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Acute Low Back Pain
By Dr. Jen Milus, DC of www.backsafegolf.com
Low Back pain is among the most debilitating injuries in America
today. Golfers are especially prone to it . But what can we do ourselves?
There is no magic bean for mechanical low back pain. There are a
variety of choices for care for your back pain: Chiropractic, Massage,
Acupuncture, Physical Therapy, pain killers and muscle relaxants.
Whatever your choice: Your healthcare provider cannot help you nearly
as much as you can help yourself. Any treatment they do really needs
to be additive to what you do yourself.
Pain is often rated on a pain scale of 1-10: 1 is barely noticeable,
and 10 is so bad that one is unable to move or function. The initial,
extreme pain that gets people to their doctor is called the acute
or inflammatory stage. Most people rate that as 7, 8, or 9 out of
10. It can be marked by localized swelling, and heat in the immediate
area. Some doctors prescribe anti-inflammatory medication for that.
I prefer rest, a few exercises, and ice- in that order.
The chemical bi-products of inflammation actually soften the tissues
in the area. This leaves those tissues more vulnerable to tearing
and long term injury. Taking soft tissues to end range by bending,
lifting, and twisting can be especially damaging. This occurs in
the golf swing. So- don't push things during that time. Rest is
important at this time. The objective is to break the inflammatory
process, re-create flexibility, and move on to strengthen and improve
coordination. This will, if all goes well, lead to less painful
episodes less often. And more enjoyable, better rounds of golf.
In this article, I will talk about ways you can do the first 2 steps:
1. Reduce inflammation and 2. Re-create flexibility. Of course,
you should check with your doctor to make sure there is nothing
that he/she needs to treat you for or with before you undertake
self care.
The Rand Study (20+ years ago) proved that chiropractic adjustments
work to reduce acute low back pain. This is certainly true in people
who have an inflammation of the facet joints in that area. However,
this can be a short lived quick fix. You can't stop there if you
want lasting relief! If the muscle spasm is not reduced, the motion
restored, and the trunk strengthened around it, the bouts of low
back pain will likely return. I am a big believer in deep tissue
muscle work, manipulation or adjustment, and therapeutic exercise-
all properly applied. They work… when used at the right stages
in the healing process.
Let's talk about what you can do on your own, though, as an adjunct,
or at home to get yourself some relief. The 3 things I would have
you do for acute low back pain are as follows:
See your doctor to rule out pathology. Then…
Get comfortable. This can be very difficult at this time.
I find that people with low back pain often respond well to the
90-90 position. This is; hips and knees both bent to 90 degrees.
Lay on your back near a sofa or ottoman. Your hips bent, and knees
bent so your behind is "scooched" up close to the sofa.
Your calves will be on the sofa. This will take the lordosis out
of the low back and allow the facet joints a break from each other…
take some of the pressure off the area.
This is a great position as it is easy on your low back and you
can slide an ice pack under your low back as well.
Ice: Ice is a great tool for reducing and breaking the inflammatory
process. It will also slow the pain nerve's transmission signal
to the brain by up to 60 meters per second for up to 12 hours. It
needs to be used repeatedly, and quite often for a few days when
you really hurt. Try to ice every 4 hours for the first 2-3 days
of your flare up. (I know- that's a lot to ask, but, it really works.)
Remember that the inflammatory process is like a camp fire. You
might think it's been put out, but if you don't go back and stomp
on it several times, and dump more buckets of water on it, it might
just smolder for a few days and come back full bore and put you
right back where you started.
The icing is great. Wait a few hours after the ice. Then do a few
exercises and ice again. Wait a few hours, do the exercises and
ice again, etc.
The exercises I recommend for acute low back pain are:
Pillow Pelvic tilts: 20 reps
In the 90-90 position, put a pillow between your knees. Suck in
your stomach and hold. Squeeze the pillow and hold. Now do a pelvic
tilt and press your low back down onto the floor and hold everything
for 5 seconds. Do this 20 times. When you are able to move, go on
to the next exercise.
Cat and Dog: 10-20 reps
Get on your hands and knees, hands and knees shoulder width apart.
Suck in your stomach. Do a pelvic tilt. Slowly push your low back
up toward the ceiling. Hold for 5 seconds. Relax, let your low back
arch as low as is comfortable. Let your shoulder blades sink together,
and lift your chin slightly. Hold for 5 seconds. Slowly take it
back up. Repeat 10-20 times.
Knees to chest roll in circles 10-20 reps each way
Lay on your back. Bring your knees into your chest. Now roll the
knees in a circle as if you had a pencil between your knees and
were drawing a circle on the ceiling. Go 10 each direction. Increase
each time until you hit 20 each way.
Drop knees to each side, 1 minute each way
Drop the knees on the floor next to you, knees and hips bent to
90 degrees. The outside of your bottom leg will be in the floor.
The other leg will be right on top. Reach the upper body the other
way. You should feel a comfortable rotation in the entire lumbar
region. Relax 1 minute each way.
You may follow with icing for exactly 20 minutes in the 90-90 position.
Here is how you make the ice bag:
Put about 20+ ice cubes in a freezer zip lock bag
Cover the cubes with water
Squeeze out the excess air
Zip it shut
Place directly on your low back.
Heat:
When your pain has reduced to 2-3/10, you can use Ice and heat together.
Use a hot shower, hot bath or hot tub with jets. Let the hot water
contact the area for 10 minutes. Then, follow with these exercises:
Do each of the above exercises, Plus:
Standing Lateral Flexions:
Stand with your feet twice hip width apart. Slide your left hand
down the outside of your left leg to support the weight of your
trunk. Take the Right hand and reach up and over your head, and
lean left. Slide the left hand down, and feel the stretch in the
right side of your low back. Lean slowly over, and hold for 15-30
seconds. Now go the other way.
Follow with 20 minutes of ice- again, at 90-90.
This routine of heat-stretch-ice is great for pumping inflammation
out of the area, relaxing spasm, and getting new healing nutrients
into the area.
Things NOT to do during this time:
Unanswered heat:
Do not put unanswered heat on the area. The heat brings in excess
blood and does not pump it back out again. It might feel good temporarily,
but it can worsen an inflammatory process… make it linger.
Always follow it with a stretch and ICE. The heat stretch ice thing
really does works!
Ice before Exercise:
Ice has its uses. But remember that it shortens, tightens and stiffens
the tissues in the area. Do not ice before you exercise. Do it afterwards.
Motions which are hard on your hot low back:
Unsupported forward flexion, Lifting heavy objects, and twisting
are all tough on your low back. Don't lift things that are a far
reach away from you; keep them close to your body.
I see people in the gym doing these things:
Rotations with weighted Bar on shoulders:
Axial loading of the spine plus rotation is damaging to the disc
and joint tissue. Besides, this really doesn't strengthen you at
all in any productive way.
This Exercise is even worse:
Axial Load, Plus rotation, plus forward flexion is extremely compromising
to your low back.
Stiff Legged Dead lefts done improperly:
Remember to keep your chin up and your low back completely flat
during this exercise. If the low back bends at all, you are already
injuring yourself.
Yoga Cobra Stretch:
This is the one where your pelvis and legs are on the floor, and
you press your trunk up and (hyper) extend your low back. This jams
your facet joints together, and can single handedly cause a facet
syndrome, and set off an episode of low back pain. Some people think
this is a good stretch… for some it is, but most it's not.
There are (somewhat different) extension exercises that work well
in a therapeutic setting- like McKenzie exercises. However, they
need to be applied by a Physical Therapist (or an exercised inclined
Chiropractor) who has been trained in the technique.
