20110802 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, AUGUST 2, 2011

HEALTH POST A NOVEL WAY TO TREAT ACHES AND PAINS >PAGE 8 EIGHT GYM MOVES THAT COULD HURT

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Hypnotism has emerged from the arcane into the mainstream of health care

Spin doctors

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2 NEWS HEALTH BITES .........................

Don’t drink the water Researchers in Spain have found potentially harmful haloacetic acids (HAAs) in the urine of swimmers within 30 minutes after exposure to chlorinated water, where the acids form as a byproduct of that water disinfection method. Elevated levels of HAAs in municipal drinking water supplies have shown a possible link to birth defects and a higher incidence of some cancers. Pool water may contain higher levels of HAAs due to longer exposure to chlorine. In the study, 49 volunteers who swam in or worked around an indoor and outdoor pool each had their urine tested. Results showed that HAAs appeared 2030 minutes after exposure and were eliminated from the body within three hours. Over 90 per cent of the exposures probably occurred as a result of swallowing pool water.

Jeanette Wang jeanette.wang@scmp.com

A killer decoded It took years to sequence the genomic code of the first E coli bacterium more than a decade ago. But technological advancements and international collaboration have helped researchers take just months to unravel that of the E coli bacterium that caused the ongoing deadly outbreak in Germany, which began in May. Scientists found that the outbreak strain was an unusual combination of enteroaggregative (diarrhoea-causing) and more dangerous and infectious enterohaemorrhagic E coli. The strain also carried a unique set of virulence and antibiotic-resistant factors. The paper, published last week in The New England Journal of Medicine, was done by a team led by University of Maryland School of Medicine Institute for Genome Sciences researchers. “I expect we will see more collaborations like this to deal with new emerging pathogens in the future,” says Dr David Rasko, assistant professor of microbiology and immunology at the university.

Total recall Memory problems due to age might be reversible, say Yale University researchers in a report published last week in the journal Nature.

Through tests on animals, they’ve found that certain compounds – such as one used in a medication for high blood pressure in adults – helped improve neuronal firing rates in the prefrontal cortex. This area of the brain is responsible for higher cognitive and executive functions, including working memory, which enables information recall, such as where you left your car keys. As one ages, the neural networks in this area weaken and fire less strongly. However, researchers note that studies involving animals often fail to produce similar results or benefits in humans.

Noses out of joint Researchers in Belgium have found that about one in three people who want a nose job also have moderate to severe symptoms of BDD, or body dysmorphic disorder. BDD is a mental condition in which excessive concern about imagined or minor defects in appearance interferes with daily life, including relationships and esteem.

Over 16 months, a team from University Hospitals Leuven surveyed 266 patients seeking nose jobs. Just 2 per cent of those who needed work done for strictly medical reasons had BDD symptoms, compared with 43 per cent who said their sole purpose was aesthetics.

Researchers noted that most patients with serious concerns about their appearance had a nose that would actually be considered normal in size and shape.

Watch your mouth That visit to the dentist could do more than perfect your pearly whites.

Researchers from Columbia University College of Dental Medicine in New York City say dental check-ups are a way to help spot undiagnosed diabetes or identify people with pre-diabetes.

“Periodontal disease is an early complication of diabetes,” the study’s senior author, Dr Ira Lamster, dean of the College of Dental Medicine, says.

In the study of about 600 people, counting just the number of missing teeth and the percentage of deep periodontal pockets could be effective in identifying people with unrecognised pre-diabetes or diabetes.

APP OF THE WEEK

Works like a dream to guide listeners into the land of nod ......................................................

Katie McGregor healthpost@scmp.com Relax & Rest Guided Meditations US$0.99 Rating 10/10 The busy mind is every insomniac’s worst enemy, but as the voiceover for this app lets you know: “You can still be deeply rested even with the mind chattering. Don’t mind it, don’t try to stop it. Let it go.”

I downloaded this app to relax, but also to stop the occasional 3am sheep counting and clock watching. It worked like a dream on the very first try. The next thing I knew, the morning alarm was sounding, and I had earphones caught in my hair.

The meditative state is also extremely rejuvenating, without the need for sleep. Meditation has been shown to benefit physiologically by lowering blood pressure, physically by increasing vitality, and spiritually by increased compassion.

The app is one of many designed and produced by Meditation Oasis, a husband and wife team. Mary Maddux has the gentle, soothing voice, and Richard creates the deeply relaxing music.

They bring more than 30 years of meditation practice and teaching to their apps, as well as the podcasts available on their site.

Relax & Rest offers three lengths of guided meditation: a short, fiveminute pick-me-up, a 13-minute deep rest meditation and a 24-

The iPhone app by Meditation Oasis

minute whole-body relaxation. As a sign of their effectiveness, I cannot tell you what happens in the last half of the 24-minute option.

You can choose to be guided by voice only, voice with music or with three choices of sounds of nature.

You can also adjust the relative volumes of the background music or sounds and the guiding voice.

While Mary’s voice is perfect for the job, Richard’s simple music is the ideal complement, with the right timbre and pace. Even the nature sounds aren’t as frenzied as usually found in other apps.

If you haven’t meditated before, or undergone simple yoga relaxation, you shouldn’t worry about what to do. As Mary says: “Relaxation isn’t something you can do. It’s about letting go of

doing.” You simply make your choices as above and then get comfortable.

Mary starts by assuring us not to worry about the mind’s business, but to shut our eyes and start focusing on our breath. Her gently spoken words come intermittently, instructing us to let go of thoughts, feel our breath and relax the shoulders, the jaw, let the belly soften …

> CONTACT US Culture Editor: Janelle Carrigan janelle.carrigan@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com Advertising: tel: 2565 2435; advertising@scmp.com

MEDICAL 3 CASE HISTORY

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Sasha Gonzales healthpost@scmp.com In June 2009, Alanna Wong went to sleep and didn’t wake up until February of last year.

