Tuesday, September 29, 2009

SLAP Lesions

A NEW Slap Test-Trying to figure out the shoulder

     The athletes shoulder can be one of the most challenging concerns of health professionals when treating athletes. Along with the knee and back it is probably the most studied and researched topics in the sport injury world. However, each professional has a different outlook and “experts” on the topic are constantly being recycled.

     One injury in particular leaves many professionals constantly second guessing themselves. A SLAP lesion is a pathology which occurs in the superior aspect of the labrum and often involves a tear traveling from an anterior to posterior manner. (Hense the term SLAP lesion –superior labrum anterior to posterior).

     The problem with this injury is its ability to often replicate other shoulder pathologies such as shoulder impingement, bicep tendinopathies, shoulder instability and rotator cuff disease. The combination of this overlap and the delay of access to mri imaging in small towns and Canada leaves quite a dilemma. That’s why it’s important to be constantly updated on new test which are evolving in the literature. This is a review of a new test described and its validity for detecting SLAP lesions.

     The study involved 113 subjects all which tried conservative treatment but failed to be successful. These subjects were put through three orthopaedic tests before undergoing an arthroscopic procedure. Once the procedure confirmed or denied a suspected SLAP lesion correlations were made. Subjects were tested using the Speed’s Test, Obrien’s Test and the evaluated supine flexion resistance test (See Links)
O'Brien's Test Video   Speed's Test Video Supine flexion resistance test

     The supine flexion resistance test is performed with the patient lying in the supine position. Both of the patient’s arms are elevated above their head with the forearms resting on the table and their palms facing upward. The examiner stands on the same side as the tested shoulder. The examiner then grasps the forearm just distal to the elbow. The patient is then instructed to attempt forward flexion while the examiner applies resistance. The idea is to emulate a throwing motion. Positive – Pain deep inside the shoulder joint or along the dorsal aspect of the joint line. (See Link for video)

     The problem with the study was the author’s lack of correlating the test with all forms of SLAP lesions and never stated why such exclusion was done? Many statistical evaluations were performed in the study but many of non importance. Sensitivity and Specificity of the test to all groups of pathologies (all injuries found on subjects) are clinically irrelevant. This tells me the test is positive when patients are in pain but not where the pain is coming from. As you can see multiple test have multiple over lap of findings with a wide arrange of pathologies. Needless to say their rarely ever is a clear cut answer when performing testing. Subjects were found to have everything from 3 different types of SLAP lesions to AC joint arthritis.

     The presenting of the results wasn’t done very effectively by the authors. They were quick to point out the good results of their study yet completely fail to discuss some of the more important findings. Such as the specificity of the test for SLAP lesions. However the specificity for supraspinatous lesions was mentioned ....go figure?

     Sensitivity for isolated SLAP Lesions was 92% compared to 58% for Speeds and 75% for O’Briens

     This means 92% of the time if a patient has a SLAP lesion this test will pick it up. It doesn’t mean 92% of the time the test is positive it is a SLAP lesion. This is often the big problem with orthopaedic testing for the shoulder. For example the test also had high sensitivity for pathologies as a whole in the study (80%).This is why it’s important to look at the entire clinical picture with the shoulder and not just rely on one test alone.
 Sometimes treatment can even help figure out the diagnosis down the road.

The idea

     Although the article lacks a good explanation of why such a test would provoke symptoms it is fairly easy to understand. The test is merely a different version of the Speed’s test. The bicep has attachments to the superior aspect of the labrum. SLAP orthopaedic test are designed to contract and tension the bicep muscle taking advantage of this bicep labrum complex. The hope is to provoke pain in which the patient is feeling due to this complex. The idea behind both the supine flexion resistance test and Speed’s is to contract the bicep tendons head and thus pull on the inflamed torn labrum.

