Running Barefoot ST 271210

Today's topic on "A Runner's Diary" in the Sports section of the Straits Times on page B11 touches on whether running barefoot is a fad.

We have written on this before and there is definitely evidence that running shoes may not prevent injuries http://weloverunning.blogspot.com/2010/08/do-your-running-shoes-prevent-injuries.html and
http://weloverunning.blogspot.com/2009/03/do-high-tech-running-shoes-work.html.

We are not saying you need to be barefoot while running but as written before, please do so progressively if you're giving it a try. Better still, come run with us during our running club and we'll show you how to run pain free.

More On Running Barefoot

The above photos show runners wearing Vibram Five Fingers (VFF) but still landing on their heels. Now the VFF's were made popular by Christopher McDougall (who was interviewed by Jeanette Wang in yesterday's Straits Times article in the previous post) in his book Born To Run.

Well, no point running in VFF's if you still land on your heels as that is what causes most running injuries. Most if not all of us have spent years wearing shoes that have caused our legs and feet to be supported by the presence of a heel so most runners now land on their heels.

Now don't get me wrong, I'm not against anyone wearing the VFF. Like I written before in a previous  post it's not the shoes you wear to run, its how you run more that is more important. That means if you master the technique, you can literally run in any shoes you want.

We had many calls and emails asking about running barefoot after yesterday's article even though Sports Solutions was not quoted in the article. I even had a student contact me on my views regarding running barefoot running for her research project.

I firmly believe that what is currently suggested by most health care professionals on the basis of pronation control and cushioning is flawed.

This is what I feel regarding choosing your running shoes. Most people can run in just about any shoe (if they run correctly) as long as they take things slowly and listen to their OWN body. Problems arise when they attempt to do too much too soon in a new pair of (minimalist) shoes.

As for running barefoot, don't go and try more than 2km or else everything may hurt since you are now loading your muscles and joints (that have been so used to shoes) much more. Gradually build up your distance and it should be fine.

Running Barefoot ST 201210

Have a look at today's article in the Straits Times under the Sports section " A Runner's Diary"on page B10 on running barefoot. Sports Solutions was not quoted in the article, but we have written on the topic before.

Here's the link.

Remember it's not the shoe, it's the technique that's more important. Master it and you can run in any shoe. I've seen runners wearing the Vibram's and still landing on their heels. Read more here.

Legs Alert

Mention tennis injuries and what will probably come to mind will most likely be shoulders, elbows and maybe back injuries right?

Well, not quite if you look at a paper published by a multinational group of physiotherapists and physicians working on the ATP World Tour. The paper showed that the main areas for concern (at least among the world's elite tennis players) are the lower limbs.

Leg injuries accounted for 39-65% of injuries sustained, followed by arm/ shoulder at 24-46% while head/ trunk accounted for 8-22% of injuries.

This is not surprising as tennis involves many multi directional movements requiring players to accelerate, decelerate, twisting and cutting etc.

The researchers suggested making the player's hips more stable to reduce ankle and thigh injuries. Come see us or talk to us at Sports Solutions regarding conditioning for your tennis both to prevent injuries and to enhance your performance.

Reference

Ellenbecker TS,  Pluim B et al (2009). Common Injuries In Tennis Players: Exercises To Address Muscular Imbalances And Reduce Injury Risk. Strength & Conditioning Journal.31(4) : pp 50-58.

Photo of Gael Monfils by Associated Press

ST 041210 Recovery Time

Have a look at the last column for this year's ST Sweet 16 Marathon Plan in today's Straits Times on page C23 under the Sports Section and you will see Sports Solutions quoted.

It was decided that the column will run today instead of next Monday since you are doing the race tomorrow.

So all the best to all our patient's taking part in tomorrow's races, the Stan Chart Marathon, the 70.3 triathlon in Phuket and the Ironman in Busselton, Perth.

ST 291110 Your Pre-Race Preparations

This is the second last column for the ST Sweet 16 Marathon plan and it discusses what runners do for their pre-race rituals. It's on page B11 on today's Straits Times under the Sports section. Go take a look and you'll see Sports Solutions mentioned.

But that's others, having your own is best. Do what suits you and what will best achieve your goals.

Also have a look at this and this.

Sports Solutions 1st Anniversary Lunch

The Physio Solutions and Sports Solutions Teams got together to celebrate SS's 1st Year Anniversary. It's always great to get some time to eat together :) Thank you to all who attended. Here's to many more years to come!

Reference For Article On Tapering

I've had quite a few patients and readers as well asking me about the source of the article I quoted in the Straits Times on tapering in the previous post. Well here it is.

Reference

Bosquet L, Monpetit J et al (2007). Effects Of Tapering On Performance: A Meta-Analysis. Medicine & Science In Sports & Exercise. 39(8): pp 1358-1365.

Email me if you want a copy of the article.

Your Marathon Taper ST 151110

Have a look at the Straits Times (page B21) under the Sports section and you'll see Sports Solutions quoted on what not to do during your taper. Go take a look.

Slightly less than 3 weeks to go before your race day so hopefully you've done your last long run. Nearly there now, hang in there.

Team Singapore Asian Games Athlete Has Compartment Syndrome? No Way

My first patient at 830 am today was an interesting case. The patient (who shall remain anonymous) was told that he/she had compartment syndrome and he/she had so far received acupuncture/ needling with current, massage (many times), electrical stimulation plus other treatment on the leg and foot etc but did not get better at all.

Now my patient is due to fly out to Guangzhou to represent Singapore for the Asian Games early next week and presented this morning with tingling sensations on the lower third of the right leg and the patient also complained there was decreased sensation there and also had pain in the web space between the big and second toe. Now those of you (who are physiotherapists) reading this should already be thinking to yourselves that nooooo, this cannot be a case of compartment syndrome.

