Sunday, October 24, 2021

Running Faster May Not Cause Shin Splints

Frequent site of shin pain/ stress fracture

We runners have always been told to train and don't strain. Running too fast, too often, can be a sure recipe for injury. That's why we always have an easy day for recovery after a hard session, to reduce our risk of injury. No runner wants to hear that they have a stress fracture or a small crack in their bones caused by overuse.

We think that when we run faster, we put more strain and load through our muscles and bones. So chances of a muscular or bone stress injury should be higher when we run faster.  We all assume that running slower (or slowly) causes less strain on our legs than running fast.

According to newly published research, fast paced running does not put any more pressure on your tibial (shin bone) which is a common area for shin splints and stress fractures than slow easy runs.

Runners in that study were asked to run at their own selected pace of slow, moderate and fast (but not all out). Reflective sensors were attached to their hips, knees and feet while they ran over force plates that measured impact (load) with each step.

I was really surprised to read that the slow paced runs (and not the fast runs) resulted in the most strain. Running at 'normal' or moderate pace for these runners caused less cumulative load than running the same distance at fast and slower speed.

The authors concluded that running fast does not necessarily cause more load on your tibial (shin bone) than slow running. Well, no excuse not run intervals once a week then if you're training for a race.

However, it may be too early to use this information to change our training habits as fatigue definitely does affect load when we run. Personally, I do feel I need an easy day of training to recover after a hard bike, run or weights session. Even when I was competing, it's usually 2 hard days of training back to back with a easy day (or total rest day) after. That way you won't have to worry about getting injured. Until an an accident strikes ......


Reference

Hunter J, Garcia GK, Shim JK et al (2019). Fast Running Does Not Contribute More Cumulative Load Than Slow Running. Med Sci Sp Ex. 51(6): 1178-1185. DOI: 10.1249/MSS.0000000000001888

Thursday, October 21, 2021

Sports Solutions Turns 12


The picture above was taken just outside the clinic when we started at Amoy Street in 2009. So that means our clinic turns 12 today!

We moved to Holland Village in 2014 after my bike accident in 2013 so I didn't have to cycle to the clinic. That was the main reason we moved (now you know).

We are most grateful to everyone on our team and patients that have stood by and supported us all this while. We will continue to do our best to update, improve and progress for our patients. Thank you from the bottom of our hearts.

Sunday, October 17, 2021

Ultrasound Or Ultra Bullshit?

When I was doing postgraduate studies in Adelaide back in 2003, I was fortunate to have David Butler as one of our tutors teaching Pain Sciences. He also introduced us to the term 'ultra bullshit' when it came to what he thought about the effectiveness of using ultrasound to treat patients. Especially those patients with chronic pain.

For those of you using therapeutic ultrasound, please do not be offended. I'm not suggesting that you cannot, should not or better not be using it, I'm just saying that we almost never use ultrasound in our clinics to treat patients.

However, I've been receiving therapeutic ultrasound almost daily since my T4 spine fracture last month. Why the sudden change? There have been studies showing that pulsed ultrasound can accelerate bone union by up to a week. I'm up for anything that helps my fracture heal better and faster!

Therapeutic ultrasound appears to effectively heat tissues (muscles, connective tissues etc) but research has not established the ideal temperatures for tissue benefit or tissue damage. Current research also suggests that therapeutic ultrasound will not help pain reduction, delayed onset of muscle soreness (DOMS) or iontophoresis (deliver medicine under the skin), BUT it does appear to facilitate fracture healing. That previous sentence you read was 'a sight for my sore eyes'!

So my beloved wife has been helping daily with my ultrasound regime, although she does delegate the tasks occasionally to my boys as she says it's terribly boring holding on to the ultrasound device.

Looking forward to my next MRI to see how my fracture has healed.


Reference

Eberman L, Schumacher H, Niemann AJ et al (2013). Research Evidence For Therapeutic Ultrasound Effectiveness. Int J Ath Trg. 18(4): 20-22. DOI: 10.1123/ijatt.18.4.20. * Thanks to Byron who got me the article.


