INTRODUCTION
Spinal Manipulative Therapy (SMT) is known to help decrease pain and improve spinal mobility. The authors of this article, Effect of Spinal Manipulative Therapy with Stretching Alone on Full-Swing Performance of Golf Players, propose that this treatment also coincides with maintenance and improvement of joint function, muscle balance and speed of neuromuscular reflexes, thus optimizing an athlete’s performance in their sport.
A golfer’s swing is a complex full-body motion which requires spinal mobility and limb flexibility. The shoulders are required to rotate up to 90 degrees and the hips by 45 degrees. This rotation places higher compressive loads in the low back (8x body weight) than rowing (7x) or running (3x). Because of this increased force on the spine, muscle strains are a common injury amongst golfers.
The researchers in this article evaluated the effect of SMT on the performance of golf players with a handicap between 0-15 during their full swing using a driver club.

METHODS
Men between the ages of 18 and 55 with a handicap from 0 to 15 and who practiced golf at least once a week for four hours were recruited from two golf clubs in Brazil. They were randomly selected to be in one of two groups: Group I was a stretch-only program and Group II was a stretch and SMT program.
The stretches performed by both groups included those for the forearm flexors, deltoids, brachioradialii, biceps, forearm extensors, levator scapulae, gastrocnemii, solei, quadriceps, hamstrings, and gluteal muscles which were performed bilaterally for 20 seconds. Each golfer was also evaluated for joint dysfunction in the cervical, thoracic, and lumbar spine. SMT was performed on the dysfunctional segments in participants in Group II only.
Prior to each treatment, the participants performed three full-swing shots and the average distance of the shots was recorded. Participants then participated in the intervention (stretching or stretching + SMT) and performed three more full-swing shots on the driving range. This process was repeated once weekly, for a total of four weeks.

RESULTS
Group II showed a gradual improvement in the pre to post intervention shot distances across the four days, as seen in Figure 1 below. The fourth and final day showed a statistically significant change between pre and post intervention. When looking at Group I’s pre to post intervention distances, the results were inconsistent, as seen in Figure 3 below. There was a statistically significant decrease in average pre to post shot distance on day two.

Figures 2 and 4 below compare the shot averages between the first and last days of the experiments in Groups II and I, respectively. There were improvements in both groups, but neither was of statistical significance.

LIMITATIONS
This study has a small sample size (43 men) and is not representative of all golfers, including the estimated 80 million female golfers worldwide, according to the National Golf Foundation.

CONCLUSIONS
The authors concluded that stretching and SMT seemed to be associated with an improvement in golfer’s swing performance. Therefore, spinal manipulative therapy could be a treatment option for patients who enjoy golfing.
Clinical Significance
Our clinicians have extensive training in manual therapy and efficiently evaluate and assess our patients to ensure they are appropriate candidates for safe manipulation techniques. Assessment of spinal mobility in the cervical, thoracic and lumbar spine, extremity joint mobility, soft tissue flexibility and strength are considered and evaluated as all are important for a successful golf swing. Come see us for an initial evaluation and treatment session to get ready for your upcoming golf season!

REFERENCE:
Costa, S., Chibana, Y., Giavarotti, L., Compagnoni, D., Shiono, A., Satie, J.: Bracher, E (2009). Effect of spinal manipulative therapy with stretching compared with stretching alone on full-swing performance of golf players: a randomized pilot trial. Journal of Chiropractic Medicine 8: 165-170.

A COMPARISON OF TWO NON-THRUST MOBILIZATION TECHNIQUES APPLIED TO THE C7 SEGMENT IN PATIENTS WITH RESTRICTED AND PAINFUL CERVICAL ROTATION
Mobilizations and manipulations to joints in the cervical spine is a common intervention performed by physical therapists to improve neck range of motion. There is controversy about using rotary thrust manipulations in the lower cervical spine and has potential to cause adverse reactions, therefore it may be more appropriate to use non-thrust mobilization techniques instead. A study looked at the effectiveness of two different types of non-thrust mobilization techniques. These 2 techniques are:

Non-thrust C7 facet joint gliding mobilization: (for restricted right rotation): “The T1 segment is manually stabilized in left rotation by pressing the left shoulder girdle in a posterior direction. Bilateral translatory movements are applied to the lamina and inferior facets of the C7 segment in the direction of right rotation.” (Left image below)
Non-thrust facet joint distraction mobilization: (for restricted right rotation): “The clinician uses his left hand to separate (distract) the right inferior facet of C7 away from the superior facet of T1. The clinician uses his right hand to maintain a ventral and medial pressure against the lamina and inferior facet of C7. This compresses the inferior facet of C7 against the superior facet of T1. This will shift the axis of movement to the left, which will facilitate greater motion (facet distraction) on the right side of the C7 segment. Manual stabilization of the T1 segment occurs by using the right lower extremity to passively press the left shoulder girdle and clavicle in a posterior direction, which rotates the T1 segment in the opposite direction of the intended mobilization.” (Right image below)
**In this study, one intervention = three consecutive, 7-second, grade III, non-thrust facet glide or facet distraction mobilizations**

Creighton, D., Gruca, M., Marsh, D. and Murphy, N., 2014. A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation. Journal of Manual & Manipulative Therapy, 22(4), pp.206-212.

