Tennis Elbow

I’m sure we have all heard the term “tennis elbow” before. Especially with the US Open wrapping up this past weekend. Tennis elbow is the common term for “lateral epicondylitis,” which is inflammation of the lateral epicondyle of the elbow.

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What is Epicondylitis?

Epicondylitis is inflammation of the elbow where the wrist extensor muscles attach. Excessive use of the muscles (especially with performing back hands) will pull on the tendon and create inflammation and pain. Patients will then start to notice pain with any activity that uses that hand like lifting and shaking someones hand. That is usually why the pain persists so long with this injury. It’s hard to not use your hand. Every time you do, it’s like poking a bruise that you can’t see. You activate the muscles, the muscle pulls on its attachment to the elbow, and you create more inflammation in the tendon. 

Certain other activities and positions can also cause pain. Patients will commonly complain of pain with sleeping or when they first get up in the morning. The reason being, when we sleep our wrist is usually in a bent position. That position will put an extra stretch on the muscle and tendon as we sleep. That constant tugging of the tendon will lead to more inflammation and pain. 

Could it be Nerve Pain?

What a great question! The answer is yes. Your radial nerve runs right next to the lateral epicondyle. 

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Sometimes when the nerve is irritated it can present as “tennis elbow.” Typically if your nerve is involved you will get more tingling or pain into the hand as well as in the elbow. It’s always a good idea to double check though to be sure the true cause of your pain isn’t missed. 

How do I Make it Better?

If you get pain with sleeping the best thing to do is wear a splint at night. I recommend this to all my patients because it allows your injury to heal while you are sleeping rather than get worse. A resting splint at night is all you should need. It is irritating to wear at first but worth it in the end. 

If you are getting pain due to your radial nerve being irritated you want to perform this exercise.

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It will help to add length and mobility to the nerve. That should help to calm the pain sensitivity down and allow you to do more with your hand. Do two sets of 10 repetitions, through a pain free range of motion, twice a day. 

If you have true epicondylitis you want to increase the strength and flexibility of the tissue. Perform these three exercises, twice daily, to increase your wrist extensor strength and flexibility. That will help to strengthen the tissue, decrease the inflammation, and allow you to get back to your Serena-esk back hand pain free.

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Racquet Fit:

One final point about tennis elbow. If you get pain when you are playing tennis but don’t get pain otherwise, it’s a possibility your racquet is not fit to you correctly. Simple things like racquet weight, and grip size can have an effect on pain in your elbow. It’s always a good idea to make sure someone fits you properly to allow you to play as much as you can without pain. 

Conclusion:

I hope this helps answer why you might have elbow pain and what you should do about it. If you have any questions don’t hesitate to contact me. Thank you for reading!






Benefits of the Romanian Deadlift for Golfers

If you are a golfer and you only have time for one exercise (or you just don’t like working out), the Romanian Deadlift (RDL) is by far my favorite. I work with a large variety of golfers, from young to old, scratch to high handicap, and no matter skill or age, everyone can benefit from some RDLs. 

What the Heck is an RDL?

So I guess before we talk about why I love RDL’s, you should know what the heck I’m talking about. RDL’s originated from olympic lifting as a way to strengthen your back and legs in one movement to help improve the clean and snatch movements. It is a combination of a straight leg deadlift, and a traditional deadlift. 

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It focuses on strengthening your spine, abdominal muscles, and your hip/leg muscles all in one movement. Now who doesn’t love that?! 

If you are intimidated to start a new exercise that you have never done before, don’t worry. I prepared a video that will get you started on how to perform the RDL in a safe manner that won’t get you injured (it’s kinda my thing).

Why do RDLs Help My Golf Swing?

If you are going to have a good golf swing you need good posture. Not only do you need good posture, you have to be able to maintain that position throughout your golf swing. Look at every pro golfer, man or women, they have a perfect setup position. They are also able to stay there through their backswing and follow through. 

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Look at Ben Hogan in this picture (arguably one of the best swings in the history of the sport). He is able to keep his back on that line throughout the swing. That will improve consistency, and power, because nothing is being wasted with unnecessary movement in the swing (It’s physics, trust me). If you want to be able to do this you better have strong abdominal and hip muscles, hence the RDL. 



Posture Sounds Cool but what about POWER!



