Refined Carbohydrates – Don’t blame the butter for what the bread did.

Food, Lifestyle

 Variety of uncooked pasta and vegetables

I start to get tired, I start to get headaches; my liver basically starts to fill up with fat because there’s so much fat and sugar in this food. My blood sugar skyrockets, my cholesterol goes up off the charts, my blood pressure becomes completely unmanageable. The doctors were like, ‘You have to stop!’

These were the words of Morgan Spurlock, the man who had MacDonalds everyday for a month for an experiment on a fast food diet.

Most experts recommend that carbohydrates (Carbs) should be about 50 to 55 percent of your total daily calories for maintaining good health. However, according to a study by American Journal of Epidemiology 2013, carbs that have been stripped of their nutritional value are as good as consuming cholesterol-rich foods, leading to life-threatening conditions.

There are two basic types of carbohydrates, simple and complex carbohydrates. The way we get it now – there are refined carbs (artificially made) and unrefined carbs (available in natural form).

Metabolism of Carbohydrates


All carbs eventually break down into glucose to provide energy for the body. The only difference is the time taken by different carbs to break down into glucose.

  • Simple and complex carbs (refined or unrefined). Both are broken down to glucose with a series of metabolic changes.
  • As blood glucose level rises, your pancreas produces insulin. The hormone that helps your body cells (muscles, brain) to absorb blood sugar for energy and some of the glucose is stored as glycogen in the liver.
  • As cells absorb blood sugar, glucose levels in the blood begin to fall. When this happens, the liver then starts releasing the already stored sugar.
  • This interplay of insulin from the pancreas and stored glycogen from the liver ensures that cells throughout the body and especially in the brain, have a steady supply of blood sugar.

Carbohydrates – Refined vs Unrefined

“Refining” is a process applied to both simple and complex carbs. Refined carbs have a longer shelf life and enhanced taste. In exchange, you lose the fiber, nutrients, water and other benefits of the food as compared to its unrefined (natural) state. Unfortunately, this process also concentrates the sugar content causing a spike in blood glucose levels when consumed.

Refined Sugar

It is available in various forms of sugar like glucose, fructose and sucrose (table sugar, brown sugar, molasses, jams, jellies, processed honey, etc). These are all simple carbs. They are small molecules and are quickly absorbed as glucose in the bloodstream.

sugar food

Refined grains

These are commonly used as refined flour to make processed foods like commercial breakfast cereals, bread, tortillas, and many junk foods that contains a lot of starch. When eaten, they are broken down into sugar by the digestive tract. They convert rapidly into simple sugars and have a similar or if not worse effect on your body as refined sugars.

Refined Carbs (both Simple and Complex Carbs)

The Health Promotion Board in Singapore recommends whole unrefined grains and to limit refined sugar intake to no more than 10%(8-11 tsp) of your daily dietary energy. Studies have also shown that processed carbohydrates may increase the risk of obesity, diabetes, brain and heart problems, more than fats, because of its growing ill-effects.

Bad Effects of Refined Carbs

Pro-inflammation – “Slow fire rising within you”

  • Spiking blood glucose levels leads to increased  pro-inflammatory free radicals. Excess glucose and insulin in the blood causes inflammation of the cells of the blood vessels. In response to this, your body uses fat to be deposited around the inflamed cells causing the formation of atherosclerosis, increasing the risk of heart disease.


  • Excess glucose in your body is also stored in your liver by converting it into glycogen. Excessive sugar can fill your liver glycogen stores to its maximum capacity.  To compensate for the overload of glucose in your blood, your liver converts all the stored glycogen into fats causing the inflammatory process in your body.
  • Refined foods also elevate C-Reactive protein levels which will be identified by a blood test. It is an indication that there are high levels of inflammation in your body.
  • Excessive gluten consumption on the other hand not only causes inflammation of the blood vessels but also inflames your gut.

High Insulin Levels – “Are you at risk of getting diabetes?”

sugar diabetes

Glucose in the blood stimulates the pancreas to secrete insulin. Excess glucose in the blood causes excess insulin secretion. As insulin’s role is to absorb and help store sugar in your blood, excess levels of insulin can drop blood sugar levels very quickly as it stores it rapidly. If blood sugar levels go down too fast, it can cause the body to crave for more sugar. But if you eat food that is too high in glucose again, it can create a vicious cycle as the blood sugar levels are never adequately balanced. If this glucose roller coaster ride goes on for months, it can have short term consequences on your mood and concentration. Long term exposure puts you at increased risk of type II diabetes. This form of diabetes means the body becomes insensitive to insulin and the excess sugar in the blood can lead to chronic inflammation of blood vessels, which in turn can lead to heart disease or other severe illnesses.

Leptin Resistance – “I always feel hungry in the night”  
Leptin is a hormone that is released by fat cells to give the body a feeling of ‘fullness’ or satisfaction. By feeling satisfied by the food we eat, we can avoid taking in excess food. If we lack leptin, it will make us hungry. This is the body’s mechanism to ensure we get the exact amount of energy we need.  If we ingest foods high in sugar, it interferes with leptin function and this means we can eat far more than our body needs and still not feel full. If we continue to eat foods high in sugars, the brain can become addicted at the same time and fail to get satisfied by the food.
Loss of Nutrition Reserves – “Sick and tired of being sick and tired?”

Your body needs essential nutrients from your food in order to metabolise sugar. Refined foods are of very low nutritional value so the body is unable to properly control and regulate sugar metabolism. Your body still has to obtain these nutrients from other sources, causing a depletion in your nutritional reserves making you feel tired.

Brain function – “Something’s not right”


Glucose rollercoaster rides puts the brain (mood, concentration, thinking) on a roller coaster ride as well. There has been studies showing links between refined sugar consumption to hyperactivity, attention deficit hyperactivity disorder (ADHD), anxiety, irritability, reduced performance in school, juvenile delinquency, mental illnesses like schizophrenia and even increased criminal behavior.

