It would be impossible to address the subtleties of the biomechanics and injury prevention in golf in one article. Concisely, one can confidently say the following: The majority of golf related injuries are strains and sprains, and those most often occur due to Poor Golf Specific Posture, Poor Golf Specific Flexibility, and Poor Swing Mechanics.

The correct balance of flexibility and stability in the trunk and hip regions is necessary to prevent lower back golf injuries. Many traditional trunk and hip stabilization exercises can cause excessive forces on the lower back predisposing the golfer to injury. The Curl Up, Bird Dog, Front Plank and Side Plank are some of the exercises that have been researched to show the best ability to strengthen stability muscles of the core without compromising the lower back.

Injury prevention and improving performance are not mutually exclusive. Shoulder stability is important to the golf swing while also preventing upper back and shoulder injuries. Proper activation of specific muscles of the back and chest, as well as muscles of the rotator cuff are pivotal to ensure the forces generated by the torso and legs are transferred through the shoulders to the club in a smooth controlled manner. Having said that, current research has shown that club head velocity in the golf swing is primarily determined by the wrist (70%), then the shoulders (20%), followed by the spine and the hips (both 5%). Keeping this in mind, each of those areas of the body must be well conditioned prior to the start of the golf season.

If a player has proper technique, prerequisite strength and flexibility in all these areas then looking at differences in the swing of a golf amateur compared to that of a golf pro can give indications on how to maximize our swings. Golf pros use the characteristics of the Stretch Shorten Cycle of muscles to their advantage. That is, if there is an increase rate of stretch in the muscle then the elastic energy stored in that muscle will be greater when it is subsequently released. Golf pros take advantage of this by increasing the magnitude of their backswing while not increasing the amount of time needed for the greater backswing. As well, a golf pro will also minimize the amount of delay in a golf swing during the transitions from set up, backswing, downswing, and follow-through. To be able to utilize this technique, the golfer must ensure that their range of motion in their hips, lower back, upper back, and shoulders are not restricted in any way, including restriction from scar tissue from previous injuries.

If you would like to have your golf swing evaluated, contact River Valley Health and one of our experts would be happy to assist you.

References:
Dr. Jeff Blanchards Golf Injury Prevention Seminar (http://www.golfinjuryseminars.com/)
Lehman, G. Resistance Training for Performance and Injury Prevention in Golf. Journal of the Canadian Chiropractic Association. 2006, 50 (1).
Hume, P. Et al. The Role of Biomechanics in Maximizing Distance and Accuracy of Golf Shots. Sports Medicine. 2005, 35 (5).

1.6-3.8 million sport related concussions occur every year in the United States. A concussion is an injury to the brain resulting from a direct or indirect trauma to the head that leads to rotational or angular force. It is important to note that actual contact with the head during trauma is not required for a concussion to occur. The most common symptom of a concussion is headache, but the symptoms range from anxiousness, depression, confusion, difficulty concentrating, change in personality, problems sleeping, or nausea and vomiting. Due to the wide range of symptoms, clinicians often look for emotional, cognitive, sleep related, or physical signs that appear soon after the event and present different from an athletes baseline. If you suspect you or someone you know are displaying concussion symptoms, ask your doctor or chiropractor as soon as possible.

How are they Managed?

There are many tools used to evaluate a concussion on the field. These include the SCAT2 and the ACE post concussion symptom scale. Generally, history of the event and present symptoms, and a physical exam including an in depth neurological exam are used to diagnose a concussion. Sometimes neuroimaging such as a CT scan or MRI will be done if the symptoms are very severe or the clinician suspects structural damage to the brain. The management of a concussion should be overseen by a trained professional such as a sports physician or chiropractor. There is no specific treatment for a concussion, and much of the recovery involves cognitive and physical rest. Often times objective physical and balance tests are used as well as neuropsychological assessments to determine the progress of a patient’s recovery.

When is it Safe to “Return to Play”?

