DANIEL B. LEONARD, D.C. ART®FARABAUGH CHIROPRACTIC OFFICE

2879 E. DUBLIN GRANVILLE RD.

Low Back Pain and Golf Mechanics

Wedgewood Country Club

Dr. Daniel Leonard

Graduate of Miami University (Exercise Science Major)

Doctorate in Chiropractic and Sports Rehabilitation

Active Release Technique®Dynamic Neuromusclouar Rehabilitation

(DNS) Only physician in Columbus utilizing this technique

Back Pain in the general population

Affects 50-80% of population 40% have back pain in any one year15-33% have point incidence at any given

time

Adams, et. Al (1999)

Causation: Internal vs. External Forces

Back pain and Golf

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 injuries sustained while golfing

(US, McCarroll et al)

Overuse Injuries in Golf

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)

Golf Injuries

Main Causes of Golf Injuries

Overuse Technical errors during the swingPhysical fitness deficiencies Aerobic, muscular strength, flexibilityNo pre-game warm upNatural environmental conditions (uneven course surface, wet grass, thunderstorms)

Sports Med 1998 Jul; 26 (1)

Technical Errors during the swing

C PostureS PostureSwaySlide

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, levator scap 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- tighness 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 testThomas 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 testThoracic Rotation testGlute stability test

Hip mobility/ stretchingFoam roller/ Swiss ballGlute 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

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 testThoracic Rotation testGlute stability test

Hip mobility/ stretchingFoam roller/ Swiss ballGlute bridge

Functional Screens

Core Endurance TestSide Bridge >70 seconds linked to less injury

(McGill 2010)

Functional Screens

Thoracic Mobility

Thoracic Extension (Wall Angle)

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 testProper activation of the posterior

chain is initiated by glute activationWeak/Inhibited glutes will be

evident by over action of the lumbarextensor muscles or hamstrings

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)

Exercise

Thoracic Mobility and Thoracic Extension

Exercise

Core Endurance

Exercise

Hip Mobility

Not what we are looking for

Exercise

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

Exercise

Glute Bridge

Poor Pattern Over-activation of lumbar muscles

and hamstrings Poor control

Ideal Pattern Core activation and Glute

activation simultaneously Good control

Chiropractic and Golf

Less than 2% of golfers visit a chiropractorGolfers suffer mainly with mechanical back

pain, making golf and chiropractic a perfect match

Spinal adjustments are known to be effective in reducing pain and increasing spinal mobility

An aggressive lumbar spine rehabilitation program should be institute as both a therapeutic and preventative measure

Dyn. Chiropractic Aug 1999; 17 (17)

Chiropractic and Golf

Three fundamental causes of golf injuries: poor posture, lack of flexibility, and poor swing mechanics All of which are often a direct result of physical restrictions or

mechanical dysfunctions which can be restored with spinal manipulation and exercise

Dyn. Chiropractic 2001; 19 (26)

“Amateur golfers achieve approximately 90 percent of their peak muscle activity when driving a golf ball. This is the same intensity as picking up a weight that can only be lifted four times before total fatigue. This level of exertion and muscular activation equates golf with such sports as football, hockey, and martial arts. The difference is that other athletes outside of golf include conditioning as part of their preparation before play.”

Paul Check-Golf Biomechanics Manual

Exercise

“Exercise programs should be started until joints have a normal end feel”

(Mennel)

The EndTHANK YOU!

Dr. Daniel B. Leonard

Farabaugh Chiropractic Office 2879 E. Dublin Granville Rd.

Columbus, Ohio 43231(614)898-0787

Copyright © 2012 Dr. Ronald J. Farabaugh