Milus Training Systems

Carpal Tunnel

2006-10-29T07:19:00.000-08:00

Carpal Tunnel and Golfers
By Dr. Jennifer N. Milus, DC
http://www.backsafegolf.com

Over 100,000 people a year undergo carpal tunnel surgery. What can we do, conservatively, ourselves, at home (or on the course) to prevent this?

Carpal Tunnel Syndrome (CTS) is becoming more and more prevalent with the computer generation, and increased use of small hand held devices. Someone you know has probably suffered from CTS. It is such a common problem; it baffles me that there is so little understanding among the medical community about its causes.

It is linked to several diseases/conditions like: diabetes, gout, thyroid disease, and obesity. It appears to be caused by repetitive motion of the hands, arms and wrist. Many people who have it just happen to do more than one thing that involves heavy use of the area. I have treated a guitar player who rides horses, will stop neither, and getting her better will be difficult. A fire fighter who pulls hose, ropes and dummies and trains with weights is another tough cookie. A golfer who works on the computer at work all day poses the same problems.

Any one of these things done alone, intermittently, will probably not cause a problem. Further: playing golf has not been shown as a direct cause of CTS. But, it could certainly contribute. And the hours a pro plays will absolutely have more effect than the 1-2 rounds a week you or I might play.

So What Happens?

CTS is the result of the compression on the median nerve as it runs through the “tunnel” parallel to the tendons that run the fingers. The wrist bones compress it from one side and a thick ligament can compress it from the other side. Once this area is over used, it becomes enflamed. The mediators of inflammation settle in there, increasing pressure and softening the connective tissue, causing the body to lay down more scar tissue, which irritates the nerves and it becomes a vicious cycle.

How does it start?

My patients tell me that they get a feeling of tightness and fullness in their wrist and forearm first. This can last from weeks to months. If it is not worked on or worked with at this stage, it will progress. (read below under conservative care). In fact, at this stage, it is not even named carpal tunnel syndrome. It is just a tightness in the forearm and wrist that will likely eventually lead to CTS.

The Classic Symptoms if CTS:

Numbness and tingling in the thumb, index and middle finger are the usual signs. Some complain their entire hand goes numb. The feelings may come and go from dropping of small object to dis-coordination during small motor tasks (typing, using a palm pilot/phone). Folks may complain of waking with numb hands or pain in the area.

Worst Case: Surgery $50,000?

I am not a surgeon. But I know some, and they do good work. I personally, would leave this option until the very last. It’s pretty invasive, and everything else should be tried first! The surgical procedure involves a snipping if the sheath that surrounds the tunnel.

So, I ask: if you can snip is later, why can’t you stretch it in the early stages when the area first starts to tighten up?

I treat conservatively. In the following paragraphs, I will describe some of the things I do/use/recommend. However: I have seen enough cases of this in my life to know when to quite while I’m ahead. I seldom take a case that has progressed to the stage of numbness. If I do, I will only see it for 8 visits. If I see no improvement at all, I refer both to a Physical therapist and to an orthopedic surgeon concurrently. Remember: the longer it goes on, the harder it is to treat conservatively.

Best Case: Catch it early!

When the tightness starts, and the numbness, pain and dis-coordination have not yet arrived is the time get conservative care. I would recommend trying all of the following before submitting to surgery.

Traumeel…. MOST IMPORTANT! GET THIS NOW!

It’s this amazing homeopathic ointment. If you get it on the internet, it’s much cheaper than retail. Apply about as much as you put on your toothbrush 4 times per day for a week, really rubbing it in deeply up in the area where you have pain.

http://www.naturalhealthconsult.com/Monographs/traumeel.html

The Wrist Wand: and it’s less than $20!

Here’s an amazing tool! This is an inexpensive padded bar about 14 inches long that comes along with an instructional DVD. It was designed by Michael Boorstein of www.wristwand.com. I have used it, recommend it for my patients and feel it’s a great tool to have in your golf bag! Get a second, and have it sitting next to your monitor at your computer work station! Use it at as recommended in the video.

Go to this page to read why it works: http://www.wristwand.com/WhyWorks.html

There is more information about how it works here:
http://www.wristwand.com/Carpal%20Tunnel%20-%20Tunnel%20Vision.pdf

Read their entire website- especially the testimonials. Stories are just that.
However, these make real sense to me… and I am a REAL skeptic.

Reduce or eliminate play for 2 weeks:

And, yes, sadly, cutting back on the time at the range, number of buckets hit, and even the round played per week might contribute to your recovery.

If you try this stuff for 2 weeks, and still have problems:

Change the Golf Grip

Ease up on the grip during address. Replace old, worn grips. Wearing a glove on both hands might result in more friction between the hand and the club, thus requiring less pressure, along with adding some padding.

