Get Ready For Golf!

Get Ready For Golf

Golf season is upon us, and with it brings a renewed desire to improve upon last season’s accomplishments.  For some of us that may mean lowering a handicap or besting our all time score.  For others this may mean simply playing more.   For older adults this usually means staying healthy enough to play more days per week or more holes per round.  Many older adults take up golf for exercise or as an important social outlet.  In fact, 70% of golfers are over the age of 60.  As we age, it becomes harder to maintain good physical health in order to have success with golf.  The following is a brief break-down of some of the physical factors which may affect our game as we age.

It starts at the turf

 The interaction of your foot with the ground may be the most important and often overlooked aspect of the game.  We tend to focus so much on the motion at the hips, shoulders, and wrists we neglect the critical interaction that is occurring between our ankle and heel joints, and the ground.  During both back swing and follow through, having proper motion and control at these joints will set the foundation for everything that will happen above it, including proper loading of the hip muscles, from which we get most of our power.  Trying to golf without decent ankle/heel strength and flexibility is akin to golfing without spikes on.  Your body simply won’t interact with the turf like you want it to.

The Hips

The hips require a lot of internal rotation during the golf swing.  Internal rotation is the motion of your leg moving towards your body.  During backswing, the back side leg internally rotates, which activates and stretches the gluteal muscles, preparing them to accelerate the club.  Lack of internal rotation will result in poor gluteal activation, and decreased power.  The reverse is true with the front side hip during follow through.  As it internally rotates, the glutes are activated to decelerate all of the force from the swing.  Any loss of motion here may result in excessive strain up the chain (lower back), or further down the chain (knee).  This is why so many golfers, even at the elite level, have lower back and knee problems.   If you have had a hip replacement, which often results in some loss of hip internal rotation, you may have experienced difficulty getting your old swing back.  The good news is this can be fixed.

The upper back

The thoracic spine, which runs from the base of your neck to the bottom of your rib cage, is responsible for a tremendous amount of rotation during the backswing.  As we age, the thoracic spine tends to get stiff.  Age-related changes can cause a forward trunk posture, which makes proper rotation during both back swing and follow-through far more difficult, and sometimes painful.  Again, this may result in excessive strain elsewhere, such as the shoulders, elbows, and wrists.   Golfers elbow, when it occurs in the lead elbow (left elbow in right handed golfer), can often be traced back to poor rotation at the thoracic spine.  The player is attempting to decelerate the backswing motion using the elbow/wrist muscles, instead of the larger and stronger back muscles.

 

Balance

One of the most critical factors, and the one I probably spend the most time addressing with my older golfers, is balance.  Not only is good balance required for a proper golf swing, it is also an important safety factor.  The swing itself can cause one to lose their balance, as can walking on a variety of unstable surfaces including grass and sand.  Balance exercises, especially those designed specifically to golf, will help to keep you safe and enjoying the game.

Golf is a great sport because it can be played by people of all ages and ability levels, however it requires a certain amount of strength, flexibility, balance, and endurance.  It is possible, usually with a few simple exercises, to maintain optimal levels of balance and flexibility in order to continue to play at the level you desire.  When you prepare your body to keep up with the physical demands of the game you will be safer, you will be able to play more, and you will be better.

Brian O’Neil is a physical therapist and certified Nike Golf Performance Specialist at Magill and Gardner Physical Therapy, in Scituate.  For more information on the Golf Performance System, please contact him at BrianOneilPT@gmail.com, or 781-545-8114.

 

Snow Safety

A snow storm tends to be good for business if you are a physical therapist.   We commonly see patients during the winter months with injuries  due to slip and falls or back injuries due to shoveling.  It is estimated that over 11,000 trips to the ER each year are due to snow shoveling-related injuries, and  thousands more will visit their primary care doctors several days or weeks later due to back pain.  The types of snow-related injuries include broken bones, head injuries, back injuries, and heart attacks, with back injuries being the most common.  Heart attacks account for 7 percent of all shoveling injuries.   It has been found that shoveling can elevate cardiovascular demands above recommended levels in as little as 2 minutes, partly due to cold temperatures' restricting blood vessels.  Those over the age of 55 are four times more likely to suffer a shoveling related injury than younger people.

