A lot of metal work |
Sunday, July 21, 2024
Sural Nerve Pain
Sunday, July 14, 2024
Hot Water (Not Cold) Immersions More Effective For Recovery
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Picture from Racold.com |
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Picture from Business Insider by Alexandre Simoes |
On the contrary, hot water immersion (below) improved recovery follwing exercise induced muscle damage (Sautillet et al, 2024).
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Picture from Newsmeter |
Quadriceps maximum strength and explosive strength were measured pre, 24 and 48 hours post exercise. Pressure pain threshold (PPT), or was also measured to quantify the recovery from muscle soreness
Here are the results. 48 hours post exercise, quadriceps maximal strength returned to baseline values after both cold and hot water immersions. However, explosive strength levels and PPT (muscle tenderness) returned to baseline levels post 48 hours only after hot water immersion.
In addition, surface electromyography (electrodes) signals from the vastus lateralis (outer quadriceps) was significantly increased following cold water immersion. Meaning more muscle fatigue. Or as patients like to say, their muscles are 'very tight'.
The authors concluded that a single session of hot water immersion (rather than cold water immersion) improved the rate of explosive strength followed exercise induced damage. When explosive power is a key performance requirement, hot water immersion should be preferred over cold.
*Note that the cold bath temperature used in this study (Santillet et al, 2024) was 11 degrees Celcius. Wim Hof (the Dutch iceman), others on Tik Tok, other social media and purveyors of commercial health and wellness have different protocols.
For those who are keen the temperature of the hot bath was 41 degrees Celsius for a duration of 15-30 minutes.
Sunday, July 7, 2024
Can Ozempic And Wegovy Help Knee Osteoarthritis Pain?
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Picture from Second Nature |
According to results from the STEP-9 trial (by Novo Nordisk) reported at the World Congress on Osteoarthritis (OARSI 2024), Wegovy, containing peptide receptor agonist (GLP-1) semaglutide not only induced weight loss but improved knee pain in people with knee osteoarthritis (OA).
STEP-9 was a multi national, multi center phase 3 clinical trial that enrolled subjects that had a BMI of >30, a clinical diagnosis of knee osteoarthritis with moderate radiographic changes and were experiencing knee pain.There were 407 subjects in STEP-9, randomly allocated 2:1 to receive once a week a subcutaneous injection of either semaglutide 2.4 mg or a placebo for a total of 68 weeks. Mean age of the subjects were 56 years and 81.6 percent were women. 60.9 percent were White, 11.8 percent Native American, 7.6 percent Black and 19.7 percent were of other ethnic origin.
Another finding was that the use of pain medication went down in the semaglutide group compared to the placebo group. This was maintained throughout the study.
Of course the are suggestions that the weight loss itself helped with the knee pain since weight loss fell by a significantly greater amount in the people treated with semaglutide versus those given a placebo. Weight loss was 13.7 percent versus 3.2 percent from baseline after 68 weeks.
The authors questioned if there is a specific action of GLP-1 receptor agonist on the knee joint itself and not through weight loss only. Especially since results from previous LOSEIT trial using liraglutide (also used to treat Type II diabetes) showed that subjects lost 2.8 kg versus a gain of 1.2 kg in the placebo group over a year did not have any change in the Knee injury and Osteoarthritis Outcome scores. The patients in that study had to undergo weight loss first before they were given the liraglutide.
Obesity is a worsening problem world wide in developed countries and Singapore has increasing numbers in people with diabetes. This is certainly going to add to the boom in weight loss drugs.
Morgan Stanley projects that the market for weight loss drugs will reach $54 billion by 2030, a 400 percent increase from today. Especially since so many celebrities have gushed about how much weight they have lost since taking them. Eli Lilly and Novo Nordisk (who owns Wegovy and Ozempic) together have at least 12 more obesity medications under development.
We are living through a cultural shift in which obesity is viewed as a disease rather than the result of lifestyle choices.
Should my patient try Wegovy instead especially since he does have knee pain from osteoarthritis? Wegovy has a higher dose of 2.4 mg semaglutide versus 2 mg for Ozempic.
Will Wegovy or Ozempic be the new default recommended treatment for osteoarthritis pain instead of surgery, gel injections and physiotherapy?
Reference
https://www.medscape.com/viewcollection/37518
*Please note that the STEP-9 study was funded by Nova Nordisk and the principal investigator Henning Bliddal acknowledged that research grants were given by Novo Nordisk to his institution as well as consulting fees and honoraria. He also received congress and travel support from Contura
Sunday, June 30, 2024
Inspired Or Pissed?
Holt (who is 29) ran his fastest 1500m race at the New York City Grand Prix on 8-9 June, finishing 2nd behind Jake Whitman, the 2022 world champion.
