Sunday, April 23, 2017

Don't Ignore That Ankle Sprain

Now that's a nasty ankle sprain
We've seen quite a few cases of ankle sprains in our clinics recently. Most of these patients are young school athletes representing their school or participating in sports.

We've always managed to get our patients playing/ competing again quite quickly. Even ankle cases that were deemed serious, we've managed to get them up and running so quickly that their parents/ coaches were pleasantly surprised.

Hence I was surprised to read that ankle even if sprained only once but not treated properly can have lifelong consequences. Especially if the sprains keep recurring.

In the study referenced below, the researchers had students who had chronic ankle instability (caused by ankle sprains) wear a pedometer for a week. Their steps taken were compared with a control group of students who had normal ankles. Gender, BMI and general health were the variables controlled in both groups.

Turns out that the students with chronic ankle instability moved significantly less than the other group. They took about 2000 steps fewer on average.

The researchers were concerned with the obvious decrease in step count as this decrease may be secondary to other functional limitations. If this decrease in physical activity continues for an extended period,it may lead to other more substantial heal risks.

Next time you sprain your ankle, make sure you get it checked and treated properly, even if it seems to be mostly healed as it can lead to lifelong consequences.

Reference

Hubbard-Turner T and Turner MJ (2015). Physical Activity Levels In College Students With Chronic Ankle Instability. J Athl Trg. 50(7): 742-747. DOI: 10.4085/1062-6050-50.3.05.


Note to self and my colleagues: be wary even of a simple ankle sprain

Friday, April 14, 2017

Is It Necessary To Cool Down After Exercise?

Stretching after a run in the rain
Back when I was working at the old National Stadium, I'll very often before work or during lunch time run on the track or grass surrounding the track.  Straight after I was done, I'll head right in to the clinic. A person walking past commented how I could do that.

I said I just stopped after running and am heading for the showers as my next patient was due soon. He said I should be doing a cool down after such a hard run.

Well, I was in a hurry to get ready for my patient. I'm sure the patient wouldn't like a sweaty, dripping physiotherapist treating him.

Looking back since primary school, I recall our physical education teachers telling us that we need to cool down after exercise and especially after a race/ competition.

Personal trainers will tell their clients that slowing to a jog and/ or lessening the intensity of the workout followed by stretching to transition out of the exercise session so as to prevent muscle soreness and improve recovery.

Some exercise machines in the gym automatically include a cool down period. After your work out time that you keyed in, the machine automatically reduces the workload and continues for five minutes so you can cool down.

I tried looking for scientific evidence regarding that and it seems none of those beliefs were true.

A study had subjects do a strenuous one time session of forward lunges while holding barbells. This is certain to make untrained people extremely sore due to DOMs over the next few days.

Some of the subjects warmed up before by cycling 20 mins gently. Others didn't warm up but did a cool down after the lunges with a similar 20 mins of gentle stationary bike riding. The rest of the group just did the lunges without warm up or cool down.

The next day, the subjects who warmed up had the least pain while there those who did the cool down and the control group had similar pain. Cooling down brought no benefits to the group.

Two other studies I found on professional football players performing cool down versus no cool down yielded the same result. Measures of performance, flexibility and muscle soreness were similar.

One valid reason to cool down after exercise is to prevent venous pooling (or build up of blood in your veins) after vigorous exercise. Blood vessels in your legs expand during prolonged vigorous exercise, allowing more blood to move through them to supply oxygen. When you stop exercise abruptly, the blood stays in your lower body. This can lead to dizziness or even fainting.

It's easy to avoid venous pooling, just keep walking for a few minutes at the end of your workout/ race and you'll maintain normal blood supply to the brain. Would you consider that as a cool down?

So, there's no real published research showing any negative effect if you don't cool down. If you are used to performing a cool down after your exercise, you can definitely carry on. If you don't feel like it, then you probably don't have too.

Unless future research shows otherwise, don't worry if your friend/ trainer/ coach tells you that you need to cool down after exercise.

