SI Dysfunction
 

Have any of you found that SI problems in golfers, and/or Sciatica, especially in the right hip or leg to be common problems with golfers?

Hamstring stretching, and and some lunges seem to help me some?

Thanks Vickie and Physioguy for the exercises!

Lagster, I have to tell you that I deal with SI with low back issues with every golfer. If they haven't developed sciatic nerve symptoms before they create a balance between the cervical and sacral regions of the vertebrae it is unavoidable. It has been completely reversable or managed without surgery with 100% percentage of my clients that have not already had surgery and do not have some other malformation of scar tissue or herniation that has created adhearance or fusion of the vertebrae. I sent a guy to an orthoped a few weeks ago and now he's on the natural path to stop the degeneration. I encourage everyone to re-visit the earlier thread and look at the information shared by physioguy. He is very poetic in verifying tha fact that most people, even non golfers, carry their body in a manner that promotes these hip and back problems. They just don't expose their pain and disfunction because they aren't passionate in their ability to use their hips.

vik

I am finding that it's unusual NOT to find some sort of sacro-iliac dysfunction in most clients with low back pain, among other problems (eg. hip flexor tightness). The culprit seems to be a lack of movement. Today's fast-paced, ultra convenience lifestyle has made most activities automated and sedentary, and, people don't make the time to devote to a regular exercise routine. We tend to sit too much, which causes the SI joint to stiffen up, as well as promote tightness in the hip and thigh musculature, particularly the hip flexors. The whole core tends to "gum" up and weaken (I recently treated a 27 year old construction worker. You would not believe how stiff his spine had gotten. He almost moved exclusively at the shoulder and hip joints, and not much in between).

Vickie has posted extensively to some of the imbalances that develop in the body, which affect our posture and movement (sit at a bench sometime, and simply watch people walk. Even without any training in biomechanics, you should be able to pick up some obvious deviations and assymetries in walking/gait). All of this puts abnormal or excessive stresses on the tissues of the body, which WILL eventually lead to tissue breakdown, such as a disc herniation. As we should all know by now, back pain tends to be cumulative. Of course, my clients always say, I never had a bad back, to which I say, "until you had a bad back!" Meaning the damage started long before the pain was actually felt.

What this all means, is that this tightness and movement restrictions at one or more joints, will demand that the movement occur elsewhere. The low back, unfortunately, often takes the hit. Many people are literally wearing out their backs day by day. Even the sacro-iliac, which has a very liimited amount of movement, can harm the low back if that little movement isn't there to feed into the system.

Hamtrings stretches and lunges are a good start, but because the SI joint has such jagged articulations, and huge, thick honkers of ligaments, the joint may have to be mobilized manually first. Following, exercises such as lunges may help keep things moving.

(An aside - it will be interesting to see how the current generation does with musculoskeletal problems. The current rates of childhood obesity, and the onset of adult diabetes in kids is alarming. Due to computers and video games, todays kids seem to be more sedentary than ever, which could mean big problems down the line)

Sorry for the length of the post, and the possibly scattered ideas. I could post pages about this subject!

I play 1.5 hours of rather intense racquetball every weekday. I feel good when I get off the court--tired, but good. I try to get in some post match stretching but more often than not it's a quick shower than back to sitting in front of the computer. If I get busy and don't get out of that chair for an hour, when I finally do get up I can hardly walk!! I just assume not sit for awhile after I play if I could.

Heh, you are not alone! There's comfort in numbers, no?

At least you are somewhat active.

I think the toughest thing to do in my line of work is convince people that they NEED to do some form of regular exercise. I don't mean joining a gym, although that might be a good thing to do.

A good program could take as little as 15-20 minutes a day, 3-5 days per week. (although I would still ask people to stretch multiple times per day)

I feel like crap when the clinic is crazy, and I don't get a chance to work out. I am just now returning to regular exercise after about 1 1/2 months of relative inactivity due to a health problem. It is amazing how quickly you lose your conditioning. Felt as weak as a kitten today! The good news is, the soreness will go away, and the strength will return in 3-4 weeks.