If a patient has compartment syndrome he/she will complain of pain, paresthesia (or pins and needles), the limbs (usually legs) being very tight, tense and full of pressure. Temporary paralysis sometimes occurs. It usually happens to athletes at the start of the season after their break when they train too hard, too soon. The muscles expand and they fill up the space in the legs and "squeeze" the nerves there leading to sensations of tightness, pressure or pins & needles as the connective tissue that separates each section or compartment does not stretch hence leading to the term.

Now, my patient is at the tail end of the season (not at the start of the season and certainly not after a break from training), the symptoms he/she complains of doesn't resemble compartment syndrome at all I thought. Why? My patient's pain did not subside after training/ cessation of activity. In compartment syndrome, with cessation of physical activity, the muscles will stop working and subsequently stop squeezing on the nerves and the patient's pain/ pressure/ tightness should settle (but did not).

The biggest clue to me was the pain between big and second toe. This is a definite L5 (deep branch) nerve root distribution (which I confirmed after checking my patient's lumbar spine).

After assessing my patient fully, I treated my patient's spine and nerves, taped his/her foot and taught a nerve stretch and I just found out my patient was better and able to train later.

Well, I am no longer working at the Singapore Sports Council and I can only treat the athletes that come and look for me at our clinics. So my best wishes to Team Singapore at the Asian Games.

All the best at the Asian Games, Team Singapore. Do us proud.

*Picture shows treatment of my patient before coming to see me

Mind Over Matter ST 081110

It's less than 4 weeks to go to your race. I've taken a look at yesterday's (081110) ST Sweet 16 Marathon plan in the Straits Times and found similar points on mental imagery discussed in our blog in the run up to the race last year as well.http://weloverunning.blogspot.com/2009/11/2-more-weeks.html

Go take a look here and here.

Drinking Too Much Water Leads To Hyponatremia ST 011110

Today's topic in the ST Sweet 16 Marathon Training Plan (on page B13 under the Sports section) talks about the perils of hyponatremia or drinking too much. Drinking too much water that is. You mean you can drink too much water? That is probably what most readers will be asking. Yes, you can.

A common reply from athletes (taking part in endurance events) will be that they have drank a lot of water yet still feel thirsty. Their tummy feels bloated and swollen and they have a upset stomach. More severe symptoms can include cramps, giddiness, disorientation, vomiting, convulsions, diarrhoea, swelling in the brain and death in severe cases. Now, you can trust me on this, I had most of the above mentioned symptoms & even spent 2 days in the ICU of a Hong Kong hospital when I drank too much water and had hyponatremia during a 100km running race in November 2000.

I've written on it before, go take a look http://weloverunning.blogspot.com/2009/06/hyponatremia-at-sundown-marathon.html.

Do You Need That Cortisone (Steroid) Injection?

Have you got any pain in your elbow, patella or Achilles tendon? I've seen many cases of what used be called tennis elbow or lateral epicondylitis and Achilles tendinitis in our clinics recently. What is now known as tendinopathy (or diseased tendon) of the elbow or Achilles as these cases are actually due to degenerative change rather than inflammation as numerous studies have shown.

Most of the time patients with tendon problems were given a cortisone (or corticosteroid) injection to treat the pain (rather than treating what caused the pain). Cortisone, an anti-inflammatory agent used to be one of the preferred treatments for overuse injuries of tendons (like tennis elbow, patella and Achilles tendinitis) which were notoriously resistant to treatment. Cortisone is often used to treat plantar fasciitis too. 

Pain wise the injections were effective, but as soon as the patients returned to the their sporting activity or even their daily activities, the pain returned. In adverse cases the tendons can even rupture. This happened on a few occasions when I was working at my previous job at the Singapore Sports Council with our national athletes after receiving the corticosteroid injections. They subsequently needed surgery to repair their ruptured tendons resulting in more time off. So for all you athletes out there, think three, four or five times and not just twice about taking that cortisone injection.

A major new review article published in the Lancet just last week raised major doubts on the efficacy (or wisdom) of using cortisone on tendon problems. Yes, the authors found plenty of evidence (in over 4 dozen high quality randomized controlled trials) that corticosteroid injections reduced patients' pain in the short term, but the effects were not great in the intermediate and long term. In fact patients receiving the injections had a much lower rate of recovery than those who did nothing or received physiotherapy (at 6 and 12 months). This was especially true for patients with tennis elbow pain, rotator cuff (swimmer's shoulder) pain and Achilles tendon pain.

There are more evidenced-based treatment for tendinopathy other than cortisone injections, ultrasound, massage, interferential currents etc. We at Physio and Sports Solutions practice evidenced-based physiotherapy (neural stretching, Mulligan MWM's, eccentric muscles strengthening exercises and Maitland joint mobilizations etc) to treat you. Come let us help you with your tendon injuries.

Reference


Coombes BK, Bisset L, Vicenzino B (2010). Efficacy And Safety Of Corticosteroid Injections And Other Injections For Management of Tendinopathy: A Systematic Review of Randomised Controlled Trials. The Lancet. Epub on 22 October 2010.


*Picture by Ballyscanion/Getty Images.

ST 251010 Knowing Your Pain Part II

After yesterday's topic (in the New Paper) on the recovery effects of Sports massage after cycling (or any other exercise),  go take a look at page B11 under the Sports section in today's (251010) Straits Times to find out more on the 2nd part of understanding or decoding your pain.

It's just under 6 weeks to your race day, not a good time to get injured. If you do, please come and see us quickly.

