Thank you for the responses and questions regarding my column four weeks ago about rolling exercises. Many of my patients have been using these as well as part of our treatments and they are finding them both challenging and helpful.
As we head into golf season in the Okanagan, incorporating some mobility activities away from the golf course can be tremendously beneficial to help golfers lower their scores and avoid injuries while they are out there.
Golfing is not considered a high impact sport by any means and it is hard to imagine a lot of injuries occurring. Nothing could be further from the truth and Tiger Wood’s most recent setback this week with low back surgery have shown. Doing to the repetitive nature of golf and the fact that is a unilateral sport (always the same side), and that it can be a forceful activity a number of injuries can occur. Among the injuries that are most common are:
- Low back strain/sprain
- Lateral epicondylitis (tennis elbow)
- Rotator cuff
- Wrist sprains
Some of the injuries in golf can be attributed to the fact that it is repetitive in that you can be doing the exact same thing well over 100 times in a 4-5 hour period. If you end up doing this a couple times (or more) per week, the strain on your body is considerable. If you don’t have required mobility or strength to cope with these demands it will catch up to you quickly.
The majority of people that I see with golf injuries related to the low back, hip or shoulder areas are because of underlying mobility problems. As part of treatment in my office, helping patients to address these problems on their own is an empowering tool for them. Providing them with a daily mobility prescription is likely one of the most important things I can do.
The Selected Functional Movement Assessment (SFMA) is perfectly geared towards golfers in order to be able to select the most specific activities that will be helpful. These protocols are used by the treating medical providers of the PGA tour and are the foundation of the Titleist Performance Institute.
The rolling activities that I have discussed in previous articles are a core activity for mobility problems with patients. Today I will include two more rolling videos that initiate movement with the lower extremity as opposed to the upper extremity that were presented in this column.
These rolling exercises can be done as a warm up for golfing to help create the necessary mobility and muscle recruitment that you will use while swinging the club. Spending 5-10 minutes completing these activities will be far more advantageous than completing static stretching. As always it is best to consult with a health professional that is skilled in assessing these movement patterns to help you determine which is most applicable.
For the Back to Basics column this week, I enlisted the help of Dr. Greg duManoir, PhD, CSEP-CEP who is an instructor in the School of Health & Exercise Sciences at the University of British Columbia Okanagan. Here are his words on education and critical thinking:
I recently had the opportunity to attend the National Strength & Conditioning Association Provincial Clinic in Vancouver. This was a professional development event for me, as well as a time to (re)connect with some excellent colleagues and friends. The plan for this event was to sit back and learn some new things and, perhaps, reconfirm some existing thoughts and ideas. The best laid plans… I never seem to be able to get away from my role as an educator, and one of the first conversations over dinner was along the lines of students asking, “What should I do with my life?” I hear this a lot in my role as an Instructor in the School of Health & Exercise Sciences at the University of British Columbia Okanagan. It was great to hear the varied, yet similar responses of the exercise professionals around the table. The main takeaway was “find what you’re passionate about; devote time and energy to that passion”.
I’m hearing this question a lot more lately, being that it’s spring and the end of the academic year (and academic career for some) is approaching fast. Students are asking, “What do I do next? Should I apply to physiotherapy? Medicine? Chiropractic?” To which I reply, “What’s your passion? And do those career paths fit with your passion?” Of course, what follows next is a big soul searching conversation as the response is often “I don’t know what I’m passionate about”! But I digress.
I often follow up this conversation with a story about my path. This is a long story for another day, but it goes something like “I wouldn’t wish my path on anyone, but it got me exactly what I want and to where I want to be.” (Writing guest blogs for Dr. Nimchuk is glamorous I know!). I knew I was passionate about exercise and exercise science. I knew I wanted to learn more about them, so decided to do some graduate work. During my graduate degrees I discovered that I really loved teaching and passing on the knowledge I gained through my studies. I took some odd teaching jobs, took some temporary contracts and eventually found myself in the Okanagan. Sure, there was sacrifice along the way, but it was well worth it.
The other piece of advice that I give to students is that their learning has just started. In the four years they’ve been a student in our program they have only just scratched the surface and really only just learned how to be critical thinkers and good learners. I implore them to continue with educational and professional development opportunities, to put into practice the theory we have taught them, to gain experiences and critically evaluate them, and to continue to seek out the answers to new questions.
So what does this have to do with the reader? First, I would say that you have a healthcare provider in Marc that has found his passion, continues to educate himself, evaluates his approaches to patient care, and now is starting to educate others. Second, find your passion. Is it running? Resistance training? Painting? Playing with your grandchildren? Finally, find support networks around you that help to facilitate experiences in what you’re passionate about.
If you’d like a slightly different view on the conversation that was had at the dinner table please visit: http://optimumsportsperformance.com/blog/what-do-you-want-your-legacy-to-be-finding-your-passion/
Thanks Marc, for the opportunity to put down some thoughts.