SI
 

Thanks Vickie and Physioguy!!

What about POSTURE? I have found that working on good posture... feels nearly military to me... seems to help with the back and SI pain.

In your opinions... what should correct, or good posture look and feel like?

I know there are various opinions on what correct golf posture should look like, and this is important. I am talking here, however, about standing, walking, and sitting posture in daily activities.

Oh boy,

Posture is one of those things that we always assess, but ultimately posture is a result of your habitual positions and activities, including resting activities, your flexibility, your strength/stability, gravity, etc. You've heard the phrase "you are what you eat"? Well, a similar saying for posture could be "You are what you do."

I know Vickie has talked about postural alignment in the past, so I'm hoping she will pop in.

In the textbooks, there is an "ideal" posture, where you look at where certain anatomical reference points line up. With regard to the spine, it should have three curves, looking like a shallow "S" when seen from the side. This is considered a neutral posture, and places the least amount of stress on the spine, as the stress is spread out around the column.

Of course, I have mentioned that many things affect posture. If we tend to slouch, the body basically succumbs to gravity, and typically the anterior (front) structures of the body tighten. The head drifts forward, the front neck muscles become tight, the chest muscles tighten, the shoulders round forward, the arms internally rotate. As we get older, the abdominal musculature tends to weaken, and, maybe combined with a little spare tire, stomach protrudes, and the low back becomes hyperarched. The hip flexors, if tight from too much sitting and lack of exercise, are so strong, they literally can "pull" the pelvis into a forward tilted position, which also contributes to an arched lower back.

You are correct that good posture may feel "military." Correct "textbook" posture, is so rare, that those people tend to stand out.

Here's the thing - I have basically stopped giving my clients traditional "posture correction" exercises. I have found that I don't get success by getting the client to "think" about their posture. I get better results by prescribing exercises which drive the body regions where I think they need to go, and then the good posture basically develops naturally.

I'll stop here, and wait to hear others' thoughts on the subject.

Physioguy is right on the money,as usual, the best way to correct your posture is by putting yourself in postures that "allow" your muscles to "remember" the way they are supposed to support the spine in action. Exercise is not natural and when you are doing a stretch or a strength movement your body is your machine. But you're right when the workout is over you don't want to feel that rigid.

If you stand facing a mirror and the back of your palms are mostly flat then you are probably rounding in the shoulders and your neck is probably protruding forward. If you look at the vitruvian man (think Leonard di Vinci's naked man in the circle) and you will see palms open, this is an over corrected posture, the one you use to workout. People with good posture will have their shoulders back, their ears up and back over their shoulder bones and the web of their hand (between the thyumb and index finger) will be reflected in the mirror instead of the hand surfaces.

Your body has a priority protocol to keep the atlas, the first cervical vertebrae (that your head sits on) and your sacrum in positive alignment. The extent to which your body can maintain this healthy aligment is a function of your repetative movements in your lifestyle. If you keep your body in alignment it will repeat that mechanical behavior, if you misalign throughout the day and don't correct then, you guessed it, it will move to the aligned postures you create most often; even to it's own detrement An easy example: The reason most golfers have a high shoulder is that they put their body in that posture frequently and repetitively to hit a golf ball without following up with a request, a correction in the alignment, to come back to a more balanced posture.

See your bones go where your muscles take them. So if the weight of your head is forward and your shoulders are rounding then the muscles will create a tension to maintain this posture. Your stretching program and your strength training program are critical to remind your body of the proper relationships of the muscles to the spine. The body has a preference for balance but can only comply with the physiclal movements to which it is exposed.