He was interviewed after the race and unlike many other runners he had no sponsorship, calling himself an amateur. He pays for his own running gear and physiotherapy sessions. That interview led to an article about him in the Washington Post. He worked 13 hour shifts in a psych ward to make ends meet, where he prevents patients from harming themselves. The running team he trains with found him when he posted his extremely hard workouts on Strava between 11 pm and midnight.
Besides living with his parents (which he was feeling embarrased about), his girlfriend also pays for their meals when they do go out. He dreams to be a professional runner and promises to return the favor if he gets sponsored. He wants to prove to sponsors that he is hard working and talented, and that he's not some schmuck (foolish).
He ends the interview by saying that he's gambling and betting his life, sacrificing everything to be a pro one day.
I thought that was really inspiring since I ran cross-country and track and field in seconday school and can identify with Holt. However, there were other running fans who saw the same interview but had a much different view.
You can watch a profanity laced video of another track fan berating Holt for his 'sob' story. He thinks Holt should quit running and get another job. He even criticized people like me who would encourage athletes like Holt.
If you watched the critique video, please share your reaction in the comments. There is no right or wrong answer, I am just curious to hear your views.
Today is the last day of the trials. Sadly, Holt did not qualify for both the 800m or the 1500m, but at least he got Puma as a shoe sponsor now.
Thank you for reading and thanks in advance if you share your thoughts in the comments.
Sunday, June 23, 2024
Rehab Is Like Snakes And Ladders
Sunday, June 16, 2024
Does Eating Just Before Sleeping Make You Fat?
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When he was 9 in 2019 |
Is that what you think too? That eating before sleep makes you accumulate fat because you are resting for many hours after you eat. Well, let me show you that this is untrue. Note that this is with pre-sleep protein consumption.
Data from men and women show that consuming protein pre-sleep does not change overnight fat metabolism (breakdown of fats to be used as energy). When research participants consume either caesin protein (found in milk, cheese and yoghurt) or a non caloric placebo, there was zero difference in the overnight fuel use or energy expenditure. There was also no difference in the amount of fat liberated from the fat cell measured with a technique called microdialysis.
This may be a big surprise to you as it is often thought that eating before bed will inhibit fat metabolism. Now you know it is not true. Protein consumption helps improve strength, recover from strenuous exercise as well as maintain and improve metabolic and structural health. Evidence suggests that the average person should consume 1.2 grams of protein per kilogram of body weight per day. Athletes should consume closer to 2 grams per kilogram of body weight.
Pre-sleep protein has also been found to decrease next morning hunger. Adequate protein consumption also promotes satiety, leading to a reduction in over-eating.
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Plant protein my son consumes |
Whey and casein protein were more popular previously due to their ease of digestion and availability. Especially since plant based protein were not so easily available then and they cost more. Most pre-sleep protein research uses casein followed by whey protein since plant-based protein has less leucine. A greater amount of plant-based protein is needed to be consumed to elicit the same response compared to a lower amount of animal-based protein.
Hence pre-sleep protein consumption does not make you gain fat. Now you know.
References
Allman BR, Morrisey MC, Kim Js et al (2020). Lipolysis And Fat Oxidation Are Not Altered With Presleep Compared With Daytime Casein Protein In Resistance-trained Women. J Nutr. 150(1): 47-54. DOI: 10.1093/jn/nxz186.
Kinsey AW and Ormsbee M (2015). The Health Impact Of Nighttime Eating: Ols And New Perspectives.Nutrients. 7(4): 2648-2662. DOI: 10.3390/nu7042648
Saracino PG, Saylor HE, Hanna BR et al (2020). Effects oF Pre-sleep Whey Vs Plant-based Protein Consumption On Muscle Recovery Following Damaging Morning Exercise. Nutrients. 12(7): 2049. DOI: 10.3390/nu12072049.
Snijders T, Trommelen J, Kouw IWK et al (2019). The Impact Of Pre-sleep Protein Ingestion On The Skeletal Muscle Adaptive Response To Exercise In Humans: An Update. Front Nutr. 6(16). DOI: 10.3389/fnut.2019.00017.
Sunday, June 9, 2024
Understanding The Recovery Of The Intervertebral Disc
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Picture from Wikipedia |
The IVD consists of a very tough outer layer called the annulus fibrosis (AF). It is made of of several layers of fibrocartilage consisting of Type I and II collagen fibers. The AF protects the soft, gel-like substance in the middle known as the nucleus pulposus (NP). The NP helps distribute pressure evenly across the IVD and prevent excessive forces on the spine.
See how thick the AF is from the picture above? Here's something else you need to know. There is a cartilaginous endplate between the AF and the vertebra (the spine). The endplates hold the IVD in place. It allows load to be spread evenly and to provide attachment to the IVD. This creates a super strong connection to the AF making it impossible for the IVD to 'slip' out of position.