TNP on 241010

Sports Solutions was quoted in yesterday's Sunday edition of the New Paper on the recovery process after cycling (so you can train harder again quicker), specifically on Sports Massage and DOMs (we've written on the topic before http://weloverunning.blogspot.com/2009/07/got-doms.html).

The recovery process applies to all sports, not just to cycling. It's in page 26 and 27 in yesterday's (241010) paper, go take a look.

Both our clinics are open on weekends and public holidays, please call to make your appointment.

ST Article On Knowing Your Pain 181010

After a few weeks break from the ST Sweet 16 Marathon Training plan, Sports Solutions is back in the news in today's Straits Times (181010) under the Sports section on page B11 on understanding or decoding your pain.

This is what we at Physio and Sports Solutions are good at, treating the root cause of your problems instead of just treating your pain to allow you to run pain free. Our many patients can testify to that.

Go take a look.

The Underpants Run In Hawaii

For those of you who are into triathlons, well, tomorrow (or 091010 in Hawaii) will be the holy grail and grand daddy of all triathlons. The Ford Ironman World Championships, held on the big island Kona in Hawaii on every full moon in October.

Why full moon every year you may wonder? You get 17 hours to make the finish line, to be an Ironman, and the full moon will offer some light to those out on the course battling to make the time cut.

Above is a picture I found in the pre race festivities, the underpants run.

All the best to all our patients taking part.

*Picture from Ironman.com

More on Glucosamine ST 250910

Have a look in Today's Straits Times under the Review section on page A35, the author writes about the fact that many elderly folks are still popping glucosamine pills despite the lack of evidence. We've actually written on this topic before on November 9 last year, here.

As mentioned, the older studies tend to have some evidence supporting the use of glucosamine, perhaps due to the studies funded by the drug companies. Current studies show a lot less evidence supporting it's (glucosamine) use on osteoarthritis as studies are a lot more stringent and require clinic trials to be registered before trials can be commenced.

While glucosamine has never proven to have any dangerous side effects, there is also no evidence to suggest that it works,. Evidence suggest that it works mainly by placebo effect.

For my patients who have been asking me on this topic, you now have more evidence.

Reference

Wandel S,  Junni P et al (2010). Effects Of Glucosamine, Chondroitin, Or Placebo In Patients With Osteoarthritis Of Hip Or Knee: Network Meta-Analysis. BMJ. 342:c4675 (Epub 16 Sep 2010).

Please email me if you want the Straits Times article or the research paper.

*Picture from Flickr

Sony Walkman NWZ W252

You've just read this week's article (in the post before this) in the Straits Times Sweet 16 Marathon plan on how you can run faster with music, so its a good time for me to do my review on the MP3 player from Sony as promised earlier.

Quite a few of my friends and even runners I don't know have come up to me and asked me about it when they see me using it, so here it is.

Weighing just 43g and wireless, it's light and not cumbersome at all. I always inevitably catch the wires of my earphones of my 1st generation iPod shuffle while running previously so having no wires dangling is really a nice change. The ear pieces are fairly comfortable and the bass is pretty good, much better than my current earphones in fact. Control of the headset is done by 3 buttons on the right, which is easily accessed. You can increase or decrease volume and switch your songs here. One complaint though is you can't rewind or fast forward within a song.

Another thing I wasn't fond of was the "Zappin" mode which plays 4 or 15 seconds bits of each song. I guess this is to allow you to scroll through your playlist until you find the song you wanna run to. Me, I just fill the entire 2G capacity with all my favorite running songs and put it on shuffle mode.

One other favorite feature of mine Sony W252 is you can get 90 mins of play time on a quick 3 minutes charge. So those of you who like me wanna squeeze in a run when your baby is sleeping and find that there is no battery will really appreciate this. Those who run longer than 90 minutes, well, you gotta make sure the battery is not flat then.

Once again, a big thank you to the 2 Hill & Knowlton staff for this great MP3 player.


*Pictures from Sony

Tuning In ST 200910

No, you were right, Sports Solutions was not quoted in today's Straits Times (under the Sports Section on page B13) Sweet 16 marathon training plan with 11 weeks to go before your big race.

But we did write on this topic before last year on July 28.

Go take a look here.

What's The Best Way To Do An Interval Workout

As you've read in this week's Sweet 16 Marathon training plans, wanting to run  faster almost always mean having to do interval training. And all of the research published on interval training have pointed to increased fitness and running faster running times.


That doesn't mean you can run intervals 4 to 5 times a week though coz' that will be like taking an express train to over training and injury occurring. So here's the catch with interval training, it looks like it's purely a science - do the work and improvement follows correct? Well, it's actually just as much an art according to this research paper from Australian researchers I chanced upon recently. 


Instead of following a fixed formula like waiting until your heart rate (HR) drops to a certain number before your next interval or resting as long as the time taken for your previous interval ran, the researchers suggested that listening to your body might be the best way after all. They coined the termed "teleoanticipation" or what they say is perceived readiness to run your next interval.

Here's what the researchers asked a group of competitive runners do during a standard interval session of 5 x 1 km at 90% of their tested all out 1 km time. For recovery, the runners A) waited for their HR to return to 130 beats; B) rest as long as their interval time - about 3:18 min; C) rest until they "felt" they can run at 90% effort.


When they followed their HR, the runners did not recover enough, and they slowed dramatically on the last three repeats. Methods B and C had similar outcomes with one highly interesting difference - when the runners were recovering by "feel", the runners chose shorter recoveries than those assigned by method B. That is, they were able to maintain their times in the 1km repeats, but in less total workout time. This probably means that the C workouts were  more efficient (or productive) than the B workouts. As you see, interval training can be more of an art than a science.


The researchers suggested that this way of running intervals should not replace all other training principles that you have used previously but to keep this in mind while considering the whole training process. 

