Beth Kais, M.Ed., CSCS, DNSET, PRT - What's New
Beth Kais, M.Ed., CSCS, DNSET, PRT  - Corrective Exercise Specialist

Why There’s No Such Thing as the “Yips”   
Beth Kais, M.Ed., CSCS, CHEK-Certified Golf Bio-Mechanic               
August 23, 2015   

WHAT!?!?  No such thing as the yips!?!?  Have you lost your mind?   Every golfer knows and fears them, may have them or know someone who has had them.  Champion golfer Tony Armour made the term famous in the mid-20 century by using it to describe his playing difficulties and a disorder was born.  It’s an affliction with no known cause or cure and possible psychological or neurological origins (1,2).  So widely accepted the legendary coach Hank Haney recently used them to describe Tiger Woods difficulty on the course (3) and The Golf Channel dedicates articles on how to cure them (4).   

What if this change in performance originated from two specific sources:  1) Breathing and 2) Rotating the torso to the right?  What if these activities altered the standing posture enough to shift and rotate the entire body toward the right?  What impact would that have on the ability to coordinate the shoulders and hips while turning to strike, or throw, a ball?   

According to Dr. Ron Hruska and the Postural Restoration Institute the diaphragm primarily influences posture and postural positioning (5).  However the diaphragm cannot contract evenly or place pressure evenly on the abdominal cavity because of the positioning of the heart and liver restricting movement on the left side.  Over time this places the body in what Dr. Hruska calls a faulty pattern of the Left Anterior Internal Chain (LAIC) (6).  Postural adaptations from a LAIC include:   

Left side positioning -   
1.     Forward and rounded positioning of the left shoulder complex. 
2.     Forward (anterior) tilt of the left pelvis arching the low back.
3.     Lengthening of the left waist.
4.     Left leg positioned away from the mid-line (abduction) and knee turned out (external rotation of the left hip/femur).

Right side positioning -
1.     Straightened or extended position of the right shoulder complex.
2.     Backward (posterior) tilt of the right pelvis flattening the low back.
3.     Shortening of the right waist (lumbar spine shifts toward the right).
4.     Right leg positioned toward the mid-line (adduction) and knee turned inward (internal rotation of the right hip/femur).


In this position the otherwise forward facing (12 o’clock) pelvis and hip bones –
1.     Shift orientation toward the right (1 or 2 o’clock). 
2.     This allows for additional opening (abduction and external rotation) of the left hip and
3.     Lowering of the left hip position (anterior pelvic tilt).
4.     Closing (adduction and internal rotation) of the right hip and
5.     Elevating of the right hip (posterior pelvic tilt).
6.     Shift of the lumbar spine to the right.
7.     This causes the bodyweight and center of gravity toward the right. 

8.     The shoulders may follow the hips and also alter their orientation toward the right (from 12 o’clock to 1 or 2 o’clock).








These changes take place gradually over a long period of time.  This allows the nervous and musculoskeletal system to adapt to and compensate for the ‘new normal’. As a result you perceive the bent and turned position as straight and forward even though it is not.  Others do not notice the altered posture because they experience the same adjustments.

Now compare the above position to the backswing of a right handed golfer:   Left side positioning -
1.     Forward and rounded positioning of the left shoulder – yes.
2.     Forward (anterior) tilt of the left pelvis – yes.
3.     Lengthening of the left waist – yes.
4.     Opening of the left hip with the left leg positioned away from the mid-line (abduction) and knee turned out (external rotation of the left hip/femur) – yes. 5.     Weight shifted off the left leg – yes.   

Right side positioning –
1.     Straightened or extended position of the right shoulder complex – yes. 2.     Backward (posterior) tilt of the right pelvis – yes.
3.     Shortening of the right waist (lumbar spine shifts to the right) – yes.
4.     Closing of the right hip with the right leg positioned toward the mid-line (adduction) and knee turned inward (internal rotation of the right hip/femur). 5.     Weight shifted into the right leg – yes.
6.     Hip bones shifted from forward orientation (12 o’clock) toward right rotation (1 or 2 o’clock) – yes.
7.     Right hip higher than left hip – [BHK1] .                           

