The answer is dynamic stretches. Dynamic stretches Dynamic stretching is useful before competition and has been shown to reduce muscle tightness. Muscle tightness is one factor associated with an increase occurrence of musculotendinous tears. More recent scientific studies seem to suggest that dynamic stretches before competition are preferably to static stretches. This may be particularly true for strength and power athletes. 

All exercises should have 5 second holds and be done 5-10 times.
Standing Cat n Camel/ Pelvic Rotation
Begin in your address position, arms across chest. Tuck the pelvis under then arch the back, creating a rocking of the pelvis into anterior and posterior position and return to a neutral spine. 

Trunk Rotation/ Vertical and Horizontal Axis
Standing in your address position, bring the palms together. Inhale as you rotate from the core and bring the both arms back. Mimic backswing then follow through with a stop at the address position.

Try the same exercise at chest to shoulder height twisting trunk and keeping arms in the parallel to the ground.

Standing Hip Stretch
Use a golf club for assistance with balance. Place one ankle on the outside of the opposite knee. Inhale as you bend your stance knee, sitting back as if you are sitting on a chair. Bring the chest toward the shin, rolling the shoulder blades together.  Reverse legs.

Shoulder Rotation Stretch
Place the club or towel in your right hand, palm facing the ceiling. Bring the right arm over your head and the right palm behind your back. Bring your left arm behind your back and clasp the club or towel.  Move the club up and down your back stopping when you feel a stretch and squeezing the club together.

Upper Trapezius Stretch
Bring the right ear toward the right shoulder. Inhale as you press your left arm toward the floor, exhale and relax the left arm.

Standing Shoulder Blade Stretch
Bring the club to shoulder height, bend your knees and tuck your pelvis under. Inhale as you press your arms away from you, tucking your chin into your chest. Exhale, lift the head and squeeze the shoulder blades together.

1) National Strength & Conditioning Association. Essentials of strength training & conditioning. Champaign, IL: Human Kinetics. 2000
2) Yamaguchi, T., Ishii, K. Effects of static stretching for 30 seconds and dynamic stretching on leg extension power. J. Strength Cond. Res. Aug;19(3):677-83. 2005
3) Shrier, I. Stretching before exercise does not reduce the risk of local muscle injury: A critical review of the clinical and basic science literature. Clinical J. Sports Med. 9: 221-7. 1999

Golf: Dynamic Stretches is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

Purpose: Shoulder and mid spine mobility.
Stand feet hip distance apart with ends of club in both hands resting in front of you on thighs.  Inhale, extending both arms straight overhead.   Bend both elbows bringing club directly behind head in line with ears.  Lower elbows as much as possible and try to straighten arms still holding club behind low back against buttocks.  Reverse, bending arms at elbows bringing club back overhead and return to front. 

Shoulder Extension with Trunk Rotation 

Purpose: Promotes range of motion through shoulders and thoracic spine.
Stand tall holding club behind you with palms facing backward.  Bend from the hips to a flat back like a bow with club aiming straight in the air.  Rotate so club moves from parallel to perpendicular to the ground. 

Lateral Trunk Flexibility

Purpose: rib cage mobility in side bend.
Stand tall holding club overhead with hands wide on grip and close to club head.  Slowly bend from side to side with intention of lengthening spine and adding space between each vertebrae. 

Lateral Flexibility with Rotation

Purpose:  rib cage mobility in rotation.
Stand tall holding club overhead with hands wide on grip and close to club head.  Slowly bend from to the side with intention of lengthening spine.   Then, without moving hips or center of gravity, rotate ribcage so club turns parallel with the ground. 

Trunk Rotation

Purpose: Prepare body for rotation
Stand with feet hip distance apart holding ends of club in both hands with arms straight in front of chest.  Rotate club and upper body to the right as far as possible. Lift up on left toe to allow further rotation.  Goal is to rotate club 180 degrees.  Inhale return back to start position.  Repeat other side. Focus on tall spine lifting away from hips.