Later, when lifting heavy objects:
Bend at the knees and hips
Keep your abs and gluts tight, and back flat!
Keep the heavy object close to your body
If you need to rotate, do so with your feet, entire body, not from
the trunk
Be healthy. Be safe, and wouldn't this all be a lot easier if you
had it on video? 
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Osteoporosis in Female Golfers
By Dr. Jen Milus, DC of www.backsafegolf.com
What is it?
Osteoporosis is bone loss that often occurs in menopausal and post menopausal women. It can be beginning, middle or end stage. This bone softening disease can lead to fracture, disability, and eventually, even death.
How is it diagnosed?
It can be seen on X-ray, and that X-ray finding is called Osteopenia. Osteopenia is not a diagnosis of early stage osteoporosis, it is merely the name for the x-ray finding. Many doctors may call it that- but it is a misnomer. By the time it is visible on X-ray, you have lost 20% or more of your bone density! At that point, you are already in a fracturable state!
Who gets it?
Mostly Caucasian women of slight build. But, others are susceptible too! Women of all shapes, sizes, and ethnic backgrounds get it. It appears to be linked to the reduced levels of estrogen associated with entering menopause.
How bad can it actually get?
The first fractures are usually spinal compression fractures, then later hip fractures. If the hips both become fractured at one time, the person will become bedridden, and that’s when the ribcage can start to deteriorate. Close to home: my grandmother died from this awful disease. Do I have your attention yet?
Spinal Fracture? Golfers Beware!
The forward leaning posture used in opening a window, or in the sport of golf can be the proverbial “straw that broke the camel’s back”! If you want to keep playing golf, then you are going to need to keep leaning forward. So: increasing calcium uptake into your bones, and thus increasing your bone density is the only answer!
Dietary and Lifestyle Issues:
Caffeine, Carbonation, Smoking, Alcohol, High Protein Diets! All of these things cause the leeching of calcium from the bones. Decrease or eliminate these things from your diet, and you will be a lot better off.
Weight bearing exercise:
The idea that walking qualifies as weight bearing exercise is preposterous. Sure- it has the effect of gravity on your spine! But, you have that amount of weight on your spine all day every day. The idea is to slightly challenge the bone’s strength on a regular basis (more than it is with gravity) to increase osteoblastic activity. That is to say, if you push the envelop with regards to the body’s capabilities, it will compensate and rise to the occasion, produce more bone cells, and increase bone density.
There are many Treatments:
In some people’s minds, the jury is out on estrogen replacement. In my mind, it is not still out. I will not take them when the time comes. I will continue eat soy products every day, as that has been shown to level out estrogen fluxes and smooth the decent into eventual lowered production. Many people find that the soy products seem to reduce or eliminate hot flashes. It’s worth a try, I think!
Some people use plant estrogen (cream) products that are available at health food stores. I have no opinion on that, other than each person should investigate that and make their own decision. I do have a strong opinion on synthetic estrogens, and that is that they will never enter my system. Again, that is a personal decision.
Estrogen replacement with Premarin elicits a strong opinion from this female doctor too. It is made from the urine of pregnant mares. I am not a pregnant horse. Therefore, I do not think it is appropriate that I ingest a product made from it. Once more, that is a personal decision. I would advise anyone who is put on that to thoroughly investigate what the side effects might be for them, and act accordingly.
There are prescription medications that are said to increase calcium absorption. But don’t be fooled, once you go on it, you need to have your liver enzymes checked every 6 months. That means it can cause liver problems. But, if your liver is otherwise healthy ie: you are not a heavy drinker, smoker, or prescription drug user, try to choose the lesser of the 2 evils. As I mentioned earlier, my grandmother actually died of osteoporosis. She had listened to some chiropractor who advised her against the medication. Her liver was otherwise very healthy, and her lifestyle very clean. There was no reason to protect her from challenging her liver a little bit. And, bottom line, she died of osteoporosis with completely normal liver enzymes. Just try to make an informed choice, and do it on an individual basis, with a doctor to takes the time to listen to your concerns.
Calcium Supplementation.
Eating foods “rich in calcium” is not enough. Our soils are depleted from years of commercial farming to support the processed food industries. Whole foods and fresh, raw fruits and vegetables are key. (Especially fruits, I hear, in a recent study!). You really do need to take a calcium supplement.
Little known fact: Calcium in the chemical form: Microcrystaline Hydroxiappetite is the most absorbable. You should take 1200mg/day. You should be able to find that in a health food store near you, or through Metagenics.
Go to this website for great prices on these great products:
http://www.totaldiscountvitamins.com/Merchant/mtgframe.htm
Then search on that page for this product:
Metagenics - cat# - MTG-CA032 - Cal Apatite Plus - 270 Tablets
I am not associated in any way with this website, and not their affiliate. It was just an easy to find source that offers great prices!
But, don’t be fooled by advertisement: Tums is not absorbable calcium. These commercials say, “… and Tums has calcium for your bones!” Funny, they forget to mention that the form of calcium in tums might make a great buffer for stomach acid, but, it is not bio-available, and cannot be absorbed into your bones! How they get away with this, I don’t know! Truth in advertising is supposed to be a law!
Oyster Shell Calcium (Calcium Carbonate) is not absorbable by the body either. In health food and drug store, this form of calcium is the cheapest. There are things in life where you get what you pay for. This is NOT one of those cases! You get NOTHING for your money here. What a coincidence- Tums is made with calcium carbonate. Go figure!
Calcium Citrate is moderately absorbable by the human body. Let’s look at the numbers, though. Out of every 10 molecules of Microcrystaline Hydroxyappetite that is ingested, about 8 can be absorbed. Out of 10 molecules of Calcium Citrate ingested, 5-6 can be absorbed. Out of 10 molecules of Calcium Carbonate (Tums) not even 1 can be absorbed. So- spend your money however you like. Just be informed about your choice!
Training with weights.
This extra load bearing will increase the formation of bone. It should be started early, though. And keep in mind this: unlike sleep, you do get to save up bone density! I have trained with weights for 25 years; my bone density is about 15% higher than an average woman my age. If I lose 20%, I will still have 95% of what’s “normal”. I am a very long way from a factorable state! Say I had walked for 25 years; my bone density would be average for a woman of my age. If I’d lose 20%, I’d have 80% of what’s normal. I would be a whole lot closer to a factorable state than if I had trained with weights. So why are so few women training with weights? My advice: get a trainer, and do it! Prevent those hip fractures while you are young. In golfers, prevent the spinal fractures, and we will be way ahead!
Make no mistake about this! Choose exercises that do not compress your spine axially (from the top of your head). And increase your weights gradually so as not to injure yourself! Using a personal trainer is the best idea. The increased strength will improve your golf game. You’ll be able to hit the ball further with your increased upper body strength!
Make sure that your trainer knows that you golf, and that you are trying to prevent osteoporosis. He or she will want to do posture maintaining, or posture improving exercises. This will include a bit of rhomboid , lat, and spinal extensor work.
Won’t weight lifting make me muscular and bulky?
This is an old wives tail. At first, the additional muscle might make you appear a little bit bigger. But that muscle will cause a rise in your metabolism, and your body will start to burn off the fat that covers those muscles. In time, the net effect will be that you are denser and leaner, and even athletically feminine. I have lifted weights for 27 years now, even lifting extremely heavy weights at times, and I still look very much like a girl, muscles and all. Genetics vary, and there are no guarantees, but I have not heard of women becoming masculine looking unless they took male hormones, or human growth hormone. Since you probably won’t be taking that, I’d say your worries are slim to none.
Warning! Be very careful!
