Thursday, April 30, 2009

Aqua Based Rehabilitation (Deep Water Running)

Recognize anyone?
If you've ever wondered how our injured national athletes still keep most of their hard gained fitness, read on.

Their pool based water work is often the key to a quick return. For those not injured, the swimming pool can also be used as a great training tool in addition to your other workouts. Look closer at the 2nd picture and you may recognize some of our badminton players who have been to the last 2 Olympics- Ronald Susilo, Kendrick Lee, Xing Aiying and Li li etc. Our Singapore badminton team went to the pool once a week at least during periods when they were training at their hardest so they can train in a setting with little or no impact to minimize injuries with yours truly leading the session in the water with them.

Now, this is not a typical swim training session like you might think. As most land based athletes are not good swimmers, I often use aqua running techniques (or deep water running) to produce a valuable training effect for them. It would take a far longer time to get them to be of a good swimming standard to get the same effect from swimming and since time is a precious commodity in sports rehabilitation hence the use of deep water running. Moreover, most of these athletes or patients are involved in some land based or running sports, so swimming offers less transferable benefits or movements that are similar to their land based activities.

Done right it is a full body workout involving the legs, arms, shoulders and core muscles.It is also a good alternative to pounding the streets day after day. A study comparing a group doing deep water running versus another group road running found both training programmes produced similiar improvements in V02 max levels.

Water is about 773 times more resistant than air, so it can strengthen all key running muscles. Water is also isokinetic, meaning the water resists you as much as you resist it. The harder you move your arms or legs through the water, the more drag force or resistance you encounter. What's more challenging? Doing the workout without a flotation device or belt. I often get my athletes to do the entire session without one to push them harder.

The pool is a very good and versatile environment for rehabilitation work and training for athletes and patients. By including this session, you can allow for injured athletes or patients to recover quicker and allow others to undertake higher intensity water based training. It will not do the aqua training technique justice for me to describe how you do it in just a few short sentences, please contact us know if you need more advice on this. Physio Solutions conducts deep water running classes, give us a ring to find out more.

Davidson, K (2000). Deep Water Running Training Improve V02 max in Untrained Women. Journal of Strength and Conditioning Research. 14 (2) 191-195

Dowzer, CN and Reilly, T (1998). Deep Water Running. Sports Exercise and Injury. 4: 56-61

Sunday, April 19, 2009

Boston Marathon

In case you didn't know, tomorrow is Patriot's Day(a public holiday) in Boston. For New Englanders, Patriots' Day remains special for it is the anniversary of the beginning of the American Revolutionary War with battles between British troops and the Minute Men of Concord and Lexington, Massachusetts.

For runners, Patriots' Day has become synonymous with the Boston Marathon or, as locals often refer to the day, Marathon Monday. One of the country's oldest athletic clubs, The Boston Athletic Association (BAA) was formed on March 15, 1887 with the support of politicians, sports enthusiasts and entrepreneurs to "encourage all manly sports and promote physical culture" (quote from its 1890 yearbook constitution).

In 1897, the BAA put on a 24.5 mile race that only 10 out of the 15 runners that attempted finished. That little event grew to become the Boston Marathon today, the crown jewel of the BAA and some say the running world as well. The first woman to run was Roberta Gibb in 1966, she had to hide in the bushes before the start of the event. Women were finally allowed to run in 1972 and of the 8 that started, Nina Kuscsik won (and all 8 finished).

This is the only marathon for non elite runners that requires you to qualify before you can participate. Trying to qualify for the Boston Marathon is the holy grail (the most sought after and most difficult goal) for many runners. Getting into Boston has become an honor, almost like qualifying for the Olympics at the "normal people" level.

All the best for all those taking part.

Tuesday, April 14, 2009

Look Ma No Hands

One of my favorite riders Mario Cipollini shown here winning the 2002 World Cycling Road Race Championships in the picture above. What does super Mario have as a advantage over his fellow sprinters? Besides his abundance of fast twitch muscle fibers, his strong core muscles are his best kept secret. Even Lance Armstrong spends extra time working on his core muscles so he can be more stable and hold his time trial position longer in the quest to get mere seconds over his competitors.

Why this topic, you may wonder? Well, many of our patients this past fortnight are cyclists, triathletes preparing for a cycling stage race in Thailand at the end of the month. Hence, I've decided to do a topic on this as it benefits all athletes and even patients who don't play sport and yet have low back pain.

Consider some research done on cyclists on whether a torso (or trunk) stabilization device would reduce metabolic cost of producing cycling power - increasing cycling efficiency and lower energy expenditure for the same cycling power output. All this translated means cycling faster using less energy. The cyclists were tested on a cycle ergometer at different power outputs, different pedal cadences with and without torso stabilization. The results show that with a stable torso, submaximal cycling power was reduced (increase in cycling efficiency was seen), meaning cycling faster with less effort. This reduction was also related to pedaling cadence. Greatest reduction was seen at lower pedaling rates where pedaling force was greatest.

The researchers concluded that implications of this study are significant for cyclists. High cadence pedaling appear to increase efficiency by reducing the amount of energy required to stabilize the upper body while cycling. Cyclists with greater core stabilty will have an advantage over those with weaker stabilzing muscles. (My patients reading this now should realize why I spent so much time teaching you how to use your deep, core muscles).

