A study in the scientific journal BMC Health Services Research shows that early and guideline adherent physical therapy following an initial episode of acute, nonspecific low back pain (LBP) resulted in substantially lower costs and reduced use of health care resources over a 2-year period.
Physical therapist researchers John D. Childs, PT, PhD, et al analyzed 122,723 patients who went to a primary care physician following an initial LBP episode and received physical therapy within 90 days. Of these, 24% (17,175) received early physical therapy (within 14 days) that adhered to guidelines for active treatment. During a 2-year time period, these patients made significantly less use of advanced imaging, lumbar spinal injections, lumbar spine surgery, and opioids than did patients in other combinations of timing and adherence. Early physical therapy patients also had 60% lower LBP-related costs as compared to 33.5% (23,993) of patients who had delayed and adherent physical therapy (between 14 and 90 days). Patients received physical therapy within the Military Health System, one of the largest single payer health systems in the United States.
“Physical therapy as the starting point of care in your low back pain episode can have significant positive implications,” Childs explained. “Receiving physical therapy treatment that adheres to practice guidelines even furthers than benefit.”
Clinical guideline recommendations in military and civilian settings are to avoid opioids and advanced imaging procedures as a first-line of treatment. However, research done mainly in civilian settings reveals that clinical practice is inconsistent with these recommendations. According to Childs, the study’s results extend the findings from civilian settings by demonstrating an association between early guideline adherent care, costs, and use of health care resources in a single-payer health system.
Initial management following a new episode of low back pain can have profound implications for health care utilization and costs. According to American Physical Therapy Association President Paul Rockar Jr, PT, DPT, MS, “Given the enormous burden of excessive and unnecessary treatment for patients with low back pain, cost savings from physical therapy at the beginning of care has important implications for single-payer health care systems.”
Golf requires much more athletic ability than many imagine
Golf is a sport with many health and wellbeing benefits. A reported 60 million people of all ages play golf across the world, sometimes into their 80s and 90s.
The health benefits have been widely reported in recent years with an 18 hole round amounting to 6-8 km of walking, requiring over 8,000-12,000 steps and a calorie burn of 1,500.
However, golf can be very demanding; requiring strength, endurance, explosive power, flexibility and athletic ability to perform a movement that produces some of the fastest club head and ball speeds of any sport.
The effect of these repeated large forces on the body can lead to many different types of injuries, which are often specific to certain areas and sides of the body in golfers, depending on their lead side.
Much research has been done on the types and likelihood of injuries experienced by golfers with the main areas of the body prone to injury being the lower back, shoulder, elbow, wrist and hips.
Below, European Tour consultant physiotherapist Nigel Tilley explains some of the common golfing injuries and how physiotherapy can help get you back on the green.
Wrist injuries – Extensor Carpi Ulnaris (ECU) injury
There are a large range of common wrist injuries in golf – we will concentrate on one main area of problem: Extensor Carpi Ulnaris (ECU) injury.
What is it?
The ECU is a skeletal muscle that extends and adducts the wrist. It has to work very hard during the golf swing and is highly prone to injury, which can be caused by high force trauma (hitting a tree root or thick grass), rapid increase in loading, continued excessive loading and technique faults.
How does physiotherapy treat this type of injury?
This type of injury will often require ‘load modification’ with more traumatic sudden onset injuries requiring immediate removal of load and PRICE protocol (protection, rest, ice, compression and elevation) or POLICE (protection, optimal loading, ice, compression, elevation). The aim here is to reduce the bleeding and swelling from the injury site if severe tissue disruption, such as a partial or full rupture, has occurred.
Lower back injuries – Non-specific low back pain (NSLBP)
What is it?
Lower back injuries account for roughly 30% of all golfing injuries, with poor technique and lack of flexibility in the mid spine and hips possible causes. Often it presents as an aching and discomfort on moving into certain positions and doing certain activities. However, the soreness and stiffness that people often present with is called ‘non specific’ as it is not usually clear which structure is causing the problem/pain.
How does physiotherapy treat this type of condition?
Trying to remain active and avoiding extended periods of rest is important in people with NSLBP. Whilst it may be a good idea in the very initial stages of the problem to reduce or avoid significant movements or activities that aggravate the symptoms, it is a good idea to keep mobile and try to do stretches and exercises that relieve the symptoms and promote normal movement. These are often specific to each individual and your physio will discuss the best options for you. Often in the initial phases the use of heat through hot packs and baths can help as well as manual therapy treatments, soft tissue massage, TENS and advice on the best ways to lift, bend, sit and move in out of the car and bed.
Elbow injuries – Tennis elbow (lateral epicondylitis)
What is it?
Tennis elbow is common in golfers, who are more likely to suffer from injuries to the outside of the elbow region, rather than ‘golfer’s elbow’ which affects the inside. In general the tendons do not show signs of inflammation but rather angiofibroblastic degeneration, collagen disarray and hypoxic tendon degeneration. This often occurs due to rapid increase in loading and or continued excessive loading due to training or technique faults that the tissues are unable to adapt to.
How does physiotherapy treat this type of condition?
The type of physiotherapy management will depend on the stage of the problem and your individual presentation. Often this type of injury will require ‘load modification’ with more sudden onset injuries requiring immediate removal of load and PRICE protocol (protection, rest, ice, compression and elevation) or POLICE (protection, optimal loading, ice, compression, elevation).
Increasing the ability of the tissue to tolerate loads and re-model can be achieved through structured exercises, which your physiotherapist will be able to advise on, depending on the stage and severity of your presentation.
Other treatment techniques include the use of manual therapy to the elbow and associated tissues and structures as well as devices called epicondylitis clasps and taping techniques that can help to offload the injured area to help it recover.
