Physiotherapy

Stand Up and Make a Difference

Stand Up and Make a Difference

The UFIT team comprising Dave Lee (Physiotherapist at UFIT Clinic Orchard) and Simon Porter (Head of UFIT Performance) have worked closely with the team at Visa Singapore to perform desk assessment demonstrations and provided education on correct sitting posture and desk set-ups to stay pain free.

Here are the exercises and stretches that work best performed at the desk. A handful of these exercises you can do at home or at the gym to help bulletproof your back, neck and hips against being seated all day.

Discovering What Lies Beyond Your Limits

Dave Lee, Physiotherapist at UFIT Clinic Orchard and triathlete, gives us insight into the world of triathlon competitions and some common injuries and issues that may occur. If you are participating in the Metasprint Series Singapore Bike-Run Duathlon on 10 March 2019, Dave’s knowledge of injuries that affect endurance athletes, especially cyclists, can help you gain better understanding and nip any issues in the bud before problems arise.

Common Musculoskeletal Conditions in Children

Being active in sports, UFIT Clinic Orchard’s Senior Physiotherapist and competitive Muay Thai fighter Nada Khalid listens to her body and is aware of any issues that might arise. She would be able to take the necessary actions and precautions as needed. That being said, this will not always be the case when it comes to children who are active in sports.

Have a RAD six pack? Not as cool as you may think!

Rectus abdominis diastasis (or otherwise known as abdominal separation) refers to the separation of the 6-pack muscles from the midline of the abdominal wall. This commonly happens during the later stages of pregnancy, and if left untreated may lead to post childbirth issues such as pelvic girdle instability, lower back and pelvic pain.

5 tips to bounce back quickly from DOMS

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Anyone and everyone who has exercised at one point or another in their life has experienced Delayed Onset Muscle Soreness, or DOMS for short. It’s that achey feeling you feel in your muscles 2-3 days post exercise, and it can often be quite painful – limiting your movement to a point where stairs seems like Everest, or you find yourself looking for a toilet with grab rails to help you into position!

Some people actively look for DOMS, and feel they haven’t worked hard enough unless they experience it. Other people, on the other hand, refuse to workout for the next week if they get any soreness after a workout. So who is right – is DOMS something to be afraid of or encouraged? And what is the best way to get over it so that we can get active again?

The science behind what exactly causes DOMS is not 100% clear, but most people agree that it is caused by micro-tears to the muscles, which leads to inflammation as they heal, causing the pain. What we know for certain is that DOMS arises in the first 24 hours post-exercise, and typically peaks 48 hours after exercise. It leads to a temporary decrease in force production for the first 48 hours post-exercise. What is clear is that lactic acid accumulation is not a component of this process, and should not be blamed for your DOMS. Eccentric training (lengthening the muscle with tension applied - for example the lowering phase of a bicep curl or on the way down in a squat) definitely leads to a lot more DOMS than fast, concentric weight training.  

So is it bad for you? In a word, no. However, it will limit your effectiveness in any subsequent exercise or sport sessions over the next two to three days, which will limit the amount of work you can get through. Importantly, it has been linked with an increased chance of injury within this 48 period, through its inhibition of certain muscles and reduction in range of movement - so try to avoid playing a football match the day after doing a heavy legs squatting session!

Recent research points to the ‘repair’ process your muscles are undergoing as the source of the pain. As your muscles are repairing themselves, they release a substance called bradykinin along with other enzymes to create growth, which causes blood vessels to enlarge and nerves to become more sensitive. The combination of the sensitized nerve endings and the increased fluid in the area lead to the pain and ‘stiffness’ felt within the muscles.

The good news is that this ‘pain’ you feel is a sign you are getting stronger, and you are getting some benefits from the training you are doing as the body goes through the damage-repair cycle. A word of caution – more DOMS does not necessarily mean you are working harder, it can just mean that you are not training very smartly, and have overloaded a particularly weak area.

