Running Solutions

This Article Caught My Eye

2012-01-09T23:35:00.087+08:00

Which article is this you ask? Well, following section below caught my eye.

"Some people would perceive the addition to be minimal, probably no more than an ounce and the distribution is spread evenly across the head. However, even a small change comes with a risk."

Rafael Nadal in his quest to serve better (as he noticed his service speed had dropped in 2011 compared to 2010) added some weight to his racquet head. This is as he realized the number of aces per match he served last season was less than half of what Andy Murray & Roger Federer managed.

Elite athletes are extremely sensitive when it comes to equipment change. Because of the repetitive movements/ stroke etc, a small change can wreak havoc and create biomechanical changes and cause injuries. True enough, Rafa started having shoulder pain in while playing in a tournament in Doha last week and lost his semi-final.

Myself included. After a bike accident that damaged my bike back in 2001, I changed bike frames (of a different brand) but set up everything else exactly the same. Just 3 days after the bike changed, I started having pain down my right hamstring. Every time after I finished the bike leg in a triathlon, I had pain in my right hamstrings every single time that whole season.

What's more surprising, 2 days after I managed to get a brand new frame similar to my previous damaged one cleared the problem almost straight away.

So as the new season beckons for all of you, make sure you don't introduce drastic changes to your training and/ or your equipment.

*Article "Nadal, creature of habit, forced to adapt to stay on top" from The Times, London republished in the Straits Times on Monday, 090112 on page B13

Sunday Times Article ST 010112

2012-01-01T18:46:00.000+08:00

Here's a good start for the new year, our Sports Solutions staff mentioned in Dr (Prof) Lee Wei Ling's article in today's Sunday Times under the Think section on page 37 on how she received help for her rehabilitation after her operations.

Today's Lianhe Zaobao

2011-12-30T20:59:00.000+08:00

Featured in today's Lianhe Zaobao, (Gino) riding his bike to work rain or shine. It's in the zbnow section, cover page and page 5. I took photos of the papers.

Aized
camera-Lumix GF1

Running Talk/ Workshop @TTSH For SPA

2011-12-10T23:51:00.002+08:00

Sports Solutions did an evidenced-based review on barefoot running versus running with shoes for the Singapore Physiotherapy Association at TTSH today followed by a running practical.

Here are some pictures from the talk and the practical.

Getting ready

Physiotherapists all ears

y'all ready to run?

Try this

Group picture

ST 071211 Safety Tips For Runners

2011-12-07T20:17:00.000+08:00

After yesterday's newspaper article, Sports Solutions quoted again in today's Straits Times on page B10 under the Sports section. Have a look.

Wrong To Equate Exercise With Danger ST 061211

2011-12-06T09:07:00.000+08:00

Sports Solutions is quoted in today's Straits Times article under the Sports section on page B8 on whether running marathons are dangerous. Go take a look.

Oakley Fast Jacket

2011-12-02T13:28:00.000+08:00

Polarized lenses

Lenses for my rainy days ride

Well, I received my Christmas present early from Oakley this year, the Oakley Fast Jacket. And my first impressions?
You know it's been raining a lot in Singapore the past few days but I've been riding still and here are my first thoughts on the Fast Jackets.

The Fast Jacket has the same SwitchLock lens change system which was first used in the Jawbone & Split Jacket so changing lenses are a breeze http://weloverunning.blogspot.com/2010/08/oakley-split-jacket.html.

One observation is that if you tend go down on your drops (or aerobars) on your bike, the Fast Jacket's frame (on top) tends to reduce your line of sight a little. It also feels slightly heavier than my current favourite model which is the Jawbone, of course http://weloverunning.blogspot.com/2009/07/blog-post.html.

What is good is that the Fast Jacket does not have a rim at the lenses's lower border which means your lower field of vision is unobstructed and the peripheral vision is great (and extremely useful when you turn around to check traffic while riding).

Ride safe, y'all.

Kinesio Taping Course KT1 & 2 on 12-13 Nov 2011

2011-11-13T21:23:00.010+08:00

Most recent KT 1 and 2 course taught by Gino at Progress Healthcare the past 2 days.
Contact us for more details if you wish to do the next course.

Yesterday's Straits Times (ST 051111) Article On Sports Massage

2011-11-06T14:17:00.001+08:00

If you read yesterday's article in the Straits Times on page C22 under the Sports section (Rubbing The Right Way), you would have read the author's personal opinion on Sports Massage on various conditions like DOMs (or delayed onset on muscle soreness).

We have written on the topic before http://weloverunning.blogspot.com/2009/07/got-doms.html. There are actually mixed results on published evidence that sports massage helps with DOMs. For every paper you find that says it helps, there will be a few more that says that the results are not significant.

With regards to blood circulation, there is actually very poor evidence that sports massage increases blood circulation (Wiltshire et al, 2010). This has been confirmed in many other studies as well.

Most beneficial effects seemed to be increased perceptions of recovery and increase in psychological well being.

Reference

Hertbert RD and De Noronha M (2007). Stretching To Prevent Or Reduce Muscle Soreness After Exercise. Cochrane Database of Systematic Reviews. Issue 4. The Cochrane Collection.

Szymanski, D (2003). Recommendations For The Avoidance Of Delayed-onset Muscle Soreness. Strength and Conditioning Journal 23(4): 7-13.

Wiltshire EV, Poitras V et al (2010). Massage Impairs Postexercise Muscle Blood Flow And "Lactic Acid" Removal. Med Sci Sports Exer Jun 42(6): 1062-71.

Zainuddin Z et al (2005). Effects Of Massage On Delayed-Onset Muscle Soreness, Swelling And Recovery Of Muscle Function. Journal of Athletic Training. Jul-Sep 40(3): 174-80.

*Picture from Flickr

Kinesio Taping For Horses

2011-10-17T17:27:00.032+08:00

Dr Kase Started taping race horses in 2005

Gudron demonstrating her taping

Yes, you read correctly, Kinesio taping can be done on horses as seen from the pictures..

Ever since Harvey Makortoff, a physical therapist from USA started taping his dog, Dr Kase has also taped race horses since 2005. In fact, Dr Kase mentioned that animals seem to respond even better to Kinesio taping than humans.

Dr Gudron Collins treats race horses in the UK and she did a very interesting presentation at the recertification in Albuquerque. In fact, Kinesio Taping Association is in the midst of preparing a Kinesio Taping course to train vets to be able to use Kinesio tape to treat the animals they see.

Kinesio Taping Instructor (CKTI) Recertification in Albuquerque

2011-10-16T12:11:00.000+08:00

Many, many interesting updates for Kinesio taping. Gino is currently attending his Kinesio Taping Instructor recertification course in Albuquerque, New Mexico in the United States from 14-16 October.

Some pictures of his visit there. Will write on the updates on later posts.

Dr Kenso Kase himself

New World Record In Berlin Marathon 2011

2011-09-25T19:59:00.001+08:00

Patrick Makau has broken the Emperor Haile Gebrselassie's world record in Berlin this year by 21 seconds after running 2:03:38 hrs.

Makau made a big surge at around 27km and Geb stepped off the road briefly. To make things worse after he resume running, he soon lost touch and dropped out and lost his world record as well.

The big news is Geb DNF again, his second in two races after New York which he "retired" and came back and now more questions will be asked if he will return.

Paula Radcliffe in her comeback race after two years out finished 3rd in 2:23:46 and qualified for the London Olympics next year.

Here are the splits for the men's race.

5km-14:36 (2:03:13 pace)
10km-29:17 (2:03:34)
15km-43:51 (2:03:21)
20km-58:30 (2:03:25)
Half-marathon -61:43 (2:03:26)
35km-1:42:16 (2:03:17)
40km-1:57:15 (2:03:41)
Finish-2:03:38

*Photo by Getty Images

Remembering 9/11

2011-09-11T21:42:00.014+08:00

Lest we forget.... Our hearts go out to those who lost their loved ones.

*Pictures from NY Times

Women's 200m Final in Daegu 2011

2011-09-03T23:59:00.001+08:00

VCB, Carmelita Jeter & Allyson Felix

A picture with VCB when she was in Singapore in 2009

Yes Usain Bolt ran a fantastic race in the 200m to redeem himself but most entralling race for the day for me was watching Veronica Campbell-Brown (VCB) outrun Camelita Jeter and my current favorite female sprinter Allyson Felix in the women's 200m race.

Not many people had expected VCB to win, certainly not me, as she had lost the 100m to Carmelita Jeter. In fact Jeter did try to haul VCB back in the closing stages of the race but VCB managed to hold her off with a storming finish after her brilliant start.

3-time 200m defending champion Allyson Felix rounded off the medals after placing 2nd in the 400m earlier. Felix tried to do the 200m & 400m double here and I guess that foiled her chances.

*Picture from Tracktownphoto.com
*Also see http://physiosolutions.blogspot.com/2009/12/jamaican-sprinters-treat.html

Saving Lives By Sharing Bikes

2011-08-14T21:13:00.000+08:00

Cycling is cleaner for the environment & much cheaper than driving cars (especially so here in Singapore). Now there may be more reason to do ride your bikes to work.

In a paper published by Spanish investigators in the British Medical Journal early this month, they found that bike sharing (in 181 982 participants) can actually help save lives in urban environments.

After accounting for air pollution and traffic mortality, the authors found that bike sharing prevented the deaths of at least 12 people each year as a result of the exercise. Annual carbon dioxide emissions were reduced by about 9 062 344 kg.

Reference
Rojas-Rueda D, de Nazelle A et al (2011). The Health Risks And Benefits Of Cycling In Urban Environments Compared With Car Use: Health Impact Assessment Study. BMJ 343: d452.

* Picture from Flickr by Steve Caddy.

News On Running On Grass & The Paleolithic Diet

2011-07-30T23:53:00.039+08:00

Two articles in today's Straits Times (300711) were discussed in our blog previously. The first article is whether running on grass can prevent injuries. This article is in page C18 under the Sports section. We've discussed this before, have a look at http://weloverunning.blogspot.com/2010/07/should-you-run-on-grass-or-on-road.html.

The other article is under the Review section on page A39 and it talks about why eating "rabbit food" (or plant based whole foods) may not help decrease heart diseases and cancer.

The writer did mention that the Paleolithic diet (based on published studies) can lower risks for heart disease. Here are the links for our article on the Paleolithic diet.http://weloverunning.blogspot.com/2009/09/should-i-be-eating-like-caveman_13.html and http://weloverunning.blogspot.com/2009/09/eating-like-caveman-part-ii.html

Battle In The Alps

2011-07-22T13:07:00.002+08:00

Galibier
photo by Roberto Bettini

Cadal Evans pulling
photo by Sirotti

Andy attacks!
photo by Roberto Bettini

If you enjoyed yesterday's stage to the top of the Galibier, expect more fireworks on tonight's stage to the Alpe d'Huez.

