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How shoulder pain affected my life?

I broke my shoulder back in 2017 and had corrective surgery to fix it.

Post-surgery, I was referred to physiotherapy to help me recover my full range of motion and strength. However, after six months of visiting, I still did not return to my full pre-surgery strength. Eventually, my insurance coverage ran out and I decided to stop seeing the physiotherapist.

I didn’t give up on my shoulder despite the limited results from my then physiotherapist. I restarted my gym membership and decided I will rehabilitate my own shoulder. 

Try as I might, I could never seem to get back the strength I felt. It would seem that I would have made the matter worse as I started experiencing sharp pain and peculiar aches. While these symptoms were initially confined to my own gym workouts, they eventually started to haunt me in my daily life too. 

As my condition worse, simple tasks like reaching for the showerhead and opening a jar felt almost impossible.

Square One Active Recovery: The exercise approach to combating pain

square one active recovery, chiropractor singapore

I did so many Google searches on what I could do to overcome my pains. I read multiple recovery stories and watched a ton of recovery videos. Even self-help videos.

I tried my best to follow the steps as closely as I can. Even so, none of these methods delivered any results. 

My symptoms continued to worsen and at some point I became afraid of going to the gym or lifting any weight because I didn’t want to make my injury worse. The last thing I wanted was to go for another surgery! 

I stumbled upon Square One Active Recovery via a Facebook post that was shared by a friend of mine who had bad knee pains. She claimed that the place was great and helped her recover when no other options worked. 

Seeing how similar my situation was, I decided to book an appointment and head down for a visit. 

Visiting Jesse was unlike any other physiotherapist or chiropractor I had been to. He was understanding and patient — never patronising — with a laser-sharp focus on working towards getting results. 

Despite my complex case history, he was able to dissect my initial problem, as well as my self-inflicted ones, in a systematic order. While his relentless questioning may seem unbearable, what resulted was a mutually clear understanding of my shoulder pain.

Jesse’s assessment methods are unique.

He asked me to try going into various positions and even exercises that are usually painful. This struck me as unique because he is the only therapist I worked with that does not shy away from pain.

His astute understanding of human body allowed us to explore my shoulder the way nobody has done before.

Jesse helps me help myself

chiropractor singapore, square one active recoveryAt the end of the session, Jesse prescribed a list of three exercises for me to bring home. Some of the exercises are to be done on a daily basis. Others? Hourly.

Performing the exercises daily as scheduled was no easy feat. It took discipline and effort to complete the exercises as prescribed. Some of the exercises even caused discomfort or pain.

It was an uneasy experience because I thought recovery was meant to be pain-free! 

Jesse was there every step of the recovery journey. He assured me that pain doesn’t necessarily damage and that patients with more pain at the start of their recovery do not experience worse outcomes.

This sounded like bullsh!t to me. However, Jesse was able to provide research articles to support his explanations.

Keeping in mind that my friend did fully recovery from her pain, and that there is some measure of science behind it, I decided to press on.

None of my treatments included any form of chiropractic adjustments or massage therapy. It was all about what actions I can take for myself to facilitate the recover I so desire. In that sense, Jesse doesn’t just hand you the fish. He teaches you how to fish for your own pain-relief.

Recovering from my shoulder pain

recovery curve, shoulder pain, chiropractic singapore

After two weeks (that felt more like two months), I started noticing that I could do more of his experiences with less pain. This was the turning point in my recovery to suggest that I was indeed getting better. 

While the exercises prescribed are not too different from what I found on YouTube or tried myself, the results are dramatically different!

As Jesse would say, trust the process.

And he was right.

During our time together, there are definitely good moments and not so good moments. As you can already imagine, Jesse would have an answer for this.

“Recovery is non-linear.”

At some point, the shoulder pain did increase significantly. I was rather concerned about this as I was worried that it’s a relapse. So, I sent Jesse a message to update him on my progress.

I remembered his episode clearly because Jesse was composed and very understanding. He took the time to understand what exactly was going on with my exercises and made adjustments to my exercise practice so that I could complete them with less pain. 

Before I knew it, the pain went away again.

In just 7 visits across 3 months, I was almost back to my full pre-surgery strength. None of the previous intervention attempts had ever gotten me this far!

Even better, activities that used to cause pain no longer did! 

In all honesty, I cannot say that my treatments with Jesse were enjoyable. It comes with its frustration and it took a lot of hard work. At my lowest point, I did feel as if things would never get better.

What I can honestly say, however, is that Jesse gave me back the quality of life that I lost since the surgery. Had I known earlier that such a treatment option was available, I would have signed up in a heartbeat.

If you have been living with chronic shoulder issues and you are simply getting nowhere with your current recovery, give Jesse a try.

He is worth the shot.

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Staying Healthy During Holiday Season

_As festive seasons draws near — be it Christmas, New Year, or Chinese New Year — we often find ourselves eating and drinking more.

This comes as no surprise in Singapore where eating and drinking are the predominant social activities. With COVID-19 measures in place, limiting gatherings to five (and soon to be eight) people, it is no surprise we find ourselves indulging more than previous years.

True as that may be, living a healthy life does not mean sacrificing times of celebration and joy.

As a firm believer of finding balance in all things, there are plenty of ways to enjoy the holidays without having to compromise on your health goals.

Making your calories count

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Getting the six pack, washboard abs can start by making your calories count. Image credit: Bao Kaiwen. Circa Post Army, 21 y.o.

One of the easiest ways to prepare for an upcoming holiday is simply account for your intake of the delectable food and beverages.

Yes, it is true that you will most likely exceed your daily calorie intake on your social nights. (Hurray to sugar-laden, fatty in all indulgent foods).

However, that doesn’t mean you can’t balance your weekly calorie intake by finding workarounds on other days. 

For two or three days before your big night out, try to consume a few hundred calories less than what you usually would.

You can choose to eat more low-calorie foods such as vegetables, or by skipping a meal completely (also known as intermittent fasting, which is perfectly safe for most individuals). With that, you wouldn’t need to sacrifice any indulgence on the holiday itself and still be able to keep in track with your health goals.

Obesity is a dangerous disease that contributes to type 2 diabetes, stroke and high blood pressure. While you may not become fat from just a few cheat meals during the holidays, failure to practise restrain or maintain healthy eating habits could easily lead to a downward spiral of poor eating behaviour. 

Increase energy expenditure i.e., exercise more

Incorporating additional movements throughout the week leading to the holiday would also greatly assist you in staying healthy.

Going for a simple jog, enrolling in a few fitness classes, or even walking after a meal would all count towards exercise.

If time is limited, waking up 30 minuets earlier to incorporate a workout in the morning! 

While this may seem dreadful, taking actionable steps to your health goal may trigger other healthy behaviours that will help you achieve your health goals. Furthermore, exercise (and waking up early) has been said to increase work productivity.

Who knows? You may just end up creating more time for yourself by taking the 30 minutes for a quick workout.

Organising healthy group activities

kingsley tay, chiropractic treatment
Exercising for weight loss doesn’t have to be painful and lonely. Choosing group sports for your next meetup can kill two birds with one stone. Image: Kingsley Tay

There is certainly a push towards more health-positive social activities in the last couple of years.