I get it, no one brags to their friends about how good their posture is. They always brag about how far they can hit the golf ball. The great thing about the RDL is that it can easily be a starting point to build some power. Once you have the movement down, you can start to load it with weight. That will build strength. Once you have a base level of strength you can start to do some “swings” which will build power in the golf swing (now I have your attention). If you have never done a swing here is a good video on how to perform one properly.

I hope you enjoy the new exercise and the savings in time. If you have any questions don’t hesitate to contact me. As always, thanks for reading.

Is My Wrist Pain Carpal Tunnel or Arthritis?

Here is a common scenario that we see in the clinic. Patient comes to us with wrist pain. They may or may not have seen a doctor and been prescribed with “carpal tunnel.” Here is the problem. Just because you have wrist pain doesn’t mean you have carpal tunnel. I’ve found that people get misdiagnosed all the time. The most common injuries that get prescribed as carpal tunnel are either wrist osteoarthritis, or cervical radiculopathy. Let me give you a couple of tips to help you self-diagnose, if this patient is you.

Is it Really Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a VERY specific diagnosis. If you have true “carpal tunnel,” you will have complaints of pain and/or numbness in the first three fingers (thumb to middle) on the palm side of your hand. You might have some pain in the palm side of your wrist too where the median nerve is getting compressed. An orthopedic test that we use in the clinic is called Phalen’s test.

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If you compress the wrist joint, it should start to intensify your numbness and pain IN YOUR HAND. If you do this test and it doesn’t reproduce your symptoms, or if you have symptoms that are not consistent with what I described, you probably don’t have CTS. 

What do I Have?

So you did the Phalen’s test and it didn’t reproduce hand pain. Or, you have pain in other parts of your arm and hand. Now what? The two most common diagnoses that I see associated with CTS are wrist arthritis and radiculopathy. Here is how you tell which of the two you may have. 

Wrist Arthritis:

Wrist arthritis is common and does hurt a lot. Think of how much your wrist moves in a day, especially in your dominant hand. The wrist is 8 tiny little bones, and each one can show signs of degeneration. When a joint degenerates, the bones rub on each other and that will lead to intense pain. That is why people get joint replacements in their hips and knees. Unfortunately, no one has developed a wrist joint replacement yet (golden opportunity for anyone reading BTW). 

Here is how you can tell if you have wrist arthritis vs. CTS. Perform the Phalen’s test again from before. If you have pain in the wrist, try performing the reverse movement placing your palms together. If that position lessens your wrist pain, and you don’t get any symptoms into your fingers, you probably have wrist arthritis. 

Cervical Radiculopathy:

Radiculopathy is a fancy medical term for “sciatica” in your arm. What is happening is a peripheral nerve is getting pinched in your neck and giving you symptoms down your arm and into your hand. Carpal Tunnel Syndrome is a specific compression of the median nerve in your wrist. That is why the symptoms should only be in your hand after the point of compression. If you are having tingling/pain in your hand but not in your first 3 digits, you could have an irritation of one of the other two nerves in your arm (radial and ulnar nerve). Here is a nice nerve distribution map of your hand.

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If you need to figure out if you have radiculopathy here are a couple of nerve tension tests to try. If either of these tests reproduce your symptoms, you have radiculopathy, not CTS. 

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Do You Get Numbness in Your Feet When Cycling?

Spring has sprung and cycling weather is finally here in the Northeast!  Many cyclists and triathletes are gearing up for summer races and charity rides.  In the clinic I have been seeing clients for a bike fits almost weekly. The common complaint I’ve been hearing is “My feet and legs go numb while riding, but that’s normal right?”  My answer is “No, that is not normal and we are going to figure what is causing it!”

The first two places I check is the saddle and the cleats.  Just like running shoes your saddle can get worn down. I call it “the squish test”.  Your saddle should not be squishy. If it is, it’s time for a new one! I also measure the distance between my clients “sit bones” and then measure their saddle to make sure they are riding on the correct saddle.  The correct saddle is crucial to your bike position and may be the cause of your numbness in your toes and legs. If the saddle is worn out or too wide it is going to cause excessive movements at the hips and the pelvis to rock which could irritate your sciatic nerve and cause pain down the leg.  This also leads to wasted energy and could cause chaffing in the lady and male parts.  On the other hand if your saddle is too narrow can compress your sciatic nerve as it exits the pelvis through the sciatic foramen.   

