Is "Reverse Spine Angle" Harming Your Low Back?

According to Titleist Performance Institute (TPI), reverse spine angle is the leading cause of low back pain among golfers. An analysis of 387 players found that nearly 40% demonstrated this reverse spine angle during their swing. That’s a lot of potential for injury.

What it is?

With reverse spine angle, from a face-on view of the golfer, the upper part of the trunk is leaning toward the target at the top of the backswing. The upper body tends to dominate the swing and the player can lose power (and distance) as a result.  

How does it happen?

Without getting into the complicated spinal mechanics of a golf swing, the basic answer is through excessive spinal extension. Under normal circumstances, the trunk is slightly flexed (bent forward) at address, but it extends during the swing and ends up relatively extended at impact compared to address. What happens in the case of reverse spine angle, the player's spine extends too far, placing much more mechanical stress on the spinal joints.

What are the main causes?

According to TPI, there are three main causes for reverse spine angle: 

1. Upper & lower body separation: the upper trunk and shoulders should rotate around a relatively stable lumbar spine. Shoulder & thoracic spine mobility are important for this separation, especially thoracic rotation. 

2. Core stabilization (abdominal & gluteal strength): If these muscles are weak or not engaging appropriately during the swing, the player might lose position, especially at the top of the backswing and/or while transitioning to the downswing.

3. Hip internal rotation mobility: Full range of motion is 45 degrees. Many people, not just golfers, tend to lose this motion, especially with age. If the body attempts to rotate beyond the hip’s limits, the body might compensate with motion at the nearest available motion segment - the low back.

How do you correct it?

Consider working with a TPI trained physical therapist if you are experiencing low back pain with your golf game. Depending on your specific limitations, they might work on improving your thoracic & hip mobility so that the lumbar spine doesn’t move excessively to compensate. They might address what’s happening at the pelvis and work on finding the optimal position and maintaining it throughout the swing. It may also help to work with a swing coach for more swing-specific advice, such as shortening the backswing or flaring the trail leg outward at setup if hip rotational mobility is lacking.

-Matt Kooy, DPT

Headaches 101

Headaches - we've all had them. Did you know that not all headaches are created equal? Some types of headaches are caused by tight muscles or irritated joints in the neck and can be helped with PT. The four most common types of headaches are:

• Migraines

  • Often experienced in recurring episodes with visual or sensory symptoms

  • Can last from a few hours to a few days

  • Many experience sensitivity to light, sound, and/or smell

  • Often accompanied by an aura (a visual, sensory, or speech disturbance prior to the headache)

  • Typically felt as pulsating pain on one side of the head and are aggravated by activity

• Cluster Headaches

  • Experienced as a severe headache on one side of the head

  • Last 15 minutes to 3 hours, happen in clusters from weeks to months

  • Pain felt behind the eye, with eye watering and nasal congestion

• Tension Headaches

  • The most common type of headache, experienced by 30-78% of people

  • Typically felt as "pressing or tightening pain" of mild to moderate intensity on both sides of the head

  • Can last minutes to days

  • Not worsened with activity

  • Often come along with increased tightness in neck muscles

  • Can be improved with PT!

• Cervicogenic Headaches

  • Pain felt on one side of the head and/or at the base of the skull

  • Can be associated with neck pain, dizziness, or jaw pain

  • Caused by tightness in the neck/shoulder muscles or irritation of the upper neck joints

  • Can be improved with PT!

If you're having headaches, reach out to a PT to see if manual therapy and targeted exercises may be able to help!

-Meghan Hom, DPT

Sources:

• Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalgia. 2013; 33 (9): 629-808.

Exercises To Decrease Risk Of Common Soccer Injuries: ACL Tears

What is the ACL?

The anterior cruciate ligament (ACL) is a ligament that connects the femur (thigh bone) to the tibia (shin bone).  It is one of several ligaments of the knee that helps provide stability to the knee joint during movement.  The ACL prevents the tibia from shifting forward relative to the femur and provides some rotational stability to the knee.

