Hydrotherapy/ Deep Water Running Again!

Since Covid started, we have not been able to bring our patients to the pool for hydrotherapy or aqua-based rehabilitation. 

The public pool we were using is only opened for lap swimming now. We are very grateful to The Ripple Club. It was with their help that we got access to a pool for our post-op patients today.

They are all surrendering....

This is not a typical hydrotherapy session in a shallow pool like what hospitals may have. Those are often indoor sessions in waist or chest deep, warm water. Range of motion exercises and light strengthening exercises are normally done then.

For our sessions, the pool is usually 1.8 metres deep. The patients use an aqua running belt to keep them afloat.

One patient had her hip labrum repaired recently while another (a triathlete) had an OCD bone fragment removed surgically. I often include aqua running techniques (or deep water running) to produce a training effect for them since they definitely cannot run on land yet. 

If done correctly, the arms, shoulders, lower limbs and abdominal muscles are involved. For those who cannot take too much impact, this is a very good alternative since water is 773 times more resistant than air. The harder you move your arms or legs, the more drag force or resistance you encounter.

Sculling with aqua belts off

This is a very useful session for rehabilitation work and training for athletes and patients. It allows injured athletes or post operative patients to recover quicker and allows others to undertake higher intensity (water based) training, with lower incidence of injury. 

It will not do the aqua training technique justice for me to describe how you do it in just a few short sentences, please contact us if you need more information on this.

References

Davidson, K (2000). Deep Water Running Training Improve V02 max in Untrained Women. Journal of Strength and Conditioning Research. 14 (2) 191-195

Dowzer, CN and Reilly, T (1998). Deep Water Running. Sports Exercise and Injury. 4: 56-61

A big thank you to Alicia and Yannick from The Ripple Club for letting our patients try their water bikes.

*Thanks to Edmund Miranda from The Ripple Club for taking the pictures too.

Farewell Car Park Party At Holland Village

As we were walking back, my 8 year old boy asked me "why don't you write about the car park party?"

My younger boy was at home with my wife as he was having a fever and my older boy and I happened to walk past the farewell party for the partial closure of the Holland Village car park just behind the old Buona Vista swimming pool.

Incidentally, both of us attended the farewell pool party at the old Buona Vista Pool back when it closed in February 2014. Our patients did their deep water rehabilitation there at the pool after surgery. In fact, I learnt to swim in that pool and I taught my boy to swim in that pool.

The old swimming pool area is now a car park. This car park is going to be a huge mixed development built by a Far East Organization led consortium.

The landscape here will truly change. We will find out how it turns out in 2024. Below is an artist impression of how it will be ......

Lumbar Spondylolisthesis But No Real Deficits So Far

Have a look at the MRI and you can see a very obvious spondylolisthesis in my 38 year old patient's lumbar spine at the L5-S1 area. The last time I saw one so obvious was when I was working at the Singapore Sports Institute in a young gymnast in 2001.

Spondylolisthelis is a condition in which one vertebra slides forward over the vertebra below it. In simple terms, it means that there is a forward slip of one vertebra relative to another.

From what my patient says, there wasn't any traumatic incidents. He complains of lumbar area aches in the past year.  Often there is discomfort over his L buttock and tightness down his L outer thigh at the end of the day. He is still able to exercise including running and playing football. Other than that he hardly has any other symptoms.

His surgeon has suggested surgical intervention to stabilize his spine at the end of next month. Looks like lots of rehab after surgery.

Finding Our Way Back To Fitness

My wife resting and still not feeling quite right after 11 days

It definitely happens to us runners at some point. We get sick, busy or injured. Well, it just happened to my family.

First my wife fell sick last Tuesday. She had a really bad sore throat, viral fever and was feeling really terrible. She thought she could self medicate and had to take two Panadol tablets thrice a day "just to barely function" in her words. I brought her to see the doctor on Thursday and she got better with the stronger medication given by the doctor.

On Friday, my two and half year old boy woke up with a fever. Oh dear, my wife groaned, she had passed it to him. We had very little sleep that night as his temperature kept spiking during the night. Our helper had to help us throughout the night too. I ended up not going to my usual Saturday morning long bike ride.

Despite not sleeping well, I managed to see patients the whole Saturday. When I got home, my older seven year old boy was running a temperature.

We spend the whole Sunday resting and trying to keep everyone comfortable at home. Thanks to my helper who decided to forgo her off day to help us. Thanks Ami!

I was the last one standing, the "last of the Mohicans" or so I thought. I woke up with a fever at 3 am on Monday morning! Grrrrrrr. I thought I was strong/ healthy enough not to catch the bug but in the end I succumbed.

I ended up not working for the past few days. My wife still hasn't gone in to the clinic. Though she's feeling better, she just doesn't seem quite right. The older boy hasn't gone to school this whole week while the younger boy still gets a fever on and off. Now that was really strong bug that got us down.