For eight months, she spent 14 to 16 hours a day in bed, breaking her slumber only to eat and use the bathroom. When she wasn’t asleep, Wong remembers feeling like she was in a dream. “Nothing seemed real,” she says, and her brain “felt foggy”. When she eventually woke up at the end of winter, she felt like her old self again – vibrant, alert and full of energy. “It was hell,” she recalls of her sleeping spell. “I was basically very sick.”

Wong, now 22, suffers from Kleine-Levin syndrome (KLS), a neurological disorder so rare that only 500 people in the world are believed to have it. Also known as sleeping beauty syndrome, the illness is characterised by recurrent hypersomnia, or severe bouts of excessive sleepiness.

According to sleep specialist Dr Nathaniel Watson, associate professor of neurology at the University of Washington and co-director of the University of Washington Sleep Institute – KLS is also marked by several other symptoms, including cognitive disturbances, behavioural problems such as binge eating and hyper-sexuality. The disorder typically begins in adolescence or young adulthood and, in many cases, lasts eight to 12 years.

KLS sufferers experience episodes where some or all of the symptoms are present. These episodes may continue for days, weeks, months or even years before disappearing, only to come back again – but no one can predict when.

Wong’s symptoms began when she was 10. Her parents noticed that she was sleeping a lot and eating more than usual. A mild-mannered and cheerful girl, she became temperamental and moody. She also had trouble understanding what was being taught in school, which caused her grades to plunge.

Her altered sleeping pattern, unusual behaviour and cognitive difficulties would last a few days or weeks, after which she would revert to her normal self again. Often,

when she came out of it, she would have little or no memory of how she felt or behaved during an episode.

As the years progressed, the episodes got longer, and the symptoms became more severe with each episode.

Wong’s parents had no idea what was wrong with their daughter. For a while, they assumed she was just going through some teenage angst, but when her behaviour got out of hand in her mid-teens, they sent her to the doctor. Many months and specialists later, they still had no reasonable explanation for the change in their little girl’s behaviour and mood. They were told that Wong might have schizophrenia or manic depression.

When she was 18 years old, Wong was finally diagnosed with KLS. A magnetic resonance perfusion test, taken during an episode, showed reduced blood flow to one side of her thalamus – the part of the brain that regulates sleep, appetite and mood.

The diagnosis gave Wong and her family some relief, but then they were told that KLS has no known cause or cure. According to Watson, the illness is also difficult to diagnose, and is in fact commonly misdiagnosed as depression with psychotic features, schizophrenia or bipolar disorder.

KLS is an orphan disease, which may contribute to the fact that it is not particularly treatable – because it is so rare, pharmaceutical companies aren’t willing to spend millions developing drugs to manage it, says Watson.

Lithium, however, has been shown to reduce the severity of episodes, and stimulants are often prescribed for sleepiness, but such medications can trigger the other symptoms. “One way we help our patients get through the disorder is to educate them about it. We also reassure them they might eventually outgrow the illness,” he says.

KLS is not fatal, but it does present a range of complications.

“It is a socially devastating disorder,” Watson points out. “The excessive sleeping and other symptoms limit the patient’s ability to go to school or work. Second, KLS sufferers are often unable to

Illustration: Angela Ho

When slumbers never cease

take care of themselves while in an episode. The constant bingeing can also lead to obesity.”

Before she knew she had KLS, Wong and her family struggled to understand what was wrong with her. But even after her diagnosis, Wong says finding information about KLS was tough. Most people she knew hadn’t even heard of the disorder.

“Educating people is key to raising awareness of KLS,” says

Kleine-Levin syndrome, or sleeping beauty syndrome, is so rare only 500 people are believed to have it

refreshed after sleep). Sometimes insomnia occurs along with another medical, psychiatric or psychological condition.

Simply changing your lifestyle or sleeping environment might do a lot to help improve your sleep. You can establish a relaxing bedtime routine, like taking a warm bath, reading a good book or listening to relaxing music before bed.

You can also try abdominal breathing exercises for 15 to 20 minutes beforehand. Lie on your

back with both hands placed comfortably on your tummy. Begin to follow your breath. Notice the sensations as you take a breath of air through your nose, inhale it through your throat and into your lungs.

Notice the sensations as the lungs and abdomen expand. Hold the breath for a moment and notice how that feels. Then exhale slowly and completely, through the mouth, and notice the release of tension in the lungs and rib cage. Pause briefly again before taking the next breath.

Watson. “If we educate doctors and the public, there will be less confusion about the symptoms.”

Wong’s episodes are no longer as lengthy or severe, and her parents hope that this is a sign that the disorder is finally leaving her.

She plans to dedicate the rest of her life to spreading global awareness of KLS and helping other sufferers cope with the dreaded illness, and she is working on several projects to help her realise these dreams.

ASK THE DOCTORS DR JENNY TSANG Q: Do you have any relaxation techniques for combating insomnia?

I have been having trouble falling asleep. Even if I do, I often wake up at 3.30am for no reason. I am unable to fall asleep again.

A: Insomnia is a medical condition when a person experiences any of the following: difficulty falling asleep, difficulty staying asleep (trouble going back to sleep after awakening), waking up too early or poor quality of sleep (not feeling

Now just allow your breathing to be natural. Focus your attention on the subtle sensations of breathing.

Imagine that you are sending warm, healing energy to every cell in your body with every breath you take.

Finally, avoid coffee, tea, chocolate and caffeinated sodas late in the day. Do not use alcohol to fall asleep. Research shows it results in a poor quality of sleep and waking up.

