What is Spinal Stenosis?
Stenosis means “narrowing of an opening”. In spinal stenosis, the space/opening in the center of your vertebrae where your spinal cord runs through from the brain stem to the Lumbar vertebra is narrowed. This can affect both the spinal cord and nerve roots.
The spinal cord ends in the upper portion of the Lumbar spine, for this reason spinal stenosis of the Lumbar spine does not cause as much actual damage to the spinal cord as it does in Cervical spinal stenosis.
Incidence of Lumbar Spinal stenosis in the U.S.A:
Lumbar spinal stenosis occurs commonly in the population. It is important to know that many people with radiological findings of stenosis may be asymptomatic. The estimated incidence is 8-11% of the population.

What causes Spinal Stenosis?
The narrowing of the spinal canal can be caused by many different factors such as -:
1. Being born with a congenitally narrow spinal canal.
2. Arthritis of the spine, whether Osteoarthritis or an inflammatory arthritis such Rheumatoid arthritis.
3. Thickening of the ligaments which lie on the inside of the spinal canal e.g Ligamentum flavum.
4. Herniated/bulging/degenerative discs.
5. Mass effect from a tumor.
6. Vertebral structure abnormality such as Spondylolisthesis which is the slippage of one vertebra on another.
7. Trauma

What are the symptoms of Lumbar Spinal Stenosis?
Here are two scenarios:
1. Mrs. Smith goes to the mall to do some shopping. After 20 minutes her legs feel heavy and tired. She sits down for a few minutes and notices they feel better so she gets back up and continues walking. After a few minutes her legs feel “tired” so she leans on a shopping cart and finds she feels much better and can keep on shopping. She also finds leaning forward and riding the stationary bike much more comfortable than using the treadmill.
2. Mr. Bob goes to play a game of golf. When walking uphill he has no problem but finds he has fatigue and cramps in his legs when coming downhill.

These are both very common scenarios in an individual with Lumbar spinal stenosis. Why did the people in the above scenarios feel better when bending forward at the waist?
Bending forward at the waist opens up the spinal canal and relieves pressure off the spinal cord and nerves which in turn reduces the symptoms of spinal stenosis.
These feelings of leg heaviness and fatigue are known as “claudication’ and can also be seen in people with circulation problems [vascular claudication]. The difference is that in vascular claudication, the symptoms are relieved by rest whether it is rest in a standing or sitting position and are not improved by flexing forward at the waist.

Other symptoms of Lumbar spinal stenosis are:
1. Numbness or tingling of the lower extremity, buttocks and or groin.
2. Urinary or stool incontinence.
3. Cramping of the lower extremity.
4. Weakness of the legs and feet.
5. Balance problems.

What to do if you think you have Lumbar spinal stenosis.
If you have any of the symptoms listed above, you should seek medical attention. You can either see your Primary care physician or see a specialist such as a Physiatrist who will perform a detailed exam.
If you have numbness around the private parts and or urinary or stool incontinence, you should seek immediate urgent medical care as you could be having a serious complication of Lumbar spinal stenosis called “Cauda Equina Syndrome” which is due to damage of the bundle of nerves which emerge after the termination of the spinal cord in the upper portion of the Lumbar spine. These nerves are responsible for supplying the muscles of the bowel, bladder and lower extremity. Cauda Equina Syndrome is managed surgically.

Management of Lumbar spinal stenosis
After a detailed medical exam, you may fall into either a conservative or surgical management case depending on your history, physical exam, lab and imaging studies. If you require surgery you will be referred to an Orthopaedic or Neurosurgeon for further management. For conservative management, if you are referred to see a Physiatrist such as myself, you may be prescribed the therapies listed below.

Conservative therapy includes:
1. Physical Therapy.
2. Orthotics [e.g. back brace].
3. Assisted ambulatory devices such as walkers.
4. Lumbar epidural steroid injections.
5. Lifestyle modifications.

Most patients who qualify for conservative management are able to maintain a good quality of life once commencing the above mentioned therapies.

In conclusion Lumbar spinal stenosis is a fairly common condition which can occur at any age but is most prevalent in the elderly population. Appropriate management provides adequate relief and restoration of function.

I hope this article was useful. Please contact our office if you have any of the symptoms described above. Stay safe and thank you for reading.

Dr. Chinwe John is a board-certified Physical Medicine and Rehabilitation specialist (Physiatrist) at Arthritis & Sports Orthopaedics. As a Physiatrist, her areas of expertise include management of musculoskeletal and neuromuscular disorders including conservative spine management (neck and back pain), sports-related injuries, neuropathy, Scoliosis, pre- and post-surgical rehabilitation, Electromyography/Nerve conduction studies, Myofascial pain, Prosthetics and Orthotics.

