12 Mar


Competitive cyclists are potentially at risk of suboptimal bone health. Although cycling is excellent for cardiovascular fitness, this type of non skeletal loading exercise does not mechanically stimulate osteogenesis (bone formation). This situation of low mechanical osteogenic stimulus to build bone can be compounded by restrictive eating patterns and associated hormone dysfunction of relative energy deficiency in sports (RED-S)

The pic shows how different sports exert site specific effects on the bone mineral density of the skeleton. In general terms, hip femoral neck BMD is more dependent on mechanical loading osteogenic stimuli, whereas lumbar spine BMD is more dependent on nutritional and Endocrine status.
What are the most effective mechanical osteogenic stimuli? Evidence from animal models demonstrates that bone responds to exercise that is dynamic, non-repetitive and unpredictable.

Load and repetitions are not such important factors. This is shown in a study of track and field athletes, where sprinters were found to have higher BMD at load bearing sites of the skeleton than long distance runners due to a local loading effect rather than a systemic effect associated with repetitive loading nature of longer distance running.

The other important consideration is that sprinters and rugby players tend to weigh more with higher lean mass than distance runners, providing higher skeletal loading forces.

These differences in anthropometric and body composition metrics are also associated with different nutritional and Endocrine status.

Swimming and cycling are similar in that both these types of exercise do not provide mechanical skeletal loading osteogenic stimulus.

Skeletal loading exercises for cyclists would have to be effective and practical, not requiring access to gym and possible to fit into training schedule throughout the season.


26 Feb

Chronic lower back pain is a leading cause of disability and a major health problem in industrialised countries. Prolonged poor posture and a sedentary lifestyle often cause chronic pain. Poor posture can lead to muscle imbalances around the flexor, extensor and rotator muscles of the back and neck. These muscle imbalances create unequal forces around and weaken the joints, thus making them more vulnerable to stress and pain.

Yoga is now emerging as a recognised means for effectively treating chronic back pain. Studies have shown a reduction in pain and functional disability in subjects with chronic lower back pain who undergo a yoga intervention. One of the first steps in practising yoga is to correct postural alignment, which should help in alleviating pain. Yoga can selectively stretch shortened, tight muscles and strengthen weak, elongated muscles.

Whether sitting or standing, the spine has natural curves that should be maintained for correct postural alignment. These curves can become habitually flattened or overly curved, leading to abnormal posture that can put excessive strain on vertebrae, discs, joints, muscles or ligaments. Abnormal flattening or curving of the spine may be the result of prolonged poor posture while sitting or standing, such as slumping, or the result of a sudden traumatic stress, such as a road traffic accident. In the long term, abnormal posture can lead to the adaptive shortening or elongation of muscles. Several abnormal curvatures of the spine have been documented, but the three most common are: (1) a hunched upper back – that is, excessive kyphosis – usually associated with a forward head posture; (2) an extreme sway in the lower back, called excessive lordosis; and, (3) a flat back posture.

The physical postures of yoga are a form of therapeutic exercise that integrate balance, co-ordination, strength and flexibility. Yoga is emerging as a promising means of alleviating lower back pain and may be of great benefit to patients, particularly when performed in conjunction with other established treatments, such as lifestyle advice, exercise, massage and mobilisations and manipulations. Yoga, when practised in a safe and strategic manner, can be a very useful tool in healing chronic back pain.

Some of the Popular Yoga Postures For Back Mobility and Strength:

Pavanamukthasana, Sethubandasana, Marjariasana, Bhujangasana, Jathara Parivarthasana..etc..,

The Running Menace!!

19 Feb

The Running Menace!!

There is a funny adage which says, Diabetes runs in the family, because no one runs in his family!! While jogging and running is a common form of exercise to keep healthy & fit, overdoing it can result in musculoskeletal s as well. The following is for a novice recreational runner and for health/fitness enthusiasts.

Start Line:

When you begin to Jog / Run, first make sure you have the following 1. Good pair of shoes, preferably with anti-pronation and good cushion 2. The terrain you are going to run, like treadmill, outdoor track, on road etc. Prefer the first two if you have an option 3. Hydrate yourself well and have a well-rested night., the last thing you will need is cramps. 4. Warm up with a low intensity cardio, stretches / foam roller.

Second, make sure you do a Basic Health / Fitness screening, get your risk factors screened for cardio vascular disease and get your Blood pressure and Body fat % Checked. Get a physician approval before you start as it might be high intense for your Heart and Body.