Dr Jenny Tsang, a specialist in psychiatry, is on the Health Post advisory panel

4 COVER STORY

An open Hypnotherapy, once perceived to be the domain of charlatans, has established itself as a credible and efficacious option in mainstream health care, writes Katie McGregor

W

ith celebrity hypnotists taking their shows to Las Vegas, it puts the practice on a par with sawing ladies in half and other magician’s tricks. But as far back as 1955, the British Medical Association recognised hypnotism as being of value, or even “the treatment of choice”, for “so-called psychosomatic disorders and psychoneurosis”. It could be used, the association claimed, for pain relief in surgical and even dental operations.

Scepticism has perhaps fuelled much research on the matter and, in 2001, the British Psychological Society commissioned a panel to do a research review. In their report, The Nature of Hypnosis, the panel concluded that enough studies had shown that the inclusion of hypnotic procedures may be beneficial in the management and treatment of a wide range of conditions and problems encountered in the practice of medicine, psychiatry and psychotherapy. It also warned that in forensic investigation, hypnosis may result in false memories and misplaced confidence in recall, indicating that indeed the hypnotised mind is open to suggestion.

In Hong Kong, Dr Lien Zun Rene Pius, president of Hong Kong Guild of Hypnotherapists and Psychotherapists, says hypnotherapy is more widely accepted than it was five or six years ago. “People are more positive and open to the idea of hypnosis as there is more information in the media, and the internet helps a lot as well,” Lien says. “In the past, people saw hypnosis as the last resort, but now they make it their first or second choice when seeking a solution to these problems.”

In 2005, there were about 30 hypnotherapists practising full time in Hong Kong. Today there are just over 100 practitioners registered with the guild. Hypnotherapist Fiona McKeand believes the increased competition is good as it makes hypnotherapy more mainstream.

“You treat someone once or twice and they are cured,” says hypnotherapist Julien Willm, who practises at Dr Susan Jamieson & Holistic Central Medical Practice.

“But quite often, the problem is a little embarrassing so people won’t broadcast their cure.”

One of the less “personal” problems frequently treated is smoking. One of Willm’s patients, a banker who has been smoke-free for nine months, says: “I had tried to stop smoking on numerous occasions and it took two recommendations by friends for me to try hypnotherapy. I was very

COVER STORY 5

mind cynical and expected a swinging watch and that kind of hocus pocus.

But it was quite a sensible session and my opinion changed straight away. It’s not a miracle cure but it greatly increased my willpower, and the results speak for themselves. I certainly have an increased respect for the power of the subconscious.”

This patient, whose name has been withheld for patient confidentiality reasons, was so impressed with the results that he also sought Willm’s help for public speaking anxiety. Again, it was a success.

Other behavioural conditions that are treated successfully with hypnotherapy include claustrophobia and other fears, weight management, stress and anxiety, insomnia and issues with self-confidence.

The emphasis of hypnotherapy should be on “therapy”, says Dr Melanie Bryan, a clinical psychologist who uses hypnosis as part of her practice at Mind Matters.

“Hypnosis is an excellent tool, but it’s not a treatment and it shouldn’t exist outside of therapy. You can’t just go on a weekend course and then mess around with people’s minds. You need to find out the reasons behind the behaviour before being able to make effective suggestions to the patient’s subconscious.” Apart from the typical behavioural problems, she also specialises in relationship counselling using hypnosis.

A therapist might ask the patient while in hypnosis to imagine the control room of the brain where they can dial down the pain FIONA MCKEAND, HYPNOTHERAPIST

While the efficacy of hypnotherapy does depend on a patient’s suggestibility or willingness, the experience of the therapist is clearly important. In Hong Kong, the guild awards members “letters” indicating their level of experience. The basic level, “licenciate”, would be competent to deal with difficulties like exam fears and smoking cessation. At the top end of the scale are those trained in psychotherapy, who could deal with more complex issues.

But the brain not only governs behaviour, it is also where the pain stimulus is “felt” or processed.

Recent studies have shown that when there is a pain stimulus,

receptors are triggered in different parts of the brain including the area that processes our emotions, giving rise to a new understanding about the subjective nature of pain.

Hypnotherapy is credited with helping patients not only manage pain relief, but also manage the stress that is either caused by pain or by the anticipation of pain.

McKeand explains some of the techniques used to manage pain: “A therapist might ask the patient while in hypnosis to imagine the control room of the brain where they can dial down the pain, or imagining pain as a block of ice that fades in colour and melts away. The subconscious mind believes what you tell it, particularly if that suggestion is repeated.” These techniques also work for tuning down cravings or anxiety.

Willm coached his wife through labour using hypnotherapy. He says: “My wife is terrified of all things medical and although in the end she needed an epidural for an emergency Caesarean section, she sailed through the whole process with a smile on her face.”

Hypnotherapy helps patients better tolerate treatments where pharmaceutical pain relief is not always appropriate, or to help reduce the dosage of pain-relief drugs during a procedure. This includes helping cancer patients endure their radiotherapy or chemotherapy, and helping child burn victims cope with the stress of wound cleaning during the healing period. “Stress amplifies the pain,” says McKeand.

Hypnotherapy can also reduce or prevent flare-ups of diseases or situations thought to be worsened by stress, such as inflammatory bowel disease. In the United States, clinical health psychologist Laurie Keefer, associate professor of medicine and director of the centre for psychosocial research in gastroenterology at Northwestern University in Chicago, says: “We know from our recent research … that hypnotherapy, in combination with quality medical care, could significantly improve outcomes in inflammatory bowel disease.

“There is evidence from other chronic diseases including cancer, HIV/Aids, irritable bowel syndrome, and chronic pain that hypnotherapy can have an immediate and positive impact on pain reduction, immune function and possibly inflammatory cytokine secretion, wound healing, recovery time after surgery, gut motility and stress.

