We may be the heaviest nation on this side of the world, preferring to warm our derrieres instead of putting them to work, but there exists a minority who partake in sporting activities for leisure and pleasure.
When this group gets musculoskeletal injuries or problems, which specialist do they consult?
Most patients will usually head to an orthopaedic surgeon whose job is to correct functional abnormalities of the musculoskeletal system, which includes bones, joints, muscles, tendons and ligaments.
They also perform surgery to address trauma, tumours, injuries and infections.
Many are still unaware that you can actually consult a sports medicine physician first.
Just because the speciality has the word “sports” in it doesn’t mean that their services are limited to athletes only.
“We are not surgeons, but physicians dealing with cases of non-surgical management of musculoskeletal and sports injuries, including overuse, trauma, and wear and tear,” says sports medicine consultant Dr Khairullina Khalid.
“We offer individualised exercise prescriptions for those with obesity and chronic diseases such as arthritis, and for special populations such as disabled athletes, pregnant mothers, the elderly and the young who are obese.
“Certain medical conditions can also be treated with exercise.
“For example, if you are diabetic or are a heart patient and want to exercise, we can tell you how to go about it.
“We work together with other specialists and physiotherapists to get you moving again.”
Presently, there are fewer than 40 sports medicine specialists in Malaysia, with half practising in the Klang Valley.
In Health Ministry hospitals, these specialists are placed in the orthopaedic department.
Regaining one’s ability and independence after an injury or illness can be a long and challenging journey, and involves a lot of elements.
Says Dr Khairullina, “Basically, we manage the patient’s recovery when they have an injury, help improve their performance, prevent further injuries and enable them to safely return to their previous level of sports or physical activity.
“We also do pre- and post-operative rehabilitation for cases of sports surgery.”
Some of the other services offered by these specialists include interventional musculoskeletal ultrasonography, protective sports gear prescription and fitness testing.
Whether you are a national athlete or a weekend warrior, it is important to fully rehabilitate from injuries before resuming activity.
According to National Sports Institute (NSI) consultant sports physician Datuk Dr Ramlan Aziz, a lot of non-professional athletes are forced into inactivity because their injury is not properly rehabilitated.
“Everybody who aspires to excel will take themselves and their sport seriously, whatever their level may be. So, we must also take them seriously and help them achieve that level.
“And if they get an injury along the way, help them to recover so that they can continue their sport.
“Sports medicine needs to have a position in society so that it can contribute to health, fitness and recreation.
“We should also encourage older people to be active in sports and compete within their own age group.
“For the disabled, it will help them get a different focus in life,” he says.
In a rehabilitation setting, there is no one quick fix for everybody. The gains may be small and the process may be slow, but more importantly, the patient has to fully recover.
“One of the factors that lead to repetitive injury is overload, plus a lack of recovery.
“For national athletes, we’ve got a centre of excellence for high performance screening.
“This includes physiology, nutrition, psychology, biomechanics, sports analysis and sports technology, which looks at coming up with our own devices to answer questions coaches might ask on how to improve the performance of top athletes,” explains Dr Ramlan, who was formerly the chief executive officer of NSI.
Because of the emphasis on youth in sports, the older athletes tend to get neglected, especially when they are injured or not winning medals.
He points out, “What message are we then sending the younger athletes? That there is no future in sports!
“We have to give them rehabilitation programmes to keep them lasting longer. No athlete wants to stay away from sports for months – it makes them crazy!
“Athletes are healthy people who want to get better yesterday. When they win a medal, it inspires the whole country.”
How soon one should start rehabilitation depends on the patient’s condition.
Dr Khairullina says, “If the pain score is more than six or the joint is swollen, then we work on reducing the pain and swelling before exercises are introduced.
“If the patient has undergone surgery and if everything is okay, we can start rehab after 24 hours.
“If there is massive swelling, we use taping in the early phase of rehab or do ultrasound procedures to locate where the problem is.”
So, is exercise really medicine?
“Yes, it’s free medicine and has very few side effects!” says Dr Khairullina.
People may argue that they stay physically active by doing housework or gardening or playing with their toddlers, but that is not exercise.
While physical activity is defined as any bodily movement produced by the skeletal muscle that requires energy expenditure (e.g. standing), exercise involves repetitive movement that is structured or well-planned, aimed at improving or maintaining one or more components of physical fitness or performance.
Exercise experts measure activity in metabolic equivalents (METs).
One MET is defined as the amount of oxygen consumed while sitting at rest and is approximately 3.5 millilitres of oxygen consumed per kilogramme of body weight per minute (ml/kg/min).
For the average adult, this is about one calorie’s worth of oxygen consumption per every kg of body weight per hour.
An activity that is four METs requires the body to use approximately four times as much oxygen than when at rest, which means it requires more energy and burns more calories.
Moderate-intensity activities such as brisk walking are five METs, while vigorous-intensity activities are six METs or more, such as jogging at nine minutes for 1.6 kilometres (11 METs).
Dr Khairullina says, “Regular physical activity or exercise makes you feel good. Multiple research shows that exercise reduces mortality and increases longevity.
“But we give all kinds of excuses for not exercising: no time, but people have time to watch television every day; too tired, but regular activity will actually improve your energy levels; weather is too hot, but you can exercise at home; exercise is boring, but you can listen to music to divert your attention; they do not enjoy exercise, but you can just do some physical activity; soreness, but that’s temporary; etc.”
Adults should aim for 150 minutes a week of moderate exercises or 75 minutes of vigorous exercises. For kids, it is 60 minutes a day three times a week.
For the regular weekend warrior, common injuries include hamstring strains.
For marathoners, it’s the iliotibial band syndrome, which is an overuse injury of the connective tissues that are located on the lateral or outer part of the thighs and knees.
And those who play contact sports usually suffer from ankle sprains.
“Sometimes, injuries occur not only because of improper warm-up, but it could also be due to external factors such as the court ground, dehydration or type of shoes used,” says Dr Khairullina.
No one can escape strains and sprains, but there are steps you can take to minimise injuries.
She says, “Know your body well, e.g. do you have flat feet or limited flexibility?
“Sort out the internal problems first by checking your blood pressure and doing a full blood test and an ECG (electrocardiogram), because you may not be aware that you have a heart problem.
“Stop smoking and try to lose weight.”
For those who are overweight, she prescribes programmes to lose weight first before embarking on an exercise regimen. But they have to be motivated to do so.
“I always ask (obese) patients if they are ready to change their lives. If they are not, then we cannot help them,” she says.
Adds Dr Ramlan, “Everybody wants to be fit and some people compete against themselves, but more importantly, you’ve got to know your body and your limits, though limits can be extended over time.
“But sometimes, you just want to do what you love, then suffer later!”