Personally I guess this is a good and practical way of training as it may mean you do not need to shell out extra money to get a HR monitor. This also gives athletes a systematic approach to train at their own pace (especially in a group setting) given that they will need to rely on their own pacing during a race so this makes good sense to practice pacing in training as well.


Reference 

Edwards AM, Bentley MB et al (2010). Self-pacing In Interval Training: A Teleoanticipatory Approach. Psychophysiology. 28 June Epub. DOI: 1111/j. 1469-8986.2020.01034.x

* Picture by RS

12 Weeks To Your Race ST 130910

As we count down the weeks to your marathon, have a read on how to get faster as today's Straits Times (130910) continues its Sweet 16 Marathon plan.

Have a look at the Sports section page B11 and you see Sports Solutions quoted.

In our weekly running club sessions, we teach you how to run pain free with good running form, just ask other regular runners who come. Give us a ring to let us know you are coming.

Nike City 10k

This this a brand new race from Nike this year on 24/10/10, replacing the extremely popular Human Race which was held for the past 2 years. Singapore is amongst 22 other cities hosting this event.

What's unique about this particular race? Besides the physical race, runners from Singapore will be competing against fellow runners from Kuala Lumpur (KL) to see who can clock more mileage from now til October 31st. And here's the deal, the winning city gets USD$30,000 donated to a charity of their choice, for Singapore it will be the Singapore Children's Society.

In order for you to do  your bit for charity, runners who sign up for the race will get 50% off the purchase of a Nike+ SportBand so you can log your mileage and play your part  by participating in the online challenge versus KL. 


Staff from Physio and Sports Solutions will be taking part in the race to do our bit for the Singapore Children's Society.

The Correct Way To Warm Up ST 300810

This week's topic in the marathon Sweet 16 training plan is on warming up. It is in today's StraitsTimes under the Sports section on page B13.

We've written on the topic before, please take a look at this and also this. 

Sunday Times 290810

Have a look at the Lifestyle section in today's Sunday Times paper (290810) under Pulse page 10 and you'll see Sports Solutions quoted in an article called "Wrist Management". Go take a look.

ST 230810

Sports Solutions in the papers today on choosing running shoes for your marathon. Go take a look in today's Straits Times under the Sports section page B15.

Runners Toes Not Harmed By Running

Yet more evidence that distance running in humans is an activity that is natural and well-evolved that we perform with great skill.

In their published article, British radiologists were interested to determine if running is harmful to our metatarsophalangeal (MTP) joints. 

Here is what they found. There is no extra synovial fluid (this is the fluid in our joints) in the MTP joints showing that running is not injurious to our joints. The MTP joints are at the base of our toes.

Measurements of the volume of synovial fluid in the MTP joints were taken after a 30 minute run and after 24 hours of rest. And the researchers found no association between moderate distance running and any increases in the volume of synovial fluid.

Reference 

Kingston AR, Toms AP et al (2008). Does Running Cause Metatarsophalangeal Joint Effusions? A Comparison of Synovial Fluid Volumes On MRI In Athletes Before And After Running. Skeletal Radiology. 38(5): 499-504.

Oakley Split Jacket

Here's a nice surprise from Oakley (thanks to Joey) today, I was given their latest Split Jacket sunglasses. It looks like the Jawbone, has the same features, just a little smaller which I guess will suit those with smaller faces well.

The polycarbonate Plutonite HDO lenses as usual have superb visual clarity with excellent peripheral vision, in fact just as good as the Jawbone.

From the first picture , you can see that the main difference is that the larger Jawbone (white) provides more coverage, especially for the lower field of version. It also has the same switchlock hinge frame which makes changing lenses real easy.

Please also see this.

Today's Straits Times 160810 - We Are Built To Run

Go take a look at today's Straits Times under the Sports section page B15 and you'll see that humans are meant to run.
The quoted article in the papers by Lieberman and Bramble (2007) points out that we humans have an exceptional cooling system, can adapt really well to hot weather and we also have spring like ligaments and tendons in our legs and feet as well as very good balance. These traits were definitely all needed by our caveman ancestors as they had to hunt and look for food.
Please also have a look at this.
Email me if you want a copy of the article.

Reference
Lieberman DE and Bramble DM (2007). The Evolution Of Marathon Running Capabilities In Humans. Sports Med 37(4-5) : 288-290.

Today's Straits Times

Go have a look at today's Straits Times (090810) under Sport page B15, especially if you are one of those who signed up for the marathon at the end of this year.

Sports Solutions will be one of the Straits Times panel of experts in the 4 month countdown as you gear yourself up for race day.

Yes, there will be a Sweet 16 plan where weekly instalments will offer a different topic each week. Stay tuned.

Do Your Running Shoes Prevent Injuries?

How do you choose your running shoes? I've been asked that question many times over. I've even compiled a shoe list regularly over the years since the 90's and yes many other physios, health professionals etc have conveniently/ blantantly taken out my name and passed the list off as their own (picture below).

One of my often copied shoe lists

For years, podiatrists, coaches and shoe salesmen etc have looked at your foot type (to see if you have a normal, low or high arches) and then recommended that you have stability, motion control and cushioned shoes respectively. The rationale being that if you had high arches, you did not pronate enough and needed softer, well cushioned shoes while if you had low arches, you tend to overpronate and needed sturdy motion control shoes to control that overpronation. Runners with normal arches needed neutral shoes and were prescribed stability shoes. This method was deeply rooted in athletic circles and widely accepted.

