It's Never Late To

...... start exercising that is.

Picture by Brian Dees from flickr.com

After my bike accident, I went to the pool 4-5 times a week for rehab rehab. There was this older gentlemen (I think he's at least 70) that I saw frequently. He would cycle to the pool and swim lots of laps. He looked really strong and I remember saying to myself that I would like to be strong and healthy like him when I get to his age.

Well I guess research is good at confirming what I believe this older gentleman is.

British researchers studied 3454 adults over 8 years who were healthy and disease free at the start of the study. Their average age at the start of the study was 63.7 years young.

The adults were considered healthy if they did not develop any major chronic diseases, depressive symptoms or any physical or cognitive impairment during the 8 years of the study.

19.3% (or almost a fifth) made it to the final follow-up healthy. Those who exercised moderately or vigorously at least once a week were on average 2.67 and 3,53 times more likely to experience healthy ageing compared t those who were inactive.

What's more amazing was that those who had only become physically active during the study had a higher likelihood of experiencing healthy ageing than those who did not.

The researchers concluded that significant health benefits were even seen among participants who became physically active relatively late in life.

Today's the last day of the year and tomorrow is a brand new year. It's a good time for you to start exercising regardless of whether you are young or old.

Reference

Hamer M, Laviole KL et al (2013). Taking Up Physical Activity In Later Life And Healthy Ageing: The English Longitudinal Study Of Ageing. BJSM. doi:10.1126/bjsports-2013-092993.

Exercise Helps Short Term Overeating

Now who's been eating too much?

If you've been eating more than normal (like me) this Christmas and are have been piling on the pounds, here's motivation to keep your exercise going.

An recently published article in the Journal of Physiology found that regular exercise helps keep your blood sugar and fat cells in the healthy range even when you consume significantly more calories over several days.

The study looked at twenty-six men who over ate for a week. Some increased their calorie intake by 50% and did not exercise at all that week. The others in the study took in 75% more calories than usual but ran 45 minutes a day.

Both groups accumulated a large energy surplus during that week (from eating way too much). Even though both groups were considered to be "unhealthy" in their weight control in the short term, the runners handled the overeating much better than those who did not run (or exercise).

The runners had stable blood sugar levels and their fat cells showed less "undesirable" genetic changes. The inactive group had much worse blood sugar control and had alterations in several genes associated with nutritional balance, metabolism and insulin action.

The authors concluded that a daily bout of exercise during a period of overeating (very common during Christmas and the New Year) will prevent many of the negative changes from happening even though you are gaining weight. Well, if you have eaten too much and haven't exercised this past Christmas and have piled on the pounds, you can still remedy it by kick starting your exercise regime before the New Year holiday period.

Reference

Walhin JP, Richardson JD, Betts JA and Thompson D. (2013). Exercise Counteracts The Effects Of Short-term Overfeeding And Reduced Physical Activity Independent Of Energy Imbalance In Healthy Young Men. J of Physiology. 591: 6231-6243.

Who is not eating?

*Pictures by Aminah with her Canon Powershot

PS And SS Lunch

Staff and their families from both clinics who were not travelling met together for lunch today at Marina Mandarin.

Thank you to all for coming and as for those who couldn't come, here's what you missed. Make sure you make it next time (Romaiza is asking that this be a monthly affair)....

Some of the staff who arrived early

Taha and Moo brought baby Naeem

Dean not the youngest any more

Wrong camera Tini and family ....

Best eater

Romaiza and her boys

Have a great Christmas and Happy New Year.

Rotate Your Running Shoes To Minimise Injury

Picture by Tomas Kalina from Flickr.com

I started running when I was twelve. I ran mostly cross country and track races (as there were definitely a lot less road races then compared to now). Since those early running days, I began rotating all my running shoes.

My mum would nag at me for having so many pairs of running shoes and wanted to throw away the older pairs. I would simply tell her I'd throw them out but secretly kept them in another place or brought them to school to keep in my locker.