Massage:

Get a recommendation from a friend for a massage for your entire upper body. Make sure they focus on your forearms. Feel free to print this out, and show it to them when you arrive. I welcome questions from you or them at any time. drjen@backsafegolf.com

To the massage therapist: You probably already know this; however, if this helps you get someone some relief, then great! Hold the wrist in one hand, palm down, hand and arm relaxed. Flex the wrist in a palmer direction while using the thumb of the opposite hand to strip the extensor muscles up towards the elbow. Slowly flex while working wrist to elbow. Traveling from wrist to elbow should take 10 seconds. Relax the grip on the arm, and straighten the wrist, start at the wrist again, flex and strip, straighten and start at the wrist again. Work for 3 minutes. Flip the arm over, and do the same on the other side, extending the wrist and working the flexors from the wrist to elbow. Now, work from the finger tips up the fingers to the palm… each individual finger 3 times. Do the same on the palm. Work the palm and the carpel area, palm up, opening up the palmer aspect of the wrist. Stretch and open the palmer side of carpel tunnel using your thumbs. Then milk the entire hand, wrist and forearm up to the elbow, then to the shoulder. Each arm should take about 15 minutes.

Chiropractor: diagnosis dependant

Use yours or get a referral from a trusted friend. They should be able to adjust/mobilize and either have a massage therapist in their office to do the above, or do it themselves. They may or may not use ultrasound- I would. They may also find something that needs work in your elbow, shoulder or neck. Remember, they are links in a chain. Each area must work fluidly so that the next link up or down stream can do the same. Make sure you find someone you trust and feel comfortable with. A good one will work miracles.

The Carpal Stretcher: $35

Here’s another neat little gadget to place next to your desk on the mouse side of your computer work station. They make them in right and left handed models.

http://www.rajala.com/cgi-bin/catalog.pl?carpel+tunnelCarpal_Tunnel_Stretch

Get well, and get back to golfing!

If you or anyone you know has golf related low back pain, please visit my website at:
http://www.backsafegolf.com/ for more information about how to work with that!