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Your cleats may also be a culprit for your pain.

If your cleats are worn down they can cause increased pressure on the foot.  Also if your cleat is in front of your knee at the bottom of your pedal stroke, this can lead to numbness in the toes as well.  A quick adjustment to the cleat can make a big difference! So if you’re getting numbness in your legs or feet it’s time to get a bike fit.  Come see me at OrthoCore!




Neck Pain ELDOA Stretch

We’ve all dealt with neck pain in the past. Some of you might be dealing with it as you read this blog post. There is a reason for the phrase “pain in the neck.” Most people will deal with it by using some heat, maybe some ibuprofen, and then just wait it out. In some cases that might work, which is great! What do you do though for that nagging neck pain that sticks around and seems to bother you every time you turn your head? Allow me to help with some neck stretches that you have probably never heard of before. ELDOA!!!

Why Do I Have Neck Pain?

Before we get to the good stuff lets talk about why you are probably having neck pain. A majority of people have neck pain because the facet joints in their spine have locked up. Facet joints are the small joints in the vertebrae that allow for neck movement.

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When they get locked up it causes a restriction when you try to turn your head to one side. It will also cause a protective spasm of the neck muscles. Your brain thinks that your spine is pretty important so whenever it recognizes there is a problem, it goes into lockdown mode. Better to be safe than sorry. In order to restore your movement and decrease the spasm you need to stretch these little joints out and give them some space. The stretches that work best are called ELDOA stretches.

What is an ELDOA Stretch?

ELDOA (Étirements Longitudinaux avec Decoaptation Ostéo Articulaire), or more easily translated to Longitudinal Osteo-Articular Decoaptation Stretching, is a technique created by Osteopath Dr. Guy Voyer. These stretches are designed to give length to the muscles, joints and myofascial system all in one movement. The most amazing thing is that they really work! I know that sounds stupid but once you see the video for the stretches you will think it looks like witchcraft. Trust me though. If you have, or have had, neck pain you should be doing these stretches regularly. They don’t take much time but you will notice a dramatic improvement in your neck mobility and a decrease in stiffness when you turn your head.

I would do each stretch for a minute at least once per day. As always if you have any questions please don’t hesitate to contact me. Thanks for reading.

How to Build a Powerful Golf Swing

Many of you may not know this but I actually started out as a volleyball player way before I was a golfer. I still play both sports and interestingly enough the more I train for volleyball, the more powerful my golf swing gets. I’m sure to most of you that doesn’t even begin to make sense. Allow me to explain why it works, and why you should start to incorporate some plyometric training into your golf fitness program.

When I talk about volleyball I’m purely talking about hitting. I LOVE hitting and I LOVE hitting it as hard as I possibly can. In order to be a good hitter in volleyball you need some key physical components. Other than being tall (trust me there are some great hitters that are short) you need to be able to jump. If you want to jump high you have to create a lot of what is called ground reaction force (nerdy physics term). What that basically means is the harder you can push down into the earth, the higher you will propel yourself up in the air.

Once you are up in the air you have to twist your shoulders and turn your vertical power into rotational power. To do this you have to have a really strong core. Otherwise all that great jumping power you have created will just be wasted. You might as well hit the ball with a wet spaghetti noodle because it will probably work better. Lastly you turn your twisting power into arm speed and turn your hand into a whip. When all that power meets the volleyball it goes DOWN!

So what does any of that have to do with the golf swing? Let’s start at the top of the backswing. As you start to come down into the ball the first thing you should do is squat. You are creating a ground reaction force by pushing your feet down into the ground. The only difference between golf and volleyball is the jump part. Actually if you look at some of the longest hitters on tour, some are actually off the ground at impact.

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Then...just like with volleyball you turn all the vertical power into twisting power with your shoulders. Lastly, use your hands like a whip and crush that little white ball as far as you possibly can.

Now the most important part. How do you incorporate plyometric training into your workouts to build a powerful golf swing? It’s really simple. Just start jumping. It doesn’t have to be complicated. You can do jumping jacks, jump rope, jump in place, anything that has jump in front of it, you can do (I feel like I just gave you a version of Forrest Gump talking about shrimp). The biggest disclaimer is you have to be sure you don’t have any pain. If you have any pain with jumping, you have to stop. You can safely perform plyometrics once a week and you will definitely start to notice some more pop in your golf swing.

