upper extremity rehab and golf and tennis enhancement · tendinitis 9 14 40 38 3 5 92 adhesive...

Dr. Barry Triestman D.C., D.A.C.B.N.American Center for Longevity, Nutrition, Chiropractic and Sports Injuries

Upper extremity Rehab and Golf and Tennis Enhancement

www.fisiokinesiterapia.biz


Introduction• Diplomate in Nutrition (1 of 750)• Second Generation Dr. of Chiropractic• Office in High Sierra Fitness• Emphasis on Nutrition• Monthly Seminars• Works with M.D. via consultations and reports• Latest in Laboratory Testing i.e.. Saliva• Take home the information and use it Tomorrow


• Better to teach a man to fish then feed him for the day

• Our goal is to get you to take care of yourself

• We don’t want you to be dependent on passive care


Our GoalsImprove your golf and tennis game

Decrease severity of injuries

Prevent Injury

Motivate you to take care of yourself forever


What are you going to learn• Nutrition and healing• Decreasing inflammation• Shoulder anatomy• Common shoulder problems• Causes of shoulder problems• What to do about shoulder problems• Elbow anatomy• Common elbow problems• Causes of elbow problems• Posture• Rehab and enhancement principles


Causes of injury• Lack of flexibility• Lack of strength• Lack of control• Lack of balance• Improper swing (see your pro)• Improper equipment• Lack of endurance (cardiovascular)• Previous injury


Healing Ability

• Hair and nail health• Keratinazation of scars• How fast do your wounds heal


Bone Health

• Phytoestrogens• MCHC Calcium• Pyrilinks-D• DEXA scan


Joint Health• Proper Biomechanics• Hydration• Movement• Nutrition• Control• Strength• Flexibility


Protein intake• 1.5- 2.0 gram per kg/day for a 175 pound individual this

would be 120-160g protein• The branched chain amino acids are the preferred

protein food source for muscles and we get them through beans (especially black and lima), brewer’s yeast,, herring, sardines and most cheeses

• Sulfur containing amino acids are important in injury prevention and reduction they are high in nuts and seeds(sesame seeds), grain germs, egg yolk, and soft cheeses(ricotta and cottage)

• Adequate Vitamin C, E• Minerals Zinc and selenium


Anabolic vs. catabolicAnabolic

– Protein synthesis

• Sleep• Meditation• Exercise• Adequate nutrition• Insulin• Testosterone

Catabolic– Protein breakdown

• Stress• Over training• Caloric restriction• Dehydration• Inflammation• Cortisol


Antiiflamitory herbs and foods• Fats that are anti

inflammatory are omega-3; from flax, salmon, and halibut

• Onion• Celery Juice • Bromelain• Curcumin• Devil’s Claw• Feverfew• Licorice root

• Food Allergies/Intolerance• Anti oxidants• Glucosamine sulfate• Chondrotin Sulfate• Niacinamide• Methionine • Vitamin E• Boswellia• Arnica Topical


P.R.I.C.E• Protect-Bracing• Rest• Ice- Ice bag rapped with

a moist towel applied 15-20 minutes on 1 hour off

• Compression-Ace bandage

• Elevate also muscle contraction as tolerated


Repetitive stress injuries(RSI)a.k.a.Cumulative stress

disorders(CTD)• Majority of injuries• Poor posture• Spinal alignment• Repeating the same

motion• Position

• Force• Vibration• Time• Inadequate rest• Cold


Types of RSI CSD

• Shoulder tendonitis• Elbow tendonitis• Carpal tunnel syndrome• Low back pain (includes disk)• Neck pain


Avoiding RSI

• Flexibility• Strength• Endurance• Rest• Stay healthy• Proper mechanics

• Cross Training• Right size club/racquet• Vibration Dampening• Correct body position• Know your limits


Phases of healing

Healing

Injury

Surface irregularity

Inflammation

Healing cells come to injury

Collagen formation Scar tissue


Tendonitis vs. Tendenosis

Tendons tendonitis(inflammation) Vs Tendinosis (degeneration)


Graston Technique• The Graston Technique is an innovative,

patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. The Technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.


