For Low Back Pain, Classification = Better Outcomes

Low back pain treatment is more effective if we can correctly classify a patient and give them a specific intervention to help get resolution. In this article I will talk about evidence based practice, the different classification systems we have in physical therapy, I will highlight a system that I tend to use, and I will also give you more information to be an educated consumer of your healthcare dollars.

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Dr. Murphy, earlier you talked about evidence based practice, what does that mean? There is a big push in the profession of physical therapy to provide evidence based care. Much like the profession of medicine, we have to have a clear reason why we are doing what we are doing. Often this is done through research. In its simplest form, we take a group of people with low back pain, we try and homogenize them (make them all very similar in all their characteristics, which could be pain level, previous history, how long they have had symptoms, age, weight) and then we break up that group and we try different interventions. We then have various tools we use at the start of treatment that we can consistently retest throughout various parts of the intervention process to measure if the treatments are helping the patients. When this research is done over and over with large groups of people in various parts of the country and world and all of that research shows similar positive outcomes, we adopt that intervention approach as an evidence based approach that is effective for a group of patients.


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For patient’s with low back pain there are various classification systems. There is the treatment based classification, the McKenzie Method of MDT (Mechanical Diagnosis and Therapy), and the clinical practice guidelines put out by our professional organization the American Physical Therapy Association. I don’t want to muddy the water too much, because there is quite a bit of overlap between these systems. I will highlight one that I have recently been studying.

For treatment of low back pain, The McKenzie Method of mechanical diagnosis and therapy was founded by Dr. Robin McKenzie, a New Zealand born physiotherapist. This is a comprehensive system of evaluation based on patient history, symptom presentation, and specific movement based interventions aimed at reducing the disability and pain associated with low back pain. I will highlight the three main classification’s within the McKenzie Method next.

Mechanical Diagnosis and Therapy

Mechanical Diagnosis and Therapy

The first classification is called a Derangement. A derangement is described as a mechanical obstruction of an affected joint. When I say mechanical I mean movement related. It also is highlighted by inconsistency and change. The patient states that the pain is variable during the day. A patient will say that certain postures or movements will cause symptoms to increase/decrease, produce their pain or diminish it, and finally centralize/peripheralize. This last one is worth explaining. When we centralize pain we bring it from a widespread area to a more focal area. When we peripheralize our pain we cause it to spread further from the low back area. This is the most commonly seen syndrome and this patient often responds quickly to intervention.

We now move on to the next classification which is Dysfunction Syndrome. This syndrome is less common. This happens from mechanical deformation of structurally impaired soft tissue. This abnormal tissue may have been the result of a previous trauma, an inflammatory, or degenerative process. The tissue can get contracted, adhered, or scarred and it needs to be remodeled. This patient has a very different presentation than the Derangement. They have pain that is often always local. Their pain is also always intermittent and is produced only when loading the structurally impaired tissue. In the movement assessment they show movement that will produce the symptom, which then does not remain worse.

The Final Classification is called a postural syndrome. This syndrome normally effects a younger person with a sedentary lifestyle. Symptoms are brought on by static loading of normal tissue. We can all envision a student who is sitting with bad posture while on their cell phone or computer.

As adults we have an obligation to ensure our kids don’t end up doing this in school now and in their jobs later!

As adults we have an obligation to ensure our kids don’t end up doing this in school now and in their jobs later!

It is uncommon to see this patient in the clinic because a simple cue with our hands or verbally to correct their posture abolishes their symptoms. So parents, the next time you see your kids sitting like this, tell them to sit up straight!

As you have seen in this write up, there is a lot more to physical therapy than meets the eye. Going to a good physical therapist who can spend time listening to your story and doing a thorough examination with you is critical. Don’t accept those PT clinics that pass you off to an aide or assistant. You should be seeing the same physical therapist each visit for continuity of care. Also, you should not accept doing the same thing in their office that you could do at home. They should be educating you, giving you a home program, and putting their hands on you therapeutically. You deserve more than just being another number that they are hurrying through the office.


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I offer a FREE discovery visit at my office in West Little Rock, AR or over the phone to help you make a decision about how to best deal with your pain and limitation. Don’t continue to let it interfere with your life; get back to doing the things you love and enjoy.



Call or text me at 501-529-2010. I look forward to helping you reach your PINNACLE.



Pinnacle Physical Therapy

5507 Ranch Dr Suite 203

Little Rock, AR 72223

brian@pinnacledpt.com








To Sit or to Stand, that is the question?

When it comes to low back pain, we are told that sitting for too long is not good for our backs. Why is that the case? What does sitting do to our low back?

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There are low back pain studies that have been conducted that measure the pressures in the spinal discs with various activities. One study in particular 1, involved a 45 year old male who had a pressure device inserted into his L4/L5 disc. This allowed researchers to measure the amount of pressure change in a variety of different activities. Running, sitting in various postures, lifting with both good and bad mechanics and even stair climbing were measured. What we observed from this study is that there are different pressures that the disc undergoes with differing positions. You may be asking, how is this relevant to me?


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What is critical to remember with patient’s is that if we treat a large group of people who have low back pain with the same interventions, we are going to help some people and we will not help others. This is where subgrouping comes into play. Subgrouping is when we take a history from the patient about their issue. From experience and research we have found certain subgroups of patients have certain characteristics and presentations. It makes logical sense that if we can subgroup patient’s with low back pain, that we can offer them more specific interventions that will better address their impairments. This is much more effective than just giving everyone the same interventions and only some people get better. More on the subgrouping in next weeks article!

Matching interventions to patient’s with specific presentations allow for better outcomes.

Matching interventions to patient’s with specific presentations allow for better outcomes.

Low back pain treatment can revolve around the reduction of your pain. When you go see a practitioner it is often because you are in pain, which is an unpleasant experience. When we are given medication, offered injections, or prescribed a specific treatment, one of the goals is to help reduce your pain. Physical therapists often take a similar approach to low back pain. There are often movements/positions that make your pain better and some that make your pain worse. There is a phenomenon called peripherilization and centralization. Some patient’s have low back pain that is associated with radiating pain that goes down the leg (sciatica). One of our goals with this type of patient is to help centralize their pain. If we can take the pain out of the leg and move it toward the center of the back we can predict that the patient has a good prognosis (they will get better with our interventions).

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When it comes to treating low back pain there are studies that will show sitting is bad for your back and just as many studies that show sitting and standing create similar stresses on the back. You may now be asking, “What is the best position?” I will tell you that in my opinion it is somewhere in-between. I advise my patient’s to not go longer than 1 hour without getting up out of your chair or if you start in standing, sitting down. This variability will help to off load some of the structures that could be affecting your back. Set the alarm on your phone so that you have to get up and move around.