If you have any questions please contact me here at OrthoCore Physical Therapy. I hope you enjoy your new, more powerful, golf swing this season!

How to Increase Hip Mobility for Golf

The PGA season has begun and, if you’re anything like me, those golf juices are flowing! It has been at least two months since I have swung a golf club (thanks polar vortex). The off season is great for recovery but it’s also a great excuse to get lazy with your fitness program. It’s very easy to get stiff over the colder months because we don’t move as much. This stiffness can rob your golf swing of consistency and power. The biggest area of your body that is responsible for power in your golf swing is your hips. So let’s get those joints moving and get this season rolling!

When you swing a golf club your hips/pelvis to internally and externally rotate about 60 degrees in each direction. As a golfer, when you go to the top of your backswing you need internal rotation of your trail hip, and external rotation of your lead hip. In your downswing you reverse those movements. A restriction in either hip, in either movement, can lead to swing faults. No matter what the fault may be, it will definitely lead to inconsistencies in your golf swing.

Another problem with poor hip mobility is a guaranteed loss of power and distance. If you want to be able to hit the ball a far way you have to be able to spin fast. When we start our downswing we actually push down into the ground with our feet. The earth is just a little bit larger and stronger than us so it pushes back and creates what is called ground reaction force (hello physics!). Now before I lose you in all my golf swing dork talk let me simplify things. For 99% of the world, our legs are the strongest part of our body (not this guy, do you even leg day bro?).

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When we push into the ground, all that energy that is created gets pushed up the legs towards our abdominals. The pelvis turns that energy into torque. The more torque that is created, the faster we spin, and the harder we hit the ball. If we have a restriction in how much our hips and pelvis can twist we can’t create as much torque and we don’t hit the ball as far as we possibly can. Make sense?

Now that I have completely confused you with talk of physics, torque, power, blah, blah, blah let me just tell you what to do about it. Here is my favorite hip mobility exercise for golf. You can perform this stretch multiple times a day. Just be careful if you have any pain in your hips and/or in your knees. If you are consistent with performing this stretch, your mobility will increase, and you will be hitting that ball farther down the fairways before you know it.

If you have any questions please don’t hesitate to contact us here at OrthoCore. Enjoy the last month of the off season and use it to get your body ready for the upcoming season.



Retiring From Powerlifting By Adam Davis (OR: How I learned to Stop Lifting Heavy and Love the Lunge)

I’ve rewritten this blog multiple times now. Originally I was just going to talk about lunges. A client of mine who’s a former trainer herself sent me an article regarding the common mistakes when both practicing and coaching lunges. This article upset me because it challenged how I’ve been coaching this movement for 6 years professionally. It was written by one of our favorite professionals in the industry to boot (Dr. John Rusin). I was forced to open my mind and accept new information. And for the first time since joining the OrthoCore Physical Therapy team, I told my clients I was teaching something wrong (well more like less efficient, we’ll say).

Now where am I going with all of this? Well first off, as a coach I have a policy that I never teach something that I don’t practice on my own, unless a client really needs something unique in their programming. I begrudgingly started to practice these new lunges. I’ve had a long love hate relationship with lunges since the first day I worked out my legs. I know their importance and the importance of unilateral work in general. But lunges suck. Or rather I sucked at lunges. So I avoided doing them for a long time during my powerlifting career. I wanted to focus on competition lifts like squats and deadlifts. Those were fun, short, and heavy sets that felt impressive. Lunges were long, grueling, and boring exercises that burned and used light weight. Not something a 23 year old powerlifter was excited to do.

Well now I’m 30 and have 3 notable prior sports injuries, arthritis of varying degrees in many joints, and a stability issue in my right hip. That issue is likely from years of ignoring lunges I’d wager. Well upon practicing these new lunges that better utilize the mechanics of the hip, I became more aware of this instability, as well as generally had better feedback from it. I had more control than ever before in this exercise when working on that right leg, and despite the muscles being stronger, it felt harder. My rotator cuff was working in ways it wasn’t before (yes your hips have a rotator cuff too).

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This newfound sensation with an old exercise blew my mind. How had I not come across this information on how to perform lunges in 6 years of training and 5 years of competitive lifting? My lower body program shifted to primarily focus on lunges first, and I began to go from heavy weight to lighter weight/higher reps. Now I perform them with unevenly loaded dumbbells to both challenge stability and engage the glutes even more than the original modification did. Compound movements like squats and deadlifts became ancillary lifts in my routine.

