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MICROBREAKS - Saving muscles from overuse

8 July 2018

Muscular pain is one of the most common pathologies of today's society. Muscle pain occurs as joints degenerate over time and become arthritic. It is associated with nearly every musculoskeletal injury and is responsible for most of the dull and achy pains felt throughout the body that "happen for no reason". With a steady rise in desk jobs, time spent on devices (computers, cell phones, tablets, etc.), we are seeing more and more patients with muscle related pain in physical therapy. Even doing household chores like vacuuming, folding laundry, hanging clothes, and unloading groceries from your car can create muscle pain. Although there are many things that happen in life that cannot be controlled, there is still much that can be done to minimize and prevent muscle pain due to overuse injuries, posture, and repetitive movements.

When working at a desk or computer for extended periods of time there are a few things you can do to protect yourself from postural and repetitive strain on your muscles. Ensure your work station is set up ergonomically with the top of your monitor at eye level. Keep things you use frequently closer to you on the desk. Have your mouse and keyboard positioned at elbow height.  Find a chair that allows you to sit comfortably with your feet flat on the ground and good lumbar support. The most important thing, however, is to not stay in any one position for too long. Set a 20 minute timer on your computer, mobile device, or use a kitchen timer, and when the alarm sounds stand up and stretch out or walk around for 1-2 minutes. This "microbreak" will allow your muscles that have been working to rest, your vascular system to bring fresh oxygen while taking away lactic acid build-up, and restore your posture before it inevitably falls into "bad posture".

Microbreaks can be used in any situation. There is research that shows more than 20 minutes of any repetitive activity can cause myofascial restriction, called trigger points, to form in the part of muscles that contract. Accumulations of trigger points and restrictions in the muscular and fascia system are what can contribute to muscle pain over a period of time. So, no matter what kind of work you are doing, if it is repetitive, remember to take microbreaks every 20-30 minutes to allow your muscles to rest and not be overworked

Dr. Jonathan Cole, DPT, CMTPT

Sports Injury Prevention

2 April 2018

Every afternoon I cover athletic programs for a local high school with the main purpose being injury prevention. Coaches, athletes and especially parents benefit from having access to information that can keep their kids healthy, safe and on the field having fun. Unfortunately for young athletes, injuries are bound to happen, at least that’s what the statistics tell us. For the sake of trying to curve the statistics and keep kids playing the sports they love, let’s go over some tips for preventing injuries before they happen.

Nutrition is a huge factor in preventing injures. Food is the fuel your body runs on so when an athlete trains or competes, it is important they have the adequate nutrition they need to replenish their body. If a portion of the diet is lacking and the body needs to pull from stored substances, the athlete could be more susceptible to certain injuries. A balanced diet with natural carbs, proteins, and fats (no trans-fats) goes a long way. Adding in a daily multivitamin or mineral supplement can help ensure the essential nutrients for an active lifestyle are available. Finally, stay hydrated! A one-to-one ratio of water to sports drinks (Gatorade) is good for high level and long duration sports. For less intense activities drinking water is just fine. Having a balanced diet can help prevent stress fractures, heat illness and many other prevalent injuries.

It’s awesome that there are so many ways for kids to play the sports they love these days. Kids can play for high school teams or summer leagues or even travel teams, and because of these, many sports are no longer seasonal. What that means is there is no off-season for rest, only a continuous cycle from one team to the next. A lot of you probably just read that last sentence and thought, “wow, that’s a lot” and you’re right. According to the American Journal of Sports Medicine, specializing in one sport without any significant rest can lead to increased rates of over-use types of injuries (think ligament sprains and tendonitis). The best thing to do is to not specialize. Different sports focus on different skills and parts of the body, this gives the body an opportunity to rest and recuperate from the stresses of the previous sport. If that doesn’t convince you, here is a bonus incentive for avoiding sport specialization: most professional athletes, in any league, played multiple sports in high school and many report that playing multiple sports helped them perform better in their primary sport (think Bo Jackson, Michael Jordan, Deion Sanders, and many more).