It may get awkward if you are doing a head stand in the office, but tell your co-workers to join in!

It may get awkward if you are doing a head stand in the office, but tell your co-workers to join in!

You may already know intuitively that one position is better for your back because the other causes pain. Another concept that needs to be addressed is the concept that not all hurt = harm. As I am writing this, I am coming up with more ideas for blog posts! More on the hurt = harm later!


The moral of the story when it comes to low back pain and in that matter, reducing the risk of developing low back pain is that you need to move your body. Motion = lotion is what I tell my patients.


If you found this article helpful, share it with a friend. If you need more specific advice, call or text me at 501-529-2010, or you can shoot me an e-mail at Brian@pinnacledpt.com. My name is Dr. Brian Murphy, I am a physical therapist and owner of Pinnacle Physical Therapy located in West Little Rock, AR.

Thanks and here’s to helping you reach your PINNACLE!

5507 Ranch Dr, Suite 203

Little Rock, AR 72223

Brian@pinnacledpt.com

Reference

  1. Wilke, Hans–Joachim, et al. "New in vivo measurements of pressures in the intervertebral disc in daily life." Spine 24.8 (1999): 755-762.



I have low back pain, now what?

When it comes to low back pain, there is no shortage of providers you can go see. You can see your primary care physician, a chiropractor, a massage therapist, a physical therapist, a yoga instructor, an orthopedic physician and even a neurosurgeon.

You may be asking, how do I then decide who is the right choice for me?


Who do I go see and more importantly how much does each option cost?

Who do I go see and more importantly how much does each option cost?

Some people want to avoid medications, surgery, and injections at all costs. This narrows the field of potential practitioners off the bat. If you are to see a physician, very likely you will be prescribed medication, given some kind of diagnostic test (X-ray or MRI) and then prescribed physical therapy. The involvement of specialists (orthopedic spine physicians and neurosurgeons is often not the first line of defense).


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Some practitioners offer more conservative approaches to treatment of low back pain. Massage therapists offer soft tissue work and stretching to address pain and limitations. Yoga instructors offer movement based interventions. Some pure Chiropractors believe that disease processes stem from a malalignment of the vertebrae (bones in your spine.) Their treatment is thus geared toward adjusting the spine so that the nervous system can function properly.

I can speak the most intelligently about physical therapists. We are movement specialists who address our patient’s impairments to help them stay active and pain free. A good physical therapist looks at the movements of your whole body to see if there are compensations in the normal patterns of movement, to find muscle weakness, to find joint restrictions, tight muscles, poor balance, and assess how a patient’s environment and activities may be affecting their pain and limitations. From there, we start to address those impairments and very often pain subsides and we can ramp activity back up.

Another difference I see in good practitioners is the ability to help patients with low back pain become independent. If you are constantly receiving care and are not taking an active role in your own recovery and health, I think you are not being properly cared for. I don’t know too many practitioners that you can take on vacation with you to help you when your back gets flared up. Because there are so many factors that play a role in a patient’s pain a very multimodal approach to intervention is indicated.

Brian, what do you mean by multi-modal approaches in low back pain treatment? I mean that there has to be a combination of manual therapy (hands on techniques) and active exercise. I do not believe in passive approaches to care. I am not going to stick you on a TENS unit (thing that makes your skin tingle) with an ice pack for 15 minutes while I catch up on notes. What in life has come easy to you without having to put in work or effort? I am telling you now that dealing with your body is no different and in fact often is harder work.

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I don’t like to give generic advice and exercises, but there are recommendations and movements that are well researched that can help reduce the risk of injury and also help alleviate current pain that may be stemming from your back. This advice does not mean that you should not go see a skilled medical provider that will employ the above mentioned approaches to your care.

Over the next weeks I will be providing this information on how you can get back to doing the things you love, after all, we can all live with some pain, but when it starts to interfere with our hobbies and interests, we have to say enough!

If this advice and these movements help you, please feel free to let me know. Write it in the comments below.

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I appreciate you reading and let me know if I can be of further service to you.

Here’s to helping you reach your PINNACLE!

Dr. Brian Murphy , DPT, OCS, ATC, PES, TPI II Medical

Owner of PInnacle Physical Therapy

5507 Ranch Dr Suite 203

Little Rock, AR 72223

501-529-2010

Brian@pinnacledpt.com

Doc I have low back pain but I think it might be Cancer! Help!

In treating patients with low back pain, it is not uncommon for me to have them come in with a very well researched, self-made diagnosis. We can thank Google for so much of the information we have at our finger tips today. It is so easy to look up what WebMD or Mayo Clinic says about our condition.

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I am going to tell you know that there is no substitute for a skilled medical provider. Physical therapists have a huge asset on our side, TIME. We have time to sit down and let you tell us your story. The reason I say this is because there are clear things that come from the history section of the examination that will point to a more serious condition that may be masking itself as low back pain.

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“Dr. Murphy, I am convinced that my low back pain is from a spinal tumor, can you please tell me I am wrong?”




I am now going to go into discussing the possible more serious pathologies that could be related to low back pain. This article is meant to ease your mind about the slim chance of you having one of these more serious issues.

Let a skilled Physical Therapist interview you to assure you that you don’t have a more serious life threatening condition.

Let a skilled Physical Therapist interview you to assure you that you don’t have a more serious life threatening condition.


”Brian, how do you know whether I have something more serious? I am convinced that I have cancer!” Some of the things we do include administering a questionnaire about your general health. It could ask questions about your 24 hour pain patterns, previous history of cancer, when you saw your primary care physician last, signs of tingling and numbness, coordination problems and history of any recent trauma. All of these questions clue us into then asking further questions to determine if your pain is of mechanical nature. What I mean by that is basically are you appropriate for physical therapy care because we are mechanical/movement specialists.

The first condition I will discuss is cancer. Spinal cancers are rare and can be picked up quite easily on plain film X rays. If you have not had an X ray performed before you come in to see us we will ask questions about your age, previous history of cancer, any recent weight loss, your pain patterns (what makes it better, worse, 24 hour response). Quite often pain stemming from cancer is constant, there is nothing you can do to make it go away, it will wake you up at night and keep you up for hours.

The large, white blob just behind the bones of the neck is a spinal tumor.

The large, white blob just behind the bones of the neck is a spinal tumor.

The next condition that I will discuss is a stress fracture or spinal fracture. There are some clear indicators that this may be a possibility when a patient comes into our clinic. This patient is typically a 50+ year old female, who has a recent history of a fall or motor vehicle accident, she has pain and tenderness in her back and she may have been using corticosteroids. With Arkansas being a direct access state, we may see this patient before they had films in the ER or at their doctors office. In this case, we would refer them out to get X rays of their back to rule out this condition.

