Rob It To Get It Free

What if you could go to a running store, pick something you like and run away with it free? No, I am definitely not suggesting that you shoplift from a running store. 

This promotion is exactly what a running store in Paris came up with last month to steal whatever you want. The catch is you will have to outrun the store's security guard, who happens to be Meba Mickael Zeze. 

Zeze happens to be a two time Olympian, who can run the 100m in 9.99 seconds and the 200m in 19.97 seconds!

Zeze had as much fun as the participants, looking at the video. He said the job reminded him of playing tag as a child, adding that he needed only a third of his top speed to catch most of the 'thieves'.

Only 2 managed to evade him, most probably as a result of Zeze having to run all day.

Distance Paris was super happy with the result despite losing 2 out of 76 attempts to 'thieves', so much so that it was turned into an video (see below).

This is a super clever idea by Distance Paris and it definitely gave them a lot of eyeballs. Any running store in Singapore willing to try this? 

Perhaps Shanti Pereira can be the security guard.

Embroidery For Our Team Building Event

You read correctly, we had Isabel Lim from Isabel Lim Designs teach us this morning. It was great fun and we had a great time together.

Isabel was really patient when it came to explaining and teaching us what to do. Here are some of the designs.

Byron's

Kaylee did this

 

Pretty cool huh? We definitely have some hidden talents in our midst.

We then proceeded to have lunch at Bumbu. Also a farewell lunch for Byron who is leaving us to move to Adelaide, South Australia. All the best to you Byron.

Sports Solutions is 14!

Yes, Sports Solutions is 14! Has it really been that long? Yes, it has. We started at Amoy Street and moved to Chip Bee Gardens in Holland Village in 2014.

A big thank you to all our families, staff, friends and patients for all your support all this while. We wouldn't have done it without all of you.

Our goal is the same all this while. To make our patients better quicker. "As long as we're happy and enjoy treating our patients, it's not really work."

Here's to many more years to come!

Accepting Payment For Online Reviews

ST201022

I read with interest in a Straits Times article as restaurant owner Charlene Yan posted online on Oct 4th that food website Sethlui.com asked for $2300 to be featured on their food blog. In addition, the email she received from one of Seth Lui's employee's offering her a spot on that list to be placed 1st, 2nd or 3rd position for an additional $400 to $600. No research, no actual food tasting done, just asking for money straight up to be featured on that list.

No prices for guessing when ST reported in the newspapers on 20th October, 2023 that paid restaurant reviews are "standard practice". Singapore chef Benny Se Teo said paid food reviews are definitely on the rise and raise concerns about objectivity since financial interests are entangled with the restaurants they are reviewing. 

The Advertising Standards Authority Of Singapore states on its website that it should be clear that "anyone who looks at the advertisement is able to see, without reading it closely, that it is an advertisement and not editorial matter".

That means any compensation like a free drink or dessert that a food blogger receives, should be clearly disclosed to the reader or viewer. If payment by the establishment is made, to be on such lists, it is then no longer an editorial decision but an advertisment and that must be clearly stated otherwise that list has no credibility.

Will you be surprised that this happens in the healthcare industry too. I received a total of 3 emails (pictured above and below) dated 14th, 16th and 20th October, asking if we want our clinics to be featured in the "25 Best Physiotherapy Clinics in Singapore (2023)". Their fees range from $500 to $2000.

You would think that the employee sending me the emails would have kept in touch with the brouhaha regarding paid restaurant reviews after it went viral on Reddit, Facebook and of course the newspapers.

At least I know the employee is persistent since I received 3 emails asking if our clinic wanted to be on that 'best' physiotherapy clinic list.

Aized tells me that we have been approached multiple times as well to be on such lists on print copies of magazines targeted at the expatriate coummunities too. 

The authenticity of such reviews for physiotherapy clinics are definitely questionable. Our clinics probably will not be on such lists since we do not pay to be on them.The main criteria for compiling a list like this is monetary and without full disclosure to the readers. Now you know.

Thankfully, majority of patients who see us and get better refer us to their family members and friends so we do not have to be on such lists.

Regarding Prepaid Packages

A patient told me she was 'convinced' to buy a 100 session prepaid chiropractic package that she had to use within 6 months to 'maintain' her neck and back health after she went for a free trial. 