Finally, sleep plays a huge role in both physical and mental health. Individuals operating on 2 hours of sleep less than their regular amount showed slowed response times like that of individuals just over the legal threshold for intoxication. If we equate this to sports such as soccer or softball, one can see how decreased reaction time increases the likelihood of injury. As well, adolescents tend to require more sleep than the average adult, who sleeps 6 to 8 hours a night. If a teenager is getting 8 to 9 hours of sleep a night they are doing pretty good. A tip for the best sleeping conditions are to have an environment that is cool, dark, and comfortable. Remember caffeine is a stimulant, so try to stay away from soda, coffee, and tea after about 3 pm or there may be some trouble falling asleep.

These tips certainly won’t prevent all injuries from occurring, but they are a good place to start. If you know someone who could benefit from reading this post, please pass it along!

Sports Injury Prevention

Kevin Thomas, ATC, SCAT

Pelvic Floor Discussion

6 February 2018

In today’s world, any condition within the pelvis especially about bowels, bladder, or sexual organs has become a very sensitive and uncomfortable topic to discuss medically. Patients tend to ignore or avoid discussing any issues with their medical providers that involve using the bathroom or difficulty during intimate relations. The unstated fact of pelvic health is that a pelvic condition or disorder is actually very common in men and women of all age groups. A study, by Harris Interactive and published in Urologic Nursing, found that 32% of Americans between the ages of 30-70 have urinary difficulty (Pelvic Floor Dysfunction, 2017). Also, according to a National Health and Nutrition Examination Survey, approximately 17% of men have experienced some sort of pelvic floor dysfunction (Pelvic Floor Dysfunction, 2017). This population needs to feel comfortable talking about these things and get the diagnosis and treatment they deserve because the majority of cases are treatable. Physical therapy can diagnose and treat these conditions. So…. Let’s talk about the pelvic floor.

The pelvic floor is made up of a group of muscles that expand across the bottom of the pelvis. They play a key role in controlling the passage of urine and feces, supporting the spine, and sexual function. These muscles also work together to maintain proper positioning of internal organs as the body changes positions. Due to the pelvic floor’s many distinct functions, several problematic issues can arise. The most common conditions are incontinence, sensation changes, over-activity, prolapse, pain during urination, and menstrual cycle difficulties. Each of these conditions can be embarrassing, painful, and debilitating. The thing to remember is that the pelvic floor is still a group of muscles that can be strained, in spasm, torn, over-active and/or even underactive causing these conditions. Similar to other muscles in the body, they can be treated and improved with physical therapy. A therapist can diagnose and treat with stretching, strengthening, and other specialized interventions to improve function and reduce pain.

This was an introduction to the pelvic floor and the physical therapy specialties of both women’s and men’s health. Stay tuned to our blog for more in depth pelvic health topics and articles addressing specific conditions.


Pelvic Floor Dysfunction. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction. Accessed January 9, 2018.

Pelvic Floor Dysfunction: 6 Myths Busted! The Kaplan Center. https://kaplanclinic.com/articles/pelvic-floor-dysfunction-6-myths-busted/. Published May 8, 2017. Accessed January 9, 2018.

Pelvic floor muscles. Pelvic floor muscles · The facts · Continence Foundation of Australia. https://www.continence.org.au/pages/how-do-pelvic-floor-muscles-help.html. Accessed January 9, 2018.

Let’s Talk Pelvic Floor

Katherine Caramante, PT, DPT

How to Return to Golf Safely after a Back Injury

29 June 2017

Injuries of the lower spine are very common in both the amateur and professional golfer. The golf swing creates a tremendous amount of stress and torque on the lumbar spine. Back pain plays havoc with our golf game. It does not allow us the flexibility or strength to maintain a proper golf swing. Even some of the most famous golfers deal with back pain and have had to have extensive physical therapy or even surgery to help get rid of their pain. You might recognize some of these professionals with a history of back problems: Jack Nicklaus, Seve Ballesteros, Fred Couples and Tiger Woods just to name a few. In the following article we will talk about common causes of back pain and how to safely return to golf after back injury or surgery.