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The final condition I will discuss today is called Cauda Equina Syndrome. This condition stems from the nerves that come out of your low back. This condition can cause serious damage to those nerves which can be a problem because those nerves give energy to your bowel and bladder! Once again, the history here is critical. One of the hallmark symptoms of this condition is bowel and bladder changes. We ask the patient if they have had issues initiating or voiding their bladder. The patient feels that they did not expel all of their urine. The patient often has saddle paresthesia, tingling and numbness around your anus and genital area. Another thing we do as physical therapists is perform a thorough neurological examination. The nerves that come from your low back give strength to key muscles in your lower legs, it gives sensation to the skin and it also controls your knee jerk and achilles reflexes. We will test all of these things to see if everything is working smoothly. We of course do not want to see a decline in any of the functions of these structures.

Changes in bowel and bladder function are a major red flag and often require immediate surgery to maintain the normal function of your nerves.

Changes in bowel and bladder function are a major red flag and often require immediate surgery to maintain the normal function of your nerves.

In the state of Arkansas you can see your physical therapist directly without seeing a physician first. We are very skilled Doctors with advanced training in neuromusculoskeletal pain and should be at the forefront of your mind when determining who to see concerning your pain and limitations.

At Pinnacle PT, I offer a free 20 minute discovery visit either in my office or over the phone. I listen to your story and ask you relevant questions to see if you are appropriate for my care. I also make appropriate referrals to medical providers I trust in the community if you need to be seen by a physician for something that I am not able to treat. All too often we just ignore our pain because we are scared and think that it is just going to go away. Don’t let your pain get any worse, because often that will lead to compensation and development of pain in other areas and a further decline in your function.


E-mail me today at brian@pinnacledpt.com, or call/text me at 501-529-2010 and let me help you get through this trying time!

Here’s to helping you reach your PINNACLE!


5507 Ranch Dr Suite 203  Little Rock, AR 72223

5507 Ranch Dr Suite 203

Little Rock, AR 72223



What is Causing my Low Back Pain?

Doc, what is causing my low back pain?

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Does low back pain bring you in to see your doctor? I know for me, that pain and limitation in my daily activities spurs me to get examined. With the prevalence of low back pain in our population today, I have many patient’s who want to know what is wrong with them. Here is where I will dive into the research to tell you why low back pain in medicine is a tricky condition.


So what do I mean by tricky condition? Remember I told that most of my patient’s come in to me asking what is causing my low back pain?The answer is anything but clear. The term pathoanatomy is how much of medicine is taught in medical school, physical therapy school, and many other schools for  body workers. This term means that we are looking for an anatomical reason for what the patient is telling us.


For low back pain this would include looking at films to help us determine the cause of pain. It seems logical that this would point us in the right direction of how to best treat patient’s with low back pain. However, this is far from the truth. The research tells us that most diagnostic tests (X-ray, MRI, CT scan) when assisting in diagnosing the low back are of very little value. Why you might ask? Because of false positives. Many of these tests find so called “pathology” or abnormalities in patient’s who don’t even have pain!

Did you know that  herniated discs can actually be reabsorbed by the body and heal completely on their own when given the right conditions and time?

Did you know that herniated discs can actually be reabsorbed by the body and heal completely on their own when given the right conditions and time?


That is confusing! Brian, you are telling me that if I go to my doctor and he orders an MRI and it shows degenerative disc disease but that the finding of DDD may not be causing my pain? Yes, my friend, you are exactly right! According to the research study by  Savage et al1 it reported that 32% of asymptomatic subjects had had ‘abnormal’ lumbar spines (evidence of disc degeneration, disc bulging or protrusion, facet hypertrophy, or nerve root compression) and only 47% of subjects who were experiencing low back pain had an abnormality identified.1


If it were as simple as looking at an MRI to find the “cause” of low back pain, it would be much better cured and would not be such a burden to us and our medical system. Just the sheer fact that you can see a massage therapist, internist, orthopedist, spine surgeon, yog instructor, chiropractor, physical therapist tells us that there is no clear concensus on how best to treat patient’s with back pain.



Now, I am not saying that those diagnostic tests are not valuable, what I am saying is that often they are not needed on the first appointment to your medical provider. Say for instance that you go to your internist for an episode of low back pain, you may be prescribed a steroid, some pain medication, an X ray will be ordered and you will be sent to PT. If you add up the cost to you and the system of this approach, it will be exorbitantly more than going directly to your physical therapist.

No thank you, I’ll try PT first. #getPT1st

No thank you, I’ll try PT first. #getPT1st

Yes, that right, in the state of Arkansas, you can go directly to your PT first. What does that mean? It means no medications, no expensive diagnostic tests, no injections, no surgery and often a very effective non invasive way to get pain relief. We are trained to determine if your low back pain symptoms are of mechanical origin. There is a small chance that you may have a serious underlying issue that needs medical attention, but we are well educated in screening for those conditions and making appropriate referrals when necessary.


So you may be asking, if there is no specific problem in my back, then how do I get relief?This is where as physical therapists we are taught to subgroup patient’s with low back pain. Based on the signs and symptoms of your condition we do a thorough history to start to determine what are the factors related to your back pain. Is there mechanical stress from work, poor postures, anxiety or depression, is there signs of instability, are you having pain that radiates below the knee, are you in a chronic state of pain? All of these questions and of course our movement examination will allow us to determine a specific treatment plan for you! Your medical provider should be spending at least 15 to 20 minutes just talking to you to determine the best course of care to get to the root cause of your problem.


All the medication in the world will not help if you are constantly sitting with poor posture at work, or if you are bending and lifting improperly. It is time we expect our medical providers to look holistically at all the factors that are playing a role in our limitations, so we can have a multimodal way to attack those impairments so we can get back to enjoying our active lives in a pain free/reduced manor.



Why not try conservative care first?

Why not try conservative care first?

As always I am here to be a resource for you, I am available via e-mail at brian@pinnacledpt.com or by phone call or text at 501-529-2010. I offer a FREE phone consultation to help guide you to a full return to the things you love. Please reach out.

Here’s to helping you reach your PINNACLE!

Brian  

Reference

  1. Savage RA, Whitehouse GH, Roberts N. The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Eur Spine J. 1997;6:106–114.

