The “Fast Five” Healthy Back Exercise Program

(Special thanks to Glinn & Giordano Physical Therapy)

• THE HAND-HEEL ROCK: Starting on your hands and knees, sit back on your heels, keeping your head down. Hold 5-10 seconds, then return to your hands and knees; then rock forward, keeping your elbows straight but bringing your hips down onto the table. Return to your hands and knees. Repeat 10 times.
• MODIFIED SIT-UPS: Lying on your back, knees bent, curl your head and shoulder blades up slowly off the table, and then back down. Repeat times. Add 1 a day as able until you get to 25 repetitions.
• PRONE POINTERS: Lie on your stomach (with a pillow under your stomach if so instructed) with arms outstretched above your head. Raise your right arm and left leg off the floor only a little, at the same time. Relax, and repeat this with your left arm and right leg. Repeat 5 times. Build up to 15 repetitions, with each limb.

• SQUAT HOLDS: Standing, keeping your back straight, bend your knees and squat as far as your knees allow, but no lower than if you were sitting in a chair. Straighten both arms out in front of you, hands clasped. Hold 5 seconds. Repeat 10 times. Build up as able to 30 seconds 15 times.
• WALKING PROGRAM: Begin by walking at a comfortable pace for 10 minutes at least 3 times weekly. If you have no back pain and your endurance permits, increase by 5 to 10 minutes. Work up until you are able to walk briskly for 45 minutes at least 3 times weekly.

How to Improve Your Golf Game and Avoid Injury

Exercise is a proven and fun way to reduce stress and improve your overall conditioning, and golf is an increasingly popular way to exercise. This article focuses on how to improve your game and avoid hurting yourself in the process.

Golf lessons and the latest equipment may make you a better golfer, but the repetitive nature of swinging a club can cause problems for those who are not taught injury prevention. During the swing, the stress placed on your spine is more than 600% greater than that of standing upright, and with many repetitions, muscles and connective tissue can become traumatized, leading to inflammation and pain. Factors such as posture, balance, flexibility, strength, and conditioning level all affect the way you swing the club, and they must work well together if you want to hit the ball with more distance, accuracy, and consistency—and avoid injury.

A golf-specific exercise program designed to increase strength and flexibility is your best bet against bodily trauma. Low back pain, a common golfer’s complaint, is usually caused by tight, inflexible muscles in the hips and lower back, coupled with weak abdominal muscles. Shoulder, wrist, and elbow pain are also often caused by tight muscles, so a good warm-up and stretch routine before golf is important. To warm up:

• Walk around a little, slowly swinging and circling your arms.
• Sit on the edge of a chair and slowly turn the upper body to your right to a point of mild tension. Then grab the back of your seat, keeping feet on the floor, and hold for 3 minutes. Repeat on the left side.

• Hold your golf club vertically and press it against your spine, one hand on top and one hand on bottom of club. Tighten stomach muscles and bow forward into an address posture. Hold 6 to 8 seconds. Repeat 20-30 times daily.

After stretching, golfers should begin on the putting green, and then go to the driving range to hit a small bucket of balls with an 8 or 9-iron to loosen up. Dan Goldstein, PT, (PTPN member, Advanced Orthopedic and Sports Physical Therapy, West Palm Beach, Florida) advises golfers to walk rather than ride, but says, "If you must take a cart, put a rolled-up towel behind your low back while riding, and use the cart for a hamstring stretch by putting one leg on the cart, and with your back straight, slowly bring your chest toward the knee until you feel slight tension for 10 seconds. Repeat 10 times per leg.”

Goldstein adds, “Because golf is a sport where your back is bent forward, do a couple of back bends after each hole to regain the arch. And to counteract constant rotation in the same direction, golfers should swing (without a ball) in the opposite direction to loosen joints in the low back.” And finally, says Goldstein, learn proper balance because “if you’re not balanced during the swing, your spine isn’t free to rotate over the hip, and you’ll put extra stress on the low back and shoulders.”

It may be hard to convince some people that golf is a sport as opposed to a leisure activity. Many non-athletes think they can pick up a golf club and just start playing without warming up, but they can get hurt. Don’t be one of them!

Getting in Shape to Play Tennis

The popularity of tennis has grown dramatically in the last decade, and as millions of Americans have taken to the courts, the number of tennis-related injuries has risen. Since tennis can be a demanding game that involves quick starts and stops and a rather unusual range of motions at very high speeds, it’s no wonder that recreational players sustain injuries to the shoulder, elbow, wrist, back, leg and foot.

If you are one of those many weekend tennis players it’s important to pay attention to the signs and symptoms of any type of injury—pain, swelling, muscle fatigue, and poor mechanics. If you do have symptoms, try consulting with a physical therapist that can determine the cause of the problem, which isn’t always obvious. What you may think is “tennis elbow” could be originating elsewhere.

