Injury recovery

From smashing Bootcamp sessions to relearning how to walk

Michelle has been a familiar face within the UFIT Bootcamps and personal training community for the last couple of years. In the middle of last year, she suffered an unfortunate accident that ruptured her Achilles tendon and temporarily put her out of training. Initially Michelle could not train and had to relearn the mechanics of how to walk again. This is her story of how she regained her fitness routine with the support of the UFIT family.


Michelle (second from right) is a familiar face within the UFIT community for the last couple of years.

Michelle (second from right) is a familiar face within the UFIT community for the last couple of years.

"There was a mild state of shock at the time of the injury. I started the morning at a UFIT Metcon class, and by the afternoon of the same day, was in an operating theatre undergoing surgery to reattach my Achilles’ tendon. The injury had nothing to do with the class. I wasn’t doing anything complicated nor particularly strenuous, it was just horrible bad luck and timing. The CrossFit Bukit Timah crew quickly got me off the CrossFit floor, into a car and immediately to the hospital.

It was awesome to have the support of the team with my injury.

I hated not having the option to train but UFIT Orchard’s gym manager Nathan motivated me with text messages about returning to the gym in good time. UFIT Clinic's senior physiotherapist Declan immediately offered physio support and a friendly reminder to eat well.

The initial physiotherapy work was challenging psychologically. The exercises were basic compared to pre-injury, and that felt a little frustrating. Declan had to teach me the mechanics of how to walk. It might sound silly, but no one thinks about the mechanics of walking, it just seems to happen automatically. In Declan’s usual super patient manner, he broke down “the steps”, and after a few shared laughs I eventually got the hang of it.

A big part of the initial recovery was on keeping a positive mindset, as it would have been easy to slip into a mini bout of depression. It sounds dramatic, but having spent a great deal of time dedicated to physical activity and then to suddenly and unexpectedly have that taken away was difficult to accept. Anyone recovering from an injury hopefully understands what I mean.

UFIT Clinic's senior physiotherapist working with Michelle.

UFIT Clinic's senior physiotherapist working with Michelle.

What I appreciated about Declan was his belief in my physical capabilities beyond what I thought was possible, and his support to get me there. On multiple occasions during my recovery, he would suggest we try something new post-injury, like a box jump. My reaction would usually be a quizzical look in response. But I would take a deep breath, a huge leap of faith, and trust in Declan’s professional wisdom. The first box jump was pretty daunting, but he’s always proved to be right.

The rehab exercises have names such as the ‘Jane Fonda’ and the ‘Stevie Wonder'.

Declan (otherwise known to me as the ‘Achilles Whisperer’) kept things interesting and challenging. The rehab exercises were named the ‘Jane Fonda’ and the ‘Stevie Wonder’ – how could that not be interesting? In between sessions he would respond to my random recovery-related text messages, so there was no doubt about his commitment to the recovery process.

Three weeks after my surgery, I was cleared to go back to training at the gym. Training has always been part of my routine so I couldn’t wait to get back to it.  It is fortunate, or unfortunate that I am stubborn and determined by nature.

Strength training has always been a big part of Michelle's life.

Strength training has always been a big part of Michelle's life.

Going back to training was only a matter of time.

Nathan and I had been training regularly for a couple of years prior to my injury, so I couldn’t wait to get back. He even offered to carry me down the stairs to UFIT Orchard to get me there! I was still wearing a protective boot and on crutches when I returned to the gym. It must have looked highly unusual to other clients, but I was determined to not let the injury get the better of me.

Nathan is amazing. He immediately adapted the workout to my physical progress. Given that I wason crutches initially, Nathan would move the equipment to physically surround me for circuit training, minimizing my “travel time” around the gym. We did a lot of upper body work and modified cardio exercises, such as battle ropes seated on a box.

"There is no elevator to success."

"There is no elevator to success."