Andy Schleck rode to a big win last night on Stage 18 of the Tour De France, attacking on the next to last climb of the day with 60 km still to ride and then hung on for the win. Cadel Evans did most of the work in the last 10km pulling along with him Ivan Basso, Thomas Voeckler, Frank Schleck etc. Alberto Contador who showed much aggression (and descended like a demon) in the last two days was dropped in the last kilometer.

Voeckler battled hard hung to to the yellow jersey by a scant 15 seconds at the top of the Galibier, (reminiscent of way back in 2004 when as a newcomer, he rode to the yellow jersey, held it for ten stages and held a 22 second lead over Lance Armstrong before losing on the top of the Alpe d'Huez). Tonight, he will face yet another big battle to hang on the the malliot jaune.

Andy Schlek is now second overall, with his brother Frank third, 1:08 min behind Vockler, with Evans fourth 1:12 back. Frank had a relatively easy day yesterday and we may see him ride well tonight to gain time as Evans will probably the best amongst them against the clock in the long time trial still to come tomorrow in the penultimate stage.

Will we see Contador explode tonight? He is currently 4:44 down, back in seventh and tonight will be his last chance to regain some time bearing in mind he is normally a much better time triallist than all of the other riders including Evans.

All will be made clearer after tonight's climb to the top of cycling's most famous climb- Alpe d'Huez.

Straits Times Article on Athletic Myths ST 090711

2011-07-09T22:41:00.001+08:00

Myth No. 1 in today's article in the Straits Times under the Sports section on page C20 looks at whether static stretching before exercise is ideal for your pre-race (exercise) warm-up.

We've written on this many times before in both our clinics' blogs, have a look, http://weloverunning.blogspot.com/2009/02/does-stretching-improve-performance-or.html,

http://physiosolutions.blogspot.com/2009/11/how-necessary-is-stretching.html,

http://physiosolutions.blogspot.com/2009/12/just-one-stretch-can-slow-you-down.html,

http://physiosolutions.blogspot.com/2010/02/more-on-stretching.html

My Patient Made It To The Top Of Mount Everest

2011-06-28T21:28:00.004+08:00

My patient Rob first came to see in to see me January this year needing help with his neck and knee pain as he was preparing to summit Mount Everest, the highest mountain in the world after missing the summit in his first attempt last year.

Rob has reached the top of each of the highest mountains in six other continents and just "needed" Everest to complete his 7 summits collection. He made it on May 13 this year. He came to see me today and shared his photos.

You da man, Rob.

Route to Everest

Ladder crossing

View of Lhotse- 8500m

South Summit

Top of the world

What Does Lady Gaga Have In Common With Tennis In Wimbledon?

2011-06-20T22:59:00.001+08:00

What does Lady Gaga have to do with tennis at Wimbledon? Well, Bethanie Mattek-Sands is ranked just behind Venus Williams, but she seems to have surpass Venus in terms of outrageous outfits at last Thursday's night Wimbledon players' party. Her dress is designed by Lady Gaga's designer Alex Noble.

Venus showed up for her 1st round match in a tiny play-suit with golden hot pants and proceeded to quickly dismiss her her opponent Uzbekistan's Akgul Amanuradova 6-3, 6-1.

Well, I'll be following the results more than the fashion.

Nicolas Mahut and John Isner are drawn to meet each other in the first round again for a second straight after last year's incredible first round duel that spanned 3 days and finished 70-68 in the fifth set breaking multiple records with Isner prevailing.

*Pictures from Getty Images, EPA & Reuters

New Running Shoes For Our Defence Forces

2011-06-18T22:06:00.103+08:00

In today's Straits Times (180611 on page B1), it is reported that our soldiers, navy and air force serviceman will all be getting new Asics running shoes. It has been reported that Asics was chosen because of its lighter weight, durability and better shock absorbing qualities than the previous Brooks and New Balance models. Selection was done after trials done by the Singapore Armed Forces (SAF) and its fitness and medical sections.

The podiatrist interviewed in the article was also quoted as saying that the models provided will be "customising the shoes to the individual's feet, forestalling tendonitis and heel pain".

As written in a previous post, there is almost no correlation between wearing proper running shoes and avoiding injuries (http://weloverunning.blogspot.com/2010/08/do-your-running-shoes-prevent-injuries.html).

If you have been reading our blog, you woulkd have read that Sports Solutions has written on this since 2009 when researchers concluded in the British Journal of Sports Medicine that sports medicine specialists should stop recommending shoe's based on a person's foot type as there is no evidence supporting it (http://weloverunning.blogspot.com/2009/03/do-high-tech-running-shoes-work.html).

Despite no credible evidence by researchers mentioned in their paper, Sports Medicine Australia (SMA), the New Zealand Society of Podiatrists (PNZ) and the International Federation of Sports Medicine (FIMS) all endorse shoes by Asics. In fact, all the reccommendations made SMA, PNZ and the FIMS are because of sponsorship arrangements (Richards et al, 2009). Is our SAF going the same way?

I have nothing against Asics, in fact I wore them when I started running a long time ago (my first coach recommended them). I sincerely hope that our SAF servicemen's injury rate will be reduced, let's see what happens. If only they know pain free running http://weloverunning.blogspot.com/2009/03/pain-free-running.html.

I have all 3 articles, email me if you want a copy.

*Picture from Mindef

References

Knapik JJ, Trone DW, Swedler DI et al (2010). Injury Reduction Effectiveness Of Assigning Running Shoes Based On Plantar Shape In Marine Corps Basic Training. AJSM published online before print June 24, 2010.

Richards CE, Magnin, PJ and Callister R (2009). Is Your Prescription Of Distance Running Shoes Evidenced Based. BJSM. 43(3) : 159-162.

Ryan MB, Valiant GA, McDonald K et al (2010). The Effect Of Footwear Stability Levels On Pain Outcomes In Women Runners: A Randomised Control Trial. BJSM published online before print June 27, 2010.

Sole Therapy?

2011-06-12T22:33:00.000+08:00

Also known as zone therapy, reflexology was "founded" by a Connecticut based ENT (ear, nose & throat) doctor William H Fitzgerald (1872-1942) so writes the author in yesterday's Straits Times (Solely Therapeutic, June 11 page A37).

His "work" was further expanded upon by an American physiotherapist Eunice D Ingham (1899-1974) who came up with the sole maps you will now see posted on the walls of reflexology shops. (I never knew this!)

The theory behind reflexology is that good health supposedly depends on good energy flow in the body. During illness, energy flow to a particular zone is disrupted and hence alters the proper functioning of organs in that zone. This shows up as tender spots on the the sole where affected organs are mapped. One can then "treat" virtually any organ since they are found easily on one's sole.

There seems to be no evidence behind reflexology though, as randomized controlled trials done on headaches, asthma, dementia, diabetes, foot swelling in pregnant women, headaches, post surgical pain, anxiety, irritable bowel syndrome, multiple sclerosis, menopausal symptoms and the common low back pain were all found to be ineffective.

Reference

Ernst E (2009). Is Reflexology An Effective Intervention? A Systematic Review Of Randomised Controlled Trials. MJA 191(5): 263-266.

Kinesio Tape in Today's Straits Times (080611)

2011-06-08T22:43:00.023+08:00

Those of you who attended the Kinesio Taping Level 1 & 2 course over the weekend will recognize the Kinesio Taping on the athlete (Straits Times page B15 under the Sports section), and how the taping can be improved.

Well, I treated the athlete and corrected his taping, he will definitely be well to swim in the SEA Games trials next week.

All the best for your trials.

* Picture from RN

Today Paper Article Quoted In Runner's World Website

2011-06-07T19:59:00.000+08:00

Yesterday I saw the article in the "Voices" section in page 20 of the "Today" newspaper and didn't think that much of it until I saw the same article quoted this morning in the Runners World website.

A cyclist (not a local Singaporean but an expatriate who formerly lived in Holland) was riding home from work on the bike section along Bedok canal was punched in the face by a jogger running in the designated cycling section. The cyclist was writing in to share his experience after a previous writer wrote in about another "road rage" incident regarding a cyclist.

Personally, I get fairly upset when any cyclist coming up behind me rings the bell when I'm walking along any pedestrian walkway. Pedestrians have the right of way in any pedestrian walkway. I usually don't give way unless the cyclist ask politely.

Now while I ride to work daily, I am always riding on the road and I never go on to any pedestrian foot paths. If I have to ride on any pedestrian walkway for whatever reason, I always give way to the pedestrians, but that's me.

Have a look at the Runner's world article here http://rwdaily.runnersworld.com/2011/06/note-to-self-avoid-the-bedok-canal-bike-path-wherever-that-is.html.

*Picture from Runner's World

Kinesio Taping Level 1 & 2 Course

2011-06-06T23:00:00.000+08:00

Gino Spent the last 2 days over the weekend teaching Kinesio Taping Level 1 and 2 at Progress Healthcare Pte Ltd (the Kinesio tape distributor).

The next course will be KT 3 in October this year while and the KT 1 &2 will probably be in November. Stay tuned for more details.

To Eat Organic Food Or Not

2011-05-01T20:08:00.000+08:00

There is increasing published evidence that the “ halo effect” in food may influence what and how much we eat. For example, research has shown that people tend to eat more at fast-food restaurants claiming to serve “healthier” foods compared to regular burger and fries joint. This may be due to people letting their guard down when something is perceived to be healthy.

Food carrying an "organic" label may influence people to think that the food is more nutritious compared to "normal" food.

Organic food has been actively debated as whether they are in fact more nutritious.

In the study referenced below, the researchers conducted a double-blind, controlled trial in which 144 subjects at their local mall compared what they thought were "normal" or "organically" produced chocolate sandwich cookies, plain yogurt, and potato chips. All of the products were actually of the organic variety – they were just labeled as being “regular” or “organic.”

The subjects unanimously preferred the "organic" food samples across all group. Perhaps they believed "organic" means more nutritious and/ or tastier. This may mean that eating organic creates some sort of a placebo effect and that they are eating healthier or lower in calories.

Reference

Lee JWC, Shimizu M and Wansink B (2011). The Health Halo Effect: Don’t Judge A Food By Its Organic Label. Paper Presented at the 2011 Experimental Biology Conference. http://experimentalbiology.org/content/default.aspx

2:03:02 Hours In 2011 Boston Marathon

2011-04-19T11:12:00.013+08:00

A super fast time in the 2011 Boston marathon of 2:03:02 hrs by Geoffrey Mutai of Kenya. This is by far the fastest time ever ran in the marathon, faster than the 2:03:59 hrs by Halle Gebreselassie in Berlin. But it will not be recognized as the world record because it is a point-to-point course (IAAF does not certify Boston as a record quality course) and course is mainly downhill in the latter stages.

The first 10k was covered in an amazing 29:06 min, projecting 2:02:47, but they slowed a little in the middle.

The 10km stretch between 30-40 km was covered in 28:25 min.....

