January 21, 2018

Happy Holidays

All of us here at Peak Performance wishing you Merry Christmas and Happy Holidays!  This is a time of year that we all get very busy with shopping, cooking, family gatherings and travel.  We hope that everyone enjoys their time with family and has safe travels.

“For to us a child is born, to us a son is given, and
the government will be on his shoulders. And he will be called
Wonderful Counselor,  Mighty God, Everlasting Father, Prince of Peace.”
Isaiah 9:6

Happy Thanksgiving

iStock_Thanksgiving (640x426)All of us here at Peak Performance wishing you a Happy Thanksgiving. This is a special time of year that we want to give thanks to all of our patients for your support.  We know that you have a choice in choosing a physical therapy provider and you chose us!  We hope that everyone enjoys their time with friends and most importantly family.


Which side should you use your cane?

How should I use my cane?

Should I use my cane on my weaker side?

A big mistake that most people make is holding their cane in their dominant hand because it feels more natural and comfortable.  However, the cane should be used in the hand opposite of the weaker leg or affected limb.  For example, if you have had a right knee replacement, you should hold your cane in your left hand. This helps to provide a wider base of support while stepping with the affected limb.  Your base of support is the area between your feet.  For example, if you stand with your feet together it is a narrower base of support versus feet shoulder width apart, which is wider and more stable.  Adding a cane with ambulation makes your base of support in a triangle shape from the tip of the cane to both of your feet.  During ambulation, there are times where you are on one foot while you are swinging the other leg forwards for advancement.  As in the example above with a right knee replacement, cane placement in the left hand allows for a wider base of support and more stability while bearing weight on the right leg and advancing the left leg forwards.  If you draw a line between the tip of the cane to your right leg and comparatively do the same thing if holding the cane in the right hand it is easily demonstrated that the distance between the two points is much wider, make it more stable with cane placement on the opposite side of the affected limb.  During ambulation, the cane should be advanced forward at the same time as the affected limb.  Normal ambulation is demonstrated with reciprocal arm swing and that remains the same when using a cane.   Your physical therapist can assist you in proper gait training utilizing your cane to ensure safety and correct use.    

~H White

Happy Easter

All of us here at Peak Performance wishing you Happy Easter.

He is not here, he has risen!  Remember how he told you, while he was still with you in Galilee.  The son of man must be delivered over to the hands of sinners, be crucified and on the third day be raised again.   Luke 24:6-7                       


Common causes of golf injuries

Are injuries common in golf?

What type of injuries are common in golf?

Why does my back hurt after golf?

Why does my shoulder hurt after golf?

Why does my elbow hurt after golf?

How do I prevent golf injuries?

As the snow and ice melts and temperatures begin to warm, there will be between 55-57 million golfers worldwide starting to make their way to the driving ranges and golf courses. Although golf is considered by many to be a recreational non-contact sport, injuries are fairly common.  Golf is considered a “moderate injury risk” sport with a prevalence rate between 25-60% for amateur players.  Approximately 40% of amateur golfers will sustain a golf related injury every year, while injury rates vary between 1.2-1.3 per year.

The golf swing is a highly complex series of integrated motions which involve most of the major muscle groups and joints of the body which transfers power from the upper extremities (arms), through the core (trunk), to the lower extremities (legs) which are firmly planted on the ground.  A proficient golf swing requires a high level of execution, coordination, and power.  The club head speed generates high velocities during a brief time (1.5 sec for amateurs, 1.2 for professionals) which contribute to high biomechanical stress on the body.  Studies have shown that significant compressive and shearing forces are produced that are highly ballistic and explosive, which are not intended for the human body. 

Lower back injuries are most common in golf, accounting for 15-34% of all injuries for amateur players.  The golf swing comprises high forces to the lumbar spinal segments, above levels of biomechanical tolerance of the supporting structures (i.e. ligaments, tendons, intervertebral disc).  Among amateur men, low back pain (LBP) accounts for 36% of all injuries; in women, LBP accounts for only 12%.  In amateur players, the lumbar spine is under greater peak compressive loads shown to be 8 times the body weight.  LBP is correlational to decreased static trunk strength, delayed trunk/core muscle recruitment and diminished trunk/core endurance which contributes to injury.

