Are You Doing It Right?

Are You Doing It Right?

April 29, 2022   Return


NE_Dr Mani

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.


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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The Sweetest Sorrows: Inspired & Staying Motivated

The Sweetest Sorrows: Inspired & Staying Motivated

April 29, 2022   Return


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!

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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!

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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.

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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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Your Gut’s Best Friend

Your Gut’s Best Friend

April 28, 2022   Return

Many of us pay our gut very little attention until we eat something that does not agree with us. Maybe it is time to change that, as a healthy gut can make a difference to our health.

While the colon is part of the digestive system, it plays no role in digesting our food. By the time the food reaches the colon, it has already been digested. So, the colon absorbs water from what is left and then, processes the leftovers into the material that normally goes out the back door when we sit on the toilet bowl.

However, the colon has another important role that is not related to the toilet, thanks to the bacteria that make their home there. From the moment we come into this world, bacteria have been growing in our intestines, especially the colon. Do not panic – these bacteria are our friends, and they help us in ways that many of us may not imagine. Chief among these bacteria are those called Bifidobacteria.   

Can we call them Fido?

So far, we have identified about 30 types of Bifidobacteria living in our intestines. They feed on some of the food in our gut (do not worry, there are plenty to go around), and in return, they repay us in the following ways:

Keep the bad guys out. Bifidobacteria produce a substance called acetic acid which suppresses the growth of potentially harmful bacteria.

A boost for our immune system. While we do not know the exact mechanism yet, there are strong indications that Bifidobacteria can stimulate the production of antibodies, increase our resistance to toxins and may even suppress the development of cancer cells!

More love for the gut

As you can see, it can be good to encourage the Bifidobacteria families to thrive in our gut. A way to do this is to include prebiotics in our daily diet. Prebiotics are used as an additional food source for the bacteria, and can be found in food rich in dietary fibre.

You can get your dietary fibre from the following:

  • Fruits and vegetables – eat plenty every day!
  • Yoghurts and dairy products with added prebiotics – check the food labels to ensure before buying.
  • Supplements containing both soluble and insoluble fibres.
The US Institute of Medicine recommends the following:
Under 50 years oldOver 50 years old

Men: eat 38g every day

Women: eat 25g every day

Men: eat 30g every day

Women: eat 21g every day



Ishibashi N, Yaeshima T and Hayasawa H. (1997). Bifidobacteria: their significance in human intestinal health. Mal J Nutr 3: 149-159.

Mayo Clinic. Available at 

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Slow Dancing with a Stranger

Slow Dancing with a Stranger

April 28, 2022   Return

Dr Nor’izzati Saedon Internal Medicine Specialist, University Malaya Medical Centre

Slow dancing with a stranger. That was how Meryl Comer, an award-winning journalist, once described her caregiving for her husband, who had Alzheimer’s disease. Caregiving is a noble vocation, but it is also a sacrifice borne out of love, one that can drain the caregiver both physically and emotionally. Dr Nor’izzati Saedon, an internal medicine specialist as well as a member of the Malaysian Society of Geriatric Medicine, kindly takes time from her busy schedule to address some common issues faced by caregivers today.


Ramona (not her real name) cares for her elderly father. A housewife, she juggles her role as a caregiver along with being a wife and a mother of two young children. She is constantly stressed and exhausted, and she sometimes loses her temper in front of her father. Ramona feels that she is failing her father as well as her family.


Dr Nor’izzati: Ramona’s predicament is actually a common one among caregivers. For caregivers in such a situation, here is my advice:

  • First, accept that we are human – we cannot succeed in everything because that is impossible. Know our mental and physical capabilities, and be honest about our limits.
  • Plan on how we can best provide care for our loved one both in the short term and long term. Our plan should also take into account our own needs and the needs of other people who are dependent on us. To help us plan better, we can attend short courses, talk to doctors and nurses and do some research online.
  • The first three to six months of caregiving are always the toughest. During this period, we should reach out to others who are going through the same journey for support. There are caregiver support groups, in person or online, that can provide advice as well as a listening ear. I also feel that physiotherapy sessions at the hospital are a good outlet for caregivers to meet and compare notes or experiences with one another. Experienced physiotherapists and occupational therapists are often willing to share insights and ideas on how to best care for loved ones. Watching how they interact with their patients is also a good way for us to improve our communication with our loved ones.
  • Studies have shown that caregivers have a higher risk of developing depression if they neglect their own well being. Thus, take an hour or two each day to recharge by doing something we enjoy – grab a coffee, take a walk, go to the gym, etc. Also, take time to tend to our spiritual needs (through prayer, meditation, etc).
  • We don’t have to do anything alone. If we can afford it, we can hire a maid (full or part time) to help. Otherwise, we can enlist our siblings, our partner and even our children. They may need some time to understand how to care for our loved one, but in the long run, they will be a big help.
  • To lift our spirits when we are down, we can attend motivational classes or listen to motivational speakers (there are many clips on YouTube), read inspirational books or talk to people who understand what we are going through (such as members of a support group). We can find fellow caregivers on social media such as Facebook, Twitter, Snapchat, Pinterest, etc who are willing to share and advise. Remember, we are never alone, so don’t lose hope!


