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Golf Injuries and Pain – How to Protect Yourself and Have Fun

by Pain Doc | Jun 27, 2015 | Low Back Pain

If golf is one of your favorite recreational activities, you likely are aware of the unique demands the game places on your body. Perhaps you even sustained an injury or developed pain related to your golf game. Let’s take a closer look at the physical demands of playing 18 holes.

First of all, let me start out by saying that besides being a popular sport, golf is a good opportunity to exercise (especially if you carry your own clubs and don’t use a cart).

Number one, it involves a lot of walking. The best part about walking is that it keeps you away from sitting. It may not sound like a big deal, but it is. Excessive sitting, science is finding, is associated with deleterious health outcomes regardless of physical activity. This means too much sitting is so bad for your health that exercising later cannot recoup the damage it does.

Secondly, you are outdoors exposed to sunshine. Getting adequate sunshine is essential to maintaining normal Vitamin D levels, which promotes strong bones, teeth and supports the body’s immune system. Being outdoors among trees and grass on the weekend is especially beneficial to your health if you have a high-stress office job during the week.

So if you abhor exercising in a gym, perhaps you should investigate the game of golf, if you haven’t already.

Now, back to the topic. Here are the potential problems that can come with playing golf:

Driving. Each hole starts out with a driver, the longer clubs with bigger, heavier heads. These clubs are designed for distance and therefore require a big swing radius (a big wind-up).

Well, that wind-up involves over-rotation of your lumbar spine. That feeling of discomfort when you swing a driver is occurring at the lumbar facet joints, the small joint surfaces behind the vertebral bodies that interlock with adjacent vertebrae above and below.

Most rotation movement of the torso is produced by the thoracic vertebral joints, from the base of the neck down to the beginning of the lumbar (low back) spine. This is because facet joints of thoracic vertebrae are relatively flat and in the same rotational plane, as illustrated below:

Lumbar vertebrae, on the other hand, have deeper, concave facet joint surfaces that act as limiters to rotation. Basically, lumbar vertebrae do not like to twist.

You can feel the pressure in your low back when you have the driver at the top of back swing position and again towards the end of the swing. The rotational (twisting) force is reduced when you lift and turn in your rear foot as you follow through the swing, but if that foot motion is delayed the lumbar spine absorbs more of the rotational force.

Over time, repeated over-twisting of the lumbar spine can cause the lumbar facet joints to degenerate and even develop fractures. This can lead to other problems, like pinched nerve roots from foraminal stenosis (narrowing of nerve passageway due to bone and/or ligament occlusion). Tiger Woods used extreme lumbar rotation in his swing and it caught up to him; he had four low lumbar surgeries over his careerr and now suffers from chronic low back pain.

The lesson here is to make sure you lift your trailing foot at the appropriate time of the swing to avoid excess rotational pressure to your lower back (and be mindful not to over rotate, otherwise risk having back problems in the future).

Another joint that bears a lot of stress during driving is the lead knee. As you follow through with the swing, your pelvis rotates with your spine. Tightly connected to each side of your pelvis are the femoral heads– one half of the hip joint. When you lift your trailing foot, it reduces rotation to your lumbar spine by removing a stabilizer, but at the price of putting a greater rotational burden on the lead knee and ankle. As the pelvis rotates and reaches end-range, it pulls the femur with it. But the femur and tibia remain stationary (golf shoe spikes dug into the turf ensure this; plus more of your weight shifts to the lead leg towards the end of the stroke). This results in a torsional force generated through the lead leg, internally rotating the hip, knee and ankle. This can cause strain to the hip joint, meniscal tears in the knee and sprain to the ankle ligaments.

So the lumbar spine and leading hip, knee and ankle are joints that absorb significant rotational stress during a driving swing.

To a lesser extent, the leading shoulder joint and wrist absorb stress due to their awkward positions; the shoulder with acute internal rotation and the wrist acute radial deviation. This can strain the shoulder rotator cuff and ligaments and tendons of the wrist.

Putting (and driving). It may not seem like a lot of movement is going on during putting, but the putting position is indeed strenuous to the lower lumbar discs. You are bent at a 30 degree angle or so at the waist for an extended time (most people concentrate and take their time before their putt attempt). This is one of the worst positions for your low back as it places tremendous pressure on your L4 and L5 discs. especially if you have a weak core (abdominal and low back muscles).