 

So what can you do to reduce DOMS quickly to get back into the gym? Here are a few tips:

  1. Warm-up and cool down before and after your session. Having an effective warmup and cool down has been shown to reduce DOMS in untrained individuals versus individuals who received neither. Your warmup should include the areas of your body you are about to workout, and you should be at least breathless by the end of it. Cool down should involve stretching, and a lot of:

  2. Foam Rolling: If you don’t know what a foam roller is, find out. Buy one, and make it your friend. Foam rolling has consistently shown to be effective at improving range of movement in tight athletes the day after high intensity workouts, and reduce DOMS. The more recent research points to a neuro-physiological affect on your muscles (desensitization of the nerve endings in your muscles) as the mechanism behind foam rolling, which may be why it is effective on DOMS.

  3. Manual therapy/Massage/Acupuncture: If your DOMS is particularly bad, speak to your friendly local physio about manual treatment and acupuncture to hasten your recovery. Both are effective.

  4. Active Recovery: Research has shown that lightly exercising the area the day after a heavy session can reduce the recovery time. For example, after a heavy squatting day, jump on a stationary bike the next day for a gentle 20minute cycle. Your legs will thank you!

  5. Nutrition and Hydration: Being well hydrated, and feeding your working muscles with good fuel should be the cornerstone of any workout program. Don’t waste your time in the gym if you are not paying attention to this outside of the gym. You will recover quicker, and you will make more progress if you do!

 

Final Word

It is unlikely you will avoid DOMS altogether when you start a new strength program. It is not something that you should be afraid of, or that should keep you away from the gym. However, pain does not need to be present in order for you to achieve progress in your conditioning. If anything, intentionally causing DOMS will only limit the amount of work that you can do in subsequent sessions, potentially slowing down your progress.

The ultimate goal of any training program is to find the optimal balance between work and recovery. The key to a great training program is to find that sweet spot where you are doing enough micro ‘damage’ to create a muscle adaptation, without crippling you for the next two days and making you miss your next session!

Recover well!


About the author

Declan is Clinic Director for the UFIT Clinic and a fully qualified, registered physiotherapist. He is passionate about helping his patients achieve their long term goals through identifying their weaknesses and imbalances, and developing a strategy to eradicate them. 

Find out more about Declan right here.

Pre-habilitation for runners with Mok Ying Rong

Meet Mok Ying Rong, our new physiotherapist at the UFIT one-north Clinic. A competitive runner and Nike Sponsored elite athlete, Ying is Singapore’s Half-Marathon record holder,  and well placed to help clients recover from sporting-relating issues!

She’s joined up with #ROCKrunners in the lead-up to the Singapore Standard Chartered Marathon, where she’ll be giving talks on one of her passions – running pre-habilitation!

Tell us about your sporting and running background

I’ve always been too active! I started competitive swimming in primary school and represented my swimming club and school at national and club levels. I moved on to triathlons in high school before running seriously at 16 and representing my school, Raffles Girls Secondary, at national meets. I was getting on the podium at these and decided to try national level events.

At first, it was intimidating running with the giants but as I ramped up my training and became more systematic, found myself winning more and more races. I’ve always been self-coached, I feel very tuned-in with my body, and pretty soon, found myself knowing what works and what doesn’t. My first race representing Singapore was the Asian Cross Country in Bahrain when I was 16.

What have been your career highlights?

Signing a contract with Nike when I was in high school and representing Singapore in the 2016 World Cross Country Championships. The partnership with Nike really boosted my confidence in my training and racing, and I’ve been representing them for almost 7 years and am simply thankful for their unwavering support.

My most significant career highlight is definitely winning the 2016 Gyeongju Cherry Blossom Half Marathon, breaking the Singapore Half Marathon record by 2 seconds! My time was 1:23:14 and I vividly remember it to be one of the most painful and intense race I have ever done.

How do you train for your races?

I select the main races I’ll do at the start of the year and then periodise my training phases. Some overseas races pop up and I take them in my stride. I’ve always believed in the journey, rather than an end-goal as running is my passion, and always make sure I do my conditioning and prehab work so I can progress my running fitness safely.

