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?
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).
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.
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.
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
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.
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!
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.
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.
Balance is not only critical in the golf swing, but driving the cart as well!
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
The golf world was set ablaze again with the sight of Tiger Woods with Kinesiology Tape on his neck.
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/
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.
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!
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 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.
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.
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.
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.
Thanks and here's to helping you reach your PINNACLE!
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.
As you come into your backswing you should not see the lead shoulder raise up, thus widening this angle.
- 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.
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!
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.
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 email@example.com.
Thanks and here's to helping you reach your pinnacle!
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.
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.
So what limitations in the body lead to this swing flaw?
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.
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.
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.
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.
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!
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.
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.
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!
If you are having pain with this exercise you can reach out to me at firstname.lastname@example.org or over the phone at 501 529-2010. My website pinnacledpt.com tells more about my philosophy as a Physical Therapist.
Thanks and Here's to Helping You Reach our Pinnacle!
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.
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.
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.
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!
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!