We are starting to see more people choosing to trek down one of Singapore’s park connectors or meeting up for a climbing session as part of their usual meetups.

If exercise is not what you are after, a picnic at MacRitchie Reservoir Park or even barbeque at East Coast Park will allow you to preplan what you eat! Choosing homemade food with less sodium, oils, and sugars will definitely go a long way.

Furthermore, your wallet will most likely thank you with all the cost savings from your own meal prep.

Getting chiropractic care

chiropractor singapore, square one active recovery
Square One Active Recovery is not your usual crack-and-go chiropractic clinic. Jesse takes his time to understand your recovery and health goals and help you help yourself achieve them.

While being active is something all of us can achieve ourselves, sustaining an injury would need more professional assistance to be truly free from pain or injury.

If you have been trying to ‘tahan’ your aches and soreness for some time already, seeking professional help from a chiropractor may be a great way to kickstart your recovery and also to practise self-kindness. 

Pain often limits the amount of activities you can engage in. This likely means no exercise for socials or even no picnics because you can’t sit on the ground without severe pain.

It is true chronic pain (or injury) is unlikely to kill you.

However, your quality of life — and also the enjoyment you get out of this holiday season — can significantly improve with the right chiropractic care.

Book in with our chiropractor today if you need help to become healthy this holiday season. Let us help you help yourself find freedom from pain

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Five Things People Do That Contributes to Low Back Pain

Most of us, no matter our age and gender, would have experienced sharp and acute pain at our lower back before. This could happen literally at any time of your life — from lifting heavy weights to mundane day to day activities such as sleeping.

Whatever it is, we know how painful and bothersome back pain is, and here are some tips to help you improve your spinal health.

Leading a sedentary lifestyle

Contrary to what you believe, having a sedentary lifestyle is actually more damaging for your lower back than weightlifting. Clinical guidelines around the world repeatedly stress that advice to keep active should be the first-line treatment for low back ache.

It is unclear why being active has a strong influence on spinal health. However, researchers and clinicians have attributed the benefit to more mobile joints, better functional range of motion, stronger muscles, healthier joints, and even better mood!

You may think keeping active is just generic good-for-you advice. Well, research is able to demonstrate that people living sedentary lifestyles are at high risks for not only back pain but also obesity!

So, take a moment right now to get moving. Talk a walk around your work station, do a couple of air squats. Moving is always good for you.

Poor lifting techniques

chiropractor singapore, low back exercise
We don’t shy away from tough work at Square One Active Recovery. We do what it takes to help you find true freedom from pain.

Adopting good lifting techniques is definitely one way to reduce your risk injury.

Good techniques start from warming up your joints and muscles before engaging in a lift and also making sure that you have a healthy attitude towards lifting weight.

While bending your knee and keeping your back straight has not shown to help with preventing injuries, your mindset before exercise can influence how you feel after!

When in doubt, always seek professional help.

And maybe avoid the broscience bent-knees, neutral spine or “use your core” approach. 

Not enough sleep

We know sleep deprivation is linked to a myriad of problems, such as high blood pressure, weakened immunity, risk of type 2 diabetes, and even obesity.

Do you know poor sleep also directly contributes to low back pain?

Poor sleep can contribute to your lumbar spine sensitivity to pain (i.e., takes less load, movement to induce a pain experience).

With increased pain sensitivity, you are more likely to experience low back discomfort. This in turn disrupts your sleep quality, thereby creating a vicious cycle.

If you have been experiencing poor sleep or prolonged fatigue, it may be a good idea to start looking into your sleep hygiene. You can always start taking small steps towards a good night rest!

Putting on excessive weight

obesity, weight loss, back pain
Our holistic approach to what it means to be healthy led us to include a clinician dietitian and a ex-fat personal trainer to our team. We believe in your full potential.

Overweight and obesity is a seldom discussed topic due to their sensitivity.

Nonetheless, no matter how we feel towards our body weight, higher BMI scores are associated with low back pain! On top of that, overweight is also the leading contributor to metabolic diseases such as diabetes and also cardiovascular diseases such heart attacks.

If you weight is on the high side and you experience back soreness, exercise is a quadruple pronged approach that can help you!

Not only will keeping active directly help with your symptom experience, exercise can also improve your mood (which helps with pain), your sleep (which also helps with pain), and even weight loss (which also helps with your pain)!

Talk about killing four birds with one stone.

If you have explored trying to lose weight but still struggle, our 12-week weight loss programme (run by personal trainer Kai who was an ex-obese boy) might just be the solution for you.

Not seeing a Chiropractor

Seeing a chiropractor does not have to be a crack-and-go experience. Chiropractor Jesse Cai focuses on exercise and lifestyle change to help you achieve long-term results.

Opting for temporary solutions such as painkillers and massages (or even chiropractic adjustments) may alleviate your discomfort for the moment.

You would know by now that they are merely short-term comfort and will never truly help you make your symptoms go away for good.

Yes, seeing a good chiropractor in Singapore can indeed be expensive. The investment, however, reaps life-long returns.

Remember, our goal is to help you help yourself find freedom from pain. And in doing so, we make ourselves redundant to you.

To start your journey to pain-free living, book in for an appointment with us today to discover the difference the right care can make.

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Five exercises for low back pain

Many people in Singapore experience back pain on a daily basis. It disrupts our daily lives and affect everything from work productivity to mundane daily activities.

While pain killers and massages may be the go-to-treatment for most people, clinical guidelines around the world all agree that staying active and exercising is the first-line treatment for low back pain.

Today we share with you five exercises of various difficulty that could be helpful for your recovery.

McKenzie extensions for painful backs

Developed in the 1950s by Robin McKenzie, the McKenzie extension is a tried and tested exercise that can easily alleviate mild back pain.

To start, lay face down (supine) with your arms by your side in a comfortable and relaxed position. If you experience pain getting into the position, take a few minutes or deep breaths to settle in.

Once you are ready, push your forearms (or palms) into the ground as you gradually try to lift your chest from the ground. As much as possible, try to keep the movement to the symptom-free range. If that is not possible, limit your range of motion to within your baseline symptom experience. E.g., If you experience 2/10 pain at the relax position, move within the 2/10 pain range and not go into the 3/10 pain range.

This exercise is very similar to the cobra pose in yoga. However, it should be noted that the exercise is design to promote spinal movements rather than to stretch your back muscles.

The McKenzie extension is extremely easy to perform and can be done at any time of the day.

Difficulty: 1/5 

Glute bridges or pelvic bridge for less painful backs

As you start to experience an alleviation in your symptoms, you may want to consider exercises that are slightly higher in intensity.

The glute bridges is a great exercise that involves your posterior chain (low back, gluteal, and hamstring muscles) as well as your trunk muscles.

Lay on your back with your knees bent. When you are ready, slowly push your feet into the ground and lift your pelvis at the same time. Once you are at your top-range, you can slowly relax again to return to the start position.

Similar to the McKenzie extension, this exercise is not designed as a stretch and there is no need to hold the top position.

For patients with a sensitise lumbar spine, you may feel an increase the symptoms as you approach the top end of your range of motion. In such cases, it will be advisable to limit your movements to the sensation-free range.