Get a Musculoskeletal Assessment done to check if you are prone for any bone, joint and soft tissue injury like the muscle and tendon. Flat foot, Tight Hamstrings and calf can cause ankle, knee or back injuries. If you have any mobility or strength issues or pre-existing injury, fix them before you start.

On the Track:

People who are already into running, need to ensure they don’t overdo it in FIT Terms!!

Frequency (How Often should I run) – always have a recovery day in between, 5 days a week of moderate intense activity is good., higher the intensity lesser the frequency (3 days), A low intensity Jog or a brisk walk is something which can done all days.

Intensity (How hard should I Train) – High intensity Training can be measured by two ways Heart Rate (HR) & Rate of perceived exertion (RPE). HR maximum (HR max) is calculated by a simple formula 220-age, if you are a 20-year-old adult then your HR max will be 220-20 = 200. A high intensity training will be at 90% and above of HR max. On a RPE scale 0 to 10 where Is 0 no effort at all and 10 is feeling of extremely hard, a high intense training will be 8 and above. Similarly, moderate intense will be 70% to 90% of HR max and 5 to 8 on the RPE scale.

Time (How long should I train) – Higher the intensity lesser the duration and frequency. A high intensity workout will be for 20 to 30mins, 2-3 times a week. Moderate intensity will be from 60 to 70mins, 3-5 times a week.

Finish line:

Remember to cool down after the run with a low intensity cardio and stretch. You may experience muscle soreness for two to three days when you are a beginner (Delayed onset muscle soreness). If it exceeds more than that you need to see a sports physio or a physician. If you are a weekend warrior (exercise only on weekends) do not do high intensity workout, and have an extended warm up and cool down. It’s also important to cross train as it can help to prevent injuries for Ex: 3days of running and 2days of swimming can help to use different muscles on different days and to reduce the impact stress on the joints, so you can run for your life time.


Exercise and endothelial function in Chronic Heart Failure

10 May

Chronic heart failure (CHF) is a disease most prevalent in the elderly. Additionally, symptoms are often aggravated in this population because of an overlap between the physiological age-related decline in exercise capacity and the disease-related functional decline. This study aimed to asses the effects of exercise training on endothelial progenator cells (EPCs) number and function in young and older CHF patients. It was found that 4 weeks of aerobic exercise training are effective in increasing EPCs number and function in young and older CHF patients.

60 with stable CHF and 60 healthy controls were divided into 2 age strata of 65 years old. Subjects were randomized until half of each strata (young healthy, young patients, older healthy, older patients) was in the intervention group, receiving 4 weeks of daily exercise training and the other half was in the control group, receiving usual care. EPCs number and function was measured at baseline and after 4 weeks.

This study found an age-related decline in EPCs number and function in healthy subjects, but not in CHF patients. After the short high-dose aerobic exercise training, a significant increase in function and number of EPCs was found in young and older CHF patients, and in older healthy subjects.

The beneficial effects of exercise training on endothelial function and EPCs were not diminished in older patients with CHF, emphasizing the potentials o

f exercise interventions in a patient group where CHF has a high prevalence.

Pendulum by night – Frozen Shoulder

12 Jan

Pendulum by night:

Many a time patients with frozen shoulder, complain of pain in the night. we as therapists, run out of ideas after a while when nothing works!!

The challenging part with adhesive capsulitis stage 1 and 2 (the inflammation & freezing stages ) the patients feels so uncomfortable in the night.,whatever the position they adopt is uncomfortable. They resort to painkillers, hot packs and end up sleeping in sitting the whole night.

I have advised them not to sleep on the affected shoulder and to lie flat.,but to no avail. So what helps??

If anyone says i can get frozen shoulder alright in two sittings please don’t believe it. I tell all my patients it will take time.,i give them atleast 3-4 months..I will discuss this in detail in another post.

Even when you sleep on the painfree shoulder, the weight of the top hand itself will increase the tension in the shoulder. I have found relief in my patients by asking them to support it on a pillow while sleeping on tummy up and on their pain free sides. kind of a distraction effect.

Recently i understood.,that the pain in the night could be because of the migration of the humeral head towards the acromion and reducing the subacromial space and causing compression of the inflammed tissues and thereby pain.

in the day , the gravity does a wonderful job of distracting the shoulder.,so i have started recommending pendulam exercise in the night.,roll on to the tummy leave your hand out of the cot, pick up the waterbottle next to you and swing 30 reps * 2 sets and trust me it helps. ( just make sure the bed is high enough to swing without hurting your hand, if not get next to the bed, take support, bend your knees slightly and swing)

It gives a traction effect and thereby relieves pain and the patients appreciate this simple tip. Managing pain is very important to get patient satisfaction and we have to do so using our physiotherapy skills , technique and most importantly common sense in most cases!!!

