back pain

Monday, March 10, 2014

If Tiger Woods were a regular patient, the advice offered to help with his back spasms might actually work. But Tiger is a breed apart and may not have the time or inclination to take a deep breath, rest and refrain from the activity that has caused the injury. In that respect, Tiger is like the elite athlete that resides in all of us. From the mechanic who bends over a car, to the factory worker who repetitively twists to install a widget, to the homeowner whose whole winter is dedicated to shoveling snow. There are bills to be paid and the body must be coaxed into another day of work. But there are defense mechanisms; muscles that are damaged go into spasm causing pain and shutting down the body no matter what the brain might say.

A golf swing is all about torque and levers. During the backswing, the shoulders and pelvis twist while the shoulders raise the arms. At the top of the swing, the momentum has to stop and reverse and as the downswing begins, the hips move forward and the upper body has to torque to allow the shoulders to bring the arms and hands into a position to hit the ball. The follow continues the torque on the trunk to complete the motion. Since the thoracic spine is relatively fixed because of the ribs that are attached, the rotation of the body has to occur in other areas. On the backswing, the scapula or shoulder blade needs to get out of the way for the arms to move and that’s the job of the trapezius muscle, the rotator cuff and the serratus anterior.  The downswing requires the lumbar spine and pelvis to rotate, generating power and torque. The hamstrings in the leg and the gluteus muscles in the buttocks are responsible for the power while other muscles keep the lower body stable. The arms and hands need to be controlled at ball contact requiring the pectorals, biceps and forearms to activate.

Injuries occur when the swing breaks down and vice versa. In golfers who alter their swing pattern or have poor swing mechanics, the muscles of the back may become inflamed affecting the swing movement. A golfer who has a stiff back loses trunk rotation causing a shorter backswing and the shoulder muscles need to work harder to maintain the speed and momentum of the swing. That may cause the traps and rotator cuffs to overload and risk injury to the upper back and shoulder injury.

The best treatment for back injury is prevention. The core muscles need to be strong, flexible and balanced. Back and abdominal muscles work together to encircle the spine giving support against gravity and when injury occurs, it is tough to rest since gravity never goes away. Then it becomes a risk reward scenario: how much time can one afford to rest, while at the same time, still trying function. Most people cannot afford to be hurt in the pocketbook while tending to the hurt in their back and time away is difficult. That is especially true for those who are self-employed (including Tiger) or are responsible for the care of others.

Healing recommendations suggest resting for a few days, using ice and heat, anti-inflammatories and finding comfortable ways to sleep, often curled up like a fetus. Physical therapy, chiropractic care, exercises and stretching may gradually be added but it may take 6 weeks or longer to settle down the back muscles and start their strengthening. And yet, small unexpected movements may cause a world of hurt. It doesn’t have to be a big lift or twist but rather a small motion that the body wasn’t quite ready for: twisting to buckle a seatbelt, lifting a toddler or sneezing that big sneeze may be enough to cause a setback.

Tiger tried to play the week after muscle spasms caused him to withdraw from a tournament and a big swing from an awkward stance was enough to cause re-injury.  Those who use their body as a tool at work, may be just like Tiger and not be able to take time away. Unfortunately, muscle healing takes time. Medical intervention can help somewhat with the pain and spasm but muscle fibers cannot be rushed to heal and there is no magic to make it faster…even if your name is tiger Woods and the Masters is just around the corner.


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