Are you getting the best from your golf game? Chiropractic and Golf By: Dr. Nicholas Wall Wall Chiropractic The Golf Swing • Setup – Posture – Training • • • • • • Backswing = Loading mechanism Top Downswing = Explode Impact = Sequence Follow through = mimic takeaway Finish = Deceleration Mechanism of a swing • Arm Abduction and Adduction • Shoulder Rotation – Internal/External • Flexion – Knees – Back – Arms • Extension – Back – Arms – Legs • Abdominal Core Swing Styles • Two main styles – Classic – Modern Modern Swing • Large shoulder rotation • Minimal hip rotation • Supposed to increase chance of striking ball with a square club face – ↑ Power – ↑ Distance • Increased separation angle – shoulder/hip separation • Causes increased lateral bend (crunching) • Overextension of spine Classic Swing • Balanced hip and shoulder rotation • Decreased separation angle • Decreases lateral bending (↓ crunching) – Lowers amount of torque on lumbar spine – Balanced, upright form on finish • Studies have shown this swing can reduce incidence of low back pain Posture • • • • Neutral spine Hip flexed Knees slightly bent T/S extended with chin tucked • Arms hanging straight down, relaxed Posture • Mobility – Feet – Hips – Thoracic Spine • These three are the key areas of the body that must be mobile and controlled, or problems arise • Many injuries can be traced back to poor posture – Training the body – Rehabilitation Stabilization • • • • • • Internal/External Obliques Quadratus Lumborum Erector Spinae Multifidi Rectus Abdominus Hip – Gluteus maximus The Feet • Dorsiflexion- 8 inch step down • Pronation- Talus must adduct and internally rotate • Calcaneal (Heel) eversion • Golf is one of the only sports that generates an explosive force with both feet on the ground at all times – This requires very mobile feet since they are locked onto the ground – Albert Pujols The Hips • During the Back Swing, both hips internally rotate – The Femur moves faster than the pelvis on the front leg, giving relative internal rotation • Hip internal rotation turns on our most powerful force producers, our anterior and posterior muscle slings • Internal rotation of the hips loads our gluteal and abdominal muscles • This activates the anterior and posterior oblique sling muscles, producing a concentric moment of force, the explosion or downswing. • If the calcaneus doesn’t evert, we will not be able to internally rotate our hips, causing a slide or sway, which makes it near impossible to get back to our original setup position. Thoracic Spine • To end range load our Anterior sling muscles, we must EXTEND and rotate through our T/S. • T/S extension is necessary to retract our scapula, stabilizing it – This “sets” the club at the top of the back swing – At this point, the T/S is extended, rotated and laterally flexed • Separate our arms from our body, POWER! Swing and Impact • Counternutation of Sacrum and hip extension • Supination of both feet • Abdominals eccentrically controlling lumbar spine extension Follow Through • Abdominal Eccentric control of lumbar extension • Hip extension • Hip internal rotation • Feet Supination • Thoracic spine extension and rotation • Left scapula retraction • Right scapula protraction Injury • What areas are most commonly injured when playing golf? - Low Back - Elbows - Wrists - Shoulders - Neck - Knees (Tiger Woods) Why? • Why do we get injured? – – – – Improper biomechanics* Repetition Overuse* Bad luck • Most golf injuries are repetitive microtrauma injuries, joints and muscles become overloaded by excessive forces and motions and symptoms present – – – – Look for the areas not moving enough and find out why they are not moving. The most common locations for these dysfunctions are the HIPS, FEET, and T/S! The body must work together as a whole to avoid injury. Chiropractic!!! • Acute trauma can occur, as in the classic “fat” shot and wrist injury Study Source of data No. of respondents Most common injuries Mechanisms/comment McCarroll et al. Amateur (942 males, 202 females) 1144 (942 males, 202 females) Males: low back, elbow, wrist/hand Females: elbow, low back, shoulder Excessive play, poor swing mechanics, hitting the ground, 50% of all injuries occurred at impact Batt Amateur 193 (164 males, 29 females) Males: wrist, back Females: elbow Incorrect swing/miss-hit (affecting wrist), overuse type injuries Nicholas et al. Amateur 368 47.6% had been struck by a golf ball in lower extremity, followed by trunk and upper extremity injury sites Most serious injury being struck by a golf ball, contusion followed by concussion and fracture were most common 528 (347 males, 181 females) Upper limb (42.4%), spine (39.7%), lower limb (17.9%) Technical injury (53.9%), overextertion of trunk