Sunday, October 10, 2021

The Intricacies Of Our Thoracic Spine


Vertebral body of thoracic spine
Since my accident, I've been researching and reading so I know how to best treat the thoracic spine when it's someone else who's hurt their thoracic spine and ribcage. So this week's post is to share what I've been reading up on the anatomy, structure and function of our thoracic spine.  Also by writing it here, I can always send this link to patients who want to know more. 
Cancellous bone
The vertebral body is not a solid block of bone. In fact, it is just a shell of dense cortical bone (outer surface of bone) surrounding cancellous bone (pictured above). This shell is not strong enough for lengthwise compression and it collapses like a cardboard box with too heavy loads (see picture below).

It is reinforced by vertical struts between the top and bottom surfaces. A strut acts like a solid, but narrow block of bone. As long as it is kept straight, it can sustain immense longitudinal loads.

Vertical struts straining under load (b)

However, struts tend to bend or bow when longitudinal forces are too strong, although a box with vertical struts is still stronger than an empty box.

Stronger with horizontal cross-beams
When cross-beams that are connected are introduced to the struts, the strength of that box is further enhanced. So, when a load is applied, this cross-beams hold the struts in place to prevent them from deforming and preventing the box from collapsing. 


Our vertebral bodies follow this internal architecture described above. The struts and cross-beams are formed by thin rods of bone called vertical (VT) and transverse trabeculae (TT). This trabeculae provides weight bearing strength and resilience to the vertebral body.

Any load applied to the vertebral body is first borne by the vertical trabeculae. When the load is too much, the horizontal trabeculae picks up the slack. Hence the load is sustained by a combination of vertical pressure and transverse tension in the trabeculae.

The advantage of this design (when it is not a solid block of bone) is that a strong but lightweight load bearing structure is constructed with minimal use of bone.

Another benefit is that the space between the trabeculae is used as channels for the blood supply and venous drainage for the vertebral body. Under some conditions, it allows for haemopoiesis (making new red blood cells) and this helps with transmitting load and absorbing force.

So how did my T4 fracture when it is supposed to be strong and resilient? Well, it wasn't just a simple fall, I was rear ended by a motorbike.


References

Bogduk N and Twomey LT (1987). Clinical Anatomy Of The Lumbar Spine. Longman Group UK.

Oliver J and Middleditch A (1991). Functional Anatomy Of The Spine. Butterworth-Heinemann Ltd.

Sunday, October 3, 2021

Running With Ankle Weights

Picture by Megan
This week's post is requested by one of our blog's readers who asked about the benefits of running with ankle weights. This reader started using ankle weights when Covid-19 caused gyms to close last year and thought that by strapping on ankle weights, it would be like adding strength training while out walking or running.

Strangely enough, I've noticed a couple of ladies who run pass my home (now that I'm stuck at home mostly after my accident) with ankle or wrist weights too. I suppose once you're aware of them, you start looking out or noticing them.

Let's get into it. We shall start with the benefits first. Running with the ankle weight makes (some of) your leg muscles work harder since the extra weight makes it heavier to walk or run.  Over time, (some of) your muscles get stronger. For instance, if you were running with the ankle weights, it would work your hip flexors more than your hip extensors as the former have to work harder to lift your leg off the ground to prepare for the next foot strike. 

When you take the extra weight off, it makes it easier to run, you can run faster or you may find it easier to run longer distances. The heart and lungs work harder too and over time, your cardiovascular endurance improves. I found a study in 2016 which supports this (Yaacob et al, 2016).

Now for the not so good part of running with ankle weights. Your gait definitely changes when you run with them. There is now added load on your joints, especially your knees, hips, ankles and lower back. This can lead to improper or faulty technique, which may create muscle imbalances and cause injury.

