The majority of golfers that come into our clinic for complaints of low back pain and other forms of injury lack flexibility through the hips, spine and ankles, all of which are heavily relied upon during the golf swing. Most professional golfers have incredible flexibility combined with excellent strength allowing them to compete at such a high level. For the weekend golfer who spends most of their day sitting at a desk, this can be a challenge.
I spend most of my time working with golfers to increase their hip flexor mobility that shortens from prolonged sitting. These muscles are located on the front of the hip and have a major influence on the curvature of the low back and how it behaves during the swing. The therapists at Nike Golf placed great emphasis on improving hip extension and rotation through a series of stretches that target the joint in 3 planes of motion. Most of us stretch in one direction and forget that we move in 3 dimensions and therefore must stretch in 3 dimensions to achieve the maximum benefit. Through the use of these stretches, I have been able to witness golfers drastically improve their follow through while resolving their back pain in a matter of 1-2 visits. Unfortunately, a lifestyle that involves sitting for 7-8 hours/day will require greater effort on your part to overcome.
The only equipment you need to perform a highly effective hip flexor stretch is a chair. Start by placing one foot on the chair and having the other foot grounded and turned inward. This is important because it really locks in the hip flexor. Lean forward at the hips until you feel tension at the front of the hip. Do not come off of the stretch and begin to gently rock forward and back for 10 repetitions, then move the hips in a side to side motion to stretch the frontal plane for 10 repetitions. It is important to also keep the back leg straight because the knee will want to bend. After those 2 motions, incorporate the transverse plane by doing a circular motion and remember not to come off of the stretch at any point for 10 repetitions in each direction, clock wise and counterclockwise. Now, switch legs and repeat. You should feel immediate relief and greater ease with the follow through of your golf swing!
Your back hurts, so you log onto your computer and Google back pain. Next thing you know you have cancer, right?Researchers found errors and inaccurate assertions in 9 out of 10 Wikipedia entries on the costliest medical conditions which was recently published by the Journal of the American Osteopathic Association.
A team of U.S. scientists said they found “many errors” in Wikipedia articles concerning the 10 costliest medical conditions. The researchers cross-checked Wikipedia entries on coronary disease, lung cancer, hypertension and back pain, among other ailments, against the latest research from peer-reviewed journals.
So, please be careful when doing your own research. I encourage you to be your biggest advocate when it comes to your health, but be careful of the garbage on the internet!
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Why You Should Get A Foam Roller
Something so simple, yet so effective! The foam roller is a great tool in physical therapy and general fitness. It is personally one of my favorite pieces of equipment to improve posture and alleviating neck, shoulder and upper back pain. The number of exercises that can be performed on these rollers are endless. They vary in length, diameter, material, color and firmness. Using a roller breaks up fibrous tissue and boosts circulation so you're less sore making it a cheap alternative to other forms of therapy while assisting in recovery from intense workouts. I've posted an article in the past about shoulder pain resulting from muscular imbalance which you can read here. If you feel that you fit into this category or if you find yourself sitting at your desk job all day this exercise is for you!
This is the "anti" rounded posture exercise and takes the strain off of the neck and shoulders that you feel all day. Do not push into pain when bringing your arms upward and try to keep the backs of your hands on the floor. You will need a roller that is long enough to perform this exercise, 6x36" seems to be the standard. You can find one in the 850HealthStore for around $15. The problem with the cheaper version is that they will start to flatten out from use. If you plan on using it frequently, you may look into spending a little extra and purchase one with plastic reinforcement. There are so many variations now that you can Google "foam roller" and find hundreds of choices. I have the Grid as part of my living room decor and use it frequently to loosen my thoracic spine and free up tight musculature. One of the exercises that I perform at home include the one shown below. You can roll up and down and massage your thoracic spine and shoulders. The Grid works great because of its firmness and ridges that act to massage the musculature while mobilizing a tight thoracic spine.
Find the Grid here...
There are hundreds of exercises that you can perform to better yourself. You can search the internet for exercises that are more specific to your needs and even YouTube them for demonstration! I hope this helps!
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I came across some disturbing stats today that were posted on Twitter by WebMD concerning pain medication. It is a sensitive topic and I'm going to voice my opinion on this one. Please chime in if you feel like it. The first stat was that enough prescription painkillers are sold each year to medicate every U.S. adult all day, every day for one month! Second, more people have died each year from drug poisonings than from motor vehicle crashes since 2009 and third, opiods now account for more overdose deaths than heroin and cocaine combined!!! Startling to say the least. I sympathize for those with pain and it can be misunderstood for sure, but this is a huge problem. We treat a large amount of pain from the physical therapy perspective, but are often not an option to our patients. If you go to the doctor for back, neck, shoulder, hip, knee, etc. pain, ask for physical therapy so we can attempt to fix the problem from a biomechanics standpoint and address the underlying issue. Let's not get you on the path to dependency! You would be surprised how we can help your pain through soft tissue work, joint mobilizations, exercise, hot/cold modalities, TENS units, etc.! I often hear about our patients only given pain meds as an option for pain and are sent home for it to reoccur. Go to your physical therapist and get evaluated because I believe what we do really helps and could potentially save the health care system large amounts of money by avoiding surgeries and filling prescriptions!
