and the hypothenar muscles (pictured above).<p></p><p>Knowing the exact site of nerve irritation during an accurate clinical examination will help decide what needs to be done for treatment. Some doctors send their patients to do a nerve conduction test, but I personally find that an upper limb tension test (with radial nerve bias) done correctly does a much better job. Others may do ultrasound imaging to help diagnosis. Do not confuse it with <a href="https://weloverunning.blogspot.com/2022/10/thoracic-outlet-syndrome.html" target="_blank">thoracic outlet syndrome</a>.</p><p>Just remember not to have a <a href="https://weloverunning.blogspot.com/2023/02/steroid-cortisone-injections.html" target="_blank">steroid/ cortisone</a> injection.</p><p>*Ulnar nerve entrapments are commonly seen in cyclists, golfers, weightlifters and construction workers.</p><p><br /></p><p>References</p><p>Kong G, Brutus JP, Vo TT et al (2023). The Prevalence Of Double- And Multiple Crush Syndromes In Patients Surgically Treated For Peripheral Nerve Compression In The Upper Limb. Hand Surg Rehabil. 42(6): 475-481. DOI: 10.1016/j.hansur.2023.09.002</p><p>Raut P, Jones N, Raad M et al (2022). Common Peripheral Nerve Entrapments In The Upper Limb. Br J Hosp Med. 83(10): 1-11. DOI: 10.12968/hmed.2022.011</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-89607007073981389782024-02-18T11:38:00.148+08:002024-02-18T14:22:44.610+08:00Does Strength Training Help Runners Prevent Injuries?<div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYf-Xl_BDHq1Qxq5MUANbHRoHHlsrprZMZDZmP2290qWvPqSBFlEVe8CeR03tZM0BFJP6widT6GCr_eWhleAV9LT7DNU821mvthQe8h1WDDo7kDYna4DZ1R1bgjoJBgYIROcWPpoM0lVCiag3qLr1lgyCwD43pZK-N2hAvO7mcdQU1AyWdzw3D5nxOR5I/s1080/Strength%20trg.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1080" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYf-Xl_BDHq1Qxq5MUANbHRoHHlsrprZMZDZmP2290qWvPqSBFlEVe8CeR03tZM0BFJP6widT6GCr_eWhleAV9LT7DNU821mvthQe8h1WDDo7kDYna4DZ1R1bgjoJBgYIROcWPpoM0lVCiag3qLr1lgyCwD43pZK-N2hAvO7mcdQU1AyWdzw3D5nxOR5I/s320/Strength%20trg.jpg" width="320" /></a></div>Last <a href="https://weloverunning.blogspot.com/2024/02/weak-core-tight-hamstrings-and-weak.html" target="_blank">week</a> I wrote about how we have been told for years that the key to staying pain and injury free can be found somewhere close to your belly button. That got most people obsessed with strengthening their <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">core</a> or abdominal muscles. Which you know by now that it is not totally <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">true</a>.</div><div><br /></div><div>Likewise many runners also believe that <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength</a> training like <a href="https://weloverunning.blogspot.com/2020/02/who-says-your-knees-cannot-come-forward.html" target="_blank">squats</a>, deadlifts and other power lifting staples can make you faster, more powerful, more efficient and less injury prone.</div><div><br /></div><div>Ever wonder what sort of <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength</a> training do top runners do? Blagrove et al (2020) did a survey of 667 distance runners (local to internationally competitive) about their <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength</a> and conditioning exercises. Most common was <a href="https://weloverunning.blogspot.com/2022/03/are-you-still-stretching.html" target="_blank">stretching</a> (86.2 percent), <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">core</a> training (70.2 percent), <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">weight training</a> (62.5 percent) and plyometric training (35.1 percent).</div><div><br /></div><div>What was most interesting was the motivation these runners reported for the <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength</a> and conditioning routines. There were 2 main answers. Reducing injury risk (63.1 percent) and improving performance (53.8 percent). There was no relationship found between <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength</a> and conditioning training and injury history in runners. The key predictor of injury was training volume. The more you ran, the more likely you would get injured.</div><div><br /></div><div> In another systematic review published last month, Blagrove and colleagues (Wu et al, 2024) found that strength and conditioning does not appear to reduce the risk and rate of running related injuries (RRI). Please bear in mind that Richard Blagrove has authored a book <a href="https://www.amazon.com/Strength-Conditioning-Endurance-Running-Blagrove/dp/1847979874/" target="_blank">Strength And Conditioning For Endurance Running</a> and worked with many elite runners on their strength routines in case you think he is against strength training.</div><div><br /></div><div>Their systematic review consist of 9 articles with 1,904 runners. Exercises done include lunges, squats, plyometric hops/ jumps, <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">core</a> routines, <a href="https://weloverunning.blogspot.com/2021/08/foot-strengthening-to-prevent-running.html" target="_blank">foot strengthening</a> etc. Given the wide variety of of regimens, there was NO significant benefit for the exercise groups compared to the control group in injury risk (runners who got injured during the studies) or injury rate (how many injuries they suffered for a given amount of running).</div><div><br /></div><div>For now that is the state and level of evidence we have with regards to strength and conditioning exercises preventing RRI. Strange that this approach (strength and conditioning) has robust evidence that <a href="https://pubmed.ncbi.nlm.nih.gov/26403470/" target="_blank">it works in soocer</a>, but not in running.</div><div><br /></div><div>What was most interesting is that 3 of the studies that produced the lowest injury risk also happened to be the 3 studies where the exercise routines was supervised rather than assigned to be performed at home. <a href="https://pubmed.ncbi.nlm.nih.gov/37789670/" target="_blank">Research</a> shows that people tend to get bigger gains when they have a spotter or trainer looking on. Similarly, runners tend to run their intervals faster and more consistently when the coach is standing on the track with a stopwatch in hand. It could also be the only way to ensure people actually do the <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength</a> and conditioning exercises. </div><div><br /></div><div>I can remember many patients who come for a follow up visit claiming they have done their exercises diligently but cannot do it when asked to demonstrate it. A strengthening exercise can only work if you actually do it and have done it correctly.</div><div><br /></div><div>Take home message? If the study (Wu et al, 2024) is true, <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a> or other forms of exercise may not lower your risk of getting injured while running. Even though the logic is sound and evidence from other sports is positive. However, there is very good evidence that strength training improves <a href="https://weloverunning.blogspot.com/2015/06/strength-training-can-improve-your-5-km.html" target="_blank">running</a> <a href="https://weloverunning.blogspot.com/2014/06/a-hard-warm-up-helps-you-run-faster.html" target="_blank">economy</a> and boosts <a href="https://weloverunning.blogspot.com/2017/11/strength-training-just-as-important-if.html" target="_blank">long term health</a>. It would be nice to get injury prevention as an added bonus but it still sounds like a good deal to me. So I will still strength train.</div><div><br /></div><div>Researchers need to have more robust studies that include supervised interventions to investigate further.</div><div><br /></div><div><br /></div><div>References</div><div><br /></div><div>Blagrove RC, Brown N, Howatson G et al (2020). Strength And Conditioning Habits Of Competitive Distance Runners. J Stren Cond Res. 349(5): 1392-1399. DOI: 10.1519/JSC.0000000000002261.</div><div><br /></div><div>Wu H, Brooke-Wavell K, Fong DTP et al (2024). Do Exercise-Based Prevention Programs Reduce Injury In Endurance Runners? A Systematic Review And Meta-Analysis. Sports Med. DOI: 10.1007/s40279-024-01993-7.</div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-80661915335764914492024-02-12T10:38:00.118+08:002024-02-12T16:03:54.488+08:00Weak Core, Tight Hamstrings And Weak Glutes?<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_i_DYcmC_Lqb8E8AeVXDISx-QEHgWK9hc1RVSKN44S25MrmrhzAw7PuTdXxnsMwe2IB1X7DMZKp1iLczna1D4m4Kz_uUSlci-FsoKvyx63oGSj1Yirk6-G9bIsfgJeEU5hwHjJvK_TbBKyPFQAYf2pBNK8R1dyLZXVV86s8OqQRK6KrvoL7rzaU3aO-E/s1078/Tight%20hamstrings.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="598" data-original-width="1078" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_i_DYcmC_Lqb8E8AeVXDISx-QEHgWK9hc1RVSKN44S25MrmrhzAw7PuTdXxnsMwe2IB1X7DMZKp1iLczna1D4m4Kz_uUSlci-FsoKvyx63oGSj1Yirk6-G9bIsfgJeEU5hwHjJvK_TbBKyPFQAYf2pBNK8R1dyLZXVV86s8OqQRK6KrvoL7rzaU3aO-E/s320/Tight%20hamstrings.jpg" width="320" /></a></div>Hope you have been enjoying your Chinese New Year break!<p></p><p>A patient came in this past week with <a href="https://weloverunning.blogspot.com/2020/01/dorian-yates-and-his-christmas-tree-back.html" target="_blank">low back pain</a> and was told by another <a href="https://weloverunning.blogspot.com/2022/12/bluetooth-hands-free-physiotherapists.html" target="_blank">physiotherapist</a> that she had a weak <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">core</a>, <a href="https://weloverunning.blogspot.com/2023/01/update-on-hamstring-injuries.html" target="_blank">hamstrings</a> and weak <a href="https://weloverunning.blogspot.com/2019/04/it-may-all-be-in-hips.html" target="_blank">glutes</a> and that was why her back hurts.</p><p>Now, I do not agree with that. Actually studies show that back extensor strength is more important than flexor (abdominal) strength when it comes to <a href="https://weloverunning.blogspot.com/2020/01/dorian-yates-and-his-christmas-tree-back.html" target="_blank">low back pain</a> (Lee et al, 1999).</p><p>Like I wrote <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">previously</a>, the idea for the need of a strong <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">core</a> was first introduced by Paul Hodges (Hodges and Richardson, 1998) when he published his article on the Transverse Abdominis (TA) muscle. His research compared the timing of TA and Multifidus in people with <a href="https://weloverunning.blogspot.com/2020/01/10-helpful-facts-about-low-back-pain.html" target="_blank">low back pain (LBP)</a> for 18 months or more against healthy subjects with no <a href="https://weloverunning.blogspot.com/2020/01/10-helpful-facts-about-low-back-pain.html" target="_blank">LBP</a>.</p><p>Hodges suggested that the TA was likely to be the main cause of <a href="https://weloverunning.blogspot.com/2020/01/10-helpful-facts-about-low-back-pain.html" target="_blank">LBP</a> as it is the most important and deepest muscle in the abdomen. It looks and works like a corset to stabilise the back.<br /><br />This article made the allied healthcare/ fitness industry conclude that the TA was a trunk stabilising muscle that was very important to strengthen for those with <a href="https://weloverunning.blogspot.com/2020/01/10-helpful-facts-about-low-back-pain.html" target="_blank">LBP</a>. Patients who had <a href="https://weloverunning.blogspot.com/2020/01/10-helpful-facts-about-low-back-pain.html" target="_blank">LBP</a> had weaknesses in their TA which led to instability in the spine.</p><p>Similarly with 'tight' <a href="https://weloverunning.blogspot.com/2023/01/update-on-hamstring-injuries.html" target="_blank">hamstrings</a> (Halbertsma et al 2001) and weak glutes. This female patient of mine can deadlift 90 kg. Her <a href="https://weloverunning.blogspot.com/2019/04/it-may-all-be-in-hips.html" target="_blank">glutes</a> are not weak nor are her <a href="https://weloverunning.blogspot.com/2023/01/update-on-hamstring-injuries.html" target="_blank">hamstrings</a> tight. </p><p>You can put all those <a href="https://weloverunning.blogspot.com/2020/01/dorian-yates-and-his-christmas-tree-back.html" target="_blank">myths</a> to rest. Your <a href="https://weloverunning.blogspot.com/2020/01/10-helpful-facts-about-low-back-pain.html" target="_blank">low back pain</a> is not caused by a weak <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">core</a>, tight <a href="https://weloverunning.blogspot.com/2023/01/update-on-hamstring-injuries.html" target="_blank">hamstrings</a> nor <a href="https://weloverunning.blogspot.com/2019/04/it-may-all-be-in-hips.html" target="_blank">weak glutes</a>. Stengthening your back extensors will be a much better option than the previously mentioned.</p><p><br /></p><p>References</p><p>Halbertsma JP, Goeken LN, Hof AL et al (2001). Extensibility And Stiffness Of The Hamstrings in Patients With Nonspecific Low Back Pain. Arch Phys Med Reh. 82(2): 232-238. DOI: 10.1053/apmr.2001.19876</p><p>Hodges PA and Richardson CA (1998). Delayed Postural Contraction Of Transversus Abdominis In Low Back Pain Associated With Movement Of The Lower Limb. J Sp Disorders. 11(1): 46-56.</p><p>Lee JH, Hoshino Y, Nakamura K et al (1999). Trunk Muscle Weakness As A Risk Factor For Low Back Pain. A 5-year Prospective Study. Spine (Phila Pa 1976). 24(1): 54-57. DOI 10.1097/00007632-199901010-00013</p><p><a class="css-1qaijid r-bcqeeo r-qvutc0 r-poiln3 r-1ny4l3l r-1ddef8g r-tjvw6i r-1loqt21" dir="ltr" href="https://t.co/w8ICw72NzB" original_target="https://pubmed.ncbi.nlm.nih.gov/9921591/" rel="noopener noreferrer nofollow" role="link" style="background-color: white; border: 0px solid black; box-sizing: border-box; color: #1d9bf0; cursor: pointer; display: inline-block; font-family: TwitterChirp, -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Helvetica, Arial, sans-serif; font-feature-settings: inherit; font-kerning: inherit; font-optical-sizing: inherit; font-size: 17px; font-stretch: inherit; font-variant-alternates: inherit; font-variant-east-asian: inherit; font-variant-numeric: inherit; font-variant-position: inherit; font-variation-settings: inherit; line-height: inherit; list-style: none; margin: 0px; min-width: 0px; outline-style: none; overflow-wrap: break-word; padding: 0px; text-decoration-thickness: 1px; text-overflow: unset; white-space-collapse: preserve;" target="_blank" waprocessedanchor="true" waprocessedid="27ilmi"><span aria-hidden="true" class="css-1qaijid r-bcqeeo r-qvutc0 r-poiln3 r-hiw28u r-qvk6io" color="inherit" style="background-color: rgba(0, 0, 0, 0); border: 0px solid black; box-sizing: border-box; display: inline; font-family: inherit; font-feature-settings: inherit; font-kerning: inherit; font-optical-sizing: inherit; font-size: 0px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-variation-settings: inherit; font-weight: inherit; line-height: 0px; list-style: none; margin: 0px; min-width: 0px; overflow-wrap: break-word; padding: 0px; text-align: inherit; text-decoration-line: none; text-overflow: unset; white-space: inherit;">https://</span></a></p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-8101740525927227222024-02-04T11:28:00.075+08:002024-02-04T13:06:33.349+08:00Tread Lightly To Avoid Knee Pain<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirA2qWa_731aHBm8viuXl28bT5s27i-l9uDeJhSXkxQicqdb03Q7V0NDUTWnTL1u9RIw2t-LFeekac-wCdPAMUScnnrIQXgMEZJZNU2xxM99tiJ5zQWi9LaQIjLE9GlOdGZreTHMNkUtHEtMOvdRsP0wfpF3xkGcyALp9EZi_D1idRWu3S95l3T4ymaRs/s600/running%20on%20egg%20shells.