Want to improve your golf swing? See a physical therapist!

With the days getting longer many take it as an opportunity to hit a bucket of golf balls after work, or to try to get out early one day to “squeeze in 9 or 18”.

As many golfers start playing more frequently, it is almost inevitable that they become frustrated with flaws in their game. Often one hears golfers saying, “I blocked the ball there” or “I was quick with my hands on that one”. Typically the frustrated reaction to a poor shot or round is, “I need some more time on the range”, “I need to get with my pro”, or “I need to look at a driver”. While practicing more, modifying your equipment and working with your pro can help, if your body won’t move enough to make  the adjustment or correction, other venues will probably continue to result in frustration. Additionally, this could result in injury or lead to a dysfunctional learned motor pattern that could have detrimental effects to one’s enjoyment of the game.

Your body is, after all, the only piece of equipment you never stop using on the golf course.

While the golfer may see a block, hook, early extension or reverse spine, a physical therapist certified by the Titleist Performance Institute (TPI) sees lead hip tightness, a lack of trail side shoulder stability or decreased thoracic spine mobility when they watch a swing.

Understanding how these dysfunctional motor patterns impact how golfer uses and performs with his or her golf club is imperative for improvement. Many people cannot perform basic functional movements, let alone produce a consistent golf swing on a foundation of a dysfunctional movement. Adding a physical therapist to your golf support team can help you assess and change the limitations of the body, making the lesson with your pro, or time on the range with your new wedge more efficient and beneficial.

With Adam Scott’s recent victory at The Masters, golf fitness has been on the national stage. Scott’s frequent appearances on the The Golf Channel’s, “Golf Fitness Academy presented by TPI” and his work with his Titleist Performance Institute team have helped him take his game to the next level.

Locally, Charlotte Country Club has started a “TPI Prep School”.  Director of Instruction, Rich Albright and Director of Custom Fitting, Allen Avakian have teamed up with TPI certified physical therapist, Chris Stulginsky in offering “Prep School” to the members.

“We wanted to connect body mechanics with the golf swing.  Each player’s body reacts differently to the body’s movement requirements for an effective golf swing.  When the body limits the movements within the golf swing, it is hard to hit the golf ball consistently”, said Rich Albright, Director of Instruction. “We saw each student gain efficiency in their ability to swing the golf club.

Both professionals also saw the personal benefits as it translates to their golf game as well,  Avakian pointed out, “personally, the program has helped to increase range of motion as well as ease of motion. My sense is that this increased mobility along with better stability will help in maintaining rhythm and tempo.” Albright added that, “[the program], had a direct impact on my back and my ability to rotate better during the swing.”

So many think that the program or physical therapy itself can be working with resistance band or stretching to improve flexibility. In fact they work a great deal on stability so one can build increase potential energy when they swing or on the motor control of functional opposites to make for a more consistent swing. With the properly trained eye, one can easily expand their program, and simultaneously make it more efficient and effective.

The program at Charlotte Country club has been a success leading the club to add another session says Avakian, “the feedback is leading us to start another session in the month of May.”

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Notre Dame Quarterback Dayne Crist’s Knee Injury: An Injury Focus Overview

This article originally appeared on the bleacher report on Oct. 31, 2010.

NickLaHam_Getty Images

Photo Credit: Nick Laham of Getty Images

Nearly a year to the day he tore his ACL Notre Dame starting quarterback Dayne Crist went down for the season with a patellar ligament injury to the knee.

The simple action of straightening one’s leg, let alone the explosion that takes place in any athletic move, comes from an intricate system and chain reaction from quadriceps contraction through the quadriceps tendon and patella itself through the patellar ligament (sometime referred to as the patellar tendon), its anchor point.

The patellar ligament (tendon) stretches from the bottom of the patella or knee cap and anchors on the front of the shin.

The structure is instrumental in allowing a person to straighten his or her leg.

When the quads fire and contract, the force is transmitted through the quadriceps tendon, and the patellar ligament uses the patella as a fulcrum to generate more strength as the individual straightens his leg.

There are many documented cases in the NFL of this, one of the most notable is the Denver Broncos’ running back Correll Buckhalter. He returned from this injury twice to be a productive NFL running back.

It will be in the best interest of Crist to have surgery this week as it will allow for less complicated repair, as scar tissue will have little time to develop and settle in.

Most surgeons will attempt to make the repair primarily, meaning using the tissue in place, if the injury is too severe a surgeon may harvest tissue from a donor or another site of the body.