Tennis injuries are generally caused by failure to warm up and stretch sufficiently; lack of flexibility, strength, and conditioning; overuse; poor mechanics; and improper equipment. So, before you head for the court, start with some cardiovascular activity such as jogging in place, skipping rope, or jumping jacks. If you’re playing at a sports club, you can warm up on a treadmill or a stationary bike. Then stretch the thighs, calves, hamstrings, shoulders, and trunk. Because of the side-to-side motion in tennis that creates tension in the inner thighs, try some “butterfly stretches” (sit on floor with bottoms of heels together, knees bent, and try to gently push knees toward the floor). To prepare for the rotational motion in tennis, warm up the trunk with some gentle twisting at the waist, bending side to side, and practice strokes (with or without a racket) to get “muscle memory” back for forehand, backhand, volley, and serve.

After stretching, try some pre-game practice drills with your partner, gently hitting ground strokes and volleys at the net. When you’re finished playing, make sure to stretch out your leg muscles while they’re still warm so they will elongate. If you don’t take the time to stretch them, they may cool down in a shortened position.

For strength and conditioning, it’s a good idea to cross-train with weights, aerobics, biking, and/or jogging. Special isometric exercises for the forearm and hand improve grip control and minimize the effects of ball impact, and the use of free weights or exercise equipment can strengthen shoulders, back, and leg muscles. To cut down on injuries, don’t play tennis more than two or three times weekly. Most importantly, consult a tennis pro to learn proper mechanics to prevent injuries.

Lastly, the right equipment can help prevent injury to the wrist, elbow, and shoulder. When choosing tennis equipment:

• Don’t use a grip that is too small for your hand.
• Don’t string racket too tightly.
• Don’t play with wet or dead tennis balls.
• Don’t use oversized racket heads.
• Don’t use a racket that is too heavy or inflexible.

The Pros and Cons of Running…

Advice from a Physical Therapist

The running fad that began in the 1970s is still going strong for millions of Americans, and after a dip in the 1990s, the number of runners is climbing. For those who have been running regularly for a long time, pluses as well as minuses have emerged. Compared with sedentary people, habitual runners have an increased life expectancy of two to seven years, a 30% to 40% lower risk of developing heart disease, and only half the risk of developing Type 2 diabetes, according to Stanford University School of Medicine professor Dr. William Haskell. Even those who run just a half-hour (two to five miles) a few times a week reap improvements in strength, blood pressure, and other measures of physical health.

Research shows that those who run steadily, but carefully, and not through injuries, are often protected against arthritis and osteoporosis, and can delay significant disability for more than 10 years. But the downside for runners is leg and knee injuries such as plantar fasciitis (heel pain), shin splints, and sore knees.

“Runners who suffer from injuries should consider evaluation and treatment from board-certified physical therapists who specialize in athletic injuries,” said Bruce Wilk, PT, OCS (PTPN member, Orthopedic Rehabilitation Specialists, Inc., Miami, Florida). But how can runners and other athletes judge the quality of care they receive from a physical therapist? Wilk’s recommendations:

• Independent evaluation: A physical therapist should provide a thorough examination of the patient, an appraisal of the dysfunction, and a summary of appropriate treatment on a regularly scheduled basis.
• Close supervision: The physical therapist should personally oversee all aspects of the patient’s individualized treatment program.
• Goal-oriented treatments: All types of interventions prescribed should be specifically designed to enhance strength, flexibility, and/or endurance. The reasoning for each treatment should be explained.
• Discharge planning: The program should include exercise and lifestyle recommendations for the patient after the conclusion of office visits and treatments to minimize the possibility of a recurring dysfunction.

Ten Tips on Avoiding Running Injuries

“Most running injuries occur early in one’s ‘career’ so it’s important to learn the correct techniques right away,” said Wilk. “It’s a shame when people needlessly stop running when—with proper intervention—they could run for many years.”

Wilk offers runners these injury prevention tips:

1. Learn proper running techniques, such as gait training and posture drills, from the experts—often physical therapists specializing in athletic training.
2. Have a training plan, such as alternating easy days with harder days. Running as much as you feel like it will cause problems.
3. Choose the right running shoes. Your shoe should feel slightly spongy when you walk on a hard surface. It should bend easily in the area of the ball of the foot, have a wide heel, about 2 ½ inches, and a slightly raised support under the arch.
4. Learn from many sources and read a variety of books and magazines on running.
5. Stretch before and after every run, especially the Achilles tendon, hamstrings, and quadriceps.
6. After stretching, warm up and “go easy before you go hard.” Walk or jog slowly for at least five minutes.
7. Vary your training. Keep “long and easy” runs separate from “short and hard runs.”
8. Pain is not normal. Respect injuries and listen to your body, reducing your mileage to a pain-free amount.
9. Rest on rest days.
10. Set appropriate goals for your fitness level. Running needn’t be competitive—just a great way to stay in shape, both physically and mentally.