The backs wing of a right handed golfer matches the postural changes caused by a faulty LAIC postural pattern.  This explains why a right handed golfer with a faulty postural pattern of LAIC can consistently complete a relatively optimal back swing with no discomfort.


LAIC faulty postural positioning and the fore swing in a right handed golfer. In order to complete the optimal fore swing the above described left and right sides must fully switch positions.

The left side must complete the following actions:

Left side fore swing positioning –
1.     Straightened or extended position of the left shoulder and torso.
2.     Backward (posterior) tilt of the left pelvis flattening the low back.
3.     Shortening of the left waist.
4.     Closing of the left hip with the leg positioned toward the mid-line (adduction) and knee turned inward (internal rotation of the left hip/femur).    
The right side must complete the following actions:

Right side fore swing positioning –
1.     Rounded or flexed position of the right shoulder and torso.
2.     Forward (anterior) tilt of the right pelvis arching the low back.
3.     Lengthening of the right waist.
4.     Opening of the right hip with the right leg positioned away from the mid-line (abduction) and knee turned out (external rotation of the right hip/femur) 5.     Hips change orientation toward the left (10 or 11 o’clock).   

What happens to the fore swing if the left and right sides are stuck in the back swing position (LAIC) with the hips positioned and turned toward the right?  The actions can only be completed by compensating muscles and joints.  These include, but are not limited to the spinal extensors, side benders and rotators.            

Left side fore swing faulty posture (LAIC) –
 
1.     Left shoulder stuck in rounded (flexed) position and right shoulder stuck in a straight (extended) position. 
2.     Left pelvis stuck in a forward (anterior) tilt and right pelvis stuck in a backward (posterior) tilt.
3.     Left waist stuck in a lengthened position and right waist in a shortened position.
4.     Left hip stuck with the leg out to the side (abducted) and right hip stuck with the leg in toward the mid-line (adducted).
5.     Note the hyperactivity of the left side (spinal erectors) and the right hip tucked under and inactive.
6.     Right hip remains higher than the left hip.

Left side fore swing faulty posture (LAIC) alternate positioning and muscle compensation -
1.     Middle back (thoracic) spine straightens and/or low back extends (lumbar hyper-lordosis) to elevate the shoulder and give the impression of shoulder straightening or extension. 2.     Low back (lumbar) spine extends to give the impression of the pelvis moving back into posterior tilt.
3.     Low back (lumbar) spine extends to give the impression of shortening (QLO, external oblique).
4.     Spine excessively rotates and left shoulder excessively abducts and externally rotates to give the impression that the hip moved in and rotated in. 5.     This creates large, thick (hypertonic) and sore (trigger point) spinal erectors on the left side and particularly along the low back (lumbar spine -both sides).

Right side fore swing faulty posture (LAIC) alternate positioning and muscle compensation –
1.     Right torso flexes to give the impression of shoulder flexion.
2.     Low back (lumbar) spine extends to give the impression of the pelvis moving forward into anterior tilt. 
3.     Low back (lumbar) spine extends to give the impression of lengthening. 4.     Spine excessively rotates and right shoulder excessively adducts and internally rotates to give the impression the hip moved out and rotated out.  Pinching in right hip.
5.     This creates flat, thin (hypotonic) spinal erectors on the right side particularly along the middle back (thoracic spine) with a thick (hypertonic) waist (QLO) with trigger points.
6.     Hips remain oriented to the right (1 or 2 o’clock) or forward (12 o’clock) but short of the equal, opposing left rotation (10 or 11 o’clock).  Weight remains on the right leg.  Golfer may slide the right hip toward the left.

The faulty posture LAIC patter also prevents proper weight shift from the right side to the left side for transfer of power.  In an attempt to shift the weight from right to left the right handed golfer slides the body mass from right to left instead of rotating the mass along the axis of performance.  A greater amount of shift and rotation occur at the shoulders because the lumbar spine extends to mimic hip movement.  The shoulder shift and rotation may also occur more because of the teaching emphasis on arm position at the beginning and end of the golf swing.

Potential consequences of right handed golfing with a faulty posture LAIC pattern.