Difficulty: 2-4/5 depending on variation

One leg deadlift for unilateral back strengthening

Your recovery shouldn’t stop at symptom resolution.

It is common for low back pain patients to assume that they are recovered when they experience no pain. However, our latest understanding of pain science suggest that this is not true.

It is important to progressively increase load through the lumbar spine during recovery to restore the robustness and resilience of your low back. The one leg deadlift is a great exercise for this.

Start by standing on one leg holding on to a weight that is in front of you. If the choice of weight (e.g., dumbbell) is too close to the ground, do elevate it by putting it on a stack of books or a low stool. This is your start position.

The exercise start with you standing up into an upright position weight the weight and lowering yourself back down to the start position again. It’s common for people to pause or rest at the standing position. However, the standing position is not the end position.

If a break at the top is required for you to complete the workout, consider regressing to a lighter weight or an easier exercise before trying this again.

Difficulty: 3-4/5 depending on weight 

Jefferson Curl for extra flexibility

Forward flexion is a movement that is poorly explored by most people because of the perceived danger of a round back.

However, research doesn’t support that a round back is dangerous for you.

The Jefferson Curl is one of the favourite spinal conditioning exercises for top gymnasts around the world. The movement improves not only strength but also flexibility through your full range of motion.

If you are experiencing tightness or soreness from your low back from long hours of sitting or a sedentary lifestyle, the Jefferson Curl could be a good exercise for you to explore in the future when you are ready.

Kettlebell Swing for the HIIT lovers

kettlebell training singapore, weight loss singapore

Having a comparable aerobic and metabolic effect as running, kettlebell swings is a great spinal conditioning exercise for HIIT lovers.

On top of burning calories as with all aerobic exercises, kettlebell swings also train glutes and hamstrings which will contribute to your low back well-being.

To increase the difficulty without increasing the weight of the kettlebell, consider variations such as one-handed swings and swing swaps to improve overall coordination and balance.


The spine plays a crucial role in all human movements. From the Olympic lifts to mundane everyday tasks, it is inevitable that you use your back.

Remember, motion is lotion.

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What does it mean to be healthy?

As stated by WHO, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

As of today, Singapore has over taken Japan to have the longest healthy life expectancy in the world.

This is wonderful news. Our public health policies to encourage Singaporeans to participate in healthy behaviours is working. From National Steps Challenge to Eat, Drink, Shop Healthy Challenge, there are lots of resources going into helping people achieve their well-being.

To a large extent, prevention is better than cure. Do you know strengthening exercises can reduce your risk of joint issues?

Here are three ways you can be more healthy.

Finding more opportunities to exercise within your current lifestyle

One of the easiest way to get more exercise into replace sedentary activities with active ones.

Take for example, choosing to walk instead of taking the bus or choosing to take the stairs instead of the lift.

While these actions seems miniscule, it will add up over time. Being healthy is not about running a yearly marathon. It is about being able to adopt health-promoting behaviours in a sustainable way.

Eating out less

Changing eating habits is always challenging when living in a food city such as Singapore.

Hawker food, while cheap and accessible, is often high in carbohydrates, sodium, and fat.

To kickstart healthier living, choose to eat at home for one additional meal a week or to bring your own lunch to work. Eating at home or bringing your own lunch to work allows you to control what goes into your meal.

Alternatively, you can order meal prep from as little as $6.50 and have healthy pre-cooked meals delivered to you.

If you have children at home, you can set a good eating example and reduce their risk of developing lifestyle diseases such as diabetes.

Focus on your inner well-being

mindfulness singapore, awareness training

Taking 15 minutes off of your schedule to meditate can make a big difference to your well-being.

Studies have shown meditation to help improve stress, anxiety, fatigue, sleep, and mood. This often translates to better productivity and increased work performance.

To start, you can start with free apps such as Insight Timer. We do recommend Rebecca Crane at Insight Timer. You can access her audio-guided mindfulness practice for free.

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Five Reasons Square One Active Recovery Is Not Your Usual Chiropractor

You may have been told by your friends or colleagues to try a chiropractor for your chronic pain.

You did a look online and you can’t seem to find one to your liking.

Today we will share with you why Square One Active Recovery is not your usual chiropractor.

Chiropractor without the chiropractic adjustments

chiropractor singapore
Chiropractor Jesse Cai used to offer chiropractic adjustments. Since then, over 80% of our clients will achieve their recovery goals in just 4 to 7 session. No more 40-session packages!

Square One Active Recovery is Singapore’s only chiropractic clinic that delivers long-term results without the need for any chiropractic adjustments!

When you go to a chiropractor for an adjustment, you do need feel super shiok after. However, the results are short-lived and you often have to go back regularly (up to three times a week)!

At Square One Active Recovery, our chiropractor Jesse uses exercise to help you find freedom from pain.

While exercise may not be the most comfortable or shiok option, it is the only treatment that doesn’t encourage dependency.

You can continue to do your exercises by yourself at home to facilitate recovery. This means better long-term outcomes, few sessions, and more cost savings!

The latest clinical studies have all recommended exercises as first-line treatment for chronic pain while clinical trials are starting to show that chiropractic adjustments does not work better than placebo!

If you have heard stories of people going to a chiropractor without any improvement, now you know why.

Chiropractic without the x-rays

Chiropractors often require their patients to go for x-rays. It may sound reasonable because x-rays can show us where the problem is and how we can fix the root cause, right?

Wrong.

Both Lancet and JAMA, prestigious medical journals, have advised against x-ray for everyday lower back pain patient.

Research from as long as ten years ago had already suggested that x-rays do not improve treatment outcomes. The latest research takes it further to show that patients who had undergone imaging have poorer sense of well-being (Radiology, 2005) and were eight times more likely to opt for surgery (Journal of Occupational and Environmental Medicine, 2010).

Needless to say, patients with x-rays spent more money on treatments than those who opt out of x-rays.

Having pain doesn’t mean you are broken

You may have been often told that you are experiencing pain because something is damaged, broken, or abnormal.

This is simply not true.

In fact, most clinical guidelines agree that staying active is the most important thing a chronic pain patient can do!

In our day-to-day lives, we would have been in situations where pain is desirable. Take for example, deep tissue massage or foam rolling.

There is no need to demonise pain, especially since we are already aware that pain alone is not always bad.

We are annoyingly evidence-based

By choosing to practise within a strict evidence-based framework, our clients are statistically more likely to get better.

We did offer an array of manual therapy — from chiropractic adjustments to dry needling — previously. However, our clients were taking too long to get better.

Since the realisation, we have transitioned to offering exercise therapy and lifestyle coaching to become Singapore’s first exercise-based chiropractic clinic.

It is common for chiropractic clinics in Singapore to sell packages upwards of 40 sessions. You will be surprised to hear that over 80% of our clients will leave our care within four to seven visits.

This is because we don’t offer any of the hands-on treatments that encourage dependency (i.e., you have to keep coming back for maintenance).

At Square One Active Recovery, we don’t do what sells best. We offer 100% evidence-based treatments.

No broscience. No marketing fluff. Only Results.

Health is more than absence of disease

personal training singapore, weight loss singapore
We offer personal training services from weight loss to increasing general fitness to help our clients achieve true peak well-being.

