Sports Injuries

The most common causes of golf injuries are playing and practicing too excessively, improper swinging mechanics, and little or no physical conditioning. Pain meds either over-the-counter or prescribed, bracing, and surgical procedures are how symptoms are treated instead of the root cause/s. If the cause/s are addressed then injury prevention comes naturally.

Overuse

Driving requires a great deal of effort and power that puts tremendous stress on the body. When done too frequently, injuries can result. The body can take all kinds of forces thrown at it. But there is a limit as to how much it can take before an injury occurs.

Too many swinging reps while playing and practicing could cause trauma to the muscles and connective tissues, which leads to inflammation and pain. Swinging and hitting with bucket after bucket of balls to improve performance will raise the risk of injury. Try practicing swinging without hitting any balls through imagery/imagination. This has become a standard tool utilized by athletes. Practice the perfect swing mentally without the risk/threat of overusing your arms and back.

Mechanics

Improper body and swinging mechanics can lead to injury. The constant swinging, bending, squatting, and walking places added stress on muscles that can lead to a shoulder sprain/strain, elbow pain, and rib fractures. Back injuries can happen when bending far too forward while in swinging motion. Common swing mistakes that can contribute to low back pain.

S-Posture

This can happen when golfers are told to stick out their rear but what happens is that they over arch their lower backs which cause hyperlordosis. This is known as an S-Posture and it inhibits the abs and glutes. Or this also happens with a lower crossed syndrome.

Early Extension

This is a term that comes from a forward swinging movement where the lower body does not rotate from the top of the backswing to follow-through. The hips and pelvis do not turn with the body. Spinal posture is extended, the head rises up and the pelvis moves toward the ball's position. When this happens the spine's muscles over-activate and force the spine into a fast extension. Forward movement of the lower body toward the golf ball can be a sign of early extension.

Reverse C

This happens at the swing's finish being in a full hyperextension position. It places added compression on the lower back right facet joints.

Overextending, Flexing, and twisting excessively, awkwardly, and improperly increases chances of injury. A bit of advice is to have your swing analyzed by a golf pro/instructor to make sure you have proper form and technique. Preventing back injuries can be achieved through proper body mechanics by properly lifting the golf bag and properly teeing the ball.

Conditioning

Muscles will be weak and inflexible when there is no conditioning. This causes them to become highly susceptible to injury. The spine is exceptionally vulnerable to increased pressure during a golf swing. This happens from rotating while leaning forward. When the low back and abdominal muscles do not have adequate strength or flexibility the high reps of swinging will eventually cause pain.

With a golf-specific strength and flexibility program, the risk of injury is lessened along with improved performance. Programs like these don't have to be complicated or take a long time. Stop potential golf injuries from happening by avoiding excessive practice sessions, swinging correctly, and regularly practicing golf-oriented strength and flexibility exercises.

Chiropractic Sports Injury Treatment

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Although golf is regarded by many as a 'gentle' game, the threat of back pain among its practitioners Is surprisingly high. Chiropractor, Dr. Alexander Jimenez explains the kinematics resulting in back pain in golfers...

Golf's leisurely nature clubs makes it popular with older adults who might be unable or reluctant to take a sport, where the dangers of injury are perceived as far higher. However, the quantity of physical activity required to play golf remains adequate to provide health benefits.

Surprisingly, however, the reality of golf and injury risk is somewhat different. While a properly executed golf swing might not seem particularly stressful, a number of biomechanical studies have shown that many joints and limbs are in reality moving at high velocity and during extreme ranges of motion (ROM)(1-3), which makes them vulnerable to trauma. The successful implementation of the golf swing takes a high degree of coordination, requiring many hours of training during which these movements are repeated hundreds of times to make things worse. Insert the fact that the golfers using poor swing actions are the most likely to be practicing and that faulty swing mechanics are likely to lead to an accident and you have a recipe for injury.

Prevalence Of Injury

Putting aside of being struck by a golf club, ball, a golf cart or perhaps lightning(!) Related to golf practice are likely to afflict the trunk and upper body. Studies show that elbow injuries and hand/wrist harms are quite common, affecting approximately 13-20percent and 25-30percent of golfers . Shoulder injuries are rather common, affecting around 8-18percent of amateur golfers. The corresponding figures for professional golfers tend to be considerably lower, however(4-7).

The incidence of low back pain (LBP) One of golfers by contrast is a somewhat more prevalent, and is proven to influence amateurs and professionals alike, regardless of skill levels(8).

Epidemiological studies have revealed that low back conditions account for roughly 25% of all golfing injuries(9,10) even though prevalence rates as large as 54 percent (28) are reported(11). In a 2009 literature review, colleagues and Cabri reported that trauma to the back signified the most common complaint experienced by both amateur and professional golf players.