How to Alkalize your Body?

7 Sep

How to Alkalize your Body

Studies have shown that if this acidic overload happens over a longer period of time, it can lead to various health conditions, including kidney stones, muscle degradation, reduced bone density, and even arthritis, diabetes, and cancer. All of these can be traced back in some way to an acidic inner terrain.

Alkaline vs. Acidic

A 2014 study, published in the European journal Diabetologia, involved tracking more than 66,000 women over the course of 14 years. Compared to women who ate an alkaline diet, participants who consumed high-acid diets showed a significant increase in developing type 2 diabetes over the course of the study, according to the results. An acid-forming diet with low vegetable intake is also linked to an increased risk of metabolic syndrome.

This is very damaging and impairs the body’s ability to repair or detoxify and will cause a person to be more susceptible to disease and illness. The most common signs of acidosis are:

Fatigue or chronic fatigue
Feeling tired, low energy
Brittle nails and hair
Low bone density, osteoporosis
Heavy breathing
Gaining weight or being underweight
Digestive issues
Arthritis, diabetes
Headaches, acne
Bad immune system
Infections, allergies, candida
Heart problems, cancer

But it’s not just the food we eat that can cause an acidic environment. Our body creates acid by using muscles, breathing, and digesting certain foods. Other factors can be stress, toxins, a polluted environment, tobacco, lack of sleep, or medications.

If you want to know whether you’re more on the alkaline or acidic side, you can easily test that at home. Simply get some test stripes at your health food store or online which you can use for either your saliva or urine to show you the results.

Literally billions of cells in your tissues rely on an alkaline environment to function properly, prevent cellular damage and fend off pathogenic microbes. So what happens when you eat an alkaline diet?

Benefits of an alkaline diet

Deeper more restful sleep
Reduction of candida overgrowth
Increased mental acuity or alertness
Enhanced memory and cognition
Easier weight loss
Increased energy
Better bone health
Reduced muscle wasting
Proper cell functioning
Healthy tissues
Mitigation of chronic diseases
Improved cardiovascular health

This doesn’t mean that all we should eat are alkalizing foods. It’s very commonly advised to opt for a balance of 80% alkaline-forming food and 20% acidic-forming food. You can take a look below and choose from the lists – just remember to keep acid-forming foods to a minimum.

Alkalizing foods to eat abundantly

All Vegetables, especially when Green and Raw

All Fruits like Melon, Apple, Berries, Grapes, Lemon. Some are slightly acidic, like Blueberries, Cranberries, and Plums.

Leafy Greens like Spinach or Lettuce, Cruciferous Vegetables like Broccoli, Kale
Pumpkin, Potatoes, Sweet Potatoes, Beets
Mushrooms, Sprouts, Legumes

Nuts & Seeds like Coconut, Almonds, Chia, Sesame

Onions, Garlic, Leek and Herbs/Spices like Parsley, Ginger

Wheat and Barley Grass, Algae like Spirulina and Chlorella

Grains like Amaranth, Millet & Quinoa
Fresh Beans, Green Peas, Lima Beans, Soy

Acidic foods to cut out

Meat, fish, shellfish

Milk, eggs, butter, cheese

Coffee, soda, alcohol

Processed and refined food
Sugar, artificial sweeteners, refined grains
Tobacco, preservatives
MSG, canned food

How to start eating alkaline today

In order to make this approach to eating a balanced diet more actionable and easier for you, we’ve come up with some general guidelines that are helpful if you want to eat a more alkaline diet:

1. Drink a lot of water to flush your system and support natural detoxification. Extra points if you add lemon to it – remember that acid tasting food doesn’t automatically mean it’s also acid forming! After waking up, drink a huge glass of water. For more alkaline effects, add some apple cider vinegar to it.

2. Combine alkaline foods in a meal with foods that are acidic to create a good balance and focus on foods that are high in potassium like lemons or bananas.

3. Choose fresh, organic, GMO-free food whenever possible. Also, look out for minerals to help your body neutralize acid wastes (organic foods have a higher nutritional content).

4. Stay as close to the natural state of a food as possible, meaning eat it raw or steamed as opposed to frying it.

5. Make salads a staple in your meal plan. Leafy greens are the most alkaline foods and also rich in vital micronutrients. Use spinach or kale for best results, the darker the better.

