Saturday, August 29, 2020

The Gaiter Controversy In Today's Straits Times Article

ST 290820
I read with interest earlier last week regarding the dispute between an SBS bus driver and his refusal to allow a passenger who was wearing a gaiter. The bus driver obviously felt that gaiters are not masks.
ST 240820 on page B9
A gaiter is a tube of fabric worn around the neck to keep skiers or runners warm in cold weather. They are currently popular with runners, cyclists etc in other countries because they can be pulled up to cover the nose and mouth and used as a mask.
Then in today's Straits Times (page A10, under Top of the news), the writer questioned if all masks are created equal when it comes to protection from Covid-19.

The author quoted a study (listed in my reference list) from Duke University that looked at all different kinds of face masks and measured how many droplets of saliva made it through each mask.

When the neck gaiter was tested, they found more droplets than if the person was wearing no mask or other face covering. This single layer neck gaiter was made of 92 percent polyester and 8 percent spandex.

She wrote that the researchers said the neck gaiter "seemed to disperse the largest droplets into a multitude of smaller droplets which explains the apparent increase in droplet count relative to no mask in that case".

What the Straits Times writer did not mention was that the Duke University study was done with just one person. Yes, you read correctly. N = 1. More like a case study really. Next, the way the researchers did measurements was with a phone camera and lasers. Surely, that's not a reliable way to measure particles of droplets.

I'm not sure if the Straits Times writer  even read the article. Even the authors of the Duke University study said that people are "drawing too much" from the article. The authors' intent was not to say this mask does not work or never use gaiters. That's not even the main part of the article.

If you search further, you will find that researchers from Virginia Tech did a neck gaiter study and found that gaiters "perform similarly to cloth masks and very well if doubled over." You can see the PDF document by authors Jin Pan and Linsey Marr on neck gaiters right here.


Fischer EP, Fischer MC, Grass D et al (2020). Low-cost Measurement Of Facemask Efficacy For Filtering Expelled Droplets During Speech. Sci Advances. DOIL 10.1126/sciadvabd3083. Read the article here.

Images when I googled "neck gaiter" above.

*As reported by another journalist in today's Sunday Times (page A2, Top of the news), MOH has since reiterated that makeshift face coverings such as bandanas, scarves and neck gaiters should not be used. This is under recommendations of the multi-ministry task force tackling the pandemic.

Again the Duke University case study was quoted. Again I'm wondering if the journalist even bothered to read the study itself ......
ST 300820 on page A2

Friday, August 28, 2020

Another Call For Bike Lanes In Singapore

ST 280820
After my previous article written earlier this month, it is heartening to see transport minister Ong Ye Kung suggest that certain under-used road lanes be converted to cycling and bus lanes in today's Straits Times (page A4 under Top of the news).

Well, definitely preferably cycling lanes please.

Remember Prime Minister Lee Hsien Loong's 2017 National Day Rally speech on the number of Singapore citizens with diabetes?  I suggested weight training as evidence suggests it helps with improved insulin sensitivity among people with diabetes and pre diabetes. If more Singaporeans start to cycle to run errands or work instead of taking the car, that definitely adds up too.

By riding to work, you get a workforce that gets fitter as they lose weight, save money and help the environment. Our mental health improves and we feel less stress and feel happier. In addition to having a cleaner and greener Singapore, we reduce our carbon footprint as well.

I have a particular favorite, when you ride bikes, you get the sheer joy of feeling the wind in your face - a better and greener version than driving a convertible.

Over to you Minister Ong Ye Kung and the Ministry of Transport.

Sunday, August 23, 2020

How Are Restaurants And Physiotherapy Clinics Similar?

ST 230820
The inspiration for this week's post came from a few unlikely sources. First was a patient telling me yesterday of how a friend on Facebook shared that a physiotherapy practice was in the red and that they needed patients to ensure the practice's survival. So if anyone needed physiotherapy to please go support that particular clinic.

Then in today's Sunday Times article, the author wrote about diners who make and confirmed bookings at restaurants but do not show up. A restaurant founder (of six restaurants/ nightspots) who was interviewed said that irresponsible behavior by diners have always existed and is now becoming social norm. To quote her, "diners feel more entitled now by the fact that the restaurants need them more than they need us".

That we definitely understand. We have our fair share of patients who make appointments and after confirming, and reminders by our staff, fail to turn up.