Dr. Jen Milus, DC

http://www.backsafegolf.com/

Osteoporosis in Senior Golfers

2006-09-30T09:57:00.000-07:00

Osteoporosis in SeniorGolfers
By Dr. Jen Milus, DC of www.backsafegolf.com
What is it?
Osteoporosis is bone loss that often occurs in menopausal and post menopausal women. However, men can get it too! It can be beginning, middle or end stage. This bone softening disease can lead to fracture, disability, and eventually, even death.
How is it diagnosed?
It can be seen on X-ray, and that X-ray finding is called Osteopenia. Osteopenia is not a diagnosis of early stage osteoporosis, it is merely the name for the x-ray finding. Many doctors may call it that- but it is a misnomer. By the time it is visible on X-ray, you have lost 20% or more of your bone density! At that point, you are already in a fracturable state! Bone scans are more sensitive, but seldom ordered until there is already a fracture!
Who gets it?
Mostly Caucasian women of slight build. But, others are susceptible too! Men and Women of all shapes, sizes, and ethnic backgrounds get it. It appears to be linked to the reduced levels of estrogen associated with entering menopause. But, that’s not the only link, or men wouldn’t get it!
How bad can it actually get?
The first fractures are usually spinal compression fractures, then later hip fractures. If the hips both become fractured at one time, the person will become bedridden, and that’s when the ribcage can start to deteriorate. Close to home: my grandmother died from this awful disease. My grandfather also had it in his 80’s and 90’s! Do I have your attention yet?
Spinal Fracture? Golfers Beware!
The forward leaning posture used in opening a window, or in the sport of golf can be the proverbial “straw that broke the camel’s back”! If you want to keep playing golf, then you are going to need to keep leaning forward. So: increasing calcium uptake into your bones, and thus increasing your bone density is the only answer!
Dietary and Lifestyle Issues:
Caffeine, Carbonation, Smoking, Alcohol, High Protein Diets! All of these things cause the leeching of calcium from the bones. Decrease or eliminate these things from your diet, and you will be a lot better off.
Weight bearing exercise:
The idea that walking qualifies as weight bearing exercise is preposterous. Sure- it has the effect of gravity on your spine! But, you have that amount of weight on your spine all day every day. The idea is to slightly challenge the bone’s strength on a regular basis (more than it is with gravity) to increase osteoblastic activity. That is to say, if you push the envelop with regards to the body’s capabilities, it will compensate and rise to the occasion, produce more bone cells, and increase bone density
There are many Treatments:
For Women:
In some people’s minds, the jury is out on estrogen replacement. In my mind, it is not still out. I will not take them when the time comes. I will continue eat soy products every day, as that has been shown to level out estrogen fluxes and smooth the decent into eventual lowered production. Many people find that the soy products seem to reduce or eliminate hot flashes. It’s worth a try, I think!
Some people use plant estrogen (cream) products that are available at health food stores. I have no opinion on that, other than each person should investigate that and make their own decision. I do have a strong opinion on synthetic estrogens, and that is that they will never enter my system. Again, that is a personal decision.
Estrogen replacement with Premarin elicits a strong opinion from this female doctor too. It is made from the urine of pregnant mares. I am not a pregnant horse. Therefore, I do not think it is appropriate that I ingest a product made from it. Once more, that is a personal decision. I would advise anyone who is put on that to thoroughly investigate what the side effects might be for them, and act accordingly.
For Men and Women:
There are prescription medications that are said to increase calcium absorption. But don’t be fooled, once you go on it, you need to have your liver enzymes checked every 6 months. That means it can cause liver problems. But, if your liver is otherwise healthy ie: you are not a heavy drinker, smoker, or prescription drug user, try to choose the lesser of the 2 evils. As I mentioned earlier, my grandmother actually died of osteoporosis. She had listened to some chiropractor who advised her against the medication. Her liver was otherwise very healthy, and her lifestyle very clean. There was no reason to protect her from challenging her liver a little bit. And, bottom line, she died of osteoporosis with completely normal liver enzymes. Just try to make an informed choice, and do it on an individual basis, with a doctor to takes the time to listen to your concerns.
Calcium Supplementation is For Men too!!!
Eating foods “rich in calcium” is not enough. Our soils are depleted from years of commercial farming to support the processed food industries. Whole foods and fresh, raw fruits and vegetables are key. (Especially fruits, I hear, in a recent study!). You really do need to take a calcium supplement.