Have a look at the splits below

Distance Time Interval Interval Projected
     Time Pace Time

   5 14:29 14:29 2:54 2:02:23
   10 29:08 14:37 2:55 2:02:47
   15 43:45 14:39 2:56 2:03:04
   20 58:43 14:58 3:00 2:03:53

Halfway 1:01:57 2:03:54

  25 1:13:16 14:33 2:55 2:03:40
  30 1:28:23 15:07 3:01 2:04:19
  35 1:42:35 14:12 2:50 2:03:40
  40 1:56:48 14:13 2:51 2:03:13

Finish 2:03:02

*Picture from Runners World

Bike Lanes War

2011-04-01T21:13:00.001+08:00

The picture above shows a battle being waged on the roads in New York City over its bike lanes.

On one side are those who want bike lanes in order to have a healthy lifestyle while being able to share the road equally.

Those against the bike lanes want their cars to own the road. They probably want to use as little energy as possible to get from one place to another. And I guess they just don't wanna support a city designed to help its inhabitants exercise while commuting.

Well, at least NYC has bike lanes. When do we get ours in Singapore?

I've been riding to school, training and work etc since I was sixteen. Dunno if we'll ever get bike lanes here.

*Picture and article from http://nymag.com/news/features/bike-wars-2011-3/

De Quervain's Syndrome

2011-03-21T23:18:00.001+08:00

Here's what a patient diagnosed with with De Quervain's I treated recently wrote on her very popular blog http://am-klutz.livejournal.com/2011/03/08/.

Thank you for your very nice comments Andrea, appreciate it.

Go take a look.

*Picture from Flickr.com - Christian Oliver Cruz.

Strength Drawn From An Arduous Test ST 130311

2011-03-13T13:33:00.000+08:00

Please go and read today's (130311) Sunday Times papers and you will see that two of our staff being mentioned by Dr (Prof) Lee Wei Ling during her stay in the hospital and her subsequent period of rehabilitation.

Have a look under the "Think" section on page 39.

A Podiatrist's View On Running Shoe Selection

2011-02-22T19:39:00.003+08:00

Ever wondered what an evidence-based Sports Podiatrist's views are on choosing your next running shoes? This is what Ian Griffins on Ransacker.com wrote.

Mr Griffins did an excellent job on saying what many current heath professionals are still doing now with regards to running shoe selection is flawed. He also discusses how the method of assessing your foot type by your wet foot print came about (and why the wet foot test is "nonsense" to quote him), why controlling pronation is a poor way of choosing a shoe, why aligning runners to the same neutral position makes no sense.

Please have a look if you want to read his post http://www.ransacker.co.uk/running-shoes/goings-on/what-running-shoes-should-you-wear-the-myths-busted/.

I've written on running shoes before, have a look here http://weloverunning.blogspot.com/2010/08/do-your-running-shoes-prevent-injuries.html and http://weloverunning.blogspot.com/2009/03/do-high-tech-running-shoes-work.html.

* Photo from Ransacker.com

Acupuncture For Chronic Low Back Pain

2011-02-13T12:28:00.002+08:00

Acupuncture is astrological in origin and not evidence-based so writes the author in a review article in yesterday's Straits Times (page A32, 120211). How is it linked to astrology? There is "qi" flowing in the human body's loop of meridians interlinking 361 points on the skin. Since the qi flows in a closed loop, you can insert needles at any point away from the painful site to relieve pain if done well.

Why 361 points? The earth takes just three minutes under 24 hours to rotate 360 degrees on its axis while the sun appears to revolve 361 degrees every 24 hours. Hence the link to astrology.

Previously I have read both articles from the Spine Journal and New England Journal of Medicine quoted by the author in which acupuncture was researched to see its efficacy on low back pain. The conclusion from the systematic review (the highest level in research) was that both real and sham acupuncture were more effective than no treatment. It added that acupuncture may be used as a supplement to other forms of conventional therapy for low back pain.

So here's the deal, real acupuncture does no better than sham acupuncture. It probably is the placebo effect working when patients feel better.

References

Berman BM, Langevin HM et al. (2010). Acupuncture For Chronic Low Back Pain. N Eng J Med. 363: 454-461.

Yuan J, Purepong N et al (2008). Effectiveness Of Acupuncture For Low Back Pain : A Systematic Review. Spine. 33: E887-E900.

Shape Magazine - Aqua Based Rehabilitation

2011-01-21T12:31:00.000+08:00

Sports Solutions featured in this month's (January) Shape magazine for our Aqua Based Rehabilitation (Deep Water Running) on pages 102-105. Go take a look.

Please also see http://weloverunning.blogspot.com/2009/04/aqua-based-rehabilitation-deep-water.html and http://weloverunning.blogspot.com/2009/06/aqua-based-rehabilitation-you-saw-it.html.

Loopz Training @ SS with Wong Li Lin

2011-01-19T22:28:00.001+08:00

Staff from both Physio & Sports Solutions gathered at SS today for a Loopz training session with founder Wong Li Lin. It can be used for both rehab and strengthening. Contact us if you are keen on finding out more.

A big thank you to Li Lin for her time.

Food Rules

2011-01-18T20:18:00.002+08:00

My son eats really well as my wife insists on buying him all the organic and wholesome food at the shops that sell them. Actually, come to think of it, my childhood meals were pretty decent too, definitely a lot less processed and junk food compared to what I eat now.

Now that I don't train like I used to before, I try to eat less junk food as I don't burn calories like I used to.

And partly because of my wife and son, I've actually bought and read the book "Food Rules" by Michael Pollan (my wife gave me this incredulous look and asked where I got the book). It'll take you less than 30 mins and it will change the way you look at food forever.

The first twelve rules are

1. Eat food.
2. Don't eat anything your great-grandmother wouldn't recognize as food.
3. Avoid food products containing ingredients that no ordinary human would keep in the pantry.
4. Avoid food products that contain high-fructose corn syrup.
5. Avoid food products that have some form of sugar (or sweetener) listed among the top 3 ingredients.
6. Avoid food products that contain more than 5 ingredients.
7. Avoid food products containing ingredients that a third-grader cannot pronounce.
8. Avoid food products that make health claims.
9. Avoid food products with the word "lite" or the terms "low-fat" or "non-fat" in their names.
10. Avoid foods that are pretending to be something they are not.
11. Avoid foods that you see advertised on television.
12. Shop at the peripheries of the supermarket and stay out of the middle.

For more rules, please read the book.

LARS

2011-01-04T23:00:00.000+08:00

Happy New Year to all, I've been meaning to write on the LARS procedure for ACL for the last few months, but never got down to it until today. One of my patients rang me up this afternoon telling me he tore his ACL on a skiing trip last week and asked for my advice.

So here it is, I posted it in the Physio Solutions blog as a follow up to our current trends in ACL reconstruction management (http://physiosolutions.blogspot.com/2009/03/current-trends-in-anterior-cruciate.html).

Have a look http://physiosolutions.blogspot.com/2011/01/lars-for-acl-reconstruction.html

Running Barefoot ST 271210

2010-12-27T22:23:00.000+08:00

Today's topic on "A Runner's Diary" in the Sports section of the Straits Times on page B11 touches on whether running barefoot is a fad.

We have written on this before and there is definitely evidence that running shoes may not prevent injuries http://weloverunning.blogspot.com/2010/08/do-your-running-shoes-prevent-injuries.html and
http://weloverunning.blogspot.com/2009/03/do-high-tech-running-shoes-work.html.

We are not saying you need to be barefoot while running but as written before, please do so progressively if you're giving it a try. Better still, come run with us during our running club and we'll show you how to run pain free.

More On Running Barefoot

2010-12-21T20:58:00.002+08:00

The above photos show runners wearing Vibram Five Fingers (VFF) but still landing on their heels. Now the VFF's were made popular by Christopher McDougall (who was interviewed by Jeanette Wang in yesterday's Straits Times article in the previous post) in his book Born To Run.

Well, no point running in VFF's if you still land on your heels as that is what causes most running injuries. Most if not all of us have spent years wearing shoes that have caused our legs and feet to be supported by the presence of a heel so most runners now land on their heels http://weloverunning.blogspot.com/2009/03/do-high-tech-running-shoes-work.html.

Now don't get me wrong, I'm not against anyone wearing the VFF. Like I written before in a previous post (http://weloverunning.blogspot.com/2010/02/barefoot-running-versus-running-in.html) it's not the shoes you wear to run, its how you run more that is more important. That means if you master the technique, you can literally run in any shoes you want.

We had many calls and emails asking about running barefoot after yesterday's article even though Sports Solutions was not quoted in the article. I even had a student contact me on my views regarding running barefoot running for her research project.

I firmly believe that what is currently suggested by most health care professionals on the basis of pronation control and cushioning is flawed, http://weloverunning.blogspot.com/2010/08/do-your-running-shoes-prevent-injuries.html.

This is what I feel regarding choosing your running shoes. Most people can run in just about any shoe (if they run correctly) as long as they take things slowly and listen to their OWN body. Problems arise when they attempt to do too much too soon in a new pair of (minimalist) shoes.

As for running barefoot, don't go and try more than 2km or else everything may hurt since you are now loading your muscles and joints (that have been so used to shoes) much more. Gradually build up your distance and it should be fine.

Running Barefoot ST 201210

2010-12-20T14:08:00.000+08:00

Have a look at today's article in the Straits Times under the Sports section " A Runner's Diary"on page B10 on running barefoot. Sports Solutions was not quoted in the article, but we have written on the topic before.

Here's the link http://weloverunning.blogspot.com/2010/02/barefoot-running-versus-running-in.html.

Remember it's not the shoe, it's the technique that's more important. Master it and you can run in any shoe. I've seen runners wearing the Vibram's and still landing on their heels. http://weloverunning.blogspot.com/2009/03/pain-free-running.html

Legs Alert

2010-12-15T20:58:00.003+08:00

Mention tennis injuries and what will probably come to mind will most likely be shoulders, elbows and maybe back injuries right?

Well, not quite if you look at a paper published by a multinational group of physiotherapists and physicians working on the ATP World Tour. The paper showed that the main areas for concern (at least among the world's elite tennis players) are the lower limbs.

Leg injuries accounted for 39-65% of injuries sustained, followed by arm/ shoulder at 24-46% while head/ trunk accounted for 8-22% of injuries.

This is not surprising as tennis involves many multi directional movements requiring players to accelerate, decelerate, twisting and cutting etc.

The researchers suggested making the player's hips more stable to reduce ankle and thigh injuries. Come see us or talk to us at Sports Solutions regarding conditioning for your tennis both to prevent injuries and to enhance your performance.

Reference

Ellenbecker TS, Pluim B et al (2009). Common Injuries In Tennis Players: Exercises To Address Muscular Imbalances And Reduce Injury Risk. Strength & Conditioning Journal.31(4) : pp 50-58.

