If you have wished for a sauna in your home but cringe at the thought of the expenses and renovation work needed to make that a reality, here are some good news: far infrared sauna (FIR) may just be what you are looking for,
- By using the FIR sauna just once every day for 30-40 minutes, it will soothe you with its warm gentle energy, while making you sweat a lot. Together with a healthy diet and regular exercise, you can burn up to 600 calories in 30 minutes! There are reports of people losing weight and some body fat after 2 weeks – good news for people with joint pain!
- Furthermore, FIR sauna can reduce the chances of having a heart attack or stroke in people who are prone to blocked blood vessels. Regular sessions of FIR sauna stimulate the release of a substance called nitric oxide. Nitric oxide relaxes the blood vessels and prevents blockage, thus improving blood flow and lowering blood pressure. FIR sauna also promotes a balance between the the release of harmful free radicals and antioxidants in your body – this is another way to help prevent blocked blood vessels
- FIR sauna can improve skin texture, firmness and tone. Fine wrinkles and rough skin can show improvement after 6 months. This is because FIR sauna stimulates our skin’s production of collagen and elastin, which can improve its strength and elasticity.
- It also helps remove toxins from our sweat, such as lead, cadmium, nickel and bisphenol A (BPA). These toxins may cause health problems – BPA can cause breast and prostate cancer, for example.
- Of course, using the FIR sauna also helps us relax and drive away stress that can cloud up your mind and affect your physical health. People with chronic pain have seen their pain become better with regular use of FIR sauna combined with counselling, rehabilitation and exercise. Better mental wellness will also help reduce your risk of depression, eating disorders and other mental issues.
How does FIR sauna compare to traditional sauna?
No special plumbing required, so it is mobile and can fit into any room in your home, Less hassle and worries!
Requires special plumbing, so once it is installed, it is a permanent fixture in your home.
It is cheaper to install compared to traditional sauna.
Installing one at home can be expensive!
FIR sauna can penetrate up to 4 cm into your skin as it uses a special waveband of therapeutic energy. This energy is safe and effective.
Studies found that traditional sauna produces hot air that only causes sweating on the surface of your skin.
1. Bickers DR and Athar M. (2006). Oxidative stress in the pathogenesis of skin disease. J Invest Dermatol; 126(12): 2565–2575. 2. Biro S, et al. (2003). Clinical implications of thermal therapy in lifestyle-related diseases. Exp Biol Med (Maywood); 228: 1245–1249. 3. Dominguez MC, et al. (1995). Effect of aluminum and lead salts on lipid peroxidation and cell survival in human skin fibroblasts. Biol Trace Elem Res; 47(1-3): 57-67. 4. Genuis SJ, et al. (2011). Blood, urine, and sweat (BUS) study: monitoring and elimination of bioaccumulated toxic elements. Arch Environ Contam Toxicol; 61(2): 344–357. 5. Genuis SJ, et al. (2012). Human excretion of bisphenol A: blood, urine, and sweat (BUS) study. J Environ Public Health; 2012: 185731. 6. Imamura M, et al. (2001). Repeated thermal therapy improves impaired vascular endothelial function in patients with coronary risk factors. J Am Coll Cardiol; 38: 1083–1088. 7. Lee JH, et al. (2006). Effects of infrared radiation on skin photo-aging and pigmentation. Yonsei Med J; 47(4): 485–490. 8. Masuda A, et al. (2005). Repeated thermal therapy diminishes appetite loss and subjective complaints in mildly depressed patients. Psychosom Med; 67: 643–647. 9. Masuda A, et al. (2004). Repeated sauna therapy reduces urinary 8-epi-prostaglandin F(2alpha). Jpn Heart J; 45: 297–303. 10. Masuda A, et al. (2006). Repeated thermal therapy improves outcomes in patients with chronic pain. International Congress Series; 1287: 298–303. 11. Mayo Clinic. Available at www.mayoclinic.org 12. National Heart, Lung, and Blood Institute. Available at www.nhlbi.nih.gov 13. Oosterveld FG, et al. (2009). Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis. A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects. Clin Rheumatol; 28: 29–34. 14. Vatansever F and Hamblin MR. (2012). Far infrared radiation: its biological effects and medical applications. Photonics Lasers Med; 4: 255–266.
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How old are most of your students? Are they mostly couples or people who come in individually?
At what age do people compete? Is it like other sports where you slow down by your mid-30’s?
That’s really young. How do you conduct classes for the little ones?
What kinds of dance do you teach, and which is the most challenging?
Which dance do you think burns the most calories?
Any other health benefits of dancing?
How long would it take for a beginner to master a dance?
Written by Tee I-Wei
Interview by Mok Shi-Lynn
Dr Au Yong Pui San
Sports Medicine Physician
Marathons, duathlons and triathlons are just a few of the many ‘tons’ in 36-year-old Dr Au Yong Pui San’s life. The other tons come from the incredible weights she handles when powerlifting. It comes as no surprise then, that she is a sports medicine physician. Her work encompasses sporting injuries, post operative rehabilitation, return-to-sports rehabilitation, exercise prescription as well as fitness assessment. As we chatted with her over her profession and her passion for endurance sports, it became obvious that this was one physician that practices whatever she preaches – and yes, she really does lift, bro.
How did you get started?
It was back in 2008, when I had just finished my housemanship. I gained a lot of weight during that time, so it pushed me into exercising. I started with casual running until an uncle at the park asked me what my running goal was and hinted at a full marathon. I didn’t even know what a full marathon was back then. So I tried to do at least 10km. In two months, I could run 10km. I ran my first 10km race (Ipoh International), and it wasn’t that tough! I got into the hype and kept looking for more races to run. The second race soon came along (King of The Road), and, amid my Dad’s concern – I did it alone. I ran and fell in love with it! When I decided that I could not run any faster, I went longer. I went from a half marathon to a full marathon, all the way to double the normal marathon distance. After doubling the marathon distance, I took up cycling too – which led me to my first triathlon. After that, I did my first Olympic distance, then 100km, then the ultra marathon. After the ultra marathon, I decided that it was enough for me in terms of long distance as it was so stressful and painful! I kept it to a marathon distance after that.
If it is painful and uncomfortable, why do you still do it?
