Tuesday, 21 February 2017

Slipped Disc and Low Back Pain in Golf


Disc herniation or slipped disc is a very common cause of lower back pain in golfers and non-golfers. The patient normally present with acute onset of low back pain following a snap or a clicking sound in the low back. Slipped disc is very common in people at the age of 20-40. There may be a radiating pain shooting down the leg in the next 24 to 48 hours following the back injury. The pain, numbness or tingling sensation will most likely radiate down the leg in a specific pattern according to the dermatome. The lowest most disc in the lumbar spine, the L5/S1 disc, is the most commonly affected disc, and the S1 nerve root can be impinged at this site.

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Prolonged sitting, aggressive coughing and Valsalva maneuver can increase the pain in the back. The radicular pain in the leg can sometimes be more pronounced than the back pain. Straight leg raise test that involves stretching of the sciatic nerve and spinal nerve roots can aggravate the pain during physical examination of the patient. Neurological examination needs to be performed to look for sensation changes, muscle weakness and reflex changes.

MRI of the lumbar spine may be needed in certain cases to aid in the diagnosis of the slipped disc. Slipped disc can present in the adolescent as well due to the fact that they often participate in aggressive and intensity sports activities.

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Thursday, 16 February 2017

Mechanical Low Back Pain in Golf


Mechanical lower back pain is a very common reason for a golfer to seek help from health care practitioners. In younger golfers, sudden growth spurs can be a cause of lower back pain as this may cause a relative tightness of the thoracolumbar fascia and hamstrings. This relatively reduced flexibility can increase the stress on the spine. Whereas in older golfers, degenerative changes at the hip may be a contributing factor for the mechanical lower back pain. Osteoarthritis of the hip can lead to decreased internal rotation of the lead hip during the swing and the additional force will be transferred to the lumbar spine. Therefore, the structures in the lumbar spine exerted by this additional stress.  

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Sacroiliac joint dysfunction is a very common cause of lower back pain in young and active populations. Research has shown that up to 40% of lower back injuries are associated with sacroiliac joint dysfunction. The presentation of sacroiliac joint dysfunction can mimic a low back strain or the pain can radiate into the buttock or posterior thigh. The joint is normally quite tender upon palpation and the pelvic landmarks can be asymmetry when compared from side to side. Leg length difference from side to side can cause asymmetry force transmission through the sacroiliac joint and the spine during weight bearing activity. A club that is not suitable for the golfer can result in poor swing mechanics.

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Saturday, 11 February 2017

Types of Low Back Injury in Golf


The lumbar spine has relatively low tolerance to rotation in comparison to other spinal segments. Therefore, a lower back injury is commonly associated with twisting or torsion of the lumbar spine. A lot of low back pain injuries occur during the backswing axial rotation that exceeded the golfer’s pain-free maximal rotation in the neutral position. Facet joints of the lumbar spine can be injured easily with only 2-3 degree of intersegmental rotation in the spine. The most commonly known mechanism of injury for a disc herniation in the lumbar spine involves axial compression, rotation and side bending of the lumbar spine.

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There are a few types of injury for lower back that present in golfers. Mechanical factors such as muscle strain or spasm, discogenic problems, spondylogenic pain or facet-related injuries can cause pain in the lower back. Some other less common factors of low back pain such as infectious, autoimmune, oncologic, abdominal, pelvic visceral causes and psychogenic factors should not be missed and overlooked. However, mechanical factors are the more common reason for lower back pain in golfers.

Mechanical lower back pain usually present as a localised back pain with associated muscle spasm or tightness and restricted movements in the facet joints. The pain can be relieved by relative rest and can be aggravated by movement, such as swinging a club. The pain can have a sudden onset or it can happen gradually. The biomechanics of the swing and overuse are the main reasons for mechanical lower back injury.

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Monday, 6 February 2017

Low Back Pain in Golf


The golf swing is a complicated and asymmetrical movement that involves the coordination of the trunk and the limbs. Significant axial twisting, axial compression, anterior-posterior shearing and lateral bending is being exerted on the spine during the golf swing. The most common cause of low back pain in amateur golfers are poor swing mechanics and poor physical condition. However, the most common cause of low back pain in professional golfers is an overuse injury. The axial compression force exposed to the spine during the swing may reach up to eight times of the body weight in golfers. The force needed to prolapse an intervertebral disc in cadavers is reported to be lower than this axial compression force.

