The Big Picture

I was away on holiday with my family last week and I had some time to think. Instead of a regular post, I came up with the following questions and some answers.

My main questions were, "How can I make myself better as a physiotherapist?", "How can I ensure that all the physios in my team get better?", "How can I make our clinics better for our patients?"

My thoughts were that I always have to keep up with the research that's out there, the solid ones of course. I keep my mind open to new ways of reading the human body and what is "normal". I look out for courses to upgrade my skills. These answers were just some of ones that came to mind.

I will of course be consulting with Aized and other colleagues for their thoughts of my questions. I'm curious to hear how they would answer my many questions. That's why I value my team. We see the world through different lenses, so I learn from their views too.

A very important group of people to consult too would be our patients. I want to find out what they think about their experiences at our clinics, and act upon them wherever needed.

This journey of life, of being a physiotherapist, of running our clinics is full of ups and downs. I keep my eyes on the big picture. The big picture is that each and every person who comes to our clinics feel heard, helped, understood and hopeful. That's really at the centre of all we do.

Lunch With The Team

Sham is right behind

Staff from our clinics came together for lunch today at Real Food at Orchard Central today. It was great to be able to see everybody at the same time, catch up, share stories and of course talk in front of the bosses (rather than just talking behind their backs). Just kidding!

Some were late, others got lost finding their way while some others weren't sure what to order at this vegan/ vegetarian restaurant. But somehow we all managed. Since my accident, Aized has been super careful about what we eat. So no surprises that she chose this place.

While waiting for everyone, we took some pictures first of course.

Romaiza early for once ....

We're always early

Incidentally, this lunch doubles up to celebrate Sports Solutions turning 10 earlier in October this year as well.

Thanks to everyone who came and for those who couldn't make it, hope you can make it the next time. Have a great remaining rest of the year.

No meat!

Head, Neck And Jaw

Taking turns for a quick assessment

After Aized last week, yours truly attended the Head, Neck and Jaw course yesterday and today. This is the next course offered after we did the Shoulders and Arms course earlier in April this year.

Wow, time really flies, it's already October today.
It was a really interesting course looking at everyone's head, neck and into their mouths. Yes, you read correctly, we got to stick our fingers inside each other's mouths.

All five different necks

We learnt about the Masseter and Temporalis which are on our face and skull, we also learnt how to treat the Medial and Lateral terygoids, which are inside our mouths and how they connect to the neck.

Showing me my Lateral Pterygoids

Yes, we got right into each other's mouths.

Medial , Lateral Pterygoids

Back to work tomorrow. And if you need to get your head, neck or jaw treated .....

Breakthrough Performances And Hot Streaks

A few fellow physiotherapists that I've treated recently commented that they were quite amazed that I've gotten them (and patients) better so quickly that it almost seems difficult to believe.

To which I'd always say that nothing really improves in a straight line. Except our age, nothing really goes up in a straight line. Just like the stock market gyrations, there are days when it rises, some days it drops like a rock or days where it moves sideways.

Success in getting a breakthrough performance (or getting a patient better) is similar. It is almost never about a single monumental shift.

Think of a glass of water that you put in the freezer.  The water starts to freeze when it goes under zero degrees celsius (or 32 degrees Fahrenheit). This does not mean that the energy needed to lower the temperature from three degrees, two, one degree and zero isn't important. In fact, you will never get the water to freeze if all the prior work to cool it down isn't done.

Similarly, breakthrough moments are often the result of many previous actions, which slowly accumulate to unleash a major change.

In order to make a significant change, you need to work persistently to break through inevitable plateaus. Just like the water gradually turning into ice, you are gradually changing and improving as you slog along.

A patient (who used to race aquathlons) recounted the following experience. He and a fellow team mate were stuck at swimming 1:40 minute for the 100 meter swim intervals for a very long time. Without any real change in training, they suddenly got it down to 1:30 minute.

A patient of mine who runs got his kilometer repeats down from 4 minutes to 3:45. Or another athlete shared that he was squatting 100 kg for three months suddenly improved to 120 kg.

Many of my patients are now done with their racing season, while some are tuning up for their last race of the year. For those preparing for the year end Singapore Marathon, remember it's almost time to taper. When you resume training after your break and perceive no change, remember that just like water that is slowly beginning to freeze, you too are putting in the work for your breakthrough performance.

Back to my conversation with the physiotherapist I treated recently. My "hot streak" on getting good results treating patients definitely rest on a foundation of prior work, during which I try to become a better physiotherapist every year (since I can probably not get faster as an athlete).

