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.

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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.

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

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.

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Monday, 16 January 2017

Diagnosis and Physiotherapy for Thoracic Outlet Syndrome

Roo’s test has a better sensitivity for provoking symptoms of thoracic outlet syndrome. This test requires the patient to adapt the “surrender position”, which involves hyperabduction and external rotation of the arm. The patient is instructed to open and close the hands for 1-3 minutes with the elbow bent and arms abducted to 90 degrees and externally rotated to compress the neurovascular structures and provoke the symptoms. The shoulder blades need to be evaluated to check for abnormal movement and position of the scapular.

Learn more about thoracic outlet syndrome. https://www.mychiro.com.my/joint-and-sports-injury/thoracic-outlet-syndrome/

The site of compression of the thoracic outlet syndrome changes the main focus of the treatment. 
However, there are a few treatments that are suitable for most of the cases of TOS. The health practitioner should correct the drooping shoulders, poor posture and poor body mechanics of the patient by teaching them proper positioning while sitting, standing and lying down. 

Manual therapy such as stretching, trigger point therapy, soft tissue mobilization, scapular mobilization and scapula-thoracic mobilization can be used to address tight muscles and restricted tissues. Restoration of the accessory motion at the sternoclavicular and acromioclavicular joints can be achieved by mobilization of the first rib. Side-bending and chin-tuck exercises help to stretch the soft tissues of the neck and strengthen the deep neck muscles. These exercises can correct anterior head carriage. Thoracic extension and brachial plexus stretching exercises can be given to reduce the tension in the muscles and neural structures.

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Wednesday, 11 January 2017

The Diagnosis of Thoracic Outlet Syndrome


People with thoracic outlet syndrome (TOS) often present with signs and symptoms that result from the compression of the neurovascular structures that travels from the neck to the axilla. They can present with pure arterial, venous or neurogenic picture, however, most health practitioners encounter TOS with a mixed presentation. Signs and symptoms of TOS include, but not limited to, neck pain, shoulder pain, numbness and tingling in the upper limb, weakness in the upper limb, and coldness in the upper limb.

Learn more about thoracic outlet syndrome. https://www.mychiro.com.my/joint-and-sports-injury/thoracic-outlet-syndrome/

People with a chronic abnormal movement of the shoulder blade are more susceptible to thoracic outlet syndrome. The tightness of the pectoralis minor, scalene and upper trapezius muscle combined with weakness in serratus anterior and lower trapezius can cause excessive anterior tilting and protraction of the shoulder blade. This can cause further compression of the neurovascular structures in the thoracic outlet.

Adson’s test is used to assist the diagnosis of arterial compression in thoracic outlet syndrome. The patient is asked to rotate the head and neck towards the affected side and extend the neck. The practitioner can check for a diminished radial pulse while the practitioner passively abducts, externally rotates and extends the arm of the patient. The patient can take a deep breath and hold it in to further increase the arterial compression at the thoracic outlet. Reproduction of the symptoms with diminished radial pulse indicates positive sign for Adson’s test.

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Friday, 6 January 2017

Common Causes of Thoracic Outlet Syndrome


Thoracic outlet syndrome is a group of conditions that involves pain, numbness or tingling sensation in the neck and/or upper limb as a result of compression of the neurovascular structures. This condition is very common in athletes that are actively involved in overhead sports. People with poor posture such as drooping shoulders are more susceptible to thoracic outlet syndrome as the diameter of the cervicoaxillary canal is reduced. Congenital abnormalities of the structures in the neck can compress the neurovascular structures in the thoracic outlet and result in signs and symptoms in the neck and the upper limb. Complete cervical rib, incomplete cervical rib with fibrous band, fibrous band from the transverse process of the lower cervical segments and clavicular abnormalities are a few of the congenital abnormalities that can cause neurovascular compression at the thoracic outlet.


Cervical ribs can present just on one side but are more commonly found on both sides when present. However, not everyone with cervical ribs have signs and symptoms of thoracic outlet syndrome. In fact, only about 10% of patients with cervical ribs have signs and symptoms of thoracic outlet syndrome. Shortening and tightening of the scalene muscles due to active trigger point can result in thoracic outlet syndrome. Patients with fractured first rib or clavicle, psudoarthrosis of the clavicle, malunion of clavicular fractures, callus formation or crush injury to the upper thorax are at a higher risk of developing thoracic outlet syndrome.

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