Here are some tips to help prevent injury:

•  Pace yourself.  Frequent bouts of less intense activity are safer for your cardiovascular and                musculoskeletal systems.  Shovel early and often.  It is much easier to push 1-2 inches                        of snow instead of waiting for it to accumulate and having to lift and heave several inches.
•   Choose the right equipment.  Use a light weight shovel, or one with a curved or extended handle       which is designed to reduce strain on your back.  If using a snowblower, don't lift,pull, or push it. Let   the machine do the work for you.  If the snow is light and fluffy a hand held electric leaf blower           works great to clear the driveway and cars.
•   Warm up.  Perform some gentle stretches to the calf, groin, hamstring (back of the thigh), and             lower back muscles before you start.  This may help prevent muscle strain.
•   Bend your knees.  We have all heard this one a million times, and I really can't stress this                 enough.  The muscles of the buttocks and thighs are the most powerful in the body, and designed to     handle the most force.  By bending the knees slightly while lifting we are engaging these muscles and     reducing the amount of force that reaches the spine.  When we first begin shoveling we have good       intentions of using our legs.  However as fatigue sets in we begin to use these muscles less and start     to use the smaller muscle of our arms and back more.  This is the time injuries are most likely to           happen.  Take frequent rest breaks, and continually remind yourself to use the leg muscles.
•   Get someone else to do it.  If you have a history of heart disease, back injury, or balance                 problems, you shouldn't be shoveling in the first place.  If you can afford to hire someone to dig you     out, then it is money well spent.  Don't be afraid to ask a family member or a neighbor to                   help out.  Many communities have volunteer organizations that offer snow removal assistance               to seniors.  Call your town's council on aging for more information.

If you experience any chest pain, dizziness, or difficulty breathing while shoveling, please call emergency services immediately.   A physical therapist who specializes in orthopedics can design a program to assist with recovery from back, neck, and joint injuries.

Brian O'Neil PT, OCS, CSCS is a physical therapist with Magill and Gardner Physical Therapy in Scituate.  He can be reached directly at BrianOneilPT@gmail.com or (781)545-8114.

Osteaoarthritis and Muscle Function

Osteoarthritis and Muscle Function

By Brian O’Neil PT, OCS, CSCS

Osteoarthritis (OA) is the most common form of arthritis, affecting some 27 million people in the US alone. Fifty percent of people over the age of 65 will have some evidence of OA in at least 1 joint on X-Ray. Risk factors for OA include age, being overweight, previous injury to a joint, genetics, and muscle weakness. Early signs of arthritis include pain, swelling, and reduced joint motion. One of the most common signs of osteoarthritis is stiffness in the morning or after a period of inactivity, which in the early stages usually resolves after a 10-15 minute warm-up period.

Many studies have focused on the relationship between muscle weakness and osteoarthritis. Significant weakness in both knee and hip muscles has been found in patients with knee arthritis. For years it had been unclear whether the weakness was a cause or a result of the arthritis; however more recent evidence indicates that muscle weakness in many cases precedes the onset of OA at a specific joint. It has also been well documented that swelling in a joint will inhibit, or shut down the muscles around the joint. This is a normal protective reflex in which the body is attempting to protect an injured joint. However, this prevents the muscle from being fully activated during voluntary contraction, and will lead to muscle atrophy, loss of strength, and difficulty with functional activities. Researchers have also recently found that strength deficits are not strictly isolated to the leg with the arthritis. The opposite limb will also exhibit muscle weakness, even when no OA yet exists in that limb.

Exercise, including targeted resistance training, global strengthening, and aerobic conditioning, has been shown to reduce pain and improve function in people with both knee and hip OA. Specific exercise can be used to reduce muscle inhibition. Exercise programs must include the entire lower extremity, and should also include strengthening activities for the uninvolved limb to promote function and prevent or delay onset of OA. Exercise programs must be considered long-term management of symptoms, with consistency the largest predictor of a positive long-term outcome. With recent evidence suggesting that muscle weakness precedes the onset of OA, exercise must be considered an important factor not only in the treatment of OA, but also in prevention.

Brian O’Neil is a physical therapist with Magill and Gardner Physical Therapy. He can be reached at MGPT@Comcast.net.

