Geaux to Physical Therapy » Sports Medicine

It’s National #PhysicalTherapy Month!

MoniquePT — Sat, 01 Oct 2011 18:27:01 +0000

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October is National Physical Therapy Month (NPTM). This year’s focus is on sports injury prevention through the lifespan. Staying active is important at every stage of life. Sports are a good option for people looking to get exercise without hitting up boring cardio equipment like the “dreadmill.” There are several options for staying active through sports by finding local sports clubs, the parks and rec department, or gym leagues. Though sports are good for our bodies, injuries do occur, especially if a person isn’t properly trained or conditioned and ready for its physical demands. What can start out as a nagging pain during sport can turn into a problem that takes a person away from a loved activity. The best way to prevent sports injuries like these is to not ignore them and seek help from the right people. Don’t give up and don’t stop moving! A physical therapist can help you move, move again, and move better.

A physical therapist will not only treat your primary problem, but also other problems that may have contributed to the injury. Physical therapists are trained to find these deficits and give clients a customized exercise program to address them to prevent the injury from reoccurring. If you would like to find a PT in your area to help you get back to sports or improve performance in sports, visit the American Physical Therapy Association’s (APTA) website. To read more about NPTM, click here.

In October, I’ll focus more on promoting physically active lifestyles, physical therapy, and its benefits. In preparation for NPTM I’ve been doing free sports injury screenings at the Milwaukee Northside YMCA. I’ll do my last one on Wednesday October 5th 4PM-6PM. I’ll also be giving out free information about injury prevention for runners, golfers, and bikers. If you’re in the Milwaukee area, stop on by and help me celebrate NPTM!

Tennis elbow… or is it?

MoniquePT — Tue, 01 Mar 2011 23:55:44 +0000

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Tennis elbow is a painful condition in which pain is experienced on the outside of your elbow with lifting and gripping (especially when your elbow is straight) and can lead to weakness in the elbow and hands. The condition can be attributed to poor technique related to tennis, however, more people suffer from tennis elbow than just tennis players. If you’re reading this, you may fall into this category. In fact, the condition is attributed to playing tennis in only 5% of the cases!

Tennis elbow commonly occurs in those who are middle-aged. Although many believe tennis elbow (also known as lateral epicondylitis) is an inflammatory condition (“-itis” means inflammation, right?), research shows that in many cases little to no inflammation is present. More recently, tennis elbow has been described in terms that do not suggest inflammation is present, such as tendinopathy, tendinosis, or lateral epicondylosis. These terms imply tendon degeneration, which research indicates is a cause of this condition.

Tennis elbow is caused by overuse and overload of the tendon beyond what it is capable of doing. Overuse and overload can mean different things to different people. It depends on how strong you are and what your body is capable of tolerating. For some people, tennis elbow can be provoked by doing more household chores in one day than normal. Others may provoke symptoms by participating in more sporting activities than normal (such as not swinging a golf club all winter and then taking a trip that includes playing 18 holes of golf 4 days in a row).

Overuse and overload leads to small tears in the tendon. Under these conditions, the tendon may not be able to repair itself properly, leading to more small tears. As part of the inadequate healing, the collagen fibers of the tendon, which give the tendon strength and support, become disorganized and weak and more “fibrotic” scar tissue is formed. The tendon becomes thicker, inflexible, and is not very strong or resilient. The improper healing of the tendon can lead to more pain and larger tears in the tendon and muscle.

Many of my patients ask about whether a cortisone injection would help. Research shows that medication and cortisone injections can provide adequate short-term pain relief, but no lasting effects, and one study even noted that tennis elbow treated with cortisone injections had poorer outcomes after 6 weeks of treatment and increased recurrence compared to those who had physical therapy or even for those who took a “wait and see” approach. Inadequate and or delayed treatment can lead to the problem becoming chronic. For more info and my opinion about cortisone injections, click here.

Treatments for this condition will vary based on the stage of healing. Physical therapists are trained to identify the stage of healing of tennis elbow and the appropriate course of treatment. Physical therapists use specific manual therapy techniques and exercises to help reorganize the collagen within the tendon, promoting better healing and improving its strength. If you think you may have tennis elbow, see a physical therapist. You can find one through the APTA.

