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?

slouched sitting.jpg



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?


lifting.jpg

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).

centralization.jpg

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 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.



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. 

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. 

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. 

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! 

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.

DSC_0108.JPG

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

Physical Therapy and the Golfing Athlete

Backswing.jpg

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