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PLAY GOLF FOREVERTreating Low Back Pain & Improving Your Golf Swing Through Fitness
By Michael Jaffe Brian Tarcy Ron Brizzie
AuthorHouseCopyright © 2010 Michael Jaffe
All right reserved.
Chapter OneUnderstanding Low Back Pain (LBP)
When I first met Julia in my office, her obvious athleticism contrasted with her chronic low back pain (LBP).
It seemed wrong. She was in great shape. Everyone gets occasional LBP, but Julia's developed into a chronic condition that had lasted for years by the time she came to see me. A "back specialist" diagnosed her with bulging and degenerative disks and told her to limit her activities.
Initially, Julia's back pain appeared only when she engaged in physical activity. But when she limited her activities, her problems worsened. She became sedentary, gained 15 pounds, and suffered continuous pain. Her job as a pathologist required that she sit at a microscope for nine hours each day, making the situation worse. Plus, the rest she was prescribed compounded her problem.
When Julia learned the core-strengthening program taught in this book and put it to use, her pain finally began to subside. It took time-six weeks of squat exercises-but by the time I saw her again, she had already lost five pounds and felt much better.
Julia's case proved again to me what I already knew-that there are many types of back pain, and even those who are in great shape can get LBP. Being in shape and having your core muscles in shape are sometimes different things.
We express ourselves with our bones and our muscles. We don't express ourselves through our internal organs. You don't often hear someone say, "You have a nice spleen."
We express ourselves through motion.
Eighty-five percent of the neurological and sensory input that goes from your body to your brain comes from your musculoskeletal system of bones, joints, tendons, ligaments, and muscles. Only 15 percent come from your internal organs.
This expression of motion comes across to others in little ways and big ways all the time in your life. When you challenge yourself, such as on a golf course, the expression is exaggerated.
The way you move says a lot about you.
Think about it. When a healthy person walks into a room, you can tell the difference immediately between that person and one who is out of shape. Being able to execute movements with optimum speed, precision, style, and grace is an attractive trait. The person who walks into a room with their head held up has style. You can see it, as opposed to the person who is schlubby and withdrawn. You notice the difference, and it sends you a huge message.
You can pick out an athlete because of the way they move and their pure confidence of movement.
And you can train yourself to be an athlete. You can train your core muscles to give you strength and grace in your whole body. Although the body can be trained to do many different things, including swing a golf club, almost all athleticism has a centerpiece: the spine and its movements.
Your back is one of the most amazing creations in the natural world, and all athleticism flows off of it. So, like Julia, at the beginning of this chapter, if you take care of training for your particular sport but ignore the core muscle group that allows you to do anything, you can, over time, run into trouble.
If you are going to train for golf, the core muscle group supporting your lower back is where it all starts. This beautiful system of bones, muscles, ligaments, and joints is susceptible to problems that can be avoided by means of a strengthening program.
Taking care of your back and the muscles supporting it will help protect you from having pain, and it will improve your back if you do have pain.
Of course, as common as LBP is, not all LBP is the same. The back is a complex structure with many moving parts. So before treating your pain, you must first understand how the back works when you aren't suffering from pain.
The Neuromuscular System
The human body inspires awe.
And the back as a unit, performing its many functions, is a wonder within the miracle body. The spine and its supporting muscles and tendons serve as a highway and interchange for nerves that bring the feel of life to all parts of your body.
When your back does things, you almost never consciously think about it. But if you think about it now, that's pretty amazing.
You have a huge instrument running through the center of your torso, and it performs seemingly all on its own. It is able to do things reflexively, instantaneously, without you ever having to tell it how. It just knows.
The Big Picture
The brain does not recognize individual muscles.
It recognizes patterns of movements-movements that are, in a sense, programmed by you over time. A pattern of movement involves individual muscles working in harmony to produce movement.
But the muscles don't work alone to produce movement from your back. The back is a complex, amazing instrument capable of producing big movements with a combination of power and flexibility. But what is really happening is rather intricate.
It starts with your spinal cord, of course, because that delivers life. But the back is more than just the cord of nerves running up to your brain. There's a lot more to it than a simple straight line. The back carries the signals that shoot to nerves and on to muscles that make movement possible. The complex machinery includes the following parts:
The cord itself is encased in bones (vertebrae). The vertebrae rest on discs, which cushion the bones. Inside the discs is a jelly-like material. The back part of your vertebrae have smaller bones, connected by tiny facet joints. These joints are found throughout your entire spine. Nerves come out between the bones, and muscles wrap the bones while also supporting the entire spine.
Ligaments connect bones to bones.
Tendons connect muscles to bones.
Although there is only one spinal cord, the working of the back is complex machinery with many moving and stationary parts.
"Lumbar" and Other Definitions
Before we continue, let's define a few common terms. Following are the parts of your body that comprise your lumbar region and that will be discussed in this book:
Lumbar spine-The five vertebrae that form your lower back. The lumbar region is the part of the spine that is below your ribs and above your pelvis.