We are the only chiropractic clinic that offers personal training and clinical dietetics services.

We don’t think health is just being pain-free or disease-free.

We also don’t believe that you can only look for professional help only when you are sick.

Our personal trainers are equipped to help you keep your body robust and resilient while our accredited dietitian provides advice on what it means to eat healthy (aka no diet fads).

Choosing healthy behaviours such as exercising and eating well can help you achieve peak physical well-being and keep lifestyle diseases such as chronic pain, diabetes, and many cardiovascular diseases at bay.


Finding a chiropractor in Singapore doesn’t have to be complicated. If you need more help to navigate the chiropractic scene, be sure to check out The Ultimate Guide To Seeing A Chiropractor.

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Three updates to the chiropractor industry in Singapore

Over the last couple of months, there have been some changes to the chiropractic clinics in Singapore. Because this may be confusing to some of you, we have decided to compile these changes for you.

Natural Healings is now Natrahea 康愈源

chiropractor singapore, natrahea

It is not clear why Natural Healings have rebranded themselves to Natrahea. If I had to guess, it would be to appeal more to the Chinese demographic.

While their core offering use to be chiropractic, Traditional Chinese Medicine (TCM) seems to be their new focus.

According to their websites, Natrahea clinics offer acupuncture (similar to dry needling), tui na, cupping, gua sha (very similiar to IASTM), and herbal remedies.

Fun fact: Aras Ignatavicius, the clinic director of Natural Healings since 2016 has moved on to R3vive Centres which he is both the founder and director.

Singapore Pain Solutions is now re:chiro

singapore pain solutions, jenny li

It is unclear what chiropractors Jenny Li or Jeff Ederer is planning to do with the rebranding. Their Facebook page mentioned that Singapore Pain Solutions was founded in 2015 and that they have rebranded to re:chiro.

Their website and email still follows the Singapore Pain Solutions branding.

Full Potential is now Chiropractic Singapore

full potential, chiropractic singapore

It sounds like an attempt to rank well on Google.

Impressively, they are ranked #4 for “chiropractic singapore” while Square One Active Recovery holds top spot for the search term.

 

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Femoroacetabular Impingement (FAI): Should I Be Considering Surgery?

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What is Femoroacetabular Impingement (FAI)?

If you have been experiencing hip pain with hip flexion (moving your knee upwards), external rotation, or internal rotation, you would have probably experienced some stiffness or even locking in your hip. Very often, patients will describe their hip as being misaligned or that something is out-of-place.

This is how the diagnostic label femoroacetabular impingement syndrome came about.

For most parts, it was assumed that in the condition the bones of your hip joint are pinching tissues causing movement issues or pain. However, the latest research is starting to find that FAI findings are common even in asymptomatic individuals.

As many as up to 31% of individuals without hip pain or symptoms or whatsoever would show some form of “abnormality” that is consistent with FAI on their MRIs or CT scans.

This challenges our understanding of how an “impinged” hip may hurt and the treatment options that are sensible for hip pain patients.

What causes femoral acetabular impingement?

It is not clear what exactly causes FAI, or that why a third of individuals without any symptoms have FAI.

In that sense if you were to have hip pain and your MRI later shows that you have FAI, that alone is not enough for us to conclude that your hip pain is coming from the FAI.

To understand FAI better, you would have to understand your hip joint.

hip pain, chiropractor singapore

The hip joint, more accurately the acetabulofemoral joint, is made up of four bones. The femur (thigh bone) is the bone that joints into the cup-shape acetabulum, which is formed by the ilium, pubis, and ischium (three pelvic bones).

Because of the cup shape of the acetabulum and the ball shape of the femoral head (of the thigh bone), this joint is often referred to as a ball-and-socket joint.

The femur doesn’t join directly to the acetabulum per se. There is an articular cartilage that called the labrum that on the pelvic surface that holds the head of the femur bone in place.

You can imagine that damage to the labrum (e.g. labral tears) can result in abnormal contact between the bones. Sometimes the labrum is completely perfect but an abnormally shaped femoral head can cause changes to the hip joint. This is how we think impingement occurs.

There are two major classes of hip impingements. The cam impingement and the pincer impingement. In cam impingement, the head of the thigh bone is not perfectly round that that changes how it is able to move within the acetabular surface of the hip joint. As for pincer deformity, it results from the excess bone from the pelvic surface covering too much of the femur bone to allow normal movement.

It is possible for a patient to have both cam and pincer deformities.

What does research say about hip surgery?

The latest study on hip surgery (published Nov 2020) with 650 participants found that surgery for femoroacetabular impingement syndrome was no more effective than conservative treatment.

According to the authors, conservative treatment and surgery can both equally improve disability for femoroacetabular impingement syndrome patients.

This comes as a surprise as arthroscopic hip surgery is gaining popularity over the more less risky exercise-based treatments or activity modification approach to managing hip pain.

The biggest reason to support orthopaedic surgery intervention as the better treatment is that surgery can correct for anatomy changes in the hip that may be contributing to a person’s symptom experience. However, research has consistently shown that pain is more complex than that.

pelvic pain, hip surgery
There is more to a pain experience than just physical damage. This is why the latest research are starting to show that surgical interventions may not be the best treatment option for pain recovery.

The latest studies have shown that MRI findings such as disc herniations or even knee osteoarthritis correlate poorly with an person’s pain experience. Furthermore, our current understanding of pain science has expanded to accept that non-physical factors (e.g. contextual factors) can contribute as much as physical factors to a person’s pain experience.

In that sense, as much as surgery can “correct” for hip impingement, it may not yield a superior outcome. Because the perceived impingement may not be the sole reason why a patient experiences hip pain!

With all of this information in mind, it doesn’t make sense to choose surgery first.

While it is indeed unfair to say conservative treatments yield better outcomes than surgery (according to this paper, it does not), it is reasonable to consider surgery as a higher risk treatment option.

Conservative treatments such as therapeutic exercises, strength and conditioning, physical therapy, motor control exercises help. These interventions have been reported to produce comparable results to surgery with significantly less risks and should be considered first-line treatment option for clients with hip pain.

If you have been diagnosed with hip pain that is not improving, book in an appointment with us to learn more about how we can help.

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Plantar Fasciitis: Should you be buying custom orthotic insoles?

 

Insoles are no doubt making a comeback in Singapore. Be it Dr. Scholl’s Orthotics for Plantar Fasciitis from Lazada, custom-made insoles from Happy Walker, or a podiatrist-prescribed pair of orthoses from the hospital, tons of options are available!

Before jumping in to buying your first pair to ease the pain at your plantar fascia and achilles tendon, it is always a good idea to understand your condition better first.

plantar fasciitis, custom insoles singapore
We really have no lack of insoles options in Singapore. Dr. Scholl’s, Dr Kong, Spenco, Happy Walker are some of the insole brands in Singapore claiming to help or prevent plantar fasciitis. For more advanced options, My FootDr and East Coast Podiatry are clinics with podiatrists that can consult with for an orthoses prescription.

What is plantar heel pain?

Plantar heel pain is one of the most common symptom experience of the lower limb. While commonly attributed to sports participation (e.g., running), plantar heel pair also often affects sedentary individuals.

