Low Back Pain and Golf Mechanics Mohamad Zein DPT

Back Pain in the general population Affects 50-80% of population 40% have back pain in any one year 15-33% have point incidence at any given time Adams, et. Al (1999)

Causes: Internal vs. External Forces Internal Causes Joint Fixations forcing motion into hyper-mobile segments Improper usage of muscles for stability (imbalance) External Causes Posture Repetitive bending Prolonged flexion Poor workout regimes Trauma

LBP Related Golf Injuries Main Causes: Overuse Technical errors during the swing Physical fitness deficiencies: Aerobic, muscular strength, flexibility… No pre-game warm up Natural environmental conditions (uneven course surface, wet grass, thunderstorms) Sports Med 1998 Jul; 26 (1)

Overuse Golf injuries originate from an overuse or from a traumatic origin (Theriault, Lachance) Amateur golfers were prevented from playing golf for an average of 5.2 weeks per year due to chronic back injuries sustained while golfing (US, McCarroll et al)

Overuse Amateurs desire to hit the ball as vigorously as the professionals but without the same technical refinement Most common area affected in the lumbar region: Paraspinal muscles, intervertebral disks, vertebral ligaments, facet joints and posterior arc (spondylolysis) (Theriault, Lachance- Golf Injuries)

The Swing Phase Preparation Backswing Downswing Impact Follow through

Biomechanics of Golf Balance Accuracy Summing Momenta Generating Momentum Swing plane Common errors Swinger

Biomechanics of Golf Balance Height of the Centre of Weight also determines the security of the balance The lower the centre of weight, the greater the stability of the body The higher the centre of weight, the less stability of the body

Biomechanics of Golf Balance Centre of Weight is found directly in the centre where the weight around it is the same The Centre of Weight changes as the body changes position The Size of the Base of Support determines how stable the body will be in a given position If the Centre of Weight moves outside the Base of Support then the body will become more unstable

Biomechanics of Golf Accuracy Sideways Accuracy can be achieved if the arc of the swing is kept in vertical alignment with the target. Errors in sideways accuracy Unintentional Slice – open clubface Unintentional Hook – closed clubface Errors caused by swing plane of club and club face angle

Biomechanics of Golf Accuracy Height Accuracy in a golf swing can be achieved if impact is made at any point on a straight or direct line to the target. Errors in height accuracy Topping/thin contact Fat contact – hitting ground b4 ball Errors caused by change in height of center of gravity

Biomechanics of Golf Momentum Summing Momenta Generating Momentum Use of Body Segments Optimum Stretch Sequence of Movement of Body Segments Optimum Contribution of Body Segments Range of Motion

Biomechanics of Golf Momentum Time Velocity trunk upper arm forearm hand To get the maximum momentum from a golf swing a large number of body parts are required. “Starting with the major body parts → smaller parts until just before impact.” (B. Abernethy, 2000) This increase the acceleration and therefore force on the ball.

Biomechanics of Golf Swing Plane The swing plane of the golf club follows a circular path. Errors in swing plane cause errors in: Height accuracy Sideways accuracy “Poor balance will always alter a golfer's swing plane, causing many errant shots” (Steve Bishop, 2008)

Kinetic Chain (system of links) Specific motions at certain segments of the kinetic chain have a dramatic effect in movement of other joints (or lack there of), and the turning on or off of certain muscles (Gray seminar 2005)

Biomechanics of Golf Common Errors Biomechanical Principles The No power/distance Topping/Fatting the ball Air swing Incorrect flight path of the ball Lifting body Feet Move Summation of Forces & Generating Momentum Height Accuracy & Height of Centre of Weight “same as above” Stance & Sideways Accuracy Height of CoW Base of Support

Technical Errors during the swing Observe Detect Assess Correct RE-Assess C Posture S Posture Sway Slide

C Posture Slumped shoulders at address and roundness to your thoracic spine Limited thoracic extension Upper cross syndrome-muscle imbalance, tight pecs, lats, upper traps, elevator scapula and weakness in mid scapular muscles, lower traps, and deep neck flexors Instability of core muscles causing poor posture and a slouched forward position at address Lack of thoracic spine extension relates to increased lumbar and cervical spine motion

C Posture Functional Screens Exercise Examples Thoracic Extension/ Wall Angle Foam Roller/ Swiss ball extension

S Posture Too much arch in the low back as a result of sticking your tail bone out too far (“J-Lo booty”) Lower cross syndrome- tightness in the hip flexors and lower back and weakness in the abdominals and glutes Lack of abdominal endurance/ strength This excessive curvature in the low back puts abnormally high stress on the lumbar joints, disks, and musculature You can successfully stick your butt out at address and keep your spine in a neutral position if you hinge from your hips. This requires good core strength and proper stabilization, the problem arises when this isn’t true and the force is generated in to the lumbar spine.