Elbow/forearm injuries (i.e. Golfer’s elbow or tennis elbow) are second most common, accounting for 7-27% of all golf related injuries and are more common in amateur players.  85% of elbow injuries involve the outer elbow (lateral epicondyle).  These types of overuse injuries are often produced from gripping the club too tightly and having inconsistent technique.  A sudden deceleration of the club head (i.e. hitting the turf) is a more common mechanism to injure the inner elbow (medial epicondyle).

Shoulder injuries are the third most common, accounting for 4-19% of all golf related injuries.  Common injuries include shoulder impingement, rotator cuff tendinitis, and posterior shoulder instability/subluxation.  Overuse injuries to the shoulder occur when relatively weak rotator cuff muscles are fatigued through excessive repetition.  During the golf swing, the shoulder is exposed through a large range of motion.  During the backswing, in a right-handed golfer, the lead shoulder is placed into maximum horizontal adduction (found to produce the significant force across the AC joint), while the trailing shoulder is placed into maximum external rotation.  The opposite occurs during the follow through.  The rotator cuff muscles undergo significant force during the uncoiling phase of the down swing (lead shoulder) while the follow through (trailing shoulder) is at risk of impingement.  The leading shoulder is most affected by injury.

The majority of golf injuries occur during the late down swing (ball impact and follow through phases of the swing).  The follow through accounts for 42% of all injuries while the late down swing and ball impact account for 18%.  Injuries are prominent during these phases because the human body harnesses the highest amount muscular activity than any other phase.  The back swing emphasizes flexibility and coiling the muscular springs to store power, while the downswing generates power that requires muscular strength of your torso, pelvis, and arms. The follow through generates even more torque due to eccentric contraction of the muscles to slow your body’s rotation of the torso and arms.  Studies have shown that younger or more skilled players have more trunk mobility and therefore utilize less muscular activity; while older or less skilled players have up to 50% less trunk rotation which contributes to higher compensatory muscular activation.

There are three main contributing factors that affect golf injuries: overuse, faulty swing mechanics, and poor training habits or fitness level.  Overuse injuries are more common in competitive players and usually involve soft tissue structures such as muscle, tendon, and ligaments.  These types of injuries are caused by short periods of intense play or high number of practice hours.  Repetitive use often produces muscle imbalances which contributes to overuse injuries.  One study found significantly more injuries in golfers who played four rounds a week or who hit at least 200 balls in one week.  Faulty swing mechanics are more typical in the amateur players.  Common flaws include “over-swinging” the club, swinging harder or faster than appropriate, deficiencies in swing technique, improper grip technique, and postural compensation.  Poor training habits or fitness levels are the most common factors to golf injury that can be readily prevented by self-intervention.  Examples of poor training habits/fitness levels include lack of warm-up, reduced mobility and flexibility, lack of strength and stability, and lack of aerobic conditioning.  Many amateur golfers play without warm-up of any kind and are in poor physical condition.  One study found that 81% of amateur golfers did not warm-up for more than 10 minutes prior to playing a round of golf.    Another study found more than 50% of the sample did not perform any warm-up prior to practice or play and fewer than 3% of the golfers were considered to have warmed-up appropriately.  

There are several ways to improve your golf game and lower your risk of injury.  Golf is seasonal in many parts of the country, so rest periods are dependent upon weather/climate.  However, in many parts of the country, golf can be played year round, therefore it is recommended to take 4-6 weeks off after 6 months of play.  Rest is important and is essential for recovery and adaptation.   Golf fitness is important year round and not just during the non-golfing months.  A golf fitness program should be comprised of three components: flexibility, strengthening, and aerobic conditioning.  The benefits of a flexibility program allows for a more fluid swing, improves back swing limits, allows for full follow through, improves muscle coordination, and most importantly reduces injury.  The emphasis of a flexibility program should target the hips/pelvis, torso, shoulder, and forearms. The golf swing uses all major muscle groups in the body, both large and small.  A strengthening program should include exercises to improve power, and should target multiple joint large-muscle groups and single joint small muscle groups.  Focus should also be placed on core musculature of the torso, hips/pelvis, and shoulder girdle.  Aerobic conditioning should also be an emphasis to improve cardiovascular endurance.  The average course is > 3 miles and often a course terrain can challenge your endurance.