Some jobs need us to show up in person. For the time being, restaurant staff, surgeons and physiotherapists are definitely in that category. With artificial intelligence and robot controlled arms who knows how long our jobs as physiotherapists are safe .....

Many other jobs or services are currently done with a combination of asynchronous work, video calls and others. A big thank you to all our patients who still despite a long and/ or a risky commute, come to see us.

We will strive to be totally switched on 100% and do our best all the time when treating you. This is our promise.

*Keeping rogue diners in check. This Sunday Times article is on page C17 under the Life section today.

Sunday, August 16, 2020

Spraino Patches For Preventing Ankle Sprains?

We see lots of patients with ankle sprains in our clinic. Recently there was a patient who sprained her ankle while playing badminton with her friends.

The lack of match play and practice as all indoor courts were closed during the circuit breaker/lockdown period probably contributed to her getting hurt.

Most ankle sprains happen on the outside of the ankle. Badminton, which is a popular sport in Singapore is mostly played indoors.

The majority of ankle sprains that occur in badminton are 'non-contact'. This means players often sprain their ankles without contact with another player.

A contributing factor is due to the shoe traction-playing surface friction mechanism since only the player's shoe is in contact with the floor when the sprain occurs. This is true across various sports played indoors like floorball, basketball, handball and badminton.

Interestingly, I came across a research paper on a low friction shoe patch called Spraino that can help prevent lateral ankle sprains in indoor sports players.
Spraino patches on outer side of shoe
The researchers studied the 480 participants (that played handball, basketball and badminton) who completed the trial. The participants were above 18 and were playing at sub elite level They trained at least twice weekly, had a previous lateral ankle sprain in the last 24 months and had returned to sport prior to commencement of the research.

The participants were randomized into two groups, with one group getting the Spaino patches to mitigate the risk of lateral ankle sprains. The other group played as usual with no Spraino patches.

The adhesive Spraino patches (meant for indoor use only) were attached along the outside edge of the shoe. The front patch covers 2-4 mm of the shoe sole while the rear patch does not. The patches had a durability of 20-40 hours of activity.

The intervention group received Spraino patches and application instructions as well as instructions on how to order new patches and report adverse events. They were encouraged to use Spraino patches during all indoor sport activities. Both groups were allowed to tape or keep using any other injury preventive measure of their choice.

The researches found that Spraino was just as effective as other preventive measures (like exercise and prophylactic bracing and taping) when compared to not using Spraino. The participants using Spraino had a 53% lower incidence rate of severe ankle sprains compared to the control group.

The Spraino group was also less fearful of getting an ankle sprain and this is important since fear can be a major hindrance to sports activity.

Now, how do I get some Spraino patches for my patient. Perhaps I should email the authors. They should have named it something else though, in my opinion ;)


Lysdal FG, Bandholm T et al (2020). Does The Spraino Low-friction Shoe Patch Prevent Lateral Ankle Sprain Injury In Indoor Sports? A Pilot Randomozed Controlled Trial with 510 participants With Previous Ankle Injuries. BJSM. DOI: 10.1136/bjsports-2019-101767.

Monday, August 10, 2020

Thera/ Massage And Vibration Guns. Do They Work?

Picture taken by iPhone 11 Pro from Shopee
Earlier in the week, I read an article on the same topic written by CNA Lifestyle. Actually, I already wrote half of the article on that exact same topic last week but decided to publish the article on bicycle lanes in Sigapore since bicycles are much closer to my heart.

The author did a good introduction on what massage or thera guns are and what they do in that article. She also interviewed other health professionals for their thoughts. So my article will be different. It will explain the science behind why thera or massage guns feel so good when you use them. And of course the evidence available.

Thera or massage guns are being advertised with all kinds of benefits like helping with aches, pain and stimulating "muscle recovery". They can certainly vibrate your muscles/ tissues but almost all the medical claims are not totally true.

Vibration therapy definitely is relaxing for most people especially if it's not too strong or sudden or in an uncomfortable location. Sitting in a warm pool with bubble jets (like a jacuzzi) come to mind and I'm sure all of you who tried will agree that it's a pleasant sensation.

And vibration, waves and frequencies are what some physiotherapists already use for treatment. These include ultrasound, electrical (TENs) and magnetic stimulation, infrared radiation and even lasers. The above are mainly microscopic vibrations aimed at cells at the cellular level and a wider range of frequencies and smaller amplitudes.