Spinal Fracture is often misdiagnosed as simple back pain! As the individual trabeculae (bone cells) give way, and we to lose height, it is largely invisible! What to do? Well, be very careful. Focus on the things that will not load the spine. Weight training by someone who has osteoporosis needs to be done with an expert. Otherwise you put yourself at risk.
What about us?
The younger women who have not yet been diagnosed with this horrible disease? Those of us who see it in our family history would have to be crazy not to make the changes listed above. Once it happens, it’s really too late! Let’s re-cap what can be done:
- Start prevention young. Start in your teens, 20’s or 30’s.
- Train with weights. Learn how to do it properly, and train hard.
- Focus on working the postural muscles that prevent forward leaning. This will decrease the compressive forces of forward leaning posture in golf.
- Take the proper Calcium: Microcrystaline Hydroxiappetite: 1200 mg/day
- Reduce or eliminate: Caffeine, Carbonation, smoking, and alcohol.
Best Wishes,
Dr. Jen Milus, DC
http://www.backsafegolf.com
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Knee Pain in Golfers
By Dr. Jen Milus, DC of www.backsafegolf.com
Many Golfers have pain in the knee onto which they pivot.
The repetitive motion of pivoting onto the forward knee causes knee pain in many golfers. It is best to catch this quickly, and do some things yourself before the pain gets bad, and you cause yourself a serious injury by playing on it while it's enflamed! What can we do ourselves?
What's really going on?
With the transference of weight to the forward foot in the follow through, most of the body's weight ends up on a joint that is not in a bio-mechanically sound position. The pelvis is turned facing forward, and the femur (upper leg bone) is internally rotated at the hip joint. This end position actually twists the lower part of the femur while it's under significant load. This tightens the muscles in the lateral side (outside) of the upper and lower leg. This includes the lateral quad and the ITB band. These muscles, can, over time, become fibrous and shortened, and cause an ITB syndrome. Further, it can grind the lower femur onto the upper tibia (meniscus/tibial plateau) and start to irritate and wear out the cartilage.
This irritation can turn to inflammation. The knee is an encapsulated joint. That inflammation can easily stagnate in there. The mediators of inflammation actually chemically soften the cartilage and ligaments within the joint. If you continue to play on it as it is, you are likely to cause further injury. This also leads to a faster progression of DJD (degenerative joint disease).
What does your doctor say?
Seeing your family doctor is a good idea- just to make sure there is nothing orthopedically wrong: no ACL, MCL or meniscus tears. Once you know the joint tissues are in tact, there's a lot you can do for yourself. These are things you should know so they can play through this injury!
Your doctor may say, "Oh, it's just arthritis!" Don't take that as an excuse to accept what's been dealt you! That's even more reason to read on and follow my instructions!!! Nor would I suggest just popping a few advil and waiting for it to go away…
So what are some solutions? Some things we can do for ourselves?!
Break the inflammatory Process:
Dixie Cup icing:
- 2-6 times a day. Morning and evening at least. The more the better.
- Leave at least 20 minutes between icings.
- Go to the store, and get a box of Dixie cups. Fill about 12 with water and freeze them. When you are ready to ice, take one out, peel away the top of the cup so you can hold the cup at the bottom, and ice cube is above the torn edge.
- Put the leg up, so the leg is almost straight, and a towel behind it. This gives the water a place to drain.
- Set a timer for exactly 5 minutes. Put that ice cube directly on the skin. Circle the knee cap on the soft tissue around it. Focus on the area just under the knee cap, and along the joint line where swelling tends to gather. Keep moving until the timer goes off: 5 minutes. Stop.
- First you will feel cold, then pain, then numbness. Don't stop until 5 minutes are up!
Traumeel:
- Use this every time after you ice.
- This is a homeopathic cream/gel remedy I use for inflammation and sports injuries. I know for sure they carry it at Whole Foods and Health Food Stores. Or search it up online.
- Use the same amount as if it were toothpaste, and you really enjoyed the flavor of it. Rub it all over the knee, knee cap and joint. Do not wash it off.
- Put more on before you go to bed!
- You can keep this in your golf bag during the season. It works really well!
Re-build the cartilage:
- Take Glucosamine Sulfate. 1500 mg/day.
- There was a book written on this stuff called "The Arthritis Cure". Read it if you like. It says that studies show it works and has no side effects. Let's face it, young or old, arthritis and wearing away of cartilage is the same thing.
- No, you can't get enough GAS in a normal healthy diet. Keep taking it even after feeling better.
- Don't buy Glucosamine HCL. Studies show it does NOT work.
- Don't bother with Chondroitin Sulfate. It works for some, but there are no placebo double blind studies out there showing that it works. There's testimony and anecdotal "proof". NOT GOOD ENOUGH for me.
Strengthen the muscles around the knee:
Remember that the muscles on the outside have become tight and over used. We now want to compensate for that by strengthening the muscles that oppose those!
- Ride a bike 3 times a week for 20 minutes on flat ground. The seat should be high enough that the knee is straight in the down position. Keep moving your feet the entire time.
- Using a stationary bike is even better. Use light tension.
- Follow with icing and traumeel
Once you start to feel a little better, Leg lifts:
- Lay on your back with your legs straight out. Turn your injured leg toe out and raise the straight leg until your leg comes up 75% of the way (about 25 % down from pointing at the ceiling).
- Do this with just the weight of the leg at first. Then put 2 soup cans in 2 tube socks, and tie the top ends together wrap them around your ankle, and use this for resistance.
- Start with 2 sets of 10 reps and work up to 4 sets of 20.
If you belong to a gym, then:
Hamstring curls:
- In the gym, use the machine that has you lay face down, and pulls your heels in to your behind.
- Start with a light weight- like 20 or 30 lbs for women, 30-40 lbs for men.
- Start with 2 sets of 12. Work up to 3 sets of 12.
- You may increase the weight and decrease your reps once you reach 3 sets of 12.
Leg extensions in the last 15 degrees of extension.
- This works the medial quad. This can change the tracking problem very fast!
- Start with your leg straight. Bend Go from barely bent to slightly straight and back again. Don't force it into hyperextension!
- Start with a relatively light weight (10-20 lbs), and only ever progress to a medium-light weight (30-40 lbs)!
- Start with 2 sets, 1 minutes rest between. Do 10 reps.
- You can work up to 6 sets, with 1 minutes rest between.
If you have any questions or concerns, please feel free to write and ask me!
drjen@backsafegolf.com
Dr. Jen Milus, DC www.backsafegolf.com. Feel better, Drive Further!
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Advanced Whole Body Circuit Training
By Dr. Jen Milus, DC www.backsafegolf.com
If you only have an hour to train, and want a really intense workout, try circuit training. The key to great circuit training is to use only major muscle groups. Each exercise must use many joints at one time. One must move exercise to exercise rapidly to force the body to move blood from one area of the body to another quickly. This increases the heart rate, increases metabolism, and intensifies the after burn. Note: This does not mean that you do the actual exercise quickly, just that you move between them quickly. Don’t waste a lot of time writing notes either!
Warm up before you do this workout, and always stretch afterwards. WARNING: Exercise at your own risk! This workout is intense and not intended for beginners. It uses only 7 different exercises. Move from one right to the other, without resting if possible. Do this workout no more than twice a week, with at least one day of rest between. Start out slow: go through all 7 just once the first few times you do the workout. Add a second time through after a few weeks, and a third time through after a few more weeks. Once you build up to it, you can blast through this workout for an hour twice a week, and not have to do anymore strength training besides that!
Read through the exercises below. Be sure you understand the instructions given. If you do not, please write to: drjen@backsafegolf.com and ask for clarification. Print out the chart on the final page. Go to the gym when it is not busy, and there is plenty of access to equipment. That way no one will steal your “toys” when you are off doing another exercise!