In a journal, Nature, which was published recently, researchers found that most people have a "hot streak" in their career - a specific period during which an individual's performance is substantially better than his or her typical performance although the timing is somewhat unpredictable.

Talking it through just 2 days ago

Thanks to my wife and fellow colleagues, we regularly discuss and break down segments of courses we've gone for to make it unique to us. We will strive to make sure this "hot streak" of getting patients better as quickly as possible continues.

Putting it all together

Reference

L Lu, Y Wang, R Sinatra et al (2018). Hot Streaks In Artistic, Cultural, And Scientific Careers. Nature 559: 396-339. DOI: 10.1038/s41586-018-0315-8.

Tensegrity Of The Spine

Lining up half the participants to compare their necks and backs

After Aized and Rachel did Arches and Legs last week, it's the turn of the three amigos this this two days as we do "Tensegrity of the Spine" over the next two days.

Range of movement in the spine

This course is very intense and heavy going as there's a lot of rationale behind the theory involved. Everyone (yes, you read correctly) got lost at some point today, including yours truly.

Let's hope we get a clearer picture tomorrow.

Strength Training Just As Important (If Not More) Than Aerobic Exercises

Lifting before running

After our two beautiful boys came along, my wife used to just run as there was not much time for any other exercise. She found big benefits from minimal running. It improved her mood and energy levels while also lowering her risk of heart disease and stroke.

After a few years of just running, she felt that her fitness level was stagnating and that she was losing strength. So earlier this year, (along with two friends), my wife has been doing twice weekly strength training sessions at the Holland Village F45  gym.

A recent study found strength training just as important (if not more than aerobic training) and can add years to your life. This is the largest study so far (over 80,000 adults) to compare mortality outcomes of different types of exercise people did.

Researchers found that strength training (both gym machines and body weight) decreased the risk of early death (23 percent) and cancer-related death (31 percent).

Earlier I wrote about how weight training can also help solve Singapore's diabetes problem as highlighted by our prime minister during the 2017 National Day Rally. This study lends more weight to my suggestions to help Singaporeans get healthier.

Moreover, the World Health Organization's (WHO) physical activity guidelines suggest 150 minutes of physical activities and two days of strength training every week.

Seems like my wife's twice weekly strength training sessions at the Holland Village F45 is spot on with WHO's guidelines.

For those intimidated by gyms, (be it costs or images of heavy weights), the researchers suggested that body weight exercises like sit-ups, push-ups, lunges and triceps dips done in your own home or local park can be just as beneficial.


Reference

Stamatakis E, Lee I, Bennie J et al (2017). Does Strength Promoting Exercise Confer Unique Health Benefits? A Pooled Analysis Of Eleven Population Cohorts With All-cause, Cancer, and Cardiovascular Mortality Endpoints. Am J Epidemiology. kwx345. https://doi.org/10.1093/aje/kwx345.

Arches And Legs

It has been a big learning week for us. Aized attended the Anatomy Trains Structure and Function course last Friday to Sunday. And Ting Jun and I went for the next part on the "Arches and Legs" for the past three days.

Some of it has been revision of earlier concepts, while incorporating more in depth details as well.

Here are some pictures from our past 3 days at the course.

Feet and arches

Let me have a look too

 Deep in thought

When it comes to learning and making ourselves better physios, we make sure we do not cut any corners. As a team, we've spent lots of time going for courses, discussing difficult cases and sharing what we've learnt with each other to improve ourselves.

Majority of our patients are by "word of mouth" referrals. A patient comes and sees us in our clinic, they get better really quickly and they then refer their families and friends to our clinic.

So please come and see us in our clinics and we'll do our best to help you.

Looking forward to using what we've learnt at work tomorrow. Yes, back to work tomorrow.

Anatomy Trains Course

Aized did the Pediatric Craniosacral Therapy course two weeks ago, while I attended the Anatomy Trains workshop this weekend.

Since I did the first two days of this course last year, I only had to come only for the third and fourth day this year.

It was good to have done a little last year and then review some the concepts while adding on to it this time around.

Here are some pictures from the course.

Theory 

More theory

At the end of the course the presenter was saying "if all of you go in to see and patients tomorrow and wonder what you need to do then I've done my job. "

He was challenging us to look at and treat our patients with a whole new perspective instead of trying to treat our patients the same way we've done.

This has been a most interesting and stimulating course. It ties in nicely with many of the things we already do with fascia while treating our patients.

Well, I'll share what I've learnt with the rest of our team and we'll all be looking to treat our patients and make them better quicker.