1.     The asymmetrical position of the pelvis and the positioning of the lumbar spine toward the right, combined with the excessive compensation in extension and rotation by the lumbar spine to perform the golf swing, places the lumbar spine at risk for injury particularly on the right side (R posterior-lateral or subluxation) .
2.     The excessive shoulder movement (abduction/external rotation and adduction/internal rotation) places the shoulders at greater risk for rotator cuff injury.
3.     The lack of rotation at the hips (abduction/external rotation and adduction/internal rotation) place the knees and ankles at additional injury risk.  The outside of the left knee (LCL) and inside of the right knee (MCL, ACL) and meniscus in both knees are particularly at risk.  Either knee or hip may also develop bursitis.
4.     The inside of the left ankle and outside of the right ankle may also experience discomfort or injury.

A faulty posture LAIC pattern occurs in everyone regardless of hand dominance since the heart and liver are located on the left side in both.  However, in the left handed golfer, the back swing becomes compromised because of the inability to turn back toward the left. The fore swing occurs with relative ease and good positioning but may over rotate toward the right.  The golfer may appear to “chop down” on the ball due to a shortened back swing.  Because the body weight remains on the right foot gravity assists momentum in acceleration.

Potential consequences of left handed golfing with a faulty posture LAIC pattern:
1.     The asymmetrical position of the pelvis and the positioning of the low back (lumbar spine) toward the right, combined with the excessive compensation in extension and rotation by the low back to perform the golf swing, places the low back at risk for injury particularly on the left side (L posterior-lateral or subluxation) .
2.     The excessive shoulder movement (abduction/external rotation and adduction/internal rotation) places the shoulders at greater risk for rotator cuff injury.
3.     The lack of rotation at the hips (abduction/external rotation and adduction/internal rotation) place the knees and ankles at additional injury risk.  The inside of the left knee (MCL) and outside of the right knee (LCL and ACL) and meniscus in both knees are particularly at risk.  Either knee or hip may also develop bursitis.
4.     The inside of the right ankle and outside of the left ankle may also experience discomfort or injury.

Unfortunately storied anecdotes repeated over the decades prevent suffering golfers, and other swing or throw athletes, from seeking corrective treatment.  The prevailing wisdom of “playing” your way out of the condition only exacerbates the misaligned posture neurologically reinforcing the faulty pattern.  Compensations in movement lead to more muscle imbalance and misaligned joint position frequently resulting in injury and sometimes severe injury as in the case with athletes.

Restoring function begins with rebalancing the posture (correcting the LAIC): This includes –
1.     Restoring proper diaphragmatic breathing.
2.     Relaxing the psoas and lumbar spinal erectors.
3.     Calming the neurological system.
4.     Restoring proper hip position over the thighs (acetabulum over femur) 5.     Maintaining proper hip position over the tights during daily activities including sitting, driving, getting up from a chair and sleeping.
6.     Strengthening hip/pelvis muscles to maintain proper position during movement or athletic demand.

For proper corrective intervention only consult an extensively trained health or fitness professional with continuing education from the Postural Restoration Institute www.posturalrestoration.com or feel free to contact Beth at www.S0-Fi-T.com .

Footnotes:
5.     https://www.posturalrestoration.com/the-science/recognizing-asymmetry 6.     Postural Restoration Institute Myokinematic Restoration Course DVD 1.    [BHK1]

Common Barriers to Health and Performance Measurable source of concern and cause of disease:  Inflammation How Inflammation manifests itself:  measured by blood panel

Common causes of Inflammation:
Common symptoms of chronic Inflammation:
of prolonged, long-term Inflammation:

Simple interventions to reduce and eliminate Inflammation:

