Posted by DrTucker in Articles by Dr. Tucker, Daily Exercises, Fitness & Exercise, Rehab Exercises, Shoulder on 12 7th, 2011 | no responses
To Your Health December, 2011 (Vol. 05, Issue 12) Share | By Jeffrey Tucker, DC, DACRB
The most common injury sites for golfers are the low back, shoulder, knee, elbow and wrist. Golfers who have low back pain demonstrate a decrease in range of motion for hip internal rotation on the lead leg (left leg for a right-handed golfer) and lumbar extension, and decreased activation and/or timing of the abdominal obliques, erector spinae and knee extensors. A good golf swing uses the left side of the body as much as the right. The hips initiate movement into the ball. The feet pushing against the ground cause a ground reaction force that sequentially travels up through the hips, the trunk and finally out the arms. The most noticeable difference between pros and amateurs is trunk rotation. Trunk rotation and flexibility are enormously important in golf. Older and less skilled players tend to use less than half the trunk rotation of younger or more skilled players.
Golfers who are looking to maximize their performance and avoid and/or rehabilitate following common golf-related injuries should try these exercises in consultation with their doctor of chiropractic:
Active Warm-Up Exercises Bend forward at the hips to touch the fingers to the floor.
Step into a stride position, extending the right leg (lunge).
Lift the right arm, rotate the spine and the head – hold this pose for 10 seconds.
Return to the stride position.
With hands on the left thigh, drop the back knee toward the floor and reach both arms overhead.
Twist the torso toward flexed front knee and hold.
Return to the hip flexor stretch position then put both hands on the floor.
Go to push-up position.
Sweep the left foot across in front – sit into the stretch and hold for 10 seconds.
Return to the push-up position.
Step forward into a forward bend and hold.
Sit into a deep squat with open knees.
Lift hands overhead, stand up and bring arms back to your side.
Now repeat this on the opposite side: Bend forward at the hips to touch the fingers to the floor. Step into a stride position, extending the left leg (lunge). Lift the right arm – rotate the spine and the head – hold this pose for 10 seconds. Return to the stride position. Hands on right thigh, drop the back knee toward the floor and reach both arms overhead. Twist the torso toward flexed front knee and hold. Return to the hip flexor stretch position then put both hands on the floor. Go to push-up position. Sweep the right foot across in front – sit into the stretch and hold for 10 seconds. Return to the push-up position. Step forward into a forward bend and hold. Sit into a deep squat with open knees. Lift hands overhead, stand up and bring arms back to your side.
The shoulder is the key anatomical structure involved in every phase of the golf swing. If you’ve suffered a shoulder injury related to golf or are just looking to improve shoulder rotation and performance, ask your doctor of chiropractic about these exercises:
Wing stretch: Place the back of your right hand on the outside upper gluteal (buttock) region so the elbow sticks out to the side. The back of the hand touches above your “pants pocket” area. Grab the right elbow with the left hand and pull it the elbow forward, simultaneously resisting the pull by stabilizing your shoulder girdle backward on the stretching shoulder. Hold this stretch for one minute.
Open book: Lie on your left side with your knees bent and your arms straight out in front of you, palms together. Keeping your knees on the ground, take your top arm and rotate your upper body all the way in the opposite direction. Perform 15 reps. Repeat on the other side.
Thoracic rotation: Get down on all fours, place your right hand behind your head, and point your right elbow out to the side. Brace your core and rotate your right shoulder (think about moving through the shoulder blade) toward your left arm. Follow your elbow with your eyes as you reverse the movement until your right elbow points toward the ceiling. That’s one repetition. Do 20 reps right and left.
Band diagonal raise: Attach a band or handle to the low pulley of a cable station. Standing with your left side toward the pulley, grab the handle with your right hand in front of your left hip and bend your elbow slightly. Pull the handle up and across your body until your hand is over your head and your thumb is pointing up (a Statue of Liberty pose). Return to the starting position. Complete 10-15 reps and repeat with your left arm.
Scaption: Perform this exercise standing in front of a mirror to monitor their form. Hang the arms down by the thighs and rotate both hands to a thumbs-up position. Retract and depress the scapulae as you lift the arms up to shoulder-height at a 45-degree angle from the trunk. The arms should make a Y in front of them. Make sure that the upper trapezius isn’t pulling the shoulders into the ears. If it is, work on pulling the shoulders down in order to push the arms up. Perform two sets of 15 reps per set.
Lie face down on a bench with your upper shoulders off the bench to perform these exercises, which involve raising the arms / shoulders to mimic the shape of a Y, T, W and L (e.g., arms up over the head forms a Y; arms straight out to the sides forms a T; etc.). Standing Y-T-W-L exercises can also be performed using a stretch strap, which allows you to maintain a consistent arm position.