Finally, golf preparation should incorporate all aspects of practice.  This would include putting, short game, intermediate game, and long game.  Incorporating and practicing all aspects of your game will allow your body rest from certain elements of the game and will protect your body from overuse, minimizing the repeated stress/strain to your muscles and joints. Proper warm up program should start with 10-15 minutes of light aerobic activity to increase blood flow/warm up muscles.  From there, progress to a stretching program for shorter durations 10-15 sec followed by ballistic/functional stretching.  Lastly, a sequential golf club warm up is also advised which should include wedges/short irons, mid irons, woods/driver, and putting.  Nearly 50% of all amateur/recreational golfers do not warm up prior to play or practice.  Only 3% of amateur golfers participate in proper warm-up.  A warm-up program has been shown to reduce the risk of injury by up to 60% risk of injury.  The most neglected part of any fitness program or sports participation is the cool down.   It is important to repeat the stretching program but using longer and sustained holds closer to 30-40 sec.  The muscles and joints will stretch better after being sufficiently warmed up after the sports activity.  Stretching after activity has also been shown to reduce inflammation and minimize post-activity muscle soreness often accompanied with exercise.

In summary, golf injuries are prevalent in both amateur and professional golfers.  Golf injuries occur from overuse, improper training, poor swing technique and commonly affect the lower back, elbow, and shoulder.  Warm up and fitness training are essential to prevent injuries and fitness training should focus on rotational flexibility, dynamic core strength/stabilization, and aerobic conditioning.  Consider a consultation with a physical therapist who has expertise in golf fitness to give you guidance.

Stay healthy and keep it in the fairway!

~Dr. Sean White, DPT, OCS, CMDT

Can steroid injections harm your body?

What’s the difference between anabolic steroids and corticosteroids? What does a cortisone injection actually do?  Will cortisone injections harm my body?

When people hear the word “steroid”, most of us think of the sports enhancement use to gain muscle. However, there is a difference between anabolic, or muscle building steroids, and corticosteroids. Cortisol is produced naturally in the adrenal cortex of the human body. This hormone is produced at higher levels when your body is under significant levels of stress. Cortisol travels through the body’s bloodstream and helps reduce inflammation. Unfortunately, natural cortisol has a short-term effect.  An anabolic steroid is a man-made substance. These steroids can be used by doctors to treat delayed puberty in young males or muscle loss in patients due to disease. However, anabolic steroids are commonly used by athletes and body builders to help enhance their performance and promote unnatural muscle growth.

A cortisone injection is a common treatment for patients suffering from pain due to significant amounts of inflammation. Cortisone is synthetically made to mimic your bodies naturally produced hormone cortisol. Cortisone injections are injected directly to the injured area. Without being administered into the bloodstream, this allows a longer period of pain relief for the patient. Remember, cortisone injections are used for inflammation not pain.  Therefore, it may take a few days for the relief of pain, as the inflammation is subsiding.

By consulting with a doctor, they will be able to inform you about the correct dosages and frequency of injections.  Overtime, cortisone injections can start to weaken tendon matrix and cartilage within a joint; therefore, a general rule for cortisone injections is not to exceed more than one every six weeks.  Most guidelines limit three to four injections per joint within a calendar year.

L. Bolen

Spring Cleaning 101

How do I prevent injury with iStock_Spring yard work (640x436)gardening and spring cleaning?

What tips should I know for yard work clean up?


The weather is starting to warm up and the snow is finally beginning to melt!  As we start to thaw out from this frozen tundra of a winter, many of us may find ourselves doing some spring cleaning.  Spring is a great time to open up the windows, air out your house, and clean every nook and cranny that has been collecting dirt all winter.  As the snow is melting, it is unveiling the damaged ground underneath.  It is becoming apparent that some yard work is much needed, and we can’t forget about the gardening!  We at Peak Performance have a few tips for you to prevent injury while doing your spring cleaning and yard work this year:


1.  Pace Yourself!

Don’t try to clean the accumulation of clutter and dirt from all winter in one day.  It is easy to get into a groove and barrel through it, but listen to your body when it tells you it needs a break.

