“I have been doing a triathlon every day this summer.” This is what my patient told me one month ago. He returned to my practice for care from his training. He has decided to do the Lobsterman’s triathlon this weekend.

He is a wonderful athlete. He was a high school track star and ran for a Division I college. He won a number of prestigious races in southern Maine.

His family has been associated with my practice for four generations. His grandparents were patients of my father, and now his nieces and nephew have been to see me.

His father and mother are terrific people. His father was a basketball star at a local high school and went on to captain his Division I college basketball team. His father has been ill the last several years. He still affectionately calls me “Roberto,” the nickname he gave me years ago when he would come into the office.

Both of his brothers were outstanding athletes for their high school and college teams. They continue to be in great shape.

This was the first time a patient told me they were doing a triathlon every day. He rides his bike about 15 miles per day before going to his summer job.

At his summer job, he and the other lifeguards will run 3 to 5 miles per day as part of their training. They also will swim each day and practice rescues. All of the lifeguards take their job seriously. Their lives and the lives of the beach goers depend on their training and fitness.

He usually will swim between a third- and a half-mile each day, depending on the tide.

He’s in the shape we all dream of being in. I have cycled with him. He talks during most of the ride while I’m breathing like a freight train trying to keep up.

His chief complaints are neck pain and tightness in his calf. He also has some stiffness in his lower back.

I have found other swimmers to have neck issues, especially if they breathe out of one side. This will cause a muscle imbalance on one side of their upper back and trapezius muscle.

Treating this type of neck pain is not complicated and it responds very well to conservative care. Preventing it from recurring takes work. I ask the athlete to get a swimming coach.

A good coach can make you more efficient in the water. This will place less stress on your body as you propel yourself through the water.

Breathing out of both sides of your swimming stroke makes you more symmetrical. This reduces the stress on one side of your upper body and neck. It’s hard to learn and takes practice.

His calf muscle had a mild strain. He has had this before when he increased the intensity of his running. I performed deep tissue work on the muscle. We reviewed stretching exercises as well.

His lower back showed some joint restriction in his lumbar spine. I used spinal manipulation to restore joint mobility.

I encourage my triathletes to do more swimming and cycling than running. Both of these sports are less stressful on the body than running. They also will maintain their cardiovascular fitness.

I hope you will consider trying a triathlon. You will be glad you did.

Dr. Robert Lynch is a former president of the Maine Chiropractic Association and head of the Lynch Chiropractic Center in South Portland. “Staying in the Game” appears every other Thursday in the Press Herald. Contact him at:

drlynch@drlynch.com

The tennis season is in full swing. Many of us are playing on clay courts, both green and red clay.

Clay is my favorite surface for tennis. It’s softer and much
easier on your feet and legs than the hard surfaces of indoor and many
outdoor tennis courts.

Because the surface is soft the ball doesn’t come off the court as
fast. This can lead to longer rallies where it takes longer to win a
point. It also results in the games and sets lasting longer, which can
be exhausting if you aren’t in great condition.

I’ve been playing for years with a friend who vacations in Maine.
Whenever he’s here, we play as often as we can. He was coming to
Portland and wanted to play at my club.

Before we played he asked me to evaluate him. He was having pain in
his right shoulder blade area — a big problem, especially when he
served. He was also tight and sore on the top of his shoulder and right
lower back. This had started several months ago.

My evaluation discovered his right shoulder was much lower than his
left. There was muscle spasm on the inside of his right shoulder blade
and trapezius muscle. He also had a very tender rib attachment at his
spine.

I also found his pelvis to be unlevel with weakness of his right
gluteus muscle. His cervical spine was also restricted when he tilted
his head to the right. His core strength needed work.

Tennis is a one-sided sport. You will swing the racket hundreds of
times during a match or practice. This creates a lot of stress and
tension on the muscles of the upper back, shoulder and arm. There’s also
a tremendous amount of torque in the pelvis and hips.

I treated him with spinal adjustments to his hips, midback, neck and
ribs. This helped level his shoulders and hips while reducing the muscle
spasm and pain. I showed him a series of exercises to help balance his
muscles and strengthen his core.

The good news was he improved and hit his serve without pain. The bad
news was he won our match. I learned to evaluate and treat him after we
play!