Reversing misalignment, bad posture, can take some time. Remember, when you start a program your body isn't performing the complete stretch so you can't get frustrated and say the workouts aren't working until you have been able to perform the movements perfectly and repeatedly. There aren't a lot of people who can do that. Everyday, when I stretch, yes everyday, I give my body an opportunity to revisit the appropriate balance of tension on my right side relative to my left side throughout the length of my spine, from my head to hips. As a consequence I don't have any back pain (I spent most of my young life in continuous but not too much crippling pain) If I feel my low back tightening up because of the activity of my life (whether it's golf, tennis, gardening, sitting at the computer) I will drop right down on the floor and do the torso twist at my first opportunity.

I start every day with about six stretches;that takes about ten minutes. I do almost the same thing at night but add or take out movements and substitute stretches that 'feel right'. Three times a week I have a stretch workout that lasts about 30 minutes where I am really working on a lot of different movements and I hold the positions for up to 90 seconds. This is usually on a shorter strength workout day immediately after my workout or later in the day in front of the news.

One of the reasons I like dumbbell work in strength training programs is that it really forces you to see your bilateral strengths and weaknesses. That is, you can see if you have a stronger side that helps out the weaker side. If you are holding a weight in each hand you can see when the weaker side is strugging. This tells you what you should be doing in your workout more accurately than following any single program someone else suggests. With every client I walk into their home with an idea of the specific work I want to accomplish and then as I see their body work realize I need to change adjust the focus of the work.

If it sounds like a lot to do just think how much the dentist could inflict if you didn't brush and floss appropriately. Your body requires the same consistent maintenance your teeth do especially since we like to use or bodies in a very aligned sport. It is a great fix for keeping your body usable, pain free and the best preventative for arthritis. You're not going to stop eating so you keep flossing.

Do your stretches, don't think about it, just treat yourself well. Be easy in your daily work when you are beginning and enjoy the relaxation. Never stretch to the point of grimmicing but make sure you really feel the stretch and be very strict in your technique. I figure there are enough threads about strength.

Gee physioguy, I may be making your thread look short.

Vik

POSTURE
 

Thanks Vickie and Physioguy!!

It sounds as if stretching and proper exercises help to encourage and set up one's posture.

Should not one consciously adjust one's posture when they find themselves getting tired and slipping into a slump or poor posture? This seems to help me.

While we are on this... what about matresses, chairs, and special pillows? I have heard that these things can make quite a difference.

Also, what about sleeping positions? I heard that stomach sleeping, for example, is bad for certain back and hip ailments.

Hi Physioguy

In the position you described (foward head, rounded shoulders) wouldn't the muscles in the back of the neck become tight?

TC

I use to pop several advils before and during each round of golf but after working with Yoda at the Pine Needles workshop I haven't needed an advil ever since to play golf. Good TGM mechanics are priceless. I know this is not the answer for everyone but I have a history of bad backs and have none playing golf since.

Well, certain muscles (the small ones at the base of the skull called the suboccipitals) basically tighten, from having to hold the head up (the suboccipitals are notorious for headaches starting at the back of the skull). But, generally, the muscles on the back of the neck are called extensors. If the head is drifting forward (in a flexion direction), the muscles are actually getting stretched. Due to the forward pull, they often feel tight, and the tone does increase, again because the muscles are on tension, holding the head up. You see, with balanced posture, the head basically sits or balances on the spine. When then head drifts forward, something has to hold it up against gravity. This is part of the reason most of us need a massage to our shoulder and neck muscles. Because the head is in a forward position, the muscles in front of the neck, the flexors, are in a shortened position, so they really are tight.

So, we may be talking semantics here, but the upper back and neck muscles tend to get into a "stretch weakness" with a forward head posture - but they have increased tone. Does that make sense? Tight, to me, refers to shortening of a muscle, while tone refers to the texture of the muscle itself.

Yikes, this stuff is hard to explain in writing!