2.  Stretch!

Who would have thought that it may be beneficial to stretch before and after cleaning and yard work?  When you are not used to being active, your body may become very stiff and sore after the increased activity of spring cleaning.  Stretching before and after cleaning will help to decrease your soreness.  If you are experiencing back pain midday through your cleaning session, it is likely due to the repetitive bending that you have been doing all day long.  It may be beneficial to place your hands in the small of your back and doing a few repetitions of back bends to counteract the flexion forces you have been placing on your spine.

3.  Use Good Body Mechanics!

It is very important to utilize good body mechanics when lifting items, dusting, washing windows, laundry, gardening, and many other household activities.  When performing any activity try to keep your spine in neutral by maintaining your natural spinal curve.  If you have to pick up an object, keep your back in neutral, squat down using your legs, bring the object close to your body, and return to standing.  It is also important to try to avoid being bent over for prolonged periods of time, as it places stress on your back.

Remember these useful tips this spring season to help prevent injury during this spring cleaning and gardening season.

H. Tipsord


Get Back into the Spring of Things

Exercise woman stretchingHow to prevent injury with exercise?

What is the proper way to begin an exercise program?

What is the proper way to stretch?

It has been a looong winter, and we know everyone is eager to get back outdoors as warmer weather approaches. With this in mind, we at Peak Performance want to remind you of a few injury prevention tips to keep you healthy while getting back into your favorite recreational activities and sports this year.

1. Put fitness first. We’re talking to you weekend warriors. (Yes you, who sit at the office all week, then hit the field, court or track WAY too hard when the weekend rolls around). This can be especially challenging coming out of the winter months when most of us have been cooped up inside and more sedentary than usual. Remember that being fit is the first step to being an athlete. While it’s great to stay active, do so consistently. Aim for 30 minutes of activity per day, most days of the week. Your body will thank you.

2. Warm up and cool down. You don’t have to spend a lot of time with these; just 5-8 minutes before and after a workout. An easy rule of thumb for warming up and cooling down is to do the activity you are about to perform at a reduced intensity. (E.g. walk slowly for a few minutes before you start a brisk walk, then repeat slow walking for a cool down). If you’re an athlete, try some dynamic stretching to warm up your muscles. Dynamic stretching involves repeated, but brief stretching of large muscle groups while you move. (E.g. standing knee to chest stretch, high kicks, lunges, and butt kicks). Sustained stretches that are held for 20-30 seconds should be performed as a cool down after your work out when the muscles are already warm.

3. Be mindful of your form. You are much more susceptible to injuring yourself if you are using improper exercise form. Think about the quality of your movements over speed and quantity of reps. Pay attention to your postural alignment, and keep exercises in ranges at which you can maintain good control. You may notice that your form worsens as you begin to feel fatigued. This is a sign that it’s time to take a rest break. Giving yourself just a few minutes of rest will typically allow your body to recover enough to resume your workout with proper form.

K. Collins


What does a torn rotator cuff feel like?

What is the rotator cuff?

What is the most common way to cause injury to the rotator cuff?

What does rotator cuff pain feel like?

How do you know if you have torn the rotator cuff?

How do you manage a rotator cuff tear?

The rotator cuff (RC) consists of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that originate from the scapula (shoulder blade) and attach to the upper most portion of the humerus (upper arm bone).  The RC muscles each have an independent action but also work together as a group to stabilize the shoulder socket in allowing functional motion of the shoulder.  RC injuries can involve any of the four rotator cuff tendons or may involve multiple tendons.  RC injuries can vary from overuse tendonitis to full thickness tendon ruptures.  Chronic degenerative tears, as seen in middle to older age adults, are most common and usually occur as the tendon gradually frays and becomes fibrotic.  The supraspinatus is the most common RC tendon injury primarily due to its location and action.  The supraspinatus tendon lies in a space just beneath the acromion process (outer tip of the shoulder blade) and just above the shoulder socket.  Inherently, this space develops arthritic changes and narrows over time producing an impingement effect.  Over the course of time with normal use of your arms, especially overhead, the supraspinatus tendon degenerates and weakens.

