May 22, 2016

Golf Specific Injury Prevention Programme

What is the Golf Injury prevention/performance program?

This golfing program is aimed at individuals who have a history of injury, are carrying an injury, have a high injury recurrence rate or those who just want to improve their golfing strength and technique.

The golf specific injury prevention program runs for 6 weeks. Individuals get a personalised program which is created following a 1-hour one-on-one initial consultation with a Physiotherapist. The Physiotherapist will do an individual assessment to look at your range and strength and will identify problem areas which can be improved in order to strengthen your golfing game. The individual will have this program to perform in their own time, as well as attending a group strengthening and mobility session once a week. This group class will be held in a gym environment and will also provide individuals with knowledge on load management and injury prevention to help them prevent risk of further injury. Individuals will notice a difference in their golfing technique, strength of their swing and their range of movement within the conclusion of the program.

Golf Injury facts

Professional Golf Association (PGA) tour players average two injuries per year with half of these injuries limiting the ability to play for an average of five weeks.
Recreational players, on average, lose approximately four weeks of playing time per injury. In terms of injury location, the lower back would appear to be the most commonly affected body part although shoulder, elbow and wrist injuries are also common.

A patient with low back pain is able to play pain free by reducing the load on his spine with a correct technique, and by strengthening weak muscle groups

During the golf swing, the force of 8x your body weight travels through the lower lumber spine causing excessive compression loading of the discs located between the bones – for comparison; running produces forces equal to 3x body weight

While a properly executed golf swing may not appear overly stressful, biomechanical studies show that many body parts are moving at high velocity and through extreme ranges of motion

In terms of spinal stress, the golf swing produces a complex loading pattern involving shear, compression and axial torsional loads with rapid changes in the direction of these forces – additional loading on the spine can be attributed to the postural strain associated with putting & compressive loading from walking & carrying clubs

The lead hip experiences a much greater rotational torque than the trail hip during the golf swing and the magnitude of forces on the knee were at least equal to those generated from running or side cutting motions. The lead knee was exposed to more varied loads and stress compared to the other knee

Many studies have shown that conditioning programmes are highly recommended for all older players irrespective of their level of participation. Not only could the programmes prevent injury, they also had the potential to improve performance.

The best approach to minimizing the risk of injury from playing golf is through injury prevention, which requires a combination of good technique, sound judgment as well as proper education and awareness.

Golf Injury prevention

Technique factors:

Many injuries arise from poor swing biomechanics, therefore taking instruction with a knowledgeable golf instructor can be an important first step towards injury prevention.

Since swing mechanics may contribute to injury susceptibility, the less efficient and inappropriate movement patterns demonstrated by less skilled recreational golfers may further increase injury susceptibility. Spinal irritation and pain could result from relative over-rotation of the spine while performing the golf swing which can occur with poor technique. Controlling spinal movement while promoting more hip turn and shortening the back swing can help to decrease the load on the lower back.

Golfers must also warm-up properly before swinging aggressively, especially with longer clubs such as a driver, otherwise injury from over-exertion could occur

Warm up:

The purpose of the warm-up is to enhance performance by physiologically and psychologically preparing the body for competition while at the same time reducing the risk of injury.

Golfers who do not adequately warm-up are 1.3 times more likely to suffer a golf related injury. Only 19% of golfers surveyed in a European study warmed up appropriately, and these golfers reported 60% less injuries than the golfers who did not warm-up.

Individually fitted Clubs:

Golf clubs represent the critical link between the human body and the golf ball. When a golfer uses clubs which are not well suited to their particular physical dimensions or swing characteristics, their body is forced to compensate. These compensations make it more difficult to swing efficiently and consistently and increase the risk of injury.

Using a club with a shaft that is 2 inches (5 cm) shorter than the recommended length resulted in approximately 4 degrees less spinal rotation at the top of the back-swing, and 8 degrees more flexion at impact

Footwear:

The average golf round requires the golfer to walk approximately 8km and is moderate intensity, long duration, interval form of exercise that can maintain & increase aerobic capacity amongst older people.

In addition to this, there is a large amount of lateral shift that can occur if the shoes are inadequate.

Load management/overuse:

Excessive golf specific practice (hitting hundreds of balls at the range) will cause muscle fatigue and the overcompensation of poor muscle recruitment patterns – this can create excessive compensation at the larger joints e.g. hips and shoulders.

Overuse through excessive practice (e.g. repetitive swings) has consistently been identified as the most common cause of injury. The ramifications of this are particularly important to senior golfers as their ability to recover from the micro-trauma associated with repetitive motions decreases with age.

Strong core control/trunk stability:

During practicing your short game such as putting or chipping, the lumbar spine is held in a fixed flexed position which can cause de-activation of the core musculature.

Adequate spinal stability is necessary to reinforce the spine to prevent segmental buckling – this is necessary to prevent low back injuries. Spinal stability is not provided by one specific muscle but rather by the coordinated efforts of the core musculature and low back stabilisers.

Poor trunk muscle endurance as well as an imbalance between flexor/extensor endurance ratios has been correlated with a history of low back pain. It has been shown that fatigue developed faster in the abdominal muscles than in the back muscles and the fatigability of the abdominal muscles in the patients with low back pain was significantly greater than that in the control group

Adequate shoulder joint control:

Control of the shoulder blade has been suggested to be necessary in the prevention and treatment of shoulder injuries. Incorrect muscle coupling can occur from sedentary jobs, and hence cause some muscles to be underactive which leads to different muscles compensating and overacting. This is evident in patients with dysfunction in the activation of the trapezius musculature which has been noted in patients with rotator cuff impingement (shoulder impingement). Activity in the trailing arm primarily occurred during takeaway, whereas activity in the leading arm occurred during acceleration. The lead side levator scapulae and rhomboid muscles also helped elevate and retract the scapula on the downswing.

Strength/Power & Mobility Training:

Resistance exercise improves the strength of the golfer and increases their ability to produce power during their golf swing. Strengthening the same muscles that are recruited within the golf swing can increase the distance the golfer can hit the ball. The strengthening exercises performed should be specific to the golfing movement and mimic the kinematics of the golfing swing. One study found large gains in leg muscle strength (approx. 50%) along with a significant increase in the maximal club-head velocity, which increased velocity at ball contact and hence resulted in several more yards of driving distance.

Limited ranges of motion/lack of mobility may be associated with decreased club speed due to decreased size of the swing arc and time to produce club speed.

Predisposing factors:

E.g. previous history of injury, sedentary lifestyle, hobbies (e.g. gardening)
These factors must be taken into consideration as well as load management to ensure decreased risk of further injury

Key anatomical/biomechanical discrepancies:

Any side-to-side discrepancies/weaknesses will be identified in your initial one-on-one screening with your Physiotherapist – this will be used to prescribe your individual exercise program in order to correct these weaknesses

Pre-season assessments:

Typically performed by a Physiotherapist with knowledge of the biomechanics of golf training and involves specific strength and flexibility testing. These assessments are used to help identify physical deficiencies that if left untreated may compromise performance or potentially cause injuries.