Posture...One Major Secret To Long Term Health

This entry of “Get In Motion” will hopefully give the mothers out there some ammo to back up your demands for children to “sit up straight.” It may give everyone some tips on a small effort investment that will change your life 10 years down the road.

Head posture, according to a 2006 study from the Harvard Med. School Journal, could be one of the greatest predictors of poor health (high risk of heart disease, stroke, and lung disorders) in the 65 – 75 year old population, but the most highly neglected area of health in the 25 – 35 age range. Poor posture increases the work load on the muscles around our spine, increases wear and tear on our joints and spinal discs, lowers our breathing capacity and the ability to oxygenate our bodies, and worst of all is a habit that is tough or impossible to break after we practice it for long periods.

For every inch our ears sit in front of our shoulders while looking at the computer screen, playing a video game, studying a textbook, etc. the weight of our head seems many times heavier to our muscles and spine. This causes most of the upper back pain that plagues our society. After assuming this position for long hours every day we get stuck in that position much like how hard it is to straighten an elbow that’s been cast at 90 degrees for 6 weeks. Aside from the consequences of neck and upper back pain, let’s demonstrate how this posture affects our shoulder and rotator cuff. While sitting in a chair, slouch your low back, reach your chin forward and then try to touch your ear with your elbow. Then sit up very straight and try again. The difference is amazing. So now we’ve got upper back pain, a rotator cuff tear, and we’re stuck in this poor postural position, all because we chose to overlook the importance of forming a good posture habit.

Good or bad posture is simply a choice. Neither way is more of a burden if we start now and not after the effects have set in. The best way to get into good head posture is to keep your eyes on the horizon and then draw your head straight back. Hold this for two seconds then slowly relax. When you feel like you’re not working, stop. That’s “your” good posture. If your ears end up far in front of your shoulders, you need to have yourself treated to reverse the restriction. If you realize how easy this change is, remind yourself every hour for a week to repeat the procedure and form a great habit.

For much more information please visit WWW.IMSJC.COM or call us at In Motion Spine & Joint Center. And listen to your mothers!

Little League Elbow & Pitch Count Restrictions

Now that school is out and summer is upon us, baseball is on the minds of many families while preventing injuries is always on my mind. Young pitchers are looking to gain an edge on their fellow competitors and some fall victim to injuries in their quest to be the next Nolan Ryan. Elbow pain is common in young pitchers with a recent study citing that nearly 26% of children ages 9-12 experience elbow pain during the season (1). “Little League Elbow” is used to describe pain along the medial (inside portion of the) elbow due to repetitive stress or overuse. Little League Elbow can ultimately result in avulsion fractures, Ulnar collateral ligament injuries (what Tommy John’s surgery repairs) or tendonitis. It is most common in pitchers 9 – 14 years old due to the non-closure of the growth plates in the arm and forearm bones. The growth plates along the medial elbow are closed on average around 15 years of age (2).

The most common cause of this injury is poor throwing mechanics, poor core and shoulder stability, muscle imbalances or just too many pitches. Little League Baseball Inc. and well know sports surgeon Dr. James Andrews have taken measures in an attempt to decrease the number of injuries by enforcing a pitch count. I have listed two charts describing what the new pitch count restrictions are based on age and the number of pitches thrown. These restrictions are only for Little League Baseball, Inc. and do not apply to USA Baseball leagues. USA Baseball is looking into having restrictions but currently is only making recommendations to their players, parents and coaches on pitch counts, rest days and types of pitches to be thrown.

Pitch count restrictions, based on age:
For pitchers 17-18: 105 pitches
For pitchers 13-16: 95 pitches
For pitchers 11-12: 85 pitches
For pitchers 10 and under: 75 pitches

Pitchers league ages 7 through 16 must adhere to the following rest requirements:
If a player pitches 61 or more pitches in a day, three (3) calendar days of rest must be observed.
If a player pitches 41-60 pitches in a day, two (2) calendar days of rest must be observed.
If a player pitches 21-40 pitches in a day, one (1) calendar day of rest must be observed.
If a player pitches 1-20 pitches in a day, no calendar day of rest is required before pitching again.

Pitchers league age 17-18 must adhere to the following rest requirements:
If a player pitches 76 or more pitches in a day, three (3) calendar days of rest must be observed.
If a player pitches 51-75 pitches in a day, two (2) calendar days of rest must be observed.
If a player pitches 26-50 pitches in a day, one (1) calendar day of rest must be observed.
If a player pitches 1-25 pitches in a day, no calendar day of rest is required before pitching again.