References

Olsen O, Sjohaug M et al (2012). The Effect Of Warm-up And Cool Down Exercise On Delayed Onset Muscle Soreness In The Quadriceps Muscle: A Randomized Controlled Trial. J Human Kinetics. 35: 59-68. DOI: 10.2478/v10078-012-0079-4.

Rey E Lago-Penas C et al (2012). The Effect Of Immediate Post-training Active And Passive Recovery Interventions On Anaerobic Performance And Lower Limb Flexibility In Professional Soccer Players. J Human Kinetics. 31: 121-129. DOI: 10.2478/v10078-012-0013-9.

Rey E Lago-Penas C et al (2012). The Effect of Recovery Strategies On Contractile Properties Using Tensiomyography And Perceived Muscle Soreness In Professional Soccer Players. J Strength Cond Res. 26(11): 3081-3088.

Sunday, April 9, 2017

Luna Mono Running Sandals Review


I've had the Luna Mono Mgt running sandals for a while now and feel ready to write about them after my most recent run in the rain. Despite being wet, the soles were truly non slip, I was truly impressed as I thought they'll be slippery but they were not at all.



Like I wrote before when I first received it, they were nice and soft to wear, almost no breaking in required compared to my other running sandals, the Earth runners huraches. They were also super light, great to bring them while traveling so they can double up as your running sandals.

With normal walking, I didn't mind the strap between my first web space (between big and second toe), but during the runs, I've had some minor discomfort and upon using normal or toe socks they went away.
Normal socks instead of toe socks
I found the "over the top" ankle strap very useful as it helped tighten the sandal to prevent my heel from slipping out (my right foot is slightly smaller than my left so I need to tighten the right sandal more).

I've even had my own version of running mini intervals with them. 3-4 times a week when I bring my two boys to the playground near our place I'll end up playing "big bad wolf" with most of the kids at the playground. I have to run hard to chase them and I must say the Lunas stay on my feet much better than my Havaianas slippers.

My calfs were a tiny bit sore the very first time I used them probably due to the fact they were new. I didn't have a problem with that thereafter.

The Luna Mono's have a fair ground feel and feel good to walk and run in. And they definitely don't give you black toenails. Thanks to Fred from Run Minimal  for the sandals.


Saturday, April 1, 2017

I Bit Off More Than I Could Chew Today

I kinda bit off more than I could chew today..... yes I'm writing that down again to remind myself not to do it again.

Waiting ..... for me to be ready
On Saturday afternoons when we have the Floss band course at Sports Solutions, I normally stop seeing patients half an hour before so I can get my act ready.  I have to get the computer and projector ready, whatever anatomy models I may need, laser pointer etc as well as eat some lunch.

Today, I had a patient who was gonna take part in a race tomorrow. And that patient requested that I do some taping as the last time we did the taping, the patient was able race pain free. The only time I could spare to do the taping was the half an hour before the course.

That of course ate into preparation time and I was late for my own course right here in the clinic. I wasn't happy with myself! As someone who takes care to always be early for my patients and appointments, I messed up.

A thousand apologies to all who turned up for the course today. I promise it will not happen again. And by the way we had a chiropractor (for the first time) who turned up for the course today too.

Right in the thick of action

Capt America watching ...while Trevor doesn't

The physio students having a go
A big thank you to Danny, Ekina and Jane who came really early and got the place ready for the course again. Couldn't have done it without them. And for helping me tidy the place after too. Please contact them at Sanctband Singapore if you want to attend the next course.

Sunday, March 26, 2017

Anatomy Trains Course

The three amigos 
Aized and Sham did the Pediatric Craniosacral Therapy course two weeks ago, while Reggie, Ting Jun (TJ) and I attended the Anatomy Trains workshop this weekend.

TJ has been at the course for the past four days and since Reggie and I did the first two days last year, we came 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

TJ has the best view for this practical
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.

Saturday, March 18, 2017

Mirror Mirror On The Wall

Rachel training while waiting for her patients
When you go to a gym, one of the first things  you notice is there are mirrors almost everywhere. And you see lots of people training in front of the mirrors. In theory, the mirrors are there to ensure you hold correct and proper form during exercise. Can mirrors really be helpful?