The hydrostatic pressure builds up in the disc, enough to cause a disc herniation in some people.

In the picture above, the golfer is preparing to hit the ball with a driver. Notice the angle of the torso relative to the legs. The fulcrum is exactly at the L5-S1 joint and the lever is the torso, with the load being the gravity vector of the torso (weight). The force (F) is partially distributed to the back muscles, but the discs still bear significant pressure in this position.

The Solution

If you’re an avid golfer, a little sore back isn’t going to stop you from playing, right? That is usually the case in those who love their sport or hobby.

So my advice to you is:

Always use proper form and good posture. When driving, emphasize generating power from your core muscles– abdominals, especially obiques–then your latissimus (“lats”) muscles. Lift your trailing foot at the precise moment to lessen lumbar rotation during a wide swing.
If you are prone to low back pain, modify your driving swing to protect your back. You may have to use less lumbar rotation and more power from your arms and shoulders. Practice your custom swing and hone it so it becomes natural during game time. For example, if you are getting low back pain, shorten your lumbar rotational arc by 30 degrees and generate more power from your latissimus muscles to compensate.
Minimize rounding (flexion) of your low back during putting and driving. A straighter or even concave low back is stronger than a flexed low back. This is called “hinging.” You keep your lumbar spine and pelvis locked, and hinge at the hip joints to lower your torso to the ground.
Exercise and stretch the swing muscles. The muscles you should target for stretching are the trapezius, latissimus dorsi, rhomboids and triceps.
Strengthen your shoulder joints by lifting light dumbbells in all directions/angles (from 12 o’clock position to 6 o’clock position) with palm facing down. Starting position of arm is down to your side; ending is as high as you can go.
Stretch your shoulder joints using a 5-10 lb dumbbell or kettle bell, letting it hang straight down as you lean over and stabilize with the other hand on a chair or your opposite, bent knee. Make small circles with the weight, increasing in size; then reverse directions.
Strengthen your core: abdominals and low back, using medicine ball exercises.
Seek out an Active Release Technique (A.R.T.) therapist in your area. This is a special form of massage that involves engaging certain muscles while the therapist works them and is great for improving range of motion.

And last but not least, my standard mantra: your body will work better for you if you feed it well and give it enough rest. Make at least 80% of your diet naturally-occurring foods (as opposed to processed and prepared foods) emphasizing colorful vegetables, animal protein (grass fed/ pastured when you can) and healthy fats (olive oil, nuts, seeds, eggs, coconut, avocado, fish). A well-nourished body can heal injuries quicker and more completely, which is especially important if you play any kind of sport.

Also, don’t expect to be sedentary all week and be able to do activities physically demanding on the weekend. Excessive sitting/ lack of exercise de-conditions muscles. It makes them less coordinated, smaller and weaker. This is a recipe for injury (“weekend warrior” injuries).

A simple hack to passively get more exercise if you are a desk jockey is to get a standing desk. It’s better for your back, and your overall health (see below).

Now, go and have fun on the golf course! (with this information in mind).

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Curcumin – Hype or New, Natural Pain Reliever?

by Pain Doc | Jun 10, 2015 | Uncategorized

Lately, you may have seen or read news articles about the use of curcumin to treat inflammation and pain. Is curcumin the latest fad supplement to hit the scene, or does this herb actually have any therapeutic benefits?

Curcumin comes from the root stalk (rhizome) of the curcuma longa, better known as turmeric, a perennial plant from the ginger family. Turmeric is native to India, and also occurs in Australia. It has been used for centuries as a spice in South Asian cuisine (curry) and as a food dye. The root stalk is heated in an oven, then ground into a fine powder.

In folk medicine, curcumin is believed to have a wide range of biological effects including anti-inflammatory, antioxidant, anti-tumor, antibacterial, and antiviral activities. However, according to the National Center for Complementary and Alternative Medicine, “there is little reliable evidence to support the use of turmeric for any health condition because few clinical trials have been conducted.”