Bicycle abs:
Always do these on a bench as shown here. Rotate and lift the upper body to touch the elbow to the opposite knee, and hold for 3-second count. Exhale as you touch the elbow to the knee, and inhale as you cross the center to go to the other side. The other elbow should be below the level of the bench, allowing for maximum rotation. You will start with 25, and work up to 100.
 
Close Grip Lat pulls:
Hold the handle in your hands, and lean back to almost 45 degrees from straight up. Contract your abs and hold them tight. Let the shoulders roll all the way up next to your ears, then pull down to the bottom and squeeze the shoulder blades together in back. Inhale as you let the hands up slowly, and exhale as you bring the handle down to touch your upper chest. Hold at the chest for a count of 3. Do this exercise with ½ your body weight the first exercise, and do 20 reps. Thereafter, during this workout, increase your weight by 10 lbs each time, and still try to do 20 reps. If you would rather do one hand-rope pulls, by all means, look here: http://www.fireagility.com/cpat_events.php
 
Ball Push-ups:
Put your knees on the ball as shown here, abs tight, hands in a wide grip position. Inhale as you lower to touch your nose to the floor. Exhale as you press up. Keep your abs tight and your body like a plank the entire time. Rolling backwards on the ball so the ball is closer to your belly button makes this exercise easier. Do 10 reps the first set, and see how it feels. After that, try for 2 more each set during this workout. For more information on working your pecs, and saving your shoulders, see regarding bench press… here: http://www.fireagility.com/faq.php
 
Decline Leg Press:
Put the Leg press seat back as far up as possible. Sit in the machine with your butt and low back pressed back against the bench. Walk your feet, on the foot plate, up so your toes hang an inch over the top of the foot plate. Press up and unlock the handles. Inhale as you lower the sled, to a 90 degree bend in the knee. Always press through your heels, and never hyper extend your knees. Start out with the sled and do a set of 20. There after, add a 10 lb. plate to each side each set.
 
Trunk Roll–ups:
Knees on the ball again, hands shoulder width apart. Roll up so your behind goes into the air. Go up to where you hips are bent at a 90 degree angle, and your shoe laces are what’s touching the ball. Do 10 reps the first set. Try to work up by 2’s each set as: 12, 14, 16, 18, 20. If you fail before you reach your number, that’s fine. Stop! This is hard! Keep your abs tight the entire time, and make sure you are plank-straight in the down position! If your low back starts to arch at all, you need to stop! You are at failure! You’ll be able to do more next time. Caution: this is a difficult exercise! It is not intended for beginners! Anyone heart rate and respiration rate will increase on this exercise. Be careful! If you feel any grinding or pain in your shoulder socket, please stop this exercise and write to Dr. Jen for another idea: drjen@backsafegolf.com
 
Hamstring Curl:
Start with You legs straight, NOT hyper extended. Take a deep breath, and blow out as you raise the heels toward your butt. Inhale as you lower. Make sure you keep your pelvis down on the bench when you lift. This picture is actually incorrect; see how the pelvis is lifted? This is what not to do. Start with 1/3 your body weight, and do 20 reps. In each successive set, you will increase your weight by the smallest amount possible, and decrease the number you do by 2.
 
Back Extensions on the ball:
Lay on top of the ball, belly button at the highest point on the ball. Hands are behind your head. Feet in the corner where the wall meets the floor, toes out. Lightly squeeze the ball with your inner thighs, and take a deep breath. Lift up until your spine it totally straight, exhaling as you lift. Inhale as you lower. Do 20 reps this and every subsequent set this workout. To make this an even more complex exercise, add rotation to this one: http://www.backsafegolf.com/strength.html
 
Best wishes in your journey!
Dr. Jen Milus, DC
www.fireagility.com
www.backsafegolf.com
Circuit Training By Dr. Jen www.fireagility.com
Exercise |
Weight |
Reps intended |
Actual |
Comments |
Bicycle Abs |
0 |
25 |
|
|
Lat Pulls |
1/3 body weight |
20 |
|
|
Ball Push-ups |
body |
10 |
|
|
Leg Press |
Sled only |
20 |
|
|
Ball Roll ups |
body |
10 |
|
|
Hamstring Curls |
1/3 body weight |
20 |
|
|
Back extension |
body |
6 |
|
|
Bicycle Abs |
0 |
25 |
|
|
Lat Pulls |
1/3 body wt.+10 |
20 |
|
|
Ball Push-ups |
body |
10+? |
|
|
Leg Press |
Sled +10 ea side |
18 |
|
|
Ball Roll ups |
body |
10 |
|
|
Hamstring Curls |
1/3 body wt.+ 5 |
18 |
|
|
Back extension |
body |
6 |
|
|
Bicycle Abs |
0 |
25 |
|
|
Lat Pulls |
1/3 body wt. +20 |
20 |
|
|
Ball Push-ups |
body |
10? |
|
|
Leg Press |
Sled+20 each side |
16 |
|
|
Ball Roll ups |
body |
10? |
|
|
Hamstring Curls |
1/3 body wt. + 10 |
16 |
|
|
Back extension |
body |
6 |
|
|
Bicycle Abs |
0 |
25 |
|
|
Lat Pulls |
1/3 body wt. + 30 |
20 |
|
|
Ball Push-ups |
body |
10? |
|
|
Leg Press |
Sled+30 ea side |
14 |
|
|
Ball Roll ups |
body |
10? |
|
|
Hamstring Curls |
1/3 body wt. +15 |
14 |
|
|
Back extension |
Body |
6? |
|
|
Bicycle Abs |
0 |
25 |
|
|
Lat Pulls |
1/3 body wt. +40 |
20 |
|
|
Ball Push-ups |
body |
10? |
|
|
Leg Press |
Sled+40 ea side |
12 |
|
|
Ball Roll ups |
body |
10? |
|
|
Hamstring Curls |
1/3 body wt. +20 |
12 |
|
|
Back extension |
Body |
6 |
|
|
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Osteoporosis in Senior Golfers
By Dr. Jen Milus, DC of www.backsafegolf.com
What is it?
Osteoporosis is bone loss that often occurs in menopausal and post menopausal women. However, men can get it too! It can be beginning, middle or end stage. This bone softening disease can lead to fracture, disability, and eventually, even death.
How is it diagnosed?
It can be seen on X-ray, and that X-ray finding is called Osteopenia. Osteopenia is not a diagnosis of early stage osteoporosis, it is merely the name for the x-ray finding. Many doctors may call it that- but it is a misnomer. By the time it is visible on X-ray, you have lost 20% or more of your bone density! At that point, you are already in a fracturable state! Bone scans are more sensitive, but seldom ordered until there is already a fracture!
Who gets it?
Mostly Caucasian women of slight build. But, others are susceptible too! Men and Women of all shapes, sizes, and ethnic backgrounds get it. It appears to be linked to the reduced levels of estrogen associated with entering menopause. But, that’s not the only link, or men wouldn’t get it!
How bad can it actually get?
The first fractures are usually spinal compression fractures, then later hip fractures. If the hips both become fractured at one time, the person will become bedridden, and that’s when the ribcage can start to deteriorate. Close to home: my grandmother died from this awful disease. My grandfather also had it in his 80’s and 90’s! Do I have your attention yet?
Spinal Fracture? Golfers Beware!
The forward leaning posture used in opening a window, or in the sport of golf can be the proverbial “straw that broke the camel’s back”! If you want to keep playing golf, then you are going to need to keep leaning forward. So: increasing calcium uptake into your bones, and thus increasing your bone density is the only answer!