The above mentioned method was exactly what the US military did in terms in handing out shoes to their recruits as injuries were rampant during basic military training. Military authorities hoped that injury rates will drop by ensuring their recruits were fitted with the correct shoes according to their foot type.In order to determine whether fitting correct shoes help in lowering injury rates, military researchers found no scientific literature in support of what they were doing and decided to do their own research.

And you know what, they found almost no correlation at all between wearing proper running shoes and avoiding injuries (this is published in the American Journal of Sports Medicine recently). Injury rates were actually highest amongst soldiers who had received shoes fitted according to their foot types. Wearing the so called "correct" shoes for their type of feet had actually increased the recruits' chances of getting injured.

If you have been following our blog, you would have read that Sports Solutions first wrote about this last year when researchers in another published article in the British Journal of Sports Medicine concluded that sports medicine specialists should stop recommending running shoes based on a person's foot type as there was no evidence supporting it. Please have a look at one of our our more popular post last year. 

And just in case you decided that published studies on military recruits were of a lower quality, another study done on experienced runners was published more recently in support of the military subjects paper. In this study, 81 runners were classified according to their foot postures (a more detailed measure of foot type than just arch shape). Runners in each category were then randomly assigned one of 3 footwear conditions, neutral (Nike Pegasus), stability (Nike Structure Triax) and motion control (Nike Nucleus).

All the women embarked on a 13 week half marathon training program. How did they fare? Nearly a third of the women had to miss some training days because of pain, with a majority of the injured runners wearing (yes you guessed correctly) shoes specifically designed for their foot postures. What's more, also of note was that motion control shoes were the shoes across the board that "caused" the most injuries.

Now in theory, overpronators should benefit from motion control shoes to limit their overpronation. However, these runners who overpronated actually complained of pain and missed training after wearing them as did a number of runners with normal feet and every single underpronating (or high arched) runner randomly assigned to a pair of motion control shoes.

This is despite that fact that motion control shoes do limit over pronation as numerous biomechanical studies of runners running on treadmills have repeatedly proved that runners who wear motion control shoes have significantly reduced pronation.

There you go, not quite what you may expect I imagine. Please email this to your friends who are planning to invest in new running shoes.

I have all 3 articles, email me if you want a copy.

References

Knapik JJ, Trone DW, Swedler DI et al (2010). Injury Reduction Effectiveness Of Assigning Running Shoes Based On Plantar Shape In Marine Corps Basic Training. AJSM published online before print June 24, 2010.

Richards CE, Magnin, PJ and Callister R (2009). Is Your Prescription Of Distance Running Shoes Evidenced Based. BJSM. 43(3) : 159-162.

Ryan MB, Valiant GA, McDonald K et al (2011). The Effect Of Footwear Stability Levels On Pain Outcomes In Women Runners: A Randomised Control Trial. BJSM. 45:715-721. DOI:10.1136/bjsm.2009.069849.

My New Sony Walkman

A big thank you to the 2 staff from Hill & Knowlton for selecting me to be a part of their Sony Walkman Runners Program. As a result, I've been given a brand new water resistant MP3 player by Sony - NWZ W252 to run with.

Am definitely delighted to be involved since I do run with music and having written on the topic before.

Please see here and here.

Besides being water resistant, the best part is that it's got no wires dangling.

This is way different and much much smaller than the Sony "Walkman" I grew up with ( the 1st generation of Sony Walkman needed 4 AA batteries). Some of you reading this will remember what I'm talking about.

Well, we all know Sony have come a long way since. Stay tune as I run a few more times with it before I do it justice with a longer write up on it.

* Picture from Sony

Should You Run On Grass Or On The Road?

After my 3 knee operations, I was paranoid about running on any other other surface other than grass. Virtually all my run training was done on grass. Yes, you read correctly, even when it meant I had to do multiple rounds/ loops around any field I could find. Some of you reading this could probably recall seeing me going round and round the patch of grass while I was running. I thought that running on grass and its softer surface will be more gentle on my joints.

And I guess I wasn't alone thinking like this. I'm sure many of you runners out there would have met some runners, coaches etc who will swear that grass and soft running surfaces are much better. So here's a topic most runners will be keen to know. Is running on grass better than running on the road. I saw an article on this topic by some Australian researchers last week. Please read on if you wanna know more.

The runners studied did 2 runs, a 10km run at 75-80% V02 max and a 10 x 1km interval session at 90-95% V02 max. The 2 runs were done on both grass and a bitumen road surface (road). The researchers measured blood & urine samples collected before, immediately after and at 3 and 24 hours after exercise.

Here's what the researchers found. There was no difference between road & grass in terms of leg inflammation and other effects measured (if you wanna know, they measured IL-6, hemoglobin & haptoglobin levels, iron and ferritin to analyze hemolysis and hepcidin).

Hard interval training on the other hand produced more inflammation than lower intensity training.

So now you know, running surface doesn't really matter. Just run, remember you can, with pain free running.

Reference

Peeling P, Dawson B et al (2009). Training Surface and Intensity: Inflammation, Hemolysis, And Hepicidin Expression. J of Med Sci Sports Ex. 41(5) : 1138-45.

*Picture from Flickr

The Tour De France Beckons

Despite all the sporting attention & focus on the World Cup going on in South Africa currently this year's Tour De France starts in Rotterdam, Holland this coming Saturday for the prologue before making its way around France for the next 3 weeks.

The tour is usually described as one of the most difficult tests of sporting performance in the world and 20 teams of 9 riders each will start.

This year's Tour has been designed to be filled with drama. Lance Armstrong has recently announced that this will be his last tour. Every stage will be vital, but with the cobbles of Arenberg awaiting on only the third stage, plus two trips up the Col du Tormalet, numerous mountain top finishes, only one individual time-trial (excluding Saturday's 8.9km prologue), and numerous other challenges, 2010 should produce GC drama throughout.

