|
This update is intended as a means for us to keep busy clinicians in the medical community up to date with recent research as it relates to physical therapy. Hopefully, this will increase the options you have when prescribing physical therapy for your patients.
Back Pain in Golf As one of the fastest growing sports in the United States, golf is more and more frequently recognized as a cause in the development of low back injuries. Amateur golfers have also identified low back pain as their most common golf-related injury. Golf injuries tend to result from overuse and develop over extended periods of time. The recreational golfer often plays sporadically, without proper warm up, and generally displays swing mechanics that need improvement. Also, poor mechanics may make overpracticing especially dangerous. Often, the golfer will make inappropriate adjustments to an already poor technique and may impose further strain on his or her body. Four types of forces are imposed on the lower back during the golf swing. Large lateral-bending, shear, compression, and torsional forces were found to affect the lumbar spine during the golf swing. These forces lead to different types of back pain including mechanical (lumbar strains or muscular spasms), discogenic, spondylogenic, or related to facet arthropathy. Myoelectric analysis in this study found that the lumbar paraspinal and abdominal muscles reached moderately high levels of activity during the golf swing. Therefore, strengthening these muscle groups is imperative to enhancement of the golf swing and preventing injury. At Renaissance Physical Therapy NW, the lumbar MedX machine specifically addresses strength and mobility in the lumbar spine and surrounding musculature. Physical therapists are experts in treating low back injuries through the use of manual techniques, exercise prescription, and a variety of modalities such as ultrasound and electrical stimulation. Prevention of injury and enhancement of the golf swing through biomechanical assessment of posture and designing a golf-specific exercise program are now offered at Renaissance Physical Therapy NW.
Alterations in Shoulder Kinematics and Associated Muscle Activity in People With Symptoms of Shoulder Impingement Rotator cuff problems are thought to account for nearly one third of physician visits for shoulder pain complaints. Motions that bring the greater tuberosity in closer contact with the coracoacromial arch are considered particularly problematic with rotator cuff dysfunctions. This study investigated the presumed association between abnormal shoulder movement patterns and shoulder impingement. The subjects were 52 construction workers with routine exposure to overhead work. The control group had no history of shoulder dysfunction and the experimental group had a history of shoulder impingement. During overhead motion, they recorded glenohumeral and scapulothoracic kinematics using electromagnetic sensors tracking 3-dimensional motion, and they also recorded scapulothoracic muscle activity using electromyographic data. Their results illustrated that the group with impingement had decreased scapular upward rotation, increased anterior tipping, and increased scapular medial rotation when under the load conditions. They inferred that the less upwardly rotated scapular position early in the painful ROM may be detrimental and contribute to impingement, and that the anterior tipping of the scapula would place the anterior acromion in closer proximity to the rotator cuff tendons, and increasing the potential for impingement. They also found that upper and lower trapezius muscle electromyographic activity increased in the group with impingement as compared with the group without impingement and the serratus anterior muscle demonstrated decreased activity in the group with impingement. The serratus anterior muscle is believed to provide the primary muscular force to produce posterior tipping of the scapula and stabilize the scapular inferior angle against the thorax during overhead motions. Considering the hypothesized clinical importance of posterior tipping to elevate the anterior acromion, the decreased serratus anterior muscle activity in the subjects with shoulder impingement was considered particularly relevant. It was noted the inclusion of the scapulothoracic musculature in therapeutic exercise programs for shoulder dysfunction is a relatively recent addition and that previous programs emphasized only the rotator cuff musculature. They concluded that scapular tipping (rotation about a medial to lateral axis) and serratus anterior muscle function should be considered when rehabilitating patients with shoulder impingement. There are exercises that strengthen the serratus anterior muscle specifically and exercises that promote appropriate upward rotation and posterior tipping of the scapula with overhead motions. We can also use specialized scapular taping techniques that provide proprioceptive feedback to promote proper scapular positioning.
The Clinical Effects of Intensive, Specific Exercise on Chronic Low Back Pain: The authors of this study hypothesized that a program of intensive exercise would be beneficial for patients with chronic low back pain. It is their contention that traditional, passive modalities are ineffective in treating chronic symptoms. In order to be effective, however, the exercise would need to be specific to the lumbar paraspinal musculature and isolate lumbar movement to avoid pelvic motions. They believed that specific diagnosis of the problem was not as important as performing the proper exercises under supervision. They followed 895 consecutive patients with reports of chronic low back pain. Of these, 627 patients completed the program, 161 patients dropped out of the program for various reasons, and 107 were unable to begin the program and, therefore, acted as a control group. The average duration of symptoms was 26 months at the time of entry into this program. Before this treatment, the patients averaged six previous forms of treatment including physical therapy, chiropractic care, and surgery. Forty seven percent of the patients were work-related claims. The method they used to isolate the lumbar spine and specifically exercise the lumbar paraspinals was the lumbar-extension MedX machine. The patients were treated an average of 18 visits on the MedX, with standard protocol. This consisted of exercise sessions of one hour twice a week. Patients also performed aerobic and general strengthening exercise. A survey was completed at the end of the training and at an average of 13 months after treatment. The results of this study show that there was a substantial decrease in low back pain in 64% of patients and in radiating symptoms in 62% of patients. This was correlated with ROM and strength gains on the MedX. The authors discovered that diagnosis did not necessarily affect results, but psychosocial factors, such as secondary gain or litigation, did decrease effectiveness of treatment to some extent. The cost of this program averaged $2250, including all medical visits and equipment for home. This may seem extensive until it is compared to the $10,000-15,000 often spent on chronic back pain conditions. This indicates that this program is a cost-effective means of treating chronic conditions. A full 94% of treated patients maintained improvement in pain levels and function after one year, compared to 25% of the control group. Reutilization of healthcare services after one year for patients not involved in litigation was 13% and for those involved in litigation was 25%, as compared to 42% and 76% of the control group respectively. References: The authors feel that this study objectively shows the benefit of intense and specific exercise for the low back in treatment of chronic low back pain. This is based on the idea that decreased motion of the chronically injured area would result in muscular atrophy, stiffness, and cartilage degeneration. Motion of this area, on the other hand, will promote healing by improving blood flow, stimulating cartilage repair, and normalizing pH of the intervertebral discs.
Manual Therapy |
Special Services |
Community Services |
Healthcare Providers in the Puget Sound This website and all content copyright © 2000-2002 Renaissance Physical Therapy NW. All Rights Reserved. info@renaissancept.com |
