Saturday, April 23, 2022

Outrun A Tesla?

One of the books I'm currently reading is an authorized biography of Elon Musk, written by Ashlee Vance. Yes, that Elon Musk, who is CEO of Tesla, Space X and SolarCity. And perhaps Twitter if his attempt to buy the company goes through.

Previously, I wasn't a fan of Elon due to his brashness and controversial behaviour. My views have changed after I started reading this book (pictured below). Coincidently, Musk is also featured in a full page article in today's Sunday Times on page A22.
Naturally, I was curious when I read about ultra runner Robbie Balenger's attempt to run further than a fully charged Tesla Model 3. On a full battery, the Tesla Model 3 would last a little over 242 miles (or 387 km). This is a grueling man versus machine race.

On April 11, Balenger and the Tesla started together 250 miles outside Austin, Texas in USA. The car was driven at a median speed of 65 miles an hour for the duration on a full charge on a remote road. Balenger's goal was to follow the car's route and cover the distance in 72 hours. 

For three days Balenger suffered due to the heat and humidity with temperatures reaching 90 degrees Fahrenheit (or 32 degrees Celcius). However he did it! He covered the distance in 76 hours, 54 minutes and 46 seconds, running further than the depleted car by 100 feet. 

The challenge was sponsored by activewear brand, Ten Thousand, as part of the company's Feat of Strength series.

Balenger , a plant-based (or vegan) endurance athlete also holds the former record for running the most laps around New York's Central Park in one day. He ran 16 loops of the 6.1 mile (9.76 km) course, covering 97.5 miles (156.16 km) in March 2021.

He also ran 3,175 miles across the USA in just 75 days in 2019. Amazing! 

Below is a picture of today's Sunday Times article on Elon Musk.

Sunday Times page A22

Sunday, April 17, 2022

Can A Bit Of Tape Rotate Leg Bones?

Unlike others in the picture above who are skeptical and think that leg bones cannot be rotated with "a bit of tape" in 2022,  I remain open to finding out how to treat our patients with knee pain

Just because I cannot ride a unicycle does not mean others cannot. Similarly if the author above cannot rotate his / her patient's leg with "a bit of tape" does not mean others can't.

We do see many patients in our clinics presenting with knee pain. Even though we have very good results treating these cases, I am always on the look out on how to get these patients with knee pain better quicker. Especially those who run.

In our clinics, we almost never tape the patient's knee, especially if the cause of their knee pain is coming from elsewhere. In fact, we do not even use rigid sports tape when we do tape the patient's knee.

Using Kinesio tape compared to using rigid sports tapes to do McConnell taping, (first published in 'Physiotherapy' journal in 1986 by Australian physiotherapist Jenny McConnell) definitely produces a superior result.  

So I was really intrigued when I saw a paper that investigated the effects of using rigid sports tape for tibial internal rotation taping (IRT) and external rotation taping (ERT) done on subjects with patellofemoral pain syndrome (knee pain) during three functional tests. During double leg squat, single leg squat and maximum isometric thigh muscle contraction.
Internal rotation taping
The researchers found that compared to no taping, both IRT and ERT significantly reduced pain during the three tests, especially for those with higher pain levels initially.
External rotation taping
ERT was found to be more effective than IRT. Why? The authors did not provide any suggestions. My thoughts are that when you externally rotate your tibial (shin bone), you can activate your gluteus medius better. Remember, one of our most popular posts shows that the cause of patients' knee pain is usually coming from the hip.

To see if the two taping techniques work, let me try the ERT and IRT techniques on my colleagues in our clinics first before I unleash them on our patients. Bear in mind we still want to treat the cause of the problem and not just the pain itself.

Deng F, Adams R, Pranata A et al (2022). Tibial Internal And External Rotation Taping For Improving Pain In Patients With Patellofemoral Pain Syndrome. J Sci Med Sp. DOI: 10/1016/jsams.202204.003

*thanks to Byron and Megan for helping me with the photos

Sunday, April 10, 2022

We Don't Just Treat Sports Injuries

Many new patients who call our clinic often tell us that they don't play any sports and wonder if they can still see us. To which we reply, "Most definitely!"