Dietary and Lifestyle Issues:
Caffeine, Carbonation, Smoking, Alcohol, High Protein Diets! All of these things cause the leeching of calcium from the bones. Decrease or eliminate these things from your diet, and you will be a lot better off.
Weight bearing exercise:
The idea that walking qualifies as weight bearing exercise is preposterous. Sure- it has the effect of gravity on your spine! But, you have that amount of weight on your spine all day every day. The idea is to slightly challenge the bone’s strength on a regular basis (more than it is with gravity) to increase osteoblastic activity. That is to say, if you push the envelop with regards to the body’s capabilities, it will compensate and rise to the occasion, produce more bone cells, and increase bone density.
There are many Treatments:
For Women:
In some people’s minds, the jury is out on estrogen replacement. In my mind, it is not still out. I will not take them when the time comes. I will continue eat soy products every day, as that has been shown to level out estrogen fluxes and smooth the decent into eventual lowered production. Many people find that the soy products seem to reduce or eliminate hot flashes. It’s worth a try, I think!
Some people use plant estrogen (cream) products that are available at health food stores. I have no opinion on that, other than each person should investigate that and make their own decision. I do have a strong opinion on synthetic estrogens, and that is that they will never enter my system. Again, that is a personal decision.
Estrogen replacement with Premarin elicits a strong opinion from this female doctor too. It is made from the urine of pregnant mares. I am not a pregnant horse. Therefore, I do not think it is appropriate that I ingest a product made from it. Once more, that is a personal decision. I would advise anyone who is put on that to thoroughly investigate what the side effects might be for them, and act accordingly.
For Men and Women:
There are prescription medications that are said to increase calcium absorption. But don’t be fooled, once you go on it, you need to have your liver enzymes checked every 6 months. That means it can cause liver problems. But, if your liver is otherwise healthy ie: you are not a heavy drinker, smoker, or prescription drug user, try to choose the lesser of the 2 evils. As I mentioned earlier, my grandmother actually died of osteoporosis. She had listened to some chiropractor who advised her against the medication. Her liver was otherwise very healthy, and her lifestyle very clean. There was no reason to protect her from challenging her liver a little bit. And, bottom line, she died of osteoporosis with completely normal liver enzymes. Just try to make an informed choice, and do it on an individual basis, with a doctor to takes the time to listen to your concerns.
Calcium Supplementation is For Men too!!!
Eating foods “rich in calcium” is not enough. Our soils are depleted from years of commercial farming to support the processed food industries. Whole foods and fresh, raw fruits and vegetables are key. (Especially fruits, I hear, in a recent study!). You really do need to take a calcium supplement.
Little known fact: Calcium in the chemical form: Microcrystaline Hydroxiappetite is the most absorbable. You should take 1200mg/day. You should be able to find that in a health food store near you, or through Metagenics.
Go to this website for great prices on these great products:
http://www.totaldiscountvitamins.com/Merchant/mtgframe.htm
Then search on that page for this product:
Metagenics - cat# - MTG-CA032 - Cal Apatite Plus - 270 Tablets
I am not associated in any way with this website, and not their affiliate. It was just an easy to find source that offers great prices!
But, don’t be fooled by advertisement: Tums is not absorbable calcium. These commercials say, “… and Tums has calcium for your bones!” Funny, they forget to mention that the form of calcium in tums might make a great buffer for stomach acid, but, it is not bio-available, and cannot be absorbed into your bones! How they get away with this, I don’t know! Truth in advertising is supposed to be a law!
Oyster Shell Calcium (Calcium Carbonate) is not absorbable by the body either. In health food and drug store, this form of calcium is the cheapest. There are things in life where you get what you pay for. This is NOT one of those cases! You get NOTHING for your money here. What a coincidence- Tums is made with calcium carbonate. Go figure!
Calcium Citrate is moderately absorbable by the human body. Let’s look at the numbers, though. Out of every 10 molecules of Microcrystaline Hydroxyappetite that is ingested, about 8 can be absorbed. Out of 10 molecules of Calcium Citrate ingested, 5-6 can be absorbed. Out of 10 molecules of Calcium Carbonate (Tums) not even 1 can be absorbed. So- spend your money however you like. Just be informed about your choice!
Training with weights.
This extra load bearing will increase the formation of bone. It should be started early, though. And keep in mind this: unlike sleep, you do get to save up bone density! I have trained with weights for 25 years; my bone density is about 15% higher than an average woman my age. If I lose 20%, I will still have 95% of what’s “normal”. I am a very long way from a factorable state! Say I had walked for 25 years; my bone density would be average for a woman of my age. If I’d lose 20%, I’d have 80% of what’s normal. I would be a whole lot closer to a factorable state than if I had trained with weights. So why are so few women training with weights? My advice: get a trainer, and do it! Prevent those hip fractures while you are young. In golfers, prevent the spinal fractures, and we will be way ahead!
Make no mistake about this! Choose exercises that do not compress your spine axially (from the top of your head). And increase your weights gradually so as not to injure yourself! Using a personal trainer is the best idea. The increased strength will improve your golf game. You’ll be able to hit the ball further with your increased upper body strength!
Make sure that your trainer knows that you golf, and that you are trying to prevent osteoporosis. He or she will want to do posture maintaining, or posture improving exercises. This will include a bit of rhomboid , lat, and spinal extensor work.
Won’t weight lifting make me muscular and bulky?
This is an old wives tail. At first, the additional muscle might make you appear a little bit bigger. It will also show up on the scale, and you will weigh more! But that muscle will cause a rise in your metabolism, and your body will start to burn off the fat that covers those muscles. In time, the net effect will be that you are denser and leaner, and even more athletic! I have lifted weights for 27 years now, even lifting extremely heavy weights at times, and I still look very much like a girl, muscles and all. Genetics vary, and there are no guarantees, but I have not heard of women becoming masculine looking unless they took male hormones, or human growth hormone. Men, you have nothing to worry about!
Warning! Be very careful!
Spinal Fracture is often misdiagnosed as simple back pain! As the individual trabeculae (bone cells) give way, and we to lose height, it is largely invisible! What to do? Well, be very careful. Focus on the things that will not load the spine. Weight training by someone who has osteoporosis needs to be done with an expert. Otherwise you put yourself at risk.
What Non-Seniors?
The younger people who have not yet been diagnosed with this horrible disease? Those of us who see it in our family history would have to be crazy not to make the changes listed above. Once it happens, it’s really too late! Let’s re-cap what can be done:
- Start prevention young. Start in your teens, 20’s or 30’s.
- Train with weights. Learn how to do it properly, and train hard.
- Focus on working the postural muscles that prevent forward leaning. This will decrease the compressive forces of forward leaning posture in golf.>
- Take the proper Calcium: Microcrystaline Hydroxiappetite: 1200 mg/day
- Reduce or eliminate: Caffeine, Carbonation, smoking, and alcohol.
Best Wishes,
Dr. Jen Milus, DC
http://www.backsafegolf.com
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PMS and Low Back Pain in Golfers
By Dr. Jen Milus, DC of www.backsafegolf.com
Women and Golf During "That Time"
Right before, and during menstruation, many women perceive weakness and low back pain, not to mention lower abdominal and pelvic pain. They may also experience weakness. This leaves many feeling enflamed in those areas. It's not imaginary, it truly is an inflammation of sorts. It is all due to a fluctuation in hormones.
For women who are prone to low back, this time can leave you feeling tight and unable to golf well. It is my opinion, that things need to be done differently during this time to relieve low back pain, than they would other wise be done.
