Are Cold (Ice) Water Immersions Effective?

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You can see from the front page of the Life section of the Sunday Times today that cold immersions are all the rage now with at least 10 new openings in recent years.

Before you jump on that bandwagon, do note that evidence shows that ice baths/ immersions does NOT help recovery after exercise. 

The more we know about cold water immersion (from research), the more it seems we (athletes and non athletes) have it wrong. Regular immersion in cold water significantly inhibits recovery from strenuous exercise. 

In fact cold water immersion after hard exercise suppressed signaling pathways associated with recovery. This suppression lasted several days. In addition, ice bathing reduced the body's muscles uptake of dietary proteins, which is important for growth and cell maintenance. Grgic (2022) showed that cold water immersion reduced exercise related strength gains while (Pinero et al, 2024) showed that ice bathing immediately after weight training inhibited muscle growth.

On the contrary, hot water immersion (below) improved recovery following exercise induced muscle damage (Sautillet et al, 2024).

Cold/ ice immersions may have other health benefits such as improving your mood and alertness, or mental wellness. When immersing your body in cold/ ice immersion, the body activates its "fight or flight" response. The blood vessels constrict to preserve your inner temperature while your heart rate and breathing increases. This shock is what causes alertness when you go into the cold water. 

If improving your mood or alertness is your goal, then mornings are a good time to do so.

Why are athletes and non athletes still doing cold water immersions? Social media is probably the cause. Wim Hof (the Dutch iceman) says that cold "activates" your metabolism and strengthens the body's immune response. Others on Tik Tok swears that ice baths improves alertness and concentration. Purveyors of commercial health and wellness have likely jumped on the same bandwagon.

Remember, hot water immersion (rather than cold water immersion) improved the rate of explosive strength and recovery following exercise induced damage. When recovery or explosive power is a key performance requirement, hot water immersion should be preferred over cold. 

You can still use ice of course. I ice my sore body parts still, because it does reduce muscle pain. I fell and bruised my elbow last week and the icing provided pain relief as the ice numbs the skin and blocks pain signals to the brain. 

References

Fuschs CJ, Kouw IWK, Churchward-Venne TA et al (2020). Postexercise Cooling Impairs Muscle Protein Synthesis Rates In Recreational Athletes. J Physio. 598: 755-772. DOI: 1113/JP278996.

Grgic J. (2023). Effects Of post-exercise Cold-water Immersion On Resistance Training-Induced Gains In Muscular Strength: A Meta-analysis. Eur J Sp Sci. 23(3): 372-308. DOI: 10.1080/17461391.2022.2033851.

Pinero A, Burke R, Augustin F et al (2024). Throwing Cold Water On Muscle Growth: A Systematic Review With Meta-analysis Of The Effects Of Postexercise Cold Water Immersion On Resistance Training-induced Hypertrophy. Eur J Sp Sci. 24: 177-189. DOI: 10.1002/ejsc.12074

Sautillet B, Bourdillon N, Millet GP et al (2024). Hot Bt Not Cold Water Immersion Mitigates The Decline In Rate Of Force Development Following Exercise-Induced Muscle Damage. Med Sci Sp Ex. DOI: 10.1249/MSS.0000000000003513

No Need To Be injured To Benefit From Physiotherapy

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A New York Times article by writer Talya Minsberg published in today's Straits Time on page C3 in the Life section. I like the part where she quoted Dr Joe Uhan, a physical therapist (that's what they called physiotherapists in USA). 

"We're sort of the Swiss Army knife of orthopaedic health. We can push on bones like chiropractors can, but we can masage tissue like massage therapists can and we can exercise like a personal trainer can."

"Be wary of any clinic that feels like a "PT mill", a quote from De Charlie Homoky another physical therapist. You definitely should have the undivided attention of your physiotherapist, quality one on one time during the whole session. That is what we do in our clinics. You are NEVER left alone on a machine, nor with a rehab/ therapy aide or attendant. We may teach you 1 or 2 exercises at the end of the session for you will not NOT be doing any exercises during your time with us. We treat you mostly with our hands, treatment you cannot do yourself.

We are not just for sports injuries or post surgical care. we can help prevent injuries and improve your quality of life. Come see us in our clinics.

Elastic Bands As Good As Weights For Building Muscles

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Use elastic bands for strength training? We have discussed this before in a post almost 4 years ago. Straits Times used an article from the New York Times. It is published in page C3 in the Life section today (080125).

Yes, research (lopes et al (2019) does suggest that using elastic/ resistance bands are just as effective as weights at building your your strength levels.  So don't fret if you don't have easy access to a gym or other fancy, expensive gym equipment. Other than your bodyweight, elastic resistance bands can be great for strengthening muscles too.