A body at rest can and tends to remain at rest. My wife is just lamenting that her fitness is gone, poof just like that! How do we start running or exercising again?

If you've been away from running more than a week, the pool  is great for doing deep water running. If you prefer something land based, you should just try walking first. The goal is to be able feel strong going on a 30 minute walk. If that's too much try 10-15 minutes walking and build from there.

Next, add in some running. Throw in a 10-15 second run after walking  five minutes. If you feel good, you can continue with 10 seconds run / 40 seconds walk for 5-10 mins. Every other day add 3-5 minutes and you'll back on your way.

Your body will definitely tell you if you've done too much during your comeback- you just need to listen to it.

Hmmm, should I go for my long bike ride tomorrow?

Actually, my helper, Ami, is the last one standing, "the last of the Mohicans". Good on you Ami!

Please Help My Swollen Knee

My patient sent me the above picture recently asking for help. Her knee became swollen after a recent run. After icing her knee, she decided to use some "imitation/ copy cat" Kinesio Tapes but that didn't resolve the swelling and worse still gave her an allergic reaction.

Knee joint effusions (or swelling) are usually caused by the knee joint producing more synovial fluid due to aggravating factors causing damage to the joint.

As little as 5 ml of fluid can increase pressure within the knee joint. This can be a source of discomfort and concern for the person affected.

It takes a very small volume of fluid in the knee (20-30 mls) to result in biomechanical changes. The quadriceps will be inhibited as a result (meaning you are less willing to use that muscle) and strength decreases rapidly.

It has also been found that swelling in the knee affects joint mechanics particularly during landing tasks. If someone has effusions in the knee, they tend to land with greater ground reaction forces (or impact) and in greater knee extension (or straightening). This results in more forces transmitted to the knee joint and its ligaments. So you can't run and jump quite as well.

When we see knee joint swelling in our clinics, we try to remove the swelling pronto. Flossing the knee joint, using correct Kinesio taping techniques with genuine Kinesio tapes definitely helps.

My favorite is of course aqua based rehabilitation/ deep water running to take advantage of hydrostatic pressure to help with the swelling. This also allows for quadriceps/ hamstrings strengthening early on without additional loading.

If the patient has more severe effusions, we may suggest altering their gait temporarily (we call this pain free walking), using non-steroidal anti inflammatory medication (NSAIDs) or even suggest they get the joint aspirated (I've tried it, it hurts like crazy).

Once the swelling settles, it will quickly and significantly reduce internal pressure in the knee as well as improve quadriceps strength.

We will quickly select rehabilitation exercises to allow specific quadriceps muscle recruitment without increasing intra articular pressure with knee extension. This is usually done in positions of partial knee flexion (20-30 degrees).

Now you know. Come see us in our clinics if your knees are swollen.


References

Hart JM, Pietrosimone B et al (2010). Quadriceps Activation Following Knee Injuries: A Systematic Review. J Athl Trg. 45(1): 87-97. DOI: 10.4085/1062-6050-45.1.87.

Palmieri-Smith RM, Kreinbrink J et al (2007). Quadriceps Inhibition By An Experimental Knee Joint Effusion Affects Knee Joint Mechanics During A Single-Legged Drop Landing. AJSM. 35(8): 1269-1275. DOI://doi.org/0.1177/0363546506296417.

After Rupturing His Patella Tendon .....

Nice leather seats ....

This is how Ronald Susilo came to our clinic after surgery to re-attach his patella tendon - his wife drove him while he sat in the back seat. Besides rupturing his patella tendon, he also tore his ACL and his meniscus.

With the Floss band

Last Saturday (20/02/16)  you saw him struggling to turn the pedals a full round while on the stationary bike. Only with the Floss band he managed to go one full round albeit with lots of shouting (in pain of course)!

On Monday (22/2/16), we went to the pool for hydrotherapy. 

And yesterday he saw his surgeon for a review. His surgeon told him "good progress". Little did the surgeon know he couldn't bend his knee more than 60 degrees last Saturday!

Today we got him on the Bongo board. Yes, both side to side and front and back. A board developed to challenge even professional athletes.

Check this out!

Holding on for dear life

What I'm trying to say is we didn't achieved this progress just because of the Floss band. Yes maybe the Floss band did kick start his rehab last Saturday by allowing him to turn the stationary bike pedals a full round. He began to believe in himself after that.

We did lots of other things along the way too, (I've left out the other rehab details of course, come talk to me if you wanna know). 

Use your Floss band as part of the treatment strategies you have to treat your patients. It's not a magic bullet. It's certainly not the only treatment aid/ tool you should be using.

To Jane Fong, Danny Ho, Sven Kruse and Sanctband, thank you for introducing to me the Floss band. It's definitely a tool I use in my bag of tools to treat my patients.

