Physical Therapy for Golfers with Low Back Pain

The most common type of injury associated with golf is low back pain (LBP), which may prevent you from playing golf and even performing everyday activities. The low back is most frequently injured part of a golfer’s body due to considerable mechanical forces, including compressive forces, shear forces and rotational forces to the lumbar spine, that are created while swinging a golf club. These forces on the lumbar spine, along with improper swing mechanics and decreased strength, flexibility, coordination or balance, place golfers at a higher risk of LBP creating injuries.

Types of Back Injuries Associated With Golf

There are a number of different types of back injuries associated with golf, including:

Mechanical Pain. The most common type of back injury is mechanical pain. Mechanical pain is often caused by a strain and will result in spasms. This type of pain is generally localized to the low back area.

Sacroiliac Joint Dysfunction. Sacroiliac joint dysfunction or SI dysfunction is an increasing recognized cause of back pain. SI dysfunction mimics LBP and may be located in the buttock and posterior thigh.

Herniated Disc. Disc herniation may occur during a golf swing. Disc herniation may be associated with a "snap" or "pop" in low back. Pain with disc herniation usually radiate down lower extremities. Pain may increase with sitting, coughing and bearing down

Compression Fractures. In the older population compression fractures may be considered due to high compression forces during swing.

Other Back Injuries. During golf swing hyperextension of the lumbar spine may cause injuries such as spondylolysis and facet joint pain. Spondylolysis is a defect in the connection between vertebrae, the bones that make up the spinal column. This type of injury is usually seen in adolescent athletes. Facet joint pain is most associated with osteoarthritis of the lumbar spine. Facet joint pain is usually increased with sleeping or resting as well as trunk side bending.

Golfers With LBP vs. Golfer Without LBP

Individuals need many physical attributes to properly perform a golf swing. To complete a swing, golfers need proper range of motion in the trunk, shoulder, torso and hips. Other needs include strength, postural stability and balance.

A recent study in the Journal of Orthopaedic & Sports Physical Therapy matched 16 male golfers with LBP and 16 male golfers without LBP. Each individual underwent biomechanical swing analysis, trunk and hip strength and flexibility assessment, spinal proprioception testing and postural stability testing. These assessments and tests results were analyzed and significant differences were noted between the two groups in trunk extension strength and lead hip adduction strength as well as limited trunk rotation toward the lead side. It was concluded that physical deficits in these areas, which may cause LBP, could be improved with exercises from physical therapy.

Another recent case study examined a golfer with decreased hip internal rotation and lumbar instability who suffered from LBP. The golfer was treated using manual physical therapy to improve hip range of motion and therapeutic exercises for lumbar stabilization. After physical therapy the golfer was able to return to golf pain-free and improved his handicap by three strokes.

Physical Therapy For Golfers With LBP

Physical therapy is a great conservative method to return to golf pain-free. LBP may cause strength deficits in trunk and lower extremities, flexibility issues in hamstrings and hips and decreased range of motion of the lumbar spine. These deficits will limit function and may cause you to play golf with pain and below your true abilities. Physical therapists are trained professionals that can examine and assess impairments and motion deficits that may impede your golf game and everyday activities. A physical therapist will be able to individualize a treatment plan to address impairments and deficits to help you return to golf pain-free as quickly as possible.

To find out if physical therapy will help with your needs call Rehab Connection at 856-547-4422 to set up a free screening for your injury.

Rehab Connection is a facility with Doctors of Physical Therapy that can address your needs to facilitate your return to golf.

Sources

Tsai, Y. P., Sell, T. C., Smoliga, J. M., Myers, J. B., Learman, K. E., & Lephart, S. M. (2010). A Comparison of Physical Characteristics and Swing Mechanics Between Golfers With and Without a History of Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 40, 430-438.

Reed, J., & Wadsworth, L. T. (2010). Lower Back Pain in Golf: A Review. American College of Sports Medicine, 9, 57-59. Reinhardt, PT, MSPT. (2013). The Role of Decreased Hip IR as a Cause of Low back Pain in a golfer: a Case Report. HHSS Journal, 9, 278-183.