Gastro-intestinal disorders – “I feel bloated”

Fibre content is reduced in refined complex carbs, this affects the function of the gut causing unwanted side-effects like excessive production of gas. This gas causes discomfort, bloating and flatus in many people. Digestive disorders come from constipation – difficulty to have a normal bowel movement.

Obesity – “I eat when I’m hungry and I’m hungry all the time”

Fructose is associated with increased fat deposition, which results from bad effects on hormones associated with satiety. Insulin-induced low blood sugar will specifically increase appetite and hunger for more carbohydrates, especially those with sugar content. Diet high in sugar content may cause greater appetite and increased hunger leading to obesity. Sugar is effectively addictive for the brain.

Eating in moderation is key and always consult an expert about your nutritional concerns when in doubt.

Avoiding the Glucose Rollercoaster

Food, Geeky stuff, Lifestyle

Several types of white sugar - refined sugar and granulated suga

We are all aware that Glucose is a primary source of energy for the body. it requires no further digestion and is available in your blood. Carbohydrates (carbs) is one such food group that breaks down into glucose during digestion.

The type of carbs that you consume will determine the amount of glucose present in your blood. The Glycemic Index (GI) is one such indicator which scales from 0 to 100, telling you the glucose level in your blood. The lower the GI, the better the food is for your body during the energy conversion process. Foods rich in protein and fats usually don’t have a GI value. While they do cause an eventual increase in blood sugar level, the process is slow unlike carbs/sugars which can cause an immediate spike.

Generally, when eating high GI foods together with proteins and fats, it slows down the body’s ability to convert the sugar as quickly. Slower sugar conversion results in a lower blood sugar spike. What this means is, if you ingest a fast-absorbing protein like casein which is found in milk, even though you will increase overall sugar levels, you decrease the effect of insulin and delay excessive absorption of the sugars in your blood. This in essence lowers the GI load on your body.

GI Standard Values (GI Low- less than 55, GI High- above 70)

Most fruits, vegetables and whole wheat foods  that we consume are on the lower side, with values in the 30s and 40s. On the other higher side of the scale, potatoes rank way up in the 80s, and white bread falls in the 70s.

White Pasta vs White Bread – Both made from Refined flour


Non-whole grain bread and pasta noodles both contain similar amounts of starch. Their starches are similarly composed of long chains of the simple sugar, glucose. The structure of bread allows more of the starch to be exposed to enzymes in our saliva and in our digestive tract. This greater exposure to enzymes allows more of the starch to be broken down into sugars giving white bread a higher GI value than white pasta. Effectively, both are still high on the GI value scale so moderate consumption will be recommended.

Insulin Insensitivity

The problem with ingesting foods with a high GI load over a prolonged time  can cause your body to become insensitive to a hormone called insulin. In the early stages (pre-diabetic) this can be reversible by making dietary and lifestyle changes. If no changes are made, and the person continues to eat high quantities of GI rich foods, it can lead to type II diabetes.

Know the GI but also the nutrient profile of your foods 

While a very high intake of GI rich foods should be avoided, you must remember that GI load does not measure nutritional intake. The body needs more than sugar for health and some foods while high in GI values, may have benefits that outweigh the disadvantages. Like brown rice, bananas and oats are all foods high in GI values, but they are also high in important minerals, vitamins and proteins essential for a healthy body. Balancing the benefits of reducing GI load while also making sure you get your full nutritional requirements is much more important. Portion size also plays an important role when it comes to such foods.

Much research have shown the benefits of low GI diet in weight loss, lowering the risk of diabetes and eliminating the sudden sugar rush and crashes. However, some studies have also shown no difference in hunger, satiety, or energy level after eating high- or low-GI foods. With research, the results of studies can’t necessarily be replicated and generalized for everyone but yes, for people who eat only high GI foods knowing its bad effects is a must.

Eating sensibly is the key!

healthy snacks

Everybody is unique with different metabolisms. Having said that, people’s metabolism also have different effects on blood glucose levels.  And most often, we eat foods in combinations of all different nutritional values. All we have to understand is that even if research trials have shown the benefits of low GI diets, in reality, it is best to only incorporate the knowledge rather than eliminating all high GI foods. That would be impractical and impossible.

Here are some GI values of the most commonly eaten foods.

Enjoy eating healthy and making healthy choices because what makes you feel better on the inside will show on the outside.

High-carbohydrate foods   Breakfast cereals   Fruit and fruit products   Vegetables  
White wheat bread 75 Cornflakes 81 Apple, raw 36 Potato, boiled 78
Whole wheat/whole meal bread 74 Wheat flake biscuits 69 Orange, raw 43 Potato, instant mash 87
Specialty grain bread 53 Porridge, rolled oats 55 Banana, raw 51 Potato, french fries 63
Unleavened wheat bread 70 Instant oat porridge 79 Pineapple, raw 59 Carrots, boiled 39
Wheat roti 62 Rice porridge/congee 78 Mango, raw 51 Sweet potato, boiled 63
Chapatti 52 Millet porridge 67 Watermelon, raw 76 Pumpkin, boiled 64
Corn tortilla 46 Muesli 57 Dates, raw 42 Plantain/green banana 55
White rice, boiled 73     Peaches, canned 43 Taro, boiled 53
Brown rice, boiled 68     Strawberry jam/jelly 49 Vegetable soup 48
Barley 28     Apple juice 41    
Sweet corn 52     Orange juice 50    
Spaghetti, white 49            
Spaghetti, whole meal 48            
Rice noodles 53            
Udon noodles 55            
Couscous 65            
Dairy products and alternatives   Legumes   Snack products   Sugars  
Milk, full fat 39 Chickpeas 28 Chocolate 40 Fructose 15
Milk, skim 37 Kidney beans 24 Popcorn 65 Sucrose 65
Ice cream 51 Lentils 32 Potato crisps 56 Glucose 103
Yogurt, fruit 41 Soya beans 16 Soft drink/soda 59 Honey 61
Soy milk 34     Rice crackers/crisps 87    
Rice milk 86            

Management and Treatment of Scoliosis

Common conditions, Lifestyle, Scoliosis

Spine osteoporosis. Spinal cord problems on woman's back

Early management of scoliosis is the key to more successful treatment and improvement of body function. We don’t guarantee that scoliosis can be cured but we sure as hell will do what we can to influence the body in the right direction.