Go take a look at the Starits Times. Or better still follow either of our blogs. We bring you up to date much quicker.

Reference

Lopes JSS, Machado AF, Micheletti JK et al (2019). Effects Of Training With Elastic Resistance Versus Conventional Resistance On Muscular Strength: A Systematic Review and Meta-analysis. Sage Open Med. DOI: 10.1177/2050312119831116.

We Did Bag Painting

Our staff took time off this morning for our team building event at the Istana Park. We painted our very own tote bags.

Our view from where we were painting

Elizabeth from Love Human Connection was our instructor and she taught us what to do so we can do our painting correctly and effectively. 

We definitely have some gems in our midst as you can see from the work done. All of us had a great time painting and just spending time together.

We had a really sumptious lunch together after that before going back to work. Yes back to life, back to reality ....

Can't wait for the next team building event.

When Is An Ideal Time To Exercise?

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Different health professionals were interviewed on when is a good time to be exercising. No surprises, we have already written on this topic before back in 2022. 

I was surprised to read that one of those interviewed commented that more observations and studies are still required to confirm the findings that suggest that we are at our best in the late afternoon or early evening. 

You can search if you like. There are more than sufficient evidence supporting circadian rhythms and physical performances peaking in the late afternoon or early evening. For most people, this is between 4-7 pm. 

Sports fans will know that NBA Finals, Champions League matches etc are all played in the late evenings. Almost all track and field world records are set in the evening as well. 

Evidence may show that the best time of the day to exercise is the late afternoon to early evening. However, that time may not suit everyone. Better to exercise at whatever time suits you best as some exercise is better than no exercise, especially in Singapore when the weather is warm year round.

The article is published in yesterday's Straits Times. Front page of the Life section. Better still, read our blog, you will get updates quicker.

Reference

Aoyama S and Shibata S (2020). Time of Day Dependent Physiological Responses To Meal And Exercise. Frontiers Nutr. DOI: 10.3389/fnut.2020.00018

Is Your Sports Bra Restricting Your Breathing?

I'll come straight to the point. Sports bras aren't always comfortable. Not only do the shouder straps slip and chafe sometimes, the bands are sometimes so tight around the rib cage that they are uncomfortable and restrict breathing.

Kipp and colleagues (2024) studied whether tight sports bras hinder breathing in runners. They had 9 international and/ or national competitive runners complete a series of treadmill tests while wearing a specially modified version of LuluLemon's Energy sports bra. The underband tightness around the RC can be increased or decreased with extra eye-and-hook attachments at the back.

The bra was also modified so that a small balloon catheter could be inserted into the underband to measure exactly how much pressure was being exerted as the runners breathed in and out.

In addition, the subjects had another balloon catheter inserted through their nose down into their esophagus to measure the internal pressures exerted with each breath by their lungs as they ran! Ouch. Check out the Instagram video Kipp posted here. Definitely worth a watch so you can appreciate what the subjects had to endure for this research.

That catheter allowed the researchers to calculate the "work of breathing" i.e. the energy used by the respiratory muscles to inflate and deflate the lungs. It has been calculated that it takes more than 10 percent of your total energy output during hard exercise.

The runs were done under 3 conditions. Once with the runners' self selected bra size, once with the bra tightened and once with it loosened. 

When the pressure on the band was tight, it was on average 16 % greater than in the loose condition. Going from self selected to tight did not change anything. However going from self selected to loose reduced oxygen (and energy) consumption. Overall difference between tight and loose conditions was between 1-2 percent in most subjects, with an average of 1.3 percent. 8 out of the 9 runners saw improvements in the loose condition. Not the 4 % change like what you get from the carbon plated super running shoes, but significant enough.

Kipp estimated that a 2 % change in oxygen consumption translates to a 3 minute improvement in the marathon time for a 3-hr marathoner runner. 

The reason for the efficiency difference is due to the tighter bra making the runners breathe differently. While running at VO2 max in the tight bra, the women had to breathe in more oxygen overall by breathing more quickly (57 versus 52 breaths per min). However they had to breathe more shallowly. 

That work of breathing took 16 percent more energy, which explains why overall whole body consumption was higher.  Secondary effects include the oxygen rich blood being diverted away from the legs to elsewhere.

It can be a serious problem if you wear your bra too tightly if you value a percent or two in performance. Kipp cited previous data suggesting that 70 % of women choose sports bras that are too small for them compared to a professional fit. If you're happy with your sports bra, you can ignore these findings.

The runners presumably chose a tighter than optimal bra because they wanted adequate support. However none of the women in the study reported that the loose condition was uncomfortable or provided inadequate support. 

