Be Patient So You Don't Become A Patient

Maybe the best thing to do now is nothing. To not change anything. My friend, whom I shall not name is always drawn to bright, new and shiny things. He is always after the latest fads. Especially when it comes to health and fitness.

Consider his diet. He is always following the latest 'flavour of the month'. Whether it's low carb, high fat, Atkins, South Beach, intermittent fasting etc, he's tried them all. I often tell him that his quickness in switching diets (due to not seeing results quickly enough) is probably detrimental to him losing weight.

I quoted him a study done by researchers comparing low fat and low carb diets. Participants were randomly tracked for a year. Those who lost the most weight were those who adhered to that diet. Being on either diet didn't matter as much. Slow and steady wins all the time in the long haul.

I would say this is exactly the same for fitness too. A paper published in the British Journal of Sports Medicine found that the best way to avoid getting injured is to slowly increase your training volume over time. Excessive and rapid increases in training loads are responsible for a large proportion of non-contact soft tissue injuries.

I travelled extensively with our Singapore badminton players and went to two Olympic Games with Team Singapore. The players had training camps and competitions all over the world and I've had the privilege of seeing world class badminton players like Lin Dan, Lee Chong Wei, Taufik Hidayat, Peter Gade and Singapore's own Ronald Susilo  train. (Below is a picture of him beating Lin Dan at the Athens Olympics).

I'm more excited than Ronald!

They all employ different strategies to build fitness and hone their court skills. Different coaches have different coaching styles. But all lead to the same objective, to be able on put the shuttlecock where they want to on court, be it with a smash or drop shot to win the point. To win the badminton match.

Sitting on court in Beijing 2008

And the key to success is that the players stick to the plan. There are many roads leading to Rome, and they get there only if they stick to their path.

If the training you did this week was twice as much as what you average over the past four weeks, you're 5 to 10 times more prone to getting injured compared to 10 percent increases in training volume and intensity.

This is especially true when my patients are returning from injury. I always tell them to err on the side of caution. Doing too much too soon may get them injured again. Our bodies need time to adapt to training loads after injury.

So as this strange, unprecedented year draws to a close, hang in there if your diet or fitness routine hasn't gone exactly to plan. Be patient, keep at it, remember it's slow and steady that always wins in the end. Patience is really a virtue.

References

Gabbett TJ (2016). The Training - Injury Prevention Paradox: Should Athletes Be Training Smarter And Harder? BJSM. 50(5): 273-280. DOI: 10.1136/bjsports-2015-095788.

Gardner CD, Trepanowski JF et al (2018). Effect Of Low-fat Vs Low-carbohydrate Diet On 12-month Weight Loss In Overweight Adults And the Association With Genotype Pattern Or Insulin Secretion. JAMA. 319(7): 667-679. DOI: 10.1001/jama.2018.0245.

Herlene's Going To The SEA Games

Unlike Herlene, I'm not going to the SEA Games in Philippines this time. Not as an athlete nor as a physiotherapist for Team Singapore. The last time I went to the Philippines I competed in the triathlon event in 2005.

But one of my patient's, Herlene is going to the SEA Games as a member of the triathlon and duathlon relay teams. I've treated Herlene since she was in Primary school. She came to see me today for a final tune up session.

So I took the opportunity to get a picture with her first before she leaves for the games on Friday.
Herlene was featured in the Straits Times on Monday 251119.

All the best at the games Herlene! We will be rooting for you.

Super Mum Rachel Yang Goes To Commonwealth Games

I first treated Rachel Yang back in the year 1999. She was then representing Hwa Chong Junior College in Track and Field throwing the javelin. Not many of you know that she started as a javelin thrower right?

Since then, she has switched to pole vaulting, become a (super) mum, did her MBA and even won medals at the last 2 SEA Games despite tearing her ACL, hurting her back (to put in quite mildly) and numerous other niggles.

Chapeau to her and her never say die spirit. She's an awesome inspiration (to me) and many, many others to say the least.

Here's wishing her (and the rest of Team Singapore athletes) all the best at the Gold Coast Commonwealth Games starting in the next few days.

Team Singapore Asian Games Athlete Has Compartment Syndrome? No Way

My first patient at 830 am today was an interesting case. The patient (who shall remain anonymous) was told that he/she had compartment syndrome and he/she had so far received acupuncture/ needling with current, massage (many times), electrical stimulation plus other treatment on the leg and foot etc but did not get better at all.

Now my patient is due to fly out to Guangzhou to represent Singapore for the Asian Games early next week and presented this morning with tingling sensations on the lower third of the right leg and the patient also complained there was decreased sensation there and also had pain in the web space between the big and second toe. Now those of you (who are physiotherapists) reading this should already be thinking to yourselves that nooooo, this cannot be a case of compartment syndrome.

If a patient has compartment syndrome he/she will complain of pain, paresthesia (or pins and needles), the limbs (usually legs) being very tight, tense and full of pressure. Temporary paralysis sometimes occurs. It usually happens to athletes at the start of the season after their break when they train too hard, too soon. The muscles expand and they fill up the space in the legs and "squeeze" the nerves there leading to sensations of tightness, pressure or pins & needles as the connective tissue that separates each section or compartment does not stretch hence leading to the term.

Now, my patient is at the tail end of the season (not at the start of the season and certainly not after a break from training), the symptoms he/she complains of doesn't resemble compartment syndrome at all I thought. Why? My patient's pain did not subside after training/ cessation of activity. In compartment syndrome, with cessation of physical activity, the muscles will stop working and subsequently stop squeezing on the nerves and the patient's pain/ pressure/ tightness should settle (but did not).

The biggest clue to me was the pain between big and second toe. This is a definite L5 (deep branch) nerve root distribution (which I confirmed after checking my patient's lumbar spine).

After assessing my patient fully, I treated my patient's spine and nerves, taped his/her foot and taught a nerve stretch and I just found out my patient was better and able to train later.

Well, I am no longer working at the Singapore Sports Council and I can only treat the athletes that come and look for me at our clinics. So my best wishes to Team Singapore at the Asian Games.

All the best at the Asian Games, Team Singapore. Do us proud.

*Picture shows treatment of my patient before coming to see me