The body is like a garden. You can use the best soil, water regularly and provide ample sunlight but nobody can guarantee that the seeds will sprout. Our aim is to give your body the best environment and let nature work its magic.

Focused Muscle Retraining to Prevent Scoliosis Progression

Your brain is the boss. It is the ultimate centre that controls your muscles and nerves. No matter how long you hold your body in the correct position, it is of no good if your higher centre is unable to learn and organize your movements

Use a Mirror

Get visual feedback and awareness to do simple exercises for your brain to learn muscle control. It is important that you also focus on your legs, arms, head and hips as well as the body works as a whole unit.


Improve Spinal Mobility

Focus on moving your back in varying positions while standing. It’s important you do small and gentle movements for constant brain signals. You should use your imagination to visualize the movements if trying to do it is too difficult and slowly work your way to incorporating them.

Twist and turn

tuck twist turn

When lying down, sitting or standing, place your arms with elbows bent to 90 degree with your thumb out. Then, gently twist your back and spine in the direction that is the easier one for you and rotate to the other side.

After you repeat this movement a few times, notice whether your back begins to move more easily if your spine begins to feel more mobile.

Stimulate the stretch reflex

The stretch reflex helps to control posture. When you bend slightly to your right, it causes a stretch in the spinal, hip and leg muscles on the left side. This activates the stretch reflex. What the reflex does, after the muscle is lengthened, is that there will be an immediate reflex contraction of the same muscle. Thus bringing your spine back to normal by adjusting and maintaining.

In most scoliosis cases, the muscles on one side of the spine are elongated while the muscles on the other side are shortened. Some might think stretching the shortened muscles will be the solution but that will actually stimulate the stretch reflex and cause further contractions.

Instead of stretching the short muscles, gently move to the side of your curve stretching the elongated muscles and let go to activate the stretch reflex.

Bending to lengthen

Correct Nutritional Imbalances

Improve the function of neurotransmitters in your brain in order to improve muscle contraction and control of posture.

Eggs/ Liver – They are rich in choline that forms acetylcholine a neurotransmitter for concentration and focus. It also plays a role in muscle coordination.

Brown rice: Serotonin, a calming neurotransmitter, plays an important role in brain activities such as learning and memory.

Spinach: Increase in folic acid that ensures your body synthesizes norepinephrine and serotonin.

Fish: Helps increase dopamine levels that are important for healthy nervous and immune system functioning

Dairy products: Increases norepinephrine a neurotransmitter that facilitates alertness, concentration and motivation.

Common Treatment Methods

  • Improving chest mobility

chest mobility

Mobilization and stretching techniques relieves the tight structures of the chest and back, helping your chest to expand.

  • Breathing exercises

diaphragm breathing Practicing diaphragmatic and deep breathing exercises will expand your chest and stretch the muscles of your chest, improving the oxygen uptake and lung function.

  • Foam roller for Myo-fascial Release


Scoliosis can cause chronic muscular strains, most commonly seen as trigger points in the muscles in the back, hips and abdomen. Using the foam roller will help loosen these muscles and potentially increase mobility.

  • Traction Therapy

scoliosis traction

Decompression traction therapy is another method used to treat back problems. This method is often used to treat mild scoliosis by giving the spine a chance to decompress and possibly influence it in the correct manner through stretching, exercises and manual therapy.

  • Correction exercises


Improving the muscle strength (especially in the abdominal muscles) and flexibility in the spine. To correct spinal curvature and stabilize scoliosis angle.

scoliotic curve heel

  • Insole Support

Scoliosis stemming from leg-length discrepancy due to a low arch and excessive inward position of your feet, can be corrected and stabilized using orthotics. Some may need a permanent heel lift due to an anatomical difference in leg length.

When there are differences in the alignment of your hips, you may be advised to use an insole to lift the lower side which will in turn, correct your posture.

  • Kinesio Taping 

RockTapeKinesio taping can be used to correct muscle imbalances and posture. This tape supports the muscles in their optimal length without restricting movements in your joints. It helps to adjust your posture correctly and reduce muscle strain. Due to the tape being an external support structure, it also provides proprioceptive feedback to the body when applied.

  • Forget about a perfectly straight back.

Instead, focus on having a strong healthy spine. It is natural to want a straight spine but opting for treatments that unnaturally forces your spine to be straight might leave you in unnecessary discomfort or pain. Even using braces or surgery have their limitations. A healthy spine would be one where you’re able to move in and out of different positions with ease.

It is still recommended to monitor the scoliosis twice a year with or without treatment.

Watching Out for Functional Scoliosis

Common conditions, Lifestyle, Scoliosis

Scoliotic curve

Have you ever seen it yourself or been told by someone that one of your shoulders is not in line with the other? Most people would have seen it but probably have no idea what it is. The condition is called scoliosis. It causes abnormal curving of the spine making your hips and shoulders appear uneven.


When do experts define scoliosis as functional scoliosis?

Functional scoliosis:

You most commonly see an exaggerated curve of the upper back (thoracic spine towards right or left side) and an excessive curving of the lower back (lumbar spine hyperlordosis).

Functional scoliosis involve compensatory curves which develop due to:

  • Leg-length differences or pelvic tilting
  • Incorrect postural response (muscle imbalance)
  • Transient or temporary, often due to painful response of your back pain

scoliotic spine

Can you get it sorted?

The curve of the spine is a consequence of faulty lifestyle or injury and often can be corrected .The curve does not twist and can be corrected by changing position and postural correction.

Look at your posture in the mirror.

  • Does your head tilt and do not line up over the hips?
  • Do you have protruding a shoulder blade?
  • Is one of your hips or shoulders higher than the other, causing an uneven hem or shirt line?
  • Any uneven neckline?
  • Are you leaning more to one side than the other?