Obrien’s is usually a test used for better confirmation because it attempts to twist and torsion the head of the bicep which may continue to provoke symptoms. However my favourite test for SLAP lesions is the bicep load test number 1 and 2 (Sen 90.9%, Spec 96.9% & Sen 89.7%, Spec 96.9%). Bicep Load Test 2 Video Bicep Load Test Video Reasoning being this test actually helps rule a SLAP lesion out by attempting to lessen the patient’s symptoms. As we all know if someone is in pain most tests will be positive and thus give us insignificant clinical findings. It is much harder when given an acute injury to find test which lessen the pain then provoke it. When the bicep load tests are negative and ease symptoms it is a significant tool for ruling out a SLAP lesion. To understand this test and other articles on SLAP lesions check out the following references.

1. Ebinger, N., Magosch, P., Lichtenberg, S., & Habermeyer, P. (2008). A New SLAP Test: The Supine Flexion Resistance Test Arthroscopy: The Journal of Arthroscopic & Related Surgery, 24 (5), 500-505 DOI: 10.1016/j.arthro.2007.11.017
2. KIM, S., HA, K., AHN, J., KIM, S., & CHOI, H. (2001). Biceps load test II: A clinical test for SLAP lesions of the shoulder Arthroscopy: The Journal of Arthroscopic & Related Surgery, 17 (2), 160-164 DOI: 10.1053/jars.2001.20665
3.Shanley KJ, Green RA, & Taylor NF (2008). An evaluation of the anatomical basis of the Biceps Load tests I and II for superior labral anterior and posterior (SLAP) lesions. Clinical anatomy (New York, N.Y.), 21 (7), 647-51 PMID: 18773481
4.Munro W, & Healy R (2009). The validity and accuracy of clinical tests used to detect labral pathology of the shoulder--a systematic review. Manual therapy, 14 (2), 119-30 PMID: 18996735
5. Green RA, Taylor NF, Mirkovic M, & Perrott M (2008). An evaluation of the anatomic basis of the O'Brien active compression test for superior labral anterior and posterior (SLAP) lesions. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], 17 (1), 165-71 PMID: 17936025

Sunday, September 27, 2009

Top 5 myths about chiropractors # 1 (2-5 to come)

#1. All chiropractors do is manipulate or adjust (“crack backs”)

     Chiropractors go through extensive training in learning different forms of manipulation. Furthermore, our education incorporates the physiology, biomechanics and reasoning behind spinal manipulative therapy. However, it is not all we do.

     Depending on your injury and the goals of the chiropractor in the treatment plan you may not even get manipulated. Certain conditions actually are contraindications to receiving manipulation such as rheumatoid arthritis, osteoporosis and extensive corticosteroid use.

     Surgeons often attempt to achieve the same goals with different forms of surgery all the time. This same analogy can be used for chiropractors. Depending on which chiropractor you see there may be different tools in their tool box. Just to name a few techniques which we practice:

Graston Technique           Active Release Therapy
Myofascial Release Therapy            Trigenics
Activator Technique           Thompson Technique
Logan Technique            Gonstead Technique
Mulligan Mobilizations            Kinesio Taping
Acupuncture           Proprioceptive Training
Rehabilitation Protocols            Orthotic prescription

Modalities such as : Shockwave Therapy, Russian Stim (EMS), Ultrasound, IFC, Microcurrent, Laser Therapy, TENS

    Case involving both acupuncture and kinesio taping
     To understand more which therapy is best for you talk to your local chiropractor and figure out which techniques they practice. Also check out some of the links provided at the end of this article. Any questions please comment. Chiropractor Myth # 2 Myth # 3

Dr. Wayne Button, BSc, DC
Graston Technique Provider
In Balance Chiropractic and Health Centre
2034 St. Joseph Blvd
Orleans, Ontario
K1C 1E6
Tel (613)-837-8885

Monday, September 21, 2009

Abdominal Aortic Aneurysm (AAA)