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="399" data-original-width="600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirA2qWa_731aHBm8viuXl28bT5s27i-l9uDeJhSXkxQicqdb03Q7V0NDUTWnTL1u9RIw2t-LFeekac-wCdPAMUScnnrIQXgMEZJZNU2xxM99tiJ5zQWi9LaQIjLE9GlOdGZreTHMNkUtHEtMOvdRsP0wfpF3xkGcyALp9EZi_D1idRWu3S95l3T4ymaRs/s320/running%20on%20egg%20shells.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture from <a href="https://www.functionalpathtrainingblog.com/2019/12/load-management-walking-on-egg-shells.html" target="_blank">Functional Path Training</a></td></tr></tbody></table>My first running coach once gave my cross country team mates and I this advice. Land 'softly' while running. "Imagine you're running on egg shells and you do not want to break them further". A few of the boys commented that it was too 'difficult'. <p></p><p>The coach then suggested to us that we run like ninjas, taking <a href="https://weloverunning.blogspot.com/2023/11/is-there-ideal-running-cadence-rate.html" target="_blank">smaller and quicker</a> steps. In fact, he made us practice that. We had to run as close to other pedestrians from behind (sharing the sidewalk) without startling them while we ran past. Turns out my running coach was correct as it helped my team mates and I avoid <a href="https://weloverunning.blogspot.com/2009/08/ladies-your-knee-pain-may-be-coming.html" target="_blank">knee pain</a>.</p><p>Here's the evidence. A group of researchers wanted to investigate whether 2 different 2-week partially supervised <a href="https://weloverunning.blogspot.com/2019/10/is-your-running-style-causing-your.html" target="_blank">gait retraining</a> programs were effective for runners with knee pain. They randomly allocated 30 runners to 3 groups. One group focusing on reducing impact, a group on <a href="https://weloverunning.blogspot.com/2023/11/is-there-ideal-running-cadence-rate.html" target="_blank">cadence</a> and a control group. </p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5r_5Luu71BEgY03MqLcP4qpuQ_3WpH4HcTGjBAU3mVJJp6Fbwx9xYdHR-EWEtzJK-PqsNZ8Kha-ePYCGa8_s3juRNqGgz33ldQ44_hm-DgmiJYsf_Vd-7OlPDjbQwULAhSlQHgNFL9t_qji40opw2BJa8dcompQ9gMGMXCrn5Z-oU0UoC0moPJ9HMQ6c/s750/reduce%20impact.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="660" data-original-width="750" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5r_5Luu71BEgY03MqLcP4qpuQ_3WpH4HcTGjBAU3mVJJp6Fbwx9xYdHR-EWEtzJK-PqsNZ8Kha-ePYCGa8_s3juRNqGgz33ldQ44_hm-DgmiJYsf_Vd-7OlPDjbQwULAhSlQHgNFL9t_qji40opw2BJa8dcompQ9gMGMXCrn5Z-oU0UoC0moPJ9HMQ6c/s320/reduce%20impact.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Visual feedback to reduce impact in the study</td></tr></tbody></table>The impact group (land softly) received instructions to reduce tibial acceleration (impact) by 50 percent while the cadence group was asked to increase running <a href="https://weloverunning.blogspot.com/2019/07/another-way-to-improve-your-running.html" target="_blank">cadence</a> by 7.5-10 percent. The control group did not receive any intervention.<p></p><p>Running pain (before and during the run), knee function, lower limb kinematics (<a href="https://weloverunning.blogspot.com/2019/10/is-your-running-style-causing-your.html" target="_blank">contralateral pelvic drop</a>, hip adduction, tibial, and foot inclination) were assessed before, immediately and 6 months after the intervention.</p><p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr5MDSNncPl_oov_vN-DSDZQuE3QpUR0U7gLRbghGAjWA4NVyyMAVfPkScHZR31JrlSfnp-W6KkAO66NA_Mvkdn2BIw9RYk-pqUgx5b7B1uYdPxeswZzEsLJM-B8We4OjxOBbj83-xEPYSIN8nYXdxsf3xxf8rvyMYNQgpmKN4wx0iFNijFDB7TAE45bs/s320/CPD.gif" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="253" data-original-width="320" height="253" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr5MDSNncPl_oov_vN-DSDZQuE3QpUR0U7gLRbghGAjWA4NVyyMAVfPkScHZR31JrlSfnp-W6KkAO66NA_Mvkdn2BIw9RYk-pqUgx5b7B1uYdPxeswZzEsLJM-B8We4OjxOBbj83-xEPYSIN8nYXdxsf3xxf8rvyMYNQgpmKN4wx0iFNijFDB7TAE45bs/s1600/CPD.gif" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture A- Injured runner with CPD and right hip adduction</td></tr></tbody></table>Compared to the control group, both the 2-week partially supervised <a href="https://weloverunning.blogspot.com/2019/10/is-your-running-style-causing-your.html" target="_blank">gait retraining</a> programs focusing on reducing impact and increasing <a href="https://weloverunning.blogspot.com/2019/07/another-way-to-improve-your-running.html" target="_blank">cadence</a> were more effective at improving <a href="https://weloverunning.blogspot.com/2022/08/its-hip-not-knee.html" target="_blank">knee pain</a> up till 6 months after the intervention. In addition, the impact reducing program was more effective at improving knee function immdiately post run. </p><p>So if your <a href="https://weloverunning.blogspot.com/2022/08/its-hip-not-knee.html" target="_blank">knee pain</a> is stopping your from running, try landing softly and/ or taking <a href="https://weloverunning.blogspot.com/2023/11/is-there-ideal-running-cadence-rate.html" target="_blank">smaller, quicker</a> steps. Hey, my running coach was right, way ahead of his time. </p><p><br /></p><p>Reference</p><p>De Souza Junior JR, Rabelo PHR, Lemos TV et al (2024). Effects Of Two Gait Retraining Programs On Pain, Function, And Lower Limb Kinematics In Runners With Patellofemoral Pain: A Randomozed Controlled Trial. 10(1): e0295645. DOI: 10.1371/journal pone.0295645</p><p><span style="color: #212121;"><span style="background-color: white;">As Peter Larson's book from 2012 says, tread lightly .....</span></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdpdKmUAIPvM_AEgNJ8Xgs-05Rfu3HLssOqCGuRpt60tENPDyn7Rwp-Tooi1TbNkWrQO6Y9ihefgiNnhf5i0PCKpj6fQZmM56ikYGpaFnnGlqTpDB84EPlw4RmrdbblbYs_aed3PUgv7XT2TUyWDaF8fRkuENyv4ekOziOIZDb9F0twk3b3phMN2K7S64/s1845/tread%20lightly.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1845" data-original-width="1294" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdpdKmUAIPvM_AEgNJ8Xgs-05Rfu3HLssOqCGuRpt60tENPDyn7Rwp-Tooi1TbNkWrQO6Y9ihefgiNnhf5i0PCKpj6fQZmM56ikYGpaFnnGlqTpDB84EPlw4RmrdbblbYs_aed3PUgv7XT2TUyWDaF8fRkuENyv4ekOziOIZDb9F0twk3b3phMN2K7S64/s320/tread%20lightly.jpg" width="224" /></a></div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-80223263878999942842024-01-28T12:28:00.130+08:002024-01-28T14:02:32.979+08:00Diastasis Recti<div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigXBGxmOseZsrf7Uj_cTWn53cQf5nrIpS2HznW91VYP_lC7_RgYeOiWGgCu_NdPVZ1xsLTZeAwQHPPziGkcgbQy8DaYTLQHgKUo3DXyVHHIA9fqb546sHvvXC96fUeIasv-tD70odS9WMYn88hdNZxHxpsJsZ9kfvYcnpVipbhb1n6dT-ELACdotg1UHs/s1515/diastasis.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="947" data-original-width="1515" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigXBGxmOseZsrf7Uj_cTWn53cQf5nrIpS2HznW91VYP_lC7_RgYeOiWGgCu_NdPVZ1xsLTZeAwQHPPziGkcgbQy8DaYTLQHgKUo3DXyVHHIA9fqb546sHvvXC96fUeIasv-tD70odS9WMYn88hdNZxHxpsJsZ9kfvYcnpVipbhb1n6dT-ELACdotg1UHs/s320/diastasis.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture from <a href="https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/facts-and-tips-for-healing-diastasis-recti-part-1-1" target="_blank">Lamaze.org</a></td></tr></tbody></table>I saw a patient this week who had given birth to her second child about 3 months ago. Her friend told her that her belly was sticking out and the bulge may remain for months or years post partpartum. </div><div><br /></div><div>She has diastasis recti of about 2 fingers width. She was afraid that she would have <a href="https://weloverunning.blogspot.com/2020/01/dorian-yates-and-his-christmas-tree-back.html" target="_blank">low back pain</a> and incontinence if the diastasis recti was not corrected.</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFDlEsWuFeqd-ZzSgHTfv7klrUQl-CVs1RCtSFbc_Kwtz-tedIR-SV4_aFSz5gX24xYPR0f0XrBAcVuYx0_ufud7Ku3BGoxXef9X_wjAJhZbwigVNb4P_2dB3HJkwkQxPBhThZCtGjbS_ZssqDXMqp9fWMaSk4_DoFn1nSGGTCqOh6vlcfSBI0myrY9o8/s1920/Diastasis%20recti.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1920" data-original-width="1440" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFDlEsWuFeqd-ZzSgHTfv7klrUQl-CVs1RCtSFbc_Kwtz-tedIR-SV4_aFSz5gX24xYPR0f0XrBAcVuYx0_ufud7Ku3BGoxXef9X_wjAJhZbwigVNb4P_2dB3HJkwkQxPBhThZCtGjbS_ZssqDXMqp9fWMaSk4_DoFn1nSGGTCqOh6vlcfSBI0myrY9o8/s320/Diastasis%20recti.jpg" width="240" /></a></div><div>Diastasis recti (DR) is the separation of the rectus abdominis (or 6-pack ab) muscles during and after pregnancy. The rectus abdominis runs in a straight line along the front of your stomach. A band of connective tissue called the linea alba divides the rectus abdominis into left and right sides. In simple terms it is the separation of the six-pack muscles into 2 halves.</div><div><br /></div><div>It happens when the rectus abdominis muscles separate during pregnancy after being stretched. The linea alba becomes thinner and gets wider as it gets pushed by the uterus when it expands. The criteria for the diagnosis of DR is a gap or separation of more than 1.5 cm at one or more points of the linea alba.</div><div><br /></div><div><div>Here is how I measure/check for the tummy gap. I get my patient to lie supine with knees bent and hip width apart. I place 2 fingers above her belly button. Then I get her to slowly lift her head, neck and shoulders off the bed like a low level sit-up. I then move my fingers below and above the belly button length wise and feel for any gaps and whether I can fit more than 2 fingers width wise. It's easy to feel for the gap this way.</div></div><div><br /></div><div>After the baby is delivered, the linea alba can retract as the connective tissue is highly elastic. It can retract (like a rubber band). This usually happens for some new mums, the linea alba repairs itself within 10-12 weeks. However, when the linea alba loses its elasticity from being overstretched (larger babies) and/ or from a second and third pregnancy, the gap widens in the rectus abdominis.</div><div><br /></div><div>Many patients have been told (by healthcare practitioners) that if DR continues after 10-12 weeks, their stomach/ <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">core muscles</a> cannot function efficiently and cannot properly support the <a href="https://weloverunning.blogspot.com/2020/02/slipped-discs-can-heal.html" target="_blank">lumbar</a> spine (low back) or stomach contents. </div><div><br /></div><div>These same healthcare practitioners that treat diastasis recti will NOT be happy reading what I write next. Yes, women with DR may have weaker abdominal muscles (and perhaps more abdominal pain) BUT no higher prevalence of pelvic floor disorders (or incontinence), low back pain and pelvic girdle (hip) pain than women without DR (Gluppe et al, 2021). </div><div><br /></div><div>In fact, subgroup analyses comparing women with severe and moderate DR to women without DR showed no difference in abdominal strength, pelvic floor disorders (incontinence), <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">low back pain</a>, pelvic girdle and abdominal pain (Gluppe et al, 2021). This is actually the first study to investigate possible consequences of DR in a subgroup of women with moderate to severe diastasis.</div><div><br /></div><div>I did not come up with that. There are many published research contrasting all that BS (excuse my language) about getting <a href="https://weloverunning.blogspot.com/2020/01/10-helpful-facts-about-low-back-pain.html" target="_blank">low back pain</a> if you don't 'fix' your diastasis recti (Benjamin et al, 2019).</div><div><br /></div><div>These studies contradict the common belief there there is an association between diastasis recti and pelvic floor disorders. It does not mean that you definitely need treatment if you have a gap in your tummy after giving birth. Do not allow others to frighten you by saying that you will have back aches/ pain, weak <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">core</a>, hip, pelvic girdle pain and even incontinence if you don't 'fix' it.</div><div><br /></div><div>So did I manage to reduce the tummy gap in my patient? I did and that may have to be a different post.</div><div><br /></div><div>References</div><div><br /></div><div>Benjamin DR, Frawlwy HC, Shields N et al (2019). Relationship Between Diastasis Of The Rectus Abdominis Muscle And Musculoskeletal Dysfunctions, Pain And Quality Of Life: A Systematic Review. 105(1): 24-34. DOI: 10.1016/j.physio.2018.07.002</div><div><br /></div><div>Giuppe S, Engh ME and Bo K (2021). Women With Diastasis Recti Abdominis Might Have Weaker Abdominal Muscles And More Abdominal Pain, But No Higher Prevalence Of Pelvic Floor Disorders, Low Back And Pelvic Girdle Pain Than Women Without Diastasis Recti Abdominis. Physiotherapy. 111:57-65. DOI: 10.1016/j.physio.2021.01.008</div><div></div><div><br /></div><div>*Thanks to Kaylee and Vean for getting me the articles</div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-77852726153840908082024-01-21T11:28:00.176+08:002024-01-21T15:01:49.397+08:00Intense Static Stretching Versus Strength Training For Muscle Growth<p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIDBmWH8xXHcDkpSTUhPGe_3XK-9wf4c9LvcUJ6pHszqOKucJqqUVhiTYUEMwyXN40zzdgJTRB8qhKN_BNDDHNtwl-PQEfXAzn-zHWVnosulo0SQ0OURsdiAiztB_EaIPGhOFPP3Y19whfINP7lbQgQ9F5OgUknvVJqmeG9piUVCi6OefsOkv3bIQnpzY/s914/stretching%20device.webp" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="914" data-original-width="685" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIDBmWH8xXHcDkpSTUhPGe_3XK-9wf4c9LvcUJ6pHszqOKucJqqUVhiTYUEMwyXN40zzdgJTRB8qhKN_BNDDHNtwl-PQEfXAzn-zHWVnosulo0SQ0OURsdiAiztB_EaIPGhOFPP3Y19whfINP7lbQgQ9F5OgUknvVJqmeG9piUVCi6OefsOkv3bIQnpzY/s320/stretching%20device.webp" width="240" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Static stretching device</td></tr></tbody></table>Who says that <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a> is needed to make muscles bigger and stronger? A study published 2 days ago showed that intense <a href="https://weloverunning.blogspot.com/2022/03/are-you-still-stretching.html" target="_blank">static stretching</a> of the pectoralis major (chest) muscles 4 times a week produced similar hypertrophy gains to <a href="https://weloverunning.blogspot.com/2017/11/strength-training-just-as-important-if.html" target="_blank">strength training</a> done 3 times a week. </p><p>What? Just as effective as <a href="https://weloverunning.blogspot.com/2017/11/strength-training-just-as-important-if.html" target="_blank">strength training</a>? I was surprised to say the least. Well you know I am not a big fan of <a href="https://weloverunning.blogspot.com/2022/03/are-you-still-stretching.html" target="_blank">static stretching</a> at all. Skeptical? I was too!