Your mattress is really of critical importance. You should look at your warranty but if you've had a mattress for more than 7 years it will probably be showing wear in the posture your body settles most. I don't adhere to the sleep posture postulations. I think your body will move around and should move around and this should all be a part of your recovery for the day. Make sure your pillow is high enough for your shoulder height but be sure when you are on your back you aren't feeling like your neck is protruded forward. I personally use the pillows from brookstone and then put a feather pillow on top of it. This combination gives me support and movability; I move a lot during sleep. Some people move less, you just have to support your rythm.

Yes, strength and flexibility training re-establish the muscle memory that remind you to maintain your posture without continually pulling back your shoulders. You will just find yourself looking for the right position. Appropriate tension will allow you to keep your chest lifted, your abdominal wall long and engaged to give rest to your neck and back. Imagine that you've learned a new language and you don't speak too well. you take it to the native country and learn to become fluent. If you come back home and don't use the language for an extended period of time you will loose your memory of the language. Such is the language of the body. Use is appropriately and often and it will maintain itself without so much mental intervention.

Vik

Re: POSTURE
 

Sorry, missed this one.

While it is great to remind yourself about posture (and it helps if your loved ones remind you about it, too), I find that it doesn't completely do the trick. Good posture has to become not a habit, but the way your body naturally wants to be in. And that has to come with proper flexibility (i.e. nothing is being strained to maintain good posture), and strength/endurance (i.e. again, nothing is being strained to maintain proper posture).

The average person is basically succumbing to gravity, as discussed with the rounded back, head-forward, rounded shoulder posture. Many people can't get close to the "ideal" posture, they need to work on flexibility big time, not just of the muscles, but the joints as well.

As far as mattresses, chairs, etc. I don't think you need to do anything fancy. For chairs, sit up straight. Period. (Mom was right all along) For sleep, try not to prop your head up on a bunch of pillows. You want to maintain normal alignment, you want to SUPPORT your head and neck.

Sleep - well, sleep gets complicated. Prone lying tends to encourage a rotated neck (otherwise you couldn't breathe!). Side lying, while comfortable, encourages hip flexor tightness - if you use this position, try a pillow or spacer between the legs to maintain spinal alignment. Supine lying would be great, if you can tolerate the position (many people cannot due to hip flexor tightness)

Hope this helps.

Re: POSTURE
 

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What about the firmness of the matress? I have also heard about matresses made from the same material as the FORM adjusting pillows.

Managing your back problems!!!
 

The answer is Trigger Point Therapy.
Start here:
http://www.mypressureproducts.com/pa...ence_chart.htm
They sell a device which you do not need.

There is also a great book on the subject highly recommended:
http://www.triggerpointbook.com/ also available at Amazon for less.

All you need to get started is a large super ball or lacrosse ball. Using a wall or the floor start deep massage on the trigger points. Depending on the injury and history it can take days or months to completely dissolve the trigger point. It is painful (in a good way) work but well worth the effort. Best of all you heal yourself at your own rate and at no cost.

Once you have the trigger points unlocked begin a strengthening program
to prevent future injury. Keep using the trigger point therapy to keep the muscles free of pain.

Re: Managing your back problems!!!
 

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Those things look really good MB6606!!! Thanks!!!

Sounds a little similar to what acupuncture is supposed to do to help pain etc..

Muscle stiffness and lack of function, including pain associated with physical activity in sedentary people can be due to atheroscleroses in the extremities of inactive people. The pain, the weakness and the stiuffness are caused by lack of oxygen in affected tissues. It is, to some extent reversable if not too far gone, you can regrow new blood vessels to the affected regions. However, if it is too far gone, it is not reversable. You will go from a walker to a fancy chair that is provided at no charge to you, thanks to the US taxpayer!

These are the same sorts of lesions in blood vessels that cause most heart attacks. When you watch a commercial talking about how some remedy prevents platelets from "sticking", look at the underlying lesion, the atherosclerosis. These things are the real issue here, and they happen all the time in your extemities (or so they say, my wife is the real expert here...but she is not here at the moment). If you are active, you will pretty much have a functional system for maintaining blood supply to the extremities, but if you get too sedentary, they more ot less shut down, and if they get really bad, you lose the ability to regrow blood vessels in certain parts of the extremities.

