Category Archives: Prevention

Avoid the Pain of Traveling

Traveling is rough on the body. Whether traveling alone on business or to a sunny resort with your family, long hours in a car or an airplane can leave you stressed, tired, stiff and sore.

Warm Up, Cool Down

Treat travel as an athletic event. Warm up before settling into a car or plane, and then cool down once you reach your destination by taking a brisk walk to stretch your hamstring and calf muscles.

In the Car:

  • Adjust the seat so you are as close to the steering wheel as comfortably possible. Your knees should be slightly higher than your hips. Place four fingers behind the back of your thigh closest to your knee. If you cannot easily slide your fingers in and out of that space, you need to re-adjust your seat.
  • Consider a back support. Using a support behind your back may reduce the risk of low-back strain, pain or injury. The widest part of the support should be between the bottom of your rib cage and your waistline.
  • Exercise your legs while driving to reduce the risk of any swelling, fatigue or discomfort. Open your toes as wide as you can, and count to 10. Count to five while you tighten your calf muscles, then your thigh muscles, and then your gluteal muscles. Roll your shoulders forward and back, making sure to keep your hands on the steering wheel, and your eyes on the road.
  • To minimize arm and hand tension while driving, hold the steering wheel at approximately 3 o’clock and 7 o’clock, periodically switching to 10 o’clock and 5 o’clock.
  • Do not grip the steering wheel. Instead, tighten and loosen your grip to improve hand circulation and decrease muscle fatigue in the arms, wrists and hands.
  • While always being careful to keep your eyes on the road, vary your focal point while driving to reduce the risk of eye fatigue and tension headaches.
  • Take rest breaks. Never underestimate the potential consequences of fatigue to yourself, your passengers, and other drivers.

In an Airplane:

  • Stand up straight and feel the normal “S” curve of your spine. Then use rolled-up pillows or blankets to maintain that curve when you sit in your seat. Tuck a pillow behind your back and just above the beltline and lay another pillow across the gap between your neck and the headrest. If the seat is hollowed from wear, use folded blankets to raise your buttocks a little.
  • Check all bags heavier than 5-10 percent of your body weight. Overhead lifting of any significant amount of weight should be avoided to reduce the risk of pain in the lower back or neck. While lifting your bags, stand straight, away from the overhead compartment so the
    woman in obvious neck  pain
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    spine is not rotated during the process. Do not lift your bags over your head, or turn or twist your head and neck in the process.

  • When stowing belongings under the seat, do not force the object with an awkward motion using your legs, feet or arms. This may cause muscle strain or spasms in the upper thighs and lower back muscles. Instead, sit in your seat first and using your hands and feet, gently guide your bags under the seat directly in front of you.
  • While seated, vary your position occasionally to improve circulation and avoid leg cramps. Massage legs and calves. Bring your legs in, and move your knees up and down. Prop your legsup on a book or a bag under your seat.
  • Do not sit directly under the air controls. The draft can increase tension in your neck and shoulder muscles.

Safe Travel For Children:

  • Always use a car seat in a car or in a plane when traveling with children below the age of 4 and weighing less than 40 pounds.
  • Make sure the car seat is appropriate for the age and size of the child. A newborn infant requires a different seat than a 3-year-old toddler.
  • In the car, the car seat should always be rear facing as the forces and impact of a crash will be spread more evenly along the back and shoulders, providing more protection for the neck.
  • Car seats should always be placed in the back seat of the car. This is especially important in cars equipped with air bags. If an air bag becomes deployed, the force could seriously injure or kill a child or infant placed in the front seat.
  • Make sure the car seat is properly secured to the seat of the vehicle and is placed at a 45-degree angle to support the head of the infant or child.
  • Ask the airline for their policy on child car seat safety. Car seats for infants and toddlers provide added resistance to turbulent skies, and are safer than the lap of a parent in the event of an unfortunate accident.

Are you drinking enough water?

Healthful self-hydration is very important to a fit lifestyle. Many times our patients suffer from muscular and spinal and joint pain, leg cramps and general malaise that could be an imbalance of fluids and electrolytes. We suggest drinking 2 glasses of water as soon as the discomfort begins.

One should consume 1/2 oz. of pure water per pound of your body weight daily (200 lbs= 100 oz. each day) and at a slow but steady sipping pace of about 3-5 oz per half hour for optimal liver and kidney clearance. Proper hydration is essential to your healing and your health each and every day.

