Level4 Physical Therapy & Performance

By 7044549812 21 Aug, 2017
"Why is it my low back hurts after I get done playing a round of golf?" was a question we got asked just last week...

So let's talk about the sport itself. Golf. It's a rotational sport.  We rotate through the trunk from the hips, all the way up through the shoulders to your hands.  Then, down through to the opposite side and then transfers all that energy to the club head and then into the ball. Hopefully, then you hit the ball square.  Then you hit it straight and right down the middle of the fairway.  It puts a lot of torque on our spine, which in turn puts a lot of stress, potentially on our spine. Now the best way to go about protecting the spine is to make sure you have great mobility and that you have good support structures around that spine. So I'm gonna talk to you about a few common areas that we tend to see problems associated people that like to play golf.

So first is weakness. This can be weakness of the hip muscles, possibly the hip flexors, hip abductors or the glutes. And then can be into our abdominal muscles.  We are talking primarily at our deeper abdominal muscles which are transverse abdominis and our multifidus. These are actually the stabilizers of our spine. If you have a weakness issue and even potentially an endurance issue, then activities that are going to specifically address that are gonna be really important for you to do. If it's an endurance issue, then you're gonna need to do these activities for a sustained period of time and do them repetitively, much like a golf swing.

Another reason you experience pain after playing golf could also be a mobility issue. If it's a mobility issue, it could be either muscle or it could be joint. If it's a mobility issue, usually we see this as a hip rotation mobility limitation or it's related to hamstrings, glutes, or hip flexors.  It could also be related to the muscles in the chest. Believe it or not, you need to have good chest mobility in order to initiate that golf swing. And because the movement is from one rotation into the other direction, you need mobility really through the entire body.

If it's a joint problem, you can do things to yourself that can address some of the joints. But unfortunately, it's better to actually have a professional do this for you. That's not saying that you can't do it. But if I'm a mechanic and I fix cars on a regular basis, would you rather the mechanic work on your car? Or  if you are somebody who's never worked on a car before, go ahead and attempt to look under the hood and figure out what the problem is..again, you can do it. But the risk is you might actually do more harm than you do good.

The other thing it could be is that maybe you have a bad swing. And that's not saying your swing is bad every single time. But let's say even 80% of the time you have a good swing. That means 20% of the time you have a bad swing. If you're an average golfer, you're probably looking at somewhere between 90 and a hundred swings, which means there's about 15 to 20 bad swings in there. That can be enough to put a tremendous amount of force, torque, and stress on your body that's going to cause you to have issues.

So if that's the case, I would recommend that you get a golf coach or a swing coach or golf pro to go ahead and look at it. Again, the same premise as previously stated. I would rather that somebody who do this day in and day out save me the headache and the time by addressing it because they're trained. They have the trained eye to catch it and therefore they can give you tips to resolve that issue quickly.

Another part of that could also be maybe you're just a weekend warrior so you only play golf on the weekends. If that's the case, I would encourage you to get out there at least once, maybe even twice during the week to work on your swing. It could be something as simple as taking, 20, 30, maybe even 50 golf swings. But going through and actually hitting because you need that muscle memory and repetition.  Repetition leads to consistency.

So that's another way that you can go about again being more on the forefront of addressing the issues that may exist. So to recap, it could be a mobility problem.  It could be a strength or endurance issue problem or it could be just a purely a poor mechanics issue.

If you'd like to find out more information about the things that we do to help people that play golf and that have low back pain, you can visit our website at .  If you're interested, there's a free, "Tips Report," that's on there. Go ahead and fill out the simple form and click submit and then we'll shortly send you an email afterwards that contains that PDF. It is some of the most useful tips that we've had that our clients have given us feedback on that they have found to be most beneficial. 