One More Great Exercise:
If you’re suffering from increased thoracic kyphosis (rounded upper back / shoulders), protracted shoulder blades and/or forward chin position, ask your doctor of chiropractic about this corrective exercise: Stand, feet together, looking straight ahead. The feet should remain in this position for the duration of the exercise. Put one hand beneath your collarbone and one hand on your belly button. Keeping your hands in that position, lift the chest with the hand under the collarbone while simultaneously pulling down with the belly button hand. This will help to lengthen the spine and reduce the slouched position. Holding the achieved position, level the pelvis by raising the middle of the pelvis with the lower abdominals. Lengthen the neck by slightly tucking the chin and imagining the crown of the head is being pulled toward the sky. Bend your knees very slightly, just enough to remove any tension from the posterior knee. Holding the achieved position, lean forward slightly to shift the center of gravity to the midfoot instead of the heel. Practice this frequently to improve posture. This opens the chest and allows for more natural breathing as well. While non-golfers may not realize it, the physical challenge of golf can be more daunting than the mental part of the game, particularly if you don’t use proper mechanics during every part of the swing. Injuries are common, which will either affect your game dramatically or stop you from playing altogether.
Talk to your chiropractor about these and other exercise strategies to improve your golf game and avoid injury. ——————————————————————————– Jeffrey Tucker, DC, is a rehabilitation specialist who integrates chiropractic, exercise and nutrition into his practice in West Los Angeles. He is also a speaker for Performance Health/Thera-Band, NASM and FMS.com .
Posted by DrTucker in Blog, Chronic Pain, Daily Exercises, Neck, Shoulder on 09 29th, 2011 | no responses
Watch this one minute video to learn which exercise to perform
Aching and stiffness in the shoulders and neck are an extremely common problem, especially for those involved in desk and computer working. If you feel like you need a daily massage, the real cause tends to be postural. Whilst seated, staring at a screen for hours on end, it is easy to fall into a slumped position, with rounded shoulders and the neck protruding forwards. Assuming this position day-in, day-out can result in shortening of the chest muscles and weakening of the small, postural upper back and neck muscles which work to pull the shoulders back. This results in the larger back and neck muscles such as Trapezius and the Rhomboids working harder and becoming tight and achy. Working on correcting these imbalances, by stretching the chest muscles and building endurance strength in the postural muscles such as the lower Trapz and Serratus Anterior can result in a long-term fix.
I treat neck and shoulder pain with soft tissue therapy, mobilization of the stiff joints, corrective exercises, stretching, and posture training.
Shoulder impingement injuries occur when the space in the shoulder joint is decreased, resulting in pinching of one or more of the tendons which pass through this space. The reason for the decrease in space is often related to poor posture. If the chest muscles are tight and the upper back muscles such as the lower Trapezius and the Serratus Anterior are weak, through extended periods of sitting slouched at a desk, then this can cause the shoulder joint to sit in a forwards position.
I treat shoulder impingement with warm laser, muscle therapy and corrective exercsies.
The rotator cuff include the supraspinatus muscle/tendon, infraspinatus muscle/tendon, teres muscles/tendon, and the subscapularis muscle/tendon. The supraspinatus is most often the muscle that causes pain. Ths is because of wear and tear that causes degeneration due to its close anatomical relationship with the acromian process. The small space between the humeral head and the acromian process houses the supraspinatus tendon, subacromial bursa and biceps tendon. If anything reduces that subacromial space, then the chances of something being pinched and worn down increases greatly.
I have seen an increase in patients with shoulder impingment syndrome. There are many causes of the impingement: 1) can be from an osteophyte (spurs or bone growth) growing down from the underside of the acromian; 2) previous shoulder trauma that either disrupts the stabilising mechanism of the shoulder joint (as in shoulder dislocation) or 3) from a past injury or poor posture that causes a change in the firing patterns of the stabilising rotator cuff muscles that allow the humeral head to bounce around or shear too much within the ‘socket’ and this increases the chance for impingement. By far the most common cause of rotator cuff problems is altered scapula position due to muscle tightness or poor muscle firing. This can influence the position of the acromian as the arm is lifted above the head. The key muscle to influence a poor scapula position is the pec minor. This muscle causes the scapula to sit in a downwardly rotated position at rest, bringing the acromian process closer to the humeral head.
