Be Grateful

Picture from Wall Decor Plus More

It's the last Sunday of the year and also my last post for 2024. Where did 2024 go? I kept asking myself this question this past month as the year seemed to have zoomed by so quickly.

It's also the time of the year when it is customary to be a little kinder and do nice things for others like donating and giving presents.

I feel it is also a good time to dwell on things that we are grafeful for. When we shift our attitudes to focus on being grateful and giving thanks (instead of harping on things that upset us), it has a direct link to our wellbeing.

The following study had researchers who recruited a group of participants and asked half to take time weekly to write a few sentences about things that they were grateful for that week (Emmons and McCullough, 2003). The other half of the participants wrote about their irritationa and complaints.

After 10 weeks, the group that centered on gratitude felt more optimistic about life than the other group. 

Surprisingly, the group that was grateful saw physical changes as well. They were more active as they exercised more and made less visits to the doctor than the group that focused on the negative aspects of life.

There was another study by Toepfer et al (2012) that tested the effects of writing letters of gratitute to other people. The results clearly showed that those that took time to say thank you in writing made people happier, more satisfied with life and had less symptoms of depression.

Take some time to feel grateful for all the little and big blessings in your life. Write them down too since this active approach to gratitude can have tangible and lasting effects on our mental well being.

A big thank you for following and reading my posts weekly.

References

Emmons RA and McCullough ME (2003). Counting Blessings Versus Burdens: An Experimental Investigation Of Gratitude And Subjective Well-being In Daily Life. J Personality Social Psych. 84(2): 377-389. DOI:10.1037/00223514.84.377

Toepfer SM, Cichy K and Peters P (2012). Letters Of Gratitute: Further Evidence For Author Benefits. J Happiness Stud. 13: 187-201. DOI: 10.1007/s10902-011-9257-7

Exercise For Your Life

I saw a patient earlier this week for her shoulder and neck pain. She goes to Aspire 55 for weight training twice a week. We were chatting about how strength training has made her stronger and able to handle aging better. 

She mentioned that she visited someone she knew who stopped exercising at Aspire 55 for 6 months. She wanted to check in on her and was shocked at how frail her friend had become.

Frailty can occur in older adults and is characterized by a decline in physical abilities and an increased vulnerability to adverse health outcomes. 

If not treated, frailty can lead to a number of adverse health outcomes such as falls, disability, hospitalizations and even death. Its presentation and diagnosis can vary as well as being overlooked or misdiagnosed as part of the normal aging process.

Evidence suggest that the prescription of a comprehensive exercise program which includes strength, endurance training, mobility and balance improves function, targets frailty and improves quality of life (Vazquez-Guajardo et al, 2024).

The picture above shows the cardiorespiratory fitness that we need for our activities of daily living. If our fitness level drops below these thresholds we will not be able to 'afford' the metabolic cost of tasks needed to remain independent. One of many reasons to stay active for as long as possible. 

Exercise is therefore more than just fitness and looking good. It also gives you the ability to stay independent and resilient for longer. Resilience represents the ability to withstand adversity and remain in homeostasis despite the physical, psychological and social challenges of aging.

No matter what age you are , keep exercising to prevent, mitigate and perhaps even reverse frailty's trajectory.

Reference 

Vazquez-Guajardo M, Rivas D and Duque G (2024). Exercise As A Therapeutic Tool In Age-Related Frailty And Cardiovascular Disease: Challenges And Strategies. 4098): 1458-1467. DOI: 10.1016/cjca.2024.01.005

The Power Of Rereading Your Old Books

Picture by Tom Morris

I have always like reading. The Five Find Outers, The Famous Five, Moonface and The Faraway Tree  by Enid Blyton were my favorites when I was growing up. 

When competing in cross country/ track and field and triathlon, I pored over race reports, scientific articles on training, and sports biographies to help my athletic performance.

I also have this habit of rereading the books I like. Some books I've even reread a few times. I've realized that the older and wiser version of myself reads, analyses and understands things differently (and better) than the younger me.

The same applies to treatment and rehabilitation. Everyone seems enarmored with new treatment strategies, answers and solutions. Always looking for the latest flavor of the month.

Of course I do keep up with the latest updates. But do they always work better? Perhaps if we reread our older books/ articles we can better understand things we have have tried, considered or perhaps even ignored previously. You may find that most of the answers are already there. 

My family and I are currently away traveling, hence the short post this week. I am taking the time to read both old and new books. I love the feeling of paper between my fingers.