Ok so let’s get to the real point here. Ever since my shoulder injury 4 years ago, I’ve been out of the competitive lifting scene. It’s been somewhat of a rough journey as I was just months away from my first major competition (everything I had done before were unofficial amatuer meets that were a bit more loosely regulated). That really messed with me. I went through ups and downs trying to get back to the numbers I used to put up before that injury, never quite making it in any of the competition lifts. I even went through a period of depression because of it and gained a lot of weight.

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The last 2 or so years I’ve been getting back into consistent training and leaned out to a nice healthy level again. But I’ve still always been training for strength overall. So “going heavy” was my priority in a lot of lifts, even if I was sure to do things like care for my shoulder health and isolate where needed. I even got my bench press up to 235 lbs after rehabbing my left shoulder from an impingement! But even though I’m mechanically stronger than I used to be in my powerlifting days (I move weight more efficiently), the fact that the actual amount of weight I was lifting was so much lower continued to nag at me. That was until the last few months.

I’ve recently come to terms with the fact that I will never compete again, at least not in any ranked league, and even if I compete in an amateur meet again I know I will be far outclassed. I had instead been focusing on my clients’ programs, and exploring new avenues like yoga. I specialize in corrective exercise and movement after all, why not broaden my own training to include more avenues regarding it? And although I was initially hesitant to admit there was information that contradicted what I coached, these lunges were my final step to finding where I really need to be training wise for my body at my age.

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Let’s wrap this up as I tend to ramble when talking about my own experiences. Focusing on these lunges first basically meant a lot of my strength and energy would be sapped for the big lifts. So I did what powerlifters swear never to do. I lifted lighter weight. My squats were endurance and mobility focused sets of 10-15 reps. My deadlifts stayed at low rep sets of 3-5 (I personally believe the conventional deadlift is risky for high reps), but the weight I used was relegated to weight that was normally not a 3-5 rep max. I also started to superset multiple types of deadlifts, so it was more like one set of 6-10 when combined, again helping my muscular endurance more than my usual training used to.

And you know what? I’m seeing tons of progress. My hip feels stronger every week. I’m still adding weight to my lifts even if I use less weight overall compared to even a couple of years ago, nevermind my powerlifting days. My shoulder mobility is more consistent, and my core imbalance is improving faster. To top it off, despite lifting so much lighter, I have more muscle mass on my body now than ever before, which helps keep my metabolism well regulated so I stay leaner easier, and cushions my poor arthritic joints.

So after 4 years of frustratingly chasing the dragon of reaching my former glory days. I’ve finally accepted that I’m not living those days anymore. I’ve retired from heavy weight you could say. I still challenge myself, but in ways that are more appropriate for my body given my history and needs. And you know what? I’m happy with my programming, performance, and body for the first time in nearly 5 years. The new year just started, so I guess this is my “new me”. Perhaps something as simple as reexamining your training programming needs is all you need for a “new you” as well. If you’d like to try and don’t know where to start you can always contact me. Otherwise I wish you all luck in your endeavours in health and wellness in this new year. And remember, it’s ok to be a different kind of athlete than you were last year.

~Adam




Hip PNF Kicks

Outside of your core muscles, the hips are probably the most important muscle group in the golf swing. They help your hips to twist and also transfer all of your leg strength up into the trunk muscles. It’s that energy transfer that helps to send that little white ball farther down the fairway. Most golfers who workout do work on their hip strength. The unfortunate part is that most are going about it all the wrong way.

The hip joint is a very dynamic joint. It is a ball and socket joint just like the shoulder.

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The great thing about the hip joint is that it can move in almost any plane due to its kinematics (scrabble word, 800pts). That allows for all the movements that happen during the golf swing. Most people think there is just a twist at the hip. The truth is there is a natural twist, squat, and lateral shift happening at the same time in the golf swing. If it happens during the golf swing why wouldn’t you train that way?

When most golfers hit the gym they might do squats/deadlifts, and some lateral walk or side lunge. Awesome! I’m not saying those are bad to do. I certainly do them when I go to the gym. What I think is important is to incorporate all the movements of the hip joint into one exercise. That way when you make a golf swing your body has been trained to moving through all those planes of movement and can transfer that energy more efficiently. That will equal more power into the golf ball, and hopefully a lot more distance.

