Written by Dan Nagorski PT, DPT
If you’ve ever had low back pain, I’m sure you’ve heard the phrase “tighten up your core.” But have you ever stopped to think, “What muscle’s really make up my core?” A common misconception, that many people think, is that you need to strengthen up your rectus abdominus, also known as, the “six pack abs,” in order to work on your core. In reality, this muscle is not part of the “core” group of muscles used to stabilize your spine; and by purely strengthening your “six-pack,” you can potentially make your symptoms worse.
The core is actually made up of several muscles, but the 2 main stabilizers are called the multifidus and the transverse abdominus. (See diagram) The way that these 2 muscles work is that they help control trunk rotation, and they provide adequate space between the lumbar vertebrae.
A common reason for low back pain is the fact that these muscles do not contract, or “turn on,” in time to dynamically stabilize your spine. This can lead to excessive compressive and shearing forces through your spine, which over time will lead to a very painful low back. There are many different ways to exercise these specific muscles, but if you’re not performing them properly, and with good technique, it may have the opposite effect that you’re looking for.
Physical Therapists are skilled clinicians who are capable of educating and prescribing exercises to our patients, which properly engage these muscles. If you have low back pain, contact your doctor and see if physical therapy is the solution to alleviating your back pain.
Paspa Physical Therapy is very proud and excited to be part of an honorable charity called Crutches4Kids! We are presently participating in collecting your unused assisted walking devices (Crutches, Canes and Fold-able Walkers) and recycling them to children in need all around the world.
To get involved all you have to do is deliver your Crutches, Cane or Walker into our office and hand it over to the reception! If you have any questions please feel free to call.
Learn more about this organization here: http://www.crutches4kids.org/our-mission/
Spring is in the air! Flowers are blooming. The weather is getting warmer. Allergy medicine is flying off the shelves. It also means that baseball season is in full swing around the corner. It’s that special time of year where fans of every team (yes, even the Cubs!) can dream of being World Series champions. However, injuries can turn every fan’s dream season into a nightmare in an instant. Baseball players (especially pitchers) are very susceptible to shoulder injuries, and rotator cuff injuries are among the most common.
The rotator cuff is a group of four muscles and their tendons that help to stabilize the shoulder joint. Those muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. They act together to keep the head of the humerus in the shallow shoulder joint. When raising your arm, the rotator cuff muscles compress the glenohumeral, or shoulder, joint to allow your larger shoulder muscles (primarily the deltoid) to further raise the arm. These muscles also serve as internal and external rotators for the arm, two very important motions for throwing a ball. These muscles must be strong enough to work against very high velocities of rotation in the arm (up to 7000 degrees/second!).
For pitchers, having these muscles working optimally is paramount to avoiding injury. If these muscles are not working as they should, the head of the humerus will ride upward and compress the space above the joint. This can lead to irritation of the tendons and, if left untreated, a rotator cuff tear. Muscular imbalances, improper throwing biomechanics, or overuse are all causes of rotator cuff problems.
Initially, conservative treatments such as oral anti-inflammatories, physical therapy, and abstaining from throwing for some time are done to see if the injured tendons will heal. Sometimes, doctors will do a corticosteroid injection to bring down the inflammation. Once a patient is pain free, he can begin Thrower’s Ten exercises, a series of exercises designed to increase shoulder and scapular musculature strength. When the player has regained his shoulder and scapular strength, he can begin a modified throwing program.
If conservative treatment does not help the player return to playing, surgery can be performed to repair the torn tendon. This is usually done arthroscopically; for massive tears, the doctor will perform open shoulder surgery (though doctors will try to avoid this as much as possible). Rehabilitation after surgery is a long process, as patients cannot begin sports specific activities until about five months post-operatively and cannot throw until about six months.
So if your fantasy team’s number one pitcher should unfortunately have a rotator cuff injury at some point during the season, does this mean he is done for the year and it’s time for you to hit the waiver wires? Not necessarily. Keep a watchful eye to see the severity of the injury. If a tear is suspected, he may have surgery and the player may be shut down for the year. With tendonitis or irritation of the tendon, the player might just be on the disabled list briefly and should return. Many players, such as the Pedro Martinez and Orlando Hernandez, have recovered from rotator cuff injuries.
However, the success rate for recovering from rotator cuff surgery are mixed, and there are many players that never return to their pre-surgery status. A recent study in the Journal of Athletic Training showed that pitchers that had rotator cuff surgery had three seasons of gradual improvement, but they never fully returned to their pre-injury form. Each pitcher has many different variables (age, injury history, extent of injury, pitching biomechanics, and others) that play a role in whether or not they will fully recover from a rotator cuff injury
So kick back, relax, and get ready to “play ball!” Just hope that your favorite pitcher does not have to hear those three dreaded words: “rotator cuff tear.”
Check out Alter-G founder Sean Whalen talking about his revolutionary development of the Anti-Gravity Treadmill!
People are referred to physical therapy or PT as the field is commonly called, for numerous diagnoses from various medical doctors. (PT’s must be licensed to practice in most states of the US.) PT’s will see diagnoses coming from orthopedics specialists, sports medicine doctors, neurologists, rheumatologists, endocrinologists, podiatrists, primary care MD’, physiatrists and gerontologists. Diagnoses ranging from low back and neck pain, shoulder/knee pain, repetitive strain injuries, ACL reconstructions, arthritis, running injuries, balance, gait disorders, neurological problems, post arthroscopy and much, much more.
In the orthopedics and sports medicine, the area of my practice, we see many patients both surgical and non-surgical. The physical therapist will initially do a comprehensive history and physical therapy examination. They will review the information gathered and put together a treatment plan/program. Patients are often given home exercises to enhance / speed their recovery.
Evaluation: The physical examination in orthopedics consist of many different clinical evaluative tools but mainly we will look at posture, gait, balance, range of motion of the affected joint, strength, special tests to assess specific muscle group and palpation.
PT’s are experts at movement evaluation, bio-mechanics and alignment. We spend a good portion of the initial consultation looking at how someone moves both statically and dynamically. The information gathered can give us many clues as to why the patient is having pain and dysfunction. We analyze these clues and are often able to zero in on the problem area.
Treatment: How is the physical therapist different from a massage therapist, chiropractor and personal trainer? Well, for one thing we are use many “tools” to treat our patients. One of the most important things we do is to educate our patients. Education allows our patients to fully understand what is going on and why they have pain. Now they can make the changes in their daily routine so that the problem does not get exacerbated. The goal is that they will not repeat postures or movements that are causing their pain or dysfunction.
Physical Therapists are skilled in palpation and manual skills. PT’s are often able to assess swelling, loss of muscle length and flexibility, poor muscle tone and many other soft tissue problems by using our hands. Physical therapists will incorporate numerous manual therapies – soft tissue mobilization, joint mobilization, massage and release techniques. The “hands-on” techniques we perform can loosen a tight muscle, increase circulation and mobility of a joint.
Providing exercise and stretching programs are an integral part of (what we do/our patients’ recovery.) Oftentimes patients are not exercising or training correctly and need a PT’s guidance. As you know exercises can strengthen muscles but oftentimes people do not perform a balanced strengthening program and this can lead to injury and pain. Usually on the first visit, the PT will provide a home program.
Other tools we employ are taping (ie: Kinesiotape,McConnell tape) gait and running evaluation using video analysis software, special equipment such as an ultrasound and laser unit, and one of the newer pieces of equipment you may see in a PT practice is an AlterG treadmill or anti-gravity treadmill.
Physical therapists primary goal is to treat their patients using non-evasive techniques and to get them back to full function in their daily life and sport.