This is a common disclaimer for herbs, vitamins and other natural supplements. In order to say with certainty that a supplement achieves its claimed therapeutic benefit, a “double-blind, controlled” study involving a large number of people with the same health issue that the supplement targets is required. The study group is divided into two groups, the test group and the control group. The test group is given the nutrient being tested, while the control group is given a placebo supplement (fake). In a double-blind study, which carries the most weight as far as credibility of results is concerned, none of the test subjects are aware of what they are getting (the nutrient or the placebo), and neither do the scientists administering them.

The study goes on for many months; sometimes years, and various metrics are taken of both groups. If there is a statistically significant, positive difference in the test group for a given metric (for example, much lower pain rating), then it’s fair to assume that the nutrient was responsible for it. If there are none, then the supplement is basically bogus.

So, how does curcumin stack up to the challenge?

Here are some research studies on curcumin worth mentioning:

A 64-person study testing curcumin for mastitis, a painful condition involving inflammation of the breast, showed that a topical solution containing curcumin successfully decreased pain, breast tension and erythema (redness due to pain) within 72 hours of administration, without side effects.

A Japanese study of 50 patients with knee osteoarthritis found that at 8 weeks after treatment initiation, knee pain scores were significantly lower in the curcumin group than in the placebo group, except in the patients who had the lowest pain score to start, with no major side effects. The study concluded that curcumin shows modest potential for the treatment of human knee osteoarthritis.

A 17-person study was done to determine the effects of curcumin on muscle damage, inflammation and delayed onset muscle soreness (DOMS) in humans. Participants did “unaccustomed, heavy” leg exercises to point of pain and enough to generate blood markers for muscle damage. The conclusion was that oral curcumin likely reduces pain associated with DOMS with some evidence for enhanced recovery of muscle performance, and that further study is required.

A study involving 30 breast cancer patients receiving radiation therapy found that orally taking 6.0 g of curcumin daily during radiotherapy significantly reduced the severity of radiation dermatitis.

A preliminary intervention trial that compared curcumin with a nonsteroidal anti-inflammatory drug (NSAID) in 18 rheumatoid arthritis patients found that improvements in morning stiffness, walking time, and joint swelling after two weeks of curcumin supplementation (1,200 mg/day) were comparable to those experienced after two weeks of phenylbutazone (NSAID) therapy. Since NSAIDs are associated with stomach, renal and liver damage, this is a very promising finding.

A placebo-controlled trial involving 40 male test subjects who had surgery to repair an inguinal hernia or hydrocele found that oral curcumin supplementation (1,200 mg/day) for five days was more effective than placebo in reducing post-surgical edema, tenderness and pain, and was comparable to phenylbutazone therapy (300 mg/day).

As of this writing, this is the extent of human studies that test curcumin’s effects on inflammatory processes. It isn’t much, but the positive effects and demonstrated potential of curcumin to improve inflammatory conditions is unmistakable.

It should also be noted that there are many rat and mice studies in the medical literature that suggest curcumin can reduce pain and inflammation by suppressing oxidative stress and “down regulating” factors (cytokines) that create the inflammatory response. This means that curcumin may tone down gene expression of genes involved in generating and sustaining the inflammatory process.

A number of other studies on curcumin’s potential therapeutic effects on colorectal cancer, Alzheimer’s disease, cystic fibrosis, asthma and other disorders have been completed with no published results at the moment, or are still in progress.

My Advice on Curcumin:

So, should you try curcumin supplements if you have an inflammatory condition? Based on this small sample of studies, my opinion is that it wouldn’t hurt to include curcumin regularly in your diet if you have arthritis, type 2 diabetes, cardiovascular disease, an inflammatory dermatological disorder, fibromyalgia or other, chronic inflammatory disease. You don’t have to buy supplements, although they are convenient; just get the curcumin powder sold in grocery stores and sprinkle it on your food as you would salt. Studies suggest that this herb is generally safe in large doses (6 mg) with minimal side effects; but just don’t over do it. Be careful of the source, as unscrupulous manufacturers may be mixing curcumin powder with the much cheaper lead oxide, which looks very similar to curcumin powder, although more reddish in color. Lead oxide mixes with hydrochloric acid in the stomach, bioaccumulates and can cause lead toxicity.

By the way, I recommend you do not keep spices for more than a year or two, as they can not only lose their taste but can also form mold.