Throwing Injuries

Injuries to the upper extremity are a frequent occurrence in the overhead athlete. Ranging from tendonitis in the shoulder or elbow to tears in ligaments and muscles to fractures. The drive and push for our young athletes to become is one contributing factor to the prevalence of these injuries. These injuries are also attributable to poor mechanics and overuse, but there are some measures that can be taken to both prevent injury and improve performance. For this discussion, we will focus on the shoulder.

To understand how to prevent injury and to understand what a physician, athletic trainer or physical therapist is describing when you or your child visits them for injury consultation, you need to have an understanding of the parts of the shoulder. Here is an attempt at translating medical jargon into everyday English.

The shoulder is an extremely complex joint. The bones of the shoulder complex consist of the humerus (arm), scapula (shoulder blade), and the clavicle (collar bone). The top of the arm looks much like a ball. It joins onto the shoulder blade in a very unstable manner. The fit is much like that of a golf ball on a golf tee. Because the contact between the two is so minimal, the shoulder is dependent on the muscles and ligaments around it to provide stability.

The Muscles
The larger muscles that affect the shoulder (the ones that are easily seen and felt) are named the deltoid muscles. Other larger muscles that directly affect the shoulder are the pectoralis (chest muscle) and the latisimus muscle (back muscle). The bicep muscle (the big muscle on the front of the arm) crosses in front of the shoulder joint. The muscles that lie deeper beneath the deltoid are referred to as the rotator cuff. The rotator cuff provides stability to help hold the arm to the shoulder blade when the arm is being moved. The rotator cuff forms a sling around the ball of the shoulder and, when it contracts, pulls the arm against the shoulder blade so it can move properly.

The Tendons and Ligaments
There are many ligaments and ligament like structures that help increase stability in the shoulder. Tendons connect muscle to bone. Ligaments connect bone to bone. Both can become irritated, tight, stretched and torn.

Illustration of shoulder

Injuries to the Shoulder
Here is a list of some of the more common injuries to the shoulder in the overhead athlete:

  1. Rotator Cuff Tendonitis: an overuse injury that can be caused by an improper contraction of some of the muscles in the shoulder, an overpowering of the bigger muscles in the shoulder, tightening of part of the labrum in the shoulder, or by poor mechanics.
  2. Shoulder Impingement: Occasionally, abnormal movement in the shoulder complex will cause the rotator cuff or bursa in the shoulder to rub against the front edge of the shoulder blade and cause irritation. If the tendons are irritated enough, you develop tendonitis. If the bursa is irritated enough, you develop bursitis.
  3. Biceps Tendonitis: The mechanism of injury is similar to that of rotator cuff tendonitis.
  4. SLAP Tear: The acronym “SLAP” stands for Superior Labrum Anterior Posterior. It is an injury that involves tearing or fraying of both the front and back of the labrum of the shoulder.  Often, it will involve the biceps tendon. It is a complicated injury because it involves both tendon and ligament.
  5. Rotator Cuff Tear: A tear in the rotator cuff does not necessarily mean a direct route to the operating table. When the rotator cuff has a tear in it, the ability for the arm to be held to the shoulder blade is altered. Depending on the size and location of the tear, Physical Therapy may resolve the problem. I try to look at rotator cuff tears like this: it is either functional or not. What I mean is that once the appropriate means have been tried to fix it conservatively, it either will or will not perform the way you need it to. If it does not, you will discuss additional options (surgery) with your physician.

Diagnosis
The diagnosis of an injury is made by the Physician or Physical Therapist doing a clinical examination. If there is a question to the exact injury or if there was a traumatic injury, additional testing such as an X-ray or MRI may be ordered by the physician. Each of the injuries in the shoulder has a specific set of guidelines that will help determine what the injury is.

Treatment
Once a diagnosis is made, proper treatment can be initiated. Because the problems listed above are the result of mechanical faults in the shoulder complex, in order for the problem and pain to resolve, correcting muscle imbalances and re-training the muscles how to work together is of utmost importance.

While modalities such as ice, heat, electric stimulation and ultrasound may be used to help calm down any inflammation that is present, correcting the imbalances often require a patient-specific series of stretching and strengthening exercises that need to be completed both in the clinic and at home.