References

Clinical Evidence Handbook: Tennis Elbow – March 1, 2007 – American Family Physician. (n.d.). . Retrieved March 1, 2011, from http://www.aafp.org/afp/2007/0301/p701.html

Andres, B., & Murrell, G. (2008). Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon. Clinical Orthopaedics and Related Research, 466(7), 1539.

Todd E Davenport, Kornelia Kulig, Yogi Matharu, & Cesar E Blanco. (2005). The EdUReP Model for Nonsurgical Management of Tendinopathy. Physical Therapy, 85(10), 1093.

Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial — Bisset et al. 333 (7575): 939 — bmj.com. (n.d.). . Retrieved February 28, 2011, from http://www.bmj.com/content/333/7575/939.full

Coombes, B., Bisset, L., & Vicenzino, B. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet, 376(9754), 1751.

Healthier Runners Are Happier Runners

MoniquePT — Fri, 11 Feb 2011 12:27:16 +0000

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The Combined Sections Meeting of the American Physical Therapy Association (APTA) kicked off yesterday with a presentation on Healthy People 2020 and how physical therapy can help America achieve its goals in health and wellness. Healthy People 2020 was developed by the US Department of Health and Human Services as a ten-year plan to improve the nation’s health. The APTA is part of the Healthy People Consortium, a group of organizations and partners that have agreed to be active participants in helping to achieve the goals of Healthy People 2020. As we move towards these goals, physical therapists will advocate for healthier, more active lifestyles, and provide rehabilitation and recommendations to ensure all Americans can start or return to being physically active for health.

The second course I attended was on the biomechanical factors impacting running injuries.^[i] As America strives towards its Healthy People goals, more people will be taking up new activities for exercise. A popular and relatively cheap endeavor for someone looking to stay active for health is running. As the presenters discussed each running injury and the contributing biomechanical factors, some information popped up which I thought you(either the beginner runner or experienced) might find useful.

79% of runners will be injured and 46% will have recurrence of the problem
If the alignment of your trunk, pelvis, and legs are off, you’re at increased risk of sustaining an injury. Not only that, the presenters did not mention this would impact your performance. Bad alignment = inefficiency
It is possible to have good alignment and still be at increased risk of injury due to inability of the muscles to absorb shock. When the body’s active shock absorbers (muscles) are inadequate, it starts to rely on passive shock absorbers (bone and cartilage).

Many of the factors that contribute to running injuries can be corrected with instruction in better form, safe training guidelines, and strength training. Number one on my list is strength training the hips. More info on my recommendations can be found here.

Physical therapists can help turn an unhealthy and injured runner into a healthy and happy one. A comprehensive physical therapy running evaluation consists of gait analysis, strength training, movement analysis, flexibilty, and ROM. It will not only feel good to have the pain gone, but the runner will likely improve performance as a result.

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References

Powers, C & Davis, I (2011). “Biomechanical Factors Underlying Running Injuries: Proximal and Distal Factors” presented February 10, 2011 at the Combined Sections Meeting of the American Physical Therapy Association, New Orleans, LA.

Concussions Are Glad to Be Taken More Seriously

MoniquePT — Tue, 12 Oct 2010 19:32:47 +0000

With Aaron Rodgers out this week with a concussion, I’ve been talking about this topic a little more. Then, today I received an email to participate in a concussion study at the University of Illinois (I’m posting a link below- if you have had a concussion consider filling it out- they are also giving away an ipod shuffle and ipad). Why are we only somewhat recently hearing about concussions as being more serious injuries? If you get hit in the head enough times, it would make sense that you might develop a few problems. What most people don’t realize is that concussions are brain injuries. In fact another term for concussion is mild traumatic brain injury (MTBI). Like all brain injuries, they are unpredictable, meaning the course or progression of healing is different in each case. Sometimes symptoms only last for a few hours, but sometimes and depending on severity, they can be long lasting disabilities. A term for lasting symptoms of a concussion is called post-concussion syndrome, in which symptoms do not go away quickly or at all.

Most of us think about football players or veterans who have suffered from a concussion or brain injury. But the types of individuals that I have also seen in physical therapy are those involved in car accidents, a slip on the ice, being hit on the head, or someone who has fallen, many times the elderly. Many times the reason they were referred to a physical therapist was for neck pain or dizziness. Sometimes these individuals have not been diagnosed with concussion or post-concussive syndrome and it’s only until I ask them about whether they have the other symptoms of concussion or MTBI that they even realize that these problems are all connected to a brain injury. Unfortunately there is no cure for brain injury or concussion, only prevention and education and awareness in recognizing a brain injury. It is important to seek medical attention to be sure the brain injury isn’t more serious or worsening.