Back pain that makes me sick to my stomach


           Back pain is probably the most prevalent complaint plaguing our health care system today.  However, the downfall of being in such a profession is when you’re a hammer all you see is a nail. It’s quick for manual therapist to forget that 7-8% of low back pain is non mechanical in nature. Furthermore, when you consider the number of visceral causes of low back pain you start to question every diagnosis. Visceral causes of back pain can include forms of cancer, endometriosis, kidney and prostate infections. Besides this redundant list there is one diagnosis which is life threading and that is Abdominal Aortic Aneurysm.
            An abdominal aortic aneurysm is when an infrarenal aortic artery diameter exceeds 3cm. Knowledge of this diagnosis is crucial for any health professional to make a timely referral and save a life. Although there is lacking research on AAA’s in the RCT form, there are numerous case studies allowing us to gather information. Normally case studies may be deemed to be low in value on the research totem pole but with such small prevalent conditions it can be an important source of information.  I particularly like case reports for this condition because I want to know every arbitrary symptom and findings these patients could possible present with. However, a fairly new case report publishes in Journal of Orthopaedic and Sports Physical Therapy (JOSPT) grabbed my interest even further. This case (referenced below) was shocking based on the age of the patient and size of the Aneurysm found. Again JOSPT does a great job as always providing video’s and power points on their online website to help readers get a better understanding of what’s being discussed.

What are the signs and symptoms?

            AAA’s are more prevalent in the geriatric population over 65. The pain or discomfort from AAA’s is caused by either the aneurysm itself pressing on structures or vertebral bodies being eroded due to such pressure.  Despite this some studies still report as high as 75% of AAA’s being  asymptomatic when discovered. Usually they are found accidentally on radiographs. SO LOOK FOR THIS IN YOUR PATIENTS WHO ARE ELDERLY, HAVE RADIOGRAPHS AND PRESENT WITH RISK FACTORS.
            When it is symptomatic it usually presents as pain or discomfort in the abdominal region, the low back, hip, groin and buttock area.  Other symptoms can include satiety, nausea, and unexplained weight loss as well. Radiculopathies and mylopathies are not usually reported.
            Due to the fact most patients with such a diagnosis will be asymptomatic it’s important to perform a thorough exam. Abdominal palpation skills are key because AAA’s measured 5cm or greater have a sensitivity of 82% being detected. This value changes depending on the size of the AAA. The good part about this is you have an increased chance of catching an AAA before it’s too late but the bad side is the greatest predictor of an aneurysm rupturing is its size.

Interesting factors regarding the published case

-Patient was only 38 years old
-Patient diagnosis was missed by his physician 
-Blood pressure was 120/80mmHg and regular heart beat of 66 beats per minute 
-While therapist was palpating the left trunk they felt a strong pulsate sensation (Normal in very thin people) 
-Mass was felt BOTH prone and supine position
-Patient was found with a 10 CM AAA and was sent for surgery two days later.

         Warning factors with patient in case report

-Smoked 10 cigarettes a day for a “number of years”
-Deep boring lumbar pain which never changed due to position, movement or time of day
-Increasing night pain waking the patient up 
-Hard to find a position of comfort or relieving
-NSAIDS did not relieve pain
-No other examination findings were positive for other sources of pain.

            The case report really hits home the importance of a thorough history and examination. It’s important to never rule out rare sources of pain because after all rare walks into your office all the time. If you don’t think so it’s just because your not looking for it and thus why it’s called rare. So remember just because your a hammer everything doesn’t have to be a nail.

Mechelli F, Preboski Z, & Boissonnault WG (2008). Differential diagnosis of a patient referred to physical therapy with low back pain: abdominal aortic aneurysm. The Journal of orthopaedic and sports physical therapy, 38 (9), 551-7 PMID: 18758044

Sunday, September 20, 2009


So you get Migraines?

            One of the most common terms thrown around by people is Migraines. A lot of people actually don’t know that a Migraine isn’t synonymous with the term headache. A migraine is just one out of the hundreds of headaches which are discussed by the International Headache Society. In fact there are many different characteristics which go into determining the type of headache you have. It can depend on the number of attacks, the nature of the headache and even its location. .

So when is my headache something serious or just a headache?

            Research and doctors have different opinions on what is warranted as a “red flag” for indication of a serious headache. Firstly, any new headache in someone over the age of 50 should be considered to be looked at by their doctor. Another thing to watch out for is any abnormal changes which occur to your common headaches. For example a headache that occurs 5 times a week but has just recently started to be accompanied by a lose in your peripheral vision. Such changing characteristics can be an example of a brain tumor which grows over time and different symptoms start to evolve. Any headache with neurological signs should definitely be examined by a professional as well. This can involve losing your vision before a headache comes on, “feeling like the rooms spinning” or numbness along the face. Headaches with a fever and a stiff neck should also warrant an emergency situation with the possibility of it being meningitis. Lastly and most importantly any headache which comes on after head trauma definitely be sent to the hospital. Such examples could include a fall from a sports injury or a car accident. Headaches occurring after a head injury can indicate a concussion or internal bleeding. This is often seen as the cause of death in many who experience fender benders and continue their day as if nothing serious has occurred.