Another player is the head teaching pro of a large New York tennis
facility. A month ago he started to have stiffness and pain in the front
of his right hip.

He was walking with a limp. He could not cross his leg. Playing was
almost impossible. He was very concerned he had degeneration in his hip
and he didn’t want hip replacement surgery.

Pain in the front of the hip with restricted motion is a reason to be worried about degenerative hip disease.

I found his hip to be very tight with spasm of the psoas and anterior
hip flexor muscles. This was restricting his hip motion. His pelvis was
locked on the right side as well.

Years of playing a one-sided sport had taken its toll. I performed
manipulation to the pelvis and deep muscle work to the hip flexor and
psoas. I gave him several exercises to do at home.

He was 50 percent better after three visits. He left for home and
would continue his exercises. He was so pleased he didn’t need surgery.

Maintaining muscle and structural balance is the key to avoiding injuries playing a one-sided sport.

Dr. Robert Lynch is a former president of the Maine Chiropractic
Association and head of the Lynch Chiropractic Center in South Portland.
“Staying in the Game” appears every other Thursday in the Press Herald.
Contact him at:

drlynch@drlynch.com

“I can’t believe the progress I have made.” This is what she said as I entered the treatment and examination room.

The timing was perfect. The Beach to Beacon 10-kilometer road race was the next day. She felt very confident she was now going to have a good race. She told me her goal and she wanted to set a personal record, even though her training was hindered.

She gave me a substantial history of right lower back pain and hamstring issues. It started a year ago, when she ran the Beach to Beacon. During the race she pulled her hamstring.

Prior to last year’s race she was having pain. It was aggravated by lying in bed on one side or the other too long. It would make her hips ache.

The pain was interfering with her running. Sitting at her desk at work also caused pain on her right sit bone, which is part of the pelvic bone.

She had tried a number of different treatments. She had a cortisone shot in her spine, physical therapy, acupuncture and sports massage. She was somewhat better but still in chronic pain.

She feels she is too young to feel this way. She wants to be active.

She can’t remember a single incident that lead to her chronic pain issues. She does give me a history of several sprained ankles.

I examined her and found her to be very fit. She has a slight bow in her legs, the left more pronounced than the right. She had muscle spasm in her right lower back and buttocks muscles. Her pelvis was rotated with a locked sacroiliac joint.

I could feel scar tissue in her right hamstring from when she pulled the muscle last year. I also found substantial loss of range of motion of her right ankle. Neurological testing for disc and sciatic nerve issues were all negative.

My diagnosis was mechanical joint dysfunction of her ankle and pelvis. This was causing motor and muscle imbalance, and it was the cause of her chronic pain.

I needed to restore the motion to her ankle. This change would alter her running gait and put tremendous stress on muscles like her hamstring. I also needed to balance her pelvis.

I manipulated her ankle and got an excellent release. I also used a special table that flexes and distracts the lumbar spine and pelvis. This helped balance her pelvis and unlock her sacroiliac joint.

I also performed deep tissue cross friction massage to breakup the scar tissue in her hamstring. She was given exercises to do at home.

She started care four weeks prior to the race. Her pelvis was more level and balanced. Her ankle range of motion was much better. Her hamstring still had a knot in it from the old pull, but it was less pronounced.

I got an email from her with an update on her results. Even though the day was very humid and her training was limited prior to the race, she broke her personal record. She was very pleased.

She was a little sore after the race. This she expected. She is going to take a week off to recover.

Chronic pain can be so frustrating for athletes and non athletes alike. It interferes with work, play and family life.

There are many causes to chronic joint and muscle pain. Finding the cause and developing a treatment plan can yield tremendous results.

“I have not been able to workout for over a month.” She has not been able to play golf. It is very difficult for her to sit at her desk and work.

Her girlfriend told her she is walking funny. Summer is going by and she wants to be outside enjoying herself.

The pain started while on vacation in the islands. She noticed carrying her purse and luggage was uncomfortable. The pain got worse on the plane. Over the next several days she was miserable.

She tells me the pain is in her lower back going into her buttocks. She also has pain in her mid back, between her shoulder blades. She has no previous history of back pain or injuries.

She did everything she could think of to avoid seeing a doctor. She took over-the-counter drugs for inflammation and pain. She used heat and ice at home. Her friends gave her their unused prescription medications for the pain and muscle spasms.