Shoulder injury – Rotator cuff injury
The shoulder is a complex joint and there is a large range of injuries that can occur within it and its structures. We will concentrate on the rotator cuff.
What is it?
The rotator cuff is a group of 4 muscles in the shoulder that are involved in movements and control of the shoulder joint. There are two main causes of injury to this structure, acute trauma and degeneration. The amount of stress needed to cause an injury to the rotator cuff tendon will often depend on factors such as the person’s age, general health and underlying condition of the tendon prior to the stress elicited on the tissue. Tears can occur from injuries such as a fall onto the arm, sudden lifting or rapid movement of the arm (such as in the golf swing) or deceleration of the club head suddenly when unexpected (hitting a tree root or getting the club head stuck in thick rough). Repetitive movements of the golf swing combined with poor technique and/or flexibility and control issues can lead to injuries to the shoulder and rotator cuff.
How does physiotherapy treat this type of condition?
The type of injury, its severity and stage will affect the physiotherapy management of the condition and the time of recovery. TENS, manual therapy and acupuncture are techniques that can help with pain relief. The aim of physiotherapy will be to return optimum function and control to the shoulder complex through structured exercises rehabilitation. Physiotherapists often use taping techniques to also help in the treatment of shoulder injuries. Advice on ergonomics, activity and lifestyle can help identify ways to reduce positions and aggravating factors that may slow the recovery or worsen the injury.
To conclude, golf requires much more athletic ability than many imagine and the consequences of this mean many people suffer injuries through poor general conditioning, lack of warm up, poor technique and practice and playing habits.
But with regular conditioning, improvement in technique, warm ups and structured practice the improvements in a golfer’s performance and reduction in injuries can be significant. Your physiotherapist can help you with this as well as provide you with effective treatment should you suffer with any injuries.
Chronic back pain
Pain can be unbearable at times. Pain, as you know, can affect you both physically, mentally, as well as emotionally due to its debilitating and degenerative effects.
There are, unfortunately, many different causes that may be the culprit toward your chronic back pain. The most important thing, right now, is to identify the reason behind what is making you suffer such pain in your back. There may be many causes, but there are also many treatments and even cures for your troubling back problems.
The key, now, is to take the action required to feel better and live a more active life.
Common Chronic Back Pain Causes
Many things can contribute to the pain in your back. Some are from normal aging and some may be from damage sustained to your nerves that happened a long time ago. Here are some common issues that may contribute to your back pain:
•A misshaped spine (scoliosis)
•Degenerative disc diseases
•Gaining weight over an unusually short period of time
•Poor posture due to any of the above mentioned
•Back injury due to heavy lifting
Uncontrollable Causes of Back Pain
Scoliosis is a fairly common congenital occurrence and most of the cases are not noticeable enough to cause back pain or strain. At other times, though, scoliosis can be a serious cause of chronic back discomfort over time. Degenerative discs in your spine are more than likely caused by the aging process of your body’s tissues, bones and ligaments. It is important to maintain a healthy diet and exercise routine on a daily basis in order to stave off the negative effects of aging on your body.
Controllable Causes of Back Pain
The majority of people, especially in developed countries, are overweight or obese due to genetics and poor, excessive diet choices. The extra weight that your body has to hold upright, is not healthy for your back. Many women are faced with making the choice of having a breast reduction because their backs can’t take the weight any longer. Then there are others who gain an excessive amount of weight too quickly, placing extra strain on their unsuspecting back column.
Even if you are not overweight, posture can still be a factor. It is very important to practice good body posture by standing up straight, pulling your shoulders back and holding your chin up, level to the ground beneath your feet.
This simple body language trick can also give you the extra boost of confidence needed from dealing with all that pain.
In addition to proper posture, picking heavy objects up properly is another thing to remember to do when the need arises. This type of chronic back pain can be caused by an injury that you have sustained after forgetting the proper way to pick up a heavy object.
Here are some common posture mistakes most people make. Learn how to fix some of these postures so they don’t cause chronic pain.
1. Pelvis Forward
Also known as lordosis, people who stand this way may be doing so in an attempt to relieve back pain, but lumbar lordosis can cause its own pain and also affect the range of movement. It sometimes develops after childbirth because the baby has pulled the pelvis forward.
This is the chronic posture of the 21st century, because so many of us are hunched over computers, tablets and phones all day. This leads to tightness in the chest and a weak upper back. Eventually, you might end up with permanent rounding of the upper back, or kyphosis.
3. Leaning on One Leg
Also known as the ‘streetwalker stance’, leaning on one leg may seem like a comfortable way to offload weight, but it puts too much pressure on one side of your lower back and hip instead of letting your core and glutes do the work.
It’s important to fix this posture with your weight evenly distributed on both legs, and to not carry heavy bags that force you to lean to one side.
4. Forward Head Posture
Look at a photo of yourself in profile. Is your head thrust forward? This can be caused by staring at a computer screen, or leaning forward straining to hear the TV. It’s important to fix this posture by keeping your line of sight level, rather than correcting this by lifting your head upwards.
5. Crossed Legs When Sitting
As sexy as those screen sirens may look, their lower backs are probably on fire. Though this position probably feels natural by now, it causes chronic slouching. Practice uncrossing your legs and sitting up straight with both feet on the floor.
6. Rounded Shoulders
Also known as ‘caveman stance’, this posture is characterized by forward-facing (though not dragging!) knuckles, when your arms are hanging by your sides. Rounded shoulders is an indication of a tight chest and a weak upper back.
7. Slouching in a Chair
As any teen can tell you, slumping may feel more comfortable than sitting up straight because it requires less effort, but all that pressure is being placed on the lower back. It signifies a weak core and puts undue strain on your ligaments, joints and other soft tissues.