So staying active is really important!

Yes, Lagster, You are talking about the temperapedic bed, I think. I have seen it, layed on it and think it feels great. I have your basic (not inespensive) Sealy Posturpedic Firm Mattress and find it quite satisfactory.

When I start with a client there are three places we begin. With their mattress, with their supplements, and then with the workout program they already use. 50% of the time we replace the ten year old mattress, most of the time I have them finish their supplements and reduce the amount they take, and I try to work always with what a person thinks they need and build from there in their exercises.

Being comfortable in your body and your sport is not rocket science but it is science and takes a certain amount of attention. As Mike posted, however, the TGM technique has reduced the torquing problem I have had with most of my clients. For people on this site, Golf should not provide additional incentive for back pain. In fact, the mechanical specificity should be considered a plus as it makes you more aware of your "alignment" mechanics in general

Happy Golfing. Vickie

Re: Managing your back problems!!!
 

I am dealing with lower right/hip issues right now. I found a guy that does trigger point therapy and it has been helping me a lot.

The main culprit is my hip flexors. Learning to stretch those properly is critical to the sciatica issue. However, the sciatic is just a symptom of some of the other mucsles in the low back pulling on the vertabrae. According to my guy, this can cause bulging and pressure on the nerve. Many doctors recommend drugs and surgery for this type of injury. But I remain hopeful that surgery will not be needed in my case.

The type of treatments I'm getting are based on the Chinese healing art known as "qigong anma". Westerners do a similar thing and call it trigger point therapy. By the way, these sessions can be brutal. But they work.

Although the sessions can be useful and expensive why not get a superball or lacrosse ball and do it yourself on the floor or against a wall.
Trigger point therapy works best if done at least 3 times a day (small doses). You may have the greatest therapist in the world but only you can feel the points where it is needed most on your body. In addition you will need to maintain these muscles if you continue to play golf or exercise.
Use the ball for 5 minutes before you play and later after you play when the muscles tighten up. I recommend rubbing over a sore spot (Trigger point) a minimum of 12 reps before moving on to the next trigger point.

Wow I love this expansion of the discussion of managing a healthy back. Exercise is necessary but these tools are viable and I use them in my practice daily.

There is a tool that also can help you reach your pressure points without straining your body or needing another person to assist and is more specific than balls. You can get it in any good health food store (not the GNC). It is shaped like an "S" and is probably about 2-3 feet long. It has a number of stretegically placed blunt nose nodules that you can place exactly on your pressure/trigger point and because of the curves you can apply pressure with the greatest of ease.

When I return from the client I am running out now to see I will find a resource on the internet and supply a link. I don't want to endorse any one provider and personally love to support my local businesses when I can but a picture is worth a thousand words and you can know better what you are looking for.

Vickie

Ok this tool is called the Backnobber. The ones you cn find from the site I listed below only have knobs at the ends. I have on from a health food store that has atleast ten knobs along the body of the apparatus and I love that one. I also have the original Backnobber II that I can snap into two pieces so it's easy to travel with it. I typically need one spot on my neck attended to when I travel so I often travel with only 1/2 of that toy.

For pictures of all of their styles:
http://www.pressurepositive.com/prod_selfcare/

To better understand trigger points
http://www.pressurepositive.com/info...ggerpoints.asp

To administer pressure for yourself
1.http://www.pressurepositive.com/infocenter/selfcare.asp

2.http://www.pressurepositive.com/info...backnobber.asp

Happy pressing. Vickie

Thanks
 

Vicky,

Thanks for the great links.

Do you have any pictures showing the best exercises fo strengthening the core?

The simple truth, Trig, is that the core muscles are the large muscles of the body that provide the power for the movements that provide free and full range of motion Most people think that core training is limited to the torso, mainly abdominals and back, but that is anatomically incorrect. One day we'll really explore the anatomy of the muscles. Anyway, that is a gross oversimplification but it is at the heart of the matter.

