Are you getting the best from your golf game?

Chiropractic and Golf

By: Dr. Nicholas WallWall 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/handFemales: 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, backFemales: 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

Theriault et al. 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%)

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, shoulderAmateurs: 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, shoulderFemales: 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 InjuryArea 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 performanceand 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.