6. Foods like whole grains or some legumes are not alkaline forming, but also offer nutritional benefits and are a part of a healthy diet – so you should eat them along with your alkaline foods. These are grains like oats, millet, spelt, or buckwheat as well as beans and lentils.

7. Replace animal foods with vegetable sources of protein, such as tofu, beans, or broccoli. These are a lot more alkaline-forming.

8. Incorporate more fruits and veggies into your diet by snacking on them, making fresh smoothies or green juices.

9. Try to eat some carrots, cauliflower, broccoli, eggplant, cucumber, potatoes, or celery every day. Soak and sprout your nuts and grains for more alkalinity.

Other ways to alkalize your body

Eat slowly and chew every bite around 30-40 times. Be careful not to overeat and overload your system.

Make meditation a habit & do some deep breathing exercises to reduce stress.

Throw away your chemical-filled shampoos, cleaning products, or air fresheners. Try to find and use natural products instead with only minimal ingredients.

Go for a walk or work out, since it helps to move acidic waste products in order for your body to better eliminate them. Extra points for getting some sunshine.

Baking soda can also help neutralize the acid and help the body to maintain pH balance in the urine and bloodstream. It is also very useful for relieving heartburn or acid indigestion.

The Six pack secret!!!

29 Aug

Many a times, i have been countered with this question.,How do i get a six pack?? Yes its a sign of a healthy , super fit body.,with our without musculoskeletal injuries, a price you sometimes pay for pushing the limits.

Once one of my celebrity client said.,the 6 pack fad is so rampant that all the film stars want one.,even a cart puller or a farmer in the village or fisherman has one!! The truth is it looks great on some and not so great on few.,the reason you lose fat all over the body and not selectively over abdomen ( There is no spot reduction ). Every man and sometimes women (wash board abs) want it., why my 7 year old nephew was trying to show me one recently.

How do we achieve it?? For me its your lifestyle.,i have seen young tennis / cricket players have six pack without hitting the gym or doing any form of specific drills..its their lifestyle (sport) that gives them.

Well then what about you and me?? Yes of course its possible.,its all about how badly??

In my experience you need to have 3-5% body fat only to have a 6 pack for men. If you are someone looking at a six pack thats what you need to aim at. Give yourself time and work towards it.


You need to burn fat.,moderate intense cardiovascular exercise.,( cycling/swimming/jogging/walking) interspersed with high intensity bouts (cross fit / functional training / boot camp) amounting to not less than 700 calories a day.

Add to that your core training and good strength training (as you may lose your muscle in the process if you don’t train them). The predominant focus should be on cardio vascular activity.

Nutrition / Diet :

Diet plays a major role.,its not about how much you eat.,its about what you eat. what does a farmer get to eat / drink?? The ragi / rice kanji, the buttermilk, milk, vegetables, fish, eggs may be. Cutting of oil, sugar, anything that tastes sweet, be it even fruits.,and switching to millets/cereals, low calorie, low fat, low sugar natural foods is the key,

Plenty of fluids and spaced out mini meals, i recently learnt about eating every hours and handful amount of right kind of food and thats what your body needs. The bottom line you don’t need to starve.

Do not stock high calorie stuffs at home.,or your temptation foods.,that are high in sugar and fat. Do not eat when stressed or when you have nothing to do.,if you have to, snack on fresh vegetables and fruits.

Do not resort to supplements, fat burners or steroids.,may give you short term, quick results in a short time.,but are potentially harmful, most of them, if not all.

Life style:

Its not those two hours you spend in the gym.,its about the rest of 22 hours that matter..if you are a software guy, sitting in front of the computer for 10 hours a day.,its gonna be difficult. if you are a sportsmen, trainer, physio you have a much better opportunity to get one and maintain it.

Stay active is the key!!


If you are blessed with a good gene, with a good resting / basal metabolic rate you are lucky.

Now go get it guys, its simple.,all it takes is only a lot of determination!!

What are we missing!!!

25 Feb

The other day, when i was in Manipal, i was little reluctant to use the shower in the guest house and i used the bucket with mug, to bathe. To my surprise, i ended up doing 25 squats at least in the process!!There used to be days, where we used to sit on the floor cross legged and do the Indian squats.,which till recently our allopathy medicine discourages to do it..We need a foreigner to research and to tell us the Indian squat position is great for bowel movement .