Have a safe holiday if you are traveling.

Anterior Pelvic Tilt

Picture of APT on the left by Oliver Ludwig

I had a patient come in this week saying he was told by another physiotherapist that he had an anterior pelvic tilt (APT) that was causing his low back pain. 

He was told that his poor posture while sitting for long hours caused it. Sitting for long hours is often thought to shorten the hip flexors while also weakening the core. There is no evidence that prolonged sitting causes APT. Some correlations were reported but lack consistency between left and right sides (Elliot et al, 2021).

However, even after being 'corrected' for his APT, his low back pain did not go away.

Many people will present in our clinic with a pelvic tilt. An article from Manual Therapy found that 85 percent of males and 75 percent of females (from 120 subjects) presented with an APT without any pain or disability. 6 percent of males and 7 percent of females presented with a posterior pelvic tilt without pain or disability too. So is APT really a dysfunction or is it normal?

There are also no agreement or guidelines as to what is too much or too little pelvic tilt. Moreover there is also no reliability between health professionals in clinical testing while assessing if a patient has APT (Preece et al, 2008). One health professional will assess you and say you have an APT while another may say otherwise.

APT is also not related to low back pain. Have a look at this systematic review by Chun et al (2017). In fact, patients that have low back pain had more 'neutral' pelvic (or hip) positions.

For those of you who have been told, APT is also not related to hip flexor tightness (Elliot et al, 2017) or a weak core (Walker et al, 1987). Neither does your hamstrings length or flexibility affect APT (Li et al, 1996).

So do not worry if someone or a health professional tells you that you have an anterior or posterior pelvic tilt for that matter. It may be changeable and may help reduce pain and/ or symptoms. It is not something that you need to be overly focused on. Treating the cause of the problem is much better than just treating the symptoms.

References

Boukabache A, Preece SJ, Brookes N et al (2021). Prolonged Sitting And Physical Inactivity Are Associated With Limited Hip Extension: A Cross-sectional Study. Musculosk Sci Pract. 51: 102282. DOI: 10.1016/j.musksp.2020.102282

Preece SJ, Willan P, Nester CJ et al (2008). Variation In Pelvic Morphology May Prevent The Identification Of Anterior Pelvic Tilt. J Manual Manip Therapy. 16(2): 113-117. DOI: 10.1179/106698108790818459. 

14 Day Lag Period Between Sleep Deficit And New Injury

Picture by Jeffrey Bown from his book Goodnight Darth Vader

Well, it's that time of the year again, where school has ended (for Singapore schools) and work in the office starts to wind down. Many of our patients are already traveling before the Christmas holiday.

Many of us, in this last month of the year, will experience less sleep due to travel, parties, family, children and shift work.

Though we would love to catch up with sleep when sleep is disturbed, even with training/ exercising taking a lower priority, it becomes more difficult with all the committments.

I often tell my patients (who are still training seriously) that there is up to 51 percent increased risk of injury especially for endurance athletes who get less than 7 hours of sleep per day in the last 2 weeks (Johnson et al, 2020).

The study recruited runners, triathletes, swimmers, cyclists and rowers. Subjective health complaints (SHCs) like psychological/ lifestyle factors, cardiorespiratory and gastrointestinal problems to investigated to see if they were associated with sleep quality, training load and new injury episodes.

Applying a 7 day and 14 day lag period, a shared frailty model was used to investigate new injury risk associations with total SHCs and sleep quality.

The investigators found that 7 day lag psychological/ lifestyle SHCs were significantly associated with new injury risk. This was in contrast to cardiorespiratory and gastrointesinal SHCs were not significantly associated with new injury risk. 

New injury risk had a significant increased association with a 14 day lag if there was less than 7 hours of sleep per day. There was no significant association with total SHCs, sleep quantity and training load factors.

The authors concluded that athletes need to be aware of the lag period between low sleep quality and its subsequent impact on new injury risk. In order to minimise the risk of new injuries, psychological/ lifestyle SHCs and sleep quantity should be considered.

Be mindful. Bear in mind that this end year period may be a time when we are most susceptible to new injury if we are deprived of sleep.

Reference

Johnston R, Cahalan R, Bonnett L et al (2020). General Health Complaints And Sleep Associated With New Injury Within An Endurance Sporting Population. J Sci Med Sport. 23(3): 252-257. DOI: 10.1016/j.jsams.2019.10.013