Sunday, June 30, 2019

Power Plate - How Useful Is Whole Body Vibration Training?

Picture from Power Plate
Recently a patient who is osteopenic came in to our clinic telling me that her trainer/ Pilates instructor got her to do some Power Plate/ vibration training otherwise known as whole body vibration training (WBVT) in the literature to help increase her bone mass or bone mineral density (BMD).

Power Plate machines have been very popular in the USA since the 1990's. I remember being a young physiotherapist at the Singapore Sports Institute (SSI) and having presentations (by the vendors) on how they work at our clinic then. We even had them on loan to us for a while to allow the athletes to try.

How does it work? The theory behind it is that by standing on the vibrating platform, vibrations can be transmitted to the large bones of the body. By "absorbing" these vibrations, the person standing on it gets stimulation in their bones and it helps improve their BMD. This is especially useful for those who cannot (due to osteoporosis) or do not engage in high impact exercises.

Another claimed benefit is that WBVT is very efficient at promoting bone health since the large number of vibrations (> 1,800 per minute) saves you time compared to running or weight training.

WBVT uses high frequency mechanical stimuli generated by a vibrating platform (e.g. Power Plate) transmitting it through the body. There are vertical or side alternating types of vibration. Most common frequencies of the magnitude of vibration are in the 30-50 Hz range.

That's when I decided to see what's been published recently so far on WBVT since the SSI didn't purchase any.

Researchers in South Africa looked at how ten weeks of WBVT affected the bone density of well trained cyclists (Prioreschi et al, 2012). One group did WBVT at 30 Hz for 15 minutes thrice weekly while riding as usual. The other control group continued with their normal training without the WBVT.

In addition, both groups of cyclists were matched by age, body weight and height with other sedentary subjects for further comparison.

All the subjects underwent regional dual X-ray absorptiometry (DEXA) scans to determine bone bass and BMD levels.

As expected, both groups of cyclists had lower pelvic bone mineral density than the sedentary subjects with no other differences observed (showing that cyclists who just cycle) have poorer done density despite having superior aerobic fitness.

After ten weeks of training, the WBVT group showed a significant increase in their hip bone mineral density (1.65% better) while there was no change in the cyclists who didn't do WBVT. By the end of the ten weeks, the control group had significantly lower spine (back) mineral density compared to the start whereas this this loss was not observed in the WBVT group.

However, another study involving swimmers did not show similar results (Gomez-Bruton et al, 2017) Researchers studied the effects of WBVT on a group of adolescent swimmers for six months. They too were split into two groups with one doing 15 minutes of WBVT three times a week. BMD's of all the swimmers were measured before and after six months of training. The results did not show any benefits for the swimmers' BMD.

I have to point out we're comparing adult cyclists and adolescent swimmers, so the results may be conflicting. The groups of cyclists and swimmers tested were also rather small. Other than that, there isn't a lot of other published research on athletes regarding WBVT.

However, there is a comprehensive review published last year summarized the findings from 17 other studies on a range of different populations (Sanudo et al, 2017). The conclusion was the WBVT seems to help children and adolescents with compromised bone mass to increase the BMD. These improvements however, are limited in postmenopausal women while there is no evidence of any benefits in young adults.

So I told my patient that probably a mixture of aerobic exercises and strength training would be more beneficial if she wanted a higher BMD or stronger bones.

Those of you who just swim, bike and do not do weight bearing exercises, do take note that you will probably need to incorporate some form of weight training or high impact/ HIIT activity to your weekly training so that you can keep your bones in good condition.


Gomez-Bruton A, Gonzalez-Aguro A et al (2017). Do ^ Months Of Whole-body Vibration Training Improve Lean Muscle Mass And Bone Mass Acquisition Of Adolescent Swimmers? Arch Osteoporos. 12(1): 69. DOI: 10.1007/s11657-017-0362.

Prioreschi A, Oosthuyse T et al (2012). Whole Body Vibration Increases Hip Bone Mineral Density In Road Cyclists.Int J Sp Med. 33(8): 593-599. DOI: 10.1055/s-003201301866.

Sanudo B, de Hoyo M et al (2017). A Systematic Review Of The Exercise Effect On Bone Health: The Importance Of Assessing Mechanical Loading In Perimenopausal And Postmenopausal Women. Menopause. 24(10): 1208-1216. DOI: 10.1097/GME.0000000000000872.

Saturday, June 22, 2019

Need 10,000 Steps A Day?