Most of the time, when someone has acute onset or hot low back pain, I recommend that they ice. But, in this instance, I would recommend some heat: on the front of the pelvis for 10 minutes, and on the low back for 10 minutes. Then I would recommend these exercises:
Pillow Pelvic tilts: 20 reps
In the 90-90 position, put a pillow between your knees. Suck in your stomach and hold. Squeeze the pillow and hold. Now do a pelvic tilt and press your low back down onto the floor and hold everything for 5 seconds. Do this 20 times. When you are able to move, go on to the next exercise.
Cat and Dog: 10-20 reps
Get on your hands and knees, hands and knees shoulder width apart. Suck in your stomach. Do a pelvic tilt. Slowly push your low back up toward the ceiling. Hold for 5 seconds. Relax, let your low back arch as low as is comfortable. Let your shoulder blades sink together, and lift your chin slightly. Hold for 5 seconds. Slowly take it back up. Repeat 10-20 times.
Knees to chest, roll in circles 10-20 reps each way
Lay on your back. Bring your knees into your chest. Hold with your hands. Roll the knees in a circle as if you had a pencil between your knees and were drawing a circle on the ceiling. Go 10 each direction. Increase each time until you hit 20 each way.
Drop knees to each side, 1 minute each way
Drop the knees on the floor next to you, knees and hips bent to 90 degrees. The outside of your bottom leg will be in the floor. The other leg will be right on top. Reach the upper body the other way. You should feel a comfortable rotation in the entire lumbar region. Relax 1 minute each way.
I also recommend that my patients get an adjustment at that time. This can relieve a lot of pressure and break that pain pattern very effectively. It works really well... for many reasons that are too long to go into right now.
Just remember, if you choose to get adjusted, see a chiropractor that you are familiar with, or one that a friend has used. This is not necessarily a reason for more than 1, maybe 2 adjustments, so beware. Chiropractic is very effective when used properly. Unfortunately, it is very often over used. Find someone you trust.
Dr. Jen
http://www.backsafegolf.com
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Rotator Cuff Pain and Golfers
Dr. Jennifer N. Milus, DC www.backsafegolf.com
Shoulder Pain in Golfers:
Rotator cuff pain, sprains, and tendonitis appear quite often in golfers. The golf swing requires full range of motion of that ball and socket joint, and full function of the muscles around it. Pain during the swing, or sharp pain on contact can indicate that you have a problem with the rotator cuff muscles, and/or their tendons. If that is the case, then it would be a good idea for you to see an orthopedist or a very good Sports Med Doc and get it looked at. If they okay it, then you can move on to these exercises. They may have other testing or studies they want you to undergo to rule out more serious problems.
Swinging the club:
The leading shoulder (for most, the left) depends a lot on the external rotators: infraspinatus, teres minor, and supraspinatus for a strong downswing and controlled follow through. These muscles are all very small. Frequent over use of them can cause small tears, and irritate the tendons. This can lead to pain, weakness, and eventual tears that require medical attention. Proper training in advance (or post rehab) can be instrumental in preventing injury, as well and increasing strength, power, and yes, distance!
The following shoulder (the right, for most) depends a lot on the pec minor, pec major and subscapularis. The pecs are easily trainable, but the subscapularis is not usually targeted on most gym workouts.
Shoulder Joint Inflammation:
The shoulder is an encapsulated joint. Once an inflammatory process starts inside the joint “capsule’, the process can be lengthy and painful. In addition to the pain, the mediators of inflammation actually chemically soften the ligaments, tendons and other joint tissues. Thus, activities that challenge those structures can cause more damage than the original injury did.
The supraspinatus, infraspinatus, teres minor and subscapularis are often referred to as the SITS muscles. Each one of these muscles has one end outside of that capsule, and one end inside the capsule. The end that is inside the capsule can become very irritated and painful. This pain is a signal that the tendons on the ends of these muscles, and the muscles themselves are more prone to injury at this time. Rest is a good idea at this point. Codman’s Arm exercises are indicated here, and your doctor should be able to show them to you. If he or she cannot, Please send me an e-mail drjen@backsafegolf.com
Because it is an encapsulated joint, the inflammation is tough to flush away. Icing is sometimes not effective (but often worth trying). Good, deep soft tissue work by an experienced Sports Massage Therapist, Physical Therapist or Chiropractor may help. Ultrasound with both of the above can help even more. Non-steroidal anti-inflammatory meds are often called on too soon, in my opinion. Try the other 3 first: ice, massage and ultrasound. I’d suggest you try Traumeel Ointment. Read more about it here: http://www.naturalhealthconsult.com/Monographs/traumeel.html I recommend against Cortisone shots until everything short of surgery has been tried. It can lead to excess scar tissue formation.
Exercise:
Exercises to avoid:
I do a lot of sports injury rehab work, which entails a lot of shoulder injury work. When someone comes to me, and says they hurt their shoulder working out, I ask what their upper body workout consists of.
All of them do at least one of these exercises:
- Behind the neck military press
- Behind the neck lat pull downs
- Straight bar bench press
This is what I tell them: "Any time you put your shoulder joint in a position that twists the shoulder joint capsule (extreme internal or external rotation, as in all 3 of those exercises) you are ringing it out like a sponge. Then, if you add a load, such as pushing or pulling, you are asking for trouble."
The usual response to my comment, "Yes, Doc, but I feel it here when I do that, and I never get that feeling with any other exercise!"
My answer, "That feeling you get is the tearing up of your shoulder joint. You don't want that feeling! Even if you don't have a big injury now, you will! Stop doing those exercises!"
Substitute (respectively): if you know them…
- back flies or upright rows for posterior delts
- Swimmer pulls with tricep push down pulley machine (straight armed) for teres/lats
- dumbbell presses and pec flies in a safe range of motion for pecs
Your shoulders will thank you.
I would also train very carefully with your shoulders in the future, matter who you are. Low back and shoulder injuries are common in golfers. Train the rotator cuff muscles specifically with light weight as a warm up on your chest and shoulder days at the gym. (The SITS muscles: supraspinatus, Infraspinatous, subscapularis, and teres minor). There are specific exercises for each. You should protect your future with just a few extra minutes each workout. Below, I will show those exercises!
Balance your workout:
For the most part, remember that people tend to train their push muscles more than their pull muscles. They over-train chest/pecs, and don't do as much lats/rhomboids. This leads to overly short muscles on the front, and internal rotation of the shoulder joint. Posture changes, to a forward lean... and palms face back when standing straight up. (The palms should face in). Try to do equal reps, sets, and weights with the front of your body as you do your back of body. It might take a while to even out!
Rotator Cuff Strengthening:
Warning!: If anything listed below hurts you, stop! Try lowering your weight. If it still hurts, then or after, ice it for 20 minutes, and write me back: drjen@backsafegolf.com. These are small muscles, with very specific actions. Be precise with your form. Form is everything here, weight is nothing.
Here are the exercises I would recommend:
1. Supraspinatus/Empty can:
Weight: 3-5 lb. dumbbell. Don’t push this- it’s a tiny muscle
Reps: 2 sets of 12
Form: Stand with a dumbbell in each hand. Do one arm at a time. Raise your stiff arm in front, up away from your body to shoulder height, no further. Rotate the hand inward until you are in a thumb down position. In that thumb down position, lower the weight until your thumb hits your thigh. Raise it, never above the shoulder level. Move slowly. Do 12 reps. Do the other arm, and repeat both.
 
2. Subscapularis:
Weight: 10-30 lbs. Form is important here, so try it light first. I do 20 lbs. with a “healthy” shoulder.
Reps: 2 sets of 12
Machine: Set a cable pulley machine so the handle is at shoulder level. Use a D ring handle.
