G.U.R. - Golfers Under Repair

Spinal Golf Injury Rehabilitation

Golf Injuries - Cause, Effect & Management

By Sandy Jamieson, PGA Professional and Ramsay McMaster, Physiotherapist

Introduction

The Melbourne Golf Injury Clinic has assessed and treated over 5000 golfers and this article outlines a template that doctors can use in their own practice to identify the cause, effect and management of golf injuries or patients who are unable to participate in the sport of golf as a result of predisposing injuries

When analyzing different golf groups, from club players to amateurs to club professionals and tour players, it is clear that each sub-group is more susceptible to specific injuries.

This short article is to increase awareness in the sports medicine professionals and physiotherapists about the causes of golf injuries as a result of: -

1. Poor swing biomechanics
2. Swing misconceptions
3. Ineffective co-ordination of the body segments within the golf swing.
4. Muscle imbalances and postural changes associated with a dominantly one-sided sport.
5. Underlying pathological and predisposing factors that inhibit golf participation and swing mechanics

It is widely known that many medical professionals participate in the sport of golf. Therefore, from our experience we shall discuss the common golf injuries incurred, and their cause, effect and management. Outlined are two doctors who attended the clinic, one with a lumbar spine disorder, and the other with tennis elbow. We have taken them through a golf specific musculo-skeletal and video screening.

Doctor 1:

62 year old male doctor – 28 Handicapper (right handed)

Subjective and Objective Summary:

Lumbar Spine: Lx 2- 3 Lumbar spondylosis

• Prolonged sitting through desk work and driving adds up to 7 hours 30 minutes per day in fixed a dynamic flexion.

• Standing in flexion with rotation over patients 6 hours 45 minutes per day.

• Hobbies include gardening/reading /social golf. All activities in the flexed position.

• Never had a golf lesson and therefore has poor swing concepts, exceptional flexion and right side flexion at impact position. “ The Crunch Factor”.

• Has been using stiff stainless steel shafts that have not been fitted to his swing/ handicap and body type.

• No warm up routine before teeing off.

Swing Faults / Misconceptions:

The modern golf swing is sign posted by a quiet and stable lower body with the majority of the body's rotation force coming from the torso. Stiff or frozen lumber spine reduces the golfers ability to obtain the rotation needed to produce consistency and power simply.

Golfers with this condition tend to make up for the lack of spinal range by over active arm and hand actions or over active lower bodies or both. These golfers tend to lack consistency and distance.

In many cases these golfers have what is known as a reverse pivot whereby their weight moves toward the target on the backswing and away from it on the downswing.

A result of this pivot is the "Crunch Factor" at impact as the body struggles to get into some sort of effective alignment.

Common Points of Reference in regard to weakness in the Kinetic Chain:

• Hip flexors especially rectus femoris tight and shortened.

• This leads to anterior pelvic tilt and compression of the L3-4-5 and S1 vertebra.

• The compression leads poor rotation in the lumbar spine causing over compensatory movement of the more mobile thoracic spine and the lateral sliding of the hips on the back swing and follow through placing a further shearing force on the lumbar spine.

• Multifides and transverse abdominus tend to be weak and results in poor lumbar stabilization, which can lead to an exacerbation of symptoms, associated with lumbar spondylosis.

Common Physical Management:

• The physiotherapist who has an overall understanding of golf and the associated biomechanics can carry out a full musculo-skeletal screening.

• A registered club fitter or contact the PGA of Australia can also carry out club fitting.

• A referral to the local PGA Professional asking for a report in the form of a video analysis still print out can be provided.

• A gentle stretching and postural reeducation program should be commenced e.g. hip flexors, quadratus lumborum, glutei and transverse abdominus stabilization.

• Ergonomic Assessment and workplace changes are essential.

• Anti-inflammatory prescribed by the doctor

Common Technical Management – Coach's Advice:

The key to improving golfers with lack of lumbar spine rotation starts with massage, mobilisation and stretching.

This then moves on to golf specific movements where lower body rotation is restricted and the golfer is encouraged to try and create extra spinal rotation.

As a result of this a proper pivot action should start to occur where by the golfers weight will move away from the target in the backswing and towards it in the downswing.

References and further reading:

• www.golfmed.net

• The Body and Golf CD Rom - Ramsay McMaster

• Poor Motor Patterns that Cause injury and Golf Rehabilitation Exercises CD Rom - Ramsay McMaster.

• Musculo-Skeletal Injury Questionnaire for senior golfers - E. Fox, DM Lyndsay and A,A Vandervoort.

• Strength Training and Injury Prevention for Professional Golfers - J.H Hellstom

• Back Pain in Novice Golfers a One Year follow-up – A. Burdorf et el

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