Inflammation and Pain – The Good and the Bad

by Pain Doc | Jun 2, 2015 | Uncategorized

If you recently injured yourself, or had a sudden onset of low back or neck pain, take note: inflammation is responsible for creating your pain sensations.

I didn’t say this was good or bad– just that inflammation, or the inflammatory response to injury/ tissue damage is maintaining the sensation of pain.

Understand that despite its negative connotation in the media, inflammation is a natural, protective response to injury that is necessary for healing.

Inflammation:

triggers the proliferation of white blood cells that attack microorganisms and remove debris;
dilates local blood vessels and increases their permeability (swelling) to bring more oxygen to the area (more oxygen is needed for the high metabolic activity of damaged tissue);
produces heat which speeds up activity and makes it difficult for germs to thrive;
results in pain to discourage you from using the injured area while it is vulnerable.
quarantines the damaged site from the rest of the body

Normally, after an acute injury such as an ankle sprain, inflammation goes through three phases:

lots of swelling, redness and pain initially for the first 72 hours (acute phase);
followed by a gradual reduction in swelling and pain as debris is cleared and special cells called fibroblasts lay down collagen fibers for repair (sub-acute, repair phase); then
remodeling and strengthening of the new collagen fibers over several weeks (post-acute, remodeling phase).

Eventually, everything gets back to normal.

So for most cases of straight-forward joint sprains/strains R.I.C.E.– Rest, ice, compression and elevation is all you need.

Rest it– don’t splint it unless necessary; just avoid placing a load on the injured joint, or avoid moving it through its full range during the acute phase
Apply ice in the beginning only to keep the swelling from getting excessive/ out of control and to reduce pain; about every two hours for 15-20 minutes a session.
Compress it– this is the least necessary, but some people find it helpful to compress the area to help encourage the swelling to go down.
Elevate it — use gravity to assist the flow of blood back to the heart. If it’s your ankle, lie down and place the injured ankle on a pile of sofa pillows so that it is above your heart.

Let the inflammation take its course and trust in your body’s wisdom to heal; helping it as needed. Unless the pain is so bad that it’s preventing you from doing things you need to do, avoid taking NSAIDs like Tylenol, Motrin or Ipuprofen. Although NSAIDs can reduce pain, they do interrupt the body’s natural attempts to heal a damaged area and may even delay healing.

When inflammation is not so good

Now, if all goes well your injured body part will be back to normal before long. But what if it is six months later, and you still feel pain?

It could mean a number of things.

Perhaps you have a bone fracture. Fractures take longer to heal.
A torn ligament or tendon takes longer to heal, as these tissues are not directly vascularized.
Infection can complicate healing.
The nature of the injury is causing a joint to be abrasive to adjacent tissue during movement.

In these cases, the cause needs to be addressed with a secondary treatment regimen.

But another possibility is that the inflammatory response has gone haywire. It continues at high levels long after the injury has completed its healing. Why this happens is unclear. In rheumatoid arthritis, it’s attributed to the body’s immune system attacking joint surfaces, which creates a continual state of inflammation and pain.

In cases of excessive inflammation, you may need to take NSAIDs to dampen the process and essentially tell your body “it’s time to stop producing inflammation.”

The other possibility is that you have a pre-existing state of systemic inflammation that is driving the process. “Systemic” in this sense generally means “widespread throughout the body.” This can be interfering with the local inflammation of your injury site.

Causes of systemic inflammation include:

allergic reactions
obesity
exposure to pollutants
diet comprised of highly processed food

In most cases it’s difficult to “feel” systemic inflammation because it is usually sub-acute/ chronic. But despite this, systemic inflammation wreaks havoc on your health. It is associated with most chronic, degenerative diseases such as type 2 diabetes, cancer, cardiovascular disease, arthritis, Chron’s disease/ colitis, and Alzheimers disease.

Blood tests that can indicate the presence of systemic inflammation include C-reactive protein (CRP), erythroctye sedimentation rate (ESR), tumor necrosis factor (TNF) and homocysteine. If your levels are high in any one of these, it is prudent to assume you have an inflammatory condition and take the necessary precautions.

First and foremost is to see your doctor to rule out pathologies/ disease processes.

Second, switch to a low calorie diet centered on whole, naturally-occurring plants and protein.