Form: Your back is to the machine. Grab the handle with a stiff arm. Raise the stiff arm out in front of you. The cable should run under your arm pit. The arm should be in the up position of the previous exercise, only palm down. Elbow locked, hand out at shoulder level. Hold your body and trunk stiff. Now translate ONLY your shoulder forward. Of course the arm and hand will move to, but it’s just a shift forward, leaving the rest of your body still. Your scapula will track along your ribcage, and your humeral head will push forward. You should feel this only lightly in under your armpit, actually in the front (anterior) surface of your scapula (shoulder blade).
 
3. External rotators: teres minor and infraspinatus:
Note: This is described and shown in the picture below for the left shoulder, but you should do all of these on both shoulders. You can then do the same thing on the other shoulder.
Weight: 5-10 lbs. I use 15 when my shoulder feels good, less when it doesn’t.
Reps: 2 sets of 12. Do Right arm, then left, and repeat.
Machine: Set cable pulley machine so the pulley and handle is at elbow height. Set your weight. This exercise can irritate, so better to err on the light side then the heavy. Use a D ring handle.
Form: Stand with your right shoulder to the machine, your left shoulder away. Hold the handle in your left hand with palm facing the machine, elbow bent to 90*. Glue your elbow to your ribcage. Keep your shoulder down and away from your ear. The inside of your forearm should be on your belly to start with. Move away from the machine until the slack is taken out of the cable. Now externally rotate your left upper arm, lifting the weight until your knuckles point straight ahead, now go a little further. Don’t force it into external rotation, it will hurt you. Lower the weight. Do 12 and go do the other arm, and repeat both.
 
4. Internal Rotators: pec. minor and subscapularis:
Note: This too is described for the right shoulder. You should do all of these on both shoulders also. But, this is only going to be described this way.
Reps: 2 sets of 12
Weight: internal rotators are stronger and less vulnerable than externals, so I go a little heavier… 20-30 lbs. for a guy… I use 20 when I feel good, and less when I don’t. Know yourself.
Machine: Leave machine in the same position as last exercise. Turn around so your right shoulder is to the machine. Glue your elbow to your ribcage. Keep your shoulder down away from your ear. Bend your elbow to 90*, knuckles pointing forward, and palm facing away from the machine. Step away from the machine to take the slack out of the cable. Rotate upper arm in to lift weight until the inside of the forearm is on your belly. Return the weight to almost touching the stack. Again, do not allow external rotation to the point of discomfort. Repeat 12 times. Do the other arm. Do both again.
 
Read this again, sitting in front of the computer, do the exercises in the air. Do it a couple of times. Then when you go to the gym, you should be able to duplicate them.
Does this make sense? I hope it helps.
This is a great warm up before any upper body workout. It takes only 3-5 minutes once you get the hang of it, and it can save you problems later. IF, however, you already have a problem, try to get help from a good Physical therapist or Orthopedist and an okay before you go at this. You could even go as far as to print this out for them and ask if it's okay for you.
Dr. Jen Milus, DC
www.backsafegolf.com
www.fireagility.com
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Carpal Tunnel and Golfers
By Dr. Jennifer N. Milus, DC
www.backsafegolf.com
Over 100,000 people a year undergo carpal tunnel surgery. What can we do, conservatively, ourselves, at home (or on the course) to prevent this?
Carpal Tunnel Syndrome (CTS) is becoming more and more prevalent with the computer generation, and increased use of small hand held devices. Someone you know has probably suffered from CTS. It is such a common problem; it baffles me that there is so little understanding among the medical community about its causes.
It is linked to several diseases/conditions like: diabetes, gout, thyroid disease, and obesity. It appears to be caused by repetitive motion of the hands, arms and wrist. Many people who have it just happen to do more than one thing that involves heavy use of the area. I have treated a guitar player who rides horses, will stop neither, and getting her better will be difficult. A fire fighter who pulls hose, ropes and dummies and trains with weights is another tough cookie. A golfer who works on the computer at work all day poses the same problems.
Any one of these things done alone, intermittently, will probably not cause a problem. Further: playing golf has not been shown as a direct cause of CTS. But, it could certainly contribute. And the hours a pro plays will absolutely have more effect than the 1-2 rounds a week you or I might play.
So What Happens?
CTS is the result of the compression on the median nerve as it runs through the “tunnel” parallel to the tendons that run the fingers. The wrist bones compress it from one side and a thick ligament can compress it from the other side. Once this area is over used, it becomes enflamed. The mediators of inflammation settle in there, increasing pressure and softening the connective tissue, causing the body to lay down more scar tissue, which irritates the nerves and it becomes a vicious cycle.
How does it start?
My patients tell me that they get a feeling of tightness and fullness in their wrist and forearm first. This can last from weeks to months. If it is not worked on or worked with at this stage, it will progress. (read below under conservative care). In fact, at this stage, it is not even named carpal tunnel syndrome. It is just a tightness in the forearm and wrist that will likely eventually lead to CTS.
The Classic Symptoms if CTS:
Numbness and tingling in the thumb, index and middle finger are the usual signs. Some complain their entire hand goes numb. The feelings may come and go from dropping of small object to dis-coordination during small motor tasks (typing, using a palm pilot/phone). Folks may complain of waking with numb hands or pain in the area.
Worst Case: Surgery $50,000?
I am not a surgeon. But I know some, and they do good work. I personally, would leave this option until the very last. It’s pretty invasive, and everything else should be tried first! The surgical procedure involves a snipping if the sheath that surrounds the tunnel.
So, I ask: if you can snip is later, why can’t you stretch it in the early stages when the area first starts to tighten up?
I treat conservatively. In the following paragraphs, I will describe some of the things I do/use/recommend. However: I have seen enough cases of this in my life to know when to quite while I’m ahead. I seldom take a case that has progressed to the stage of numbness. If I do, I will only see it for 8 visits. If I see no improvement at all, I refer both to a Physical therapist and to an orthopedic surgeon concurrently. Remember: the longer it goes on, the harder it is to treat conservatively.
Best Case: Catch it early!
When the tightness starts, and the numbness, pain and dis-coordination have not yet arrived is the time get conservative care. I would recommend trying all of the following before submitting to surgery.
- Traumeel…. MOST IMPORTANT! GET THIS NOW!
It’s this amazing homeopathic ointment. If you get it on the internet, it’s much cheaper than retail. Apply about as much as you put on your toothbrush 4 times per day for a week, really rubbing it in deeply up in the area where you have pain.
http://www.naturalhealthconsult.com/Monographs/traumeel.html
- The Wrist Wand: and it’s less than $20!
Here’s an amazing tool! This is an inexpensive padded bar about 14 inches long that comes along with an instructional DVD. It was designed by Michael Boorstein of www.wristwand.com. I have used it, recommend it for my patients and feel it’s a great tool to have in your golf bag! Get a second, and have it sitting next to your monitor at your computer work station! Use it at as recommended in the video.
Go to this page to read why it works: http://www.wristwand.com/WhyWorks.html
There is more information about how it works here:
http://www.wristwand.com/Carpal%20Tunnel%20-%20Tunnel%20Vision.pdf
Read their entire website- especially the testimonials. Stories are just that.
However, these make real sense to me… and I am a REAL skeptic.
- Reduce or eliminate play for 2 weeks:
And, yes, sadly, cutting back on the time at the range, number of buckets hit, and even the round played per week might contribute to your recovery.
If you try this stuff for 2 weeks, and still have problems:
- Change the Golf Grip
Ease up on the grip during address. Replace old, worn grips. Wearing a glove on both hands might result in more friction between the hand and the club, thus requiring less pressure, along with adding some padding.