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Got Knee Pain?
Got knee pain? The knee is an interesting joint and I'm finding that the more knees I treat, the less I focus on the knee itself. In my other blogs I had mentioned how the hip influences the low back, well it also plays a major role in knee health. The knee likes to bend forward and back, flexion and extension, and would like to avoid the rotational component. It seems that those with knee pain lack what we call, proximal stability, quite often. The hip is weak and causes the knee to want to drift inward especially during single leg stance. Try this, stand on one leg only and try to lower yourself down in a mini-squat. Does your knee want to cave inward towards the midline of your body? If so, that is hip/glute weakness. If it does not, we may look into the ankle and other factors, but in most cases this is pretty common. That weakness may not be exposed through low level activities, but may create problems when performing repetitive activities, i.e. running, and load bearing activities, i.e., stairs.
Research is also coming out now stating that physical therapy is just as effective as arthroscopic knee surgery to correct meniscus tears (the cushion between your knee joint). This was featured on Dr. Oz on 04/25/14 with exercise demonstration. The exercises on the video are a conservative start, but I would encourage you to try the resisted side step exercise I described in my previous blog Piriformis/Sciatic Pain? Do This Exercise. It is great because it does not stress the knee so you can perform it without irritating your knee pain and indirectly make your knee stronger. Just balancing on one leg alone is also very important because it gives us a good idea how the hip is performing. If you try and you're struggling to stay upright, your hip is weak and makes you more susceptible to knee injury.
For any questions you may have about knee pain, contact me at email@example.com
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For those of you who don't know, 850 is the area code for which I reside in. It is the Destin, FL area which is a major hub for stand up paddle boarding (SUP) and the location of BOTE, YOLO and GUSU boards. You can't live here and not notice their presence in the area. At first, I didn't see the excitement in them. I'd sit on the beach and watch people float by and wonder how that was seen as enjoyable. Next thing you know, I had to have one! I rented one first to test it out and was amazed by how much fun I had. It is a great form of exercise and it puts you out in nature where you can see a different world below you. It is not at all like riding in a boat, you're right on the water and in full control. Imagine having dolphin swim by and seeing different fish while exercising and staying fit. The board is great because it forces you to use your lumbo-pelvic stabilizing muscles, your core, and using your entire body to paddle. We sit at work and spend most of our days in a slouched position, paddle boarding forces you to use your postural muscles which is great for your overall health. They even have Yoga classes on the boards and races are becoming very popular. Not to mention, the great cardio workout and metabolism boost. You can travel pretty far on a paddle board and venture to remote areas, turn it into a camping trip and just be outside! We all have gone to the beach and parked our butts in one spot, sort of like at work except better surroundings! Why not get up, paddle, enjoy nature, all while exercising and staying in shape?!!
So get off your butt and go paddle!
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Also, check out Stand up Paddle Board Review and Tower Paddle Boards
I recently read a post on Runner's World about what to do for piriformis syndrome and I felt like they had left something out. From working with piriformis and "sciatic" pain on a daily basis, I'd thought I'd share a little info on an exercise that has done wonders for my clients. Often, runners and triathletes neglect frontal and transverse plane movements, meaning that they do not perform any exercises going side to side or with a rotational component because all of their movement is in forward, backward flexion and extension. Some runners choose not to do resistance exercises at all because of the idea of carrying too much muscle mass which, I think, is a mistake. You can train to be strong and avoid the bulk while making yourself a more balanced and efficient runner. Your hip/glutes are vital in controlling rotational forces of the lower extremity and protecting the back from accessory movement. It's like driving on tires that are not balanced, they wear faster just like your joints. Your glutes are part of your "core", much more important than the 6 pack abs (they just look good). If you are already flexible, stretching the piriformis will provide you with little benefit other than temporary relief. The glutes and piriformis need strength to accept your body weight when landing on one leg while running. Strengthening the glutes may help with your knee pain as well believe it or not (We had an Ironman solve his knee pain within days of performing this exercise I'm about to describe). Your knee does not want to rotate, it wants to flex and extend. If the upper leg rotates inward because of weak glutes, it puts strain on the knee joint and IT Band. So, once again, you can try to stretch the IT all that you want, but the strength in the glutes will most likely provide the greatest benefit.
I am a huge fan of an exercise that we call resisted side step because of how effective it is in targeting your butt muscles. The only equipment you need is a theraband with good resistance. You can tie one around your ankles or purchase one in the 850HealthStore through Amazon. Blue or green would be your best bet, blue being more difficult. The continuous loop band seems to provide better resistance (12 inches). Now, walk sideways with it around your ankles while keeping your toes pointed a tad inward and avoid pointing outward because it will engage your hip flexor instead of the muscles we're going after. Also, avoid leaning sideways and keep your midsection tight. You can walk sideways for approx. 20 feet then walk back without turning around. Do 3 sets and you will feel it! Give it 2 weeks of performing most days of the week and you will be a better athlete!
