Sunday, April 22, 2018

The Secret to Living Is Giving

Linden reels the lead runners in on Heartbreak hill
That's a famous quote by Anthony Robbins. And boy is he right!

When Sports Solutions was still at Amoy Street, I'd often notice there were some elderly people collecting used drink cans, cardboard and newspapers to sell.  I asked them how much they got for the cans and newspapers. In case you're interested, it's one dollar for a kilogram of aluminium drink cans and 20 cents for a kilogram of paper or cardboard.

One afternoon while walking back to the clinic from buying my lunch from the Amoy Street Food Centre, I saw an elderly lady struggling with some cardboard. I immediately helped her and offered her some money. She refused my offer so I offered her my lunch instead. She accepted the lunch. I remember feeling good that at least I helped her with a meal.

I'd almost forgotten about that incident until I read about Boston 2018 marathon winner Des Linden's generous act. Linden told 2017 New York marathon winner, Shalane Flanagan that chances are she may drop out (of the race) and offered to block the wind or adjust the pace for Flanagan. After Flanagan took a now famous toilet break near the halfway mark, Linden waited for her and they both then caught up with the elite pack later.

After helping Flanagan back to the pack, Linden also helped Molly Huddle. Helping Flanagan and Huddle somehow distracted Linden from her own plans to give up and she started feeling better. After realizing she was in fourth position then, she figured she probably shouldn't drop out.

Your brain releases dopamine, endorphins and serotonin when you help someone according to research (Sprouse-Blum et al 2010). All these hormones are great to have during a race. Endorphins help reduce pain, dopamine increases motivation and focus and serotonin boosts your mood.

So those surge of hormones probably helped Linden turn her race around.

In Linden's case, there may be oxytocin released too. Our brain releases oxytocin when you feel a bond with another person. This bond reminds you that you're not alone in your suffering. This may help you focus on the bigger picture, not how bad you feel at that moment. Linden later confirmed this post-race when she said, "Today was bigger than one person, it was really all of us pushing each other."

Sports psychologists will explain this as an example of disassociation which means Linden stopped thinking about how terrible she felt during the race and started to think beyond her pain. This helped reduce her perception of fatigue. An excellent example is how you suddenly feel better when your favorite song comes on when you're running. For that moment you've stopped paying attention to the pain and discomfort.

Associative thinking means you are thinking about your performance, checking your form and pace.

So how can you apply that to your own race? Try cheering on a fellow runner or team mate who's struggling or exchanging high-fives with them or even spectators along the course. This will help you feel more connected to them. That can help you boost your mood and in turn, your performance.

Capitalize on the surge of hormones to be positive for the rest of the race.

Chapeau to Linden for her selfless acts of sportsmanship, she thoroughly deserved her win.


Sprouse-Blum AS, Smith G el al (2010). Understanding Endorphins And Their Importance In Pain Management. Hawaii Med J. 69(3): 70-71.

Sunday, April 15, 2018

Barbells Or Bikes?

Both weight training and aerobic exercises are necessary
I came across this article recently which suggested lifting weights was more beneficial for losing weight compared to hopping on your bike for a ride or going for a run. The article suggested that burning calories via strength training will help you lose more fat than burning the same amount of calories doing moderate aerobic exercises.

Those headlines are good for creating media buzz but I'll say that it's not totally true if you look at that particular study in detail.

Now, before you say I'm biased, bear in mind I've written earlier how strength training is just as important as aerobic exercise. After not strength training for almost nine years, I started strength training again last year after I realize I was losing muscle mass with each passing year.

The study was funded by Les Mills International, a New Zealand company behind BodyPump, a barbell workout class. That means the study was commissioned by Les Mills International, thereby having a vested interest in promoting weight training.

There were only 12 female subjects in that particular study. They were tested during and after a resistance training workout (a BodyPump class) compared to a steady state moderate intensity session on a stationary bike.

In both workouts, the female subjects burned around 335 calories and had increase in levels of Human Growth Hormone (HGH), which is known for rapidly build muscle and to promote fat burning.

The women's HGH levels were 56 percent higher after the weight training session (light to moderate weights with high reps) compared to the steady state cycling session. Now, many previous research has shown increases in HGH levels in response to weight or resistance training, even in the elderly.

That's another reason why I resumed weight training, to make sure I get those doses of HGH, believed to be the elixir of youth, but that's probably another post.

For weight loss, the results were not unexpected as our metabolic rate stays up for a few hours after weight training. This ensures that more calories are being used even after training.

Bear in mind that strength training affects your body differently compared to aerobic (or cardio) exercises even if the calories burnt are similar. The headlines of this article generated by media buzz may claim that strength training is superior to cardio, but current research shows that both are necessary to be healthy and functional.

