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Back Injuries

POSTED: Thursday, September 19, 2013, 5:30 AM
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I was always amazed when working with athletes how it seemed that lower back pain was accepted as the norm. Most people brush off the sore back that they wake up with and hope that by moving around, it will get better. While there is some truth to that statement, just moving around and not really doing anything to help or fix it can lead to compensation issues—which can cause greater pain in the future or lead to time away from sports and activities that you love.

Most Americans, athletes or not, have some form of back pain. They wake up with it hoping that as the day goes on it gets better. This pain affects athletic performance and limits outcomes, whether you realize it or not. This pain can be the difference between attaining your best time or personal record… or just being able to complete a distance. Ignoring the pain can lead to hip pain, knee pain and ankle pain. Unfortunately, back pain rarely goes away on its own and only gets progressively worse.

I most often hear that people have had back pain for years. They finally just came to see me because they could not get out of bed or it finally prevented them from doing an activity. By this time, it is months of therapy to get you back to your sport. The time to deal with back pain is when you feel it, the first time—not when you can’t get out of bed. And back pain is NOT hereditary. Just because you father had back pain does not mean that you will have back pain.

POSTED: Thursday, September 5, 2013, 5:30 AM
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“What should I do? Heat or ice?” 

The amount of times I have been asked this could qualify for the Guinness Book of World Records. The most confusing part for people is that if you ask 20 different health care professionals, you will get 20 different answers because the literature varies on this—as do most people’s experiences and preferences on what to tell their patients. 

There are a few general rules that I tell my patients to follow as guidelines for when to use heat or ice.  The first—and this most, if not all healthcare practitioners will agree upon—is that 24-48 hours after sustaining an injury, ice should be applied.  This is where RICE (Rest, Ice, Compression and Elevation comes into play. After the 48 hours, we enter that gray area.

POSTED: Thursday, August 29, 2013, 5:30 AM

A pain in the butt. Sometimes that is how the infamous athletic injury begins — just a pain in the butt. Many times I see runners, cyclists and other athletes who have pain in their back, legs and hips. Often they all can point to one specific spot that hurts.

This spot that hurts is generally in the piriformis muscle. When it is irritated it is called piriformis syndrome, sometimes it is lumped into the broader term of sciatica.

The piriformis muscle is a small muscle located in the glute region. It attaches from the tail bone to the hip. It is the cause of a lot of pain in the butt, the back and the hip. It is a common injury of many recreational and professional athletes, but also for people who sit for most of the day. Many people classify as generic back pain or sciatica but in fact it is a different diagnosis all together. The good part about piriformis syndrome is that if caught early, it can be easily treated.



POSTED: Tuesday, August 27, 2013, 6:00 AM
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Shoulders take a lot of abuse in our daily lives. We lift and carry heavy objects, reach in awkward ways, hang bags from them, throw things and undoubtedly stress them with the repetitive tasks demanded by our professions. Additionally, the misguided workout positions, routine recreational pursuits and participation in sports unintentionally lead to the most common shoulder injuries.  

I usually see people in my office by the time things have gotten so bad that they can no longer participate in their sports, workouts, and many of their regular daily activities.

One injury that involves the shoulder is rotator cuff dysfunction. Whether in the form of tendonitis, weakness, or tears, the muscles that make up the rotator cuff are usually part of the problem.
Four shoulder blade muscles work together to make up the rotator cuff. These muscles are responsible for all of the motions involved with throwing (lifting the elbow out to side, rotating the forearm backward, forward and extending the arm behind back). When these muscles are working properly they do more than just allow us to throw. They help keep the shoulder in the correct position to allow for pain-free reaching in all different directions. When rotator cuff weakness or dysfunction develops, an imbalance of the forces at the shoulder occurs with reaching and the shoulder joint position is altered. Over time, this causes friction on the tendons when we reach in different ways and “tendonitis” or "bursitis" is a common result.