Does scoliosis cause pain? What is so bad about it?

Most scoliosis is painless and more often than not, it goes unnoticed. However, with more advanced curves, pain arises due to other problems.

Common symptoms caused by scoliosis:

  • Excess fatigue – Fatigue is common while sitting or standing for prolonged hours but with the addition of scoliosis, extra strain is put on the body.
  • Poor body mechanics – Shortened muscles on one side of the curve causes spasms, tightness and incorrect movement patterns.
  • Respiratory problems – Restrictive rib structure may cause lung problems due to lack of full expansion of your chest. This may cause difficulty in breathing and the body may have trouble getting enough oxygen in more severe cases.
  • Inflammatory joint conditions – Arthritis is seen in the spine. The joints lose their cartilage that cushion the spinal discs. They get inflamed and bone spurs are formed. If spinal disc presses on the nerves, severe pain can develop which may require immediate medical attention.
  • Disc degeneration and low back pain – Due to degeneration, the disc between the vertebrae may become weakened and rupture. Treatment may involve removal of the old rods and extension of the disc fusion into the lower back.
  • Emotional Effects in Adults – Due to the increase in adults developing scoliosis, there is also an increase in problems of general health. Social, emotional and possibly mental health due to the physical appearance and social stigma of scoliosis.
  • Height loss – Fusion of the spinal disc in severe cases may cause height loss. However, much of the growth takes place in long bones, which are not affected.

How bad it can get?

scoliosis angle measure 

Mild Spinal curves less than 20 degrees is seen in about 80% of people with bad back or uneven hips. Experts recommend that curves beyond 20 degrees should be monitored in the event the condition worsens. These measurements of the length and angle of the curve are usually measured from a recent x-ray for optimum accuracy.

Why did you develop Scoliosis?

Physical stress or injury

Maintaining a wrong posture throughout the day puts an uneven load on the spine causing tight muscles of the body. This muscular changes compresses the joints and can cause injury over time.

exaggerated posture

In such conditions, if you engage in sports like tennis or dragon-boating where often it involves only one side of your body. One side will become overloaded and tend to be dominant. The imbalance causes muscles to be overused and the injury can worsen due to joint stress. The spine will adapt to this new posture as it’ll follow the path of least resistance causing a functional scoliosis to occur.

posture in tennis

Your spinal curves changes when after an extended period, some muscles get tightened and shortened on one side while lengthened and weakened on the other side of your body. This gives an uneven appearance even standing up straight. Problems like lack of muscular control and coordination while engaging in high impact activities may also cause injury and muscle imbalances. Scoliosis is most common among dancers, gymnasts, swimmers and single-handed sports enthusiasts.

Do you have weak bones?

Bone problems can be caused by a lack of estrogen (during menopause), Vitamin D (sunlight), calcium and impact (exercise). These can cause a decline in bone density. Experts recommend measuring bone mineral density and seeking ways to improve your lifestyle to prevent further damage.

Detection and Correction

Early observation and intervention can help correct your curves. Most scoliosis curves are mild and are mainly due to incorrect postural conditions. All you need is a little input on lifestyle changes in order to improve the mobility in your spine and maintain good health.

The truth is, our body has an extraordinary capacity to self-correct and adapt.

Mobility vs Flexibity

Exercise, Geeky stuff, Lifestyle

fexibility vs mobility

As professionals, we deal with a wide range of conditions for joints and soft tissue problems. We all work with different methods, approaches and principles. At the end of the day, the truth is, we are all solution driven and we all work to make lives better.

We often come across with words like mobility and flexibility throughout our education and training. Whether you are a physical therapist, an osteopath, fitness trainer or a massage therapist. From a professional perspective, when we look at problems with movements, we immediately think of all the tight structures that are causing any restriction in the range of motion (ROM).

Now, the big question is – is this lack of ROM a mobility problem or a flexibility problem?

Let’s make this clear so that we can consider what’s contemporary for best clinical practice.

Flexibility – “Oh this looks very tight, let me stretch this for you!” 

We often use the word “flexibility” too quickly because it is a very convenient and quick way to communicate with a novice. When you say that the lack of ROM is because of tightness in the muscles indicating a flexibility issue, it implies that stretching all the tight tissues can fix the problem. However, are we really dealing with the underlying issue here?  What we are doing is not addressing the real problem AND only treating the symptoms. What if there is a misalignment in the joints causing impingement or some sort of joint restriction?

What are we missing?

The term ‘flexibility problem’ for all joint restrictions would actually mean that we are looking at the problem from only one perspective. Thus using the word ‘flexibility’ shows a great lack of understanding of the injury itself.

When injured, why do we get tight muscles and soft tissue structures?

Post-injury your muscles involuntarily contract to safeguard the injured site. Contracted muscles get fatigued causing soreness and pain. They also pull on bones compressing joint structures. So over-tight muscles now cause over-tight joints. Tight joints lead to stiffness and can cause more pain. Long-term compression of these joints leads to cartilage damage and joint restriction in ROM. Therefore, if you are only looking at the flexibility problems of the muscles and have been stretching them, you might be favoring the injury and causing more damage. 

If you have a stone in your shoe and it hurts your feet to walk. No matter how much you stretch your foot, when you place your foot back in the shoe, your muscles will instantly tighten up in response to the pain.

Furthermore, when you have painfully contracted muscles protecting the injured area, you also adapt to different movement patterns. This adaptive pattern of incorrect movements only perpetuates the pain of injury through muscular over-contraction causing an increase in joint restriction.

ROM Restriction is a Stability and Motor Control Problem

Every movement of our body is a functionally skilled movement which is controlled by the neuro-muscular system that co-ordinates your joints and soft tissue structures. Simply put, your ability to actively move a joint through a range of motion is not only dictated by the flexibility of the muscles or the mobility at the joint but also by your central nervous system.

Mobility – “What is the restriction?”