So my headache doesn’t appear serious, what causes my everyday headache or migraine?

            Research has examined the cause of headaches and migraines for years to only find there is not one simple answer. The most common method used by Medical Doctors, Neurologist and people in the alternative health care field is what’s called a headache diary. In this diary a person writes down characteristics of their everyday headache and life. When their headache started, how long it lasted and its intensity. Headache diaries as well can help pinpoint activities, food, drink and even social situations which may be causing a person’s headache. Things that stimulate the onset of a headache are called “triggers”. Common triggers consist of different foods like chocolate, cheese, bananas and even foods with high levels of MSG like Chinese food or bologna. When it comes to beverages the most common triggers are red wine, high caffeinated and diet drinks as well.  However, not eating or drinking enough can also bring on headaches when people are dehydrated or skipping meals. One of the big areas in research with headaches is the involvement of hormones. Evidence for this can be seen with women experiencing headaches almost twice as much as men. Also, headaches that appear with relevance to their menstrual cycles, during pregnancy and menopause. Changes in barometric pressure due to flying or the weather can also be a trigger. Even more confusing is what’s called a “rebound headache” brought on by headache medication. That’s correct, taking medication to help your headache can actually on occasion cause more headaches. When one takes a lot of medication for a headache that has established itself as a regular occurrence they may expose this headache to a transformation. This means that your 5 day a week Migraine may now get transferred into a 7 day a week tension headache.

So what do I do for my headache?

   If any signs are present which are mentioned above I strongly recommend seeing your family doctor or a neurologist regarding the problem. If your headache appears to be relatively “benign” meaning nothing too serious there are many options. For a common headache try some over the counter medication. However, if you are a chronic headache sufferer it is good to consider a combination of things. First, taking a headache diary is a good help to any health care provider to determine what is causing your headache. Lay outs for these diaries can be found online. Secondly, trying to avoid the many “triggers” mentioned above should help eliminate some of the options of things that may be causing your headaches. Third, depending on your current health status talking to your doctor about different medication options and being screened by a neurologist may be of help. In addition, seeing alternative health care has also been shown to be effective with headaches. This can range from anything such as a good diet layed out by nutritionist or naturopath, exercises, massage and other options from your local chiropractor. Chronic headaches often have a high association with depression, sleep problems and substance abuse as well, so consulting a councilor may be important. There are even migraine support groups online where people share information.

Sitting Posture

Ever been to a ball game and it comes time for a seventh inning stretch?

             Well too bad our life doesn’t have a seventh inning stretch or at least our day jobs. As if work isn’t bad enough, studies have shown sitting for prolonged periods of time can lead to some health problems, particularly in your lower back.

Remember your mom telling you to sit up straight at the dinner table and not to slouch?
            Well, although that does represent an ideal posture in our everyday life in the long run it is actually better to slouch a little bit. Any posture that is maintained for a long period of time, whether it is slouching, sitting up straight or even leaning to one side puts our body through an adjustment process. In the science world this is known as the “creep” phenomenon.  That is because as you are trying your hardest to maintain that upright position while you are sitting soft tissues over time begin to move and creep to conform to your posture. It is the same principle that’s applied to your dentist giving you braces to straighten your teeth.
            To elaborate further, your back consists of little bones called vertebrae which stack up on one another. The area in between these vertebrae are called disc. Ever hear of a herniated disc?  That’s when the soft, jelly-like center of the disc ruptures through the firmer outer layer. Almost like the cream coming out of a Boston cream doughnut…well not exactly.