Similarly, since the shoulder is not being held in proper alignment, the tendons may also become ‘pinched’ between the shoulder bones, resulting in impingement syndrome.  I see this develop commonly in people who lift weights to strengthen the larger muscles of the front of the body (chest, biceps, deltoids), but neglect the smaller mid-back and shoulder blade muscles.  This muscle imbalance at the shoulder is similar to many of the dysfunctions I have written about previously that also develop at other joints (low back, knees/hips/ankles) due to an imbalance of forces where the larger muscles dominate without the control of the smaller stabilizing muscles.

Other common shoulder injuries involve separations, dislocations and generalized laxity of ligaments. In all cases, the ligaments, which are responsible for joint stability, have been injured and are less effective at holding the bones in place. The surrounding shoulder muscles need to compensate for the ligament damage with proper strength and stabilization training to control large shoulder movements in addition to quick, smaller arm motions.

Another common problem involving the shoulder is ‘frozen shoulder’ or adhesive capsulitis. This may occur secondarily to painful dysfunctions like the ones described above, after periods of immobilization (i.e. with fracture healing) or due to an unknown cause. In any case, significant loss of shoulder range of motion develops as the capsule of the shoulder tightens due to disuse over time. A cycle of pain and dysfunction develops, consciously or not, in which pain with shoulder movements causes one to stop performing the painful movements. This lack of movement and disuse allows the capsule to tighten and the surrounding muscles to weaken. Further attempts at use of the shoulder cause more pain so, over time, lack of movement takes over and people end up with a shoulder that is “frozen.”

With traumatic injuries or slowly progressing shoulder pain, it is always beneficial to seek treatment sooner than later. I have seen some people fully recover within days after initiating a rotator cuff strengthening program. This quick recovery will not happen, though, if months or years worth of damage is already done. Symptoms can still be alleviated and even fully abolished, but the rehab will be much longer.

Be kind to those hard working shoulders, be aware of pain with any shoulder movements and be sure to seek treatment should the need arise.

Below are links to a few basic videos of shoulder strengthening exercises that target the posterior muscle groups, rotator cuff and postural muscles:



POSTED: Tuesday, July 30, 2013, 5:00 AM
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A strong and well-aligned spine is key to improving performance with sports, recreation, work and home activities. A repeating theme that keeps arising in discussing injury prevention is the need to balance muscle strength and flexibility in all planes (anterior, posterior and sides).

Most athletes are quite strong with trunk flexing muscles, like the rectus abdominus (‘6-pack’ ab muscles) but lack trunk extensor strength. The trunk extensors keep the spine erect when upright and lift the trunk upwards when positioned face down. Similarly, there are a many common exercises focusing on the big, powerful trunk muscles, but there is a lack of knowledge about how to effectively strengthen the smaller stabilizing muscles of the trunk.

Our bodies are equipped with a group of muscles that surround our trunk and work perfectly together to create a stable bracing effect for the spine. This is what prevents discs from bulging out of place and painful spinal conditions. One of the most important stabilizing muscles, the transversus abdominus (TA), is engaged when you activate the lower abdomen wall by "drawing-in." 

Not to be confused with the diaphragm, which controls breathing or the rectus abdominus, which flexes the trunk forward, the TA serves to act like a girdle for the abdomen. In standing, it contracts along with the main posterior spine stabilizer, the multifidis for a bracing action all the way around. This co-contraction is the basis for a stabilization program that can be made more challenging by adding numerous arm, leg, and trunk positions either statically or dynamically and with the use of equipment including physioballs, medicine balls, body blade, Bosu, Pilates, TRX, etc.

It is equally important to strengthen these muscles while maintaining correct spinal posturing. Whether seated or standing, a neutral spine is key. The natural curve of the low back, the lordosis, needs to be maintained by tilting the pelvis slightly forward. In sitting, you will know it is in the correct position when you feel weight through the "sitz" bones, the ischial tuberosities and all of the spinal segments stack naturally from bottom, up.

