Is Your Diet Keeping You In Pain?

Working in Sports Medicine and Spine care, it is expected that almost every patient will come in with a pain-related injury. With expats being so active in Shanghai, knee injuries from extreme workouts or back pain from playing rugby are regular encounters.  While standard medical care, including physical therapy, medication, injections and bracing, remains the primary approach to treatment, it has its limitations. More and more today, lifestyle factors are being looked at for their contribution to injury and pain. Recent studies indicate that medical care, while invaluable, can be aided in its effectiveness by a diet low in pro-inflammatory foods and high in foods the promote healing.  Continue reading “Is Your Diet Keeping You In Pain?”

Let your Pain Float Away: Swimming to Reduce Lower Back Pain

When you live with back pain, simple tasks become difficult, quick errands require more time, and taking road trips with your family is a challenge. From sitting on planes, trains and automobiles for hours at a time to lugging heavy suitcases from city to city, travelling can be irritating to both your stress levels and to back pain. One of the best ways you can keep your back healthy and strong over the summer is by maintaining an aerobic exercise routine. And one of the best forms of aerobic exercise is swimming.  Continue reading “Let your Pain Float Away: Swimming to Reduce Lower Back Pain”

Extreme Workouts: The Current Wave of Fitness

Every decade of my lifetime has been marked with some type of fitness craze. The 70s brought distance running into the limelight. In the 80s, it was all about leg warmers, spandex, aerobics and the thighmaster. At the end of the century, 8 minute abs, Taebo, bodybuilding and creatine were at the forefront. Currently, we are in the middle of an extreme workout craze.   Cross-fit and Boot camp programs are popping up all over Shanghai. While people love the conditioning and fitness achievements of these programs, there is a certain level of injury risk that only recently is becoming more appreciated.

So, what do each of these programs involve exactly? Let’s review a few you may know, as well as a few you may not.


One of the most popular of the extreme workout routines, Cross-fit started in 2000 in the Unites States. The program is typically an hour long and involves a mix between aerobic exercise, gymnastics (body weight exercises) and Olympic weightlifting.   The sessions will typically start with a warmup, skill development, “workout of the day” and stretching. Many of the exercises are timed, requiring participants to perform as many reps as they can within a short period.

Boot Camp/TRX

While not an official program, boot camp style exercise has become increasing popular in the last 10 years. It is group program utilizing interval training over the course of an hour to improve strength and fitness. Many programs utilize the TRX suspension system, which uses a set of ropes and webbing to help a person work against his/her own body weight. Other exercises such as kettlebells, weights and plyometrics are also incorporated. These explosive workouts are meant to push people beyond when they would do on their own in a gym.


These are both home video based programs, which incorporate weight training, martial arts, yoga, calesthetics, etc., into an interval training program that is designed to slowly advance a person through the program over 60-90 days. In addition, the P90x program has an “Ab ripper” exercise set, designed to work your abdominal muscles to extreme fatigue.

Tough Mudder

While not an actual exercise program, this extreme activity that has become increasing popular in the last few years. Designed by British Special Forces, Tough Mudder is an endurance event series in which participants attempt a 10-12 mile long military-style obstacle course. The obstacles play on common human fears, such as fire, electricity and heights. Injury risk is certainly a known factor to all participants.

Though many of these programs have touted great success of improving fitness, not so commonly discussed is the injury risk associated with so called “extreme” workouts. A medical case report published early last year describes a case of abdominal rhabdomyolysis following the P90x program. Rhabdomyolysis is a condition when damaged muscle cells are recycled by your body quickly. This can lead to significant kidney injury. While this is not a condition unique to extreme workouts, it is something being seen more commonly among them. Shanghai is not immune to this problem. We have seen several cases of rhabdomyolysis, alongside tendon and other muscle injuries related to extreme workouts. The best way to reduce the chance of injury is by heeding the following advice:

  • Listen to your body. You’re not 18 anymore. Your body will not respond the same way to injury as it did when you were younger. When you are experiencing pain, rest. When you restart an activity after an injury, don’t resume at the same intensity level as the time of your injury. Yes, some pain should be expected with workouts: sore muscles and feeling tired are normal. Sharp pain around the joints or spine pains are not normal. Don’t push through it.
  • Technique and form are key. One of the biggest pitfalls of any extreme workout is when people push themselves harder; they do so at the cost of proper form and technique of the exercise. This is the main reason most injuries occur. If you can’t maintain correct posture, dial down the intensity and focus on the mechanics. This will keep you safe.
  • Go at your own pace. Athletes are competitive by nature. Working in group classes and watching your fellow athletes our-perform you will be a motivating factor to improve yourself. While this motivation can be good, it can also push a person beyond their limits, putting him/her at risk for injury. Continue to push yourself, but do it in a safe manner. Don’t let anyone else dictate your pace except yourself.
  • Stay hydrated. One of the biggest risks associated with rhabdomyolysis is kidney damage. Keeping hydrated is the primary method to reduce this risk after extreme workouts. Pre and post workout hydration is key. Don’t just drink water; mix in sports drinks or other rehydration additives to maintain a good electrolyte balance. At least 1-2 liters of fluid will help to keep your fluid levels balanced.

If all else fails, when an injury occurs, make sure you seek out medical care with professionals who are experienced in sports injuries. This will give you the best chance of getting back in the gym and pushing your body to the edge!

Medicine Ball and how to Use it

Ask anyone of your friends for their advice for methods to relieve back pain and you will get a variety of answers. Sleep with a pillow under your knees, go swimming twice a week, hang upside down from a door jam, use more fish oil and antioxidants, etc. Of course, many of these remedies while interesting, are not based on any corroborating scientific research. One of the biggest trends amongst people today is to use a large exercise ball, aka Swiss ball or physio ball, at work instead of an office chair. Continue reading “Medicine Ball and how to Use it”