Photo of Gael Monfils by Associated Press

ST 041210 Recovery Time

2010-12-04T19:28:00.001+08:00

Have a look at the last column for this year's ST Sweet 16 Marathon Plan in today's Straits Times on page C23 under the Sports Section and you will see Sports Solutions quoted.

It was decided that the column will run today instead of next Monday since you are doing the race tomorrow.

So all the best to all our patient's taking part in tomorrow's races, the Stan Chart Marathon, the 70.3 triathlon in Phuket and the Ironman in Busselton, Perth.

ST 291110 Your Pre-Race Preparations

2010-11-29T14:32:00.000+08:00

This is the second last column for the ST Sweet 16 Marathon plan and it discusses what runners do for their pre-race rituals. It's on page B11 on today's Straits Times under the Sports section. Go take a look and you'll see Sports Solutions mentioned.

But that's others, having your own is best. Do what suits you and what will best achieve your goals.

Also have a look at http://weloverunning.blogspot.com/2009/11/last-week-before-your-marathon.html and
http://weloverunning.blogspot.com/2009/12/day-of-your-race.html.

Sports Solutions 1st Anniversary Lunch

2010-11-28T22:16:00.000+08:00

The Physio Solutions and Sports Solutions Teams got together to celebrate SS's 1st Year Anniversary. It's always great to get some time to eat together :) Thank you to all who attended. Here's to many more years to come!

Reference For Article On Tapering

2010-11-21T15:08:00.001+08:00

I've had quite a few patients and readers as well asking me about the source of the article I quoted in the Straits Times on tapering in the previous post. Well here it is.

Reference

Bosquet L, Monpetit J et al (2007). Effects Of Tapering On Performance: A Meta-Analysis. Medicine & Science In Sports & Exercise. 39(8): pp 1358-1365.

Email me if you want a copy of the article.

Your Marathon Taper ST 151110

2010-11-15T22:38:00.001+08:00

Have a look at the Straits Times (page B21) under the Sports section and you'll see Sports Solutions quoted on what not to do during your taper. Go take a look.

Slightly less than 3 weeks to go before your race day so hopefully you've done your last long run. Nearly there now, hang in there.

Team Singapore Asian Games Athlete Has Compartment Syndrome? No Way

2010-11-11T23:48:00.009+08:00

My first patient at 830am today was an interesting case. The patient (who shall remain anonymous) was told that he/she had compartment syndrome and he/she had so far received acupuncture/ needling with current, massage (many times), electrical stimulation plus other treatment on the leg and foot etc but did not get better at all.

Now my patient is due to fly out to Guangzhou to represent Singapore for the Asian Games early next week and presented this morning with tingling sensations on the lower third of the right leg and the patient also complained there was decreased sensation there and also had pain in the web space between the big and second toe. Now those of you (who are physiotherapists) reading this should already be thinking to yourselves that nooooo, this cannot be a case of compartment syndrome.

If a patient has compartment syndrome he/she will complain of pain, parasthesia (or pins & neeedles), the limbs (usually legs) being very tight, tense and full of pressure. Temporary paralysis sometimes occurs. It usually happens to athletes at the start of the season after their break when they train too hard, too soon. The muscles expand and they fill up the space in the legs and "squeeze" the nerves there leading to sensations of tightness, pressure or pins & needles as the connective tissue that separates each section or compartment does not stretch hence leading to the term.

Now, my patient is at the tail end of the season (not at the start of the season and certainly not after a break from training), the symptoms he/she complains of doesn't resemble compartment syndrome at all I thought. Why? My patient's pain did not subside after training/ cessation of activity. In compartment syndrome, with cessation of physical activity, the muscles will stop working and subsequently stop squeezing on the nerves and the patient's pain/ pressure/ tightness should settle (but did not).

The biggest clue to me was the pain between big and second toe. This is a definite L5 (deep branch) nerve root distribution (which I confirmed after checking my patient's lumbar spine).

After assessing my patient fully, I treated my patient's spine and nerves, taped his/her foot and taught a nerve stretch and I just found out my patient was better and able to train later.

Well, I am no longer working at the Singapore Sports Council and I can only treat the athletes that come and look for me at our clinics. So my best wishes to Team Singapore at the Asian Games.

All the best at the Asian Games, Team Singapore. Do us proud.

*Picture shows treatment of my patient before coming to see me

Mind Over Matter ST 081110

2010-11-09T20:48:00.001+08:00

It's less than 4 weeks to go to your race. I've taken a look at yesterday's (081110) ST Sweet 16 Marathon plan in the Straits Times and found similar points on mental imagery discussed in our blog in the run up to the race last year as well.http://weloverunning.blogspot.com/2009/11/2-more-weeks.html

Go take a look http://weloverunning.blogspot.com/2009/11/3-weeks-to-go.html and http://weloverunning.blogspot.com/2009/11/2-more-weeks.html

Drinking Too Much Water Leads To Hyponatremia ST 011110

2010-11-01T23:10:00.002+08:00

Today's topic in the ST Sweet 16 Marathon Training Plan (on page B13 under the Sports section) talks about the perils of hyponatremia or drinking too much. Drinking too much water that is. You mean you can drink too much water? That is probably what most readers will be asking. Yes, you can.

A common reply from athletes (taking part in endurance events) will be that they have drank a lot of water yet still feel thirsty. Their tummy feels bloated and swollen and they have a upset stomach. More severe symptoms can include cramps, giddiness, disorientation, vomiting, convulsions, diarrhoea, swelling in the brain and death in severe cases. Now, you can trust me on this, I had most of the above mentioned symptoms & even spent 2 days in the ICU of a Hong Kong hospital when I drank too much water and had hyponatremia during a 100km running race in November 2000.

I've written on it before, go take a look http://weloverunning.blogspot.com/2009/06/hyponatremia-at-sundown-marathon.html.

Do You Need That Cortisone Injection?

2010-10-29T19:38:00.001+08:00

Have you got any pain in your elbow, patella or Achilles tendon? I've seen many cases of what used be called tennis elbow or lateral epicondylitis and Achilles tendinitis in our clinics recently. What is now known as tendinopathy (or diseased tendon) of the elbow or Achilles as these cases are actually due to degenerative change rather than inflammation as numerous studies have shown.

Most of the time patients with tendon problems were given a cortisone (or corticosteroid) injection to treat the pain (rather than treating what caused the pain). Cortisone, an anti-inflammatory agent used to be one of the preferred treatments for overuse injuries of tendons (like tennis elbow, patella and Achilles tendinitis) which were notoriously resistant to treatment.

Pain wise the injections were effective, but as soon as the patients returned to the their sporting activity or even their daily activities, the pain returned. In adverse cases the tendons can even rupture. This happened on a few occasions when I was working at my previous job at the Singapore Sports Council with our national athletes after receiving the corticosteroid injections. They subsequently needed surgery to repair their ruptured tendons resulting in more time off. So for all you athletes out there, think three, four or five times and not just twice about taking that cortisone injection.

A major new review article published in the Lancet just last week raised major doubts on the efficacy (or wisdom) of using cortisone on tendon problems. Yes, the authors found plenty of evidence (in over 4 dozen high quality randomized controlled trials) that corticosteroid injections reduced patients' pain in the short term, but the effects were not great in the intermediate & long term. In fact patients receiving the injections had a much lower rate of recovery than those who did nothing or received physiotherapy (at 6 and 12 months). This was especially true for patients with tennis elbow pain, rotator cuff (swimmer's shoulder) pain and Achilles tendon pain.

There are more evidenced-based treatment for tendinopathy other than cortisone injections, ultrasound, massage, interferential currents etc. We at Physio & Sports Solutions practice evidenced-based physiotherapy (neural stretching, Mulligan MWM's, eccentric muscles strengthening exercises & Maitland joint mobilizations etc) to treat you. Come let us help you with your tendon injuries.

Reference

Coombes BK, Bisset L, Vicenzino B (2010). Efficacy And Safety Of Corticosteroid Injections And Other Injections For Management of Tendinopathy: A Systematic Review of Randomised Controlled Trials. The Lancet. Epub on 22 October 2010.

*Picture by Ballyscanion/Getty Images.

ST 251010 Knowing Your Pain Part II

2010-10-25T08:50:00.000+08:00

After yesterday's topic (in the New Paper) on the recovery effects of Sports massage after cycling (or any other exercise), go take a look at page B11 under the Sports section in today's (251010) Straits Times to find out more on the 2nd part of understanding or decoding your pain.

It's just under 6 weeks to your race day, not a good time to get injured. If you do, please come and see us quickly.

TNP on 241010

2010-10-25T08:33:00.001+08:00

Sports Solutions was quoted in yesterday's Sunday edition of the New Paper on the recovery process after cycling (so you can train harder again quicker), specifically on Sports Massage and DOMs (we've written on the topic before http://weloverunning.blogspot.com/2009/07/got-doms.html).

The recovery process applies to all sports, not just to cycling. It's in page 26 and 27 in yesterday's (241010) paper, go take a look.

Both our clinics are open on weekends and public holidays, please call to make your appointment.

ST Article On Knowing Your Pain 181010

2010-10-18T15:27:00.002+08:00

After a few weeks break from the ST Sweet 16 Marathon Training plan, Sports Solutions is back in the news in today's Straits Times (181010) under the Sports section on page B11 on understanding or decoding your pain.

This is what we at Physio and Sports Solutions are good at, treating the root cause of your problems instead of just treating your pain to allow you to run pain free. Our many patients can testify to that.

Go take a look.

The Underpants Run In Hawaii

2010-10-08T21:31:00.004+08:00

For those of you who are into triathlons, well, tomorrow (or 091010 in Hawaii) will be the holy grail and grand daddy of all triathlons. The Ford Ironman World Championships, held on the big island Kona in Hawaii on every full moon in October.

Why full moon every year you may wonder? You get 17 hours to make the finish line, to be an Ironman, and the full moon will offer some light to those out on the course battling to make the time cut.

Above is a picture I found in the pre race festivities, the underpants run.

All the best to all our patients taking part.

*Picture from Ironman.com

More on Glucosamine ST 250910

2010-09-25T23:06:00.005+08:00

Have a look in Today's Straits Times under the Review section on page A35, the author writes about the fact that many elderly folks are still popping glucosamine pills despite the lack of evidence. We've actually written on this topic before on November 9 last year (http://weloverunning.blogspot.com/2009/11/glucosamine-chondroitin-msm.html).

As mentioned, the older studies tend to have some evidence supporting the use of glucosamine, perhaps due to the studies funded by the drug companies. Current studies show a lot less evidence supporting it's (glucosamine) use on osteoarthritis as studies are a lot more stringent and require clinic trials to be registered before trials can be commenced.

While glucosamine has never proven to have any dangerous side effects, there is also no evidence to suggest that it works,. Evidence suggest that it works mainly by placebo effect.

For my patients who have been asking me on this topic, you now have more evidence.