What got you into physiotherapy?

I was getting my fair share of injuries, my most tragic moment being having 5 stress fractures at one time over my left foot. I also had multiple shoulder issues from swimming. I started to do my own research to understand why I was getting injured which sparked my interest in physio and I knew this was the career for me.

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What is pre-habilitation?

As a physiotherapy student, I did workshops with companies and small interest groups, spreading my passion for pre-habilitation (prevention instead of rehabilitation) for runners. I initiated a project called ‘RunFree’ when I was in my 3rd year, which believed that running should be free for all, made possible if people can run free from injuries. I’ve run sessions for anyone wanting to progress their running safely, including a movement screen based on research and running biomechanics, followed by guidance with these runners on a safe running program.

What’s in your head before a race?

I’m still bad at this – always getting nervous before a race! But my favourite mantra for myself would be – just run! Just get out and run. No fear! ☺

Come and meet her at the UFIT one-north Clinic or within the UFIT running community very soon.

Foot pain: To treat or not to treat?

When we exercise frequently it's inevitable we'll get aches IN OUR ANKLES AND FEET FROM TIME TO TIME.

In the case of UFIT Clinic client Evy Theunis, a trip to senior physio Declan Halpin was definitely worthwhile after she experienced an extended period of foot pain.

FIND OUT about her steps to a solid recovery after an achilles tendonitis diagnosis ... 

"At the end of my pregnancy, my left achilles started to hurt. I didn’t think much of it, and assumed it would just disappear after delivery.

Little Alexander came, but the pain in my left foot stayed! Short walks would still really hurt, so I decided to go see a doctor who referred me to a physio – and there came UFIT Clinic's Declan Halpin!

Apparently I had developed Achilles Tendinitis, and was in for a couple of months of recovery. No running, no tennis, no cycling outside, no lunges, no step ups, NO HEELS, no nothing, HELP!!!!

My plan to get back in shape before I would go back to work went out the window - or so I thought. Let alone do the Spartan race I had planned for in November.

But thanks to my weekly appointments where Declan stretched and massaged my Achilles (we did accupuncture as well), and thanks to the new exercises he gave me to strengthen my heel muscles, we quickly started seeing progress.

(An important point to note: when your physio gives you exercises, do them - sounds logical right - but most people apparently don’t. And it makes a huge difference).

As I was on a mission, Declan really worked with me to help me get as much variation in my training possible without jeopardizing or slowing down my recovery. I negotiated a lot :-)

All in all, it took us about 6 months to get me completely back to normal, AND, with the help of Declan’s magic hands, I made it to Bintan and finished my first Spartan!".

The award-winning UFIT Clinic is Singapore’s leading exercise rehab, injury recovery and women's health clinic. It's holistic approach and full range of physiotherapy and massage-related services by its experienced and friendly specialists can help you prevent injuries before they happen, or get you back on track as soon as possible once you're injured. 

10 Minutes to 10 more yards!

How much money do you spend every year on trying to improve your golf game?

$500 on that new M2 driver, $300 on those comfortable new performance FootJoys, not to mention the multiple lesson packages over the course of year. Although well fitted clubs and apparel are important, and of course the input from a professional is invaluable, you are missing out one of the most important facets of your golf game. You! Constant changing of equipment in order to improve your game can be compared to the Ferrari F1 team trying new colour schemes, new uniforms for the drivers, without doing anything to improve the car itself. Put simply, having a better body will have you playing better golf.

You cant go onto social media these days without seeing videos of Rory, DJ, Jordan and Jason working out with their trainers. Funny how I just mentioned the top 4 players in the world at the minute? More and more professionals are waking up to the improvements they can make in their game with small changes in their physical fitness. If it works for finely tuned athletes like the pros, it works 10 fold for us amateurs.