“Our research suggests that hypnosis boosts self-efficacy, meaning that patients feel more in control of their disease and are in turn more proactive around managing it.” healthpost@scmp.com

THERAPY HELPS SCEPTIC OVERCOME FEAR OF HEIGHTS The US National Institutes of Health describes hypnosis as a state of mind in which the individual is highly focused, relatively unaware of his or her surroundings, and possibly more able to accept and use therapeutic suggestions. People vary in their responsiveness, or susceptibility, while under hypnosis.

Guiding a client into hypnosis is known in the trade as induction and, hypnotherapists agree, it’s easy to do with a bit of training.

The most commonly used method is to simply relax the patient through progressive muscle relaxation, suggesting images, and generally distracting the busy conscious mind until, as hypnotherapist Fiona McKeand describes it, “the face

slackens and the patient gets a ‘look’.

Sometimes it’s necessary to give the conscious mind something to do if it is too busy,” she says. Such tasks might include counting down or eye fixation techniques such as watching a pendulum.

I tried a hypnotherapy session with Julien Willm to confront my fear of heights. Although my research had made me less sceptical, I was still worried that I wouldn’t be able to relax enough and have to fake a hypnotic state so as not to embarrass my therapist.

However, Willm assured me I could do no wrong since there was nothing for me to do. He said that I might hear everything he said or just a background burbling. He explained

that in fact the hardest people to hypnotise were those who were exhausted or taking medication, as they might simply fall asleep.

I lay down and relaxed. I think I heard much of what Willm said to me but I can’t really remember. Being hypnotised is just part of the session.

A therapist will discuss your issues with you beforehand so that he or she can work out how best to talk to your subconscious.

A day later I tested Willm’s work.

Pacific Place’s upper-level glass barriers have always been a problem for me. If I walked too close to the edge my stomach lurched, I’d get light-headed and feel as if I might suddenly flip over the edge. This time, I felt nothing. Katie McGregor

6 HEALTH

Breast practices A campaign seeks more support for mothers who nurse their babies, but Hong Kong’s involvement lags behind, writes Jeanette Wang

W

hen Simmy Li, 31, returned to work from maternity leave at the end of April she was given a welcome-back gift of dreams.

Her bosses at the Hong Kong Committee for Unicef, elated with the first birth in the office in some 20 years, had converted a toilet – about the length and width of a car – into a nursing room. It was furnished with a fridge, air purifier, electric outlet, a table and a chair.

Basic it may be, but for Li, a new mother who has chosen to breastfeed her child, there is nothing like a designated clean and private area in the workplace for expressing breast milk in peace.

Under the Baby Friendly Hospital Initiative (BFHI), launched here in 1992, the Hong Kong Committee for Unicef hopes more employers of all industries will follow suit and provide such facilities in workplaces. In line with World Breastfeeding Week, which ends this Sunday, the committee is emphasising the point.

“You don’t need a luxurious space; you’re talking about a very small but clean and relaxing environment,” says Irene Chan, chief executive of the committee.

“It’s really about the readiness to plan and help.”

Unicef’s nursing room in its Blue Pool Road office cost only HK$2,500 to set up. The money, however, goes a long way in promoting the health of both mother and baby.

Breastfeeding is one of the most effective ways to ensure child health and survival, according to the World Health Organisation (WHO).

Babies who are not breastfed are more likely to have gastroenteritis, chest infections and “a whole lot of health issues”, says Dr Patricia Ip, BFHI chairwoman.

The WHO recommends exclusive breastfeeding for babies until the age of six months and continued breastfeeding, with appropriate complementary foods, for children aged two or beyond.

In a study by University of Hong Kong researchers published last year in BioMed Central Pregnancy and Childbirth, it was found that few mothers in the city breastfed exclusively, and most of those who did stopped within three months.

Caden, who turned six months old last week, has been exclusively breastfed by Li and has not fallen ill since birth. Every day, Li spends about 30 minutes to 45 minutes in

Simmy Li advises employees returning from maternity leave to speak up and let management know their needs as nursing mothers.

Photo: Nora Tam

If employers provide the facilities and encouragement, the retention rate of working mothers will be much higher IRENE CHAN, HK COMMITTEE FOR UNICEF

the nursing room to express her milk. “I’ve decided to breastfeed my child for as long as I can,” says Li, an assistant manager.

Breastfeeding rates have been low in Hong Kong in the past, but Ip says they are rising. About 20 years ago, statistics collected

by BFHI found that roughly two out of 10 mothers leaving the hospital intended to breastfeed their child.

Now seven to eight out of 10 mothers intend to do it.

Furthermore, Ip says about half of Hong Kong mothers return to work after childbirth, hence the importance of supporting breastfeeding at workplaces.

Chan says employers should also have a policy that allows for nursing breaks.

Under the International Labour

Organisation’s (ILO) Convention No 183: “A woman shall be provided with the right to one or more daily breaks or a daily reduction of hours of work to breastfeed her child.”

The number and duration of these interruptions is up to national laws and regulations – but should be counted as working time and remunerated accordingly.

According to the ILO’s report Maternity at Work: a review of national legislation published last year, at least 92 countries have laws providing for breastfeeding and regular breaks for mothers.

However, a check with the Hong Kong Labour Department’s Employment Ordinance online found no mention of breastfeeding under the chapter on Maternity Protection.

“If employers provide the facilities and encouragement, the retention rate of working mothers will be much higher,” says Chan.

The rate of absenteeism will also drop, says Ip. “Most of the time it isn’t the mother who is taking sick leave [for herself], but ... to look after a sick child.”