Reference

Wandel S, Junni P et al (2010). Effects Of Glucosamine, Chondroitin, Or Placebo In Patients With Osteoarthritis Of Hip Or Knee: Network Meta-Analysis. BMJ. 342:c4675 (Epub 16 Sep 2010).

Please email me if you want the Straits Times article or the research paper.

*Picture from Flickr

Sony Walkman NWZ W252

2010-09-23T22:30:00.000+08:00

You've just read this week's article (in the post before this) in the Straits Times Sweet 16 Marathon plan on how you can run faster with music, so its a good time for me to do my review on the MP3 player from Sony as promised earlier (http://weloverunning.blogspot.com/2010/07/my-new-sony-walkman.html).

Quite a few of my friends and even runners I don't know have come up to me and asked me about it when they see me using it, so here it is.

Weighing just 43g and wireless, it's light and not cumbersome at all. I always inevitably catch the wires of my earphones of my 1st generation iPod shuffle while running previously so having no wires dangling is really a nice change. The ear pieces are fairly comfortable and the bass is pretty good, much better than my current earphones in fact. Control of the headset is done by 3 buttons on the right, which is easily accessed. You can increase or decrease volume and switch your songs here. One complaint though is you can't rewind or fast forward within a song.

Another thing I wasn't fond of was the "Zappin" mode which plays 4 or 15 seconds bits of each song. I guess this is to allow you to scroll through your playlist until you find the song you wanna run to. Me, I just fill the entire 2G capacity with all my favorite running songs and put it on shuffle mode.

One other favorite feature of mine Sony W252 is you can get 90 mins of play time on a quick 3 minutes charge. So those of you who like me wanna squeeze in a run when your baby is sleeping and find that there is no battery will really appreciate this. Those who run longer than 90 minutes, well, you gotta make sure the battery is not flat then.

Once again, a big thank you to the 2 Hill & Knowlton staff for this great MP3 player.

*Pictures from Sony

Tuning In ST 200910

2010-09-20T22:19:00.008+08:00

No, you were right, Sports Solutions was not quoted in today's Straits Times (under the Sports Section on page B13) Sweet 16 marathon training plan with 11 weeks to go before your big race.

But we did write on this topic before last year on July 28.

Go take a look
http://weloverunning.blogspot.com/2009/07/tuning-in.html.

What's The Best Way To Do An Interval Workout

2010-09-17T21:28:00.006+08:00

As you've read in this week's Sweet 16 Marathon training plans, wanting to run faster almost always mean having to do interval training. And all of the research published on interval training have pointed to increased fitness and running faster running times.

That doesn't mean you can run intervals 4 to 5 times a week though coz' that will be like taking an express train to over training and injury occurring. So here's the catch with interval training, it looks like it's purely a science - do the work and improvement follows correct? Well, it's actually just as much an art according to this research paper from Australian researchers I chanced upon recently.

Instead of following a fixed formula like waiting until your heart rate (HR) drops to a certain number before your next interval or resting as long as the time taken for your previous interval ran, the researchers suggested that listening to your body might be the best way after all. They coined the termed "teleoanticipation" or what they say is perceived readiness to run your next interval.

Here's what the researchers asked a group of competitive runners do during a standard interval session of 5 x 1 km at 90% of their tested all out 1 km time. For recovery, the runners A) waited for their HR to return to 130 beats; B) rest as long as their interval time - about 3:18 min; C) rest until they "felt" they can run at 90% effort.

When they followed their HR, the runners did not recover enough, and they slowed dramatically on the last three repeats. Methods B and C had similar outcomes with one highly interesting difference - when the runners were recovering by "feel", the runners chose shorter recoveries than those assigned by method B. That is, they were able to maintain their times in the 1km repeats, but in less total workout time. This probably means that the C workouts were more efficient (or productive) than the B workouts. As you see, interval training can be more of an art than a science.

The researchers suggested that this way of running intervals should not replace all other training principles that you have used previously but to keep this in mind while considering the whole training process.

Personally I guess this is a good and practical way of training as it may mean you do not need to shell out extra money to get a HR monitor. This also gives athletes a systematic approach to train at their own pace (especially in a group setting) given that they will need to rely on their own pacing during a race so this makes good sense to practice pacing in training as well.

Reference

Edwards AM, Bentley MB et al (2010). Self-pacing In Interval Training: A Teleoanticipatory Approach. Psychophysiology. 28 June Epub. DOI: 1111/j. 1469-8986.2020.01034.x

* Picture by RS

12 Weeks To Your Race ST 130910

2010-09-13T08:48:00.001+08:00

As we count down the weeks to your marathon, have a read on how to get faster as today's Straits Times (130910) continues its Sweet 16 Marathon plan.

Have a look at the Sports section page B11 and you see Sports Solutions quoted.

In our weekly running club sessions, we teach you how to run pain free with good running form, just ask other regular runners who come. Give us a ring to let us know you are coming.

Nike City 10k

2010-09-01T20:28:00.002+08:00

This this a brand new race from Nike this year on 24/10/10, replacing the extremely popular Human Race which was held for the past 2 years. Singapore is amongst 22 other cities hosting this event.

What's unique about this particular race? Besides the physical race, runners from Singapore will be competing against fellow runners from Kuala Lumpur (KL) to see who can clock more mileage from now til October 31st. And here's the deal, the winning city gets USD$30,000 donated to a charity of their choice, for Singapore it will be the Singapore Children's Society.

In order for you to do your bit for charity, runners who sign up for the race will get 50% off the purchase of a Nike+ SportBand so you can log your mileage and play your part by participating in the online challenge versus KL.

Staff from Physio and Sports Solutions will be taking part in the race to do our bit for the Singapore Children's Society.

The Correct Way To Warm Up ST 300810

2010-08-30T21:38:00.000+08:00

This week's topic in the marathon Sweet 16 training plan is on warming up. It is in today's StraitsTimes under the Sports section on page B13.

We've written on the topic before, please take a look at this (http://weloverunning.blogspot.com/2009/07/no-need-for-long-warm-up-in-heat.html) and also this (http://physiosolutions.blogspot.com/2010/02/more-on-stretching.html).

Sunday Times 290810

2010-08-29T21:28:00.001+08:00

Have a look at the Lifestyle section in today's Sunday Times paper (290810) under Pulse page 10 and you'll see Sports Solutions quoted in an article called "Wrist Management". Go take a look.

ST 230810

2010-08-23T09:52:00.000+08:00

Sports Solutions in the papers today on choosing running shoes for your marathon. Go take a look in today's Straits Times under the Sports section page B15.

Runners Toes Not Harmed By Running

2010-08-22T19:48:00.001+08:00

Yet more evidence that distance running in humans is an activity that is natural and well-evolved that we perform with great skill.

In their published article, British radiologists were interested to determine if running is harmful to our metatarsophalangeal (MTP) joints.

Here is what they found. There is no extra synovial fluid (this is the fluid in our joints) in the MTP joints showing that running is not injurious to our joints. The MTP joints are at the base of our toes.

Measurements of the volume of synovial fluid in the MTP joints were taken after a 30 minute run and after 24 hours of rest. And the researchers found no association between moderate distance running and any increases in the volume of synovial fluid.

Reference

Kingston AR, Toms AP et al (2008). Does Running Cause Metatarsophalangeal Joint Effusions? A Comparison of Synovial Fluid Volumes On MRI In Athletes Before And After Running. Skeletal Radiology. 38(5): 499-504.

Oakley Split Jacket

2010-08-17T17:26:00.010+08:00

Here's a nice surprise from Oakley (thanks to Joey) today, I was given their latest Split Jacket sunglasses. It looks like the Jawbone, has the same features, just a little smaller which I guess will suit those with smaller faces well.

The polycarbonate Plutonite HDO lenses as usual have superb visual clarity with excellent peripheral vision, in fact just as good as the Jawbone.

From the first picture , you can see that the main difference is that the larger Jawbone (white) provides more coverage, especially for the lower field of version. It also has the same switchlock hinge frame which makes changing lenses real easy.

Please also see (http://weloverunning.blogspot.com/2009/07/blog-post.html).

Today's Straits Times 160810 - We Are Built To Run

2010-08-16T21:52:00.006+08:00

Go take a look at today's Straits Times under the Sports section page B15 and you'll see that humans are meant to run.

The quoted article in the papers by Lieberman and Bramble (2007) points out that we humans have an exceptional cooling system, can adapt really well to hot weather and we also have spring like ligaments and tendons in our legs and feet as well as very good balance. These traits were definitely all needed by our caveman ancestors as they had to hunt and look for food.

Please also have a look at this (http://weloverunning.blogspot.com/2009/10/human-body-is-built-for-distance.html).

Email me if you want a copy of the article.

Reference

Lieberman DE and Bramble DM (2007). The Evolution Of Marathon Running Capabilities In Humans. Sports Med 37(4-5) : 288-290.

Today's Straits Times

2010-08-09T15:26:00.003+08:00

Go have a look at today's Straits Times (090810) under Sport page B15, especially if you are one of those who signed up for the marathon at the end of this year.

Sports Solutions will be one of the Straits Times panel of experts in the 4 month countdown as you gear yourself up for race day.

Yes, there will be a Sweet 16 plan where weekly instalments will offer a different topic each week. Stay tuned.

Do Your Running Shoes Prevent Injuries?

2010-08-03T15:28:00.011+08:00

How do you choose your running shoes? I've been asked that question many times over. I've even compiled a shoe list regularly over the years since the 90's and yes many other physios, health professionals etc have conveniently/ blantantly taken out my name and passed the list off as their own.

For years, podiatrists, coaches and shoe salesmen etc have looked at your foot type (to see if you have a normal, low or high arches) and then recommended that you have stability, motion control and cushioned shoes respectively. The rationale being that if you had high arches, you did not pronate enough and needed softer, well cushioned shoes while if you had low arches, you tend to overpronate and needed sturdy motion control shoes to control that overpronation. Runners with normal arches needed neutral shoes and were prescribed stability shoes. This method was deeply rooted in athletic circles and widely accepted.

The above mentioned method was exactly what the US military did in terms in handing out shoes to their recruits as injuries were rampant during basic military training. Military authorities hoped that injury rates will drop by ensuring their recruits were fitted with the correct shoes according to their foot type.

In order to determine whether fitting correct shoes help in lowering injury rates, military researchers found no scientific literature in support of what they were doing and decided to do their own research.

And you know what, they found almost no correlation at all between wearing proper running shoes and avoiding injuries (this is published in the American Journal of Sports Medicine recently). Injury rates were actually highest amongst soldiers who had received shoes fitted according to their foot types. Wearing the so called "correct" shoes for their type of feet had actually increased the recruits' chances of getting injured.

If you have been following our blog, you would have read that Sports Solutions first wrote about this last year when researchers in another published article in the British Journal of Sports Medicine concluded that sports medicine specialists should stop recommending running shoes based on a person's foot type as there was no evidence supporting it. (Please have a look at one of our more popular posts last yearhttp://weloverunning.blogspot.com/2009/03/do-high-tech-running-shoes-work.html).