Outcome StudiesInjury Average

# of TreatmentsComplete

100%Excellent

90%+

Good80%

+

Fair 70%

+

Unchangedless than 70%

Success Rate

Achilles Tendinitis 8 4 73 15 0 8 92

Ankle Sprain 8 6 52 24 6 12 82

Plantar Fasciitis 7 2 44 24 11 19 70Patella Femoral

Syndrome 11 5 42 24 24 5 71

Cervical Pain 11 4 49 29 13 5 82

Low Back Pain 11 8 44 35 6 7 87

Fibromyalgia 10 6 31 44 6 13 81

Hip Pain 9 8 30 50 4 8 88

Hamstring Strain 8 12 58 12 12 6 82

ITB Tendinitis 7 0 64 18 9 9 82

Lat Epicondylitis 10 15 44 31 4 6 90

Med Epicondylitis 8 13 27 20 7 33 60Rotator Cuff

Tendinitis 9 14 40 38 3 5 92

Adhesive Capsulitis 15 0 18 55 18 9 73Carpal Tunnel

Syndrome 8 5 60 21 9 5 86

Wrist Tendinitis 7 13 46 33 4 4 92

Scar Pain 9 0 46 8 38 8 54

* = Median # of treatmentsSuccess Rate: Rate: Percentage of Resolution equates to attaining the patient/clinician goals of 1) increase in function,

and 2) decrease in pain.


Training consideration• Age• Training level• Previous injury• Cardiovascular fitness 3 x 20 to 5x 40 always able

to talk easily• It takes 20 weeks for ligaments to heal• Muscle fiber size is reduced 14-17 percent after 72

hours of immobilization but slows after 5-7 days• Bone hardness drops to 55-60 percent after

immobilization• Fatigue is when injuries are more likely to happen


Safety• Warm-up Benefits:

– Increase abilities– Promote healing– Strengthen bones– Strengthen muscles– Decrease future injury– Increased confidence enhance mood

• Bracing benefits increased proprioception


Guide to know something is wrong

• Negative range of motion change• Presence or increase in swelling• Presence or increase increase in pain • Plateau or decrease in strength• Ligamentous damage


Strength

• Machine• Free weights • Open chain to closed chain• Eccentric exercise stress ligaments more then

muscle• Recovery times for strength 1 to 3 to 1 to 4• for endurance 1 to 1 to 1 to 2• 3 sets to failure


Flexibility

• Stretching Static• Dynamic• 30 seconds 5 times


Proprioception• Stork stance in

doorway– Stork stance with

club• Balance board• Posture and

Medicine ball

•Kinesthetic sense•Trampoline•Ball wall walks•Club/racket balancing


Program progression• Range of motion to isometric to isotonic to

functional activities• High repetition low weight• In early rehabilitation twice a day is better• Goal is to over load not overwhelm• Isometrics first i.e. quad sets• Isotonics in pain free range• Initiate at slow speeds and progress to faster

speeds


Program progression continued

• Initiate skills that are simple and progress to more difficult

• Initiate skills at short distance and progress to longer distance

• Unloaded to loaded skills


25 Million Americans play golf

The Golf Swing is a complex, explosive and physically explosive action

You can increase your club swing range by improving your joint/muscle flexibility

You can increase your club swing speed by developing your muscle strength

You can increase your club swing control by training your dynamic postural balance and segmental control

In a typical round of golf a 10 handicap player will swing the club 50 times with an additional 50-75 practice swings If you play everyday 700+ per week

Golf Facts


Walk about 8000 yards

Kids get head injuries

People get struck by lightning

Skin cancer

Low Back>Elbow>Hand>Wrist>Shoulder> Knee

Golf swing promotes postural imbalance

Cardiovascular performance Many players have a decrease in ability after the 13 the hole

Golf Facts continued


Tennis Facts

• 300-500 bursts per match• Tennis swing promotes imbalance• Rotator cuff>Biceps>Elbow>Wrist>Low

back>Ankle sprains>Muscle cramps>Plantar fasciitis


Additional tips

• For women don’t use your significant others old clubs

• For men stretch• For seniors if your hand is bothering a

larger grip may help


Shoulder anatomy


Chest stretch


Shoulder• Mobility and strength of hips, thoracic and

cervical spine• Tendonitis• Bursitis• Impingement• Partial rotator cuff tears• A/C separation


Rhomboid stretch

1. The patient may stand or sit, with knuckles placed to the temples with palms facing out.

2. Contract the rhomboid and squeeze the scapula together. Imagine their medial borders touching.

3. Separate the scapula by hinging the forearms forward until the elbows touch in front of the chin. Do not let the wrists bend.