Mobility is a correct and intelligent word used by clinicians. When we use the word ‘mobility’, we give a very holistic approach to the problem addressing the stability and mobility control of the body. We look at all the anatomical structures and physiological processes that are possibly affected in the injury process.

So when we say it’s a mobility problem, we address:

  • Flexibility problems of soft tissue structures.
  • Movement problems of the joint due to its structural changes.
  • Motor control problems of the joint due to behavior or protective responses.

Therefore, it is important to recognize that flexibility is crucial but is only one of the components of mobility. There are three solutions to ROM restriction but if we name it as a flexibility problem then there is by definition only one.

The Mobility Approach

Mobility is influenced by the structure of joint, ligaments, capsule, neurological control, behavior, fascia, pain and/or fluid dynamics. Whereas stretching generally focuses on muscles and to a lesser degree, ligaments and perhaps fascia.

Take your finger and pull it back as far as you can safely go, that is flexibility. Now hold your entire finger and the base near the knuckle and circle it in varying ways, the muscles are not stretched but the finger is still moving.

That is improving its mobility, which can influence synovial fluid and joint health.

In the Mobility approach, you look at,

1. Awareness of existing function or restrictions.

2. Releasing or promoting normal mobility through joint mobilization, education of correct movement patterns, correct stage of stretching depending on needs (dynamic, active, passive or active-assisted).

3. Functional stabilization training – prioritizing correct movements and motor-control.

High Heel Pains – Getting it sorted!

Common conditions, Lifestyle, Pain

painful heel conditions

It’s very tempting to wear that pair of stilettos on party night but going through the same excruciating pain every time you wear high heels could be a sign that you need help. The “long legs” effect is temporal, where the damaging effects of high heels on your back, hips, knees and feet may be long term.

The common complaint is pain. Its source could be from your bones, ligaments, tendons, muscles, fascia, toenail beds, nerves, blood vessels, or even skin.

Considering where the location of your pain and with a thorough assessment of your body, experts can understand and nail the root of your problems.

There are various treatments you may want to consider in favour of high heels. Postural correction exercises, joint mobilisation, stretching and strengthening exercises may prove beneficial for your back, hips, knees and ankles.

Types of treatment:

  • Achilles tendon pain

Applying ice on Achilles’s tendon, massaging your foot will increase blood circulation and reduce swelling especially at the back of your heel or the ball of your foot. Ice pack should be applied for a maximum of 10-15 minutes otherwise the effect will be reversed. Ultrasound therapy can also help enhance the healing process of your inflamed tendon by improving circulation.


  • Joint Mobilization

Mobilizing the joints of your body addresses any limitations in movements. This helps short and tight muscles, soft tissue restriction, joint capsule restriction, motor control problems, joint range of motion dysfunction and nerve-related issues.

Ankle joint mobilization therapy of doctor man to woman

  • Tight Calf muscles

Extended wear of high heels may shorten your calf muscles. Therefore, the best way to address calf tightness is to use a heat pack on your calf muscles to reduce pain, soothe and improve its blood supply. You could also use a foam roller to relieve tightness.

wall stretch

Simple calf stretches against the wall would also help, hold each stretch for at least 30 seconds.

Take the support of the wall, with the leg to be stretched kept straight at the back. Bend the front leg leaning into the wall causing a stretch to the calf muscle of the back leg. Hold position and repeat for at least 3 sets.

  • Orthotics for Arch support and Cushioning

bunion splint

You could see a podiatrist and invest in customised insoles if you have heel pain. Otherwise, off-the-rack silicone metatarsal pads will also help to protect your forefoot. You basically want to provide as much cushion to your feet as possible to reduce and absorb impact.

  • Bunions

Applying a cold compress over the bunions will reduce pain and swelling. Padding over the bunion will help prevent friction. Corrective orthosis footwear will straighten the toe and put it in its correct alignment during recovery.

Toe alignment correction

  • Treat Metatarsalgia

Rest, ice and avoid weight bearing. Ultrasound therapy can be used to reduce pain and enhance healing. Metatarsal mobilisation is also recommended for improving the range of motion. Use metatarsal pads for relief of pain while standing.

metatarsal pads

  • Prevent Haglund’s Deformity (the bumps at the back of heel)

Avoid wearing strappy heels. Soft-backed shoes or going barefoot helps reduce the friction around the area. Use heel pads to cushion the heel or underneath the heel to lift it up and reduce pressure when walking. Applying cold compress, doing calf stretches and trying ultrasound therapy over the Achilles tendon attachment will help.

US for bumps

  • Support your foot with Kinesio taping

Kinesio taping is a technique used to support your foot structures and promote the natural healing process without restricting the joint range of motion. It lifts the skin to help with drainage and prevent circulatory swelling.

high heels KT tape

  • Knee and Back Pain

Pain in the front of the knee and low back pain is common due to postural adjustments caused by high heels. A rest from high heels, pain relief treatments, mobility exercises, stretching and posture correction would be necessary. It is best to get professional advice and assessment of your back and knees to help determine the severity of your pain and its causes.

Although there are several techniques to treat the cause of your pain, prevention is always better than cure. In fact, it’s always good to get your pain managed before it gets disabling and cripples your lifestyle.

High Heels – Your Guide to Making the Right Choices

Common conditions, Lifestyle, Pain

kitten heels

What if experts could tell you that high heels could be safe for your feet. Ever noticed that your friend can wear their 3-inch stiletto heels all day without complains while you can barely walk 3 steps in the same height? Well, it’s not because your colleague has a good pair of shoes. It’s actually because you’re wearing the wrong pair!

Things to look out for when buying heeled shoes

Every person is different with varying shapes and feet sizes, making it difficult for experts to give a specific number for the number of inches you can add to your heels. Here are few recommendations that they give depending on the structure of your feet.