Yes, our discs are actually very strong and hardy. How strong are our IVD's? In a published study on thoracic discs in the young (28 years old plus minus 8 years) , it took about 740 pounds of force to compress the disc height 1 mm. For the older subjects (70 years young plus minus 7 years), it took almost 460 pounds of force. Note that these are on cadavers with the muscles and bones cut away (Stemper et al, 2010).
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Picture from Feki et al, 2024 |
Sunday, June 2, 2024
A Better Way To Train Your Quads
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Leg extension exercise |
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Right quadriceps femoris muscle |
The subjects then completed a 10 week training program comprising of 2 strength training sessions each week. This consisted of 3 sets of exercises from week 1-5 and from week 6-10 onwards, 4 sets of exercises. They performed either 15-20 reps of leg extension or if they cannot reach 15-20 reps to failure (where the quads cannot do another rep).
2 pre and post training measurements on the proximal and distal rectus femoris and vastus lateralis muscles were done with ultrasound imaging to compare results.
The findings were that the quadriceps femoris muscle hypertrophied following the 10 weeks of strength training. The rectus femoris part of the quadriceps femoris had significantly greater hypertrophy in both the proximal and distal regions at 40 degrees of hip flexion compared to 90 degrees hip flexion.There were however no hypertrophy changes in the distal proximal and distal regions of the vastus lateralis muscle. This finding was expected as the vastus lateralis is a single joint muscle and its muscle length was constant and did not change during both hip positions.
The authors concluded that performing the leg extension exercise with 40 degrees of hip flexion had superior increases in hypertrophy of the rectus femoris muscle compared to 90 degrees hip flexion. So definitely not always true that you need good posture/ exercise form when exercising.
This is attributed to the longer muscle length in the rectus femoris when the leg extension exercise is performed with the hip at 40 degrees flexion. Note that the rectus femoris is a 2 joint muscle where it can both flex the hip and extend the knee. The other 3 muscles in the quadriceps femoris are capable of only extending the knee. This makes the rectus femoris most prone to muscle strain injuries especially when sprinting and kicking.
The authors suggest that training the rectus femoris with 40 degrees hip flexion would make it stronger and offer a protective effect against rectus femoris strain injuries.
Reference
Larsen S, Kristiansen BS, Swinton PA et al (2024). The Effects Of Hip Flexion Angle On Quadriceps Femoris Muscle Hypertrophy In The Leg Extension Exercise. Sport Rxiv. DOI: 10.51224/SRXiv.407
Sunday, May 26, 2024
What Does The Fibularis Longus Muscle Have to Do With Knee Pain?
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R Peroneal Longus (Peroneal Longus) |
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Fiblaris logus is part of the lateral line |
Sunday, May 19, 2024
10 Bodyweight Squats Or Walk 30 minutes?
Well, I can suggest a fairly simple way to improve your blood sugar regulation better than a single 30 minute walk if you're pressed for time. Also helps to lower cancer and cardiovascular related mortality.
A recently published study (Gao et al, 2024) on overweight and obese subjects who either sat uninterrupted for 8.5 hours or had interruptions while sitting with matched energy expenditure and duration. A 30 minute walk at 4 km/hr, sitting with 3 minutes walking at 4km/hr or squatting 10 times every 45 minutes.
The authors found that doing 10 body weight squats every 45 minutes or short frequent walking breaks during a 8.5-hour period of sitting improved blod sugar regulation better than a single 30 minute walk (at 4 km per hour).
These superior benefits seemed to be associated with increased muscle activity intensity in their targeted muscle groups during frequent transitions from sitting to activity.
These brief, intense bursts of activity (bodyweight squats in the study) termed 'exercise snacks' offer a simple yet strong strategy to mitigate the health risks associated with our sedentary lifestyles. It is not too difficult to get up from sitting and do 10 bodyweight squats every 45 minutes (or when you can). You can also do burpees or run up stairs to break up sedentary periods. Those at home may want to do some dumb bells/ kettle bells swings.
Of course some other people may prefer to walk outside for fresh air, sunlight meeting other people and psychological/ mental health benefits. Or a combination of exercises and walks. Works well too. Go on and add some some exercise snacks into your day.
References
Gao Y, Li QY, Finni T ey al (2024). Enhanced Muscle Activity During Interrupted Sitting Improves Glycemic Control In Overweight And Obese Men. Scan J Med Sci Sp. 34(4): e14628. DOI: 10.1111/sms.14628
Stamatakis E, Ahmadi MN, Gill JMR et al (2022). Association Of Wearable Device-measured Vigorous Intermittent Lifestyle Physical Activity With Mortality. Nat Med.28: 2521-2529. DOI: 10.1038/s41591-022-02100-x
Sunday, May 12, 2024
Will My Metabolic Rate Slow Down As I Age?
