Health x Wellness

Square One Active Recovery introduces exercise-based chiropractic care

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Square One Active Recovery is the first exercise-based chiropractic clinic in Singapore. Founded by Jesse Cai in 2018, his approach focuses on how movement is medicine and that an active lifestyle is the key to a functional and fulfilling life.

Square One Active Recovery

We spoke with Jesse to understand about chiropractic care, and some common myths and uses. 

The Active Age (AA): Tell us more about yourself. How did you get into chiro?

Jesse Cai (JC): That’s a bit of story. I was studying veterinary science at University of Queensland and I dropped out after a year. I realised being a veterinarian wasn’t something I wanted to do for the rest of my life. I enrolled in law school at Murdoch University. Unfortunately, law school was an even worse fit. I realised  I really love anatomy and did an internal transfer to the chiropractic program.

Chiropractic school had its challenges, but I did enjoy myself. I stuck it out. That’s pretty much how I ended up a chiropractor. One of the things I enjoyed was being able to work with many passionate pro-athletes while I was in Australia. There was the Australian Football League, Forrestfield Football Club and so on. Even now, my clients include Kingsley Tay, who’s representing Singapore in Beach Volleyball this year.

AA: Why do you think there is a need for chiropractic care? 

JC: Need is a strong word. I wouldn’t necessarily think there is a need for chiropractic care. Sure, there’s a market gap to fill when it comes to back pain, knee pain, musculoskeletal-type issues and or even sports injury management in Singapore. At the end of the day, however, most of us aren’t going to die from pain or an ankle sprain.

That doesn’t mean you have to live with your pain though. I think everyone deserves to live to their full potential (and pain-free) so that’s what we aim to do. If you are actively looking to get rid of your pain and want to improve your athletic performance, I want to help you. While most of us wouldn’t be dying from pain, that doesn’t mean pain is a non-issue. There’s also a lot of research that’s showing that chronic pain is associated with higher rates of depression and anxiety, missed days of work, poorer work performance – it is a big problem affecting our daily lives. There are more than 100 million chronic pain sufferers in US alone. It may might not sound like much but that’s more than diabetes, cancer, and heart diseases combined.

Scary, isn’t it?

AA: Could you list common uses of chiropractic care – when & why? 

JC: I get a lot of tendon injuries and knee pain clients at Square One Active Recovery, followed by neck/shoulder pain at my practice.

1) Tendon injuries

Most of our clients are professionals in their mid-thirties to mid-forties and a fair few of them are fairly athletic. They play tennis twice a week or maybe workout two to three times a week with the trainer. We do see a lot of tennis elbows (a type of tendinopathy) at Square One. Probably a third from playing tennis and the rest of them from their gym training. Tendon injuries are the result of repetitive overuse over prolonged period of time. They tend to come in either when their sport is being affected (i.e. it starts to affect their tennis game or their lifts) or when their daily life is affected (e.g. they are unable to turn door knobs without pain). It really depends on what is important to them. We tend to see people only when they are looking to take action to get rid of their pain. For some of them, their tennis games are a big part of their lives and come in straightaway when they feel that something is wrong. Majority would probably take a wait-and-see approach and we see them when their pain starts to creep to their daily life.

[You can reference our blog post] on Nine High Value Tips For Your Tendon Pain. We see so many of them that we decided it might be a good idea to share our thoughts on tendon pain so people can understand their recovery better.

2) Knee Pain

Knee pain is really tricky to work with. We do see clients getting back to their A game after one or two visits (of course, they worked very hard with their home exercises) and on the other end of the spectrum we have a particular client who has been with us for about ten visits. The progression from visit to visit is steady but slow. It might sound like it’s a terrible but he had previous treatments and this is the first time he is getting any improvement at all. So, he’s happy.

Most of the knee pain clients we deal with are from running or HIIT training. No, we don’t get them to stop. In fact, we highly recommend that they keep training. We want to know they are getting better because they are getting better and not because of rest.
For [many of them], they do get back to running within three to four months.

3) Neck/shoulder pain

Neck and shoulder pains are a bit different. We usually start to see these clients when they realise their work performance is being affected. A fair few of them travel weekly so for them having a painful neck after a flight means they have one less work day as far as productivity goes. There is another group of neck pain clients who find their neck pain so intense in their daily work life that their job performance is being affected. It would be fairly accurate to say that this group of clients spend extended period of time in the same position.

The obvious solution is to stop sitting or to stretch/move around. We take a slightly different approach for them. We try to work with their neck resilience. Essentially, we give them exercises for their neck and shoulder so they can spend more time sitting before the pain starts. It sounds unorthodox but (to be honest) you shouldn’t be having neck pain from sitting at the desk for 6-8 hours. It’s not exactly a high intensity activity. We do see most of our clients in this demographic group have fairly poor neck strength, endurance, and movements as well. So, we work with them to address them too. But the primary goal is to increase their capacity to
sit. Every so often our clients would come back to tell us – in complete surprise and gratitude – that they can sit for the whole day without pain. It’s interesting for me because it’s amazing how something so basic for most of us (i.e. sitting) mean so much for them.

AA: Could you list 3 common myths to debunk – what they are and what are the right steps? 

Rest = recovery
Some ex-clients think home exercise (the sort I prescribe to them) is too much effort. They admit that they’ll rest and wait for it to go away. The truth is all tissue heals with time but recovery is a completely different ballgame. Yes, the tissue may heal but that doesn’t mean they’ll be back to a pre-injury state. If you were to cut yourself, the wound would eventually heal. If you cut yourself deep enough, you’d get a scar post-healing. The properties of the tissue would have changed. This goes for musculoskeletal injuries. Yes, all tissues heal with rest but that doesn’t mean they’re back to pre-injury state. It may take additional work. I mean, that’s why it’s called rehabilitation right?

2) Pain = damage

Most people think if it hurts. something is wrong. If it hurts a lot, something is very wrong. We see that a lot when trying to get clients back to normal movements. They are genuinely afraid to squat because they’re so afraid of the pain being bad for them. Not  so much because of the pain intensity itself. It’s gotten so serious we have a term for this – kinesiophobia. I actually have questionnaire to screen patients for this!

3) Chiropractors offer only adjustments and you’ve to keep coming back/Manual Therapy works

Manual therapy refers to any hands-on technique applied to joints or soft tissues for the purpose of pain relief. Common examples include chiropractic adjustments, massage, IASTM, and even dry needling. When mechanical stimulation (massage, chiropractic adjustment, etc) is applied applied to our skin, a whole lot of receptors are activated. We see a decrease in cytokines and substance p
with an increase in endorphins and cannabinoids. These compounds work together to help us feel good. We are almost certain these manual therapy-associated changes are neurological in nature.

Manual therapy is not your long-term pain solution but it does work as an adjunct therapy (i.e. to be used concurrently with other treatment). Manual therapy is at best second-line treatment as far as musculoskeletal care is concerned. The top choice for ALL clinical guidelines is exercise, advice, and education. This is exactly what we are about.

AA: Any advice to people looking to start chiropractic care for their ailments/self-improvement? 

JC: Always seek professional advice. The tricky part is finding someone whom you can trust. It helps to do your due diligence. Research, research, research! There’s lots of information on Google and on online forums. It’s easy to find out who are the better or less good chiropractors.

There are also formal recommendations published in academic journals:

These are good recommendations to follow for your best outcomes.

Article responses by Jesse Cai, 31, Founder of Square One Active Recovery, Singapore’s first exercise-based chiropractic clinic in Singapore

Pictures credit to Square One Active Recovery



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