Remember, the best hole is the 19th hole. And if you're in pain on the 19th hole, that's never any way to finish your round. So get out there, have fun, enjoy the sun. And don't have any back pain. Make sure if you do, that you get it addressed so that you can make it the best so it doesn't affect you socially, psychologically, and physically!
By 7044549812 11 Aug, 2017
Dr. Dawn Andalon, DPT, MTC, CPI
By 7044549812 18 Jul, 2017

This is one of the most common shoulder questions we get asked in the clinic.

This week I had a question asked by one of our clients Brooke, 49, from Encinitas, who asked…

“For the past several weeks my shoulder feels fine, as long as I don’t use my arm. But as soon as I try to reach or lift something, I get pain down the outside of my arm. Why does my shoulder do that?”

At this point, Brooke sounds like a lot of patients we initially start treating who complain of shoulder pain. Like many others, she thought it would go away on its own. When it didn’t, she attempted to treat it herself with advice she found on Google and YouTube, but was again unsuccessful. Now she’s experiencing a very common presentation of shoulder pain.

When she reaches out, particularly to the side or across her body, she gets a sharp pain in her shoulder that extends down the side of his upper arm.

Other common complaints we hear in the clinic from our clients experiencing shoulder pain are with activities such as:

  • Fastening a bra
  • Putting on or taking off a jacket
  • Sleeping on the painful shoulder
  • Reaching to the top shelf
  • Reaching for a wallet in the back pocket
  • Reaching for an item in the back seat of the car
  • Reaching to turn off the alarm clock
  • Lifting their children or grandchildren
  • Pulling a gallon of milk out of the fridge
  • Fastening a seatbelt
  • Exercising (push-ups, pullups, overhead lifts, etc.)
  • Sports (golf, throwing overhead, tennis, CrossFit, etc.)

Do any of these symptom patterns sound familiar?

If it does, you’ve probably wondered what exactly is causing you to have this pain that is interfering with your everyday life. I’m willing to bet that you have also searched the Internet attempting to self-diagnose - in the hopes that you can treat it yourself.

This approach can be dangerous… potentially leaving you more confused than providing a solution . During your search, you will come across many potential causes.

You will read about conditions like:

  • Bursitis
  • Tendinitis
  • Impingement – which if not treated can eventually lead to rotator cuff tendinitis and tears
  • Rotator Cuff Tear
  • Labral Tears
  • Arthritis
  • Adhesive Capsulitis/Frozen Shoulder
  • Multi-Directional Instability
  • Dislocation
  • Nerve Entrapment

And on, and on, and on…

There’s so many different diagnosis’ how can you possibly know why your shoulder hurts when you raise it? More importantly, knowing what you should do to treat it?

It’s amazing that as complicated as the human body is, let alone the fact that your shoulder is the most complicated joint in the whole body (to be explained in greater detail below), you are attempting to fix it yourself... neglecting the possibility of making your shoulder pain worse!

Would you do the same thing when your car’s transmission blows up, or if the brakes are malfunctioning… heck, what if you had severe pain in one of your molars - would you perform your own root canal? Do you ask the pilot to move over because you know how to fly the plane better? Of course not, you would leave it up to the specialist… Right!?... Right!? The human body is no different.

Understanding and treating your shoulder when you first begin to feel pain can prevent surgery and costly medical treatments.

It is important to understand why your shoulder hurts the minute it starts to hurt.  

Here’s why:

The first thing you need to do is find the exact cause of your shoulder pain.   Finding the source and the cause of your shoulder pain will help you be able to treat it and prevent further damage. What could the problem actually be?

By 7044549812 08 Jul, 2017

Neck and shoulder pain are never any fun! In fact, it is the 8th leading cause for disability in the United States and 4th in the world. If the head is not held in the correct postural position, then it exerts about 3.6 times more force than it takes to stand upright with good posture.  With the human head weighing about 10 pounds, it means at least 36 pounds of force is required to hold position to the otherwise 10 pounds in good upright positioning. Additionally, neck and shoulder pain account for roughly 10 million medical care visits every year, and growing!

It’s no wonder that neck and shoulder pain are so problematic to so many people around the world. Neck and shoulder pain are often one of those things you never think about until you have the pain and suffer for weeks, even months, before deciding to do something to make it better.