Pain from an inflamed and/or partially torn RC typically presents over the outer portion of the shoulder, often with radiation down the outside of the upper arm.  Pain can vary from a dull ache, in particular at rest or when lying down, to a sharp pain with certain movements such as reaching out away from your body.  In cases of a fully torn RC, it is common to not have any pain as the tendon and nerve endings have been completely severed.  You likely have a partially torn RC tendon if pain is worsened with resisted activities with your arm moving out away from your body or overhead.  You are likely to have a full rupture if you are unable to move your arm away from your body without shrugging your shoulder to compensate.

If you suspect injuring your RC, try to avoid lifting any significant weight with your arms that would force your elbow to leave your side.  Try resting from above shoulder height work activities for a couple of weeks and try taking over the counter anti-inflammatories while trying gentle mobility exercises.  X-rays are not usually beneficial in diagnosing RC injuries and in most cases the RC will heal with the proper rest and exercises.  An MRI is the preferred imaging test to confirm a RC tear but are expensive and usually not necessary unless the condition is not improving after 6-8 weeks of conservative management.  Cortisone injections may be beneficial in acute cases but are usually unsuccessful in relieving pain in more chronic conditions.  If symptoms persist for longer than 10-14 days without any sign of improvement, consult with a physical therapist to help guide you with the most appropriate exercises.  In most cases, rotator cuff injuries can heal without surgical intervention.  Physical therapy, with proper exercise progression, can promote tendon healing and strengthen the uninvolved rotator cuff muscles and surrounding musculature.

~Dr. Sean White, DPT, OCS, Cert MDT

Why does my back hurt after shoveling snow?

Why does my back hurt after shoveling snow?

What do I do when my back hurts after shoveling snow?

iStock_Man shovel snow‘Tis the wonderful holiday season…..not to mention the frigid cold temperatures, snow and ice that comes with it for us Northerners.  It’s that time of year to get the winter gear out of storage and get ready for the first snow.  Get your winter jacket, mittens, scarf and hat, oh….. not to forget the snow shovel.

Is your body in any condition to shovel snow or maybe you are like most people and the last time you did anything physical was last year when you shoveled snow?  Have you ever noticed after shoveling snow from the driveway your back feels sore or achy? Worse yet have you felt pain or pins & needles radiating down the back of your leg.  The other day, I looked out my window and saw the neighbor hunched over holding his back.  He appeared to be in agony, stuck forward in a bent over position.

When a person shovels snow, there is a combined movement pattern of forward bending coupled with twisting/rotation.  This combination of movements over a period of 20-30 minutes can play havoc on your back, especially if you already have a history of back pain.   During such an event, several anatomical structures may be involved such as muscle, ligament/tendon, joint, bone or the intervertebral disc.  Often the disc is subject to injury when stressed in such a way.  When a person bends forwards and then couples the movement with twisting/rotation, the orientation of the disc fibers becomes distorted and weakens.  The disc can become inflamed and swollen causing back pain and/or muscle spasms.  If severe enough it may cause pain and/or pins & needles to radiate down the leg.  The distorted disc tissue may also create a mechanical blocking effect where a person gets stuck forward and can’t stand back up straight without intense pain, just like my neighbor.

The solution….. be mindful of your posture.  Try to maintain your shovel moving forward.  When you scoop up the snow, pivot on your foot by turning your whole body to dump the snow.  Move in unison rather than separating your upper and lower body by twisting.  You should also consider alternating sides that you dump the snow, shovel down one direction to the left then come back going to the right.  Take frequent breaks and allow yourself to stretch your spine backwards by supporting your hands on your hips and leaning backwards.  This is a great way to counter-balance the spinal movements you just did by shoveling snow.  When you’re finished, its a good idea to go in the house and lay on the floor onto your stomach and prop up onto your forearms to stretch your spine backwards.  Maintain this position for a minute or two.

The next time you shovel snow, take this advice instead of walking back into your house and sitting on your rump as that may cause the disc tissue to swell even more!

S. White
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