Sunday, November 18, 2018

From Stressful To Pleasant Memories

Guess where we went?
Every time before we travel, I get really stressed. Patients who have not seen me for a while suddenly asking to be seen on short notice. There are also many other things to be done in the clinic before leaving not to mention packing. My wife and kids often bear the brunt of my stress.

Even though we often think of vacation as a time to relax and recharge, traveling with two young boys sometimes come with definite difficulties. Especially when my older boy fractured his arm last year while we were in Brisbane.

This time we made sure to plan for mishaps and disasters. This often leads to bickering over the slightest thing with my wife and leaves me feeling stressed out. Thankfully, my wife does all that planning, taking up time, finances and stamina. I just pay.

The houses we find are often big and beautiful, but ultimately they aren't home. My older boy likes feeling safe and secure and we make sure both of them have that.

We never ever travel red-eye anymore after a particularly bad experience when my younger boy didn't sleep a wink and all hell broke loose when we landed and had to wait a long time at immigration. After the birth of our boys, we only fly with Singapore Airlines as the boys get a toy/ game once on board, are served their child meals first and they can be entertained by the in-flight entertainment system.

Fortunately, we didn't plan hours of walking, sightseeing or other touristy stuff. Too many activities make our boys tired.  In fact, we normally avoid the touristy places and plan plenty of down time. We normally rent houses near rivers or beaches and farm stays. Both my boys especially the little one love farm stays, feeding the animals, collecting your own herbs, vegetables and fresh eggs.

My wife pack lots of snacks so that the boys don't get hungry and have temper tantrums. We often go through pictures taken during the trip and laugh at what we did. Our boys really like this time together as we share new experiences, conversations and laughter.The best memories seem to come from these spontaneous moments.

During stressed times while traveling, which may be due to family, children or indignities of bureaucratic travel, I just need to calm down and think of the happy times.

Everyone in my family is sleeping as I type this, so that I can give them my undivided attention during the other times. So please excuse me not writing until I'm back in early December.
Fireworks at Darling Harbour last night

Sunday, November 11, 2018

Breakthrough Performances And Hot Streaks


A few fellow physiotherapists that I've treated recently commented that they were quite amazed that I've gotten them (and patients) better so quickly that it almost seems difficult to believe.

To which I'd always say that nothing really improves in a straight line. Except our age, nothing really goes up in a straight line. Just like the stock market gyrations, there are days when it rises, some days it drops like a rock or days where it moves sideways.

Success in getting a breakthrough performance (or getting a patient better) is similar. It is almost never about a single monumental shift.

Think of a glass of water that you put in the freezer.  The water starts to freeze when it goes under zero degrees celsius (or 32 degrees Fahrenheit). This does not mean that the energy needed to lower the temperature from three degrees, two, one degree and zero isn't important. In fact, you will never get the water to freeze if all the prior work to cool it down isn't done.

Similarly, breakthrough moments are often the result of many previous actions, which slowly accumulate to unleash a major change.

In order to make a significant change, you need to work persistently to break through inevitable plateaus. Just like the water gradually turning into ice, you are gradually changing and improving as you slog along.

A patient (who used to race aquathlons) recounted the following experience. He and a fellow team mate were stuck at swimming 1:40 minute for the 100 meter swim intervals for a very long time. Without any real change in training, they suddenly got it down to 1:30 minute.

A patient of mine who runs got his kilometer repeats down from 4 minutes to 3:45. Or another athlete shared that he was squatting 100 kg for three months suddenly improved to 120 kg.

Many of my patients are now done with their racing season, while some are tuning up for their last race of the year. For those preparing for the year end Singapore Marathon, remember it's almost time to taper. When you resume training after your break and perceive no change, remember that just like water that is slowly beginning to freeze, you too are putting in the work for your breakthrough performance.

Back to my conversation with the physiotherapist I treated recently. My "hot streak" on getting good results treating patients definitely rest on a foundation of prior work, during which I try to become a better physiotherapist every year (since I can probably not get faster as an athlete).