Next, increase intake of the following herbs/ supplements/ superfoods:

Curcumin
Ginger
Fish oil
Dark cherries
Nattokinase
Green leafy vegetable juice

Drink adequate amounts of water throughout the day, reduce your stress and get eight hours of restful sleep. As your inflammation resolves, you will notice faster healing, more energy and strength, clearer mind and a leaner body.

Often it’s the simple things that are within your control that have the most powerful healing effect on your body.

As Hippocrates said, “make food your medicine and medicine your food.”

If you experience chronic pain, check out my book on Amazon, Erase Your Chronic Pain: Unleash Your Body’s Full Healing Potential.

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Is There Anything Besides Drugs for Chronic Pain Treatment?

by Pain Doc | Mar 30, 2015 | Lifestyle Modification

Chronic pain is a complex, physiological process involving specialized sensory cells, nerves, your brain and spinal cord and a multitude of biochemical substances..

Chronic means the injury/damage/disease of the affected body region has gone through the normal stages of healing, but some degree of pain still remains. This can be due to incomplete healing, permanent physical damage to structures, continual re-injury/ aggravation of the area or even “imprinting” into the spinal cord where the central nervous system literally “memorizes” the pain signals, causing them to be ever-present.

Musculoskeletal conditions arising from trauma or gradual wear and tear dominate chronic pain cases (pain originating from bones, joints, muscles, soft tissues). Diseases affecting the nerves such as shingles, advanced diabetes, trigeminal neuralgia and other peripheral nerve diseases often become chronic in nature as well.

Research suggests that one’s conscious reaction to pain (how you respond to it) influences the severity of pain; that is, the perception of it. Someone who embraces his pain and defers to its presence out of excess fear or worry is less likely to improve than someone who resists giving in and “moves into” the pain by not focusing on it too much as he goes about doing what he desires. This strongly suggests that pain has both physiological (body) and psychological (mind) components to it, and therefore, treatment for it should incorporate methodologies that address both.

Options for Treating Chronic Pain

Treatment for chronic pain includes acetaminophen (Tylenol), non-steroidal anti-inflammatories (aspirin, ibuprofen), anti-depressant drugs used “off label” for pain (amitriptyline, Cymbalta), anti-convulsant drugs used off-label for pain (Lyrica), corticosteroids (Prednisone) and opiate drugs (morphine, codeine). They work in different ways to decrease pain; some not fully understood. And, they all come with side effects, which differ from person to person.

TENS units and spinal cord stimulators are instruments used to block or interfere with pain signals as they travel through the central nervous system.

So between strong drugs with unpleasant and often dangerous side effects and devices designed to block pain, the medical options for treatment are disappointing. These interventions are not intended to cure the problem at its source, but rather interfere with its manifestation via chemical and electrical means.

However, two instruments I have come across are in a “gray area” in that the mechanism of action involves stimulating actual, natural healing of injured cells. The first one is red light therapy, which works on human cells very much like how sunlight causes photosynthesis and energy production in plant cells. I recommend red light therapy for joint pain from osteoarthritis and sprains/strains. You can also use it to heal minor cuts and lacerations faster.

The second one is Pulsed Electromagnetic Field Therapy, or PEMF. PEMF uses low frequency, low power magnetic fields in the range of frequencies that is naturally produced by the human body, to normalize cells whose membrane charge, or voltage, has been disrupted by disease processes and strong environmental electromagnetic fields such as those from power cables and electronics. When the cell membran charge is normalized, the cell’s metabolism and respiration is boosted which results in faster healing of disease; especially inflammatory disorders. Pulsed EMF can be used to treat many types of chronic disorders including chronic pain, fibromyalgia, pulmonary disease, heart disease and headaches. Watch the video below where I explain how PEMF works:

If you suffer from chronic pain, I suggest you direct your attention to creating conditions in your body that optimize health. This may not “cure” chronic pain entirely due to its complex nature, but a healthy body is in a much better position to heal and regenerate than one that is not.

