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The festive season is here once again! A time of celebration with the rising eagerness to travel. We’re pretty sure you’re counting down the days to your great year end travel, whether it’s to visit your loved ones, explore new destinations, or just some time off to clear out all your unused annual leave. For those of you fortunate enough to experience a white Christmas, we can only imagine the upcoming long haul flight! However, along with travelling comes many post holiday effects – not just in the form of back to work blues, but also as travel aches and pains accumulated from long journeys.   Background Ever wondered why it feels so good to stretch out those legs during the occasional toilet stop? Prolonged sitting can make almost anyone stiff (this includes time spent working at your desk). While sitting, fluid accumulates in the muscles, especially in the lower legs. When this happens, it may slow down blood circulation and promote muscle stiffness. Not only does prolonged sitting cause stiffness to the muscles, it can also affect our joints. That’s why movement counters this effect. Nutrients are only pumped into the cartilage as the joints move, due to the lack of blood vessels in the cartilage joint surface. Moving your joints ever so often helps lubricate and nourish the joint surfaces.    Prevention We decided that, as spine and joint care specialists, we had the responsibility to share and educate on some preventive measures since many of our Practice Members will be travelling during the upcoming holiday season. As there are two major modes of transport when travelling, we will cover methods that can help reduce the aches and pains in both of these situations: By car We all have that one friend or relative who has shared their story...

When my sister first got pregnant, I leaped with joy. My first question, if I remember correctly, was the gender but obviously it was too soon to tell! However, being a physiotherapist, one of my first few questions to her was, ” Are you exercising?!” and she, of course replied, “Can I??” This is one of the most frequently-asked questions that many women, particularly active ones, have with regard to pregnancy. Exercise during pregnancy is no laughing matter as we have two lives at stake here — mother and child. So, is it safe to exercise when you are pregnant? “Absolutely!” There are many reasons why pregnant women would think that exercise is more harmful than helpful when it comes to their unborn child. During pregnancy, there are many anatomical and physiological changes (physical and functional changes) in your body! A hormone known as ‘relaxin‘ acts to relax your ligaments to open up your pelvic region. Furthermore, cardiovascular changes are necessary to sustain you and your baby during rest and exercise. Moreover, weight gain and increased curvature in your lower back changes your centre of gravity, thus throwing off your balance. How could anyone possibly exercise with all these bodily changes? You most definitely can! However, there are many things you need to know about exercising in order to keep you and your baby safe. This includes precautions, contraindications (absolute no-nos), tell-tale signs to stop exercising, frequency, duration and suitable types of exercise. So, to save you time, here is a summary of recommendations from multiple clinical guidelines.   What are the benefits of exercise in helping me and my baby? Exercise is, without a doubt, safe for you and your baby during and  after pregnancy. Done within the right parameters, it would benefit you by: Improving general fitness...

A Clinical Perspective by Dr. Timothy Burkhart D.C. (Burkhart & Chapp Chiropractic) I have been in practice for 28 years and integrated spinal decompression treatment into my practice in 2008. Since then, I have treated hundreds of patients with spinal decompression. The results have been amazing, and more and more people are seeking this treatment as an alternative to surgery. As I explain spinal decompression to patients, one of the most frequent questions I am asked is, “What is the difference between traction and decompression?” You could also make the argument that a CT scan is in fact an X-ray evaluation. Yes, the CT uses radiation, but it is much different than a plain view X-ray film that might be taken in a medical or chiropractic facility. So, what’s the difference? The difference is the technology of the equipment used. Pulling a patient in opposite directions in the cervical or lumbar spine with a set of cables IS NOT the same as a patient directly captured to a table that is monitoring decompressive force in millisecond intervals. Straight line or axial traction has been around as a back treatment for a long time. Unfortunately, the results of traction treatment have had a poor record of treating chronic low back pain or similar conditions. If one considers the study done by Anderson & Nachemson (FN study), intervertebral disc pressure actually was found to significantly increase under traction. This is an inconvenient truth for those who argue that decompression is traction and traction is decompression. In 1994, Gustaro Ramos, MD, etal (FN study) was able to establish that decompression treatment could significantly reduce intradiscal pressures. Decreased pressure in the intervertebral disc leads to, by its very nature, a “phasic physiological” change that can bring about positive outcomes in patient care. As more...

Dr Joseph covered running and osteoarthritis in our previous blog post. However, what we’ve also seen of late is a rise in popularity in cycling. You can see many new bicycle shops sprouting around the Klang Valley as well as casual cyclists along the highways on weekends. The relatively low cost to own a bicycle plus the wide range of brands for sale makes cycling one of the fastest growing sports in Malaysia. However, not only has outdoor cycling risen in popularity, group indoor cycling in large chain gyms like Celebrity Fitness or Fitness First have also been very popular amongst Malaysians. These classes are often packed on most weeknights and each class is choreographed by an instructor along with loud pulsating music. One of the most common complaint you will hear from any cyclist is pain from their low back or from their knees. It’s not surprising that these are the most common complaints due to the body’s posture when it is hunched over the handle bars. There are a few factors that lead to these complaints, but the biggest contributing factor to low back or knee pain is actually improper bike fit. For anyone who has been to a group indoor cycling class, they will tell you how the instructor will spend a few minutes before the class starts to help newcomers with their bike settings (seat height, handlebar distance etc.). This is very important as it could lead to serious injuries if not done correctly. As such, just like indoor cycling, anyone who is looking to purchase a new bicycle should get themselves fitted properly for their new bike. Even if you own an existing bicycle and are already clocking a few 100 kms every other weekend, whether on your road or mountain bike, it would be a good idea to...

Running (e.g. track and field, marathons, trail running) had become increasingly popular in the recent years. This can be easily demonstrated by the increasing number of participants in major running events in Malaysia (e.g. Standard Chartered Kuala Lumpur Marathon, Penang Bridge Marathon, Putrajaya Night Run to name a few). Despite its growing trend among Malaysians, many still contemplate the risk of ruining their knees and hips when they start running. Being an avid runner myself, I, Dr Joseph, have always been asked by my practice members, “Aren’t you going to destroy your knees with all that running?” Hence, I thought it would be good to share some thoughts to address these concerns in this month’s post by covering two key areas.   Are runners at greater risk of developing hip and/or knee osteoarthritis than non-runners? The general perception among the public and medical profession is that running increases your risk of osteoarthritis and that you should stop running once you have been diagnosed with osteoarthritis. This joint disease is commonly viewed as a death sentence to a runner’s career. But is it? The focus of this post would be on knees and hips osteoarthritis. This is because these are the two most common joints where osteoarthritis often targets, making it the most common form of arthritis and joint disease worldwide. It is considered by many as a “wear and tear” degenerative process that develops slowly as we age; similar to a car after a certain mileage. The assumption that running increases the risk of osteoarthritis was based on the premise that repetitive joint motion and impact results in thinning and damage to joint cartilage. Earlier studies involving a small number of runners and some animal studies have previously supported this assumption. However, since the 1980’s, newer studies with better design and a larger sample of...

So what is the big deal with posture? Well, let’s face it, we spend countless of hours staring down at our “screens”. If it isn’t the screen of our digital device, it’s our laptop or computer screen at work, or it might be the TV screen when we get home.  All these excessive “screen time” is causing us lead a sedentary lifestyle. Our daily use of these modern technology with all its usefulness is not only altering our lifestyles, it is subtly ruining our posture and negatively impacting our overall health. Our Digital Addiction As reported in one of Malaysia’s daily newspaper a couple of years back, Malaysians spend an average of up to 12 hours a day on their digital devices. It doesn’t help that because of our addiction to our digital devices, it’s taking up precious time on healthier pursuits like exploring the outdoors or staying physically active. Our addiction to our devices aren’t helping our already sedentary life. According to AIA’s Health Living Index, Malaysians do generally want to get healthier but need the right guidance. As chiropractors and rehab specialists, the best start as you begin to take control of your health, is to be more aware and conscious of your everyday posture. Over here at Spinefit, we have seen many complaints of low back pain, tightness in the neck, pain in the shoulders or arms/wrists as a result of their work. With their constant use of their digital devices (also see “text-neck syndrome”) and their poor posture hunched over their laptops or keyboards for long periods, coupled with a sedentary lifestyle, it isn’t surprising that so many desk-bound individuals are coming in with the complaints mentioned earlier. Over time, they would’ve developed poor posture and can lead to discomfort and injury. Posture At Work Poor posture can also be a result of either weak core muscles (inability...

Over here at Spinefit, we have a specialised treatment that is safe, fast and effective for multiple soft tissue injuries. During the shockwave treatment, the machine uses a single acoustic pressure waves to treat musculoskeletal and dermatological pathologies. It is non-invasive and an alternative to surgery, steroidal injections and oral medication.   So how does it work? The radial shockwave machine that we use here in Spinefit uses compressed air to accelerate a projectile that strikes a fixed applicator at high speed (up to 90 km/h). The kinetic energy here is then converted into a shock wave to deliver to the target tissue through the skin. This positive pressure in the wave causes shear stress in the tissue whereas the negative pressure causes cavitation bubbles that then causes secondary waves as it bursts. These waves are given in a pulsating manner (measured in Hertz), thus giving its name “shock wave”. In every person, the chronic pain generator (C nerve fibers) releases a very specific substance (Substance P). This is very similar to when someone eats a red hot chilli pepper (or cili padi)! The C nerve fiber is responsible for transmitting pain but then disables them for an extended period of time. Imagine the feeling of initially having your mouth on fire, then feeling like it’s gone completely numb. Well, research has indicated that shock wave therapy works quite the same way. When activated, the C nerve fibers releases Substance P in the tissue as well as in the spinal cord. This substance is responsible for causing slight discomfort during and after shock wave treatments. However, with prolonged activation, C nerve fibers become incapable for some time of releasing Substance P and causing pain. With the reduction of Substance P, it causes so-called neurogenic inflammation to decline – fostering healing together...

“Slipped disc” is a layman’s term commonly used to explain the condition with regards to the intervertebral disc in the spine (See Figure 1). Other terms associated with a slipped disc are also known as having a ‘disc bulge’, ‘disc herniation’ or ‘prolapsed disc’.   An intervertebral disc is located in between the vertebrae (hence its name) and it acts like a shock-absorber in the spine. When someone sustains an injury to their disc, be it due to degenerative changes, trauma, or any other pathologies of the disc, it tends to move and protrude outwards (imagine squeezing a jelly donut, see Figure 2), causing compression on the nerve that exits the spinal level.   There are four stages to a disc herniation (See Figure 3) and they commonly occur in the neck and low back. Here are some of the common signs and symptoms of someone who might have a slipped disc: Neck pain/low back pain Numbness and tingling sensation to the arms and/or legs Weakness in arms and/or legs Bowel and/or bladder dysfunction (in severe cases) Saddle anaesthesia (in severe cases)   Q: Who gets slipped discs? Slipped discs are most common in people aged (but not limited to) between 30 and 50. They affect twice as many men as women. Here at Spinefit, we have treated Practice Members as young as 19 years old and as old as 70 years old! Q: How do I know if I may have a slipped disc? If you have ever lifted something heavy from an awkward position and you experience a ‘snap’ or ‘popping’ sensation in the low back, followed by an intense sharp and shooting pain suddenly, it might be a good indicator that you might have had a slipped disc. Poor posture when you sit or stand could place the disc under an excessive amount...

It’s so good to be in the middle of the monsoon season after experiencing many months of scorching heat. But it looks like the weather is beginning to heat up, bringing with it certain health risks. As the temperature changes due to the monsoon, the efficacy of the human immune system will significantly reduce. As a result, our bodies are more susceptible to bacteria, germs and viruses that cause diseases. It also doesn’t help that we’ve just come out of a festive season of potential unhealthy eating (for some!). In short, our immune system is the balance of relationship between cells and organs that work together to protect us from disease. These defence cells are found in organs such as the tonsils, spleen, lymph nodes and bone marrow. Our immune system produces antibodies on a daily basis that track and destroy foreign substances that cause disease. With the ever changing weather, here are FOUR(4) tips to help improve your body’s immune system: Eating right and a well-balanced diet That’s right! This is one of the key things you can do that would immediately make a big difference to the immune system. Having the right balanced diet, eating regularly and consuming the right types of nutrition is key. For example, consuming too much sugar and highly processed foods (e.g. instant noodles, margarine, processed meats etc.) can suppress the immune system. It is especially imperative to avoid food containing high levels of both sugar and saturated fats if you feel you are beginning to fall ill. Foods rich in Vitamin C (e.g. guava, dark leafy vegetables, broccoli, kiwifruit, berries, citrus fruits etc.) should be included as part of the diet during this season, as Vitamin C is a potent antioxidant that helps boost the immune system. A superfood you can include in your diet is garlic. Surprisingly,...

Ever had a tight feeling over the calf muscles after your run? And that tightness can’t seem to go away even after religiously stretching out the muscles or in some cases, a deep tissue sports massage? Or if you’re like some who may have a chronic back pain that you can’t shake off and has been bothering you for as long as you can remember? If you can relate to any of these examples, perhaps you could give dry needling a go.   What causes these tightness? Trigger points (TrP) are contracted “knots” over your muscles that are hypersensitive and tender when palpated. These points can be formed as a result of direct injury or developed over a long period of time due to overuse injury or poor posture. In the case of a runner above, constant training with very little intervals for rest may be a contributing factor to these trigger points forming in the calf muscles, even though they stretch after.     So, what does dry needling do? Dry needling is a muscle therapy technique where the procedure is to use a thin “filament needle” as a medium, inserted into these trigger points.  Essentially, the goal of dry needling is to achieve a localised “twitch” response in the muscle as the practitioner uses the needle to release the trigger point(s). This will then cause a release of muscle tension and relief of pain. Dry needling can help to improve clinical conditions such as chronic low back pain, shoulder impingement syndrome, chronic ankle instability and more.     In general, dry needling is a safe and systematic procedure. At Spinefit, we use new sterile and disposable needles during each dry needling session. Most of our practice members (and internal team) who have gone through a dry needling session, feel little to...