Injury to the ACL:

ACL sprains are a common sport injury of the lower extremity.  ACL sprains are graded on a scale from 1 to 3 based on the amount of damage the ligament has sustained, with a grade 3 ACL sprain indicating a complete tear of the ACL.

ACL injuries are typically described as contact or non-contact injuries.  A contact injury is when direct impact or contact is made against the knee, for instance during a football hit or soccer slide tackle.  A non-contact injury occurs when an athlete moves in a specific way that overloads their ACL, which may include pivoting, cutting, twisting, or landing awkwardly from a jump.  ACL injuries are often non-contact injuries.  An athlete may be at an increased risk of sustaining a non-contact ACL injury if they have poor strength and movement mechanics through their legs.

Ways to Decrease the Risk of a Non-Contact ACL Injury:

An athlete cannot plan for contact injuries; however, they may be able to decrease their risk of sustaining a non-contact knee injury.  Exercise-based knee injury prevention programs are a great way to decrease the risk of non-contact injuries during sports.

According to guidelines from the Journal of Orthopedic and Sports Physical Therapy, “there is strong evidence for the benefits of exercise-based knee injury prevention programs, including reduction in risk for all knee injuries and for ACL injuries specifically, with little risk of adverse events and minimal cost.”

It is recommended that all young athletes, particularly age 12-25 years of age in high risk sports (football, soccer, rugby, netball, basketball, and skiing) participate in a knee injury prevention program.  This is especially true for female athletes under the age of 18 due to the increased risk of sustaining a non-contact ACL injury in this group.

A comprehensive knee injury prevention program should include:

• Strength training

  • Strengthening exercises of the core, hips, and lower extremities.  Exercises to include in a strengthening program are double leg squats, single leg squats, lunges, Nordic hamstring curls, plank variations, and heel raises.

• Flexibility exercises

  • Addressing flexibility of the quads, hamstrings, hip adductors, hip flexors, and calf muscles.

• Plyometrics and agility

  • To improve jumping and landing mechanics with exercises that include single leg jumps (forward and backward), skater jumps, and squat jumps, as well as running and agility exercises in forward, backward, and lateral directions.

A knee injury prevention program should also:

• Be performed multiple times per week with training sessions that last longer than 20 minutes

• Be started in the pre-season and continued during the regular season.

Examples of Knee Injury Prevention Programs:

• FIFA 11+

  • The FIFA 11+ program is a soccer warm-up that was designed by international sports medicine experts to decrease injury risk in soccer players aged 14 or older.  It was designed to be a comprehensive warm-up that incorporates jogging/running, strengthening, balance, plyometric, and agility exercises to decrease risk of injury during practice and games. 

  • CLICK HERE to learn more about the FIFA 11+ program here:

• Journal of Orthopedic and Sports Physical Therapy (JOSPT) Knee Injury Prevention Program

  • The JOSPT has created a knee injury prevention program with comprehensive exercises to reduce the risk of knee injury with sports.

  • CLICK HERE to see a video of these exercises for field sports (soccer, football, etc).

  • CLICK HERE to see a video of these exercises for court sports (basketball, volleyball, etc).

Working with a Physical Therapist:

A physical therapist can help screen athletes for injury risk and help athletes develop a program to reduce injury risk.  A physical therapist can help develop an exercise program that addresses an athletes specific strength impairments or body mechanics with sport specific movements.  To schedule an appointment with one of our physical therapists, CLICK HERE.

-Sean Tyler, DPT

Exercises To Decrease Risk Of Common Soccer Injuries: Muscle Strains

Muscle and tendon injuries are some of the more common injuries sustained by soccer players.  Muscle and tendon injuries are more common in soccer players than joint and ligament injuries, including ACL injuries.   Common areas for muscle and tendon injuries in soccer players include the muscles of the thigh and groin, mainly the quadriceps, hamstring, and adductor muscles. 