It signifies to me how life is – not everything in life is going to be easy. You need to feel how uncomfortable life can be physically to know what comfort really means. We live in a time where everything is comfortable – air-conditioning to stop sweating, parking close to the entrance to avoid a humid walk through the car park. You won’t know just what you are capable of. We are capable of so much more. So I think I need a reminder that I can do a lot, and endurance sports is one way to keep reminding myself of that.
How often do you train and what’s your training regimen like?
I train six days a week. On Mondays during my lunch break, I do deadlifts for an hour. When I head home in the evening, I have a cycling session on the trainer. Tuesdays are for upper body strength training, evenings, I’ll either cycle or run on the trainer. Wednesdays are my squat days and a day off from cardio. Thursdays are my ‘add-on or accessories’ strength training day, where I work on upper body, core, balance and specific areas. Then another cycling session in the evening. Fridays are my off days. Saturdays are long ride days while Sundays are long run days. I have a “deload” every three to four weeks where I wind down training for about a week, then I restart. This helps to give my body a rest from the load I am constantly putting it under, before I hit hard again in the new week.
Are you disciplined in other areas too – rest, diet and stress management?
I am very particular about sleep, making sure I get my minimum 8–9 hours. I sleep at 9.30pm because I’m usually so tired by then! I’m up again the next morning around 5.30am. In terms of dieting, I don’t particularly limit myself to just healthy food as I believe that kills a lot of the joy. Everything should be in moderation, and I try to eat as sensibly as I can: load up on carbohydrates for squat days, more protein for cardio days.
Do you ever worry about over-exercising?
You need to be in tune with your body – do you feel aches and pains or niggling discomforts? After a certain age, niggling pains can become chronic issues. My advice to recreational athletes is to do cross training, which means you do similar activities, but not the same. For example, if you are a runner, try swimming, cycling or even yoga. Do things that are different so it does not add load to the same joints you use for your primary sport; plus, you also get to strengthen the other parts of your body. And for those who think that all this muscle use causes degeneration – well, think of it this way: if you do not use your muscles and store them away like a newly bought pair of shoes that is never worn, it will fall apart when you take it out a few years later!
What are some of the highlights or memorable moments of your sporting adventures?
It would be the time when I fell from my bike and broke my finger. It’s memorable because I never got to experience this whole injury process as a patient, because I am always the doctor. It was exciting – waiting for the ambulance, waiting for the X-ray, going back to work with my cast on, and even learning to write with my left hand. Being a right-handed person, I found out that I could learn to write and do a lot with my left hand, so that was a good experience.
What are your future goals or targets?
I am currently doing 85kg for my deadlifts and 65kg for squats, but I would love to lift double my body weight in my deadlifts and squats. It is a bit lofty but I am hoping to do it soon. I’m doing a lot of reading, watching the professionals and analyzing the biomechanics and positioning.
Why do you think that you, as a healthcare professional, should be fit?
How you look is your best advertisement. You want the patient to trust the advice that you are giving, and I am a firm believer in practicing what you preach. If I tell my patient that she has to walk for half an hour, three times a week, and she asks me “Doctor, do you do all this yourself?”, I have to be able to say “Yes, I do it six times a week.”
Any tips on how a couch potato can start an exercise regimen?
Start with short durations, but do it as frequently as you can. Habit formation is the most important part of exercise. If you can do the same exercise daily, even just 10 minutes, for three weeks, it becomes a habit, much like brushing your teeth. Once the habit is formed, you make the durations longer. And find activities that really interest you – find your passion. If you like to dance, go for Zumba. If you like to fight, go for muay thai. If you like something more rugged, go for trail hiking. The more you like something, the more frequently you will do it. And most importantly – do not get injured! One injury can set you back many months. Prevention is better than cure.
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Words Hannah May-Lee Wong
Doctors may talk the talk, but how many of them walk the walk (or run the run, for that matter)? When we first encountered Dr Lau Choon Ping for an article on scoliosis, admittedly, we noticed that he is super fit! Scrolling through his Facebook, we saw an array of action shots taken from the various marathons he participated in. When we said we wanted to interview him about his sporting activities, the orthopaedic surgeon immediately told us (and with great enthusiasm) that he exercises with a close-knit group of friends, all of whom are doctors as well.
Upon hearing this, we just had to meet this group for ourselves.
The friendly doctors were more than happy to talk to us about their journey towards fitness. The cheery group of friends consists of Dr Siva Kumar Ariaretnam, Dr Chooi Yue Seng, Dr Badrulhisham Bahadzor, Dr Robert Penafort and Dr Lau Choon Ping.
With mutual support and encouragement, they have all progressed far and achieved much in the realm of fitness and endurance sports. Just last year, Dr Lau reached the pinnacle of triathlons – he completed the notoriously difficult Ironman Triathlon. The others in the group have also racked up a long list of successfully completed endurance events such as full marathons, aquathlons (swim and run), duathlons (run, cycle, run) and triathlons (swim, cycle, run).
And here’s the catch: all of them started this journey only around three years ago.
Their collective message is clear and simple: exercise is good for you, everybody should do it and it’s never too late to start.
In this HealthToday exclusive, the doctors share with us about their respective fitness experiences, training routines, motivations and plans for the future.
Dr Lau Choon Ping
Consultant Spine Surgeon
Sports Profile: Triathlete (Running, swimming, cycling)
How did the group meet?
Siva, Chooi and I are orthopaedic surgeons. We trained together in the orthopaedic department of the same university hospital, so we have known each other for a long time – 18 years! Robert was our lecturer. Badrul was introduced to the group when he was part of our relay run team in an event in Putrajaya in 2017.
How did you get the group into marathons?
Most of us were already doing some form of exercise. Robert, Chooi and I played badminton weekly while Siva was cycling all around Penang. I started running back in 2014 after a charity run someone asked me to join. The run was only 10km, but when I completed it, I was surprised to discover that I can run!
At the badminton sessions I was still participating in, all I could talk about was running. And after some pestering, I finally got my friends to run with me. Note that the group hasn’t been doing this very long… only a few years. But it’s possible. You just need to start and be persistent. They went from starting to run to doing a full marathon within a year.
What motivates you to keep at it?
