Golf has become one of the nation’s most popular sports with a participation rate of 19.5%.
On the surface, the physical demands of golf appear minimal; however, probing deeper reveals that the golf swing actually produces forces of up to 8 times an individual’s body weight. Combining these forces with the repetitive nature of the sport, it is not surprising that low back pain constitutes 26-52% of all golf-related injuries. In addition, trunk muscle imbalances, poor biomechanics, and a lack of flexibility specifically in the leading hip have been cited as possible causes for golf-related low back pain. (Gluck, 2008)
With such a high incidence of low back pain, prevention becomes quite important. The prevention of low back pain in golfers is multi-faceted and involves altering swing biomechanics, strengthening the spinal stabilizers, improving hip and rotational flexibility as well as a good warm-up prior to playing (Gluck, 2008). Moran et al. (2009) recommends incorporating dynamic stretching as opposed to static stretching into the warm-up as this was found to improve both the distance and accuracy of shots using a 5-iron.
Having the muscles and joints of the body assessed for flexibility and stability issues may be a great first step in improving your golf game.
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It’s getting warmer outside and that means summer shoes! But be careful when you reach for those strappy heels as wearing high heels may be a potential cause of back pain.
Approximately 59% of women wear high heeled shoes 1-8 hours a day. Wearing heels can create deviations from a normal standing posture and may create muscle fatigue and instability. Wearing heels shifts the body’s centre of mass upwards and forward and creates and increase in the lumbar lordosis.
Gait becomes less efficient, and the strength and firing patterns of the muscles in the lower limbs can be altered1. In a recent study by Oleksy, M., et al (2012) they found increased activation of the lumbar paraspinal musculature in women wearing both high and low heels. This activation increased as heel height increased. It is suspected that this increase in muscular activation is necessary to compensate for the shift in centre of mass and to attenuate increased forces through the spine. Increased lumbar muscle activity can potentially increase local muscle fatigue, decrease oxygenation to the region and lead to the development of repetitive strain injury. Interestingly this study also demonstrated a difference in pelvic motion in younger and middle aged women. Sagittal pelvic motion was increased during heel wearing for the younger group of women only. It is thought that this pelvic motion helps to compensate for the abnormal posture and that middle aged women may not compensate as well, leading to greater risk of injury to the tissues.2
So, especially for those of you who already suffer from back pain, it may be worthwhile to limit your heel wearing to decrease risk of repetitive strain injuries to the back musculature.
By Dr. Jennifer Fergusson
1. Simonsen E., Morten B.S., Norreslet, A. et al. Walking on high heels changes muscle activity and the dynamics of human walking significantly. J Appl Biomecanics 2012 (28) http://www.ncbi.nlm.nih.gov/pubmed/22431211
2. Mika A, Oleksy Ł, Mika P, Marchewka A, Clark BC: The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait. Am J Phys Med Rehabil 2012;91:425Y434.
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As we get closer to Race weekend and mileage is slowly increasing so to do the aches and pains.
Let’s just review one cause of those aches and pains. Tendinopathy. This is an injury to the tendionous part of the muscle, near it’s attachment to the bone. It is most commonly found at sites like the Achilles, or patellar tendons in runners.
Tendinopathies have two factors contributing to their etiologies; mechanical and vascular. Mechanically the load on the tissues exceeds the strength of the tissues to the point where the tendon cannot repair itself. This leads to increased mechanical breakdown of the tissues (tendinosis). Repeated overload, or trauma may also lead to an inflammatory response of the tendon sheaths with degeneration of the tendon fibres (tendonitis). Tendons generally have a poor blood supply, which is a limiting factor in the ability of the tendons to heal.
A study by Grau, Maiwald, Krauss et al (2008) aimed to identify causes of patellar tendinopathy in female runners. After comparison of runners with and without patellar tendinopathy the following results were found; pateints with Patellar Tendinopathy had faster knee flexion, slower hip extension, increased pronation velocity (not increased amount of pronation), more hip adduction but occurring later in the gait cycle and lack of joint co-ordinationin the lower limb.
This is thought to translates into;
- weak knee extensors, abdominals and back during the eccentric touchdown phase of the gait cycle.
- weak hip extensors during the concentric push off phase of the gait cycle.
- Delayed max hip adduction and early internal rotation of the tibia.
Therefore these authors suggested that the treatment of patellar tendinopathy should include reducing load of the quad group and improving its strength eccentrically, improving hip abduction strength to minimize excessive adduction, strengthen the hip extensors, and eccentric and concentric balance coordination exercises for better joint coupling.
Stretching and strengthening these muscle imbalances my aid in reduction of pain for runners suffering from patellar tendinopathy.
If you think you may be suffering from an overuse tendon injury, please come visit us! www.reformbodyclinic.ca
Article review by Dr. Jennifer Fergusson BASc, DC
1. Grau, S., Maiwald, C., Krauss, I., et al. What are causes and treatment strategies for patellar-tendinopathy in female runners? Journal of Biomechanics, 2008. 41 (9)
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Are you planning on competing in a marathon or half marathon this year? It is important that runner’s are diligent about injury prevention, as 90% of individuals training for a marathon will suffer from injury and about 50% of those injuries will affect the knee.