Posterior capsule stretch1. Stand at address with your feet, knees, hips and

shoulders parallel to the plane line.2. Place the head of your driver on the plane line about

18" outside your back foot. Place your right thumb on the top of the grip with the back of your hand facing the target.

3. Reach back with your left hand and take hold of the grip just below your right hand. The back of your left hand should be facing just as it would during a normal golf swing.

4. Push with your right hand away from the target and pull with your left hand toward the target. Let your hips turn toward the target. Feel the pull at the glenohumeral joint.


Inferior capsule stretch


Supine external rotation


Standing external rotation


Standing internal rotation


Medial rotator stretch


Anterioinferior capsule stretch


Inferior capsular stretch


Shoulder depressor exercise


Supine abduction exercise


Standing abduction


Standing flexion


Supraspinatus exercise


Internal and external shoulder exercise


Thera-band Internal Rotators


Thera-band External Rotators


Thera-band posterior Deltoid


Shoulder pulley exercise


Thera-Band anterior and middle deltiod


Wrist anatomy

Carpal Tunnel syndrome

Tendonitis/tendonosis

Arthritis


Carpal exercises


Palm/forearm flexor stretch


Wrist extensor stretch


Pronator/supinator exercise


Wrist exercises

• Wrist curl• Reverse wrist curl• Fishing wrist curl• Can Rolls• Rubber band• Squish ball• Finger baton


Low back painLook at foot postureHip and leg postureShoulder flexibilityMuscle sprainSubluxationDisc injuryLigament strain


posture

Neutral spine


Anatomy of a curve


Golfer’s pattern

• Tight hip flexors and spinal extensors

• Weak abdominals and gluts• Tight hamstrings


Trunk curl up over active/tight hip flexors weak abdominals


Test for hip flexors

• Thigh should be below table

• Knee should be bent at least 90 degrees


Poor posture


Suck in the gut = Better backTransverse abdominal muscle


Flexibility

• Tight neck muscles • Mid back tightness• Hip• Calf• Hamstring


Trunk stabilization:

• The trunk needs to be stabilized in any injury

• The trunk has highest concentration of muscles , bones, ligaments and nerves

• The trunk is your base; in any activity, if base is weak the rest crumbles


Trunk stabilization

• Spinal stabilization• Pilates• Feldenkrais• Alexander technique• Breathwork


Trunk Stabilization

• Combination of– Control– Balance– Strength– Endurance– Flexibility


Full spinal extension

• Start low• Keep pelvis

down


Groin Stretch


Safe hamstring stretch


Hip flexor stretch


Lying pelvic tilt


Sitting Pelvic tilt


Standing pelvic tilt


Quadruped pelvic tilt


Doggy pointer


Ball pelvic tilts


Doggy pointer


Dead Bug


Dead bug


Dead Bug


Doggy pointer


Lunge


Ball Bridge


Ball bridge 2


Ball superman


Lunge


Ball push-up


Ball squat


One leg ball bridge


Feet


Foot posture


Proper shoes


Lab tests• How is your Digestion• CBC with a differential• Chem. screen • C-reactive protein• Sed Rate• Ferritin• Thyroid panel including t-4, t-3 TSH,reverse t-3• Adrenocortex stress profile• Salivary hormone testing• Oxidative Stress


Healthiest people teach

• Take the information home and use it• Teach it to your friends and relatives• We grow by helping others


• 7/16 7pm Sports nutrition: Nutritional ways to promote healing and growth of bones, ligaments and muscles

• 8/6 7pm Stop Headaches NaturallyUp and Coming Seminars: • Skiing and snowboard enhancement with do-it-

yourself rehab• Natural medicine for Immunity• Massage 101• Natural medicine for fertility, pregnancy and

lactation• Natural medicine for neck pain• Women’s wellness with an emphasis on

hormones


Special offer

• 25% of any services until July 5• For seminar participants


Short adductor


Long adductor


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upper extremity rehab and golf and tennis enhancement · tendinitis 9 14 40 38 3 5 92 adhesive...

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