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

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











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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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!