Shoulder mobility                                                                                                      

Purpose:  spinal rotation.                                                                                               Stand in address position with same hip tilt and spine angle.  Hold onto ends of club allowing arms to fall in place in alignment with feet.  Inhale prepare.  Exhale rotate upper body as if in backswing trying to turn shoulders, arms, and club.  Pause.  Inhale repeat to start.  Repeat backswing 10x.  Then proceed to follow through on opposite side.  Focus on controlled movements.

Quadricep Stretch

Purpose: Prevent injury and promote range of motion by warming up before round.
Stand and kick right leg back bending at the knee and grasp ankle with right hand.  Gently pull foot back while pushing hip forward to feel stretch in muscle between knee and hip joints in front of leg.  Repeat with left leg.  Club may be used as prop for balance.

Hamstring Stretch

Purpose:  Lengthen spine; stretch shoulders, hamstrings, and calves.
Use club for support.  Press heel down with toes up with a straight leg as you push your hips back.  Feel the stretch on the back of the leg from the ankle to buttocks.  Keep your back straight and head up as you bend forward from your hips.

Shoulder Push-Pull

Purpose:  Prepare shoulder pain for fast action during swing.
Hold the hosel end of a golf club behind your neck with your right hand.  Align the club down the back vertically and hold the grip end with your left hand near your buttocks, palm facing out.  Pull the grip down to stretch triceps, and push elbows out to stretch chest and front of shoulders. Then pull the hosel up.  Switch sides.

Golf: Static Stretches is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

Forever looking for that magical move that takes strokes off your score probably leads you straight to the driving range to hit a few hundred golf balls. Sure! Practice makes perfect, right?  Even simple pre-season training drills will improve your swing, game and help prevent mid-season injuries for years. Let’s go golfers, other sports have pre-seasons. Let’s catch on!

What’s the bottom line?

The goals of any golfer are:

Increase range of motion in the golf swing.  Improved flexibility allows a complete backswing and extended follow through.  Having this full ROM will decreased chance of injury.

Add control and power to the golf swing.  Well trained muscles increase control and ability to generate more club head speed.

Improve energy and endurance.   muscular control will improve function and muscles will tire less through each round.

Reduce chance of injuries on the golf course through stretching and identifying uncomfortable movements.

Analysis of “Your Swing”

Leg and hip is responsible for power production initiation of the golf swing.

Trunk muscles transfer power from the legs to the torso to accelerate the club head.

Chest and shoulder muscles produce the actual swing action and play critical role in club head speed.

Arms are responsible for club control and largely determine club head impact.

Off-Season:
Three strength training sessions per week for general base and core strengthening, as well as for muscle control is sufficient. During the off season months is the best time to focus on overall muscle strength and enhance golf driving power.

Examples of exercises include all on machines: leg press, squats, hip abduction and adduction, trunk rotations, push ups, planks, standing hip extension, abdominal crunches.

Pre-Season:
Once you have a strong base and balance of muscle, you can maintain by reducing your total body strength training sessions to twice per week. Now is the time to develop sport specific skills utilizing tiny, but key muscles such as low back and rotator cuff musculature.

This program might include progressing to free weight and cable or theraband as resistance.  Exercises would include leg press, squats, hip abduction and adduction stepping with theraband resistance, standing cable trunk rotations, push ups, planks, U stance training with theraband leg swings, hip extension, trunk rotation and abdominal crunches.

In-Season:
Practice and Play! To prevent injury after long activity days with multiple rounds, you must take care of the sport specific muscles. Stretching muscles used will aid in not only assist in a better golf swing with a larger range of motion, but injury prevention as well.

The basic flexibility exercises that are relevant to golfers are standing or seated hamstring, lower back, and upper back and shoulder stretches.

These stretches will allow for the ability to play and practice more golf with fewer aches and pains at the 19^th hole as well as on off days.

