Sunday, March 26, 2023

Sit Up!

I have written previously that there is no posture that fits everyone. What may be deemed as a 'bad' posture may be suitable for another person. Moreover, if 295 physiotherapists (from 4 different countries) can't agree exactly what 'good posture' is then how can the average or non medical professional know.

How to sit up comfortably?
*I won't say that you need to always sit up straight. Case in point, I often slouch and lean back while sitting as it is the most comfortable position for my twice broken back.

However, there are other benefits to sitting up straight it seems. Researchers compared subjects who sat up straight to subjects who slump and found that good posture was linked to higher confidence. 

The participants were asked to think about and write down their best or worst qualities while they were sitting with their backs erect and pushing their chest out (confident posture). Or slouched forward with their back curved (doubtful posture). They then completed a number of measures and reported their self evaluations. The ressearchers found that sitting up straight boosted their assuredness in their ideas (Brinol et al, 2009).

Another study by Peper et al (2018) tested how sitting position affected students tested on their feelings about math tests. Students who were good at Math experienced no difference taking the test slouching or sitting up straight. The students who were anxious about Math found the test more manageable when sitting up straight. 

So taking a brief moment to breathe and adjust your posture before a tough conversation with your boss or a big presentation at work can help you navigate important moments with confidence. How we carry ourselves doesn't just affect our bodies, it also affects our brains.


Brinol P, Petty RE and Wagner BC (2009). Body Posture Effects On Self-evaluation: A Self-validation Approach. E J Social Pysch. 39(6): 1053-1064. DOI: 10.1002/ejsp.607

Peper E, Harvey R, Mason L et al (2018). Do Better In Math: How Your Body Posture May Change Stereotype Threat Response. NeuroRegulation. 5(2): 67-74. DOI: 10.15540/nr.5.2.67

*Too many companies have spent money on ergonomic programs to prevent back pain. This usually involves 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 that 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 not sitting up straight is not the cause of the back pain.

Wednesday, March 22, 2023

Should A Chiropractor Manipulate Your Neck?

ST article on 220323
An article from the Straits Times today, on page C4 under the Life section. It was originally published in the New York Times  2 days earlier. There was a big uproar last year because a chiropractor there caused a patient, Caitlin Jensen to be paralyzed after he manipulated her neck.

Actually there were already many complaints against chirpractors back in 2020 during the midst of the coronavirus pandemic. The International Chiropractors Association (ICA) posted 2 reports that claimed that chiropractic care can help the immune system implying that they may be helpful in preventing Covid-19. (Cote et al, 2020). 

More than 150 researchers from 11 countries found no valid clinical scientific evidence that chiropratic care can prevent impact the immune system. They asked that appropriate action be taken against those making unsubstantiated claims that spinal adjustments can boost immunity or benefit patients with infectious diseases, especially Covid-19 infections.

This recent episode merely added fuel to the fire.


Cote PB, Bussieres A, Cassidy JD et al (2020). A United Statement Of The Global Chiropractic Research Community Against The Pseudoscientific Claim That Chiropractic Care Boost Immunity. Chiropr Man Therap. 28, 21. DOI: 10.1186/s12998-020=00312-x

There has been previous unhappiness against chiropractors in Singapore too. Here's the Straits Times article.

Sunday, March 19, 2023

How To Wake Up Alert And Refreshed

Do you go to bed early, sleep through the night and still wake up tired and groggy? - Well, it happens to me quite regularly. Turns out that I'm not alone. A study found that fewer than 1 in 3 Americans are getting enough restorative sleep (Robbins et al, 2022). 

You may say that the Americans have more distractions, but in Singapore, 41 percent of adults get between 4 to 6 hours of sleep a night only, even though they should be clocking in 7 to 8 hours.

Not only do we have insufficient sleep, the vast majority of us are not getting the right kind of sleep. So we wake up less alert, have less energy and poor moods in the morning. Low quality and/ or quantity of sleep has terrible far reaching effects, from short term ability to focus to long term risk for chronic diseases.

The good news is that there is a way to fix this. Another published study by Vallat et al (2022) listed 3 steps we can do to eliminate that groggy feeling we get when we wake up. The researchers studied 833 twins and genetically unrelated adults and demonstrated that how effectively one wakes up during the hours following sleep is not assocated with genetics. 

They found 4 independent key factors. sleep quality/ quantity the night before, physical activity the day prior, a breakfast rich in carbohydrates and a low blood sugar level following that breakfast. 

The researchers found that sleeping in for an extra 30 minutes on a morning when you need it was associated with increased alertness in that morning. Physical activity (or exercise) the day before also had a strong link to feeling alert and awake the next morning. The more exercise the better it seems.

Breakfast matters. Participants who ate a breakfast high in low glycemic carbohydrates like whole wheat bread, oats, brown rice felt more alert. However, eating breakfasts that were sugary or high glycemic carbohydrates (muffin, cereal bar, white bread, potatoes) and excessive protein had the opposite effect. 

That's the secret to waking up alert and refreshed every morning. So definitely don't skip breakfast.