Anyone who exercises regularly would know that exercise makes you feel good. I find that when I stop exercising for a week or two, the body gets so weak and tired.
What do you love about running marathons?
Most people who do endurance sports would agree that after a certain point, the body reaches that neutral zone where we are not struggling with our breathing. We really enjoy that period when we’re quite comfortable just carrying on. Sometimes, we don’t even realize the time or the distance. Only after we’ve finished, we realize how much we’ve done.
I also feel immense satisfaction when I can achieve some of my targets. I always like to challenge myself a little beyond my comfort zone, and when I succeed I feel very happy.
Tell us about your most memorable sports event.
For me, it was definitely the Ironman last year. It was an event of extreme long-distance – the whole thing took about 13 hours or more. I went through a range of emotions: excitement from completing the swim, to feeling pain, to questioning myself as to what I had gotten myself into.
The Ironman Triathlon comprises of 3.8km swimming, 180km cycling and 42km running. In the early parts of the event, I told myself, “I’m performing quite well, maybe I can complete this in a better timing.” I completed my cycling stretch and started running again, but during that 42km run, at about 10km in I started feeling problems – my legs began hurting. At that time my target started dropping: instead of finishing in good time, I aimed to finish in a reasonable time. Then another 10km in, from a reasonable time, my goal dropped to just being able to finish at all.
The last 10km was a real struggle because we needed to pass the finishing point three times. It seemed like every time I was there, I had one more round to go. At the last round, when I finally reached the finishing line, I remember being so excited that I made it. To top it all off, my overall timing was quite good.
Dr Robert Penafort
Consultant Orthopaedic and Trauma Surgeon
Sports Profile: Marathon Runner
How did you get started with marathons?
When you think of the word “marathon”, normal people just cannot imagine how someone can run for so long. I had this exact same perception, right until I was 54 years old. I started by running 2km around my house. Then the distance increased until finally, Chooi and I signed up for our first event – a 10km run in 2015. We had never run 10km before. The most we trained was 5km or 6km. We joined the PJ Half Marathon, and that’s when what we thought impossible became possible. It was our beginning.
Any tips on how to push yourself?
Some people are self-motivated – they can wake up early every morning and do it alone; but I’m someone who needs a partner. Since I always need at least another person to train with me, I get a few friends who are willing to exercise together.
Siva is the one who always coaxes us into doing the longer distances. For example, when we’ve done 15km, he says, “Ok, guys, let’s go for 21km!” He even ‘conned’ us into doing a 22.5km run when we thought it was supposed to be 21km. We were cursing him for weeks, right until the race was over. We were exhilarated because we finished it. I think that’s how we, as a group, carry each other forward.
When you participate in an event where there are thousands of people, the energy is so high. You will find yourself flying at a pace that you could never do during your training. The next thing you know, the event is over, and the exhilaration is indescribable. This will push you to the next level and the next.
The trick is to train in small doses and increase the distance every week. Do things at your own pace, but make sure you keep on increasing. Don’t get stuck at 5km and run that same distance every week. You’ve got to do little bit more and join events to motivate yourself.
What’s your training or exercise routine like?
On a regular week when there are no events, I probably spend three times a week exercising. If there is an event, I would go four times a week. Once a week, I do hill training which means 8km or 10km on a hill. Another day of the week, I’ll go to the gym. During the weekend, I do a longer distance – maybe 15km or 18km. Sometimes, I would even do a 30km run when preparing for a full marathon. If I miss these exercise sessions, whether it’s because I am overseas or have other commitments, I really feel like something is missing in my life.
What motivates you to keep exercising?
Keeping fit motivates me. Exercise allows oneself to feel much better, healthier and that’s what keeps me going.
Also, I often get patients who are overweight and they are having problems with their backs and knees. I have to tell them to eat healthy and exercise, but it’s much better when I am a living example.
Dr Chooi Yue Seng
Consultant Orthopaedic Surgeon
Sports Profile: Triathlete (Running, swimming, cycling)
How did you get started?
For me, this has all been part of a journey towards self-discovery. When I was younger, I never had the time to do these sorts of things. Studying medicine, I had to sacrifice and study, spend years and years in university, head buried in books. At this stage of my life, I realized that work-wise, I am where I want to be, so it’s time to explore new things.
As Robert mentioned, my debut event was a 10km run at the PJ Half Marathon back in 2015. During that first run, my body was in Pain City and my mind was screaming at me to stop. But as we recovered at the finish line, we eventually found ourselves planning our next running event. The great satisfaction of finishing the marathon had morphed into a strong sense of accomplishment and pride. This would prove to be a recurring theme in all our runs.
What keeps you motivated?
When you join all these activities, you’ll get into contact with different groups of people. For me, I’ve been introduced to the swimming people, the biking community, the running community and the tri-community. They’re all very interesting people from all sorts of different backgrounds. It’s a form of networking that is also a healthy distraction from work.
What is your training schedule like?
It depends on the goal. I have a tri-coach who discusses my goals with me. I just want to better my time and finish events well, and that translates into the amount of training I must do.
I used to train twice a day, but it was more than my body could handle so now I train once a day.
How do you find the time?
You’d be surprised. If you document the things you do in a day, you’ll realize that you waste a lot of time unnecessarily. If you patch all that time together, you can make one hour, and one hour is all you need every day to get that quality training.
What are your future goals?
Of all the three sports I do, I am quite decent in my swimming. I like swimming and, being a low impact sport, it’s something you can carry on until old age.
Initially, I had plans to retire on a cruise ship and be a medical officer on board. See, I have pretty much planned out my retirement! Seriously though, a few weeks ago, Badrul and I signed up for a lifesaving course. With what happened to the boys stuck in the cave in Thailand, I found that search and rescue is a noble thing to do. Since I have a medical background, my aim eventually is to extend into lifesaving. I am also quite interested in learning how to scuba dive.
Dr Badrulhisham Bahadzor
Sports Profile: Triathlete (Running, swimming and cycling)
How did you get into triathlons?
When I first started, I just wanted to look good. I was getting a bit overweight at the time, so I wanted to lose weight and build muscle. I started going to the gym, and then I became fit. After that, I thought I should take up something, so I started running.
