Improve Golf Performance with Chiropractic
What you need to know
Golf Biomechanics and Playing recommendations
Studies evaluating calorie expenditure playing golf typically identify golf as a moderate-intensity physical activity with energy expenditure of 3.3–8.15 kcal/min A golfers total energy expenditure of 531–2467 kcal/18 holes Golfers walking 18 holes take between 11,245 and 16,667 steps Golf is a widely practiced sport, with approximately 55 million regular players worldwide . In addition to the pleasure of playing, golf has also recognised health benefits. Indeed, it has been shown that practicing golf improves mental and physical health
Phases of Swing In Gold
The 4 phases of a golf swing: - The address when the golfer is facing the ball, static and preparing for movement. - The backswing when the golfer initiates his movement bringing the club up and back. - The downswing when the golfer accelerates the club forward and downward until it hits the ball. - The follow-through starts just after the ball impacts the club and aims to stop the movement, that is, decelerating the club. Laterality Golf swing movement is highly asymmetric. The golfer laterality is defined as: - Lead side or dominant side, which is closest to the target. For a right-handed golfer, the lead side is the left side, and vice versa. - Trail side or non-dominant side is the farthest side from the target, that is, the right side for right-handed golfers. Some researchers have divided the backswing, downswing, and follow-through phases into two or three sub-phases based on nine events. Those sub-phases are: - Take away, corresponding to the initiation of the swing movement. - Mid-backswing, defined when the club is horizontal during the backswing. - Late-backswing, defined when the club is vertical during the backswing. - Top of backswing, defined as the instant when the clubhead speed starts to be oriented downward and frontward. - Early downswing, defined when the club is vertical during the downswing. - Mid-downswing, defined when the club is horizontal during the downswing. - Ball contact or impact, defined when the clubhead hits the ball. - Mid-follow-through, defined as when the club is horizontal during follow-through. - Finish, defined as the end of the movement, generally with the club up and back.
Golf Related Low Back Pain
Research studies have shown that lower back pain (LBP) from golf account for between 18% and 54% of all documented ailments, leading many researchers to regard the condition as the most common golf injury What are the forces in the spine and muscles that can cause low back pain in golfers Spinal vertebrae consist of vertebral bodies and spinous, transverse, and superior articular processes. The vertebral body has cartilaginous plates on both ends which deform under compressive load. Between each vertebra, intervertebral discs also aid with compressive force absorption. During compression, the nucleus pulposus encapsulated within the intervertebral disc presses into the vertebral body causing the cartilaginous end plates to bulge inward, compressing the calcaneus bone of the vertebral body. The processes of the vertebrae provide attachment sites for trunk flexor and extensor muscles, and inferior articular facets allow vertebral articulation. Damage to the articulating surfaces between vertebrae can lead to spondylolisthesis which often results in low back pain. The forceful nature of the full golf swing clearly incorporates large magnitude trunk, shoulder and lead hip movements Research calculated the compressive, shear, lateral-bending and rotational loads on the L3-4 segment of the lumbar spine during golf swings using a five iron Injury due to repeated loading is why LBP is frequently reported as an overuse injury rather than an acute injury in golfers. It has been further suggested that the asymmetrical pattern of the golf swing may lead to deterioration of the right lumbar spine around L4-L5 in right-handed golfers. Repeated lateral bending with simultaneous pelvic rotation may be a mechanism contributing to this deterioration Compressive forces on the L4-L5 vertebrae are the result of trunk muscle activity and GRF during the golf swing.These forces have been reported between 6.5 and 8+ times body weight immediately after impact In golfers, LBP is a common indicator of chronic injury. With improper loading patterns, repetitive stress on the tendons and ligaments connecting the gluteal and ES muscles to the pelvis and vertebrae can lead to the development of LBP. Some golfers may be predisposed to developing LBP irrespective of golf swing technique. Interestingly, body mass index (BMI) has been negatively correlated with LBP development in young golfers, while body mass was positively related to