Robbins R, Quan SF, Buysse DJ et al (2022). A Nationally Representative Survey Assessing Restorative Sleep In US Adults. Frontiers In Sleep. Vol 1. DOI: 10.3389/frsle.2022.935228

Vallat R, Berry SE, Tsereteli SE et al (2022). How People Wake Up Is Associated With previous Night's Sleep Together With Physical Activity And Food Intake. Nat Commun 13,7116. DOI: 10.1038/s41467-022-34503-2

Sunday, March 12, 2023

Don't Ignore The Small Stresses

Breathtaking sunset
Most of us can ignore the smaller things that irk us. Like a rude sales staff, a terse message from your manager, or even a full basket of laundry not done. We ignore the smaller micro-stresses and just focus on the big stuff since the small things do not evoke the fight or flight mechanism. Unlike getting hit with big, bad news like getting fired from your job or a serious illness.

The small things that require our attention can definitely add up. Even when we ignore them our bodies do not. Small stresses can trigger some of the same physical effects as big stresses including increasing blood pressure and lower quality sleep (Cross and Dillon, 2023).

This is often why we feel exhausted or even defeated at the end of the day, even if nothing big went wrong. They can eventually have an outsized impact on our mental and physical health.

A really interesting study by Kiecolt-Glasr et al (2015) found that even a relatively minor social stress experienced within 2 hours of a meal can affect your metabolism of that meal by adding 104 calories to that meal. If that occurs daily, it adds up to 11 pounds (or 5 kg) a year.

We can all take steps to be more aware and address the micro stresses in our lives. Communication helps. Speak to your boss if he/ she is routinely annoying you by not giving you enough time for datelines. Or call your child if he/ she does not respond to your messages. You will be surprised at how much eradicating a small but repeated stressor can boost your mood.

Cross and Dillon's research shows that people with robust personal lives, i.e. those having family, friends and hobbies that keep them occupied tend to be less affected by work related micro stresses.

Practicing meditation and mindfullness can clear your mind and clear away the big and small stresses.  Being both grateful and thankful for what you have helps too.
So I am doing just that, enjoying the rainbow and the breathtaking sunsets while on holiday with my family now. 


Cross R and Dillon K (2023). The Microstress Effect: How Little Things Pile Up And Create Big Problems - And What To Do About It. Harvard Review Press. 18 April 2023.

Kiecolt- Glaser JK, Habash DL, Fagundes CP et al (2015). Daily Stressors, Past Depression, And Metabolic Responses To  High-fat Meals: A Novel Path To Obesity. Biol Psychiatry. 77(7): 653-660. DOI: 10.1016/j.biopsych.2014.05.018

Sunday, March 5, 2023

Can Fitness Classes Help Your Next Ultra Marathon?

I was a little skeptical before I read the article which suggested that fitness classes in gyms can help prepare you for your next trail or ultra race. The article by Vincent et al (2022) found that trail runners who took a multifaceted approach to training significantly lowered injury risk through better movement and reduced fatigue during runs. 

Then I read that these gym classes (in the article) were fitness classes that bring together multiple components like strength and aerobic exercise while introducing variety and fun at the same time. I realized it's just cross training put in a fanciful way. Note that this cross training is not CrossFit

The term cross-training first became popular back during the running boom in the late 1970's and 1980's. Runners who got injured and wanted to keep their fitness would 'cross-train' by doing another kinds of workout like cyclingswimming or even weight training. Runners who were not injured and wanted to prevent injuries would cross train to correct muscular imbalances on some days. Plus the variety in training prevented burnout and boredom. It subsequently lead to an increase in popularity in triathlons the the birth of cross training shoes (*see below).

Back to the article, which found that the majority of of acute and chronic trail and ultra running injuries occurs in the lower leg usually. Especially in the knee and ankle. More than 70 percent are due to overuse (or an increase in load). Ankle sprains are the most common acute injuries. 

You need to be looking ahead to respond to to the variations in ground surfaces, make selections on which obstacles to avoid, read the weather signs etc when running a trail ultramarathon. Hence, you need to anticipate, predict and react to maintain balance while navigating trails. Especially when fatigued and hungry

The article found that trail runners who took a multifaceted approach to training significantly lowered injury risk  through better movement and reduced fatigue during runs.

Since trail running is repetitive, gym classes create movement variation that will expand your range of motion and activate different sets of muscles to reduce overuse injuries. All of which can keep you health and injury free to help you cross the finish line.

Gym classes do not just mean spinstationary cycling or treadmill running. You can choose a class that is  heart rate based interval workouts that include resistance training, rowing or bootcamp etc. You can practise specific aspects like pushing or pulling sled, using the rower to increase overall force production that you might not do on the road or trails.

Studies show that concurrent strength and endurance training help improve running performance by improving strength and running economy. Runners can then run for longer periods of time without fatigue. This is really important if you are training for ultras.

If you plan to go down this path, have a specific goal race in mind and create an objective for what you want to achieve with gym classes. It can be as simple as bouncing back quicker from your long run or running faster up a certain hill. Those who use heart rate monitors may need to find classes to monitor your heart rate zones.

Gym classes should not affect your long term goal. Start with one every week to help you get a feel for the class and to allow for ample recovery especially if you find the class challenging. 


Vincent HK, Brownstein M, Vincent KR (2022). Injury Prevention, SafetrainingTechniques, Rehabilitation, And Return To Sport In Trail Runners. Arthros Sp Med Rehab. 28;4(1): e151-e162. DOI: j.asmr.2021.09.032.

*The Nike Air Trainer 1 (in chlorophyll, above) was originially created as a multi purpose performance shoe back in 1986. Nike's goal was to have one shoe so that you can run, weight train, do other sports and exercises with it so you don't have to carry a few pairs of shoes with you around. 

John McEnroe used it when he was still playing professionally. Click on the link to see the picture (Getty images copyright, so I can't use it here).