After getting good enough results to be sponsored, my shoe rotating "habit" got worse I guess.

Back then, I simply felt that using different shoes each time I ran would stress different parts of my foot and legs and hopefully less chance of me getting injured.

Turns out I was right. A recently published study suggests that runners who rotate more than one pair of running shoes are significantly less likely to get injured compared to those who wear the same pair of shoes each time they ran.

The researchers studied 264 runners over 22 weeks. Information on training volume, injury rate, cross training, shoe usage and other variables were obtained. 116 runners in the study used a single pair of running shoes, with 91% of their running done in that same shoe. The other 148 runners used multiple pairs of running shoes. They had a main pair which they ran in (an average of 58% of their runs) while also using another 3.6 pairs (on average) for their other runs during the study period.

The researchers found that those who rotated their running shoes had 39% lower risk of getting injured during the study period compared to those who ran mainly in one pair of running shoes. The researchers suggested that different shoes distributed impact forces from running differently, lessening repetitive strain on the legs during running.

Depending on the shoe's midsole height and firmness, a person's stride length and ground reaction time also changes, affecting running gait although these factors (midsole densities, structure and geometry) need further research. Also in support of reducing injury due to varying loads, the researchers found that the runners who also cross trained had lower incidences of injury.

Well, all you shoe geeks can rejoice now that you have an excellent reason to convince your significant other, wife, husband or mum that you need another pair of running shoes.

Reference

Malisoux L, Ramesh J et al (2015). Can Parallel Use Of Different Running Shoes Decrease Running-related Injury Risk? Scand J Med Sci Sports. 25(1): 110-115. DOI: 1111/sms.12154.

*Picture by Ian Dennoir of shop window @ Carnaby Street Soho London from Flickr.com

I like!

Kinesio Taping KT Level 1 on 111213

The year seems to have flown by, it's already eleven twelve thirteen and just enough time to fit in one final Kinesio Taping KT Level 1,2 course for 2013.

It's also the first time this course is held on a week day @Progress Healthcare. Previously it's always held over Saturday and Sunday.

Other than the local participants, we also have participants from Indonesia and Philippines who flew in for the course specially.

Here are some pictures from the course.

Guess who?

What's Bruno saying with his fingers?

Taping rhomboids

Reassessment after taping rhomboids

Treat Your Chronic Neck Pain

Women keep saying that we men don't get it, well that's quite true in some cases. We've written before on why women get neck pain (take a look at the video too).

A sustained forward flexion (or poke chin) posture is associated with increased cervical (neck) compressive loading and creep response (or deformation) in the connective tissue.

Here's more evidence from Australian researchers that people with chronic neck pain demonstrated a reduced ability to keep an upright posture when distracted. This means you may start sitting in your office chair with a good posture but your posture deteriorates when you get distracted (e.g. when your boss calls you or when your workload piles up).

58 female subjects with greater than 3 months on chronic neck pain (and 10 control subjects with no pain) participated in the study. Changes in the participants' cervical and thoracic (neck and upper back) posture were measured every 2 minutes during a 10 minute computer task.They were then split in two different exercise groups.

One group received training of the cranio-cervical flexor muscles - picture below (CCF, for which renowned neck researcher Gwen Jull is known for) while the other group received endurance-strength training of the superficial cervical flexor muscles.

Longus Colli and longus Capitis (from Wikipedia)

The researchers showed that after an exercise program targeted at training the deep neck flexors (CCF), people with chronic neck pain demonstrated an improved ability to maintain a neutral neck posture with prolonged sitting.

So here's why you should come to either of our clinics if you have neck pain. Aized has trained under Gwen Jull and she can definitely help you with your neck pain.

Reference

Falla, D Jull G et al (2007). Effect Of Neck Exercise On Sitting Posture In Patients With Chronic Neck Pain. Physical Therapy 87(4) : pg 408-417.

* Thanks to Ming and Dew for helping me get the article.