Carpal Tunnel Syndrome – Anatomy

The carpal tunnel is a small tunnel found at the base of the palm of the hand. It is bordered by the little wrist bones and a thick ligament called the retinaculum. Inside this space, there is the median nerve and the tendons that bend the fingers and the thumb. The tendons are protected by a synovium sheath. When these get inflamed, this may put pressure on the median nerve.
What are the symptoms of Carpal Tunnel Syndrome?

Usually pain begins in the wrist and palm area, and at times the pain can be felt in the fingers and forearm. Tingling and numbness may occur along the median sensory distribution, which includes the thumb, index, middle, and half of the ring finger. In addition, progressive Carpal Tunnel Syndrome can result in motor weakness of the intrinsic muscles of the hand.  

Other common symptoms include:

• Awakening at night by pain, cramping and/or numbness in the wrist and hand.
• Dropping objects, clumsiness.
• Having difficulty with gripping or pinching objects because of pain or weakness.
• Pain with writing or performing activities that require fine handling of objects like sewing, knitting or cutting.
• Pain to wrist or hand, and/or tingling and numbness to the fingers when gripping the wheel while driving.
• Pain to the anterior aspect of the shoulder.

Causes and Risk Factors:

Median nerve neuropathy, occurs when there is a compression on the median nerve, or a traction injury of the median nerve.

• Compression of the median nerve can happen when there is swelling surrounding the median nerve. Prolonged inflammation can also eventually lead to scar tissue surrounding the nerve.
• Traction of the median nerve can occur from an overstretching injury to the nerve such as a fall on the outstretched hand.

Most common activities and factors that increase the risks of developing carpal tunnel:

The most common risk factors to developing carpal tunnel are:

• Women: are more susceptible to developing carpal tunnel versus men. It is thought to possibly due to the carpal tunnel being smaller.
• Being overweight: Being overweight is well documented as a significant risk factor to developing carpal tunnel syndrome.
• Aging
• Sustained and, or forceful repetitive gripping: Manual workers in cold environment are particularly at risk ex: meat packers
• Fall on an outstretched hand
• Distal radius fracture
• Repetitive forceful or sustained gripping with vibration: ex: Manual workers using tools like jack hammers.
• Pregnancy: The increase in fluid retention is thought to be the reason of increased susceptibility to carpal tunnel syndrome while a women is pregnant. CTS will usually resolve following the birth.
• Diabetes
• Hypothyroidism
• Rheumatoid arthritis
• Tumors or ganglions
• Alcoholism

Acute Carpal Tunnel Syndrome Treatment and Prevention:

Early diagnosis and treatment is very important, therefore seeing your physician and hand therapist upon onset of symptoms will improve your outcome.

Important acute treatment considerations:

• Resting your wrist and hand is very important. A wrist splint that maintains your wrist straight should be worn daytime and nighttime during the acute phase. It has been shown in research that the pressure in the carpal tunnel is less when the wrist is kept in a neutral position. Wearing the wrist splint at night is very important to maintain this position. Most people tend to maintain their wrist in a bent position for prolonged periods at night. This position increases the pressure on the median nerve, therefore brings on tingling, numbness and/or pain during the night.
• You may apply an ice pack for 15 minutes to the wrist area for pain and swelling relief.
• NSAIDs (Nonsteriodal anti-inflammatory drugs).
• Physical Therapy for home exercise program guidance.

Activities to avoid any aggravating activities such as:

• Forceful or sustained gripping, carrying of lifting.
• Sustained use of the computer or mouse.

Prevention:

• Keep your hands warm. Your hands are more likely to get stiff and numb in cold weather.
• Take stretch breaks at work. Alternate tasks if possible to keep your hands from fatiguing.
• If you work at a desk, make sure to set up a proper work station and use ergonomic tools when possible ie large grip for mouse, oversized pens.
• If using tools that have a high frequency vibration, use vibratory dampening equipment ie. Anti-vibration gloves.
• As always, work on improving your posture!

Physical Therapist, Allyce Staffen,  joined Arthritis & Sports Physical Therapy in 2006.

She brings over 20 years of experience as a Hand Therapist treating upper extremity injuries, including post-operative hand rehabilitation and splinting.

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What is a trigger point?  A trigger point is an area in the skeletal muscle which is very sensitive and irritable even to light touch.  The area of the muscle which has a trigger point is usually but not always firmer to the touch compared to other parts of the muscle; at times a hard knot can be felt.  Pressing on a trigger point can result in pain being felt not only over the trigger spot but in another part of the body.  This is called “referred pain.”

There are many injuries and conditions that can result in trigger point formation and during your office visit with your Physician a cause of the trigger point formation will be determined following a detailed history, physical exam and appropriate diagnostic studies.