Some of the techniques that are included are exercises to strengthen the rotator cuff and scapular stabilizing muscles. The Graston technique and Kinesiotaping may also be used to help free any adhesions that may be restricting motion or facilitate specific muscle to contract of relax. Lastly, your Rehab Connection Physical Therapist will use manual resistance or stretching and joint mobilizations techniques to help recreate the appropriate muscle balance.

For more information on treatment options for your shoulder, or any orthopedic or neurological condition, please contact one of your family and neighborhood physical therapists at Rehab Connection.

Torticollis and Physical Therapy

Torticollis is a condition that occurs when the muscle that runs up and toward the back of the neck becomes tight, weakened, or thickened, causing the head to tilt; the chin points toward one shoulder while the head tilts toward the opposite shoulder. The most common form of this condition is congenital muscular torticollis (CMT), which affects infants and is generally diagnosed within the first 2 months of life; however, torticollis also can occur in adults.

In 1992, the American Academy of Pediatrics began their “Back to Sleep” campaign to reduce Sudden Infant Death Syndrome (SIDS). The campaign successfully decreased SIDS by 40% in the United States, but it had an unintended result of contributing to the development of CMT in about 1 in every 250 infants. (Talk to your family physician and/or pediatrician if you have any questions about the “Back to Sleep” campaign.

If symptoms such as trouble breathing or swallowing, weakness in the arms or legs, impaired speech, difficulty walking, a pins-and-needles feeling or numbness in the arms or legs, or urinary or fecal incontinence accompany the head tilt—seek immediate medical attention.

What is Torticollis?

Torticollis is the tilt and/or rotation of the head because of tight and weak neck muscles. It occurs when the muscle that runs up and toward the back of the neck (the sternocleidomastoid muscle) becomes tight, weakened, or thickened.

  • Congenital muscular torticollis (CMT) is the most common form of the condition. It affects infants and is generally diagnosed within the first 2 months of life. CMT is often caused by birth trauma, or by sleeping or remaining in 1 position for a prolonged period of time.
  • Postural torticollis is diagnosed when the infant’s head tilt comes and goes. It is diagnosed within the first 5 months of life and often is the result of a lack of a variety of positions.

Torticollis may lead to additional problems, such as:

  • Flattening of the skull (phylagocephaly) in infants
  • Movement that favors 1 side of the body, affecting the arms, trunk, and hips. This can lead to strength imbalances, such as an elevated shoulder and side-bending of the trunk.
  • Developmental hip dysplasia
  • Scoliosis
  • Limited ability to turn the head to see, hear, and interact with surroundings, which can lead to delayed cognitive development
  • Delayed body awareness or lack of self-awareness and interaction
  • Difficulty with balance

Signs and Symptoms

An adult, child, or infant may keep the head tilted and/or rotated toward 1 side of the body as attempting to straighten the neck is difficult or painful. For example, if the muscle on the left side of the neck is shortened, weak, or in spasm—the head may tilt toward the left shoulder and rotate toward the right.

There may be tightness in the neck or a noticeable lump in the neck muscle. Pain may or may not be present, depending on the type of torticollis.

How Is It Diagnosed?

Torticollis is generally diagnosed by physicians. Experienced pediatric physical therapists may diagnosis the need for treatment of congenital muscular torticollis and positional torticollis.

Once the type of torticollis is determined, your physical therapist may provide treatment. In most cases, torticollis is a muscular problem, and physical therapists are musculoskeletal experts.

How Can a Physical Therapist Help?

Regardless of the patient’s age, physical therapy is the primary treatment for all forms of torticollis. Physical therapists provide treatment to address the impairments that are caused by torticollis. Early treatment results in the best outcomes.