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5507 Ranch Dr Suite 203

Little Rock, AR 72223

Dogwood Crossing Building





Balance and the Golf Swing

The sport of golf is very unique in that it involves one of the most complex movements of the human body. Mastery of the golf swing requires balance, flexibility, strength, power, coordination, rhythm, and stability. When determining the objectivity  of these characteristics we can look at golfers of varying skill levels. Very proficient golfers have characteristics that are different than the recreational golfer. There have been studies that have compared these differences. One particular study looked at 257 healthy male golfers.1 In this study they compared the characteristics of different skill levels; the skill levels that they compared were <0 handicap, 1-9, and 10-20. What they found in regard to balance in particular was that very efficient golfers, < 0 HC showed much better single leg stance balance during certain conditions that were tested on a Kisler force plate at a frequency of 100 Hz. This is a device that allowed researchers to introduce a certain force and see how the golfer reacted to that force. That date is then collected and compared across the different groups.

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Why is balance important in the golf swing?

Technology today is allowing researchers and golfers to determine how the ground is utilized during the golf swing. Have you ever seen a long drive player hit a golf ball? They literally leave the ground! Pieces of equipment like the Boditrack allows us to see the transfer of weight during the different components of the golf swing. What we are finding is as the club is being taken away, in this instance for a right handed golfer, there is a center of pressure shift onto the trail right leg which peaks when the club shaft is parallel to the ground. Before the player even gets to the top of the back swing we see the pelvis start to turn as we come into the downswing.  There is a rather quick transition of weight onto the lead leg. This center of pressure shift requires balance to keep the body within its base of support. When you think about how quick the golf swing happens, it is critical to control all the moving parts and momentum that is created along with the shifting of the weight. This all takes balance!

I utilize this technology to train a golfer on how to react to the ground and also to cue them how to work on balance movement control.

I utilize this technology to train a golfer on how to react to the ground and also to cue them how to work on balance movement control.

How does the body balance?

There are three main systems involved in balance. The first is your visual system. Your eyes take in information that is then sent to the brain through the optic nerve. This information is interpreted by the brain and the brain sends commands down the spinal cord to tell your body what to do. The inner ear functions in a similar way. There is fluid that moves in your inner ears. Surrounding certain parts of where that fluid flows are hairs. According to how those hairs react to the movement of the fluid information is once again sent to the master controller, the brain. Our last system that aids in our balance in our joints. Our joints have certain cells which react to changes in pressure, stretch, or their environment to send signals up to the brain for the brain to interpret. The brain will then send signals back down to tell your body to fire a muscle or step to avoid a fall.

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Can balance improve?

One particular study2 looked at balance as one of the variables they tested to see how it reacted to practice. In this study, which was conducted over 8 weeks, there was a statistically significant change in the patient’s balance after the training was completed. The training did encompass more than just balance work, but also included flexibility work, strength work to upper and lower body, as well as some aerobic exercise. There are numerous other studies that show how training and challenging the various systems can help with balance will improve a person’s ability to prevent falls as a result of a loss of balance.

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Balance is not only critical in the golf swing, but driving the cart as well!



References

1. Sell, TC, et. al. Strength, flexibility, and balance characteristics of highly proficient golfers. Journal of Strength and Conditioning Research. 2007;21(4):1166–1171

2. Lephart, SM. et. al. An eight week golf specific exercise program improves physical characteristics, swing mechanics, and golf performance. Journal of Strength and Conditioning Research. 2007;21(3):860–869











Frozen Shoulder Explained!

Frozen shoulder syndrome is a condition that effects people’s ability to do their daily activities. This article is a resource for education and guidance on what to do if you think you have this condition. It does not take the place of a skilled assessment by a highly trained medical professional (ME!). Feel free to use the information, but if you are not seeing progress I would like you to reach out to me so I can hear your story and be a further resource for you.

Read More

Aging Gracefully: The benefits of resistance training

As we age unfortunately we loose muscle mass, which means we get weaker. You can’t avoid this decline but you can make it more gradual. Do you know the recommendations, the frequency, the specifics, the science, and do you have a resource you can talk to in order to find out more. Now you do. Read this article and let me know if you have any questions.

Read More

Lions, and Tiger, and KT tape, O My!

The golf world was set ablaze again with the sight of Tiger Woods with Kinesiology Tape on his neck. 

https://ftw.usatoday.com/2018/07/tiger-woods-kt-tape-neck-stiffness-reaction

https://ftw.usatoday.com/2018/07/tiger-woods-kt-tape-neck-stiffness-reaction

 

The rumors started flying, he is hurt, what is going on, is he done for good this time? 

I wanted to write about Kinesiology Tape to give you some more information about where it came from, what it does or reports to do, and if it is beneficial. 

Where did it come from? 

Kinesiology Tape was developed KT in the 1970’s by a Japanese chiropractor named Dr. Kenzo Kase. It is made of tightly woven elastic fibres, which can be stretched to approximately 120% of their original size.  This elasticity is similar to that of human skin. 

The Kinesio Taping Method first gained recognition outside of Japan in the 1988 summer Olympics in Seoul, South Korea. Introduction to the USA occurred in March 1995 in Portland, Oregon at the Northwest Athletic Trainers Association Annual Clinical Symposium. Europe was next to find the value of Kinesio Tex Tape in 1996. The technique is used by Physical Therapists, Occupational Therapists, Certified Athletic Trainers, Massage Therapist, Doctors of Chiropractic, Medical Doctors, Nurses, and Acupuncturists all around the world.    https://kinesiotaping.com/about/what-we-do/

https://www.wsj.com/articles/SB10001424052748703465204575208193178227952

https://www.wsj.com/articles/SB10001424052748703465204575208193178227952

 

What does it do? 

Some of the purposed benefits of KT tape include: normalization of muscular function, increased vascular and lymphatic flow, reduced pain by neurological suppression, corrected joint misalignment, relieved abnormal muscle tension, and increased proprioception. 

All of these fancy words basically mean that it can help decrease pain by having an effect on your nervous system, it can help with the process of ridding your body of bi products that are harmful to you,  and it can help with stimulating your body to help heal itself. 

Is it beneficial? 

There is conflicting evidence as the effectiveness of KT tape in doing what it reports. The problem with research is that often times it is done in an environment that is more controlled. This means that it is under conditions that are not always the same as a person may experience in the real world. There are better ways to structure a research study to leave it with as little bias as we can, but the scientific process is far from perfect. 