As stated above there are many causes of trigger point formation, here is a list of some of the causes and conditions where  I see trigger points form in muscles commonly in my practice as a Physical Medicine and Rehabilitation Specialist .  This is by no means a complete list of causes.

1. Whiplash injuries especially after Motor Vehicle Accidents.
2. Myofascial pain.
3. Poor posture and biomechanics.
4. Cervical, Thoracic and Lumbar sponylosis.
5. Cervical, Thoracic and Lumbar sprain/strain.
6. Overuse of muscles due to a multiple of causes.
7. Muscles with Tendons that are inflamed or strained.
8. Muscles with Ligaments that are sprained.

What does the Trigger point injection or Dry needling entail?

In both cases a very thin sterile needle is placed in the muscle which has the trigger point.  In the case of Trigger point injections, numbing medicine such as Lidocaine is used along with a low dose of corticosteroid [in the absence of any contraindications].  In Dry needling no medication is injected after the needle is put into the muscle.  The injection is done after making the skin above the muscle sterile.  In some cases a coolant vapor can be sprayed before the injection however most times in my practice the thin size of the needle and my training enable me to place the needle in with little or no discomfort just the way an acupuncturist would.  Once in the muscle the trigger point is located, usually the muscle will twitch once the needle is in the trigger point and if any medication is being injected it will be injected at that point.  The needle is then withdrawn from the muscle and a small bandage is placed over the injection site.

Would you benefit from trigger point injections/dry needling?

If you are referred to a Physiatrist to determine if you would benefit from trigger point injections or dry needling a detailed history, physical exam and indicated studies will be done first. Not all hard, painful areas in a muscle are due to trigger points.  It is very important that you see a Physician to determine that such areas are trigger points before going ahead with injections or other management.

Are there any side effects or risks of the injection?

When the injection is performed by a qualified health practitioner the risks of the injection are minimal but can include:

• Bleeding, Infection, Puncture of organs [depending where the injection is performed]
• Muscle scarring and muscle trauma
• Allergic reactions to the medications injected
• In some cases the patient may feel lightheaded for a few seconds or minutes.  If this occurs the patient is made to lie down and is monitored till the feeling passes.

Not all patients will qualify for these injections and proper screening will eliminate most of the risk and side effects.  For patients who do qualify Trigger point and Dry needling injections, these injections are a minimally invasive, effective and easily available tool in reducing pain and restoring/increasing function.

I hope this article was useful.  Please contact your Primary doctor and report if you are having trigger point areas in your muscles.  Stay safe and thank you for reading.

Dr. Chinwe John is a board-certified Physical Medicine and Rehabilitation specialist (Physiatrist) at Arthritis & Sports Orthopaedics. As a Physiatrist, her areas of expertise include management of musculoskeletal and neuromuscular disorders including conservative spine management (neck and back pain), sports-related injuries, neuropathy, Scoliosis, pre- and post-surgical rehabilitation, Electromyography/Nerve conduction studies, Myofascial pain, Prosthetics and Orthotics.

Although arthritis is not curable, many treatment options are available that can help increase joint function, reduce pain, and allow patients to maintain an active lifestyle.

Older methods of treatment involve a gradual step-by-step approach to treating arthritis. Treatment progressed from Tylenol, to non-steroid anti-inflammatory drugs such as Ibuprofen, to prescription medication, injections, and lastly surgery.

Currently, our expert physicians treat arthritis by using a comprehensive multi-modal approach.  A multi-modal approach combines several treatment options to successfully manage arthritis. By using several methods at the same time, a better and more effective treatment is delivered. Non-surgical treatment options include oral and topical medications, braces, non-steroid anti-inflammatory drugs, injections, physical rehabilitation, and weight control.

Non-Surgical Options Include:

Oral and topical medications

Certain medications can help treat the pain caused by arthritis. These include:

• Over-the-counter pain relievers, such as: Aspirin, Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin, etc.), Naproxen (Alleve)
• Topical pain relievers, such as: creams, rubs, sprays
• Prescription pain medications, such as: Celocoxib (Celebrex), non-narcotic pain meds, and rarely narcotic pain relievers

Neutraceuticals

Neutraceuticals are medications that are not governed by the FDA, such as glucosamine-chondroitin-sulfate, SAM-e and shark cartilage.  These medications have been used by some with success, but they are not controlled for consistency or effectiveness.

Braces

Braces are useful to help decrease stress across joints and to increase warmth in the joint, which can help reduce pain and swelling casued by arthritis.