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Let me begin by saying that this new technology called the Piezo Wave 2, has provided our physical therapy clinic with amazing results in the first couple weeks of treatment. It is nothing like we have ever experienced in the treatment of musculoskeletal pain. The Piezo Wave 2 is described as Myofascial Acoustic Compression Therapy (MyACT). There slogan is "Not all modalities are created equal" and I tend to agree. Our clinic has "experimented" on numerous clients with a variety of orthopedic issues from post-op patella fracture to chronic neck and low back pain and have received unexpected, yet very positive results. The only mistake we've made is not documenting client's responses after treatment. So, what is it?
Piezo Wave 2 was developed by Richard Wolf and a company called ELvation out of Germany. Richard Wolf was a leader in the development of endoscopes. MyACT delivers mechanical energy in the form of sound waves to the target tissue which includes tenocytes in tendons, fibroblasts in ligaments and skin, osteocytes in bone, chondrocytes in articular cartilage and endothelial cells in blood vessels which are all highly responsive to mechanical energy. What is great about MyACT is that you can also vary the depth of the treatment by changing the adapter on the sound head from 5mm to 30mm. I like to describe it as a metal detector for unhealthy tissue and trigger points. Please see my post for further explanation of trigger points. This device has pin-point delivery in targeting unhealthy tissue through a mechanical stimulus resulting in cellular changes that promote increased circulation and pain relief. You cannot feel the treatment around healthy tissue which also helps us as therapists to more accurately address our client's pain when we come across the discomfort of a trigger point. It is comparable to having a deep tissue massage in a fraction of the time and we suggest you drink plenty of water after the treatment just as you would after a massage.
We are more than excited to offer this treatment at Sandestin Physical Therapy Services as part of the Sandestin Executive Health & Wellness Center. Your first session is FREE because we believe you have to experience the results. This is no gimmick, it really is showing amazing results! Stop by or call (850)267-6755.
Have a Difficult Time Staying In Shape Because You're Stuck At Your Desk All Day?
Your job demands long hours and most of it is sitting behind a desk or sitting at meetings. Not to mention, you had to sit in your car and drive to and from work to later go home and sit down to eat dinner. You're exhausted after and give in to any thought of exercise. Let me help. First of all, your health is at risk. "Alpa Patel's 2010 study, published in the American Journal of Epidemiology (Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults), which found a common link between physical inactivity and cardiovascular disease mortality even after adjusting for smoking, body mass index, and other factors." (MoveForwardPT.com) Got your attention?! Yes, sitting at a desk all day is now being compared to the mortality rates of those who smoke. Not to mention, the harmful effects on your posture which leads to muscle imbalance and later back, neck and shoulder pain. The computer has provided us physical therapists with job security because of the amount of people affected. What do we do? There are several things we can do, most of which won't get you fired. You obviously will have a difficult time getting your boss to buy you a treadmill desk, so a cheaper alternative would be the DeskCycle Desk Exercise Bike Pedal Exerciser By DeskCycle (the long way of saying bike that fits under your desk, or just the pedals). It is on Amazon for $150, small price to pay for your health and if you don't have a gym membership, there you go. Other options include taking short breaks and walking the staircase a couple times, going for a walk at lunch, doing cardio exercises in place (jumping jacks, jogging, mini-squats, etc.), just close your office door! Posture is also important. Prolonged sitting causes atrophy of your postural muscles and tightness of the large muscle groups that round your shoulders and tilt your pelvis forward, both of which are major contributors to upper and lower back pain. To improve neck and shoulder discomfort, step into your door frame of your office, put your elbows on the frame at shoulder height, gently lean in and feel a stretch in your shoulders and chest (don't stick your head out like E.T. either), hold for 30 seconds at least 3 times, a couple times during the day. Grab a thera-band palms up with both hands at shoulder width and rotate your arms outward maintaining a 90 degree bend at your elbow while squeezing your shoulder blades together. Do not use your upper traps (shrug) to compensate, squeeze your shoulder blades down and back for high repetitions greater than 30. Also, follow the link about shoulder pain to help with your posture at 850health.com.
Thera-bands are great for your office because they do not take up any space and can give you varying resistance to be effective with several exercises. No thera-band? Sit back against the wall with your knees at 90 degrees and just hold for as long as you can or just simply sit and stand from your chair until you fatigue.
It is easy to give in to the long hours, but you will find yourself more efficient at your job and at life if you get active! Take care of your body, it's the only one we get!
For more exercises, email me at firstname.lastname@example.org or stop by our office at Sandestin Executive Health and Wellness Center!
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Dr. Mark Giovanini
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Scott Rusin is the Director of Physical Therapy at the Sandestin Executive Health & Wellness Center in Sandestin Resort, Miramar Beach, FL. He has a degree in Physical Therapy, is a Certified Strength & Conditioning Specialist (CSCS) and Nike Golf NG360 Performance Specialist Powered by the Gray Institute.