Sunday, January 31, 2021

Oakley Sutro Review

I got a nice surprise earlier this week from Oakley Singapore- the Sutro sunglasses in red. They were actually released earlier a while ago but I only just got mine. Better late than never.

I tried it during my bike ride yesterday and it was awesome.

My fellow cycling friends who bought the Sutro's earlier said the long ear stems did not sit well with their helmets' adjusting and fastening. I use the Giro Air Attack helmet and they were fine.

Another comment was since the ear stems did not have any rubber (Oakley uses Unobtanium) to hold the sunglasses in place, they are not as secure and tends to move around. Again, they felt fine on my face while on the bike. Perhaps if you're riding off road or running they may be less secure with all the movement. However, I really like the retro Oakley wording (pictured above) on my ear stems compared to the 'O' Oakley logo commonly used now.

Greg Lemond and the Factory Pilots

I found out that the Sutro is modeled after the Oakley Factory Pilot Eyeshades made popular by Greg Lemond In the 1980's. Lemond won the Tour De France in 1985 wearing the Factory Pilot's and and they were the sunglasses many cyclists wore back then. There is a nice tribute to the Factory Pilot just above the nose piece (picture below).

Nice tribute

The huge, goggle style lens may not suit everyone's taste, but I think they're great at providing a large field of vision. The holes provide more than ample ventilation and they definitely didn't fogged up during yesterday's ride. Peripheral vision is superb with the Sutro's and you would expect nothing less in any Oakley sunglasses. Definitely a plus for cyclists.

Thanks again to Joey from Oakley Singapore.

*I remember watching Greg Lemond (above) winning the 1989 Tour De France by 8 small seconds over Laurent Fignon on the final day in the individual time trial (ITT). He had a deficit of 50 seconds before the day started. No one thought Lemond could pull it off as the ITT was just 25 km long. You can't make up 50 seconds over 25 km. But Lemond did, he averaged 54.545km/h in what was then the fastest ITT ever! 

The race was the greatest ever comeback in modern history as Lemond was shot by accident by his brother in law when they were hunting in April 1987 (Lemond first won the TDF in 1985 and 'gifted' the race to teammate Bernard Hinault). He underwent two surgeries and missed the TDF in 1987 and 1988.

Wednesday, January 27, 2021

Run On Softer Surfaces Or Improve Running Technique?

I read with interest two recent letters written to the Forum page in the Straits Times in the past month. One writer suggested making softer surfaces for runners at park connector paths to take care of runners' knees.

Another writer said it's not the running surface but a runner's poor running technique that causes the knee joints to wear out.

In today's Forum page, another two writers wrote in with their comments. The first writer acknowledged that both running surfaces and running technique may be the cause of knee problems. However, he thinks that excess weight may be a contributing factor too since 30 percent of 500 respondents in a survey said they had gained 5kg during the pandemic (of course there were many others who lost weight too).

The second writer, a medical doctor suggested brisk walking rather than running for joint longevity. He also said that his heathiest octogenarian patients maintain a healthy weight by being active through walking rather than pursuing 'exercise achievement goals'.

Running definitely does not wear out your knees. I've written about this before and there is so much research supporting this.

If anyone should be paranoid about running wearing out the knee joints, it should be me after 3 knee operations. The following are my personal views, backed by published articles. 

Although research has shown that there is no difference between running on the road versus grass in terms of leg inflammation, I personally feel it is much softer to run on grass or the soft sand on the beach compared to running on the pavement or road.

If you're heavier, that can put more load on the joints definitely, but running does not wear out the joints. By all means improve your running technique or do deep water running if you have to.

Be patientincrease your training load gradually, have at least one rest day a week and don't do too much too soon.

*Have a look at page A17 in today's Straits Times (270121)

Sunday, January 24, 2021

How To Increase Range Of Motion

All the kids posed for this picture

A typical comment from many of our patients is that they have been stretching all the time but their muscles still feel tight. 

Range of motion (ROM) is necessary as part of our health and important during sports performance. And static stretching is often prescribed to get better ROM gains. We know from previous research that static stretching is effective in improving our range of motion. 

