Golf is one of the most popular recreational activities in America, with approximately over 25 million players country-wide. One of the most appealing aspects of golf is the ability to continue playing well into our 60s, 70s, and even 80s, but although the sport may not seem as physically demanding as others, injuries can be quite common. Losing the ability to play golf due to back pain can be very frustrating, but there has been research into rehabilitation in order to return to the sport quickly as well as prevention strategies to reduce the risk of reinjury. In an article by Christopher Finn, MSPT, CSCS, TPI CGMP, these concepts are reviewed and discussed.

As people age, the spine’s mobility and ability to absorb forces decreases. This can lead to lower back pain (lumbar pain) which has been attributed to approximately 1/3 of all golf injuries. The majority of these injuries are caused by the repetitive motions of the golf swing over time instead of one traumatic event, and are more likely to occur if muscular imbalances or poor swing mechanics exist. These injuries can include muscular strains, facet joint inflammation, spondylosis, disc herniation, and even stress fractures of the ribs.

The treatment of these issues usually benefits from a multidisciplinary approach involving both Physical Therapy to assess muscular imbalances and weakness, and PGA pros to assess flaws in swing mechanics. Physicians may also order medical imaging for further diagnosis, prescribe medication, or utilize cortisone injections to help reduce pain in the short-term.

Physical Therapy has been shown to be very effective in treating low back pain and other injuries in golfers. During someone’s time in physical therapy, they can expect to receive screening and treatment to restore muscular balance throughout the body. These include:

• Core stabilization exercises
• Spinal mobility and range of motion assessment
• Diaphragmatic breathing techniques
• Muscular flexibility training
• Hip, trunk and shoulder strengthening
• Transversus abdominis and multifidus activation

Since the body works in unison throughout a golf swing, it is difficult to say any one exercise is the most important. Muscle groups are constantly activating while others are simultaneously turning off, all while the joints and muscles require the proper mobility and flexibility to freely move through their required range of motion during the swing. Therefore, it is beneficial to have a professional identify these areas of limitations in order to develop a personalized plan for recovery and reduce the risk of injury in the future.

If you are interested in reducing your low back pain while golfing or would like to learn of any muscular imbalances that could be affecting your game, physical therapy may be a great option for you! The therapists at Physical Therapy First have an extensive background in treating orthopedic and sports injuries of all kinds, and are able to dedicate the one-on-one treatment time that you deserve to get you to where you want to be.

Sources:

Christopher Finn, MSPT, CSCS, TPI CGMP. Rehabilitation of Low Back Pain in Golfers: From Diagnosis to Return to Sport. In Sports Health. July/August 2013. Vol. 5. No. 4. Pp. 313-319

Viewpoint Article backed by Research

As physical therapists, we encounter many different types of people with various personalities and diverse backgrounds. These people come see us to move better and to feel better with the mindset that physical interventions can help them achieve their goals. However, we cannot disregard the psychological impact we can have on our patient care and the language we use is a HUGE component of this.

In a viewpoint article published in the Journal of Orthopaedic and Sports Physical Therapy, the authors give us insight on how the language we use with our patients can impact their understanding of their condition, their ability to improve, and the overall rehab process. Some common words that are mentioned to patients in day to day orthopedic care may actually be harmful and set them up mentally for a more challenging rehab process.

Below is a great chart that displays some of these common words that may have a negative connotation and can affect the rehab process. On the right side are suggestions for alternative words that patients can think of instead and what more clinicians should start using:

Each word or phrase on the two sides have similar meanings, however the words on the right take some of the medical jargon out allowing patients to have a better grasp on their condition and be helpful for their rehab process.

The human body is complex and musculoskeletal rehab can be complex! But THAT’S OKAY, the physical therapists at Physical Therapy First are here to help make your rehab process go smoothly with less confusion. We have 1 on 1, hour long sessions with all of our patients which gives us the ability to provide you great care, get you feeling better, AND answer all the questions you have along the way!

Check out the article below for more information on this topic

Reference:

Stewart M, Loftus S. Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation. J Orthop Sports Phys Ther. 2018; 48(7):519-522

Every few years a group of expert physical therapists gather together to review the latest evidence-based research on a given area. The expert group reviews the quality of published research and discusses the best and worst strategies for clinical examination and treatment approaches. These summaries of evidence are referred to as the ‘Clinical Practice Guidelines’ and they are considered a guidebook for clinical physical therapists to follow in practice. In 2017, experts met with the purpose of updating the clinical practice guidelines for people with hip pain, stiffness, and potential hip osteoarthritis (OA) and improving treatment strategies when treating patients with hip pain and mobility deficits in relation to hip OA. Hip OA is extremely common with men showing higher rates of OA than women. Risk factors for developing hip OA include age, history of hip developmental disorders, previous hip injuries, reduced hip motion (especially internal rotation), presence of hip osteophytes, lower socioeconomic status, higher bone mass, and higher body mass index (BMI).

