4/13/2016. Movement and Golf An Overview to Minimize Dysfunction and Maximize Performance. Disclosures. Introduction: Our Team

Transcription

1 Movement and Golf An Overview to Minimize Dysfunction and Maximize Performance Ohio Physical Therapy Association Annual Conference 4/23/16 OSU Sports Medicine 1 Introduction: Our Team Mike Martin, PT, MPT, OCS, CGFI-M2 Erik Hemenway, AT, PTA, CGFI-J2 Anthony Ganim, PT, MPT, OCS, CGFI Kyle Steinbauer, PT, DPT, OCS, CSCS, CGFI 2 Disclosures The individual presenters for this course and The Ohio State University Wexner Medical Center, Sports Medicine, have no conflicts or disclosures to report. 3 1

2 s Learn basic components and functional requirements of the golf swing Understand common examples of dysfunctional posture or movement patterns involved with golf Highlight common changes across the lifespan, and how they contribute to injury or poor performance Identify techniques for assessing dysfunction and providing intervention strategies to correct Review recommendations for a successful, comprehensive golf medicine and performance program 4 Introduction 5 Background/Etiology 2015: 25 million amateur golfers in U.S. National Golf Foundation Statista.com: million reported golfing in the past 12 months (2015) Injury Prevalence: Up to 40% of all amateur golfers have pain/injury 33-37% Low Back Pain 6 2

3 Background Sources of potential injury: The golf swing Poor mechanics Poor lie or ground conditions Overuse Predisposing physical condition prohibiting safe swing Improper equipment 7 Background Non-swing sources of injury: Walking No cart: miles over 18 holes Cart path only: miles over 18 holes Pushing cart or carrying bag Uneven surfaces, hills, thick grass Bending over to pick up ball Accidents/Trauma The golfer who is injured 8 Background Common injury/pain locations Low back Elbow Lateral elbow lead arm Medial elbow trailing arm Thoracic Spine Shoulder Hip Foot, knee, other 9 3

4 Golf Swing Basics 10 The Golf Swing What do most golfers desire in their swing? More Power Better Consistency How do we achieve this? Understand typical golf swing posture and movement Utilize the Kinematic Sequence Development of swing efficiency of movement and power Assess biomechanics of the patient Why Golf Biomechanics? Studies have tried to characterize the ideal golf swing Many different teaching and assessment techniques out in the market Review of previous literature findings from clinical standpoint: 1. Understanding efficient movement principles of the golf swing will help a practitioner express advice and corrections on a clients swing 2. Corrections should lead to a reduction of injury 3. Biomechanics work has role in the development of accuracy and distance in the golf shot Source: Hume et al,

5 Phases of the Golf Swing 13 Setup (Address) Posture Address Posture Basics Golfer starts in relaxed forward bent posture Cervical and Thoracic Spine in forward bent position Lumbar spine in neutral positioning Trunk Flexion ~ 45 degrees Hip Flexion ~ degrees Knee Flexion ~ degrees Source: Rose et al & Hume et al, 2005 Takeaway/Backswing Purpose: Positioning of the golfer in preparation for an effective and powerful downswing Period of takeaway from the ball after the address Movement Basics Slowest Portion of the golf swing Multi-plane approach to muscle activation and movement Primarily torso and lower body rotation focus Good Mobility in neck, trunk, pelvis, hips (Rose et al, 2015). 5

6 Downswing/Acceleration Quickest Portion of the Swing Divided into sub phases: 1. Forward swing phase, which initiates the downward motion of the club 2. Acceleration phase, which accelerates the club downward. Movement Basics: Gluteus maximus for power generation Downswing hinges on what the glute max can do Glute max has over 50% activation all the way to the early stages of the follow through swing Gluteus medius for lateral stabilization Source: Hume et al, 2005 Downswing/Acceleration Muscles with the most activation during the downswing Gluteus Maximus Biceps Femoris Vastus Lateralis Pectoralis Major Scapular Stabilizers (Rhomboid, Serratus Ant.) Rotator Cuff Musculature (infraspinatus and subscapularis) Source: Rose et al Impact/Follow-Through Point of the swing where most deceleration occurs Pelvis and Thoracic Rotation are decelerating speed but have extensive movement into the follow through Source: Cole,