S Posture Functional Screens Exercise Examples Core endurance test Thomas test Side bridge Tri planar psoas stretch

Sway Excessive lower body movement away from the target during your back swing that forces your weight to the outside of your back foot Very difficult to attain proper weight shift during the transition and the downswing Proper rotation around the back hip is only possible if adequate amount of internal rotation exists. If the body is unable to rotate around this hip then lateral movements will dominate the pattern Secondly the ability to separate your upper body from lower body allows the lower body to laterally stabilize while rotating during a large shoulder turn. Limited trunk to pelvis is usually caused by reduced spinal mobility Finally, the ability to laterally stabilize your right leg during the downswing is directly dependant on the strength and stability of your gluteal musculature

Sway Functional Screens Exercise Examples Hip rotation test Thoracic Rotation test Glute stability test Hip mobility/ stretching Foam roller/ Swiss ball Glute bridge

Slide Excessive lower body lateral movement towards the target during your downswing Stability on the lower body is crucial in order to accelerate during the downswing Once the lower body starts its forward shift into the downswing its job is to transfer energy to the upper body and stabilize the extreme rotary forces that are created in the upper body. If there is no stable platform to rotate around, players will lose power and try to develop speed in an inefficient sequence

Slide Proper rotation around the front hip is only possible if adequate amount of internal rotation exists. If the body is unable to rotate around this hip then lateral movements will dominate the pattern Secondly the ability to separate your upper body from lower body allows the lower body to laterally stabilize while rotating during a large shoulder turn. Limited trunk to pelvis is usually caused by reduced spinal mobility Finally, the ability to laterally stabilize your right leg during the downswing is directly dependant on the strength and stability of your gluteal musculature

Slide Functional Screens Exercise examples Hip rotation test Thoracic Rotation test Glute stability test Hip mobility/ stretching Foam roller/ Swiss ball Glute bridge

Functional Screens Core Endurance Test Side Bridge >70 seconds linked to less injury (McGill 2010)

Thoracic Extension (Wall Angle) Functional Screens Thoracic Mobility Thoracic Extension (Wall Angle)

Hip Mobility (internal/external rotation) Functional Screens Hip Mobility (internal/external rotation) Ideal hip rotation 45º internal 45º external rotation Artifically increasing hip stiffness in normal subjects caused profound changes in the profile of trunk movements and balance control (Gruneberg, 2004) “I am continually surprised at the number of people with back troubles who also have hip troubles” (McGill, 2005)

Functional Screens Glute Stability test Proper activation of the posterior chain is initiated by glute activation Weak/Inhibited glutes (Glute Amnesia) will be evident by over action of the lumbar extensor muscles or hamstrings

Thomas Test (hip extension) Functional Screens Thomas Test (hip extension) Hip extension is directly related to lumbar spine function If tightness is present in the hip flexors (psoas muscle) in order to get extension, the lumbar spine has to continually over extend to compensate= excessive wear on the posterior elements of the lumbar spine

Treating functional findings Lumbar aliments commonly seen in golfers will be clinically improved by rest, manipulation, traction, and a good lower back rehabilitation program designed to regain maximal flexibility and strength (Sports Med 1998 Jul; 26 (1)

Exercises Thoracic Mobility and Thoracic Extension

Exercises Core Endurance

Exercises Hip Mobility

Exercises Tri-planar psoas stretch Tri planar stretching allows the muscle to be stretch in all planes where as static stretching only accounts for one plane

Exercises Glute Bridge Poor Pattern Ideal Pattern Over-activation of lumbar muscles and hamstrings Poor control Ideal Pattern Core activation and Glute activation simultaneously Good control

Exercises Golf Squat Over Head Lunges Quads Hams Glutes Core Torso Shoulders: stability/strength Triceps Grip

Take Home Message “Exercise programs should be started until joints have a normal end feel” (Mennel)

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