A possible reason is that women select and try on sports bras at rest. None of the breathing parameters meaured in Kipp's study were affected at rest. It was only during hard exercise when the runners were breathing hard and inflating their lungs that problems emerged. 

It may be best to choose your sports bra based on how it feels during a hard workout rather how it felt at the store. Sports bra designs are much more than just tight the underband is. All the elite runners in this study had small to medium breasts. It also depends on the activity you are doing. 

There are more than enough models and patents amongst different brands for women to choose between insufficient support and excessive tightness. Pick what you need.

If your sports bra feels tight enough when you are exercising that you wonder if it may interfere with your breathing then it probably is.

Reference

Kipp S, Leahy MG and Sheel AW et al (2024). Sports Bra Restriction On Respiratory Mechanics During Exercise. Med Sci Sp Ex. DOI: 10.1249/MSS.0000000000003403

Burnout When You Specialize Early In Sports

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We already are a small nation. Made worse by the fact that most Asian parents tend to prefer degrees to medals. So no surprises as the author noted that many coaches observe that students who specialize early in sports to gain direct admission to the preferred school tends to lose interest after maor exams. 

Just like the author, Gino has written previously about Singapore losing talented young athletes from the Sports School. Many of these 'talented' kids who are early maturers (at 13 years old when they go to Secondary school) don't carry on competing and drop out. 

Previously, another article from the Straits Times, (260818) on why we should not turn childhood into a race for results, the author wrote about how US Olympian Katie Ledecky describe swimming as "really just for her still a hobby". She has by the age of 21 won five Olympic gold medals and a silver, owns six world records and a US$7 million dollar deal with a swimwear company.

She was quoted in a New York Times article saying "I feel lucky that I could enjoy swimming," and "people need to relax ... and take a step back and realize that you don't have to be great at this young age. It's not about immediate results". Ledecky said she recalled she had not raced in events longer than 25 yards (22.9 metres) until she was eight years old.

May I suggest that your child not be involved in more hours of organized sports than their age. Expose them to as many different options as possible while waiting as long as you can to find a sport for them to specialize. Then you can support them as much as possible.

This is exactly what author David Epstein suggest in his book Range: Why Generalists Triumph In A Specialized World,

The Sunday Times article is on page A21 under Views. Go take a look.

To Stretch Or Not To Stretch Before Exercise

Can't believe our Straits Times is using a New York Times article in today's paper in the Life section on Page C3. 

The author cited 2 recent reviews but ddid not include the references so there was no way to verify the research.

What we have written before is just one static stretch of 30 seconds can reduce your maximum strength. You're more likely to get injured if you do static stretching before exercising.

Good static flexibility also does not help prevent injuries. This topic has been the studied widely, a few studies have found that there are some benefits, while a few other studies have found that being too flexible is associated with injury. Most do not seem to make much difference.

Static flexibility is not associated with non sports related problems like low back pain.

We have written on this since 2009. Was hoping this is common knowledge. 

So take note that static flexibility is not that important, unless your specific sport requires it. Stretching before, during or after a workout does not prevent subsequent muscle soreness. It does not reduce inury risk either (Herbert et al, 2011).

The goal of warming up is to physically warm your muscles to make them more pliable as well as get your heart rate up to be ready to deliver oxygen to your working muscles. 

If you run, you can ride a stationary bike for 10 minutes or just run the first kilometer real slow before picking up the pace. If you're playing badminton or tennis, I'll suggest some lunges, side to side movements, i.e. sport specific movements that you may use while playing.

Reference

Herbert RD, Noronha MD and Kamoer SJ (2011). Stretching To Prevent Or Reduce Muscle Soreness After Exercise. Cochrane Reviews. DOI: 10.1002/14651858.CD004577.pub3

Here's the article from today's paper. probably don't have to read it Our blog articles on stretching are much better.

Team Building Event

We had Isabel Lim from Isabel Lim Designs teach us embroidery this morning for our team building event. We learnt how to do the back stitch, the lazy daisy, woven rose and statin stitches. 

MJ's cats

It was great fun learning a new skill and we had a great time together learning how to decorate a little bag.

Riz made this for his wife Stacy

We had lunch after that which doubles up as a farewell lunch to Byron who is leaving us to move to Adelaide, South Australia. 

All the best for your future endeavours Byron. 

An Article About Fascia

Finally an article in today's Straits Times about fascia. It was originally published in the New York Times. This helps explain a little about how and why we treat fascia and how caring for it can improve your health.

There are many skeptics and naysayers still, but more research and knowledge is definitely emerging. It's in the Life section of today's Straits Times on page C3.

