Friday, August 23, 2019

Run Longer Or Run Faster?

Picture by Richseow from Flickr
Your coach many plan a different variety of training runs for you. You can do a steady long run, threshold runs, add in some fartleks, some hard core intervals / HIIT and of course the recovery runs.

However, it boils down to really just two options if you want to fitter and faster. You can train harder with a higher intensity or you can train more. In an ideal world, I would run long and run hard daily. That doesn't happen of course, otherwise injuries would soon be knocking on your door.

Those two variables, intensity and volume are the "bread and butter" of all training programs for running, cycling, football, all sports really. Sports psychologists would add mental skills training to the mix.

If we had to choose one, which is better? Which gives you more bang for your buck?

That was exactly what two groups of researchers were debating over a recent article published recently. The paper investigated whether exercise intensity trumps volume to promote increases in skeletal muscle mitochondria (power generators of our cells).

With more mitochondria in our cells, the stronger we become, so the debate was whether running faster or running longer is better at boosting endurance.
Nice to do a long run here
Those in favor of high intensity training explained that when comparing training programs where subjects do an equal amount of work, those training at higher intensities and lower volume see the biggest gains in mitochondria. That group also suggested that vast majority of people are unwilling or don't have the time to spend long periods of time doing high volume training anyway (Gibala et al, 2019).

The second group of researchers presented evidence of a combined analysis of 56 studies that showed a strong relationship between total training volume and mitochondrial changes suggesting that volume is really the key variable (Bishop et al, 2019). That same analysis did not find any significant relationship between intensity and mitochondrial changes.

The second group also conceded that higher intensity exercise will result in a greater mitochondrial response per minute of exercise. This is a crucial point as we live in a time where everything competes for our time and attention. Getting stronger and fitter in less time may be more efficient for people to meet their fitness goals (Gibala et al, 2019).

In competitions however, we race to see who can be the fastest runner, cyclist etc, not who spent the least amount of time training. Those of you who train to race would definitely do a combination of long slow distance, interval/ HIIT training and medium paced runs. I did all of the above anyway when I was still competing.

And I can tell you many roads lead to the podium. Since both intensity and volume helps trigger mitochondrial adaptations, you should do which you enjoy and helps you improve more.

There are times I really enjoy the camaraderie of doing long runs and long rides. However I also love that adrenaline rush, the release of endorphins I get when putting the hammer down while running or cycling hard.

If you do the same long slow runs or interval training over and over again, it will eventually lead to diminishing returns. Or it will drive you crazy. I know I will go nuts if I just do long slow distance and nothing else.


Bishop DJ, Botella J and Granta C (2019). Cross Talk Opposing View: Exercise Training Volume Is More Important Than Training Intensity To Promote Increases In Mitochondrial Content. J Physiol. DOI: 10.1113/JP277633.

MacInnisMJ, Skelly LE and Gibala MJ (2019). Cross Talk Proposal: Exercise Training Intensity I More Important Than Volume To Promote Increases In Human Skeletal Muscle Mitochondrial Content. J Physiol. DOI: 10.1113/JP277634.

I wish I can fly ....

Thursday, August 15, 2019

You Definitely Do Not Need Extra Sodium Supplementation, Not Even In Hot Conditions

A few weeks ago I wrote about why it is not necessary to consume sodium to prevent muscle cramps. That post was popular as many runners shared it.

Well, here's further proof and confirmation that you do not have to consume sodium, even in a long ultra marathon.

Researchers found that majority of ultra runners (66 percent) in a race feel that sodium supplements should be made available at aid stations to prevent hyponatremia  and muscle cramping.

Previous research shows that consuming extra sodium does not prevent cramps, dehydration or nausea. Findings actually show that excessive sodium consumption can lead to the extra sodium left as residue on your skin and clothes. This is commonly seen as a white deposit left on your skin especially after a long training session or race.

After you consume too much sodium, it may lead to drinking too much water causing hyponatremia. Trust me here, as I'm guilty of this actually. I spent 2 days in the intensive care unit of a Hong Kong hospital when I had hyponatremia during a 100 km race in November 2000.

The researchers also found that a typical race diet (sports drinks, gels and bars) will usually provide enough sodium for your needs. Moreover sodium itself is not a source of fuel that can help sustain your efforts.

The researchers concluded that that study showed that no sodium supplements are required for ultra marathons in hot conditions lasting 15 to 30 hours (Hoffman et al 2015).


Hoffman MD et al (2015). Sodium intake During An Ultramarathon Does Not Prevent Muscle Cramping, Dehydration, Hyponatremia, Or Nausea. Sp Med Open. 1(1): 39.

Hoffman MD  and White MD (2019). Belief In The Need For Sosium Supplementation During Ultramarathons Remains Strong: Findings From The Ultrarunners Longitudinal Tracking (ULTRA) Study. Appl Physiol Metab. DOI: 10.1139/apnm-2019-0238.

Monday, August 12, 2019

Patient Can Run 10 Km In An Hour But Can't Stand For 30 Minutes

My patient came in complaining that she can run for an hour with no pain/ problems. However, when she had stand in line at the security checkpoint at the airport for barely 30 minutes, her back started to hurt. So why does standing often feel harder than running?

