Thankful For Accidents

Talking to my boys at the hospital

I definitely had my fair share of accidents, actually 2 major ones I will never ever forget. I'm sure you know and remember yours. When you slipped and grazed your knees or broke a bone. Or that illness that took a long time to get better. It could also be a job or a gig that you failed to land.

Then there are the positive 'accidents' too, too many that we often forget to mention. A friendly smile or nod from a fellow runner or cyclist. A kind act from a stranger who happened to be passing by.

I am thankful to be born here. To be surrounded by family and friends and to be given opportunities that many others never even dreamed of. And from those opportunities given, the belief that we have in others and efforts that enabled results. 

To be able to read, to talk and to connect. To have others give us the benefit of the doubt. To be able to smile at times, and the chance to contribute towards our community.

With 2002 Commonwealth Games silver medalist, Patrick Lau

So many things to be thankful for. I am very thankful I met up with a old patient (pictured above) and friend yesterday. I am also thankful that many old friends and newer friends and patients who have reached out to me after my recent accident. Some of these friends met by chance or accident. 

Not many of us celebrate Thanksgiving in Singapore. I definitely have many things to be thankful for, my wife, family and friends for sure. Accidents included. 

11 Weeks After His Accident

His shirt says 'Rather be riding'

At almost 11 weeks post spinal fracture after a cycling accident, we find ourselves back in Prof Hee's clinic. Today we compared his MRI films from the day of his accident with the imaging done after 10 weeks of healing. It's 60% healed, which is great for his age and fitness level. 

But Gino being Gino, is raring to go and felt a little disappointed that he can only return to work gradually at the end of November. To maintain his fitness, he is allowed only intermittent running with brisk walking, light weight training and cycling on his stationary bike. I thought that was great news! 

But looking at his face a few hours after the appointment with his doc, I could see that he was trying to wrap his head around the fact that he wasn't closer to full healing. It is tough being a patient, waiting for our bodies to take the time it needs to heal fully. I guess that's why we're called patients when we seek treatment!

I know that he's grateful to be well and have the chance to return to work soon, but it takes time to accept that his body doesn't heal as quickly as he wants or needs to. He has done the best that he possibly could be done in terms of healing, now the hard part .. to wait.

Aized

Are You A 'Difficult Patient'?

*Have to walk with crutches - 2003

I had a patient call me yesterday asking if he could see me in our clinic as he had been called a 'difficult patient' by the last health professional he saw. I explained that I was still on medical leave after my cycling accident, and he could perhaps see my colleagues in our clinic. However, I would be happy to answer his queries if needed.

Picture from coreimpodcast.com

Of course I then asked why he was called a 'difficult patient' and his reply was "because I ask too many questions". My immediate thoughts were how can any healthcare professional tell patients that they are 'difficult patients'  when they are just asking questions about their own health?

Actually, I'm probably a very 'difficult patient' too. Make that the worst 'difficult patient'. I've been a patient before while still racing/ competing triathlons with three knee operations. Following that a skull and spine compression fracture and now another another spine compression fracture just ten weeks ago. 

Aized will tell you that during ALL of my doctor's appointments, I'm always in the doctor's clinic asking the poor guy lots of questions. "Ok Dr A, B or C, the the million dollar questions are; when can I cycle, run, carry my child, lift weights or go back to work?" These were questions that were very important to me. Still are now. Even though as a physiotherapist I should know most if not all the answers myself.

Borrowing the words of Aized's wise friend, "Healing isn't a bed of roses, it isn't a fluffy fairytale. It is tiring, gruesome and painful". I can definitely vouch for that.

Most times, it's just that patients want confirmation of what they have researched on the internet. Most of us have all done this at some point or other. Of course we need to bear in mind that answers off the internet may not necessary be medically sound advice or correct diagnoses. 

For me, personally, patients who ask a lot of questions are actually good, but wanting me (or another healthcare professional) to tell them what they want to hear may not always happen.

Back to my patient. I asked that patient what his questions were.  His reply was "I'm so glad you asked, I have quite a few on my list!"

That is also why I usually end my time with each patient by asking, "Any questions so far?", "Which questions have we not answered today?" or, "Is there anything we should have talked about that we have not?"