The way I treat this problem is by teaching clients the proper exercises to influence the firing patterns of the dynamic stabilisers of the shoulder – the rotator cuff. For example the simplest way to activate a subscapularis muscle is grab a 1-2 kg dumbbell and lie on the floor on your back. Place the arm up into 90 degrees abduction so the elbow supports the arm on the floor and the hand holding the weight is directly over the elbow. Slowly lower the dumbbell towards the floor moving towards the head (this is eccentric external rotation – controlled by subscapularis). Only lower to about 45 degrees and then return to the start (concentric internal rotation – again subscapularis). As an activation drill this can be done with a light weight and non fatiguing repetitions.
The easiest way to loosen an infraspinatus is to self massage it. Stand against a wall, place the hand behind the head and with the other hand, reach around and place a tennis ball in the back of the shoulder (between the shoulder blade and the wall). If it hurts then press on it. Hold the trigger point for about 1 minute and then move on to a different spot.
Furthermore, the pec minor and levator scapulae need to be loosened and stretched. And the muscles which work to upwardly rotate the scapula need to be strengthened (the trapezius and the serratus anterior).
I always recommend the foam roll to improve poor thoracic spine mobilty and extension. Lack of motion in the thoracic spine influences the scapula. I have also used the warm laser on most of these cases with very good results.
February 15, 2011 (San Diego, California) — A physical therapy program can effectively treat most patients who present with atraumatic full-thickness rotator cuff tears and shoulder pain, without the need for surgery, researchers announced at the American Academy of Orthopaedic Surgeons (AAOS) 2011 Annual Meeting.
“Our non-operative program is successful in over 90% of patients and the effect seems to last at least 2 years,” John E. Kuhn, MD, associate professor and chief of shoulder surgery at Vanderbilt University Medical Center in Nashville, Tennessee, and director of the Multicenter Orthopedic Outcomes Network (MOON) Shoulder Group, said.
In the United States, at least 10% of persons over age 60 years, or nearly 6 million people, will develop a rotator cuff tear.
Prospective Cohort Study
The study included 396 patients age 18 to 100 years who had atraumatic full-thickness tears documented by magnetic resonance imaging and no other abnormality. The primary symptom was pain in most patients.
Patients were assigned to a physical therapy program that included daily postural exercises, active-assisted motion, active training of scapula muscles, and active range of motion, along with anterior and posterior shoulder stretching. They also performed thrice-weekly rotator cuff and scapula exercises. The program has been shown to be effective in patients with impingement syndrome.
Study participants also did manual mobilization exercises with assistance from a therapist.
Patients returned at 6 and 12 weeks. At this point they could decide that 1) treatment was successful and they needed no formal follow-up, 2) they had improved but would like to continue therapy with scheduled reassessment in 6 weeks, or 3) nonoperative treatment had failed and they would undergo arthroscopic rotator cuff repair.
Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit.
Improvements on Multiple Outcome Measures
Six-week data indicate that fewer than 10% of patients had decided to undergo surgery.
Of patients in whom follow-up data were available for at least 2 years, only 2% had opted for surgery.
The analysis also revealed that patients who decided to undergo surgery generally made their decision within 6 to 12 weeks of starting physical therapy. In addition, patients did most of their physical therapy at home and usually made only 1 weekly visit to the physical therapist.
Finally, Dr. Kuhn emphasized that the physical therapy program alleviated pain without “doing anything to the tear.” The finding suggests that pain may be a less suitable indication for rotator cuff repair than is weakness or loss of function.
American Academy of Orthopaedic Surgeons (AAOS) 2011 Annual Meeting; Abstract #319. Presented February 15, 2011.
These findings are typical of what I find in my rehab practice. Those clients that do the exercises improve.
Posted by DrTucker in Ankle, Arthritis, Hip Pain, Inflammation, Knee pain, Laser Therapy, Low Back Pain, Neck, Shoulder, TMJ (Temporomandibular Joint), Treatment on 11 16th, 2010 | no responses
You can feel the warm deep tissue penetration. This deep heat significantly increases the body’s cellular production of ATP (Adenosine-triphosphate) to reduce inflammation and heal the inflamed area.
Here are some of the benefits of using the deep tissue penetration that laser provides safely and effectively:
Healing and pain relief with no side effects, drug interaction effects, or invasive surgery.
Treats acute and chronic conditions as well as post surgical pain.
Pain relief is often felt immediately.
Most laser treatments take only 10-20 minutes.
Are you a potential candidate?
- If you have pain that is of musculo-skeletal origin, laser therapy may be for you:
This includes sports injuries, back and neck pain, any joint pain (knee, shoulder, ankle, etc), bursitis, tendonitis, tennis elbow, contusions, strains and sprains, carpal tunnel syndrome, chondromalacia patellae, arthritis, fibromyalgia, heel spurs, plantar fascitis, migraine headaches, neck pain/whiplash, nerve root pain, postoperative pain, repetitive stress injuries, TM joint pain and more.