Long Term Effects For Sports Related Injuries?

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Found the perfect answer for youths who are told to exercise more frequently, in last Tuesday's (300523) Straits Times article and the comic section in today's Sunday Times (above). 

Please do not get me wrong, I am not disputing the fact that sports are very good for our youths. When they take part in sports, it teaches them teamwork, sportsmanship, improves their self esteem while letting them try risk taking (safely). And of course it makes them healthy and strong. Both physically and mentally.

Be aware that when these children/ teenagers focus too early on a single sport, they often lose interest when the going gets tough. Correct technique is very important, much more important than just brute strength. Especially when they sometimes fail to develop basic movement skills. 

We know that young athletes are definitely not small adults. Remember Gino has written about not forcing the teenage athletes. 

Our youths have very elastic connective tissue and are very resilient. Unless they are perpetually injured, there probably will not be permanent long term effects. Our clinics can definitely treat them if you need. 

Have a look at the article published on 300523 in the Straits Times on page A14.

Bowling For Team Building

I woke up with a really sore throat and running a temperature and groaned. It's our team building event today. I probably have to give it a miss. So Gino had to send our older son to school before meeting the rest of the team.

Looks like I missed some K-pop bowling the rest of the team did. And lunch as well.

They also celebrated Byron's birthday (yesterday). 

Looks like I have to look forward to the next team building session then. 

Those 'Ugly' Thick Midsole Shoes Again

Page A20 300423 Straits Times 

My last post on those 'ugly' Hoka shoes earlier in April 2023 being more popular now was echoed by the Straits Times deputy editor in yesterday's Sunday Times on page A20. 

The deputy editor wrote how she had to 'convert' from her delicate ballet flats (or minimalist type) to more sensible shoes after a foot tendon injury and foot joint stress.

Her family actually sniggered when she changed her shoes since her Generation Z children and husband had been wearing those 'ugly' maximalist shoes all the time. She explained that it was perhaps due to her "poor footwear choices over the years, from flimsy flip-flops to vertiginous heels".

I should draw your attention that evidence for "flimsy" footwear is actually very sound provided the wearer's running (and walking) technique is correct.

Using results of Daniel Liberman's study, runners who land correctly in their running technique will have benefits as impact is a lot less (even less than landing on your heels with cushioned shoes on).  If you land wrongly (with minimalist shoes) the impact is 7 times greater thus greatly increasing the chance of injury. See picture below.

(From Liberman et al, 2010)

Unfortunately most of us (runners) are very impatient for results and do not master the correct running/ landing technique while just using minimalist shoes thinking that will be sufficient.

 Also read why if you run in more cushioned/ expensive shoes, the more likely you seem to get injured to further support why running in minimalist shoes with correct technique is superior to running with cushioned/ expensive shoes. 

Page B5 Forum section

Moreover, a young reader (18 year old Amos Loh) wrote in today's Forun page B5 (pictured above) that this may "perpetuate a culture of consumerism and superficiality" since there is also pressure amongst Generation Z to keep up with te latest trends.

Reference 

Liberman DE, Venkadesan M et al (2010). Foot Strike Patterns and Collision Forces in Habitually Barefoot Versus Shod Runners. Nature. Jan 463(7280): 531-535.

Those 'Ugly' Hoka Shoes

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I did not call them ugly, the NYT headlines did. I do see more people wearing them now though. They have been popular for quite a few yeras now. Gino has written quite a few posts on them too. However, results from the studies were not good. 

Runners not used to such thick midsoles in that study (2018) absorbed more of the impact forces of running and in less time. While wearing the regular midsole height running shoes, the impact forces of each step were lower and more evenly spread over time.

In a follow up study to the earlier study (2019), the researchers had the runners run in the maximalist shoes for six weeks (so the runners get used to them) before they repeated the testing. The runners somehow did not adjust to the shoes. Interestingly, the runners still landed with greater force and pronated more in the maximalist shoes compared to their initial test run.

Yet another follow up study which was just published last month on a new group of male and female recreational runners (Hannigan and Pollard, 2020). The researchers got New Balance to custom make a pair of their neutral running shoes to allow them to alter the shoe by adding or removing foam. This shoe can then serve as minimalist, traditional or maximalist shoes to allow the researchers to focus solely on the role of cushioning in the runners' form.

This time, a few of the runners in this study were found to land heavily in the minimalist and maximalist shoes, but they pronated most in the maximalist shoes.

The authors commented that looking at the three studies as a whole would suggest that extra cushioning does influence several aspects of the way we run. The thickly stacked soles of maximalist shoes seem to subtly affect balance, making the shoe more unstable. This is then likely to increase ankle movement and pronation.