There is a term called placebo that I feel is beneficial to define and explain. A placebo according to Wikipedia is a substance or treatment that has no intended therapeutic value. We often know of this term from studies on drugs. A control groups is often given a placebo drug which can just be a sugar pill and it acts as a way to compare the results of the patient's who are actually receiving the drug under the study. The problem with a sham or placebo taping is that any tape that touches the skin has an effect on the body which is hard to determine. We have nerves in our skin that send signals to the brain which can have an effect on the brains response (thus the purported effect on the nervous system) 

There is a very specific way that is taught on how to apply the kinesio tape. The direction of the taping, the amount of pull, the goal of the tape, the results of the evaluation and the goal of what the tape is helping to do all need to be taken into consideration as to the value they bring to help the patient reach their goals. When I treat a patient, if they mention a prior treatment or approach that was beneficial to them, I know that they have a psychological attachment to that treatment because they found it beneficial before. I am sure going to use that treatment, because I know there is value attached. The mechanism of KT tape may just be psychological in nature, if you think it works it does. The brain and nervous system, our beliefs, our feelings, our past experiences all play a large role in the physiological response of our bodies to treatment. 

We know that when we think about positive things, they tend to happen in our lives. I feel that this holds true in medicine as well, we can't forget how powerful the mind is in healing our bodies. 

http://ispeventcenter.com/blog-post/positive-thinking-a-gamechanger/

http://ispeventcenter.com/blog-post/positive-thinking-a-gamechanger/

 

Remember that I am always here to be a resource for you. My name is Brian Murphy, I am a doctor of physical therapy and owner of Pinnacle Physical Therapy in West Little Rock, Arkansas. Please e-mail me if you have any questions: Brian@pinnacledpt.com or shoot me a call or text to 501-529-2010. 

Thanks and here's to helping you reach your PINNACLE! 

Brian 

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Orthopedic Physical Therapy

Orthopedic physical therapy is the specialty practice of evaluating the patient’s body and its movements. As a physical therapist we specialize in optimizing movement which may be altered from a variety of circumstances. One way happens to people who maintain habitual postures. When you think of someone who sits at a desk or performs repetitive tasks, they are predisposed to abnormal forces which can lead to musculo-skeletal pain or limitation. Physical therapists can help modify the work environment to help minimize forces while at the same time make the patient more tolerant to those forces so that there is not tissue breakdown and therefore pain.

What impairments do you have that keep you away from your passions?

What impairments do you have that keep you away from your passions?

As an orthopedic physical therapist we also specialize in helping people who are having joint issues. As we age there can be degenerative changes that occur in our joints. The joints that come to mind first are of course the knee and hip. In those situations, physical therapists help a patient to develop a plan that will prevent limitation in daily activities as well as hobbies while at the same time help them with pain management and prevention of surgery in a very holistic way which is proven by research to help in most cases.

Not interested in taking medications, getting injections, or having surgery. A physical therapist is a great option to help you get back to doing the things you love.&nbsp;

Not interested in taking medications, getting injections, or having surgery. A physical therapist is a great option to help you get back to doing the things you love. 

Another way an orthopedic physical therapist can help a patient, which in my opinion is the most effective is in injury prevention. We are trained to do thorough assessments of your nervous and musculo-skeletal systems to see if they are performing optimally. I bring up the example of doing your yearly physical with your primary care doctor. We all know the value of having a physician listen to our heart, check our blood pressure, perform blood work and check in on our internal systems to ward off disease and help cure our ailments. Why not also have a yearly checkup with your movement specialist who can help you stay active in a noninvasive way by warding off potential injuries before they happen and sideline you from doing the things you enjoy.

There is a great resource for consumers of health to educate themselves on their options when it comes to treating pain and limitation. There is a movement called GetPT1st which highlights in more detail the benefits of seeing an orthopedic physical therapist. I urge you to check out this resource and see if physical therapy will be right for you.

http://getpt1st.com/why-physical-therapy/

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If you are in the Little Rock area, there is an orthopedic clinic specialist which is a credential that very few physical therapists have in the country let alone the state. He is willing to help analyze your movement, educate you on a specific plan of care catered to your needs, and empower you by teaching you what you need to do at home to get the best timely outcome. 

Check out www.pinnacledpt.com and Dr. Brian Murphy for more information. 

Dr. Brian Murphy, DPT, OCS, ATC, PES&nbsp;  Owner of Pinnacle Physical Therapy in West Little Rock, AR

Dr. Brian Murphy, DPT, OCS, ATC, PES 

Owner of Pinnacle Physical Therapy in West Little Rock, AR

Swing flaws and body limitation connections: Hanging Back swing pattern

The hanging back swing flaw happens when the player fails to shift their weight onto their lead leg during the downswing. This swing flaw really prevents power generation from the core and hips. 

Hanging Back, which kills your power!&nbsp;

Hanging Back, which kills your power! 

Shot Implications

When a player demonstrates this characteristic they end up compensating by placing the ball further back in their stance to ensure they can make contact with the ball. It mainly leads to inconsistency in ball striking as well as poor distance. 

Body Factors

The tie between the body and this swing flaw can be seen in poor balance/stability in the lead leg, poor mobility or lack of motion in the lead leg (hip or ankle), or even an injury that is preventing the player from loading the lead leg because of fear of soreness or pain. A lack of power and strength in the lower body can also cause a player to have more of an upper body golf swing, which is very inefficient. 

Exercises

Like Lance Gill said above, this exercise is a great way to learn to increase strength in the hip rotator muscles while at the same time allowing the hip joint to rotate both internally (post position) and externally (backswing position). 

The above exercise is also a great way to apply a little resistance into loading of the lead leg. There is also a tendancy for the body to fire stabilizing muscles as the band is trying to pull you in an opposite directions of your intended weight shift, which in this case is onto the lead leg. The firing of these stabilizing muscles as well as other larger muscles helps the body to ingrain the movement from a nervous system standpoint. What that means is that your body sends a signal up to your brain and as you are doing the exercise (sending the signal) your body is becoming more efficient at that ideal movement. 

 

Call today for a FREE phone consultation, I am here to help make 2018 be your best golf season yet. 

501-529-2010

 

Thanks and here's to helping you reach your PINNACLE! 

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Swing Flaws and Body Limitation Impairments: Over the Top

Over the Top

This swing characteristic is very common in higher handicap golfers. This commonly occurs with overuse of the upper body on the downswing portion of the swing. The player brings their club from outside to in and does not keep in in the slot. The slot is the intended swing path of the club that is ideal to put the club face squarley on the ball. 

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Shot Implications

If you have this swing characteristic it is common for you to pull the shot if your clubface is square and for you to slice the shot if your club face is open at impact. This fault makes it very difficult for you to consistently strike the center of the club face when you make contact with the ball. 

Body Limitations

This swing characteristic can be seen if you have a hard time with disassociation. Disassociation is huge in the golf swing; this is the ability for you to keep one area of your body stable while moving another part of your body. Their is an ideal sequence to moving the parts of your body during the downswing. If for instance you have stiffness in your hips or pelvis and they are not moving effectively, it is not uncommon to see a golfer using more of their upper body to swing the club, this often leads to the over the top swing fault. 

