We Don't Just Treat Sports Injuries

Many new patients who call our clinic often tell us that they don't play any sports and wonder if they can still see us. To which we reply, "Most definitely!"

As all our physiotherapists are trained to read your body to ascertain how it's positioned in various postures and during movement. We work like detectives, finding the main cause of your problem. We know exactly what we can change to make a difference to your problem and when we might need to refer a patient out to a specialist e.g. neurosurgeon etc.

We specialize in spinal pain and problems, joint pain, muscle strains, joint sprains, nerve related problems (where you might experience pins and needles, numbness or reduced sensation or strength), headaches, and of course injuries that you sustain during sports.

So exactly how different is a sports physiotherapist and a musculoskeletal (meaning muscle and bones) physiotherapist? Having worked in a professional sports setting, treating elite athletes for 10 years, traveling with Team Singapore athletes to the Olympics, SEA, Commonwealth, Asian Games and others and now being in private practice for 12 years , I will attempt to explain the main differences..

The biggest difference would be the time allocated to the athletes and patients. When treating athletes at a professional level, we may sometimes see the athlete 3 times a day. 

Say we have a badminton player who has a niggle in his foot, we get to experiment with taping the player's foot with rigid or Kinesio tape. How can I change his navicular bone position? That alone may determine how well the player trains that morning. Or, if there's a match later that evening we can trial any tape, shoe, or racket earlier in the week before the actual game. 

Oftentimes, the head coach will request specific sessions with injured players to get them up to speed with recovery.

Taping with rigid tape

In an actual game, the physiotherapist has to be paying attention and watching to get clues about the mechanisms of injury. We often need to assess and treat our player ASAP usually within the minute.  I will have in my kit bag, different types of tapes ready, blister kit. splints, nail cutter, scissors, lotions, painkilling sprays etc. in case I need them. We try to be the 'magic' healer, asking questions, cleaning sweaty areas to treat, to allow them to play again.

Yes, Treating elite athletes can be very time consuming and labor intensive.

In a private practice setting (like Physio Solutions and Sports Solutions), the patients are just as eager to be pain free, to get better and to return to exercise. Unlike a competition setting, we get much more time to ask questions and assess thoroughly. Finding and treating the cause of the problem becomes easier. The hands-on, manual therapy we do has huge benefits in changing a patient's condition. However, we may only get to see patients once or twice a week. 

It is, therefore, important to educate patients on what they have to do in the time between appointments. We may teach them self tests and exercises on e.g. their calf range to see how they're progressing. We are easily contactable via text, email or phone if you need to ask questions between your sessions.

In summary, when you become our patient, WE GOT YOU.

Does Weight Training Stunt Growth In Young Adolescent Kids?

14 yo Miles with Dad Ving Henson at The Pit

I remember clearly being told by my teammates as a young runner at twelve that I should never do weights as it would stop me from growing taller.

This misconception about weight training often comes from fellow teammates, well meaning parents, physical education teachers and even some coaches. Actually, the sport your child participates in (sprinting, jumping or contact sports) will generate greater forces than training in the weight room.

This widely held belief that weight training especially when performed during puberty/ adolescence stunts growth still persist in the present day. Due to this, young athletes and children should only perform body weight exercises and not do any training with barbells, kettlebells or even dumbbells.

Fret not if you're a parent or teacher of a young athlete. There is simply no evidence to support this belief at all. Many studies have looked into this topic and found that weight training has no negative impact on skeletal growth. It will not stunt growth.

Actually, studies show consistent findings that young subjects have increased strength, speed and power, while losing weight, gaining muscle and stronger bones. There is also a reduction in injury rates. Good news for parents if your child keeps getting injured. This is especially true even when the young subjects have not reached puberty.

So it makes very little sense from a bone stress point of view if you stop your child from going to the gym but allow them to participate in sports.

So how soon can your child start weight training? We do not have any suggestions from any local authority but the Australian Strength and Conditioning Association suggest that a child can start weight training at six years old. As long as he/she can follow clear instructions and understand the dangers when training.

If you do send your child/ athlete for weight training, make sure the learn the correct techniques by a good strength coach who has experience working with young athletes. Remember, don't force the young athletes if they are not keen.


References

Barbieri D and Zaccagni L (2013). Strength Training For Children And Adolescents: Benefits And Risks. Collegium Antropologicum. 37(2): 219-225.

Faigenbaum AD and Meyer GD (2010). Resistance Training Among Young Athletes: Safety, Efficacy And Injury Prevention Effects. BJSM. 44(1): 56-63.

Falk D and Dotard R (2019). Strength Training In Children. Harefuah. 158(8): 515-519.

After seeing 14 yo Miles training above, my 9 yo was inspired to do the same

Playing More Sports Beneficial For Young Children - Straits Times Forum Page

ST 250719

I have written previously that you should not push young athletes to specialize in a single sport too early. It was a very popular article on our blog with many readers asking to share it.

In the article in the forum page today of the Straits Times, scientific studies suggest that children who play multiple sports between six and twelve are much better off. They develop stronger motor control skills, aerobic fitness and confidence.

Children who specialize in a single sport before twelve are more prone to overuse injuries and burnout.

I see many cases like this when the child is trying to get to a school of their choice via the Direct School Admission scheme which allows students to gain direct entry to a secondary school or junior college based on their sporting talents. Children in the Singapore Sports School are particularly prone.

Late specialisation sports includes track and field, badminton, football and basketball. So those of you who have children in these sports please remember not to push them. You can definitely support wholeheartedly them if they are interested.