Post-operatively, the client will be partial weight bearing period for five to six weeks, rehab protocol will be determined by the surgeon but will be modified if need be by working with the board certified physical therapist in charge of the rehabilitation.

Typically the client starts bending the knee himself one to two weeks after surgery, straightening it is typically only performed passively with assistance.

It is important to start ranging the knee in rehab as soon as possible as the two complications associated with this surgery are quadriceps weakness and lack of range of motion.

Of course those are actually dependent on each other as limitations in strength can limit range of motion, and limited range of motion can over time lead to limitations in strength and stability.

Some clients can return to athletic activities in as short of a time as six months, however, returning to the high level of playing competitive college football could take eight to nine months.

Many factors go into the length of recover period, the surgery itself and the client’s physical initial response have a great deal to do with the recovery time, as does the physical therapy afterward.

The real work will be done in physical therapy as the client will be spending at least four to six hours a week, conservatively speaking, in rehab.

The goal will be to decrease the onset of scarring, contracture or range of motion limitations. This will mostly likely be done with and great deal of manual ranging and the use of a constant passive motion (CPM) machine.

Additionally, the goals will be to encourage tissue regeneration, and decrease swelling and edema. Traditionally the use of ultrasound and electric stimulation is used in this situation.

With more recent advancements in technology, those modalities have been less utilized especially in the cases of higher end athletes.

In case with Kellen Winslow Jr after his motorcycle accident in 2005, and with the bone bruise to Lindsay Vonn at the Vancouver Olympics, the use of FDA approved cold laser therapy has been utilized to assist in speeding up the recovery process with biochemical stimulation versus just temporarily decreasing the pain as is the case with ultrasound and electric stimulation.

Not only do the clients report decreased pain, they report more mobility and stability in a shorter time period.

Finally, the goal will be into introduce athletic activities, first going forward, then forward and backward. Overtime side to side activities will be introduced at 25, 50 and 75 percent speed. Crist will eventually be allowed to perform compound athletic movements again at 25, 50 and 75 percent before returning to non-contact practice activity.

Once Crist returns to full football activities, the use of a brace may be warranted.

However, it would be more for comfort then anything else as the traditional braces you see most football players wear provide lateral stability primarily protecting the ACL and collateral ligaments.

Christopher Stulginsky, PT is the managing partner of Ayrsley Town Rehabilitation, in Charlotte, NC. He is a Prehab Network Specialist, an 830 Cold Laser Certified Premier Provider and certified by the prestigious Titleist Performance Institute.  Christopher has provided injury coverage to numerous websites most notably Deadspin, Redskins.com and NFLSportchannel.

New York Giants QB Eli Manning Day to Day with Plantar Fasciitis

This post original appeared on the bleacher report on Oct. 8, 2009

Last weekend, in what looked like a pretty mundane play, New York Giants quarterback, Eli Manningsuffered an injury to the bottom of his right foot.  It was enough to sideline him for the rest of the game and to keep him out of practice on Wednesday, according to the injury report at NFL.com.

Plantar Fasciitis is inflammation of the plantar fascia, a dense connective tissue structure that runs along the bottom of the foot from the heel to the area around the ball of the foot.

Though referred to as one unit, it is actually comprised of many thin layers that have to work together and glide over each other in order for it to work together as one unit. When that area gets inflamed, the layers do not properly glide and as a result cause pain in the bottom of the foot.

The severity ranges, a relatively mild case can be isolated to one area of the foot, where a severe case can be felt from the heel to the ball of the foot.

Based on reports, it seems that the injury is located on just one area of the foot. Nevertheless, plantar fasciitis can be unbelievably painful, it effects nearly 2 million Americans each year and may affect 10 percent of the American population in their lifetime.

It is a condition that has sidelined Tim Duncan of the San Antonio Spurs and Shaquille O’Neil of the Cleveland Cavaliers. The patient’s that I see with this diagnosis report that basic tasks, like walking, are unbelievably painful let alone high performance task like throwing a football.

The foot is foundation of the body and, as a result it is the foundation for proper biomechanics of the football throw. The injury is located in Manning’s right foot, which he uses to the plant before he passes the football.

The condition could affect his ability to plant and drive off of his right foot, which could affect his accuracy; it could increase time the ball is in the air, and give the defense more time to react.

