Sunday, January 31, 2016

High Heels Anyone?

Picture by Vestman from Flickr
What you wear on your feet can affect how your body moves. Just watch your little kids. When they walk or run in their bare feet, they tend to land near the front of the feet. Put them in well supported shoes and straight away they start to land on their heels.

High heeled shoes affect the shape and functioning of our feet . Walking in heels can also change the natural position of the foot-ankle complex, and this may lead to problems going up the lower limb to your spine.

It has been demonstrated that the feet and ankles of women who wear heels over a long period of time are different from those who wear flats (Cronin, 2014). Hence a group of researchers wanted to track the progression of changes in women who spent time wearing high heels.

The researchers recruited a group of young university women training to be airline attendants who were required to wear high heels for their training since they needed to wear them if hired by the airline company. With each passing year, the women will have one extra year of heel wearing, making it easy to track changes.

Girls from each year from freshmen to seniors were selected and their ankle strength (on computerized exercise machines) and proprioception (joint position sense) tested on a wobble board.

Results showed that the sophomores and juniors had greater strength than the freshmen (who were mostly new to wearing heels) in muscles around the inside and outside of the ankle.

This difference suggest that wearing high heels may at first lead to adaptation and increased strength as the ankles respond to stresses placed on it by the high heels,

The senior women (who had been wearing high heels the longest) showed weakening of the same muscles compared with even the freshmen. In fact, muscles at the front and back of the ankles were weaker and proprioception was much worse.

All of the sophomores and above women subjects had worse balance than the freshmen even as some of their muscles were getting stronger.

This may be due to the ratio of strength between the muscles on the sides of the ankles and those of front and back become increasingly unbalanced over the years. This leads to ankle instability and balance problems and eventually a decrease in strength in the muscles that had been stronger for a while.

Despite the findings, the researchers do not suggest women deliberately avoid wearing high heels, but suggests strengthening their ankle whenever possible by doing simple heel lifts (in bare feet rise onto your toes repeatedly) and heel drops (stand on the edge of a stair and slowly lower your heel over the edge).

Whilst sitting, the researchers also suggests taking off your heels since the heels can alter the resting length of tendons and muscles around the ankle which can destabilize the joint and increase injury risk.

Remember the scene in the movie Jurassic World where the heroine had the Tyrannosaurus Rex released from its paddock and lures it into battle with the Indominus where she ran in her high heels? I had this scene in my mind as I read the articles.

Well, if you ever attempt to run from a fast moving deadly animal, high heels are perhaps the worst choice of foot wear possible.

You have been duly advised. Heel wearers beware as strength imbalances around the ankle are known to increase risk in the hamstrings or upper leg and the lower back as well.


Cronin NJ (2014). The Effects Of High Heeled Shoes On Female Gait: A Review. J Electromyo Kinesiol. 24(2): 258-263. DOI:10.1016/j.jelekin.2014.01.004.

Kim MH, Choi YT et al (2015). Reducing The Frequency Of Wearing High-heeled Shoes And Increasing Ankle Strength Can Prevent Ankle Injury In Women. Int J Clin Pract. 69(8): 909-910. DPI: 10-1111/jcp.12684.

Sunday, November 22, 2015

Physio And Sports Solutions Brunch

Special menu for PS and SS
Both PS and SS staff and family members (well those who could make it anyway) came for brunch at Fika Swedish Cafe and Bistro earlier today. We even got the whole cafe to ourselves for the event.

Reggie missed the brunch because he's away for his stag party in Bangkok. Yati was feeling under the weather while others were travelling.

On their phones while waiting for the latecomers
Dean's favourite physio
Except for Aminah, here are all the latecomers

Group picture before Tini and family came
For all our staff who couldn't come, please join us next time coz here's what you missed.

Sunday, November 8, 2015

Will Running With A Stroller Cause Injuries?

Good o' running days with Marlene, Mia and Dean
Back when Dean was younger, I tried running with him sometimes. Yes, him in a stroller with me pushing. Sometimes alone, sometimes with Marlene.

Hence, it was with great interest when I came across the article which investigated if running with a stroller impacted your running form or more importantly, whether it caused injuries.

It started when the author (a physiotherapist and 2:44 hour marathoner) started running with a stroller so he could train without having to leave his infant daughter. (That's a way of multi tasking too). He couldn't find any research on how running with a stroller may impact his form so he conducted his own research with a couple of colleagues.

The researchers studied a group of runners who had not ran with strollers in the past year. They ran in an indoor track both with and without a stroller at their own comfortable pace. The stroller weighed in at 22 pounds (about the weight of an average one year old with stroller).