A proper weight shift is also critical to prevent this swing fault. A right handed golfer shifts their weight from the trail leg the lead leg very early in the downswing. If you have poor balance, or decreased core and glute strength it will force you to not shift as effectively and you end up coming over the top. 

Exercises/Corrections

There are drills you can perform to help with disassociation, and mobility of the upper and lower body. 

The Bretzl : http://www.mytpi.com/improve-my-game/swing-characteristics/over-the-top_v2

The stretch above is a great way to work on your mobility and the stretching of key areas in your body that need mobility to make a powerful golf swing. 

If you need any advice, please feel free to reach out to me at Brian@Pinnacledpt.com, by phone or text at 501-529-2010. I offer a FREE phone consultation to see if I can help you with your impairments so that you can return pain free to this things you enjoy.

Thanks and here's to helping you reach your Pinnacle! 

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Swing flaws and body limitation characteristics: Reverse spine angle

The reverse spine angle swing flaw is evident when the player demonstrates a lean of their upper body toward the target. For a right handed golfer this would be to their left at the top of their backswing. 

This lean of the upper body toward the target is a key characteristic of the reverse spine angle.&nbsp;

This lean of the upper body toward the target is a key characteristic of the reverse spine angle. 

Shot Implications

This position makes it very difficult to properly sequence your downswing. The proper kinematic sequence is for the hips and pelvis to begin the movement of the downswing followed by the upper body, arms, and finally the hands and club. This allows for the energy stored in the muscles of the trunk to be released in such a way that maximizes power into the ball. If this sequence is abnormal then power is bled from the swing and increased forces can be put into the body. This position also makes it difficult to find the proper path of the golf club as it travels toward the ball, which leads to inconsistency in the path of your ball toward your selected target. 

A SHANK IS WHEN YOU HIT THE BALL MORE TOWARD THE HOZEL OF THE CLUB.&nbsp;

A SHANK IS WHEN YOU HIT THE BALL MORE TOWARD THE HOZEL OF THE CLUB. 

Body Factors

In order to maintain your spine angle during the backswing your body has to be able to do certain things. First, you have to be able to separate your upper body from your lower body. If you are unable to do this it could be because of a mobility issue ( joint stiffness, or muscular tightness). Another reason why you may not be able to separate your upper body from your lower is because of what is called a motor control/stability issue. This is when your body must be trained in how to properly move.

Mobility in the thoracic spine (upper part of your back) as well as your hips are critical during your backswing. If mobility in these areas is limited your body will lean and sway to compensate. This compensation is the reverse spine angle swing flaw. This position puts a lot of stress on the right side of your low back. 

Mobility and flexibility are shown here, but don't try this as a warm-up before your golf round.&nbsp;

Mobility and flexibility are shown here, but don't try this as a warm-up before your golf round. 

Stability in the core and around the hips is critical to efficiently move and properly sequence your swing. We know stability is an issue when we test you using the TPI screen and other exam techniques. Working on strengthening the core and looking at your rolling patterns is a way that we help to train your stability. 

Exercises

Try this exercise to ensure you are keeping your pelvis in neutral. This is another body issue that can cause you to extend or arch your back which then puts you in a reverse spine angle position. 

Call today for your free phone consultation. I am here to be a resource for you. 

 501-529-2010

Thanks and here's to helping you reach your PINNACLE! 

Swing flaws and body limitations connections: Flat shoulder plane

This swing flaw has to do with the alignment of the plane of the shoulders compared to a line drawn straight up through your spine. 

Angles drawn at address&nbsp;

Angles drawn at address 

As you come into your backswing you should not see the lead shoulder raise up, thus widening this angle. 

As you can see, now that he is at the top of his backswing this plane has totally changed.&nbsp;

As you can see, now that he is at the top of his backswing this plane has totally changed. 

Shot Implications 

- This can lead to poor power into the ball

- Club is out of position and a compensation movement has to happen in order to get the club face on the ball. This leads to inconsistent ball striking. 

Body Limitations 

Shortened latissimus dorsi musculature or stiffness in the spine can lead to an inability to turn the upper body independently of the lower body. 

Try this exercise to stretch your lats! 

Make sure that you have tightness in this muscle before you stretch it out. You can perform 3 x and hold each one for 30 seconds.&nbsp;

Make sure that you have tightness in this muscle before you stretch it out. You can perform 3 x and hold each one for 30 seconds. 

 

Both the hips and shoulders have to demonstrate great flexibility and movement. In order for you not to compensate elsewhere it is critical that the shoulders and hips both have the movement ability to help you get into an aggressive position at the top of your backswing without demonstrating the flat shoulder plane.  

Try this exercise to make sure your hips are rotating effectively. 

Sitting in this position, as one knee goes in toward the floor the other goes out. You can alternate positions performing 30 x alternating holding for around 5 seconds.&nbsp;

Sitting in this position, as one knee goes in toward the floor the other goes out. You can alternate positions performing 30 x alternating holding for around 5 seconds. 

Remember that none of these exercises are meant to cause pain. You should also seek the advice of your primary care physician before starting any new exercise program. If you are having pain, you can reach out to your local TPI professional for a golf specific assessment. I can be reached at pinnacleDPT.com, over the phone at 501 529-2010, or at brian@pinnacledpt.com. 

Thanks and here's to helping you reach your pinnacle!

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Swing flaws and body limitation connections: The dreaded sway

My job as a level II TPI medical provider is to determine what limitations a golfer has in their body that may lead to injury, or a faulty swing pattern. I don't understand how to teach you to swing the club, that is why I work with your swing coach! My job is to prepare your body through gaining flexibility, strength, power, stability, and mobility where you need it so your swing coach can then teach you to maximize your swing. 

The Sway

This swing fault is where the lower body moves laterally (sideways) away from the target. This swing fault can lead to decreased power, reduced lower body speed and decreased trunk stability. Th results in decreased distance with your clubs. 

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Body Connections

So what limitations in the body lead to this swing flaw? 

The Ankle

If the ankle has a limited ability to move it can effect your body's ability to keep the weight on the inside part of your arch during the backswing. This can contribute to the body moving away from the ball (sway). Try this exercise to prevent this from happening. 

Start with the foot flat, without lifting the whole foot, try and lift the inside arch of the foot and curl your big toe under. Hold this position for 5 seconds, and perform 15 x on both feet. 2-3 x a week is adequate to build strength in your arch and help with mobility.&nbsp;

Start with the foot flat, without lifting the whole foot, try and lift the inside arch of the foot and curl your big toe under. Hold this position for 5 seconds, and perform 15 x on both feet. 2-3 x a week is adequate to build strength in your arch and help with mobility. 