The stages of recovery in a concussion are stepwise and are as follows: 1) No Activity; 2) Light aerobic exercise; 3) Sport specific exercise; 4) Non-contact training drills; 5) Full contact practice; 6) Return to play. These stages have to be very gradual and should be overseen by a healthcare professional. The progression can take a matter of days to months, it depends on the specific patient. A patient will have to complete each stage without any post concussion symptoms, otherwise the patient will return to the previous step. There are special considerations such as age, severity of symptoms, and high risk nature of the sport which will modify how concussions are managed. If you have any questions about Return to Play criteria, please ask your sports physician or chiropractor.

River Valley Health can help!

Doctors of chiropractic are trained in the treatment of neuromusculoskeletal injuries, including the evaluation of concussions. If a patient has severe symptoms, they should go to the nearest Emergency Department at the closest hospital. If a patient has mild symptoms and would like a caring doctor to monitor their progression through rehabilitation before “Returning to Play”, River Valley Health can do that.
River Valley Health also offers cutting edge technology called the D2 which helps evaluate if an athlete is fit to “Return to Play”. The D2 involves reaction time, motor movement evaluation, and serve as a great baseline and follow up for athletes in high risk sports. To learn more click here
River Valley Health also has an in house psychologist who can help monitor and evaluate the athlete’s progress. If you suspect someone you know has had a concussion or is showing concussion symptoms, please have them evaluated by a qualified healthcare professional.

Click here to see an informative video!

References:
McCrory, P. et al. Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. British Journal of Sports Medicine. 2009; 43(suppl 1).
Scorza, K., et al. Current Concepts in Concussion: Evaluation and Management. American Family Physician. 2012;85(2):123-132.

Please note that this change relates only to basic exercise therapy. Performance programs, biomechanics analysis and more involved exercise therapy programs will continue to be supervised by our exercise and biomechanics specialists and will therefore be billed and scheduled separately.

As well, the rate for Performance Enhancement will be changing to $60 for an initial assessment and $40 for follow up sessions.

If you have any questions or concerns, please feel free to discuss them with your provider or one of our managers.

The U.S. National Library of Medicine defines Carpal Tunnel Syndrome as “pressure on the median nerve […] that can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.” The Median nerve supplies sensation and movement to the thumb, index, middle, and half of the ring finger. The area of the wrist where the median nerve enters the hand is called the carpal tunnel. Any swelling of the structures passing through the tunnel can cause compression on the median nerve and consequently give rise to the symptoms discussed. There are both surgical and non-surgical treatments for Carpal Tunnel Syndrome.

Symptoms that mimic those associated with Carpal Tunnel Syndrome may be caused by other musculoskeletal conditions, such as Thoracic Outlet Syndrome (TOS) and Active Trigger Points. Thoracic Outlet Syndrome may result in muscle weakness, numbness and tingling, as well as signs of poor circulation in the arm and/or hand. These symptoms arise due to compression of nerves and blood vessels in the Thoracic Outlet, the space between the rib-cage and the collar bone. Compression may be caused by injury, over-use (such as desk work), or pre-existing conditions such as an extra cervical rib. Presentation mimics Carpal Tunnel Syndrome with similar numbness and tingling but involves the entire hand and not just the previously mentioned portion as seen with CTS. Also, TOS usually involves symptoms throughout the arm while carpal tunnel normally just involves the hand and those structures “downstream” of the wrist.

Active Trigger points indicate specific spots located along skeletal muscles that have become hypoxic (low in oxygen supply) and tight, are associated with decreased blood flow. They present with local and referred patterns of pain, and can be caused by acute trauma (damage) or repetitive microtrauma to the area. Trigger points in the shoulder may cause referred pain throughout the arm and cause altered sensation in the lower arm (Alvarez DJ and Rockwell PG, 2002). The referred pain and symptoms that can arise from the trigger points mimic the symptoms of CTS. Trigger points in the upper and lower arm for example, may irritate nerves that supply structures in the arm and hand. These symptoms are similar to CTS, however the underlying cause is different, and therefore treatment to alleviate the symptoms should be modified.