Check your ankle range of motion (ROM)

The ankle joint is formed where your leg bone (Tibia) articulates with one of the foot bone called talus. Below the ankle joint is a small fluid-filled cavity called sinus tarsi. The size of the sinus tarsi  determines how much your ankle can move. If the movement of your ankles are restricted due to lack of flexibility in your ankles or due to small sinus tarsi, then wearing high heels would lead to ankle pain.

sinus tarsi

Test your ROM for high heels

In sitting position, straighten your knees and move your ankle from neutral position downwards to know your range of ankle plantar flexion. This range is from 45-55 degrees normally but may vary from person to person.

Print 18_Estes_Pages

If any high-heeled pair of shoes puts your feet beyond your normal range of ankle plantar flexion, then you will start with pains in your feet, knees, hips or back. A simple way is to look for shoes with a platform wedge in the front so you’ll get your forefoot elevated as well.

wedge platform

Correct Fitting Shoes

The Back of the shoes

Ensure that the heel counter fits you properly and fits well at the back of your heel to prevent your feet from slipping out as you walk.  If there is a gap between your heel and the shoe, friction blisters that may form as a result and could lead to Hagland’s deformity.

loose fit shoes

You may also want to pay special attention to the back of your feet when wearing sling-back shoes. Such shoes may rub against the back of your heels, causing pain and inflammation.

The Front of the Shoes

Proper shoe size is crucial to prevent the tip of your toes from hanging off the shoes in the case of open toe shoes. Notice the shape and the size of the toe box. If it is too big, you risk getting friction blisters from over-clenching your toes in an attempt to prevent it from slipping out of the shoe. This will shorten the soft tissues resulting in hammer toes. Shoes that are too tight or small will also put pressure on your toes and heels, leading to painful hammer toes, corns, and blisters.

hammer toes in shoes

The Shape of your heel

The pointy stiletto heel puts more pressure on the ball of your foot while wedged heels, which are thicker, distributes your body weight over a larger area of your foot.  The wedged heel usually has a skinny center with a slightly wider bottom, providing slightly more stability as compared to the pointy stiletto heel.

wedges or stilettos

Contrary to  popular belief, wedged heels are not stable. There’s little flexibility for your feet and you have to lift your whole foot right off the ground to walk, stomping your foot back down afterward.

The position of the heel is another key indicator. Ideally, it should be located right under the heel bone and not at the back of the foot. You are going to be thrown off balance if the heel is positioned too far back.

Pay attention to the “slope” or “pitch” of the heel. 

high vs low heels

2-3 inch Heels

Whether you are at college or working all day, a 2-3 inch comfortable pair of shoes will be enough to support the movements of your ankle and not place it in a vulnerable state for injuries. Kitten heels shoes will not only save you from foot troubles but it will lend a trendy feminine look with your dress. For most women, the recess of the sinus tarsi is moderate. The 2-3 inch heel will have a gradual slope of about 20-30 degrees plantar flexion, therefore, will be more comfortable.

Above 3 inches

Some 3.5 to 4-inch heels will have a straight drop down to the front portion of the shoe putting increased pressure on the forefeet. That is bad for your feet as it overloads the weight on your toes and balls of your feet. Such heels should be worn only occasionally and are definitely not suited for walking as it’s likely to cause foot problems with prolonged usage.

Arch Support

Those who have noticed their sole lays flat on the ground may have excessive movements in their foot joints. This condition is known as flat feet and wearing high heels may feel comfortable as they put your feet in an arched position. However, it’s best to avoid excessively high heels for unstable joints. Similarly, it’s better for people with stable joints to wear lower heels, as long as they are supportive to their arches.

If you choose the right pair of shoes for your feet, painful foot conditions could be avoided. In fact, you could enjoy wearing your heels all day without any problems. A sound advice would be to also avoid wearing anything too flat or too high for extended hours to prevent any damage to your joints and soft tissue structures.

Head over heels for Stilettos – Is it worth the pain?

Common conditions, Lifestyle, Pain

high heels

Most of us would desire to wear that pair of Louboutin’s or to own a pair from Lady Gaga’s shoe stash. Whether you want to steal a celebrity style secret or wear a pair to match your outfit, there’s no denying that women of all ages love them.

What high heels do 

They change your posture so that your lower back is arched, your pelvis and chest is thrust forward, the buttocks are tightened and the calf muscles firm. This makes you taller, feel slimmer and overall changing your silhouette. With the right pair, it also enhances your authority and presence.

As amazing as it sounds, wearing high heels can be a daily struggle for many women. Wearing the wrong size, shape and fit causes undue stress and pain in your calves, knees and back. Most women are unaware of the amount of stress high heels can place on their body. Back pain, hip pain, knee pain, ankle pain and/or foot pain can all stem from incorrect shoes.

Walking – Correct Pattern of Movements

The pattern of how our body parts move while we walk is called the gait. From the time your heel strikes to the next time the same heel strikes again, there are a series of movements occurring at your hips, knees and feet.


Posture, Centre of Mass and Gravity

Correct posture improves muscular function and brings stability to your moving body. Your stability is also determined by a mid-point in your body that has the most gravitational pull, this shifts according to body movements.

Body Stability
Think of a car as the moving body and the gravitational force acting at its centre. If this car had to tilt sideways, the centre of mass and line of gravity would be shifted to the heavier side, causing an imbalance in forces.
car and gravity.
Wearing High Heels

Your ankle is forced into an unnatural downward position and the body adapts itself to maximise limb stability. Putting you in a highly unstable and vulnerable position to sustain an injury during movements.

When standing straight up without heels, your body creates a 90-degree angle on the floor, which is normal stance. Think of your body being a rigid column, putting on a pair of heels would force your body to tilt forward. The angle between the floor and heel would decrease from 90 degrees to 70 degrees.

angles with floor

However, the body is NOT a rigid column. Our posture adjusts to maintain stability and these adjustments pose greater stress on our back, knee, ankle and foot.

Postural Changes

High heels change the alignment of your spine, hips, knees and ankles pushing your centre of gravity forwards. This causes excessive pressure on the front of your knees.