Our goal in managing sports injuries is to assess, diagnose, proper treatment and prevent future injuries. Pitching is a whole body activity so when assessing these injuries you have to look at ALL of the joints and muscles from the foot to the hand – this is commonly referred to as “Evaluation of the Kinetic Chain”. Just as in a chain, it is only as strong as its weakest link. Once you determine the weak link and make it stronger you make the entire chain stronger. Commonly in pitchers with “Little League Elbow”, they are over-compensating and too much stress is placed on their elbow, and that is why the injury occurs.

Hopefully this article sheds some light on what healthcare professionals and youth baseball organizations are doing to limit injuries in children. For more information please feel free to visit our website at www.imsjc.com or call 615-302-4747.

1.) Lyman, S., Fleisig, G., Andrews, J., et al; “Longitudinal study of elbow and shoulder pain in youth baseball pitchers”. Medicine & Science in Sports & Exercises, May 2001.

2.) Bradley, JP. Upper extremity: Elbow injuries in children and adolescents. Pediatric and Adolescent Sports Medicine. Vol.3. 1994: 242-61.

Low Back Pain and Golf

Are you a golfer who has, or have had low back pain and just chalked it up as a normal consequence of being an avid golfer? Well, I’m here to tell you that it’s not normal, and there are reasons and solutions for your pain. A golfer with sound technique, proper core stability, muscular balance, and good awareness of how to perform basic activities of daily living rarely will succumb to the effects of low back pain. So let’s discuss what causes low back pain in the golfer and what to do to combat this golfing epidemic.

When comparing golf injuries to amateurs vs. golf professionals, the number of injuries to the low back differs between the two groups. Of all golfing injuries sustained by professionals, 25% of those injuries are to the low back, amateurs however injury their back at a rate of 36%.(1) If you consider how many swings a pro takes vs. the average amateur player in the course of a year this statistic becomes even more intriguing. This indicates that proper technique and training can decrease the rate of low back pain. (1) Metz, J. Physician and Sports Medicine, July 1999, Vol. 27, No.7.

Pain is our body’s “Check Engine” light and it goes off when we have an injury or if body parts are being stressed too much. Many of us are forced to sit a fair amount of the day due to driving, work, etc. This increases the amount of stiffness in our hips and causes poor posture in our upper and mid back. These muscle imbalances are amplified when we do something more challenging, like golf or other recreational activities. Golf requires mobility from our neck to our ankles and if one area becomes overly stiff then an adjacent area will be forced to compensate. More times then not, low back pain is the result of it compensating too much.

Even though golf is a rotational sport, our low back is not designed to rotate, however, our hips and our mid back are designed for rotation. Our core helps support our low back as well as generates power for the golf swing. The muscle imbalances mentioned earlier will cause to core to be inadequate for golf or even everyday stresses. To determine if you lacking the proper core stability or muscular balance necessary to play pain free golf, contact your local golf fitness doctor who can perform a series of functional tests specific to this issue.

So, instead of allowing your low back pain to continue, I suggest you determine why your “Check Engine Light” is on and consult a golf pro and golf doctor to formulate a plan to decrease your pain and increase your ability to golf longer and pain free. Feel free to contact In Motion Spine and Joint Center at 615-302-4747 or at www.imsjc.com.

Neck and Shoulder Pain: Are “Knots” the Cause or the Effect?

According to how many people I see getting massages in the mall, face down in those kneeling chairs, it’s obvious that neck and upper back pain is very common.  And that those people getting the massages feel that getting the shoulder “knots” worked out will fix the reason for their pain.  I’d like to switch the focus with this article and offer a logical approach to take before have the “knots” worked out.

A knot forms in a muscle for a couple of reasons.  First, if a muscle is being over-stretched too much of the time, the brain tells the muscle to constantly fight the pull leaving scar tissue, usually at the top of the shoulder.  This person usually has poor shoulder or neck posture.  The posture usually worsens with sitting at a computer, playing an instrument, reading, etc. 

Second, if a muscle is constantly over-worked and/or used for a job it is not meant to perform, it gets fatigued without the chance to recover, leaving scar tissue or “knots”.  This person has poor shoulder blade stability.  The shoulder elevators (at the top of the shoulder) are over-worked and the stabilizers are not doing their job.  The pain and soreness in this scenario is similar to getting sore from a workout, and then doing the same workout the next day.  Without time to recover, muscles will soon fail.

In both of these situations it’s not the “knot” that’s at fault.  It is a consequence of poor posture or faulty shoulder movement.  My suggestion is to have the cause fixed before having the effect removed.  In reality, the “knot” is your body’s attempt to create stability at the shoulder and neck and removing it could worsen your stability.  A massage temporarily feels good, but leaves you needing more and more.  At In Motion Spine & Joint Center we spend the time to find the missing link and fix the posture, shoulder function or both.  Treatment may be a combination of spinal adjustments, muscle manipulation, rehab exercises, and most importantly advice.  Please call the office or visit www.imsjc.com to learn more.