Li advises employees returning from maternity leave to speak up and let management know their needs. Ask, she tells them, and you’ll be likelier to receive. jeannette.wang@scmp.com

WHY IT’S THE NATURAL CHOICE It’s crucial to a child’s long-term health Professor Ellis Hon Kam-lun of Chinese University’s department of paediatrics says: “Breastfeeding provides a foundation towards good health.” His research shows that formula-fed babies have a higher risk of contracting diseases and suffering obesity. “Breastfed babies have reduced rates of sudden infant death syndrome during childhood, and cardiovascular disease and diabetes when aged,” he says. Those breastfed perform better in intelligence tests, too.

Breast milk is better than formula University of Virginia researchers found strong evidence that breast milk, with natural enzymes, reduces the incidence of a wide range of diseases. “Breast milk supports the baby’s immunity and provides the perfect balance of nutrients,” says Fern Hauck, associate professor of family medicine and public health sciences. Valerie Wiens, a leader from La Leche League, a non-profit body that promotes breastfeeding, adds: “Antibodies are not found in formula and therefore don’t offer the natural nutrient profile to support a growing baby.”

Breast milk is a complete meal Packed with proteins, fats and vitamins, a single serving of breast milk provides a baby’s necessary nutrients. The protein lysozyme protects against E Coli and salmonella, promotes the growth of healthy intestinal flora, and has antiinflammatory functions. Sarah Hung from La Leche League says: “A baby starting on solids is likely exposed to pathogens. Since breast milk changes with the baby’s growth, the body builds up a natural defence against disease.”

It’s good for mum too Breastfeeding could help with post-pregnancy weight loss, as it uses about 500 calories a day, says Hung. Health conditions such as breast and ovarian cancer, type-2 diabetes, obesity and postnatal depression are less common in women who have breastfed. Besides, breast milk is readily available and affordable.

Michelle Tchea, healthpost@scmp.com

8 HEALTH

Get to the point There are few myotherapists in Hong Kong but plenty of people who could benefit from the treatment, writes Suzanne Harrison

R

ecreational golfer James Lim had tried many different forms of therapy over a six-month period to fix his frozen shoulder. Then he gave myotherapy a go, and was soon back in the swing of things.

“We set a treatment plan and it took a little time to gain full function, but I was playing golf within a month,” says Lim, a property consultant in his mid-50s.

The term “myotherapy” references myo – Latin for “muscle” – and “fascia”, which are thin, fibrous sheets of connective tissue that cover muscles. It’s a form of physical therapy used to treat or prevent soft tissue pain and restricted joint movement caused by muscle fascia dysfunction.

Relatively well-established in the US and Australia, it falls under the umbrella of massage therapy, which is considered complementary and alternative medicine. Although relatively unknown in Hong Kong compared to popular treatments such as physiotherapy and

osteopathy, awareness of myotherapy is growing.

When Liam Fitzpatrick, a physiotherapist and myotherapist trained at Australia’s Royal Melbourne Institute of Technology, moved to Hong Kong in 2004, he was consulting about 20 to 25 patients a week – 15 for golf training and about five to 10 for myotherapy.

These days, about 90 per cent of the some 30 patients he sees a week are specifically for treatment, he says.

Fitzpatrick, director of MyoActive Back and Sport Injury Clinic in Central, believes many professionals are high-functioning

Myotherapy stems from trigger point therapy, pioneered in the early 1940s by the late Dr Janet Travell

type-A personalities who ask a lot of their bodies and therefore suffer overuse injuries and poor musculoskeletal habits.

“Myotherapy addresses this lifestyle exceptionally well, through its clinical assessment and focus on softtissue retraining,” he says.

Myotherapy stems from trigger point therapy, pioneered in the early 1940s by the late Dr Janet Travell, who used the technique to treat late president John F. Kennedy’s bad back.

Trigger points are the most tender points in a taut band of muscle fibres, and can cause pain and strain in the muscle. The pain from a point may travel a long distance; pressing on a trigger point in the calf, for example, can reproduce pain and tenderness in the lower back. By deactivating the

trigger points, Travell often found the pain vanished immediately.

In 1976, Bonnie Prudden, a US fitness expert, began to theorise that trigger points could be released by applying manual pressure to the muscle for several seconds with the fingers, knuckles and elbows. She reported that many patients saw big and fast improvements. Over 10 years, she gradually developed the system now known as myotherapy.

Myotherapy uses other techniques including massage, passive stretching, hot or cold therapy, myofascial dry needling (acupuncture) and transcutaneous electrical nerve-stimulation therapy. The goal is to avoid future problems by retraining muscles that have been under- or overfunctioning.

Katie Palmer, a myotherapist at Physio-Central who also trained at RMIT, says the most common problems she sees are sports injuries, in particular those of the shoulder or elbow, as well as problems with the jaw, head and neck region, and back pain.

Other problems that myotherapists can treat, says Fitzpatrick, include oedema (swelling of the feet, especially during pregnancy), stiffness and pain associated with poor posture, headaches and migraines, tennis elbow, arthritis, knee, foot and leg pain, shoulder pains, and chronic fatigue syndrome.

Abby Yek Cheung, a physiotherapist at PhysioMotion in Central, says myotherapists play an important dual role with a physio in rehabilitating a patient.

“As physiotherapists, we do a lot of joint and muscle work ourselves, but if we feel the problem is predominantly muscular, we will refer the patient to a myotherapist to rehab them quicker,” she says.

She believes myotherapy can be effective, and that those who practise in Hong Kong have a good reputation among physiotherapists.

Lim, back on the fairway, seconds that. He says: “I was happy with the myotherapy approach and recommend it.” healthpost@scmp.com

FINGERS ON THE TRIGGER A torn infraspinatus muscle – widely reported as the second most often injured muscle in the shoulder’s rotator cuff – spurred my visit to myotherapist Liam Fitzpatrick. This was after three years of pain, many physiotherapy and osteopathy treatments, and many cortisone injections.