We all have to queue at some point or other in our life. Especially in Singapore, whether it's waiting in line for your favorite food or lining up for the the Bicentennial 20 dollar note that was launched recently. Or at the airport.
Queuing for the Bicentennial note
When we are walking or running, our muscles contract and relax (or flex and extend). When we stand still in upright position, we are lengthening (or straightening) our hip flexor muscles in a sustained position. After a while in that position the Psoas and Illiacus muscles fatigue. The human body is made to move, it is not made to be in stationary postures.
Psoas and Illiacus muscles
If if you hold your hand straight in front of you, they fatigue quickly. This would be similar if you're standing still.

Some people stand with they knees hyperextended, this can further extend your hip flexors and in some cases makes an arch (in the foot) drop a little (although I personally don't think it is necessarily bad).

You can easily remedy the above by standing with "soft knees". Bend the knees slightly about five degrees or so, just so you don't hyperextend them.This helps to distribute your weight more evenly.

Research shows that nearly 50 percent of people develop some kind of back pain from excessive standing, even if they have never experience back pain previously or had a previous injury.

Taking walking breaks for five minutes every 30 minutes can help alleviate the back pain you get from standing. This is from the small movements your spine gets from walking. (have a look at our previous article on how running can be good for your back). Subjects that walked (faster than  a stroll), but slower than a run had less low back pain after two hours of standing compared to those who just stood.

If you can't take a walking break, other ways to dissipate forces from accumulating in your back include placing your foot on a curb or ledge. Keep alternating legs to reduce load on different sides of your back.

I used to work at the old Raffles Hotel for a couple of months while waiting for my exam results and I did the breakfast shift at the main restaurant and night shifts in the then "Tiger Tavern" and Long Bar.
Foot rest at the Long Bar in Raffles Hotel
There was a foot rest all around the bar counter for patrons to rest their foot. So they can linger in the bar longer. Now you and I know why.


Gallagher KM, Payne M et al (2019). Walking Breaks Can Reduce Prolonged Standing Induced Low Back Pain. Human Movt Sci.  66 : 31-33. DOI: 10.1016/j.humov.2019.03.012

Some history for you readers. The Tiger Tavern was named after a tiger was killed in the old Raffles Hotel.

Sunday, August 4, 2019

What? $3000 For A Steroid Jab!

Straits Times 030819, page B5, home section
Wow, that's very expensive for a steroid/ cortisone injection! What shocked me was that some doctors actually charged more as a result of the court case against an orthopaedic surgeon whose patient complained to the Singapore Medical Council after she developed side effects. 

On the flip side, some doctors stopped giving the steroid/ cortisone injections after that case.

As an athlete or as someone who is actively exercising, you definitely do not want to have a steroid/ cortisone injection. There are high chances of degenerative changes in the surrounding area where the  steroid is injected.

Here's a true story when I was working at the Singapore Sports Institute (formerly Singapore Sports Council). I've never written about this before and I guess it's time to put it on record. Back then, I used to treat the badminton players frequently and followed them on training trips and competitions.

In 2006-2007, Ronald Susilo was having right elbow pain, his playing arm. He was subsequently injected with steroids (cortisone) to help with the pain so he could train and compete.

Tragedy struck at the 2007 SEA Games in Thailand. He tore a forearm muscle while playing at the Games. I was tasked with accompanying him back to Singapore for a visit to the surgeon to repair it.

I've accompanied Ronald for all his sporting surgeries. His shoulder in 2004, Achilles in 2005 and right forearm in 2007. These were his words to the surgeon, "Gino knows my body better than I, he's been around for all my operations."

As usual I was waiting outside the operating theater for Ronald when they operated on his forearm. The first words the surgeon said to me when he came out of the operating theatre was, "We found cortisone still in his arm." My interpretation was that he meant too much steroid/ cortisone had been injected into Ronald's forearm. That probably caused the muscle to tear.

Granted, there would definitely be occasions where a steroid/ cortisone injection is needed.  However, speaking from experience, if you're an athlete or participating in sports regularly, please reconsider if your doctor suggests a steroid/ cortisone injection. There are definitely other ways to treat your pain/injury besides getting a steroid/ cortisone injection.

Here's a picture of Ronald after his left Achilles tendon rupture in 2005 at the World Badminton Championships. Kudos to him for coming back to play after each and every badminton career threatening surgery.

Run For The Hills

Oops, wrong picture?
I first started running cross country races at Macritchie reservoir when I was twelve. I soon realised that when the going got tough up the slopes, I was able to hang in there with the faster runners and sometimes even gap them. That was a big boost for my confidence as I was just starting to get serious about running then.

So definitely good advice in today's Sunday Times article on running hills for strength to prepare for the 2019 Straits Times run. Running hills are much more "run" specific to get stronger rather than other forms of strength or weight training.

Now, don't get me wrong, I'm not saying don't do weights, I definitely do strength training too.

I've written before on why running hills are important. And the fact that running down slopes does not harm your Achilles tendon.

Personally I like to run hard up slopes for training. Either I'll find a nice gradual incline of about 800 metres to a kilometre long and run repeats up the slope. I usually walk or jog down very slowly to recover.

Or a shorter, steeper slope of about a hundred meters long and run really hard up the slope. Again, I'll normally walk or jog down slowly to recuperate before repeating till I get tired.

New runners please add hills to your training gradually.

Here's the actual article in today's paper. It's on page A22 under the Sports section.