Little known fact: Calcium in the chemical form: Microcrystaline Hydroxiappetite is the most absorbable. You should take 1200mg/day. You should be able to find that in a health food store near you, or through Metagenics.
Go to this website for great prices on these great products: http://www.totaldiscountvitamins.com/Merchant/mtgframe.htm
Then search on that page for this product:
Metagenics - cat# - MTG-CA032 - Cal Apatite Plus - 270 Tablets
I am not associated in any way with this website, and not their affiliate. It was just an easy to find source that offers great prices!
But, don’t be fooled by advertisement: Tums is not absorbable calcium. These commercials say, “… and Tums has calcium for your bones!” Funny, they forget to mention that the form of calcium in tums might make a great buffer for stomach acid, but, it is not bio-available, and cannot be absorbed into your bones! How they get away with this, I don’t know! Truth in advertising is supposed to be a law!
Oyster Shell Calcium (Calcium Carbonate) is not absorbable by the body either. In health food and drug store, this form of calcium is the cheapest. There are things in life where you get what you pay for. This is NOT one of those cases! You get NOTHING for your money here. What a coincidence- Tums is made with calcium carbonate. Go figure!
Calcium Citrate is moderately absorbable by the human body. Let’s look at the numbers, though. Out of every 10 molecules of Microcrystaline Hydroxyappetite that is ingested, about 8 can be absorbed. Out of 10 molecules of Calcium Citrate ingested, 5-6 can be absorbed. Out of 10 molecules of Calcium Carbonate (Tums) not even 1 can be ablsorbed. So- spend your money however you like. Just be informed about your choice!
Training with weights.
This extra load bearing will increase the formation of bone. It should be started early, though. And keep in mind this: unlike sleep, you do get to save up bone density! I have trained with weights for 25 years; my bone density is about 15% higher than an average woman my age. If I lose 20%, I will still have 95% of what’s “normal”. I am a very long way from a factorable state! Say I had walked for 25 years; my bone density would be average for a woman of my age. If I’d lose 20%, I’d have 80% of what’s normal. I would be a whole lot closer to a factorable state than if I had trained with weights. So why are so few women training with weights? My advice: get a trainer, and do it! Prevent those hip fractures while you are young. In golfers, prevent the spinal fractures, and we will be way ahead!
Make no mistake about this! Choose exercises that do not compress your spine axially (from the top of your head). And increase your weights gradually so as not to injure yourself! Using a personal trainer is the best idea. The increased strength will improve your golf game. You’ll be able to hit the ball further with your increased upper body strength!
Make sure that your trainer knows that you golf, and that you are trying to prevent osteoporosis. He or she will want to do posture maintaining, or posture improving exercises. This will include a bit of rhomboid , lat, and spinal extensor work.
Won’t weight lifting make me muscular and bulky?
This is an old wives tail. At first, the additional muscle might make you appear a little bit bigger. It will also show up on the scale, and you will weigh more! But that muscle will cause a rise in your metabolism, and your body will start to burn off the fat that covers those muscles. In time, the net effect will be that you are denser and leaner, and even more athletic! I have lifted weights for 27 years now, even lifting extremely heavy weights at times, and I still look very much like a girl, muscles and all. Genetics vary, and there are no guarantees, but I have not heard of women becoming masculine looking unless they took male hormones, or human growth hormone. Men, you have nothing to worry about!
Warning! Be very careful!
Spinal Fracture is often misdiagnosed as simple back pain! As the individual trabeculae (bone cells) give way, and we to lose height, it is largely invisible! What to do? Well, be very careful. Focus on the things that will not load the spine. Weight training by someone who has osteoporosis needs to be done with an expert. Otherwise you put yourself at risk.
What about Non-Seniors?
The younger people who have not yet been diagnosed with this horrible disease? Those of us who see it in our family history would have to be crazy not to make the changes listed above. Once it happens, it’s really too late! Let’s re-cap what can be done:
1. Start prevention young. Start in your teens, 20’s or 30’s.
2. Train with weights. Learn how to do it properly, and train hard.
3. Focus on working the postural muscles that prevent forward leaning. This will decrease the compressive forces of forward leaning posture in golf.
4. Take the proper Calcium: Microcrystaline Hydroxiappetite: 1200 mg/day
5. Reduce or eliminate: Caffeine, Carbonation, smoking, and alcohol.