Trochanteric Bursitis – A Big Pain In The Hip

Pain focused around the widest part of the hip, that gets worse with activity, direct pressure, or crossing a leg could be Hip or Trochanteric Bursitis.  This condition results when the hip muscles apply too much pressure over the fluid filled bursa sac that lies over the hip bone. 

If you closely watch them walk, the people that have or will have this problem can be spotted.  With each step they usually have an exaggerated shift in their hips toward the foot that is planted.  This observation tells us that the muscles that should stabilize their hip, the Gluteus Medius for example, aren’t doing their job, it is “asleep”.  But, the body usually doesn’t fail when one muscle quits working; it compensates and uses the Tensor Fascia Latae muscle (TFL) that crosses right over that hip bursa.  If this muscle imbalance sticks around it will result in trochanteric bursitis.

Hip bursitis is typically a stubborn condition and requires a multi-faceted approach to resolve.  The TFL muscle that is irritating the bursa must be stretched.  The gluteus medius that is “asleep” must be rehabilitated and then the proper movement pattern restored during walking or one leg standing.  And, quite possibly the foot must be addressed, the foundation for the knee and hip.

At In Motion Spine & Joint Center we use multiple soft tissue techniques and functional rehabilitation to relieve the pain and correct the problem.  If you have any questions about this or other conditions please refer to www.imsjc.com or call 615-302-4747.

Good Advice For Your Back When and If You Need It

Recently a good friend that lives out of state had an acute episode of low back pain. My wife, being more involved with Facebook than me, saw that he had put a posting on Facebook and there were numerous people giving “advice”. She asked if I had seen the posting, which received a quick “no”, and then she thought I should give some quality recommendations. Being curious, I decided to look at what people had written. Most of the advice was TERRIBLE which gave me the idea to write this article in an attempt to have some good advice floating around.

Advice for Sudden onset of back pain
Chill out -- Not Heating pads! Applying ice for 20 min, off for an hour and then repeating several times will help decrease local inflammation. With an injury there is inflammation and heat commonly will make inflammatory conditions worse. I am yet to see a person put ice on a new injury and it make them feel worse, however I can not count the times I have seen the opposite happen with heating pads, hot packs or Therma-Care patches. → Moral of the story, when in doubt choose ICE over heat!

Move but don’t stretch hard. Dr.Gordon Wadell, MD wrote a book called “The Back Pain Revolution”. To quote him directly he stated,”...a death sentence for a bad back is bed rest”. Any movement that is relatively pain free, such as walking or doctor prescribed exercise, is better than laying on your back waiting for it to get better. However, often I have seen people try to stretch out a back or neck problem only to make it worse. Gentle movements in the pain free zone are the way to start your recovery. → Moral here: Move gingerly. Don’t lay around. Walking is therapeutic and don’t try to stretch through pain.

Seek the Advice of a professional. Often patients receive exercises that are prescribed to help their back. Exercises given to your friend may actually make your condition worse because every patient is unique, as is their condition. For example, bending forward is often good for a person with spinal stenosis but will absolutely wreck a person with a disc injury. If we don’t know what condition the patient has then there is no way to give good advice. I commend people for trying to help their spouse, neighbor, friend or stranger, but I hate to see people doing more harm than good because their friend gave them a stretch or exercise that they had done in the past for different condition. → Moral: Get a diagnosis from a trained health care provider so YOU get the right advice for YOUR condition.

This is just scratching the surface for advice on back pain. The back is a complex structure, so being judicious with advice is only way to prevent further injury to yourself or to your friend (…and if your wondering if I posted on my friend’s Facebook page, sorry, I didn’t. I called him up and learned a lot more and sent him to a good doc). For more information or health tips please visit WWW.IMSJC.COM or call 615-302-4747.

Low Back Knowledge - From the Best In the World

Dr. Hawkins attended a seminar in Naples, FL taught by two of the top musculoskeletal doctors in the world. The seminar covered the most up to date techniques for treating lower back injury and rehabilitation exercises.

Dr. Pavel Kolar from Prague, Czechoslovakia presented developmental neurology and dynamic neuromuscular stabilization. His examination allows us to see the motor patterns of patient’s brains and how those patterns are causing injury. Treatment teaches patient’s brains (not their muscles) to recall the safe patterns that we all had as children but lost due to old injury or repeated poor postures.

Dr. Stuart McGill is the director of spine research from the University of Waterloo, Canada and is highly sought for rehabilitation of tough pain cases in top athletes around the world. He taught spine sparing strategies and functional rehabilitation exercises. His most exciting topic was performance enhancement exercises for the elite athlete. He also presented research from his lab about the exact mechanisms of low back injury.