LBP.Golfers with BMI > 25 experienced more instances of LBP from mechanisms outside of golf Research looked into how much compressive load is in a golf swing and found the average compressive loads represent forces equivalent to about 8 times body weight In comparison, running produces spinal compression forces equal to approximately 3 times body weight golfers with low back pain may use key trunk muscles, such as the abdominals, differently during the downswing phase than golfers without low back pain Researches have found onset times of major bursts of activity from some of the abdominal muscles were delayed in the golfers suffering LBP. In particular, the lead external oblique (left in right-handed golfers) was activated significantly later during the backswing in the golfers with LBP when compared to the asymptomatic controls
Risk Factors for low back pain in Golf
1.It has been suggested that golfers with LBP have less abdominal muscle activity during the golf swing, which possibly results in less trunk flexion during the downswing 2.In golfers with LBP, a combination of less abdominal muscle activity with less trunk flexion could lead to less total trunk ROM and more pelvic ROM and require more rotation to be facilitated by the lumbar vertebrae 3. Improper hip strength and mobility The golf swing has asymmetrical muscular demands. During the backswing of right-handed golfers, the external rotators (e.g. glut max, glut med, psoas major and minor, and piriformis) of the lead hip are stretched eccentrically. Simultaneously, the opposite motions occur in the rear hip as clockwise pelvis rotation is restricted by the internal rotators (e.g. adductor longus, brevis, and magnus; and pectineus). Counter-clockwise pelvic rotation begins the downswing and is the result of gluteal and hip rotator muscle actions. Because these muscle actions are not equal in direction, force, or velocity, ROM deficiencies and strength imbalances can develop overtime. Limitations in hip ROM may be a product of capsular tightening 4.Lateral bending and pelvic rotation The combination of torso lateral bending and pelvic rotation, commonly referred to as ‘crunch factor,’ has previously been identified as possible contributors to low back pain development in golfers Lumbar vertebrae segments uniquely contribute to axial rotation and lateral bending motions. During trunk rotation, the L2-L4 vertebrae bend away from the direction of rotation, while L4-S1 bend toward the direction of rotation resulting in the desired trunk motion. 5. Over rotation in the Trunk. Excessive trunk rotation may indicate an effort to increase pelvis and torso separation for power generation; however, dynamically moving outside of active ROM could be detrimental to spinal health A shorten backswing that reduces trunk rotation was reported to decrease spinal loads compare to a full golf swing
Return To Play After Shoulder Surgery for Golfers
The return-to-golf rate after shoulder arthroplasty was highest after anatomic TSA (78%) compared with HA (64%) and RSA (59%). The most commonly reported duration before returning to a full 18 holes was 5 to 6 months, but patients returned to putting and chipping earlier. Overall, the studies suggested that handicap can be expected to stay the same or improve. Driving distance seems to decrease by 10 to 20 yards (9-18 m) after RSA and increase by approximately 10 yards (9-18 m) after TSA For people aged over 70 years and the indications for cuff tear arthropathy or fracture (compared with primary osteoarthritis or rheumatoid arthritis) have been negative predictors of returning to golf
Factors that contribute to low back pain in golf
A typical golf swing creates sufficient stress (e.g. compressive load) on the lumbar spine to potentially injure the intervertebral discs. LBP from golf is usually more related to cumulative load (i.e. repetition) than trauma associated with a single swing. Spinal stress from golf is asymmetrical, i.e. it primarily affects the trail side and can lead to degenerative changes of the trail side lumbar facet joints and vertebral bodies. Side bending through impact is one of the main contributing factors to trail side spinal injury / degeneration. Golfers suffering from LBP typically “slouch” more at address which may contribute to a steeper swing plane and increased lateral sheer on the downswing. Golfers with LBP may be over-rotating their spine at the top of the backswing and at the finish position. Golfers with LBP appear to have abnormal trunk muscle recruitment patterns and less muscle endurance which may diminish the ability of the lower back support musculature to protect the spine. Lead hip rotation restrictions may lead to swing compensations that in turn over-stress the lumbar spine causing LBP.