What does this have to do with me sitting all day?
            When you sit for a long period of time this jelly center starts to “creep” its way to the back of your disc. This is because usually when people sit they bend their back slightly forward allowing this part of the disc to move. Doing this years on end may predispose someone to this type of injury. Especially if you’re a worker that transfers from this seated position to a heavy lifting type of job very quickly. That is because now you not allowing the disc time to shift back in place. So now you go to lift something and BAM herniated disc. This is very popular in ambulance drivers that drive or sit their entire shifts and then have to carry a person at the scene of an accident. This can also be applied to a construction worker who now goes from sitting in a truck for 8 hours and is then asked to help with a project requiring lifting. The debate is even brought up with workers compensation boards. A worker who was bending over to lift on the job for many years now puts their back in such a state for this injury to occur. Then off the job one day the worker sneezes and gets a herniated disc. Although the injury didn’t occur at work his occupation put him at risk for this injury.

So what can I do?

            Well a couple of tips to help prevent your back from these biomechanical changes. First, and foremost GET OUT OF THE CHAIR. Try standing when your phone rings to talk to customers and take trips to the water cooler when you can. If you work in an industrial setting, try to stand on your break time. Secondly, do something that contrasts to your sitting posture such as while you’re standing try stretching your back by reaching for the ceiling or extending your arms to the wall behind you. Thirdly, get a good ergonomic chair. This can be anything depending on who you talk to but mostly try to get a chair in which the seat pan, back rest and height can be adjusted in multiple ways and shift the posture of your seat many times throughout the day. Fourth of all if you cannot stand at all you may want to consider a lumbar back support. These have been shown in research to help very little. When they do work it has often been attributed to the fact that it makes the worker more aware of their posture.
            It’s important to note these suggestions are for an individual trying to prevent a back injury. Such suggestions do not guarantee a lifetime free of back pain. Furthermore, certain conditions can override these friendly tips. If concerned about having one of these conditions or just obtaining more on ways to counteract the problem speak to your local chiropractor about your options.

Friday, September 18, 2009

Achilles Tendon Injuries

      Although many people associate the Achilles tendon to an image of Brad Pitt getting an arrow through his back ankle, it is actually a fairly debilitating sports injury. There have been many attempts and different approaches to treating the Achilles. However the key to residing the pain may actually be in a treatment that provokes it.

       From Sweden Hakan Alfredson has done considerable research on a strict exercise regiment to help people relieve their Achilles problems. The best part about it is its non invasive, completely conservative and can be done from the comfort of your own home.
Alfredson’s study found that doing “eccentric heel drops” will results in subjects with mid-portion Achilles tendinopathy returning to preinjury activity levels within 12 weeks. The success rate of these subjects was 89%.

The exercise has to be done in both a knee straight position and the knee bent. The idea of these two different positions is to try and train the Gastrocnemius muscle (Knee straight) and the Soleus muscle (Knee bent). Both of these muscles join to help form the Achilles tendon. The protocol is outlined as 3 sets-15 reps, twice a day, every day for 12 weeks. This includes both the knee straight and knee bent exercises (180 reps a day). The patient has to return to the starting position by using their hands or good foot. Concentric contractions have to be completely avoided.

      Besides the protocol being extensive the downfall also lies in the fact these exercises have to be performed with some level of pain. If the patient is performing the exercises with no pain they have to have the exercises progressed by putting on a backpack or using weights. This increases the amount of load and force now travels through the Achilles tendon.

      Furthermore, Alfredson wanted to figure out why his results were not as good for those subjects with insertional Achilles problems (enthesopathy). A couple years later he performed the same protocol on those with Achilles entheopathies but changed the exercise to only bringing the foot to 90°. By this simple change the results went from 32% success rate in the past to 67%.

   The idea behind the change was those with enthesopathies also have retrocalcaneal bursitis accompanying the problem. By bringing the foot past 90° the calcaneous shifts backwards to impinge the bursa. Doing this repeatively did not help the problem and by simply bringing the foot to 90° you eliminate this factor.

       Make sure to rule out other diagnosis such as inflammatory anthropathies, posterior impingement syndrome, Haglunds disease and Sever’s disease.