Some runners seen our clinic have gotten seriously injured while wearing maximalist running shoes. However, I'm definitely not against any runners switching to them. Provided they have tested them and ease into training with them slowly and finding them suitable.

Hoka Clifton - fashionable?

The newspaper article on page C6 in the Life section of the Straits Times today (120423) also mentioned that it was now 'fashionable' to wear them. Seriously?

References

Hannigan JJ and Pollard CD (2019). A 6-Week Transition To Maximal Running Shoes Does Not Change Running Biomechanics. AJSM. 47(4): 968-973. DOI: 10.1177/0363546519826086.

Hannigan JJ and Pollard CD (2020). Differences In Running Biomechanics Between A Maximal, Traditional And Minimal Running Shoe. J Sci Med Sp. 23(1): 15-19. DOI: 10.1016/j.jsams.2019.08.008

Pollard CD Ter Har JA et al (2018). Influence Of Maximal Running Shoes On Biomechanics Before And After A 5k Run. Orth J Sp Med. 6(6): 2325967118775720. DOI: 10.1177/2325967118775720.

What's Love Gotta Do With It?

Everything! Love has to do with everything in medical care. The human touch cannot be lacking. Definitely agree with semi-retired paediatrician Dr Quah Tuan Chong in today's forum page B5.

And patients can definitely sense whether their health care providers genuinely care for them, even love them or are just dispensing their technical skills.

We definiyely care and love are patients. We posted this before Dr Quah wrote in to the forum page of the Straits Times.

Feel hopeful, cared for, heard and understood when you come to us with your pain.

We spend a whole hour with you face to face, at your first session, to figure out what’s going on by doing a thorough assessment.

It starts with you telling us what you’d like to achieve from your time with us. You get to tell us all you think might be contributing to your pain, all the necessary medical history and ask as many questions as you need.

The more you understand about your pain and what’s causing it, the faster you’ll get better.

We then read your body, to see how it’s sitting, standing or doing the movement that reproduces the pain. We do special tests if necessary, feel your connective tissues, joints and muscles to get an idea of what’s happening in your body. We figure out with you what outside factors may be perpetuating your pain.

Good clinical reasoning helps us create your treatment plan. We have many tools to help you achieve your goals.

Don’t put up with your pain. Get It Solved Today At Physio Solutions & Sports Solutions ♡

Not Meeting Physical Activity Targets

Despite physical education classes being our children's favourite lessons in schools, more than half of our children and adolescents do not meet the global recommendation of at least 60 minutes moderate to vigourous exercise per day. Our country scored C- (40-46 percent) for overall physical activity.

Our country has provided more than enough spaces and sports facilities for physical activities and movement. In fact Singapore was given an A+ for community and environment support for physical activities. 

We have a supportive environment as well as a government that promotes and implement programs for physical activities and sports. It's up to us as parents to ensure our children spend more time outdoors at parks or playgrounds. 

The article is on page A13 in today's Straits Times.

We Went Batik Painting For Our Team Building Session

Our fourth and last team building session for the year. We have had one every quarter this year.

We decided to go and learn batik painting at Kamal Arts center. It was definitely a very interesting session!

Definitely not as easy as it looks. Please look here for more pictures.

Let The Children Play

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As the author of the article (who is also a principal of a local school) said, physical education classes are most popular amongst our school children. 

Physical activity is definitely good for both the mind and the body. Let them play and definitely don't turn their childhood into a race.

Have alook at the article on page C4 under the Life Section.

Pottery Class For Team Building

Yes, that's what we did for our team building event this quarter. We had lots of fun learning how to coil.And it's definitely not as easy as it looks. 

A big thank you to Jeanettte Wee from Ves Studio for teaching us. You can also look at their pictures here.

Our masterpieces

After that we had lunch together as well.

Looking forward to the next team building session.

Is It Ok To Train Through Your Pain?

I spent the last few days preparing for the talk I was going to give at UBX Training Singapore about healing after injury and whether it is ok to train through your pain. I had not done an in-person talk in forever and was feeling nervous before it!

With Rebecca, the owner

The owner of UBX Singapore had asked if I could give a talk for their members a few weeks ago and of course I agreed. I have known her for many years and am happy to share what I know.

In order to truly understand the concept of UBX Training, I signed up to attend sessions there. I wanted to ensure that I could tailor the talk to their members. It really worked for me in that I do not have to book my sessions. I can rock up at UBX anytime they are open. Another plus point is that the sessions are fun!

I hope that the UBX members and coaches who attended the talk this afternoon found it useful. I had a great time.