Injections

There are two types of injections commonly used in the treatment of arthritis:

• Corticosteroid Injections, which are strong anti-inflammatory medications that decrease inflammation and help to minimize pain.
• Viscosupplementation, such as Euflexxa injections, is a procedure that involves the injection of a gel-like substance (hyaluronic acid) into joints. These injections lubricate the joints and decrease inflammatory mediators.  These lubricant injections are currently approved for use in the knee, but they have been used in other joints such as the shoulder, ankle, elbow, hip, and small joints in the hand with great success.

Lifestyle Changes

You can make changes to your daily lifestyle, which can help to manage arthritis symptoms.

• Exercise is strongly recommended for arthritis patients. Exercise can reduce pain, improve physical function and muscle strength, and generally decrease debility caused by arthritis.
• Weight loss: Dr. Peyton comments, “Every additional pound you carry equals 3 extra pounds of pressure on your hip joint, 4 extra pounds on your knee joint, and about 9 extra pounds on your patella femoral joint, which you use going up and down stairs, standing up, and getting off the toilet.”  Even modest weight loss can decrease a significant amount of stress across your joints.
• Physical Therapy can help to reduce painful symptoms of inflammation, prevent deformity, joint stiffness, and maintain strength in the surrounding muscles. When pain and swelling are better controlled, treatment plans may include exercises to increase range of motion, and to improve muscle strength and endurance.

Our physicians carefully review all non-surgical treatment options available. Surgical treatments are only used when non-surgical treatments are no longer a viable option.

Arthritis & Sports Physicicans

At Arthritis & Sports Orthopaedics our providers develop comprehensive treatment plans for patients living with arthritis. Our physicians,  Dr. Sam Wilson, Jr., Dr. Chinwe John, Dr. Matthew Griffith, and Dr. Randall Peyton each specialize in the latest non-operative and operative treatments for arthritis.

Please consult one of our physicians and begin a treatment plan to manage your joint pain.

There are many benefits to your child playing on a sports team. It keeps them active and healthy, builds self-esteem, and establishes long-lasting values. With sports injuries on the rise, though, parents should remain mindful of how to lower the risks for their child athletes.

According to the Center for Disease Control and Prevention, high school athletes alone account for an estimated 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations every year. This high rate of sports-related injuries is fueled by an increase in participation, leading to overuse and trauma. According to orthopaedic surgeon Matthew Griffith, “Many sports-related injuries can be prevented. It’s very important to train properly to prepare for sports participation and also to recognize overuse injuries early and to get them evaluated.”

 The most common sports-related injuries include sprains and strains, growth plate injuries, repetitive motion injuries and heat illness. Failure to recognize and treat these injuries in young athletes can lead to chronic conditions or more severe problems. It’s important to keep the line of communication open between the child, coach, trainer and doctor.

Common causes of injuries in young athletes include preexisting medical problems, poor pre-season conditioning, improper equipment or playing conditions, inadequate training or coaching, improper warm-up, not enough time off between training sessions, playing while tired or injured, poor nutrition, dehydration, and high temperatures.

More than half of all sports injuries are preventable, and it’s important to try to identify any issues before starting a new season or sport. This includes getting a pre-season physical by a doctor. This way, existing injuries can be identified and treated, preventing further aggravation that might result in a more serious condition down the road.

All too often, a new sports season means immediately jumping into an intense practice schedule that predisposes the child to injury. “It’s critical that athletes train prior to beginning a new sport, so they can build endurance, flexibility and the strength to make the transition less stressful on the body,” Dr. Griffith says.

A proper warm-up is also key to preventing injury. This includes 5-10 minutes of light aerobic exercise followed by a thorough session of stretching to include all muscle groups used in the sport. During childhood periods of rapid growth, it’s common for muscle tightness and imbalance to occur. This increases the risk of injury and is all the more reason to properly stretch and warm up.

For young athletes, you can’t underestimate the importance of adequate supervision and instruction. As athletes develop over time, it’s critical that they learn the proper playing technique to avoid injury or a repetitive-use syndrome. According to Dr. Griffith, “Most throwing injuries that we see in young athletes result from overuse and improper mechanics. This can be prevented by optimizing throwing mechanics and keeping proper form as well as avoiding throwing while fatigued and playing through pain.”

A good diet and proper hydration help prevent injury and improve performance. Playing sports places a high demand on the body, and this means the athlete needs the proper fuel to keep up with the body’s adaptations, including building muscle and bone mass. Without this, the risk of soft tissue injuries and stress fractures increase. You must also hydrate properly on hot days – heat illness can be life threatening and may result from a combination of high temperatures, dehydration and poor conditioning.

It’s important to rest to allow for recovery after participating in sports. Young athletes should have at least one or two days off each week from their sport(s). In addition, playing on multiple teams year-round greatly increases the risk of repetitive-use injuries. Therefore, Dr. Griffith recommends young athletes take at least two to three months off each year from playing their sport. It’s safer to play different sports or to cross train to avoid overuse.