Nathan was aware of my fitness ability before I got injured, and we trained with the goal of getting back to that level. He plans our sessions carefully so there is steady progress, and along the way there were short term goals we have continued to meet and reset. He pushes me with good natured encouragement and I never want to disappoint him. Our conversations between workout sets revolve around nutrition, the choice of workout music, or just sharing a good laugh. There is never a dull moment! With Nathan’s broad knowledge of fitness and nutrition, hardly a session goes by without him sharing a nugget of his wisdom.

We have reintroduced more complex movements back into my workout, slowly increasing weights to restore strength and stamina. Nathan and Declan stayed in contact about my recovery progress, so there is a consistent approach in both physiotherapy and strength work.

Prior to my injury, I also trained regularly at the East Coast UFIT Bootcamp, where the gang have become good friends. During rehab, the WhatsApp group chat became a motivation to return to Bootcamp. As soon as I was stable on my feet, I rejoined Boxfit. Being among the strong and sassy East Coast group continues to inspire (as well as entertain) me. Bootcamp trainers like Marcus have also been hugely supportive of my progress. Exercise variations are always offered to compensate for limitations – although it is no less challenging to do burpees in lieu of a run around the carpark!

The strong and sassy East Coast UFIT Bootcamp gang.

The strong and sassy East Coast UFIT Bootcamp gang.

The recovery process has been an emotional journey.

Doing more and more physically are milestones of progress. My goals now are to achieve a target weight for a deadlift and bench press that will get me on the gym whiteboard. Within the year, I also want to complete a 5 km race, and finish the certified program on sport and exercise nutrition. It’s a personal mission not to take my physical capabilities for granted. UFIT has been a huge part of the process and I couldn’t be more fortunate and grateful for support from the entire community – the staff and the fitness buffs.  Its been tough, but also a great deal of fun. Thank you!"

Supercharging the hip

Fighting sports have become huge in Singapore over the last few years with the rise of the one championship, KBX fight promotions, and specialist boxing gyms opening up.

Whether it's martial arts, Bootcamping, CrossFitting or PT you do - and anyone who works out frequently - puts their muscles and joints through intense loads. Don’t get me wrong, this is not a bad thing at all and with enough time to adapt, your bodies will benefit significantly from the increased demand. However as with any contact sport, there is no shortage of injuries.

In this article I'll outline a few good ways to avoid any hip injuries from martial arts - or any other rigorous training. I’ll also give you tips and show some simple exercises that can reinforce your hip and the surrounding structures so you are less likely to be injured and need physiotherapy.

After all, prevention is better than cure!

Hip injuries

Ouch, I’ve had a few, usually by throwing a flashy kick too high without warming up or pushing it too far whilst stretching with a partner and pulling my hamstrings. Muscular strains are very common and the majority will clear up in 2-6 weeks if you do the right things.

Please note it's important if you have any ongoing or recurring hip issues that you get them assessed by a physiotherapist ASAP, there are many different structures that could be at fault.

How to avoid them

Load up gradually – in other words don’t jump from sofa to sparring in one day, if your body is not conditioned to the stress you are about to put it through you’ll increase the risk of injury. This goes for returning vets as well as beginners.

Make sure you are warm – OK this might be a given but you’d be surprised how many guys think doing a quick jog up and down the room is enough. Get your blood pumping, get those neurons firing and do some dynamic stretches before you start.

Increase your hip mobility – This is important in all sports but extra important if you like flashy kicks, or intend to roll with someone who is going to try and pull your legs to the opposite sides of the room.

Supercharge your leg muscles – Try out the exercises below to supercharge your hip.