However, the latest systematic review/ meta-analysis shows that strength training (ST) is just as effective as static stretching in getting improvements in ROM.

The researchers pooled data together and found eleven good quality studies comprising 452 participants to derive the following results.

Interventions lasted between 5 and 16 weeks while training frequency ranged from two to five times a week. Subjects included healthy sedentary subjects, subjects who already participate in ST subjects with fibromyalgia and subjects with chronic neck pain. There were also elderly adults who had difficulties in one of four tasks, transferring, bathing, walking and going to the toilet.

Both ST and static stretching groups showed significant improvement in ROM in seven of the studies. Differences between the groups were non significant. They did not find any significant differences in active and passive ROM for both ST and stretching. Dynamic stretching did not improve ROM in any of the groups.

You must be wondering how ST helps to improve ROM that is not statistically distinguishable from static stretching. The authors wrote that ST with an eccentric focus requires the muscles to produce forces in a lengthened position. This is what helps improve ROM. They also found that concentric strength training improves ROM when full range is required.

One study demonstrated significant reductions in pain associated with increases with strength, suggesting that decreased pain sensitivity may be another mechanism in which ST help increase ROM. Another mechanism may be an improved agonist-antagonist co-activation helping ROM gains.

The authors concluded that both ST and static stretching can improve ROM both in the short and long term suggesting that there are both neural and mechanical factors at work. Both ST and stretching can be prescribed to help improve ROM. If one does not respond or adhere well to a stretching program, they can switch to strength training instead.

What does that all mean you (if you did not understand the discussion above)? If you're looking to get an increase in your range of motion say in your knee joint, you can do eccentric strengthening exercises with some stairs at home. This previous article explains everything in a simple manner.

Just remember that static stretches are best done after exercise as just one bout of static stretching can slow you down as well as reduce your maximum strength.


Afonso J, Ramirez-Campillo R, Moscao J et al (2021). Strength Training Is As Effective As Stretching For Improving Range Of Motion: A Systematic Review And Meta-analysis. DOI:

Sunday, January 17, 2021

Is Good Posture Just A Myth?

If 295 physiotherapists (from four countries) cannot even agree on which is the best sitting posture, then how can the average person know what is? 

Other than having the physiotherapists do a back beliefs questionnaire (BBQ), the above mentioned study had a range of nine sitting options ranging from slumped to upright sitting. 85 percent of the physiotherapists surveyed selected one of two postures as 'best', with one posture being selected more significantly than the other. 

However, those two frequently selected postures were very different to say the least. The physiotherapists who selected the more upright posture had more negative low back pain beliefs in the BBQ. The main differences were what constitutes what a 'neutral' spine is and what is the best sitting posture is.

If you are slouching at your desk, almost everyone will tell you to sit up straight and watch your back. This is especially so when bending forward or while lifting. Back in 2019, I first suggested that slouching while sitting is not necessarily bad for you, challenging society beliefs about posture and back pain

So many companies have spent money on ergonomic programs to prevent back pain. This would usually involve a health professional/ physiotherapist (trained in ergonomics) checking your office chair/ desk height, screen height/ position with respect to your keyboard/ mouse to ensure everything is lined up in a straight line.

However, there is very little evidence linking back pain to poor posture. Oops, this basically means a huge profitable industry on work place/ home office ergonomics has very little sound evidence. 

All the published research to date has shown that there is no relationship between any postural factors causing back pain. This includes the shape and curves of the back, asymmetries and how we use our backs.

Yes, if you already suffer from back pain, you may feel it more while sitting, especially for long periods. But sitting is not the cause of the back pain.

One of my patients told me that she just bought a two thousand dollar Herman Miller chair due to working from home 'causing' her back pain. It definitely helps with sitting up straight, however, it did not seem to help her back pain. That's why she still came to see me yesterday.

So, if you currently do not have neck/ back pain, you do not need to worry about your posture. If you do have pain, then your posture may affect it. Sitting for a sustained period is best avoided. The best ergonomic chair/ table will still give you pain. It is better to move more. Take breaks. Get advice and/or treatment to move with confidence and less pain.


