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  • The Best Posture Is The Next Posture

    The Best Posture Is The Next Posture

    Stop Blaming Posture for Your Golf-Related Joint Pain [Listen to the podcast]

    With the emergence of a strong body of literature in the rehab world that basically debunks the “poor posture” myth. There is a growing group of modern physical therapists who worry less about posture more about the adage “the best posture is the next posture.”

    I think we can take a little bit of this as it relates to “golf address posture.” Tommy Fleetwood has a C-Posture, Adam Scott has been in and out of that classic S-posture, and the exciting Matthew Wolff has quite the dynamic setup at address.

    One of the first exam tests I learned in physical therapy school was the “plumb line screen.” It’s a static posture assessment related to where one’s head is in relation to shoulders, shoulders in relations to spine, spine in relation to hips, knees, feet and so on. This screen came with a nice picture of Janda’s upper and lower crossed syndrome with an elaborate explanation from a professor about “tight muscles here creates weakness in muscles here, etc…”

    I remember feeling excited, this concept was an explanation dream that fulfilled my own confirmation bias. “So I just stretch what’s tight, and strengthen what’s weak and I’ll heal everyone!”“

    Good” posture had been explained to me time and time again from when I was at a young age and even through my undergraduate exercise science program…now I had a name to call it and clinical doctoral-level education to substantiate it.

    Wow, were my school teachers, professors, and own mother incredibly wrong. Muscle imbalance theories (Janda and others) have not done well in rigorous academic and clinical research. Time and time again there is poor reliability in our ability to assess postures and poor correlation with pain and function (1-7). There really is no data to support these ideas. Labeling people with upper or lowered crossed syndrome and attempting to treat it in the same nomenclature (stretch what’s tight, strengthen what’s weak) doesn’t work any better than generally getting more exercise.

    In fact, I’d argue using the upper and lower crossed nomenclature with our clients could be considered malpractice by today’s evidenced informed standards. There is an emerging body of literature revealing the magnitude of nocebo effects on pain and function (8). Nocebo, simply put, is if we say something negative about somebody’s body (i.e. posture in the context of this blog post), it impacts the degree of pain and function they are experiencing. Imagine the nocebo implications as a golf instructor when trying to help a guy improve his game and there aren’t any “compliment sandwiches”…that’s another conversation for another day.

    So, let’s fast forward 2.5 years of PT school and 6 years of orthopedic clinical practice later, I was sitting in the Titleist Performance Institute certification seminar in Orlando on the morning of Day 1. I arrived early and started flipping through the seminar manual placed on my chair. I chuckled and had a huge facepalm as the first few pages discussed Janda’s upper and lower crossed syndrome. Furthermore, one of the first screen tests we learned through the Titleist Performance Institute was the “Setup Posture Screen.” It’s a static golf posture assessment where the clinician tries to determine if the client falls into 1 of 3 posture groups (S-Curve, C-Curve, or Neutral).

    If we consider what the evidence has shown time and time again about posture/position in the musculoskeletal research combined with the fact that “nocebo” language directly impacts are clients nervous system, function, and pain…should we be even looking at this?

    I get it, the screen is a screen. It starts with the lens nice and wide and narrows in on problem areas. I use it almost daily. The whole point of this in the golf rehab and performance realm is to get away from labeling static positions because it’s hard to be reliable, creates nocebo, potentially increase posture fear and catastrophization.

    Check out our podcast we did with Par Four Performance talking more about posture.

    References:

    • Fedorak C, Ashworth N, et al. Reliability of the visual assessment of cervical and lumbar lordosis: how good are we? Spine 2003; 28: 1857-1859.
    • Roffey DM, Wai EK, Bishop P. Causal assessment of awkward occupational postures and low back pain: results of a systematic review. The Spine Journal 2010: 10; 89-99.
    • Youdas JW, Garrett TR, Egan KS, et al. Lumbar Lordosis and Pelvic Inclination in Adults With Chronic Low Back Pain. Physical Therapy2000: 80; 261-275.
    • Barrett E, O’keeffe M, O’sullivan K, Lewis J, Mccreesh K. Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Man Ther. 2016;26:38-46. (https://www.ncbi.nlm.nih.gov/pubmed/27475532)
    • Dolphens M, Cagnie B, Coorevits P, et al. Sagittal standing posture and its association with spinal pain: a school-based epidemiological study of 1196 Flemish adolescents before age at peak height velocity. Spine. 2012;37(19):1657-66. (https://www.ncbi.nlm.nih.gov/pubmed/22108378)
    • Christensen ST, Hartvigsen J. Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther. 2008;31(9):690-714. (https://www.ncbi.nlm.nih.gov/pubmed/19028253)
    • Villumsen M, Samani A, Jørgensen MB, Gupta N, Madeleine P, Holtermann A. Are forward bending of the trunk and low back pain associated among Danish blue-collar workers? A cross-sectional field study based on objective measures. Ergonomics. 2015;58(2):246-58. (https://www.ncbi.nlm.nih.gov/pubmed/25374330)
    • Petersen GL, Finnerup NB, Colloca L, et al. The magnitude of nocebo effects in pain: a meta-analysis. Pain. 2014;155(8):1426–1434. doi:10.1016/j.pain.2014.04.016
  • The Florida Physio Golf Performance Consult

    The Florida Physio Golf Performance Consult

    We combined a Physical Therapy Evaluation, Titleist Performance Institute Screen, Club Head Speed Assessment, Strength Assessment, and a Power assessment in our golf performance consult.