If you have plantar heel pain, you will be familiar with experiences of ache, soreness, or even sharp pain at the underside of the heel bone. It’s often most painful upon pressure, typically after a period of inactivity (e.g., first step of walking after sitting or getting out of bed).

What is the main cause of plantar heel pain?

Plantar fasciitis is the condition that often leads to plantar heel pain. Plantar heel pain strictly refers to the symptom experience of the heel while plantar fasciitis refers to a pathology of the plantar fascia.

Despite the -itis suffix, which is commonly used for inflammatory diseases, plantar fasciitis is NOT the result of an inflammatory process. As much as the sole of your foot or heel may feel painful or tender to touch, it is not inflamed.

Some patients with plantar heel pain may also have heel spurs that may contribute their symptom experience.

What is the main cause of plantar fasciitis?

The exact mechanism behind plantar fasciitis remains unclear. However, researchers have identified mechanical load and tissue capacity to be risk factors. This include factors such as obesity, training environment (e.g., running on hard surfaces), sudden increase in training volume (e.g., too much too soon), or even long periods of standing or walking.

While high arch is frequently suggested as one of the risk factors for the condition, research does not seem to support that the arch of your foot alone causes plantar heel pain.

It is important to note that most of the risk factors associated with plantar fasciitis or plantar heel pain are modifiable! This means you can take small steps towards walking pain-free!

How do I permanently get rid of plantar fasciitis?

If you are looking for an ultimate cure for your heel or feet pain, you are in it for a shock.

The latest clinical guidelines by American Physical Therapy Association was revised in 2014 and their recommendations did not take into consideration research that has surfaced between now and then.

According to them, interventions such as manual therapy (e.g., massage, IASTM), stretching, taping, foot orthoses, night splints, ultrasound, dry needling can be considered even though research supporting these treatments are lacking.

Their recommendation also include education and counselling for weight loss, which makes sense given the mechanical nature of the condition, as well as therapeutic exercise, which also makes sense given the “too much too soon” risk factors associated with plantar fasciitis.

There are exercises you can do to help with your sole pain. For example, eccentric contraction of the calf muscles, commonly confused as a stretching exercise, is likely to help more than 20 minutes ice packs and shoe inserts in the long-term.

If you are currently living with plantar heel pain, it would be a good idea to seek medical advice from an evidence-based chiropractor or physiotherapist to help you through your recovery. The research pertaining to the condition is grey and it will take a therapist with competent clinical reasoning to help you through this difficult time.

Do insoles help plantar fasciitis?

This is the million dollar question we are trying to address in this post.

Should you be spending $20 for a off-the-shelf Dr. Scholl’s insole or perhaps a more expensive $60 Spenco slippers? Maybe you have tried them both to no avail and you are wondering if a $400++ custom insoles would do you good.

Here’s the unfortunate truth: the latest research suggest that custom orthotics are no better fake/sham orthotics, and could potentially be inferior to your regular GP treatment.

A study published in British Journal of Sports Medicine two months ago found that custom-made insoles were no better than sham insoles or standard medical care.

In the study, 185 participants were randomised to receive treatments from podiatrists and medical doctors/general practitioners.

For the group that was receiving custom-made insoles, 3D imprint of the foot was taken and insoles were made accordingly to the discretion of the prescribing podiatrist. For the group receiving sham insoles, a 3D imprint of the foot was also taken. However, the insoles were made to have as a little mechanical effect as possible.

The GP group any non-surgical intervention that was deemed appropriate by the attending GP. This include medication or even corticosteroid injections.

At the end of 12 weeks, the participants who received standard medical care showed greater improvements than those who were prescribed with the orthoses.

While supporting the bottom of your foot may help you feel better in the short-term, research doesn’t suggest that it is superior to standard medical treatment.

Will you wear your custom insoles?

Regardless of whether insoles work or not work (at this point, it looks like they do not work), the bigger question to ask yourself is if you would wear them.

The same study revealed that almost half (43%) did not wear the prescribed orthotics on a daily basis and 8% of them did not wear it at all!

If you are thinking of getting a pair of orthotics for your supporting the arch of your feet, consider if you would be willing to wear them on a daily basis. While that may seem like an obvious thing-to-do, it could still be an uncomfortable change.

The current research doesn’t seem to strongly suggest that insoles will be your pain solution. However, remember that most of the risk factors that could contribute to your heel pain are modifiable. There is alway something you can do to start your first step towards recovery.

If you need more help with your plantar fasciitis, book in with an appointment with us via the form below and discover the difference the right care can make.

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Weight Loss: The Ultimate Eating and Exercise Guide I

I may not be that knowledgeable in most things but when it comes to losing weight, I have a story to tell.

Being obese since most of my childhood, I was no stranger to the relentless teasing at school.

“Eh Kaiwen, how come you eating double of mine sia?”

To a large extent, I hear them. Deep down, I truly wanted to change. The hardest step is always the first.

What is sustainable weight loss?

weight loss singapore, exercise, abs

It doesn’t matter if you think you are lazy or you have no idea what is the first thing you should do for yourself.

Unlike what some may want you to think, these are not excuses. They are completely valid reasons.

I totally understand how you are feeling and here is my secret: the first and best thing you can do as a start is to stop focusing on short-term results.

There are far too many fad-diets that promise — sometimes falsely promise — fast results. The fitness industry alone is not to be blamed. Since ‘fast’ became an integral part of our lives, people are unwilling to wait. They want results now.

I have no gripes with getting fast results. However, it does come at a price — sustainability. Getting into a 3-month keto diet will help you shed the pounds fast, yet most. if not all, of the progress is thrown straight out of the window the moment a diet ends. As for those hard-die dieters who pledge to #keto4life, do we really need to part ways with some of the best tasting foods on earth just to have a more desirable body type?

Are there no other options?

Regardless of how it is you decide to approach your weight loss, always consider sustainability.

To keep your weight loss sustainable? Stop chasing short-term results.

How to Count Calories Correctly?

This brings me to my second tip: calorie counting.

Back in school, I did a whole 15 minutes presentation on this topic trying to convince the Prof and my classmates why calories counting is the key to weigh loss (and for some, healthier living). Today, it is my job to convince you the same.

Calorie counting, all science jargon aside, can be summed up to 4 words: calories in, calories out.

Simply put, if you eat less than your body uses daily, you WILL lose weight. No matter what you eat! Heck, you could eat nothing but junk food all day. If it falls under your caloric expenditure (i.e., calories out), the scale will tip in your favour.

P.S. I highly advise against junk foods because they have zero nutrition value and will not sate you (i.e., make you feel full).

To start this practice, download the MyFitnessPal app. It has a massive food data base and allows you to record the calorie content of your own meals.

You begin by tracking one week of your daily food take and comparing to your body weight after 1 week. After some trial and error of how much to eat, you will get the sweet spot where your weight would stay fairly constant for this. You can refer to this as your current calorie maintenance level.

This will take time. I took a whole month when I first embarked on this practice because it was impossible to accurately determine the calories served in junior college canteen foods.

There is no need to rush through this. This practice will serve to be useful for the rest of your lives.

Can counting calories allow you to eat more?

