Tuesday, April 30, 2019

Don't Run More Than Two Marathons A Year

ST 300419
For the longest time, I've told my patients that the elite marathoners take up to six week to recover fully from a marathon. Mere mortals like us probably take much longer.

Yes they do start running again a few days later. The legs feel pretty much recovered after a month or so. But they don't race again for the first six weeks. That's one day off for every kilometer they raced in the marathon.

And they just restrict themselves to them just two marathons a year. If not, they don't recover fully. That hampers their preparation for the next race.

Yes, you can read from the article above that the best marathoner in the world, Eliud Kipchoge limits himself to just two marathons a year. Are you running more than that in a year?

"All the team - the coaches, the medical staff - believe that if you run many marathons, then you can't run strong marathons.

We prepare well, plan well, then run a beautiful marathon. Then come back, relax, prepare well and plan again.

The training is intense. Those running five a year, I want to meet them and ask them to describe their training.

It takes three, four months to make your mind cool and confident. You need to be ready in your head. To feel inspired.

The mind drives the body. The body can't drive the mind. If the mind is tired, you are done and when you train, you hit the wall often."

I rest my case.

Go and have a look. The article is in page C8 in today's Straits Times, under the Sports section, taken from The Guardian.

Monday, April 29, 2019

Shoulders And Arms

Really heavy ....
It's back to learning as I attend another course with Anatomy Trains. This time as you can see it's on the Shoulders and Arms.
How do all the scapulars compare?
It's fairly intense in terms of theory, videos to watch and lots of practical as well. Looks like the next couple of days will pass fairly quickly.

New vocabulary
New participants to meet, new terms to get used too and new ways to "body read" each other. Looks like I may have to burn midnight oil to review everything we've done today.

Sunday, April 21, 2019

What Happens When Patients Find Out How Good Their Doctors Really Are?

Looks like doctors and mercenary medical agents are back in the news for all the wrong reasons again in yesterday's Straits Times article.

While we are on doctors, I came across this interesting article on "The Bell Curve: What happens when patients find out how good their doctors really are?"

It gave me a totally different perspective on the medical world. Be it in medicine, physiotherapy or any other health related field, it is now fashionable to say we're practicing evidenced-based medicine, evidenced-based physiotherapy etc. This simply means whatever we do or use to treat patients is backed by research rather than our own instincts or ad-hoc experimentation.

The article documented the results of a Cleveland pediatrician named LeRoy Matthews in the 1960's. Due to his persistent efforts, his hospital's mortality rates for cystic fibrosis was less than two percent compared to higher than twenty percent for the rest of the country (USA). What made his program different was that he started aggressive treatment long before his patients became sick.

Warren Warwick, the pediatrician who conducted the study of LeRoy Matthews much higher than normal success rate, now heads the Minneapolis cystic fibrosis program. Ever since that study, Warwick has tried to do better than everyone else. It currently has the best results in the country.

What makes him and the hospital's program different is his combination of focus, aggressiveness and being inventive. He thinks hard about his patients, pushes them and always improvises.

From the article, "We are used to thinking that a doctor's ability depends on mainly science and skill. The lesson from Minneapolis is that these may be the easiest parts of care. Even doctors with great knowledge and technical skill can have mediocre results; the more nebulous factors like aggressiveness and consistency and ingenuity can matter enormously."

The first question that comes to my mind after reading the article is where Sports Solutions and Physio Solutions stand on a bell curve for Physiotherapy? We need to push ourselves to make us the best at making patients get better fastest. To always learn, to be consistent, to innovate. That is our promise to you.

Here's the link to the article. It takes fairly long to read, but definitely worth your time.

Sunday, April 14, 2019

It May All Be In The Hips

*Very nice hip extension, Prefontaine leading Viren
Last week article was all about reducing your injury risk to stay healthy so you can keep training consistently.  Training consistently allows you to improve. For those of you who participate in races, this week's article will discuss how to improve your athletic performance with another simple exercise.

The biggest muscle we have in the human body is the big and very strong gluteus maximus muscle (there are also two smaller gluteus medius and gluteus minimus muscles). The gluetus maximus muscle extend our hips. This is evident when we're climbing stairs, running up slopes and especially if you're having to sprint for the finish line.

My patients who run tell me they often go to the gym to do strengthening exercises as well to get stronger. Often they are told by their personal trainers to make their quadriceps stronger. Nothing against making the quads stronger, but if you're hoping to improve your sprint performance by doing lots of squats then you should consider another exercise.