She was a former worker’s compensation adjuster and had frequently denied chiropractic treatment. Her friend recommended she make an appointment with me for an evaluation. She was skeptical.

She told me she was worried about the cost of care for her condition. She is a self-employed single mother of two. She has to purchase her own health insurance. She has a $10,000 deductible.

My examination reveals a woman that appears much younger than her stated age. She seems to be very fit. Her gait and posture are compromised. She had to swing her hip and leg around to step forward.

There is muscle spasm in her left buttocks, lumbar spine and between her shoulder blades. There is tenderness to palpation over a rib attachment between her mid back and her shoulder blade.

I tested her range of motion. Side bending of her lower back is restricted and she has lost motion in her left sacroiliac. Her reflexes and motor strength are normal. She is not pinching her sciatic nerve.

My diagnosis is mechanical lower back and mid back pain from joint dysfunction in her pelvis, lumbar and thoracic spine. Imaging studies did not appear appropriate at this time.

I recommended a short trial series of chiropractic spinal adjustments. She agreed.

This was her first time to a chiropractor. She was a little nervous and concerned that the manipulation would be uncomfortable. She tolerated my procedures very well.

She scheduled a follow-up appointment in four days.

She was so excited on her next visit.

Her pain was almost gone and she was functioning at a much higher level. “I wish I had come in to see you sooner.”

My examination revealed a significant reduction in her muscle spasm and tenderness. Her joint dysfunction and range of motion returned to normal.

I discharged her from active care with a few simple exercises.

I gave her the green light to return to all her normal activities including golf and going to the gym.

She was also surprised at how affordable the care was that she received. The high deducible for her insurance caused her to delay care and treat the condition herself.

I highly discourage patients from taking drugs that have not been prescribed specifically for them. This can be dangerous.

Many times patients just need a high-touch, low-technology approach to restore their health.

“You wrote about me.” This is what my new patient said as I introduced myself to her.

She had read my previous column about lower back and leg pain caused by the sacroiliac joint. She was one of many readers that emailed me for more information. She also wanted an appointment for an evaluation.

She has been an athlete all her life. She also has coached women’s basketball at the college and high school levels. Now all she wants to do is play golf without pain while summering in Maine.

She tells me her pain is in the right side of her back and goes into her buttocks. She has had the pain for several months. It was not going away.

I asked if there was any weakness in her leg. She said her foot feels weak at times, especially when she gets tired.

My examination found muscle spasm in the lower back and buttocks. She can stand on her heals and toes. The strength of her large toe is weak. Stretching the sciatic nerve is negative.

Overall she is a very fit and healthy woman.

I diagnosed her with a possible herniated disc in her lumbar spine. This was indicated by the weakness in her leg and was complicated by her sacroiliac and pelvic misalignment.

Not all herniated discs need surgery. Studies indicate only about three percent of patients with herniated discs require surgery. Surgery is warranted for severe and unrelenting pain or when neurological signs like motor weakness progress.

Portland is fortunate to have an excellent neurosurgical group. Our practices work well together and we often refer our patients to the most appropriate care.

I agreed to treat her. I told her we would constantly monitor her for any negative changes in her neurological signs. If this happened she would be referred for an MRI and neurosurgical consultation.

We started using chiropractic manipulation. The strength came back in her toes and her pain subsided so she could play golf in comfort.

She was thrilled. After three visits she stated “this is the best I have felt in years.”

Another patient contacted our office for an appointment after reading my last column. She is training for the Beach to Beacon 10K. She had pain in her left-lower back and buttocks.

As athletes increase the intensity of their workouts this puts more strain on their structure. If they are out of balance they are prone to injuries.

I found that her pelvis was not level. She had a weakness of the hip flexor and gluteus maximus. She had one very tender spot on the outside of her buttocks. This is the attachment of the piriformis muscle.

This muscle was described by Dr. Glazer in his column last week. He wrote how training with a properly fitted bike is so important to a cyclist with piriformis syndrome.

I recommended manipulating her sacroiliac and some sacroiliac exercises before and after each run. These exercises are easy to do and are so effective. They help heal and prevent abnormal gait issues.

On her follow-up visit the strength of the hip flexor and gluteal muscles returned to normal strength. What most impressed her was the pain in her piriformis was reduced by 50 percent after one visit. She is expecting to run a great race.