Greg duManoir, PhD, CSEP-CEP is an instructor in the School of Health & Exercise Sciences at the University of British Columbia Okanagan. His areas of expertise include: cardiovascular exercise physiology in performance, aging and environmental conditions, strength & conditioning, and development of teaching and learning opportunities for the qualified exercise professional. He can be found at: http://www.ubc.ca/okanagan/hes/faculty/Greg_duManoir.html
A few weeks ago I was able to take the Selected Functional Movement Assessment (www.sfma.com SFMA) course along with some other great local practitioners of varying disciplines. The SFMA and Functional Movement Systems (FMS www.functionalmovement.com) have become very popular in North America. While many of the ideas in this approach are not new, they have done a very good job in helping physical practitioners to quickly identify movement faults in patients and be able to provide treatment and exercise guidance in algorithmic format.
The SFMA basic protocols are relatively simple. It takes a clinician less than five minutes to help a patient attempt the initial movement screens. The person’s ability to complete these are basically scored on a pass/fail basis and with each movement that is not successfully completed, there are much more specific breakout movement screens that are used to narrow down the problem.
One of the main components of this course was to determine whether or not a patient’s underlying problem (which we all want to solve) fell into either a mobility problem; which can be helped through manual therapy; such as Active Release Techniques, manipulation and range of motion based exercise or a stability problem where a person’s ability to recruit and activate required muscle groups in order to correctly perform basic movements.
Once a stability problem is identified, one of the go to screens/exercises is assessing a person’s ability to roll over from front to back and back to front. This may seem ridiculous and simplistic but is actually an embedded neuro-developmental activity that many (if not most) adults lose the ability to properly do. The rolling activities are not unique to SFMA; as the DNS (Dynamic Neuromuscular Stabilization) approach has long used rolling and other inherent developmental activities such as crawling. Not being able to roll properly is a sign of improper muscle recruitment and firing sequences. The rolling is a basic movement that should be mastered before moving onto more complicated stability strengthening patterns.
Mastering rolling is not a one-time accomplishment either. You can lose the ability to roll and this may be brought to your attention by an increase in pain of an old, nagging injury. Checking your rolling and practicing it during a period of increased pain may help you synchronize your movement patterns again.
Getting a proper assessment using the SFMA protocol is very useful for athletes and weekend warriors as well as people who are in chronic pain. Learning how to roll is a great tool to have in your back pocket. I have attached two videos below that show front to back rolling and back to front.
Please consult a skilled rehabilitation practitioner (chiropractor or physical therapist) who is skilled in this approach to have yourself assessed with this approach.
Part of my everyday practice is to see patients with low back pain who are also experiencing related sciatic symptoms. In the course of the initial assessment one of the most important things I can do is determine if this patient is appropriate for chiropractic treatment. Through a thorough clinical evaluation, we are able to determine if the symptoms are being caused by a mechanical or structural problem that can be resolved with manual treatment. In rare cases a patient may need to be referred for more advance imaging such as a CT scan or an MRI.
When people get sciatic pain, they usually associate that with a “pinched nerve”. The pinched nerve terminology is a simplistic (and not usually accurate) view of looking at things that unfortunately chiropractors, doctors and therapists have used to describe back pain that has referral along with it. In actuality, the majority of the time, we are not talking about a disc impinging on a nerve. It can be soft tissue that is causing the problem that is something that Active Release Techniques can help resolve. The facet joints, which are the joints between the upper and lower vertebrae can also get irritated and they themselves can cause some referral of pain into the legs.
With a true herniation or bulging disc that is impinging on a nerve root, there is a certain set of clinical symptoms that can be looked at to determine what exact nerve root and what disc level is causing the problem. In the case of getting an MRI, a good physical exam is important because often times patients will get the imaging done and have bulging discs that do not correlate with the clinical presentation. A look back at a previous article in my archives regarding MRI’s highlighted some of the concerns with using them.
A chiropractic approach to treatment of disc and nerve root related problems is very effective to hopefully eliminate the need for a surgical procedure. Combining manual therapy with the correct clinically indicated rehab exercises is the first step and it all starts with performing a thorough physical assessment. Determining what relieves pain and what increases it lets us determine what exercises will be helpful and which ones will be provocative. There is an abundance of literature showing that conservative care of these problems is preferred choice with a surgery being the last resort.
A year-long study in the Journal of Manipulative Physiologic Therapy, (October 2010) compared chronic sciatica patients with symptomatic lumbar disc herniations who received either a microdiscectomy or 21 chiropractic visits. The researchers found that 60% of the patients who received chiropractic care benefited to the same degree as those who underwent surgery. The study’s authors recommend that patients with a symptomatic lumbar disc herniation try chiropractic first, before considering surgery.
Read more Back to Basics articles
- Is Paleo right for you? Jan 9
- Supplements for pain management Nov 28
- Core exercises you are better off without Nov 14
- Why your back hurts Oct 31
- Choosing a personal trainer Oct 17
- The problem with "making good time" Oct 3
- The ankle-foot complex Sep 5
- Common questions in my office Aug 22
- Are your sources reliable? May 16
- Assessment and treatment of headaches Apr 4
- Simple things with powerful effects Mar 21
- Finding the balance Mar 7
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