Best Wishes,
Dr. Jen Milus, DC
http://www.backsafegolf.com

Osteoporosis in Female Golfers

2006-09-30T09:36:00.000-07:00

Osteoporosis in Female Golfers
By Dr. Jen Milus, DC of www.backsafegolf.com
What is it?
Osteoporosis is bone loss that often occurs in menopausal and post menopausal women. It can be beginning, middle or end stage. This bone softening disease can lead to fracture, disability, and eventually, even death.
How is it diagnosed?
It can be seen on X-ray, and that X-ray finding is called Osteopenia. Osteopenia is not a diagnosis of early stage osteoporosis, it is merely the name for the x-ray finding. Many doctors may call it that- but it is a misnomer. By the time it is visible on X-ray, you have lost 20% or more of your bone density! At that point, you are already in a fracturable state!
Who gets it?
Mostly Caucasian women of slight build. But, others are susceptible too! Women of all shapes, sizes, and ethnic backgrounds get it. It appears to be linked to the reduced levels of estrogen associated with entering menopause.
How bad can it actually get?
The first fractures are usually spinal compression fractures, then later hip fractures. If the hips both become fractured at one time, the person will become bedridden, and that’s when the ribcage can start to deteriorate. Close to home: my grandmother died from this awful disease. Do I have your attention yet?
Spinal Fracture? Golfers Beware!
The forward leaning posture used in opening a window, or in the sport of golf can be the proverbial “straw that broke the camel’s back”! If you want to keep playing golf, then you are going to need to keep leaning forward. So: increasing calcium uptake into your bones, and thus increasing your bone density is the only answer!
Dietary and Lifestyle Issues:
Caffeine, Carbonation, Smoking, Alcohol, High Protein Diets! All of these things cause the leeching of calcium from the bones. Decrease or eliminate these things from your diet, and you will be a lot better off.
Weight bearing exercise:
The idea that walking qualifies as weight bearing exercise is preposterous. Sure- it has the effect of gravity on your spine! But, you have that amount of weight on your spine all day every day. The idea is to slightly challenge the bone’s strength on a regular basis (more than it is with gravity) to increase osteoblastic activity. That is to say, if you push the envelop with regards to the body’s capabilities, it will compensate and rise to the occasion, produce more bone cells, and increase bone density
There are many Treatments:
In some people’s minds, the jury is out on estrogen replacement. In my mind, it is not still out. I will not take them when the time comes. I will continue eat soy products every day, as that has been shown to level out estrogen fluxes and smooth the decent into eventual lowered production. Many people find that the soy products seem to reduce or eliminate hot flashes. It’s worth a try, I think!
Some people use plant estrogen (cream) products that are available at health food stores. I have no opinion on that, other than each person should investigate that and make their own decision. I do have a strong opinion on synthetic estrogens, and that is that they will never enter my system. Again, that is a personal decision.
Estrogen replacement with Premarin elicits a strong opinion from this female doctor too. It is made from the urine of pregnant mares. I am not a pregnant horse. Therefore, I do not think it is appropriate that I ingest a product made from it. Once more, that is a personal decision. I would advise anyone who is put on that to thoroughly investigate what the side effects might be for them, and act accordingly.
There are prescription medications that are said to increase calcium absorption. But don’t be fooled, once you go on it, you need to have your liver enzymes checked every 6 months. That means it can cause liver problems. But, if your liver is otherwise healthy ie: you are not a heavy drinker, smoker, or prescription drug user, try to choose the lesser of the 2 evils. As I mentioned earlier, my grandmother actually died of osteoporosis. She had listened to some chiropractor who advised her against the medication. Her liver was otherwise very healthy, and her lifestyle very clean. There was no reason to protect her from challenging her liver a little bit. And, bottom line, she died of osteoporosis with completely normal liver enzymes. Just try to make an informed choice, and do it on an individual basis, with a doctor to takes the time to listen to your concerns.
Calcium Supplementation.
Eating foods “rich in calcium” is not enough. Our soils are depleted from years of commercial farming to support the processed food industries. Whole foods and fresh, raw fruits and vegetables are key. (Especially fruits, I hear, in a recent study!). You really do need to take a calcium supplement.
Little known fact: Calcium in the chemical form: Microcrystaline Hydroxiappetite is the most absorbable. You should take 1200mg/day. You should be able to find that in a health food store near you, or through Metagenics.
Go to this website for great prices on these great products: http://www.totaldiscountvitamins.com/Merchant/mtgframe.htm
Then search on that page for this product:
Metagenics - cat# - MTG-CA032 - Cal Apatite Plus - 270 Tablets
I am not associated in any way with this website, and not their affiliate. It was just an easy to find source that offers great prices!
But, don’t be fooled by advertisement: Tums is not absorbable calcium. These commercials say, “… and Tums has calcium for your bones!” Funny, they forget to mention that the form of calcium in tums might make a great buffer for stomach acid, but, it is not bio-available, and cannot be absorbed into your bones! How they get away with this, I don’t know! Truth in advertising is supposed to be a law!
Oyster Shell Calcium (Calcium Carbonate) is not absorbable by the body either. In health food and drug store, this form of calcium is the cheapest. There are things in life where you get what you pay for. This is NOT one of those cases! You get NOTHING for your money here. What a coincidence- Tums is made with calcium carbonate. Go figure!
Calcium Citrate is moderately absorbable by the human body. Let’s look at the numbers, though. Out of every 10 molecules of Microcrystaline Hydroxyappetite that is ingested, about 8 can be absorbed. Out of 10 molecules of Calcium Citrate ingested, 5-6 can be absorbed. Out of 10 molecules of Calcium Carbonate (Tums) not even 1 can be ablsorbed. So- spend your money however you like. Just be informed about your choice!
Training with weights.
This extra load bearing will increase the formation of bone. It should be started early, though. And keep in mind this: unlike sleep, you do get to save up bone density! I have trained with weights for 25 years; my bone density is about 15% higher than an average woman my age. If I lose 20%, I will still have 95% of what’s “normal”. I am a very long way from a factorable state! Say I had walked for 25 years; my bone density would be average for a woman of my age. If I’d lose 20%, I’d have 80% of what’s normal. I would be a whole lot closer to a factorable state than if I had trained with weights. So why are so few women training with weights? My advice: get a trainer, and do it! Prevent those hip fractures while you are young. In golfers, prevent the spinal fractures, and we will be way ahead!
Make no mistake about this! Choose exercises that do not compress your spine axially (from the top of your head). And increase your weights gradually so as not to injure yourself! Using a personal trainer is the best idea. The increased strength will improve your golf game. You’ll be able to hit the ball further with your increased upper body strength!
Make sure that your trainer knows that you golf, and that you are trying to prevent osteoporosis. He or she will want to do posture maintaining, or posture improving exercises. This will include a bit of rhomboid , lat, and spinal extensor work.
Won’t weight lifting make me muscular and bulky?
This is an old wives tail. At first, the additional muscle might make you appear a little bit bigger. But that muscle will cause a rise in your metabolism, and your body will start to burn off the fat that covers those muscles. In time, the net effect will be that you are denser and leaner, and even athletically feminine. I have lifted weights for 27 years now, even lifting extremely heavy weights at times, and I still look very much like a girl, muscles and all. Genetics vary, and there are no guarantees, but I have not heard of women becoming masculine looking unless they took male hormones, or human growth hormone. Since you probably won’t be taking that, I’d say your worries are slim to none.
Warning! Be very careful!
Spinal Fracture is often misdiagnosed as simple back pain! As the individual trabeculae (bone cells) give way, and we to lose height, it is largely invisible! What to do? Well, be very careful. Focus on the things that will not load the spine. Weight training by someone who has osteoporosis needs to be done with an expert. Otherwise you put yourself at risk.
What about us?
The younger women who have not yet been diagnosed with this horrible disease? Those of us who see it in our family history would have to be crazy not to make the changes listed above. Once it happens, it’s really too late! Let’s re-cap what can be done:
1. Start prevention young. Start in your teens, 20’s or 30’s.
2. Train with weights. Learn how to do it properly, and train hard.
3. Focus on working the postural muscles that prevent forward leaning. This will decrease the compressive forces of forward leaning posture in golf.
4. Take the proper Calcium: Microcrystaline Hydroxiappetite: 1200 mg/day
5. Reduce or eliminate: Caffeine, Carbonation, smoking, and alcohol.