Recommendations for helping you back in golf
Get your posture scan assessment and ROM assessment at Health Wise Chiropractic to see where there may be poor spinal or muscle hygiene Improve trunk rotation flexibility to help control relative over-rotation of the spine during the golf swing. Allowing the lead heel to lift slightly at the completion of the backswing may avoid excessive spinal torsion by allowing more pelvic turn. Asymmetry in trunk rotation forces between the back and down-swings may create an adaptive asymmetry in trunk rotation strength between the lead and trail sides in golfers who play and practice a lot. Golfers should therefore be encouraged to take practice swings both left and right handed. Maintain good hip rotation mobility especially on the lead side. Warm-up for more than 10 minutes prior to playing and practicing and don’t carry clubs on shoulders when playing. Push carts or caddies are preferable. Consider “free-release” or rocker-soled “unstable” shoes to help alleviate LBP.
Knee Injuries in Golf
Lead knee is subject to a higher magnitude of stress and more demanding motions than the trail knee. The occurrence of knee injuries related to golf ranges from 3 to 18% of all injuries, with older players generally demonstrating a higher prevalence of injury. The mechanisms contributing to knee injuries during golf are unknown, but reports from the literature suggest that high joint loading and complex motions may increase risk of injury, especially in the lead (target-side) knee. Chronic (pain over 3 months) and acute injuries are commonly reported in golf, with the lower back and the knee accounting for the majority of chronic injuries
Upper Body Injuries in Golf
A study into Australian golfers found the Incidence rate of golf injury was 15.8 injuries per 100 golfers, equating to 0.36 to 0.60 injuries/1000 h/person. Elbow and forearm injuries were second most common (17.2%), and shoulder/upper arm injuries (11.8%) were fourth most common. Almost half the injuries were sustained during the golf swing, mostly during ball impact or follow-through. Recurrent injuries were most common, and it was more likely that injuries occurred over time as opposed to acutely. In many instances, the golf swing exceeds 100mph in an effort to drive a ball more than 300 yards . The golf swing is idiosyncratic to the golfer and there is no “right” way to swing a golf club. The upper body, including the cervical and thoracic spine, shoulder, elbow, and wrist, are common areas for injury related to the golf swing to occur. That is why we urge all golf players to come to our Chiropractic clinic to check their muscle and spinal hygiene to see where flaws may be occurring that need to addressed. Amateur golfers, in contrast with professional golfers, had more muscle activity in the pronator teres of the trail arm in the forward swing phase and a trend toward increased activity in the acceleration phase. Professional golfers, in contrast, had more pronator teres muscle activity of the lead arm in the acceleration phase and a trend toward increased activity in the early follow-through phase. Professionals also swing with greater clubhead speeds and, as previously noted, have increased playing volume per week. For instance, it was noted that greater than 70% of professionals hit more than 200 balls per week, whereas less than 20% of amateurs hit the same amount per week
Types of Injuries in Golf that occur in the upper body
Neck : - Spinous process avulsion fracture - Cervical disc tear and herniation - Cervical facet sprain or arthritis Cervical ligament, muscle or fascial pain Shoulder - Labral injury - Biceps tendinopathy - Glenohumeral instability from injury to the labrum or capsule - Acromioclavicular joint sprain or arthritis - Rotator cuff tendinopathy and subacromial impingement Glenohumeral osteoarthritis Back - Thoracic disc tear and herniation - Thoracic facet sprain or arthritis - Asymmetric thoracic osteophytosis Thoracic ligament, muscle or fascial pain Elbow and Wrist - Lateral epicondylitis Medial epicondylitis - Hook of the hamate fracture - Extensor carpi ulnaris tendinitis or tenosynovitis or subluxation Flexor carpi ulnaris tendinitis or tenosynovitis
How phases of swing can cause problems in your body