Sara (not her real name) loves her father, but she soon feels trapped by her role as his caregiver. All her time is spent caring for him, and she soon misses her old life. “The rest of my family can do whatever they want, but they expect me to just drop everything to take care of a sick old man,” she complains. She has tried asking them for help, but they always say they are too busy with their own families.


Dr Nor’izzati:

When someone like Sara becomes a caregiver, he or she must accept that there will be significant, even big changes to the person’s life. However, this does not mean that the person must completely put his or her own life on hold. It just means that a little more planning needs to be done.

For example, Sara may want to go on a holiday. She can plan ahead for this, perhaps by engaging the temporary services of a nursing care facility to take care of her father while she is away. Alternatively, she can plan for staggered breaks, such as taking two or three weekends off, by hiring a helper to step in during those weekends.

When it comes to family members who leave all caregiving responsibilities to the caregiver, like Sara’s siblings seem to have done, she cannot force them to help, but she can try to slowly change their ways by bringing them along to the clinic for her father’s medical check-ups. The doctors can be good allies in helping these families understand the need for the entire family to support the caregiver’s efforts.

Universiti Malaya Medical Centre (UMMC) holds clinic sessions that bring together caregivers and their family members, encouraging them to open up, exchange opinions and discuss ways to improve the caregiving situation together. Sara and other caregivers may find such sessions useful. To check out the sessions, just drop by the General Geriatric Outpatient Clinic at Klinik Perubatan 3 on Friday afternoons.


Lin (not her real name) is a caregiver for her mother who is suffering from dementia. Her mother constantly makes unreasonable demands, and often becomes verbally abusive when Lin fails to please her. Lin is overwhelmed, but she is afraid to confide in anyone, as she fears that people may view her ‘failing’ as a sign that she is not a good daughter.


Dr Nor’izzati:

For care-receivers who have dementia or other conditions that affect the brain, it is not uncommon for them to experience personality changes. A formerly patient and loving parent may become irrational and demanding. They may also become verbally and physically abusive.

It can be difficult to care for someone we love, only to be made to feel unappreciated and unloved. We may also feel that we no longer know our loved one – he or she is now a complete stranger.

These emotions are only natural, but we should not allow them to consume us. It is our loved one’s disease that is making him or her behave this way. Diseases that affect the brain can make our loved one say things out of frustration or without basis. Often, our loved one is not aware of what he or she is saying or doing. So, blame the disease, not the person. Doing so will help us to better cope with the situation.

Here are some things that caregivers such as Lin can consider doing:

  • If a situation becomes too much to handle, take 15 minutes to calm ourselves and gather our feelings. It is fine to leave our loved one alone to do so, as long as they are in a safe environment.
  • Do not concern ourselves too much with what other people think of us. We should instead take comfort in knowing that we are doing our best for our loved one.
  • Having said that, we should protect ourselves if our loved one becomes violent. Keep sharp and dangerous items out of this person’s reach. We can also consult a physician for advice; some medications to calm our loved one when he or she becomes agitated and aggressive may be useful.


Rama (not his real name) and his wife care for his father, who has an advanced stage of cancer. The doctors recommend end-of-life care to make his father’s remaining days as comfortable as possible. Rama, however, feels overwhelmed at the thought of losing his father, and finds it very difficult to be even in the same room as him, much less care for him. “Sometimes I wish that he would pass on soon, so that I can stop feeling all this hurt and pain inside my heart,” he admits.


Dr Nor’izzati:

Caring for someone dependent on us is a very physically and emotionally demanding task – it can be overwhelming and even draining. For loved ones who are at the end stage of their life, it is normal for caregivers to feel helpless, as there is not much they can do for the loved one at that time. Sometimes, they may also be reminded of their own mortality – they are aging, and they too will pass on one day – and this realization may only add to their grief.