This information was presented and debated and challenging cases were treated by both physicians. Two of the patients were top level athletes, an Olympic sprinter and a champion mixed martial artist, and the others were long-time chronic back pain cases in average men. Attendees as well as the presenters could obviously see that both methods applied together made for the most effective rehabilitation of the worst backs.

Attendance of this seminar was by invitation and with only 50 invitations sent across the US, the two doctors feel very privileged to have been invited, and are now able to bring this information back to Spring Hill and benefit its toughest pain cases. For more information about In Motion Spine & Joint Center please visit WWW.IMSJC.COM or call 615-302-4747.

“Patellofemoral Syndrome” Such a Pain in the Knee

Knee pain is one of the most common complaints heard in our office, and patellofemoral syndrome one of the most common causes. This pain is felt just deep to the patella or kneecap and usually causes pain when rising from a chair or going up and down steps.

The patella is lined on the back side by a layer of cartilage which helps it slide smoothly over the femur or upper leg bone. The quad muscles (front of the thigh) and the patellar tendon (just below the kneecap) are attached there and it acts as a pulley. When the patella is under too much compression for too long the cartilage underneath gets worn and causes pain.

There are mostly two reasons for the kneecap to get overloaded. The first is when the quads are too tight. They pull much harder than the kneecap can withstand and cause greater wear and tear than normal. The second is when the kneecap tracks poorly in the groove it rides in across that upper leg bone. When muscle imbalances pull the kneecap to one side, the joint’s lifespan is decreased by half, wears out and causes pain.

Soreness after a run or strenuous exercise is usually normal. But, if a person has knee pain with normal activities such as going up and down stairs, they should get theirs checked quickly. This will avoid irreversible cartilage damage. With the correct diagnosis and when the specific cause of the problem is found, patellofemoral syndrome can be fixed with specific muscle stretching and rehab exercises. If you are having knee pain, and would like to get it fixed, please call us at In Motion Spine & Joint Center.

Peripheral Nerve Entrapments

Contrary to popular belief, all pain or numbness that is felt in your arm or leg doesn’t have to be coming from dysfunction in your spine. Many people are told this and sometimes it is true, but many times it is not. The term Peripheral Nerve Entrapment, or Peripheral Neuropathy, is a fancy way of saying that a nerve is irritated or compressed somewhere other than the spine but is causing symptoms to be felt down one of your limbs (ex. arm or leg). Many different symptoms can arise when one has irritation or compression of a nerve. You may experience muscle weakness, pain, numbness, tingling or even hypersensitivity with this condition.

It is critical when seeing a healthcare provider for any of these symptoms that the person is trained to determine if the problem is due to a spinal condition or due to Peripheral Nerve Entrapment. Common tests are MRI, X-rays or Nerve Conduction Velocity Tests (NCV). However, there are cheaper and yet quite sensitive tests that can be performed in the office to determine where a possible Peripheral Nerve Entrapment is located. Neurodynamic tests will stretch specific nerves and if performed correctly will commonly reveal the location of the entrapment. These tests have been around for many years and have been performed with great success, especially in Australia where they were developed.

People commonly ask how Peripheral Nerve Entrapments occur and the answer is several things. It could have developed due to a repetitive movement, a previous injury that resulted in adhesions or scar tissue within the muscle or just plain wear and tear.

Once a Peripheral Nerve Entrapment is correctly diagnosed and located then treatment can begin. Conservative treatments such as Active Release Technique (ART) or specific soft tissue release, nerve stretches called Sliders or Flossing Maneuvers and muscle rehab are commonly performed in our office for this condition.

If you have further questions about Peripheral Nerve Entrapments please don’t hesitate to contact our office for more information at 615-302-4747 or www.imsjc.com.

Sciatica - Causes and Treatments

If you’ve recently had pain down the back of your leg, WebMD or your neighbor probably told you that you have “Sciatica”.  However, the term sciatica simply means you have pain along the sciatic nerve.

Sciatica is a symptom of something that is causing that pain, just like a runny nose is a symptom of allergies, an infection or a virus.

So now that we know what sciatica is, a better question would be “What is causing my sciatica”?  There are multiple conditions that can cause sciatica.  The most common causes are:

• Spinal Stenosis

• Lumbar Disc Herniation, Bulge or Prolapse

• Joint Dysfunction

• Piriformis Syndrome

• Peripheral Nerve Entrapment (Nerve irritation at a place other than your spine)

• Muscle Imbalances in the pelvis or leg

--All of these conditions can cause low back or pelvis pain that goes into the buttock and down the back of the leg.  