</p><p>81 participants were allocated to 3 groups in this study. A <a href="https://weloverunning.blogspot.com/2022/03/are-you-still-stretching.html" target="_blank">static stretching</a> group, <a href="https://weloverunning.blogspot.com/2017/11/strength-training-just-as-important-if.html" target="_blank">strength training</a> and control group. Pec stretching was done for 8 weeks, 4 days per week for 15 minutes per day. Those in the <a href="https://weloverunning.blogspot.com/2017/11/strength-training-just-as-important-if.html" target="_blank">strength training</a> group trained 3 times a week doing 5 x12 repetitions. All the subjects were instructed to maintain their regular exercise routine during the study. They exercised at least twice a week in a wide range of sports like fitness training, team sports or <a href="https://weloverunning.blogspot.com/2018/04/barbells-or-bikes.html" target="_blank">strength</a>-<a href="https://weloverunning.blogspot.com/2018/12/aerobic-exercises-key-to-aging-well.html" target="_blank">endurance</a> training. </p><p>Results showed significant strength increase in the <a href="https://weloverunning.blogspot.com/2022/03/are-you-still-stretching.html" target="_blank">static stretching</a> and <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a> group compared to the control group. There were no significant differences between the <a href="https://weloverunning.blogspot.com/2017/11/stretching-your-muscles-or-stretching.html" target="_blank">static stretching</a> and <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a> group.</p><p>There was moderate muscle thickness increases in the <a href="https://weloverunning.blogspot.com/2017/11/stretching-your-muscles-or-stretching.html" target="_blank">static stretching</a> and <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a> group compared to the control group. Muscle thickness was measured using <a href="https://weloverunning.blogspot.com/2021/10/ultrasound-or-ultra-bullshit.html" target="_blank">ultrasound</a> imaging. There was actually no difference between the <a href="https://weloverunning.blogspot.com/2017/11/stretching-your-muscles-or-stretching.html" target="_blank">static stretching</a> and <a href="https://weloverunning.blogspot.com/2018/04/barbells-or-bikes.html" target="_blank">strength training</a> group.</p><p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiHjz09Ifqp1O_M7zGytGPIQKJH10EXM1sjGnA0h6Ot2vpFeLOgpl_Ciit8DQDiXIQgDzzd_GoRf88-cKDvwCMzxRWP8p8-A9UNo_WANMRQ-dUxSXNMm0ZiurA1XnMyn1N1absu5ZrnZzS67j_ThNBX1qbbbPGnohEyINjwK61J-noptfK5eHKzta8jZg/s685/ROM%20test.webp" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="266" data-original-width="685" height="124" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiHjz09Ifqp1O_M7zGytGPIQKJH10EXM1sjGnA0h6Ot2vpFeLOgpl_Ciit8DQDiXIQgDzzd_GoRf88-cKDvwCMzxRWP8p8-A9UNo_WANMRQ-dUxSXNMm0ZiurA1XnMyn1N1absu5ZrnZzS67j_ThNBX1qbbbPGnohEyINjwK61J-noptfK5eHKzta8jZg/s320/ROM%20test.webp" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Range of motion test</td></tr></tbody></table>In terms of range of motion (ROM), <a href="https://weloverunning.blogspot.com/2017/11/stretching-your-muscles-or-stretching.html" target="_blank">static stretching</a> group had significant moderate ROM increases compared to the <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a> group. No difference in ROM between the <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a> and control group.</p><p>It has been suggested that the shared underlying physiological mechanism between stretching and <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a> is the high stretching tension both produces to induce stretch mediated hypertrophy (Warneke et al, 2023). This tension translates into chemical signals that stimulate anabolic processes to generate new muscle tissue.</p><p>Wow. Increased size, strength and range in 8 weeks compared to <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a>. However, note that <a href="https://weloverunning.blogspot.com/2022/03/are-you-still-stretching.html" target="_blank">static stretching</a> via a stretching device like in this study needed a second person to assist and adjust the stretching device. Moreover, regular <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">strength training</a> can prevent <a href="https://weloverunning.blogspot.com/2015/09/men-do-get-it.html" target="_blank">osteoporosis</a> and sarcopenia.</p><p><br /></p><p>References</p><p>Warneke K, Wirth K, Keiner M et al (2023). Comparison Of The Effects Of Long-lasting Static Stretching And Hypertrophy Training On Maximal Strength, Muscle Thickness And Flexibility In The Plantar Flexors. Eur J Appl Physiol. 123(8): 1773-1787. DOI: 10-.1007/s00421-023-05184-6</p><p>Wohlann T, Warneke K, Kalder V et al (2024).Influence Of 8-weeks Of Supervised Static Stretching Or Resistance Training Of Pectoral Major Muscles On Maximal Strength, Muscle Thickness And Range Of Motion. Eur J Appl Physiol. DOI: 10.1007/s00421-023-05413-y</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com1tag:blogger.com,1999:blog-2468644079235991563.post-40487187154922903732024-01-14T10:28:00.139+08:002024-01-14T13:37:13.253+08:00Do Not Inject The Bursa<div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIPLEy_r8VHCSom47Ov6KcKxCqHSIzK83ax27cdXXNfTLTRpI3R5K9t8IPOGEzKAhU4DlAUylNCZbECwH63DLODF1Zt6ZNf4KiwwRSsHQFBbclRuYw1vl62lcywyYxlenS5HbrGkiNtHWbgaj98t5fl3F3Ik3Zzj4SB5TubE__-Zi6hcaS6HyNH8TJ71o/s320/Shd%20impingement%20.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="320" data-original-width="280" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIPLEy_r8VHCSom47Ov6KcKxCqHSIzK83ax27cdXXNfTLTRpI3R5K9t8IPOGEzKAhU4DlAUylNCZbECwH63DLODF1Zt6ZNf4KiwwRSsHQFBbclRuYw1vl62lcywyYxlenS5HbrGkiNtHWbgaj98t5fl3F3Ik3Zzj4SB5TubE__-Zi6hcaS6HyNH8TJ71o/s1600/Shd%20impingement%20.jpg" width="280" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">R subacromial bursa</td></tr></tbody></table>I was very surprised when I came across the following findings from a research paper. Whether an accurate placement of <a href="https://weloverunning.blogspot.com/2023/02/steroid-cortisone-injections.html" target="_blank">corticosteroid injection</a> into the subacromial bursa for <a href="https://weloverunning.blogspot.com/2021/02/shoulder-pain-still-after-subacromial.html" target="_blank">subacromial</a> pain (or <a href="https://weloverunning.blogspot.com/2021/02/shoulder-pain-still-after-subacromial.html" target="_blank">shoulder impingement</a>) resulted in decreasing <a href="https://weloverunning.blogspot.com/2021/07/4-exercises-to-avoid-if-you-have.html" target="_blank">shoulder pain</a> and disability (Chung et al, 2022)</div><div><br /></div><div>A bursa is small sac (or bag) filled with fluid. They act like thin shock absorbers between the bones and other moving parts of the body like muscles and <a href="https://weloverunning.blogspot.com/2022/03/train-your-tendons.html" target="_blank">tendons</a> to reduce friction. When a bursa gets irritated (or inflamed) it fills up with more fluid resulting in a condition called bursitis. We have many bursae (plura for bursa) in our hip, elbow and knee joints.</div><div><br /></div><div>Researchers reviewed video images of <a href="https://weloverunning.blogspot.com/2021/10/ultrasound-or-ultra-bullshit.html" target="_blank">ultrasound</a> guided <a href="https://weloverunning.blogspot.com/2019/08/what-3000-for-steroid-jab.html" target="_blank">corticosteroid injections</a> to rate the accuracy of injection into 3 groups. Group 1: Definitely/ probably not in the subacromial bursa. Group 2: Probably in the subacromial bursa and Group 3: Definitely in the subacromial bursa. </div><div><br /></div><div>There were a total of 114 subjects. 22 were categorised in Group 1, 21 into Group 2 and 71 in Group 3. I definitely expected the subjects in Group 3 to have the best result, but I was wrong. </div><div><br /></div><div>Results showed that there were no significant differences between the 3 groups at 6 weeks. So, no clear evidence that accurately injecting the subacromial bursa under <a href="https://weloverunning.blogspot.com/2021/10/ultrasound-or-ultra-bullshit.html" target="_blank">ultrasound</a> guidance is better than missing it. Even if the injections were done *blind versus guidance by ultrasound! </div><div><br /></div><div>*Blind means the injection is done at the point where the patient says the pain is versus using ultrasound to guide the injection into the correct inflamed area.</div><div><br /></div><div>The authors concluded that the accuracy of injection placement in shoulder impingement did not influence pain and function suggesting that improvements in patients' outcome did not require ultrasound guidance.</div><div><br /></div><div>Perhaps there is no difference in outcomes possibly because neither 'blind' nor ultrasound guided <a href="https://weloverunning.blogspot.com/2023/02/steroid-cortisone-injections.html" target="_blank">corticosteroid injections</a> work in the medium to long term. The sample size is small and follow-up period is too short. Plus y'all know how I feel <a href="https://weloverunning.blogspot.com/2023/02/steroid-cortisone-injections.html" target="_blank">about steroid injections</a>.</div><div><br /></div><div><div>Another systematic review also investigated ultrasound guided versus landmark injections for rotator cuff related pain (<a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/msc.1643" target="_blank">Adamson et al, 2022</a>) and came to the same conclusions.</div><div><br /></div></div><div>Will these findings affect the doctors/ surgeons who <a href="https://weloverunning.blogspot.com/2019/08/what-3000-for-steroid-jab.html" target="_blank">charge more</a> using ultrasound guided injections compared to doing the injections 'blind'?</div><div><br /></div><div>And another paper (Marshall et al (2023) showed that the subacromial bursa promoted an early inflammatory response in an <a href="https://weloverunning.blogspot.com/2023/02/new-evidence-that-collagen-may-help.html" target="_blank">injured tendon</a> to help healing. Using a rat to model rotator cuff injury and repair, the bursa protected the tendon adjacent to the injured tendon and maintained the structure of the underlying bone. </div><div><br /></div><div>I do not normally consider results from obtained from animal studies usually (rats in this case), but am persuaded in this case as every time a 'diseased' or damaged body part is deemed worthy of removal or function suppressed, we find out later it is a bad idea. Like our tonsils and meniscus.</div><div><br /></div><div>Inflammation and healing are definitely misunderstood. Our busae release essential inflammatory fluid/ cells for help our injured tendons recover. Injecting them with <a href="https://weloverunning.blogspot.com/2023/02/steroid-cortisone-injections.html" target="_blank">cortisone/ steroids</a> means hindering the body's own healing process and harming your own <a href="https://weloverunning.blogspot.com/2022/03/train-your-tendons.html" target="_blank">tendons</a>. Think of it as the human body is being programmed to sort out its own injuries.</div><div><br /></div><div>References</div><div><br /></div><div>Adamson N, Tsuro M and Adams N (2022). Ultrasound-Guided Versus Landmark-Guided Subacromial Corticosteroid Injections For Rotator Cuff Related Shoulder Pain: A Systematic Review Of Randomised Controlled Trials. Musc Care. 20(4): 784-795. DOI: 10.1002/msc.1643</div><div><br /></div><div><div>Chean CS, Raval P, Ogollah RO et al (2022). Accuracy Of Placement Of Ultrasound-Guided Corticosteroid Injection For Subacromial Pain (Impingement) Syndrome Does Not Influence Pain And Function: Secondary Analysis Of A Randomised Controlled Trial. Musc Care. 20(4): 831-838. DOI: 10.1002/msc.1634</div><div><br /></div></div><div>Marshall BP, Ferrer XE, Kunes JA et al (2023). The Subacromial Bursa Is A Key Regulator Of The Rotator Cuff And A New Therapeutic Target For Improving Repair. bioRxiv (Preprint). July 2. DOI: 10.1101/2023.07.01.547347</div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-53130961377061155572024-01-07T08:28:00.006+08:002024-01-07T11:35:49.904+08:00Should Only Top Athletes Get Sponsorship?<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2gFMbbd8DEhWJ-3KOqEsPjmDrgCBqc42JhGmGA6Yg6Sccf9mjSc-F5J3ol-vqPW45QxhYkutOXZQb7vcn1Wm6APtmZ6BCCFzGjCTyWRl_KYnmLleoUdqaQKUvPu2reLwq9pOmQ2FX1_Rmh2Jn8fux5NXuY-vb1kjS2GCCN0pQNF7nqrkvn6pW0F4rkcY/s900/Alica%20Schmidt.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="799" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2gFMbbd8DEhWJ-3KOqEsPjmDrgCBqc42JhGmGA6Yg6Sccf9mjSc-F5J3ol-vqPW45QxhYkutOXZQb7vcn1Wm6APtmZ6BCCFzGjCTyWRl_KYnmLleoUdqaQKUvPu2reLwq9pOmQ2FX1_Rmh2Jn8fux5NXuY-vb1kjS2GCCN0pQNF7nqrkvn6pW0F4rkcY/s320/Alica%20Schmidt.jpg" width="284" /></a></div><p></p><p>I was in Australia for the past 2 weeks and happened to come across news of a 400m runner, Alica Schmidt of Germany. Questions arose on social media on why she was being sponsored by <a href="https://www.hugoboss.com/sg/en/women-boss-x-alica-schmidt/" target="_blank">Hugo Boss</a> despite her not so stellar performances on the track.</p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbLTd5tysyXE7sMNXJ1vbEYsCT3-b64DXnq4swNolIZBtFfJtaKMNphGkO3njly3Qnxq63bODCtzaMAykb8IVKz6oAd7qoS4XOVJq-rogURh34ltGKELXsamNEb2rInF2rsJWf50aFrn1yRDqhtym72siQyTm-BCTj4AI4DM5_-Es9PiD0PpiNii1oawI/s1885/Screenshot%20(1327).png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="910" data-original-width="1885" height="154" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbLTd5tysyXE7sMNXJ1vbEYsCT3-b64DXnq4swNolIZBtFfJtaKMNphGkO3njly3Qnxq63bODCtzaMAykb8IVKz6oAd7qoS4XOVJq-rogURh34ltGKELXsamNEb2rInF2rsJWf50aFrn1yRDqhtym72siQyTm-BCTj4AI4DM5_-Es9PiD0PpiNii1oawI/s320/Screenshot%20(1327).png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Schmidt's <a href="https://www.hugoboss.com/sg/en/women-boss-x-alica-schmidt/" target="_blank">Hugo Boss ad</a></td></tr></tbody></table>Though she had represented Germany at world and European level, and made the 4x400 m relay at the 2020 Olympics, she did not compete at the Olympics. She has also never won a major individual title. Actually, she 'only' ran the 147th fastest time in the 400m in 2023. <p></p><p>Schmidt revealed that she only gets <a href="https://www.dailymail.co.uk/sport/othersports/article-12674533/Worlds-sexiest-athlete-Alica-Schmidt-reveals-earnings-track-runner-German-star-admits-huge-social-media-presence-allows-avoid-taking-time-job.html">700 Euros while representing Germany</a> so it is impossible to make a living from athletics. Her main source of income comes from social media where she has 4.8 million followers on <a href="https://www.instagram.com/alicasmd/?hl=en" target="_blank">Instagram</a> and 2 million follwers on <a href="https://www.tiktok.com/@alicaschmidt?lang=en" target="_blank">Tiktok</a> which helps her pursue her sporting career.</p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCGWU3AMfkVl8LEZ1AgqhhyBZo9FoGkKdcR4d20PuDQ__GBCM3heP_LqnUWxrc25M95_wrjsj0uf7lYkNI7qmf9f_FHAw75mC1rOELQjSxSCTjA9G8VtTPBmF1aiI1miPDVXVlX4Pu8LS2unmXYylRCaS1Y-lnlxh4lStjPowHwb80-O2gxDkwZCJAU6U/s320/bella-hadid-nike-cortez-45-years-00.