1.Alfredson, H., & Cook, J. (2007). A treatment algorithm for managing Achilles tendinopathy: new treatment options British Journal of Sports Medicine, 41 (4), 211-216 DOI: 10.1136/bjsm.2007.035543
2.Jonsson, P., Alfredson, H., Sunding, K., Fahlstrom, M., & Cook, J. (2008). New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study British Journal of Sports Medicine, 42 (9), 746-749 DOI: 10.1136/bjsm.2007.039545

3. Pain in the Achilles Region with Hakan Aflredson and Jill Cook chapter 32 Brukner and Khan, Clinical Sports Medicine Medicine 3E, McGraw-Hill Australia 2006.

Wednesday, September 16, 2009


As if getting old wasn’t bad enough now my bones might break?

Well, such a statement isn’t completely true...or is it? I’m referring to the disorder known as osteoporosis. As if the rising population of senior citizens didn’t have enough to worry about, osteoporosis, like high cholesterol and blood pressure is a condition which can occur silently with no symptoms.

What is it?

Osteoporosis is a metabolic bone disease that causes the body to break down bone at a much greater rate then bone formation. There are a few forms of osteoporosis but the most common form is post menopausal. Estrogen is a hormone which aids the body in slowing down the release of calcium from bones. When women enter menopause the amount of estrogen in their body decreases which is one of the many reasons aging women are at a greater risk for developing osteoporosis. But don’t think your safe because your a man. Although women suffer from osteoporosis more then twice as much as men, they are still at risk. This relates similarly to men who experience a decline in testosterone with the effects of aging. Both these hormones play a part in affecting what’s called Bone Mass Density which can be consider as the quality or thickness of your bones.

What are the risk factors?

Need another reason to quit smoking? That’s right, women who smoke usually are much thinner. Having a less lean body mass being applied to their bones usually means a lower bone mass density. Furthermore, smoking interferes with estrogens role in the body and has been shown to cause menopause earlier then in women who don’t smoke. Living a inactive lifestyle with little to no exercise as well as high stress levels can also be risk factors. Stress affects the amount of Calcium and Vitamin D you absorb in your diet, stripping your bones from the nutrients it needs to survive. Enjoy your morning coffee or a beer at the end of the day? Well both alcohol and caffeine can affect not only ones ability to absorb nutrients but are also diuretics which causes us to urinate more and influences our loss of calcium. Try not consuming more then three cups of coffee, tea or soft drinks a day and keep alcoholic intake to a minimum of two drinks daily. Other risk factors consist of being female, over the age of 50, family history of osteoporosis, a diet low in calcium and vitamin D and even certain medications.

How can I stop this from happening to me?

There are many ways a person can decrease their risk of developing osteoporosis. One of the most important ways to reduce ones risk of osteoporosis is get active. Bone mass density usually peaks around the age of 30 and then slowly starts its decline as we enter the aging process. Getting active early as an adolescent or even later as an aging adult can help slow the loss of bone mass density. Most importantly think about implementing weight bearing exercises into your lifestyle and put your muscles and bones to work. Also, focus on exercises which increase your balance and can help reduce the risk of falls which can lead to osteoporosis fractures. However, people who are already suffering from osteoporosis should try and refrain from exercises which put the back into forward flexion such as sit ups, abdominal crunches and cycling. This position puts more force through the back which can lead to fractures. Try increasing the amount of calcium and vitamin D into your diet. Calcium is important for your bones and vitamin D helps it be absorbed. Depending on your age calcium and vitamin D daily requirements can vary. Refer to www.osteoporosis.ca and the Canadian food guide to see more. Calcium rich foods are milk, cheese, yogurt, and fortified orange juice and soy products. Vitamin D can be found in margarine, eggs, salmon, herring and fish oils (such as cod liver oil).

Another approach is to modify your risk factors such as decreasing your intake of caffeine, alcohol and cut back on the smoking. The elderly should take precautions to reduce their risk of falls such as keeping hallways and stairwells clear of clutter, installing hand rails in appropriate areas around the house and avoid overly loose fitting clothing, high heels and rugs which are not bolted down. For further insight one should consult their local chiropractor or medical doctor.

Tuesday, September 15, 2009

Golf Pain

Why am I in pain when I golf?