After assessing posture and asking questions about an exercise regimen or the possibility of other injuries, Fitzpatrick went to work on the shoulder, asking where I could feel the pain and pin-pointing it by getting me to show which arm movements were the most painful.

So far, it was pretty much like other manual therapists.

However, he then anchored the top of my shoulder with one hand and used the fingers on the other hand to dig deep into the muscle and fascia on the shoulder to the point where I was clenching my teeth through the pain.

Then he asked me to reach my arm forward and then pull it back, while he continued the pressure. His anchoring hand pulled back on the top of the shoulder to realign it to where it was prior to the injury.

He explained that when one muscle is under-functioning, others take over, and my right trapezius (between the neck and shoulder) was doing all the work, rolling forward in the process.

The idea was to “train” it to roll back while at the same time “un-knotting” the infraspinatus.

The deep digging and “un-knotting” style of manipulation hurts – and my shoulder was sore for a few days afterwards – but not as much as the chronic pain that had affected my daily life for years.

The loosening sensation 72 hours after the treatment was impressive and the old pain is now unnoticeable during normal activity. Suzanne Harrison

DIET 9 Nigella Lawson admits to often cooking two chickens when one will do, but that habit comes in handy for whipping up a quick chicken salad. Photos: AP

Cool eats on hot days NUTRITION ......................................................

Nigella Lawson

It is something of a cliché that all women turn into their mothers.

“That is their tragedy,” Oscar Wilde said.

I would not call my increasing resemblance to my late mother tragic, but I am certainly bemused by it. The strange thing is that these growing similarities present themselves in the kitchen. All of my mother’s culinary peculiarities are now mine.

I “decant” food into ever smaller bowls in the refrigerator. I roast two chickens when I need one, keeping the other to pick at in the fridge. I put white pepper, not black, on cabbage. I complain when people don’t use a separate knife for butter – all those crumbs are so irritating.

And, like my mother, I get annoyed when I am told not to go to any effort but “just make something cold” for dinner. People who don’t cook always assume that cold food somehow gets to that readily edible stage without being cooked, when all it means is that you have had to do the preparation earlier.

But I have put aside that irritation because at this time of year I do see the logic of eating

Even if a salad is no more than a few ingredients … it doesn’t have to be apologetically cobbled together

something cold. And the preparation doesn’t have to be extensive.

Luckily, given my two-chicken habit, there is always some cold meat for a salad. Those who don’t want to turn on the oven can buy prepared cold chicken that is not too dry and desiccated.

Even if a salad is no more than a few ingredients, mostly green, combined in a bowl, it doesn’t have to be an apologetically cobbledtogether affair.

I am a big believer in the simple summer two-course meal: the sort you can eat in the kitchen or at a table in whatever outdoor space you might be lucky to have, gratifyingly picking at it while you ruminate on the ways of the world.

Because a salad necessarily lacks heft, I feel it must be substantial in flavour. The one here, with a base of tangy but still tender baby spinach leaves, is definitely that. I have transferred the elements of my favourite guacamole recipe to a leafy spinach salad.

In making guacamole, I replace the customary onions with scallions, and I never use tomatoes.

All I want to notice really is the coriander, avocado and lime. That approach works nicely for a chicken salad (and turkey, too). Chilli peppers are optional: some people don’t want too much heat. But don’t sit on the fence with the coriander – you need all that fresh but earthy pungency.

If you would like to bulk it up a little, I suggest getting two pita breads, and splitting them lengthwise so you have four thin, tapering oval slices. Toast the slices for about five minutes in the oven.

After you cool them, break them into shards and toss them into the salad. I sometimes add a little crunch by tearing up the bright green leaves of a romaine heart and tossing them into the bowl.

As for dessert, I keep true to the maternal line here, too. I use an old recipe of my grandmother’s, something she called Barbados cream. It’s Greek or whole-milk yogurt and heavy cream combined in a bowl and given a thick sprinkled covering of soft brown sugar, light or dark as you wish.

I presume the sugar she used came from Barbados, hence the name.

Anyway, it is the ultimate in a no-cook dessert. Wrap the bowl in plastic and refrigerate it for up to 24 hours to let the sugar turn into a dark bronze liquid, slowly seeping into the cream and yogurt. It tastes like a light crème brûlée without

the sugar crust. When you are ready, take the cream-yogurt mixture to the table with a bowl of blueberries. Sit down and feel quietly pleased with yourself: you have made the perfect early summer lunch and not so much as broken a sweat.

The New York Times

No-bake way to entertain guests requires little preparation, but cream needs to chill overnight ......................................................

Nigella Lawson The New York Times Roast chicken salad Time: 10 minutes Serves 4 10 cups baby leaf spinach 51⁄2 cups roast chicken, cooled and roughly shredded 4 scallions, finely sliced into rings 1 cup chopped fresh coriander 2 ripe avocados 11⁄2 tsp Maldon salt, or table salt to taste Finely grated zest of 1 lime 2 tbsp fresh lime juice 2 tbsp extra virgin olive oil Freshly ground black pepper • In a large mixing bowl, combine spinach leaves, chicken, scallions and about 3⁄4 cup of coriander.

• Halve the avocados and discard pits.

Scoop out curls with a spoon, or peel avocados, and cut fruit into chunks or slices. Add to the salad.

• In a small bowl, stir together salt, lime zest and lime juice. Whisk in oil and pepper to taste. Pour over salad, tossing gently by hand.

• Arrange salad on a large plate or in a salad bowl and sprinkle with the remaining chopped coriander.

Blueberries and Barbados cream Time: 5 minutes, plus overnight chilling and standing time Serves 4 1 cup heavy cream 1 cup Greek or other plain whole-milk yogurt 1/3 cup soft brown sugar, or as needed 2 cups blueberries • The day before serving, combine the cream and yogurt in a mixing bowl, and

whisk until thick but not stiff. Scrape into a shallow serving bowl about 20cm in diameter.