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="192" data-original-width="320" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCGWU3AMfkVl8LEZ1AgqhhyBZo9FoGkKdcR4d20PuDQ__GBCM3heP_LqnUWxrc25M95_wrjsj0uf7lYkNI7qmf9f_FHAw75mC1rOELQjSxSCTjA9G8VtTPBmF1aiI1miPDVXVlX4Pu8LS2unmXYylRCaS1Y-lnlxh4lStjPowHwb80-O2gxDkwZCJAU6U/s1600/bella-hadid-nike-cortez-45-years-00.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Bella Hadid's picture from Nike </td></tr></tbody></table>This hate or backlash is is not new. Back in 2017, Nike announced that fashion model <a href="https://www.instagram.com/bellahadid/">Bella Hadid</a> would be the face of its previously popular Cortez sneaker, designed in 1972 for <a href="https://weloverunning.blogspot.com/2012/12/the-100-best-running-sneakers-of-all.html" target="_blank">runners</a>. If you're an <a href="https://weloverunning.blogspot.com/2018/09/mid-life-crisis-in-older-athlete.html" target="_blank">older</a> runner you will remember the Cortez, after all even Forrest Gump (pictured below) used it for his runs.<p></p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIIqJhAnlLhsjyxr8AJ9RLO6VKrl_UG5mLexOc44bFulfkj3JwLnSSwtggkvSMkFBN5tEUQxgXAiunvWZzGTY9cqrTnGn6yVp4YyV3cI5xfEs8uTgfQvAdHo5HxCQjdBXg-ZjWzDZhqiTsFF_rWfzcea1DchVRklldCXSC_w3RCE6DBL-cBZj_uTgMOWY/s320/Forrest%20Gump.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="180" data-original-width="320" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIIqJhAnlLhsjyxr8AJ9RLO6VKrl_UG5mLexOc44bFulfkj3JwLnSSwtggkvSMkFBN5tEUQxgXAiunvWZzGTY9cqrTnGn6yVp4YyV3cI5xfEs8uTgfQvAdHo5HxCQjdBXg-ZjWzDZhqiTsFF_rWfzcea1DchVRklldCXSC_w3RCE6DBL-cBZj_uTgMOWY/s1600/Forrest%20Gump.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture from <a href="https://sneakernews.com/2015/02/23/nike-brings-back-og-forrest-gump-cortez/" target="_blank">Sneaker news</a></td></tr></tbody></table>The Cortez was being re-released as a <a href="https://weloverunning.blogspot.com/2014/05/skechers-named-hottest-major-brand.html" target="_blank">fashion</a>/ lifestyle sneaker. This followed a series of fashion models being chosen to front the campaigns of other sportswear brands - Kylie Jenner (Puma), Karlie Kloss (Adidas) and Gisele Bundchen (Under Armour) just to name a few.<p></p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieUjiUoFa1V02GM_3v5kXn5p9I1_8cVbb-oIfycV4z_17_L7Isdry_C3tAc7ton3R1jQLSTYwh8A2RI12xaGAuWrmoBdI9AtzVxZ1wIi-acE5mhLsxGLdZQAaVujhRfkpO-R5exlBNbG3xgkEu500RTGK4OG2nhrHaEf5EuFKCj1e1n0gLRUW4jCgXZio/s1895/Screenshot%20(1329).png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="901" data-original-width="1895" height="152" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieUjiUoFa1V02GM_3v5kXn5p9I1_8cVbb-oIfycV4z_17_L7Isdry_C3tAc7ton3R1jQLSTYwh8A2RI12xaGAuWrmoBdI9AtzVxZ1wIi-acE5mhLsxGLdZQAaVujhRfkpO-R5exlBNbG3xgkEu500RTGK4OG2nhrHaEf5EuFKCj1e1n0gLRUW4jCgXZio/s320/Screenshot%20(1329).png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"></td></tr></tbody></table>Naturally, some professional athletes have picked up on this back then and commented <a href="https://twitter.com/Meryl_Davis/status/798595578011664384/photo/1?ref_src=twsrc%5Etfw&ref_url=https%3A%2F%2Fwww.racked.com%2F2017%2F5%2F31%2F15691954%2Fstop-casting-jenner-hadid-sports">against this trend</a> (pictured above).<p></p><p>If you were the decison maker at Hugo Boss, would you also pick Schmidt? Both athletes and models can be influencers/ ambassadors for brands. Just because Schmidt is not a world or Olympic athletics champion means she is less valuable to Hugo Boss since Hugo Boss is not a sports brand. </p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1Ml7Uprvqg-BB95O6xb0em6jeCwUkmCf6PVRne-xMNcdBIlUXqfR5af-rwbKthjmypLwFM0kUAJ3-bRmYXrs0k3BNkv6QhAgnJ5Nio2nwEMlsC5RSkIh2a646is-2w_cPsx2g-ZzODKc_CoZI0mtcmgsZi9w2F0QhSPsh6kKhDcm0Yh0ejrx4kaPF19o/s1024/Shaunae%20Miller-Uibo.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="576" data-original-width="1024" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1Ml7Uprvqg-BB95O6xb0em6jeCwUkmCf6PVRne-xMNcdBIlUXqfR5af-rwbKthjmypLwFM0kUAJ3-bRmYXrs0k3BNkv6QhAgnJ5Nio2nwEMlsC5RSkIh2a646is-2w_cPsx2g-ZzODKc_CoZI0mtcmgsZi9w2F0QhSPsh6kKhDcm0Yh0ejrx4kaPF19o/s320/Shaunae%20Miller-Uibo.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Shaunae Miller-Uibo</td></tr></tbody></table>Schnidt has great looks, blond hair and blue eyes, essential in the entertainment industry but not mandatory in the sports arena. She will be able to showcase Hugo boss to a wider audience and increase their sales. She may actually bring more audience to athletics. Shaunae Miller Uibo (pictured above) won the 400 m event at the 2016 and 2020 Olympics. She looks good too, but would you pick her over Schmidt if you were looking for someone to front your campaign?<p></p><p>Should only top athletes get sponsorship? iI's a dog eat dog world out there. Athletes (and models) have short sporting lifespans and that can all end with a single major injury. So I say let all athletes and models take advantage of what they have while they can be it sporting ability, personality or looks.</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-53930415370422661212023-12-31T14:18:00.000+08:002023-12-31T14:18:11.517+08:00Farewell 2023<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuafCd0G4vpBh6laUnZBRoHc-RecxDxEhDSHec4eVF8x10WmVdOjZ2lOx_iJ5gsM8Lf76AnJvlKxipLGx1urOk8Ct7TOo4xivwHHHqQsFXVC1kCoAAGgmCPxa2lY2BpvDxBvvPivw7_ZEQvNQAuCxn-ghFWznCTSerLO6ATkepJbK0-D2vKA0YM82dm4U/s2048/sunset.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2048" data-original-width="1536" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuafCd0G4vpBh6laUnZBRoHc-RecxDxEhDSHec4eVF8x10WmVdOjZ2lOx_iJ5gsM8Lf76AnJvlKxipLGx1urOk8Ct7TOo4xivwHHHqQsFXVC1kCoAAGgmCPxa2lY2BpvDxBvvPivw7_ZEQvNQAuCxn-ghFWznCTSerLO6ATkepJbK0-D2vKA0YM82dm4U/s320/sunset.JPG" style="cursor: move;" width="240" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Sunset at Cowrie beach, Melbourne</td></tr></tbody></table>Time really has flown by. It's the last day of the year as I type this final post for 2023 in Melbourne, Australia.<p>As the sun sets on 2023 and we welcome 2024 on the horizon, here are some of my thoughts before we ring in the new year. </p><p>I sustained a paper cut on my finger last week while leafing through some books and magazines. The cut is super tiny, almost invisible but still hurts a fair bit. </p><p>This is always an analogy that I give my patients about the many injuries and the subsequent pain they feel. The pain is not always <a href="https://weloverunning.blogspot.com/2022/01/pain-does-not-mean-youre-injured.html" target="_blank">proportional</a> to the <a href="https://physiosolutions.blogspot.com/2019/08/only-one-painful-shoulder-but-mri-for.html" target="_blank">actual tissue damage</a> . Remember this the next time you hurt your <a href="https://weloverunning.blogspot.com/2019/06/change-arms-change-neck.html" target="_blank">neck </a>, <a href="https://weloverunning.blogspot.com/2020/01/dorian-yates-and-his-christmas-tree-back.html" target="_blank">back</a>, <a href="https://weloverunning.blogspot.com/2018/08/fat-pad-most-painful-in-knee.html" target="_blank">knee</a> or roll your <a href="https://weloverunning.blogspot.com/2019/03/still-cant-run-6-months-after-ankle.html" target="_blank">ankle</a>. Or <a href="https://weloverunning.blogspot.com/2020/12/patient-says-she-has-sciatica.html" target="_blank">other</a> body parts.</p><p>For those of you who have <a href="https://weloverunning.blogspot.com/2018/12/the-what-hell-effect.html" target="_blank">eaten too much</a> (like me) over the festive season and not kept up with your regular <a href="https://weloverunning.blogspot.com/2013/12/exercise-helps-short-term-overeating.html" target="_blank">exercise</a> routines, here are some suggestions for getting in some activity no matter where you are: </p><p>Find and do any exercise you <a href="https://weloverunning.blogspot.com/2021/05/stationary-cycling-just-as-good-as.html" target="_blank">enjoy</a>. Some (or even a <a href="https://weloverunning.blogspot.com/2014/08/big-benefits-from-minimal-running.html" target="_blank">tiny bit</a>) is better than none. More is almost always better. <a href="https://weloverunning.blogspot.com/2019/06/need-10000-steps-day.html" target="_blank">Walking</a> and climbing stairs count too. </p><p>Both <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">weight</a> (or <a href="https://weloverunning.blogspot.com/2017/11/strength-training-just-as-important-if.html" target="_blank">strength</a>) training and <a href="https://weloverunning.blogspot.com/2018/12/aerobic-exercises-key-to-aging-well.html" target="_blank">aerobic</a> training are important but the best <a href="https://weloverunning.blogspot.com/2021/06/how-much-exercise-is-good-for-your-brain.html" target="_blank">exercise</a> is the one that gets done.</p><p>Whatever amount of <a href="https://weloverunning.blogspot.com/2022/08/when-is-best-time-to-exercise.html" target="_blank">exercise</a> you are capable of today, that will be enough. Do that amount. Just start.</p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi71IdxFo_fir1twMwrLEvujJOM961U9v6ro9DnNIXs9mBnZUJuDa7CQVzYexCZcIFDmO70dieO9C36GXUIkdNaskPSknVZVtdki2LPVn0S4XKsxarfzl0HGwWnR3PgV5r7qB6rySc9g87aPKkBlUchgLhcfuJ0LTt1QEyw3JUQGedNwY1fK8VaP1Tc23E/s2082/Farmstay%20clouds.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2082" data-original-width="1920" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi71IdxFo_fir1twMwrLEvujJOM961U9v6ro9DnNIXs9mBnZUJuDa7CQVzYexCZcIFDmO70dieO9C36GXUIkdNaskPSknVZVtdki2LPVn0S4XKsxarfzl0HGwWnR3PgV5r7qB6rySc9g87aPKkBlUchgLhcfuJ0LTt1QEyw3JUQGedNwY1fK8VaP1Tc23E/s320/Farmstay%20clouds.jpg" width="295" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">At <a href="https://www.ripplesntonic.com.au/" target="_blank">Ripples N Tonic</a> farmstay</td></tr></tbody></table>Have a great 2024! Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-14490675956419990132023-12-22T08:08:00.044+08:002023-12-22T08:47:57.881+08:00Still Walking With Crutches After One Month?<p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUwflXffhSv5raK3PqnADJHJ8lWzh3e3dWIeCmTAQvYxsHKmGQCc1xF28m0P87V9bm0qCazS6tGY8Z6o9TBrh7rtaAyIqwbR1gLBd_zc7LuhKNzoAObFA_48Su9uZY67wNneCPoyCiZqfmb0ymSHZkklMmuRk7_S0HFVb9VDCv7kGYp0XNfjjcrVXyT7w/s3840/Neymar.webp" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2160" data-original-width="3840" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUwflXffhSv5raK3PqnADJHJ8lWzh3e3dWIeCmTAQvYxsHKmGQCc1xF28m0P87V9bm0qCazS6tGY8Z6o9TBrh7rtaAyIqwbR1gLBd_zc7LuhKNzoAObFA_48Su9uZY67wNneCPoyCiZqfmb0ymSHZkklMmuRk7_S0HFVb9VDCv7kGYp0XNfjjcrVXyT7w/s320/Neymar.webp" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture from <a href="https://www.goal.com/en/lists/watch-neymar-screams-pain-rehab-session-brazil-star-crying-acl-surgery/bltd34e0cba54c86fb0" target="_blank">Goal.com</a></td></tr></tbody></table>Neymar Junior is definitely a world class footballer who just had an <a href="https://weloverunning.blogspot.com/2023/10/front-knee-pain-after-acl-surgery.html" target="_blank">ACL reconstruction</a> after tearing his <a href="https://physiosolutions.blogspot.com/2009/03/current-trends-in-anterior-cruciate.html" target="_blank">anterior cruciate ligament</a> (ACL) on 181023. However, his rehabilitation does not seem world class at all. </p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/SzIBAbQ-IQ4" width="320" youtube-src-id="SzIBAbQ-IQ4"></iframe></div><p>You can hear him yelling when his knee is being forced to bend (knee flexion) with 3 people involved. I am not sure if the <a href="https://www.youtube.com/shorts/SzIBAbQ-IQ4" target="_blank">video</a> was put up just to garner more views, but that is not what to do if you want to improve knee bending range. Getting full extension (knee straightening) is more important early on to avoid any chance of getting a <a href="https://weloverunning.blogspot.com/2019/09/my-patient-has-cyclops-lesion.html" target="_blank">cyclops lesion</a>. </p><p>And still walking with crutches after one month? Our patients are sometimes discharged and walking with no crutches from the hopsital or our clinic after a few days.</p><p>Come see us in our <a href="https://www.facebook.com/goodphysios" target="_blank">clinics</a> if you need <a href="https://weloverunning.blogspot.com/2022/05/quads-and-squats.html" target="_blank">rehabilitation</a> after your your <a href="https://weloverunning.blogspot.com/2021/01/which-acl-graft-is-less-likely-to-tear.html" target="_blank">ACL reconstruction</a>.</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-49245160409014538892023-12-16T23:08:00.001+08:002023-12-17T05:06:19.412+08:00Iliopsoas Related Groin Pain<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb6ZgyHH8B_uNvUyhCcTLP0pc7dtcI-PrXhyphenhyphene8XG0XTfyOVrTP9c3speLOXS7WHGw_6qal_bzBKFoBlMN0SoSP8C2UGgU_ibbwsWAuSjZ9hxU6WHocg6GsHwI6oqUy6WEfhkmjQKo7GtWXjr_IBHfGcvrcRdocnN_kJ2t-GlGEDeVLayoX9Kxu74abqdk/s1920/Iliopsoas.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1920" data-original-width="1440" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb6ZgyHH8B_uNvUyhCcTLP0pc7dtcI-PrXhyphenhyphene8XG0XTfyOVrTP9c3speLOXS7WHGw_6qal_bzBKFoBlMN0SoSP8C2UGgU_ibbwsWAuSjZ9hxU6WHocg6GsHwI6oqUy6WEfhkmjQKo7GtWXjr_IBHfGcvrcRdocnN_kJ2t-GlGEDeVLayoX9Kxu74abqdk/s320/Iliopsoas.jpg" width="240" /></a></div>Previously I have written about hip <a href="https://weloverunning.blogspot.com/2023/09/hip-adductor-related-groin-pain.html" target="_blank">adductor related groin pain</a> (ARGP), which is the most common area for <a href="https://weloverunning.blogspot.com/2023/09/hip-adductor-related-groin-pain.html" target="_blank">groin pain</a>. There is also iliopsoas related groin pain (IRGP). Patients who have IRGP usually have iliopsoas tenderness/ pain while stretching the area and have pain with resisted hip flexion (or bending). <p></p><p>There is not enough evidence to suggest which exercise protocol or treatment technique is superior for treating IRGP. However, there is evidence to suggest a quicker <a href="https://weloverunning.blogspot.com/2023/02/is-it-easy-to-return-to-pivoting-sports.html" target="_blank">return to sports</a> (and to running) using a multi-modal program (<a href="https://weloverunning.blogspot.com/2020/06/this-is-what-our-physiotherapists-can-do.html" target="_blank">manual therapy</a>, <a href="https://weloverunning.blogspot.com/2022/03/are-you-still-stretching.html" target="_blank">stretching</a>, heat and <a href="https://weloverunning.blogspot.com/2021/06/are-s-coaches-or-physiotherapists-real.html" target="_blank">exercise therapy</a>) compared to <a href="https://weloverunning.blogspot.com/2021/06/are-s-coaches-or-physiotherapists-real.html" target="_blank">exercise therapy</a> alone (Weir et al, 2010).</p><p>Strengthening the iliopsoas via <a href="https://weloverunning.blogspot.com/2022/02/isometric-exercise-training-trumps-hiit_6.html" target="_blank">isometric</a>, concentric and <a href="https://weloverunning.blogspot.com/2017/05/eccentric-exercises.html" target="_blank">eccentric</a> contractions using <a href="https://weloverunning.blogspot.com/2021/04/scoff-not-at-elastic-resistance-bands.html" target="_blank">elastic bands</a> for 6 weeks have been found to substantially improve iliopsoas (hip flexor) strength (Thorborg et al, 2016). King et al (2018) found that athletes had high rates of pain free return to sports participation and had improved cutting performance when rehabilitation focused on inter-segmental (<a href="https://weloverunning.blogspot.com/2019/10/clam-shell-exercises.html" target="_blank">lateral hip</a>, legs and <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">abdominals</a>) control.