Considerations When Training Clients With Crohn’s Disease
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pelvic Floor Dysfunction and Chronic Groin, Low Back and Lower Limb Pain
February 28, 2012
Statistics state that as many as 1 in 5 Americans of every age suffer from some type of pelvic floor dysfunction during their life time (Stein 2010).  When counseling a client with chronic, non-specific low back pain, groin pain, hip/pelvic pain after injury, surgery or athletic participation practitioners address the spine, hips and surrounding musculature omitting the base of support for all these structures – the pelvic floor.  It’s proximity to the sex organs and impact on bodily functions makes it embarrassing for clients to discuss.  However, it’s location in the lower bowl of the abdomen makes it an essential member of the core stabilizing lumbopelvic cylinder.  Failure to address pelvic floor dysfunction after injury, surgery or repetitive athletic participation can result in continued spine and hip instability causing chronic back and pelvic pain and predisposition to additional spine, hip, neck, shoulder and lower limb injuries as well as impaired breathing and disruption of organ function.
The anatomy of the lumbopelvic cylinder consists of muscles and bones. It begins just below the lungs with the diaphragm.  It descends along the front and side of the torso with the transversus abdominis supported by segmental attachments to the psoas and abdominal muscles.  It descends along the back of the torso with the spinal column supported by the segmental attachments of the lumbar multifidus.  It ends in the bowl of the pelvis with the pelvic floor (Chaitow & Lovegrove 2012). 
Abnormal pelvic floor function negatively impacts spinal stability, intra-abdominal pressure, respiration, sexual function, continence and pelvic organ support (Chaitow & Lovegrove 2012) resulting in global instability, chronic joint pain and predisposition to injury.  The pelvic floor as the most essential arch in the body providing the base of stability for all lower limb and foot joints (Dalcourt 2012).  Integrity of the trunk is essential to maintain joint position, respond to perturbations, avoid low back pain/injury, insure proper proprioception, and develop power and strength (Landow 2010).
Pelvic floor dysfunction (PFD) occurs after injury, sports participation or surgery.  Examples of injury include a hard fall or blow to the sacrum or tail bone as in falling on ice or off a horse or telescoping femoral injuries when landing on the feet after a long fall as in sky diving.  Sports associated with PFD also report frequent groin injuries from kicking, quick multi-directional lateral changes or pelvic rotation during axial loading as in soccer, running, golf, ice hockey, figure skating, football, baseball, ballet, martial arts and gymnastics (Chaitow & Jones 2012).  The reported incidence of groin pain and injury as a result of sports participation is as follows:  cycling – 22 to 91%, running – 70%, football – 22% and ice hockey 13 to 30% (Chaitow 2012).  Any lower abdominal surgery may result in the abnormal pinning of deep fascia to muscle (Dalton & Hedley 2012) causing PFD.
Additional causes of PFD include hernia, infection, cancer or sexually transmitted disease.  Special considerations for women include endometriosis, pregnancy (large baby, twins), difficult delivery or cesarean and multiple pregnancies.  Sexual violence is another cause with greater physical and psychological implications.  Treatment of the victims of sexual violence should include other medical professionals to ensure a successful outcome.
The pelvic floor identifies a consortium of muscles.  The deepest muscle, the levator ani, is often referred to as the pelvic diaphragm and is divided into two parts – the pubovisceral and iliococcygeal muscles.  The superficial muscle, the pereneal membrane or urogenital diaphragm, sits above the levator ani (Chaitow & Jones 2012). These muscles consist of both smooth and striated muscles of which approximately two thirds are type 1 and innervated by the pudenal nerve through direct branches from sacral nerves S3-S4.  The pelvic floor contracts or relaxes as a whole but may also contract or relax in segments (Chaithow & Jones 2012).
The pelvic floor, like all muscles, can become hypotonic or hypertonic after injury, sports participation or child birth.  Corrective exercises specific to strengthening a hypotonic pelvic floor include Kegels (pelvic contractions stopping and restarting urination).  Kegel exercises, in the absence of proper breathing and appropriate deep abdominal wall activation and strength, cannot resolve lumbopelvic cylinder dysfunction, gait abnormalities and trunk instability.  To ensure a full recovery from a hypotonic pelvic floor the practitioner should evaluate the strength and function of the entire lumbopelvic cylinder and instruct the client in proper breathing techniques and appropriate core/limb coordination exercise.