Recovering from Back Pain that did not require surgery

Most commonly, back pain is treated with conservative, non-surgical care. The first step of recovery after a flare-up of back pain is rest. Resting the back for the first 5-7 days is a must to help decrease the inflammation within the tissues. If you are able to see your doctor or a physical therapist during the first week after your injury, they can prescribe medication or exercise to help progress the healing process. The second step is to regain full flexibility and mobility of your spine. Gentle stretches in all planes of motion of the lumbar spine will help, but be careful not to stretch too aggressively to re-inflame your back. The third step is adding strength and stability to your low back and core muscles to help support your spine during a golf swing. The strengthening exercises should be pain free but yet fatiguing to build spine strength.

A return to the golf course program is critical. I recommend starting on the putting green and chipping green. Slowly working your way to the driving range. Start on the driving range with your short irons. After successfully swinging your short irons without a flare up, progress to your long irons. Increase to fairway woods and your driver if you did not have any flare-ups with your long irons. Having confidence in your back is very important before you return to the golf course. I recommend being pain free for at least one week on the range before returning to the golf course.

Recovering after Back Surgery

Recovery after surgery depends on how bad the condition was before surgery, the type of surgery performed, and how the golfers body responds to healing. Make sure you follow all of your surgeon’s orders and restrictions. The two most common back surgeries for golfers are a Discectomy or Microdiscectomy and a Lumbar Fusion.


Most patients can start rehabbing their back approximately four weeks after the procedure. Physical therapy focuses on regaining flexibility of the spine initially, progressing into strength of the low back and core musculature. As long as the body is healing well, most golfers can return to the driving range around 2 months and progress from short irons to long irons. Tee shots and fairway woods are usually started around the third month after surgery. Golfers can start playing 9 holes after three months but I recommend they walk instead of ride in a golf cart to gain the extra exercise. After approximately four months, golfers can return to playing 18 holes.

Lumbar Fusion

Returning to golf after a spinal fusion will be much longer in order to allow the spine to heal correctly around the internal fixation of the fusion. Physical therapy usually does not begin until approximately three months after the surgery to allow bone healing to occur. First phase of rehab after a lumbar fusion is gentle stretching and strengthening at approximately three to four month post-surgery. If physical therapy is progressing well, then the golfer can start lightly swinging at around six months.

As described before, the same progression from green to tee is taken before the golfer returns to the course. As always, the medical professionals and golfer need to listen to the golfers body to know how fast or slow to progress them back to the golf course.

The Debate of Walking vs. Riding during a Golf Round

29 June 2017

The game of golf began in Scotland as early as 1457 and by 1744 the first rules of golf were established. The first golf cart was introduced in the 1930’s but, the golf cart did not become popular on golf courses until the 1960’s. For almost two hundred years, walking was the only way to play a round of golf. In this article, I will outline several of the benefits of walking the golf course versus riding in a golf cart including, benefits to your health, benefits to your golf game, and social advantages.

One of the most obvious advantages of walking during a golf round is the health benefits. A golfer usually burns twice as many calories walking 18 holes as does one who rides. Walking 18 holes is equivalent to a 3.5 – 4 mile run and can exceed 10,000 steps during a typical golf round. This exercise will help maintain a healthy weight, prevent or manage conditions such as heart disease, high blood pressure and Type 2 diabetes, strengthen muscles and bones, improve your balance and coordination, and improve your overall mood.

You might even see your golf handicap improve with regular walking during golf rounds. Walking allows you to set your own pace, get a better feel and get into a better rhythm during the round. The golfer can create more consistency in their pre-shot routine and the golfer does not feel as rushed due to their fellow partner waiting in the cart. Walking can even improve the social atmosphere during a round. Instead of talking with the same golfer in the cart for 18 holes, the walking golfer has a chance to have conversations with the other golfers in their foursome as they walk up the fairway or to the green for their next shot.

If you prefer playing with a foursome during a normal 18 hole round, riding in a golf cart does not save any time. Think about how much time you have wasted looking for another golfers golf ball in the rough and woods or how much time it takes your partner to hit their shot, then drive to your ball and you hit your shot. Golf carts do have their place in the golfing world. They are very beneficial to golfers who may not physically be able to walk a complete round but still want to enjoy the game they love. Next time you play a round of golf, try walking instead of riding in a golf cart and just see if walking helps you enjoy the game of golf how the game was originally intended to be played.