My step count today
I've had many patients wear activity trackers just so they know how steps they take each day. 10,000 steps a day seems to be the standard recommendation to lose weight, lower risk of heart disease and to be healthy.

In fact a few years ago, the Health Promotion Board even had a contest that enabled participants to win air tickets if they accumulated 10,000 steps daily.

Do we really need to take 10,000 steps a day to be healthy? We are likely to assume it is 10,000 steps since many of our watches, smart phones and activity trackers use that number as a goal.

Well, newly published research shows that you don't necessarily have to walk 10,000 steps to reap the full benefits.

The researchers studied 17,000 women by having them wear an activity tracker the whole time during their waking hours for seven days. The tracker tracked the steps each subject took per minute during the day, but without showing any readout of the totals so the subjects would not know or respond to the count. The subjects were monitored for four years after the study.

Those who walked an average of 2,700 steps a day had the highest risk of dying.

After that, the more steps they took, the longer their lifespan up to a 7,500 steps. After 7,500 steps, there were no extra benefits. Intensity did not matter. How fast or slow the subjects walked made no difference.

The sweet spot for reducing the risk of dying prematurely was about 4,400 steps per day. Compared to those who walked 2,700 steps, those who walked 4,400 steps per day had  a 41 per lower risk of death.

Now you know.

IM Lee, Shiroma EJ et al (2019). Association Of Step Volume And Intensity With All-cause Mortality In Older Women. JAMA. DOI: 10.1001/kamainternmed.2019.0889.

Sunday, June 16, 2019

Definitely No Bull

Energy drinks on offer - you buying?
My previous article on energy drinks like Red Bull was one of the more popular articles the year I wrote about it. Many readers commented that they were not aware how bad energy drinks were. In fact, the World Health Organization issued a statement calling energy drinks a potential danger to public health.

Now it seems that there may be more reasons to avoid energy drinks.

A recently published article suggest that caffeinated energy drinks can also raise blood pressure and alter your heart's electrical circuit.

That is definitely not surprising considering there was a case report showing atrial fibrillation (or abnormal heart rhythm in a 14 and 16 year old boy) and even a case of heart attack in a 19 year old previously after consuming energy drinks

The researchers tested two groups of healthy people between the ages of 18-40.  One group drank energy drinks that can be easily purchased containing 304-320 milligrams of caffeine while the other drank a placebo drink consisting of lime juice, carbonated water and cherry flavoring.

The participants drank 946 ml (or 32 ounces) of either one of those drinks on three separate days while researchers measured their heart's electrical activity and blood pressure. Measurements were taken before they drank, twice within the hour that they drank the beverage and four hours after.

Now, you'll be shocked to read that they group that drank the energy drink showed higher QT intervals up to four hours later. The QT interval is the time it takes the lower chambers of your heart to prepare for a beat. In general, the normal QT interval is below 0.4 to 0.44 seconds. If the interval is too short or long, it can cause arrhythmia. This is a condition where the heart beats abnormally.

Other than the change in QT intervals, those that drank the energy drink had a significant increase in systolic and diastolic blood pressure.

Coffee lovers will be glad to know that the researchers do not think that caffeine is the main culprit for the increase in QT interval. It may be the caffeine in combination with the other ingredients like sugar, high fructose corn syrup, artificial sweeteners and non nutritive stimulants like guarana, ginseng taurine, L-carnitine, inositol, verba mate and D-glucuronoalactone that caused the changes.

The researchers cautioned the elderly, young children and those of you who have underlying long QT intervals, hypertension and taking antibiotics and anti-arrhythmic medication to be careful with consuming energy drinks.

Also, consuming a few cans of the energy drinks can certainly exacerbate those with underlying heart conditions or those taking certain heart medications.


Shah SA, Szeto AH et al (2019). Impact Of High Volume Energy Drink Consumption On Electrocardiographic And Blood Pressure Parameters: A Randomized Trial. JAHA. 8(11). DOI: 10.1161/JAHA.118.011318.

Now that's a lot of bull you do not want

Monday, June 10, 2019

Back From Mount Everest To Sports Solutions

Fresh from returning from her climb, PS came to our clinic today and presented me with an autographed picture of her on Mount Everest. Very kind of you PS, thank you very much indeed!

Here's a close up
Whilst treating her, she shared her stories from the climb, leaving me spellbound for more. It was really nice listening to her experience. Glad our clinic can be of help.