When I first started, I could only run one kilometre and it was so painful. I kept at it and was determined to join an event. My first one was in 2016, which I finished in good time. I joined more and more events until, after a year, I considered taking up other things. I didn’t know how to swim, so I thought maybe that’s the thing I should try!
It wasn’t easy. I searched for a coach and took up private lessons. It took me one whole year to learn how to swim and I felt like giving up so many times.
Eventually, I participated in an aquathlon in Putrajaya at the end of 2017, which marked my first time swimming in an open water environment. The event was 750m of swimming and 5km of running. At the end of it, it was another milestone achieved.
I continued swimming and running, and I have since joined Oceanman and other events. Then, seeing Lau complete the Ironman last year, I wanted to give it a go. So I got a bike. I did my first triathlon early this year and I hope to participate in Ironman by the end of the year.
How do you keep motivated?
I always try to set objectives and for me, events are my objectives. If I have an event every month or two months, I’ll always be trying to work towards achieving good results for that event.
Tell us about your most memorable event.
Coming from a person with no swimming background, to be able to swim in the ocean is the best thing that has happened to me in a long time. Completing the 2km swimathon in Port Dickson was probably my most memorable event.
I’m 46 this year and I started learning how to swim at 45. Previously, I couldn’t even float. For those who are learning to swim later in life, you will go through many hurdles. You will want to quit, and I went through that phase many times. After six months, I still couldn’t do it and I thought I was just not born to swim. But my coach told me to just keep persisting. One day, it was like a light bulb suddenly went on and I began swimming.
What are your future goals?
I am also interested in lifesaving. I once saw a little boy drown in a pool. He was five years old. I tried resuscitating him, but he died. This was a first-person experience that made me want to learn to swim even more and also learn lifesaving. Eventually, I hope I can teach kids how to swim. I think it is a very important life skill to have from early on.
Dr Siva Kumar Ariaretnam
Consultant Orthopaedic Surgeon
Sports Profile: Duathlete (Running and cycling)
What motivates you?
I’d have to say that my friends in the group motivate me. If not for them, I would never have started running marathons. When we have to get up at 5am on a Sunday, the thought of hanging out with the bunch, getting breakfast, cracking jokes with one another… that’s a very big driving force. That’s the good thing about a group.
What do you love about endurance sports?
You know, in the beginning, I thought I needed music to run. I borrowed headphones and bought Bluetooth earphones, but now I don’t use them. I don’t need to listen to anything and I don’t need music to distract me from the run. The run itself is like a drug, and when I tell people this, they think I’m crazy. There are days when I get up at 4.30am to run 30km alone and it’s not something people normally do. But to me, it really is a form of relaxation. The exercise and the good feeling I get when running is enough motivation for me. And it really helps to clear my mind.
Sometimes, when climbing a mountain in the middle of the afternoon on my bike, I’ll be struggling and sweating a lot. But when I complete my objective, I’m always in awe of what I’ve accomplished. I also have issues with cramps… I would reach a point where I am cramped out and I can’t run anymore. I’d be lying on the road before getting back up and walking home. But still, I would do it again. It would never set me back. I’ve got to find out why it happened and overcome it. I’ll ask myself if it could be caused by nutrition, lack of fluids or training. That’s what consumes my thoughts every day, and it’s uplifting. When I was cycling in Penang, my friends and I would either talk about our previous ride or the next event. I was never alone in this; there was so much to think about and look forward to and I feel very fulfilled.
Please give us some tips about avoiding injuries.
Injuries can happen when you are not used to exercising and you overdo it when you start, such as by running long distances every day. Your tendons, ligaments and bones are not accustomed to the stress and it needs time to adapt to the loads you’re bringing. It’s important to start small: start with walking, increase the duration, increase your speed, then throw in a few runs so it becomes a walk-run and eventually upgrade yourself to running when you are ready.
In running literature, there’s this 10 percent rule: every week you do 10 percent more than the last week. If you go beyond the recommended, for example 20 percent, your chances of injuries are five times higher. Even for us, sometimes when we have a free week, we’re tempted to overdo ourselves. But we still need to abide by these rules and increase the running doses slowly.
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WORDS DR AU YONG PUI SAN
Sport Medicine Physician
Are you confused with the conficting information that you have read online or shared by your friends – why does one injury need ice while another needs a warm compress? Perhaps you are puzzled why a cold and/or warm compress were applied at certain times during physiotherapy sessions. For the fourth article in our series on sports injuries, a sports medicine physician explains when you should apply warm and cold therapy for sports-related injuries.
Warm therapy comprises warm compress, warm towels, heat-producing electrotherapeutic modalities and basically anything that provides heat or warmth.
In the same manner, cold therapy includes ice, cold compress and cold-producing electrotherapeutic modalities.
A cold pack is recommended if active inflammation is present especially in acute injuries such as:
- acute (newly occurring) muscle strains or tears
- acute ligamentous sprains or tears
- acute fare of arthritic joints which includes knee osteoarthritis
- new bruising due to contusions to soft tissue
- delayed onset of muscle soreness (DOMS).
In a nutshell, if you have any injury that causes sudden pain and there is increased warmth in the painful area, you will not go too wrong by applying a cold pack.
WHY IS A COLD PACK USEFUL FOR THE ABOVE CONDITIONS?
There will be bleeding and hematoma (blood clot) in acute soft tissue injuries. Sometimes, the bleeding takes a while to stop which is why you will experience swelling. If the bleeding is superficial enough, there is bruising on the skin. With the new injury, there will be onslaught of inflammatory cells and chemicals that aid in the future process of regeneration of normal tissues.
However, swelling and inflammation causes severe pain and disability so much so the person suffering from the injury cannot proceed with early rehabilitation or even just daily activities of living. Therefore, a cold pack helps to constrict the blood vessels thus reducing the amount of cumulated swelling and controls the number of inflammatory cells entering the injured area.
With the reduction in swelling and number of inflammatory cells, so does the pain felt by the injured person.
A cold pack also to a certain degree, slows the nerve conduction of pain signals to and from the injured area to the brain thus it will be interpreted as reduction in pain.