So I’ve teased you enough. You are probably saying at this point “what exercise does all this at once? That sounds like an infomercial.” PNF (Proprioceptive Neuromuscular Facilitation) patterns are the way to go. They are simple patterns that move the hip through all the ranges of movement in one movement. Here is a quick video that will show you how to go through the patterns on your own.


I prefer that clients do it without holding on if they can. That way you are working on balance as well which is also very important in the golf swing. I also will have people start with moving slow so you have to own the movement. Once that gets easy add some speed to it. Just don’t move so fast that you start to lose your balance and fall over. If you can’t do it with the resistance band at first that is okay. Just work on the patterns without resistance until it gets easy.  

You will definitely feel the burn in your hips when you do these exercises (take that Jane Fonda). Work on this over the off season and see how much farther you hit that golf ball once winter is over.

OrthoCore Physical Therapy has convenient locations in Westerly and North Kingstown, RI. For more information on our services please call (401) 667-0131






Facet Joint Back Pain

I treat a lot of people with back pain. The hard part about treating patients with back pain is getting the work we do on the table, to translate to standing and walking. Patients who are older (I’m talking 35+) will usually have pain due to a facet issue, degeneration in the back, or both. Lying down is a great position for those issues because it doesn’t put pressure on the back. Once you stand up, the back compresses, puts pressure on the joints, and the pain returns. If this sounds like you, let me give you a simple solution to provide you with some relief for your back pain with standing.

What’s a Facet Joint?

Unless you went to PT school, or some form of medical school, you have no clue what a facet is or what degeneration looks like in your back. Well...that is what I’m here for. Let me school you on some anatomy. Facet joints are the joints of the spine. Just like any other joint in the body, the spine moves. It requires joints to allow that to happen. In your spine you have facet joints on each side of every vertebrae from your head to your hips.

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Like all your other joints, the facet joint can get inflamed. When you compress an inflamed joint, it hurts. Facet joints get compressed when you are standing and when you extend. Hence the reason why lying down feels better, and standing hurts.

What do I do for Standing?

Since most of us can’t lie around all day, what do we do when we’re standing to help alleviate back pain? The key to having less pain with standing is understanding the position of your pelvis. Most of us have what is called an anterior tilt at our pelvis. That means that the front of our pelvis sits lower than the back part of our pelvis.

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Speaking in generalities, this usually happens because our hip flexors are tight and our abdominals are weak. In the game of tug-of-war, a tight muscle always beats a weak muscle. In therapy we will try to stretch the hip flexors, and strengthen the abdominals to correct the imbalance. That doesn’t always carry over to a standing position though. Sometimes, you have learned to stand like that so you need to retrain the brain to stand in a neutral pelvis. What is the best way to do that? Train your hips in a standing position. Here is a simple exercise that I like to give my patients that have back pain with standing.

Give this a try to help alleviate your back pain with standing. You can perform as many of these as you want. The exercise is meant to help you retrain your brains standing pattern. There is no resistance involved so you don’t have to worry about overdoing it.

I hope this helps correct your back pain you are getting with standing. If you have any questions please contact us. If you want a free session to review how to perform the exercise properly just mention this post and OrthoCore will give you a free 15 min session at any of our clinics. Thank you for reading!







Knee Arthritis vs. Meniscus Tear

I’ve had a lot of patients throughout the years with knee pain (I know, earth shattering beginning to a blog post). The biggest thing that we do as Physical Therapists is figure out what is the cause of your pain. I feel like I’ve had a group of patients recently, that have knee pain and their MRI shows they have a meniscus tear…and arthritis. The problem with having both is it makes it hard to discern where the pain is coming from because they are so closely related. The other problem with having both is that surgeons are usually shy about performing a meniscectomy (remove the torn meniscus) because it may not relieve your pain symptoms. That being said, let’s talk about the differences between the two so you can make an educated decision if this is what you are dealing with.

What is a Meniscus Tear?

The meniscus is the shock absorber of your knee. You have one on the inside (medial) and outside (lateral) of your knee. If you were looking down from the top of your knee they look like two lima beans. If you look at them from a straight on view they look like a race car track meaning the peripheral portions are thicker and it slopes down towards the middle of the knee from there.