People taking medications or even vitamins may have a unique need to add water to their diet. Exercise and forced-air heat like furnaces and car heaters dry you out as well. Many bottled drinks are in fact, less effective than plain old water. If your urine is yellow, or your feet are dry, add 2 glasses of water to your normal routine. Drink extra water on days you exercise, have massage, or require the heater in your house or car. Stop the pain. Don’t get dehydrated!

glass of water | prevention

Eight a day

The body loses, on average, about two to three quarts of fluid daily through perspiration, exhaled moisture, and excretion. You must replace this fluid, hence the rule of thumb about consuming the equivalent of at least eight 8-ounce glasses of water daily. Some of the water you need comes from solid foods, especially fruits and vegetables. You get the balance from liquids you consume (juices, milk, soups), which are just as good as water.

Any change in diet, particularly an increase in protein or salt consumption. or an increase in exercise or outdoor temperature may raise your fluid needs. Certain drugs, notably diuretics, will increase water loss, as will alcohol or caffeine. Dehydration is a particular problem among the elderly, in part because the thirst mechanism becomes less efficient as we age.

Normally thirst is the best sign that you need more fluids. But if you’re exercising or working strenuously in the heat, you can lose a quart of water an hour. Don’t wait until you’re thirsty: drink before, during and after your workout.  If you fail to do this and need to replenish the water you’ve lost, weigh yourself after your workout, and drink a pint of fluid for each pound you’ve lost.

One glass of water shuts down midnight hunger pangs for almost 100% of the dieters studied in a University study.

Lack of water is the #1 trigger of daytime fatigue.

Preliminary research indicates that 8-10 glasses of water a day could significantly ease back and joint pain for up to 80% of sufferers.

A mere 2% drop in body water can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing on the computer screen or

Drinking 5 glasses of water daily decreases the risk of colon cancer by 45%, plus it can slash the risk of breast cancer by 79%, and one is 50% less likely to develop bladder cancer.

Drinking one glass of water before going to bed avoids stroke or heart attack.
why people need to urinate so much at night time.

Gravity holds water in the lower part of your body when you are upright (legs swell).
When you lie down and the lower body (legs and etc) seeks level with the kidneys, which remove the water then because it is easier.

Drinking water at a certain time maximizes its effectiveness on the body:
2 glasses of water after waking up – helps activate internal organs
1 glass of water 30 minutes before a meal – helps digestion
1 glass of water before taking a bath – helps lower blood pressure
1 glass of water before going to bed – avoids stroke or heart attack
Water at bed time helps prevent night time leg cramps. Your leg muscles are seeking hydration.


Are you drinking the amount of water you should every day?

TORN MENISCUS: When Do We Need Surgery?

man with sore knee

If It’s Aint Broke, Don’t Fix It

If you were told you had a meniscus tear either by physical evaluation or by testing such as MRI should you have a surgical repair?  If it’s not very painful, not locking and not changing functional tolerance, I say “No”.

Exam Findings – We evaluate using physical findings. Physical exam is as important as testing. You may have a positive test but no other symptoms. Symptoms such at locking or catching and high level of joint effusion (fluid) are as telling as tests when considering management strategies. Increased levels of effusion indicate severity of injury.

Common Symptoms: Popping, swelling and stiffness. Pain, especially when twisting or rotating your knee. Difficulty or inability straightening your knee fully or experiencing what feels like your knee were locked in place.

Location: The location (zone) of the tear is one of the important factors in determining treatment. Tears at the outer edge of the meniscus (red zone) tend to heal well because there is good blood supply. Minor tears may heal on their own with a brace and a period of rest. If they do not heal or if repair is deemed necessary, the tear can be sewn together. This repair is usually successful in the red zone.

The inner two-thirds (white zone) of the meniscus does not have a good blood supply, so it does not heal well either on its own or after repair. Typically the torn portion is removed (partial meniscectomy) and the edges of the remaining meniscus are shaved to make the meniscus smooth and limit catching.

Type of Tear: Also, the pattern of the tear may determine whether a tear can be repaired. Longitudinal tears are often repairable. Radial tears may be repairable depending on where they are located. Horizontal and flap (oblique) tears are generally not repairable.