Above all, communication is key to preventing injuries in children. Talk to young athletes about preventing and identifying injuries. Children should learn how to train properly, eat healthy and hydrate. They should understand the serious impact that playing while injured can have on their body, and they should feel comfortable coming forward to a parent or coach when hurt.

Dr. Griffith’s Top 6 Rules for Healthy Athletes

1)    Pre-season: Start training before the season and get a physical from your doctor.

2)    Before play: Warm up and stretch for 5-10 minutes before practice. Make sure to target all the major muscle groups that you’ll be using.

3)    During play: Drink water! Stay hydrated. Listen to your body.

4)    After play: Take at least 2 days off each week to recover, and make sure you’re getting plenty of rest.

5)    Post-season: Take at least 2 months off from your sport to give your body a break and avoid overuse injuries.

6)    Year-round: If anything feels wrong, talk to your coach or doctor. Playing through the pain could create a long-term injury or condition.

Dr. Matthew Griffith

Dr. Matthew Griffith is focused on the non-operative and surgical treatment of patients with sports injuries and disorders of the shoulder, upper extremity and knee.

Dr. Griffith attended Duke University for his undergraduate education and received his M.D. from the University of Oklahoma. He completed his orthopaedic surgery residency at the prestigious Hospital for Special Surgery (Cornell University) in New York City. Subsequently, he received fellowship training in sports medicine and shoulder surgery at Massachusetts General Hospital (Harvard University) where he served as an assistant team physician for the New England Patriots, Boston Red Sox and Boston Bruins.

What is an Anterior Hip Replacement?        

 In any hip replacement procedure, the top of the thigh bone and the socket of the pelvis are replaced. There are several different surgical approaches used to accomplish a hip replacement.       

 An incision in the hip can be made in a few locations:      

• Posterior Approach: The incision is made in the back of the hip.
• Lateral or Anterolateral Approach: The incision is made on the side of the joint.
• Anterior Approach: The incision is made in the front of the joint.
• Two Incision Approach: Two incisions are made.

The goal of all approaches is to successfully replace the-ball-and-socket joint of the hip in the appropriate position, with as little trauma as possible to the tissues.    

Dr. Peyton comments, “I have used the anterior lateral approach for 20 years, which is only slightly different. It is still an anterior approach which has less dislocations, but it begins lateral so the incision is on the outside of the hip.       

I started using the anterior approach about 2 years ago. I have visited a fellow surgeon in Belgium where they have done this approach strictly for 20 years. This experience has helped me make the transition smoother and easier for my patients.”   

How does the anterior approach differ from other approaches?    

The anterior hip replacement is unique because the surgeon is able to avoid cutting the muscle surrounding the hip joint. Since the incision is made in front of the joint, the surgeon is able to avoid removing and reattaching the muscle, and instead uses the muscle splitting approach to get to the hip joint.       

What are the possible advantages to this approach?        

Since the muscle surrounding the joint is not cut, it is thought that rehabilitation can advance more quickly because the reattached muscle does not have to heal.       

Dr. Peyton comments, “The ultimate rate of success is similar to the anterior lateral approach, but the muscles seem to recover faster which translates into less limp and less muscle discomfort in the early (first 3-6 month) period of recovery.”     

What are possible disadvantages to this approach?     

One specific complication is injury to a skin nerve, the lateral femoral cutaneous nerve, which is adjacent to the incision made for the anterior approach hip replacement. Injury to this nerve, can lead to pain and abnormal sensations along the front and side of the thigh. This occurs very infrequently.       

Is the anterior approach better?        

While anterior approach hip replacements may provide some benefits when compared to other types of hip replacements, studies have provided conflicting evidence which approach is the best. There are advantages and disadvantages to each approach.  The ultimate goal of any hip replacement is to result in a long lasting, pain-free hip joint.       

If you are considering hip replacement, please consult your physician about the best approach for you.       

Dr. Randall S. Peyton has been practicing orthopaedics in the Northern Virginia area since 1995. Dedicated to delivering quality care, Dr. Peyton is President and CEO of Arthritis & Sports, which he founded in January 1998. He is an orthopaedic total joint surgeon, focused on the treatment of arthritis, sports injuries and musculoskeletal problems of the hip, knee and shoulder.

Take a walk around the tennis court to slowly bring down your heart rate.  Once your breathing is back to normal, do these stretches on both sides of the body. Hold each stretch for 15-30 seconds while you inhale and exhale slowly.

Knee/Chest Flex

In a standing position, bend one leg and grasp it with both hands behind the knee and slowly pull your leg to your chest.