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Typically a torn meniscus will hurt right over the joint line and will be sore at end ranges of knee movement. It will also usually hurt with activity, especially loading and twisting. Remember, its your shock absorber, so the more bumps you take the more strain you are putting on it. Think of it like driving a car. If you go over a lot of bumps you will feel it more.

When you have a torn meniscus the surgeon will usually just cut out the torn portion, which is usually on the inner portion. That way they can take the torn tissue, while still leaving a lot of meniscus for you to play with.

Recovery is usually quick (if you have a good PT) and you are usually back to your normal activities in a couple months time.

What is Knee Arthritis?

Arthritis is a loss of cartilage. Cartilage is like the shiny end of a chicken bone. When cartilage slides on cartilage, no problem, when it starts to wear down is when bone gets exposed and can lead to inflammation and pain.

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Arthritis is usually worse in the morning and at night. During the day, if you keep your knee moving without much impact, it usually makes the joint feel better. Activities like biking, swimming, non-impact weight lifting are good.

Arthritic pain is usually more global, meaning it’s hard to pinpoint with your finger. Sometimes it hurts in one area. The next day it could hurt in a completely different area. It depends on how much arthritis you have and what types of activities you are doing.

The surgical solution for arthritis is a knee replacement which isn’t as easy to recover from as a meniscectomy obviously. Recovery from a knee replacement is 3-6 months (back to activity with some pain) with full recovery usually by a year.

How do I know what to do?

So what do you do if you go see a doctor only to find out that you have a meniscus tear AND knee arthritis? The best thing to do is start to write down where you have pain in your knee and when. If you start to see that it is more over the joint line, and more with jumping/twisting activities, it’s probably coming from your meniscus. If you find that it is more painful in the morning, but gets better as the day goes along, and not in a consistent spot, it’s probably arthritis.

I would always recommend trying a course of PT first. In both cases there have been plenty of studies that show that PT can be effective without requiring surgical intervention. If PT doesn’t help and it appears to be more meniscus, if it were my knee, I would have the surgery. If PT doesn’t help and it appears to be more arthritis, it depends on what I would recommend. A knee replacement is a much bigger surgery, but is also really effective for relieving knee pain. It is really age related but I will say this … most patients that I have, that have had knee replacement surgery, say they wish they had done it sooner.

I hope this helps to give you an idea of why your knee hurts and what you can do about it. If you have any questions please comment below. If you would like to schedule an evaluation to see what might be causing your knee pain, please contact us at OrthoCore Physical Therapy  401-667-0131 to make an appointment at our Westerly or North Kingstown locations.




Running with Knee and Back Pain

So, I’ve been running more lately. To anyone reading this that knows me, knows that comes as an enormous surprise. I used to be a huge runner (3-4 times/wk) but, running and I fell out of love when I started to get injured. My knees and my back were always bothering me. I was getting tired of showing up to work and feeling worse off than my patients. Instead of working on the flexibility and strength deficits that I had, I decided to just stop running. Not exactly what I would recommend to any of my patients but, effective at eliminating my pain nonetheless.

Well I’m back on the team! I credit my return to three things. 1. Like most other people who run, it’s easy to just get out of the house and run. It doesn’t require driving anywhere, or signing up with any gyms, etc to participate. 2. I can do it with my kids in a stroller. I get to spend more time with them, and it gives my wife a little break (double bonus). 3. I was intrigued when I saw that “Headspace” had a running packet. To those of you who don’t know, Headspace is a meditation app. I’ve been using it for a while now and the running specific pack piqued my interest. I was pleasantly surprised it actually made it really enjoyable to run. It didn’t feel like the mental struggle that I remember from the past.

Unfortunately, with my renewed love of running, my knee and back pain returned as well. It’s like when you get back together with an old girlfriend and realize part of the reason why you broke up was her annoying best friend. Well this time the friend isn’t going to break us up again. Instead of running from my problems (see what I did there), I’m going to address them and make sure that I can keep my feet on the road.

My main issue (as is the case with many runners) is that I have very tight hip flexors and IT bands. Those muscles run in the front of the hip and can restrict your hip extension and stride length.

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The problem with the hip flexors, and the reason why I get back pain, is that they anchor at the lumbar spine. When they are tight, your spine will flex with every stride and put excess pressure on your spine causing pain. The IT Bands run all the way down to your knee. When they are tight they will pull your knee out of alignment. That misalignment with every step will eventually lead to pain. Hence, the reason why I get knee and back pain when I run.