“Walao eh, I don’t want to make my life difficult leh. Like that I won’t enjoy the food liao cause I’m going to be obsessed with the calories.”

Many people are put off by the idea of calorie counting. As a society, we love to eat. I hear you.

Here’s the thing, the mindset behind counting calories should be to restrict what you enjoy. Instead, it facilitates mindful eating and liberates your food choices. It teaches us to prioritise what brings us joy.

It boils down to the fundamental concept of don’t eat too much too soon. A lesson my very own parents tried to instill in me since I was the chubby kid. However, what I struggled with was what exactly is “too much”?

I always ate till satiety with whatever food I can find. Junk food or clean meals, I’ll eat them all!

pizza, cheat day, weight loss diet
Discovering my love for pizza while my parents were away on holiday was terrible for my body weight. I ate pizzas every day for an entire fortnight! Image credit: Carmen Hong

When I was in secondary two, my parents went away for the June holidays gave my pocket money to eat whatever I would like for the month. My daily meals were from the neighbourhood caipng stall until one day a flyer came through my door: “Domino’s Pizza couple deal! 2 medium pizzas of your choice with dessert and sides.” I haven’t had much experiences with pizzas before and decided to give them a try. I picked up the phone and made my first order.

Before I realised it, I had pizzas every day for an entire fortnight! If I were to guesstimate, a medium pizza is anything between 1000-1500kcal depending on the choice of toppings. I ate close to 3500-4000 calories a day! This would include the delectable sides of chicken wings, breadsticks, and the always-gorgeous molten lava cake.

As a 14-year-old boy back in those times, never did I imagine that such eating behaviour would make me fat. Since I didn’t feel overly full by the end of each day, I figured I wasn’t overeating. When school started, all of my friends would have noticed my weight gain — something that was completely unaware of.

If I had known calorie counting or portion control back then, it could have transformed my life. It would have not taken me so long to reach where I am today.

Adopting a calorie counting lifestyle may come with its challenges initially. However, it does eventually become a habit just like brushing your teeth or scrolling through social media.

Once you establish the maintenance calories you need to stay at any given weight, subtract 500 calories from it and maintain your eating eating within that range. It may not be perfect given our tendencies to under or over record calories. It will, however, improve over time. Continue to closely monitor your body weight with your scale and adjust your eating accordingly to achieve the optimal results.

Don’t forget calorie density

these 500 calories may look vastly different between food groups. We now come to the concept of caloric density, and how differing food groups will offer different satiety levels for the same number of calories. Compare one Double McSpicy meal with a bowl of Wanton Mee. Even without the meal, a single burger clocks in at a whopping 924 kcal, whereas our local hawker food is only at 411 kcal, literally half of the burger. Two individuals who went for lunch ate this 2 different food, one of them would have ingested double the calories of the other, even though they may both feel the same level of satiety.

As a rule of thumb, foods that have more fat will always be denser than foods without, since fat has 9kcal/g compared to the 4kcal/g for carbs and protein. Doing some simple math, you can easily tell that 20g of fat will have more than double the calories of 20g of carbs or sugar, hence the caloric density. Food that are high in fat can often be found in fast food chains, fried foods, desserts made with high cream or butter etc. My mom gave me a good advice that still serves me well to this day and perhaps will aid you in your journey too: if your hand gets greasy when you touch the food and cannot wipe away without soap, it is too fat.

Understanding the density of food groups will greatly aid your decisions as to which food should you eat for the day. You can eat that Starbucks Cheesecake, but just remember how much calories you have left to play around with so you wont overshoot your limit for the day. Similarly, if you ate low density foods like plain popcorn, watermelon or my favorite dessert Agar Agar (it is surprisingly low in calories), you could treat yourself a cup of bubble tea since it will not impede your progress. Like I said, calorie counting is about liberating your food choices, such that you can stick with the process for the rest of your life and not having to resort to crash diets.

How much cardio will help me lose weight?

weight loss workout, abs transformation
Abs: From flab to fab. My 17-year old self (L) versus 21-year old self (R). While most people are quick to shout about their 4-week or 12-week transformation, it is the sustainable long-term change that I value the most. Image credit: Bao Kaiwen. 

This is my final advice: cardio.

Yes, yes, we all hate hard work, but sometimes it can help lead you to your goals faster. Everything I mentioned beforehand was regarding calorie intake, and cardio can be viewed as your calorie output.

If you do a 2.4km run, you would roughly burn off 200 kcal depending on your body and gender. That is 200kcal more food you can eat or 200kcal of energy deficit that will contribute to your weight loss. The reason why I didn’t mention cardio earlier is simply because exercise plays a much less significant role in weight loss. The age old saying of never being able to outrun a bad diet surprisingly holds true.

When it comes to cardio, it can be much more than the standard jogging or running. As a rule of thumb, if you’re doing something that makes it hard to breathe for a long period of time, it’s cardio. This includes anything from the land, air and sea such as boxing, cycling, swimming, surfing, playing a sport, or even walking. Yes, walking is considered cardio if you do it enough.

For starters, go for a 15-20minute jog at a comfortable pace, where you can still talk but would rather not. Doing this thrice a week would be an additional 600 kcal deficit give or take, which is almost 1/5th of the deficit needed to lose 1 pound of fat! All of this with minimal effort.

As you get accustomed, increase either your pace, duration or frequency to your liking. I have personally tried a twice a day cardio session, one HIIT and one slow jog, on top of gym training, and I can attest it is not impossible given you have ample time between them and a solid amount of sleep. Combining this with your improved food choices, you would literally be a fat burning machine that won’t feel like shit by the end of the week.

As a parting note, the only way to lose weight is to strive for a sustainable caloric deficit, which is easily done with a good diet and cardio plan. Speaking of diet, calorie counting is a way to liberate your food choices so that you can eat your laksa and drink your soju without feeling guilty. It is not meant to be a diet, but rather a lifestyle because let’s face it, a life without indulgence isn’t a life worth living.

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Beginner’s Guide To Personal Training in Singapore

Maybe you’re new to the gym and you are at a total lost of what to do.

Maybe you’re frustrated at not seeing the results you want from your training program.

Maybe you need a little more motivation to help you reach the new year resolutions you have set some ten months ago.

Maybe you want a familiar face to help you feel more comfortable with exercising.

If any of this sounds familiar, personal training may just be what you are looking for.

A personal trainer can be a great source of knowledge, motivation, and comfort to help you get the results you are after from the gym while feeling great about it.

Searching for a fitness trainer, however, can be a daunting task. With so many choices and even more broscience to sift through, it comes as no surprise that you may be feeling overwhelmed. Don’t fret just yet. This guide to personal training will cover everything from what services fitness coaches provide, to the cost of hiring one, and what traits you should look out for in a trainer.

What personal trainers do?

The first step to hiring a personal trainer is understanding what they do and how they can help you.

Personal trainers work with you one to one or in small groups to understand your needs and goals and develop a training plan to help you reach those goals.