Your provider can assist you in treating these syndromes to relieve pain and numbness in the hands. Treatments, such as Active Release Techniques and Graston, may be effective in releasing scar tissue that causes these symptoms. As well, your provider can refer you to the proper medical professional if carpal tunnel syndrome is suspected or a surgical intervention is required.

References
A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001469/
Alvarez DJ and Rockwell PG (2002). Trigger Points: Diagnosis and Management. American Family Physician, 65, p653-660. http://www.aafp.org/afp/2002/0215/p653.html.

Here’s a sneak peak!

Thirty percent (30%) of all skiing injuries involve sprains of the knee, most commonly the MCL (medical collateral ligament) and ACL (anterior cruciate ligament) (Khoele, et al. 2002). This occurs for different reasons based on the skier’s skill level, the most common being when the knee tilts inwards and the lower leg is forced forwards. This often happens during a fall or when catching an edge. In 47% of these injuries, improper binding settings (DIN: Deutsches Institut für Normung) was one of the causal factors (Khoele, et al, 2002). Improper binding settings can prevent the release of the foot from the ski during a fall and cause undue stress on knee.

Preventing knee injuries when skiing is multifactorial. With the pediatric and youth skier, appropriate strength is required before jumping into ski boots. This also is true for the adult skier. Areas of specific focus should be in the hip stabilizers, knee stabilizers, hamstrings and lower back. Ask the appropriate health professional to evaluate these areas and to obtain ways to strengthen them adequately. Appropriate equipment is also important. Always wear a helmet. Also, make sure the binding settings are appropriate for both the weight and skill level of the skier. A ski shop will have the appropriate charts and tools to adjust the bindings. This is an often overlooked step, especially if one is getting hand me down skis. On the hill, take a lesson. Ski instructors are professionals who will teach the new skier to navigate the hills safely.

As is the case for most things involved with snowboarding, when injuries happen they happen big. The most common are fractures which often occur while riding on surfaces that are hard and icy (Dohjima, et al. 2001). Avoiding riding in these conditions may be advisable – and snowboarding is a lot more fun in powder anyway. Other notable injuries in snowboarding, albeit rare, are spinal injuries and head injuries. When they do occur the results can be devastating. Almost all of these injuries have been associated with jumping (Khoele, et al 2002). Asking snowboarders not to jump is unrealistic, however it is important for a snowboarder to ride terrain within their skill level.

In closing, skiing and snowboarding are great winter sports which can offer high speed thrills and family fun, however precaution should be taken to prevent injuries this coming season. These preventative steps can take the form of physical conditioning and strengthening of specific body areas, getting the right equipment and skill training, and being aware of the mountain conditions.

References:
Khoele, M. S., et al. Sports Medicine. 2002, 32 (12), 785-793.
Dohjima, T., et al. Acta Orthop Scand. 2001; 72 (6): 657–660

Photo property of J. Chow, Skier: James Nicol

Article by Dr. Jonathan Chow

Sport Psychology can be applied to anger management when dealing with referees and coaches. Many times athletes have difficulties accepting a poor call (or a call they disagree with) from a referee. A sport psychologist can provide skills to athletes to deal with these so-called “losses of control”. Even business professionals can benefit from sport psychology skills in the application of dealing with employees and employers.

Sport psychology is as unique as the individual athletes who seek help from a sport psychologist. Working with a sport psychologist typically begins with an assessment to determine what performance goals are to be accomplished. Following sessions are used to develop skills and abilities that will help the athlete accomplish their goals.

For athletes, sport psychology explores the mental game and how psychological aspects of sport can make an athlete a better performer. Traditionally there are several basic mental skills that have been taught to athletes. These skills include: Self-awareness, relaxation, goal setting, Imagery/Visualization, Self-Talk maintenance, concentration/focus, and motivation. However, sport psychology is not limited to just these skills, in fact sport psychology has a large host of applications that many athletes ignore.

For example, sport psychologist’s can provide athletes skills and knowledge that will help confuse or disrupt an opponent’s concentration. Sport psychology can help coaches develop better tactics to use against an opponent or team through attacking not only technical and physical weaknesses, but mental weaknesses as well. Sport psychologists can provide coaches with new strategies to communicate with teams and athletes, sometimes diffusing difficult or tense situations.