Muscular Imbalances

Prolong use of high heels can cause excessive shortening of calf muscles resulting in the thickening of the Achilles tendon. Walking around barefoot or in flat shoes may cause pain and discomfort. If you are experiencing this, it may be time to seek treatment before it is too late.

achillis tendonitis

High Heels vs No Heels

During normal stance, body weight is spread evenly from the heel and ball of the foot. So, the center-of-pressure (COP), where the most weight is distributed, is located in the middle of the foot.
When standing in high heels, the shift in angle causes the body’s weight to tilt forward. The center of pressure is shifted to the ball of the foot. 90% of the body weight is now focused on the ball of the foot.
pressure areas

High heels and joint problems

The higher the heel, the greater the stress potentially causing strain, pain and stiffness of the ankle and knee joint structures. It is also been reported that wearing heels more than 3 inches over time puts women more at risk of ankle and knee osteoarthritis. The effect is worsened in overweight cases.

Painful conditions due to High Heels

  • Bunions

Bunion is a condition when your big toe joint begins to lean inwards and becomes enlarged. It is more likely to be triggered by wearing very pointy shoes or  shoes that are too tight on your toes. You start with swelling, redness, tenderness and pain at the base of your great toe even when you’re barefoot. Over time, your big toe deforms and pushes inwards towards the other toes. This changes the normal positioning of your toes, spreading pain in the front of your foot and a loss in foot aesthetic will also occur.

Toe alignment correction

  • Metatarsalgia

This is a symptom caused by excessive stress and inflammation on the front of the foot while standing in high heels. It is felt on the metatarsal heads and pain gradually increases over weeks rather than suddenly. The front area of your foot may also feel tender when you press on it. The pain lasts during weight bearing and depends on the extent of stress on your metatarsals.


  • Hagland’s Deformity

High heels with back straps that are constantly rubbing against the upper part of your heel cause Hagland’s deformity.

You’ll notice:

  • A bump on the back of the heel
  • Pain in the area where the Achilles tendon
  • Swelling and redness in the back of the heel

foot deformity

This will eventually lead to bursitis. A Bursal is a fluid-filled sac that separates tendons from bones. An inflammation of this sac is called bursitis. Bursitis will cause Achilles tendonitis and make the bump even more prominent and painful.

  • Hammer toes

Excessive and prolonged weight and stress deform the toes into a bent position which does not correct even at rest. The muscle and ligament imbalances over the toes cause inflammation and rigidity leading to arthritis.

hammer toes in shoes

Walking on a Marble – Morton’s Neuroma

This condition is caused due to excessive thickening of the tissues around the nerves of your toes. The most frequent location is between the 3rd and 4th (3rd web space) and less commonly in 2nd and 3rd metatarsals (2nd webspace) as the foot is narrower between the third and fourth metatarsals. This means that the nerves that run between these metatarsals are more likely to be compressed and irritated.

You will feel pain worsen when walking barefoot or if the metatarsal heads get squeezed together in your narrow fitted shoes. Pain comes and goes intermittently. You may experience severe pain attacks from two to several times in a week.


Although there are many painful conditions associated with the use of high heels, the demands for it keep increasing because of fashion trends and downright vanity.

It would not be wise to sacrifice fashion for health and comfort. But with every problem, there is always a solution. Wearing just the right height of heels will help ensure good foot placement and minimize injury to your body. If you are a fan of high heels, you may want to seek expert opinion on how to maintain foot health or wear insoles to ensure good arch support and equal weight distribution. The solution may not be a perfect one, but we always aim to create a solution nonetheless. It’s easy to say ‘no, stop doing it’ but why people come to us is as we create imperfect solutions in order to let people keep doing what they love.

Low Back Pain – The Mystery Revealed

Common conditions, Lifestyle, Pain

low back pain

It’s fascinating how our bodies are unique. In this diverse life on earth, humans fall into the category of “vertebrates”, simply put – the one with a backbone. Our spine is made up of 24 moveable bones called vertebrae. Each vertebra stack over another at the facet joints to form your spinal column which ends on your sacrum (tail bone).


Spinal Column

The spine is divided into three segments:

  • Cervical (Neck) – 7 Cervical vertebrae
  • Thoracic (Upper and mid-back) – 12 Thoracic vertebrae
  • Lumbar (Low back) – 5 Lumbar vertebrae

The inward curve of your lower back is called lordosis which is unique to the human spine and helps us stand straight. The other slight upward curve of your upper back is called kyphosis. The reason why you have an “S” shaped spine with these natural curves is to prevent excessive stress on one particular spine segment. It provides the right balance and distributes any mechanical stresses imposed on your body during sitting, standing, running, lifting and other daily activities.

Vertebral sandwiches 

Between two vertebrae lies a fluid-filled cushion called spinal disc. Its function is to prevent the bones from rubbing against each other. All the discs of your vertebrae have a spring-like effect and are great shock-absorbers due to its gel-like elastic texture.

Disc problem

Connections – Spinal cord and Nerves

Your brain continues down as the spinal cord which runs through your spine within a canal formed by all vertebrae.  Several nerve roots branch out next to the discs from your spine and supply signals to the arm, trunk, and leg muscles for movement. These nerves are the connections our brain makes with all the structures of our body.

3d rendered illustration of the male nerve system

Ouch! My back hurts

This is the problem. We are aware of the fact that our bodies can adapt and heal itself. Yet, we often fail to listen to our body and push ourselves beyond our body’s tolerance capacity. We start with aches and pains, realizing when it’s too late that there’s something much worse happening. This may sound harsh, but you may be giving yourself back pain by not listening to your body.

What’s happening to your back?


How much weight can your spine take? Do you really know your spine’s load bearing capacity?

Loss of Spinal Bracing

When you engage in an activity, all the supporting structures of your spine like the ligaments of your spine, back muscles and abdominal tighten to brace your spine. In order to maintain strong spinal support, soft tissue needs to maintain their optimal length. When muscles and ligaments shorten or lengthen beyond their optimal length, they lose their capacity to brace the spine imposing greater stresses. This results in a shear force on the spine which may cause discs to pop.