Golf Exercise is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

Tendons and ligaments should be treated in the same manner by considering the mechanics of injury, adaptation to activity, and healing response during rehabilitation. Mechanical loading of a tendon/ligament can create injury with a single high load strain or repetitive loading or misuse injuries. The single high load strain can result in sprains, partial tears or ruptures which are more prevalent in ligaments, as muscle will rarely contract hard enough to tear a tendon. Achilles and patellar tendon ruptures are usually a result of muscle forces in combination with external forces. In repetitive strain situations the tissue injury begins with micro damage, which if created too quickly cannot be repaired fast enough. This results in pain, swelling and degradation of the tendon/ligaments mechanical properties. When this cycle continues, it can create a progressive degradation and make the tissue more susceptible to traumatic overload injuries. Tensile load is dictated by increased length of tissue stretched by percentage. A 1.5%-3.0% tensile load is common in normal activities, however without this stimulation the tissue will weaken, and with increasing the tensile load tendon strength will improve. Injury is created usually with over 10% tensile loads.

After a soft tissue injury the tendon/ligament will go through a typical soft tissue healing process. Inflammation 3-7 days, proliferation 2-3 weeks followed by remodeling after 2-3 weeks and up to more than one year, all in overlapping stages. Through the remodeling phase, the tissue fibers increase cross-links and align in the direction of tensile load. It is critical that the rehabilitation program provide adequate stress in a program of progressive loading that avoids inflammation. We must avoid over stress that can impede the healing process and cause scar tissue to form. The paradox of functional tissue training comes in balancing between sufficient loading to guide the healing process and overzealous loading that continues inflammation and tissue degradation. We minimize inflammation with early mobilization and PROM-AAROM program. This may be increased as the tissue progresses into the remodeling phase by progressive AROM, isometric and eccentric exercises followed by high repetition progressive exercises including CKC with proprioceptive and perturbation activities assisting in return to normal upper level activities.

Careful management of exercise type and intensity relative to the particular tendon or ligament injury, as well as awareness of the phase of recovery the tissue has reached is the key in progressing the patient. Optimal management will produce minimal pain and increased speed of healing, providing improved patient satisfaction.

About the Author:
Ross Hutchinson, PT, CSCS, has been actively involved in Colorado physical therapy since 1991.
You can contact Ross at his Arvada, Colorado office.

Functional Stress for Tensile Tissue is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

With recent improvements in implant fixation and wear reduction, 95 percent of orthopaedic surgeons who responded to a survey say they place no limitations on swimming, golf, walking on even surfaces, bicycling on level surfaces, or climbing stairs when recommending activities for patients with a well-functioning total hip replacement (THR) or total knee replacement (TKR). Higher-impact activities are more commonly discouraged, and there is a trend towards more activity restrictions following successful TKR.

Nearly all respondents strongly encouraged low-impact activity, patients were discouraged from jogging, difficult skiing, and singles tennis. None of the respondents indicated that they had strong scientific evidence for their recommendations.

Dr. Swanson and his co-researchers, Frederick Dorey, PhD, and Thomas P. Schmalzried, MD, are with the department of orthopaedic surgery at the University of California Los Angeles.

In a different review “Athletic Activity after Total Joint Arthroplasty,” published in the October 2008 issue of the Journal of Bone and Joint Surgery.  This study was conducted by William L. Healy, MD; Sanjeev Sharma, MD; Benjamin Schwartz, MD; and Richard Iorio, MD—documents a trend for hip and knee surgeons to allow more athletic activity after joint replacement, but notes that no good evidence exists to support this trend.

 “High levels of activity may compromise the durability of joint replacement and reduce implant survival,” says Dr. Healy, the lead researcher. “Implant wear has been shown to be related to how much the joint is used as opposed to the length of time the artificial joint has been in place.”

Innovations such as alternative bearing surfaces, large femoral heads, hip resurfacing, unicompartmental knee replacement, mobile-bearing knee replacement, and high-flexion knee replacement offer the potential for high-demand function with low rates of failure, but these potential benefits have not been proven, the study reports.

“We need to keep in mind that surgeons and patients often assess the success of joint replacement differently,” Dr. Healy says. “Surgeons look at pain, function, survivorship, and the need for revision surgery, while patients consider their pain and activity. If the joint allows them to play their favorite sport without pain, they may not be concerned about needing an additional surgery in the future.”

