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.

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.

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)

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.

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.

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.

This year we are supporting the Best Foot Forward Campaign. Best Foot Forward is a public education program developed by the Canadian Chiropractic Association to address the issue of debilitating falls among older Canadians.

Falling can be much more debilitating than many of us realize. Here are some statistics from the Public Health Agency of Canada’s Report on Senior’s Falls in Canada;

• Falls are the second leading cause, after motor vehicle collisions, of injury-related hospitalizations for all ages, accounting for 29% of injury admissions.
• Almost 62% of injury-related hospitalizations for seniors are the result of falls.
• The fall-related injury rate is nine times greater among seniors than among those less than 65 years of age.
• Almost half of seniors who fall experience a minor injury, and 5% to 25% sustain a serious injury such as a fracture or a sprain.
• Falls cause more than 90% of all hip fractures in seniors and 20% die within a year of the fracture.
• Families are often unable to provide care, and 40% of all nursing home admissions occur as a result of falls by older people.
• Even without an injury, a fall can cause a loss in confidence and a curtailment of activities, which can lead to a decline in health and function and contribute to future falls with more serious outcomes.
• A 20% reduction in falls would translate to an estimated 7,500 fewer hospitalizations and 1,800 fewer per- manently disabled seniors. The overall national savings could amount to $138 million annually.

To help prevent falls it is important to know the risk factors.

• One of the most important risk factors is muscle weakness and reduced physical fitness. This can lead to poor strength, balance, flexibility and coordination which can make everyday activities difficult and dangerous.
• Age related changes in vision can increase fall risk by 2 and a half times.
•  Chronic Illness such as arthritis, stroke, low blood pressure as well as cognitive impairment can increase the risk of falling.
•  Certain medications and/or multiple prescriptions can affect coordination, alertness, and cause muscle stiffness or weakness.
•  Unsupportive footwear, long dresses and baggy clothing can get caught and cause a stumble; and carrying objects such as groceries or a laundry basket can increase fall risk.
•  Poor diet and improper nutrition can lead to fatigue, weakness, and poor bone health.
•  A fear of falling can either motivate a person to improve their strength and balance or can lead to avoidance of activity, greater insecurity and increased disability
• It is important to eliminate falling hazards around the home. This includes unnecessary rugs, poor lighting, installing hand rails where necessary and removing clutter.

Stay tuned for more information on fall prevention this month.

To read the full Seniors Fall Report please click on the link below.

http://www.chiropractic.on.ca/Resources

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