Friday, June 30, 2017

How Is Running Good For Your Back?

Many of us runners have heard that running is bad for your knees (although I've put that beyond reasonable doubt here).

Many more of us have been told that running "overloads" our intervertebral discs (IVD) and causes jarring on our spine. And that in turn leads to low back pain.

 I've written about how my own back feels better after running after my accident.

Well, here's more proof that people who regularly run or walk briskly tend to have healthier discs in their spines than people who do not exercise.

This findings refute the myth that running overloads your spine. In fact it shows that running makes the spine sturdier.

The IVD's are located between the vertebrae, acting as cushions to dissipate shock. They contain a thick, sticky fluid that compresses and absorbs pressure during movement to keep your spine in good shape.

Aging, disease and/ or injury can cause the IVD's to degenerate and bulge causing back pain which sometimes can be debilitating.

Check out the evidence provided in the following study. 79 adult men and women were recruited for the study, of which two-thirds of the group were runners for at least five years. The "long distance" group ran more than 30 miles (48 km) a week while the others ran between 12-25 miles a week (19-40 km). The last group rarely exercised at all.

In order to get more information out of the study, the subjects wore accelerometers. Accelerometers measure movement in terms of acceleration forces, or how much power your body is generating when you move.

All the subjects' spines were scanned using MRI, measuring size and liquidity of each disc. In general, the runners' discs were larger and contained more fluid than those who didn't exercise!

Mileage did not matter. The IVD's of the runners who ran less than 30 miles per week were almost identical to the "long distance" group. The authors suggested that compared to moderate mileage, heavy training does not increase disc health nor does it contribute to deterioration.

Here's what's more surprising. The accelerometers showed that walking briskly at about four miles (or 6.4 km) per hour generated enough physical force to bring movement into the range associated with the healthiest IVD's.

Slower walks and standing in place were outside this range. (Now you know why your backs hurt when you stand and not move). Running faster than 5.5 miles (or 8.8 km) per hour were outside the range as well.

The "sweet spot" for IVD's health seem to be between fast walks and gentle jogs.

Things to note. This is a one-time snapshot of the subject's backs. This study cannot prove that running (or exercise) caused the subjects' IVD's to become healthier. Not yet anyway. It shows that people who ran had healthier IVD's.

It also does not tell us whether running (or exercise) can help treat existing disc problems.

My thoughts? The available evidence strongly indicates that IVD's like movement. If you've always been walking and running don't listen to the naysayers. If you have never ran before and want to, perhaps it will help if you start walking briskly first, this will strengthen your IVD's. Progress to run walks (run a little, walk a little) before running to gradually ease your back into it.


Belavy DL, Quittner MJ, Ridgers N et al (2017). Running Exercise Strengthens The Intervertebral Disc. Scientific Reports. Article No: 45975. DOI: 10.1038/sreo45975.

Friday, June 23, 2017

Please Help My Swollen Knee

My patient sent me the above picture recently asking for help. Her knee became swollen after a recent run. After icing her knee, she decided to use some "imitation/ copy cat" Kinesio Tapes but that didn't resolve the swelling and worse still gave her an allergic reaction.

Knee joint effusions (or swelling) are usually caused by the knee joint producing more synovial fluid due to aggravating factors causing damage to the joint.

As little as 5 ml of fluid can increase pressure within the knee joint. This can be a source of discomfort and concern for the person affected.

It takes a very small volume of fluid in the knee (20-30 mls) to result in biomechanical changes. The quadriceps will be inhibited as a result (meaning you are less willing to use that muscle) and strength decreases rapidly.

It has also been found that swelling in the knee affects joint mechanics particularly during landing tasks. If someone has effusions in the knee, they tend to land with greater ground reaction forces (or impact) and in greater knee extension (or straightening). This results in more forces transmitted to the knee joint and its ligaments. So you can't run and jump quite as well.

When we see knee joint swelling in our clinics, we try to remove the swelling pronto. Flossing the knee joint, using correct Kinesio taping techniques with genuine Kinesio tapes definitely helps.