The Hip Muscles

Ensuring that two of the butt muscles the gluteus medius and maximus are activated will help prevent the sway from occurring. Try these two exercises to ensure these muscle are strong. 

The object with this exercise is to tighten your buttocks without feeling any tightness develop in your hamstring or back&nbsp; muscles. The hamstrings are the muscles in the back of your thigh. Hold for 5 seconds and perform 20&nbsp; repetitions.&nbsp;

The object with this exercise is to tighten your buttocks without feeling any tightness develop in your hamstring or back  muscles. The hamstrings are the muscles in the back of your thigh. Hold for 5 seconds and perform 20  repetitions. 

This exercise targets the gluteus medius muscle, a key muscle in keeping your pelvis stable. Can perform by walking sideways both directions, make sure not to sway your upper body and stay in a slightly squatted position.&nbsp;

This exercise targets the gluteus medius muscle, a key muscle in keeping your pelvis stable. Can perform by walking sideways both directions, make sure not to sway your upper body and stay in a slightly squatted position. 

Hip Range of Movement

The hip has to be able to rotate, if there is stiffness in the hip joint a sway will happen to allow you to get to the top of your backswing. Try this exercise to ensure appropriate hip range of movements. 

You can alternate sides bringing one knee toward the ground as the other knee goes out. Alternate 30 x.&nbsp;

You can alternate sides bringing one knee toward the ground as the other knee goes out. Alternate 30 x. 

Thoracic Spine (Upper Back)

Movement in the upper back is critical to provide an efficient turn during the backswing. If this area is stiff  the body will sway to compensate for the lack of movement above. 

From left to right is the sequence. You want to make sure you don't allow the knees to separate during this drill. You can move 10 x to the right and then repeat to the left.&nbsp;

From left to right is the sequence. You want to make sure you don't allow the knees to separate during this drill. You can move 10 x to the right and then repeat to the left. 

Try these exercise to prevent the dreaded sway and if you need any assistance or any of these exercises cause pain, please feel free to reach out to me at 501 529-2010 or brian@pinnacleDPT.com. 

 

Thanks and here's to helping you reach your PINNACLE! 

How Do I Hit the Ball Further? Work your Butt!

As a Titleist Performance Institute Medical Provider I get asked the question, “How do I improve my driving distance.” The answer from my perspective as a movement and musculoskeletal expert is that you have to have a combination of flexibility and stability. The body is made up of regions that are meant to be very mobile, think of your shoulder, and other regions that are meant to be stable, think of your low back. Stability is often attained by strengthening key regions of your body that help to generate power and help transfer that power into the ball.

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The gluteus maximus is a muscle that is very active in the forward swing which is the phase from the top of the backswing until when the club is horizontal. Studies have shown that for a right handed golfer there is 100% activity in the right gluteus maximus muscle.

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A simple exercise to help strengthen this muscle is below. The top picture is your starting position and the bottom is your ending position. You can perform 10 to 15 repetitions and hold the end position for 5 to 10 seconds. This is a great way to strengthen your glutes which will allow you to hit the ball further!

This is the starting position.&nbsp;

This is the starting position. 

You want to pull the knees apart (the band around the knees provides additional contraction of the hip and core musculature) then lift your butt off the floor.&nbsp;

You want to pull the knees apart (the band around the knees provides additional contraction of the hip and core musculature) then lift your butt off the floor. 

If you are having pain with this exercise you can reach out to me at brian@pinnacledpt.com or over the phone at 501 529-2010. My website pinnacledpt.com tells more about my philosophy as a Physical Therapist.

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Thanks and Here's to Helping You Reach our Pinnacle! 

Prevention Strategies for the Injured Swimmer

"Coach, I just did my thousand warm up and my shoulder is killing me, what should I do?"

There are a lot of factors that go into determining why a swimmer is injured. I wanted to give you some tips and ideas on what you can do to try and treat these injuries on your own. 

Tip 1: The best strategy is to avoid injury before it comes! You must have a solid flexibility, strengthening, and endurance training program under your belt that you are performing consistently! 

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*Stay tuned for my video series that is going to give you this exact program! 

Tip 2: Careful monitoring of training volume, intensity, and duration will go a long way in calming down an injury. Complete rest is rarely indicated because of the deconditioning that develops. Certainly looking at adjusting the above parameters for a short time will give the athlete time to allow the healing process to be effective. 

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Tip 3: Specifically for the shoulder, avoidance of using hand paddles is a good idea as these put more stress on the shoulder. Avoiding or limiting the painful stroke is also a good idea. Modification of the dry land training program will prevent continued stress to the injured area. 

Thank you Lord, I don't have to use paddles today!&nbsp;

Thank you Lord, I don't have to use paddles today! 

Tip 4: Application of ice to the affected area helps to reduce pain and inflammation as well as proper use of anti-inflammatory drugs when appropriate will help reduce pain and improve function. 

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Tip 5: Have your coach take a look at your swim mechanics. Ensuring that you are swimming with correct technique goes a long way in avoiding increased stress to structures in your body that can cause pain. 

I hope these tips are helpful for you and keep you swimming and performing at your best. 

If you are still struggling to get your injury under control please reach out to me anytime at brian@pinnacledpt.com, or call me at 501-529-2010.

Come back next week for the start of the video series on exercises that you MUST be performing!

Thanks and Here's to Helping you Reach your Pinnacle! 

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Swimmers, Why Do Your Shoulders Hurt?

All of those dedicated hours in the pool to get ready for your next big meet. Have you ever wondered why your shoulder hurts when you swim? I am going to write a series of blogs discussing some of the causes of shoulder pain in swimmers and what you can do about them. 

Shoulder Impingement

Anatomy of the Shoulder

Anatomically the shoulder joint is a very unstable joint. I equate it to a golf ball sitting on a golf tee. The ball is the head of your humerus (upper arm bone) and the tee is the glenoid fossa ( socket which is part of the scapula or shoulder blade). The shoulder relies heavily on ligaments, muscles, and cartilage to help provide stability. 

The shoulder joint from the back (left picture).&nbsp; Shoulder joint from the front (right picture). And looking at the glenoid fossa (where the upper arm bone joins with the shoulder blade)

The shoulder joint from the back (left picture).  Shoulder joint from the front (right picture). And looking at the glenoid fossa (where the upper arm bone joins with the shoulder blade)

Impingement Explained

Impingement is when the humerus glides upward and causes stress on structures that sit under your acromion (part of your shoulder blade). There are a lot of pain sensitive structures that lie under this subacromial space, namely your rotator cuff musculature and your bursa sac. The rotator cuff is the musculature that helps to perform certain movements of the arm and shoulder blade as well as what helps to provide stability to the joint. A bursa sac is a fluid filled sac that helps to dampen forces and helps the shoulder joint move more freely. During the recovery phase or above water portion of the swim stroke the arm is going into a flexed and internally rotated position. This position along with the force of the water during hand entry puts a lot of stress on the shoulder joint and its surrounding structures. 