A hypertonic pelvic floor restricts the ability of the diaphragm to expand and transversus abdominis to contract during respiration.  This leads to hyperventilation syndrome (HS) and altered breathing pattern disorders (BPD) (Chaitow 2004). Over time HS and BPD alters mood (constant fight/flight breathing), changes body chemistry (respiratory alkalosis), and hypercapnoea (increased levels of CO2) which compromises key core stabilizer by reducing or eliminating the postural (tonic) and phasic contractions of muscles necessary for spinal stability (Chaitow, Breathing Pattern Disorders, motor control and low back pain, Journal of Osteopathic Medicine, 2004; 7(1): 34-41). 
The hypertonic pelvic floor does not respond to Kegel exercises but does respond to trigger point therapy.  In a study of 56 continent physiotherapists (51 women and 5 men age 23 to 56) all tested positive for a hypertonic pelvic floor with some of the cases demonstrating clear differences in tonicity from one side to the other.  Trigger point therapy was administered and tonicity returned and pain resolved after approximately two to five breaths (Carrire & Feldt 2006). 
Individuals can administer their own trigger point therapy by sitting on a tennis ball placed between the coccyx and vaginal opening or just inside the coccyx and breathing deeply (Chaitow 2008).  More sensitive or difficult cases may require clinical instruction on Thiele Massage.  Again, to ensure a full recovery from a hypertonic pelvic floor the practitioner should evaluate the strength and function of the entire lumbopelvic cylinder and instruct the client in proper breathing techniques and appropriate core/limb coordination exercise.
Chronic PFD as a result of injury, sports participation or child birth may result in the presence of altered concomitant muscle contractions and scar tissue extending from the pelvic floor to other pelvic muscles.  The opposite also holds true and an injury to another pelvic muscle may result in scar tissue that extends to and entraps the pelvic floor.  Susceptible muscles include but are not limited to: psoas major, iliacus, tensor fasciae latae, pectinius, gracilis, and adductor magnus, brevis, longus (Chaitow 2012).  Symptoms of this disordered relationship include repeat groin strains, non-specific hip or pelvic pain, lower limb and low back pain that does not respond to traditional manual therapies, stretching of the susceptible muscles or core conditioning.  Normal hip and spine range of motion may exist despite this disordered relationship.
Susceptible muscles resulting in posterior pelvic tilt attach to the sacrum and coccyx pulling it forward (Weiss 2012).  These muscles include piriformis, quadrates femoris,  and gluteus maximus. Symptoms of this disordered relationship include restricted sacral counternutation, chronic L5/S1 strain, deep pelvic and sacral pain, lower limb and low back pain that does not respond to traditional manual therapies, stretching of the susceptible muscles or core conditioning.  Abnormal hip and spine range of motion usually accompanies this disordered relationship.
Chronic PFD, groin strains and low back pain does not respond to traditional manual therapies for a variety of reasons. Therapists specializing in PFD only treat the pelvic floor and frequently do not address the disordered breathing or lack of core conditioning and faulty muscle patterns.  For manual therapists and exercise specialists the pelvic floor sits in the industry ‘no fly’ zone where touch is forbidden at best and a law suit at worst.  Additionally, the client may be reluctant to discuss the other symptoms of PFD including urinary incontinence, drip or leakage after urination, genital pain, pain during and after sex, pain during orgasm, complete avoidance of sex, hemorrhoids and bowel incontinence.  The client also might not connect these symptoms to their injury and PFD.
In the case of chronic PFD as a result of a hypertonic pelvic floor the client demonstrates core development to a point and no further or returns to instability randomly despite lengthy and otherwise proper training.  A hypertonic floor increases the pressure in the lumbopelvic cylinder which then increases the pressure on the internal organs.  The body resists any further organ compression by reducing the range of motion in the diaphragm and transversus abdominis.  When contracting a fully functioning diaphragm and transversus abdominis the body responds by destabilizing or moving the spine, intermittently shutting down the transversus abdominis, and reducing or eliminating the breath.