A really balanced resistance training program wil address these issues. Now the secret is to know how to organize your exercises. Most people don't have a balanced frame so when they start a program that looks balanced ,they are actually neglecting to recognize the functional individuality of their own physical needs. One person may need more abdominal work, someone else may need more work in the functional hip muscles, another the back, someone else might find very little work get's everything moving and someone who looks like they have it all together may find a more complicated program is made to order.

Now let me state here that I consider a balanced strength training program to include resistance training (whether it's weights, bands, medicine balls or your own body weight) and you must also have a flexibility program that correlates. Your muscles have two primary functions, contract for power and flexibility for counter balance. It is the perfect orchestration of these two functions with the appropriate muscles that keep the spine neutral. The better the communication between these two functions, the more range you can accomplish and the less potential for injury and thereby negative symptom you will experience.

This is as "lay person" languaged as I can make it and I think it is important to be that basic. I use kinesiology (muscle testing) to determine the orchestration of my clients programs because it looks beyond the obvious imbalances and attends to the way the muscles work together; which could also be termed the way the muscles communicate. It isn't always just mechanics. There are many neurological, emotional, behavioral, and chemical components to the way a body works.

Whoa, you might be thinking. Be not disuaded, much good work can begin with a sound program and some good instruction. If you can find someone to do a kinesthetic survey, all the better. But there are good trainers out there that know how to work more specifically with your physiology. You just have to be willing to interview a few.

For the record I should point out that the popularity of core training was inspired by the popularity of pilates in the last few years. I have been asked about this mode of training a number of times and could refer to previous posts. Mainly I would say that if you are considering this version of core training you still need to interview and even observe a class before you attend. With some of the permanent spinal disabilities I live with (without pain or diminished life activity, by the way) I needed a pilates facility that could address a more general population with really talented teachers. I found one, but not without rejecting a few reputable facilities in the process. You have to pay attention to your needs. Period.

Vik

McKenzie therapy?
 

Today I saw a spine expert and the good news is he said I have no serious back problems, ie, disk problems, etc. His view is that a McKenzie trained chiro and/or therapist will be able to take care of my issues.

Vicky - do you know anything about this type of therapy.

By the way, he also said I do not have sciatica problems.

- Trig

Edit - here's the website http://www.mckenziemdt.org/index_us.cfm

Great news for you Trig! I am only familiar with the method as a comprehensive, methodical, and effective modality with the proper learning. Basically you will have an evaluation and then movements will be assigned. I'll try to look into it a little further. Let us know if you take it on. Vickie

Stretches
 

Lunges and hamstring stretches help some!!

Do you have any other stretches to loosen up the S.I. area?
How long do you hold the stretches?

I've tried a couple of Yoga type classes. That does seem to help some, but they hold many of those poses for quite a while.

You know, I agree that you have to train the body to allow it to 'learn' to maintain itself. I teach it everyday. The body will truly comply with the most frequently 'requested' posture, period. I do think mattress quality matters and am forever amazed at the numer of homes that I go into with mattresses 10 years or older. I actually had a client who 'wouldn't quite'believe me until he stayed at a four seasons (on a golf trip) for a week and found that he slept better; felt more rested and freer when he got out of bed. As to the Temperapedic(spelling may be off caz it's a trademark and I didn't look it up); I just was exposed to my first one last week and have to say it is quite magical. I am not sure it is for everyone. My suggestion to all of my clients (in terms of firmness and cost and brand) is to go to a reputable retailer in the middle of the day when they are reeeaaally slow and take some time to really lay down on the beds that you are interested in. I had a woman actually take her pillow recently.

I personally have a Serta 'Westmont' pillow soft (firm) that is fabulous! I found it exactly as I suggested. I personally think firm is better but from there your body should be allowed to follow it's own rythms.

Hope this helps. It's just my two cents, after all. Vickie