As all our physiotherapists are trained to read your body to ascertain how it's positioned in various postures and during movement. We work like detectives, finding the main cause of your problem. We know exactly what we can change to make a difference to your problem and when we might need to refer a patient out to a specialist e.g. neurosurgeon etc.

We specialize in spinal pain and problems, joint pain, muscle strains, joint sprains, nerve related problems (where you might experience pins and needles, numbness or reduced sensation or strength), headaches, and of course injuries that you sustain during sports.

So exactly how different is a sports physiotherapist and a musculoskeletal (meaning muscle and bones) physiotherapist? Having worked in a professional sports setting, treating elite athletes for 10 years, traveling with Team Singapore athletes to the Olympics, SEA, Commonwealth, Asian Games and others and now being in private practice for 12 years , I will attempt to explain the main differences..

The biggest difference would be the time allocated to the athletes and patients. When treating athletes at a professional level, we may sometimes see the athlete 3 times a day. 

Say we have a badminton player who has a niggle in his foot, we get to experiment with taping the player's foot with rigid or Kinesio tape. How can I change his navicular bone position? That alone may determine how well the player trains that morning. Or, if there's a match later that evening we can trial any tape, shoe, or racket earlier in the week before the actual game. 

Oftentimes, the head coach will request specific sessions with injured players to get them up to speed with recovery.

Taping with rigid tape
In an actual game, the physiotherapist has to be paying attention and watching to get clues about the mechanisms of injury. We often need to assess and treat our player ASAP usually within the minute.  I will have in my kit bag, different types of tapes ready, blister kit. splints, nail cutter, scissors, lotions, painkilling sprays etc. in case I need them. We try to be the 'magic' healer, asking questions, cleaning sweaty areas to treat, to allow them to play again.

Yes, Treating elite athletes can be very time consuming and labor intensive.

In a private practice setting (like Physio Solutions and Sports Solutions), the patients are just as eager to be pain free, to get better and to return to exercise. Unlike a competition setting, we get much more time to ask questions and assess thoroughly. Finding and treating the cause of the problem becomes easier. The hands-on, manual therapy we do has huge benefits in changing a patient's condition. However, we may only get to see patients once or twice a week. 

It is, therefore, important to educate patients on what they have to do in the time between appointments. We may teach them self tests and exercises on e.g. their calf range to see how they're progressing. We are easily contactable via text, email or phone if you need to ask questions between your sessions.

In summary, when you become our patient, WE GOT YOU.

Sunday, April 3, 2022

My Patient Has Os Trigonum Syndrome

Not her legs
My 11 year old patient came in complaining of pain at the back part of her ankle. She's an avid ballet dancer and tennis player and trains up to 4 times a week.

After examining her thoroughly, I found that her pain was reproduced at a very specific location, especially when she was pointing her foot. I explained to her mum that she probably has Os Trigonum syndrome.

The Os Trigonum is a small, extra accessory bone that is sitting at the back of the ankle joint. This extra bone may be present in up to 20 percent of the general population. It forms when one area of the bone fails to fuse with the rest of the bone (the talus in this case). Often people do not know if they have an Os Trigonum if it has not caused any problems. 

This is similar to the accessory navicular bone in the foot, which usually does not cause any problems. However, it can cause pain after twisting your ankle (just like it can cause pain in the accessory navicular bone in the foot). This happens when the Os Trigonum moves or breaks leading to pinching at the back of the ankle joint, causing what is known as a posterior impingement. 

It can also be caused by repeated downward pointing of the toes, which is especially common in ballet dancers (when assuming an en pointe position) and football players (when shooting).

Sometimes it can be mistaken for pain originating from the Achilles tendon. An x-ray is usually ordered by the doctor to show the Os Trigonum at the back of the ankle. A MRI scan is used occasionally to exclude articular cartilage damage in the ankle.


Skwiot M, Sliwinski Z, Zurawski W et al (2021). Effectiveness Of Physiotherapy Interventions For Injury In Ballet Dancers. PLoS one. 24(6): eo253437. DOI: 10.1371/journal.pone.0253437.

Thanks to Byron for the picture