Individuals can administer their own trigger point therapy using a tennis ball or OPTP “little pinky” ball in the bikini or ‘tighty whitey’ area.  This region encompasses the lower abdomen, gluteals, intersection of the ilotibial band/TFL/Glute med-min and the pelvic floor – basically any area a bikini bottom or brief underwear covers.  Place special emphasis on incision scars and take care to avoid sensitive nerves.  The femoral nerve sits outside the bikini area and should be avoided.  Pressure should be tolerable, mildly uncomfortable, and held until the trigger point becomes comfortable (approximately 2 to 5 relaxing breaths) before moving on to the next trigger point.  Breathing should remain consistent and relatively deep throughout.  Rib or shallow breathing, as in mild hyperventilation, indicate the pressure is too deep and should be adjusted downward until breathing returns to normal.
Individuals unable to perform the trigger point release may relax the pelvic muscles by lying face down on a rolled bath towel.  Place the towel on the lower abdomen below the navel, above the pubic bone and inside the hips.  The towel should be a comfortable height and allow deep and relaxing breathing.  Place the head/neck in a comfortable position as well.  Remain until fully relaxed and then roll off the side of the towel and onto the back.
Successful stretching for PFD occurs along the deep front line (Myers, p. 192) in a closed chain and includes the torso muscles.  Lateral lunges with opposite arm reach over head and multidirectional lunges with opposite arm reach over head stretch this line as an entire, functional complex (aka the “Saturday Night Fever” stretch).  Minimal discomfort should occur as the client holds the stretch for 2 to 5 easy breaths. Again, breathing should remain consistent and relatively deep throughout.  Rib or shallow breathing, as in mild hyperventilation, indicate the stretch is too deep and the range of motion should be adjusted downward until breathing returns to normal.
Returning to optimal performance begins with the health of the lumbopelvic cylinder and the pelvic floor.  Its location in the ‘no fly’ zone and embarrassing symptoms make it difficult to discuss and treat.  Its contribution to chronic groin, low back and lower limb injuries make it essential to address.  Kegel exercises strengthen a hypotonic pelvic floor while trigger point therapy and deep front line stretching releases a hypertonic floor.  Successful results occur in the presence of a normal breathing pattern and fully functioning transversus abdominis.  Strength, power and performance improve only when the lumbopelvic cylinder functions.
References:
Chaitow, Leon and Jones, Ruth Lovegrove  2012. Chronic Pelvic Pain and Dysfunction. England, Churchill Livingstone, p. 34.
Dalcourt, Michol, 2012. Footwear and Function – Views on Barefoot Training, 1/11/12, NSCA webinar.
Chaitow, L. and Jones, R. L.  2012. Chronic Pelvic Pain and Dysfunction. England, Churchill Livingstone, p. 101.
Dalton, Eric et al 2012.  Dynamic Body.  USA, Freedom From Pain Institute, p. 69.
Chaitow, L. and Jones, R. L.  2012. Chronic Pelvic Pain and Dysfunction. England, Churchill Livingstone, p. 41.
Carriere, Beate, Feldt, Cynthia Markel 2006.  The Pelvic Floor.  New York, Thieme, p. 107.
Chaitow, L. and Jones, R. L.  2012. Chronic Pelvic Pain and Dysfunction. England, Churchill Livingstone, p. 102.
 
POTS and Medication -
(For more specific information on POTS see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1501099/ )
If you or a family member begin to experience an onset of dizziness, lightheadedness or rapid heartbeat when moving from a lying to sitting position consider the side effects from medications (particularly ADD/ADHD and antidepressant medications) and consult your attending physician.
Beth Kais MEd CSCS C.H.E.K. • Hey Panayiotis - I work with a hunt seat and dressage elite rider. In the absence of injury we focus on reversing the muscle imbalances caused by riding for hours. This includes extremely tight adductors and hip flexors and the program includes stretches for these muscles and strength exercises for the abductors/external rotators and hip extensors. This prevents excessive anterior pelvic tilt negatively affecting the rider's balance and causing low back pain.  Polo players have the additional consideration of continuous one side rotation. This can overtax the trunk and shoulder rotators on one side causing a rotation toward the midline on the dominant side. Corrective stretching should focus on the dominant side rotators while strengthening the non-dominant side in rotation. This will maintain balance from right to left and rotation neutral to keep the rider neutral/balances in the seat . Continuous shoulder internal rotation on the dominant side should also include internal rotator stretch with external rotation strength exercises and overall internal/external shoulder rotation exercises on the non-dominant side.

Website Builder provided by  Vistaprint