You read it here first. Have a look the at Straits Time article if you're keen in the Forum section on page B8.

Don't Force The Teenage Athletes

I read with interest a recent New York Times article about Katelyn Tuohy. A female teenage track phenom with the headline "America's Next Great Running Hope, and One of the Cruelest Twist in Youth Sports."

Although Katelyn had already won titles and set records at sophomore (15-16 years old) level, the article made the point that many previous high school phenoms fail to live up to their early promise because of changes to their physique. The article pointed out that this seems to be a cruel twist in youth sports as girls turn into women.

The article mentioned that it was nearly impossible to predict an elite girl's future success in distance running because the female body changes so much as they continue to grow. Other than a good lung capacity, long distance races require great body weight to strength ratio. The teenage girls are skinny in their early years. Then as they mature and and grow, they may not develop the strength to move their bigger bodies  as quickly.

It's not surprising then that many girls end up with eating disorders, body related issues and end up getting injured. Off the top of my head, I can think of so many teenage athletes I've treated over the years that ended up going down that same path.

Many of the young athletes couldn't understand that it was perfectly normal to have the ups and downs (in their performances) they experience as their bodies change. Girls tend to put on more fat to prepare the body for reproduction. Good if we want to maintain our population, but not good if you're an elite athlete looking to improve your performance.

I had a former classmate PTL in primary school. He won the "Individual Champion" title in our school's track and field meet after winning 100, 200 m and the shot putt (plus the 4 x 100 relay too). That streak started in Primary Four (while he was ten) til Primary 6 (there was no meet from Primary One to Three).

We went to the same Secondary school and he won the 100, 200, 400 m and 110 m hurdles to emerge "Individual Champion" again in Secondary One and Two.

While in Secondary Three (they finally had longer events in track and field), PTL won the first 3 events and finished runners up for the 110 m hurdles event. We shared the "Individual Champion"  title after I won the 1500, 3000 m, 2000 m steeplechase and was 2nd for the 800 m. (Luckily for me, they gave out 2 trophies).

By the time we were in Secondary Four, I won all my four events while PTL didn't win any of his individual events. I ended winning our school's only individual medal at the National School's meet later that year while PTL ran the relays and never competed again after that.

Looking back now I know PTL reached puberty and had his growth spurt earlier than us in Primary school and was physically superior to everyone else. That's how he won all the events earlier. When the rest of us "caught up" hitting puberty later he didn't have that advantage anymore.

Perhaps PTL, having been raised on victories from young, could not comprehend or accept defeat. Early victories may have paved the way for defeat and giving up eventually.

Hence, I will never ever push my kids to excel in sports or something they don't like. I was never pushed when I was a kid. The desire all came from within. However, if they're keen, I will definitely help, support and guide them if I can.

So parents, teachers, coaches and all of you who are involved with young athletes take note of what Kara Goucher said. "Talent never goes away. Once these women/ girls (or boys) adjust to a mature body, the talent can come through again. The obsession with labeling these girls as 'the next big thing' is part of the problem  .... Katelyn is very talented. She will grow and probably slow. But once she adjusts, if she still has the love, the talent will still be there."

Don't push the kids, support, guide and help them if they themselves wish to excel.

Here's a close up of my first Individual Champion trophy. Thanks to my brother who took the pictures for me.

Young Athletes Are Not Small Adults

I've had a few worried parents message or call me on the past two weekends saying that their child has had sharp pain suddenly without any falls or accident. A common area of complaint is in the knee or heel.

After a few short questions and answers I am usually able to reassure the parent that their child is fine and nothing is really serious about the painful episode.

Often these young children/ athletes have growing pain. The long bones grow quite quickly (especially if they are having a growth spurt) and the muscles don't lengthen quite as quickly. When the child is active, this shorter muscle(s) often pull on the bony attachments and cause pain.

Their muscles usually will not have developed enough strength to compensate for the sudden increase in lever lengths.

My older boy who is eight plays football once a week. Other days he's at the playground running, jumping and climbing etc. He's growing taller and  his muscles are not always strong enough to generate the forces required to move his longer and now heavier legs. As a result, he often has this "growing pain" in the night especially after he'e been particularly active.

I just taped my older boy's leg last night

From treating all the young and teenage athletes in our clinics, we observe that it may take up to about nine months for the muscles to develop length and strength after a growth spurt in their bones.
This form the basis of injuries that these young athletes get. If the bones grow longer and the muscles don't quite catch up in length, the muscle will be relatively shorter and hence tighter.

The area most prone to overload is where the muscle attaches via the tendons to the bones. Hence these pain and injuries we see are growth related.  Common areas are where the Achilles tendon inserts in the heel bone (usually known as Severs disease, although it is definitely not a disease), and the patella tendon on the shin bone (Osgood Schlatters disease).

Other areas include the quadriceps tendon into the knee cap (Sindling Larsen disease) and the attachment of the hip flexors onto the pelvis.

It is usually due to overload of the tendon attachment to the bone from doing too much too soon (without rest) that causes these pain or injuries.

Majority of the time, most of these cases get better when the muscles "catch up" with the bone growth by lengthening and getting stronger.

Stretching the muscle may be worse sometimes as static stretching can place more traction forces on the tendon insertion on the bone. We tend to teach our young patients and their parents to use the trigger ball instead.

Correct strength training that is pain free often helps the muscle take load off the tendon attachment. Don't use a load that is too heavy.

Come see us in our clinics if your young or teenage child athlete needs help.