Here are my favourite exercises to build up hip mobility and muscle robustness – Also great to use as part of your warm up;

1.     Long stride with a twist

  • Start in a long lunge position, with your back leg completely straight.
  • Put both palms on the floor in line with your front foot.
  • Twist towards your front leg, lifting your nearest arm up to point towards the ceiling – your body should end up facing your front leg.
  • Hold for 10 seconds
  • Repeat 10 times each side.
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2.     Bridge with hip and knee drive

Beginners:

  • Start by laying on your back, with your knees bent and both feet flat on the floor
  • Brace your core
  • Squeeze from your glute and drive your hip up towards the ceiling

Advanced:

  • Start by lying on your back, with one knee bent foot flat on the floor.
  • Grab one leg and pull your knee in as close to your chest as possible.
  • Push up into a bridge with the leg still on the floor and hold for 5 seconds.
  • Repeat 15 times each leg.
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3.  Deep squat with counter balance

Beginners:

  • As below but without a weight.

Advanced:

  • Grab a kettle bell or a weight – doesn’t need to be too heavy you are using it as a counter weight so you can sit back into the squat.
  • Sit back into a squat and push your elbows against the inside of your knees to push them out.
  • Hold it and gradually sink lower into the squat as your muscles relax.
  • Repeat 5 times.
 
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4.     Cossack goblet squats

You can do this one of two ways depending on your current flexibility.

Beginners:

  • Start in a standing position,
  • Lunge down to the side keeping both feet facing forwards and holding the weight in front of you.
  • Repeat on the other side.
  • Sink lower into the position each time.

Advanced:

  • Start in squat position
  • Keeping as low as possible push over to one side
  • Then push across to the other
  • Repeat 5 times each side
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5.     Internal rotation with lateral pull

Beginners:

  • Start on all fours
  • Attach band around hip close to groin and make sure it is taught
  • Push your bottom down and backwards.

Advanced:

  • Attach a resistance band around your upper thigh as close to the groin as possible, and make sure it is taught
  • Internally rotate your leg as shown in the picture
  • Starting in an upright position, push your back leg back and your body forward as is doing the pigeon stretch
  • Repeat 5 times each leg.
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6.     Nordic Hamstring curl

  • This exercise is for advanced only, please make sure you have sufficient strength in your hamstrings before attempting this.
  • The main focus of this exercise is on the lowering phase known as the eccentric phase.
  • Get yourself into a neutral pelvic position and brace your core muscles as if someone is about to hit you in the stomach.
  • Keep your body as straight as possible and lower yourself down as low and as slowly as you are able
  • If you need assistance getting back up its ok you push with your arms up the start position then repeat
  • Repeat 3 sets of 4 repetitions.
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That’s my top six to supercharge the hip, I hope you enjoyed it and good luck trying them out. If you are interested in learning more handy tricks and exercises to help you stay injury free follow my instagram @thefightingphysio I am also available for consultations, treatment and advice at the UFIT Clinic one-north.

17 UFIT highlights of 2017

And just like that, 2017 is done! We're excited about what the new year will bring - but just before moving on, can't help but reflect on what an amazing year 2017 has been.

There have been so many highlights and exciting developments over 2017 - far too many to mention - and here we've chosen just 17. 

We thank our wonderful community of clients, partners and friends for your amazing support and congratulations to all of you on reaching your personal goals and milestones over the year. We have loved working with you and are really excited about getting you Fitter, Leaner Stronger next year.  Stay tuned as we continue to pop up in exciting new places in SG and beyond!