When it comes to DOMS, the pain felt is due to micro trauma to the muscles caused by physical activity thus it will react exactly like an acute injury but with a much lesser extend and pain subsides quickly. Depending on pain tolerance, sometimes cold therapy is not even necessary but if the discomfort is affecting daily activities, it is advisable to apply a cold pack to ease the symptoms.
“IN A NUTSHELL, IF YOU HAVE ANY INJURY THAT CAUSES SUDDEN PAIN AND THERE IS INCREASED WARMTH IN THE PAINFUL AREA, YOU WILL NOT GO TOO WRONG BY APPLYING A COLD PACK.”
LET’S LOOK AT WARM THERAPY
Indications for warm therapy:
- Tight or spastic muscles
- Stiff joints – chronic arthritis (not during fare-ups)
- Any musculoskeletal discomfort or aches and pains that do not have any symptoms of acute infammation such as no increased warmth of the painful area, no swelling and defnitely not very painful.
Now let’s look into the reasons for the above indications. Muscles that are tight or affected by spasms should ideally be stretched out. However, stretching out tight muscles from the get-go can be tough therefore a warm compress is helpful in this situation. A warm compress increases blood flow to the area thus ‘warming up’ the muscle for stretching making the process much easier.
Sometimes, a warm compress can be applied before you stretch as it helps you stretch faster. This is also the basis of Hot Yoga and Bikram Yoga where the heated surrounding helps you get into the yoga pose.
A warm compress helps to increase blood circulation to stiff joints and the surrounding muscles especially in chronic osteoarthritis. It also eases the movement of the joints for easier and more conducive physical therapy. This is why patients with knee osteoarthritis almost always start with applying warm towels or compress to their knees prior to physiotherapy sessions.
However, sometimes arthritic joints tend to flare or become acutely inflamed due to walking too much so a cold compress is better. In a nutshell, the choice between warm or cold therapy depends on the symptoms.
As long as there are no symptoms of acute injuries or inflammation, a warm compress may help reduce musculoskeletal aches and pains. Many people prefer a warm compress over cold as it is more comfortable.
HOW WOULD YOU APPLY A COLD AND/OR WARM PACK?
For acute injuries or inflammations, apply a cold pack for 20 minutes and repeat every 2 hours. A note of caution when using a cold pack – it is advisable to protect your skin with a towel before applying the ice as direct cold contact to skin can cause a phenomenon known as ice burn, which is as painful as heat burn.
For those who are just returning to sports after an injury, it is better to use a cold pack over the previously injured region almost immediately after sports to prevent possible discomfort or swelling. The use of cold pack can be gradually reduced as participation in the sports become more regular and pain free.
Apply a warm pack over applicable areas for 15-20 minutes prior to stretching tight muscles or for physical therapy in arthritic joints. To prevent heat burn, protect your skin with a towel. HT
“A WARM COMPRESS INCREASES BLOOD FLOW TO THE AREA THUS ‘WARMING UP’ THE MUSCLE FOR STRETCHING MAKING THE PROCESS MUCH EASIER.”
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WORDS PANK JIT SIN
This may not be the most well-known fact, but June 21 is International Day of Yoga. The worldwide celebrative day is still fairly new as it was incepted in 2015 by the United Nations General Assembly. However, yoga is anything but young. It is believed to have originated in India around 3000 B.C. with stone carvings of persons in yoga poses being found in the Indus Valley, which is one of the main civilizations during the Bronze Age. The word ‘yoga’ is derived from Sanskrit and means to join or unite, which is a reflection of yoga’s aims of uniting the body and consciousness.
Since then, yoga has seen many changes and in more recent times, different forms or styles of yoga have been introduced, catering to different needs—physical, mental or spiritual. While it should ide- ally be practiced in totality as the benefits of the trinity are syner- gistic, yoga is fine being practiced for its physical benefits. In other words, yoga has been split into its components to cater for the needs of the modern human.
Why do yoga?
Scientifically sound studies point to yoga’s effectiveness in improving many conditions including multiple sclerosis, asthma, irritable bowel syndrome, hypertension, drug addiction, osteoarthritis and mental health issues. It doesn’t take a genius to figure out why yoga is so beneficial for health. It is a low impact exercise and the various poses and stretches performed in yoga improve fitness and blood circulation throughout the body. The end result is improved oxygen delivery to all parts of the body and improved flexibility of the body without the negative impact of injury of more physically demanding sports such as futsal or squash.
The breathing exercises performed during yoga are also good in reducing anxiety, stress and depression—a study concluded that yoga can be considered a complementary medicine as it can reduce a disease treatment costs by reducing the use of medication. It is quite obvious that the calming breathing exercises and shift in focus away from one’s illness are the key reasons for yoga’s potency. Meditation and breathing exercises can help one be ‘present,’ thus improving a person’s mental wellbeing. By being in the ‘now,’ worry about the past and anxiety about the future can be washed away, leading to a present and alert frame of mind.
Jojo Struys, the yoga instructor
Mental health and stability is an important aspect of overall health. Jojo Struys, the famous TV celebrity, yoga practitioner, and cofounder of OhanaJo Studio, says she frequently meets people who suffer from insomnia and are stressed. She can see the signs and symptoms especially in new mothers and people who work long hours. “They [the people who work long hours] come back from work and they can’t disconnect from work,” said Jojo. Similarly, when these people wake up, the first thing they do is check their emails or messages. Should a disturbing or negative message come in early in the morning, that sets the mood for the rest of the day. It destroys one’s initiative to meditate and exercise, which are essential to the mental and physical health of the person. “The world can wait another 20 to 25 minutes. It is important to look after our thoughts and ensure the first part of the day is set aside for yourself, before you interact with the world.”
In light of the mental and physical benefits we can gain from practicing yoga, let’s do some sun salutations now! HT
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Dr Manimaran Subramaniam Consultant Orthopaedic Surgeon
It is not enough to do the right thing in life; we need to do the right thing the right way. Ah, words of wisdom. Before you start questioning my sanity for waxing philosophical in an article that is about bone and joint health, rest assured – I was actually referring to playing sports and exercising. Now, why do I say this? What does the mantra ‘doing the right thing the right way’ have with working out and sports? “A lot, actually,” says Consultant Orthopaedic Surgeon Dr Manimaran Subramaniam.