The physical therapist will work with a child’s caregiver or with an adult patient to develop and reach mutual goals. This may include an individualized treatment plan to:

  • Strengthen neck muscles
  • Correct muscle imbalance
  • Gain pain-free movement (range of motion)
  • Improve postural control and symmetry
  • Improve the body’s alignment by easing muscle tension

These goals may be achieved through stretching, strengthening, massage, positioning, taping, and a home exercise program. If not treated, torticollis can become a permanent condition.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions, including torticollis. However, you may want to consider:

  • A physical therapist who is experienced in treating individuals with torticollis
  • A pediatric physical therapist if it involves a child

Rehab Connection offers Pediatric Physical and Occupational Therapy Services and has clinicians with experience in working with patients with Torticollis. Please feel free to contact us at our main office (856) 547-4422 if you have further questions or would like to schedule an appointment.

Graston Technique

As a physical Therapist our main objective is to get our patients well and back to a more functional state. We have a myriad of therapeutic modalities and types of exercises that may be implemented for the most optimal outcome. One of the less conventional and well known is the use of Graston Technique.

After an injury, our bodies develop scar tissue during the healing process, not only on the skin, but in deep tissues, muscles, tendons and joints. Over time it can excessively build up and become fibrous and knotted, leading to pain and dysfunction. The Graston Technique instruments allow the physical therapist to detect and treat areas of scar tissue and adhesions by separating individual fibers of tissue and “combing” out the restrictions, which allow deeper penetration in the tissue.

Graston Technique uses any one of six tools made of stainless steel that are either convex or concave-shaped. The tool’s rounded, smooth edges are used to scan over the injured area and give direct feedback to the practitioner.  The vibration, and quality of the tissue is amplified though the instrument. The scar tissue or abnormal tissue glide is treated directly and successfully by allowing the therapist to introduce a controlled amount of micro trauma into the area of excessive scar tissue or soft tissue fibrosis. Every instrument is designed for a different area of the body based on contour and specific tissue needs.

Patients with any type of soft tissue dysfunction can benefit from the Graston Technique in conjunction with an individual therapy program incorporating stretching and strengthening exercises. We have had particular success for conditions resulting from soft tissue injuries and overuse such as lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow) rotator cuff tendinosis (shoulder pain), plantar fasciitis, shin splints and Achilles tendonitis, and patellofemoral disorders (knee pain). The Graston Technique has also shown positive results for treatment of chronic conditions of the tissues such as myofascial pain syndrome and carpal tunnel syndrome (wrist pain)

Graston Technique works by:

  • Invoking an inflammatory process, which in turn increases the blood flow to the area, promoting the natural healing process.
  • Increasing the pliability of soft tissue and is always used in conjunction with passive stretching to improve flexibility.
  • Breaking down scar tissue formed after injury.
  • Increasing activity of fibroblast cells which are responsible for building new, strong soft tissue.

Rehab Connection has several Graston trained therapists. Please feel free to contact us at our main office (856) 547-4422 if you have further questions or would like to schedule an appointment.

The Applications and Benefits of KinesioTape

Established in 1984, Kinesiotape has been an extremely useful tool that has been improved upon over the years and is used by numerous medical professionals in the area. In conjunction with a sound clinical program, it can have vast benefits ranging from improving musculoskeletal alignment to decreasing edema and pain. Recently, KinesioTape has been used on elite athletes to improve their mechanics and perfect their skills. However, you do not have to be an Olympic athlete to benefit from this up and coming medical modality.

How Can You Benefit From KinesioTape?
The applications of KinesioTape are vast. Once your clinician performs a thorough examination and evaluation, he or she can determine whether KinesioTaping will benefit you and the appropriate technique to address your individual needs. In conjunction with an evidence based therapeutic program, KinesioTape can improve the functions of the musculoskeletal, circulatory, and lymphatic systems. It can improve musculoskeletal alignment by re-educating the neuromuscular system, enhance performance, and improve circulation and healing by affecting the lymphatic and circulatory systems. The combination of effects on these systems can also lead to decreased pain and can assist in returning the body to homeostasis (state of stability). The tape is able to do this all while allowing full and normal range of motion. If you are experiencing swelling, pain, or malalignment issues, most likely KinesioTape can benefit you! To be more specific, we will discuss common diagnoses KinesioTape has been a useful tool in treating.