The good news for me (and anyone reading this with similar problems) is that it’s really easy to fix. All I have to do is stretch those muscles regularly to keep my body aligned and moving properly. Here is my favorite hip flexor and IT band stretch. If you are stretching pre-run then perform 15 repetitions holding the stretch for just a couple of seconds. If you are stretching post-run then hold for 30 seconds to a minute and perform the stretch a couple of times.

I hope this helps you stay flexible and keeps your feet on the pavement. If you have any questions please contact me here at OrthoCore Physical Therapy. Otherwise, HAPPY RUNNING!

Foot Pain Due to Flat Feet

I know this comes as no surprise but I’ve been treating a lot of feet lately. Apparently when you open a second office with a Podiatrist that is bound to happen. A majority of feet problems that I see are due to flat feet. About 12% of the population have flat feet. That might not seem like a lot but when you consider the amount of people in the world, that’s a lot of fallen arches.

Most foot problems, that are due to flat feet, stem from weakness in the arches of the feet. There are a group of 9 small muscles in the foot that help to create and maintain the shape of the arch.

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Just like any other muscle in the body, if you don’t use it you lose it. The hard part about people with flat feet is that the muscles are constantly on stretch. A muscles that is constantly stretched, is going to be weak. So you are really fighting an uphill battle. The other difficult part for most people is they don’t know how to strengthen their feet. What do you do? Put a tiny dumbbell around your toes and do curls? As much as I would love to see people try that, it wouldn’t be effective. Here is one of my favorite exercises to do to strengthen the intrinsic muscles of the foot (crazy socks not required, but recommended).

If you perform this exercise regularly it will help to strengthen the foot muscles and start to build up your arch. If you have a really flat foot, I also recommend wearing a foot orthotic to give a little extra support and bring the arch up to where it belongs.

I hope this helps to keep your piggies from aching and get you up and on those feet pain free. If you have any questions please contact us . Thanks for reading!

 

When it Comes to Swing Length Size Really Does Matter, and Shorter is Better

Something that always comes up when I’m working with my golfers is their backswing length. Many golfers, and teachers, think that it’s vital to get to the top of their backswing, and get the golf club parallel to the ground. While I don’t disagree that players need to get to a good position at the top of the backswing, I do think that everyone has a unique backswing point. That point is very dependent upon how much flexibility you have.

How Many Degrees Do You Need?

Most professional golfers have 60 degrees of rotation in their shoulders, and 60 degrees of rotation in their hips. If you add those up it’s 120 degrees of rotation that is available (I know, difficult math). Now, you don’t need 120 degrees of rotation to get to the top of a “normal” backswing (lets just use parallel to the ground as a point of reference). You only need about 90 degrees of rotation to get there. There are two problems that most amateur golfers are faced with though. 1: They don’t have even close to 90 degrees of rotation. 2: If they do, that still isn’t enough.

Some of you are probably saying “what the heck! You just said I only need 90 degrees to get to the top of my backswing.” Let’s look back at those numbers though. Pro’s have 120 degrees and you only need 90 degrees to get to the top. That gives us a 30 degree difference (I know, hard math again). The pro golfer will get to the top of their backswing and then start the swing with their hips without moving their shoulders. That gives a greater stretch through the trunk and shoulders, and requires those extra degrees of rotation to prevent the shoulders from coming along for the ride. This gives them power and consistency with their swing.

So What Does an Amateur Do?

If you don’t have 120 degrees of rotation all is not lost. You should certainly do some stretching to improve your rotation if you don’t. What I do with my golfers is find the spot in their swing where they can still move their hips in the downswing. From there we use the K-vest system for biofeedback to memorize where that point is and prevent their swing from getting too long. It also helps them to coordinate the start of the downswing with their hips vs. their arms like most do. Once they do the flexibility exercises and improve their rotation we can continue to lengthen the swing without affecting the power and consistency they have created.

If you don’t have a fancy K-vest system but still want to find the correct length of your backswing watch this video.

The biggest thing to look for is the ability to start your hips without your arms. I always err on the side of short. You will be surprised how short you can make your swing and still hit the ball a far distance.

I hope this helps to improve your power and consistency with your golf swing. If you have any questions please contact me. Visit OrthoCore and learn more or make an appointment. Enjoy your new shorter, more powerful, swing.