And just in case you decided that published studies on military recruits were of a lower quality, another study done on experienced runners was published more recently in support of the military subjects paper. In this study, 81 runners were classified according to their foot postures (a more detailed measure of foot type than just arch shape). Half the runners received shoes appropriate for their feet as described earlier (overpronators had motion control etc and so on). while the rest of the runners received their shoes randomly.

All the women embarked on a 13 week half marathon training program. How did they fare? Nearly a third of the women had to miss some training days because of pain, with a majority of the injured runners wearing (yes you guessed correctly) shoes specifically designed for their foot postures. What's more, also of note was that motion control shoes were the shoes across the board that "caused" the most injuries.

Now in theory, overpronators should benefit from motion control shoes to limit their overpronation. However, these runners who overpronated actually complained of pain and missed training after wearing them as did a number of runners with normal feet and every single underpronating (or high arched) runner randomly assigned to a pair of motion control shoes.

This is despite that fact that motion control shoes do limit over pronation as numerous biomechanical studies of runners running on treadmills have repeatedly proved that runners who wear motion control shoes have significantly reduced pronation.

There you go, not quite what you may expect I imagine. Please email this to your friends who are planning to invest in new running shoes.

Please also see http://weloverunning.blogspot.com/2010/02/barefoot-running-versus-running-in.html.

I have all 3 articles, email me if you want a copy.

References

Richards CE, Magnin, PJ and Callister R (2009). Is Your Prescription Of Distance Running Shoes Evidenced Based. BJSM. 43(3) : 159-162.

Ryan MB, Valiant GA, McDonald K et al (2010). The Effect Of Footwear Stability Levels On Pain Outcomes In Women Runners: A Randomised Control Trial. BJSM published online before print June 27, 2010.

My New Sony Walkman

2010-07-28T22:30:00.010+08:00

A big thank you to the 2 staff from Hill & Knowlton for selecting me to be a part of their Sony Walkman Runners Program. As a result, I've been given a brand new water resistant MP3 player by Sony - NWZ W252 to run with.

Am definitely delighted to be involved since I do run with music and having written on the topic before.

Please see (http://weloverunning.blogspot.com/2009/02/hey-there-delilah.html) and (http://weloverunning.blogspot.com/2009/07/tuning-in.html).

Besides being water resistant, the best part is that it's got no wires dangling.

This is way different and much much smaller than the Sony "Walkman" I grew up with ( the 1st generation of Sony Walkman needed 4 AA batteries). Some of you reading this will remember what I'm talking about.

Well, we all know Sony have come a long way since. Stay tune as I run a few more times with it before I do it justice with a longer write up on it.

* Picture from Sony

Should You Run On Grass Or On The Road?

2010-07-13T20:46:00.008+08:00

After my 3 knee operations, I was paranoid about running on any other other surface other than grass. Virtually all my run training was done on grass. Yes, you read correctly, even when it meant I had to do multiple rounds/ loops around any field I could find. Some of you reading this could probably recall seeing me going round and round the patch of grass while I was running. I thought that running on grass and its softer surface will be more gentle on my joints.

And I guess I wasn't alone thinking like this. I'm sure many of you runners out there would have met some runners, coaches etc who will swear that grass and soft running surfaces are much better. So here's a topic most runners will be keen to know. Is running on grass better than running on the road. I saw an article on this topic by some Australian researchers last week. Please read on if you wanna know more.

The runners studied did 2 runs, a 10km run at 75-80% V02 max and a 10 x 1km interval session at 90-95% V02 max. The 2 runs were done on both grass and a bitumen road surface (road). The researchers measured blood & urine samples collected before, immediately after and at 3 and 24 hours after exercise.

Here's what the researchers found. There was no difference between road & grass in terms of leg inflammation and other effects measured (if you wanna know, they measured IL-6, hemoglobin & haptoglobin levels, iron and ferritin to analyze hemolysis and hepcidin).

Hard interval training on the other hand produced more inflammation than lower intensity training.

So now you know, running surface doesn't really matter. Just run, remember you can, with pain free running http://weloverunning.blogspot.com/2009/03/pain-free-running.html.

Reference

Peeling P, Dawson B et al (2009). Training Surface and Intensity: Inflammation, Hemolysis, And Hepicidin Expression. J of Med Sci Sports Ex. 41(5) : 1138-45.

*Picture from Flickr

The Tour De France Beckons

2010-07-01T22:18:00.007+08:00

Despite all the sporting attention & focus on the World Cup going on in South Africa currently this year's Tour De France starts in Rotterdam, Holland this coming Saturday for the prologue before making its way around France for the next 3 weeks.

The tour is usually described as one of the most difficult tests of sporting performance in the world and 20 teams of 9 riders each will start.

This year's Tour has been designed to be filled with drama. Lance Armstrong has recently announced that this will be his last tour. Every stage will be vital, but with the cobbles of Arenberg awaiting on only the third stage, plus two trips up the Col du Tormalet, numerous mountain top finishes, only one individual time-trial (excluding Saturday's 8.9km prologue), and numerous other challenges, 2010 should produce GC drama throughout.

No team time trial though and Alberto Contador should be happy about this given that his Astana team is not as strong as Armstrong's Radioshack team and Contador has said in a interview today that carrying the favourite's tag isn't easy for him.

The other reason why the Tour is so great to follow is that you can study and appreciate the science and analysis of the riders' strategy, physiology and performance.

Who knows how the next three weeks will pan out? But wherever it is, I'll be watching. For now, Wimbledon and the World Cup will take up my TV time.

The Perfect Taper

2010-06-20T20:59:00.006+08:00

Have you trained really hard for your important race but ran or raced poorly because of mucking up your taper.

Runners have always tapered, especially prior to a big race in order to freshen up and improve performance. Rest the mind, rest the muscles, carbo load etc. Big problem is we never know exactly how to get the taper right. Moreover, this is what every runner tapering will fear- losing their hard earned fitness.

Well, here is the latest published research on how to get your taper before your big race correct. Interested? Please read on.

The researchers studied a group of university cross country runners before and after a 3 week tapering period for a 8 km race. At their peak training, the subjects ran 6x a week logging up to 72km (or 45miles).

During their 3 week taper, the runners ran 73%, 73% & 50% of the normal mileage. They did intervals and easy runs, but cut back on "moderate" runs (like tempo runs).

Here are the results. After the 3 week taper, the average race times for their 8km race dropped from 27:42 to 26:12 mins. Every single runner improved their times after the taper. There was no decline in aerobic fitness, Vo2 max or running economy. In fact the runners gained muscle strength (in the calf) after the taper.

The author suggested that this same taper strategy will work up to marathon distance races. To achieve your PR, try this taper.

3 weeks before your race, do 75% of your normal mileage. Stop most medium-hard runs, but do usual interval training.

2 weeks before, same as above.

Last week before your race, do 50% of your normal distance. Stop ALL medium-hard runs & do 50% of usual intervals.

Race day, kick ass.

Reference

Luden N, E Hayes et al (2010). Myocellular Basis for Tapering in Competitive Distance Runners. J App Physiology 108: 1501-1509.

Running For Your Life

2010-06-06T20:17:00.008+08:00

I had this odd habit when I was a lot younger. I'll get something nice like a new watch, pen or shoe then I'll keep it somewhere safe. Then I will get the same thing (but not quite as nice) and use this instead of the "good" stuff that I got earlier. The thinking was that if I didn't use it, it'll last forever.

I guess I still have this habit sometimes and my wife will often ask me why I do that. Fortunately I didn't take the same approach with my body. I figured if I didn't use my body it'll definitely not last forever. Unlike machines, our bodies are made to move.

As with bicycles (or car, motocycle fill in your own), for the bike to perform their best you have to maintain it. While I was still racing triathlons, I spent lots of time cleaning, adjusting, lubricating and even polishing my bike. (For the difficult stuff, I'll get Kenneth or Yusoff from Cycleworx to help).

Now that I'm not racing and have a new born son, unlike a piece of mechanical equipment (which wears out the more you use it), I actually get stronger the more I exercise, now that I don't train like before. (Likewise I become a lot more unfit if I didn't).

Our bodies do share something similar with mechanical equipment. If you don't understand their limits, they can break down. If I run 3 times a week for half an hour and feel great and then decide that I will then run 6 times a week for an hour each time then I may be inviting an injury to come. (Trust me, I've had 3 knee operations remember). That's when I learn patience.

We live in an instantaneous society now and expect results overnight. Well, this is what I learnt, you don't become a great athlete overnight (and likewise you don't turn into a lousy athlete overnight or after a poor race). Our bodies can do almost anything we ask of it as long as we give it time to adjust to new demands.

The truth is when it comes to our bodies, we have to use it or lose it. If we don't, we'll find that one day when we want to go for a run and we can't as if we don't push ourselves, our bodies start to decline.

All right, I better get moving, not to run, but my son is starting to cry.

Atacama Crossing

2010-05-25T20:33:00.014+08:00

Some photos from one of our patients who competed in the Atacama Crossing, a six day 250 km foot race across the Atacama Desert of Chile.

Besides the distance, the other challenging factor is the race takes place at more than 2500 m above sea level. Here are some of her really amazing photos.

This is what she said.

Hi Gino,
Thank you for the physiotherapy sessions in taking away the pain that was centred on my right knee, especially with those exercises. While the Atacama Crossing (Chile) entailed pain (and monster blisters), you helped sort me out before the race and my knee problems so i could withstand the other elements! Thanks again.

Melanie Wee

You are most welcome Mel.

If you want to read more please go to http://www.4deserts.com/blogs/comptetior_blog_new.php?authorid=NTcx&blog=16

Today's Running Club @ SS

2010-05-13T21:53:00.004+08:00

To all the new runners that came for this evening's running club- Li Bin, An Qi, Philip, Boon and Peter (hope I spelt everyone's names correctly), thank you for coming and hope you had a good run.

Please practice as we discussed and all of you will run pain free and faster. See you at the next running session.

American Record By A "Fat" White Runner

2010-05-09T21:08:00.005+08:00

This has been the most discussed topic for the past 2 weeks in most of the running forums I've read. American Chris Solinsky became the first white and heaviest runner so far, at 73 kg to dip under the 27 minutes barrier for 10000 m on the track.

By running 26:59 mins, Solinsky became the first non African born runner to break the 27:00 barrier, and on his debut race at 10000 m too.

Only 30 other men have run under 27 mins, and Solinsky is 9 kg heavier than the next heaviest.

Consider some of the following most illustrious runners on that list, Haile Gebrselassie at 1.65m and 56kg, Kenenisa Bekele (1.6m/ 54kg), Paul Tergat (1.82m/ 63kg) and Sammy Wanjiru (1.63m/52kg). Until Solinsky (who at 1.85m is the tallest), nobody heavier than 65 kg had run under 27 mins.