</p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj503s7dAH4uRbcJNQ5MDzTFlRzxTMhSJwhpeV7TWeWSENffmEPv3hiYcREFus1JmKHecFjpKo-hJzrL3RmFXDr2GPRHpcsIKjQLs4irY73HWJ8udNRx5YG9mFTS2SYp0tmsKMvm_ewH__xTha9DE6pgKlvPBvqZO2hQY7-cTRljdBvzFhSAR8oZVKboTk/s1485/neutral%20spine.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1485" data-original-width="1371" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj503s7dAH4uRbcJNQ5MDzTFlRzxTMhSJwhpeV7TWeWSENffmEPv3hiYcREFus1JmKHecFjpKo-hJzrL3RmFXDr2GPRHpcsIKjQLs4irY73HWJ8udNRx5YG9mFTS2SYp0tmsKMvm_ewH__xTha9DE6pgKlvPBvqZO2hQY7-cTRljdBvzFhSAR8oZVKboTk/s320/neutral%20spine.jpg" width="295" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Neutral spine, anterior or posterior tilt</td></tr></tbody></table>There you have it, no magic stretches, protocol, nor any <a href="https://weloverunning.blogspot.com/2021/10/ultrasound-or-ultra-bullshit.html" target="_blank">therapeutic machine</a> to really treat groin pain on its own. Some physios teach <a href="https://weloverunning.blogspot.com/2020/01/transverse-abdominis-and-low-back-pain.html" target="_blank">core</a> or stabilization exercises with a neutral spine (pictured above).<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXzvYB7Om46_2L9uDps9umrUjkjoFXXxH5DV5jPDWJQLASi1X4sQkqGLRUvhNViPMqDnYA70od3YUzURQTRTY5XoA4w-Kzwf597oJgUsVti1-KHNlIOzqKIUfvfbqpHEkyKsor6aTGMrP5MYx6ABcgZ76EBgTa2FXkX4MkLIxHakRvxx7tmWkI_DVB7QE/s1271/3%20planes%20of%20motion.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="919" data-original-width="1271" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXzvYB7Om46_2L9uDps9umrUjkjoFXXxH5DV5jPDWJQLASi1X4sQkqGLRUvhNViPMqDnYA70od3YUzURQTRTY5XoA4w-Kzwf597oJgUsVti1-KHNlIOzqKIUfvfbqpHEkyKsor6aTGMrP5MYx6ABcgZ76EBgTa2FXkX4MkLIxHakRvxx7tmWkI_DVB7QE/s320/3%20planes%20of%20motion.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">3 planes of motion</td></tr></tbody></table>Like I wrote <a href="https://weloverunning.blogspot.com/2023/09/hip-adductor-related-groin-pain.html" target="_blank">before</a>, we do see many patients with groin pain in our clinics. Our approach to treatment is very different. It depends on what our assessments show. The patients do not do any <a href="https://weloverunning.blogspot.com/2021/06/are-s-coaches-or-physiotherapists-real.html" target="_blank">strengthening exercises</a> when they are in the clinic. We prefer to treat them using mostly our hands instead. Since the pelvis (or hip) has 3 planes of motion, we treat them with our hands with respect to he 3 planes of motion (pictured above).<div><br /></div><div>For example, for a patient with groin pain, they may also have a hip rotated to the right side (pictured below). </div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiPg4mXqpObD4n4gNCB_ASFNTs3JwO7rfVmzHzxBATHti2G46PHbNhJqCN9kgSOCQfBU83Q75XjwzD8MT-fmKhsKP1V_FSw4BlQI38FRw81CVLcP3_VQ3QG0Ht3BzBsRp6jMCUuLgppcAwRBRNjGz_jiHIOgDFhzIm71TYQsaIMNybG_QAeRoxmpqoPg8/s1920/R%20pelvic%20rotation.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1088" data-original-width="1920" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiPg4mXqpObD4n4gNCB_ASFNTs3JwO7rfVmzHzxBATHti2G46PHbNhJqCN9kgSOCQfBU83Q75XjwzD8MT-fmKhsKP1V_FSw4BlQI38FRw81CVLcP3_VQ3QG0Ht3BzBsRp6jMCUuLgppcAwRBRNjGz_jiHIOgDFhzIm71TYQsaIMNybG_QAeRoxmpqoPg8/s320/R%20pelvic%20rotation.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Hip rotated to right side</td></tr></tbody></table><div>We can treat the hip with respect to the shorter side. Short in terms of length. So the right side is shorter in front (pectineus) in the picture above, while the left hip is shorter behind. </div><div><br /></div><div>The patients can then do the strengthening exercises they need on their own. We treat what they cannot do themselves in the time they have with us. Come see us in our <a href="https://www.facebook.com/goodphysios" target="_blank">clinics</a> if you have groin pain.</div><div><br /></div><div><br /></div><div>References</div><div><br /></div><div>King E, Franklyn-Miller A, Richter C et al (2018). Clinical And Biomechanical Outcomes Of Rehabilitation Targeting Intersegmental Control In The Athletic Groin Pain: Prospective Cohort Of 205 Patients. BJSM. 52(16):1054-1062. DOI: 10.1136/bjsports-2016-097089</div><div><br /></div><div>Thorborg K, Holmich P, Christensen R et al (2011). The Copenhaen Hip And Groin Outcome Score (HAGOS): Development And Validation According To The COSMIN Checklist. BJSM. 45(6): 478-491. DOI: 10.1136/bjsm.2010.080937</div><div><br /></div><div>Weir A, Jansen JA, vande Port IG et al (2011). Manual Or Exercise Therapy For Long-Standing Adductor-Related Groin Pain: A Randomised Controlled Clinical Trial. Manual Therapy. 16(2): 148-54. DOI: 10.1016/j.math.2010.09.001</div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-75355469953850265592023-12-10T10:38:00.142+08:002023-12-10T18:24:03.738+08:00Does Having Different Leg Lengths Cause Injuries?<div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEQr1-DozHyOld6D2TplXUYr5m49dB6C5j2RR1k_70snbA3NK88cFWUMjUcRvsQttGxthv9RSPKYgAS88Xsuu6dDFHxXeZS-DYKnXq8cv-BY8OWlGJSI04nAQiwAwlFSakQWmMyBd0u5WP4z_peLbjXa5cz_k_delg4aD1UpMiVlIOPffz-c3DrXkrXqE/s744/LLD.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="744" data-original-width="448" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEQr1-DozHyOld6D2TplXUYr5m49dB6C5j2RR1k_70snbA3NK88cFWUMjUcRvsQttGxthv9RSPKYgAS88Xsuu6dDFHxXeZS-DYKnXq8cv-BY8OWlGJSI04nAQiwAwlFSakQWmMyBd0u5WP4z_peLbjXa5cz_k_delg4aD1UpMiVlIOPffz-c3DrXkrXqE/s320/LLD.png" width="193" /></a></div></div><div><div>A runner came to our clinic this past week with a brand new pair of <a href="https://weloverunning.blogspot.com/2023/05/do-orthotics-reduce-kneecap-loads-in.html" target="_blank">orthotics</a> as he was found to have a <a href="https://weloverunning.blogspot.com/2019/02/leg-length-discrepancy.html" target="_blank">leg length discrepancy</a> of half a centimetre (cm). He ran the Singapore Stan Chart <a href="https://weloverunning.blogspot.com/2019/04/dont-run-more-than-two-marathons-year.html" target="_blank">marathon</a> last week with them and ended up with a slight injury. </div><div><div><br /></div><div>I had previously written about how it is very common to have a <a href="https://weloverunning.blogspot.com/2019/02/leg-length-discrepancy.html" target="_blank">leg length discrepancy</a> (LLD) and that most of the time it did not matter for most people. I had not provide any references to justify my <a href="https://weloverunning.blogspot.com/2019/02/leg-length-discrepancy.html" target="_blank">post</a> then so please allow me to do so now. </div><div><br /></div><div>Actually, 90 percent of people have a LLD of up to 1 cm (Gordon and Davis, 2019). Knutson et al (2005) also reported that that the most people have an average leg length difference was 0.52 cm and for majority of people this difference does not matter unless there is a difference of 2 cm or more.</div><div><br /></div><div>What about <a href="https://weloverunning.blogspot.com/2014/06/shin-splints-most-common-in-new-runners.html" target="_blank">runners</a>? Would having different limb lengths cause an injury for <a href="https://weloverunning.blogspot.com/2014/07/runners-run-lot-also-sit-lot.html" target="_blank">runners</a>? Many <a href="https://weloverunning.blogspot.com/2018/06/collapsed-arches-and-tibialis-posterior.html" target="_blank">healthcare</a> professionals insist LLD can cause injuries and will often prescribe <a href="https://weloverunning.blogspot.com/2018/06/collapsed-arches-and-tibialis-posterior.html" target="_blank">orthotics</a> to correct this <a href="https://weloverunning.blogspot.com/2019/02/leg-length-discrepancy.html" target="_blank">discrepancy</a>.</div><div><br /><div>While running, there is only single leg stance phase (where one foot contacts the ground) and some flight time (where both feet are off the ground) before the other foot contacts the round. At no point is both feet on the ground at the same time when we run (running does not have double leg stance phase unlike walking).</div><div><br /></div><div>LLD actually has a greater effect on double leg stance (both feet contacting the ground) activities. During single leg stance activities, the effect is lessened as the gluteal (or buttock) muscles, especially <a href="https://weloverunning.blogspot.com/2019/10/clam-shell-exercises.html" target="_blank">gluteus medius</a> work to stabilize the pelvis. </div><div><br /></div><div>Hence, running is less likely to be affected by leg length differences and studies have shown that LLD was not associated with the development of a running injury (Hespanol et al, 2016). </div><div><br /></div><div>Rauh et al (2018) did find that male runners with a LLD greater than 1.5 cm had a greater chance of developing a lower leg (shin/ calf) injury.</div><div><br /></div><div><div>Now you know that LLD of up to 1 cm are very common and unlikely to cause pain in many cases, especially runners. There is also insufficient strong evidence when to start treatment and it should not be based solely on the length of the LLD. </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSHjsCmWSYGRHlv38IeGQwUbK20IyWI2b8cj-5ajQ1N398SIY-qUO8qFJ1yVihsCUPrmprGUkhVq419_RVmYLHTx6XYZstM-XXbJP1IVQ3TBWH7posvN6VnNp_iN3ORteCCHd1SlNmWi1JFPKpA46km9tHUjF6aQEnL6fE9Vl1PyNgmzxa55iwL6cdqCw/s320/Trendelenburg%20sign.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="320" data-original-width="251" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSHjsCmWSYGRHlv38IeGQwUbK20IyWI2b8cj-5ajQ1N398SIY-qUO8qFJ1yVihsCUPrmprGUkhVq419_RVmYLHTx6XYZstM-XXbJP1IVQ3TBWH7posvN6VnNp_iN3ORteCCHd1SlNmWi1JFPKpA46km9tHUjF6aQEnL6fE9Vl1PyNgmzxa55iwL6cdqCw/s1600/Trendelenburg%20sign.jpg" width="251" /></a></div><br /><div>If the gluteus muscle is weaker on the left (pictured), it can cause a functional leg leg difference and cause that side of the pelvis to drop lower. If the difference is above 2 cm, there is a higher chance that biomechanics are affected and can cause problems. Majority of people do not have this.</div><div><br /></div><div>What about differences of 1 to 2 cm? Personally I believe if it ain't broken, don't fix it. Meaning only if a patient or runner's condition is causing pain then we it may be worth exploring if changing hip or leg strength helps.</div></div><div><br /></div><div><div>References</div><div><br /></div><div>Gordon J, Eric MD, Davis DE (2019). Leg-Length Discrepancy : The Natural History (And What We Really Know). J Ped Ortho. 39():p S10-S13. DOI: 10.1097/BPO.0000000000001396</div><div><br /></div><div>Kuntson GA (2005). Anatomic And Functional Leg-Length Inequality: A Review And Recommendation For Clinical Decision-Making. Part 1, Anatomic Leg-Length Inequality: Prevalence, Magnitude, Effects And Clinical Significance. Chiro Man Therap 13,11. DOI: 10.1186/1746-1340-13-11</div><div><br /></div><div>Hespanhol Junior LC, de Carvalho AC, Costa LO et al (2016). Lower Limb Alignment Characteristics Are Not associated With Running Injuries In Runners: Prospective Cohort Study. Eur J Sp Sci. 16(8): 137-144. DOI: 10.1080/17461391.2016.1195878</div><div><br /></div><div>Rauh MJ (2018). Leg-Length Inequality And Running-Related Injury Among High School Runners. Int J Sp PT. 13(4): 643-651. PMID: 30140557</div></div></div></div></div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-1315697493557518462023-12-03T12:28:00.170+08:002024-01-02T19:43:34.761+08:00Simple Hopping Exercise Improves Running Performance<div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-OYcEiXDbvv-t0Q60ecewRHeFgDm3mIRFSKwjS-LkT5V6WfyDGt6cDOJ0SNJpwsDK4BLbNt0y_7zqT18NXEy3YjNlLxLWhxNX8cvtBBnBG5gyvN6FKFvzSklwy72xh7R54051yfAuYRhsa282BdP4Bn9OqRq98-lIT-djri8rqiV3BorYcIuUYLCS1TU/s1920/jump.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1920" data-original-width="1440" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-OYcEiXDbvv-t0Q60ecewRHeFgDm3mIRFSKwjS-LkT5V6WfyDGt6cDOJ0SNJpwsDK4BLbNt0y_7zqT18NXEy3YjNlLxLWhxNX8cvtBBnBG5gyvN6FKFvzSklwy72xh7R54051yfAuYRhsa282BdP4Bn9OqRq98-lIT-djri8rqiV3BorYcIuUYLCS1TU/s320/jump.jpg" width="240" /></a></div>Last week's topic was on <a href="https://weloverunning.blogspot.com/2023/11/how-long-does-your-running-shoe-last.html" target="_blank">when to change</a> your running shoes, with a key finding showing that energy consumption while running with newer PEBA midsoles was 1.8 percent less compared to EVA misoles. And using less energy means we can run further and faster. Running performance is thus dependent of how efficiently we move, which is defined as <a href="https://weloverunning.blogspot.com/2019/07/another-way-to-improve-your-running.html" target="_blank">running economy</a> (RE).</div><div><br /></div><div>In case some of you are not willing to shell out a few hundred dollars for a new pair of <a href="https://weloverunning.blogspot.com/2023/11/how-long-does-your-running-shoe-last.html" target="_blank">PEBA midsole</a> running shoes, let me suggest another way to improve your RE without spending any money.</div><div><br /></div><div>Here is what authors who investigated the effects of spending just 5 minutes daily doing double leg hopping (similar to plyometrics) over 6 weeks (Engeroff et al, 2023). </div><div><br /></div><div>34 amateur runners (29<span face="-apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Oxygen-Sans, Ubuntu, Cantarell, "Helvetica Neue", sans-serif" style="background-color: white; color: #222222; font-size: 18px;">±</span>7 years, 27 males) were assigned to a control group or a hopping exercise group. Those in the control group did not do the hopping exercises but continued with their own exercise. </div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxY_nFHIUKz-r2k4dtZc3OTGhVPGUNZJoFzO1YPcPdfz474VudWbrQwzXKWlXw6IB7QW_KEr_rGLrI1UMVszpmmAdJN3l0FBAIzTUtAy620N21OYVXlLZo4IsJ3fHX4miBT5T0XhBBeKvulfZ5-Co6N1yil0HzNViZi_0gEienRClqtsulE5KJC_SexwQ/s2498/Jumping%20program.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="910" data-original-width="2498" height="117" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxY_nFHIUKz-r2k4dtZc3OTGhVPGUNZJoFzO1YPcPdfz474VudWbrQwzXKWlXw6IB7QW_KEr_rGLrI1UMVszpmmAdJN3l0FBAIzTUtAy620N21OYVXlLZo4IsJ3fHX4miBT5T0XhBBeKvulfZ5-Co6N1yil0HzNViZi_0gEienRClqtsulE5KJC_SexwQ/s320/Jumping%20program.jpg" width="320" /></a></div>Those in the hopping exercise group did the regular exercises plus the hopping. The hopping bouts lasted 10 seconds each initially, (they did 5 times with 50 seconds rest) with the bouts gradually increasing and the rest periods shortening (pictured above). Each week after, they added an additional set of hops and reduced the rest times by 10 seconds to have a total training time of 5 minutes.