Returning to Golf after LBP: Restoring Your Client’s Drive without Reinjury

Golf is a popular activity, particularly in the older population which provides an opportunity to play a game that enables someone to socialize while truly enjoying the outdoors. Low back injuries are prevalent in the workplace as well as in golfers, but LBP can be prevented.

Once a client has sustained an injury, he or she is even more susceptible to another injury. This makes it even more more important for the client to be educated about his or her condition, how to strengthen correctly and how to take a holistic training approach to return to the game.

Movement Analysis: Human Movement Training for Golf1

When we look at golf in terms of the swing mechanics, it is important to understand functional anatomy and biomechanics to produce the necessary force to hit the ball.

Fig. 1. The golf swing

Source: Carr

The golf swing consists of three major phases:

1)preparation;

2)execution phase(backswing and downswing) and;

3) follow through.

Preparatory phase and setting1

The posture and alignment of the golfer influences the golfer’s ability to rotate properly, transfer weight and maintain good balance during the swing. The body must be aligned so that feet, hips and shoulders are parallel. The golfer’s left arm is straight while the right is partially flexed keeping the head positioned over the ball.

Muscles contracted: Rectus abdominis, deltoids and forearm flexors.

Backswing phase1

The purpose of the backswing is to establish a perfectly balanced powerful position at the top of the swing. Here, the hands and the shoulders must start in one motion. The weight of the feet in the stance is shifted laterally from the front to the rear foot. This shifting increases the range of hip rotation. At the top of the backswing, the shoulders are coiled, the hands are swung high and the arms are extended.

Muscles contracted: Latissimus dorsi, teres major, teres minor and quadriceps. The extensors stabilize the golf club.

Downswing-follow-through phase1

The downswing is initiated by hip rotation. At this point, the golfer must lengthen the lever arm, which results in an increased acceleration of the club head. Simultaneously while the hip turns, a transfer of weight occurs. The weight is shifted from the back foot to the front foot. This shifting of weight enables the golfer to increase the impact area and improve accuracy. When the downswing is initiated by the hips, and the turning of the hips unwind the upper part of the torso, the shoulders and arms flow easily into the swing. At the point of impact, the wrists straighten while the trunk produces the force with other muscles producing a maximum striking effort.

Restoring your client’s drive: Strengthening the “weak link”

Many muscles support the lumbo pelvic junction and contribute to its control and stability. Per the research, anatomically and biomechanically, the focus of core strengthening should focus on strengthening the weaker erector spinae/multifidi, external obliques, TVA and quadratus lumborum. There is biomechanical and motor control evidence that argues that different muscles and different control strategies may be involved in the control of different elements of stability.3

Training to Improve Spinal Stability and Prevent Low Back Injuries

Due to the muscular demands of the golf swing, training the trunk musculature improves performance and decrease injury risk. Proper spinal stability is the amount of trunk muscle co-contraction necessary to reinforce synergistic coordination between the nervous and musculoskeletal system.4

Retraining inured areas for optimal performance

In order to retrain injured lumbar musculature, three things must be taught; motor control, core and systematic strength training as described by Hibbs et al. Motor control is stability where the CNS modulates the efficient integration and recruitment of local and global muscles.

Core strength training is overload training of the global muscles which leads to hypertrophy as an adaptation to overload training. Systematic strength is overload strength training of the global muscles. Relearning motor patterns to properly recruit muscles in isolation is vital in order progress to functional positions and activities.5

In the next section, simple sport-specific exercises that you can teach the golfer client to target the “weak links” appear below.

Fig. 4. Four-point plank Fig. 5. Side plank targeting the external oblique and QL (strengthening erector spinae)
 Fig. 6. Back extension on ball Fig. 7. Diagonal D1 flexion to extension with cable
Fig. 8. Medicine ball twist-throw

Progression of golfing training

A following outline describes a 6-week return to the golf mesocyle.

Weeks 1 to 2: Relearning how to properly contact the transversus abdominis is vital.

Weeks 2 to 4: Static lumbar strengthening exercises beginning with planks and side planks are essential to rebuild the weak foundation of the lumbo-pelvic girdle. Progression can be made by increasing repetitions and/or altering the base of support(ie. four point plank with alternating leg lift)

PRE’s: Since the Lat’s are one of the primary movers in all phases of the swing, lat pulldown exercises are an excellent exercise as well as seated mid row exercise. While diagonal trunk chop simulates the golf swing. Stretching: The postural hip flexors, quadriceps and lumbar extensors are vital for golf.

Weeks 4 to 6: Oblique and dynamic core stability strengthening should be included at this stage. Examples are standing medicine ball toss in golfer’s stance, standing medicine ball toss throw(figure 8), seated on floor rapid trunk rotation using medicine ball in hands(twisted side to side) with knees bent.

Summary

Golf is a popular activity for the young and old providing an opportunity to play a game that enables someone to socialize while enjoying the outdoors. Golf requires practice, skill, finesse and most of all patience. However, it is important to understand a client’s full medical history and any injuries before designing and incorporating a regular strength training program. Core strengthening, flexibility training and practice are all key elements to help your client to play optimally without injury.

References

1. Carr, Gerry. 1997′ ‘Mechanics of Sport: A Practitioner’s Guide. Human Kinetics,’ pp. 136-137.

2. McHardy, A, MChiro, Henry Pollard, & Luo, K, 2007, ‘One-Year Follow-up Study on Golf Injuries in Australian Amateur Golfers,’ ‘ American Journal of Sports Medicine,Vol. 35, No. 8, pp. 1354.1359.

3. Hodges, P, 2003, ‘Core stability exercise in chronic low back pain.’ Orthopedic Clinical North American. Vol. 34, pp. 245-254.

4. Lehman, G, 2006, ‘Resistance training for performance and injury prevention in golf,’ Journal of Canadian Chiropractic Association. Vol. 50, No. 1, pp. 27-42.

5. Hibbs, A et al, 2008, Optimizing Performance by Improving Core Stability and Core Strength,’ Journal of Sports Medicine, Vol. 38, No. 12, pp.995-1008.

About the Author

Biography: Chris Gellert, PT, MPT, CSCS, CPT is the President of Pinnacle Training & Consulting Systems. Gellert offers educational workshops on human movement, home study courses on human movement, and consulting services. As a clinician, author, presenter, with extensive experience having treated and worked with individuals’ of all ages with various spinal injuries, post surgical conditions, traumatic and sport specific injuries in industrial rehabilitation, outpatient and private practice settings. He is presently pursuing an advanced Master’s Degree in Orthopedics/Manual Therapy in Australia. For more information, contact www.pinnacle-tcs.com or email him at [email protected].

About

These resources are for the purpose of personal trainer growth and development through Continuing Education which advances the knowledge of fitness professionals. This article is written for NFPT Certified Personal Trainers to receive Continuing Education Credit (CEC). Please contact NFPT at 800.729.6378 or [email protected] with questions or for more information.