POSTED: Friday, June 21, 2013, 6:00 AM
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Previously we discussed how muscle imbalance leads to movement dysfunction in athletes. When athletes move poorly, either during games or training, they increase their injury risk and decrease performance. There are various systems to assess and correct movement dysfunction: Postural Restoration Institute, Functional Movement Screen, National Academy of Sports Medicine’s (NASM) Corrective Exercise Program, and Vladimir Janda’s systems to name a few.  Although these systems have differences, they all target imbalances, not pain.

Karel Lewitonce said, “He who treats the site of pain is often lost.” Although some situations do require treating the site of pain… this statement emphasizes the need to address movement dysfunction and not only focus on painful areas when rehabilitating or preventing injuries.

Evaluating movement dysfunction can be very complex; however, here are some simpler assessments and corrective exercises that can be performed. A common evaluative technique in movement dysfunctionis squatting because it is extremely functional. Ideally, with hands folded to the chest an athlete should be able to squat so they are almost to the floor while keeping their heels on the ground (similar to the way a toddler squats.) Many athletes are unable to squat correctly due to muscle imbalances.

POSTED: Tuesday, June 18, 2013, 10:02 AM

Foam rolling has gained a lot of notoriety in the last few years but the big question is always: Is this a fad that I really should partake in? The simple answer is yes, you should.

Whether you are a professional athlete, an amateur athlete, a weekend warrior or just sit at your desk all day, foam rolling should be part of your daily routine. The truth is they can save you from pain that can take you out of everyday life.

What exactly is foam rolling? Foam rolling is massaging different parts of your body while lying on a foam roll. This is extremely beneficial for anyone to perform. It is safe and effective and can be done on any part of the body. During our daily routine muscles are stretched and shortened, sometimes for very long periods of time, like sitting at a computer or running a long distance and sometimes very forcefully like running down the steps or lifting a heavy weight. The actions performed by our muscles everyday takes a toll on them. Using our bodies every day, whether it be to exercise, carry kids around or do our jobs, takes a toll and muscles become tired and injured.


POSTED: Sunday, June 16, 2013, 4:00 AM
Andy North chips out of the sand to reach the 11th green during the opening round of the Senior PGA Championship golf tournament in Parker, Colo., on Thursday, May 27, 2010. (AP Photo/David Zalubowski)

Golfing can be a great and relaxing sport for many to enjoy, but there are common injuries that can occur in the weekend warrior golfer.

Golf is a full body sport—your swing and stroke involves your entire body. Injuries can occur in many different places, the most common occurring in the low back, elbows and shoulders.

Low back or lumbar injuries can occur during the coordinated movement of the golf swing. This area of your body is subjected to several forces: lateral bending, shearing, compression and rotation. Amateurs often swing harder, instead of more skillfully, to hit the ball farther. This increase of force puts stress on your body and tends to lead to low back injuries. As you get older, you also have an increased opportunity for arthritis as your spine will become less flexible. Good body and swing mechanics is essential for the prevention of low back injuries.

About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Robert Senior Sports Doc blog Editor
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Robert Cabry, M.D. Drexel Sports Medicine, Team physician - U.S. Figure Skating, Assoc. Team Physician - Drexel
Brian Cammarota, MEd, ATC, CSCS, CES Symetrix Sports Performance, athletic trainer at OAA Orthopaedics
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Rothman Institute, Head Team Physician for the Phillies & St. Joe's
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Rothman Institute, Head Team Physician - Eagles, Head Orthopedic Surgeon - Flyers
Joel H. Fish, Ph.D. Director - The Center For Sport Psychology, Sports Psychology Consultant - 76ers & Flyers
R. Robert Franks, D.O. Rothman Institute, Team Physician - USA Wrestling, Consultant - Philadelphia Phillies
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer at The Sporting Club at The Bellevue
Cassie Haynes, JD, MPH Co-Founder, Trap Door Athletics, CrossFit LI Certified
Eugene Hong, MD, CAQSM, FAAFP Team Physician - Drexel, Philadelphia University, Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Main Line Health Lankenau Medical Center, Team Orthopedist - Philadelphia 76ers
Justin Shaginaw, MPT, ATC Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
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