Better Golf (and Less Injuries) with a Balanced Body

By Ada Wells, MPT
As seen in the Fall 2009 Balanced Body Pilates COREterly

As Pilates instructors, we possess a unique set of tools that can help golfers decrease their chances of injury and improve sports performance. To have a successful golfing experience, the individual must not only possess the proper skills to know how to properly swing a club, but they must also possess the range of motion, strength, and neuromuscular control to allow their body to actually execute the swing. While it is helpful to understand the complex biomechanics of the golf swing motion, focusing on just a few key critical areas will help most golfers.
Why golf is so difficult and why all the injuries?
Having a consistent golf swing with good form is a difficult task because of the complexity of its biomechanics. Without going into too much detail, there are a few aspects of the golf swing that are helpful to understand. First, the spine is subject to a very rapid and complex loading pattern. In less than 1.5 seconds, the spine and extremities are taken to their end ranges of motion, making the extensibility of soft tissues dictate the path of the swing. Lacking flexibility in the mid-back and hips may cause the lumbar spine to bend and rotate in ways that increase spinal stress. The golf swing also involves a combination of non-functional movement patterns and rotational movements around multiple axes. Since these are not typical motions, i.e. the head moves opposite the body through most of the swing, there are different neuromuscular firing patterns that must occur. Individuals may be prone to upper body injuries if they don’t possess the strength to control their flexibility in these atypical positions. Regardless of age, gender, or experience, muscle strength and flexibility imbalances can impair one’s ability to play effectively, especially when combined with poor instruction or form.

backswing1-400x570.png
Critical Areas:
Many swing faults and injuries are the result of lacking range of motion or motor control in a few key areas. Below are some suggestions that are helpful when working with your golf client.
Spine Range of Motion and Control: Optimal spinal mobility at all levels is critical since limitations at one area will increase compressional forces on another. This is particularly important during the end ranges of the swing when control of thoracic extension and rotation need to be maximal. The pelvis should also stay relatively neutral throughout the swing to allow the body to rotate around a neutral spine axis. Note that the pelvis stays neutral despite changes in hip position and its directional orientation throughout the swing.

Mat exercises such as the mermaid and saw are helpful for encouraging spinal rotation and pelvic control, whereas the swan and swimming are helpful in working with spine control in extension.
Hip Range of Motion and Control: Good hip range of motion, particularly hip internal rotation and hip extension, is very important. A tight iliotibial band combined with weak hip abductors can be a culprit for many swing faults. What is often overlooked is the importance of also working on hip and lower extremity control in weight bearing positions.
The reformer is the obvious place to work on hip flexibility, whether performing the supine legs in straps series or the standing lunge/hip flexor stretch. Performing hip work on the reformer with the client standing in their golf address position is helpful for training muscular control with the hips in flexion and spine in neutral think speed skater or the standing splits series.
Cervical Mobility and Scapular Control: Integrating postural exercises is necessary for any sport, but with golf, the added complexity of the head moving in an opposite direction of the arms and thoracic spine makes it critical. Also, the potential for repetitive upper extremity injuries exists if the golfer doesn’t have good scapular control.
Lying supine, parallel to the foam roller is a great place to start with most golfers, as it allows them to engage their core stabilizers while mobilizing their mid-back and stretching out their pectorals. Prone exercises on the combo chair are helpful to encourage scapular stabilization while the spine moves into spinal extension and rotation positions. On the mat, the spine twist is excellent for working on good spinal mobility in neutral. Performing variations with neck and arm position can make it very functional for the golfer. Arm springs on the trapeze table can be used in standing or kneeling to work on scapular control in a variety of directions.
Summary
In general, a non-specific, but balanced Pilates session with good form and cues, will be of benefit to golfers, whether or not you even mention golf or have ever played yourself. However, if you choose to specifically target golfers or if you frequently have golfers as clients, it is helpful if you have a deeper understanding of the complexity of the golf swing. Take lessons, talk to a pro, take golf-specific fitness courses, and try it yourself so that you understand what is physically required to have a good golf swing and to maximize results with your golfing clients.
Ada Wells, MPT, owner of Rebalance, Inc., graduated from UC Davis with a B.S. in Physiology. She received her MPT from Chapman University. She is Polestar certified and a member of APTA and PMA. Ada specializes in combining manual therapy with Pilates-based exercise for sport-specific rehabilitation and performance programs with a special interest in golf. For the past 7 years, she has provided Pilates services to the celebrity golfers at the American Century Golf Championship.