The results show that while running with a stroller, the runners had a forward lean of 6.7 degrees more than running without. There was a reduction in trunk rotation of 11.4 degrees and an average of 2.9 degrees reduction in trunk side flexion running with the stroller. There was also an increase in pelvic tilt of 2.8 degrees while hip extension was reduced by 3 degrees running with the stroller.

All in all, although running form changed slightly, the changes were small and probably will not affect runners who want to regularly run with strollers.

The authors concluded that the change in form was due to runners pushing the stroller with both hands. Running with both hands pushing the stroller caused the increase in forward lead while reducing the rotation brought about by arm swinging normally. As a result, the authors suggested running with just one hand on the stroller to allow at least one arm to swing.

The researchers concluded that there was absolutely no reason not to run with a stroller. They also recommended some mobility work to stretch the hip flexors and trunk rotation and extension.

I found the forward leaning actually helped make the run faster although it was easier to run with only one arm on the stroller. The lean was exactly what Gino teaches in his pain free running technique for our patients to run without pain. If I ran with just one arm on the stroller, I found that I could not maintain my normal running pace. It was also a struggle to run up hills without the leaning.

Keep your run to an hour or less. My son starts getting unhappy beyond that. Here's another tip, have a toy in the stroller for you to help distract them. Make sure the toy is attached, if not you'll find yourself retrieving the toy from time to time.

Running to a playground or park and stopping for a while will make the run more fun for your child. It disrupts your run but the smile you get makes it all worth it.

Don't assume cars will give way to you on the road. On the contrary, be more cautious.


O' Sullivan R, Kieman D and Malone A (2015). Run Kinematics With And Without A Jogging Stroller. Gait and Posture.

Wednesday, October 28, 2015

Eat Less Bacon, Ham And Sausages

Today's Straits Times article
The news as been abuzz with the fact that processed meat like ham, bacon and sausages etc are as harmful to your health as cigarettes.

The World Health Organization's International Agency for Research on Cancer analysed 800 studies and issued a health warning for eating too much meat.Processed meat, alcohol, asbestos and tobacco were all together in the same group as the Group 1 category of carcinogens.

Well, Gino has written about this before last year.

Have a look at the Straits Times article on Page A4 under Top of the news.

Thursday, October 22, 2015

Exercising with Music ST 211015 - You Saw It Here First

ST 211015
If you look at the Straits Times (211015) article on "Headphones that are music to fitness buffs' ears on page B14 you'll read that sports earphones are really popular now.

Gino has written about exercising/ running with music before. In fact he's written follow up post on exercising/ running with music. He's even been asked to review Sony NWZ W252 way back in 2010.

Sadly one of the earphones doesn't work anymore. We liked it so much we actually bought a new one with 8 GB of memory.

Stay safe when you run with music as your hearing will definitely affected.

Sunday, September 27, 2015

Teaching the Kinesio Taping Level 1-2 Course

Gino spent the last two days teaching the Kinesio Taping Level 1-2 course @Progress Healthcare (tape distributor).

Attending the course were physiotherapy students, sports science students, local and foreign physiotherapists, an occupational therapist and a sports doctor from Indonesia too.

Day 1 consists of theory and concepts of Kinesio taping along with facilitation and inhibition of muscles. Day 2 allows the participants to learn mechanical corrections, fascia and space correction and other corrective techniques.

Here are some pictures taken from the course.

Showing the "weave" and the "wave"
What's with the pink tape?
Jon's push-up position taping 
Ram's head?
Also have a look more pictures here.

Sunday, September 20, 2015

Yesterday's Straits Times Article (ST190915) On Proper Rest Crucial To Better Athletic Performance

If you've read yesterday's Straits Times (ST 190915, page C12) article on how recovering well can contribute to improved performance, you would have read that the author wrote that "there are no convincing studies to show the correlation between massages and athletic performance".

Gino has written on Sports massage before. There was a funny story about a Singapore Olympic swimmer in that post. And even a strange comment from a principal physiotherapist from a hospital suggesting massage may cause nerve damage and strokes???

Yes massage cannot push toxins from muscles to your bloodstream. Neither can it flush lactic acid from your muscles.

What massage does is it allows you to tolerate and endure harder training since it can hasten recovery (by softening fascia and making your muscles relax) and allows you to train hard again quicker.
And if you can consistently train harder without getting injured? Surely that means improved athletic performance.

There are many different ways to locate and interpret published studies, so you just have to be mindful of what you read.

For more evidence to show that sports massage helps, please have a look at the references in this post.