“My MRI and X-rays are negative.” This is a common statement from my patients with lower-back pain.
They have had a full diagnostic work-up and the findings are negative. They do not know what is wrong with them. The over-the-counter pain relievers and anti-inflammatory drugs do not work.
Now what? They do not want to take steroids or injections, and surgery is out of the question.
The pain is interfering with their work, family life and sports activity. They want to get better without drugs or surgery.
The sacroiliac joint is what allows your hips to move as you walk. This joint is where the dimples are on each side of your lower back.
They give you the wiggle in your walk, which is more pronounced in a woman. This is because a woman’s hips are wider than a man’s.
One patient told me his health care provider told him he had an iliotibial band issue, which was the reason the right side of his back and buttocks hurt. The pain also traveled down the side of his leg.
He is a friend staying at my house. He lives in Florida and has a summer home up the coast. He and I have played tennis together for years. When he is catching an early morning flight out of Portland to go to work, he stays with me.
I took him to Prout’s Neck Country Club for a tennis match. After playing, we cleaned up and I then evaluated his lower back, looking for the cause of his pain.
He is very fit for his age. He has no neurological deficits that would indicate he has a disk lesion or herniation. The range of motion in his lower back is normal. There is muscle spasm in the buttocks and tenderness over his right sacroiliac.
I found on muscle testing a weak gluteal muscle and hip flexor. There was no movement of his right sacroiliac joint. The joint is stuck.
I told him the sacroiliac joint is the cause of his back, hip and leg pain. I performed an adjustment to the joint to restore its motion. The adjustment works beautifully and his muscle strength returns to normal. The pain reduced immediately. Exercises were prescribed so he can maintain the normal function of the joint.
Another patient recently ran a 3:30 marathon. She is one of the fittest athletes for her age I have seen in my practice. Now she can barely teach her classes as a personal trainer.
She told me the pain was in her lower back and buttocks. It went into the inside of her thigh and down to her calf. She couldn’t do speed work, and teaching kick boxing classes was aggravating the pain.
I found muscle spasm in her buttocks. Her hamstring, buttocks and hip flexor were all weak. When she lifted her right knee her sacroiliac lifted. It should rock down and back, as her other side did perfectly.
I tested her for sciatica, which was negative.
I treated her with an adjustment. I will use ultrasound to reduce muscle spasm and inflammation, if necessary.
The sacroiliac joint has no disk. That is why it is difficult to image the joint and have a positive finding with MRI and X-ray. Often the patient will be frustrated there are no findings on examination to validate the pain they are experiencing.
I find the sacroiliac joint to be cause of many patients’ lower back, hip and leg pain.
I love the shoulder joint. When a patient comes into the office with pain and discomfort in their shoulder I enjoy the challenge this condition brings to me as a clinician. The shoulder is a very unstable joint. This instability is caused by its anatomy and function.
It also has a number of muscles and tendons attaching to these bones. The muscles of the chest, upper arm, neck, shoulder pad and upper spine all converge in the area of the shoulder.
All this anatomy must be in perfect balance for the shoulder to function optimally. In the old days they call this anatomy the shoulder girdle. All this anatomy was needed to stabilize and support the shoulder like a girdle.
What makes the shoulder so unique is its range of motion. You can move the shoulder in so many directions. The downside to this motion and the workload demanded by athletes makes it vulnerable to injuries.
The shoulder can throw a baseball 90 mph. It is used to tackle a man running at full speed. It can also swing a tennis racket so you can hit a serve 125 mph over the course of 3 sets.
Injuries to the shoulders can be as simple as a strain of a muscle to more severe injuries such as fractures of the clavicle, subluxation or particle dislocation, dislocation or torn tendons.
I have patients come into the office and they have self diagnosed their shoulder pain. The most common self diagnosis is an injury to the rotator cuff or roto cuff attachment.
The rotator cuff is a tendon. Four muscles of the shoulder join together and anchor to the shoulder by this one tendon.
A blunt force or wear and tear from throwing or swinging a racket can injure this tendon.
One patient came in the office complaining of shoulder pain from pitching. He is in high school and was told he had a roto cuff injury.