Actually, another study (Nindl et al, 2014) found that doing two hours of cardio boosted HGH secretion more than one to two hours of strength training.

As runners, cyclists and triathletes, we don't just exercise to burn a certain number of calories. I certainly don't. I do so because I love that adrenaline rush, the release of endorphins that I don't get with strength training. If I can solve some other problems while running, well, that'a a real bonus.

In my group rides, we don't always go at 68 percent heart rate (like the study), we do put the hammer down at times (at Coastal road), or surge up hills when we go up Mount Faber or NTU. I'm sure you do the same while riding with your friends or running intervals.

When we push the pace, our heart rate as well as our HGH levels soar. A study on sprint interval (Stokes et al, 2002) showed that doing just one 30 second sprint interval caused HGH levels to increase more than 430 percent!

Next time you feel your legs burning when your friends try to drop you, it's a good sign you're gonna have elevated levels of HGH.

So run, bike and lift weights, they are all beneficial but don't be too worried about counting how much calories you're burning.

If you're trying to lose weight, don't be too obsessive over what calories you are eating or what you are using.  As human beings, we are athletes, not Bunsen burners. Calories from drinking coconut juice or eating an avocado are processed differently by your body compared to drinking Coke or eating donuts or fried kuay tiao.


Harris N, Kilding A et al (2018). A Comparison Of The Acute Physiological Responses To BODYPUMP Versus Iso-caloric And Iso-time Steady State Cycling. J Sci Med Sp. DOI: 10.1016/j.jsams.2018.02.10.

Nindl BC, Pierce JR et al (2014). Twenty-hour Growth Hormone Secretory Profiles After Aerobic And Resistance Exercise. Med Sci Sp Ex. 46(10): 1917-1927. DOI: 10.1249/MSS.0000000000000315.

Stokes KA, Nevill ME et al (2002). The Time Course Of The Human Growth Hormone Response To A 6s And a 30s Cycle Ergometer Sprint. J Sports Sci. 20(6): 487-494.

Sunday, April 8, 2018

Going Bananas?

Ready to go riding with my bananas
I've written before that sports drinks cannot  totally replace your electrolyte losses during exercise. Moreover, sports drinks are manufactured and may contain flavorings and chemicals that you may want to avoid.

And if you're like me and prefer eating real food and drinking lemon water (or just plain water) rather than sports drinks while exercising, then you may be doing enough to replace the carbohydrates to fuel your exercise and even speed recovery.

A preliminary study in 2012 found that cyclists performed better for a strenuous bike ride if they had a banana or sports drink compared to water. The cyclists also had lower levels of inflammation after the ride. That study did not show why and how the carbs were aiding recovery.

The same authors did a new study that was recently published using more sophisticated techniques to track molecular changes inside the cyclist's bodies.

The subjects' underwent a intense 75 km bike ride inside the laboratory. In one ride, they drank only water while in another ride, they had water, eight ounces of a sports drink or half a "Dole" banana every 30 minutes.

The subjects' blood was tested before during and immediately the ride and even 45 hours after the ride. Inflammatory blood markers and metabolites were assessed during and after to test how much stress was taken by them.

When the cyclists' drank only water during the ride, relatively high levels of inflammatory markers were found. These same markers were much lower if the cyclists' had consumed the banana or sports drinks. Metabolite profiles were less stressed regardless of whether they had the banana or sports drink compared to without.

One obvious difference was those cyclists' that ate the bananas had blood cells that produced less COX-2 (a genetic precursor of an enzyme). This was not seen if they drank only water or had the sports drink.

For those interested, COX-2 enzyme stimulates prostaglandin production, which increases the intensity of inflammation. Those of you who take inflammatory medication like Arcoxia or Celebrex tablets note that they are COX-2 inhibitors. They help reduce inflammation.

This study suggest that bananas might perform comparably although it is unknown how bananas affect the cells' gene expression. So instead of popping pills like Arcoxia and Celebrex prescribed to you, you may want to eat more bananas and ginger.

It was calculated by the researches that half a standard banana provided similar carbohydrates as a cup of sports drink and the cyclists' had half every 30 mins. Bear in mind your needs may be different. Some cyclists' also complained of feeling bloated after eating that amount of bananas.

So be warned before you go bananas over ingesting bananas in your next long ride or race.


Nieman DC, Gillitt ND et al (2012). Bananas As An Energy Source During Exercise: A Metabolomics Approach. PlosOne. DOI:10.1371/journal.pone.0037479

Nieman DC, Gillitt ND et al (2018). Metabolic Recovery From Heavy Exertion Following Banana Compared To Sugar Beverage Or Water Only Ingestion: A Randomized, Crossover Trial. PlosOne. DOI:10.1371/journal.pone.0194843

*Note that Dole Foods which sells bananas funded both studies. However, they company did not have any involvement in study design, data collection, analysis, decision to publish or preparing the article.