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Picture from Genesispersonalfitness |
Metabolisms varies by 20 percent or more from person to person regardless of activity level or body composition (Rimbach et al, 2022). So for those of us who run or exercise to manage our weight, yes it does burn calories, but it does not boost our metabolism, at least not in the long term.
The researchers also found that if you happen to be on the skinnier side, it is not that you have a faster metabolism (Rimbach et al, 2022).
The researchers measured metabolism using doubly labeled water. Participants in their studies drank water containing hydrogen and oxygen isotopes, which researchers can track in the body. How quickly they lost the isotopes through peeing, sweating and even breathing were monitored. These enabled them to ascertain how many calories are burned in that time, or what is known as total energy expenditure i.e. metabolism.
The total energy expenditures studied were measured at 2 time points, ranging from 2 weeks to more than 8 years. Body size and composition were adjusted for since more cells burned more calories and fat and muscle burned calories at different rates.
The researchers found that the subjects' daily energy expenditures did not change over time. A person with high metabolism today will have it high in a few months or even a few years. Likewise, a person with slow metabolism today will still have it slow in a few months or a few years.
Here's the good news. The researchers found that having a slow metabolism did not make people more likely to gain weight. Nor did having a fast metabolism less likely to gain weight.This is attributed to the human brain's outstanding ability to match calories consumed to calories burned in the long run.
So, running or any exercise is not a magic metabolism booster. Exercise is complex and it affects how our body regulates all its cells, which in turn affects hunger, fullness, immune function and even behaviour.
Those who exercise will obviously see day to day fluctations in the calories burned. More on long runs/ hard days compared to recovery days. Our bodies adjust how much energy we use during our non exercise hours to keep the total caloric burn within a fairly narrow range.
So, you do not gain weight as you age because your metabolism slows down (Pontzer et al, 2021). We have all been mislead by this myth. We should not use it as as excuse. You gained weight because we do not move and/ or exercise as much and because we may have lost some muscle mass.
Reference
Pontzer H, Yamada Y, Sagayama H et al (2021). IAEA DLW Database Consortium. Daily Expenditure Through The Human Life Course. Science. 373(6556): 808-812. DOI: 10.1126/ science.abe5017
Rimbach R, Yamada Y, Sagayama H et al (2022). Total Energy Expenditure Is Repeatable But Not Associated With Short-term Changes In Body Composition. Nat Commun 13,9. DOI: 10.1038/s41467-021-27246-z
Friday, May 10, 2024
Cold Play?
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ST 100524 |
Sunday, May 5, 2024
Can Cycling Lower Your Risk Of Knee Arthritis?
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Picture by Dennis Thong |
Lo et al (2024) studied 2600 older adults with and without knee OA using knee X-rays, subjective knee pain, and a questionnaire regarding their lifetime history of various physical activities during 4 periods of their lifes: 12 to 18 years old, 19 to 34, 35 to 49 and over 50.
The study used 3 different outcomes. Persistent knee pain, OA based on X-rays (radiographic OA) and symptomatic OA (having both knee pain and radiographic OA. Note that what is seen on X-ray (OA knees) does not always correspond to pain. This means that some subjects had knee radiographic OA but NO pain.
Almost half the subjects reported some history of cycling and these subjects were less likely to have OA in their knees. How much less? Those with any history of cycling were 17 percent less likely to have knee pain, 9 percent less likely to have radiographic OA and 21 percent less likely to have both.
Half of those who cycled reported only cycling regularly during one of the 4 age periods, usually the youngest age period from 12 to 18 years old.
Those who cycled during 1,2,3 or 4 of the periods studied reduced their risk of symptomatic OA (i.e. painful knees) by 17, 19, 28 and 43 percent. Meaning lifelong cyclists reduced their risk of symptomatic OA by nearly 50 percent.
The researchers also found that subjects with a history of swimming, strength training and running had lower rates of OA. This is consistent with previous evidence that running DOES NOT ruin your knees despite what every non runner and ex runner you know will insist running does.
You may love watching the beautiful game, but a history of playing the beautiful game (football) even just as a teenager bumped up knee OA risk by a factor of 2. This elevated risk remained even after adjusting for BMI, suggesting that the problem is likely related to acute knee injuries suffered while playing football.
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Picture by Dennis Thong |
Reference
Lo GH, Richard MJ, Kriska AM et al (2024). Bicyling Over A Lifetime Is Associated With Less Symptomatic Knee Osteoarthritis : Data From The Osteoarthritis Initiative. Med Sci Sp Ex. DOI: 10.1249/ MSS 0.0000000000003449
All pictures by Dennis Thong. Many thanks to Dennis and Eugene Phua for the pictures.
Sunday, April 28, 2024
Are Cold (Ice) Water Immersions Effective?
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Picture from Scienceforsport |
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Good for icing |