 

Pilates and the Compromised Spinal Cord

back_pain_icon
By Allison Cabot, PT; Dawn-Marie Ickes, MPT; and Gabrielle Shier, MPT
As seen in the Summer 2008 Balanced Body Pilates COREterly
When an individual is afflicted with a spinal cord injury, there generally will be a loss of motor function and/or sensation at and below the level of injury. Where along the spine and how the injury took place will dictate the severity of the loss. The most common spinal cord injuries occur from motor vehicle accidents, gunshot wounds, and sports related accidents or falls. Non-traumatic occurrences are classified as spinal cord dysfunction.
Establishing a wellness program is extremely beneficial for maintaining and improving functional abilities and emotional well-being for patients with spinal cord injuries or dysfunction. A well-rounded program should include elements which enhance functional independence in addition to promoting fitness, balance, core strength and spinal stability.
Staying well despite injury or dysfunction involves commitment to a healthy lifestyle. Exercise is one step which, if properly executed, can enhance the functional ability of an individual afflicted with a spinal cord dysfunction. It also promotes general well-being and improved self-esteem. But with any exercise programming, precautions must be adhered to. Prior to initiating any exercise, you must learn the indications and contraindications of this population. It is imperative to consult with a trained health care professional who specializes in spinal cord injury/dysfunction.
Pilates when used in a rehabilitative capacity is an excellent choice of exercise for those individuals with a neurological impairment of the spine. It incorporates modern biomechanical principles focusing on posture, body alignment and proper muscle recruitment. It challenges the proprioceptive system so that in a spinal cord injury client – you can strengthen the nerve to muscle message, so that even if the muscle cannot be further strengthened, you can maintain or even strengthen the nerve message from the central nervous system. In addition, it facilitates the mind-body connection and breath for overall relaxation and one’s own awareness of body and self.
Pilates is ideal for persons with disabilities, because the repertoire is all encompassing with over 500 exercises. In addition, every exercise can be modified according to the mobility and ability of the participant. Because Pilates uses spring resistance instead of weight bearing exercises, spinal cord injury patients who have partial involvement can effectively strengthen the legs. Each exercise focuses on concentration, control, precision, and the fluidity of the movement. In addition, breath and core stability are key components to each exercise. It also is different from conventional weight training in that its focus is on facilitating the smaller stabilizing muscles and core musculature. These muscles are imperative in order to maximize normal function and restore trunk control.
The benefits of Pilates for a spinal cord client include, but are not limited to, improved stability, flexibility, core strength, shoulder, spinal and pelvic stability, a more balanced musculature, improved motivation and self-confidence/esteem. Postural integrity is found and maintained. Best of all it is safe and effective.

 

Case Study – Patient with spina bifida – incomplete
Mark* was ambulatory and functional, but was unable to run and walked with a limp, one leg being much weaker than the other. He was highly motivated to strengthen “what he had” by doing lower body strengthening exercises at the gym. However, he experienced chronic knee and lower back pain. During the first year of his physical therapy, which included Pilates, his pain decreased by 90%! He showed remarkable improvements in strength and function. Now after 2 years, Mark has shown signs of increased strength in both legs, particularly in his weaker leg. Now his knees are pain-free and his limp has disappeared. However, when he attempts to strength train on his own at the gym, the pain returns. Not only is Mark an example of how Pilates can change the way a person moves, it illustrates how one must continue the practice to get the full benefit Pilates can offer. 20150703_132532
The inherit nature of the equipment which includes the Reformer, Cadillac, and Wunda chair encompasses versatility and improves effectiveness of exercises because of the springs. The springs come in various tensions and therefore can be utilized to produce different levels of tension. Utilization of the Pilates equipment should be performed only by those individuals who have been adequately trained. A trained instructor should be spotting their client at all times and if working with this population type should have adequate knowledge of how to work with a neurological client.
For more information on spinal cord injury and dysfunction please refer to NCPAD’s fact sheet on Spinal Cord Injury.
Allyson Cabot, PT, is a partner at Core Conditioning, integrated Wellness centers offering Pilates-based rehabilitation in Burbank and Studio City, CA. She holds a B.S. in Kinesiology from UCLA and graduated from CSULB in 1991 in Physical Therapy. She is certified in Pilates and Gyrotonic®.
Dawn-Marie Ickes, MPT, is a partner at Core Conditioning, integrated Wellness centers offering Pilates-based rehabilitation in Burbank and Studio City, CA. She holds a B.S. in Biology from Loyola Marymount University and graduated with a Masters in Physical Therapy from Mount Saint Mary’s College in 1996. She sits on the national Board of Directors for the Pilates Method Alliance. She is certified in Pilates.
Gabrielle Shrier, MPT, is a partner at Core Conditioning, integrated Wellness centers offering Pilates-based rehabilitation in Burbank and Studio City, CA. She holds a B.S. in Kinesiology from UCLA and graduated with a Masters in Physical Therapy from USC in 1994. She is certified in Pilates and Gyrotonic®.