I'd like to point out that you need to learn how to activate your core muscles without activating the superficial muscles and still be able to transfer them to your sport or activity. I know for a fact that many of our patients have been taught wrongly despite having 'learnt' it before from previous physiotherapy, Pilates or other core classes. Please come talk to us if you have any questions.


McDaniel J et al (2005). Torso Stabilization Reduces The Metabolic Cost Of Producing Cycling Power. Canadian J App Physiology. 30(4) : 433-41.

Friday, April 10, 2009

Tired? It's All In The Head

I was trailing in 2nd place in the last 100 metres of my maiden 1500 metre race on the track at the Singapore National  Stadium when I was 13. My legs were shot, my lungs were screaming from the effort and my brain was telling me to stop. I told myself that it ain't over til the fat lady sings and I certainly did not see nor hear no fat lady singing. Suddenly, I was able to summon up my one final push, I dug into my reserves and was able to out kick my opponent. I won the race. Where did that burst of strength come from, I kept asking myself? Wanna know? Please read on.

There is growing evidence that when your muscles, lungs etc scream for you to stop taxing them during exercise, it is just one factor out of many that the brain takes into account when determining how tired or fatigued we feel.

The brain actually uses a mixture of conscious, sub-conscious and physiological cues to control our muscles and hold them back from reaching a truly exhaustive stage. Hence, when the brain "decides" that your muscles had enough stress, the brain causes the distressing sensations that you and I interpret as "heaviness" or muscle fatigue.

In the study reviewed,the researchers studied cycling performances in 2 groups of elite cyclists. One group was given just 10 mgs of amphetamines (or stimulant) while the other group received a placebo. The cyclists worked at a level of exertion that felt the same to them (on a scale known as the Rate of perceived exertion scale).

The results were fascinating, to say the least. Brace yourself for this. The group receiving the stimulant rode 32% longer before their power output fell to 70% of their start values. Comparing with the placebo group at the same time which the test ended, the group receiving the stimulant had significantly higher levels of power output, oxygen consumption, heart rates, ventilatory volumes and blood lactate concentrations.

The findings provide proof that there must still be a "reserve store" even when our muscles scream out asking us to stop. If the muscles were really fatigued (or tired) because they were at the point of "exhaustion or empty" then the stimulant wouldn't have produced any improvement in the group of cyclists receiving it.

What does this mean for you and I? It means that even when we feel tired (in the muscles) during endurance exercise (be it running, cycling or swimming etc), it doesn't mean we're gonna have to stop (or lose your race, game etc). If we can override the brain, we can often push on. So don't give up til the fat lady sings.


Swart, J, Lamberts, RP, Gibson, A et al (2008). Exercising with reserve: Evidence that the CNS regulates prolonged exercise performance. BJSM. 43(10): 792-8. DOI: 1136/bjsm.2008055889.

Sunday, April 5, 2009

Sock It

I've had a few discussions with my patients and some athletes regarding compression garments/ socks this past week so I thought I'll do a write up on the topic. I first used them back in 2005 and those of you who know that I used to race and asked me how I recovered quickly to train consistently, well here's one the secrets (since I don't race anymore). Some of our national athletes (and gold medalists at the games) that I treated from badminton, table tennis and sailing also started using them prior to and during the 2006 Asian Games in Doha. There is a growing body of evidence in recent times on the benefits of compression garments for athletes, especially in "energy return" and clearance of lactate from tired muscles.

Compression socks were first created to help diabetic patients improve circulation, now they are used by cylists, runners and of course triathletes looking to help with the recovery process and run faster of course. A recent study done by German scientists on "below the knee" compression stockings (or socks) adds further evidence for these benefits. Two tests were performed, the second within 10 days of recovery of the first test. The first test involved some runners wearing the compression socks for a treadmill test while other runners did not. The opposite for the second test. Runners were randomly assigned as to the order which they performed the test. Results were as follows. With the compression socks the runners ran longer (36:44 vs 35:03 min), had a higher workload (422 vs 399 kJ) while maximum aerobic capacity was not significantly different (although it was slightly higher in runners wearing the socks). More importantly, researchers found that running performance at anaerobic threshold was significantly higher (meaning you can run in your fastest optimal speed before onset of accumulating lactic acid longer).

Before all of you rush out to get some of your own, here's the deal. The garments may work but in our super hot and humid climate in sunny Singapore, please take note that some of its effects may be negated. I've never raced in any of the garments, I've only put them on after training so I can recover and train again the next day. The socks may be most practical to race with compared to long sleeved tops and bottoms.

Paula Radcliffe wears the compression socks while racing and of course set the women's marathon best time wearing them as well (but she faltered at the Beijing Olympics - not because of the socks though). Those of you familiar with cycling, Samuel Sanchez who won the Olympic cycling road race wears them before and after his races (especially so if he has a flight to catch after). Allen Iverson of the Philadelphia 76ers wears a compression garment on his dominant arm while playing hoops. So does Boston Celtics star Ray Allen, in fact he wears it over both arms. Martina Hingis wore one over her right arm while playing tennis.

One last note, I once answered the door dressed in full long sleeve top and bottom after a hard training session. The postman delivering the parcel gave me a strange be warned.


Kemmler W et al (2009). Effect Of Compression Stockings On Running Performance In Men Runners.  J Strength Cond Research 23(1): 101-105. DOI: 10.1519/JSC.0b013e18eaef3.