A thorough review of the patient’s history and a physical examination by a quality physician can help determine the cause of your sciatica symptoms.  Whether it is any of the above conditions, they usually respond well to focused manual care in conjunction with rehab exercises.  The majority of “sciatica” issues do not require surgery. 

Once your health is restored, simple changes to your daily routine and incorporating specific exercises can eliminate sciatica once and for all.  This type of instruction should be incorporated along with your treatment to facilitate the treatment process. 

For more information on “Sciatica” or how it is properly treated please contact Dr. Mark Hawkins at In Motion Spine and Joint Center at 615-302-4747 or visit our Website at www.imsjc.com.

Start Improving Your Golf Game This Winter For Better Results Next Summer

With temperatures hovering around freezing, the farthest thing from my mind is golf. However, if one of your New Year’s Resolutions is to improve your game, now is this time to start. There are certain things that need to be started several months before golf season to ensure a long and injury free year.

Golf is a unique sport in that it requires certain areas of your body to demonstrate exceptional strength and other areas of sufficient flexibility. Both of these attributes take time to develop and therefore specific training should start several months in advance to your target date.

The most common “problem areas” I see in evaluating golfers is the lack of flexibility in the hips and the lack of core stability and overall endurance. This is seen in golfers of all abilities too. Below I will list certain key points to improving both. Just remember that any new exercise program should be started under the guidance of your health care provider to be sure that you are healthy enough to participate.

Flexibility of the Hips

Be sure to stretch often and ALWAYS following any kind of exercise routine. Research has shown that stretching 30 seconds 4-5 times a day gives better, longer lasting results versus stretching 2-3 minutes once a day. Also stretching is a great way to cool down following an exercise routine and helps decrease soreness.

Focus on Rotation of the hips. The golf swing is a “Multi-planar” exercise, which means it moves in more than just one direction. It forces you to move front to back, side to side and around an axis of rotation, therefore we need to be flexible in all directions.

For great stretches, and A LOT of them that are demonstrated with a video, I would recommend going to www.mytpi.com and sign up for a free account. This website has a great deal of information that is very helpful to the avid golfer.

Core Stability & Endurance

To increase core endurance start with exercises such as a Side-Bridge or a Front Plank from your knees. These exercises train your core for stability and are much safer on your back than the standard sit-up. Also these exercises will work ALL of the abdominal muscles. 

If training at a gym, try to keep your workout moving. One great way to help with endurance is to go from one exercise to another several times before repeating the first exercise. For example: Perform a 30 second Side-Bridge, then immediately perform 25 lunges, then immediately perform 20 push-ups, then break for 30 seconds and start over. This will keep your heart rate up and thus help with cardiovascular endurance.

This is just scratching the surface when it comes to golf specific training, stretching and program design. Understanding what part of your game you want to improve as well as what your unique strengths and weaknesses is what will ultimately take your game to the next level. For questions on Golf Specific Training or anything in the article please don’t hesitate to contact our office at 615-302-4747 or email us at info@imsjc.com and feel free to visit our website www.imsjc.com.

Preventing ACL Injuries

ACL Injuries are thought to be unpreventable, and in some situations that is entirely true. However, some ACL tears ARE preventable and that is the area of recent rehabilitation research. According to Dr. Frank Noyes, nearly 100,000 ACL injuries occur every year and of those, 30,000 will happen to college and high school female athletes. Ironically, the vast majority of these injuries that occur to females are Non-Contact. A Non-Contact ACL injury usually occurs during landing or sudden stopping.

In 1999, the average cost of an ACL surgical repair was $17,000. That in combination with loss of scholarships, wages, etc, brings the annual cost of ACL injuries up to $37 million dollars.

The question most commonly asked is, "Why are ACL injuries more common in females?" The answer is complex yet very simple -- Males are different than females. Several physical factors have been identified as to why females are at a higher risk than males. In comparison to males, females have:

• A wider pelvis (causes an increased Q-angle. see fig. 1)
• Different hormones (Decreased ligament stiffness)
• Hamstring/ Quadriceps Strength Ratio
• Smaller ACL Size (Easier to tear)
• Smaller Femoral Notch (less room for ACL to move)
• Poor Jumping Technique. (commonly due to muscle imbalances)

The ACL tears due to uncontrollable torque forces at the knee. The knee is blamed for these injuries but actually the hip musculature is the one to blame. Muscle imbalances and faulty technique can be corrected. Dynamic Rehabilitation can help decrease these non-contact injuries. In a recent study, females who participated in a Dynamic Rehab program, such as the one offered at In Motion Spine and Joint Center had a reduction in incidence by 62%!