Another factor when considering treatment is that repairs to the lateral meniscus (on the outer side of knee) typically heal better than repairs to the medial meniscus (on the inner side of the knee).

Physical Therapy: In many instance we can manage meniscal tears without the risk of surgery and the after effects of surgery. Meniscal rehabilitation can range from 4 weeks to 4 months. Typically we see results to independent programs by 8 weeks. High repetition low intensity exercise with decreased weight bearing can help heal meniscus tears and improve joint effusion. Muscle training to improve support about the knee and keep proper alignment through the entire limb. Modalities and NMES for muscle activation are effective treatments to restore normal function.

Spinal Stabilization Exercise

spinal stabilization exerciseSpinal stabilization is an important aspect of recovery from spinal pain, whether the problem is newly acquired or chronic. Exercise and proper body mechanics are well matched in this approach. Injuries and poor posture cause pain resulting in weakness that will not resolve completely without personal effort on the part of the person seeking assistance.  The symptomatic spinal segment may be held in a comfortable mid-range position by muscle force rather than a back brace.  Joint or disc pain will cause muscle spasm to protect itself, triggering additional pain.  By practicing “muscular fusion” during movement and static postures,  the pain is most often controlled and the muscles supporting the painful segment begin to overcome inhibition.  During movement, stability may also be maintained.  Proper muscle development and volitional control can be difficult to teach.  Spinal stabilization is a well-structured and meaningful application of tasks that result in balanced strength and reaction skills sufficient to control spinal pain.

The muscles responsible for the support of spinal segments are compromised by direct injury, and indirect factors including postural faults, gait deviations, hypermobile ligaments, muscle weakness, substitution or imbalances, and post-surgical or post-partum conditions.  Identifying and addressing problems in leg length discrepancies, foot position and support, knee and hip function, and whether they are symptomatic or simply inefficient are critical clinical decisions.  The most significant factor in clinical success with back pain is the consistency with which the back pain sufferer can be motivated, inspired, prodded, schmoozed, compelled, tricked, or simply asked to perform specific tasks (exercises and proper body mechanical movement) every single day.  Success is likely within 3 weeks if compliance is achieved.  Additional exercise training in aquatic,
unloaded and remedial situations bring the spinal pain sufferer back to the level of activities desired.

Osteopathic and chiropractic physicians and physical therapists attempt to restore normal joint mobility and position.  The only substantive support following these procedures is the normal muscle function of the region.  As in other joint issues, the ability to discontinue passive treatment of the spine is ultimately linked to the restoration of normal muscle strength, balance and reaction time.

How The Back Works

By Guy Slowik MD FRCS –

The spine, which connects the skull to the pelvis, is also called the vertebral column. It consists of 24 segments of block-shaped bone called vertebrae and an additional 9 fused vertebrae that make up the lowest part of the spine, the sacrum and tailbone. Each vertebrae of the vertebral column has protruding bony areas for the attachment of muscles that are important for the spine to move. The spinal column protects the spinal cord and its emerging nerves that run down most of the length of the spine.

The vertebrae have two major functions:
· To bear the weight of the body
· To house the spinal cord or spinal nerve roots (cauda equina) within the spinal column

The spine is arranged in three natural curves:
· The neck region or cervical spine, made up of 7 vertebrae – where the vertebrae curve forward.
· The trunk region or thoracic spine, made up of 12 vertebrae – where the vertebral column curves backward, and to which the ribs attach
· The low back region or lumbar spine, made up of 5 vertebrae – which curves forward in the same direction as the cervical spine.

When these curves are in their normal alignment, the body is in a balanced position. This distributes weight evenly throughout the vertebrae so one is in a less vulnerable position for strain and injury.

There are two major parts to each vertebra:
· Vertebral body – The vertebral body is the front portion of the vertebrae. It is shaped like a cylinder and is greater in height than the back portion.
· Vertebral arch – The vertebral arch is the back portion of the vertebrae. It is an irregularly shaped structure.

At the center of each vertebra is a hole, protected by the surrounding strong bone. Placed together, the central opening of each vertebra makes up the spinal canal through which the spinal cord, cauda equina, or spinal nerve roots pass. The spinal cord is the mass of nerve that connect the brain to the rest of the body.