Then we have this thoppukaranam., our teachers used to make us do as punishment if we come late to school..again we need a outsider to tell is its brain yoga.We used to run and play barefoot, when we were kids.,now the newly born baby has socks and mitts!! Thanks to western influence. Now the whole world says, walk / run barefoot!!

Well water pulley and rope, Carrying pots on the head and waist, pounding rice (ulakkai), the ammi kal (Hand Grinder stone), Chakki and kulavi & aatukal (stone grinder ), mortar and pestle have been traditionally great functional work., solagu or muram and pan grinder are great relaxing exercises, Now they are all near oblivion since everyone has moved towards electrical grinders. Incidentally my physio saranya, accounted how all these were greatly useful during the power cut in the flooding days in Chennai. I also see all of them taking place in fitness in the form of functional exercise in recent times.,which were part of our day today life till about 20 years back!!

Cycling / walking to school great cardio exercise.,we used to do doubles and triples on the cycle.,playing on the streets in the hot sun (talk about vitamin D). My 8 year old nephew was recently jumping on the stair case from 4-5 steps.,didn’t feel like stopping him.,as i recently read jumping and plyometrics are great for fascial fitness!!

Growing up, we were less protected.,allowed to fall and rise, get hurt.,today i feel children are too protected within the confines of the wall. The whole world is realizing what we as india has offered to the world.,yoga, varma, ayurveda…its time we realized what we have in store!!

Growing up, we were less protected.,allowed to fall and rise, get hurt.,today i feel children are too protected within the confines of the wall. The whole world is realizing what we as india has offered to the world.,yoga, varma, ayurveda…its time we realized what we have in store!!

It’s not just what you eat, it’s how you eat

23 Feb

Healthy eating is about more than the food on your plate it is also about how you think about food. Healthy eating habits can be learned and it is important to slow down and think about food as nourishment rather than just something to gulp down in between meetings or on the way to pick up the kids.

  • Eat with others whenever possible. Eating with other people has social and emotional benefits particularly for children and allows you to model healthy eating habits. Eating in front of the TV or computer often leads to mindless overeating.
  • Take time to chew your food and enjoy mealtimes. Chew your food slowly, savoring every bite. We tend to rush though our meals, forgetting to actually taste the flavors and feel the textures of our food. Reconnect with the joy of eating.
  • Listen to your body. Ask yourself if you are really hungry, or have a glass of water to see if you are thirsty instead of hungry. During a meal, stop eating before you feel full. It actually takes a few minutes for your brain to tell your body that it has had enough food, so eat slowly.
  • Eat breakfast, and eat smaller meals throughout the day. A healthy breakfast can jump start your metabolism, and eating small, healthy meals throughout the day (rather than the standard three large meals) keeps your energy up and your metabolism going.
  • Avoid eating at night. Try to eat dinner earlier in the day and then fast for 14-16 hours until breakfast the next morning. Early studies suggest that this simple dietary adjustment eating only when you’re most active and giving your digestive system a long break each day may help to regulate weight. After-dinner snacks tend to be high in fat and calories so are best avoided, anyway.

How your refrigerator can help you with weight loss?

6 Feb

Healthy eating and staying fit has to start from your home don’t expect it only from the gym or the exercise. There are many changes you can make in your home that not only make living a lot easier for all family members, but will make your home an assistant in your weight loss endeavor. Right now we will focus on the kitchen. One of the first changes you should tackle is your refrigerator. Focus on what you put on the middle shelf. The middle shelf is the first place our eyes go when we open our fridge door. Let’s make sure you spot the food that will work for you and not against you. That’s where you should store single serving sized containers filled with cut fruits, veggies , boiled egg , boiled peanuts , boiled chana / rajma .

If you are into making your own 100 calories snack packs, the middle shelf is a good home for them also. Of course, this is going to leave you with some items that need storing elsewhere. If you or your family members just cannot stand the thought of giving up those sugary or high energy drinks, store them in the lower vegetable drawer. That way they are out of sight. It’s important to make as much room as you can for healthy, unprocessed food. Single serving containers sure make life easier for us. Keep at least 6 single serving sized containers of protein. Go even further, if you like, by using a color coded system. Green containers are for veggies, orange are for fruits, maybe yellow for low fat dairy. We even have the option to use those tiny containers for items like salad dressing, condiments and such.There’s no denying that those cute containers can make life easier. There are many more ideas for streamlining your home into your own weight lose assistant.

Don’t get overwhelmed by taking on too much at once. Make one change or modification at a time . We encourage you to make changes in your kitchen to make your life and dieting easier and more enjoyable. Go on, you can do it.