A chiropractic clinic offered a free trial session at a roadshow in a mall and she went to try. She had appointments to go 3 times a week, which is terrible for a working adult's schedule. To add salt to injury, each appointment lasted less than 5 minutes. 

You may have heard similar horror stories or even experienced them personally. Not just chiropractors, it can also be the beauty therapist pointing out all you flaws while offering you a limited time promotion to treat them while you were in a vulnerable position. 

Actually, the beauty industry received 1454 complaints last year, accounting for about 10 percent of all complaints that the Consumers Association Of Singapore (CASE) received.

My wife was in a similar position too previously. She had gone for a massage and while lying face down was asked to add essential oils and buy a package. She felt trapped in the room until she agreed to buy more sessions.

Prepaid packages often happen in pressure sales tactics where you are told that your crooked back, posture, freckles etc can lead to paralysis or something worse if left untreated. Often they prey on your fears to ensure that they can hang on to you, hoping that they will not lose you to another competitor. You are then locked in as all the money is paid upfront.

There are physiotherapy clinics that sell packages too, despite the Ministry of Health saying physiotherapists cannot do so. Perhaps these clinics pay kickbacks to rouge agents and doctors to refer them patients so they practice such tactics. MOH investigated physiotherapists, doctors, insurance agents and others after a physiotherapy clinic in Camden Medical Centre went bust for inflating insurance claims by selling packages.

As a business owner, I can understand that this helps to protect the businesses that sell them. Running a physiotherapy clinic (or beauty salon) requires significant capital, which includes staff, rent and equipment as part of overhead costs. When patients/ clients buy a package, it helps to allay these costs quickly, especially for a new clinic.

Selling a package does not work in our clinic. For instance, if I treated 5 new patients a day and each of them buys a package of say, 10 sessions. I would owe them 9 sessions after their first session, but I would soon run out of appointment slots to see them if all new patients buy a package. 

It will only work if the patient sees another colleague or each session is less than 5 minutes. In our clinics, initial sessions are 60 minutes long and follow up sessions 30 minutes if needed.

Actually we try to make our patients well as soon as possible instead of hanging on to them. We prefer that they get pain free and be happy patients so that they refer their families and friends to us. 

As patients (or customers), please do not be afraid to say no if you are asked to buy a package. If a promotion sounds too good to be true, it probably is. These salespeople/ healthcare professionals will try hard selling tactics, often by preying on your fears. However, you have the right to decline any offer that does not align with your needs or if you are not ready to make a decision. Stick to your decision firmly and politely.

Remember under the Allied Health Professions Council which registers physiotherapists in Singapore, does not allow physiotherapists to sell packages. You can definitely visit a clinic that does not offer any packages so you do not have to worry about committing to any large upfront payment.

Front Knee Pain After ACL Surgery?

ACL marked 20mm from each end by Dr Nuelle

While looking for a topic to write this week, I came across a research paper by Rahardja et al (2023) comparing knee pain and difficulty with kneeling between the bone-patella tendon bone (BTB) and hamstring graft after anterior cruciate ligament (ACL) reconstruction. 

I subsequently found a Twitter thread concerning the article where an orthopaedic surgeon says he "don't believe" what the paper says (see picture below).

Compared to now, there were more patients whose surgeons used the BTB graft when they tore their ACL's when I started work as a physiotherapist in the late 1990's. The hamstring autograft (not cadaver graft) is most commonly used now. 

One of the main reasons patients are told not to use a BTB graft  is because it (supposedly) causes anterior (or front) knee pain. 

A total of 10,999 patients who had ACL reconstructions were analyzed at 2-year follow-up. 9.3 percent (420 cases out of 4492 reported consequential knee pain (CKP) while 12 percent (537/4471) reported severe kneeling difficulty (SKP). For those into research, the Knee and Osteosrthritis Outcome Score (KOOS) was used to identify patients reporting CKP, defined as a KOOS Pain subscore of ≤ 72 points. 

The authors wrote that the most important predictor of CKP at 2-year follow-up was having significant pain before surgery while the most important predictor of SKP was the use of a BTB versus hamstring graft.

I do not agree with the authors' observation. I have treated many patients who had ACL reconstructions in the past 24 years. In the first few weeks after the ACL reconstruction, patients who choose either graft do have a little anterior knee pain presumably from the operation itself. After 6 weeks, anterior knee pain is very rare especially for those with the BTB graft. Very occasionally if they kneel onto the BTB graft site, they may have some kneeling pain which goes away quickly once they change position.