Falls and How To Prevent Them

By Brian O'Neil PT, OCS, CSCS

One out of three adults age 65 and older will fall each year.  Falls are the leading cause of injury death in the US, with 20,000 deaths among older adults each year.  Fifty percent of those hospitilized due to a fall-related injury are discharged to long term nursing care and will never return to independent living.  Direct medical costs from falls amount to almost 30 billion per year.  There are several risk factors that will increase an older adult's chance of suffering a fall.  They include gait and balance problems, poor vision, muscle weakness, chronic health problems, diabetes and/or peripheral neuropathy, taking 4 or more medications, and environmental factors such as poor lighting and lack of hand rails and grab bars.  Although advanced age is a risk factor, falls are not a normal part of aging and should not be tread as such.

Fall prevention must begin in the home.  Grab bars should be installed in the shower and beside the toilet.  All stairs should have hand rails on both sides, and any scatter rugs should be securely taped down or removed.  Re-arrange closets and kitchen so that the things used most often are between waist and shoulder height.  Review medications with your physician to see if dosages can be reduced, and see your optometrist yearly to have your vision checked.  Increase your vitamin D intake to help improve muscle strength.  You may also consider beginning a community-based exercise program, such as Tai Chi or the Otago Exercise Program.  Both programs have been thoroughly researched and proven to reduce falls from 35-60%.

Tai Chi is an ancient Chinese martial art that has been adapted over the past century into a popular exercise form.  It involves gentle motion exercises that improve body awareness, balance, and strength.  It is offered by many communities, including here in Scituate, as a proven, effective fall prevention strategy for seniors.  It has many other health benefits as well, including stress relief, cardiovascular health, and joint health.

The Otago Exercise Program is another evidenced-based exercise program designed to improve strength and balance.  Initially instructed by a physical therapist, it can be performed at home at a person's own convenience.  This program involves low-impact, standing weight training and balance exercises, and is supplemented by a walking program. 

If you have fallen in the past or feel like you may be at risk, please visit your doctor or physical therapist in order to be properly assessed and referred to an appropriate fall prevention program.

Brian O'Neil is a physical therapist with Magill and Gardner Physical Therapy in Scituate, Massachusetts.  He can be reached at mgpt@comcast.net.

 

Posture and Aging

        

My patients often ask me what they can do to improve their posture.  As a physical therapist, posture, or the correction of adverse postural adaptations, is one of the things I most frequently work on with people.   Posture is not only the basis for movement but also contributes to our overall health and well-being.  Good posture is essential for proper movement of the extremities, balance, gait, breathing, and emotional health. Poor posture can not only lead to problems with the musculoskeletal system but with cardiopulmonary and peripheral nervous systems as well. Research has shown that individuals with poor posture have higher incidences of depression, lower subjective life-satisfaction scores, and higher rates of chronic pain. Postural adaptations are a normal part of aging, but are effected by a confluence of physiological and environmental influences.  The more we can change or limit these influences, the more control we will have over our own posture and thus our overall health.

As we age, many things contribute to postural adaptations. Degeneration of the spine begins gradually in the third decade of life.  The intervertebral discs, the cushioning structures between each vertebrae, begin to lose some of their water content and also begin to lose height.  The individual bones, called vertebrae, begin to lose minerals which results in less dense, brittle bones. The breakdown of the vertebrae can cause excessive kyphosis, or forward lean of the mid and upper back. Osteoporosis can make this worse. And because this is the foundation for the head and neck, this will cause the head to pitch forward. If this becomes severe it can compromise lung capacity and can contribute to breathing problems and higher risk of pneumonia. It will also limit normal mobility at the shoulders and can lead to bursitis, tendinitis, and arthritis of the shoulders.

Other postural adaptations can be seen in the lower extremities. Decreased sensation and balance will result in a wider base of support and toeing out at the feet. This can lead to inhibition and atrophy of some of the larger core and buttock muscles, further contributing to functional weakness. Shuffling gait, decreased step length, and fear of falling can contribute to a higher risk of falls. Age-related collapsing of the arches of the feet can result in slightly flexed knees and hips, further contributing to a hunched over silhouette. 

Many of the unfavorable postural adaptions described above can be slowed or prevented. Regular stretching of the chest and back muscles can prevent excessive kyphosis. Regular balance exercises can help with fear of falling and gait disorders. Strengthening exercises for the arms, legs, and back muscles will contribute to more upright posture, and regular cardiovascular exercise will contribute to emotional health and help to keep all of your joints healthy. I would encourage anyone serious about addressing their posture to consult their physician or visit a physical therapist to learn how they can begin to make these changes.

Brian O’Neil is a physical therapist with Magill and Gardner Physical Therapy in Scituate, Massachusetts.