Well, this is a complex question that can’t really be answered without understanding golf. Although a traditional sport golf is becoming more popular due to the success of golfers like Tiger Woods. Even though golf can be played for many years as opposed to something like football, it can still put a lot of wear and tear on the body. Professional golfers actually have more low back problems than athletes in any other sport.

The swing of the golfer can be broken down into 5 stages: the take away, the backswing, the downswing, the acceleration and the follow through. Pain in different stages of the swing can often indicate different injuries. Golfers usually experience injury for three main reasons 1) faulty swing mechanics 2) overuse and 3) hitting an object other then the ball.

What are some common golfer injuries?

Research has stated that most injuries in golf tend to occur in the leading shoulder, the elbow and the low back. However, the mechanics of golf can affect the whole body. A good golfer needs to incorporate both upper body flexibility and power from their legs in order to be efficient. When one region lacks motion other areas may compensate and cause injury. Adding to this concept, studies have shown that golfers who sustain back injuries tend to have less hip rotation.

A lot can be said about a golfer when observing their finishing position. There are two main finish positions, the “I” position and the “C” position. The “I” position is when the shoulders, torso and hips are aligned, with a neutral spine. In the “C” position the back is extended or bent away from the leading side. The “C” position often means a golfer is not rotating their hips and shoulders together due to bad form or trying to overpower the ball. By ending in this “C” position a golfer puts extra force into the back area that is not needed. Get a friend to videotape your swing to find out which position you fall into.

The shoulder is another area subjected to injury in golf. If an older golfer experiences pain in their lead shoulder during their backswing it may be arthritis. This position can jam the bones of the shoulder together and cause pain in these individuals. If experiencing pain during the follow through of a swing the person may be experiencing what’s called shoulder instability. This means certain muscles around the shoulder are weak and allowing more movement to occur in the shoulder then we would like.

Elbow problems can occur on either the inside or outside of the elbow. When pain occurs on the inside of the elbow, this may be what’s called medial epicondylitis a.k.a “golfers elbow“. Most commonly “golfers elbow” is an overuse injury. What occurs is muscles in the forearm that attach to the elbow in this location are getting stressed. “Golfers elbow” can also occur due to a golfer hitting their club against the ground during a missed swing or when taking a large divot. Pain on the outside of the elbow is known as lateral epicondylitis a.k.a “tennis elbow”. “Tennis elbow” is often associated with the golfer gripping the club too firmly, trying to maintain a straight lead arm or having weak shoulder muscles leaving the elbow to try and generate most of the power.

So what do I do to avoid injury?

Try implementing a warm up routine in your golf game. Research has shown golfers who have a warm up routine of 10 minutes or more experience less injuries, a better handicap and even a faster club head speed of up to 10m/s. However no one wants to get hurt before even warming up. For golfers who drive a long time to get to the course or morning golfers a few minutes should be taken before attempting to warm up. Three things are to be achieved while warming up. First, it’s important to prepare your body for a long day of swinging. Try to increase your body temperature by performing simple warm up exercises but avoid anything involving bending the back forward. The second thing is to stretch as many muscles as possible. If muscles are stiff and not stretched more injuries can occur. The third goal of a warm up is to do something specific to your sport. The most common warm up routine is air swings. These should be done for 30 seconds while increasing the range of motion and power in each swing.

Another suggestion to avoid injury involves carrying a golf bag. Try getting a golf bag which has two straps allowing forces to be distributed evenly. If you have a one strapped golf bag try alternating shoulders throughout the day. There is even some suggestion this can help train a back to endure forces. Also, put the heaviest clubs in the department closest to your back for this helps distribute the weight to your body. When all else fails get a trolley or a golf cart. The last suggestion is try not to overdo it. Golfers who play 4 or more rounds a week sustain twice as many injuries as other golfers. So remember when on the green it’s ok to play mean, but until then make sure to take ten. For more information on golf injuries or to get assessed and treated for one contact me at the information below Writers note- If you have a question about general health, muscles or joints or even a suggestion for an article comment below with your suggestions.

Dr. Wayne Button BSc DC
Graston Technique Provider
In Balance Chiropractic and Health Center
Orleans, Ontario
2034 St. Joseph Blvd
Tel (613) -837 -8885
Email – dr.button@gmail.com