Many long distance running aficionados (myself included) were really surprised that someone this "big" could run so well. Most if not all other true elite long distance runners are never this tall nor this heavy. Solinsky is currently the tallest and heaviest (can we call him "fat") sub 27 min 10000 m runner. Prior to Solinsky, Paul Tergat (who on a good day can outrun Gebrselassie) is the next tallest at 1.82m but tip the scales at only 63 kg. Which makes Solinsky's achievement even more remarkable.

So, don't let anyone tell you that you that you are too big or fat or not fast enough. You can prove them (and their stereotypes) wrong. You have to work pretty hard though.

*Photo from letsrun.com

Rugby Injuries

2010-04-21T19:15:00.003+08:00

Rugby has been in the news (even in the front page of our Straits Times) recently for many reasons the last week or so especially since the fight that broke out in the National Schools 'B' division final which sparked comments even from politicians and newspaper editors (who normally would not even watch rugby).

Well, I'm not about to join in the fray. I am actually going to write about rugby injuries that we've been treating as we've been seeing quite a few patients who play rugby as well in the last month or so (we had a player tearing the ACL representing Singapore at the Hong Kong 7's tournament).

I went to do some research to see if there are any published similarities with our local rugby injuries and here's what I found (although articles were mainly on professional rugby players).

Here's what some of the published papers found. Rugby union is a high risk sports for players' knees, highest among all other football, rugby codes (which supported previous research findings). Medical personnel at clubs reported knee injuries on a weekly basis. Knee injuries accounted for the highest number of days for injury absence (21% of all injury absence days) and were characteristically severe, with a disproportionately high number of days injured per injury.

ACL (anterior cruciate ligament) injuries accounted for the greatest proportion of days missed (255 days or 29% of all knee injury days), followed by MCL (medial collateral ligament). Injuries tended to be more common among the back row. This is fairly similar to what we saw, although we saw many shoulder injuries among the rugby players as well.

Most severe injuries occurred during contact (being tackled rather than tackling). More significant for coaches and medical personnel to take note, usually in the final 20 minutes of a match.

The physical nature of rugby makes contact injuries fairly difficult to prevent although coaches, physios can put in place a number of conditioning (or prehab) measures to help ensure players are properly prepared for the demands of the sport.

Please also see http://physiosolutions.blogspot.com/2009/05/why-men-dont-get-it_28.html

References

Dallalana RJ, Brooks JH et al (2008). The Epidemiology of Knee Injuries in English Profesional Rugby Union. Am J Sports Med. 35(5) : 818-830.

Quarrie KL and Hopkins WG (2008). Tackle Injuries in Professional Rugby Union. Am J Sports Med. 36(9) : 1705-1716

*Picture by Rich Seow

Rinse And Spit

2010-04-06T20:17:00.005+08:00

Here's an interesting bit of information that may surprise you if you taking part in the OSIM triathlon this weekend. Sure did surprise me. 2 different studies support this.

In the first study, runners were asked to run as hard as they can on a treadmill. Before one run, they rinsed their mouth with a sports drink of 6 % glucose but didn't swallow. Before their second run, they rinsed their mouth with an identical placebo drink with no calories and also didn't swallow the drink. Results? The runners ran faster and felt better when the rinsed their mouths with the sports drink.

In the second study, cyclists made made to do an all out 60mins time trial while a) consuming a placebo drink with no sugars or electrolytes, b) a common sports drink, c) rinsing their mouth with the sports drink but not swallowing any. Here's the funny result. The cyclists performed best while rinsing their mouths with the sports drink but not swallowing. Go figure.

So if you are feeling bloated on the bike or during the run and can't get any fluids down, just rinse and spit out your sports drink. You can still do well.

All the best to our patients taking part this weekend.

Reference

Rollo I, Williams C Et al (2008). The Influence of Carbohydrate Mouth Rinse on Self -selected Speeds during a 30-min Treadmill Run. The International J of Sp Nutrition & Ex Metabolism. Dec 18(6) : 585-600.

Potter A, Bouckert J et al (2008) Mouth Rinse of a Carbohydrate Solution Improves 1hour Cycle Time Trial Performance. Scandinavian J of Med and Science in Sports. Nov 3 Epub.

*Picture from Flickr.com

Sports Solutions & Kinesio Taping In Today's Straits Times

2010-03-27T21:17:00.015+08:00

Lance Armstrong, David Beckham, Serena Williams and our national athletes have used it before. Lance even talked about it in his book "Every Second Counts".You can probably use it too. And you don't even have to be an athlete. 85% of Kinesio tape users are non athletes. It can also be used in pediatric patients (e.g. cerebral palsy, torticollis etc), patients with neurological conditions like Parkinson's and patients with bruising and swelling.

Have a look at the Sports section in the Straits Times today (270310) and you'll read more about Kinesio Taping.

Some of our staff have been using it since 1999. Of course we do not use the tape for everything, we will still find the cause of your pain and treat it (rather than just treating your pain). And if our patients require Kinesio taping, we will use it at no extra charge.

We also teach Kinesio taping courses, let us know if you are keen.

*Lance Armstrong, David Beckham & Serena Williams photos from Kinesiotaping.com

*Cycleworx rider Ang Kee Meng taken by Jeanette Wang

Triathlon Training And Injuries

2010-03-24T18:41:00.010+08:00

Due to the fact that last Sunday was the Singapore Aviva 70.3 Ironman race, both our clinics Physio and Sports Solutions saw a fair bit of triathletes last week (for both Physiotherapy and Sports Massage) and this week as well (post race massage). We've also treated a number of overseas participants as well and some won their age groups too.

Since I treat lots of injured (and sometimes not injured) triathletes over the years (and having raced many before in the past myself), I've had the opportunity to ask our patients lots of questions about their training regime, equipment, tapering and racing of course. Here are some things I've noticed about triathletes, which strangely is also supported by a published research paper I came across this past week.

There seemed to be no real difference in overuse injuries in both Olympic distance (OD) and Ironman distance (IM) athletes. Chances of an OD patient getting a injury recurring was much less compared to their IM counterparts.

The research paper reported that OD triathletes suffered less from running injuries but those who did were out injured longer compared to IM triathletes. The less the OD triathletes trained, the more they seemed to be injured (these are the newbie triathletes).

For the IM distance triathletes, the overuse injury rates corresponds to the number of intensive sessions done. Yes, this is what I've noticed as well, the more the interval sessions, the higher chance of IM triathletes sustaining an overuse injury, especially during "brick" (combining bike-run sessions) training. This may be due to the "cumulative stress" of performing back to back sessions of hard biking and running.

The authors also noted that when some triathletes get injured, there is a tendency to increase training load in another discipline rather than resting. This frequently further increased their injury recurring and may delay their time to recovery.

Come talk to us if you need help whether you are training for your first Sprint, Olympic distance or done lots of Ironman distance races, we'll be most happy to help you.

Reference

Vleck VE et al (2010). Triathlon Event Distance Specialization: Training and Injury Effects. Journal of Strength Cond Res. 24(1): 30-36.

*Picture of Aviva Singapore Ironman 70.3 by RS

Kinesio Taping Course At SS

2010-03-14T21:38:00.008+08:00

Kinesio Taping Level 1 (KT1) and 2 (KT2) was taught at Sports Solutions yesterday and today by our certified Kinesio Taping Instructor Gino in conjunction with Progress Healthcare Pte Ltd (the distributor for the Kinesio Tapes).

Thank you for all who attended, especially our foreign participants from Malaysia, Philippines, USA and Germany.

Stay tuned for more info on the next course.

Protein Protection

2010-03-07T14:58:00.003+08:00

If you've been racing hard in the OCBC bike race today or trained really hard earlier in the day (in anticipation of other races later in the season) read on for some simple dietary intervention that can help maintain your immune function (prevent you from getting sick).

There is much research to show that combining carbohydrate (CHO) and protein after heavy exercise can aid in replenishing your glycogen stores and tissue repair.

There is also growing research evidence that protein may aid immune recovery and also lower the risk of respiratory tract infections. Not any protein but protein in the form of branch chain amino acids and glutamine.

Researchers in the study below studied a group of competitive runners after a 2 hour run. The control group was given water immediately after and 1 hour post exercise. The "immediate feeding" group were given a CHO-protein solution straight after exercise plus water 1 hour later while the "delayed feeding" group received water straight after the run and the CHO-protein solution an hour later.

Results showed that consuming the CHO-protein mix straight after the exercise had a significant effect on neutrophil degranulation. On what you said. This is the marker used in tracking susceptibility to infection. It is very common to find a drop in neutrophil degranulation after tough bouts of exercise which means you are more likely to fall sick. This means that you can avoid that by some quick and smart refueling.

Here's the suggested mix from the research, consume 1.2 grams of CHO per kg of body mass while adding 0.4 grams protein per kg body mass. For a 65kg athlete, that means you will need 78 grams of CHO & 26 grams of protein.

Reference

Costa RJS, Oliver SJ et al (2009). Influence of Timing of Post-exercise Carbohydrate-Protein Ingestion on Selected Immune Indices. International J of Sport Nutrition & Ex Metabolism. 19(4) : 366-384.

*Picture from Flickr

Cycling And Knee Pain

2010-03-04T22:31:00.008+08:00

With the OCBC bike race this weekend, both our clinics have been seeing quite a few cyclists this past week and so I thought I'll do a write up on the combination of cycling specific factors that can cause ailments/ grief to your knees.

These factors can often be divided into cycling specific reasons, bike specific and cyclist specific reasons. Cycling specific causes are mainly due to suddenly increasing distances, intensity, hills, using heavier gears and lower cadences while bike specific reasons are likely to occur when radical changes are made to your saddle height, setback and/ or cleat position.

I will elaborate more on the cyclist specific factors that can cause your knee injuries as this often happen due to your own individual make-up and biomechanics, i.e. intrinsic rather than extrinsic reasons.

The first cyclist specific factor that can cause your knee pain is usually due to anatomical differences such as a leg length discrepancies (bearing in mind most of us will have this). Most often though, I've found that most cyclist tend to favor one leg over the other. This is usually the leg with your thigh closest to your seat post when you are pedaling which partly explains why knee pain seldom affects both knees equally.

All of us have had falls, knocks, scrapes and other injuries which may lead to us subtly changing the way we move and so previous injuries (cycling related or not) can also be a contributing factor to causing knee pain. This is especially more so when we decide to ride more than normal at the start of the season or when we have a new bike etc.

The cumulative effect of the two reasons mentioned above can then upset the forces your knees have to deal with while pedaling. Each pedal stroke bends and straightens the knee joint but it should never straighten your knees fully (if it does, your saddle is too high). The push (straightening) phase starts when your knees are bent at about 110 degrees, and the knees start to bend again at about 35 degrees (when you start the pull phase of your pedal stroke). Your muscles and tendons around the knees are the direct shock absorbers for the forces transmitted there. Hence overused or tight muscles which arise from repetition (with you turning the pedals over and over again) can contribute to increased forces to your knees.