This article will discuss 3 secret strategies to eliminate that neck and shoulder pain. It will explain what you can do and why each is so important for your neck and shoulder health.

By 7044549812 30 Jun, 2017

This week I had a question asked by one of our amazing clients, Rob, 51, from Carlsbad… And it’s one that we get asked often! It went something like this…

“This past weekend I was skating and I hurt my back. It was so bad I had to call in to work on Monday morning because I was bed-bound with ice packs and taking Advil. I’ve had this type of back pain many times in the past. I usually wait for the pain to magically disappear because I’ve never known when it is okay to exercise when my back is hurting?

I understand the confusion “Dr. Google” might bring and more importantly, I also know the thought of doing any movement at all when you’re going through some kind of pain might feel a little scary. You definitely don’t want to run the risk of aggravating your back pain any more in case it turns into something more serious.

It’s very important that you don’t go ‘too hard’ too early, especially if you don’t know what’s really going on.

And you especially don’t want to wake up one day finding yourself unable to roll out of bed easily, having to take you 20 minutes to get dressed, and where standing or sitting has become a nightmare from what YOU did and now made it worse.

But don’t let that worry you too much – that’s rarely ever the case!

An aching lower back doesn’t mean you’ve got to be laid up for days, with heat and ice packs and a bottle of painkillers until it magically disappears.

In fact, you CAN keep moving and on the contrary to common thinking - not moving at all can make your back pain worse!

Here’s why…

If you suffer from lower back pain that comes and goes, as little as gentle walking can help. You will notice it will make a big difference versus just lying in bed.

Walking is a completely natural movement that keeps your joints mobile and muscles working – even those in your feet, legs, hips and torso – which play an important role in keeping the muscles strong in your back that help with posture.

Furthermore, appropriate stretching combined with walking will  improve your back’s overall strength, flexibility and posture, which in turn, can help stop back pain from creeping up on you when you least expect it. What’s more, it can also reduce how painful it feels and how much it gets in the way of day to day life.

So, here’s the important question to answer now that you know it’s 100% okay to exercise even if you’ve got a bad back…

What exercise can you actually be doing? Because of course, too much exercise, or exercise that’s strenuous could make it worse or keep it hanging around longer.

By 7044549812 23 Jun, 2017

Diastasis Recti often occurs during pregnancy when the growing baby stretches the abdominal muscles and tissues. Some women’s abdominal area heals on its own after the baby is born, but approximately 33% of women's don't heal completely postpartum by 6-8 weeks. So is your belly pooch because of diastasis or is there another underlying issue?  A proper self-assessment or seeing a Physical Therapist is key to finding out.     

Click here!   Self Assessment Tool

 I do hear quite a bit from women that they were told they need surgery to repair diastasis.  I would like to inform you THERE IS HELP for this without surgery!  

This is not something your OB/GYN will always assess at your 6 week post delivery visit and more moms are inquiring and searching “Google” for solutions.  


Physical Problems Caused By Diastasis Recti:

The separation of the abdominal muscles can cause a number of problems including:

  • Difficulty restoring the tone in their abdomen (i.e. abdominal bulge)
  • Lower back problems
  • Pelvic instability/Hip pain (i.e. sacroiliac and/or pubic symphysis)
  • Pelvic floor problems (e.g. decreased bladder control).

By 7044549812 14 Jun, 2017

At Level 4 Physical Therapy and Performance, it is not unusually for us to hear of people complaining of either pain or numbness while favoring their back. Medical doctors often suggest physical therapy and stretching to help relieve the incredible pain of Sciatica. Treatment can begin while there is still pain, but the hopeful outcome is that the pressure on the Sciatic nerve is relieved through stretching and exercise, relieving the agonizing pain and eliminating the limping.

How does Sciatica Cause Pain?

Sciatica is not a “true” medical diagnosis, but rather it describes a symptom that does not exactly point to the true underlying physical problem. Sciatic pain can originate either in the lower back region or in the buttock and can spread down the back of one or both legs; following the path of the Sciatic nerve.