• Sprinkle with enough brown sugar to cover top of yogurt mixture. Cover with plastic wrap, and refrigerate for 12 to 24 hours.

• Remove yogurt mixture from the refrigerator and allow it to come to room temperature. Serve yogurt and berries in separate bowls, allowing guests to help themselves. healthpost@scmp.com

10 FITNESS SWEAT GYM MISTAKES

Muscle in on new moves ......................................................

Melvin Hoe healthpost@scmp.com Are you working out in the right way? Anfernee Leung, a strength conditioning coach and co-founder of Core Functional Fitness in Kowloon, gives his take on what works and what doesn’t.

Bad move: lateral pulldown behind the neck The lateral pulldown is an exercise that targets your upper back and biceps, but executing the exercise the wrong way can expose you to injury. If you’re pulling the bar behind your neck, the front part of your shoulder joint gets the brunt of the load, and this can expose you to a rotator cuff injury.

Do this: pull the bar down to the front of your body, towards your chin or, if you can, your collarbone.

For the best muscle-building benefit, visualise your shoulder blades coming together as you execute the motion.

Bad move: chest fly machine This looks like a good exercise for your chest, but in reality it overstretches your frontal deltoid (shoulder) muscles and can cause your rear deltoids to stiffen up. As such, this movement can cause shoulder impingement syndrome (the compressing of a shoulder tendon).

Do this: go with exercises such as the dumbbell bench press, dumbbell incline press or push-up, as they don’t tax your shoulders at unnatural angles and are the best way to build or tone your chest muscles. Research has shown that pectoral muscles are activated up to 23 per cent more during the bench press compared with when doing the chest fly.

Bad move: abduction and adduction machine “People flock to these machines in search of thinner thighs,” says

During a lateral pulldown, it is far better to pull the bar down in front of your chin rather than behind your head Leung. This exercise is performed seated on the machine with your legs straight, moving along an outward or inward arc against padded leg braces. While it appears that the movement hits the problem spots, it really works only a small portion of the leg muscles.

Do this: perform squats or lunges instead to target the entire leg muscle and glutes at the same time.

Bad move: lying double leg raises This movement is performed lying on your back while raising both legs at the same time, targeting your abdominal and lower back muscles.

But it places a huge amount of strain on your lower back. So in this case, the risks outweigh the benefits.

Do this: raise one leg at a time while keeping your other leg bent. Aim to

keep your hips and back stable on the ground while you are doing this exercise.

Bad move: deep knee bend squats You’ll see some advanced strength athletes advocating a “rock-bottom” squat for maximum strength gains, but Leung advises against this extreme. A deep squat – with your glutes nearly touching the ground – can over-stress and injure your knee joint. What’s more, if you add weight, you’ll face a higher chance of injury.

Do this: focus on bending your knees until they reach a 90-degree angle – then push yourself back up.

“Squat until your knees are parallel with the ground, and you’ll get maximum benefit with lower risk,” Leung says.

Bad move: back extension bench This exercise is performed when you lie face down on a downwardsloping bench, before raising your back upwards – like a backwards situp. Although Leung concedes that this exercise does engage the lower back muscles in a significant way, he believes most people can’t see how far their torso rises, so they overextend the range of motion.

Do this: get a gym instructor to spot your movement, or use a lower back machine to set boundaries for your range of motion and prevent injury.

Bad move: sit-up This abdominal exercise staple can actually do more harm than good.

“Most of the work to get the body upright is performed by your hip flexors and back muscles,” says

Leung. “Raise your body too quickly, or move your body out of alignment, and your chance of straining your back increases.”

Do this: do a crunch instead. While the range of motion seems small, it targets abdominal muscles more effectively without the risk of injury.

Bad move: upright row It looks like a good exercise for strengthening your shoulders and trapezius muscles, but it has the potential to cause a shoulder injury.

Raising the barbell or dumbbell too high can lead to shoulder impingement syndrome.

Do this: skip the upright row and focus on the shoulder exercise staples of overhead presses, dumbbell laterals and barbell or dumbbell shrugs.

WORKOUT

Driving golf balls won’t do much for fitness ......................................................

Dorene Internicola Hitting golf balls at the driving range can lift the spirit, but does it also tone the flesh?

The exercise potential of swinging a club may be limited, experts say, but the more fitness you bring to the range, or the golf course, the stronger your stroke will be.

“Most people don’t think of the driving range or playing golf as a form of exercise, but it is,” says Robert Yang, a sports performance coach and founder of the Performance Lab in Encinitas, California. “The professionals make it look smooth like butter,

but there’s quite a bit of power and strength involved.”

He explained that wielding a driver can be compared to hoisting a weight so heavy that you can lift it only four times. But don’t expect to swing your way to streamline shape.

The volume of exercise is simply not high enough. Yang says that even on a golf course, people are actually swinging the club for only 21⁄2 to three minutes. “The rest of the time you’re just walking,” he says.

Conversely, Yang says fortune, whether on the golf course or on the driving range, favours the fit.

“Each body has physical limitations, whether it’s lack of strength or flexibility. If you improve them, you’ll hit the ball farther,” he says.

Golfers don’t get enough exercise on the course. A fitness programme is advised. Photo: Oliver Tsang

“Whether you’re 16 or 60, you should focus on strength and power training to improve your game.”

He says older, more sedentary golfers can transform their game by working on their posture. “They’ll stand up straighter,” he says.

“They’re able to rotate more efficiently. That improves their golf swing.”

Taking a golf club back over your head, following through and moving your body to strike the ball all involve a range of motion not experienced by most people on a daily basis, according to Kevin Burns of the American Council on Exercise.

