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.

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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.

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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. 

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   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 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 

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. 

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. 

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. 

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. 

sway.png

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. 

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  muscles. The hamstrings are the muscles in the back of your thigh. Hold for 5 seconds and perform 20  repetitions. 

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. 

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. 

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. 

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.

Joint-by-Joint.jpg

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.

Butt.jpg

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. 

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. 

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! 

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).  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. 

supraspinatus.png

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. 

Scaption.jpg

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!