Since we last talked about snow shoveling we have seen numerous back injuries attributable to this activity, many of which required Interventional spine pain procedures to identify their underlying causes.
The spring and summer seasons allure many of us to be more active than previously before in the winter. Many of us enjoy gardening and mowing the grass. Others would rather hire someone else to do it in order to free up our limited time to participate in sporting activities and enjoying one of most fulfilling simple things to do in life; playing catch with your child.
It turns out that we can use the mechanics of the golf swing as a wonderful model to help us understand what needs to be done to both condition and protect ourselves from back and neck pain from practically any other movement. We can also extract specific components of the golf swing and apply them to yard work, clamming, fishing, pulling weeds, shoveling dirt, starting a lawnmower, throwing out the trash or a water balloon. We can further apply the golf swing model to most summertime sports including basketball, soccer, Frisbee toss, inline skating and volleyball. If we really think about it, all activity movements that require bending and twisting are observed in the golf swing.
An old friend and colleague, Gary Gray, who happens to be a very well known physical therapist, shared with me some amazing observations of how the spine handles the stress of a golf swing, allowing us to understand what the back does with any particular activity. He coined the term “golf swing faults and body fixes” to mean that when you watch the flaws of someone’s golf swing, they usually manifest from unhealthy movement substitutions for those that the player is unable to execute. When joint movements above and below the back are smooth and equal from one side to the other, coupled with a spine that is encased with a strong surrounding core of muscles i.e. the muscles that run from the knees to the chest, there is a minimal stress reaction to the spine. Otherwise the increased stress to the individual spine segments and components from repetitive motion wear and potentially cause pain. For instance, for an effective golf swing, the hip and trunk muscles require the flexibility and strength needed in the back swing and coordination where the middle back twists faster than the back and hips to allow full coiling of the trunk in the windup phase of the swing. If the hamstrings are tight, the quality and extent of this motion will be poor, leading to suboptimal follow through and a less powerful stroke. If there is muscle tightness in the back of the left shoulder, the same consequences will ensue. Unhealthy golf swing movements reflect unhealthy movement patterns that adversely affect the back and neck, which will replicate with any other activity that requires twisting, bending, pulling, pushing throwing and or swinging. Before we map out which spine structure is causing a patient’s pain with an Interventional spine injection procedure, we work together with a physical therapist to identify orthopedic problems similar to the above conundrums.
For instance, a few months ago we saw a 68 year old male named George who was an avid golfer up until he underwent lumbar discectomy 2 years ago. His biggest complaint was that his back pain not only prevented him from playing 18 holes, but the severe back spasms he developed from his long game interfered with his concentration and posture for his short game. After carefully listening to him, we noted on his physical examination that the muscles that twist the hips were extraordinarily tight. He had marked tenderness over the right sided back joints (facet joints). I asked him to demonstrate his golf swing for me and sure enough, in both his windup and follow through, most of the twisting occurred in the back and not at the hips. I had him see a physical therapist for corrective exercises to address this issue, but despite his improved flexibility, his back pain persisted. The MRI of his back showed that he had significant arthritis of the facet joints at the same level of his prior surgery. This is not surprising because once part of the disc is removed, its torque converting ability becomes compromised and thus shares more of its load with the joints behind it. These joints, through wear and tear as well as age, develop arthritis. After taking him to the Interventional spine pain procedure room, we were able to identify the joints in question that were causing his pain through the use of x-ray guided injections of anesthetic onto the actual nerves that allow those joints feel pain. Although the relief was temporary and reproducible, the result allowed us to apply a specific solution to the problem in that we mapped out the structural cause of his back pain, namely the right sided facet joints. . Through the judicious use of a procedure called Radiofrequency neurotomy, we were able to cauterize the nerves that were previously anesthetized, freeing him of his back pain and allowing him to return to play in a way that was quite gratifying.
So we can see that there are many layers of potential problems to a patient’s back pain that not uncommonly go overlooked or unappreciated that mandate unbridled attention to detail.