My favorite is of course aqua based rehabilitation/ deep water running to take advantage of hydrostatic pressure to help with the swelling. This also allows for quadriceps/ hamstrings strengthening early on without additional loading.

If the patient has more severe effusions, we may suggest altering their gait temporarily (we call this pain free walking), using non-steroidal anti inflammatory medication (NSAIDs) or even suggest they get the joint aspirated (I've tried it, it hurts like crazy).

Once the swelling settles, it will quickly and significantly reduce internal pressure in the knee as well as improve quadriceps strength.

We will quickly select rehabilitation exercises to allow specific quadriceps muscle recruitment without increasing intra articular pressure with knee extension. This is usually done in positions of partial knee flexion (20-30 degrees).

Now you know. Come see us in our clinics if your knees are swollen.


Hart JM, Pietrosimone B et al (2010). Quadriceps Activation Following Knee Injuries: A Systematic Review. J Athl Trg. 45(1): 87-97. DOI: 10.4085/1062-6050-45.1.87.

Palmieri-Smith RM, Kreinbrink J et al (2007). Quadriceps Inhibition By An Experimental Knee Joint Effusion Affects Knee Joint Mechanics During A Single-Legged Drop Landing. AJSM. 35(8): 1269-1275. DOI://

Friday, June 16, 2017

Both Men And Women Equally Unhappy With Their Bodies

Picture by suez92 from Flickr
I do happen to see quite a lot of men and women who are unhappy with their bodies. And lately, some boys and girls too. Previously, I used to treat a lot more women who were unhappy about how their bodies looked so they'll exercise more and get injured in the process. They'll come and see me hoping that I'll make them pain free so they can exercise again.

Their injuries were easy to treat, their mindset much more difficult.

Well, it seems that men are just as likely to be insecure about their looks. I think we're in a cultural shift in terms of the ideal body image. In movies, advertisements and magazines etc, the ideal man is often portrayed and shown to be more muscular than men in the real world.

Don't get me started on the ideal female physique. The fantasy female has a slim hourglass figure with big boobs and a BMI which was in the normal range but close to the underweight category.

A recently published study of 12,716 respondents found that only 28% of men said that they were "extremely satisfied" with their appearance compared to 26% of women.

It is not surprising to note that weight was closely to people's body image. Only 24% of men were extremely satisfied with their weight while 20% women felt extremely satisfied with theirs.

These findings are consistent with the emphasis placed on the importance for being slender for women and appearing athletic and/ or lean for men.

Take note that the subjects had to opt in to take part in the study so this sample size may not be representative of the general population.

And it gets worse for kids. Adolescent boys who were dissatisfied with their body shape were found to be more likely than girls to self criticize and feel distress (Mitchison et al, 2016).

Don't let others tell you how you look affect you. You're stronger than that.


Federicks DA,Sandhu G et al (2016). Correlates Of Appearance And Weight Satisfaction In A U.S. National Sample: Personality, Attachment Style, Television Viewing, Self-esteem And Life Satisfaction. Body Image. 17:191-203. DOI: 10.1016/j.bodyim.2016.04.001.

Mitchison D, Hay P et al (2016). Disentangling Body Image: The Relative Associations of Overvaluation, Dissatisfaction, And Preoccupation With Psychological distress And Eating Disorders In Male And Female Adolescents. Int J Eating Disorders. 50(2): 118-126. DOI:

Sunday, June 11, 2017

Is Running On A Treadmill More Difficult Than Running Outside?

I've had patients travelling this past couple of weeks during their kid's school holidays. The only time they could run was on a treadmill in the hotel. A few of them have asked me why they found running on a treadmill more tiring than on the road or track. 

I thought this was strange as running on a treadmill should not be more difficult than running outside and looked it up. 

And true enough, I found an article in which runners were asked to run on a track and then asked to rate how difficult the exercise felt. They then went on a treadmill without a display unit of the speed they were running and told to set the treadmill at the same pace they thought they had just ran. Almost all the runners chose a speed that was much slower. 