Facet-The joints of the spine. The joints have joint lining and joint fluid that can become inflamed just like a larger joint such as a knee joint.
Disc annulus-The outer two-thirds of the spine disc, made up of tough, connective tissue. Tears in this tissue can be painful.
Nucleus pulposis-The inner one-third of a disc, made up of a gelatinous material. This is the material that leaks out of herniated discs and is irritating to spinal nerves. A leak leads to an inflammatory response.
Transversus abdominus-A sheet of muscle that runs across your lower abdomen. This is the cornerstone muscle for core strengthening.
Rectus abdominus-Muscles that form the center of your abdomen. These are your six-pack muscles.
External abdominal oblique-Abdominal muscles that make up the side walls of your abdomen. These fibers run diagonally down from your side to your belly button.
Internal abdominal oblique-Abdominal muscles that make up the inner layer of your abdominal wall. These muscle fibers run in the opposite direction of the external abdominal oblique.
What You Can't Control
You cannot control time.
Unfortunately, the human body is not designed to last forever, and the spine is especially susceptible to wear because you use it all the time to support yourself. Bone rubs on discs. Cells break down in all of your muscles, bones, and joints.
All humans, whether they have pain symptoms or not, experience some natural deterioration of the bone and disc structure. There really is such a thing as natural wear and tear.
What You Can Control
The human body is awe-inspiring, but you have to take care of it or it can fail you.
One of the first things you can control is your weight. Your weight has a major effect on LBP because carrying around extra weight forces muscles to work harder to support you, causing extra strain.
If you have extra weight, chances are that your muscles are not as toned to carry the weight as they would be if you didn't have the weight in the first place.
Maintaining a healthy weight is only part of what you can do.
Just as important is embarking on a fitness program-a functional training program that focuses on your whole body working as a unit. A functional training program targets core muscles that support the spine, and it challenges flexibility and balance to increase your ability in both areas.
There is a lot you can control when it comes to lower back health. But even with the best program, you can end up in pain.
Lower back pain is divided into three different types:
Acute-Acute pain lasts less than three weeks. It's caused when you bend or twist, and you actually sprain your back. Ouch! But it goes away. It hurts, it bothers you, and in three weeks or so, you are done with it. This is the most common type of LBP.
Subacute-Subacute pain lasts longer than three weeks. It lasts three months, for whatever reason. Such an injury takes a while to go away, and it doesn't heal quickly, but it does get better.
Chronic-Chronic pain lasts longer than three months. People can have chronic back pain on a daily basis; or they can have recurrent pain, which means it goes and comes back very quickly. Patients with chronic pain are those who end up with a lot of disability.
Acute pain can develop into chronic, long-lasting pain, but unless you suffer an obvious permanent injury, acute pain can be expected to get better.
A little rest can help, but a lot of rest can hurt. With all three types of pain, activity is necessary to begin the healing and strengthening process.
The Vague Term, "Sciatica"
A common term is thrown around a lot with regard to LBP: sciatica.
The interesting thing about sciatica is that, well, it doesn't actually exist. I mean the term is sort of a wastebasket word for a number of problems that stem from an irritation to the largest nerve in your body, your sciatic nerve. This nerve is made up of two nerves that start in your back, go down your buttock and the back of your thigh, and go down the calf and into the foot. When you sit and you have back pain, you feel your sciatic nerve. Sciatica is a general term that doesn't describe any medical diagnosis.
The Misnomer, "Slipped Disc"
There is no such thing as a slipped disc. The discs are securely anchored to the bones of the spine and do not slip out of place. The term is incorrectly used to describe two different problems: a lumbar vertebral disc that has become wider (bulged backwards or to one side), or internal disc material that has herniated outside of the disc's tough outer layers.
Common Causes of Lower Back Pain
LBP has four basic causes.
Because the back is complex and is connected to the rest of the body, when you experience LBP you most likely have a mechanical problem that falls in one of four categories: muscular dysfunction pain, osteoarthritis, lumbar disc pain, or lumbar nerve root (radicular) pain.
Muscular Dysfunction Pain
When a muscle hurts, you know it. The pain stops you in your tracks. A muscle that hurts sends reflexes to the spinal cord, preventing contraction of that muscle. Thus, hurt muscles are weak. Muscle dysfunction pain is due to muscle spasm, microscopic tears, and fatigue of muscles. How does this happen?
Muscles fatigue. An example would be contracting your biceps (elbow-bending) muscle and holding it tight for a few minutes. You will develop pain in that muscle.
Poor posture and overuse can do the same thing to your back muscles. Because of the complex nature of the back, numerous structures and processes are involved in any movement; and repetition, particularly repetition of poor habits, can cause problems in many areas. Muscles do strain.
The most common cause of LBP in amateur golfers is poor stroke mechanics. The most common cause of LBP in professional golfers is overuse and fatigue. If you golf a lot, and you have poor mechanics, you obviously increase your risk. And if you are not in shape, you really increase your risk.