Our daily routines do not prepare us for the game of golf. Most of us spend Monday to Fridays seated at a desk, at a steering wheel, or on the couch, with maybe an hour or two at the gym if we’re lucky. This lifestyle does not prepare us at all for the physical requirements of the game of golf. If we don’t turn or rotate our bodies at any time throughout the week, Saturday mornings first tee shot becomes even more of a challenge. Not to mention the closing three holes where our bodies have thrown in the towel.

Coaches all the time tell us the importance of turning, rotating, posture, weight shift etc. However, it can by nigh on impossible to avoid these flaws if your body is too stiff, weak or off balance to cope with the demands of what the coach wants you to do. Thats why at the UFIT Clinic, we assess your body to establish your physical abilities to efficiently swing a golf club. By performing our Titleist Performance Institute screening with our Golf Physiotherapist, you will get a picture of where you are lacking physically and where you need to improve.

Ok, so you've showed me what I am struggling with, how are you going to help me? Physical improvements can occur at home, in the gym, at the range, wherever you can find time. Also, don’t think you have to find hours in your busy schedules to make improvements. As little as 10 minutes at home can help you hit longer and more accurate.

Common Example

A lot of golfers struggle with their shoulder turns into the back swing, causing a lot of us to standup in the swing which means we will be club path on the downswing will be affected. A simple circuit for improving your shoulder turn in less than 10 minutes can be seen below.

Performing a bow and arrow movement. Open the chest for ten repetitions. You should feel the stretch in your shoulder, chest and mid back.

Performing a bow and arrow movement. Open the chest for ten repetitions. You should feel the stretch in your shoulder, chest and mid back.

With your hand behind your head, open your chest by raising your elbow up towards the ceiling. The stretch should be felt in the chest and upper back. Perform 10-12 repetitions.

With your hand behind your head, open your chest by raising your elbow up towards the ceiling. The stretch should be felt in the chest and upper back. Perform 10-12 repetitions.

Using a foam roller between the shoulder blades, mobilise the upper back by extending over the foam roller. Hold for two deep breathes and relax. Repeat eight repetitions.

Using a foam roller between the shoulder blades, mobilise the upper back by extending over the foam roller. Hold for two deep breathes and relax. Repeat eight repetitions.

Perform this circuit for 10 minutes twice a day, and watch your clubhead speed, club path and plane and your finish improve before your eyes!

 

ABOUT THE AUTHOR

As a musculoskeletal physiotherapist, Paul has a extensive experience within professional sport (Football Association of Singapore), private physiotherapy and in the public hospital sector (Singapore General Hospital). Having experienced the profession in a number of settings, Paul has developed a keen insight into what is required to help people of all ages and athletic levels. 

Sitting Uncomfortably? You should be.

Everyone knows we need to exercise, right? If you don’t know this, I worry for you. But the question is – do you get enough exercise? This, of course, depends on what we consider enough exercise. The American Physical Activity Guidelines (2016) ask us to do 120 minutes to 150 minutes of moderate physical activity in a seven day week. 

Reflect for a second: Do you get this done? And more importantly, is this enough

Let’s think about it in an average American’s week – say, for example, the most famous American of them all: Homer Simpson. Homer Simpson gets up every day at 7am. He sits down and has his breakfast. He then sits in his car on the way to work, where he sits for 8 to 9 hours at a computer console. He then sits back in his car for another 30 minute drive home, before sitting down for his dinner with his family, and then sitting in front of the TV for the rest of the evening. Doesn’t sound great, does it? 

Well, how about if I told you that Homer does a 60-minute walk twice a week around his neighbourhood, would that improve your opinion of his sedentary lifestyle? Sure, it is better that he does these walks, but it doesn’t take away from the huge amount of sitting and non-activity that he partakes in daily, and weekly. Here-in lies the problem! 

In the modern day world, we partake in incidental daily activity less and less. Our most popular forms of entertainment - the TV, cinema, professional sports watching, and videogames - all involve us sitting down! We sit down at home for meals, we sit down when we commute to work, and we definitely sit down at work! In fact, the average American worker sits for 8 hours a day in their work place! 