Researchers have found that for most people, running biomechanics are similar whether running on a treadmill or outside (Riley et al 2008).

In fact, running on a treadmill is less jarring than running on the ground outside. A 2014 study (Kaplan et al, 2014) showed that we strike the ground with about 200 percent of our body weight while running on an outside track. This was reduced to 175 percent of our body weight when running on a treadmill. 

Evidence suggest that the hard work associated with treadmill running is psychological. Many studies show that people experience less fatigue, more vitality and greater pleasure waling outside compared to walking on a treadmill. 

Personally I feel it is definitely nicer to exercise outdoors. I don't like running on the treadmill too much. I'd much prefer running outdoors any time. I feel like a caged hamster going on and on in a wheel when I'm running on a treadmill. 

Picture from giphy
However, after my accident, I'm very happy just being able to do any exercise. A run is a run, whether outdoors or on a treadmill.


Kaplan Y, Barak Y et al (2014). Referent Body Weight Values In Over Ground Walking, Over Ground Jogging, Treadmill Jogging, And Ellipticall Exercise. Gait Posture. 39(1): 558-562. DOI: 10.1016./j.gaitpost.2013.09.004.

Kong PW, Koh TM et al (2012). Unmatched Perception Of Speed When Running Overground And On A Treadmill. Gait Posture. 36(1): 46-48. DOI: 10.1016./j.gaitpost.2012.01.001.

Riley PO, Dicharry J et al (2008). A Kinematics And Kinetic Comparison Of Overground And Treadmill Running. Med Sci Sports Ex. 40(6): 1093-1100. DOI: 10.1249/ MSS.0b013e3181677530.

Thompson CJ, Boddy K (2009). Does Participating In Physical Activity In Outdoor Natural Environments Have A greater Effect On Physical And Mental Wellbeing Than Physical Activity Indoors? A Systematic Review. Environ Sci Technol. $5(5): 1761-1772. DOI: 10.1021/es102947t.

Monday, June 5, 2017

Should I Be Using A Standing Desk?

Now, that's a different standing desk. By Liz Henry from Flickr
Sitting kills. That's the headline many of you would have seem or read in the last few years. You've also read or heard that sitting is the new smoking. And if you've been following our blog, I've written before that despite exercising a lot, if you sit too much at work, you can be what is known as an active couch potato. Worse still, all that sitting can negate the benefits of your exercise.

Well fortunately for me, I hardly get to sit much when I'm working in the clinic.

Many of my patients have asked about the benefits of a standing desk. I even found a picture (below) of former British Prime Minister Winston Churchill working on his slanted standing desk.
Kurt Hutton/picture post via Getty
Standing desks have been suggested as an alternative to the ills of sitting. And there's studies to show that working upright (at a standing desk) can help correct your posture and tone your stomach and legs without compromising your focus.

And in kids, standing desks seems to increase their energy levels and reduce hunger.

My take on standing desks? I've seen many of my patients go straight from sitting to a standing desk get different problems. Being unaccustomed on their feet all day long poses new risks. It can inhibit proper circulation and add additional pressure to your hips, legs and lower back. Sort of like jumping from the frying pan into the fire if you ask me.

And unfortunately, research shows that standing once or twice throughout your work day will not offer you enough relief. So don't switch to a standing desk if you've been sitting all day straight away, make sure you gradually phase it in.

What are the alternatives? I prefer the stability ball or better still the saddle stool with adjustable height so that you can perch on it if you're not quite used to standing yet.
Our clinic's saddle stool
There's also the desk cycle, though I definitely haven't tried it yet.
Desk cycle

Commiassaris DA, Konemann R et al (2014). Effects Of A Standing And Three Dynamic Workstations On Computer Task Performance And Cognitive Function Tests. Appl Ergon. 45(6): 1570-1578. DOI: 10.1016/j.apergo.2014.05.003.

Garcia MG, Laubil T and Martin BJ (2015). Long-term Muscle Fatigue After Standing Work. Human Ftr and Ergo Society. 57(7): 1162-1173. DOI: 10.1177/0018720815590293.