One method to prevent injury is through biomechanics. Heiderscheit et al (2011) examined the effects of manipulating step rate on mechanics at the hip, knee and ankle. The study had runners increase their step rate by both 5% and 10%. By doing this, they determined that loading at the knee was decreased by 20 and 34% respectively. Hip loading was only reduced if step rate was increased by 10%. The suggested mechanism for the decreased loading is a reduced stride length and biomechanical changes that lead to increased stiffness in the lower extremity.
Therefore, increasing step rate may be a valid method to prevent injury. Aim for a step rate of 180 steps per minute or 90 steps per foot. Implementation of such change can be difficult; however, the use of a metronome to increase step rate during your run may be helpful.
For more information check out the following link: http://www.ncbi.nlm.nih.gov/pubmed/20581720
By: Dr. Carrie Johnston
Heiderscheit, BC, Chumanov, ES, Michalski, MP, Willie, CM, Ryan, MB. (2011). Effects of step rate manipulation on joint mechanics during running. Medicine & Science in Sports & Exercise, 43(2):296-302.
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From the Ontario Chiropractic Association. www.chiropractic.on.ca
We all love winter! Fresh snow, crisp cold air and sunny days. But it also means icy steps and sidewalks, snow to shovel and finding the best ways to stay warm.
Whether you’re a snowboarder, skier, snowmobiler, jogger or skater, you need to know how to take care of your back in winter conditions. Otherwise, the sudden twists and bumps from winter sports can sideline you with painful muscle strains and tears. Some winter sports, like snowmobiling, skiing, tobogganing, and snowboarding, can be especially hard on your back.
Always warm up.
Start by stretching your muscles at home. Focus on the lower back and leg muscles, such as hamstrings and calf muscles. When you arrive at your sporting destination, warm up again. Your chiropractor or fitness professional can advise you on the best stretches for your favourite sports, but here are some examples:
• Skating:
Do some lunges. Take a good-sized forward step with your right foot, and let your left knee sink toward the floor. Keep your shoulders aligned over your hips. Repeat 5 to 10 times, and then do it all over again with the left foot.
• Skiing:
Do 10 to 15 squats once you’re at the ski hill. Place your legs shoulder-width apart, align your knees above your feet and lower your buttocks slowly. Straighten up slowly and repeat.
• Tobogganing:
Do some knee-to-chest stretches while sitting or lying on your back. Pull your knees to your chest and hold for 30 seconds. This helps your spine be as flexible as possible as you bounce through the snow.
Use the right safety equipment.
This means helmets, face guards, and protective clothing. Make sure that your equipment is in good condition, and fits properly. Shop at a reputable outdoor or sporting goods store, and have someone there adjust and fit your equipment to your size and shape.
On the slopes, make sure that ski and snowboard bindings are adjusted for your height and weight. Always check the weather conditions and watch the trails for icy patches and other potential hazards.
Dress for the weather.
Layered clothing works better to keep your muscles warm and your skin dry so you don’t get chilled. You may want to invest in clothing designed specifically for winter outdoor activity (available at your local outdoor or sporting goods store), or layer garments made of natural fibres (like cotton, wool and silk).
Know when to rest.
Rest when you feel tired. Stop your activity immediately if you experience sudden or prolonged pain in any joint or muscle. Cool down by stretching, and change into dry, warm clothes.
Stay hydrated.
Don’t be fooled by the temperature! Your active body needs plenty of fluids even though it’s cold outside. Be sure to drink lots of water or juice before, during and after winter sports.
Follow these tips, and you’re well on your way to having a safe and healthy winter.
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Balance is something we often take for granted, until that is, we slip and fall on an icy sidewalk. Falls can leave people seriously injured especially those who are getting older. Many factors contribute to fall risk in the elderly. Risk factors can include decreased mobility of the feet and ankle joints and reduced sensory information to and from structures. Accurate sensory inputs and compensatory motor out puts are essential for proper balance. These inputs are based on signals from both cutaneous (skin) inputs and joint inputs. Can we affect those inputs and possibly decrease fall risk?
A study by Vaillant, J., Rouland, A., Martigne, P. et al. showed that a 20 minute session of manual massage of the feet and mobilization of the joints of the ankles and feet significantly improved the one leg balance test in patients aged 65-95 years. For more information visit http://www.ncbi.nlm.nih.gov/pubmed
Any strategy to reduce fall risk, especially in the elderly population is important. Consider this next time someone asks you for a foot massage!
Reference
Vaillant, J., Rouland, A., Martigne, P. et al. Massage and mobilization of the feet and ankles in elderly adults: effect on clinical balance performance. Manual Therapy. 2009; 14.