Best Wishes,
Dr. Jen Milus, DC
http://www.backsafegolf.com

Knee Pain in Golfers

2006-09-08T23:04:00.000-07:00

Knee Pain in Golfers!
By Dr. Jen Milus, DC of www.backsafegolf.com

Many Golfers have pain in the knee onto which they pivot

The repetitive motion of pivoting onto the forward knee causes knee pain in many golfers. It is best to catch this quickly, and do some things yourself before the pain gets bad, and you cause yourself a serious injury by playing on it while it’s enflamed! What can we do ourselves?

What’s really going on?

With the transference of weight to the forward foot in the follow through, most of the body’s weight ends up on a joint that is not in a bio-mechanically sound position. The pelvis is turned facing forward, and the femur (upper leg bone) is internally rotated at the hip joint. This end position actually twists the lower part of the femur while it’s under significant load. This tightens the muscles in the lateral side (outside) of the upper and lower leg. This includes the lateral quad and the ITB band. These muscles, can, over time, become fibrous and shortened, and cause an ITB syndrome. Further, it can grind the lower femur onto the upper tibia (meniscus/tibial plateau) and start to irritate and wear out the cartilage.

This irritation can turn to inflammation. The knee is an encapsulated joint. That inflammation can easily stagnate in there. The mediators of inflammation actually chemically soften the cartilage and ligaments within the joint. If you continue to play on it as it is, you are likely to cause further injury. This also leads to a faster progression of DJD (degenerative joint disease).

What does your doctor say?

Seeing your family doctor is a good idea- just to make sure there is nothing orthopedically wrong: no ACL, MCL or meniscus tears. Once you know the joint tissues are in tact, there’s a lot you can do for yourself. These are things you should know so they can play through this injury!

Your doctor may say, “Oh, it’s just arthritis!” Don’t take that as an excuse to accept what’s been dealt you! That’s even more reason to read on and follow my instructions!!! Nor would I suggest just popping a few advil and waiting for it to go away….

So what are some solutions?! What to do yourself?

Break the inflammatory Process:

Dixie Cup icing:
2-6 times a day. Morning and evening at least. The more the better.
Leave at least 20 minutes between icings.
Go to the store, and get a box of Dixie cups. Fill about 12 with water and freeze them. When you are ready to ice, take one out, peel away the top of the cup so you can hold the cup at the bottom, and ice cube is above the torn edge.
Put the leg up, so the leg is almost straight, and a towel behind it. This gives the water a place to drain.
Set a timer for exactly 5 minutes. Put that ice cube directly on the skin. Circle the knee cap on the soft tissue around it. Focus on the area just under the knee cap, and along the joint line where swelling tends to gather. Keep moving until the timer goes off: 5 minutes. Stop.
First you will feel cold, then pain, then numbness. Don’t stop until 5 minutes are up!

Traumeel:
Use this every time after you ice.
This is a homeopathic cream/gel remedy I use for inflammation and sports injuries. I know for sure they carry it at Whole Foods and Health Food Stores. Or search it up online.
Use the same amount as if it were toothpaste, and you really enjoyed the flavor of it. Rub it all over the knee, knee cap and joint. Do not wash it off.
Put more on before you go to bed!
You can keep this in your golf bag during the season. It works really well!

Re-build the cartilage:
Take Glucosamine Sulfate. 1500 mg/day.
There was a book written on this stuff called “The Arthritis Cure”. Read it if you like. It says that studies show it works and has no side effects. Let’s face it, young or old, arthritis and wearing away of cartilage is the same thing.
No, you can’t get enough GAS in a normal healthy diet. Keep taking it even after feeling better.
Don’t buy Glucosamine HCL. Studies show it does NOT work.
Don’t bother with Chondroitin Sulfate. It works for some, but there are no placebo double blind studies out there showing that it works. There’s testimony and anecdotal “proof”. NOT GOOD ENOUGH for me.

Strengthen the muscles around the knee:
Remember that the muscles on the outside have become tight and over used. We now want to compensate for that by strengthening the muscles that oppose those!
Ride a bike 3 times a week for 20 minutes on flat ground. The seat should be high enough that the knee is straight in the down position. Keep moving your feet the entire time.
Using a stationary bike is even better. Use light tension.
Follow with icing and traumeel

Once you start to feel a little better, Leg lifts:
·Lay on your back with your legs straight out. Turn your injured leg toe out and raise the straight leg until your leg comes up 75% of the way (about 25 % down from pointing at the ceiling).
·Do this with just the weight of the leg at first. Then put 2 soup cans in 2 tube socks, and tie the top ends together wrap them around your ankle, and use this for resistance.
·Start with 2 sets of 10 reps and work up to 4 sets of 20.

If you belong to a gym, then:

Hamstring curls:
In the gym, use the machine that has you lay face down, and pulls your heels in to your behind.
Start with a light weight- like 20 or 30 lbs for women, 30-40 lbs for men.
Start with 2 sets of 12. Work up to 3 sets of 12.
You may increase the weight and decrease your reps once you reach 3 sets of 12.

Leg extensions in the last 15 degrees of extension.
This works the medial quad. This can change the tracking problem very fast!
Start with your leg straight. Bend Go from barely bent to slightly straight and back again. Don’t force it into hyperextension!
Start with a relatively light weight (10-20 lbs), and only ever progress to a medium-light weight (30-40 lbs)!
Start with 2 sets, 1 minutes rest between. Do 10 reps.
You can work up to 6 sets, with 1 minutes rest between.

If you have any questions or concerns, please feel free to write and ask me!

Feel Better! Drive Further!

Dr. Jen Milus, DC

drjmilus@gmail.com
http://www.backsafegolf.com/

Women and Golf During "That Time"

2006-09-08T20:13:00.000-07:00

Right before, and during menstruation, many women perceive weakness and low back pain, not to mention lower abdominal and pelvic pain. They may also experience weakness. This leaves many feeling enflammed in those areas. It's not imaginary, it truly is an iflammation of sorts. It is all due to a fluctuation in hormones.