Another study researched 196 Golfers who had only taken up the game(12). While 25\% suffered pain back during the analysis period, the majority of those participants were unaware that playing golf was linked to their LBP. The authors concluded that golf may aggravate pain due to the forceful nature of the motions associated with playing and practicing.

Benefits Of Chiropractic Care For Golfers

Demands Of The Swing

To understand how something Seemingly benign as golf can cause a high prevalence of lower back pain, so it helps to appreciate the biomechanics of the swing (see Figure 1). The golf swing involves a slow deliberate turning of the trunk from the target (the backswing) followed by a strong rotation of the trunk towards the goal on the downswing. Although there are other spinal movements present throughout the swing motion, the axial twisting forces are especially notable because this type of writhing has been identified as a substantial risk factor for low back injury disorders in occupational settings(13).

Studies investigating the axial forces at Play throughout the swing motion have produced some startling findings. Among the first studies looked at forces on the lower back during a full golf swing whilst using a five iron -- especially the compressive, shear, lateral- bending and rotational loads over the L3/4 segment of the thoracic spine(14). Kinematic, kinetic and surface EMG data was collected from four pro golfers and four amateur. Shear loads were high but were higher averaging 596 Newtons of power 329 Newtons from the pros. Loading on the other hand has been greater averaging nearly 7,600 Newtons versus 6,100 Newtons in the amateurs.

To place these loads in View, consider that forces are generated by the swing of an expert golfer around of an amateur around six times bodyweight and eight times his/her bodyweight. Think about that spinal compression forces in a runner are about three times body fat, and you may start to appreciate the issue. It's also worth noting that cadaveric studies have proven disc prolapse to occur with compressive lots of approximately 5,500 Newtons, which explains why the swing motion can boost the risk of a serious low back injury(15).

Despite the risk of acute low back injury as a result of the swing report the onset of LBP.

Insidious LBP is thought to happen as a Consequence of loading as a result of The mixture of magnitude Forces together with a high Frequency of swing repetitions. Studies Reveal that elite golfers consistently Suffer LBP during golfing activities tend To get a greater frequency of swing Repetitions (ie spend more time playing And practicing) than symptom-free Golfers(16). Cumulative loading probably Clarifies why elite players identify overuse Rather than a traumatic event because the trigger Of the LBP(17).

Asymmetry & LBP

As we could see in Figure 1, a comparatively slow backswing followed with a downswing and follow-through produces an asymmetrical back rotational velocity, leading involving the trail and lead sides. Indeed, studies show that LBP predominantly happens on the road side -- ie the right side of a right-handed golfer and radiological analyses of elite gamers have demonstrated a significantly higher rate of path side vertebral body and facet joint arthritic change than age-matched control subjects(11).

Other researchers have also noticed that both left axial rotation velocity and appropriate side-bending angles onto the downswing reached peak values almost simultaneously and after ball effect, coinciding with the point where the majority of players in their analysis document experiencing LBP(18). The implication is that a large amount of side bend angle combined throughout the impact stage damages by creating intervertebral shear, the thoracic spine. This motion is possibly harmful since it is resisted by disk strength instead of bony architecture, thereby resulting in injury and painon the road side.

One approach to decrease lateral shear is to decrease right-side bending (at a right- handed golfer). Studies reveal that elite players with LBP tend to deal with the ball with more spinal flexion -- ie they slouch longer and use more side-bend throughout the swing compared to healthy golfers(19). The good news for golfers is when setting around the ball that decreasing the amount of side-bend that is right on the downswing may be as straightforward as using position. In addition, it is important to notice longer clubs may help in this respect and that bending promotes.

The 'X' Factor

In a bid to hit the ball further and harder, a backswing, which in theory at least allows time for maximum power to be generated before ball contact is developed by many golfers. Backswing creates axial loading in the spine. Once the pelvis begins rotating towards the target a fraction prior to the acromion or shoulder line, this is particularly true during the initial stage of the downswing. The concept is to create the maximum 'X' factor stretch -- defined from the transverse plane between a line connecting the right and left anterior superior iliac spines and a second line drawn through the acromion processes. A player can increase this 'X' variable stretch by up to 19% throughout the first stage of the downswing.

The problem, obviously, is that this stretch introduces higher loadings to the backbone. A supra-maximal or over-rotation twisting of the trunk when increases the risk of spinal irritation and subsequent LBP. Moreover, many golfers are not able to replicate this amount of rotational stretch in the practice when asked to do this from a position in a moderate rate. It has led some investigators to question if the loading can be reduced.