Hamstring Stretch #1

Lay on your back and bend both knees. Straighten one leg and raise it. Use your hands to gently increase the stretch. Point your toes toward your face to stretch the calf.

Hamstring Stretch #2

In a seated position, place the foot of the one leg against the inside of the knee of the other leg. Try to bring the chest to the thigh by bending forward from the hips. Keep the back straight. Pull your toes back to point toward your face.

Spinal Twist

In a seated position, place the left foot on the outside of the right knee. Bring the right arm around the left knee, resting the elbow above the outside of the left knee. Slowly turn your head and upper body to the left to look over your left shoulder.

Quadriceps Stretch

Stand on one leg (if necessary for balance place one hand on a wall). Bend the opposite knee and grasp the ankle. Keep your back straight and buttocks tucked under. Do not turn or twist your knee.

Groin Stretch

Standing: Stand with your legs greater than shoulder width apart. Place hands above the knee. With toes pointed forward, slowly bend the knee your hand is on until you feel a stretch in the groin area. Shift your weight to the left, then repeat to the right.

Sitting: Sit on the floor. Bring the bottoms of your feet together and pull toward your body. Place your elbows on your knees and try to push down. Hold for 15 to 30 seconds.

“C” Hip Stretch

Stand with your right hand on your hip, your feet flat with your weight on your right leg and your left leg crossed in front of it. Gently push the left hip out.

Posterior Shoulder Stretch

Cross your left arm over the front of your body and pull it toward your body (angling downward) using your right hand. Hold for 15 to 30 seconds.

Shoulder Stretch

With your left hand, hold a racket behind your back by the throat or handle with the head of the racket pointing down. With your right hand, slowly pull the racket head down, bringing your left elbow to your ear and pointing it to the ceiling. Then slowly pull up with the left arm, pointing the lower elbow to the floor.

Calf Stretches

Extend one leg behind you while keeping the other leg forward. Keep the back leg straight with your heel on the floor and the foot pointing forward. Bend the knee of the front leg. Do not arch your lower back (look at first photo). Bend the back leg, keep the weight of your body on the front leg (look at second photo).

Forearm Stretch

Extend one arm straight in front of you you with the palm up. Use the opposite hand to gently stretch the wrist back (extension). Turn the palm down and gently stretch the wrist downward (flexion).

Research shows that dynamic stretching (stretching with movement) is most effective in warm-ups, and that static stretching (stretching without movement) is best post-play.

Avoid sudden, jerky movements and bouncing while you stretch. If you feel pain, stop immediately and seek medical attention if necessary. Consult your physician before beginning any exercise program.

In this first post we’ll go over warming up and dynamic stretches.  In the the next we’ll discuss static stretches and cooling down.

Before Playing

Warm-up Exercises

Begin with five minutes of walking, light jogging, jumping jacks or side shuffling. Mix the activities for variety. The purpose of the warm-up is to raise your body temperature, ready your heart and lungs for exercising and improve overall muscle function. The goal should be to reach the point of beginning to perspire.

Upper Body Stretches

Arm Circles

Target muscles: Deltoid muscles and rotator cuff (shoulder)

Hold your arms out to your sides at shoulder height with palms down and rotate them in small forward circles. Perform 10 forward and 10 backward circles. Then do 10 forward and 10 backward large arm circles, using the shoulder’s full range of motion. You should feel a slight stretch in the shoulders as you perform the exercise.

Internal/External Rotation

Target muscles: Rotator cuff (shoulders)

Hold your arms out to your sides at shoulder height and bend the elbow 90 degrees so your fingers point up toward the sky. Using the shoulders’ full range of motion, rotate your shoulders forward once and then backward once in a controlled manner. Do 10 repetitions.

Wrist Circles

Target muscles: Wrist flexors and extensors in the forearm

Hold both arms out in front of your body at shoulder length with the palms facing down. Rotate your wrists in clockwise circles, using the full range of motion to feel a slight stretch in the forearm muscles. Perform 10 clockwise and 10 counter-clockwise circles.

Wrist Flexion and Extension

Target muscles: Wrist flexors and extensors in the forearm

Hold both arms out in front of your body at shoulder length with the palms facing up. Flex your wrists by bending the hands toward the body; then extend them away from the body. Use the complete range of motion in the wrist. Do 10 repetitions alternating one flexion and one extension.

Lower Body Stretches

Toe and Heel Walks

Target muscle: Calf and lower leg

Walk on your toes from sideline to sideline, repeat while walking on heels.

Straight-leg Swings

Target muscles: Hamstrings (back of thigh) and hips

Holding onto fence, swing one leg forward (with knee straight) as high as you can without discomfort or until you feel a stretch in the back of the leg. Perform 15 leg swings forward, then 15 backward: switch legs.