- If you have the wound that is slow to heal and has been resistant to treatment, you may be a candidate for laser therapy. This includes slow healing fractures, as well as soft tissue injuries and ulcers.
- If you have multiple trigger points (sore spots in the muscles) that do not go away, you may be a candidate for laser therapy. This includes areas associated with fibromyalgia.
- If you have had Prolotherapy or PRP, and wish to accelerate the response of healing, you may be a candidate for laser therapy. This includes any area that has been treated with Prolotherapy/PRP injections.
- If you need Prolotherapy or PRP therapy but are afraid of needles, you may be a candidate for laser therapy.
- Laser therapy stimulates the same areas that Prolotherapy targets. It does it without needles, but requires a lot more time and repeated treatments to gain the result that can be gotten from Prolotherapy and laser together.
Feel free to call me directly at 310-473-2911 or call my cell phone at 310-339-0442
Thera-Band Tubing Exercises for Tennis: These exercises are designed to help improve strength and prevent injury.
Perform these exercises with a resistance that allows you to complete 15-20 repetitions to fatigue; start with one set and progress to 2 sets of 20. Increase to the next color resistance level when these exercises become easy.
|Thera-Band Tubing with Door Anchor|
|Pull webbing of Door Anchor through clasp to create 2 loops at end opposite of disk. Slide one handle of the tubing up through one loop and then down through the second loop of the Door Anchor. Pull and tighten the Door Anchor loops down securely on the tubing to fix length as needed.|
|Thera-Band Tubing Forearm Pronation
Secure the middle of the tubing under one foot. Grasp the handle with your wrist facing upward and forearm resting on your thigh. Slowly rotate your forearm so your palm faces downward. Hold and slowly return.
|Thera-Band Tubing Forearm Supination
Secure the middle of the tubing under one foot. Grasp the handle with your wrist facing down and forearm resting on your thigh. Slowly rotate your forearm so your wrist faces upward. Hold and slowly return.
|Thera-Band Tubing Wrist Extension
Secure the middle of the tubing under one foot. Grasp the handle with your wrist facing downward and forearm resting on your thigh. Slowly extend your wrist upward. Hold and slowly return.
|Thera-Band Tubing Wrist Flexion
Secure the middle of the tubing under one foot. Grasp the handle with your wrist facing upward and forearm resting on your thigh. Slowly bend your wrist upward. Hold and slowly return.
|Thera-Band Tubing Reverse Fly
Hold one handle in each hand, and grasp tubing about a shoulder-width apart. Extend your arms at shoulder level and keep your elbows straight, stretching the tubing. Hold and slowly return. Keep your head and trunk upright.
|Thera-Band Tubing Lat Pull Down
Secure the middle of the tubing to a door or sturdy object above shoulder level. Grasp the handles at shoulder-level and pull backwards, bending your elbows. Bring your hands to your shoulders. Hold and slowly return. Keep your head and trunk upright.
|Thera-Band Tubing Shoulder Dynamic Hug
Grasp both handles and wrap the tubing around your upper back. Bend your elbows and slightly abduct your shoulders. Bring the handles together, and cross over the other forearm. Keep your wrist straight and elbows slightly bent. Hold and slowly return.
|Thera-Band Tubing Bent-over Row
Stand on the middle of the tubing. Slightly stagger your step and lean forward at your hips. Don’t arch your back. Grasp both ends of the tubing with your elbows extended at your side. Pull one end of the tubing upward, bending your elbow. Hold and slowly return. Brace your abdominals and don’t rotate your trunk.
|Thera-Band Tubing Shoulder External Rotation
Securely attach the middle of the tubing to a door or sturdy object. Place a rolled-up towel under your arm. Bend your elbow at your side and bring your forearm in front of your body. Grasp handle and pull outward, keeping your elbow by your side, and forearm parallel to the ground. Hold and slowly return. Keep your wrist straight.
|Thera-Band Tubing Shoulder Scaption
Grasp both handles and stand on the middle of the tubing. Lift your arm out to your side and slightly forward (about 30 degrees from your body). Keep your elbow straight and palm facing forward. Lift to shoulder level, hold and slowly return.
|Thera-Band Tubing Elbow Extension
Stand on the middle of the tubing. Extend your shoulder and grasp handle with your elbow bent behind you. Straighten your elbow, keeping your shoulder extended. Hold and slowly return.
|Thera-Band Tubing Elbow Flexion
Stand on the middle of the tubing. Grasp the handles with your palms facing upward. Bend your elbows upward, keeping your elbows by your side and your wrist straight. Hold and slowly return.