Researchers studied whether training the gluteus maximus or the quadriceps stronger was more effective for performance found that the hip thrust exercise (for gluteus maximus) more specific and better gains transferred to running/ sprinting (Gonzalez-Garcia et al, 2019).
Hip thrust (also called bridging)
What exactly is a hip thrust? The easiest way to do it is lying on a firm surface with your knees bent and lift your buttocks (also known as bridging). You can add resistance by doing it with a elastic band around your waist to make it more difficult. In the hospitals, this exercise is often given to patients who are recuperating from surgery.
Single leg version on unstable surface
To progress, you can bridge on an unstable surface like a gym ball with both legs followed by single leg (picture above).

If you're in the gym, while facing upwards, you can rest your arms and neck on a bench and bridge with your knees bent. I've also seen gym rats resting a loaded barbell on the hips to make it more difficult.

All the above described exercises are all suitable and good if you want to make your hip extensors (gluteus maximus) stronger. However, they are all done lying down, i.e. in a non weight bearing position. In running, you are definitely upright and not lying down.
Starting position
Hence, my preferred way to make the gluteus maximus stronger is in a standing position with an elastic band. Lean forward slightly with your back straight and straighten your right leg against the resistance of the elastic band. Repeat with good form until fatigue and do the same with your left leg.
Extending the R hip
I find that this way of strengthening the gluteus maximus is more specific and mimics the running posture. Strength gains are more easily transferred.


Gonzalez-Garcia J, Morencos E et al (2019). Effects Of 7-Week Hip Thrust Versus Back Squt Resistance Training On Performance In Adolescent Female Soccer Players. Sports. 7(4): 80. DOI: 10.3390/sports7040080.
*Taken from page 46 and 47 with my iPhone X from one of my favorite books "The Olympians" by Sebastian Coe with Nicholas Mason.

You see Steve Prefontaine leading Lasse Viren in the 1972 Munich Olympics with brilliant form! Excellent hip extension, Viren with his R hip, Prefontaine with his L hip. Both were wearing Adidas at this Olympics.

Prefontaine would later be the poster boy for Nike while Viren would do the same for Asics.

Sunday, April 7, 2019

How To Reduce Your Injury Risk By Half

Starting position
Want to reduce your risk getting a running injury by half with no equipment needed? It takes less than ten minutes a week. It also helps you become a stronger and faster runner. What's the catch? Some of you will already be asking.

It almost sounds to good to be true, but this has well documented research to back it up. Researchers reviewed 15 studies (8459 male and female subjects) across different sports with subjects ranging from 18 to 40 years old. Those that did the Nordic hamstring exercises (also know as Icelandic curls) decreased their injury rates by 51 percent.
Lean forward and hold
My patients often struggle when I show them how to do it. We get the patient to kneel at the edge of our treatment bed with both ankles secured. The patient then progressively leans forward from the knees while keeping their back straight. When they can't hold the position any longer, they just use the hands to catch themselves as they fall forward.

Please bear in mind that the Nordic hamstring exercise (NHE) is extremely difficult to do. Some of my patients who had their anterior cruciate ligament (ACL) reconstructed can barely manage one rep before their hamstrings start to fatigue/ cramp. It's also quite common to get delayed onset of muscle soreness (DOMs) after attempting the NHE.

To progress, you can slowly increase the number of repetitions over two to three months. You can also lean forward further and hold that position longer before you fall forward.

For patients who struggle to do a single repetition, I'll get them to start with another similar exercise to the NHE that lengthens the hamstring at the same time while it's contracting. I get my patients to do the Arabesque first. The patient stands on one straight leg with the other leg behind while attempting to reach forward to touch a bottle or a cone etc. This movement is repeated until fatigue sets in.

When the Arabesque becomes easy, they can progress to doing the NHE.

The above two exercises are also very useful in Australian Rules football, soccer and rugby since the hamstrings are commonly injured in these sports too.

One last tip, if you can't find anyone to hold your ankles while doing the NHE, try putting your feet under a couch with a mat in front to cushion your landing.


van Dyk N, Behan FP et al (2019). Including The Nordic Hamstring Hamstring Exercise In Injury Prevention Programmes Halves The Rate Of Hamstring Injuries: A Systematic Review And Meta-analysis Of 8459 Athletes. BJSM. DOI: 10.1136/bjsports-2018-100045.