One study found that reducing the comparative amount of spinal distress or torsion by increasing the range of hip turn during the backswing could assist in cases of golfing-related LBP(20). In another study, researchers asked whether an intense backswing was essential(21). The researchers investigated the effects of using a backswing on ball- club-head rate and contact accuracy. The results showed that restricting the backswing by nearly 20\% (thereby decreasing spinal loading) had no adverse impact on overall swing operation.

These and other outcomes have led some investigators to suggest that golfers with LBP adopt a more 'classic' golf swing -- as being used in an earlier age of the match. A reduced X factor, which decreases the following and torque stress on the lumbar spine is incorporated by the swing. This is achieved by allowing the lead heel (ie left heel in a right-handed golfer) to lift during the backswing to allow the pelvis (and not just the shoulders) to flip off from the goal.

Getting To The Core

Considering the role of trunk musculature in generating the swing movement (equally downswing and backswing), it's unsurprising that investigators have investigated whether core muscle dysfunction is implicated in golf-related LBP. Some studies do suggest that golfers with LBP appear to trigger their trunk muscles to symptom-free golfers, and it's likely that over time, these differences contribute to decreased back muscle strength and endurance.

As an example, one study found that the beginning times of major bursts of activity from a number of the abdominal muscles were delayed in the golfers afflicted LBP(22). Specifically, the direct external oblique (left in right-handed golfers) has been activated significantly later throughout the backswing from the golfers with LBP when compared to asymptomatic controls. Another study looked at EMG activity from the abdominal and back muscles of golfers with and without LBP, also discovered that highly skilled players tended to show reduced erector spinae action near the top of the backswing and at ball impact(23).

A small number of studies have compared back muscle endurance in golfers with and without LBP. For instance one study (51) investigated the total time golfers with and without LBP can maintain an isometric transverse abdominis regeneration and found that healthy golfers could keep the static contraction for substantially more than the golfers with LBP(24). This is relevant because transverse abdominis is known to be very important for shielding the thoracic spine by tensioning the thoracolumbar fascia(25).

Another study found that isometric trunk extensor (eg erector spinae) holding times for golfers with LBP was considerably lower than values reported by healthy areas(26), along with an Australian analysis on trainee golf professionals found that golfers using a path negative (ie right side to get a right-handed golfer) shortage of 12.5 seconds on the static side- bridge endurance evaluation reported more frequent episodes of moderate to acute LBP(27). Further evidence indicates that elite golfers have a tendency to have greater axial rotation strength in the way they generally swing a golf club (ie to the left for a right-handed player) and that this asymmetry or imbalance is very likely to be more pronounced in golfers with LBP(28). Together, these findings imply that most golfers, but particularly those vulnerable to LBP should execute some regular core stabilization training exercise (see Box 1).

Summary & Recommendations

It's more than likely that the regular custom of his/her sport is going to be a major element when a golfer poses with low back pain. Besides the typical treatment modalities for LBP, it is useful for clinicians to understand how the kinematics of golfing could result in LBP and what practical recommendations regarding golfing clinic could be made to individuals in order to accelerate recovery and reduce the risk of re-injury. Box 2 outlines these recommendations.

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A club golfer was cured of a nagging consistent shoulder pain. Shoulder injury chiropractor, Dr. Alexander Jimenez evaluates the case study.

Here’s a pertinent quote from the late lamented author of Letter From America, Alistair Cooke: ‘To get an elementary grasp of the game of golf, you must learn, by endless practice, a continuous and subtle series of highly unnatural movements, involving about 64 muscles, that result in a seemingly “natural” swing, taking all of two seconds from beginning to end.’

An avid club golfer with a handicap of 4 and a right-handed stroke asked for assistance with his nagging L shoulder pain that had recently become markedly worse and finally was threatening to stop him playing. He explained he knew he must have asked for help sooner, but he believed it would just go away (one of the most commonly heard statements by treating practitioners!) and it had now been hanging around for about six months in total, despite routine training.

He explained that initially it only used to damage when he caught his chipper from the grass and disrupted his follow-through, but now if he used an iron he'd feel a sharp pain unless he happened to stroke the ball flawlessly. It would also ache when he slept on the side, and after playing a full round it ached for some days. He had tried a million stretches and even appeared quite flexible with specific movements around the shoulder. In addition, for some years he had battled with R low- back pain and anterior hip pain which, when really bad, would render him limping a couple of days after an 18-hole round.

Assessment

Evaluation showed all the signs of rotator-cuff tendinitis (inflammation and microscopic breakdown of tendon), together with accompanying weakness of the muscle itself, leading, over time, to excessive anterior translation of the head of his humerus (extra shearing of the ball in his socket joint) on follow-through. This would likely cause an impingement of his already thickened tendon beneath the rectal acromial arch of the shoulder, giving him the sharp stabs of pain he complained of more lately.