Pilates for Fibromyalgia

By Gabrielle Shirer
As originally seen in the Fall 2006 edition of the Pilates Coreterly

According to the National Fibromyalgia Association, Fibromyalgia Syndrome (FMS) is an increasingly recognized chronic pain illness characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. While the cause and etiology of FMS is unknown, FMS affects 6-12 million people in the United States: more commonly women at a ratio of 9:1 and between the ages of 25 and 50 years old.

Obtaining a true diagnosis of Fibromyalgia is difficult since no objective diagnostic tests currently exist. The American College of Rheumatology established a tender point palpation diagnostic criteria in 1990. The presence of pain occurring in 11 out of 18 tender point sites and present for at least 3 months is required for diagnosis.

Common symptoms of FMS include:

  • Sleep disturbances
  • Morning stiffness
  • Headaches
  • Irritable bowel syndrome
  • Painful menstrual periods
  • Numbness or tingling of the extremities
  • Restless legs syndrome
  • Temperature sensitivity
  • Cognitive and memory problems (sometimes referred to as ‘fibro fog’)

Traditionally, physical therapy has been shown to be helpful with the treatment of FMS and is best used with interdisciplinary therapeutic applications. The goal of physical therapy with FMS is education of the syndrome with instruction on limits and management. Exercises are important to maintain and improve function and assist in managing pain, therefore it is crucial to establish an independent home exercise program. Muscle energy techniques (MET) have been shown to be highly effective. In a research study completed by Mary Silva, MET showed a noted 50% or more decrease in pain levels in 60% of patients, a decrease in the medications required, and improvements in quality of life. MET includes gentle stretching of the musculature with gentle contraction of that muscle. From this we can conclude that Pilates, based on its principles, can be very helpful in treating this population.

Important considerations when working with this type of population include compliance of the client, any co-morbid conditions, medications the client is taking or any other psychological components that may exist. Poor posture and a sedentary lifestyle have been reported to be great perpetuators of trigger points.

Additionally, the presence of “fibro fog” can have a significant impact on the client’s success with any home programming designed for them. It is imperative to write down all home exercise instructions and include as many descriptions and pictures as possible.

Individuals suffering from Fibromyalgia tend to fear that any exercise is going to make their pain worse. However, current research on Fibromyalgia and exercise shows that low impact aerobic exercise (if performed correctly) can be done without increasing pain. For some clients it can be effective in actually increasing their current pain threshold. A review study of aerobic exercise suggests beginning with short stints (3-5 minutes, 3 times a week) and progress over time to at least 30 minutes, 4 times a week. As with any component of an exercise program designed for this group, gradual progression is key.

Few studies exist that have examined the effects of strengthening with the Fibromyalgia patient, but there are studies which have shown an improvement in strength, but not necessarily of a decrease in symptoms. Over the years, we have had clients report an improvement in their overall sense of well-being, which they claim improves their ability to manage the aspects of this syndrome. Improvements in posture due to the nature of the Pilates work were also widely reported.

There are many reasons why using Pilates is effective for conditioning or rehabilitation of a client with Fibromyalgia. Pilates is a low impact program that focuses not only on core strength and stability, but the use of breathing and breath work. Breathing oxygenates blood and increases circulation to all regions of the body. With recent studies showing that breathing while incorporated during exercise can increase relaxation of muscles and thus avoid undue tension, the use of Pilates is a “no brainer”.

A strong tendency for those suffering from Fibromyalgia is to “disconnect” from their body. Pilates’ emphasis on the connection of the mind to the body, can also be a huge benefit. Clients’ ability to participate in an exercise program from which there is no exacerbation of symptoms can greatly improve their sense of well being. From a musculoskeletal standpoint, it also allows for the improvement in articular mobility of the spine in a very gentle and supported environment.

Hypermobility has been reported to be an additional factor affecting clients with Fibromyalgia. There is a greater tendency for the muscles to rotate, causing imbalances and trigger points. (Travell and Simmons 1983)

Key areas of focus for this type of program design are primarily endurance, posture and managing fatigue. One strategy for optimizing the exercise experience for the client is timing their sessions earlier in the day. By starting the day with an oxygenating breathing-focused routine, the onset of fatigue can be pushed back in some cases.

(continued above)

Another very important consideration for this type of program design is to keep repetitions to a minimum. Unlike traditional stabilization programs, the issue of muscle endurance is paramount for success. The muscles must be comfortable during all phases of any exercise, contraction and relaxation. This could mean that the speed of movement is cut in half for many of the Pilates exercises. It is important however, not to strain the structures by having the client move too slowly. A comprehensively trained Pilates instructor with 2-3 years of experience is strongly recommended as this disorder is multifaceted.