During this period, caregivers such as Rama should seek emotional support. Here are some suggestions:

  • Find a person to talk to, in order to unload our stress and anxiety. A caregiver support group will be tremendously helpful.
  • It may also be good to discover (or rediscover) spirituality (such as by joining a religious group), to find comfort when faced with issues such as the mortality of life.
  • Meditative and relaxation techniques such as yoga can also be helpful.
  • If we feel overwhelmed or confused by the care needed by our loved one during this period, it may be good to hire a part time qualified nurse to make daily or weekend visits.
  • If our loved one needs more specialized care, we can consider locating a good nursing home for him or her. After placing our loved one in a home, we should still visit regularly to monitor the care given to our loved one. Our visits will also provide comfort to our loved one (who may need time to feel safe in a new environment), and knowing that he or she is receiving the best professional care will also be a source of comfort to us.  

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Arghh! Muscle cramp is killing me!

Arghh! Muscle cramp is killing me!

 April 27, 2022   Return

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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Moving House? Don’t Break Your Back Over It

Moving House? Don’t Break Your Back Over It

 April 27, 2022   Return


Speaking from recent first-hand experience: moving houses is NOT FUN. Whether it’s due to a new college, a new job, or a change in family circumstances, the process of packing up and moving an entire household’s worth of possessions to a different building can be incredibly stressful for everyone involved—and potentially hazardous to one’s health. Read up HealthToday basics on how to stay both sane and safe while dealing with a big move.

  1. Pack smart.

Heavy objects go in smaller boxes, lighter objects in bigger boxes. Do not under any circumstances fill a human-sized box with books just because you want them all in the same place. Unless you or your moving help are secretly a superhero, someone’s joints will end up in a bad condition, and that someone’s chiropractor will be very pleased.

For reference, the Malaysian Department of Occupational Safety and Health (DOSH) recommends a maximum lifting- and-lowering weight of 25 kg for average adult men (16 kg for women). 

Spread the weight out among large boxes by putting heavier, sturdier items (books, papers) at the bottom of the box, then filling the remainder with lighter items (bedding, clothes). If the heavy stuff is fragile (dishes, glassware), the lighter materials can be arranged to pad them as well.

When packing, try to put the box on a chair or table so that you don’t have to keep bending down to put items inside.

  1. Lift with your legs, not with your back.

Bending your back over and over to pick up heavy boxes is a sure- fire shortcut to causing a back injury that could last anywhere from a few hours to a lifetime. To prevent that, make sure you lift (and lower!) objects using a squatting movement that spreads out the weight through your hips and legs.

Remember the DOSH maximum weight recommendations? That assumes you’re holding it as close to your core as possible. A box of dishes may seem manageable when you’re carrying it next to your belly, but if it’s going on the top of a stack or an overhead shelf, try to reduce its weight even further.

And as always, don’t try to carry everything on your own; adrenaline may help you in the short term to pick up that heavy end table by yourself, but you’ll feel the ache days later.

“Put heavier, sturdier items at the bottom of large boxes, then fill it with lighter items.”

  1. Have some protective gear on hand (and face and feet).

Consider a face mask to keep your sinuses clear. Even if you’re not usually sensitive to everyday levels of dust, the layers of ancient dust that tend to be stirred up from forgotten corners of the house in a move can cause uncomfortable sensations in your lungs and trigger allergies you didn’t know you had.

“It’s important to keep walking paths through rooms as clear as possible.”

If you’re doing a lot of the lifting yourself, a pair of good work gloves (durable, stretchable, sweat-resistant and well-padded) will help you in both getting a good grip on heavy objects as well as protecting your hands from injuries.

Comfortable shoes are also invaluable since you’ll likely be spending a lot of time on your feet. Think about anti-slip soles, ankle protection and good arch support; your favourite old sports shoes will probably do.

  1. Keep the floor clear of stepping hazards.

Moving is a messy process by nature, but it’s important to keep walking paths through rooms as clear as possible, especially if renovations are still in progress. Sweep the floor at the end of each day to clear potential splinters or other sharp debris that might end up in someone’s foot later.

Don’t leave scissors or blades  lying around on the floor, even when in the middle of packing or unpacking. Another hazard to look out for are electrical cables, loose pieces of plastic or other packaging that could trip people up while carrying items.

  1. Don’t forget to rest.

It can be tempting to survive  the moving period with 4 hours’ sleep a night and enough coffee to replace half of your blood circulation, but it’s best to try avoiding this. Lack of sleep impairs your concentration, memory, and dexterity, which can lead to accidents (tripping, dropping objects), bad decisions (stacking fragile objects precariously) as well as added stressful moments (struggling to deal with five different contractors calling you at once).