This study had 30 participants who had cervical pain rated as 2/10 or higher, pain with both left and right active cervical rotation, and limited active cervical rotation in both directions when measured with a CROM. The participants were split in half in which one group received the facet joint glide technique and the other received the facet joint distraction technique.

Outcomes measured for this study were degrees of active right and left rotation, pain rating at end range right and left cervical rotation, and the number of adverse reactions produced. These measures were taken before and after the mobilization technique was performed.

The results display that both groups of participants had a statistically significant increase in both right and left active cervical rotation range of motion: about 5 degrees increase in both directions. There was also a statistically significant decrease in pain levels for both right and left active cervical rotation. No adverse reactions were reported by any subject. One technique did not produce significantly better results compared to the other technique.

Limitations of this study include: the researcher was not blinded, challenging study reproducibility since training is likely required to perform the same techniques, possible placebo affect may have occurred, small sample size, possibility for measurement error, and does not look at long term outcomes.

Despite the limitations, these 2 techniques show that they can be a safe, low risk, and effective addition to a treatment session for patients with limited and painful cervical rotation range of motion. However, these techniques do not prove to be a stand alone way to improve cervical pain and range of motion. It is recommended that therapeutic exercise and other manual therapy interventions should be performed in addition to these techniques to have the best outcomes.

Reference:

Creighton, D., Gruca, M., Marsh, D. and Murphy, N., 2014. A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation. Journal of Manual & Manipulative Therapy, 22(4), pp.206-212.

How to Avoid Surgery if You Have a Lumbar Herniated Disc

If you’ve been diagnosed with a ruptured or herniated disc in your back, then you’re likely suffering from muscle spasms, sharp/dull pain, cramping, leg weakness or loss of function, and/or sciatica. Your  pain likely intensifies with coughing, sneezing, or bending. Herniated discs can be very painful injuries that impact your day-to-day life. The good news is that you don’t necessarily have to get surgery to repair your herniated disc. In fact, studies have shown that 90% of patients were able to recover by pursuing non-surgical courses of treatment. The following exercises, in conjunction with proper physical therapy treatment, can help relieve your symptoms and strengthen your back muscles.

How Does a Herniated Disc Happen?

Before we get into the exercises, it’s important to know what a herniated disc is and how it’s caused.

In between each of the vertebrae in your lumbar spine, there is a shock absorbing “pad,” this is called a disc. The purpose of these discs is to protect the spine from daily activities, like walking, running, jumping, etc. Each disc has two parts: a soft, gel-like inner ring, and a touch outer ring. When your outer ring is injured or weak, it may allow the inner ring protrude out. This is commonly known as a herniated disc.

Common causes for a slipped or herniated disc are age, being overweight, weak muscles, and/or a sedentary lifestyle. You may be at increased risk for a herniated disc if you often turn or twist your back while lifting objects, or if you use tobacco or have poor posture.

Note: the images in this article are all copyright backintelligence.com

1.       Decompress your spine

–          Find something you can hang from, like a bar or the top of a doorframe.

–          Reach overhead and hold the bar with an overhand grip.

–          Allow yourself to hang for 30 seconds.

–          Repeat 3 times.

Copyright backintelligence.com

This exercise will take pressure off your discs by creating space between your vertebrae.

2.       Prone extension

–          Lie on your stomach.

–          Put your forearm on the floor next to your body, so that your elbow is bent at a 45 degree angle.

–          Slowly prop yourself up on your elbows, keeping your hips in contact with the floor

–          Continue to prop yourself up until your elbows are bent at a 90 degree angle.

–          Hold the upwards position for 10-15 seconds before returning to your starting position.

–          Repeat the stretch 10 times, gradually increasing the time you hold the upward position until you reach 30 seconds.

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This stretch will aid in pushing the disc back towards the center to improve the healing process. When you’re performing this stretch, your goal should be “centralization of symptoms,” meaning that the pain that typically travels down your affected leg should come back up, closer to your lower back. This exercise may be hard to tolerate at first, so proceed slowly and with caution.

3.       Cat-Cow

–          Begin on your hands and knees.

–          As you inhale, let your stomach “drop” towards the floor and look up towards the ceiling.

–          Slowly exhale, rounding your spine (upwards, towards the ceiling) while using your hands to press into the floor and slightly curving your neck to look at your feet.

–          Do 2-3 sets of 10.

Copyright backintelligence.com

This stretch will open the intervertebral disc space, helping to relieve pressure on the herniated disc while improving the mobility of the spine.