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Snow can pile up fast! A shovel full of snow can weight 5-7 pounds! Thats a lot of repeated lifts by the time you finish the driveway or sidewalk!
According to a survey of 500 Chiropractor’s in Ontario, shoveling snow is the #1 cause of back pain during the winter months. Don’t let shoveling snow get you down this winter. Check out these tips for keeping your back pain free during this shoveling season;
- Warm up prior to shoveling; for example a 10 minute walk and a few simple stretches should do it!
- Use the proper tools. A light weight, push shovel is best!
- Don’t let the snow pile up; shovel frequently.
- You can spray a metal shovel with teflon to prevent the snow from sticking to it.
- Avoid sudden twisting movements by pushing the snow instead of lifting when possible.
- When you do have to lift, bend your knees and use your legs. Try to keep the back straight.
- Take lots of breaks. Backs get injured when the muscles fatigue and can no longer support the back. A short break can refresh the muscles and decrease your risk of repetitive strain injury.
- Dress for the weather! Wear layers.
- Stay hydrated. Don’t let the cold fool you, shoveling is hard work!
Always stop if you feel pain in your chest or back. If the pain in your chest persists seek medical attention. If the pain in your back persists, visit your chiropractor!
For more information on the Lift Light, Shovel Right Campaign visit
http://www.chiropractic.on.ca/Resources/PublicEducation/LiftLightShovelRightpub.aspx
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The feet are an important link to running pain free. While running or jumping, the feet need to maintain an adequate balance of both stability and mobility in order to provide a solid lever for propulsion and to absorb ground reaction forces associated with locomotion. With such large responsibilities it is not surprising that problems in the feet may actually result in issues further up the leg. In a recent study by Kaya et al. (2009), it was determined that having a bunion with an angle greater than 15° was associated with having patello-femoral pain syndrome in the knee. The exact mechanism by which this occurs has yet to be determined; however, the presence of bunions may lead to abnormal foot pronation (flattening of the arch) which in and of itself has been cited as a factor in patellofemoral pain syndrome.
Both the addition of exercises that focus on reinforcing the intrinsic foot musculature and arches and the hip stabilizing musculature may also be of value when dealing with knee and foot pain of this nature.
Kaya, D., Atay, OA., Callaghan, MJ. et al. Hallux valgus in patients with patellofemoral pain syndrome. Knee surgery, sports traumatology, arthroscopy, the official journal of the ESSKA. 2009; 17(11)
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Overhead athletes are continually plagued by shoulder injuries. For example, in swimmers, 90% of injuries are to the shoulder (Weldon et al., 2001). As a result it is important to understand why these shoulder injuries occur so that appropriate methods of prevention and treatment can be utilized.
One common reason for injury is an interruption of the kinetic chain. The kinetic chain refers to the sequence in which muscles and joints are activated to create smooth, seamless and efficient movement. Interruption of this “normal” sequence of events, generates compensations that occur at various muscles and joints throughout the chain which, overtime may result in injury due to increased stress on the tissues. Causes of kinetic chain disruption include muscle imbalances, improper skill mechanics, poor flexibility, or a poorly healed or rehabilitated injury. (Lintner et al., 2008). Proper treatment is important for injury recovery and prevention should focus on proper skill mechanics as well as biomechanical assessment to determine where deficiencies may lie.
Weldon, EJ., Richardson, AB. Upper extremity overuse injuries in swimming. A discussion of swimmer’s shoulder. Clinics in sports medicine. 2001 20(3)
Lintner, D., Nooner, TJ., Kibler, WB. Injury patterns and biomechanics of the athletes shoulder. Clinics in sports medicine. 2008 27(4)
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Headaches are a common complaint among the general population. Globally, 47% of the population suffer from headaches1. The International Classification of Headache Disorders describes several subcategories of headaches. One source of headaches that may be less familiar to the general population is cervicogenic in origin. This type of headache originates from dysfunction of the joints, and/or muscles of the neck and leads to symptoms of head, neck and arm pain. Thorough assessment of the muscles and joints can help determine if a headache is cervicogenic in nature.
A study by Ylinen et al. 2010 followed female office workers with chronic neck pain through strength and endurance training programs and discovered significant decreases in both headache and neck pain. Exercises included isometric strength and endurance training, dumbbell exercises for upper back, and neck, stretching and 4 sessions of mobilization and soft tissue therapy. The rehabilitation regimen was performed 5 days a week2. More information about this study can be found at; http://www.ncbi.nlm.nih.gov/pubmed/20461336
The neck is prone to imbalances and chronic injury from daily activities and it often gets neglected during a typical workout. The results of this article suggest that regular training may reduce head and neck pain. Have a Health Professional assess and develop an individualized rehabilitation program for your neck.
1. Stovner, L., et al., The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia, 2007. 27(3): p. 193-210
2. Ylinen, J., Nikander R., Nykanen, M., et al. Effect of neck exercises on cervicogenic headache: a randomized controlled trial. J Rehabil Med. 2010; 42
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