She also shared that she brought her Strassburg sock with her to Everest. So we decided that we will hold a raffle in her honor. The person who gives the best reason as to why they need a Strassburg sock will win one.

I'll let PS decide who gives the best answer on our Facebook page.

Here's the Strassburg sock you readers stand to win. Please go to our clinic's Facebook page and leave your comments. The winner will be announced end of this week on 160619. All the best!

Strassburg sock
Please like our FB pages and share the post.

Sunday, June 9, 2019

How Gelatin (Jell-O) May Help Healing

Home made soursop flavoured
I came across Professor Keith Barr's work on ligaments, tendons and how they heal etc and was amazed that gelatin may hold the secret to recovering from many ligament and tendon injuries.

Professor Baar and his colleagues at UC Davis have been growing "engineered ligaments" in the university lab, subjecting them to all sorts of loads/ abuse) to understand what factors affect injury risk and healing. They may also have found how to train and feed (yes, you read correctly) connective tissue like ligaments, tendons, bones and cartilage.

We've always thought that connective tissue does not heal well. But Professor Baar's "engineered ligaments" grown from remnants of ruptured ACL's collected during reconstructive surgeries showed that it may not be totally true.

When ligaments are "exercised" by movement/ stretching, they respond by forming new collagen fibers (these are the building blocks for new ligaments and tendons). However, this process peaks in about ten minutes and begins to switch off if exercise is continued. Exercising for three hours may be good for your heart and muscles, but not great at all for your tendons, ligaments and other connective tissue.

The "engineered" ligaments also respond to proline, an amino acid. Professor Baar found that best way to ingest proline was taking gelatin. Their study showed that blood test of participants in a skipping rope test for six minutes, three times a day doubled the rate of collagen growth. When the participants consumed 15 grams of gelatin with Vitamin C an hour before each skipping rope session, collagen growth doubled again.

Now, I'm not asking all of you to run out and buy all the gelatin you can get, cook and eat it an hour before doing the specific exercises you need. Skeptics among you readers (myself included) will probably scoff at the idea of eating gelatin and hoping that it will specifically go to strengthen the injured ligaments and tendons in your body.

Professor Baar himself has said that as word of his research spreads, some athletes may develop unrealistic expectations. Eating gelatin without doing the specific strengthening exercises to help new collagen fibers grow in the stressed areas is one. The optimal exercises will depend on what type of connective tissue you're trying to strengthen.

For the injured and non injured athletes that are reading this, I've read that hydrolyzed collagen powder is easier to use compared to gelatin as it does not require boiling and cooling down. It also seems to be equally effective for tendons based on preliminary research in Professor Baar's lab.

For those of you who torn your ACL fully, no amount of gelatin plus specific exercises would help. This is more for patients who have strained (not totally torn) ligaments and tendons.


Lis DS and Barr K (2018). Effects Of Different Vitamin C-enriched Collagen Derivatives On Collagen Synthesis. Int J Sp Nutr Ex. DOI: 10.1123/ijsnem.2018-0385

Shaw G, Lee-Barthel A et al (2017). Vitamin C-enriched Gelatin Supplementation Before Intermittent Activity Augments Collagen Synthesis. Am J Clin Nutrition. 105(1): 136-143. DOI: 10.3945/ajcn.116.138594.

*picture by Smabs Sputzer (1956-2017) from Flickr

Sunday, June 2, 2019

Change The Arms, Change The Neck

First assessment
Here's another patient who came in to our clinic complaining of neck pain, tingling, and sensations of electric currents/ pins and needles, down his left arm.

This patient works as an electrician and often has to be in awkward positions running electrical wires. He feels worse after prolonged time spent looking upwards - mostly due to running ceiling electrical wires.

He was referred to our clinic by another friend who had seen us and gotten better without needing surgery as suggesting by his surgeon.

Just like the other lady who had neck pain, I didn't treat his neck. Just treated his arms and shoulder girdle.

Have a look at the picture after treatment.
After treatment
You can see quite an dramatic change not only in his neck but in his rib cage and hips too. Even his nephew who came with him was amazed at the change.
Before and after
Have a look when I put both pictures together above. Quite a big difference? All done in less than an hour.

What did I do? No mobilizations or manipulations of the thoracic and cervical spine at all. Just treating the arm lines as seen in the picture below except for levator scapulae. Left that out as I wanted to "exclude" the neck.
Superficial and deep back, front arm lines