Know that:

Your body is a community of interconnected, living cells that affect one another. For example, an intestinal cell and a muscle cell have a functional relationship. This cellular relationship can be influenced via lifestyle changes, primarily through your diet, activities and thoughts/attitudes to reduce pain.
Cells are the basic unit of the human body, and like the human body your cells consume food, breathe oxygen, perform work, burn energy stored in food and produce waste.
What enters your body via your mouth, lungs and skin gets into all of your cells (with the exception of those substances that cannot cross the blood-brain barrier).
Areas of chronic pain are where cells are in a state of distress. They may be producing inflammation, abnormally firing nerves, and/or not getting rid of their waste products properly.
You can greatly influence the functional state of all your cells by what you think, what you eat and drink, and what you do with your body.

When it comes to pain it is better to think in wholistic terms — the whole body, not just where it hurts. This is how your body is designed; how your body functions; and how it heals itself. Your starting point is your mindset and attitude. Use it the create health in your body by all means available to you; and there are many. Use Pulsed EMF for maintenance to enhance energy in your cells and enable efficient cell function and healing. This is your best bet for overcoming chronic pain.

Chronic Neck Pain or Stiffness? Get Your Neck Curvature checked

by Pain Doc | Feb 27, 2015 | Neck Pain

The cervical spine is the thinnest and most flexible part of the human spine. It is tasked with supporting the weight of the head in the upright position while allowing turning in multiple planes — looking left, right, up, down and behind. It also contains structures directly tied to life sustenance, which is why the neck is a logical target when it comes to martial arts/ self-defense and restraint (and unfortunately, murder).

Given all these vital functions, it is wise to take good care of your cervical spine in a proactive way.

The cervical spine is naturally designed to curve, where the apex is at about the level of the Adam’s apple.

This curve behaves much like a spring in a car’s suspension; or the slight upwards curve you see in any bridge design. Long ago, architects discovered that the load capacity of bridges could be dramatically increased simply by integrating curves or arcs into the design. Like a neck curve, a bridge curve or arc distributes weight over a greater area so that gravity cannot concentrate over one small area and cause structural failure.

neck_xr_flat If the neck curve helps distribute the weight of the head in the upright position, what do you suppose might happen if the curve straightened out or started to bend in the opposite direction like the one to the left?

If you lose your cervical curve over time, which could happen from years of poor posture or trauma like multiple rear-end car collisions, you will probably not notice it until several years pass. The change in biomechanics shifts a greater burden of support to your cervical discs and vertebral end plates. This promotes disc degeneration. The once thick and healthy discs lose fluid content, lose strength, allow the center material to bulge out (herniate, protrude or rupture) and cause bony protuberances called osteophytes to form all around the edges of the vertebrae and facet joints.

For some unfortunate people, the bony projections narrow the passageways where the nerve roots and spinal cord pass through (a condition called spinal stenosis) and neck surgery is necessary to prevent nerve tissue from permanent damage, paralysis and severe paresthesias (numbness, tingling) in both the arms and legs.

So the bottom line: be conscientious about the importance of the health of your cervical spine. Don’t get blind-sided by an MRI diagnosis of “multiple-level, severe degenerative disc disease with advanced neural encroachment.”

I’ve seen such cases where patients were oblivious to what was developing inside their necks. They dismissed their neck stiffness and aches to “getting older” or simple muscle strain. When massage and chiropractic provided only temporary relief, they had a cervical MRI done which revealed the formidable origin behind these symptoms, and the next step was neck surgery. Neck surgery of this nature involves removing the damaged disc, shaving off the osteophytes and inserting a bone graft to promote fusion of adjacent vertebrae.

Prevention is the best approach. You don’t have to have neck problems to start preventive measures. In fact, the vast majority of patients who have early to moderate stage degenerative disc disease have no complaints. It’s like a cavity — you don’t feel anything as the pit erodes the tooth enamel, but as soon as it hits a nerve, you will definitely be aware of its presence. But by that time, you’ll need invasive procedures. In the case of a cavity, it means either a filling or tooth extraction; in the case of a cervical disc, it might mean cervical decompression surgery.

Below is a video that summarizes the importance of maintaining a healthy cervical curve (“lordosis”) and exercises to maintain or restore your neck curve so that it can better withstand the physical demands placed on it and hopefully preclude the need to visit an orthopedic surgeon years down the road.

Also, make sure to check out this site’s Self-Care for Neck Pain video, which demonstrates home care procedures for managing musculoskeletal neck pain and/or stiffness.