In fact, an orthopaedic surgeon commented that his few "non BTB" (i.e. hamstring graft) patients tend to have more anterior knee pain than his BTB graft patients (see picture below).

Moreover if you have read my earlier post, Spindler et al (2020) suggests that the HS graft is 2.1 times more likely to tear again compared to the BTB graft. Surely this is supporting evidence that the BTB graft is the 'better' and 'stronger' graft? 

There should be no reason to use "anterior knee pain" as an 'excuse' to use other graft choices rather than the BTB graft. 

Choosing your graft after tearing your ACL will definitely be influenced by discussions with your doctor, surgeon and physiotherapist. If you do not want to use your own BTB and hamstring graft, you can also use an allograft (cadaver) now. 

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

References

Rahardja R, Love H, Clatworthy MG et al (2023). Comparison Of Knee Pain And Difficulty With Kneeling Between Patella Tendon And Hamstring Tendon Autografts After Anterior Cruciate Ligament Reconstruction: A Study From the New Zealand ACL Registry. AJSM. DOI: 10.1177/03635465231198063

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.

Optimal Exercise Form Is Not Always Right

Aized and I had an interview with a physiotherapist last week. She found out physiotherapists in our clinic worked 4 days a week and she was keen to join our team. The interview had a practical component where she had to ask questions, assess and treat my "mid and low back pain" (for my twice broken back). 

After some questions and assessments, she decided that my weight lifting form was causing my discomfort. She then proceeded to "correct my form" for my weight training.

I understand the need to be very strict with textbook form for lifting and making sure technique is efficient to complete the task at hand whether it is during a rehab exercise or just moving a barbell in a strength movement from A to B.

Just so we can be on the same page, I am writing about what most personal trainers, strength coaches and physiotherapists consider textbook form. Feet shoulder width apart, back straight during a squat/ deadlift for instance.

That being said, there are definitely situations where less than "ideal" or "optimal" form is indicated and this is what I will be writing about.

Patients who have anatomical or even mobility limitations cannot do an exercise with textbook form or through full range correctly. Consider the following pictures above and below. Our bones and joints are shaped and angled differently and this will mean that there will be a large variability in individual ranges of motion and variations in exercise form and technique. You may have to squat wider with toes out while others may squat in a narrower stance with toes facing inwards.

Different femoral head angles

The squat technique is usually advised when lifting heavy objects over the stoop technique since this technique is thought to result in lowering intervertebral disc (IVD) compression and shear forces compared to the stoop technique.

Squat (a) versus stoop (b) lifting

However, when we compare squat versus stoop lifting, the squat lifting is not favored over stoop lifting (this is in contrast to current recommendations). 

The following study actually showed that lifting with a flexed spine produced LOWER spinal compression forces than lifting with a neutral spine (Van Arx et al, 2021).

Then there are patients who have widespread chronic pain but no tissue pathology. There is often lots of fear and avoidance of activity in these patients that if you focus too much on form it will be counter productive.These patients may be in a deconditioned state and I will be happy just to get them moving compared to someone who wants to deadlift a 100 kg.

Similarly with patients who are not active and had never play sport their whole lives. They often struggle with what we think are really simple movements and exercises. So long as there is no pain and they are not aggravating anything in low level exercises (example a half squat), I am fine with form that is not ideal for the time being and may work at improving it later.

Older patients often have other multiple health conditions and they may be other things to work on instead of spending too much time trying to teach a single exercise.

Physiotherapists who treat patients with neurological conditions like Parkinson's disease and stroke, will tell you that these patients definitely cannot do exercises with textbook form.

This post is not meant to ridicule anyone who insists on teaching textbook form while teaching exercises. Nor am I suggesting you let your patients have freedom to do whatever they want when exercising. I am simply suggesting that there are situations where insisting on textbook form is not ideal nor practical.

Reference

Von Arx M, Liechti M, Connolly L et al (2021). From Stoop To Squat: A Compressive Analysis Of Lumbar Loading Among Different Lifting Styles. Front Bioend Biotech 4: 9: 769117. DOI: 10.3389/fbioe.2021.769117

Please read this for more on squat versus stoop lifting.

Different shaped pelvis