Are you getting the best from
your golf game?
Chiropractic and Golf
By: Dr. Nicholas Wall
Wall Chiropractic
The Golf Swing
• Setup
– Posture
– Training
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Backswing = Loading mechanism
Top
Downswing = Explode
Impact = Sequence
Follow through = mimic takeaway
Finish = Deceleration
Mechanism of a swing
• Arm Abduction and Adduction
• Shoulder Rotation – Internal/External
• Flexion
– Knees
– Back
– Arms
• Extension
– Back
– Arms
– Legs
• Abdominal Core
Swing Styles
• Two main styles
– Classic
– Modern
Modern Swing
• Large shoulder rotation
• Minimal hip rotation
• Supposed to increase chance of striking ball with
a square club face
– ↑ Power
– ↑ Distance
• Increased separation angle – shoulder/hip
separation
• Causes increased lateral bend (crunching)
• Overextension of spine
Classic Swing
• Balanced hip and shoulder rotation
• Decreased separation angle
• Decreases lateral bending (↓ crunching)
– Lowers amount of torque on lumbar spine
– Balanced, upright form on finish
• Studies have shown this swing can reduce
incidence of low back pain
Posture
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Neutral spine
Hip flexed
Knees slightly bent
T/S extended with
chin tucked
• Arms hanging
straight down,
relaxed
Posture
• Mobility
– Feet
– Hips
– Thoracic Spine
• These three are the key areas of the body that must be
mobile and controlled, or problems arise
• Many injuries can be traced back to poor posture
– Training the body
– Rehabilitation
Stabilization
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Internal/External Obliques
Quadratus Lumborum
Erector Spinae
Multifidi
Rectus Abdominus
Hip
– Gluteus maximus
The Feet
• Dorsiflexion- 8 inch step down
• Pronation- Talus must adduct
and internally rotate
• Calcaneal (Heel) eversion
• Golf is one of the only sports
that generates an explosive force
with both feet on the ground at
all times
– This requires very mobile feet
since they are locked onto the
ground
– Albert Pujols
The Hips
•
During the Back Swing, both hips
internally rotate
– The Femur moves faster than the
pelvis on the front leg, giving relative
internal rotation
•
Hip internal rotation turns on our
most powerful force producers, our
anterior and posterior muscle slings
•
Internal rotation of the hips loads
our gluteal and abdominal muscles
•
This activates the anterior and
posterior oblique sling muscles,
producing a concentric moment of
force, the explosion or downswing.
•
If the calcaneus doesn’t evert, we
will not be able to internally rotate
our hips, causing a slide or sway,
which makes it near impossible to
get back to our original setup
position.
Thoracic Spine
• To end range load our Anterior
sling muscles, we must EXTEND
and rotate through our T/S.
• T/S extension is necessary to
retract our scapula, stabilizing it
– This “sets” the club at the top of
the back swing
– At this point, the T/S is extended,
rotated and laterally flexed
• Separate our arms from our body,
POWER!
Swing and Impact
• Counternutation of
Sacrum and hip
extension
• Supination of both
feet
• Abdominals
eccentrically
controlling lumbar
spine extension
Follow Through
• Abdominal Eccentric
control of lumbar
extension
• Hip extension
• Hip internal rotation
• Feet Supination
• Thoracic spine extension
and rotation
• Left scapula retraction
• Right scapula protraction
Injury
• What areas are most commonly injured when playing
golf?
- Low Back
- Elbows
- Wrists
- Shoulders
- Neck
- Knees (Tiger Woods)
Why?
• Why do we get injured?
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Improper biomechanics*
Repetition
Overuse*
Bad luck
• Most golf injuries are repetitive microtrauma injuries, joints and muscles
become overloaded by excessive forces and motions and symptoms
present
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Look for the areas not moving enough and find out why they are not moving.
The most common locations for these dysfunctions are the HIPS, FEET, and T/S!
The body must work together as a whole to avoid injury.
Chiropractic!!!
• Acute trauma can occur, as in the classic “fat” shot and wrist injury
Study
Source of data
No. of respondents
Most common injuries
Mechanisms/comment
McCarroll et al.
Amateur (942 males, 202 females)
1144 (942 males, 202 females)
Males: low back, elbow,
wrist/hand
Females: elbow, low back,
shoulder
Excessive play, poor swing
mechanics, hitting the ground, 50%
of all injuries occurred at impact
Batt
Amateur
193 (164 males, 29 females)
Males: wrist, back
Females: elbow
Incorrect swing/miss-hit (affecting
wrist), overuse type injuries
Nicholas et al.
Amateur
368
47.6% had been struck by a golf
ball in lower extremity, followed
by trunk and upper extremity
injury sites
Most serious injury being struck by
a golf ball, contusion followed by
concussion and fracture were most
common
528 (347 males, 181 females)
Upper limb (42.4%), spine (39.7%),
lower limb (17.9%)
Technical injury (53.9%),
overextertion of trunk during
swing (30.8), overuse (14.1%)
Theriault et al.
Burdorf et al.