Alternate Toe Touch

Target muscles: Hamstrings (back of thigh) and hips

Stand with the left leg forward, while keeping the knees straight, but not locked. With your right hand, reach down toward the left foot as far as is comfortable, to the point of feeling a light stretch in the back of your leg. Then stand up all the way, step forward with the right leg and reach for the right foot with the left hand. Walk from sideline to sideline, standing up all the way between each step/reach.

Long Walks

Target muscles: Hip flexors (front of hip) and quadriceps

Walk from sideline to sideline with extra long steps, keeping your back leg nearly straight and moving the hips forward until you feel a light stretch at the front of the hip on the same side as your back leg.

Forward Hurdle Walk

Target muscles: Inner and outer thighs

Move your right leg backward, up and around to the front as if you were stepping over a hurdle that is approximately waist high. Walk from sideline to sideline while alternating legs.

Cross-over Hip Stretch (Grapevine)

Target muscles: Outer thighs

Facing the net, cross your left leg over your right leg and push the right hip out until you feel a light stretch in the outside of your hip. Stand up straight and step to the right with your right foot. Continue to walk sideways by repeating the steps above. When you reach the sideline, reverse the movement and walk back to the left, crossing over with your right legs.

Torso Stretches

Standing Trunk Rotations

Target muscles: Abdominal and lower back muscles

Stand with your feet shoulder width apart and your hand on your hips. Rotate your torso by leaning forward from the waist, then moving to the left, back and right. Do 10 repetitions.  Then reverse the directions and do 10 more.

Diagonal Chops to the Knee

Target muscles: Abdominal and lower back muscles

Stand up straight with your feet shoulder width apart. Bring your left knee up and your right elbow down until they touch in the middle. Stand up straight and repeat the exercise on the other side of the body. Perform 10 repetitions of one chop to the left and one to the right.

Diabetes can cause many problems for your body including damage to your feet. Orthopaedic surgeon, Dr. Wilson comments, “As a matter of fact, foot problems are one of the main reasons diabetics are hospitalized.” In our office, Dr. Sam Wilson specializes in treating all foot and ankle problems.

Why does diabetes cause problems for your feet?

Diabetes causes excess sugar, or glucose, to build up in your blood. This can damage the nerves in your feet and reduce the flow of blood to your feet. As a result, when your feet develop blisters, small cuts, or other minor injuries, you may not feel or notice them. And without enough blood flow to your feet, these injuries may heal very slowly and eventually become infected.

For these reasons, it’s extremely important even if you wear special diabetic shoes, to pay close attention to your feet.

Here are some tips to keep you and your feet healthy.

• Check your feet every day. Once a day, carefully look over your feet for calluses, cuts, bruises, and other injuries. Be sure to check the tops of your feet, the soles, and the areas between your toes. If you have trouble seeing the bottom of your foot, place a  metal mirror on the floor and hold your foot over it. Put antibiotic ointment and an adhesive bandage over cuts, scratches, and other wounds, and keep an eye on how the wound is healing. If it doesn’t begin healing within a few days, call your doctor immediately.
• Clean your feet daily. Use soap and water to wash your feet every day, and pat them dry with a towel — even between the toes.
• Moisturize your feet. Diabetes can cause your skin to become dry, which can lead to cracks in the skin that become infected. Be sure to put lotion or another moisturizer on your feet — but not between your toes — after bathing.
• Wear the right socks. Always wear socks with your shoes, whether they’re regular shoes or special diabetic shoes, in order to prevent sores and blisters. Be sure to wear socks made of a breathable material that allows sweat to escape. Dr. Wilson comments, “Light colored socks will help to identify any bleeding.”
• Know when to get help with foot maintenance. As long as you don’t have nerve damage or poor circulation, and your blood sugar is under control, it’s probably OK to trim your own toenails  and gently file your calluses. But if you have numbness or poor blood flow to your feet, or your diabetes is not well-controlled, you should let a medical professional handle these tasks.
• Don’t go barefoot. It’s easy to step on a sharp object or stub your toe when barefoot. Even inside your house, wear shoes or slippers. Dr. Wilson comments, “You should wear flip flops in the shower.”
• Don’t soak your feet in hot water. The National Institute of Health advises that you should not soak your feet. But if you do, be sure to keep the water under 100 degrees. Since you may not have proper sensation in your fingertips, use a thermometer to measure the water temperature. Dr. Wilson comments, “If you have open sores on your feet do not soak your feet at all, but wash them with soap and water. Make sure the water is not too hot!”.
• Don’t hesitate to see an orthopedic physician, if you have a minor wound that hasn’t healed within 10 days or is showing signs of an infection, such as redness or swelling.