What's worse is if your muscles cannot handle the extra weight, this added load gets transferred to your bones, joints and the articular cartilage. So the risk of carrying a heavier load may outweigh the potential improved performance for runners.

My take? If you have been using them and have no issues or injuries, you can probably carry on. However, if you're a new runner then I will suggest other ways to add training load to improve so as to minimize your chance of getting injured.

Would I run with ankle weights? Most probably not. The closest I came to using something similar was a weight vest. I did this way back in 2000 and 2001 when I was training for the Oxfam 100 km Trailwalker event and I used to walk (not run) up and down the steps in the spectator stands at the old National Stadium to get stronger. 


Reference

Yaacob NM, Yaacob NA, Ismail AA et al (2016). Dumbbells And Ankle-wrist Weight Training Leads To Changes In Body Composition And Anthropometric Parameters With Potential Cardiovascular Disease Risk Reduction. J Taibah Uni Med Sci. 11(5): 439-447. DOI: 10.1016/j.jtumed.2016.06.005

Sunday, September 26, 2021

Eat More And Triumph

Picture from Runtastic.com
I remember a fellow cross country runner who was on the stockier side, was really strong and fast (of course now I know he had what we call a mesomorph body type). The teacher in charge back then suggested that he '"needed to weigh a certain amount so he could run even faster".

This teacher had good intentions no doubt, but he was a Math teacher 'assigned' to be in charge of cross country running and not a 'real' running coach. Looking back, I'm not even sure if that teacher himself ran at all.

Anyway, my friend took his 'advice' and tried to lose weight mostly by not eating or eating a lot less. Not only did he lose weight, he lost a lot of his natural strength and his confidence to boot as he fared poorly in races thereafter. He quit running soon after. 

We now know that being a good athlete is all about finding what works for you. It's about finding YOUR 'strong'. We need to fuel our bodies adequately if we want long term growth and success.

For some runners, that means following that advice my cross country teacher gave to lose weight. For others, it means having a body that looks different (to the norm) and weighing more or less. All body types can work given our different and unique genes and backgrounds.

The problem with that advice is that it is often interpreted from elsewhere, an outlier perhaps, a person that won an Olympic medal. Interpreting data from outliers may be great if you're an exercise scientist writing up research to publish in a scientific journal. Definitely not great for giving advice to other athletes.

Athletes that go against their unique genes and background will not fare well with this training stimulus. They will be like a ticking time bomb and will almost always get slower with time, just like my former team mate.

Consider the *New Zealand rowing team, A survey they did found that all but one rower was at risk of having low energy because of their beliefs and eating habits. Coaches and Rowing NZ officials worked with their rowers to take up a challenge and eat more, thus changing their approach and culture to fueling. The rowers became faster, stronger and happier. Rowing was New Zealand's most successful sport at the Tokyo Olympics and four female boats won medals.

Here's what rower Brooke Donahue, who won a silver medal at the Tokyo Olympics recently said, "Now I understand being lean isn't a priority, being strong is," and "It doesn't matter what I sit on the scales. It's opened us up to understand it's not about a number but more about a good feeling, knowing we're fueling well." 

Eating well and eating enough can fuel your performance and recovery for long term growth and adaptation. Food can be your legal and natural performance enhancing 'drug'.


Reference

McFadden S (2021). Tokyo Olympics: How Our Female Rowers Ate More And Triumphed. Published on 17 Aug 2021. *Article on the New Zealand rowing team is taken from Stuff.

Sunday, September 19, 2021

Minimum Dose Of Training To Stay Fit

2 months after accident in 2013
I've written about how quickly you can lose your running fitness in the past. With my recent accident, I'm definitely losing fitness as the days pass. 

However, I'm probably not the only person who worries about losing fitness. Many people have lost their fitness during this Covid pandemic. I remember a few of my patients who are security officers for ministers/ VIP's whose ability to train while on duty is severely restricted. Similarly for military personnel on certain postings. Others with personal conflict, family commitments, caring for an ill family member and injury may face the same situation.