Back pain in beginner males
196
Baseline survey: life-long
cumulative incidence of back pain
was 63%, 28% had a history or
back pain within 1 month prior to
answering the survey
Those that were athletes had
increased odds ratio of 2.1:1 to
previous back pain compared with
non-athletes
Gosheger et al
Amateur and professionals
643 amateurs (70.9% males), 60
professionals (90% males)
Professionals: back, wrist, shoulder
Amateurs: elbow, back, shoulder
More than 80% of injuries were
attributed to overuse in the back,
shoulder, knee and elbow
McCarroll and Gioe
Professional
226 (127 males, 99 females)
Male: low back, wrist, shoulder
Females: wrist, low back, hand
Sugaya et al.
Low back pain among
elite/professional
283 (115 regular tour males, 55
senior tour males, 113 tour
females
Low back, followed by neck/high
back and elbow and shoulder
equaly
72% experienced injuries that
caused them to miss a tournament
or perform at a lower level, mostly
due to back and upper extremity
injuries
McNicholas et al.
Sports medicine clinics data
collection
286
Most common site was reported as
upper limb, followed by trunk and
knee
Nearly 90% were recreational
golfers. Of the upper limb injuries,
lateral epicondylitis was most
common, followed by shoulder
impingement and medial
epicondylitis
Finch et al.
Sports medicine clinics and
emergency depts
34
Lower back, elbow and knee
Overuse, a twist or rotational
component of the swing, poor
swing mechanics, aggravation of
previous injury. Elbow injury due
to overuse (2/3) and missed hits
(1/3)
Incidence of Injury
Area
Amateur %
Professional %
Male %
Female %
Low back
15-34
22-24
25-36
22-27
Wrist
13-20
20-27
18-28
12-36
Elbow
25-33
7-10
8-33
6-50
Professionals
• Wrist
• Low Back
• Mechanism
– Repetition
– Hitting something other than golf ball
Amateurs
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Elbows ****
Low back
Wrist
Shoulders
Mechanism
– Poor mechanics ****
– Overuse
– Hitting the ground
Low Back
• Most common injured area
• Mechanism of injury:
– Setup: Extension or flexion? Too much rotation?
Combination?
• Reverse pivot swing fault
• Early extension swing fault
• Sedentary lifestyle
Low Back
• Why is it getting injured?
– Compensations:
• Tight hips: poor loading during backswing, poor glut max and
med function
• Tight t/s: must be able to extend and rotate
• Stiff ankles: poor dorsiflexion and subtalar joint eversion
– Muscle Imbalance
• Abdominals: stabilize the spine, rotate around a stable L/S
• Gluts Max: control weight shift to back leg, control femur
internal rotation, proper loading for power and control
• Scapular stabilizers: serratus anterior, middle and lower trap
– ADLs and function
Elbows
• Amateurs/Professionals
– Golfer’s elbow (medial epicondylitis)
– Tennis elbow (lateral epicondylitis)
• Mechanism of Injury:
– Overuse of the wrist extensors eccentrically
slowing down wrist flexion and pronation.
– Casting swing fault.
– Scooping motion at impact.
– Slicing shot pattern.
Wrists
• Cartilage weakness/Hook of
Hamate fx
– Swing faults of Casting or
Over the Top (compression
of cartilage during ulnar
deviation)
– Hitting a fat shot, causing fx
• Lack of:
– Spine extension
– Hip internal rotation
– Hip extension
– Tight pecs/lats.
How do you prevent injury?
• Know your weakness areas
– Golf swing
– Loss of function
• Correcting weaknesses
– Lessons
– Chiropractor
• Exercise/Rehabilitation
• Keys to successful rehab:
– Are you working on the key link?
– Does your rehab mimic golf?
– You must know golf biomechanics to understand how
injuries occur!
Injury Prevention
• Go see your chiropractor!!!!
• Education
• Pre-game Stretching
• Training
Low Back
• Chiropractic adjusting
• Core Musculature
– Exercises
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Bridge
Side Bridge
Cat-Camel
Bird Dog
• Glut Musculature
– Exercises
• Glut Bridge
• Bird Dog
• Wobble Board
Thoracic Spine
• Adjust for extension
• Exercise ball mobilization
• Bruegger’s posture
• Stretch tight muscles - Pecs, lats
Elbow/Shoulder
• Elbow
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Chiropractic Adjustments
Exercise ball throws
Thera-band
Hip and T/S mobility
• Shoulder
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Chiropractic Adjustments
Hip and T/S mobility
Thera-band
Lawnmower pulls
Wrist
• Chiropractic Adjustments
• Strengthening
– Thera-band
– Broccoli stretching
– All ROM
• Stabilization
– Thera-band
– Wood chops
– Bracing
• Training hips and T/S
References
• McHardy A, Pollard H, Luo K. Golf Injuries – A Review of the
Literature. Sports Med 2006; 36 (2): 171-187
• Lehman G. Resistance training for performance
and injury prevention in golf. JCCA 2006; 50(1):27–42.
• Gluck GS, Bendo JA, Spivak JM. The Lumbar Spine and Low
Back Pain in Golf: A Literature Review of Swing Mechanics and
Injury Prevention. The Spine Journal 2008; 8 (5): 778-88.