Physiotherapy

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 

From surgery to CrossFit in six months

In May 2017 James Metcalfe slipped in his condo carpark and shattered his elbow. It needed surgery and for two whole weeks he couldn't move his arm at all. He sought help from UFIT Clinic physio Paul Doohan - and fast forward six months does Personal Training with Melanie Lim at UFIT Tanjong Pagar three times per week.

Before that he had never stepped foot inside a gym before, and is now flawlessly lifting and doing sled pulls each session, and has complete use of his elbow and arm again. Thanks to Mel's advice he has also cut back on his beers and is losing weight and getting fitter and stronger every day.

Find out how he got back on the mend so quickly ...  

What was your injury and what did you do about it? 

I shattered my elbow. I got a spiral fracture of the radial head, dislocated elbow joint and tore all of the ligaments and tendons connecting to my bicep and tricep. 

 
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I was referred to Paul by an ex-UFIT employee who I know socially. She initially passed me to Declan who I saw twice before he went off on his one-north adventure leaving me in Paul’s hands.

How often did you see PAUL and were you able to train much then?

I saw Paul once a week every week for six months. I was totally unable to train at the beginning, I couldn’t move my left hand or arm at any angle. That progressed to picking up a simple day to day object, to developing the flexion and extention to being able to feed myself with that arm’s hand and doing up my buttons on a shirt which was a good test of progress. An extra button a week!

This built up slowly over a couple of months and I was then able to lift a light dumbell which is when I asked if he could refer me to a trainer and that's how I found Mel.  

What kind of rehab did you have?

The painful but quick kind. It was really a combination of many things, the technical terms you will have to ask Paul. From shocking the bicep muscle with electro pads at the beginning of each session to making them remember they were still there, and they were needed for the bottom half of my arm to work, through to massaging the joint and lots and lots of Paul distracting me with talking about the Premier League while pushing, pulling and increasing my range of motion.

 
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What have you enjoyed most about doing rehab with Paul?

He communicates directly like me, was sympathetic to the pain I was going through both physically and mentally, and is very obviously knowledgable in his field and I trusted him. We both played sport and both getting married within a couple of months of each other so time during the sessions went quickly. Beyond liking Paul as a bloke, he got results and quickly, so going back for the next session never felt like a trial. 

How is your training now? 

It's great! I train with Melanie Lim at UFIT Tanjong Pagar and haven't felt this physically fit in the four years that I have lived in Asia, and I could not have imagined training like this six months ago immediately after the accident. Mel kicks my ass three times a week at CFTP, but she does more than just make me sweat, she encourages me to believe in the power of the mind and that with self discipline and self belief so much is possible. 

 

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I’m so grateful to everyone that I have met, both at the Clinic and CFTP. For picking me off the ground seven months ago as a broken man, both mentally and physically, for telling me it’s going to be OK and giving me that adult cuddle that I needed, and equally for getting me fit, pushing me to do better and giving me a huge smile walking (lungeing & squatting more like), into getting married next month and finishing what has been a crazy year as a very happy man. 

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Let's hear it from PAUL THE physio ...

Paul Doohan, James' UFIT Clinic physio adds: "James had a pretty complex elbow fracture, after an accident in his condo. He was struggling a lot after his surgery, as he was unable to even button his shirts due to his pain and stiffness. This affected his activities of daily living massively. 

For a condition of this nature, the first thing we needed to do was to make James trust his elbow again. As an area of the body that is heavily innervated (remember hitting your funny bone?), an injury of this magnitude meant the whole arm was highly sensitive. Naturally patients like James are very protective of the fractured area, but very quickly this overprotection can cause more issues. Helping James move his arm and regain his strength wasn’t the difficult part, it was helping him trust his arm to allow him to do a press up, or catch a cup that was falling. 

When you have something that affects your life as much as James’ injury did, it was vitally important that we were on the same page from day one. He responded very well to his initial treatment, and was always diligent with the tasks I asked him to complete in his own time.

We set small goals, for instance monitoring how many buttons he could fasten on his shirt, to demonstrate the improvements he was making. Eventually, we got a position where we both agreed that he no longer needed to come, as he had met the goals he outlined when we started.

That handshake of a patient who has come such a long way is one of the most rewarding moments as a physiotherapist, and I was very pleased when that day came.

For James, having a patient with an honest and strong work ethic made my job a lot easier. I was able to provide the framework and knowledge on how he was going to get better, but it was his attitude in doing the at times monotonous work that means he has made such a good recovery. It was a pleasure to have the opportunity to work with James, and I can only see him continuing going from strength to strength.

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OVER TO MEL, JAMES' PERSONAL TRAINER

“Working with James has been an absolute joy - he’s hardworking, patient and inquisitive. I’m grateful for the trust he’s put in us as a team - together, our goal is continue to help him lose body fat, while rehabbing the injured elbow as much as possible.  

We believe in the importance of balance - loving what we do, and achieving results simultaneously. In the lead up to his wedding, we’ve progressed from static/isometric exercises in the trunk, to adding eccentric work and finally now, we are doing concentric exercises like squatting and bench pressing. A huge feat considering just months ago, he was in a sling! 

On Fridays, we do strongman training - anything from harnessed bear crawls, sled pushes, rope pulls. Due to his injury, we have had to be creative about programming work that may cause structural damage. Much of the hours James have put in are boring, cyclical aerobic work that the general population would not deem exciting - but it is his dedication to the goal, and positivity that keeps us on track. 

I've recommended some changes to his diet, including cutting out beers and tracking his meals. We are seeing the weight fall off, and his body composition change dramatically. Our secret goal is to get James to support his own bodyweight in a plank by the end of the year, and move up to push-ups.

Training James has thought me so much about the power of keeping a positive and growth-oriented mindset, regardless of the circumstance. He’s one of a kind."

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His determination and willpower is fantastic and will see him get the results he wants.

JAMES' dream team: his physio and personal trainer

Paul Doohan   is a musculoskeletal physiotherapist, and has extensive experience in professional sport, private physiotherapy and in the public hospital sector. Possessing certification with the Titleist Performance Institute, Paul specialises in the assessment and treatment of golfers, delivering effective results in injury management and prevention, as well as performance improvement.

Paul Doohan is a musculoskeletal physiotherapist, and has extensive experience in professional sport, private physiotherapy and in the public hospital sector. Possessing certification with the Titleist Performance Institute, Paul specialises in the assessment and treatment of golfers, delivering effective results in injury management and prevention, as well as performance improvement.

Melanie Lim   is a certified CrossFit coach and personal trainer, accumulating over 200 hours of coaching in various landscapes in Asia.  She has experience building boxes and communities around the common goal of achieving fitness, and finds motivation in seeing her clients desire and pursue change aggressively.  

Melanie Lim is a certified CrossFit coach and personal trainer, accumulating over 200 hours of coaching in various landscapes in Asia.

She has experience building boxes and communities around the common goal of achieving fitness, and finds motivation in seeing her clients desire and pursue change aggressively.