</div><div><br /></div><div>RE, peak oxygen uptake (VO2 peak) and respiratory exchange ratio (RER) were measured at 3 running speeds (10, 12 and 14 kmh) before and after the hopping program.</div><div><br /></div><div>The authors found that the simple double legged hopping exercise can enhance <a href="https://weloverunning.blogspot.com/2019/07/another-way-to-improve-your-running.html" target="_blank">running economy</a> (RE) at higher speeds (12 and 14 km/h) in the subjects. The benefits are pronounced even when the hopping regimen is kept simple and done for 5 minutes daily. Maximum aerobic capacity was unchanged if their regular running and exercise habits were maintained.</div><div><br /></div><div>The authors sugested that the increase in <a href="https://weloverunning.blogspot.com/2018/03/achilles-tendon-length-and-running.html" target="_blank">Achilles tendon</a> stiffness improved RE since <a href="https://weloverunning.blogspot.com/2022/03/train-your-tendons.html" target="_blank">stiffer tendons</a> are more capable of transferring energy to help movement. Their data showed significant improvements in RE while the subjects were running at 12 and 14 km/h but not at 10 km/h which provides support that Achilles tendon stretch and recoil increases with running speed (Lai et al, 2014).</div><div><br /></div><div>What I felt was important was that there were no reported injuries nor side effects from the hopping exercise protocol. It is also not known if the hopping can be done in a fatigued state? Would that then lead to possible injuries? </div><div><br /></div><div>The hopping described in this study is really simple. The subjects hopped as high as they could using both legs with both legs either straight or slightly bent. So no need to do box or squat jumps! Other than packing my <a href="https://weloverunning.blogspot.com/2009/01/rope-skipping.html" target="_blank">skipping rope</a> with me when I'm traveling later this month, I'm going to try this as well.</div><div><br /></div><div>References</div><div><br /></div><div>Engeroff T, Kalo K, Merrifield R et al (2023). Progressive Daily Hopping Exercises Improves Running Economy In Amateur Runners: A Randomized And Controlled Trial. Sci Rep 13, 4167. DOI: 10.1038/s41598-023-30798-3</div><div><br /></div><div>Lai A, Schache AG, Lin YC et al (2014). Tendon Elastic Strain Energy In The Human Ankle Plantar-Flexors And Its Role With Increased Running Speed. J Exp Biol. 17: 3159-3168. DOI: 10.1242/jeb.100826</div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-71673257461318715022023-11-26T14:28:00.053+08:002023-11-26T16:59:35.634+08:00How Long Does Your Running Shoe Last?<div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWOOrKooFwf-MxAi-1cbbmAdYS5jyhVBQfaOV8Z-3nVy6DLlXgOMe5t-xdm2jaIJNFi83T5idYbPiwobNZ7Q0h0Og8aO6s5p8bcizQxuqMc7bFYFeI8Cc0h1gB5WLH72-AG2DsUrOXKUESZgrZ5_cbx8oV9-z667qj8yWRO3OO0aN9EOR8Z1GRtS4hBGY/s1080/premium-foams-guide-19679545-1080.webp" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="1080" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWOOrKooFwf-MxAi-1cbbmAdYS5jyhVBQfaOV8Z-3nVy6DLlXgOMe5t-xdm2jaIJNFi83T5idYbPiwobNZ7Q0h0Og8aO6s5p8bcizQxuqMc7bFYFeI8Cc0h1gB5WLH72-AG2DsUrOXKUESZgrZ5_cbx8oV9-z667qj8yWRO3OO0aN9EOR8Z1GRtS4hBGY/s320/premium-foams-guide-19679545-1080.webp" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture from <a href="https://runrepeat.com/guides/running-shoe-foams-guide" target="_blank">Run Repeat</a></td></tr></tbody></table>Ever wondered how long before you need to change your <a href="https://weloverunning.blogspot.com/2010/08/do-your-running-shoes-prevent-injuries.html" target="_blank">running shoes</a>? A bit of history on midsole technology. Previously, the <a href="https://weloverunning.blogspot.com/2015/10/what-about-energy-return-in-your.html" target="_blank">midsoles in running shoes</a> were all made with ethylene-vinyl acetate (or EVA). Then Adidas managed to secure (Adidas bought the technology from <a href="https://www.basf.com/global/de/who-we-are/history/chronology/1865-1901.html" target="_blank">BASF</a>) their Boost midsole out of thermoplastic polyurethane (TPU) in 2013 which led to many marathon world records falling. In 2017, Nike's super shoe, the <a href="https://weloverunning.blogspot.com/2022/11/only-some-runners-ran-faster-using.html" target="_blank">Vaporfly</a>, was made of polyether block amide (PEBA) and it is still the current dominant midsole.</div><div><br /></div><div><div>Previous anecdotal evidence and hearsay suggest EVA midsole running soles tend to last between 300 to 500 miles (480 to 800 km). There was an older study supporting this information (Cook et al, 1985). The researchers measured shoes shock absorption at frequent intervals between 0 to 500 miles. </div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP1NnsF2HGwBJnlUMdn3FGNGa9z10IFExJlm2tN7veanBIH9SIqL7bwNV_lJt-r5bnh32LC_QpOpyLvA9SKaStXgxQ37Msxwh0a7ITj8IMVuoaX5gASzYRiVoqWpsXsVwNLmprnkRiqvs_lKbvJEZA-X86JbMksYjS-hUhCQ0wMe6_ZxKjtzVwR0ej6Ks/s658/shoe-durability-1.webp" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="493" data-original-width="658" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP1NnsF2HGwBJnlUMdn3FGNGa9z10IFExJlm2tN7veanBIH9SIqL7bwNV_lJt-r5bnh32LC_QpOpyLvA9SKaStXgxQ37Msxwh0a7ITj8IMVuoaX5gASzYRiVoqWpsXsVwNLmprnkRiqvs_lKbvJEZA-X86JbMksYjS-hUhCQ0wMe6_ZxKjtzVwR0ej6Ks/s320/shoe-durability-1.webp" width="320" /></a></div>A machine was used to simulate running impact as well as 2 vounteers who actually ran 500 miles (pictured above). The 2 human volunteers show similar patterns compared to the machine (see diagram). Human testing showed that EVA midsole shoes retained 80 percent of shock absorption after 150 miles (240 km) and 70 percent after 500 miles (800 km). The curve then flattens out between 300 to 500 miles which is probably where we get shoe lifespan information from.</div></div><div><br /></div><div>More recently, a bunch of researchers teamed up with the brand <a href="https://www.on-running.com" target="_blank">On</a> and manufactured prototype running shoes that were almost identical (Rodrigo-Carranza et al, 2023). One had the new PEBA super foam while the other had the traditional EVA midsole. </div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNTKDh3umL-b8MxBBayibpBNBVV4wIR0GK7jkonhFGKowuoY0StOBr1FlbLk2KFGRKVBd_u_Smk8C4l5S5m-r8w7LL5F3E5iQLYsuWDSUQGSd2HoOfw2GrBsDUzaG83AszdAXBDvygI0piIMCFSbvzSX01sPARN37n1X8xO75hJOWIn2-YCdkmBUaYMOE/s500/shoe%20mechanical%20stiffness.webp" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="500" data-original-width="421" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNTKDh3umL-b8MxBBayibpBNBVV4wIR0GK7jkonhFGKowuoY0StOBr1FlbLk2KFGRKVBd_u_Smk8C4l5S5m-r8w7LL5F3E5iQLYsuWDSUQGSd2HoOfw2GrBsDUzaG83AszdAXBDvygI0piIMCFSbvzSX01sPARN37n1X8xO75hJOWIn2-YCdkmBUaYMOE/s320/shoe%20mechanical%20stiffness.webp" width="269" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Shoe testing from <a href="https://onlinelibrary.wiley.com/doi/10.1111/sms.14526" target="_blank">Rodrigo-Carranza et al (2023)</a></td></tr></tbody></table><div>Both versions also had a curved <a href="https://weloverunning.blogspot.com/2023/07/super-shoes-world-records-and-navicular.html" target="_blank">carbon fiber plate</a>. They tested the shoes before and after 280 miles (448 km). 22 runners performed a running economy test to measure how much energy they used at a given pace, once in fresh shoes, once with pre-worn shoes. The researchers themselves actually ran 280 miles (448 km) in each pair of shoes to pre-wear them for the research!</div><div><br /></div><div>The researchers found that the new super foam did lose their powers quicker. In fact they were no better than the traditional EVA midsole when they did. A key finding was that energy consumption while running with the new PEBA midsole shoe was 1.8 percent less than using the new EVA shoe. This strengthens the case that the super foam itself is more important ingredient since both versions of the prototypes had <a href="https://weloverunning.blogspot.com/2022/11/only-some-runners-ran-faster-using.html" target="_blank">carbon plates</a> in them.</div><div><br /></div><div>Another key finding was that after 280 miles (448 km), there was no significant difference between the 2 shoes. The EVA did not lose anything while the PEBA super foam shoe got 2.2 percent worse. Please note that not all PEBA foams are created equal. On's super foam may not be totally similar to Nike's and other brands.</div><div><br /></div><div>I have not converted to <a href="https://weloverunning.blogspot.com/2023/07/super-shoes-world-records-and-navicular.html" target="_blank">super shoes</a> yet as I do not like them stacked <a href="https://weloverunning.blogspot.com/2020/02/thinking-of-changing-to-maximalist.html" target="_blank">too high</a>. Moreover, I currently only run 2-3 times a week and I <a href="https://weloverunning.blogspot.com/2013/12/rotate-your-running-shoes-to-minimise.html" target="_blank">rotate</a> between 2 to 3 pairs of shoes with EVA and TPU midsoles. I run in them until they start to feel "flat". It is relatively easy to feel especially if one of my other newer pairs still feels supportive by comparison. I usually retire that "flat pair" from running but will still use them for walking. If you're using the PEBA foam super shoes, you may have to change them earlier.</div><div><br /></div><div>If you are interested, have a look at <a href="https://runrepeat.com/guides/running-shoe-foams-guide" target="_blank">Run Repeat</a>, where infomation on a huge range of high performance super foams are available. The author, Carlos Sanchez runs 100 km a week and has run three sub 3 hours marathons. Sanchez suggests that shoe foams take more than 24 hours to 'recover' and some foams recover faster than others so you may want to <a href="https://weloverunning.blogspot.com/2013/12/rotate-your-running-shoes-to-minimise.html" target="_blank">rotate</a> your running shoes to maximise comfort and shoe life.</div><div><br /></div><div><br /></div><div>References</div><div><br /></div><div>Cook SD, Kester MA and Brunet ME (1985). Shock Absorption Characteristics Of Running Shoes. AJSM. 13(4): 248-253. DOI: 10.1177/036354658501300406</div><div><br /></div><div>Rodrigo-Carranza V, Hoogkamer W, Gonzalez-Rave JM et al (2023). Influence Of Different Midsole Foam In Advanced Footwear Technology Use In Running Economy And Biomechanics In Trained Runners. Scan J Med Sci Sp. DOI: 10.1111/sms.14526</div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-22888751712533822822023-11-19T13:18:00.047+08:002023-11-19T14:03:47.569+08:00Is There An Ideal Running Cadence Rate?<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigsKfadzFa-cTVns6-1CTM9SYQ814_hh2kYPKQ33dJXNyr4NHZzibwS0GUL6xYCXZzWZ_EuFyGbz3MCVJCeQQnKDXexQ-0R6MfiLU1nLY1fsMgtjo0v04VLDCXY-pdd4zJk5A4MXii5UCL2CWKt23RZs7rLXVxoVBJzQNbCupeSJqV85kRpjh9Xo624PI/s1532/IMG_0048.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1532" data-original-width="1242" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigsKfadzFa-cTVns6-1CTM9SYQ814_hh2kYPKQ33dJXNyr4NHZzibwS0GUL6xYCXZzWZ_EuFyGbz3MCVJCeQQnKDXexQ-0R6MfiLU1nLY1fsMgtjo0v04VLDCXY-pdd4zJk5A4MXii5UCL2CWKt23RZs7rLXVxoVBJzQNbCupeSJqV85kRpjh9Xo624PI/s320/IMG_0048.jpg" width="259" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture from <a href="https://www.tracksmith.com/" target="_blank">Tracksmith</a></td></tr></tbody></table>180 steps per minute seems to be the accepted magic number for cadence (or the number of steps) in long distance running. If you read the old Runners World magazine, you will know that legendary running coach Jack Daniels got that magic number by counting the number of steps the elite runners took at the 1984 Los Angeles Olympics.<p>This is also part of the '<a href="https://weloverunning.blogspot.com/2022/02/does-good-running-form-make-you-run.html" target="_blank">ideal running form</a>' criteria. It is also a relatively simple quantity to measure and change since it's much easier to tell a runner to increase their cadence than altering than <a href="https://weloverunning.blogspot.com/2016/01/you-should-not-be-heel-striking.html" target="_blank">heel strike</a>.When you take smaller, quicker steps, it optimizes your efficiency and minimizes your injury risk by reducing impact on your <a href="https://weloverunning.blogspot.com/2009/08/ladies-your-knee-pain-may-be-coming.html" target="_blank">knees and hips</a> with each step. </p><p>What if you can turn over your legs even faster? Watch the elite female Japanese marathoners when they race, they get close to 200 steps per minute. Does more mean better? What does current research say?</p><p>Burns and colleagues (2019) found that running cadence varies greatly. It actually depends on your running speed. Your cadence will differ when doing a <a href="https://weloverunning.blogspot.com/2022/07/keep-jogging-or-rest.html" target="_blank">track interval</a> session versus an easy <a href="https://weloverunning.blogspot.com/2017/04/is-it-necessary-to-cool-down-after.html" target="_blank">recovery</a> run.</p><p>They studied 20 males and females who placed in the top 25 male and female finishers at the 2016 Ultra Running100 km world championships. The race was held in Spain and consisted of 10 laps of 10 km each lap along an almost completely flat course. This is ideal to determine if there were any specific characteristics that had an effect on cadence. Data was collected from the <a href="https://weloverunning.blogspot.com/2022/09/how-accurate-is-your-smart-watch.html" target="_blank">smart watches</a> of the runners.</p><p>A survey was done after the race via email asking about their age, weight, height, training, racing experience and their racing speed.</p><p>Only speed and height of the runners have an effect on each individual runners' cadences. The study showed that when the runners run faster, their step frequency increased. Taller runners also had lower step counts compared to shorter runners. This study found that every extra inch in height was associated with a decrease of just over 3 steps per minute in cadence. A <a href="https://weloverunning.blogspot.com/2010/05/american-record-by-fat-white-runner.html" target="_blank">6 foot tall</a> runner in the race took about 18 steps per minute less than another runner who is 5 foot 6 inches.</p><p>Makes sense that longer legs will take fewer steps each minute to cover the same distance. </p><p>The lead author, Burns, finished 5th in the race and included himself in the study. The runners' cadences differed greatly, ranging from 155 to 203 steps per minute. The highest and lowest averages actually finished within a couple of minutes of each other. </p><p>Guess what number came up when Burns took an average of all the runners' cadences? 182 steps a minute. Now, that is really close to the optimal 180.</p><p>The study also showed that <a href="https://weloverunning.blogspot.com/2016/04/your-running-style-definitely-changes.html" target="_blank">fatigue</a> had no effect on cadence, possibly due to the very flat course. Even when the ultra runners were in the later stages of the race, they held the same <a href="https://weloverunning.blogspot.com/2009/03/dont-set-off-too-fast.html" target="_blank">pace</a> from the start. In fact they had even faster step counts near the finish when they ran faster despite being <a href="https://weloverunning.blogspot.com/2016/04/your-running-style-definitely-changes.html" target="_blank">tired</a>.