Previous studies showed mixed results about using mirrors for exercise. Some studies show workout benefits, some no effects while others show negative effects depending on the specific task and experience level of subjects.

Currently, there is a lot of evidence showing that external focus leads to better performance than internal focus while performing physical tasks. Let's say you're shooting a basketball on the free throw line. Focusing on the rim rather than the movement of your wrist will get you better results. One reason is external focus (focusing on the rim) allows well-practiced movements to take place on auto pilot. This is more efficient than trying to directly control wrist action (internal focus).

A group of researchers studied the role of mirrors in attentional focus by getting subjects to do two series of tests. One involved flexing the elbow as hard as possible (single joint movement). The other test involved jumping as high as possible (multi joint movement).

In both cases, tests were done four times under the following conditions. Internal focus, external focus, neutral and finally with a mirror.

To sum up, external focus was best for both series of tests, while internal focus was worse. Using mirrors were no different (statistically) from the neutral condition.

So for both tasks, the mirror didn't really matter. Perhaps while doing resistance type training with heavier weights, mirrors may be helpful for maintaining symmetry of movement or correct form. What is important is that external focus trumps internal focus.

Runners take note that a previous study found that focusing on your form or your breathing (internal focus) results in worse running economy than if you focused on the surroundings (external focus).

References

Halperin I, Highes S et al (2016). The Effects Of Either A Mirror, Internal Or External Focus Instructions On Single And Multi-joint Tasks. PLOS One.
http://dx.doi.org/10.1371/journal.pone.0166799

Schucker L, Hagemann H et al (2009). The Effect Of Attentional Focus On Running Economy. J of Sports Sciences. 7(12) : 1241-1248. http://dx.doi.org/10.1080/02640410903150467.

Saturday, March 11, 2017

Stress Fractures In Teenage Female Runners

Icing the shin
The Singapore National School's competitions are usually held between March and late May every year since 2009. And it's that time of the year again where we see many patients in our clinics with shin splints. Mostly adolescent and teenage girls and the occasional boy.

Why are girls more susceptible to shin splints and stress fractures? Well, some new data shows that if teenage female athletes don't eat enough to support their training, there will be complications regarding their subsequent training and health.

The study tracked 323 female athletes at Stanford University in 16 different sports including cross country running. Bone scans and questionnaires were used to assess the runners based on the components of the "female athlete triad" consisting of "low energy availability, with or without disordered eating, menstrual dysfunction and low bone mineral density. "

Risk status were calculated based on an article published in the British Journal of Sports Medicine  in 2014. Have a look at Figure 4 in the article if you're keen to know more about the calculations.

Looking only at the cross country runners (47 runners) data, half the runners were classified as low risk, and three of those later developed stress fractures.

Sixteen of the runners had moderate risk and 50 percent of these developed stress fractures within a year. These girls were about four times as likely to get injured compared to the low risk group.

Seven runners were in the high risk group and five of them developed stress fractures. They were nearly six times as likely as the low risk group to get injured.

Well, if you're thinking like me, not so good news for the girls if you're a runner and in the moderate to high risk group.

The researchers suggested the following guidelines for female athletes in the moderate to high risk group. The athletes need to ensure they're getting enough calories to support their training along with calcium and Vitamin D. Their menstrual function, bone health and nutrition needs to be monitored on an ongoing basis.

Higher risk athletes may have to consider using low impact cross training more often in their weekly routine. Good sleep and recovery are important too.

Stress fractures occurred mostly in the foot for the low risk athletes, probably as a consequence of biomechanics and jumping sports (due to higher forces).

In the higher risk categories, many of the stress fractures were in the sacrum, pelvis and femoral neck (where the bones tend to be softer). These areas may be due to weakened bone rather than biomechanical forces.

So all the doctors, physiotherapists, physical education teachers, coaches, heads of departments and administrators in charge of female teenage athletes reading this post, please take note.

Reference

Tenforde AS, Carlson Jl et al (2017). Association Of The Female Athlete Triad Risk Assessment Stratification To The Development Of Bone Stress Injuries In Collegiate Athletes. AJSM. 45(2): 302-310. DOI: 10.1177/0363546516676262.