Unlimited low-impact activity ‘OK’ after Total Joint Replacement is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

Training Tip # 1: FLEXIBILITY:
The first component of pre-season training is flexibility.  Typically we are beginning training pre season because we are not in the best shape possible.  Flexibility has been shown to decrease injury as long as it is done often.  It is not important when it is done relative to exercise but it is important that it be done often.  Flexibility training regimes should focus on hip flexors, hamstrings, trunk flexibility, and calves.

Stretching should be done with at least 20 second holds and no bouncing.  Each stretch to a point of pull and discomfort not pain.  6 repetitions of 20 second holds should be sufficient but with problem areas, holding a moderate stretch for several minutes may be appropriate.

Training Tip #2: BALANCE AND COORDINATION:

Trying to balance standing on one leg can be a challenge, however if you want to improve balance and coordination try standing on semi-circle foam tubes (available at most physical therapy practices) and doing one-legged dips. For timing and a good plyometric workout try jumping rope. Bongo boards and BOSU balls are fun and are used by many national ski teams for coordination drills, Excellent cross-training can be done through inline skating, trail running, and trampoline training.

Balance and coordination are the corner stone to good alpine skiing. Without it you fall down a lot. A prescription for training in this second focus area can progress from 2 legged to one-legged activity.  Bicycling, Total Gym squats, jumping rope, are all quality plyometric activities. Stair and bleacher hops are good too as a progression of weight. When you get good at it try it on one leg.
Training Tip #3: STRENGTH:

Here, a heavy dose of legs and trunk work with moderate focus on the upper body is good. As in all these components a good warm-up period is mandatory. Once the blood is moving a series of squats, leg press, calve raises, leg curls, and ab/adduction exercises is suggested. The trunk focus could be using a gym ball for high crunches, low crunches, twisting crunches, and face down lower back exercises over a gym ball and plank exercises in each position.  Plyometric ball throws overhead, and side to side will also train the trunk in a faster, resisted mode. 

Even though we don’t ski on our arms it’s good to work the lats, triceps, and upper back muscles to support a pole plant and assist you ability to withstand falling, if and when you may. With a strong core you can stabilize and correct while allowing the feet something solid to turn against.

Training Tip #4: SPEED:
Quick lateral movements can be ingrained by placing a pillow on the floor and hoping sideways from foot to foot while maintaining a balanced upper body. An excellent resistant drill is to attach a rubber sport cord around your waist, then have a partner hold one end while you run. Your partner should provide enough resistance to keep you at bay. Try this while running sideways. This is the true test of your lateral movement agility.

Quick sprints, lateral hops, resistant running drills with a sport cord (surgical tubing), and obstacle course hops are suitable drills. Timing is everything and in skiing if you don’t have quick feet the skis will soon be taking you for a ride instead of the other way around.

Training Tip #5: ENDURANCE:

Raise your heart rate. It doesn’t matter what sport your chose to do this via, as long as it is one you enjoy and can commit to doing. The sky is the limit for this: mountain biking, swimming, roller blading, running, hiking, basketball, soccer, tennis, and any other aerobic activity to improve your endurance level. The key is to pick something you enjoy and then do it regularly.

If your goal is to ski strong all day long then a solid base of aerobic fitness is essential. How long you tend to ski continuously without rest will dictate the duration of you aerobic fitness training. If you ski runs from top to bottom then you may need longer intervals of training, however if you ski short distances or duration of the day you may only need to match or slightly increased that interval.

The components of flexibility, balance and coordination, strength, speed, and endurance should be a part of every skier’s preseason training. Of course the intensity will change from World Cup racer to recreational free skier but the fundamentals will remain the same. Most skiers over age thirty don’t aspire to be the next Bode Miller, however we all want to be quicker, stronger, and more confident and safe on our skis. The benefits to be gained from preseason conditioning, include increased athleticism and injury prevention.

“PT Ski Tips” by Ross Hutchinson, PT is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy