Friday, August 28, 2009

Ladies, Your Knee Pain May Be Coming From Your Hips

How many of you ladies have knee pain? Well, you may be interested in this then. I have seen quite a few women runners/ triathletes the last couple of weeks, both elite and recreational with knee pain in the clinic. And guess what? Majority of my patients knee pain came as a result of weakness in the hips. Yes, some of them do have contributing factors coming from the knee itself, but the main cause was the hip weakness. So the hip weakness basically led to knee pain.

Well, you do know that at Physio and Sports Solutions we are really good at treating the cause of your pain rather than just treating the pain itself. So besides treating the patients' knee pain, the main thing was to explain the rationale of the treatment plan to them and then teach them how to specifically strengthen the hip muscles.

The strange thing is I've actually noticed this trend quite a while earlier from treating previous patients. So I was really pleased to find an article that was published earlier this year that confirms what I thought.

The study had 19 female runners with knee pain and a separate control group of another 19 female runners as well without knee pain. The group of women with knee pain had greater average hip internal rotation range and reduced hip muscle strength compared to the other group.

The authors concluded that it is the abnormal hip mechanics and decrease strength levels rather than the difference in hip shape and structure of women (as compared to men) that caused their knee pain.

So ladies, if your knees are causing you grief while running, please come in and see us and we will treat the cause of it to prevent it from coming back. And then you can run, pain free of course.


Souza RB and Powers CM (2009). Predictors of Hip Internal Rotation during Running: An Evaluation of Hip Strength and Femoral Structure in Women With and Without Patellofemoral Pain. Am J Sp Med. 37(3):579-587.

Tuesday, August 18, 2009

Strength Training Makes You Eat Less

Alright folks, latest update on my post last friday regarding Time magazine's article on The Myth About Exercise.

Remember that the writer claimed that you tend to be hungry and eat more after you exercise and hence, exercise is not effective in promoting weight loss.

Well, the latest research show that a strength training workout (or weight training session) does not increase your calorie consumption after your workout. If you include the calories burned while exercising, the exercise session actually results in a lower net calorie consumption.

So all you personal trainers reading this can now tell this to your patients/clients to reassure them.


Ballard, TP et al (2009). Effect of Resistance Exercise, With or Without Carbohydrate Supplementation, on Plasma Ghrelin Concentrations and Post exercise Hunger and Food Intake. Metabolism. Aug 58(8): 1191-1199.

Friday, August 14, 2009

The Myth About Exercise

That's the front page headlines of this week's Time magazine. The writer says that while exercise may be good for you, it will not help you lose weight, it's watching what you eat that really counts.

I can already hear some of you groaning-"what??? All my exercise was done in vain." Well, this is what the writer of the article 'Why Exercise Won't Make You Thin' attempts to tell us why exercise is unnecessary for weight loss.I do not agree with him, and here's why.

The writer claims that working out is ineffective in promoting weight loss because exercise makes people hungry. So you tend to eat a lot more after you exercise, worse still he says that after exercising he indulges in some junk food (to reward himself) because he deserves it. He thinks that exercising is a waste of time and he stops eating desserts and didn't gain weight. This he thinks is evidence enough that by eating less you can lose weight.

The few articles he quoted did seem to support what he wrote, but there are many many more articles that don't support what he wrote at all(which he didn't include).

Those of you who've tried dieting know that yes you do lose weight fairly easily and quickly but you do know that the weight comes back super quick once you stop. Moreover, your metabolic rate slows down while you are dieting and after a while the weight loss will plateau.

If you eat more than what you use (in terms of calorie expenditure), you will gain weight. If what you use (especially if you exercise) is more than what you eat, then you will lose weight. This is the way I explain to my patients/ friends when they asked me for advice on losing weight. So even if you ran an hour on the treadmill and reward yourself with a plate of fried kuay tiao or brownie (or fill in your own favorite), then you probably won't lose much weight.

So, what have I gotta do to lose weight? well, you combine exercise with clever eating and do it on a long term to lose weight and keep the weight off. Come talk to us if you need any advice on this.

Plus there are other good reasons to exercise, please also see this and this.
This Time magazine article is probably what most people will read and think that they don't have to exercise. Certainly, not the best read for our increasing numbers of overweight children as well. Please tell your friends that it's not true.

Please email me if you want a copy of the Time article.

Friday, August 7, 2009

Risk Of Osteoporosis In Male Cyclists

Now that I've gotten your attention, the picture of the CT scan on the left shows a healthy tibia (shin bone) while the one on the right shows one that is osteoporotic.

Now, here's the very surprising news that I read from this article recently. In their study, the researchers found that the group of serious male cyclists had greater rates of osteoporosis when compared to a group of control subjects. That's very surprising as women are more usually prone to having osteoporosis as compared to men.

The very exact reason why cycling is an excellent exercise also has its dramatic drawback because of its low weight bearing nature. Less weight bearing means less loading on your bones and joints (that's why it's good), but it also means that it doesn't stress your bones enough to stimulate it. Our bones need a certain degree of weight bearing stress to stimulate it to regenerate to form new and stronger bone. Hence, some degree of weight-bearing is not only good for the bones but also necessary.

In this study, the serious male cyclists (rides 7-22 hours a week and 9.4 years of racing experience), had lower body fat, more muscle and greater calcium intake compared to an age and weight matched control group. However, they also had 2.5-3 times greater rates of osteoporosis and osteopenia (near-osteoporosis).

So what's a biker gotta do about this, you'll ask? The researchers didn't offer any advice, but it'll be fair for me to suggest that a modest amount of running and/ or strength training in a standing position (hence weight bearing) will probably do the trick. Want something more challenging, try rock climbing.


Smathers, AM et al (2009). Bone Density Comparisons In Male Competitive Road Cyclists and Untrained Controls. Medicine & Science In Sports & Exercise. Feb; 41(2): 290-296