An ACL screen has been prepared by the Drs at In Motion Spine and Joint Center to definitively identify which females are at the highest risk of an ACL injury. This type of screen would be ideal for high school programs or other athletic programs for the following sports:

• Volleyball
• Basketball
• Soccer

An ACL Tear Prevention program can be implemented along with standard conditioning or weight training. The good thing too, is that the exercises and stretches can be performed at the gym, on the field or at home. With high school and college athletic programs becoming more competitive, not to mention scholarship opportunities, the effects of an ACL tear can be devastating. For more information on ACL Tear Prevention, ACL screening, team options, or an in-depth lecture on this information, please contact In Motion Spine and Joint Center at (615) 302-4747.

Active Release Technique (ART)

A revolutionary soft-tissue technique that helps from head to toe.

In Motion Spine and Joint Center is currently the only clinic that offers Active Release Technique in Spring Hill. ART is a soft-tissue technique that allows the doctors to treat a multitude of conditions ranging from headaches, low back pain and sciatica to carpel tunnel, plantar fascitis and Tennis elbow. Designed to remedy soft-tissue conditions associated with muscles, tendons, nerves and ligaments, ART is proven to be one of the most effective techniques for these and other conditions.

ART is performed on specific structures on the body that may have formed scar tissue due to over-use, acute injuries or inflammation. This scar tissue can increase and keep tissues from moving freely. As the scar tissue builds up, muscles will become shorter and weaker, the increased tension on the tendons causes tendonitis, and nerves can become trapped. This can cause reduced range of motion, loss of strength, and pain. If a nerve is trapped you may also feel tingling, numbness, and weakness. By palpating, or "exploring" the area in question, doctors can find these areas of scar tissue, also known as adhesions, and help remodel the tissue and reduce the scar tissue. This can often increase the range of motion, decrease pain and help prevent other areas of the body from becoming "over-worked".

ART consists of more than 500 specific clinical applications for the effective treatment of various soft tissue conditions. The benefits of ART are increased when used in conjunction with joint mobilization/manipulation and therapeutic exercises. ART is so effective, that it has been used on U.S. Olympic Teams, Ironman participants, and professional teams, including the Tennessee Titans. For Questions about Active Release Technique please call In Motion Spine and Joint Center at (615) 302-4747.

Attention Bow Hunters!!

Don't Let Your Shoulder Get the Shaft

With bow season upon us, many avid hunters will scamper to their "perch" in hopes of seeing that trophy animal. Many hunters may be ill prepared when that special moment presents itself, especially if the hunter is required to hold his/her draw for quite some time. In order to successfully hold the bow in the "full draw" position for any length of time requires the archer to possess a lot of strength.

The key to holding the "full draw" position is to consistently use the larger back muscles (such as the "lats", rhomboids, as well as the mid and lower traps). If the archer uses the smaller rotator cuff muscles or the arm muscles more than the larger back muscles, fatigue will set in sooner and the archer will "shake" more.

As with any other sport, "perfect practice makes perfect". A common mistake is archers will practice for a long period of time per session. This may force the archer to use the smaller muscles around the shoulder as the large back muscles fatigue resulting in inconsistency or injury. Because the small muscles are not designed to handle the increased load, shoulder pain is common occurrence. Slowly increasing the practice time will keep the archer using the same muscles every time.

A few good exercises to strengthen the large back muscles are pull-ups, reverse push-ups, low-rows and shoulder blade retractions. There are numerous exercises that can be performed, such as using Thera-bands to simulate drawing the bow or Swiss Ball exercises, however, talk with your doctor prior to starting any new exercise program.

Once the archer has a stronger back and has put in the proper amount of "perfect practice", the results are sure to follow. For more information about preventing shoulder injuries or sharing a good hunting story, please contact In Motion Spine & Joint Center at (615) 302-4747.

The Chiropractic Adjustment

For this edition I would like to discuss why joint adjustments / manipulations are used as part of treatment at In Motion Spine & Joint Center. An adjustment involves bending or rotating a “stuck” joint to the end of its range of motion and applying a very quick but short force beyond that range. This increases the range or quality of motion.

So why do joints get stuck?

• Gravity and Posture: Gravity encourages slouching, slouching causes poor postural habits, and those habits make joints stiff.

• Injury: Injuries cause muscle spasms, muscle spasms, after only days cause joints to get stuck and stay that way.

• Body Type / Genetics: Some people are just stiff. You can gauge yourself by placing your palm down on a desk and lifting one of your fingers with the other hand. If you feel a lot of resistance, you probably have stiff joints. Compare this with others.

If increasing range of motion is the goal, then it is crucial that adjustments are applied only to joints that are stuck! When joints get stuck in one area, we feel tight and restricted, and some people will try to “pop” their own neck or back, a wildly common trend among middle and high school students. Self-adjusting may fix your tight feelings after a couple of times over a couple days, and that’s great. If you get short term relief and feel yourself needing this pop more and more, you are likely making the problem worse by causing instability in the region. Instability is much more difficult to fix and causes arthritis at an early age. Joint popping feels good because it causes a release of chemicals that the brain loves, but it’s only helpful if used in the right spots.