For women who are prone to low back, this time can leave you feeling tight and unable to golf well. It is my opinion, that things need to be done differently during this time to relieve low back pain, than they would other wise be done.

Most of the time, when someone has acute onset or hot low back pain, I recommend that they ice. But, in this instance, I would recommend some heat: on the front of the pelvis for 10 minutes, and on the low back for 10 minutes. Then I would recommend these exercises:

Pillow Pelvic tilts: 20 reps
In the 90-90 position, put a pillow between your knees. Suck in your stomach and hold. Squeeze the pillow and hold. Now do a pelvic tilt and press your low back down onto the floor and hold everything for 5 seconds. Do this 20 times. When you are able to move, go on to the next exercise.

Cat and Dog: 10-20 reps
Get on your hands and knees, hands and knees shoulder width apart. Suck in your stomach. Do a pelvic tilt. Slowly push your low back up toward the ceiling. Hold for 5 seconds. Relax, let your low back arch as low as is comfortable. Let your shoulder blades sink together, and lift your chin slightly. Hold for 5 seconds. Slowly take it back up. Repeat 10-20 times.

Knees to chest, roll in circles 10-20 reps each way
Lay on your back. Bring your knees into your chest. Hold with your hands. Roll the knees in a circle as if you had a pencil between your knees and were drawing a circle on the ceiling. Go 10 each direction. Increase each time until you hit 20 each way.

Drop knees to each side, 1 minute each way
Drop the knees on the floor next to you, knees and hips bent to 90 degrees. The outside of your bottom leg will be in the floor. The other leg will be right on top. Reach the upper body the other way. You should feel a comfortable rotation in the entire lumbar region. Relax 1 minute each way.

I also recommend that my patients get an adjustment at that time. This can relieve alot or pressure and break that pain pattern very effectively. It works really well... for many reasons that are too long to go into right now.

Just remember, if you choose to get adjusted, see a chiropractor that you are familiar with, or one that a friend has used. This is not necessarily a reason for more than 1, maybe 2 adjustments, so beware. Chiropractic is very effective when used properly. Unfortunately, it is very often over used. Find someone you trust.

Dr. Jen
http://www.backsafegolf.com

2006-09-05T21:35:00.000-07:00

Acute Low Back Pain in Golfers:
By Dr. Jennifer N. Milus, DC
www.backsafegolf.com

Low Back pain is among the most debilitating injuries in the America today. Golfers are especially prone to it . But what can we do ourselves?

There is no magic bean for mechanical low back pain. There are a variety of choices for care for your back pain: Chiropractic, Massage, Acupuncture, Physical Therapy, pain killers and muscle relaxants. Whatever your choice: Your healthcare provider cannot help you nearly as much as you can help yourself. Any treatment they do really needs to be additive to what you do yourself.

Pain is often rated on a pain scale of 1-10: 1 is barely noticeable, and 10 is so bad that one is unable to move or function. The initial, extreme pain that gets people to their doctor is called the acute or inflammatory stage. Most people rate that as 7, 8, or 9 out of 10. It can be marked by localized swelling, and heat in the immediate area. Some doctors prescribe anti-inflammatory medication for that. I prefer rest, a few exercises, and ice- in that order.

The chemical bi-products of inflammation actually soften the tissues in the area. This leaves those tissues more vulnerable to tearing and long term injury. Taking soft tissues to end range by bending, lifting, and twisting can be especially damaging. This occurs in the golf swing. So- don't push things during that time. Rest is important at this time. The objective is to break the inflammatory process, re-create flexibility, and move on to strengthen and improve coordination. This will, if all goes well, lead to less painful episodes less often. And more enjoyable, better rounds of golf.

In this article, I will talk about ways you can do the first 2 steps: 1. Reduce inflammation and 2. Re-create flexibility. Of course, you should check with your doctor to make sure there is nothing that he/she needs to treat you for or with before you undertake self care.

The Rand Study (20+ years ago) proved that chiropractic adjustments work to reduce acute low back pain. This is certainly true in people who have an inflammation of the facet joints in that area. However, this can be a short lived quick fix. You can’t stop there if you want lasting relief! If the muscle spasm is not reduced, the motion restored, and the trunk strengthened around it, the bouts of low back pain will likely return. I am a big believer in deep tissue muscle work, manipulation or adjustment, and therapeutic exercise- all properly applied. They work… when used at the right stages in the healing process.

Let's talk about what you can do on your own, though, as an adjunct, or at home to get yourself some relief. The 3 things I would have you do for acute low back pain are as follows:

See your doctor to rule out pathology. Then…

Get comfortable. This can be very difficult at this time. I find that people with low back pain often respond well to the 90-90 position. This is; hips and knees both bent to 90 degrees. Lay on your back near a sofa or ottoman. Your hips bent, and knees bent so your behind is "scooched" up close to the sofa. Your calves will be on the sofa. This will take the lordosis out of the low back and allow the facet joints a break from each other… take some of the pressure off the area.
This is a great position as it is easy on your low back and you can slide an ice pack under your low back as well.