He goes on to explain, “Malaysians have become more health-conscious these days. Aside from eating healthier, more of us are working out. Gyms are mushrooming all over the place. You see great turnouts at marathons and triathlons. There are also more people, especially youngsters participating in extreme sports such as skateboarding and mountain biking. Even those who aren’t into vigorous exercises are making an effort to be physically active with simple activities like brisk walking and jogging.” While it is great to see more people getting off their bums and into the gym, Dr Manimaran says that an issue has arisen: sports injuries.
“Every physical activity poses some risk of injury. Sports injury refers to an injury which arises directly or indirectly from any sports activities. This is why it’s so crucial for us to not only do sports and exercises but to do it the right way,” he stresses.
Acute vs. chronic
Sports injuries are divided into two types: acute and chronic. How do we know which is which? Dr Manimaran explains that acute injuries occur suddenly when playing or exercising. Sprained ankles, strained backs and fractured hands are some examples. You may have an acute injury if you experience the following:
- Sudden severe pain
- Difficulty in placing weight on leg, knee, foot or ankle
- An arm, wrist, elbow, hand or finger that is very tender
- Unable to move a joint normally
- Extreme weakness in the leg or arm
- A bone or joint that is visibly out of place.
Meanwhile, chronic injuries happen after a person has played sports or exercised for a long time. Signs to watch out for include:
- Pain when playing sports or exercising
- A dull ache when resting
Must I see a doc?
When asked if all sports injuries warrant attention from a healthcare professional, he replies, “There are some injuries which you can treat on your own. This is where R.I.C.E. comes in.” No, we are not talking about the Malaysian food staple. R.I.C.E is a self-care method which helps to alleviate pain and relieve swelling.
R for Rest
Rest is the most effective way to begin the healing process after an injury. A sprained muscle is weak and susceptible to further injury, especially within the first few hours.
I for Ice
The effects of ice are most significant within the first two days of injury. Applying ice to an injury can help relieve pain and prevent swelling as this reduces blood flow to the wounded area. To avoid your skin from becoming too cold, use a cold pack or a bag of frozen peas (wrapped in a towel) instead of ice. If you do use ice, don’t place the ice bag directly on bare skin as frostbite can occur. Apply the ice for 15-20 minutes at a time; allow your skin to return to normal temperature in between icings.
C for Compression
An elastic bandage wrapped firmly around an injury can further prevent swelling and ease pain by keeping the area somewhat immobilized. The bandage doesn’t necessarily keep you from moving, but it can remind you not to move it. If a wrapping causes tingling or numbness in the extremity, remove it and rewrap the area more loosely. It shouldn’t be so tight that it causes discomfort or interferes with blood flow. Even gentle compression can help keep fluid away from the injured area.
E for Elevation
Propping an injury above your heart levels helps fluid drain away from the wounded area while reducing swelling. If you can’t elevate the injured area to a level above your heart, try keeping it at the same level or close to it. If you suffer an injury in the hips or buttocks, lie down with a pillow situated below your buttocks or lower back. This is to help lift the area of injury.
Aside from R.I.C.E., remember not to apply heat to the affected area during the first 72 hours as this will increase blood flow to that area.
When to get it checked
What about sports injuries which require medical attention then? How does one know when to see a doctor? According to Dr Manimaran, you need to get it treated by a doctor if you have the signs below:
- Severe pain, swelling or numbness from the injury
- Unable to put any weight on the injured limb
- The injured joint is deformed or feels unstable
- Recurrent injury at the same part of the body.
There are several treatment options available but the type of treatment prescribed ultimately depends on the patient’s injury. Non-steroidal anti-inflammatory drugs (NSAIDS) for example, are given to inhibit the inflammatory process, and subsequently, reduce pain. NSAIDS are available in oral, patch or paste forms.
Post-injury physiotherapy is another key aspect of treatment. After assessing the patient’s injury, the therapist will initiate electrostimulation, ultrasound or cryocuff ice therapy to limit the effects of inflammation.
“The last thing you want to do while recovering is to inflict more damage to the injured area. After a certain period of immobilization, controlled movement of the affected area will help the patient to recover faster. With movement, comes stretching,” explains Dr Manimaran. “As the injury heals, scar tissue forms. After a while, the scar tissue will shrink. This shrinking brings the injured tissues back together. When this occurs, the injured area becomes tight or stiff. This significantly ups the risk of further injury. Hence to prevent the injured area from stiffening, stretching is necessary.”
He also cautions, “Don’t play sports until you can stretch the injured area without feeling any pain, stiffness or swelling. Even when you’re ready to play, start slowly and increase the intensity gradually.”
When does an injury warrant surgery? “Surgical intervention is required to fix injuries that cannot be treated with the aforementioned methods. Examples of such injuries include torn Achilles tendons, fracture-dislocations of joints and torn anterior cruciate ligament of knee joints,” he explains. “If your doctor recommends surgery, ensure that you discuss matters thoroughly with them so you understand what the surgery entails and how long your rehabilitation is. All these factors matter because they will determine a good surgical outcome.”
Steering clear of injuries
Reiterating his earlier point, Dr Manimaran says, “Sport injuries are never a fun experience so why treat them when you can prevent them? This is why everyone needs to exercise and do sports the right way.”
Citing statistics, he says, “Lack of pre-exercise warm-up contributes to 50% of injuries. Warming up is highly beneficial as it warms up your muscles, gets your blood flowing and lowers injury risk. The easiest way to warm up is to work out slowly for the first few minutes, then pick up the pace. For instance, walk briskly for 5-10 minutes before running.”
But don’t just warm up; cooling down is equally important. “Cooling down post-exercise brings your heart rate and temperature back to normal. Cool down by ending your routine at a slower pace for the last 5-10 minutes.”
Other tips for minimizing your risk of sports injuries include:
- Keep your body flexible by doing stretching exercises at least twice weekly.
- Ensure you are approaching a particular sport with the right technique.
- Listen to your body. If you feel pain when exercising, stop immediately. Don’t work through the injury. You can expect sore muscles post-workout but you should never feel pain when exercising.
- Don’t be a weekend warrior. Trying to do a week’s worth of exercise in a day will strain your body tremendously.