At In Motion Spine & Joint Center, knowledge and research about how joints should move is applied both to analysis and treatment. After the joints are adjusted Drs. Hawkins and House go one step further to find out why they got stuck. Tight muscles are stretched with Active Release Technique and proper movement patterns are trained through specific rehab exercises. For questions or if your child is consistently popping their neck, please call 302-4747 or visit WWW.IMSJC.COM.

How to Prevent Shoulder Problems

Throwing is a component of many sports, however the focus here is on the over-hand pitcher. The act of throwing is a "whipping" maneuver where acceleration generated in torso and lower body is released through the arm and eventually to the ball. In the professional pitcher, at least half of the force production is due to the lower body's contribution which therefore decreases the demands on the shoulder. This point is often lost by more amateur pitchers or throwers who try to throw "from the shoulder."

The muscles of the rotator cuff are the supraspinatus, subscapularis, infraspinatus, and the teres minor. These muscles function during the throwing motion as stabilizers more than “movers”. The rotator cuff muscles are designed to add stability to the shoulder even though it is moving rather violently. Shoulder injuries often occur when the rotator cuff muscles become the muscles that are trying to generate all the force for throwing/ pitching vs. adding stability to the shoulder (specifically the glenohumeral joint) so the arm can act as a “whip”.

There are ways to train that will help decrease the likelihood of shoulder injuries however some pitchers are more susceptible to these injuries than others. To find out if your pitcher is at risk of a throwing injury, and to prevent it before it happens please contact In Motion Spine and Joint Center or a health care provider that is trained in sports pre-hab, rehab, and treatment. Some tips on training the shoulder are mentioned below.

If you would like more information on this topic or on shoulder injury prevention screens for throwing athletes (overhand or windmill), please contact In Motion Spine and Joint Center at info@imsjc.com or call (615) 302-4747.

Training and Rehabilitation Suggestions

• Shoulder muscles must be trained both eccentrically and concentrically.

• Emphasis should be placed on endurance of the rotator cuff muscles.

• Training of the scapular stabilizers is essential for providing stability for the moving scapular (shoulder blade) platform.

• Stretching of the posterior capsule and musculature may help prevent shoulder impingement.

• An emphasis on trunk rotational training is paramount for decreasing the demands on the shoulder.

Strength Training and Golf: Do they Mix?

The answer is a resounding YES!! The old misconception that strength training will "hurt" your golf swing is not true. That may have been true in the past because people didn't know how to strength train in a way that was conducive to their golf game. Today research and time has proven that you can train with weights (even heavy weights) and improve your game. There are a few keys that make this possible.

Always Remember to stretch before AND after your workout. Golf is unique in that you need flexibility and power therefore you need to stretch as much as you strength train.

Do a variety of exercises that mimic the golf swing.

Exercises such as a wood-chop will help strengthen golf specific muscles in a way that simulates a golf swing. Also do combo-moves, such as a lunge holding a medicine ball with a twist (just like the picture with 2007 Masters Champion Zack Johnson). This will strengthen your lower body, improve balance and help train rotation in your lumbar spine (lower back) under control.

Train the muscles that are involved in the golf swing the most. 

The muscles that do the most work in a powerful golf swing, according to EMG analysis, are: Abs, Obliques, Lats, Pecs, Rotator cuff muscles (Supraspinatus, Infraspinatus, Subscapularis & Teres Minor), and Glute maximus and medius.

Don't put the Cart in front of the Horse! 

Many times people will train out of order. Always Remember that the proper progression for any sport specific training is: Stability – Strength – Power. Make sure you first train your core to support your back, and then work on adding strength to the muscles that are "movers".

Increase Flexibility in the areas that need it.

Your hips and your shoulders are designed to move a lot during the golf swing, therefore, they should be stretched and "loosened-up". The most common problem I see is when people have stiff hips and they then try to get more rotation from their low back, thus causing an injury. Each vertebra in your low back can only rotate a few degrees so don't try to force too much movement there.

Keep it in the Short Grass!

For more information on how you can improve your golf game through proper golf fitness, please contact In Motion Spine and Joint Center at (615) 302-4747.

Pregnancy Pain

Find out why it hurts and how we can help.

For most women, the period of time during which a mother is carrying her child is one of the most memorable and joyous periods of her life. However, for many women the period they were with child was an unpleasant experience because of "PAIN". For about half of all pregnant women, low-back pain is an inevitability. In fact, the overall prevalence of back pain during the 9-month period is thought to be approximately 50%. Moreover, the pain can begin as early as week 12 and continue up to 6 months after delivery.