Because of the individualized nature of this disorder, it is often intimidating when designing a program for a client with “so many variables”. This is in fact why the Pilates method is so appropriate for this population. The individualized nature of Pilates and its specificity in combination with such a wide range of equipment versatility is what makes it so beneficial.

Clients with FMS will improve best with personalized programs, which can be accomplished with Pilates. The focus should be on gentle stretching exercises and on deep, core stabilization work for both pelvic and scapula stabilization.

Generally, mat work may be too challenging as a starting point for clients with Fibrolmyalgia. Because it lacks the support and proprioceptive associated with the Reformer and the Trapeze table, mat work can result in excessive stress to the muscles and joints resulting in a poor movement experience for the client. Appropriate modifications and simplifications to mat exercises do exist , which can be incorporated into a home program.

Some good mat exercises include:

  • Theraband LE stretching and chest opening
  • Neutral pelvis
  • Grounding
  • Pelvic clocks
  • Bridging
  • Bent knee fall outs
  • Heel slides
  • Knee folds
  • Chest lifts
  • Ribcage arms
  • Spine stretch forward
  • S/L leg work
  • Standing footwork

A gentle, modified Reformer workout might include:

  • Footwork in neutral pelvis
  • Arm circles
  • Leg in strap work
  • Short spine
  • Arm work seated on the long box
  • Rowing
  • Stomach massage
  • Spine stretch forward (bi/unilateral)
  • Eve’s Lunge
  • Mermaid

The Trapeze table is also a good location to work since the patient feels more stable and the springs can be made as light or heavy as needed by moving the bar. I start many clients here to ease them into the idea of doing exercises without feeling intimidated.

  • Supine arms with tower bar
  • Supine arm work
  • Leg in strap work
  • Mini-swan
  • Mini-reverse tower
  • Supine arm work
  • Leg in strap work
  • Mini-swan
  • Mini-reverse tower

The most important thing to realize with this type of population is that little will be achieved rapidly and time is a large part of the equation. Gains will be made slowly and there will most likely be setbacks. The important message to get across to clients, should they express frustration, is to reinforce to them that even if their pain level is staying somewhat the same, they are getting stronger. That IS improvement.

Gabrielle Shrier graduated with a B.S. in Kinesiology from UCLA and holds a Master’s degree in Physical Therapy from USC. Co-owner of Core Conditioning and a PMA Gold Certified Pilates Instructor, she is also certified in Gyrotonic®. She has practiced physical therapy since 1994 and has been a member of the APTA for over 14 years. Gabrielle served as the continuing education director at Davies Medical Center and was a member of the continuing education committee for the Golden Gate District of the APTA. She spent the early part of her career specializing in neurologic disorders and is NDT certified. Additionally, Gabrielle practices Women’s Health and CranialSacral Therapy. She has spent the past 7 years integrating Pilates and her background in physical therapy with her love of sports.

Do you have carpal tunnel syndrome?

You may first notice it as tingling or pins and needles in your thumb, index, middle and ring fingers. Your hand may feel weaker than usual, and you may even drop objects.

Perhaps you’re woken at night with pain in your hand that’s relieved by shaking, hanging or massaging the hand. The pain may even involve your arm and shoulder, and you can experience darting pains from the wrist.

These are all common symptoms of carpal tunnel syndrome.

The Carpal Tunnel Ligament

 What’s a carpal tunnel?

The carpal tunnel is a space in the wrist surrounded by wrist bones and by a rigid ligament that links the bones together. The median nerve runs through the narrow carpal tunnel. If any swelling occurs, the large median nerve can easily be compressed, causing symptoms of CTS.

Swelling in the wrist can occur during pregnancy, with medical conditions including diabetes, rheumatoid arthritis and thyroid imbalance, and as a result of repetitive hand movements common in many occupations. The tendons in the carpal tunnel can become irritated and inflamed by awkward postures, strong gripping, mechanical stress on the palm, vibration, or repetitive hand movements.

What about keyboard work?

A possible link between CTS and keyboard or computer use is now considered doubtful, with most reviews finding no consistent evidence to support that extensive computer use is a risk factor.

However, keyboards can cause any pain or strain in the hand and wrist, and symptoms can come from elsewhere along the median nerve. Its not to say that computer keyboard use doesn’t cause disorders of the arm, but is doesn’t cause carpal tunnel syndrome.

How to treat CTS.

You can’t work through carpal tunnel syndrome.

Despite pain and stiffness being initially mild, they can increase until your hand hurts all the time, and you can suffer permanent damage if the cause is not addressed.

Treatment includes rest, anti-inflammatory drugs, cold packs or a splint. Certain medications can also help to reduce the swelling.

If symptoms are severe, surgery may be necessary, but should not be the first choice of treatment.

Source: safetyandhealthmagazine