Additionally, it can affect his ability to generate power on down field throws and will limit he mobility in the pocket in attempts to avoid the defensive pass rush. Typically the goal of treatment is to decrease the initial inflammation associated with acute injuries by resting and icing the structure.

Going forward, the goal needs to be to continue to address the residual inflammation in the area as well as improve the range of motion.  Electric stimulation, ultrasound, iontophoresis or phonophoresis with 0.4 percent dexamethasone are indicated along with use of cold laser and stretching the gastrocnemius and soleus, which make up the “calf muscle.”

On game day, the medical staff can use injection therapy and give extra support to the area with taping techniques. Additionally they can modify Manning’s footwear to decrease the symptoms in an attempt to decrease the effect of the injury on his performance.

In Manning’s situation, because he is a professional athlete, other biomechanical factors such as tightness and strength deficits of the hip and knee may not need to be addressed.

However, if you have or are experiencing these symptoms, be wary of a treatment program that is isolated to the bottom of the foot. In most situations, plantar fasciitis is caused and is, therefore a symptom of biomechanical issues elsewhere in the body.

These muscle imbalances cause the plantar fascia to be overloaded with forces it is not able to withstand causing injury.  Addressing just the plantar fascia and without addressing additional factors increase the chances of the recurrence and could make the situation chronic.

Christopher Stulginsky, PT is a 2003 graduate of the physical therapy program at the Rangos School of Health Sciences at Duquesne University in Pittsburgh, PA.  He has worked at The Johns Hopkins Hospital in Baltimore, MD and in various sports medicine clinics around the country. Currently, he is the managing partner at Ayrsley Town Rehabilitation, a physical therapy clinic in Charlotte, NC.

Neck Stinger: A Look at the Injury Keeping Chris Samuels Out Against the Chiefs

This article originally appeared on the bleacher report on Oct. 13 2009

If you were trenched up in your football cave this weekend and saw clips from the RedskinsPanthers game, you watched the pressure the Panthers’ defensive line was able to apply to Redskins quarterback Jason Campbell, ultimately resulting in five sacks for the game.

The Panthers’ defense was aided by the loss of Redskins six-time Pro Bowl left tackle Chris Samuels, who left the game at the conclusion of the second play from scrimmage after suffering a neck stinger.

As a result, Samuels will be held out next week against the Kansas City Chiefs.

A stinger is a painful condition which usually is result of a direct blow to the head, neck, or shoulder; however, it is possible in any sport or activity.

In this case, the injury was suffered after Samuels went to block Panthers defensive end Tyler Brayton, which caused a forceful stretch of the nerves.

According to the Washington Post article, Redskins center Casey Rabach, who has had the injury in the past, said “That’s a scary injury.”

The name comes as a result of the sudden and intense stinging pain that shoots down your arm or in your hand.

The feeling is similar in nature to that of a limb that has “fallen asleep”; however, in the case of a “stinger,” the onset is sudden, and the intensity greatly increases. A mild case can last for just a few seconds; in a more severe or chronic case, symptoms may persist over longer periods of time and result in decreased coordination, strength, and sensation in the affected arm.

The injury should be immediately reported to coaches, trainers, or a team physician; ignoring them and continuing to participate could lead to more significant injury.

The application of ice to the neck and shoulders will help the discomfort initially; however, going forward the individual should seek out treatment from a skilled physical therapist to prevent further complications.  Treatment may consist of moist heat, soft tissue massage, thermal ultrasound, treatment with the FDA approved ML 830 cold laser and passive stretching may be used to decrease any muscle spasm that may have resulted in continued symptoms.

Muscle spasm is often overlooked as a cause for delayed recovery. When one voluntarily contracts a muscle, they have the ability to voluntarily relax that muscle.

When one is hit, the body goes into a protective, involuntary protective contraction, and it is more difficult to release. When a person has larger, more powerful muscles, the resulting muscle spasm can be more powerful as well and take longer to release.

Even when the symptoms are relieved, the muscle spasm must still be addressed to prevent future or lingering complications.

Be wary of treatment programs that just use passive modalities and do not address the resulting muscle spasm. Doing so can delay your recovery time and delay the return to your activity.

Once the symptoms have dissipated, treatment should focus on strengthening the muscles of the cervical spine and improving the range of motion as well, particularly in the front of the neck.

Additionally improving one’s sports-specific technique can decrease the chances of re-injury.

If symptoms persist, an X-ray, MRI, EMG, or CT scan may be indicated to rule out disc herniation or nerve damage.