Symptoms of concussion or MTBI:^[i]

headaches
confusion
difficulty reading
memory deficits
neck pain
nausea and vomiting
dizziness
personality or mood changes

Here is a nice link to an article about what concussions and mild traumatic brain injuries are.

Here is a video of someone who has post-concussion syndrome as he describes what it feels like:

httpv://www.youtube.com/watch?v=reMBWnFU60A

Adolescent Concussion: 1 Prep Football Season 1,800 hits to the head

If you think you might have had a concussion or MTBI, be SURE to seek medical attention from your doctor.

Illinois Study if you would like to participate and have had a concussion before.

Thanks to kedoink kedondeng on Flickr for the picture.

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References

Umphred DA. (2007). Neurological Rehabilitation, 5th ed. Mosby: St. Louis.

Precious PRICE

MoniquePT — Sat, 09 Oct 2010 13:24:26 +0000

Someone stopped into the clinic yesterday with a hamstring strain asking what type of stretches she should be doing. She also mentioned that someone recommended she put heat on it. First question is always “When did this occur?” “Yesterday.” “Well, in that case, use PRICE.” For 24-48 hours following an injury I recommend PRICE.

Protection: When an area is injured, you want to make sure you protect it from reinjury.

Rest: Do NOT skip this step. Allow your body to heal. If you don’t wait an adequate time and rest the affected area, you run the risk of reinjury or improper healing, and then it could potentially turn into a chronic problem.

Ice: Ice is the only modality you want to use immediately following injury and for two days after, NOT heat. Ice is an anti-inflammatory and at this stage you don’t want to do anything that would increase swelling, such as heat. Use ice 15 minutes every hour in most cases. If you need an ice pack recipe, click here.

Compression: A little bit of compression wrapping will help to limit swelling, but be sure not to wrap the area too tightly as you don’t want to restrict blood flow.

Elevation: Keep the affected limb elevated above the level of your heart in order for swelling to be kept at minimum.

Still in pain, not sure of what to do? Find a PT or seek medical attention from your doctor.

Thanks to wwarby on Flicker.com for this picture!

Running Gait Analysis

MoniquePT — Tue, 05 Oct 2010 02:05:15 +0000

Today I helped a high school athlete return to competing in a cross country meet and not only that, meet a personal best and without knee pain. In just 2 short sessions. Ok, so I know I’m bragging, but I was really proud of this accomplishment, which was 75% the effort of my patient and 25% me shoving them in the right direction. A key 25% achieved through a running gait analysis and customized exercise program with instruction in proper form and alignment with functional movements. I perform a running gait analysis on all of my clients that are runners. Running gait analysis is a skilled observation of running technique and form that is then compared to the main complaint to come to a biomechanical hypothesis as to why they are in pain and how they can improve their performance. Physical therapists are also trained to analyze walking gait. Running analysis is then used to guide instruction in appropriate running form to address the main complaints. Comprehensive testing of strength, movement patterns, balance, and neuromuscular control is also done to identify contributing factors to the inefficient pattern to achieve a well-rounded plan of attack. Though whether it be to relieve a sore knee or just improve performance, a running gait analysis should be the first step in helping a runner to achieve his or her goals. When instruction is given to reduce an inefficient technique and this is combined with a personalized exercise program you get happier, less stressed joints and possibly….. a personal best.

Want a free analysis? Attend our runners clinic this Wednesday, October 6th. Click on the events tab for more information.

Golf and Back Pain

MoniquePT — Sun, 29 Aug 2010 19:21:40 +0000

Most golfers might think that there is no more painful condition than a case of the “shanks.” In terms of mental anguish and inner turmoil, I have to agree… it hurts. But if we look at physical, musculoskeletal injuries that plague the game of golf, back pain is the most prevalent and disabling. Both professional and amateur golfers suffer the most from back injuries with 35% of amateur injuries occurring in the low back.^[i] This isn’t surprising considering what it takes to play golf. Golf is a sport that requires repetitive movement and twisting of the spine in a bent over position, which is very strenuous on the body, especially the lumbar spine, or low back.^[ii] Particularly stressful to the low back is the modern style of swing in which a larger shoulder turn and restricted hip motion in the backswing is advocated. Golf pros call this the “X Factor” or “Coil” in which elastic energy is stored and released to create a more powerful downswing, and hopefully, more distance. Golfers most often get back pain localized the the trail side of the low back and depending on the severity of the injury, you may be out for weeks or your game may be affected long-term.

Researchers have investigated back pain in golf and potential risk factors. An article published in the July 2010 Journal of Orthopaedic and Sports Physical Therapy indicates weakness in trunk extensors and hip muscles may be the differing factor between golfers with and without back pain.^[iii] Trunk extensors are the muscles that run up and down the back and hold a person erect and provide stability and control. The golf posture challenges these muscles to stabilize the spine in the address position and throughout the swing. Without these muscles working optimally, you’re at risk for developing pain. Differences in hip rotation range of motion between hips and improper coordination of movement between the hips and low back are also seen in golfers with back pain.^[iv] Of course, other factors can contribute to the development of low back pain in golfers, including technique, level of conditioning, skill level, and equipment to name a few.

Physical therapists help golfers overcome back pain.

The first way I tackle back pain in my golfing clients is to ask a few questions about their style of play and practice:

How much time do you spend practicing, and how do you structure your practice?
- Research has indicated that prolonged putting practice can fatigue the trunk extensors and affect the kinematics of the swing.^[v] When these muscles are fatigued, they do not stabilize the spine as well and can contribute to a back strain or disc disease. I’m not saying to stop practice putting…. but you may not want to practice this for 30 minutes and then practice anything using your full golf swing… i.e. going long with the driver since your muscles will not be able to support your back as well. This also goes for your pre-round routine. Don’t get there an hour early and stay hunched over your putter and then try and smash-drive your golf ball into smithereens. Practice a little putting to get a feel for the greens and leave the longer practice sessions for another time.
How many times a week do you play?
- Playing more than 3 times per week? Your back pain could be simply due to overuse. Playing 3 times per week and then practicing a few more days is a lot of twisting around your spine. Too much twisting in a short period of time can lead to an injury. Allow yourself to rest from golf and stay active with another activity. Do cross training, strength training, or participate in another non-rotational sport.
How do you warm up?
- If the answer to this question is a drive-thru for your grande low-fat 2-pump latte ten minutes before that 7AM tee time, then Houston, we have a problem. Not warming up before an early morning tee time is especially problematic. While we sleep, the discs in our back swell. Once we are upright for at least 1 hour, the discs return to normal height and become less swollen. Placing load and stress on the discs, as the golf swing does, when they are swollen increases the risk of tearing or herniating them. Wake up early and stay standing for at least 1 hour prior to playing golf. If you don’t wait this amount of time you are really setting yourself up for a disc injury. Just think about it as actually enjoying your breakfast and getting mentally prepared for the best game of your life.
- Don’t hold your stretches when warming up. If you hold your stretches you can induce muscular weakness and research has shown that this type of stretching as a warm-up impairs the golf swing kinematics, resulting in a less supported spine and reduced performance. Do your stretches, but do them “dynamically” which means continuously moving, never holding.

The other component of my treatment approach to back pain in golfers is a comprehensive physical therapy evaluation. In particular, I look at hip mobility, flexibility, strength in the trunk and core, movement patterns, and posture. As a TPI-certified medical professional, I also assess golf setup posture or address position and screen the swing. If technique is an issue, I send my clients to a PGA Golf Professional. Don’t let back pain keep you from playing golf. If you have any pain, consult with a physical therapist that specializes in sports and orthopaedics. Take care of your back and enjoy golf for years to come.

References

1. Foster,Larry. (2004). Dr. Divot’s Guide to Golf Injuries. North Salem, NY: Doctor Divot Publishing.

2. Parziale JR, Mallon WJ. Golf Injuries and Rehabilitation. Phys Med Rehabil Clin N Am 17 (2006) 589–607.

3. Tsai YS, Sell TS, Smoliga JM, et al. (2010). A Comparison of Physical Characteristics and Swing Mechanics Between Golfers With and Without Back Pain. Journal of Orthopaedic and Sports Physical Therapy. 40(7): 430-438.

4. Harris-Hayes M, Sahrmann SA, & Van Dillen LR. (2009). Relationship Between the Hip and Low Back Pain in Athletes Who Participate in Rotation-Related Sports. J Sports Rehabil. 18(1):60-75.

5. Evans K, Refshauge KM, Barrett R, & Adams RD. Swing Kinematics in Skilled Male Golfers Following Putting Practice. J Orthop Sports Phys Ther. 2008;38(7):425-433.

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References

Foster,Larry. (2004). Dr. Divot’s Guide to Golf Injuries. North Salem, NY: Doctor Divot Publishing.
Parziale JR, Mallon WJ. Golf Injuries and Rehabilitation. Phys Med Rehabil Clin N Am 17 (2006) 589–607.
Tsai YS, Sell TS, Smoliga JM, et al. (2010). A Comparison of Physical Characteristics and Swing Mechanics Between Golfers With and Without Back Pain. Journal of Orthopaedic and Sports Physical Therapy. 40(7): 430-438.
Harris-Hayes M, Sahrmann SA, & Van Dillen LR. (2009). Relationship Between the Hip and Low Back Pain in Athletes Who Participate in Rotation-Related Sports. J Sports Rehabil. 18(1):60-75.
Evans K, Refshauge KM, Barrett R, & Adams RD. Swing Kinematics in Skilled Male Golfers Following Putting Practice. J Orthop Sports Phys Ther. 2008;38(7):425-433.

Run Less to Run Better

MoniquePT — Mon, 26 Apr 2010 13:02:55 +0000

I recently participated in a runners clinic, where I gave out information about runners stretches, foam rolling massage techniques, and training schedules for running a 5K and half marathon. Questions about injury prevention usually led down the same path- run less and cross-train. There are those out there that believe the best way to train for runs is to run… and JUST run. In terms of injury prevention and performance, runners should be cross-training. Treat your exercise like your investments and diversify. Running is a great endurance sport, but it does require flexibility, strength, and stability, particularly of the hips and core. If you don’t have sufficient strength in these areas, your form can suffer, resulting in overuse injuries and an inefficient running gait that makes you slower. Weak core and hip muscles result in more side to side motion, rather than linear motion, which wastes energy.
Check out this video to see how weakness in the pelvis can affect form.

http://www.youtube.com/watch?v=k1hlY0EMYJw

To make your runs more efficient and prevent an injury, participate in other activities and exercises to strengthen, stretch, and stabilize key areas of the body. It’s important to remain flexible in the hips and lower legs to prevent a host of running conditions from plantar fasciitis to iliotibial band syndrome. To maintain good linear motion and prevent fatigue, strength train, particularly at the hip and core, but also postural muscles to maintain a neutral and straight spinal position.

Diversifying Activities:

1. Pilates: It builds hip and core strength,which is important to maintain good running form, in addition to working on your posture

2. Yoga: Don’t like to stretch? Try yoga. You’re stretching multiple muscle groups in a session and it’s more fun that holding a quad stretch for 30 seconds. Additionally yoga can benefit your body by reducing stress and improving balance.

3. Strength Training: Hard to run up that hill? You need to work on your strength. Use weights and get stronger. Also work on the muscles in your back to maintain a good posture while running.

4. Bike: Looking to work on your endurance in other ways? Try another endurance sport that requires good leg strength- cycling. Try some interval training for variety.

So, yes, you may have to take days out of the week to do exercise that does not involve running. If you’re unsure of what to do, a physical therapist can evaluate your running mechanics and look at your strength and flexibility to make a customized exercise program to fit your needs. In the long term, running less will make you a better runner. Diversifying your activities will improve your form, making you more efficient and faster, and keep your body more balanced and free of musculoskeletal injuries.

If you want a yoga and pilates breakdown, visit PTJess’ blog here for yoga and here for pilates

More on the chicken guy whoa. Would like to know the end of the story and how he finished that marathon…

To Stretch or Not to Stretch- That is the Question

MoniquePT — Fri, 29 Jan 2010 16:53:25 +0000

Whether ’tis nobler to suffer the strains and pains of prolonged stretching, or to take arms through dynamic warm ups and replace them. This post will not end as a Shakespearean tragedy, for there is not a plague on either form (static or dynamic) of stretching. Recently, a group of therapists at our clinic got together to discuss evidence surrounding the topic of stretching.

Our meeting was inspired by questions from patients regarding our opinions on stretching regimens. Static stretching, holding a muscle in a lengthened position for at least 20 seconds for a low number of repetitions, has been widely touted in the past for improving flexibility and preventing injuries. Dynamic stretching, bringing muscles into lengthened positions without holding and performing several repetitions, which resembles more of a warm-up, has fallen into favor as the pre-sport regimen of choice to improve performance and prevent injuries. O Research, O Research, wherefore art thou Research?

Static stretching has been shown to improve flexibility and range of motion and this form of stretching is used widely in physical therapy. Several studies we discussed and researched showed that immediately following static stretching, including up to an hour afterwards, a muscle can be weakened. In terms of injury, when a muscle is weakened it may not give the best joint protection, thus there may be more injuries and certainly impaired performance. Looking through some of this research, the ways in which muscles are weakened is uncertain. One study found that stretch-induced muscle weakness may only be present at certain positions when a muscle contracts. I wasn’t able to find research on effects of static stretching on injury prevention in sports. A question I had following reading through some of the research on the topic was, “How long does this stretch-induced weakness last?” Can we stretch a few hours ahead of a sport-activity and return to pre-stretch strength?

Because of these findings many trainers and physical therapists advocate against static stretching immediately before sports events. Not only can static stretching immediately before sports activities put you at potential risk for injury, but it can also negatively impact sports performance. In regard to golf, static stretching pre-round has been shown to reduce clubhead speed, accuracy, drive distance, and ball contact. Thus, I recommend a specific dynamic warm-up that targets key muscle groups for golf.

What about those who participate in a regular static stretching program. Is regular stretching beneficial? A study published in Medicine and Science in Sports and Exercise by researchers from Brigham Young University-Hawaii and Louisiana State University shows a regular stretching program alone can improve physical performance. After 10 weeks of a regular stretching program 3 days per week, muscle strength, power, and strength endurance was improved.

In terms of static stretching’s ability to prevent injuries, a review of literature from 2002 in the British Medical Journal concluded that the reviewed articles deemed reductions in muscle soreness following exercise were not significantly impacted by stretching. Injury risk reduction in military recruits was insignificant based on review and there was insufficient evidence to make a conclusion for athletes. I reviewed an article from 2003 in Military Medicine, that examined the effects of stretching in 901 Japanese military recruits during their 3-month basic training. The authors stated that most of the military recruits were not used to the regular, strenuous activity that basic military training entails. The stretching group of this study engaged in 20 minutes of a stretching program prior to and immediately following daily physical training. It was found that recruits that were assigned to the stretching group had lower injury rates for muscle and spinal injuries, though overall rates were not significantly different. The muscle and spinal injuries include strains, tendinitis, and back pain. As a physical therapist who sees many people with these types of injuries, it does not surprise me that those who stretched regularly endured less of these types of injuries. To stretch, perchance to reduce injuries, seems plausible if done regularly for certain types of conditions.

It’s hard to research the effects of regular static stretching on injury prevention in the general population, those who are coming to physical therapy. I have a few words that come from my experience and training. Regular static stretching is particularly important to prevent painful conditions and injuries in those who are not flexible. Inflexibility in certain muscles can cause altered postures and bad joint positions, which can in turn lead to most significantly- back pain and rotator cuff disorders to name a few. If a muscle is tight, it must be stretched. As we age, our muscles lose elasticity, thus it becomes more important to stretch the older we get to prevent joint stiffness and maintain good mobility. If you are as bendable as Gumby, you shouldn’t be focusing on stretching. When muscles and ligaments are stretched too much, it can render a joint unstable. If a joint is unstable it can move slightly in and out of position or it’s joint socket. Over time this can create painful conditions including arthritis. In this condition, it is important to do strengthening, resistive training.

Prior to doing strenuous work, say shoveling snow, gardening, or moving furniture, I recommend warming up dynamically and avoiding static stretches as discussed previously. Because static stretches can weaken muscles and these types of physical activities can demand full muscle strength, you may be setting yourself up for an injury. A warm-up would include any aerobic activities that get the body moving, say, repeated squats, biking, jumping jacks, or walking in place for 5 – 10 minutes.

If you are unfortunate enough to have sustained an injury or are dealing with a painful musculoskeletal condition, a physical therapist is best trained to determine A: Whether you need to do certain stretches and B: What stretches you should be doing.

My final thoughts on stretching:

Generally, if you are not flexible you need to engage in a regular static stretching program
Perform dynamic warm-ups and stretches prior to athletic events to prevent injury, this is not the time to do static stretches
Stretching helps many people overcome pain and injury and should be prescribed by a trained, educated professional for such cases
Don’t overstretch- if you are VERY flexible, you should be focusing on getting stronger, so you can add stability to your joints

References

Arnold G Nelson, Jason D Allen, Andrew Cornwell, & Joke Kokkonen. (2001). Inhibition of maximal voluntary isometric torque production by acute stretching is joint-angle specific. Research Quarterly for Exercise and Sport, 72(1), 68-70.

I Shrier. (2004). Does Stretching Improve Performance? A Systematic and Critical Review of the Literature. Clinical Journal of Sports Medicine, 14(5), 267-273.

Gergley, J.. (2009). ACUTE EFFECTS OF PASSIVE STATIC STRETCHING DURING WARM-UP ON DRIVER CLUBHEAD SPEED, DISTANCE, ACCURACY, AND CONSISTENT BALL CONTACT IN YOUNG MALE COMPETITIVE GOLFERS. Journal of Strength and Conditioning Research, 23(3), 863-867.

Rob D Herbert, & Michael Gabriel. (2002). Effects of stretching before and after exercising on muscle soreness and risk of injury: Systematic review. British Medical Journal, 325(7362), 468.

Masatoshi Amako, Takaaki Oda, Kazunori Masuoka, Hiromichi Yokoi, & Paolo Campisi. (2003). Effect of static stretching on prevention of injuries for military recruits. Military Medicine, 168(6), 442-6.

Golf Conditioning in the Off-season

MoniquePT — Fri, 04 Dec 2009 20:27:36 +0000

http://www.youtube.com/watch?v=5CKguqxwhxg

The fall of the first flurries means golf season is officially over in southeast Wisconsin (for most). To stay in shape, prevent injuries, and prepare for a better 2010 season, start your golf off-season conditioning. Off-season conditioning will help golfers in two ways: improved performance and decreased injuries next season. As Tiger Woods puts it, “It would be asinine for someone not to work out and go play football. It doesn’t make sense for golf, either.” Golfers needs to be limber, yet strong and balanced. Because of the repetitive nature of golf and the position you are playing from in a bent over position, postural muscles need to have strength and endurance to do their jobs effectively. Inflexibility and weakness of postural muscles leads to back pain, particularly in the lumbar spine. With more time in the off-season you can start training for a better 2010.

Here are the key elements to a golf conditioning program:

Aerobic exercise
- Golf requires endurance. Examples: bike, treadmill, elliptical, stepper. Mix it up with high intensity intervals: For 30 seconds go full force with some resistance, slow it down for 1 minute without resistance and do this 7 times. This will really get the heart working.
Flexibility
- Golf demands flexibility from the ground up, meaning stretch from the calves up to the upper traps. If you’re not stretching this way, you will decrease your turn or turn only from your low back, leading to bulging discs, pinched nerves, and arthritis.
Core Strength
- Because of the high amount of strain on the spine it is of utmost importance to strengthen the muscles that support it: glutes, abs (lower and upper), scapular muscles (rhomboids, mid and lower traps in particular)
Balance
- In the swing, weight is transferred from the trail leg to the lead leg. If you don’t have the balance to stand on that lead leg and remain strong you won’t be able to transfer as much power on release.
Weight Training
- Power is generated in the swing from the ground up so I recommend working on developing strong legs: calves, hams, quads, and glutes.

Golfers who do not work on these areas put themselves at a performance disadvantage and a higher risk of developing injuries. A lot of the golfers I see in physical therapy have to rehab low back or neck pain. At times, these injuries can end a golf career or severely limit ability to play. Of course the best way to train would be to find a professional that can identify your biggest golf-specific weaknesses and design a specific conditioning program and workout routine to match. You can find a golf fitness or medical professional on the Titleist Performance Institute’s website: mytpi.com. Get in the gym this winter and start preparing for an injury-free, lower-score 2010.