No team time trial though and Alberto Contador should be happy about this given that his Astana team is not as strong as Armstrong's Radioshack team and Contador has said in a interview today that carrying the favourite's tag isn't easy for him.

The other reason why the Tour is so great to follow is that you can study and appreciate the science and analysis of the riders' strategy, physiology and performance.

Who knows how the next three weeks will pan out? But wherever it is, I'll be watching. For now, Wimbledon and the World Cup will take up my TV time.

The Perfect Taper

Have you trained really hard for your important race but ran or raced poorly because of mucking up your taper.

Runners have always tapered, especially prior to a big race in order to freshen up and improve performance. Rest the mind, rest the muscles, carbo load etc. Big problem is we never know exactly how to get the taper right. Moreover, this is what every runner tapering will fear- losing their hard earned fitness.

Well, here is the latest published research on how to get your taper before your big race correct. Interested? Please read on.

The researchers studied a group of university cross country runners before and after a 3 week tapering period for a 8 km race. At their peak training, the subjects ran 6x a week logging up to 72km (or 45miles).

During their 3 week taper, the runners ran 73%, 73% & 50% of the normal mileage. They did intervals and easy runs, but cut back on "moderate" runs (like tempo runs).

Here are the results. After the 3 week taper, the average race times for their 8km race dropped from 27:42 to 26:12 mins. Every single runner improved their times after the taper. There was no decline in aerobic fitness, Vo2 max or running economy. In fact the runners gained muscle strength (in the calf) after the taper.

The author suggested that this same taper strategy will work up to marathon distance races. To achieve your PR, try this taper.

3 weeks before your race, do 75% of your normal mileage. Stop most medium-hard runs, but do usual interval training.

2 weeks before, same as above.

Last week before your race, do 50% of your normal distance. Stop ALL medium-hard runs & do 50% of usual intervals.

Race day, kick ass.

Reference

Luden N, E Hayes et al (2010). Myocellular Basis for Tapering in Competitive Distance Runners. J App Physiology 108: 1501-1509.

Running For Your Life

I had this odd habit when I was a lot younger. I'll get something nice like a new watch, pen or shoe then I'll keep it somewhere safe. Then I will get the same thing (but not quite as nice) and use this instead of the "good" stuff that I got earlier. The thinking was that if I didn't use it, it'll last forever.

I guess I still have this habit sometimes and my wife will often ask me why I do that. Fortunately I didn't take the same approach with my body. I figured if I didn't use my body it'll definitely not last forever. Unlike machines, our bodies are made to move.

As with bicycles (or car, motocycle fill in your own), for the bike to perform their best you have to maintain it. While I was still racing triathlons, I spent lots of time cleaning, adjusting, lubricating and even polishing my bike. (For the difficult stuff, I'll get Kenneth or Yusoff from Cycleworx to help).

Now that I'm not racing and have a new born son, unlike a piece of mechanical equipment (which wears out the more you use it), I actually get stronger the more I exercise, now that I don't train like before. (Likewise I become a lot more unfit if I didn't).

Our bodies do share something similar with mechanical equipment. If you don't understand their limits, they can break down. If I run 3 times a week for half an hour and feel great and then decide that I will then run 6 times a week for an hour each time then I may be inviting an injury to come. (Trust me, I've had 3 knee operations remember). That's when I learned patience.

We live in an instantaneous society now and expect results overnight. Well, this is what I learnt, you don't become a great athlete overnight (and likewise you don't turn into a lousy athlete overnight or after a poor race). Our bodies can do almost anything we ask of it as long as we give it time to adjust to new demands.

The truth is when it comes to our bodies, we have to use it or lose it. If we don't, we'll find that one day when we want to go for a run and we can't as if we don't push ourselves, our bodies start to decline.

All right, I better get moving, not to run, but my son is starting to cry.

Atacama Crossing

Some photos from one of our patients who competed in the Atacama Crossing, a six day 250 km foot race across the Atacama Desert of Chile.

Besides the distance, the other challenging factor is the race takes place at more than 2500 m above sea level. Here are some of her really amazing photos.

This is what she said.

Hi Gino,
Thank you for the physiotherapy sessions in taking away the pain that was centred on my right knee, especially with those exercises. While the Atacama Crossing (Chile) entailed pain (and monster blisters), you helped sort me out before the race and my knee problems so i could withstand the other elements! Thanks again.

Melanie Wee

You are most welcome Mel.

If you want to read more please go to http://www.4deserts.com/blogs/comptetior_blog_new.php?authorid=NTcx&blog=16

Today's Running Club @ SS

To all the new runners that came for this evening's running club- Li Bin, An Qi, Philip, Boon and Peter (hope I spelt everyone's names correctly), thank you for coming and hope you had a good run.

Please practice as we discussed and all of you will run pain free and faster. See you at the next running session.

American Record By A "Fat" White Runner

This has been the most discussed topic for the past 2 weeks in most of the running forums I've read. American Chris Solinsky became the first white and heaviest runner so far, at 73 kg to dip under the 27 minutes barrier for 10000 m on the track.

By running 26:59 mins, Solinsky became the first non African born runner to break the 27:00 barrier, and on his debut race at 10000 m too.

Only 30 other men have run under 27 mins, and Solinsky is 9 kg heavier than the next heaviest.

Consider some of the following most illustrious runners on that list, Haile Gebrselassie at 1.65m and 56kg, Kenenisa Bekele (1.6m/ 54kg), Paul Tergat (1.82m/ 63kg) and Sammy Wanjiru (1.63m/52kg). Until Solinsky (who at 1.85m is the tallest), nobody heavier than 65 kg had run under 27 mins.