Here are some goals that you may have:

  • Kickstart your healthy lifestyle journey
  • Lose weight to fit into that beautiful clothes you just bought
  • Fat loss to get the summerbod for the perfect Instagram pics
  • Increase energy levels and day-to-day awesomeness
  • Improve your athletic performance for a major competition
  • General health and fitness workout
  • Pre and post-natal training to regain strength

To help you achieve your personal fitness goals, most personal trainers will take a holistic approach. Your personal training session may include cardio exercises, strength and conditioning, nutrition advice, or even lifestyle change coaching.

If you are not interested in strength training, some personal trainers in Singapore are trained in other training method such as Animal Flow or MoveNat. The movement-based approaches tend not to utilise weights and focus more on quality of movement.

Whatever your goals may be, a good personal trainer will you able to help you achieve them.

How much does a personal trainer cost in Singapore?

personal training, how much does personal training cost
Source: Fitness First Singapore

Now that you have a rough idea of what a personal trainer does and how they can help you. You’re probably wondering about the cost. Well luckily for you, personal trainers are available from as little as $35 per session for less established fitness instructors up to above $250 for a celebrity trainer.

How much you pay will depend on the experience of the personal trainer, the personal training programs, and the training package you sign up for.

While hidden fees and unclear pricing may have been a marketing gimmick many years ago, most gyms have since adopted a transparent approach to their fee structure.

fitness factory, personal trainers
Source: Fitness Factory

If you are looking for something less commercial, boutique gyms such as Fitness Factory are options to consider. While more expensive, these gyms tend to specialise on certain niches and come with a wealth of knowledge and experience to help you achieve your fitness goals. Ultimate Performance is another specialised gyms in Singapore that focuses on muscle building and weight loss.

To save some money, consider how many training sessions you are willing to commit to for a start. The more sessions you signed up for, the cheaper you tend to pay per session. You also also tend to see results faster!

Is it worth to hire a personal trainer?

You may be thinking if it’s worth paying some one $100+ to exercise when you could potentially find some one for less on Carousell.

As the saying goes, “you can’t put a price on health”.

It’s not uncommon to see people spending hundreds of dollars on a night out at the club. Why would you not spend $100 (or less) to train with a personal trainer? While we do agree that a night out can bring priceless experiences, investing in your health would also have its own returns.

Here are some reasons why a personal trainer is well worth your money:

  • Personalised training plan crafted for your specific needs and goals
  • Faster results than trying to figure things out on your way
  • Lower risk of injury with proper guidance
  • Accountability

If you are struggling to keep to your new year’s resolution, then a personal trainer can give you the accountability you need to reach your fitness goals. When you have committed money for a 12-week fitness program, you would definitely be more motivated to showing up for the workout that you know your body so badly needs.

Above all, the biggest value from hiring a PT is the time-saving.

Many of us have busy schedules and want to make the most of our time in the gym. Yet often what we see are gym-goers milling around aimlessly trying different exercises. A personal trainer will programme an effective workout routine so you can give the best value out of your time. With effective and safe workouts, you get to your goals quicker with less time wasted during each session and the rest time you may need should you get injured.

We do understand that hiring a personal trainer is not exactly spare change. Yet at the same time, the value that PTs can bring to the table and the opportunity cost of not having one can add up.

P.S. If you feel like you don’t need some one physically present to help you achieve you recovery goals. Most trainers have started to offer online personal training. This is particularly useful for clients who only need a program written and are very happy to train on their own.

How long should you have a personal trainer?

So, you’ve found a stellar trainer who suits your needs and works well with you and have now been training with them for some time. You may start to wonder how long you should keep working with your trainer.

This depends on your goals and how far away you are from them. You may have short term goals that you wish to achieve and thus only need a personal trainer for that period of time. If you want an overall lifestyle change, sticking with your trainer for a longer time allows them to know you better which will lead to better results.

Your current fitness level also plays a big role in this. If you were completely sedentary and want to run a marathon, it could take over a year to prepare you for that. But if you were already running half marathons, the time required to complete the peat would be much less.

Another major factor is how often you’ll hit the gym. If you’re visiting your trainer three times a week, you may reach your goals in 12 weeks. But if you’re only visiting once a week, that duration may extend to 24 or even 36 weeks.

A good personal trainer will help you set time-based goals and advise on how long you should engage him or her for. Before committing to any programme or packages, make sure that both your trainer and yourself are on the same page.

What do personal trainer certifications mean?

personal trainer singapore, functional training
On top of being an award-winning athlete, Justin is also trained in the Functional Movement Screen and a Functional Range Conditioning Mobility Specialist.

Once you’ve decided to hire a personal trainer, you’ll probably want to check his qualifications. Searching on the internet can be a daunting task with so many different organisations offering personal training certifications.

ACE, NASM, ISSA, ACSM, NSCA, FISAF, NCSF?

There are many, many personal trainer certifications available in Singapore. Do note that both personal trainers and personal training certifications are not regulated in Singapore. When choosing a personal trainer, you may want to consider the quality of the training they have to undergo for the certification as well as the any other additional training the PT may have received.

ACE personal certification is issued by the American Council on Exercise. FiT Singapore is the provider of the certification in Singapore and it is SkillsFuture eligible.

NCSF, National Council on Strength & Fitness, is another SkillsFuture eligible program in Singapore that is being offered by Gold’s Gym.

If you are looking for a local program, perhaps consider Singapore Management University’s Certificate in Exercise Science. While not strictly a personal training certification, the six-week programme seems to be fairly comprehensive and is taught by Jonathan Wong, the founder of Genesis Gym Singapore.

What is a good personal trainer?

With all of this information, how do you know you’ve gotten a good trainer? Here are some traits that we’ve found good trainers to possess:

First, knowledge. A good trainer understands how exercises work and what it would take to do them properly. They are able to modify exercises, to progress or regress them, based on your current fitness or limitations.

Second, a good trainer should adopt an educational approach. Some trainers are afraid of giving too much information or advice because they fear they would lose their clients. Good personal trainers, however, do not subscribe to some beliefs, and would go to the extra mile to empower you.

Third, a good trainer will also ensure that they are understood. While using science and research to guide decision making processes, good trainers would avoid the use of scientific jargon and complex terms in their sessions.

Lastly, homework. Some trainers may only offer workouts while you’re in session. But if you’re like many of us, you may have periods where you’re too busy to come to the gym. That’s why a good trainer will design home workout programs that you can do to continue towards your goal even if you’re unable to attend the sessions.

This prevents your progress from stagnating or even worse, deteriorating. After all, who wants to see weeks of progress go down the drain just because they had a busy week?

Living a fit and healthy lifestyle doesn’t have to be complicated. While hiring a personal trainer does require some effort and money, working with a trainer is likely to pay off in invaluable ways for the many years to come.

If you are looking for a personal trainer to kickstart your health and fitness goals, drop us a message to find out more about how we can help. Our team of highly trained professions (personal trainers, chiropractor, and even a dietitian) will be able to help you unleash your full potential.

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Understanding Ground Movements: Animal Flow and MovNat

A quick search on any journal databases will reveal strong evidence supporting the benefits of exercising.

While virtually everyone will agree is good for you — from reducing pain to improving longevity and quality of life — there is little clarity on the type of exercises we should performing for maximum health value.

Many “professionals” in the health and fitness industry exploit the grey areas to push and to capitalise on the “latest” and “greatest” trends.