O'Sullivan K, O'Sullivan P et al (2012). What Do Physiotherapists Consider To Be The Best Sitting Spinal Posture? Manual Therapy. 17(5): 432-437. DOI: 10.1016/jmanth.2012.04.007

Slater D, Korakakakis V et al (2019). "Sit Up Straight" : Time To Re-evaluate. JOSPT. 49(8): 562-564. DOI: 10.2519/jospt.2019.0610

Our spines have natural curves. It is not totally straight at all. You can see from the picture above that the neck is slightly concave, the chest area is convex while the lumbar (low back) region is again concave. In an ergonomic assessment, a 'good' posture usually refers to eliminating/ straightening out these curves.
Here are some common myths and facts about low back painslipped discs and your core muscles if you're interested in reading more.

Sunday, January 10, 2021

Which ACL Graft is Less Likely To Tear Again?

Post op -view from the front
In all my years of being a physiotherapist, I have treated many patients and athletes who tore their anterior cruciate ligament (ACL) and opted to have surgery to repair it. 

View from the back
In the earlier days, the bone patella tendon bone (BTB) graft and the hamstring/ gracilis (HS) graft were the more popular choices. Allografts (cadaver graft) were not popular then, but they are definitely more accepted now.

I've had many patients (not just the athletes) who subsequently re-tore their HS graft. However, I have yet to encounter a patient who re-tore their BTB graft.

If my observations were accurate, surely then the BTB graft would be the 'better' and 'stronger' graft? Now it seems like there is evidence supporting my observations.

Researchers studied 770 patients (14-22 years) who were injured playing sports and had a six year follow up period. These patients had one normal un-injured knee and the injuredACL knee was reconstructed using the BTB or HS graft. Average age of the subjects was 17 years, of which 48% were female.

There were 492 (64%) BTB grafts and 278 (36%) HS grafts.

The chance of a subsequent  tear on the same reconstructed knee at six years was 9.2% compared to 11.2% in the uninjured normal knee. If it was either knee, the rate goes up to 19.7%.

The three most likely predictors of a subsequent re tearing of the operated knee were knee ligament laxity prior to knee operation, graft selection and age.

Those patients who had a HS graft were 2.1 times more likely to re-tear their ACL graft compared to those who had the BTB graft.

Choosing your graft after tearing your ACL will definitely be influenced by discussions with your doctor, surgeon and physiotherapist etc. Moreover, besides the BTB and HS grafts, you can also use an allograft (cadaver) now. 

Please bear this information in mind if you were to tear your ACL. Please come talk to us if you have any questions.


Spindler KP, Huston LJ, Zajichek A et al (2020). Anterior Cruciate Ligament Reconstruction In High School And College-age Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates? 48(2): 298-309. DOI: 10.1177/0363546519892991.

R knee

Friday, January 1, 2021

Health Trends For 2021

Straits Times 1/1/21

Great suggestion in today's Straits Times article on the back page (B16, under Sports section) where the author suggested having more local running events for women.

I say not just more races for women only, but men and those under 21 too. In a year where most if not all running races were cancelled, runners are starved for social interaction and a chance to clock a personal best time for some or be quick enough for that elusive Boston qualifying (or BQ) time.

Perhaps with the rollout of the vaccines making exercising in enclosed spaces safe again, people may still want to go back to gyms, yoga studios and fitness centers etc.

I'm hope I'm wrong for the sake of those businesses, but I think gyms, yoga, Pilates studios may not be totally out of the woods yet. Bike shops, cheap dumbbells and other home exercise equipment will definitely continue to be in hot demand. Since March 2020, where most the world started lockdowns, too many people have learnt how simple, cheap and safe training at home is. 

I'm predicting that running, cycling, long walks and roller blading will continue to be popular in this new year. Let's all recognize the benefits of our local parks, bike lanes, park connectors and green spaces. All these spaces definitely impact our health.

A lot of us started baking, cooking and even growing our own food since the lockdown. All are healthy trends and may we continue to do that.

Let's continue to support our own local communities, the smaller shops and restaurants as they battle to carry on. We bought all our Christmas and birthday gifts from Everyday Vegan Grocer and Le Matin.

Here's wishing all of you a safe, healthy and wonderful year ahead.