Kids Who Are Fit Learn Better

Picture by linkway88 from flickr.com

Here's why, I posted it in our other blog, have a read right here.

Children Are Less Fit Today

Children's fitness have declined significantly worldwide over the last 46 years. The evidence was just presented by Australian researchers at the American Heart Association conference recently. An analysis of 50 studies on more than 25 million children age 9 to 17 in 28 countries around the world (Singapore included) between 1964 and 2010 showed that kids today are not running as fast or as far compared to their parents.

And this spells bed news as healthcare costs look set to rise. Why? If a young person is unfit now, chances are they may more likely develop conditions like heart diseases later on in life according to lead researcher Grant Tomkinson.

Tests were done to measure how far the kids could run in a set time (usually between five to fifteen minutes) or how long they took to run a half mile to two miles. Overall, the kids today are about 15% less aerobically fit than children 30 years ago. This is about 90 seconds slowed when running a mile (or about 1.6km).

Being unfit for kids also mean that they may not learn as well and quickly compared to fitter kids. Other studies show that active pre teens are helps academic performance. More on those studies at a later post.

In Singapore, the aerobic performances of 3300 Singaporean children between 9 to 17 years tested in 1980 and retested in 1991 remained fairly stable, declining just less than 1 per cent. This is much better than the 5.5% decline internationally. However, before we rejoice prematurely, the researchers could not find any published data for Singaporean children after 1992 so we do not know for sure how our kids compare thereafter.

I grew up in Singapore in the 80's and do remember being tested yearly (so my cohort fared fairly well then according to the data). Am wondering what happened to the data in the 90's then (since the researchers could not find any data published).

The researchers suggested that the drop in endurance running performance is due to increases in fat mass. They also suggested that kids should engage in at least 60 minutes of exercise that involves the body's big muscles such as running, swimming etc.

You can read more from here.

*Picture of the 2013 Cold Storage Kids Run by Runsociety.com

Kinesio Taping At New Town Secondary School

New Town Secondary School - that's why I spent the whole morning teaching both athletic and Kinesio Taping and to the school's badminton players earlier today.

The school had contacted me a few months ago about doing a taping workshop specifically for their badminton players.

Here are some of the pictures from this morning.

Coaching Bryan to take my place....

Easy does it

Mr James Koh on top of things

Getting Mr James Koh involved

Please contact us if you are keen to have a customized taping workshop for your company, school or sports group.

*Thanks to Boo Wen Qian and Clare Tang for helping out at the workshop.

Pilatique Host Introduction To Kinesio Taping Workshop

Dean building his Lego

While my son was having fun, I was doing another Introduction to Kinesio Taping workshop in KL, this time at Pilatique. Their branch in Singapore is just behind Sports Solutions in Gemmil Lane. I had met Steven previously and he kindly agreed to let me use his studio in KL to do the workshop.

Steven and Melissa have much experience running their Stott Pilates courses both in Malaysia and Singapore and they managed to organize this really well given this was a very last minute request for them to host the workshop.

Why was this a last minute workshop? Some of you who've attended the workshop today and yesterday and will know why but for now I'll leave that story for another time....

Here are some pictures that Steven took while I was teaching.

Getting started at Pilatique - nice venue

All ears

Getting Kevin involved

Another pregnant mummy

A big thank you once again to Steven and Melissa for letting me use their Pilatique studio in KL. For more pictures have a look here.

Introduction To Kinesio Taping @ Tunku Abdul Rahman University College

Almost immediately after arriving in KL yesterday afternoon, I was whisked away to Tunku Abdul Rahman University Colleague by Yannie (who had attended a previous Kinesio Taping Level 1, 2 course and our Sports Massage course)  to do the Introduction to Kinesio Taping to some of the students there. Her friends and classmates had heard a lot about Kinesio Taping and wanted to find out more.

There was a big crowd waiting for me, more than 60 plus students plus some members of the public.
Most in the crowd knew anatomy so we could get into the practical real quick.

 Here are some of the pictures from the workshop.