- Massage:
Get a recommendation from a friend for a massage for your entire upper body. Make sure they focus on your forearms. Feel free to print this out, and show it to them when you arrive. I welcome questions from you or them at any time. drjen@backsafegolf.com
To the massage therapist: You probably already know this; however, if this helps you get someone some relief, then great! Hold the wrist in one hand, palm down, hand and arm relaxed. Flex the wrist in a palmer direction while using the thumb of the opposite hand to strip the extensor muscles up towards the elbow. Slowly flex while working wrist to elbow. Traveling from wrist to elbow should take 10 seconds. Relax the grip on the arm, and straighten the wrist, start at the wrist again, flex and strip, straighten and start at the wrist again. Work for 3 minutes. Flip the arm over, and do the same on the other side, extending the wrist and working the flexors from the wrist to elbow. Now, work from the finger tips up the fingers to the palm… each individual finger 3 times. Do the same on the palm. Work the palm and the carpel area, palm up, opening up the palmer aspect of the wrist. Stretch and open the palmer side of carpel tunnel using your thumbs. Then milk the entire hand, wrist and forearm up to the elbow, then to the shoulder. Each arm should take about 15 minutes.
- Chiropractor: diagnosis dependant
Use yours or get a referral from a trusted friend. They should be able to adjust/mobilize and either have a massage therapist in their office to do the above, or do it themselves. They may or may not use ultrasound- I would. They may also find something that needs work in your elbow, shoulder or neck. Remember, they are links in a chain. Each area must work fluidly so that the next link up or down stream can do the same. Make sure you find someone you trust and feel comfortable with. A good one will work miracles.
- The Carpal Stretcher: $35
Here’s another neat little gadget to place next to your desk on the mouse side of your computer work station. They make them in right and left handed models.
http://www.rajala.com/cgi-bin/catalog.pl?carpel+tunnel|Carpal_Tunnel_Stretch
Get well, and get back to golfing!
If you or anyone you know has golf related low back pain, please visit my website at:
www.backsafegolf.com for more information about how to work with that!
Dr. Jen Milus, DC
www.backsafegolf.com
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Low Back Pain, Chiropractic and Golfers
By Dr. Jen Milus, DC of www.backsafegolf.com
What’s the quick fix versus the long term fix?
Chiropractic can relieve low back pain quickly, but the long term fix takes a much more active role on the part of the patient/golfer.
Isn’t the jury out on whether chiropractic works for low back pain?
I’d say not. The Rand Study of the 80’s proved (by placebo double blind study) that specific chiropractic adjustments work to relieve acute low back pain better than sham adjustments (i.e. nothing at all). I would hope, then, if one finds a competent chiropractor, and that chiropractor can figure out which vertebra’s aberrant motion is causing the flair up of low back pain, and corrects the motion of that particular segment, relief could be had.
Motion of a segment of the spine
Imagine a bicycle chain. As you peddle, the sprocket turns, and the well oiled chain glides smoothly over both sprockets front and back. The motion is clean, and you can spin as fast or slow as you like.
The vertebrae in the spine can become affixed (sort of locked up) to the vertebra (e) above and or below. This causes a lack of motion in the joint that is supposed to move fluidly. The muscles in the area, in response, will become tight and irritated. In an effort to make the bone move again, they contract and pull on the covering (periosteum) of the bone. The periosteum is very pain sensitive. Pain becomes evident on the area. The facet joints between adjoining vertebrae are more pain sensitive, and they don’t like when they cannot move, and become inflamed as well. This combination creates pain in that area- sometimes worse than others.
Envision, once again, the spine like the bike chain. If all the links move when against the adjacent links, things flow smoothly and are pain free. If these lock up, flexibility and function are lost, your rotation is impeded and your golf game suffers. As pain levels rise, your game suffers more.
Does this result last?
That, in my opinion, is questionable. A person’s low back can have a certain pattern of dysfunction; certain vertebrae which get fixated against the ones above or below.That pattern is difficult to break. The Chiropractor may take several adjustments to restore motion. Other times, if the spine is very healthy, and the person is very hydrated and flexible, aberrant motion can be fixed with only one or two adjustments.
If a chiropractor gets this vertebra moving again, it should relieve the pain, right?
Well, this is true a lot of times. There are problems with it though. Adjusting can set things in motion again. But often they won’t keep moving unless you get adjusted a whole bunch of times. And, more importantly, if you get adjusted, and don’t do your homework (stretches) the motion that has been restored will not remain. The body will revert to it’s old way. Although the time lines are much longer, I liken this to a person who gets braces, gets their teeth straightened, and then never wears their retainer. In a few years, the teeth are right back where they started. The same will happen in your spine.
In my experience, over-adjusting is a potential problem. It can create hyper-mobile joints, and cause a person to need to be adjusted. That is why it is important to do trunk stabilization and core muscle strengthening once the acute pain episode is over. This can prevent further episodes. Besides, who wants to go get adjusted once or twice a week for the rest of their life? In my opinion, over adjusting, coupled with a lack of strengthening creates a need for adjusting….and a dependence on your chiropractor that is just not necessary.
There are, of course, exceptions, and people who need more intensive care. A second opinion is often a good idea if a lot of care is recommended.
What should the patient do?
The way to make the results of care lasting is to use exercise along with adjusting. These exercises will be different depending on what your diagnosis is, and at what stage of care you are in. They should change as you progress. You chiropractor should give you these exercises. First, they will be coupled with ice, and assist in pain relief. Then they will be used to re-create flexibility. Finally, they will strengthen.
You may have to revisit these phases regardless of whether you keep up with your strengthening exercises. In my experience, though, the long term follow through and the acceptance of responsibility for fitness helps a lot more than a learned helplessness and the search for the magical adjustment (or magic bean as I call it.)
Finding a Chiropractor
Many people find their healthcare providers in the yellow pages or advertisements. I don’t recommend that. I would ask a trusted friend (or more than one) who have used a healthcare provider in the discipline being considered. Get several referrals if you think it will help you make a better choice.
There are many, many, very hard working, and well-intentioned chiropractors out there. If you find one, and you think it’s a match, stick around at whatever level you feel comfortable with. They should be peaceful with helping you as much as they can without chasing you down, calling incessantly and pestering you to get care. That’s your decision. Unfortunately, there are some out there who just don’t seem to get that.. That happens in every walk of life, though. That’s why I recommend getting a referral.
Watch out for:
Beware of doctors who ask you to sign a contract that you will follow through with care. Your healthcare (and health/fitness) is completely up to you, and you should feel no pressure to perform any course of care because of some silly contract that you were pressured into signing.
Also, some chiropractors will ask that you pay in advance for care or for a year or even lifetime care for a sum of money. If anyone asks you to do this, turn and walk out. If a doctor does this, they are acting as an insurance company on your spinal health, and legally, to do this, they must have some amazingly large sum of money in the bank… like tens of millions of dollars. This money would need to be available should anything go wrong in your course of care… anything involving your spine… from cancer to accidental injury.
Conjunctive Care
In my experience, chiropractic, deep tissue massage therapy, ultrasound and therapeutic exercises are the best mix of care… properly applied. The same thing does not work for everyone.
Other joints:
Some Chiropractors adjust other joints in the body: knees, hips, wrists, even feet. I have found it extremely helpful when I have had problems with these areas. Restoring and correcting motion to just about any joint can help feel better, and perform better in your chosen sport/activity.
In Conclusion
Best wishes for you and your spinal health. Feel free to contact me and ask any questions you want answered. I will do my best to answer them, or find someone who can.
Dr. Jen Milus, DC
www.backsafegolf.com
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