    If you are a golfer, there is no surprise that your physical ability plays a huge role in your ability to swing the club efficiently, with speed, with power, and do this pain free over 18 holes.

    Our Golf Performance Consult includes 16 movements from the Titleist Performance Institute (TPI) Screen that are golf specific and focus mainly on mobility or range of motion. We start with the TPI screen because it really takes the lens nice and wide and helps establish some base lines. You will get an electronic copy of your screen results sent to your email.

    Because the golf swing is really a “power” move we need to look at your overall power. We look at your ability to throw a 6-8# medicine ball from your chest in sitting, and from a shot put right and shot put left. We take the power component and break it down further.

    Power, by definition in the strength and conditioning world is SPEED X STRENGTH. So, we look at your club head speed as it relates to norms within your handicap and age range (CLICK HERE). We then do upper body, lower, and core strength tests to assess strength.

    Basically, you are going to get a red light, yellow light, or green light for each test we look at. So between mobility (TPI Screen), strength, speed, and power tests. We can make a list of your problem areas. The Physical Therapy Evaluation is used for is you have a painful area. We use examination techniques performed by a board certified Doctor of Physical Therapy to help determine the cause of your pain and get your on a plan that helps get you out of pain.

    Sign up for a golf performance consult to get started moving, feeling, and playing better golf.

  • Stop using 2 golf clubs right before you tee-off!

    There is an old adage in baseball to swing something really heavy so that when you grab something lighter, it feels way later and you can swing faster. This is true only if the heavier item is less than 12% heavier than the intended item.

    Research has shown that using weighted bats as training aids is an effective training method provided they are only marginally heavier or lighter than the regular bat used (+or-12%). Also using the heavy “donut” attachment that is still popular as a warm-up device is definitely not advised. The donut device has been shown to actually alter the swing motion pattern (Southard and Groomer, 2003) and decrease swing speed (DeRenne, 1991).

    Many golfers will grab two clubs to warm-up. STOP! There is a better way to warm-up. A Titleist Performance Institute Professional can create an individualized warm-up for you. But general speaking, you would want to have some dynamic movements where you go in and out of a certain movement for 8-12 repetitions and even perhaps some type of resistance.

    You can schedule consult to learn more about an individualized warm up at this link: Florida Physio Golf Physical

    Video On This Topic

    Southard, D. and Groomer, L. (2003). Warm-up with baseball bats of varying moments of inertial: Effect on bat velocity and swing pattern. Research Quarterly for Exercise and Sport. Vol. 74. No. 3. pp. 270-276.

    DeRenne, C. (1991). Myths in resistance training: The donut: Does it improve bat velocity? National Strength and Conditioning Association Journal. Volume 13, Number 3, pp. 43-45.

  • What is OCS?

    All practicing Physical Therapists are required by law to have completed an accredited physical therapy program and become licensed in their respective states. Some professions may advertise that they practice “physical therapy or physiotherapy” but are not licensed with their respective state.

    Once a PT has completed a bachelors, masters, or Doctor of Physical Therapy degree, they must pass a licensing test to meet the minimum standards to practice PT.

    Beyond the licensing process, though not required, PT’s can become board certified in a specific field. This requires completion of 2000+ hours in the field of choice as well as passing a rigorous test demonstrating competence in that specific field.

    You can think of Board Certification for PT similar to what it means to become a fiduciary in the financial planning realms. It’s a demonstration of expertise in a certain niche of health care with the client/patients best interest in mind.

    At Florida Physio, Dr. Leighton completed requirements for board certification in orthopedics (the OCS).

    Research has shown that board certified physical therapists help patients achieve goals and outcomes faster with less money spent.

    Another study by Childs et al in 2005 concluded that physical therapists who are board certified in orthopedic physical therapy have superior knowledge in managing musculoskeletal dysfunction compared to that of general physical therapists, general physicians, and physician specialists with the exception of orthopedists.You can find a board certified specialists by contacting The American Board of Physical Therapy Specialties (ABPTS) at www.abpts.org. These specialists are recognized for ensuring clinical excellence, expert clinical reasoning, and a current knowledge of research.