Enjoy The Tiger Woods Show While You Can, Because it May Be Over Sooner Than You Think

Tiger’s golf game may be peaking, but his movement suggests the end may be near

Tiger Woods

Unless you were on another planet this weekend, you could not have missed the Tiger Woods show in full effect.  It felt like a throwback to Tiger’s earlier years, with crowd sizes already in the thousands from the first tee box and growing with every hole and the eruptions getting louder with every made birdie putt, everything in the golf world felt right.  After seven top 12 finishes in 14 starts and a 2nd place finish this weekend at the PGA Championship, the buzz around the sports media world and general public has been unanimous… he is officially back.  On the newest issue of Golf magazine, the headline simply states “This tiger is for real”.

tiger magazine coverI myself am an admitted Tiger Woods fanboy.  You would be hard pressed to find someone else who follows Tiger Woods more closely than I do.  The idea of him hoisting another major championship trophy gives me butterflies.  I started playing the game of golf because of Tiger.  As my friends and family can attest, I am a Nike loyalist because of Tiger.  I even started buying Bridgestone golf balls this year because of Tiger.  With all that being said, I am truly worried about Tiger and it has nothing to do with his golf career or whether he ever wins again.  What I am ultimately worried about is his health in everyday life.  I am worried that if someone does not get Tiger basic functional movement patterns corrected soon that it could be the last straw for not only his career, but could permanently alter his day to day life for the worse.

Tiger has already undergone an L5-S1 fusion approximately 1 year ago to help alleviate his pain and shooting symptoms into his legs.  The reason for his fusion is simple: he lacked the ability to control his spine at that L5-S1 segment leading to excessive shear on the vertebrae and disc, leading to breakdown and nerve damage.  Because Tiger could not stabilize that joint effectively on his own, the solution is to provide artificial stability via the surgical procedure.  To be clear, the disc breakdown was not the problem, it was the symptom.  No different than if we have a hole in the roof and every time it rains, it ruins the carpet on the floor.  The carpet getting ruined is not the problem; it is a symptom of having a hole in the roof.  No sane person would ever recommend just replacing the carpet after every rainstorm.  They would quickly identify the hole in the roof and fix that before ever replacing the carpet.  Tiger’s actual underlying problem was the inability to control the spine; therefore, if Tiger, or anyone else who undergoes spinal surgery, does not learn to control the spine postoperatively, then it’s only a matter of time before they break down again.  The only difference is that the next time they break down, it most likely won’t be at the fused segment; but rather, it will be at a segment above or below the previous surgery.  Want proof?  In a 2018 study looking into reoperation rates following spinal fusion, researchers found that over 12% of patients required a reoperation within 2 years of the initial surgery, and almost 20% required reoperations within 4 years of initial surgery.  The number one reason why they required re-operation was adjacent segment pathology, meaning the segment above or below the surgical site breakdown (1).

The common misconception is that a fusion can and/or will fix all your pain and complaints.  As we stated above, a spinal fusion treats the symptoms, NOT the underlying movement dysfunctions that led to needing the surgery in the first place.  To better understand, we will use the example of a patient experiencing a heart attack.  When excessive blockage of blood flow to the heart happens, it can trigger a heart attack.  When this happens, a cardiothoracic surgeon will often perform angioplasties by inserting balloons and/or stents to open up the restricted blood vessels, or may perform a bypass procedure whereby blood flow is redirected from blocked vessels to healthy vessels.  Even though the surgery was necessary, the cardiothoracic surgeon realizes that a combination of factors led to the patient needing the surgery and will attempt to address all those factors post-operatively to ensure the patient is better, including diet, weight loss, stress, sleep, exercise, smoking, etc.  The cardiothoracic surgeon does not perform the heart procedure and then just give the patient a pat on the back and send them on their way.  Too often, post-surgical spinal patients believe that the spinal surgery fixed the underlying problem and that they now just need to let time take place for healing.  Furthermore, over half (55%) of surgeons do not send their patients to physical therapy following spinal surgery (2).  I was shocked when I first read this statistic because we work with so many great spine specialists on a regular basis that appreciate what we can offer patients, but it made me realize that even with all the spine patients we treat postoperatively, that there is another half of the population who are never referred to physical therapy postoperatively.

So back to Tiger and why I am so concerned… As I mentioned previously, Tiger revealed a significant movement dysfunction this weekend.  So what movement dysfunction am I talking about?

After Tiger completed his round and walked off the course, he began climbing stairs on the walkway. While stepping up, Tiger displayed a major asymmetry when climbing the steps. As you can see in the picture and video (starting at the 21 second mark) below,.