The supraspinatus muscle (shown below) and its tendon are often affected in impingement of the shoulder. 

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This muscle plays a key role is stabilizing the head of the humerus to prevent it from migrating upward into the acromion. This muscle along with others are susceptible to fatigue as the swimmer's practice progresses. This is where performing specific dry land training exercises helps to strengthen and build the endurance of those muscles. 

Try this exercise: It has shown a large level of contraction in the supraspinatus muscle. Make sure you are using a weight that you can perform 2-3 sets of 15 to 20 repetitions. Don't raise your arms straight ahead, but angled out slightly. 

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If you can't seem to get a handle on your shoulder pain. Give me a call or shoot me an e-mail and I will be able to do a thorough assessment to find your impairments that are leading to the true cause of your pain. 

Click on Pinnacle Physical Therapy below to head to my website for more information about me and my practice. Please like my FB page 'Pinnacle Physical Therapy.' I will be posting some cool videos on there specifically to keep Central Arkansas Swimmers healthy! 

Office Work and What it Does to Your Game!

You're the typical type A personality. You can literally sit at your desk and do work for hours at a time without a break. Although your boss and your bottom line may benefit from this productivity, your golf game DOES NOT! 

Upper Body Implications

What we see with the typical work station set up is that we are forced to take a posture that causes a rounding of our shoulders, a forward head posture, and an increased curvature of our thoracic spine. Pain can also go hand in hand with these postures. As the old saying goes, form follows function. Being in this position for most of the day will cause changes in body structures that are having a negative effect on making an optimal golf swing. 

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Rounded Shoulders

Tightness of pectoralis major/minor musculature and the inefficient position of the head of the humerus (upper arm bone) can prevent you from getting your arms to an efficient position in the top of your golf backswing. 

Use this stretch to prevent tightness in the pectoralis musculature and pain in the neck and shoulders. Perform 2-3 x throughout the work day. Each time you perform this stretch you can do 3 repetitions holding each stretch for 30 seconds. You should be feeling a pulling sensation just below and in front of your shoulder. If you have had previous injury in your shoulder consult with your medical provider before trying this stretch. 

You might have to find a strategic location in your office to perform this stretch. You can always tell your boss you do your best thinking when you are in a corner!&nbsp;

You might have to find a strategic location in your office to perform this stretch. You can always tell your boss you do your best thinking when you are in a corner! 

Thoracic Kyphosis

This is the fancy word for increased arch in your upper back (the thoracic spine). What happens here is that the joints in the thoracic spine that allow that area of your back to move become less mobile with prolonged poor posture. This will literally reek havoc in your golf swing because you need around 50 degrees of thoracic spine rotation at the top of your golf backswing to create any type of power and coil in the musculature. This coil is then released to exert energy into the golf ball. 

Use this exercise to prevent lack of mobility in this area as well as neck, shoulder, and upper back pain. You can perform this exercise 2-3 x per day. Each time you perform the exercise you want to hold this end position shown below for around 5 seconds. Start in an upright sitting position. 10 repetitions each time is adequate. Make sure you are feeling this in-between your shoulder blades. You are basically using the top of the chair as a fulcrum to help mobilize your Thoracic Spine. 

Make sure your chair is not going to roll backward when you perform this exercise.&nbsp;

Make sure your chair is not going to roll backward when you perform this exercise. 

Cervical Spine

This is the neck and with a forward head posture we find that a lot of tension is developed in the musculature on the back side of your neck which leads to neck pain and headaches. This occurs because you have now created an increased demand of trying to hold your head up against the force of gravity! Your head is not a light part of your body. Some of us even know co workers who have REALLY BIG HEADS! With the continued load of gravity pushing it further down, the ligaments, bony structures, and musculature have to counter that movement. 

What also happens in the above scenario is that the musculature that is deep in the front of your neck becomes weak, this can effect your neck's ability to move.  During the golf swing you need around 70 degrees of cervical rotation. 

Use this exercise to ensure the deep neck flexor musculature stays strong and that you are preventing increased loads on your neck which may lead to pain. Always remember that when the neck is stacked directly over your shoulders, gravity is just applying compression, not flexion (bending forward) which is what can cause neck pain. Perform this exercise 4-6 x throughout your day. Each time you perform it you can hold for around 5 seconds and perform 10 repetitions. The idea is to make a double chin, but remember you want to be gentle. Double chin is in! 

Try to keep your chin level, don't let your neck extend. Imagine your chin is resting on a desk and you are trying to push it straight back.&nbsp;

Try to keep your chin level, don't let your neck extend. Imagine your chin is resting on a desk and you are trying to push it straight back. 

I included the above exercises because they can be done without a lot of equipment in your office. Remember, we are all individuals.  Finding the best exercise plan for your specific needs mean you have to have a thorough examination, evaluation, and plan of care established for YOUR SPECIFICATIONS. 

Use these exercises to ensure you are ready to play your best golf after you leave the office for the day! 

If you need extra assistance, sign up for my free phone consultation under contact on my website (pinnacledpt.com) and I can be a resource for you to help you reach your Pinnacle! 

 

Physical Therapy and the Golfing Athlete

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As you can see from the above picture, the golf swing is a very complex movement that requires the body to have strength, power, flexibility, balance, mobility, motor control, and stability.

What better practitioner to seek treatment from than a Physical Therapist who is TPI Medical II certified?

What is TPI?

TPI is the worlds premier player development center located in Oceanside California. They offer advanced equipment fitting methods, detailed swing analysis, and science based player conditioning.

TPI has also been doing research on thousands of golfers to find what swing characteristics are optimal and which ones lead to injury. Not only do they look at the swing but they have coined the term body-swing connection.

They teach medical professionals how to assess the golfers whole body to determine if there are physical limitations that are leading to current or eventual injury, are bleeding power from their swing, or are not optimal to play their best golf.

The TPI Screen

The TPI screen is made up of 16 specific assessments that are correlated with a players ability to make an optimum swing. The skill of your Physical Therapist at Pinnacle Physical Therapy in this specific assessment along with his past experience allows Brian to formulate a plan to attack your limitations.

You no longer have to be playing golf in pain!

 

A quote by one of the best swing coaches in the business sums it up well. "If you are in the business of coaching, physically training or medically evaluating golfers, TPI Certification should be mandatory." - Butch Harmon