In a journal, Nature, which was published recently, researchers found that most people have a "hot streak" in their career - a specific period during which an individual's performance is substantially better than his or her typical performance although the timing is somewhat unpredictable.
Talking it through just 2 days ago
Thanks to my wife and fellow colleagues, we regularly discuss and break down segments of courses we've gone for to make it unique to us. We will strive to make sure this "hot streak" of getting patients better as quickly as possible continues.

Putting it all together
Reference

L Lu, Y Wang, R Sinatra et al (2018). Hot Streaks In Artistic, Cultural, And Scientific Careers. Nature 559: 396-339. DOI: 10.1038/s41586-018-0315-8.

Friday, November 2, 2018

Farewell Car Park Party At Holland Village


As we were walking back, my 8 year old boy asked me "why don't you write about the car park party?"

My younger boy was at home with my wife as he was having a fever and my older boy and I happened to walk past the farewell party for the partial closure of the Holland Village car park just behind the old Buona Vista swimming pool.

Incidentally, both of us attended the farewell pool party at the old Buona Vista Pool back when it closed in February 2014. Our patients did their deep water rehabilitation there at the pool after surgery. In fact, I learnt to swim in that pool and I taught my boy to swim in that pool.


The old swimming pool area is now a car park. This car park is going to be a huge mixed development built by a Far East Organization led consortium.

The landscape here will truly change. We will find out how it turns out in 2024. Below is an artist impression of how it will be ......

Sunday, October 28, 2018

Know Change Know Pain

Blue marker indicates cleat postion
My last patient yesterday came in to see me with anterior knee pain. This patient recently changed to a new pair of cycling shoes and started having knee pain since 15/10/18.

Despite resting for a few days, the anterior knee pain was still there after trying to cycle on 19th and 24th October.

This patient tells me "cycling is an almost daily affair" and spends a considerable amount on the saddle.

After asking my patient a few more questions and assessing thoroughly, I was convinced the pain was triggered after changing cycling shoes.

I'm reminded of a previous post back in 2012 when Rafael Nadal changed his tennis racquet in his quest to serve better. Tennis fans would clearly remember how Roger Federer had problems affecting his back after a racquet change in 2013. In fact, after an extended period on the sidelines because of an elbow injury Novak Djokovic had to make adjustments to his tennis racquet early this year as well.

Back to my cycling patient. Before my accident when Sports Solutions was still at 108 Amoy Street, I used to cycle to work and back daily. I was very aware of the riding position on my bike. Any slightest change in saddle height, stem length or "strange noises" on the bike I would be able to notice it quickly. If you ride you bike regularly enough, you'll know I'm not exaggerating.
Superficial Front Line
After treating my patient's Superficial Front Line, it's back to cycling yesterday (after treatment) and today albeit on the trainer first and a slight change in pedaling technique.
Able to ride yesterday and today
Don't try to make key changes to your cycling, running shoes, swim technique or golf swing etc right smack in your regular season if you're competing. Just like you wouldn't use a new pair of racing shoes without trying it way before the race.

In my opinion, it's much better to use the new gear after your time off at the end of your season after you've not been riding or running etc. Your body will not be so sensitive to the changes. This I've learnt the hard way.

White marks the spot
Just in case you're wondering, we do mark the insert inside the cycling shoe too.

Monday, October 22, 2018

Tensegrity Of The Spine

Lining up half the participants to compare their necks and backs
After Aized and Rachel did Arches and Legs last week, it's the turn of the three amigos this this two days as we do "Tensegrity of the Spine" over the next two days.
Range of movement in the spine

This course is very intense and heavy going as there's a lot of rationale behind the theory involved. Everyone (yes, you read correctly) got lost at some point today, including yours truly.

Let's hope we get a clearer picture tomorrow.

Sunday, October 14, 2018

The Amazing Fiona Oakes

Picture from Livekindly.co
I've never heard or read about Fiona Oakes before. Until my wife told me about her two days ago. She is so unassuming, humble and in her own words "I'm not really a runner". Actually she is a fantastic runner. Fiona Oakes is the fastest woman in the world to run a marathon on all seven continents and the north pole both in cumulative and elapsed time.