Ronald Susilo going down stairs

Recovering From Bangkok Bomb Blast ST 051115

Straits Times (051115)

Sports Solutions is featured in the Straits Times today. One of our patients recovering after being injured on August 17 this year in the Erawan Shrine at the Rachprasong section in Bangkok while on holiday there with his family.

We wish him well for his recovery.

It's in the Straits Times today on page B10.

Hydrotherapy

One Last Farewell Swim

One last swim for charity

This was the pool where I learnt how to swim in the 1970's. I've been teaching my son how to swim there too this past few years. When my wife was pregnant, she did hydrotherapy there for her low back pain and to get some exercise as well.

When I started training seriously for triathlon, this was the pool that I started training at. When I broke my head and back last year (and my previous knee surgeries) this was the the very place I came to do my rehabilitation.

So definitely on this last day that Buona Vista Pool is opening its doors for the last time I had to come and bid a very fond farewell to the pool.

In fact, I went to the pool twice today. Brought patients there for hydrotherapy this morning and later in the afternoon went with my wife and son to take some pictures and for one last swim with my son. We went earlier in the afternoon before the crowd came, hence it look really empty.

Big splash coming up

Look mama, I can swim

We'll definitely miss you dear Buona Vista Pool.

Who Came For Hydrotherapy Today?

Who's that jumping?

I've been going to the pool fairly regularly (especially since that's the safest exercise/ rehabilitation I can do after my bike accident and often alone too.

Occasionally I get Ronald Susilo (former Olympian, Sportsman of the Year) joining me. Recently he was actually planning to play in the current ongoing Li Ning Singapore Super Series Badminton Open and he requested joining me at hydrotherapy to do some conditioning. (Alas, he did not get his chance, but that's a different story).

Now, Ronald and I go back a long way, I've been treating Ronald since the late 1990's, way before he became a household name in badminton. We've done hydrotherapy previously while he and the rest of the Singapore Badminton team were preparing for the Olympics.

And, surprise surprise, he showed up with 2 of his young charges today at the pool for some conditioning with him, with me taking charge - just like the old days.

Ronald taking a rest

Now, it was with dismay that I read in the papers today that all 3 of our male local shuttlers were knocked in the qualifiers yesterday and so Singapore will not have any representation in the main draw of the Men Singles today.

So hopefully, with today's session and more, Ronald's young players will do well enough to do us proud at subsequent Singapore Open's and more.

All the best at the tournament, Team Singapore.

Aqua Based Rehabilitation (Deep Water Running)

Recognize anyone?

If you've ever wondered how our injured national athletes still keep most of their hard gained fitness, read on.

Their pool based water work is often the key to a quick return. For those not injured, the swimming pool can also be used as a great training tool in addition to your other workouts. Look closer at the 2nd picture and you may recognize some of our badminton players who have been to the last 2 Olympics- Ronald Susilo, Kendrick Lee, Xing Aiying and Li li etc. Our Singapore badminton team went to the pool once a week at least during periods when they were training at their hardest so they can train in a setting with little or no impact to minimize injuries with yours truly leading the session in the water with them.

Now, this is not a typical swim training session like you might think. As most land based athletes are not good swimmers, I often use aqua running techniques (or deep water running) to produce a valuable training effect for them. It would take a far longer time to get them to be of a good swimming standard to get the same effect from swimming and since time is a precious commodity in sports rehabilitation hence the use of deep water running. Moreover, most of these athletes or patients are involved in some land based or running sports, so swimming offers less transferable benefits or movements that are similar to their land based activities.

Done right it is a full body workout involving the legs, arms, shoulders and core muscles.It is also a good alternative to pounding the streets day after day. A study comparing a group doing deep water running versus another group road running found both training programmes produced similiar improvements in V02 max levels.

Water is about 773 times more resistant than air, so it can strengthen all key running muscles. Water is also isokinetic, meaning the water resists you as much as you resist it. The harder you move your arms or legs through the water, the more drag force or resistance you encounter. What's more challenging? Doing the workout without a flotation device or belt. I often get my athletes to do the entire session without one to push them harder.

The pool is a very good and versatile environment for rehabilitation work and training for athletes and patients. By including this session, you can allow for injured athletes or patients to recover quicker and allow others to undertake higher intensity water based training. It will not do the aqua training technique justice for me to describe how you do it in just a few short sentences, please contact us know if you need more advice on this. Physio Solutions conducts deep water running classes, give us a ring to find out more.

References

Davidson, K (2000). Deep Water Running Training Improve V02 max in Untrained Women. Journal of Strength and Conditioning Research. 14 (2) 191-195

Dowzer, CN and Reilly, T (1998). Deep Water Running. Sports Exercise and Injury. 4: 56-61