Many of my golfing patients who have LBP are poorly conditioned and display bad posture, and yet they are focused on their golf game. They demand Ferrari performance from their bodies, but they treat their bodies like a Yugo.
It is this mismatch that frequently leads to LBP. When the patient demands more from their body than it can reasonably deliver, muscles give out, and it hurts.
Arthritis is a degenerative process in the joints. Osteoarthritis is arthritis of aging-the natural wear and tear that comes with getting older. Everyone has it, although not everyone feels it.
Some people have severe arthritis and have to live with some degree of lumbar pain. The majority of arthritis should not be painful. Often, when I review a patient's x-rays, I see what looks like severe arthritis-but when I meet the patient, they say that their back is fine and they are visiting about a shoulder problem. Pictures don't equal pain. Even severe arthritis on an x-ray does not correlate well with pain.
But arthritis is real, and it can cause pain.
Sometimes the amount of arthritis in the lumbar area is so great that there is a narrowing of the canal where the lumbar nerves exit the spine. This condition is called lumbar spinal stenosis.
Spinal stenosis causes pain because of the arthritis in the joints. But it also chokes nerves while you walk.
In 90 percent of cases, patients with spinal stenosis get dull aches to sharp pains down their buttocks, thighs, and legs when walking a few blocks.
In 50 percent of those with spinal stenosis, there is numbness and weakness in the legs. Patients find that the walking pain can quickly be relieved by sitting. It is walking that hurts. People with this condition often lean on their shopping carts when they walk the aisle in a grocery store. Bending at the hips opens up the canal a bit, relieving their symptoms.
Spinal stenosis, although worrisome, usually doesn't get worse. And most people who get it only have mild stenosis.
About 85 percent of all patients with spinal stenosis respond to conservative treatment. In fact, 70 percent of patients do not get worse. About 15 percent have significant improvement without surgery. Only 15 percent of those with spinal stenosis require surgery to correct the condition.
Lumbar Disc Pain
The anatomy of vertebral discs is unique.
The outer two-thirds of the disc is a tough, fibrous tissue in alternating spiral layers. This is the area where the sensation nerves of the disc are located.
The inner one-third of the disc is a gelatinous substance called nucleus pulposis. This gelatinous substance helps diffuse compression and bending forces.
When we age, our bodies undergo changes. This is especially true of our discs.
When we are born, our discs are 90 percent water; by the time we are 65 years old, the discs have dried to only 30 percent water. This drying out (desiccation) is part of the normal aging process and is not painful.
When a disc loses water, it gets shorter and wider. This is a bulging disc. It is a normal part of aging and is not, by nature, painful. However, tears in the outer two-thirds of the disc do occur, and these can be painful.
Most tears heal on their own in three to six months. But sometimes the tears are large and allow the gelatinous material to leak out. This condition is very painful because the jelly is irritating to nerve tissue. The leakage is the cause of nerve root pain that shoots down the leg from a herniated disc.
A herniated disc often starts with a simple, dull pop and a twinge in your back. This twinge develops into a dull backache for the next three days. After three days the back gets better, but severe pain runs from the buttock down the leg and below the knee.
Lumbar Nerve Root (Radicular) Pain
The word radicular means nerve root. The nerve root, is the part of the nerve that has branched off the spinal cord but has not yet exited the spinal canal. When this area becomes inflamed, it is called nerve root radiculitis -meaning the nerve is injured.
People refer to pinched nerves when actually the nerve is inflamed. This is the most common cause for irritation running down the leg. This inflammation is most often due to herniated lumbar discs. It shows itself as pain, weakness, and numbness.
Most of this pain can be treated successfully with time, proper posture, weight loss, exercise, anti-inflammatory injections, and physical therapy.
The healing process is slow and orderly:
Pain goes away in 4 to 6 weeks. Strength returns in 6 to 12 weeks. Numbness goes away in 3 months to a year.
Excerpted from PLAY GOLF FOREVER by Michael Jaffe Brian Tarcy Ron Brizzie Copyright © 2010 by Michael Jaffe . Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
PART I: THE BACK....................1
1 Understanding Lower Back Pain....................3
2 Deciding to See a Doctor....................17
3 Finding the Right Treatment....................25
PART II: THE GAME OF GOLF....................37
4 Examining Why Golfers Get Lower Back Pain....................39
5 Analyzing the Golf Swing in Pieces....................51
PART III: THE PROGRAM....................71
6 Examining How Muscles and Nerves Work....................73
7 Back Basics: Posture and Body Mechanics....................79
8 Get Ready: Getting Started and Finding the Correct Equipment....................91
9 Using Functional Training to Change Your Life....................101
10 Using Functional Training to Change Your Life: Low Impact....................139
11 Stretching on the First Tee....................151
12 Conclusion: Motion Is Life....................163