The Sciatic nerve can be the source of pain when it is compressed by soft tissue, bone, scar tissue, inflammation and/or pressure from a intervertebral disc. The Sciatic nerve travels through the lumbar vertebrae, across the buttocks, and then branches down the legs to the feet.

Problems that generate this type of sciatic pain includes the following:

      • pregnancy  

      • pelvic misalignment

      • herniated disc

      • stenosis (the narrowing of the nerve space)

      • decreased flexibility in muscles of the hip joint


Focusing on Pain Relief

Considered one of the most painful conditions that involve the lower back and legs, the Sciatic nerve system consists of the largest nerve (as big as your thumb) and the individual nerve roots branching out from the spine. When this very large sciatic nerve is irritated, it makes simple movements in life a living nightmare of pain.

Different areas of compression along this nerve are often the cause of varying symptoms involving the lumbar area of the back, muscles of the buttocks, back of the thighs, and behind the knees, ankles, feet and toes. Nerve impingement creates numbness, tingling, weakness, and deep pain.

Medical doctors understand that everyone experiences this type of back pain differently. They prescribe physical therapy treatments knowing that professional therapists perform evaluations to discern the best type of treatment modes for each individual. For the specific needs of sciatica patients, a combination of solutions are offered.

How to Manage Sciatica Symptoms

Sciatica pain varies from constant and incapacitating to occasional episodes. This pain varies because of the different locations where the Sciatic nerve can be compressed, pinched or irritated. Some patients experience pain, tingling, and numbness down both legs. Others experience sciatic pain on only one side and down one leg.

First, unlike other types of back injury pain problems, physicians recommend that patients keep moving. But, this is difficult to achieve when certain movements are extremely painful. Patients need to maintain their back and leg muscle strength to prevent further compression in the Sciatic nerve. This is precisely why medical doctors recommend that their patients meet with a physical therapist to determine a set of therapies most appropriate for specific pain areas. Treatments may include gentle pain free exercises, stretching, massage and proper bending and movement instructions, according to when patients experience relief.

This is why at Level 4 Physical Therapy & Performance, we implement Pilates exercises early and safely – to focus on strengthening your core muscles, keeping you flexible and active in a pain free range, and to help assist with pain relief.

Clinical research studies show the sooner a patient begins physical therapy, the better the outcomes are. Physical therapy should begin within 10-14 days of the onset of pain.

If you’re experiencing Sciatica pain, call us now at (760) 503-4440 or email us at to arrange a FREE Discovery Visit with one of our back/Sciatica specialists.

Click below to claim your special report with 9 of the top tips to help ease your back/sciatica pain… Click on the red button below.

By 7044549812 08 Jun, 2017

With roughly 26 million golfers in the United States and about 6.5 million of those being over the age of 65 years, back pain is becoming more prevalent in the game of golf. As we age, natural spinal mobility decreases, which makes us more susceptible to injuries of the spine. It is estimated that nearly 35% of all golf injuries occurring happen in the low back, making it the number one location for golf injuries.  In addition, the direct annual costs for low back pain are around $91 billion each year.  Read ahead as we discuss 3 secrets to keeping pain away from your golf game.


1.     Dynamic Stretches

Warming up properly is so important, especially as you age. We say it often, but so few actually do it.  With a growing number of baby boomers wanting to continue playing golf into their elder years, it’s important to implement a preparatory routine before starting your round.  

I know what you might be thinking… If I have a 6:30am tee time, how early do I need to arrive at the course to get this stuff done? The routine doesn’t have to be long and we recommend less than 15 minutes. We also recommend doing a routine that is dynamic in nature. One that takes you through large movement patterns, starting off slowly and progressing up in speed. The reality is you will probably spend more time putting your shoes on, getting your bag situated on your cart and hanging out in the clubhouse than you will actually doing a good warm up.  Check out the video below on what a good dynamic warm up entails..

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