during swing (30.8), overuse (14.1%) Theriault et al. Burdorf et al. Back pain in beginner males 196 Baseline survey: life-long cumulative incidence of back pain was 63%, 28% had a history or back pain within 1 month prior to answering the survey Those that were athletes had increased odds ratio of 2.1:1 to previous back pain compared with non-athletes Gosheger et al Amateur and professionals 643 amateurs (70.9% males), 60 professionals (90% males) Professionals: back, wrist, shoulder Amateurs: elbow, back, shoulder More than 80% of injuries were attributed to overuse in the back, shoulder, knee and elbow McCarroll and Gioe Professional 226 (127 males, 99 females) Male: low back, wrist, shoulder Females: wrist, low back, hand Sugaya et al. Low back pain among elite/professional 283 (115 regular tour males, 55 senior tour males, 113 tour females Low back, followed by neck/high back and elbow and shoulder equaly 72% experienced injuries that caused them to miss a tournament or perform at a lower level, mostly due to back and upper extremity injuries McNicholas et al. Sports medicine clinics data collection 286 Most common site was reported as upper limb, followed by trunk and knee Nearly 90% were recreational golfers. Of the upper limb injuries, lateral epicondylitis was most common, followed by shoulder impingement and medial epicondylitis Finch et al. Sports medicine clinics and emergency depts 34 Lower back, elbow and knee Overuse, a twist or rotational component of the swing, poor swing mechanics, aggravation of previous injury. Elbow injury due to overuse (2/3) and missed hits (1/3) Incidence of Injury Area Amateur % Professional % Male % Female % Low back 15-34 22-24 25-36 22-27 Wrist 13-20 20-27 18-28 12-36 Elbow 25-33 7-10 8-33 6-50 Professionals • Wrist • Low Back • Mechanism – Repetition – Hitting something other than golf ball Amateurs • • • • • Elbows **** Low back Wrist Shoulders Mechanism – Poor mechanics **** – Overuse – Hitting the ground Low Back • Most common injured area • Mechanism of injury: – Setup: Extension or flexion? Too much rotation? Combination? • Reverse pivot swing fault • Early extension swing fault • Sedentary lifestyle Low Back • Why is it getting injured? – Compensations: • Tight hips: poor loading during backswing, poor glut max and med function • Tight t/s: must be able to extend and rotate • Stiff ankles: poor dorsiflexion and subtalar joint eversion – Muscle Imbalance • Abdominals: stabilize the spine, rotate around a stable L/S • Gluts Max: control weight shift to back leg, control femur internal rotation, proper loading for power and control • Scapular stabilizers: serratus anterior, middle and lower trap – ADLs and function Elbows • Amateurs/Professionals – Golfer’s elbow (medial epicondylitis) – Tennis elbow (lateral epicondylitis) • Mechanism of Injury: – Overuse of the wrist extensors eccentrically slowing down wrist flexion and pronation. – Casting swing fault. – Scooping motion at impact. – Slicing shot pattern. Wrists • Cartilage weakness/Hook of Hamate fx – Swing faults of Casting or Over the Top (compression of cartilage during ulnar deviation) – Hitting a fat shot, causing fx • Lack of: – Spine extension – Hip internal rotation – Hip extension – Tight pecs/lats. How do you prevent injury? • Know your weakness areas – Golf swing – Loss of function • Correcting weaknesses – Lessons – Chiropractor • Exercise/Rehabilitation • Keys to successful rehab: – Are you working on the key link? – Does your rehab mimic golf? – You must know golf biomechanics to understand how injuries occur! Injury Prevention • Go see your chiropractor!!!! • Education • Pre-game Stretching • Training Low Back • Chiropractic adjusting • Core Musculature – Exercises • • • • Bridge Side Bridge Cat-Camel Bird Dog • Glut Musculature – Exercises • Glut Bridge • Bird Dog • Wobble Board Thoracic Spine • Adjust for extension • Exercise ball mobilization • Bruegger’s posture • Stretch tight muscles - Pecs, lats Elbow/Shoulder • Elbow – – – – Chiropractic Adjustments Exercise ball throws Thera-band Hip and T/S mobility • Shoulder – – – – Chiropractic Adjustments Hip and T/S mobility Thera-band Lawnmower pulls Wrist • Chiropractic Adjustments • Strengthening – Thera-band – Broccoli stretching – All ROM • Stabilization – Thera-band – Wood chops – Bracing • Training hips and T/S References • McHardy A, Pollard H, Luo K. Golf Injuries – A Review of the Literature. Sports Med 2006; 36 (2): 171-187 • Lehman G. Resistance training for performance and injury prevention in golf. JCCA 2006; 50(1):27–42. • Gluck GS, Bendo JA, Spivak JM. The Lumbar Spine and Low Back Pain in Golf: A Literature Review of Swing Mechanics and Injury Prevention. The Spine Journal 2008; 8 (5): 778-88.