In our clinics, I actually give out my personal mobile phone number, in case patients have questions any time after their appointment. Why? Because I do expect questions from patients. Or they can message or email me if they think of some after their treatment session.

*The picture above was taken on 16th July 2003 after my 3rd knee operation in Adelaide, South Australia, where I was studying for my Masters in Musculoskeletal and Sports Physiotherapy. The surgeon said I had to be non weight-bearing on my R leg for 6 weeks after the operation. However, he said cycling was fine since the articular cartilage he repaired would benefit from exercise that stimulated the repaired area without weight bearing forces. 

So I taped the crutch to my bike, cycled to university and walked around with crutches. Aized thinks I'm a DIFFICULT patient ;)

My Basic Guidelines For Running

Screenshot from the talk

Thank you to those of you who took time to attend the talk on running we had 3 days ago. From the 'live' questions and those I received via email, it seems like many Singaporeans did take up running last year during the circuit breaker/ lockdown. Good to know that many have continued running since then.

Many of these runners are not aspiring to complete a marathon (not yet anyway). However, they all seem to want to run faster. Well, as runners, we all want to run faster and longer for some reason. 

Over the years, I've put together a set of guidelines for runners, my patients or anyone who wants to keep running for health, fitness or performance.

Some runners swear by their heart rate monitors (HRM). Those who know me know that I do not like training with a heart rate monitor (HRM) even though I was sponsored by Polar Heart Rate Monitors when I was still competing. I just used their HRM as watches. (FYI - Polar was the market leader for HRM before Garmin came along and disrupted that market). 

I am not against anyone training with HRM's. My take is that our bodies do not work in physiological zones where exceeding aerobic zones is a crime. When feeling good, your easy runs can be a little faster, But if you're tired or not recovering quickly, then I'd say your easy run can be at a snail's pace. Better still take a rest day. No doing planks, core exercises etc, just total rest. 

The next few suggestions are specially for those who run ultras. Please don't feel obligated to follow anybody's training, especially if they're pro or semi-pro. This means trying to clock 100 km a week, running twice a day etc. All of these tips/ suggestions on training have too many cofounding factors and variables so do not even venture there. Plus in sunny and super humid Singapore, it takes a lot more to recover from all that mileage.

Don't keep chasing mileage and vertical (climbs) totals. They are variables for stress, but they are not the actual stress experienced by your body. A 20 km run is just a 20 km run. Or it may act like a 30 km run if you have been up at night with a sick child or rushing a dateline at work. Our bodies know the distance we've covered, but stress from other non physical factors mentioned above is interpreted as stress by the body too. More stress is not always better. Our bodies can adapt to lower or higher volume as long as the stress is appropriate for you.

I have patients who deliberately fast before training to improve performance. Perhaps it MAY improve energy efficiency in some (very few) athletes, but I rather they eat and find their 'strong' to train harder instead of messing with their sensitive metabolic pathways.

Those of you who listened to my talk will know that I'm not recommending minimalist nor maximalist shoes for everyone. Wear shoes that are comfortable for you and not anyone else. Different shoes work for different people.

Do stay active and engaged in activities and groups you find meaningful and care about you, as they help increase both quality and quantity of life. Social interaction is critical for mental and physical health.

Can Exercise Prevent Memory Loss?

My son was watching me go through my Prezi slides for my talk on running next Wednesday when I came across an interesting article on the last page of the Business Times (below).

BT 301021

The author, a medical doctor was writing on preventing memory loss, about how when we find ourselves forgetful, we should not pass it off as aging.

He goes on to talk about how high blood pressure increases in mid life and this appears to be an important risk factor for developing dementia later in life.

There also seems to be a detrimental effect on our health if resting heart rate (HR) is high. The author quoted a Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) study, where those with a prior stroke who had a higher resting HR than 67 beats per minute had an accelerated cognitive decline.

So a high HR may be considered as a risk factor for cognitive decline and dementia.

Wow, straight away I thought that this definitely serves as a huge incentive to keep exercising and keep my blood pressure and resting HR low.

So here's good reason for you to attend my Zoom talk on running next Wednesday (3/11/21) so you can keep exercising to prevent memory loss and cognitive decline.

Here is the link to register.

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

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.