If you are training for a summer competition and your training is not going well, your structure may be out of balance. Do not postpone an evaluation. Diagnosing and correcting the problem will make your summer more enjoyable.

“My MRI and X-rays are negative.” This is a common statement from my patients with lower-back pain.

They have had a full diagnostic work-up and the findings are negative. They do not know what is wrong with them. The over-the-counter pain relievers and anti-inflammatory drugs do not work.

Now what? They do not want to take steroids or injections, and surgery is out of the question.

The pain is interfering with their work, family life and sports activity. They want to get better without drugs or surgery.

The sacroiliac joint is what allows your hips to move as you walk. This joint is where the dimples are on each side of your lower back.

They give you the wiggle in your walk, which is more pronounced in a woman. This is because a woman’s hips are wider than a man’s.

One patient told me his health care provider told him he had an iliotibial band issue, which was the reason the right side of his back and buttocks hurt. The pain also traveled down the side of his leg.

He is a friend staying at my house. He lives in Florida and has a summer home up the coast. He and I have played tennis together for years. When he is catching an early morning flight out of Portland to go to work, he stays with me.

I took him to Prout’s Neck Country Club for a tennis match. After playing, we cleaned up and I then evaluated his lower back, looking for the cause of his pain.

He is very fit for his age. He has no neurological deficits that would indicate he has a disk lesion or herniation. The range of motion in his lower back is normal. There is muscle spasm in the buttocks and tenderness over his right sacroiliac.

I found on muscle testing a weak gluteal muscle and hip flexor. There was no movement of his right sacroiliac joint. The joint is stuck.

I told him the sacroiliac joint is the cause of his back, hip and leg pain. I performed an adjustment to the joint to restore its motion. The adjustment works beautifully and his muscle strength returns to normal. The pain reduced immediately. Exercises were prescribed so he can maintain the normal function of the joint.

Another patient recently ran a 3:30 marathon. She is one of the fittest athletes for her age I have seen in my practice. Now she can barely teach her classes as a personal trainer.

She told me the pain was in her lower back and buttocks. It went into the inside of her thigh and down to her calf. She couldn’t do speed work, and teaching kick boxing classes was aggravating the pain.

I found muscle spasm in her buttocks. Her hamstring, buttocks and hip flexor were all weak. When she lifted her right knee her sacroiliac lifted. It should rock down and back, as her other side did perfectly.

I tested her for sciatica, which was negative.

I treated her with an adjustment. I will use ultrasound to reduce muscle spasm and inflammation, if necessary.

The sacroiliac joint has no disk. That is why it is difficult to image the joint and have a positive finding with MRI and X-ray. Often the patient will be frustrated there are no findings on examination to validate the pain they are experiencing.

I find the sacroiliac joint to be cause of many patients’ lower back, hip and leg pain.

I love the shoulder joint. When a patient comes into the office with pain and discomfort in their shoulder I enjoy the challenge this condition brings to me as a clinician. The shoulder is a very unstable joint. This instability is caused by its anatomy and function.

The shoulder is made up of three bones. The upper arm bone, called the humerus, the clavicle and the scapula.

It also has a number of muscles and tendons attaching to these bones. The muscles of the chest, upper arm, neck, shoulder pad and upper spine all converge in the area of the shoulder.

All this anatomy must be in perfect balance for the shoulder to function optimally. In the old days they used to call this anatomy the shoulder girdle. All this anatomy was needed to stabilize and support the shoulder like a girdle.

What makes the shoulder so unique is its range of motion. You can move the shoulder in so many directions. The downside to this motion and the workload demanded by athletes makes it vulnerable to injuries.

The shoulder can throw a baseball 90 mph. It is used to tackle a man running at full speed. It can also swing a tennis racket so you can hit a serve 125 mph over the course of 3 sets.

Injuries to the shoulders can be as simple as a strain of a muscle to more severe injuries such as fractures of the clavicle, subluxation or particle dislocation, dislocation or torn tendons.

I have patients come into the office and they have self diagnosed their shoulder pain. The most common self diagnosis is an injury to the rotator cuff or roto cuff attachment.

The rotator cuff is a tendon. Four muscles of the shoulder join together and anchor to the shoulder by this one tendon.

A blunt force or wear and tear from throwing or swinging a racket can injure this tendon.