Christopher Stulginsky, PT, is a 2003 graduate of the physical therapy program at the Rangos School of Health Sciences at Duquesne University in Pittsburgh. He has worked at The Johns Hopkins Hospital in Baltimore and in various sports medicine clinics around the country. Currently, he is the managing partner or Ayrsley Town Rehabilitation, a physical therapy clinic in Charlotte, N.C.

Super Bowl XLIV: A Look at the Injury That May Sideline Colts’ Dwight Freeney

This article originally appeared on the bleacher report Feb 1 2010.

As the Indianapolis Colts travel to Miami today to take on the New Orleans Saints in Super Bowl XLIV, reports surfaced last evening that Pro Bowl defensive end Dwight Freeney flew to South Florida on Friday to initiate treatment on a right ankle injury.

Allegedly, Freeney sprained his ankle attempting to avoid Jets quarterback Mark Sanchez late in the AFC Championship Game.

An ankle sprain occurs when a force, which typically occurs while running, jumping, or with a sudden change in direction, results in a stretching or a tear occurs in the ligaments of the foot and ankle complex.

Eighty to eighty-five percent of ankle sprains occur when the foot or ankle “rolls” in, or underneath the body. This causes damage to the complex ligamentous structure on the outside of the ankle.

The main ligament effected is usually the anterior talofibular ligament, which can be found at the four o’clock position of the lateral malleolus, or outside ankle bone. With more severe sprains, the calacaneofibular ligament, which can be found at the seven o’ clock position, is affected as well.

These two major ligaments are a part of a larger group which are designed to protect one of the most complex joints in the human body from excessive movement.

Though the Colts have insisted in multiple reports that Freeney has a low ankle sprain and not a torn ligament, a team spokesman has classified the injury as a third degree low ankle sprain.

Based on the severity, ankle sprains are classified as one of three grades. A Grade I ankle sprain is classified as a stretching of the ligaments without tearing; Grade II is classified by some tearing and abnormal joint movement; Grade III usually describes complete tearing and severe ankle instability.  After injury the area becomes swollen and painful to the touch, normal movement such as walking is very difficult.

The foot and ankle complex is to the body what wheels and tires are to a vehicle. They are the contact with the ground, controlling the body, giving it traction, and create a great deal of fine motor movements decreasing the amount of force translated to the rest of the body.

Just as vehicle performance would be affected by under inflated tires, Freeney’s injury, if he attempted to play, would limit the ability to cut and change direction.

One of the most impressive defensive players in the NFL, who Tom Brady once described as “the most intimidating player” in the league, would find that his bull rush, speed, and spin move would be vastly compromised, if possible at all.

Initial treatment involves elevation, ice, and rest.  Ultrasound, electric stimulation, and treatment with the ML 830 cold laser may be indicated to reduce swelling and pain. A walking boot or crutches may be utilized to relieve the increased symptoms that occur with normal movement.

Moving forward, it is very important that physical therapy treatment focuses on increasing strength of the foot and ankle to improve stability and prevent re-occurrence.

Be wary of treatment programs that only rely on ultrasound or electric stimulation to reduce swelling. Additionally, programs must focus strengthening the muscles contained in the foot and ankle, as well as dynamic ankle strength of the muscles that cross the ankle joint.  Treatment cannot be limited to traditional ankle strength testing.

Many patients receive and are prematurely discharged from physical therapy because of strength testing.  Ankle sprains rarely occur because of a lack of strength; many times, the person presents with maximum strength in testing. Sprains tend to occur many times because, from a neuro-muscular standpoint, the muscle cannot recruit the strength fast enough to prevent injury.

Treatment programs usually focus on a return to traditional strength patters versus dynamic strength, which could be one of the reasons that re-injury rate, which is 20 percent in the everyday population, and is higher in the athletic population, is so prevalent.

As with any injury or illness, prevention is key; participating in a comprehensive Prehab or injury prevention program can actually help to prevent this injury or reduce the severity when injury occurs. If an injury does occur, it is important to be armed with knowledge on how to evaluate proper protocols in order to give yourself the best chance at a full recovery.

Christopher Stulginsky, PT is the managing partner of Ayrsley Town Rehabilitation, in Charlotte, NC. He is a Prehab Network Specialist, an 830 Cold Laser Certified Premier Provider and certified by the prestigious Titleist Performance Institute.  Christopher has provided injury coverage to numerous websites most notably Deadspin, Redskins.com and NFLSportchannel.