His standing posture gave us the most clear clues as to why this had evolved, without ever needing to video his stroke biomechanics: rounded shoulders and a very noticeable low- rear arch (lumbar lordosis) are classic signs of poor postural control resulting in wrong movement patterns within his stroke. Gradually over time something needed to give often it's the non-dominant arm.

Had he had been middle-aged, we may have X-rayed his shoulder to search for any calcification of his tendon (he'd just turned 30), and only if progress wasn't going well would we believe doing an ultrasound scan to find out the size of scarring and limb breakdown.

Treatment

Rehabilitation could have a month or two if all went according to plan the key unknown factor is how well he'd take on the challenge of holding his shoulders and pelvis differently; this re-education procedure is frequently the most difficult. The general treatment procedure will first entail improving flexibility so that appropriate posture positions can be held most of us get stiffness in a number of our joints because of gravity wrecking our great posture.

Recent improvements in sports physiotherapy have enhanced the speed of the process significantly. Aside from a systematic stretching regime from the patient, we 'release' muscle tightness by deep-tissue massage and trigger-point treatment, heat, a home program of self-pressure massage with a tennis ball, and mobilizing of the tight parts of the capsule of the shoulder with seat-belts. Tightness in the posterior rotator-cuff muscles of this specific patient took a lot of effort to workout, and lat dorsi and pec major/minor were also big players.

Additionally, he had considerable stiffness in his thoracic spine, particularly with L rotation, which was worked loose, as were certain gluteal and hip-flexor muscles.

The Next Two Phases

Secondly, postural muscles needed to be 'turned on', ie recruited correctly, and a schedule of gradual strengthening of their ability to restrain the joints to which they're responsible began. In this instance the crucial ones were the lower and mid trapezius and transversus abdominus muscles we also taped up them sometimes to help him remember to continue using them, until it became more habitual.

Around this time, pain has gotten less and less of a problem along with his postural control was growing nicely. He was able to come back to his coach and start utilizing the positional changes in his stroke, slowly increasing the stroke distance and frequency and all the while maintaining his flexibility with the tennis ball. This third phase, which entails integrating the right posture into the stroke, has to do with the coach, and requires substantial discipline on the part of the athlete to ensure he remains inside the realms of what his brand new system can tolerate without being overloaded. Because he can still overdo it!

All went well, with all the golfer reaching one of his best-ever scores in the Queensland Open Tournament three months later. However, two weeks after that he dived badly in a game of rugby and twisted the exact same L shoulder and ripped the exact same rotator-cuff tendon he'd worked so hard to fix. Back to the chiropractor.

Choosing to receive treatment from a chiropractor won’t stop your slice or improve your putting, but it just might end up improving your overall game and lowering your score. It’s no secret that golf can be hard on your lower back. The quick, repetitive twisting motion required to swing a club puts your back at risk every time you play, and if you already have a back injury you’re putting other muscle groups at risk. Keep reading to learn how to improve your golf game in El Paso with chiropractic care.

How Chiropractic Boosts Your Game

Since a chiropractor is specifically trained to treat the entire neuromusculoskeletal system they are able to help golfers reduce the amount of stress and strain placed on their bodies. The lower back does undergo a lot of stress with the torque of a standard golf swing, but there are other body parts that can affect your golf game, too. Pain or range of motion issues in your shoulders, elbows, knees or wrists will definitely affect your swing and lead to inflated scores.

Chiropractic treatment can put your body back into alignment, remove nerve compression, and improve blood flow to vital muscles. When you are free from pain and your mobility isn’t hindered in any way, you can swing freely and focus on your game.

It All Begins With You

Although you can improve your golf game in El Paso with chiropractic, taking steps to help yourself will improve it even further. Arrive early at the course and do some warm up stretching and light swings before your game. Whether you hit some balls at the practice range or not, stretching and loosening up is key. You’ll also want to perform some light stretches after your round to keep your muscles loose and lengthened.

It’s easy to get dehydrated out on the golf course, but not drinking enough can set the stage for a strained muscle or similar injury. Make sure you drink plenty of water before, during, and after playing golf, especially if it is hot outside. If you walk the course when you play, avoid carrying your bag and pull it instead. Carrying a heavy golf bag over 18 holes can cause disc problems and irritate nerves.

If you have the option, avoid wearing metal spikes when you play. They have the potential to get stuck in the ground during your swing, causing a serious knee or back injury. And if you find that your swing is causing pain in any area of your body, consider taking lessons to learn a more efficient way to swing your clubs. If you follow these tips you’ll enjoy a pain-free round every time out.