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The more upright classic golf swing involves more simultaneous rotation of the hips and shoulders. This result in less rotational stress on the lumbar spine and less sideways bending of the spine at impact. The modern golf swing involves limited hip and pelvic rotation at the top of the backswing, and the hips are used to initiate the downswing while the shoulders and the trunk are still loading in the backswing. The reverse C position, or the hyperextension of the lumbar spine is found in modern golf swing during follow-through. All of the above-mentioned factors can be the reason for lower back pain in modern golfers.

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Wednesday, 1 February 2017

Chiropractic View on Low Back Pain in Golf


Golf is a popular sporting activity that provides a social setting for players to spend time with friends. The frequency of play for this sport differs from other sports, as it increases with age. This is a sport without any physical contact and requires relatively low levels of activity but over a prolonged period of time. In male professional golfers, lower back injuries are the most common form of injuries reported, followed by elbow and forearm injuries. Whereas in female professional golfers, the most frequently reported injuries are lower back injuries, followed by left wrist injuries. Chronic overuse is the most common cause of injury, especially during the swing at impact and during the follow-through phase.

Learn more about back pain. https://www.mychiro.com.my/spine/back-pain/

Research showed that people who involved in golf only are more likely to have low back pain when compared to people who are active in other sports at the same time. This suggests that inactivity and lack of physical fitness prior to taking up golf may be a risk factor for low back pain in golf. One study actually reported a lower risk of lumbar disc herniation in active golfers who played two or more times per week.

The main function of trunk muscles during the golf swing is to stabilise the spine. The erector spinae muscle is found to be more active in pain-free golfers. Golfers with low back pain tend to fire these muscle groups before starting the backswing. This can lead to an increased stiffness of the spine and increased pressure in the lumbar disc. However, these muscles are not activated before the backswing phase in pain-free golfers.

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Thursday, 26 January 2017

Chiropractic View on Leg Movements in Low Back Pain


Chronic low back pain can affect the movement coordination of the trunk, pelvis and lower limbs during movements in daily living. Changes of level are normally required during walking. For example, when crossing a road, stepping on the sidewalk, mounting doorsteps, climbing stairs and etc. Adaptations in muscle recruitment are necessary and these are more challenging than level walking. Chronic low back pain can have a significant impact on these muscle recruitment pattern and causes a change in the normal walking pattern.

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When healthy people without low back pain is requested to stiffen the trunk by contracting their abdominal muscles, or wearing a lumbar support belt that limits trunk movements, this results in similar  outcomes in thorax-pelvis coordination as observed in low back pain patients. However, the pelvis-leg coordination showed slightly different results, with the pelvis movements stayed out of phase with the legs.

During a slow walk, the hamstring activity of healthy people with no low back pain decreases as the walking speed decreases at the end of the swing phase, right before the heel touching down. The knees are more extended at touchdown. People with lower back pain tend to walk slower compared to normal healthy people. Therefore, this suggests that people with lower back pain will have more significantly extended knees and reduced hamstring activity at touchdown. There is an increased in the vertical forces and minor shock absorption when the knee is more extended at touch down.

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Saturday, 21 January 2017

Chiropractic View on Gait Pattern Alterations with Low Back Pain


The gait pattern of a person with lower back pain is usually different from that of a normal person without lower back pain. The most common finding is that people with lower back pain tend to walk slower than the normal healthy individual. The presence of pain and/or the avoidance behaviour associated with pain can explain this slower walking pattern.

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In normal healthy subjects without lower back pain, horizontal thorax and pelvis rotation are more in phase when they walk at lower speeds. This means that the thorax and the pelvis rotate in the same direction about the same time. However, when they walk at higher speeds, the phase difference between horizontal thorax and pelvis rotation increases and tends toward anti-phase.

People with chronic lower back pain have difficulty adjusting pelvis-thorax coordination and the horizontal thorax and pelvis rotation are more in phase even when they walk at higher speeds. This remains the same when they are running and they have less transverse plane coordination.

This reduced movement coordination variability can be explained by increased stiffness of the trunk in people with lower back pain. There is an increased activity of the superficial lower back muscles in people with chronic lower back pain in order to protect the spine for unexpected movements of the thorax and pelvis during walking. The muscle activity of the erector spinae and rectus abdominis is increased and this leads to an increased stiffness of the spine.

For more information or inquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my