One patient came in the office complaining of shoulder pain from pitching. He is in high school and was told he had a roto cuff injury.

Evaluation revealed his shoulder to have full range of motion. I performed muscle testing of the four muscles of the roto cuff. The supraspinatus was weak and tender to palpation. He had an elevated shoulder. His shoulder blade was out of alignment.

Treatment consisted of manipulation of the shoulder blade and the upper spine to relax the shoulder. He was given exercises with a tube to promote strength.

I spoke with his coach. We discussed his pitching motion. I want him throwing with his legs and not just his arm. He responded well and continued to pitch without issues.

Bench pressing heavy weights can also compromise the shoulder. If you bring the bar too low, so the elbow goes past 90 degrees, it puts a huge strain on the shoulder.

A patient was convinced he hurt his bicep tendon benching. He had pain in the front of the shoulder.

He is in great shape for his age but he had the range of motion of a fire hydrant. This is a problem for athletes that concentrate on building muscle without flexibility.

He strained his AC joint. This is the junction of the shoulder blade and collar bone. His anterior deltoid was weak. His bicep tendon was not involved.

I manipulated the AC joint and used ultrasound. We also recommend stretching exercise to improve his range of motion. Benching properly with less weight was reinforced.

If you take good care of this magnificent joint it will take good care of you.

Mental toughness, use it to your advantage.

He has nerves of steel. Ice water runs through his veins. He is clutch. This is what is said to describe an athlete when he excels under pressure.

He choked. He has the yips. He was wide open and dropped the ball. This is said of someone who lets the pressure of the moment get to him.

I love the title of the book “Pressure is a Privilege,” the autobiography by tennis great Billy Jean King.

She wanted to feel pressure. This is why she trained so hard. Walking onto center court for the final at the U.S. Open or Wimbledon was a privilege she earned, and she wanted to take advantage of the opportunity.

I have found you can achieve mental toughness through discipline and goal setting. You must be committed to doing what is necessary to achieve your goals.

You have to look at the demands of the competition, develop a training program and make the proper lifestyle adjustments. You have to be mindful of what you eat and drink. This is the fuel you need to run your body. No junk food.

You must remain calm under pressure and try to maintain your breathing and heart rate. You will see athletes slow down and become more deliberate as the pressure mounts.

They will take a deep breath to get oxygen to the heart and brain. This will relax them. A relaxed muscle is a stronger muscle and will respond more efficiently than a tense muscle.

A patient had been struggling with tennis elbow for seven months. His father referred him to my office.

My examination found tenderness in the elbow but he showed some muscle weakness in his grip. This indicated an irritation to a nerve in his cervical spine.

Our treatment included adjusting his elbow, wrist and upper spine, including his neck. The motor strength returned quickly and his elbow pain started to resolve.

Then I worked on his confidence. I discussed his training with him. I told him not to try and make up for lost time.

His father is an excellent player and hired a local coach. He has made some changes to his swing mechanics.

I tell him it is OK to lose a match to a much more skilled player. You should never lose to someone at your level or below. If you do, it is all mental.

One of my patients asked me to hit tennis balls with her son. He had an excellent game but he had trouble winning matches even against players he should beat easily.

In one game when he was serving, he hit two hard serves to my backhand that I could not return. The rest of the game he hit his serve to my forehand and I won the game. He was just playing, not playing to win.

I spoke to his mother and coach. They worked with him. The young man can now blow me off the court.

I have seen many athletes return to play too soon when they are injured. They end up aggravating the injury.

If you are injured, take care of your injury first. Rest and recovery are part of training.

“I have no time to exercise.”

“I can’t afford a gym membership and personal trainer.”

“The gym is too crowded.”

I have heard all the excuses why a patient can’t exercise. I want to break down the barriers so you can get the job done. Your life and health depends on it.

I hear patients tell me they do not have an hour and half to spend at the gym three to five days per week. I respond: If you are spending that much time at the gym, you are doing something wrong.

Exercise does not have to be complicated. If we make it complicated we all can make a lot of money from it.

The only equipment you need is a pair of sneakers, T-shirt and a pair of shorts. You do not need to spend hundreds of dollars on equipment to get the job done.

Your body weight is your equipment. They do not have dumbbells and treadmills in the military.

Our lives can be hectic. Let’s get the job done in the least amount of time.