Why It Hurts

Pregnancy, especially the later stages, is fertile ground for back pain. Your center of gravity shifts because your uterus expands. Your abdominal muscles lose tone. Hormonal changes temporarily loosen important support structures - ligaments and tendons - leaving you with joints and muscles in the back and pelvis that seem to groan under the stress of increased weight. The cumulative effect of these stressors creates a perfect recipe for pain and discomfort.

How We Can Help

Given that most pregnancy pains occur in predictable patterns, the doctors at In Motion Spine & Joint Center implement specific protocols for treating and preventing the pains that most affect expecting mothers. Dr. Hawkins and Dr. House have learned and fine-tuned their treatment after having served as residents of the Barnes Jewish Christian Hospitals, Pregnancy Pain Clinic. Through the use of highly effective hands-on treatments and rehabilitative exercises we are able to formulate a treatment plan that will quickly relieve pain, preventing it from recurring, or keep it from happening in the first place.

Keeping the Baby Safe

Furthermore, utilizing a natural form of pain treatment helps eliminate the need for pain medication altogether. The resultant decrease in pain medication may reduce the mother's exposure to unwanted side-effects, and protect the unborn from the adverse reactions of unnecessary medication. For information on this topic, please contact us at at (615) 302-4747.

IT Band Syndrome – what is it?

IT Band is short for Iliotibial Band which is a continuation of a small muscle on the side of your pelvis called the Tensa Fascia Lata (TFL). IT Band Syndrome most commonly occurs due to overuse. This problem commonly affects runners, especially those with hyperpronated feet (Flat-Feet) and those who do a lot of downhill running. IT Band Syndrome does also affect other athletic groups as well as non-athletes.

The most common symptom with IT band syndrome is knee pain. This pain can be on the outside or inside part of the knee, but is more commonly found on the outside. As mentioned previously, this condition and the associated pain is due to overuse. The reason the IT Band becomes overused is because another muscle is not "pulling its weight". If this is the case, the IT Band will become extremely tight, due to overuse, which will alter the mechanics of the knee. This increased tension and altered knee mechanics will cause many of the symptoms associated with IT Band Syndrome. If the symptoms get severe enough, it could lead to "popping" around the hip called "Snapping Syndrome of the Hip".

Once this condition is properly diagnosed, a multi-therapy approach that includes muscle release and specific exercises can take place. Active Release Technique (ART) is phenomenal when treating this condition, especially if the patient participates in their rehab exercises as prescribed. The results of a multi-therapy treatment approach are often very successful.

For More Information about IT Band Syndrome, please contact In Motion Spine and Joint Center at (615) 302-4747.

Don't Let Shoulder Pain Take You Under

A glance at shoulder pain in competitive swimmers

Swimming has been heralded as being the ultimate exercise. Phrases such as "No Impact" or "Stress free to your joints" are commonly used when swimming is discussed as a training regime. This is true most of the time, but that old saying "Too much of a good thing, is Not a good thing" applies to competitive swimmers. Shoulder pain causes Olympic and Senior National swimmers to miss training and events 35% of the time. 

Let's put in perspective how much training a competitive swimmer does. During the average 2 hour training session, the swimmer may swim about 6,000-7,000 yards (or 3.5 - 4 miles). Then figure that on average, the swimmer will make somewhere between 1,500 - 4,000 strokes per training session. That would equate to be about 1,000,000 stroke cycles per year (Females could possibly have an additional 660,000 stroke cycles per year because they generally have shorter arm strokes).

Swimming selectively strengthens the anterior chest musculature as well as the internal rotators of the shoulder (such as the latissimus dorsi), leaving the external rotators rather weak in comparison. This muscle imbalance in conjunction with the repetitive microtrauma due to the nature of training will commonly cause shoulder pain. 

Perfect form helps decrease the likelihood of injury, however, as fatigue sets in, that ability to maintain perfect form becomes harder and harder. This is why specific training, focused exercises and proper stretching are so very critical and can help decrease shoulder pain. 

Stretches performed by many swimmers may actually be causing more harm than good. The front (Anterior Capsule) of the shoulder in swimmers usually has excessive laxity, which is one of the common causes of shoulder pain. If this part of the shoulder is excessively stretched the risk of Shoulder Instability raises drastically. Also specific exercises, especially those associated with shoulder blade (scapular) stability, can help decrease the likelihood of shoulder injuries and pain.

Competitive swimmers are always looking for the edge. Don't let shoulder pain take you out of the match. For more information on shoulder pain in competitive swimming, please contact In Motion Spine and Joint Center at (615) 302-4747.