Tiger Comparison

Tiger displays a major asymmetry in posture when standing on one leg and lifting the other up to the next step. On the left picture, Tiger is standing on his right leg only and lifting his left leg up toward the next step. He does an excellent job of stabilizing his R leg while in single leg stance, he keeps his spine neutral and unloaded, and keeps his pelvis in line. This movement will lead to a happy and healthy back. For the picture on the right side, he is now standing on his L leg while lifting his R right toward the next step. In this picture, Tiger displays the classic lumbar extension rotation movement impairment syndrome, with his spine rotating and falling into excessive extension (look at the difference in shirt wrinkles on the left verses nothing on the right) resulting his buttocks falling out to the right, all resulting in excessive compression and shearing on the lower lumbar spine.

Asymmetries as massive as the one displayed above is a major issue and something we seek to identify and correct in all our patients. How can we expect our high level athletes to move correctly during a high velocity movement such as a golf swing, if they cannot simply stand on one leg while flexing the other hip and be incapable of maintaining a stable spine position?  The answer is simple, we cannot and should not. One might think I am over exaggerating the seriousness of matter, but the reality is that for most people repeated small abnormal stresses, known as repetitive microtrauma, are placed on the body leading to breakdown, not singular traumatic events.  Even for Tiger, he did not damage his spine from a car wreck, fall, or one traumatic swing.  His low back has been breaking down for years due to the accumulative effects of repetitive microtrauma from not only his swing, but also the day-to-day movement dysfunctions while walking, climbing stairs, squatting, lunging, etc.  Because his L5-S1 are now fused together and he has still not corrected the underlying movement dysfunction that led to his initial breakdown, the next time he gets injured it will either be at the hips (below segment) or at the L4-L5 region. The irony of the situation is that the way he moves off the golf course may play a bigger role in his future breakdown than how he moves on the course itself. World renowned physical therapist, Shirley Sahrmann, says it so simply “we must undo in our day to day life what the sport does to us.” Every sport has very different demands. With golf, the biggest demand is rotation. The problem is not that Tiger is rotating while playing golf; the problem is that he continues to rotate through his spine through all his other day to day movements, thereby putting fuel on a fire, instead of undoing those faulty movements.

To be clear, I am not critiquing any of Tiger’s current or previous medical providers. We have no idea what has been discussed or attempted with Tiger. Based on multiple reports, Tiger has been known to be stubborn and it’s very possible, his health providers have attempted to fix these movement dysfunctions, and Tiger might see the fixes as unimportant and unnecessary.  What I can tell you is that no one can move with those flaws and expect to stay healthy long term, much less the game of golf’s greatest player ever who has a history of knee issues, 4 previous spinal surgeries, and a swing speed over 125+ mph. The good news is it’s never too late to improve movement quality. For the millions of Tiger fans and more importantly, for Tiger himself, I hope he addresses these issues sooner rather than later, so he can not only keep playing the game he loves, but also enjoy his life with his children down the road.

References

  1. Irmola, TM, Häkkinen, A, Järvenpää, S, et al. Reoperation rates following instrumented lumbar spine fusion. Spine. 2018; 43:4. Doi: 10.1097/BRS.0000000000002291
  2. McGregor AH, Dicken B, Jamrozik K. National audit of post-operative management in spinal surgery. BMC Musculoskeletal Disorders. 2006;7:47. doi:10.1186/1471-2474-7-47.

 

We Must Build a Foundation Before We Can Build Walls

A few nights ago, I couldn’t sleep and ended up watching a show about the construction of the Burj Khalifa, the tallest building in the world. In the show, they mentioned that the design used approx. 50% the amount of steel used in the construction of the Empire State Building, which is half the height of the Burj Khalifa. That fact initially surprised me, before realizing it was a simply matter of improved design efficiency and building a better foundation which could tolerate higher loads. That concept brought me back to one of our principal philosophies we apply at OSSPT, which is to ensure we build a better foundation of movement quality, before we ever increase movement quantity. The foundation of physical therapy should be about correcting faulty movement patterns.

“Tarzan, to me, is the epitome of fitness.  The guy is strong, agile and quick.  He can run, jump, climb and swing through trees.  If we take a person who moves well and put them on a Crossfit type of training program, we turn them into Tarzan.  If we take that same program and give it to the majority of people in society who move poorly, we turn them into a patient.”

– Gray Cook

Faulty movement patterns are the underlying reason behind ALL chronic conditions and many acute injuries. Without fixing the foundation, we are fighting a losing battle and eventually the walls will come crashing down, whether that be a recurrence of previous injury, worsening of current symptoms, or simply developing a new injury complaint. The number one risk for musculoskeletal injury is a previous injury, clearly indicating that something we are doing in the rehabilitation process is wrong and insufficient.