Phases of the Swing When thinking about a golf-related injury, particularly as it relates to the cervical and thoracic spine along with the shoulder, elbow, and wrist, it is important to think about the phases of the golf swing . Identifying the phase of the golf swing where a golfer feels pain may lead to more specifically identifying the diagnosis and a potentially modifiable swing adjustment to decrease pain. There are three separate pairs of actions that occur in six phases of the golf swing There is the ball address (starting position) and the backswing, the forward swing up to ball impact which includes club acceleration, and then the complete follow-through (end of swing). Each phase of the swing involves the use of specific muscles and joints whose main functional purpose is to create a multi-lever system that generates maximal speed from the clubhead in a precise trajectory and in a wide arc of motion to hit a fixed object on the ground. Overextended straight arms or locked elbows and abnormally high muscle tension in the forearms from a tight grip reduce effectiveness in creating speed in the downswing and can induce elbow and wrist injuries at ball impact . A grip without interlocking hands or too loose a grip increases the danger of dropping the club, causing a loss of precise ball impact and injury to the elbow, wrist, or hand with ground impact.), an excess backswing can increase stress in the left thumb and right wrist). Excess arm/shoulder elevation on the backswing, with the left arm crossing the left shoulder, impinges the subacromial soft tissues, such as rotator cuff tendons and bursa, and it requires optimal stabilization from the rotator cuff muscles. In the forward swing and acceleration phase, thoracic and abdominal muscle strains can occur after vigorous trunk rotation on the downswing. At the ball impact phase, lateral or medial epicondylitis can occur if the grip is too tight or the elbows are held too tightly or are overextended. Excessive wrist flexion/extension in the downswing, or hitting the ground after losing balance, can cause serious hand and wrist injuries. In the early follow-through phase, shoulder ligaments and rotator cuff muscles can experience excessive mechanical stress in a vigorous follow-through. Injuries in the late follow-through phase typically occur in the low back and lower extremities. Having the golfer bring a video of their swing to their appointment or asking them to demonstrate their swing can be very helpful in identifying the diagnosis and also potentially the etiology of a golf injury.
Golf warm up Suggestions
Core and Gluteal Strengthening : A. McGill Big 3 (curl-up, side-plank and “bird-dog”) These exercises work on core stability with the abdominal bracing concept while sparing the spine of excessive load. Go through the circuit 3 times with 10 reps per exercise each circuit. B. Basic squat with push-hands or hold a golf club across the shoulder blades (similar to bend-the-bar technique) and connect a belt above knees. Start with bend-the-bar technique (with the golf club serving as the bar) to activate the latissimus muscles and belt above knees to activate gluteal muscles. Hip hinge to activate the gluteal muscles and spare the knees. As you go through the squat, pull down on the club for latissimus activation, and spread the floor with the feet and push out with the knees for further gluteal activation. Spend 6 seconds down and 2 seconds up, slow to fast. Stop lowering when the lumbar spine flexes. Complete three rounds with 10 repetitions per round. Get the Lower extremity mobilised A. Place hands on golf club and place club across shoulders and plant your feet as if you were going to squat. Rotate your hips to each side, think of pointing your belt buckle to the right and to the left. Slightly roll onto the inside and outside of the feet as your twist. Try completing 3 rounds and 10 repetitions each way. B. Repeat the first exercise but this time one leg at a time with the other leg just having the big toe touching the ground, as opposed to the whole foot flat on the ground. Recommend 3 rounds and 10 repetitions each way. Get the upper back and shoulder mobilised A. Clasp hands behind your head. With hands behind the head, raise your elbows upward to activate the thoracic back. You can also stand to the side of the golf and lean into the cart. Hold for 5–10 seconds, repeating 5–10 times. B. Hinge slightly at the hips like you are addressing a golf ball. Clasp hands behind the head and bring elbows together and then spread them apart. Recommend 3 rounds and 10 repetitions each round. Get the elbow and wrist moving Extend, flex, ulnar and radial deviate (up, down, side-to-side) the wrist both without resistance first. After one round, add resistance by holding a golf club in the hand. Recommend 3 rounds per hand and 10 repetitions (one repetition includes all four directions). Get the whole body moving Brace your core and push hands into hips to extend hips back to activate the back muscles. Lift one leg off the ground, reaching back behind you. Slowly rotate the leg internally and externally. Practice 10 repetitions (1 internal and external rotation) for 3 rounds. Repeat on other leg. If unable to maintain balance with the leg reaching in the air, toe-touch the reaching leg to the ground to help maintain balance.