The accumulation of excessive loads over time can exceed your body's ability to dissipate forces which can lead to damage if not given a chance to recover, which then leads to injury (hence the need for rest days).

The good news is the vast majority of these cycling specific knee pain improve quickly (with non-operative intervention) with correct identification and treatment of the cause of your pain, something which we at Physio and Sports Solutions are good at.

Please come look for us if you need. And all the best to all of our patients who are taking part in the race.

*Thanks to my patient KM for allowing me to take a picture of his knees.

Adidas miCoach Pacer

2010-03-02T22:33:00.005+08:00

Received this from Adidas recently and have put it to test.

The miCoach Pacer combines a heart rate monitor, pedometer, calorie counter and real time coaching that you can connect to your iPod. It also has online coaching tools that allows you to keep track of your workouts and guide you along to improve your times.

It comes with a heart rate monitor device to strap around your chest, a stride sensor which attaches to your laces and the main control unit which collects data. After your calibration is done, the Pacer can start collecting data.

I've only just tried it a few times, stay tuned as I try it out a few more times before I can comment further.

Dr Kenso Kase Visits SS

2010-02-24T22:38:00.009+08:00

Dr Kenso Kase, founder of the Kinesio Tex tapes and taping technique dropped by at our clinic today for a visit and also to be interviewed by the media.

Besides using the Kinesio tapes as part of our treatment process when needed while treating our patients, we will soon be teaching Kinesio taping courses as well. Stay tuned for more details.

Please also see http://physiosolutions.blogspot.com/2010/02/certified-kinesio-taping-instructor.html

New Kinesio Tapes

2010-02-23T21:58:00.006+08:00

Got a roll of the new Kinesio tapes from Dr Kenso Kase himself. It's on the right of the picture, called Kinesio Tex Plus. It's thinner, lighter and made especially for people with ultra sensitive skin (even though the original Kinesio tape has no latex). See the new "leaf" like (that's what Dr Kase calls it) patterns.

According to Dr Kase, this new tape will only be released later this year in June. Well, you get a sneak preview here first. You get to see the skin color here. Apparently there will be up to 7 colors with the new tapes (there's skin, pink, blue and black now).

Well, we'll be trying out the new Kinesio tapes in the clinic.

Please also have a look at this (http://physiosolutions.blogspot.com/2010/02/certified-kinesio-taping-instructor.html).

Barefoot Running Versus Running In Shoes

2010-02-03T21:38:00.005+08:00

Here's the latest and hottest debate in online running forums this past week after this article was published last week in the Nature journal (reference below). The article reviewed landing patterns while running barefoot or with running shoes and which produced more forces. You know what, the barefoot debate is about to get hotter.

The scientists studied 5 different groups of runners and had them run barefoot and in shoes while measuring their foot strike patterns, (whether the runner landed on their heels, midfoot or forefoot) impact forces, loading rate and joint angles .

What did they find? The runners who ran barefoot landed more towards the fore and mid foot. Nothing new here as many previous studies showed this already. They also found that while running barefoot the runners had a reduction in loading rate and peak impact forces (3 times lower in fact).

We know in theory that with higher impact forces means greater injury risk and this paper's findings may suggest that people who run barefoot (or at least in minimalist shoes) may have a higher chance of avoiding injury.

I guess the media will probably have a field day over this and suggest that running shoes have caused all your injuries and that you should throw away your running shoes and start to run barefoot.

Now before you all go out and chuck your running shoes away, please bear this in mind. If you haven't at all been running barefoot or even in minimalist shoes and you go try and run say even 5km barefoot I bet you'll be sore and probably even get injured the next day. Why? Well, you are now loading your muscles and joints (that have been used to shoes) that are definitely not used to this sort of loading. Even the authors suggested that there needs to be more controlled studies on whether runners who run barefoot have reduced injury rates.

So the question remains on whether barefoot running reduces injury rates or help you run faster. Well, what we do know from this latest study is that barefoot running may protect you, your feet and lower limbs from some of the impact related injuries experienced by a high percentage of runners. If you want to try it, please do so progressively.

If you enjoyed this please also see this http://weloverunning.blogspot.com/2009/03/do-high-tech-running-shoes-work.html and http://weloverunning.blogspot.com/2009/03/pain-free-running.html and please pass this information on. Please email me if you want the articles referenced below.

References

Jungers W (2010). Biomechanics: Barefoot Running Strikes Back. Nature. 463: 433-434.

Liberman DE, Venkadesan M et al. (2010). Foot Strike Patterns and Collision Forces in Habitually Barefoot versus Shod Runners. Nature. 463: 531-535.

*Picture from Nature cover

No Pain, More Gain?

2010-01-27T22:18:00.005+08:00

Before you carry on reading, I'll like to get this straight right from the start. If you choose to take high doses of pain medication before your races, there may be a potential risk of higher injury as pain may be an important warning of impending muscle or joint damage. Large doses of pain medication taken often, too may have harmful effects on your liver, kidneys and gastrointestinal (stomach) tract & lining.

I am saying that I do not recommend the chronic & frequent use of analgesics (pain medication) to help enhance your athletic performance. So if you insist, don't say I didn't warn you.

Now you're ready to read what this is all about. A group of British scientists have found a novel way of for elite endurance athletes to go even faster. Since the "pain" of high intensity exercise affects our performance (meaning if racing hard & fast is too painful, we slow down), one way to improve performance is to then lower our pain levels to enable us to go faster.

In their randomized double-blind study(meaning both participants & researchers don't know which cyclist gets the meds or a placebo), they gave the elite cyclists a dose of 1.5 grams of acetaminophen (the active ingredient found in Tylenol) or a dummy tablet before a 16km time trial - (distance like a prologue stage of the Tour de France).

The results were astonishing to say the least. Cyclists were 2% (or 30seconds over 16km) faster while on the pain medication while recording a higher heart rate and producing more lactate (meaning they were able to push themselves harder) and rode faster while rating the effort easier. What's more, the authors also hinted that this actaminophen effect could be even more dramatic in longer duration events.

Before all of you run out to get hold of some even stronger pain medication (I shan't tell you what) than acetaminophen (as acetaminophen is actually quite mild, which makes the research even more remarkable) similar research has been done with stronger pain medication. The subjects in that study felt super and went out too hard in the first half of the time trial and slowed down big time in the second half. Now you wouldn't want that in your race would you. Please see http://weloverunning.blogspot.com/2009/03/dont-set-off-too-fast.html. Previous studies using aspirin or ibuprofen returned conflicting results.

Now I can hear some of my readers and patients asking me already, so what did I take while I was still racing. I didn't take anything in the "small" races, I only took them in my goal races. What did I take and what was the dosage? Come speak to me and I will reveal all.

Mauger AR, Jones AM & Williams CA. (2010). Influence of Acetaminophen on Performance during Time Trial Cycling. J Appl Physiol Jan 108(1): 98-104.

*Picture from Flickr

How To Fight Fat The Fun Way

2010-01-24T12:49:00.006+08:00

Have a look at today's Sunday Times (241010) and you will see Sports Solutions quoted in the Lifestyle section on page 10.

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

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

Let's Go Green This New Year

2010-01-13T20:27:00.004+08:00

Cycling is among the most environmentally friendly activity out there. If you ride your bike to work, you contribute to the green movement that is steadily growing.

By riding your bike to work, you will get more benefits than your employer will offer. You lose weight, save money, help the environment, feel less stress and happier and also get fitter in the process. The fitter and faster you get, the more fun you have. Better still, after a while what feels easy to you feels hard to people who don't ride that often.

Besides the numerous physical benefits, you get to feel the sheer joy of feeling the wind in your face - well this is what I call the poor man's version of driving a convertible.

Choose the safest route not necessarily the shortest. Get a bike that fits and suits you. You don't need the latest, most colorful or expensive bike.

We may have a long while to wait (or never) before we get bike lanes in Singapore, or even just having parking stations on the side walk would be a good start.

Until we do, ride safe and see you on the roads.

*Picture above - My colleague does this sometimes (if he doesn't ride from home to the clinic on his road bike), he rides his foldable bike from his home to the MRT, wheels it on the MRT, gets off and rides to the clinic. Surely almost everyone can start like this.

More Presents

2009-12-22T23:11:00.002+08:00

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

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

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

Thank you once again PJ.

Present From Oakley

2009-12-22T23:10:00.006+08:00

Got an early Christmas present from Oakley.

My 2nd pair of Jawbones, black this time with vented lenses (as compared to my 1st pair in white). Also see http://weloverunning.blogspot.com/2009/07/blog-post.html

Great peripheral vision.

Taking Stock Of Your Season

2009-12-17T21:28:00.005+08:00

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

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

Here is where your training logbook will come in handy if you have been keeping track of your training (http://weloverunning.blogspot.com/2009/02/write-it-down.html). I looked at how consistent I was with my training, where I slacked off and how (if it affected) my training and racing subsequently.

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

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

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

Pain In Your Neck

2009-12-13T13:20:00.003+08:00

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

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

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

Lose Weight By Stepping

2009-12-06T20:17:00.009+08:00

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

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

Day Of Your Race

2009-12-02T21:10:00.005+08:00

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

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

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

Remember my post on the fact you do not need a long warm up in the heat (http://weloverunning.blogspot.com/2009/07/no-need-for-long-warm-up-in-heat.html). Well, it's still pretty humid though cooler at this time of the year and you've got a long way to run so you don't have to have a lengthy warm up. Watch the elites, even they don't really warm up a lot, they too will be saving their energy for later in the race.

Start slow (about 6-10 secs slower than your goal pace) so you can preserve some of your glycogen stores for later and finish strong (http://weloverunning.blogspot.com/2009/03/dont-set-off-too-fast.html).

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

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

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

All the best for your race.

*Picture of Singapore Flyer taken before the race.

The Last Week Before Your Marathon

2009-11-28T23:08:00.004+08:00

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

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

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

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

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

Stay tuned for one more post just before race day.

*Picture from Flickr

2 More Weeks

2009-11-22T13:40:00.006+08:00

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

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

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

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

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

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

Til my next post, take care and rest well.

*Picture from Flickr by Brian Gudas Photography

3 Weeks To Go

2009-11-15T20:39:00.006+08:00

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

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

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

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

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

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

Glucosamine, Chondroitin & MSM

2009-11-09T22:32:00.006+08:00

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

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

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

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

Reference

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

Do More Bicyclists Lead To More Injuries?

2009-11-01T21:59:00.005+08:00

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

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

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

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

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

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

Here's the link to the New York Times article. (http://well.blogs.nytimes.com/2009/10/27/do-more-bicyclists-lead-to-more-injuries).

*Picture by Getty Images