Category: Lifestyle

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
• Swelling
• 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
• Swelling.

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.

NSAIDS

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.

Physiotherapy

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.

Rehabilitation

“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.”

Surgery

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.

Think positive

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.

Be realistic

• 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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