You might technically have “more time” if you sleep less, but your body will process things slower, so it might not really be worth it.

If you can’t get your full 8 hours’ sleep during the night, try to find the opportunity for a nap on a chair or in a car during the day; even a short 15-minute stint can help improve your mood and your ability to process problems. If you’re unable to fall asleep, it’s still not time wasted; just the act of reclining with your eyes closed helps relax your body, and puts you in a slightly better state than otherwise.

  1. Don’t forget to eat and drink water, too.

In the chaos of moving, sometimes it’s easy to forget you’re hungry or thirsty until you actually sit down for a moment and feel your stomach growl, or start to feel faint while standing. Ideally, you shouldn’t be straining yourself to that point; make a point of trying to eat and drink at around your usual meal times.

Maybe you’ve packed all your kitchen stuff already, or you just don’t have time to cook or to make a drive out and eat. Getting takeout delivered is fine, but be sure to keep some level of fruit, vegetables, lean meat and grains in your diet. Easy grab-and-go foods to stock up on like biscuits, granola bars, hard- boiled eggs, yogurt and blended juices can help keep you going.

Keep water bottles handy. As tempting as it is to grab sports drinks or soft drinks for the energy rush, your body needs to stay hydrated, especially with the amount of water you’ll be losing as you sweat while moving around all day in the heat. HT

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Exercise Myths Debunked

Exercise Myths Debunked

 April 25, 2022   Return


Wai Hoong

Fitness Director & Co-Founder of W Fitness


Want to lose weight or get fit but don’t know what to believe? Take the advice of a professional fitness coach, Wai Hoong.

Myth #1: I must train every day!

Truth: If you work out every day of the week at high intensity, it is just a matter of time before you hurt or injure yourself. It is recommended to cycle your training, keeping your workouts varied. Try out new activities at different levels of intensity. Much like how athletes have their on-off seasons, we should find a suitable balance for ourselves.

Myth #2: Women will get bulky from lifting weights.

Truth: Men and women are physically built very differently. Women have less muscle tissue, higher progesterone levels, and lower testosterone levels as compared to men. Hence, lifting weights will not bulk up a woman. However, it will benefit them in many ways. Lifting weights helps improve bone density and reduces a person’s risk of developing osteoporosis; it encourages fat loss (the lean muscle you will develop though lifting weights burns more calories than fat even at rest). Lifting weights also helps you gain strength (which can be useful for daily activities such as carrying a baby, groceries, doing manual work, etc); it improves athletic performances for athletes and decreases chances of injuries (in the knee or in the back).

Myth #3: I can eat whatever I want since I work out every day

Truth: Perhaps this may be true if you are younger, have good genes or already have a diet that’s wholesome and filled with food of high nutritional value. Otherwise, you can’t exercise your way out of a bad diet. Be mindful of the food you consume. A cheat meal occasionally is fine. But if you (for example) have a cake every night or indulge in unhealthy processed food every day, your diet wouldn’t provide you with the necessary nutrition for repair and recovery after workouts. Healthy wholesome meals aren’t just restricted to steamed chicken and vegetables every day—there are plenty of fun, interesting and healthy recipes available online to follow. Learn how to cook better using nfresh ingredients, substitute unhealthy sauces or seasonings with herbs and use healthier cooking methods. HT



June 25, 2020   Return


Kevin Kruse, business speaker and co-author of We: How to Increase Performance and Profits through Full Engagement has a few ideas on how to work under a bad boss.

  • Are you the only one with issues with the boss?
  • Do you find that all the bosses you’ve worked with are terrible?
  • If you answer yes to any of the above— or to both questions—it may be worth considering that perhaps you, not your boss, are the one with the issues here. It may be time to adjust your expectations more realistically when it comes to your boss. If you think your boss is the problem,read on!

Talk it out!
Your job as well as your boss’s are a shared accountability—it is within your right to ask for a meeting with them to discuss your performance. Bring up how well you are performing in certain areas of your job and how you believe things can be improved. Use some diplomacy and even cunning to persuade your boss that the implementation of your ideas would be beneficial for the both of you.

Think positive.
If your boss is uncooperative or too difficult to talk to, examine the positive aspects of your job. Are you learning new and marketable skills? Is the salary worth the trouble? If the good outweighs the bad boss problem, it may be worth hanging on for a little longer.

How long will the boss be around anyway?
UIf you are working in a large company that changes bosses every few years, it may be worth hanging on until a hopefully better boss steps in.

If all else fails, it’s time to look for a new job.
At the end of the day, your mental and physical health is more important! HT