I thought I had it bad when I've had three knee operations before but Fiona has had seventeen knee operations and no patella (or knee cap)! Can you even imagine the rehab she has had to go through?

She was told when she was fourteen that she would find it hard to walk properly, let alone run again. It is truly amazing that she is still able to run so well. All this while being a vegan who eats one meal a day while while running an animal sanctuary.

So maybe we really don't need to eat meat and definitely not the sports and dietary supplements that are being marketed at us.

Watch the video, her partner Martin wonders how she can wake up at 3:30 am to start feeding the animals, run 20 km, come back and work all day cleaning and tending to the animals.

This just shows that the human body is truly resilient, amazing and and can perform really tremendous feats when there is a bigger cause (saving animals in Fiona's case).

If you're a runner, you have to watch the film, it's free until tomorrow.


*In case you're wondering why her running shoes look odd (I did) in the Marathon Des Sables, she's taped them up to avoid them falling apart.

Monday, October 8, 2018

Does Exercising Later In The Day Affects Your Ability To Sleep?

Zzz after a hard ride ...
I've written before in a previous post that I'm a poor sleeper. If you're like me, when I pushed myself too hard at training, I actually found it harder to fall asleep. The more I need (and want it), the harder it is for me to get it.

And sleep you know is critical for your mental and physical well being. If you're athlete, sleep is the easiest and cheapest intervention you can utilize to help your performance.

Hence, I was quite intrigued when I saw work from researchers who tested the effects of whether morning or evening workouts will affect your sleep by measuring melatonin levels. Melatonin is a hormone secreted in the pineal gland that regulates sleep and wakefulness.

Melatonin levels start to rise around your bedtime. It helps to lower your body temperature (now you know why it's so hard to fall aslleep when it's been so hot recently) and a rise in sleepiness. Melatonin levels usually peak around 3 am for most people.

The volunteers in the study were tested on three different days. A day with no exercise, a day when they exercised at 9 am or another at 4 pm. Their workout was a 30 minute  run at 75 percent VO2 max. Melatonin levels were measured with a saliva test at 8 pm, 10 pm and 3 am.

The results showed that those who did the 4 pm exercise session had much lower melatonin levels at 10 pm and 3 pm compared to the 9 am exercise group. It means that those who exercised in the afternoon (or those of you who can only train after work) will have a tougher time falling and staying asleep. End of story, period?

Not really. Don't worry if you're like most other Singaporeans who mostly have time to train only after work hours.

Melatonin is just one part of the equation in your quest to fall and stay asleep. Melatonin levels may not be the main reason why you cannot fall asleep.

For you to get a good night's sleep, it may depend on what you you eat/ drink, the wavelength of light emitted by your smart phone, the temperature of your room, your exercise routine/ intensity and not just your workout time rather than just your melatonin levels.

If you're going for a "relaxing" evening run, and clearing your head over stresses you've encountered during the day, it's gonna be a lot easier than doing sprint intervals. Although some runners may even say that the intervals make them tired and thus make them sleep better. This alone may be far more important than melatonin levels.

Another factor that is not addressed in the paper by the authors is whether genetically you are a "night owl" or a "lark"? The New York Times has a good article on how there's a strong basis on a person's natural inclination with regards to the times of day when they prefer to sleep or when they're most alert.

Some of you reading this now (after exercising late in the day and not sleeping) are likely to be "owls" and not likely to get up early to exercise since you sleep later. This may may due to your circadian wiring rather than exercise timing. So shifting your exercise timings to the morning may "rob" you of your morning sleep without helping you to fall asleep earlier.


Reference

Carlson LA, Pobocik KM et al (2018). Influence Of Exercise Time Of Day On Salivary Melatonin Responses. Int J Sp Physiol Perform. 30: 1-13. DOI: 10.1123/ijspp.2018-0073.

*Picture by Jeremy Ong