Many long distance running aficionados (myself included) were really surprised that someone this "big" could run so well. Most if not all other true elite long distance runners are never this tall nor this heavy. Solinsky is currently the tallest and heaviest (can we call him "fat") sub 27 min 10000 m runner. Prior to Solinsky, Paul Tergat (who on a good day can outrun Gebrselassie) is the next tallest at 1.82m but tip the scales at only 63 kg. Which makes Solinsky's achievement even more remarkable.

So, don't let anyone tell you that you that you are too big or fat or not fast enough. You can prove them (and their stereotypes) wrong. You have to work pretty hard though.

*Photo from letsrun.com

Rugby Injuries

Rugby has been in the news (even in the front page of our Straits Times) recently for many reasons the last week or so especially since the fight that broke out in the National Schools 'B' division final which sparked comments even from politicians and newspaper editors (who normally would not even watch rugby).

Well, I'm not about to join in the fray. I am actually going to write about rugby injuries that we've been treating as we've been seeing quite a few patients who play rugby as well in the last month or so (we had a player tearing the ACL representing Singapore at the Hong Kong 7's tournament).

I went to do some research to see if there are any published similarities with our local rugby injuries and here's what I found (although articles were mainly on professional rugby players).

Here's what some of the published papers found. Rugby union is a high risk sports for players' knees, highest among all other football, rugby codes (which supported previous research findings). Medical personnel at clubs reported knee injuries on a weekly basis. Knee injuries accounted for the highest number of days for injury absence (21% of all injury absence days) and were characteristically severe, with a disproportionately high number of days injured per injury.

ACL (anterior cruciate ligament) injuries accounted for the greatest proportion of days missed (255 days or 29% of all knee injury days), followed by MCL (medial collateral ligament). Injuries tended to be more common among the back row. This is fairly similar to what we saw, although we saw many shoulder injuries among the rugby players as well.

Most severe injuries occurred during contact (being tackled rather than tackling). More significant for coaches and medical personnel to take note, usually in the final 20 minutes of a match.

The physical nature of rugby makes contact injuries fairly difficult to prevent although coaches, physios can put in place a number of conditioning (or prehab) measures to help ensure players are properly prepared for the demands of the sport.

Please also see http://physiosolutions.blogspot.com/2009/05/why-men-dont-get-it_28.html

References

Dallalana RJ, Brooks JH et al (2008). The Epidemiology of Knee Injuries in English Profesional Rugby Union. Am J Sports Med. 35(5) : 818-830.

Quarrie KL and Hopkins WG (2008). Tackle Injuries in Professional Rugby Union. Am J Sports Med. 36(9) : 1705-1716

*Picture by Rich Seow

Rinse And Spit

Here's an interesting bit of information that may surprise you if you taking part in the OSIM triathlon this weekend. Sure did surprise me. 2 different studies support this.

In the first study, runners were asked to run as hard as they can on a treadmill. Before one run, they rinsed their mouth with a sports drink of 6 % glucose but didn't swallow. Before their second run, they rinsed their mouth with an identical placebo drink with no calories and also didn't swallow the drink. Results? The runners ran faster and felt better when the rinsed their mouths with the sports drink.

In the second study, cyclists made made to do an all out 60mins time trial while a) consuming a placebo drink with no sugars or electrolytes, b) a common sports drink, c) rinsing their mouth with the sports drink but not swallowing any. Here's the funny result. The cyclists performed best while rinsing their mouths with the sports drink but not swallowing. Go figure.

So if you are feeling bloated on the bike or during the run and can't get any fluids down, just rinse and spit out your sports drink. You can still do well.

All the best to our patients taking part this weekend.

References

Rollo I, Williams C et al (2008). The Influence Of Carbohydrate Mouth Rinse On Self-selected Speeds During A 30-minute Treadmill Run. Int J Sp Nutr Ex Metab. 18(6): 585-600.

Potter A, Bouckert J et al (2008) Mouth Rinse of a Carbohydrate Solution Improves 1hour Cycle Time Trial Performance. Scandinavian J of Med and Science in Sports. Nov 3 Epub.

*Picture from Flickr.com

Sports Solutions & Kinesio Taping In Today's Straits Times

Team OCBC rider Ang Kee Meng 

Lance Armstrong, David Beckham, Serena Williams and our national athletes have used it before. Lance even talked about it in his book "Every Second Counts".You can probably use it too. And you don't even have to be an athlete. 85% of Kinesio tape users are non athletes. It can also be used in pediatric patients (e.g. cerebral palsy, torticollis etc), patients with neurological conditions like Parkinson's and patients with bruising and swelling.

Have a look at the Sports section in the Straits Times today (270310) and you'll read more about Kinesio Taping.

Some of our staff have been using it since 1999. Of course we do not use the tape for everything, we will still find the cause of your pain and treat it (rather than just treating your pain). And if our patients require Kinesio taping, we will use it at no extra charge.

We also teach Kinesio taping courses, let us know if you are keen.

*Lance Armstrong, David Beckham & Serena Williams photos from Kinesiotaping.com

*Cycleworx rider Ang Kee Meng taken by Jeanette Wang

Triathlon Training And Injuries

*Picture of Aviva Singapore Ironman 70.3 by RS

Due to the fact that last Sunday was the Singapore Aviva 70.3 Ironman race, both our clinics Physio and Sports Solutions saw a fair bit of triathletes last week (for both Physiotherapy and Sports Massage) and this week as well (post race massage). We've also treated a number of overseas participants as well and some won their age groups too.

Since I treat lots of injured (and sometimes not injured) triathletes over the years (and having raced many before in the past myself), I've had the opportunity to ask our patients lots of questions about their training regime, equipment, tapering and racing of course. Here are some things I've noticed about triathletes, which strangely is also supported by a published research paper I came across this past week.