The evidence is compiled and rated by the panel of experts on a scale of A to F as recommendations to patients and clinicians with ‘A’ indicating strong evidence and ‘F’ indicating weak evidence. After reviewing all of the most cutting-edge, highest quality research on the topic of hip OA, the group released the following recommendations for treating hip pain, stiffness, and OA. I will highlight a few of the key takeaways and how this will affect you, the patient, when seeing your physical therapist for a full 1-on-1, one-hour session at Physical Therapy First.

 Assessing Baseline Pain and Function:

The evidence demonstrates level ‘A’ support in recommending the completion of the following three measures: (1) the visual analog pain scale (VAS) to provide a numeric rating for your pain; (2) the Lower Extremity Functional Scale (LEFS) to evaluate your difficulty in completing daily and recreational activities; OR (3) the Hip Disability and Osteoarthritis Outcome Score (HOOS).

The physical therapist will also utilize standardized validated functional tests to establish your baseline functional level. This provides a benchmark for comparison with future reassessments to determine the level of progress that has been made during your bout of physical therapy. These functional tests include:

• 6-minute walk test: Walk consecutively for 6 minutes and measure the distance traveled.
• 30-second chair stand: Stand up and down as many times as you can in 30 seconds.
• Timed Up and Go Test: Stand up from a chair, and walk out 10 feet and back 10 feet.
• Single leg stance: Stand on one leg for up to 30 seconds without losing your balance.
• The step test: Step up and down off from an 8-inch step to assess balance and strength.

All of these functional tests are combined to evaluate your overall functional status and identify any potential limitations. They are all recommended in the clinical practice guidelines with support of level ‘A’ evidence.

Physical Exam:

The physical therapist will complete a hands-on assessment of your mobility, flexibility, and strength of your affected hip in order to identify specific restrictions or impairments. This assessment will include assessing your lumbar spine, hip, and knee to rule out the possibility of the back or knee referring pain into your hip. In addition, the physical therapist will look deeper into your hip restrictions to assess your overall hip flexibility in all directions. The hip primarily moves in six directions, as shown in the figure below:
Note: Image provided by www.sequencewiz.org

After assessing your hip mobility and flexibility, the physical therapist will then assess both your left and right hip strength with hands on strength testing of the hip abductors, adductors, internal rotators, external rotators, flexors, and extensors.  After completing the appropriate physical evaluations, and reviewing your history of what causes your discomfort, reported pain levels, and any functional impairments, the PT will then move to implement interventions that will specifically help you to heal the fastest.

Diagnosis:

The diagnosis of probable hip OA comes from a compilation of the key findings from the physical therapist’s evaluation. Factors that would indicate hip OA as opposed to non-hip OA are as follows:

• Moderate anterior or lateral hip pain during weight-bearing activities
• Morning stiffness less than 1 hour in duration after wakening
• Hip Internal Rotation less than 24 degrees
• Internal Rotation and Hip Flexion 15 degrees less than the nonpainful side
• Increased hip pain associated with passive hip internal rotation
• Absence of history, activity limitations, and/or impairments inconsistent with hip OA

Having more factors that are present on the above list suggests that it is more likely that a person has hip OA. Typically, after showing a few of the above factors, your physical therapist will be in contact with your primary care physician or orthopedist (when applicable) to discuss medical imaging to confirm this diagnosis.

Intervention:

The interventions prescribed will be those which are best matched by level of evidence available. These include:

• Manual Therapy [Level A]: Soft tissue mobilization, hip stretching, and joint mobilizations
• Patient Education [Level B]: Support for exercise adherence, and understanding of the condition are very beneficial for patients.
• Exercise [Level A]: Specific stretching and strengthening specific to the patient’s limitations.
• Modalities [Level B]: Ultrasound and heat can be beneficial in the short term for hip pain from OA.
• Bracing [Level F]: Not recommended.
• Weight Loss [Level C]: In collaboration with the patient’s entire medical team, weight loss for people who are overweight or obese could be beneficial in improving pain and function.

Follow Up Treatment and care both in Physical Therapy and at Home:

After reviewing all of the findings with your physical therapist, we will then determine your best individualized care plan. This includes how often to attend physical therapy sessions, how often to complete self-care activities and exercises at home, and what activities to do. Level ‘A’ evidence supports doing a combination of your home exercises and physical therapy 1-5 times per week, over 6-12 weeks in order to see beneficial results. The exercises prescribed to you for home are individualized for each person, but will most likely include activities such as hip stretching, hip strengthening, balance exercises, education on self-care including potentially using an assistive device, potential weight loss, and goal setting towards the goals that are identified by YOU, the patient.

Physical Therapy First provides 1-on-1 sessions with a licensed doctor of physical therapy, most of which are board certified in orthopedics, for full 60-minute sessions. We accept most major health insurances and have flexible scheduling to best accommodate your needs.

All of the above refers to the following citation: Michael T. Cibulka, Nancy J. Bloom, Keelan Enseki, Cameron McDonald, Judith Woehrle, Christine M. MacDonald. J Orthop Sports Phys Ther 2017;47(6):A1-A37. doi:10.2519/jospt.2017.0301