But there’s a down side. “Outside of the adrenaline rush of striking the ball and hitting it a long distance,

there’s very little cardiovascular benefit,” Burns says.

He says the driving range compares unfavourably with the golf course. “Walking nine to 18 holes has tremendous cardiovascular benefits, especially if you do it on a regular basis,” he explains. Any activity that will get someone off the couch and moving is a good activity, he says, but an overall fitness plan should include cardiovascular, range of motion and weight-bearing exercises.

Yang concurs. “If your goal is just to swing a club and be active, then you’ll achieve the goal,” he says. “If you’re looking to lose five inches [12.7cm] off your waist, that’s not going to happen.” Reuters

WELL-BEING 11 FIT & FAB

A banker who’s hot on the trail ......................................................

Jeanette Wang jeanette.wang@scmp.com Sandro Gianella runs down a long and steep flight of steps on the infamous Twins trail in Tai Tam, his legs flowing smoothly like a waterfall. Fifty metres later, the Swiss banker has doubled the gap on me.

In a few moments, he’s out of sight.

“Lean forward,” Gianella advises, on how to tackle these steps faster.

Unfortunately, this fearless instinct, which he honed through chasing his dad and older brother down the Alps on skis, eludes me.

Gianella, 36, has been a common face – and typically among the leaders – in trail running races in Hong Kong since he moved here 11 years ago. “I love the simplicity and the freedom of running,” says the Geneva native, who has completed the 100-kilometre Oxfam Trailwalker for 10 straight years, with a best time of 16 hours, 21 minutes. “Trail running puts you in contact with nature and lets you escape for a moment the noise and trappings of a hectic city.”

Among his most memorable achievements, he says, was finishing the 2008 Gobi March, a 250kilometre race through the Gobi Desert, and the 2010 Ultra-Trail du Mont-Blanc, a 166-kilometre race with a climb of about 9,500 metres.

His goal for this year is to run a total of 1,000 kilometres in official races. With 577 kilometres run so far, Gianella is right on schedule.

What goes through your mind on those long runs?

A lot – from making sure that I put my feet in the right places to avoid injuries, to the latest world news.

Recently I have been thinking about how to achieve my goal of running 1,000 kilometres of official races in one calendar year. As I run, I think of the next most exotic or exciting destination to complete the remaining 423 kilometres.

Sandro Gianella runs near Tai Tam Reservoir.

Photo: Jonathan Wong What is your favourite trail in Hong Kong?

The MacLehose Trail, specifically sections three, four, seven and eight.

These sections of this beautiful route represent the perfect contrasts of Hong Kong: the skyscrapers and busy city life, with the white, sandy beaches and beautiful green hills of the New Territories.

I love exploring new trails. The best feeling for me is to run from home to a destination where I’ll be rewarded by a beautiful landscape, or a beach where I can take a swim – especially during the summer, when the temperature and humidity are dangerously high.

Hongkongers often complain that the air is bad, or that they don’t have the

time, and that’s why they don’t exercise. What do you reckon?

Sure, pollution is a problem in Hong Kong, and we should all take steps toward a cleaner and less polluted city. But I believe that first and foremost, it’s about making a personal choice to prioritise exercise over more immediately gratifying, but less rewarding, options. Hongkongers should look at the bright side of things. We’re in such a unique and convenient city where you don’t have to travel far to find a good place to exercise, whether indoors or outdoors. I would encourage everyone to schedule exercise and stick to it.

I usually run in the morning before work. It suits my schedule better than in the evening, when I

might have to stay late in the office or have other obligations.

How do you reward yourself after a tough workout?

The destination and the opportunity to be in communion with nature is a reward in itself. However, if I manage to get in a good training session or break my personal record, a great dinner or lunch at one of the best French or Italian restaurants in the city is my favourite treat.

What’s your advice for people who want to get started in ultra-running?

Know that your body is capable of a lot more than you think. Know that at one point you will want to give up, and this is when your mind takes over. If you are new to ultra-running,

it’s good to chat with experienced runners, as you will learn a lot about nutrition, equipment and training, and you will avoid making mistakes that might discourage you.

Don’t be intimidated by the number of kilometres in a race, but break it down in sections and checkpoints, and make sure that you know the type of fuel – food and drink – that your body needs.

Make sure you hydrate well prior to the event and take electrolyte supplements to avoid cramps.

And don’t forget to pace yourself – which I often don’t.

So, what’s your secret to looking fabulous?

Ha ha! Are you serious? Get a good photographer – that’s a good start!

THE TASTE TEST RICE CRACKERS

Crunch time for serial snackers ......................................................

Jeanette Wang jeanette.wang@scmp.com Blue Diamond almond nut thins HK$25 for 120.5g, Nature’s Village (Lyndhurst Terrace) These are made from rice flour and almonds, but there isn’t much of a nutty taste to them.

The almonds, however, give these snacks a nutritional boost, being high in protein, fibre, vitamin E and hearthealthy monounsaturated fat.

Verdict: Good, but a little salty.

Edward & Sons brown rice snaps HK$46 for 100g, Nature’s Village Every now and then I get a craving for crisps, which takes lots of willpower to overcome.

These cheddar-flavoured baked crackers are a fabulous alternative. They’re yummy dunked in hummus or eaten plain, and I hear they’re great with a smother of cream cheese.

Verdict: Definitely go for seconds – a serving of eight crackers has just 60 calories and 1.5g of fat.

Mary’s Gone Crackers crackers HK$48 for 184g, Nature’s Village A colleague liked this so much, she took home the leftovers after our tasting.

Made with seemingly bland and boring ingredients – brown rice, quinoa, flax seeds and sesame seeds – the crackers are surprisingly tasty.

A kick of black pepper helps.

Verdict: Rich and crispy, these would pair well with a range of dips, from salsa to chilli.