There seemed to be no real difference in overuse injuries in both Olympic distance (OD) and Ironman distance (IM) athletes. Chances of an OD patient getting a injury recurring was much less compared to their IM counterparts.

The research paper reported that OD triathletes suffered less from running injuries but those who did were out injured longer compared to IM triathletes. The less the OD triathletes trained, the more they seemed to be injured (these are the newbie triathletes).

For the IM distance triathletes, the overuse injury rates corresponds to the number of intensive sessions done. Yes, this is what I've noticed as well, the more the interval sessions, the higher chance of IM triathletes sustaining an overuse injury, especially during "brick" (combining bike-run sessions) training. This may be due to the "cumulative stress" of performing back to back sessions of hard biking and running.

The authors also noted that when some triathletes get injured, there is a tendency to increase training load in another discipline rather than resting. This frequently further increased their injury recurring and may delay their time to recovery.

Come talk to us if you need help whether you are training for your first Sprint, Olympic distance or done lots of Ironman distance races, we'll be most happy to help you.

Reference

Vleck VE et al (2010). Triathlon Event Distance Specialization: Training and Injury Effects. Journal of Strength Cond Res. 24(1): 30-36.

*Picture of Aviva Singapore Ironman 70.3 by RS

Kinesio Taping Course At SS

Kinesio Taping Level 1 (KT1) and 2 (KT2) was taught at Sports Solutions yesterday and today by our certified Kinesio Taping Instructor Gino in conjunction with Progress Healthcare Pte Ltd (the distributor for the Kinesio Tapes).

Thank you for all who attended, especially our foreign participants from Malaysia, Philippines, USA and Germany.

Stay tuned for more info on the next course.

Protein Protection

If you've been racing hard in the OCBC bike race today or trained really hard earlier in the day (in anticipation of other races later in the season) read on for some simple dietary intervention that can help maintain your immune function (prevent you from getting sick).

There is much research to show that combining carbohydrate (CHO) and protein after heavy exercise can aid in replenishing your glycogen stores and tissue repair.

There is also growing research evidence that protein may aid immune recovery and also lower the risk of respiratory tract infections. Not any protein but protein in the form of branch chain amino acids and glutamine.

Researchers in the study below studied a group of competitive runners after a 2 hour run. The control group was given water immediately after and 1 hour post exercise. The "immediate feeding" group were given a CHO-protein solution straight after exercise plus water 1 hour later while the "delayed feeding" group received water straight after the run and the CHO-protein solution an hour later.

Results showed that consuming the CHO-protein mix straight after the exercise had a significant effect on neutrophil degranulation. On what you said. This is the marker used in tracking susceptibility to infection. It is very common to find a drop in neutrophil degranulation after tough bouts of exercise which means you are more likely to fall sick. This means that you can avoid that by some quick and smart refueling.

Here's the suggested mix from the research, consume 1.2 grams of CHO per kg of body mass while adding 0.4 grams protein per kg body mass. For a 65kg athlete, that means you will need 78 grams of CHO & 26 grams of protein.

Reference

Costa RJS, Oliver SJ et al (2009). Influence of Timing of Post-exercise Carbohydrate-Protein Ingestion on Selected Immune Indices. International J of Sport Nutrition & Ex Metabolism. 19(4) : 366-384.

*Picture from Flickr

Cycling And Knee Pain

With the OCBC bike race this weekend, both our clinics have been seeing quite a few cyclists this past week and so I thought I'll do a write up on the combination of cycling specific factors that can cause ailments/ grief to your knees.

These factors can often be divided into cycling specific reasons, bike specific and cyclist specific reasons. Cycling specific causes are mainly due to suddenly increasing distances, intensity, hills, using heavier gears and lower cadences while bike specific reasons are likely to occur when radical changes are made to your saddle height, setback and/ or cleat position.

I will elaborate more on the cyclist specific factors that can cause your knee injuries as this often happen due to your own individual make-up and biomechanics, i.e. intrinsic rather than extrinsic reasons.

The first cyclist specific factor that can cause your knee pain is usually due to anatomical differences such as a leg length discrepancies (bearing in mind most of us will have this). Most often though, I've found that most cyclist tend to favor one leg over the other. This is usually the leg with your thigh closest to your seat post when you are pedaling which partly explains why knee pain seldom affects both knees equally.

All of us have had falls, knocks, scrapes and other injuries which may lead to us subtly changing the way we move and so previous injuries (cycling related or not) can also be a contributing factor to causing knee pain. This is especially more so when we decide to ride more than normal at the start of the season or when we have a new bike etc.

The cumulative effect of the two reasons mentioned above can then upset the forces your knees have to deal with while pedaling. Each pedal stroke bends and straightens the knee joint but it should never straighten your knees fully (if it does, your saddle is too high). The push (straightening) phase starts when your knees are bent at about 110 degrees, and the knees start to bend again at about 35 degrees (when you start the pull phase of your pedal stroke). Your muscles and tendons around the knees are the direct shock absorbers for the forces transmitted there. Hence overused or tight muscles which arise from repetition (with you turning the pedals over and over again) can contribute to increased forces to your knees.

The accumulation of excessive loads over time can exceed your body's ability to dissipate forces which can lead to damage if not given a chance to recover, which then leads to injury (hence the need for rest days).

The good news is the vast majority of these cycling specific knee pain improve quickly (with non-operative intervention) with correct identification and treatment of the cause of your pain, something which we at Physio and Sports Solutions are good at.

Please come look for us if you need. And all the best to all of our patients who are taking part in the race.

*Thanks to my patient KM for allowing me to take a picture of his knees.