I recommend to my patients that they exercise in the morning. People that exercise in the morning are the most consistent with their program.

Another benefit to exercising in the morning is you jump start your metabolism for the day burning calories for eight hours.

I recommend three basic exercises; push-ups, sit-ups and lunges.

Lunges work every muscle in the lower body. This is where you take a long step forward. Now try and bring your knee close to the floor while keeping your forward knee at a 90-degree angle.

This works the bottom of your feet, calves, thighs, hamstrings and buttocks. Hold onto a chair if necessary. You can do one lunge at a time or walk across the room.

Next is sit-ups. Bend your knees again at a 90-degree angle cross your arms over your chest and try and touch your forehead to the ceiling. This will engage all the muscles of the abdomen without compromising your lower back and neck. The last exercise is push-ups. These can be done off your toes or your knees. What is important is you keep your body straight.

This exercise involves the muscles of chest, back, abdomen or core, and your legs.

These three exercises hit the majority of your muscles, except your biceps. Unless you’re parading down the beach you do not need big guns.

One of my favorite patients owns a fabulous local restaurant with her partner. Whenever I go in for dinner, she always shares with me how her home exercise program is doing.

One time she was concerned that the back of the arms were not toned and she did not like the look. She asked if there was a way to work the triceps.

I told her to do her push-ups with her thumbs and index fingers touching each other. The next time I was in the restaurant she was showing off the muscle definition in her triceps. She was so excited that such a simple exercise yielded such big results. It only takes six weeks to see changes in your muscle tone.

The last key is cardio. Athletes with the best bodies are sprinters. High intensity, short-duration cardio creates muscle better than running or walking slowly.

“How many should I do”?

Patients always ask this question. I respond, “Who cares?” Some days you will feel strong and can do eight push-ups; other times not so many. Do the exercises until you are tired.

Start these exercises now and you will see changes in your body by Memorial Day weekend.

Stretching confuses many athletes. They want to know whether it is really necessary, and whether it will prevent injuries.

If it is necessary, when should you do it? Do you do it before, during or after your activities?

Experts have been all over the map on this issue. I remember when it was recommended that you do a deep and hard stretch before your workout. This advice led to many injuries from overstretching cold muscles and tendons.

Studies now show that it is best to begin your workout with a light warm-up. This warm-up will get blood flowing to the muscles that you will be exercising.

If you are a runner, it is best to start at 50 percent of your normal speed and then gradually increase speed. You will know you are warm when your body starts to perspire.

This is good advice for other sports as well. If you are hitting the slopes, start with a few cruising runs before you head for the moguls. Hit some tennis balls from the service line to get your legs and arms loose.

I have always had issues with stretching. I tried the hard-stretch routines before workouts, and they never appeared to prevent injuries. Those routines may have even caused a few, especially to my Achilles tendon.

I now do a very light and short stretch before any sports. I spend more time warming up, trying to get the heart rate and blood flow going before I exercise. I do a deep stretch at the end of my workout.

Sometimes I need to be reminded to slow down when I start out for a run. A former running partner who was an excellent middle-distance runner would frequently remind me to start a little slower.

As I warmed up and the sweat would start, then our pace would pick up. Usually, her pace would be faster, and I only would see her tail lights for the rest of the run.

A great warm-up, if you are going to the gym to train, is to start with a yoga routine of sun salutation. This is a series of gentle movements that wakes up your spine, legs and shoulders.

This past weekend, I showed a friend these exercises to do before golfing. He was complaining he was losing flexibility and not hitting the ball very far.

I also travel with a set of elastic bands that I recommend to patients. They are great to warm up your entire body. You can also substitute them for dumbbells.

I showed Leo how to use the straps, and he was amazed at the total body workout you get from them. This warm-up only takes a few minutes to get the heart rate up and the blood flowing to the major muscles.

Many of the old-school exercises also can get you ready to exercise. This includes jumping jacks and running in place, lifting your knees to your waist. Throw in a set of pushups for good measure.

Another exercise people forget about is jumping rope. If it is good enough for boxers, it should be good enough for you.

Listen to your body. If the exercise causes any symptoms to increase, modify or stop your program and see a health care professional.

If you are consistent with your exercise program, you will see amazing results in a short time. Your health and energy level will increase and your weight decrease.