While these exercises may help to relieve your pain and speed up your recovery process, you should still seek medical advice before performing these stretches, and utilize them in conjunction with a physical therapy treatment plan. To book an appointment, give us a call at 800-PT-FIRST or send us a request through http://www.physicaltherapyfirst.com/contactus/

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

3 Sleep Positions That Will Fight Morning Pain and Stiffness

Are you woken up every day by morning pain and stiffness? While these symptoms may be annoying or uncomfortable, don’t fret. It’s likely nothing serious.

Typically, morning back pain is a result of low-grade inflammation, which gets worse with age and is noticeably worse at the start of the day. The most underestimated culprit of early morning pain and stiffness is strain due to awkward sleeping positions or using the wrong pillow, and the back is one of the most vulnerable areas for this this type of irritation.

If your pillow is too high or stiff, your neck will remain flexed overnight, which can lead to morning pain and stiffness. Here are the best sleeping positions to help you minimize morning pain and discomfort:

If you have early morning neck/back pain, try to sleep on your side or your back.

Back Sleepers

When sleeping on your back, use a rounded pillow under your neck to support its natural curve, and a flatter pillow to cushion your head. An easy way to achieve this is to tuck a neck roll into the bottom of a flat pillow. To maintain the natural “S” curve of your spine, use pillows to support your lower back and knees.

Side Sleepers

When sleeping on your side, avoid using pillows that are too high or too low. Keep your spine straight by using a pillow that is higher under your neck than under your head. This is one of the healthiest sleeping positions for your back because it allows you to maintain the natural “S” shape of your spine. However, Gravity can pull your lower back down and using a pillow that is too high will put strain on your neck. To support the natural curvature of your spine, you may also want to consider using a pillow to support your lower back and knees.

Stomach Sleepers

Try to avoid sleeping on your stomach. This position is tough on your spine because it arches your back and turns your neck to the side. It may be hard to control how you toss and turn throughout your sleep in the night, but it is worth trying to fall asleep in a healthy position, as this posture is notorious for causing lower back pain and muscle strain. If you absolutely cannot fall asleep in another position, try using a pillow under the hips/pelvic area to raise your lower back and support your lumbar curve.

If your symptoms continue to persist or worsen, you may want to consider consulting a physical therapist. You cam learn more about the conditions we treat here.

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

How Exercise Can Help Your Lower Back Pain:

 Are you suffering from low back pain? When your back is hurting, you may just want to lie in bed and rest. This is understandable, but it may not help you get any better. Did you know that moving is actually good for your back? Exercise can strengthen back, core, and leg muscles, helping you support your spine and relieve back pain. However, depending on the cause, severity, and type of back pain you have, some movements are not recommended and may even be harmful. Let’s go over which exercises you should try, and which ones you should be avoiding.  

Do – Partial Crunches:

Lie on the floor on your back with your knees bent and your feet flat. Place your hands behind your neck (or cross them over your chest, whichever is more comfortable for you), then tighten your stomach muscles and raise your shoulders off the floor. As you’re raising your shoulders, you should be exhaling. Do not use your arms to pull your neck. Keep your elbows straight out. Hold this position for a second, then slowly lower back down. Your feet, tailbone, and lower back should maintain contact with the floor at all times. Repeat 8-12 times and keep proper form to prevent excessive stress on your lower back.

Avoid –  Sit-ups:

Sit-ups may put a lot of pressure on the discs in your spine. While you may think they will help you strengthen your core muscles, it is best to avoid this exercise if you’re struggling with low back pain.

Do – Lumbar Extension Stretches:

If you suffer from disc herniation, this exercise may help you. However, if your pain is a result of a vertebrae fracture or spinal stenosis, be very careful. Start by lying on your stomach. Bend your elbows underneath you and keep your palms flat against the surface. Keeping your hips and pelvis in contact with the surface, lift your upper torso off the ground. Only go as high as you feel comfortable. Do 10 repetitions, holding the pose for 10 seconds each time, and work yourself up to 30 seconds.

Avoid – Burpees:

Burpees are a high impact exercise that are supposed to be done at a high speed. This combination can be detrimental to those who are suffering from low back pain.

Do – Sciatic Nerve Stretch:

If you are experiencing radiating pain in the legs, buttocks, calf, and/or foot, then this stretch may benefit you as if follows the path of the sciatic nerve. Stretching the nerve will desensitize it and reduce your pain. Start by lying on your back with your hand behind your knee on the side where you have pain. Flex your knee and then flex your ankle back and forth, holding each position for a few seconds Perform 10 repetitions on each side.

Avoid – Double Leg Lifts:

This movement should be avoided by those with lower back pain. Often times, people use their lower back to hoist their legs in the air, putting pressure on the spine. This is ineffective and may lead to further injury or increased pain.

Still experiencing pain? Request an appointment.

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.