Excessive effort for Strenuous activity

When lifting, the heavier the load and the further away the weight is placed from your body, more effort is imposed on your back muscles increasing mechanical stress to your spine.

incorrect lifting

Curve gone wrong

The soft “S” shaped curve of your spine is lost. Poor postural alignment can severely affect the lower lumbar curve. The curve could either get exaggerated or flat. exaggerated posture

The position of your pelvis, your hips and the muscles around them play a major role in maintaining a normal low back curve.

Disc problems

Injury to your spinal discs is one of the most common reasons why you have low back pain. Faulty exercise methods, high impact sports activities, lifting heavy weights or even sleeping incorrectly could predispose great amount of stress on your spine. The disc injury could be of various types and degrees that could affect the spinal cord and compress the nerve roots causing pain to be felt immediately in your back or down the back of your legs.

disc problems

Think of a normal burger with all its contents perfectly fitted within the bun. Now imagine pressing onto it causing all its contents to bulge out.

disc bulge

Lack of Nutrition

Weak bones

The load bearing capacity of your spine also depends on the amount of bone mineral content.  The risk of injury is expected to be more among people with low bone density. Lack of vitamin D (sunlight), calcium and other minerals are reported to be less in women than men, thus putting women more at risk of back injury than men if proper care is not taken.

Disc Dehydration

The disc as previously discussed is a fluid-filled gel-like cushion structure between each vertebra. The outer part of the disc is gelatinous and the inner part of the disc is filled with water. During the day, as you engage in various activities, water is slowly squeezed out of the disks. This loss of water is then recovered by your spine by successfully re-hydrating your discs while you sleep. When you are dehydrated and your discs are unable to re-hydrate, they become rigid and lose their capacity to absorb shock thus leading to disc degeneration and back pain.

Protect your Back

Although there are several treatment methods used by clinicians, identifying the source of your back pain at an early stage and taking appropriate precautions is the best solution. You may want to consider getting your spine assessed by an expert and if necessary get early treatments. We always believe it is better to be preventive than reactive!

Run safe, run right.

Exercise, Lifestyle

Runners Knee

No matter what body type you are or the level of activity you do, a good run does wonders. Most of us run for fitness, fun, stress relief or even for a living.

Even the world’s fastest runner, Usain Bolt, will not deny the fact that running is a high impact aerobic exercise and many injuries could be associated with it. Simply put, it is not uncommon for some to experience some sort of aches and pains in your knee after running.

One of the most common knee injury affecting people is “Runner’s Knee”. Though this condition is associated with running, even normal people who engage in knee workouts could be affected by it.

Runner’s Knee- the Mystery behind it

“Runner’s knee” is a term used to describe pain and inflammation in the front of the knee due to several factors. It is mostly believed to be a fault in the biomechanics of your body during the running process.

Runners Knee-osteopathy

Biomechanics of running

Biomechanics is the study of the structure and function of body systems when forces are applied.

In simple words, when you run, the foot impact creates a force that transfers upwards to your knees. The force meant to propel you forward is about 2 to 3 times your body weight. To prevent this force from directly impacting your knees, correct posture and placement of your foot is required. Together with coordinated contraction of your leg muscles to balance out these forces.

good run

Injury and pain are believed to occur if there is:

  • Muscular imbalances, tightness and stiffness around the knee.
  • Malalignment of your joints affecting the correct heel placement. For example, poor posture or runners with flat or high-arch feet.
  • Over- activity and weakness in the leg muscles.

How to run safely?

Experts researching on Cheetahs are amazed at their genetics and want to pass along few tips that you could implement.

Cheetah so fast

Tips for humans

Get Good Shoes

Many shoe manufacturers have realized the importance of shoes for performance and have responded by giving us a range of options.

Important things you want to look for:

  • Light weight shoes for swift movements
  • Correct fit – snug and supportive
  • Good arch support

Always Warm-up and Cool-down

Warm-up exercises will prepare the circulatory and respiratory system for the upcoming workout. It also improves the flexibility of your muscles whether it’s just walking or running. On the other hand, cool down exercises help you to gradually lower your heart rate and blood pressure as well as restore the flexibility of your muscles. By skipping them may cause muscle aches and pains after the run.

Maintain the flexibility in your joints, tendons, ligaments and muscles

You want to avoid any restrictions on your movement while running. Improve the range of motion of all the joints and reduce the risk of any muscle strains.

Correct your posture

Poor posture creates imbalances in your muscles and restricts the circulation of blood to them. Over time, it may reduce the oxygen supply which may affect overall health. Therefore, posture is one of the things we try to correct as much as possible.

Prevent Over-striding and Under-striding

Normally you should land with your feet right under you. Over- striding is increasing your stride length over your normal capacity while under-striding is the exact opposite. This happens when you are not bending your knees enough maybe due to tightness in your muscles, joint stiffness and/or poor circulation in your legs.

Watch your Strides- Cadence

Moving with long steps while you run is great! But you may want to consider the number of strides to be maintained about 85-90 per minute with each leg. You could use a digital metronome to record and regulate your strides.

Listen to your body

It will truly help you recognize any restrictions, tightness, faults in your posture that need fixing.

Enrich your brain

You will be amazed how your body adapts to what your brain knows. You can control your body movements and speed just by learning the correct body postures and foot placements.

Maintain good upper and lower body coordination

Muscles work together to cause a movement and running involves co-ordination of your upper and lower limb muscle groups. Any fault in this co-ordination will impose great stress and cause muscle imbalances.

Breathe well

Running being a high impact aerobic exercise requires a great amount of oxygen supply to your muscles to produce energy.

Simple Exercise:

“Diaphragmatic Breathing or Belly breathing”- Breathe deep from your belly, see your stomach rise out as your diaphragm contracts. Practice this technique at rest or while running, it will surely help!


Every person is unique and we need to look at what our body requires. Whether it is tight muscles or faulty posture, you need to fix it before its too late. A safe run is what you want without worrying about injuries, you may want to consider meeting the experts to get a detailed assessment of your body before starting any physical activity.