Opening of UFIT Orchard gym, with UFIT's 50 staff

Opening of UFIT Orchard gym, with UFIT's 50 staff

Team UFIT dominates team events  

Team UFIT dominates team events  

Fitness Fest mass workout for 1,000s

Fitness Fest mass workout for 1,000s

England rugby pro Dan Norton coaches UFIT kids

England rugby pro Dan Norton coaches UFIT kids

Launch of UFIT Performance in Hong Kong and Vegas

Launch of UFIT Performance in Hong Kong and Vegas

The expansion of Bootcamps team WeFit

The expansion of Bootcamps team WeFit

UFIT  heavyweights at mass staff workout

UFIT  heavyweights at mass staff workout

Singapore's Fittest CrossFit PT Couple at UFIT

Singapore's Fittest CrossFit PT Couple at UFIT

UFIT appointed in-house LinkedIn gym provider

UFIT appointed in-house LinkedIn gym provider

Continuation of UFIT staff professional development

Continuation of UFIT staff professional development

Amazing personal milestones reached

Amazing personal milestones reached

Launch of Personal Training @ UFIT Tanjong Pagar 

Launch of Personal Training @ UFIT Tanjong Pagar 

UFIT Bootcamps wins Best Outdoor Class award

UFIT Bootcamps wins Best Outdoor Class award

UFIT Clinic awarded Asia's Best Rehab Facility award

UFIT Clinic awarded Asia's Best Rehab Facility award

UFIT Clinic opens 2nd branch at one-north

UFIT Clinic opens 2nd branch at one-north

UFIT Retreats welcome guys at Phuket Retreat

UFIT Retreats welcome guys at Phuket Retreat

And Mok and Maire our physios win half marathons 

And Mok and Maire our physios win half marathons 

And that's a wrap for 2017 -  now with nearly 100 staff.

And that's a wrap for 2017 -  now with nearly 100 staff.

MRI scans - are they necessary?

As a physiotherapist in Singapore, I see two things very often: patients with back pain, and patients with recently acquired MRI results (usually the same people). Why? Well, the prevalence of back pain in Singapore is often because the patients have combined a high pressured, desk-bound job with a lack of exercise and movement in their daily lives.

And their envelope containing their MRI results?  This is usually because the first thing their doctor has done when they reported back pain is to send them for a scan to see ‘how bad it is.’

This is because in Singapore, as in most of the world, MRIs and related high-tech imagery have ballooned into a multi-million-dollar industry to both the providers and the referrers. Indeed, in the United States last year, Medicare paid out over $14 billion dollars for MRIs alone.

 
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The problem is that most patients and many doctors still perceive MRIs as an easily accessible commodity that will provide the answers as to where the pain has come from, and therefore the solution to getting rid of the pain. However, this relies on two massive assumptions:

Assumption 1:   MRI scans are always accurate

The Truth? MRI scans are surprisingly difficult to read, and different radiographers looking at the same scan will often report different findings!

Assumption 2: MRI scans’ findings are always related to the problem

The Truth? Issues found by an MRI scan are often completely misleading, can have nothing to do with the pain you are feeling, and can be a completely normal part of ageing.

Let’s dig a little bit deeper.

So how accurate are MRI scans?

A very recent study conducted by Herzog et al, published in the Spine Journal in April 2017 assessed the accuracy of MRI imaging and reporting, by asking a 63 year old patient with current pain, and a long history of lower back problems to visit ten different MRI centres in succession, and get a report from each one.  The results?

1 Patient

10 MRI Scans

49 different ‘issues’ reported

0 of these ‘issues’ seen across all 10 scans.

This is a scarily clear demonstration that MRIs are not the clear snapshot that patients often believe that they are.

So why is there a difference between different MRI centres? First of all, like with physiotherapists, you can get good, skilled radiographers, and you can get inexperienced or under-skilled radiographers.

Secondly, just like your TV and computer, imaging technology is constantly changing and improving. So an Ultrasound or MRI machine from 10 years ago is going to be very low quality compared to a machine produced in the last two years.

Finally, an uncomfortable aspect of the medical industry: many doctors now own their own imaging machines, and will charge a premium for potentially unnecessary scans to ‘confirm’ their diagnosis. Is there anything a patient can do about this? Not much besides trusting your doctor to refer you to a trusted imaging centre, and hoping for the best.

Are MRI scans even relevant?

In most cases, no. A large systematic review conducted by Brinjikji et al, in 2014, assessed the MRI findings of 3,110 people with No Reported Back Pain. The findings? A significant number of these perfectly fine people were found to have problems, issues, or ‘degradation’ within their spines, which became more common as they got older.