Dr. Wilson comments, “If you have vision problems or tight joints and cannot see your feet, have a significant other check them daily. Even if you don’t have an immediate problem, you may need to see your physician at least once a year to examine your feet.”

If you are having foot problems due to diabetes, or if you have any further questions please contact our office to schedule an appointment.

Dr. Sam Wilson is dedicated to providing state-of-the-art care to patients with foot and ankle problems. Dr. Wilson received his undergraduate degree from the United States Military Academy at West Point, New York. His Doctor of Medicine degree was obtained from Emory University School of Medicine in Atlanta, Georgia. He served his Orthopaedic residency at Tripler Army Hospital in Honolulu, Hawaii. Lastly, he completed his Foot and Ankle Fellowship at The Johns Hopkins Hospital in Baltimore, Maryland.

It’s important to warm up and stretch about 15-20 minutes before you tee-off. Stretching and warming up can not only help to increase flexibility and prevent injury, but also improve your golf game.

Warming up

Walk briskly 3-5 minutes, either around the car parking lot or around the course.

Stretches

Cervical Rotation and Flexion

• Put your hand onto your left shoulder blade.
• Then grab the back of the left side of your head with your right hand and gently pull your head down and across toward your right knee.
• Maintain good posture.
• Stretch for 20-30 seconds.
• Repeat on the other side.
• Complete 2-3 repetitions.

Wrist Flexor and Extensor Stretch

• Hold your left arm in front of you with your palm facing down.
• Keep elbows straight, pull your wrist up by grabbing the top of your fingers. Hold for 20-30 seconds.
• Now point your palm up. Hold for 20-30 seconds.
• Repeat both stretches on the other side.
• Complete 2-3 repetitions.

Shoulder Stretch

• Position your feet as though you’re about to hit a golf ball.
• Hold your left elbow with your right hand.
• Keeping your left elbow pointed up, bend your left wrist toward your left shoulder.
• Rotate your body to the right.
• Pull your left wrist until you feel a slight pull in your back.
• Hold for 20-30 seconds. Repeat on the other side.
• Complete 2-3 repetitions.

Pectoral Stretch

• Bring the club behind you.
• Pull your arms down to the middle of your back.
• Hold for 20-30 seconds.
• Complete 2-3 repetitions.

Trunk Rotation

• Position your feet as though you’re about to hit a golf ball.
• Bring the club behind you.
• Rotate your body to the left side until you feel a slight stretch along the right side of your trunk.
• Hold for 20-30 seconds.
• Repeat on other side.
• Complete 2-3 repetitions.

Hip Flexor Stretch

• Kneeling on your right knee, slowly push your pelvis down while slightly arching your back, until you feel a slight stretch in front of your right hip.
• Hold for 20-30 seconds
• Repeat on other side.
• Complete 2-3 repitions.

Hip Flexor Stretch with Side Bending

• Kneeling on your right knee, gently glide your hips forward until you feel a slight stretch in your front hip.
• Then raise your left arm and lean to the right side until the stretch is felt along the left side of your trunk.
• Hold for 20-30 seconds
• Repeat on other side.
• Complete 2-3 repetitions.

Hip Flexor Stretch with Rotation

• Kneeling on your right knee, slowly push your pelvis down while slightly arching your back, until you feel a slight stretch in your front hip.
• Place your left hand on your right knee and rotate your body to the left until you feel a gentle stretch along the left side of your trunk.
• Make sure to keep your back straight.
• Hold for 20-30 seconds
• Repeat on other side.
• Complete 2-3 repetitions.

Hamstring stretch

It helps to have something to lean against for this stretch.

• Lift your left leg, point your toes facing upwards, and bend your right knee slightly.
• Lean forward, keeping your back straight,  until you feel a comfortable stretch in the back your left thigh.
• Hold for 20-30 seconds.
• Repeat on other side.
• Complete 2-3 repetitions.

Please complete all stretches slowly and carefully. Before beginning any new exercise routine, seek advice from your physician or physical therapist. If you feel any pain or discomfort during these stretches stop immediately!

Tatiana Valentine, Physical Therapist (DPT, COMT), joined Arthritis & Sports Physical Therapy in July 2009. She received her Doctorate of Physical Therapy from University of Vermont in May 2008. A strong believer in lifelong learning, Tatiana has recently become a Certified Orthopaedic Manual Therapist (COMT) after successfully completing all required Maitland-Australian Physiotherapy Seminars and final exams.

At Arthritis & Sports Physical Therapy Tatiana specializes in treating all general orthopaedic conditions, specifically injuries to the knee, foot, ankle, hip, shoulder, elbow, and spine.