Even ESWT (or shock wave) uses high intensity waves to smash kidney stones, (used by doctors) and/ or stimulate bone healing. Many other physiotherapists also uses ESWT to treat plantar fasciitis.

An article published in the British Journal of Sports Medicine showed that runners who receive daily sessions of vibration therapy on the legs were less sore  and had fewer blood markers associated with soreness compared to runners who did not (Broadbent et al, 2010).

Coarse vibrations have interesting neurological effects too. Vibrations added to really flexible gymnasts appears to increase their flexibility further (Kinser et al, 2008).

One reason why vibrations help is a change in our proprioceptive state. Proprioception is how we sense or judge our position. When the body is being vibrated or shaken, plenty of input goes to our cerebellum in the brain. When there is no danger perceived by the cerebellum, the nervous system send signals for the body to relax. That's why the body calms down and you feel good.

Another reason is the strong and distinctive vibratory sensations are quite the opposite of feeling stiff and tight. Just like splashing cold water on your face when you're hot, vibration feels like a natural remedy to your stiffness.

So patients with conditions like muscle strains, neck pain and especially low back pain with fear being a big part of it may feel better after using massage guns or other vibration therapy.

However, if you have shin splints (will hurt more actually), plantar fasciitis and nerve entrapment issues then they probably will not help.

So, still thinking about splashing your your earned cash on this? Save your money. Or better still come see us in our clinic to treat the cause of your problem.


Broadbent S, Rousseau JJ et al (2010). Vibration Therapy reduces Plasma IL6 And Muscle Soreness After Downhill Running. BJSM. 44(12): 888-894. DOI: 10.1136/bjsm.2008.052100

Kinser AM, Ramsey MW et al (2008). Vibration And Stretching Effects On Flexibility And Explosive Strength In Young Gmynasts. Med Sci Sp Exer. 40(1): 133-140. DOI: 10.1249/mss.0b013e3181586b13.

Saturday, August 1, 2020

Bicycle Lanes In Singapore?

Singapore's only bike lane@ Coastal road
I last wrote about having bicycle lanes on the road way back in 2010 and 2011. No one really paid attention then. Then earlier this week, British Prime Minister Boris Johnson came out promising to build thousands of miles of new bike lanes to get the Brits moving and healthy after months of coronavirus lockdown.

His pledge came after plans to force restaurants to display calories on menus as part of a bigger battle to help the British lose weight. This is after an analysis by the Organization for Economic Development released in 2019 found that Britain was the second fattest nation in Europe, with almost a third of the population classified as overweight.
ST 1/8/2020 on page A23
Being obese makes one more vulnerable to many diseases including the coronavirus.This is especially true for Johnson himself after his own experience with Covid-19. His life was in danger and he had to be treated in intensive care largely because he was overweight. He had previously dismissed the idea of government intervention over what the public should eat, but changed his mind after being hospitalized.

When Minister Mentor Lee Kuan Yew was still alive, he did consider special bike lanes for cyclists in Singapore. He had in his younger days cycled to university in Cambridge and had to also cycle about five miles uphill to visit his girlfriend and later wife as she lived in a different hostel.

From -Hard truths to keep Singapore going
"It's better for everybody's health, it's better for the environment and it's certainly better than having the place or having the roads overcrowded with cars, taxis, buses."
From -Hard truths to keep Singapore going
During the circuit breaker/ lockdown in Singapore, it was a dream come true for cyclists, as there was so much less traffic on the roads. My sons and I went cycling almost daily as we did not have to worry about sharing the roads with the cars and buses. Throughout the world, bicycles were selling like hotcakesincluding Singapore, as many people rode bikes for both transport and exercise.

Some of you reading this may say that it's too hot to ride bicycles to the office or to run errands. Yes, in our climate you will will definitely need a shower after riding to work. But it will also not to be too cold when it rains. So we will need to have toilets and parking spaces for bicycles. A small price to pay for a cleaner and greener environment.

Many drivers will not like this idea (there are many drivers who hate cyclists if you look at the online forums) of bike lanes on our roads. Well, you can't please everyone.

Newly appointed transport minister Ong Ye Kung, are you reading this?

*A big thank you to Jeffrey Keng. The very first picture right at the top and the one just above was taken from a video by Jeffrey Keng on 22/9/18 while we were cycling along Coastal road.