Explaining the weave and the wave

Sharing one many laughs with the group

Prior to the session, one of the students had been taped by her physiotherapist using copy cat tapes. I assessed her with the copycat tape, removed the copy cat and tape reassessed her before putting the original Kinesio Tex tape (in picture below).

Elaine in her best Cleopatra pose

Well Yannie didn't take a great photo of Elaine after I retaped her with Kinesio tape, but the end result was totally different to say the least.

Final touch up for Elaine's taping

Who's causing a commotion....

I had a really great time with the students and shared many laughs with them, looking forward to teaching there again.

A big thank you to Yannie, Melodie, Windson and Steve for assisting me and to Miss Ler for letting me give a show and tell to the students.

NBA Stops Derrick Rose From Wearing Kinesio Tape....

Picture from USATSI

It was first reported on CBS Sports that Derrick Rose of the Chicago Bulls couldn't wear Kinesio tape to help ease his neck pain. Rose had been wearing it for the past 2 games to help his neck pain.

The decision was quickly reversed though (2 hours later). Have a look here. The journalist writing that article wasn't convinced of the usefulness of Kinesio tape though saying it was merely placebo effect helping.

Well, those of you who've tried the tape may beg to differ, especially those of you who've done the Level 1,2 and 3 courses.

Here's another look at the tape.

Picture from Getty Images

Achilles Pain Related To Your Glute Strength

I've just had 3 patients in a row today all come and see me with pain in their Achilles. Strangely enough, all 3 had weakness in their gluteus medius muscle despite that side being their dominant (and should be stronger) leg. That was also the leg that had Achilles pain. Hence this write up.

It has been published and I've written before on how your gluteus medius (or buttock muscles) can cause knee pain especially in females. Well guess what, I just found a published paper from Australian researchers that found a link between gluteus medius and maximus weakness and Achilles pain (in male runners). Yet more confirmation on how important your gluteus medius and maximus really are.

The Australian researchers in the published paper compared 2 groups of male runners where one group had Achilles pain while the control group did not. Both groups of  runners did short runs at about 6:40 min per mile pace and the group of runners with Achilles pain were found to activate their gluteus muscles later than the group with no Achilles pain.

And not only that, their gluteal activation was also shorter in duration compared to the pain free group. This is of significance as poorer gluteal muscle activation can cause increased hip internal rotation and adduction (movement towards the midline of the body) leading to Achilles problems.

The authors are suggest retraining and strengthening gluteal muscles be included for runners with Achilles injuries.

The causes of your Achilles pain can be multifactorial, one of which can be due to your weakness in your gluteus medius and maximus as described above. Come see us at Physio and Sports Solutions to treat the cause of your Achilles pain.

Worth a look?

Reference

Smith MM, Honeywill C et al (2013). Neuromotor Control in Runners with Achilles Tendinopathy. Med Sci in Sports Ex. doi: 10.1249/MSS .0000000000000133.

*Pictures from Flickr.com

Triathletes Feel Less Pain Than Others

Me at the 2005 SEA Games on the left

We know triathletes can handle a lot of pain, especially since they need to push through pain barriers to complete their races. A new study published recently shed some light on how good triathletes are at handling pain.

Researchers at Tel Aviv University in Israel studied a group of Ironman triathlon (swim 3.8km, bike 180km and run 42.195km--yes they go through a lot of pain) triathletes and another group (who swam, ran and did other sports but do not compete in races).

Both groups of participants went through a battery of tests including one that involved applying a heating device to one arm while the other arm was submerged in cold water. In addition the participants also had to answer a questionnaire on pain perception, stress perception and fear of pain.

Compared to the other group, the triathletes displayed greater pain tolerance during the tests. They rated lower pain intensity on the pain scale and tolerated pain longer allowing the researchers concluding that triathletes can perform at high levels because they feel less pain compared to casual exercisers. What the researchers cannot decide is whether triathletes compete in triathlons because they feel less pain or they feel less pain because they train for and compete in triathlons.