Neuromuscular Training for golfers
Horizontal bench press3 sets × 5 repetitions × 80%/4 min Seated row machine3 sets × 5 repetitions × 80%/4 min Leg press machine3 sets × 5 repetitions × 80%/4 min Seated calf extension3 sets × 5 repetitions × 80%/4 min Triceps cable push-down3 sets × 5 repetitions × 80%/4 min Explosive Strength Training Combined exerciseSets/Repetitions/Load/Repetitions/Rest Between Sets Horizontal bench press + plyometric push-ups3 sets (6 repetitions × 70% + 10 repetitions)/4 min Seated row machine + explosive pull-downs3 sets (6 repetitions × 70% + 10 repetitions)/4 min Leg press machine + vertical jumps over hurdles (45 cm)3 sets (6 repetitions × 70% + 10 repetitions)/4 min Seated calf extension + vertical jumps over hurdles (45 cm)3 sets (6 repetitions × 70% + 10 repetitions)/4 min Triceps cable push-down + plyometric push-ups3 sets (6 repetitions × 70% + 10 repetitions)/4 min Golf-Specific Strength Training ExercisesSets/Repetitions/Rest Between Sets Golf drives with weighted clubs3 sets × 10 repetitions/4 min Accelerated drives with an acceleration tubing club system3 sets × 10 repetitions/4 min
Flexibility and strength ideas for golfers
Flexibility For golfers, a lack of flexibility in the hip flexors and limitations of internal rotation correlate with injuries to the low back. Golfers should therefore perform daily stretching of the hip flexors and internal rotation of the hip Golfers may also find it useful to stretch for trunk rotation and basic overall shoulder flexibility as well, given that these areas are also integral to the swing. Stretching should be performed for 1 set of 30 seconds at least once a day. Because static stretching during warm-up can be detrimental to performance, research recommend dynamic stretching before an event, such as trunk twists and walking knee to chest. Strength A basic routine addressing all major muscle groups should provide the foundation for the program. For the legs, this includes a combination of front squats and dead lifts. It also includes variations of the bench press and rows for the upper body while setting aside time for the all-important scapular stabilisers and rotator cuff A flexible bar overhead is oscillated for 30 seconds while holding the arm statically against a resistance band or tubing. Because muscular endurance capacity is a major factor in golf, all exercises should be performed in the 15-repetition range, focusing on maintenance of form over any other variable. Although core strengthening is part of the above-mentioned activities, the higher demand on the trunk during the golf swing justifies specific core stability exercises, such as plank and rotations. The ability to hold the plank position for 60 seconds is ideal for the amateur golfer
Tips for older adults playing golf
Lower Body Joint Moments during the Golf Swing in Older Adults Several joint moments during the golf swing on the lead side (external knee valgus, hip adduction, hip extension) and the trail side (knee flexion, hip adduction, hip extension) were greater than the moments on the joints during gait and sit-to-stand. Several joint moments during the golf swing on the lead side (external knee valgus, hip adduction, hip extension) and on the trail side (hip flexion) were correlated to club head speed. When golfers choose to take a cart when playing golf, understandably they will walk a much shorter, but still considerable, distance (3.18 km) This large valgus load on the knee joint has been prospectively linked to degenerative disease in the lateral knee compartment and anterior cruciate ligament injury These data suggest that the golf swing could be painful and/or slow the healing/rehabilitation process in those with lateral compartment knee pathology or ACL injury. This valgus moment on the lead knee in the golf swing peaks in the early part of the downswing, but the mechanics of how this moment is produced is variable amongst the participants in the study.