More importantly, sport psychologists are also trained to deal with significant mental health problems such as eating disorders and depression. Athletes often experience additional life stressors and the added pressure can very often be overwhelming, resulting in the development of depression, anxiety disorders, or even eating disorders. Sport psychologists are not only trained to deal with sports related issues but mental health issues that may even be life threatening.

Athletes reaching retirement are often faced with a significant change in lifestyle that can be difficult to accept. In fact, retiring from a sport can sometimes be as traumatic for an athlete as losing a loved one. Sport psychologists can help guide athletes through the emotions that come up during retirement from sport.

If you are an athlete in need of a sport psychologist or just need someone to speak to regarding a problem you may be facing, a registered provisional psychologist and sport psychologist is available at the clinic to answer your questions and help with any concerns you have.

Join us on September 29 from 5-8PM as we unveil our new logo, launch our website, and reveal the changes in our office.

The evening will feature treats from our friends at DaCapo, info about our services, and prizes to be won!

Jason Gregor from TEAM 1260 will also be hosting his show in our office, be sure to tune in to hear Jason’s show from 2-6PM.

We would LOVE to see you there!

Inter-venous (IV) vitamins and minerals are superior to those taken orally as they are absorbed directly into general circulation, rather than needing to be digested, metabolized and then absorbed. This allows for more available nutrition to be and used by our bodies. IV therapy is especially useful in individuals with malabsorption issues – where nutrients are not properly broken down and used by the digestive system. In addition, IV therapy can provide an athletic edge, preparing the body for endurance events or assisting with recovery afterwards.

IV therapy for general health maintenance contains, but is not limited to, high dose vitamin C, pantothenic acid (B5), pyridoxine (B6), selenium, zinc chloride, magnesium citrate, multi-trace minerals, B complex vitamins and folic acid (B9). Depending on the person and their individual needs, some formulations may vary slightly.

IV therapy is beneficial for immune boosting, energy restoration, adrenal gland support, fatigue reduction, pre and post endurance exercise nutrition and hydration, stress reduction, acute infections, chronic depression and more.

If you have any further questions, or if you would like to see whether IV therapy is right for you, please contact Dr. Leyanna Zubach, ND at River Valley Health.

It is well known that foods can elicit an immune response. We see the most common reactions in anaphylaxis, where the body rejects a food so violently that it becomes a medical emergency. The reactions I will address, however, are those that tend to fly “under the radar” or are simply dismissed as a nuisance. Here I am referring to skin rashes, chronic gas and bloating, irritable bowel syndrome, alternating constipation and diarrhea, chronic headaches, lethargy, weight gain, asthma and joint pain and many others.

When we talk food allergies, there are two main food antibodies (a subset of proteins) that are responsible for the majority of the allergic responses or sensitivities that can occur. The first set of food proteins are called immunoglobulin E. These IgE reactions are rapid reactions that generally occur immediately after consumption and can cause life-threatening allergies (for example: peanut allergy). While IgE reactions can occur in seconds to minutes, immunoglobulin G reactions take hours to days to develop. Thus the difficulty in uncovering which food is the culprit without doing specific testing.

IgG food sensitivity testing provides answers about which foods could potentially be contributing to various health concerns experienced by the individual. By way of a quick finger-prick blood test, proteins in the blood with the highest reactivity by our immune system are uncovered. This information is understood to depict which foods out of a variety of different food categories should be avoided. The food categories tested include, but are not limited to, dairy, meat and seafood, fruit, vegetables, various grains, sugar and coffee. A more specific test can applied to test for yeast in the body should there be a past medical history of chronic yeast infections, athlete’s foot, and other skin conditions attributed to yeast.

Food sensitivity testing can provide answers to frustrating health concerns that otherwise have no reasonable explanation. If you feel that many of your health concerns have a connection to the food you eat, you may be a candidate for IgG food sensitivity testing.