Since I'm in the same boat, I'm reading up to find out exactly how or what I need to do so I don't lose too much, or better still maintain whatever fitness I have left 2 weeks post accident.

Let me share what I found out from researchers from the US Army Research Institute of Environmental Medicine. They looked at three key training variables, frequency (how many days a week), volume (how long the session, how many sets or reps to lift) and intensity (how hard or how heavy the weight). 

Only studies on athletic performance (not weight loss or health) in which the training was reduced for at least 4 weeks were considered. This is to distinguish them from research on tapering before a big competition (usually a 3 week taper).

Most of the studies reviewed were based on work done by Robert Hickson in the early 1980's (Hickson and Rosenkoetter, 1981). Hickson's subjects were put through 10 weeks of brutal training. They involved 6 days of cycling or running for 40 minutes at 90-100 percent maximum heart rate (HR) at the end. Then for the next 15 weeks, they reduced the number of weekly sessions to twice or four times a week. Duration was reduced to 13 or 26 minutes and intensities of the sessions were reduced to 61-67 or 82-87 percent of max HR.

Picture from Med Sci Sp Ex article

In Hickson's original study , VO2 max is shown on the Y (or vertical axis) on the left of the picture above. You can see that after the 10 weeks (albeit brutal) training block on the X axis, VO2 max have improved by a impressive 20-25 percent. For the next 15 weeks, their VO2 max stayed at their improved values, despite training dropping down to 2-4 days a week. The subjects were recreationally active but untrained. 

Overall conclusion of this review is that you can get away with just 2 sessions a week as long as you maintain volume and intensity of your workouts. This is similar to what Hickson found with further confirmation in some areas. 

However, please bear in mind that maintaining your VO2 max is not the same as your ability to perform long duration activities (oops for me then since my Saturday bike rides go up to 3 hours). Similarly, don't expect to run your best marathon time after a few months of 2 times a week training. Your leg muscles will definitely not be able to handle it.

When duration of training was reduced by one (13 minutes) or two thirds (26 minutes), VO2 max gains were preserved for 15 weeks. The study included short (5 minutes) and long (2 hours) endurance. No prizes for guessing that short endurance was preserved when comparing the 13 and 26 minutes group, but those who reduced their training to 13 minutes fared worse in the 2 hour test.

When training intensities were dropped by a third (from 90-100 percent to 82-87 percent), VO2 max and long endurance declined. When training intensities were dropped by two-thirds (61-67 percent), most of the training gains were wiped out. Takeaway message is you can get away with training less often, or for a shorter duration but not with going easy.

A few other points to note. These conclusions were based on what I'll say is an "unsustainable training protocol" of hammering 6 days a week with one rest day! Most of us would surely have a more balanced training program of hard and easy days. 

The subjects used were not trained athletes nor military personnel. If you've been  training for years, you would have some structural changes like a bigger heart and a more extensive network of blood vessels that would hopefully take longer to take away (yay for yours truly).

Of course elite athletes would probably have a higher level of absolute fitness which may fade away quicker initially.

All you gym rats will be happy to know that the overall pattern is fairly similar when it comes to strength training too. Both frequency and volume of workouts can be reduced as long as intensity is maintained. Several studies found that even once a week training is enough to preserve maximum strength and muscle size for several months.

However, for adults above 60, evidence suggests that twice a week strength sessions are better at preserving muscle. Same for training volume, older people will need two sets while one set per exercise for young populations will suffice.

Now you (and I) definitely know what it takes. 

References


Hickson RC and Rosenkoetter MA (1981). Reduced Training Frequencies And Maintenance Of Increased Aerobic Power. Med Sci Sp Ex. 13(1): 13-16

Sperring BA, Mujika I, Sharp MA et al (2021). Maintaining Physical Performance: The Minimal Dose Of Exercise Needed To Preserve Endurance And Strength Over Time. J Strength Cond Research. 35(5): 1449-1458. DOI: 10.1519/JSC.0000000000003964