However, all this doesn’t really matter, unless sitting is bad for you. Well, let me ask you another question – is smoking bad for you? Every educated person, from the age of eight upwards, knows that smoking is harmful for your health and should not be encouraged. Now, what if I told you that sitting is as bad for your health as smoking? Shocking, right? Unfortunately, we now know this to be true: 

 

  •      Statistically speaking, prolonged sitting (7 hours or more) every day is as likely to give you cardiovascular disease, as smoking 15-20 cigarettes a day is to give you cancer. 
  •       - American Cancer Society (2013) 


More worryingly, according to the American Cancer Society, the negative effects of prolonged sitting on your health “cannot be undone by intermittent bouts of exercise.” In the same way that you cannot smoke twenty cigarettes and then go for a one mile run ‘to clear your lungs’, you cannot sit for eight hours a day, and then do a 30 minute gym session to avoid the negative impact on your health. Starting to sit uncomfortably?

So where do these findings come from? There have been a couple of big studies recently that have shed light on this ‘Sitting Disease.’ The first, in 2010, was published in the Journal of Epidemiology by Patel et al. They followed 123,000 Americans (male and female) for a period of 13 years, taking data on a whole host of subjects. Shockingly, they found that women that were sedentary for more than 6.5 hours a day, were 94% more likely to die of heart disease during the study, than those that sat for less than 3 hours. These effects were a little bit less pronounced in men, but still startling: 68% of men who sat for more than 6.5 hours a day would succumb to life ending cardiac disease than their more active counterparts. Possibly the most worrying part of these findings were that these risks were completely unrelated to how much exercise the subjects reported getting.

Another study, this time from the Brits, asked 4,560 adults to self-report their activity levels. Published in the British Journal of Sports Medicine by Chau et al. in 2013, they found that after controlling for sex, race, economic status, and activity level, prolonged sitting significantly increased a person’s risk for diabetes and heart disease. This increased risk was evident in those who sat for as little as four hours per day! 

So what exactly is it about sitting that is so bad for us? Basically, if you are sitting down right now, everything from your rib cage down has gone into ‘metabolic shutdown.’ Below your diaphragm, your muscles have stopped working. Therefore, while your heart continues working to pump the blood around your system, you are using far less blood glucose and triglycerides. Persistently high levels of these floating around your body will eventually guarantee you either heart or circulatory disease.  

Sitting uncomfortably now? Don’t worry, there are things we can do to stop the downward slide. 

The first, and most obvious solution, is to Stand Up while at work. Researchers at the University of Chester found that by standing up for three hours a day (5 days a week, at work), subjects heart rates were found to be 10 beats per minute faster than those sitting in the same time. This is an improvement of about 50 calories burned an hour, or 750 extra calories burned in your working week. Whilst this might sound like much – over the course of the year, this works out to the equivalent of running 10 marathons over the year!

If your office currently doesn’t support a standing work environment, talk to your management about it. In ten years time, it will seem archaic to have desks in a corporate environment which cannot be raised to allow office workers to stand up while working. Think of how quickly the corporate environment got rid of ‘smoking areas’ once the true cost of smoking was realised! Until then, take regular breaks from sitting, implement stand up meetings, or have a ‘walking lunch’ with colleagues. At the very least – no more sitting on the MRT! 

Good luck! Your body will thank you in the long term. 

 

About the author

Declan Halpin (written while standing – kind of)

 

Declan Halpin is a physiotherapist based in Singapore, at the UFIT Clinic. He has worked with the Singapore Rugby Union as both physiotherapist, as well as the Western Province Stormers in South Africa. He is a senior medical educator for World Rugby, and travels throughout Asia delivering courses on medical care in rugby. Recently, Declan was asked to step in for the New Zealand All Blacks as their physiotherapist at the HSBC 7s in Singapore. For more information on this topic, or help with injuries, please contact him at www.ufitclinic.com.sg or make an appointment through +65 6532 2025.