My personal experience suggests the latter. Cumulative effects of hard workouts does blunt the body and mind to pain. It makes you more willing to put up with pain and tough it out until you cross the finish line.

Reference
Geva N and Defrin R (2013). Enhanced Pain Modulation Among Triathletes: A Possible Explanation For Their Exceptional Capabilities. J Int Assoc for study of Pain. doi : 10.1016/j.pain.2013.06.031

Beards Keep You Young, Healthy And Handsome

2002 Sprint World Champion Sean Eadie

Have you thrown away your razor yet? Here's why you may wanna consider tossing your razor in the trash can and how beards can be useful other than in the looks department (as some women like men with beards).

Researchers have found that men with beards and moustaches actually enjoy numerous benefits. In a study from Queensland Australia, researchers found that beards block 90-95 per cent of UV rays, thereby slowing the ageing process and reducing your risk of skin cancer. Better still if you have asthma. Pollen and dust will get caught in that bunch of facial hair of yours, lessening your chance of an attack.

Moisture is also retained by the hair keeping you young and fresh faced (probably less in Singapore since it's already so humid, but definitely in Australia).

Down side of course is that beards can spread infection if you don't look after it and it can make eating some meals real messy.

Sean Eadie with his gold medal

Reference

Paris AV, Turnbull DJ and Smith D. (2012). Dosimetric Investigation of the Solar Erythemal UV radiation Protection Provided By Berads and Moustaches. Radia Prot Dosimetry. 150 (3): p 278-282. doi: 10.1093/rpd/ncr418

*Picture from cyclingnews.com by Rochelle Gilmore

New Marathon World Record 2:03:23 Hours

Once again, the Berlin marathon has lived up to its name as the fastest marathon in the world. This is the 9th world record ran in Berlin so far, with eight coming in the last 15 years.

The man who beat the world record this year is Wilson Kipsang, from Kenya of course. Kipsang won the bronze medal at the London Olympics last year after winning the 2012 London marathon. His previous claim to fame was missing the world record by 4 seconds when he won Frankfurt marathon in 2:03:42 hours. This was less than a month after Patrick Makau set Berlin's seventh world record after running 2:03:38 hours in 2011.

Kipsang ran Berlin in 2:03:23 hours to best Makau's time by 15 seconds. He is 31 years old, in only his fourth year of racing marathons. Berlin was his 7th race.

It was a well controlled race overall. The pace makers did a good job running the first 30 km well. Kipsang's 10 km splits were 29:16, 29:03, 29:42 and 29:11. He ran an amazing 2:49 min / km for the final 2 km.

Will we see a sub 2 hour marathon soon? Exercise physiologists say it's not possible yet. We await and see what the Kenyans can do.

*Picture from Iaaf.com

Laughter Is The Best Medicine?

Have a look at pages 10-11 in today's Mind Your Body section of the Straits Times and you will see our staff being quoted as being a skeptic when asked if laughter yoga can help with improving your aerobic fitness.

Can laughing yoga really improve your aerobic fitness? Please read on to find out. It's posted in our other blog.

What Do You Do When Your Child Tears His ACL

I was at the supermarket yesterday when I met a patient of mine and his wife. After we exchanged greetings they informed me that their teenage child had just tore his anterior cruciate ligament (ACL) during football training at the Singapore Sports School recently. 

A MRI scan taken confirmed that the ACL was torn. In addition, to complicate matters,the MCL and meniscus was also damaged and there was some bone bruising as well. They then asked for my opinion on what he should do. 

I thought writing about our chance encounter would be really helpful for other parents too and so this is how today's post came about.

My immediate suggestions were to settle the inflammation, regain pain-free full range followed by strengthening the muscles around the knee joint before deciding whether he needs to reconstruct his ligament. All of which are covered in this post in our other blog.

Concurrently, they probably needed to consult a surgeon or two as to whether he needed surgery. In an earlier post, we discussed a published study in which active adults who opted for specialized rehabilitation  after tearing their ACL may not need the operation as their knees were found to be clinically stable and had no real loss in function even five years later. 