Evaluation revealed his shoulder to have full range of motion. I performed muscle testing of the four muscles of the roto cuff. The supraspinatus was weak and tender to palpation. He had an elevated shoulder. His shoulder blade was out of alignment.
Treatment consisted of manipulation of the shoulder blade and the upper spine to relax the shoulder. He was given exercises with a tube to promote strength.
I spoke with his coach. We discussed his pitching motion. I want him throwing with his legs and not just his arm. He responded well and continued to pitch without issues.
Bench pressing heavy weights can also compromise the shoulder. If you bring the bar too low, so the elbow goes past 90 degrees, it puts a huge strain on the shoulder.
A patient was convinced he hurt his bicep tendon benching. He had pain in the front of the shoulder.
He is in great shape for his age but he had the range of motion of a fire hydrant. This is a problem for athletes that concentrate on building muscle without flexibility.
He strained his AC joint. This is the junction of the shoulder blade and collar bone. His anterior deltoid was weak. His bicep tendon was not involved.
I manipulated the AC joint and used ultrasound. We also recommend stretching exercise to improve his range of motion. Benching properly with less weight was reinforced.
If you take good care of this magnificent joint it will take good care of you.
Mental toughness, use it to your advantage.
He has nerves of steel. Ice water runs through his veins. He is clutch. This is what is said to describe an athlete when he excels under pressure.
He choked. He has the yips. He was wide open and dropped the ball. This is said of someone who lets the pressure of the moment get to him.
I love the title of the book “Pressure is a Privilege,” the autobiography by tennis great Billy Jean King.
She wanted to feel pressure. This is why she trained so hard. Walking onto center court for the final at the U.S. Open or Wimbledon was a privilege she earned, and she wanted to take advantage of the opportunity.
I have found you can achieve mental toughness through discipline and goal setting. You must be committed to doing what is necessary to achieve your goals.
You have to look at the demands of the competition, develop a training program and make the proper lifestyle adjustments. You have to be mindful of what you eat and drink. This is the fuel you need to run your body. No junk food.
You must remain calm under pressure and try to maintain your breathing and heart rate. You will see athletes slow down and become more deliberate as the pressure mounts.
They will take a deep breath to get oxygen to the heart and brain. This will relax them. A relaxed muscle is a stronger muscle and will respond more efficiently than a tense muscle.
A patient had been struggling with tennis elbow for seven months. His father referred him to my office.
My examination found tenderness in the elbow but he showed some muscle weakness in his grip. This indicated an irritation to a nerve in his cervical spine.
Our treatment included adjusting his elbow, wrist and upper spine, including his neck. The motor strength returned quickly and his elbow pain started to resolve.
Then I worked on his confidence. I discussed his training with him. I told him not to try and make up for lost time.
His father is an excellent player and hired a local coach. He has made some changes to his swing mechanics.
I tell him it is OK to lose a match to a much more skilled player. You should never lose to someone at your level or below. If you do, it is all mental.
One of my patients asked me to hit tennis balls with her son. He had an excellent game but he had trouble winning matches even against players he should beat easily.
In one game when he was serving, he hit two hard serves to my backhand that I could not return. The rest of the game he hit his serve to my forehand and I won the game. He was just playing, not playing to win.
I spoke to his mother and coach. They worked with him. The young man can now blow me off the court.
I have seen many athletes return to play too soon when they are injured. They end up aggravating the injury.
If you are injured, take care of your injury first. Rest and recovery are part of training.
“I have no time to exercise.”
“I can’t afford a gym membership and personal trainer.”
“The gym is too crowded.”
I have heard all the excuses why a patient can’t exercise. I want to break down the barriers so you can get the job done. Your life and health depends on it.
I hear patients tell me they do not have an hour and half to spend at the gym three to five days per week. I respond: If you are spending that much time at the gym, you are doing something wrong.
Exercise does not have to be complicated. If we make it complicated we all can make a lot of money from it.
The only equipment you need is a pair of sneakers, T-shirt and a pair of shorts. You do not need to spend hundreds of dollars on equipment to get the job done.
Your body weight is your equipment. They do not have dumbbells and treadmills in the military.
Our lives can be hectic. Let’s get the job done in the least amount of time.
I recommend to my patients that they exercise in the morning. People that exercise in the morning are the most consistent with their program.