Ice: Ice is a great tool for reducing and breaking the inflammatory process. It will also slow the pain nerve's transmission signal to the brain by up to 60 meters per second for up to 12 hours. It needs to be used repeatedly, and quite often for a few days when you really hurt. Try to ice every 4 hours for the first 2-3 days of your flare up. (I know- that's a lot to ask, but, it really works.)

Remember that the inflammatory process is like a camp fire. You might think it's been put out, but if you don't go back and stomp on it several times, and dump more buckets of water on it, it might just smolder for a few days and come back full bore and put you right back where you started.

The icing is great. Wait a few hours after the ice. Then do a few exercises and ice again. Wait a few hours, do the exercises and ice again, etc.

The exercises I recommend for acute low back pain are:

Pillow Pelvic tilts: 20 reps
In the 90-90 position, put a pillow between your knees. Suck in your stomach and hold. Squeeze the pillow and hold. Now do a pelvic tilt and press your low back down onto the floor and hold everything for 5 seconds. Do this 20 times. When you are able to move, go on to the next exercise.

Cat and Dog: 10-20 reps
Get on your hands and knees, hands and knees shoulder width apart. Suck in your stomach. Do a pelvic tilt. Slowly push your low back up toward the ceiling. Hold for 5 seconds. Relax, let your low back arch as low as is comfortable. Let your shoulder blades sink together, and lift your chin slightly. Hold for 5 seconds. Slowly take it back up. Repeat 10-20 times.

Knees to chest roll in circles 10-20 reps each way
Lay on your back. Bring your knees into your chest. Now roll the knees in a circle as if you had a pencil between your knees and were drawing a circle on the ceiling. Go 10 each direction. Increase each time until you hit 20 each way.

Drop knees to each side, 1 minute each way
Drop the knees on the floor next to you, knees and hips bent to 90 degrees. The outside of your bottom leg will be in the floor. The other leg will be right on top. Reach the upper body the other way. You should feel a comfortable rotation in the entire lumbar region. Relax 1 minute each way.

You may follow with icing for exactly 20 minutes in the 90-90 position.

Here is how you make the ice bag:

Put about 20+ ice cubes in a freezer zip lock bag
Cover the cubes with water
Squeeze out the excess air
Zip it shut

Place directly on your low back.

Heat:

When your pain has reduced to 2-3/10, you can use Ice and heat together.
Use a hot shower, hot bath or hot tub with jets. Let the hot water contact the area for 10 minutes. Then, follow with these exercises:

Do each of the above exercises, Plus:

Standing Lateral Flexions:

Stand with your feet twice hip width apart. Slide your left hand down the outside of your left leg to support the weight of your trunk. Take the Right hand and reach up and over your head, and lean left. Slide the left hand down, and feel the stretch in the right side of your low back. Lean slowly over, and hold for 15-30 seconds. Now go the other way.

Follow with 20 minutes of ice- again, at 90-90.
This routine of heat-stretch-ice is great for pumping inflammation out of the area, relaxing spasm, and getting new healing nutrients into the area.

Things NOT to do during this time:

Unanswered heat:

Do not put unanswered heat on the area. The heat brings in excess blood and does not pump it back out again. It might feel good temporarily, but it can worsen an inflammatory process… make it linger. Always follow it with a stretch and ICE. The heat stretch ice thing really does works!

Ice before Exercise:

Ice has its uses. But remember that it shortens, tightens and stiffens the tissues in the area. Do not ice before you exercise. Do it afterwards.

Motions which are hard on your hot low back:

Unsupported forward flexion, Lifting heavy objects, and twisting are all tough on your low back. Don't lift things that are a far reach away from you; keep them close to your body.

I see people in the gym doing these things:

Rotations with weighted Bar on shoulders:

Axial loading of the spine plus rotation is damaging to the disc and joint tissue. Besides, this really doesn't strengthen you at all in any productive way.

This Exercise is even worse:

Axial Load, Plus rotation, plus forward flexion is extremely compromising to your low back.

Stiff Legged Dead lefts done improperly:

Remember to keep your chin up and your low back completely flat during this exercise. If the low back bends at all, you are already injuring yourself.

Yoga Cobra Stretch:

This is the one where your pelvis and legs are on the floor, and you press your trunk up and (hyper) extend your low back. This jams your facet joints together, and can single handedly cause a facet syndrome, and set off an episode of low back pain. Some people think this is a good stretch… for some it is, but most it's not. There are (somewhat different) extension exercises that work well in a therapeutic setting- like McKenzie exercises. However, they need to be applied by a Physical Therapist (or an exercised inclined Chiropractor) who has been trained in the technique.

Later, when lifting heavy objects:

Bend at the knees and hips
Keep your abs and gluts tight, and back flat!
Keep the heavy object close to your body
If you need to rotate, do so with your feet, entire body, not from the trunk

Feel Better, Drive Further!

Dr. Jen Milus, DC
http://www.backsafegolf.com