However, their teenage son is definitely different from the active adults studied. Evidence suggests that athletes definitely perform better with a reconstructed knee. They definitely needed to discuss at length with their surgeon and their son as well whether he wants to resume competitive sports. I suggested that their son be present at these discussions as he may need to explain his own medical history to his future coaches and subsequently when he reports for national service in the army as well.

One important consideration would be the graft the surgeon chooses to use. Some studies suggest that using the hamstring graft means the hamstring muscle remains weakened even up to five years after the operation despite rehabilitation. There are also cadaver ligaments although a number of studies show that these frozen and sterilized tissues may not be as strong as the bone patella tendon or hamstring option.

One final suggestion was for their child to remain in close touch with his team. He should attend training sessions and games still and help with the coaching staff if necessary. this ensures he feels he's still part of the team and keep his spirits up.

* Picture from richseow - Raffles vs ACJC  'A' Division semi finals match, 2013.

Want To Run As Fast As The Kenyans?

Want to run as fast as the Kenyans? You may need to lose some more weight. A new study suggests that Kenyan runners are fast because of their extreme thinness (and not just due to living / training from young at altitude).

For a long time it was thought that the success of Kenyan runners were due to their walking/ running long distances on their way to school while growing up. In comparison, our kids now get a ride in fancy cars from their parents or the school bus to school and play computer games after. And, of course struggle to keep up in major marathons and get their behinds kicked.

Renown scientists Yiannis Pitsiladis and Daniel Lieberman were among the group of researchers who tested the early training theory and to their (and mine) surprise found that there was not sufficient evidence supporting that. These mostly thirteen year old Kenyan kids were really active and they covered around 7.5km to and fro in their daily trips to school and back. They also did not eat any junk food. The kids who ran and walked the most to school did not actually have the highest Vo2 max scores.

Rather, what actually stood out in their research was that the kids had a really low BMI (body mass index), i.e. they were really thin. Being fit and skinny means you'll have a high Vo2 max. These "untrained" kids were found to have the potential to run a 2:18 marathon for the boys and 2:39 hrs for the girls! And these are just the groups' averages.

So bad news for the rest of the world as Kenyan runners will probably continue to dominate distance running for a while yet.

Reference

Gibson AR, Ojiambo R, Konstabel K, Lieberman DE et al (2013). Aerobic Capacity, Activity Levels and Daily Energy Expenditure in Male and Female Adolescents of the Kenyan Nandi Sub-Group. PLoS One. 8(6) : e66552. doi: 10.1371/journal.pone.0066552.

*Picture from Flick.com

How Can the Imitation/ Copy Cat Tapes Compete?

The participants had a lot of fun on the second day of the Kinesio Taping course today. Unlike KT 1 on day one, which covered different muscle facilitation and inhibitory techniques, they learnt six different corrective techniques in KT 2

Janell in action

Hey, is that Superman's knee?

Fabian William deciding if Vanessa or Lisa can tape better

Like some of our previous participants, some of the current participants have actually attended other imitation/ copy cat tape such as Acti-tape. Kinesiology and Rock tape etc courses. Of course they were not impressed and were advised to attend Kinesio Taping courses - the original tape founded since 1979 and the real deal.

Kinesio Taping's KT 1,2 courses are held over 2 full days or 16 hours of contact time. Imitation/ copy cat tape courses are usually just half a day long. 4 hours versus 16, there is no comparison at all.

Kinesio Taping KT Level 1,2 and 3 course are the only taping courses that award recognized CME (continuing medical education) points for medical professionals who must attain a certain number of points to allow them to work with a valid license in Singapore. None of the other imitation /copy cat tape courses award CME points.

Now you know. So make sure the person treating you is trained and not using imitation or copy cat tapes.

Here are more pictures from Day 2 of the course.

Wileen under pressure

Dalong caught trying to take upskirt pictures

Class picture