</p><p>According to the article, there are only 2 ways to increase your cadence, become shorter (like the elite female Japanese marathoners) or go faster. Bear in mind that everyone has a different optimal cadence. Having a higher cadence (than 180) does not necessarily make you a better runner. </p><p>Burns finds that when he is fitter, his cadence is lower at a certain pace since his steps are longer. When his cadence is faster than normal at the same pace, he uses that as a sign that he needs <a href="https://weloverunning.blogspot.com/2019/08/run-for-hills.html" target="_blank">hill</a> work or speed work to get stronger. </p><p>That is a much better way to use cadence to improve your running rather than aiming for a specific number. Especially when everyone's mechanics are different. It is also a good and simple aspirational goal for runners since many runners overstride and land on their <a href="https://weloverunning.blogspot.com/2016/01/you-should-not-be-heel-striking.html" target="_blank">heels</a>, putting <a href="https://weloverunning.blogspot.com/2014/05/todays-straits-times-article-180514.html" target="_blank">excessive forces</a> on their knees. </p><p>Reference</p><p>Burns, GT, Zendler JM and Zernicke RF (019). Step Frequency Patterns Of Elite Ultramarathon Runners During A 100-km Road Race. J Appl Physiol. 126(2): 462-468. DOI: 10.1152/japplphysiol.00374.2018</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-57522340133239009292023-11-12T11:18:00.049+08:002023-11-12T15:59:05.249+08:00How To Be A Better Trail Runner<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOkr4TrR_X8-vu-uGDy9BOMbRvG983psAkuVrzpLUWN7YvQnNd6FwfqZYKvWrP4OfkGE60JPYKaea61fy6mJ2Fz2JJTszQLc-Q32KO_4Q5dD3EqImj6Yo5QfxhPc-CBV9AWNVPE9knZhaWnbytuc9XyHZaS5wHgmxicalH4snj01oH9z6qneo_sx9bvXc/s1024/Melvin%20trail.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1024" data-original-width="768" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOkr4TrR_X8-vu-uGDy9BOMbRvG983psAkuVrzpLUWN7YvQnNd6FwfqZYKvWrP4OfkGE60JPYKaea61fy6mJ2Fz2JJTszQLc-Q32KO_4Q5dD3EqImj6Yo5QfxhPc-CBV9AWNVPE9knZhaWnbytuc9XyHZaS5wHgmxicalH4snj01oH9z6qneo_sx9bvXc/s320/Melvin%20trail.JPG" width="240" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture by <a href="https://www.facebook.com/lee.h.melvin" target="_blank">Melvin Lee</a></td></tr></tbody></table>Many of my patients are now running on trails, making the switch from running on the road which they say is boring. There are also many more organized trail races world wide, and many of our patients participate in these trail races.<p></p><p>What does it take to become a better trail runner? A recent published study compared elite and recreational trail runners in a series of lab tests and found that the elite runners were more efficient over both <a href="https://weloverunning.blogspot.com/2015/02/gotta-love-hills.html" target="_blank">hilly</a> and level terrain (Besson et al 2023). As a result, they required less energy to maintain a given pace. They were found to have greater leg strength compared to recreational runners. </p><p>The same researchers found similar results when they compared elite trail and elite road runners. The trail runners had stronger leg muscles and were more efficient on <a href="https://weloverunning.blogspot.com/2015/02/gotta-love-hills.html" target="_blank">hilly</a> terrain (Sabater et al, 2023)</p><p>So, do <a href="https://weloverunning.blogspot.com/2017/05/eccentric-exercises.html" target="_blank">leg strengthening exercises</a> if you want to run better on the trails. Other than visiting the weights room, you can carry a heavier backpack while climbing <a href="https://weloverunning.blogspot.com/2017/05/eccentric-exercises.html" target="_blank">stairs</a> or walking/ running up and down stadium <a href="https://weloverunning.blogspot.com/2017/05/eccentric-exercises.html" target="_blank">steps</a>. I used to wear a <a href="https://weloverunning.blogspot.com/2014/06/a-hard-warm-up-helps-you-run-faster.html" target="_blank">weight vest</a> while training for the <a href="https://www.oxfamtrailwalker.org.hk/" target="_blank">Oxfam Hong Kong Trailwalker</a> event at the old National Stadium <a href="https://weloverunning.blogspot.com/2017/05/eccentric-exercises.html" target="_blank">steps</a>. It definitely made the <a href="https://weloverunning.blogspot.com/2015/02/gotta-love-hills.html" target="_blank">uphill</a> sections easier during the event.</p><p>Another pattern that has turned up in studies of <a href="https://weloverunning.blogspot.com/2015/02/gotta-love-hills.html" target="_blank">hilly</a> running trail races is to keep your effort and not your pace constant. The faster finishers showed greater variability in their pacing. They ran slower (or walked) on the steeper sections and ran faster on the downslopes to make up time (Corbi-Santamariaet al, 2023). </p><p>Most trail runners tend to have a fixed <a href="https://weloverunning.blogspot.com/2009/03/dont-set-off-too-fast.html" target="_blank">pace</a> and try maintain that regardless of terrain. A more efficient strategy is slow down on the uphills and speed up on the downhill sections relative to your average <a href="https://weloverunning.blogspot.com/2009/03/dont-set-off-too-fast.html" target="_blank">pace</a>. So don't push harder on the up slopes to keep pace, slow down instead to keep your effort constant. You can run faster on the downslopes to get back the time you lost for those who are racing.</p><p>Please bear in mind that there's a skill to running fast downhill, particulary on technical terrain. More so during ultras as more than10 hours of racing makes one very fatigued. Not worth having a catastrophic fall while running downhill.</p><p>Are trekking poles useful? Usage of trekking poles can be contentious among trail runners. Giovanelli and colleagues (2023) tested runners on the steepest <a href="https://weloverunning.blogspot.com/2017/06/is-running-on-treadmill-more-difficult.html" target="_blank">treadmill</a> in the world, in their lab. Their <a href="https://weloverunning.blogspot.com/2017/06/is-running-on-treadmill-more-difficult.html" target="_blank">treadmill</a> can be set to 45 degrees, at a grade of 100 percent! They found that using trekking poles does not save energy, but they do <a href="https://weloverunning.blogspot.com/2016/09/can-antihistamines-decrease-muscle.html" target="_blank">save your legs</a>. On a hill climb of 20 degrees incline, runners applied 5 percent less force on their <a href="https://weloverunning.blogspot.com/2016/09/can-antihistamines-decrease-muscle.html" target="_blank">legs</a> but reached the top 2.5 percent faster.</p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgYYtjDWxIHTFuTu564o0tYcSqduJl9rD7q0E4KwO7VE6SzwtYu-kTznSp4h5IQzPZfVeO7o_wq3qrZr9h1kTOwW3vwCEZdA37QHq2_7Ahck_VHnZIkd5ueAsW-fjldBbZq0KRZVWRdhSGMG6XXkxZ2OJGW2Q_9W7R_K4RrBExUao7Pa44JhHs9H5Ei7w/s1280/hardrock-100-kilian-jornet-2017%20trekking%20poles.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgYYtjDWxIHTFuTu564o0tYcSqduJl9rD7q0E4KwO7VE6SzwtYu-kTznSp4h5IQzPZfVeO7o_wq3qrZr9h1kTOwW3vwCEZdA37QHq2_7Ahck_VHnZIkd5ueAsW-fjldBbZq0KRZVWRdhSGMG6XXkxZ2OJGW2Q_9W7R_K4RrBExUao7Pa44JhHs9H5Ei7w/s320/hardrock-100-kilian-jornet-2017%20trekking%20poles.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Picture from <a href="https://run247.com/running-news/trail/hardrock-100-kilian-jornet-course-record-win-dislocated-shoulder-injury" target="_blank">Run247.com</a></td></tr></tbody></table>Even Killian Jornet uses trekking poles (pictured above). Why shouldn't you?<p></p><p>There you go, three ways to become a better trail runner. Strength training, varying your pace and trekking poles. Watch out for tree roots on the trails while running!</p><p>References</p><p>Besson, T, Sabater PF, Varesco G et al (2023). Elite Vs Experienced Male And Female Trail Runners: Comparing Running Economy, Biomechanics, Strength, And Power. J Strength Cond Res 1: 37(7): 1470-1478. DOI: 10.1519/ JSC.0000000000004412</p><p>Sabater PF, Besson T, Berthet M et al (2023). Elite Road Vs Train Runners: Comparing Economy, Biomechanics, Strength, And Power. J Strength Cond Res 1: 37(1): 181-186. DOI: 10.1519/ JSC.0000000000004226</p><p>Corbi-Santamaria P, Herrero-Molleda A, Garcia-Lopez J et al (2023). Variable Pacing Is Associated With Performance During The OCC Ultra-Trail Du Mont-Blanc (2017-2021_. Int J Environ Res Pub Health. 13: 20(4): 3297. DOI: 10.3390/ijerph20043297</p><p>Giovanelli N, Pellegrini B, Bortolan L et al (2023). Do Poles Really "Save The Legs" During Uphill Pole Walking At Different Intensities? Eur J Appl Physiol. DOI: 10.1007/s00421-023--05254</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com1tag:blogger.com,1999:blog-2468644079235991563.post-81490825915093134312023-11-05T09:38:00.037+08:002023-11-05T13:32:59.053+08:00Strength Matters More Than Size<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx7ADJ13zoSJD-xzJh9fqh1YEkpvCfQm6xrFfHQ7csA-RxTNLFYbis-yB0z3_jnZyUOLTNi4_o0eo0ql1DWEoVZe2y2ZvOCTs_paC276Ka-Hcv3LNoa-zuu83jjvMCgkb0xiaEpXke-GKj9b0r6PEvDF048BepQySC-qf_6esc4zHlHRxdW1DKxQcc6_A/s1080/20184835_108144786511362_1029674025023963136_n.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1080" data-original-width="1080" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx7ADJ13zoSJD-xzJh9fqh1YEkpvCfQm6xrFfHQ7csA-RxTNLFYbis-yB0z3_jnZyUOLTNi4_o0eo0ql1DWEoVZe2y2ZvOCTs_paC276Ka-Hcv3LNoa-zuu83jjvMCgkb0xiaEpXke-GKj9b0r6PEvDF048BepQySC-qf_6esc4zHlHRxdW1DKxQcc6_A/s320/20184835_108144786511362_1029674025023963136_n.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Pawel Poljanski's legs at the <a href="https://www.instagram.com/p/BWshQ0FhGhY/" target="_blank">Tour De France</a></td></tr></tbody></table>My colleague was wondering why I was not 'big' (or muscular) despite exercising regularly. I explained to her I was more <a href="https://weloverunning.blogspot.com/2022/07/is-high-mileage-necessary-to-run-fast.html" target="_blank">Type I</a> muscle dominant (or <a href="https://weloverunning.blogspot.com/2022/07/is-high-mileage-necessary-to-run-fast.html" target="_blank">slow twitch</a> muscle) as most <a href="https://weloverunning.blogspot.com/2018/12/aerobic-exercises-key-to-aging-well.html" target="_blank">endurance</a> athletes are. Those who have predominantly <a href="https://weloverunning.blogspot.com/2022/07/is-high-mileage-necessary-to-run-fast.html" target="_blank">Type I</a> muscle fibers are lean, not big and muscular.<p></p><p>Her obesrvation is accurate. I actually lift <a href="https://weloverunning.blogspot.com/2018/04/barbells-or-bikes.html" target="_blank">weights</a> twice a week and even though I can squat 90 kg, my thighs are still skinny.</p><p>I also explained to her that it is better to be strong than have big muscles. <a href="https://weloverunning.blogspot.com/2017/11/strength-training-just-as-important-if.html" target="_blank">Weight training</a> can make you stronger and your muscles bigger. They are both related since bigger muscles are usually stronger. However, they are not identical. You can get stronger without adding muscle bulk. </p><p>This happens when the signaling from your brain to your muscles become more efficient and how effectively your muscle fibers are recruited. You can add muscle without getting stronger, this typically happens when you gain weight.</p><p><a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">Strength</a> is also a much better predictor of cognitive performance than muscle mass. Storoschuk and colleagues (2023) studied 1424 adults above 60 years of age between 1999 and 2002 in a health and nutrition examination study (NHANES). These subjects had DEXA scans to assess body composition, leg strength tests, a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291255/" target="_blank">digit symbol substitution test</a> (cognitive test) and questionnaires that assessed physical activity habits. The DEXA scan is used to determine how much muscle one has in their arms and legs and fat-free mass index (FFMI), which shows total muscle to height.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaxeE_janYnNGJKmwktjLZ9GaL1ArrSg0ijnVEaXcV4BQCph9wnrN8cn2w_DzsSMENqyn8BMtt3mY7N9RSzUjZrpfUF714dmt3A6LHRVO8hEoYbbx4P31ultDfVHJ05zpC6_vxXf44_3goOpbRQyoiuQ2PXejN5Mulo5xS_j3QzMd76lSU6pEyVncuX7U/s730/strength-vs-muscle-2023-1024x431.webp" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="307" data-original-width="730" height="135" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaxeE_janYnNGJKmwktjLZ9GaL1ArrSg0ijnVEaXcV4BQCph9wnrN8cn2w_DzsSMENqyn8BMtt3mY7N9RSzUjZrpfUF714dmt3A6LHRVO8hEoYbbx4P31ultDfVHJ05zpC6_vxXf44_3goOpbRQyoiuQ2PXejN5Mulo5xS_j3QzMd76lSU6pEyVncuX7U/s320/strength-vs-muscle-2023-1024x431.webp" width="320" /></a></div>The figure above presents the benefits of different variables on cognitive performance. The farther on the right each square is, the greater the cognitive benefits. You can see that low FFMI (low muscle mass) has no significant effect on cognitive scores, while peak leg force (a measure of strength) definitely have a significant benefit. Those who did resistance training (or <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">weight training</a>) for at least once a week has an even stronger effect.<p></p><p>Strength explained about 5 percent of the variance in cognitive scores, while muscle mass explained only 0.5 percent. Low strength levels raised the risk of premature death, but low muscle mass did not. In contrast, another study by Tessier et al (2022) found that low muscle mass predicted more rapid cognitive decline over a 3 year follow up period, after accounting for differences in strength. Perhaps it would be premature to conclude that muscle mass (being big) does not matter.</p><p>Confused? Storoschuk et al (2023) explained that there is a difference between the muscle you get from physical activity and muscle you get in the process of gaining weight. Greater muscle mass may just be a larger body size rather than greater strength, which does not seem to translate into protection from cognitive decline and other health benefits.</p><p>Moreover the conflicting results from the 2 studies are possible due to different popolulations, different cognitive tests and different sample sizes. </p><p>My take on this? It is good if you have big muscles and I will still lift <a href="https://weloverunning.blogspot.com/2023/07/body-weight-training-may-not-be-enough.html" target="_blank">weights</a> twice a week to at least maintain and avoid losing what I have. Getting stronger is much better, and that is the main reason why I do <a href="https://weloverunning.blogspot.com/2019/10/does-weight-training-stunt-growth-in.html" target="_blank">weight training</a>. Even though I do not seem to gain muscle I am able to increase the reps and quality of the exercises I perform. </p><p>So, to ward off cognitive decline, <a href="https://weloverunning.blogspot.com/2017/11/strength-training-just-as-important-if.html" target="_blank">strength training is just as important as aerobic exercises</a>.