Soccer players may have an increased risk of injury to these muscles and tendons if they have any of the following:

• Poor muscle strength

• Poor muscle flexibility

• Hip and core weakness

• A previous muscle or tendon injury in these areas

• Too quick of a return to sport following an injury

Research studies suggest that regular participation in a lower extremity strengthening program may help decrease the risk of sustaining a muscle or tendon injury during soccer activities.  A comprehensive strengthening program for a soccer play should include specific exercises that target these areas.  Specific exercises for each muscle group will be provided in the sections below.  

QUADRICEPS MUSCLE STRAINS

The quadriceps muscle group (“quads”) includes the rectus femoris, vastus lateralis, intermedius, and vastus medialis.  These muscles are on the front of the thigh and are responsible for flexing (raising) the thigh and straightening the knee.  The quadriceps are a common area for strain during soccer due to the knee and hip forces generated with kicking and sprinting.  An exercise program that includes quad strengthening exercises, specifically eccentric quadriceps strengthening, can increase muscle strength and may reduce the risk of quad strains during sport activities.

See the Videos Below for Quadriceps Eccentric Strengthening Exercises

HAMSTRING MUSCLE STRAINS

The hamstring muscle group includes the biceps femoris, semitendinosus, and semimembranosus.  The hamstrings are on the back of the thigh and are responsible for extending the thigh behind the body and bending the knee.  Hamstring strains are the most common soccer muscle injury and often occur during high speed running, sprinting, and kicking motions.

During an explosive kicking movement, the hamstring muscles have to be strong enough to control the quick straightening of the knee and forward movement of the thigh.  A comprehensive exercise program to decrease hamstring muscle strain risk should include strengthening of the glutes, strengthening of the abdominals and trunk muscles, and improving eccentric hamstring strength. 

See the Videos Below for Hamstring Eccentric Strengthening Exercises:

(Exercise at 0:48 in this video)

ADDUCTOR MUSCLE STRAINS

An adductor, or groin strain is an injury to the muscles on the inside of the thigh.  The adductor muscles most commonly strained include the adductor magnus, adductor longus, adductor brevis and gracilis muscles.  The adductors are a common location for a strain to occur in soccer due to the high amount of eccentric loading with cutting, kicking, and planting movements.  A strain can happen in the muscle belly, where the muscle meets the tendon, or where the tendon attaches to bone.  Research suggests that including eccentric adductor strengthening exercises in a strengthening program may reduce the risk of groin injuries in soccer players.   

See the Videos Below for Adductor Eccentric Strengthening Exercises:

Questions? CLICK HERE to contact the author of this blog, Sean Tyler, DPT.

Exercises To Decrease Risk Of Common Soccer Injuries: Ankle Sprains

An ankle sprain occurs when the ligaments of the ankle are overstretched as the ankle is rolled, twisted, or turned in an awkward or unexpected way.  Ligaments are connective tissue of the body that connect one bone to another bone and provide support through a joint.  Lateral ankle sprains, or sprains to the outer ligaments of the ankle, are the most common forms of ankle sprains in soccer players due to the movements required of the sport.

Ankle sprains are assigned a grade (grade 1, 2, or 3) based on the extent of injury to the ligaments.  The recovery time from an ankle sprain is typically longer with higher grade sprains.

Soccer players may have an increased risk of ankle injury if they have any of the following:

• Weakness through the muscles of the calf and ankle 

• Poor balance and control of the ankle or foot with dynamic activities

• Tight calf muscles

• A history of previous ankle sprain or injury 

Our joints and tendons contain sensory receptors called proprioceptors that respond to the movement and position of the body.  Proprioceptors communicate information to our brain and muscles and help us maintain or change our body position.

Research studies suggest that regular participation in a lower extremity strengthening program that includes proprioceptive training may help decrease the risk of having an ankle injury during soccer activities.  A lower extremity strengthening program should also include exercises that address strength and mobility impairments in the ankle in addition to building proprioception. 

Check out the video below for dynamic balance exercises to improve ankle proprioception:

Questions? CLICK HERE to contact the author of this article, Sean Tyler, DPT.