Another benefit to exercising in the morning is you jump start your metabolism for the day burning calories for eight hours.
I recommend three basic exercises; push-ups, sit-ups and lunges.
Lunges work every muscle in the lower body. This is where you take a long step forward. Now try and bring your knee close to the floor while keeping your forward knee at a 90-degree angle.
This works the bottom of your feet, calves, thighs, hamstrings and buttocks. Hold onto a chair if necessary. You can do one lunge at a time or walk across the room.
Next is sit-ups. Bend your knees again at a 90-degree angle cross your arms over your chest and try and touch your forehead to the ceiling. This will engage all the muscles of the abdomen without compromising your lower back and neck. The last exercise is push-ups. These can be done off your toes or your knees. What is important is you keep your body straight.
This exercise involves the muscles of chest, back, abdomen or core, and your legs.
These three exercises hit the majority of your muscles, except your biceps. Unless you’re parading down the beach you do not need big guns.
One of my favorite patients owns a fabulous local restaurant with her partner. Whenever I go in for dinner, she always shares with me how her home exercise program is doing.
One time she was concerned that the back of the arms were not toned and she did not like the look. She asked if there was a way to work the triceps.
I told her to do her push-ups with her thumbs and index fingers touching each other. The next time I was in the restaurant she was showing off the muscle definition in her triceps. She was so excited that such a simple exercise yielded such big results. It only takes six weeks to see changes in your muscle tone.
The last key is cardio. Athletes with the best bodies are sprinters. High intensity, short-duration cardio creates muscle better than running or walking slowly.
“How many should I do”?
Patients always ask this question. I respond, “Who cares?” Some days you will feel strong and can do eight push-ups; other times not so many. Do the exercises until you are tired.
Start these exercises now and you will see changes in your body by Memorial Day weekend.
Stretching confuses many athletes. They want to know whether it is really necessary, and whether it will prevent injuries.
If it is necessary, when should you do it? Do you do it before, during or after your activities?
Experts have been all over the map on this issue. I remember when it was recommended that you do a deep and hard stretch before your workout. This advice led to many injuries from overstretching cold muscles and tendons.
Studies now show that it is best to begin your workout with a light warm-up. This warm-up will get blood flowing to the muscles that you will be exercising.
If you are a runner, it is best to start at 50 percent of your normal speed and then gradually increase speed. You will know you are warm when your body starts to perspire.
This is good advice for other sports as well. If you are hitting the slopes, start with a few cruising runs before you head for the moguls. Hit some tennis balls from the service line to get your legs and arms loose.
I have always had issues with stretching. I tried the hard-stretch routines before workouts, and they never appeared to prevent injuries. Those routines may have even caused a few, especially to my Achilles tendon.
I now do a very light and short stretch before any sports. I spend more time warming up, trying to get the heart rate and blood flow going before I exercise. I do a deep stretch at the end of my workout.
Sometimes I need to be reminded to slow down when I start out for a run. A former running partner who was an excellent middle-distance runner would frequently remind me to start a little slower.
As I warmed up and the sweat would start, then our pace would pick up. Usually, her pace would be faster, and I only would see her tail lights for the rest of the run.
A great warm-up, if you are going to the gym to train, is to start with a yoga routine of sun salutation. This is a series of gentle movements that wakes up your spine, legs and shoulders.
This past weekend, I showed a friend these exercises to do before golfing. He was complaining he was losing flexibility and not hitting the ball very far.
I also travel with a set of elastic bands that I recommend to patients. They are great to warm up your entire body. You can also substitute them for dumbbells.
I showed Leo how to use the straps, and he was amazed at the total body workout you get from them. This warm-up only takes a few minutes to get the heart rate up and the blood flowing to the major muscles.
Many of the old-school exercises also can get you ready to exercise. This includes jumping jacks and running in place, lifting your knees to your waist. Throw in a set of pushups for good measure.
Another exercise people forget about is jumping rope. If it is good enough for boxers, it should be good enough for you.
Listen to your body. If the exercise causes any symptoms to increase, modify or stop your program and see a health care professional.
If you are consistent with your exercise program, you will see amazing results in a short time. Your health and energy level will increase and your weight decrease.