</p><p>References </p><p>Tessier A, Wing SS, Rahme E et al (2022). Association Of Low Muscle Mass With Cognitive Function During A 3-Year Follow-up Among Adults Aged 65 To 86 Years In The Canadian Longitudinal Study On Aging. JAMA Netw Open. 5(7): e2218826. DOI: 10.1001/jamanetworkopen.2022.19926</p><p>Storoschok KL, Gharios R, Potter GDM et al (2023). Strength And Multiple Types Of Physical Activity Predict Cognitive Function Independent Of Low Muscle Mass In NHANES 1999-2002. Lifestyle Med. 4: e90. DOI: 10.1002/lim2.90</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-12054539073130432292023-10-29T10:18:00.000+08:002023-10-29T10:18:05.319+08:00Rob It To Get It Free<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8ZwC3EQiC384DvFDHGOuwDC8rx0u-CAzziXsG023cOxbdE35BCl-LvlmuuYv6aSlQTUIruW5f9O4TtUbsEB7ZsepyheP_KM4WS1hDqtFXShaciLwLrcPjC9JbkM_Q8irB0PM9uYbuhf6svzrrqGYSLrBMyHcdnLVKyP7_uEjTMPlBtpO9TQRY4B9zwPk/s1569/Rob%20it.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="914" data-original-width="1569" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8ZwC3EQiC384DvFDHGOuwDC8rx0u-CAzziXsG023cOxbdE35BCl-LvlmuuYv6aSlQTUIruW5f9O4TtUbsEB7ZsepyheP_KM4WS1hDqtFXShaciLwLrcPjC9JbkM_Q8irB0PM9uYbuhf6svzrrqGYSLrBMyHcdnLVKyP7_uEjTMPlBtpO9TQRY4B9zwPk/s320/Rob%20it.png" width="320" /></a></div>What if you could go to a running store, pick something you like and run away with it free? No, I am definitely not suggesting that you shoplift from a running store. <p></p><p></p><p>This <a href="https://www.youtube.com/watch?v=SIcBa5eBOJQ" target="_blank">promotion</a> is exactly what a <a href="https://distance-store.com/" target="_blank">running store in Paris</a> came up with last month to steal whatever you want. The catch is you will have to outrun the store's security guard, who happens to be Meba Mickael Zeze. </p><p>Zeze happens to be a two time Olympian, who can run the 100m in 9.99 seconds and the 200m in 19.97 seconds!</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXbyEdManrEqv46ND1xPgkPY4DDjBAvwmHoaeZMxkA87MSVjDmi4I9AG7dsDnimPnuVsgYRGZPTrTinNo_4z9fbe9kSlcPa3FPG7f2HsMWMZRJsDRNZkrYIOO_VfxBnMayIK1rMqYvWYyjXrMEfLO6nw7oLJFpG20lfxLm8QaAi-hcTrpd0ReBki-Fz6Y/s1901/Zeze.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="925" data-original-width="1901" height="156" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXbyEdManrEqv46ND1xPgkPY4DDjBAvwmHoaeZMxkA87MSVjDmi4I9AG7dsDnimPnuVsgYRGZPTrTinNo_4z9fbe9kSlcPa3FPG7f2HsMWMZRJsDRNZkrYIOO_VfxBnMayIK1rMqYvWYyjXrMEfLO6nw7oLJFpG20lfxLm8QaAi-hcTrpd0ReBki-Fz6Y/s320/Zeze.png" width="320" /></a></div>Zeze had as much fun as the participants, looking at the video. He said the job reminded him of playing tag as a child, adding that he needed only a third of his top speed to catch most of the 'thieves'.<p></p><p>Only 2 managed to evade him, most probably as a result of Zeze having to run all day.</p><p><a href="https://distance-store.com/" target="_blank">Distance Paris</a> was super happy with the result despite losing 2 out of 76 attempts to 'thieves', so much so that it was turned into an video (see below).</p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/SIcBa5eBOJQ" width="320" youtube-src-id="SIcBa5eBOJQ"></iframe></div>This is a super clever idea by <a href="https://distance-store.com/" target="_blank">Distance Paris</a> and it definitely gave them a lot of eyeballs. Any running store in Singapore willing to try this? <p></p><p>Perhaps Shanti Pereira can be the security guard.</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-37240511511189122142023-10-26T19:00:00.051+08:002023-10-29T10:49:56.882+08:00 Embroidery For Our Team Building Event<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVhnkW-PGN7NMjijo0gCLg6PBiTNTEqMvBNT6hbYTmnzra_XBpAO1DsrXgKHh2mXYfJwIaxF-YkkMgnj6kULXyHvPv5bpHQOHwhXR8DSVP04PF_HVW5mySwI_wBLPwPckIYp28lR74VJ36g1eO503FQdzt4wW21FALFnf8RJFES11wOfCoZVIqsf7q_rE/s1018/Groupshot.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1017" data-original-width="1018" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVhnkW-PGN7NMjijo0gCLg6PBiTNTEqMvBNT6hbYTmnzra_XBpAO1DsrXgKHh2mXYfJwIaxF-YkkMgnj6kULXyHvPv5bpHQOHwhXR8DSVP04PF_HVW5mySwI_wBLPwPckIYp28lR74VJ36g1eO503FQdzt4wW21FALFnf8RJFES11wOfCoZVIqsf7q_rE/s320/Groupshot.JPG" width="320" /></a></div>You read correctly, we had Isabel Lim from <a href="https://www.isabellimdesigns.com/" target="_blank">Isabel Lim Designs</a> teach us this morning. It was great fun and we had a great time together.<p></p><p><a href="https://www.isabellimdesigns.com/" target="_blank">Isabel</a> was really patient when it came to explaining and teaching us what to do. Here are some of the designs.</p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi69OuVVq7x3KtOuV-mpoHrZlHrRH1M26omrV5EO5D3RwUtpL__EWWPu5kltpO7ImujF9TKCiT1-HUj-lGtYtg6CSKjgDaKgJxVa9pAI0UVJKZnSxYs3VS0JfMya9mKT5l8yvrPfFqGGHGUzZSnH54PhzoQnnTvOG8Ta9nIuGvnV407AJ9ZtjnC5ug2TEU/s1600/BT.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1200" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi69OuVVq7x3KtOuV-mpoHrZlHrRH1M26omrV5EO5D3RwUtpL__EWWPu5kltpO7ImujF9TKCiT1-HUj-lGtYtg6CSKjgDaKgJxVa9pAI0UVJKZnSxYs3VS0JfMya9mKT5l8yvrPfFqGGHGUzZSnH54PhzoQnnTvOG8Ta9nIuGvnV407AJ9ZtjnC5ug2TEU/s320/BT.JPG" width="240" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Byron's</td></tr></tbody></table><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxYGxhPiFocsIBHNfcHTbRscYeqovA8Z4pf1kvOSNINx8GEwd_8ygLXkpPIjHO1AyHASpFXhP2qZMHCfjB6yVfaRmdSg09jev-Q9kECpZ6ldXptMUjLcAJns38E0qn5EPuWF_yA4xI5XG8C8K4igKVQ1CLAeD-5qOgwpcCwWl979RAW6QV8JUSsZVj8bw/s1280/KL.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="720" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxYGxhPiFocsIBHNfcHTbRscYeqovA8Z4pf1kvOSNINx8GEwd_8ygLXkpPIjHO1AyHASpFXhP2qZMHCfjB6yVfaRmdSg09jev-Q9kECpZ6ldXptMUjLcAJns38E0qn5EPuWF_yA4xI5XG8C8K4igKVQ1CLAeD-5qOgwpcCwWl979RAW6QV8JUSsZVj8bw/s320/KL.jpg" width="180" /></a></div><div class="separator" style="clear: both; text-align: center;">Kaylee did this</div><div class="separator" style="clear: both; text-align: center;"> </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqRp8qB154RhsK86UiIyTFb0gtWtRQHS6Iho9LYnN2qDKfga0Pf4SsHa_a0VHu9uXLiettWiJrEwHOulbsD1Mms0dKG20HR4ScWf-ln99zqn-NeXrtTKZsb_r1gBmFoxP1NEbrC-gDyBvEMFhIefGv53YNPJtFgXHPyrY1lTFaEUQGYYQCiL0DpNfy4ag/s1920/Flower.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1920" data-original-width="1080" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqRp8qB154RhsK86UiIyTFb0gtWtRQHS6Iho9LYnN2qDKfga0Pf4SsHa_a0VHu9uXLiettWiJrEwHOulbsD1Mms0dKG20HR4ScWf-ln99zqn-NeXrtTKZsb_r1gBmFoxP1NEbrC-gDyBvEMFhIefGv53YNPJtFgXHPyrY1lTFaEUQGYYQCiL0DpNfy4ag/s320/Flower.JPG" width="180" /></a></div><p>Pretty cool huh? We definitely have some hidden talents in our midst.</p><p>We then proceeded to have lunch at Bumbu. Also a farewell lunch for Byron who is leaving us to move to Adelaide, South Australia. All the best to you Byron.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKTC_jp49ugt2r5v08KvR18l80PBacqKG7LwR9FnsX-T256-5e-AL6cJHrcvJL8CFJemU6jZwu94z7uE_TRg1RIFvaW1qiNlZmiVdAKcntDFnxly3nMkp9bV_ivAOvmYmbA3FySjPELIDbcS5hDyO5kmEtLN-xlQ03M8WOQWzkEmmS8X92WNqguGzc_wc/s1024/Bumbu.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="768" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKTC_jp49ugt2r5v08KvR18l80PBacqKG7LwR9FnsX-T256-5e-AL6cJHrcvJL8CFJemU6jZwu94z7uE_TRg1RIFvaW1qiNlZmiVdAKcntDFnxly3nMkp9bV_ivAOvmYmbA3FySjPELIDbcS5hDyO5kmEtLN-xlQ03M8WOQWzkEmmS8X92WNqguGzc_wc/s320/Bumbu.JPG" width="240" /></a></div>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-4190000484391142432023-10-21T20:55:00.013+08:002023-10-26T18:59:45.959+08:00Sports Solutions is 14!<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEju2IF7-QCmPr5mU2fZSmdiaRA1Nwd1m92KWPjF1Tx-IH5X2RJWNybKs4UBnlLAYRGTXEYRBTs7vli2_DyrscYvTyx-MoOEtE201Qx6PStQOGh3vcE5z6k6x7R0qKmkp4gnImACYN8ooxHkWXH7RseJMLJGbGMFXszThMdxV0RoYky-S849G4ZuqT62fFI/s1080/SS%20is%2014.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1080" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEju2IF7-QCmPr5mU2fZSmdiaRA1Nwd1m92KWPjF1Tx-IH5X2RJWNybKs4UBnlLAYRGTXEYRBTs7vli2_DyrscYvTyx-MoOEtE201Qx6PStQOGh3vcE5z6k6x7R0qKmkp4gnImACYN8ooxHkWXH7RseJMLJGbGMFXszThMdxV0RoYky-S849G4ZuqT62fFI/s320/SS%20is%2014.png" width="320" /></a></div>Yes, Sports Solutions is 14! Has it really been that long? Yes, it has. We started at Amoy Street and moved to Chip Bee Gardens in Holland Village in 2014.<p></p><p>A big thank you to all our families, staff, friends and patients for all your support all this while. We wouldn't have done it without all of you.<br /><br />Our goal is the same all this while. To make our patients better quicker. "As long as we're happy and enjoy treating our patients, it's not really work."<br /><br />Here's to many more years to come!</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0tag:blogger.com,1999:blog-2468644079235991563.post-12720634536971496762023-10-20T20:00:00.267+08:002023-12-25T16:22:34.327+08:00Accepting Payment For Online Reviews<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEe7n_ttW0eOP027FFfSObqti51PvDATn9sr977oGzPyGKnRUm1UvI-rnW_iWY4x5xOOyGuHYV9TnhaJBUwPUPMfmhD_1Y_hK5LhPcxtzzJo7rdOlkeIi9SVQhujySGv1EOOHuwMbVGwf1PUkmfyceuS8dosF-teKknlPBQp4wmOoqYsuaswxIZeX25kg/s1761/IMG_6344.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1761" data-original-width="1036" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEe7n_ttW0eOP027FFfSObqti51PvDATn9sr977oGzPyGKnRUm1UvI-rnW_iWY4x5xOOyGuHYV9TnhaJBUwPUPMfmhD_1Y_hK5LhPcxtzzJo7rdOlkeIi9SVQhujySGv1EOOHuwMbVGwf1PUkmfyceuS8dosF-teKknlPBQp4wmOoqYsuaswxIZeX25kg/s320/IMG_6344.jpg" width="188" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">ST201022</td></tr></tbody></table>I read with interest in a <a href="https://www.straitstimes.com/singapore/popular-blog-sethluicom-refutes-claims-it-does-not-disclose-taking-payment-for-food-reviews" target="_blank">Straits Times article</a> as restaurant owner <a href="https://www.facebook.com/photo?fbid=10169323854355487&set=a.10151085171600487" target="_blank">Charlene Yan posted online</a> on Oct 4th that food website <a href="https://sethlui.com/" target="_blank">Sethlui.com</a> asked for $2300 to be featured on their food blog. In addition, the email she received from one of Seth Lui's employee's offering her a spot on that list to be placed 1st, 2nd or 3rd position for an additional $400 to $600. No research, no actual food tasting done, just asking for money straight up to be featured on that list.<p></p><p>No prices for guessing when ST reported in the newspapers on 20th October, 2023 that <a href="https://www.straitstimes.com/singapore/paid-restaurant-reviews-standard-practice-but-being-transparent-is-key-say-food-bloggers" target="_blank">paid restaurant reviews are "standard practice"</a>. Singapore chef Benny Se Teo said <a href="https://www.facebook.com/benny.s.teo/posts/pfbid02XEwGZh8rFjoiB5BWeLASokJMA6qaC5gY9uRoudCH8ugSTPb2R4R9Xfv2gxWq9q6ql?ref=embed_post" target="_blank">paid food reviews</a> are definitely on the rise and raise concerns about objectivity since financial interests are entangled with the restaurants they are reviewing. </p><p>The Advertising Standards Authority Of Singapore states on its website that it should be clear that "anyone who looks at the advertisement is able to see, without reading it closely, that it is an advertisement and not editorial matter".</p><p>That means any compensation like a free drink or dessert that a food blogger receives, should be clearly disclosed to the reader or viewer. If payment by the establishment is made, to be on such lists, it is then no longer an editorial decision but an advertisment and that must be clearly stated otherwise that list has no credibility.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7v7EMmom1195sNY5kcvaSJkCvuIVkkB0BBAn5Vb3jGAuFxzzTMLH9aJ12GgDNx4q4v4Rs2xhSXLDhI41195n-J_ejXnL7_FP3CWcLoyWDIACjmG1-CgZ1YGWOQ1ew_P-Safb9umWrYWJgK6B2_5wq0xTMRzrdFB_g4oB0CkvsPm7tTmKUuzPqqNVJmRE/s640/Ad%201.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="295" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7v7EMmom1195sNY5kcvaSJkCvuIVkkB0BBAn5Vb3jGAuFxzzTMLH9aJ12GgDNx4q4v4Rs2xhSXLDhI41195n-J_ejXnL7_FP3CWcLoyWDIACjmG1-CgZ1YGWOQ1ew_P-Safb9umWrYWJgK6B2_5wq0xTMRzrdFB_g4oB0CkvsPm7tTmKUuzPqqNVJmRE/s320/Ad%201.png" width="148" /></a></div>Will you be surprised that this happens in the healthcare industry too. I received a total of 3 emails (pictured above and below) dated 14th, 16th and 20th October, asking if we want our clinics to be featured in the "25 Best Physiotherapy Clinics in Singapore (2023)". Their fees range from $500 to $2000.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhv5A5FkNvoTblLKuEXwk9N_9s0M8KsNkJ3OwdKM8B1xbczVfVQre2ey6QEkDEBJ9nASWEGwQGdEywjICemN_MeMc5h9Od9W9amHcLbaiqHfk00ZLXmBT2OO9P7pCcXHocncfE3KyITgn1q85i-1QegWMVjQwVvyp6HCL8D_gDxlA6zsUwgbmcr7ZHkjJo/s640/Ad%202.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="295" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhv5A5FkNvoTblLKuEXwk9N_9s0M8KsNkJ3OwdKM8B1xbczVfVQre2ey6QEkDEBJ9nASWEGwQGdEywjICemN_MeMc5h9Od9W9amHcLbaiqHfk00ZLXmBT2OO9P7pCcXHocncfE3KyITgn1q85i-1QegWMVjQwVvyp6HCL8D_gDxlA6zsUwgbmcr7ZHkjJo/s320/Ad%202.png" width="148" /></a></div>You would think that the employee sending me the emails would have kept in touch with the brouhaha regarding paid restaurant reviews after it went viral on <a href="https://www.reddit.com/r/singapore/comments/1715oup/sethluicom_asks_for_money_to_be_featured_in_one/" target="_blank">Reddit</a>, <a href="https://www.facebook.com/photo?fbid=10169323854355487&set=ecnf.854895486" target="_blank">Facebook</a> and of course the <a href="https://www.facebook.com/photo?fbid=10169323854355487&set=ecnf.854895486" target="_blank">newspapers</a>.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhze6nlNOLPZSCbn0FIj8ebVwpnIP-xLZ0HWP3ltZHaKN8R0uc2fiLhAXNu_JeSap7SCc-bWtT3uyXOjSKNp0wCThFQs9Ll3Q_z2njYeGzpa7QlHIbKF_5BOEb2QhpbwvzLttzg9iEm7U6jAeYOaVvsLolelaKfG6Xub9lC-MkE3k8VDqAc_VpgN6jEJNY/s640/Ad%203.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="295" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhze6nlNOLPZSCbn0FIj8ebVwpnIP-xLZ0HWP3ltZHaKN8R0uc2fiLhAXNu_JeSap7SCc-bWtT3uyXOjSKNp0wCThFQs9Ll3Q_z2njYeGzpa7QlHIbKF_5BOEb2QhpbwvzLttzg9iEm7U6jAeYOaVvsLolelaKfG6Xub9lC-MkE3k8VDqAc_VpgN6jEJNY/s320/Ad%203.png" width="148" /></a></div>At least I know the employee is persistent since I received 3 emails asking if our clinic wanted to be on that 'best' physiotherapy clinic list.<p></p><p><a href="https://weloverunning.blogspot.com/2019/05/raising-two-kids-and-two-clinics.html" target="_blank">Aized</a> tells me that we have been approached multiple times as well to be on such lists on print copies of magazines targeted at the expatriate coummunities too. </p><p>The authenticity of such reviews for physiotherapy clinics are definitely questionable. Our clinics probably will not be on such lists since we do not pay to be on them.The main criteria for compiling a list like this is monetary and without full disclosure to the readers. Now you know.</p><p>Thankfully, majority of patients who see us and get better refer us to their family members and friends so we do not have to be on such lists.</p>Gino Nghttp://www.blogger.com/profile/08822889264049507077noreply@blogger.com0