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One third of normal, healthy 20 year olds have ‘degenerative’ signs in their lower back! And two thirds of perfectly healthy 50 year olds were found to have disc bulges! So what does this tell us? Spinal changes are a NORMAL part of ageing. Disc changes are a NORMAL part of ageing. And more importantly, negative changes in your spine are not always associated with pain.

Does this mean we should just throw all MRI machines in the Singapore River, and never speak of them again?

Of course not! MRI machines are an important diagnostic tool, but should not be used alone to figure out where your pain is coming from. They should be used as one element of a thorough assessment by your physio or doctor to figure out what is wrong with your back (or shoulder or knee), and figure out the best treatment strategy moving forward. As the physiotherapy expert Adam Meakins succinctly says, ‘Treat the Man, Not the Scan.’

The good news for you as a back pain patient in Singapore (or anywhere else in the world)?

Even if you have MRI findings that say that you have disc bulges, disc degeneration, and all sorts of issues going on – it is not a death sentence, and you do not need to go under the knife to ‘fix’ the problem!

Find yourself a good physio (quick plug: we have great ones at the UFIT Clinic), or a good doctor (ask us, we know many!) and complete your assessment with them to see what other factors might be contributing to your pain, and what we can do together to get you back on your feet, and back to being fit, healthy, happy and pain-free as quickly as possible!  

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Back and neck pain? Doctor or physio?

Back AND neck pain - doctor or physio: Who should you choose?

The question I constantly encounter here in Singapore is ‘I have a sore back. Should I come see you, or should I see a doctor first?’

Being a physio myself I am obviously biased, but physiotherapists train for four years to get a degree specialising in chronic pain issues and musculo-skeletal breakdowns. We should be involved from the beginning in the treatment and care of any back pain or neck pain issues.

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Unfortunately, here in Singapore (and in many countries around the world) the medical insurance companies require a doctor’s referral in order for physiotherapy claims to be approved, so the answer is usually ‘Go see a doctor, and ask them to refer you to me.’ If that seems like a complete waste of your time, and the insurance company’s money, then you would be correct. It now appears that we have good reason to be frustrated by this out-dated approach:

A recent study conducted by Cook et al., published in October 2017, investigated the amount spent and the overall recovery outcomes of patients with back or neck pain who went to either physiotherapists first, or to their local doctor. In total, they reviewed cases for 603 patients who reported neck and back pain between 2012 and 2014.

The results? Those that selected to see the physiotherapists straight away saved BIG on medical costs. In fact, each patient saved an average of $1,543 USD a year (over $2,000 SGD) compared to their counterparts who chose to visit a doctor first. And their outcomes one year later? No difference between the two groups. So, in effect, the group that went to see the physio got the EXACT same outcome, for significantly LESS cost.

Why is this? It may be due to the doctor’s reliance on imaging. For more on this, check my blog on the topic here.

So back to the question: ‘I have a sore back. Should I go see a physio or a doctor?’  

The answer: A physio – we’ll help your back and your wallet. The science says so…

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To discuss an issue with your friendly local physio in Singapore, please contact us here.

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ABOUT THE AUTHOR

DECLAN HALPIN, UFIT CLINIC DIRECTOR

Declan is passionate about helping his patients achieve their long term goals by identifying their weaknesses and imbalances, and developing a strategy to eradicate them. Declan has always maintained a strong sporting interest, and previously worked as an Academy Physiotherapist for Crystal Palace Football Club (a professional football club in London), and as a Rehabilitation Coach for the Western Province Stormers Academy (professional rugby club from Cape Town). Within Asia, he consults to the Indonesian Athletics Association as a Performance coach and physiotherapist. In Singapore, Declan has worked as both physiotherapist and strength and conditioning coach to the Singapore National Rugby team (who achieved bronze medal at the SEA Games). 

QUALIFICATIONS 

  • BSc Sport and Exercise Science 
  • MSc Physiotherapy 
  • AAP Dry Needling Certification 
  • L1 Crossfit Trainer 
  • Senior Medical Educator World Rugby