Monday, April 2, 2018

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.

Saturday, March 24, 2018

Storm Before Floss Band Course

Storm outside our clinic
There was a big storm before the Floss band course today and maybe that's why the turn out was less than normal. But it certainly didn't dampen our spirits. We had a chiropractor, physiotherapy students, a Singapore Cycling Association coach, another strength and conditioning coach from CrossFit Fire City and personal trainers.
Flossing Ben's knee
As usual, I took the time and effort to explain Tensegrity, what and how our fascia functions and the Pain Gate Theory (by Ronald Melzack and Patrick Wall, 1965) so that the participants understand how the Floss band works. And they can in turn explain to their patients, athletes and friends what the Floss band does.
Can't touch my head
A big thank you to Amy, Danny Ekina and Jane for coming to get the clinic ready for the course. That allowed me to eat after I saw patients in the clinic from this morning. And for packing up after, so I can see another patient.

A big thank you to everyone who came despite the heavy storm before. Hope everyone learnt useful strategies that you can use use in your own area or work, play and training.

Please contact them at Sanctband Singapore for the next Floss band course and if you need to get the Floss bands.

A big thank you to everyone who came despite the heavy storm before. Hope everyone learnt useful strategies that you can use use in your own area or work, play and training.

Wednesday, March 21, 2018

Learning From Tom Myers

With Tom Myers
Reggie and I spent the last 2 days at the Anatomy Trains BodyReading Masterclass with the man himself,Tom Myers.

Having done some Anatomy Trains courses previously, some of what we learnt was revision, but mostly what Tom went through was new, highly enlightening and a different perspective.

Wrestling with Tom
Sharing center stage with Tom on Day 1
Rachel is up for Day 3-4 tomorrow on "Resilience: Taking the strain and coming back stronger." Stay tuned.

Sunday, March 18, 2018

Achilles Tendon Length And Running Performance

My patient's L Achilles

Two years ago, after my marathon running patient tore his left Achilles tendon (AT) and had it repaired. About six weeks after the surgery, his surgical site got infected. The surgeon had to remove the repaired tendon. After the infection was cleared, the surgeon grafted the lateral gastrocnemius (calf) muscle to repair the tendon. 

Needless to say, he couldn't really run let alone think of finishing another marathon. After trying traditional Chinese medicine (TCM) and seeing another physiotherapist for over two years with not much improvement, a fellow runner I've treated before suggested he come and see me.

For runners, the hips, knee and ankle joints generate large amounts of forces during running. The ankle joint (via the Achilles tendon ) contributes remarkably to supply the power required while running.  
R calcaneus bone, where the Achilles inserts

The AT plays an important role in storing and returning elastic potential energy during the stance (foot flat on the ground) phase in walking and running. 
L Achilles inserting on calcaneus

I was wondering how else to help my patient when I came across a research paper investigating AT length and running performance on male Japanese 5000 meter runners (between 20-23 years of age). Their personal best times range from 13:54 minutes to just under 16 mins.

Their running economy was tested by calculating energy costs with three 4 minute runs at running speeds of 14, 16 and 18 km/h on a treadmill with a 4 minute active rest at 6 km/h.

Ready for the results? The researchers found that absolute length of the medial (inner) gastrocnemius (or calf), but not lateral gastrocnemius and soleus muscle correlated with a faster 5000 meter race time and lower energy cost during the submaximal treadmill tests at all 3 speeds tested.

This is after normalizing medial gastrocnemius muscle length with the subject's leg length. That is, the longer the medial gastrocnemius muscle, the better the running performance in endurance runners.

For the medically inclined, note that each AT length was calculated as the distance from the calcaneal tuberosity to the muscle tendon junction of the soleus, medial and lateral gastrocnemius respectively.

Possible reasons to achieving superior running performance may be that the longer medial gastrocnemius and AT store and return more elastic energy (and potentially reduces energy cost) from the ground reaction force compared to a shorter AT.

Have to treat both R and L leg
Reading that paper definitely gave me more clues to treat my patient (and other patients with Achilles tendon and plantar fascia problems). I am happy to say that my patient has since progressed to running up to 12 km.

He is now definitely looking forward to running his next marathon.


Ueno H, Suga T et al (2017). Relationship Between Achilles Tendon Length And Running Performance In Well-trained Male Endurance Runners. Scand J Med Sci in Sp. 28(2): 446-451. DOI: 10.1111/sms.12940.