- Use proper sports attire and equipment. For example, wearing the appropriate shoes can protect you from both acute and chronic overuse injuries. Ensure your equipment fits you properly, is in good working condition, is used correctly and consistently and is the right design for your sport.
Dr Manimaran concludes, “Sports and exercise are excellent tools for staying fit and healthy. However, what’s more crucial is doing these activities correctly. That way, you will be able to enjoy them as long as you desire.” So, do it right, folks!
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Like every person with diabetes, surely you want to stay healthy. However, it can be challenging to change your lifestyle. To manage type 2 diabetes, you will need to unlearn habits that contributed to this condition, adopt new habits and continue to apply these changes to your life every day. This can be easier said and done, but it is possible.
The right attitude keeps you motivated during challenging times.
- View your diagnosis as an opportunity to step up your healthy lifestyle and get rid of bad habits that are holding you back.
- Focus on the benefits you will get from these adjustments (better health, improved sleep, healthier weight, etc).
Know diabetes well
Understanding your condition and how you can control it will give you the confidence to take charge of your health and do what is best for you.
- Read up on type 2 diabetes online or in books, and talk to doctors and dietitians to clarify your doubts and concerns.
- Be careful of misperceptions and false information, though. Always check with your healthcare team if you are unsure.
Make your goals
- Make long-term goals to give yourself a sense of direction as well as purpose. These could be lowering your blood glucose below a certain value, or spending more hours each day being physically active.
- Also make short-term goals as you strive to meet your long-term goals. For example, you may want to lose 5 kg by the end of two months. Succeeding in your short-term goals will motivate you to keep going as you strive to achieve your long-term goals.
- Give yourself a treat each time you meet a goal.
- When setting goals or making plans to adopt a healthy habit, make sure that they are achievable within the time frame you have set for yourself. Otherwise, you are only setting yourself up for failure and disappointment!
- Adopting new habits and breaking old habits may take time, so make changes gradually.
- For example, if you did not eat fruits and vegetables often in the past and you now want to include more in your plans, you may not be able to quickly adopt a full vegetarian diet. It may be better to instead include a vegetable side dish and a fruit during every main meal, and slowly increase the amount over time.
Can’t enjoy your meals?
You may find yourself missing your old favourite (but unhealthy) meals, or you may need some time to get used to your new diet. Here are some tips to help make your mealtimes enjoyable again.
- Get your whole family involved. Healthy, balanced meals with less salt and fats are good for everyone, not just people with diabetes!
- There are many recipes online only that will show you how to prepare simple and quick, yet delicious meals that are great for people with diabetes. Try them out!
- You can also exchange recipes and cooking tips with other people with diabetes in support groups both online and in real life.
- Another benefit to creating your own tasty diabetes-friendly meals is that you will rely less on diabetes-friendly foods and snacks sold in stores, which can be quite costly.
- There are many free apps you can download into your phone to make it easier to keep track of your blood glucose, calories and more. They will help make your mealtimes less complex and, hence, more easy to enjoy!
No motivation to exercise?
Often, “I’m too busy to exercise!” or “I am too tired!” is all in your mind. If you really want to, you can spend a healthy part of the day being physically active.
- If you are still getting used to your new routine, make the effort to wake up earlier to exercise the first thing in the morning. Better get it out of the way before you start coming up with excuses to put it off!
- If you feel self-conscious about your appearance, or you don’t know how to start, find an exercise buddy to help you out. Having an exercise buddy is also good because the two of you can motivate one another.
- If you are not fond of exercising with other people, you can exercise at home by following instructional videos (on YouTube and other sources) on yoga, aerobics and more.
- If you need extra motivation (and who doesn’t?), there are a variety of free apps you can download on your phone. There are apps to help you keep track of your physical activity, send motivational messages regularly and even make physical activity a fun game that puts you in competition with other users. Getting physically active is now easier, and more fun, than ever!
Oops, slipped up?
You may find yourself backtracking to your old habits, sometimes without realizing it until it is too late.
- Don’t give up if this happens. Slipping up only means that you are human like everyone else!
- Once you realize that you have slipped up, think back to the circumstances that might have led to this slip-up, and plan on either how to avoid falling into such circumstances again or, failing that, what you can do to avoid giving in to temptation when it arises.
- If you find yourself slipping up often, it is time to revisit your goals. How can you motivate yourself again? Perhaps it is time to come up with new goals, or a new approach to reach your goals. You can consult your healthcare team or support group if you need further advice.
Keep track of medications
- If you have a hard time keeping track of whether you have taken your medications (especially when you have to take several of them), you can either get a pill case or download a phone app that can help remind you to take your medications.
- You should take your medications even when you are feeling healthy, and discuss with your doctor or pharmacist before taking any complementary medicine. Remember that complementary medicine should not replace your current medications.
- Also, keep your medical appointments, as they allow your doctor to monitor your health and conduct necessary tests to detect signs of diabetes-related complications.
- Don’t forget: get an eye screening test with an ophthalmologist once a year! This will help detect diabetic retinopathy and other diabetes-related eye diseases.
The closing word
We hope this Special Report has shed some light onto some lesser-well known pitfalls of type 2 diabetes, and we have motivated you to take those important steps to take charge of your health.
Living with type 2 diabetes often means having to deal with increased risks of other health conditions, such as diabetic retinopathy and dyslipidaemia, but this does not mean that your future is bleak.
With proper lifestyle adjustments, medications and the right attitude, you can still lead a healthy and fulfilling life. The journey may seem daunting from where you stand right now, but you can do it. And the good thing is, you won’t be alone in your efforts. Remember, your healthcare team will be there every step of the journey. You also have your family and friends. Furthermore, in this time and age, there are fellow people with diabetes whom you can get in touch with through Facebook, Twitter, WhatsApp, Instagram and more. Thanks to modern technology, physical distance is no longer an issue. You are never alone even in your most trying time.
As Olympic track star Jim Ryun said, “Motivation is what gets you started. Habit is what keeps you going.” There is plenty of motivation if you know where to look, and we hope you can find yours to get those healthy habits in place for you to keep going. Good luck and best of health to you!
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WORDS DR AU YONG PUI SAN
Sports Medicine Physician
For the third article in our series on sports injuries, a sports medicine physician explains about muscle cramps caused by exercise and ways of overcoming them.