Ever wonder why your hip or knee become arthritic on one side and not the other? Ever wonder why your neck or low back are not getting better with years of adjustments, massages, etc? Ever wonder how you developed bone spurs in your your foot, heel, hip, shoulder, etc? The most likely answer is that you moved incorrectly, year after year, until finally, you developed structural changes, and then pain. As Gray Cook asks, are you moving poorly because you are in pain? Or are you in pain because you are moving poorly? We know that structural changes begin before we start experiencing pain, and we know that structural changes happen when we move improperly; therefore, we know that faulty movements lead to pain overtime. Here’s the great news… we can change how we move and if we change how we move we have an excellent opportunity to eliminate the pain cycle once and for all. baby squat

Try this quick test… perform a squat just like the kiddo in the picture to the right. If you can’t do it as well as that infant, then you are predisposed to injury. It’s as simple as that. We must squat, lunge, walk, climb stairs, push, pull, reach, etc. with proper mechanics, not because we are attempting to be elite level athletes, but simply because we are human beings and we must successfully build a solid movement foundation before we can build the walls of strength, flexibility, etc. around it.

“Success is doing the ordinary things extraordinarily well.”

– Jim Rohn

 Not sure if you move correctly or not, schedule an evaluation with me and we will perform the Functional Movement Screen, a reliable and valid tool, to determine what weak links you may have that could eventually be the crack in your foundation, and then provide you with the proper tools to fix it before it becomes a bigger problem.

 

Our Profession Owes You an Apology

When an individual has a heart related condition, they see a cardiologist… When an individual has a skin related condition, they see a dermatologist… When an individual has a cancer related condition, they see an oncologist.

In every area of our lives we search for the experts, why should physical therapy be any different?

The quality of care we have come to expect from the physical therapy profession has become so low that the assumption is that all physical therapy is the same; however, this could not be further from the truth. When a physical therapist graduates from school, in a sense, they become a “jack of all trades”. They have a very broad knowledge base making them novices in all aspects of physical therapy including orthopedics, pediatrics, acute care rehab, neurological, spine,  sports rehabilitation, etc; similar to how graduates of medical school have developed a foundation of cardiology, neurology, immunology, etc. The major difference between medical school and physical therapy school, is that for the majority of physical therapists, the structured training ends after PT school, unlike medical school graduates who then advance to a multiyear residency program focused on a singular specialty, often followed by fellowship training to further specialize.

As any orthopedic surgeon would agree, not until the residency and/or fellowship programs do they become confident in providing the quality of care necessary to make measurable improvements for their patients.

“I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times.”

– Bruce Lee

Why don’t more physical therapists undergo additional training?

The unfortunate, but honest answer is that it’s not required and patients aren’t demanding that their physicians refer them to the experts. Most patients do not search for the best physical therapy clinic to attend and often go wherever the doctor recommends. Unfortunately, many of these referral decisions are based on location, personal relationships, or financial ties with that clinic. Furthermore, Less than 10% of physical therapists have completed a post graduate residency program and less than 2% of physical therapists have completed a manual therapy fellowship program, so the public often does not even know these residency and fellowship programs exist.

Does this mean that you can not be a good quality PT without completing a residency or fellowship program? 

Definitely not. I know quite a few good PT’s who have not completed residency and fellowship training, but I know for a fact that  these same PT’s would love to  complete a residency program if the costs were not so high, the time demands were not so much,  if their employers were more supportive, and if insurance reimbursement was paid based on results.

How is OSSPT any different?

First, every one of our therapists has completed fully accredited advanced orthopedic and/or sports residency programs. Also, our physical therapists have completed or are actively completing a manual therapy fellowship program to further improve his/her skills. Additionally, our company is independently owned by the same physical therapists treating you in the clinic with no outside influence by any hospitals, medical groups, or corporations, so patients can take a lot of confidence in knowing that the only reason physicians recommend us is based on the quality of care we provide and our excellent results. Finally, we are such strong advocates of residency and fellowship training that we cover the entire cost to complete the programs for all new physical therapy employees.

Moving forward, I challenge you, the patients, to demand more from us. Do your homework and seek a higher level of physical therapy care. We spend hours debating the best restaurants to eat, searching the internet for the best shopping deals, and researching the best physicians and surgeons, then blindly go to the nearest physical therapy clinic to our home/work without thinking twice. Ask friends for recommendations, ask your physician if they have any financial ties to the clinic they are referring, drive the extra 5 minutes to receive a superior level of care, understand you have a right to choose where you want to attend physical therapy.

If you have the choice of a superior level of care, for the same price, with the same therapist each visit, why not choose OSSPT? If you have more questions or would like to specifically discuss your case please reach out to me personally at Jeff@OSSPT.com or call us at 405.735.8777 to schedule an evaluation.