How Improved Flexibility can Improve Your Golf Game

29 June 2017

Are you a golfer that is stiff every morning when you first get out of bed? Do you avoid the 7 A.M. tee time because you feel stiff? By introducing a few simple stretches into your exercise routine, you can increase your power, improve your consistency, and decrease your risk of injury. Flexibility is just one component in making your golf swing more efficient. Other components include balance, strength and coordination. In this article we will discuss how flexibility will not only make you a better golfer, but also a more consistent one.

Why is Flexibility important?

Flexibility promotes a more consistent, efficient and powerful swing. Today’s professional golfers are amazing athletes that have extraordinary flexibility, especially in their spine. The better flexibility a golfer has, the more they can maintain good posture throughout their swing and maintain a good axis of rotation around their spine. By maintaining this good axis of rotation, a golfer will keep the club on the proper path for square contact. If a golfer has poor posture, their golf swing will become inefficient, and if they have a limited axis of rotation, they will lose power and distance on their shots. Also, if you have lack of flexibility or a restriction within your golf swing, your body will have to compensate elsewhere and this can lead to injury. The three most important areas to concentrate on flexibility for a golfer are: head/neck, the mid back, and the hips. We will focus on these three areas so you that you can gain or maintain flexibility for your golf game.

How to improve your flexibility:

Neck Flexibility – having good neck flexibility will allow better shoulder turn while allowing you to keep your eyes focused on the ball. The two most important movements of the neck are rotation and side-bending.

  • ROTATIONAL STRETCH WITH OVER PRESSURE - Turn your head to one side as far as you can and then use your hand on the same side to assist in turning the head further for a gentle stretch.Hold for 15-20 seconds and repeat 3-5 times each side.

  • UPPER TRAP STRETCH – Move your ear towards your shoulder and add overpressure to your head with the same sided hand. You will feel a stretch in your opposite upper trapezius muscle. Hold for 15-20 seconds and repeat 3-5 times each side.

Mid-back and Low-back Flexibility – spine flexibility is very important to generate power in the golf swing. The more rotation of the spine, the longer the arch of the swing which produces more club head speed and more distance on the shot.

  • SPINE ROTATION STRETCH - Lie on the ground with your arms spread perpendicular to your body. Lift both legs off the floor, knees at a 90-degree angle. Inhale and bring your legs to the left, maintaining contact of your shoulders with the floor. Exhale, initiating the movement from your oblique abdominal muscles, and bring your legs back to the starting position. Switch sides and repeat 5 times in each direction holding each stretch for 15-20 seconds.
  • OPEN BOOKS RIB CAGE – Lie down sideways and bend both knees. Take the downside hand and place it on top of the top knee – use the hand to keep the knees from rotating. Now take the top hand and reach under the downside rib cage and grab the ribs. Slowly rotate the torso toward the sky using the top hand to help and the bottom hand to resist the lower body rotation. Hold for 15-20 seconds and repeat 5 times in each direction.

Hip Flexibility – the hip joint is a ball and socket joint which allows for a large range of movement through the joint. This large range of movement is important in the golf swing to increase the axis of rotation that the body rotates around to generate a consistent golf swing.

RUSSIAN TWIST ON SWISS BALL - Lie with shoulder blades and head on the ball and your feet flat on the floor. Raise arms straight in the air, clasping hands together. Slowly rotate your shoulders to the right until your arms are roughly parallel to the floor. Hold for 5-10 seconds and then rotate to the left. Repeat 10 times to each side.

LEG CROSS OVER STRETCH - Lie on ground and cross right leg over left, with left hand on right knee. Rotate body to the left, bringing right arm to shoulder height.

Hold stretch for 15-20 seconds and repeat 5 times to each side.

Greater flexibility will improve your chances of becoming a more consistent golfer while also having the ability to improve power and distance with each swing. Flexibility is not the only component of the body that needs to be addressed to have the most efficient and consistent golf swing. Working on strength training, balance, and coordination will also improve your overall golf swing, but without flexibility, you will not be able to take full advantage of the other components during your swing. If you have any pain or discomfort when performing these stretches, please contact a TPI physical therapist in your area for a consultation.

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