At Square One Active Recovery, we do not blindly subscribe to broscience and marketing fluff. Today, we will explore the truth behind ground movements — one of the up-and-coming movement training niche that is predicted to be the next big hit in the trillion-dollar wellness industry.

What is movement training?

ido portal, movement culture, functional movement singapore

Before we can discuss ground movements, we have to first talk about movement training.

With its roots in gymnastics, calisthenics, martial arts, yoga, parkour, capoeira, and many many other disciplines, “movement training” is a broad term use to describe any form of exercise that emphasises movements over strength. From crawling like an animal or to flow in graceful, deceptively effortless and aesthetically pleasing movements, there is no clear definition of what constitutes movement training.

Many consider movement training to be a subset of functional training. But functional to whom?

Popularised by Israeli Ido Portal, movement culture moves away chasing numbers on the barbell or holding contortionistic yoga poses. Instead, it focuses on refining the basics of movements and increasing the efficiency of how a person moves.

It comes as no surprise that movement training seeks to make a practitioner fundamentally good at moving. This assumption is that this would translate to superior physical performance.

What is ground movement?

animal flow singapore, lizard crawl, ground movement

Within movement training, there is a specific approach known as ground movement.

As defined by Erwan Le Corre, one of the pioneers of movement training, ground movement consists of “positions and movements that you do while your center of gravity is lower than your knee level when you’re standing, regardless of which part of the body is the base of support.”

If you have trouble imagine that, think of rolling, crawling, squatting, and kneeling. Essentially the primary movements you may expect a toddler to do.

With the increased interest in exercise and movements, we are seeing many branded programmes making their way to market. Some examples include Animal Flow, MovNat, and GMB Fitness. All of which have developed their flavour and interpretation of movement training, and with that their own movement programs and trainer certifications.

Let’s take a look at what they offer.

What is Animal Flow?

If you have had a gym membership, you may have come across an Animal Flow class in your gym.

As one of the most popular movement training system, Animal Flow, sometimes also branded as Primal Fitness classes, can be found from Fitness First to ActiveSG gyms.

Animal Flow is a ground-based movement system with six components.

1. Wrist Mobilisations: simple exercises to promote flexibility and strength in your wrists, and to prepare them for loading. Since this is a ground-based training approach, it is essential that your wrists can support your body weight. It is not uncommon for beginners to experience mild wrist soreness (which should self-resolve in a few hours) after their first Animal Flow class!

2. Activations: static (i.e., no movement) hold exercises. The idea behind it is to “connect” and “wake up” the body before the start of ground movement.  The Beast and the Crab are the two activation positions utilised in Animal Flow.

3. Form Specific Stretches: exercises that will begin in an animal form hold before movements are introduced to move the body through a wide range of motion. The intent is to increase mobility and flexibility.

4. Traveling Forms: exercises that require locomotion (i.e., move from one place to another place) that mimics animal movements such as the Ape, Beast, and Crab.

5. Switches and Transitions: movements that link the animal forms together. In Animal Flow, they comprise of the Underswitch, Side Kickthrough, Scorpion, and Front Kickthrough.

6. Flows: all the components are combined into a single fluid “flow” routine.

Animal Flow promises “increased mobility, flexibility, stability, power, endurance, skill and neuromuscular coordination”. While there is no clear evidence to support this, the claim sounds reasonable enough and warrant the benefit of doubt.

If we were to dig deeper though, is it possible for any structured exercise program with a proper load management protocol to not deliver the same benefits?

I am willing to bet that weightlifting can also yield the same benefits!

What is MovNat?

MovNat is a coaching method developed by Erwan Le Corre on the practice of natural movement skills.

Unlike Animal Flow, MovNat comprises of more than just ground movement. It also includes locomotive skills (such as running, jumping, climbing, and swimming) and object manipulation skills (such as carrying, throwing, and catching).

In that sense, MovNat is a lot more well-rounded as a exercise choice.

However, it has not caught on as well as Animal Flow. According to the MovNat website, there are no licensed facilities in Singapore. Human Naturally, an outdoor exercise company by MovNat certified coaches in Singapore, seemed to have since closed.

A characteristic of the MovNat curriculum is the emphasis on movement efficiency, with five movement efficiency principles which includes breathing techniques.

movnat, functional movement

MovNat do make a few claims about the benefits of their program.

1. MovNat would make you fitter, stronger, and leaner. This sounds fair. Any form of exercise would very likely make you fitter, stronger, and leaner.

2. MovNat can benefit you in your sport by reducing physical deficiencies, imbalances, and preventing injury. This is contentious. There’s no high quality research to suggest that the approach to physical exercise can prevent injury.

3. MovNat can be used in conjunction with therapy to help people recover from injury. Again, high contentious.

It should come as no surprise that a search for MovNat on Pubmed would yield zero results.

A case of lifestyle or evolutionary mismatch?

There are some plausible hypotheses to why ground movements may be helpful.

Neurologist Jack E. Riggs first coined the term Evolutionary Mismatch in 1993. In his commentary, evolutionary mismatch refers to the maladaptation of ancient genes to modern civilisation. The genes which made our ancestors from hundreds or thousands of years ago well adapted in to survive and thrive to the environmental demands previously, is no longer adequately adapted for the living demands of today.

A Harvard professor of human evolutionary biology, Dr Daniel Lieberman, further unpacks this theory with a hypothesised list of diseases which is result of this evolutionary mismatch. He asserted that musculoskeletal conditions such as lower back pain, flat feet, and osteoporosis could potentially be the mismatch between our physical body and 21st century living.

The suggestion is that perhaps our diets, sedentary lifestyles, and other behaviour are contributing to our pain and problems. Their solution was that we should try to imitate the environmental demands of our ancestors to reduce our susceptibility to these conditions.

This is where movement training comes into play.

Many movements in movement trainings are close imitations to the movements our hunter-gatherers ancestors from centuries ago would perform in their daily activities.

By training within fundamental and primal movement framework, they exert that the physical adaptations may lead to improved physical function as well as reduced pain and injury. However, research and clinical guidelines are unable to find evidence to support that moving the way our ancestors do is superior to any other forms of exercise available today.

Is ground movement for me?

With the lack of evidence supporting the claims of various movement training programs such as Animal Flow and MovNat, is ground movement even worth your time?

The connections made to movements of our distant ancestors and our postural reflexes are indeed rather far-fetched and not supported by any clinical studies.

However, ground movement as a form of physical exercise, is not without merits.

First, it is fair to assume that participating in any form of exercise — crawling like a bear and walking like a crab inclusive — will benefit you.

Second, class and instructor fees aside, it is low cost. You do not need any specialise equipment in order to participate in ground movement exercises.

Third, it is convenient to practise ground movements. You can literally do it anywhere!

Fourth, ground movements cater to people of all ages and abilities. An experienced instructor can easily progress and regress the movements to suit your physical fitness levels.

Fifth, there is a huge social component to it. Most ground movement classes are conducted in groups. There are also lots of IG content sharing of people working through their practice.

While movement training might not prevent injury, there is no need to throw the baby out with the bathwater. All the claims aside, ground movements can be a meaningful exercise that will bring you physical health benefits.