Each vertebra has important bony projections called processes that provide sites for the attachment of ligaments and muscles that are important for the stability and movement of the spine.
· The projections on either side of each vertebra are called transverse processes, and the ones at the back are called the spinous processes. The transverse processes are long and slender; the spinous processes are broad and thick.
· The back portion of the vertebrae, behind the transverse processes, consists of an area of bone called the laminae.
· On the back part of the vertebrae are two upper and two lower processes that form the joints connecting the back part of each vertebra. These are the facet joints. They are important for movement between each vertebra and for movements of the entire vertebral column as a unit.

The Discs Of The Back
Between each vertebra are spongy pads, like soft cushions, called discs – or more correctly, intervertebral discs. Each disc has a soft jelly-like center called the nucleus pulposus, which is surrounded by a fibrous outer envelope called the annulus fibrosis. Eighty percent of the disc is water, which is why it is so elastic. Together, a disc with the attached part of the vertebra above and below is considered an intervertebral joint. These joints allow the movement of the back.

Healthy discs are elastic and springy. They make up 20% to 25% of the total length of the vertebral column. Initially, the disc contains about 85% to 90% water, but this amount decreases to 65% with age, resulting in disc degeneration.

The Spinal Cord And The Lower Back
The nerves that come off the spinal cord are called nerve roots. These nerve roots pass through small openings on either side of the connecting vertebrae. Various nerve roots combine to form spinal nerves.  There are five pairs of lumbar (lower back) spinal nerves. The nerve roots that arise from the end of the spinal cord and continue down the spinal canal through the lower part of the spine looks like a “horse’s tail” and are collectively named the cauda equina.

The Ligaments Of The Back

There are a series of ligaments that are important to the stability of the vertebral column. Important to the lumbar spine (lower back) are seven types of ligaments:
· Anterior longitudinal ligaments and posterior longitudinal ligaments are associated with each joint between the vertebrae. The anterior longitudinal ligament runs along the front and outer surfaces of the vertebral bodies. The posterior longitudinal ligaments run within the vertebral canal along the back surface of the vertebral bodies.
· The ligamentum flavum is located on the back surface of the canal where the spinal cord or caude equina runs.
· The interspinous ligament runs from the base of one spinous process (the projections at the back of each vertebra) to another.
· Intertransverse ligaments and supraspinous ligaments run along the tips of the spinous processes.
· Joint-related structures called capsular ligaments also play an important role in stabilization and movement.

The Muscles Of The Lower Back
The muscles and tendons of the spine have been described as being a supporting system for the spine, much like a tent supported by guide ropes.
· A group of back muscles called the erector spinae are an example of these muscles, which form on each side of the spine and consist of three columns. These muscles move the lower back, help straighten the back, provide resistance when a person is bending forward at the waist, and help a person return to the erect position.
· The multifidus is another important muscle of the lumbar region. This muscle is thick and prominent in the lumbar spine and becomes smaller at its attachments high up the spine. It is an effective lever arm that allows the lumbar spine to bend backward.
· The interspinales muscles, located on either side of the interspinous ligament, also are active in the backward bending of the lumbar spine.
· The intertransversarii muscles attach to the transverse processes. These muscles are not only active in backward bending, but also in bending from side to side.
· The intersegmental muscles are a series of muscles near the bottom of the spine that connect one intervertebral segment to another.
The abdominal muscles, located at the front and side of the abdomen, are very important in supporting and protecting the abdominal internal organs. They also play an important role in protecting movement of the vertebral column in backward bending, forward bending, and side bending.

Reference: –  Edited by Guy Slowik MD FRCS

Golf: Dynamic Stretches

A pro golfer typically might warm up 90 minutes to 2 hours before walking out to the tee.  His routine would consist of stretching, putting hitting, practicing short game and then back to any special shots and out to the green.  A typical routine for a recreational golfer would be different.  Get out of the car, find your friend and get whatever you forgot at the pro shop, swing a couple practice shots, and go to the tee.  Typically we don’t warm up until half way through the front nine.  The question is what is a quick time efficient way to warm up before golf with our busy lives.

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 Exercise

General Exercise—an area of the game often ignored by amateurs
Most non-professionals rush from work to their cars, show up at the course, take their clubs out of the trunk, hop on a motorized cart to the tee, and start swinging! This can be very dangerous!

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.

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.

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.

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 19th hole as well as on off days.