What Diagnoses is KinesioTape Suitable For?
KinesioTape can address a variety of issues as mentioned previously. To be sure it is right for you; the best approach is to consult a clinician who can conduct a thorough examination and evaluation. Common diagnoses it can be used for include, but are not limited to, plantar fasciitis, Achilles tendinitis, patellofemoral pain syndrome, shoulder instability, neck and back pain, upper trapezius tightness and lymphedema, In many instances, you do not have to have a specific disability to benefit from KinesioTape. It can be used to facilitate improved mechanics and prevent injury when used during a physically demanding activity, event or painful daily activity.

How Does KinesioTape Work?
KinesioTape works by lifting the skin and targeting different receptors within the somatosensory system. This lifting effect forms convolutions in the skin thus increasing interstitial space and allowing for a decrease in inflammation of the affected areas. If the tape is applied to a patient on a stretch greater than its normal length, it will “recoil” after being applied and therefore create a pulling force on the skin or muscle that it is being applied to. The direction and amount of recoil on the target muscle/area will affect the treatment outcome.

What is KinesioTape Made of and How Long Does it Last?
It is a latex free material with acrylic adhesive, which is heat activated. The cotton fibers allow for evaporation and quicker drying leading to longer wear time, up to 4 days. How the tape affects the body is dependent on its usage throughout the body and how it is applied. Despite its ability to last a long period of time, if at any point the tape irritates the skin, it should be taken off immediately.

Where Can You Find A Provider That Uses KinesioTape?
Ask your primary care provider or orthopedic physician where you can find a clinician with KinesioTaping experience in the area. Rehab Connection is one of those facilities with Doctors of Physical Therapy utilizing KinesioTape to compliment their evidence-based programs in Barrington, Lumberton, Cinnaminson, and Cherry Hill, NJ!

Feel free to call (856) 547-4422 or go to rehabconnection.org for more information.

Plantar Fasciitis

The plantar fascia is made up of a strong fibrous band that starts at the heel bone and passes through to the forefoot. It provides support to the bottom of the foot and acts as a shock absorber during activity.

Plantar fasciitis is frequently described as foot pain that can be felt at the heel or along the arch and ball of the foot. You may also hear it referred to as heel spur syndrome. It is actually an inflammation of the plantar fascia that first becomes irritated and then later inflamed.

The main symptom is pain on the bottom of the foot or heel that is usually at its worst upon rising and increases over a period of months. People describe the pain as being very intense when they get up in the morning and take their first step or after they have been sitting for long periods of time. After a few minutes of walking the pain often decreases because walking stretches the fascia. For some the pain subsides but returns after spending long periods of time on their feet.

Factors that contribute to the development of plantar fasciitis include:

  • Over 40 years of age
  • A job, sport or hobby that involves prolonged standing or weight bearing activities
  • Rapid increases in length or levels of activity such as a new exercise program or new job that requires standing for longer periods of time
  • Decreased calf muscle flexibility (tight heel cord)
  • Obesity
  • Excessively high or flat arch
  • Walking barefoot or in shoes with poor support

Physical therapists are trained to evaluate and treat plantar fasciitis. Physical Therapy may include one or more of the following: modalities, stretching, strengthening exercises, taping, instrument assisted soft tissue mobilization (Graston Technique), and other manual techniques and modalities.

An individualized exercise program will be provided to meet each patient’s specific needs. Instruction in a home exercise program will be given initially and modifications will be made throughout the course of therapy. Stretching of the plantar fascia, Achilles tendon and hamstring will be incorporated into the treatment plan and should be performed before getting out of bed in the morning to decrease the symptoms of the first step in the morning. Kinesio Taping may be applied and left on between treatment sessions to reduce the stretch and stress on the plantar fascia, especially with weight bearing. During Physical Therapy, various modalities including phonophoresis and iontophoresis may be used to drive topical corticosteroids into soft tissue structures. Restricted activity and regular icing will help with the pain and are often incorporated into the regime.

In conjunction with Physical Therapy other treatments may be prescribed from a physician such as injections, casting, night splints, medications, orthotics, and laser therapy. Surgical intervention is a treatment of last resort if all else fails to alleviate the pain.

Research shows that most cases of plantar fasciitis will improve over time with conservative treatment. Please consult the experienced Rehab Connection Physical Therapists to address your individual needs and answer any questions.