Muscle cramp is a strong and painful contraction, often interpreted as sudden and severe spasms or tightening of a muscle that last anywhere from a few seconds to a few minutes.
Exercise-associated muscle cramps (EAMC) happen during physical activities. Let’s take a look at the WHYs, HOWs (how does it happen and how to prevent it) and WHATs (what to do when it is happening to me) of EAMC.
Why does EAMC happen?
Traditionally, it was thought and it is still popular opinion that muscle cramps during physical activities occur due to dehydration as a result of not drinking enough water, and also exercising in environments that are too warm and humid causing profuse sweating. Excessive sweating leads to deficiency of electrolytes such as sodium, potassium and magnesium. Other causes of muscle cramps include inadequate amount of stretching and muscle fatigue.
People have been believing the theory of electrolyte deficiency being the leading cause of EAMC. So, electrolyte replacement supplements and drinks have taken off significantly in the endurance sporting scene.
However, personal opinions from individual users on whether or not electrolyte replacement supplements and drinks work vary greatly. Some users swear by them, but some claim they are an absolute waste of money. Data from published researches also vary – most findings point to little or no effects of electrolyte replacement on reduction in muscle cramping.
In fact, in recent years many studies have debunked the theory of electrolyte deficiency being the leading cause of EAMC and showed that there is no correlation among EAMC, sodium intake and low blood sodium levels. Sodium is the most common electrolyte to be supplemented.
Also, if you read the sports drinks labels properly, you will notice that the amount of electrolytes present in most popular brands of sports drinks are miniscule and negligible, with the main component of the drink actually being carbohydrate in the form of SUGAR.
When it comes to dehydration, that theory may not hold that much weight as excessive and improper rehydration during prolonged endurance events possibly lead to hyponatraemia, which means low sodium in blood. It happens when people drink too much water too fast resulting in a dilution effect. The term exercise-associated hyponatraemia was first coined in the 1980s and has detrimental effects to the body which ultimately if not treated early, can lead to death. Now the guideline recommends to “drink according to thirst”.
How about the theory of inadequate stretching causing cramps?
Often mid endurance events, when someone suddenly seizes up with a very bad muscle cramp of the leg, the first thing that comes to mind is to stretch that muscle. And anyone who has experienced it will know that stretching the spastic muscle is extremely painful and at that point in time feels like a pointless procedure. But physiologically, the advice to stretch holds a lot of weight.
Keeping the anatomy and physiology lesson short and simple, there are two components in our muscles called muscle spindles and Golgi tendon organs (GTO).
Muscle spindles lie within the fleshy bulk of our muscles and they function to detect the lengthening or stretching of the muscle. When it detects the muscle being stretched, it will send a signal to the brain to prevent further stretching of the muscle. This prevents the muscle from being overstretched hence, preventing muscle tear and damage.
The GTO on the other hand lies at the border where the muscle meets the tendon – all muscles join to become tendons before attaching to a bone – and functions as such: when the muscle contracts forcefully or spastically, such as in a muscle cramp, the muscle tugs at the GTO and the GTO dutifully sends a signal to the brain to tell the spastic muscle to relax.
Therefore, when EAMC occurs, stretching of the affected muscle causes the GTO to send signals to the brain to cause the cramp to stop, for that muscle to relax and release, while the muscle spindle prevents you from overstretching and further hurting yourself. Thus, stretching DOES indeed help to reduce the occurrence of EAMC – or any muscle cramps for that matter – and halts the EAMC when it is already happening.
In recent years, many researchers started hypothesizing that the cause of EAMC is from the central nervous system. Central nervous system is a combination of the brain, the nerve fibres and endings, and the muscles that the nerve supplies. In fact, the altered neuromuscular control theory is taking more weight in the efforts of narrowing down the causes of EAMC and factors such as muscle fatigue, inadequate muscle conditioning and training and muscle damage/injury all fall into this theory.
From my experience of treating patients on the race course and also in retrospective history taking of patients who suffer from EAMC, they all tend to have a few things in common:
1) Inadequate conditioning/strengthening of the muscles – poorly conditioned muscles tend to be weaker, fatigue easily and quickly, and unable to take the rigours of sporting activities. The stronger and more conditioned the muscle is, the more resistant it is to cramps.
2) Inadequate training specificity – not to be confused with inadequate strength, as some of these athletes have good musculature due to regular exercise. However, SPECIFIC training for a particular sport or activity is important as different sports require the use of different muscle groups and different energy systems, to name a few. If you plan to participate in a road running race, training to run more is important.
3) Overtraining/muscle damage or injury – inadequate rest and recovery from overzealous training will lead to overtraining, which may lead to a certain degree of muscle or tendon damage or injury. Injured muscles do fatigue easily and may not withstand activities being participated in.
What can be done to reduce the incidences of EAMC?
Proper and adequate training is important. If you signed up for a half marathon, then train to run the distance and put in adequate time and mileage. Showing up at the start of a half marathon – or whatever distance – without any training may result in a very painful limp towards the tail end of the race due to bad cramps.
Stretching is important and highly recommended as an integral part of one’s training regime. If you feel a cramp is about to happen mid activities, it is advisable to take some time to stretch before continuing.
Rest is equally as important as the training itself. The more intense and often you train, the more rest and recovery is necessary. Injured and damaged muscles become tired easily and cramp more often.
Despite the lack of evidence supporting electrolyte supplementation and replacement drinks, if they work for you from past experiences, you should continue to take it.
On the note of altered neuromuscular control theory, there has been recommendation of consuming pickle juice instead of electrolyte drinks to prevent and even cure EAMC. The exact mechanism of how that works is still unclear and current research studies available out there did not come to any conclusive answer as to why it works. It has been hypothesized that the vinegar content in pickle juice triggers some muscular reflexes when the juice comes into contact with the back of the throat. This same reflex shuts down the misfiring of neurons in muscles thus causing cessation of EAMC. As it can be a cheaper alternative, no harm in giving that a try. On that same note, the idea of any liquid drink with vinegar in it can be used in place of pickle juice; for example, apple cider vinegar, kombucha, kimchi juice, etc.
Note: I take diluted apple cider vinegar before and during my long runs. HT
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