7 Impact/Follow-Through Following impact, the upper thorax turns through at least 120 and the golfer concludes with their vertebral column in a hyper-extended position Trail shoulder (right in right-handed golfers) pointing towards the target, and their hands positioned high above their head. This posture is commonly referred to as the reverse C position Source: Cole, 2015 Kinematic Sequence Biomechanics and movement are only one component of the efficient golf swing TPI Philosophy: We don t believe there is one way to swing a club. We believe there are an infinite number of ways to swing a club. But we do believe there is one efficient way for everyone to swing a club and it is based on what they can physically do Kinematic Sequence True measure of an efficient golf swing Correlates with the mechanical motion of the body Use of 3D to measure energy transfer Source: TPI Level 1 Manual Acceleration The Kinematic Sequence The Downswing Phase 1. Pelvis accelerates and peaks at a lower speed than other segment, and then decelerates rapidly 2. Thorax accelerate to a higher speed than the pelvis, and the decelerates rapidly 3. Lead Upper Arm accelerates to a higher speed than the thorax and then decelerates rapidly. 4. Club continues accelerating reaching maximum speed at impact. Source: TPI Level 1 Manual 7

8 The Kinematic Sequence Energy Initiation/Transfer 22 The Kinematic Sequence Key Points The Kinematic Sequence 1. The sequence should be consistent despite the swing style 2. Each segment of the body builds on the previous segment, increasing speed up the chain 3. Each segment of the chain slows down as the next segment continues to accelerate 4. Sequence is the key to consistency; energy transfer is the key to power 3-D analysis determines swing efficiency and/or limitations; the physical screen determines why those inefficiencies may be occurring Source: TPI Level 1,

9 Common Dysfunctional Swing Patterns 25 Swing Faults Swing Faults Specific swing characteristics or patterns which contribute to both poor or inconsistent performance and pain or injury Every golfer has characteristic swing patterns that are either a result of or lead to physical limitation or dysfunction 26 Categorizing Swing Characteristics Characteristics relating to posture Characteristics relating to lower body movement Upper body characteristics and injuries 27 9

10 Swing Characteristics Relating to Posture Posture at Address Neutral Posture C Posture S Posture 28 Posture at Address C posture Typically hypomobile thoracic spine Poor scapulothoracic stability Hypomobile lumbopelvic and hip regions Inability to reach full excursion during backswing Will lead to other swing characteristics and potential contributors to injury 29 Posture at Address S Posture Inhibited deep abdominal mm. Decreased lumbopelvic stability Increased compression at lumbar spine Inability to maintain posture through swing 30 10

11 Posture During and Through the Backswing Loss of Posture Reverse Spine Flat Shoulder Plane 31 Loss of Posture Any significant alteration from your body s original setup angles during the golf swing. - TPI Decreased lower body mobility Decreased trunk/core and hip stability Decreased shoulder, torso or lat mobility 32 Reverse Spine Excessive backward upper body bend at the top of the golf swing #1 Cause of LBP in amateur golfers! Decreased hip mobility Right hip IR Decreased torso, spine, shoulder, lat mobility Decreased trunk/core and hip stability Increased lumbar paraspinal tension and inhibited deep abdominals 33 11

12 Flat Shoulder Plane A change in the plane of the shoulders when turning to the top of the backswing Shoulder plane perpendicular to spine at address but turns to more horizontal plane at top of backswing Same physical deficits as loss of posture and reverse spine 34 Lower Body Movement Characteristics 35 Sway Any excessive or significant lower body movement away from the target during the backswing Limited rear hip IR Decreased R hip stability/decreased gluteal strength Decreased torso, shoulder, lat mobility 36 12

13 Slide Any excessive lower body movement toward the target during the golf swing Decreased lead hip IR Decreased lead hip stability Decreased torso, shoulder, lat mobility (gluteus medius) 37 General Upper Body Characteristics The Ultimate Cheater Body will compensate in any way possible to complete a task Lack of lower body mobility or stability leads to decreased power output Lack of upper body mobility leads to decreased swing excursion Body will attempt to compensate through excessive arm/wrist/hand movement or activation Chicken winging Casting Scooping 38 Upper Body Swing Characteristics Difficult for untrained person to assess without video analysis In PT eval, look for keys through pt report, pain assessment (location, quality, etc.) and objective evaluation Elbow injuries Shoulder injuries Wrist/hand injuries 39 13

14 Considerations Across the Lifespan 40 Deficits Across the Lifespan- Juniors Common Injuries with Junior Players Golfer s Elbow Low Back Pain Bone Injuries Shoulder Pain Sunburn Alternative Issues Deficient Training Practices Long Term Athletic Development Long Term Athletic Development (LTAD) First coined by Istvan Balyi in 1998 Key Focus of training is on performing age-appropriate drills to maximize potential of training LTAD uses foundational approach found in 10 year rule Research has concluded that it takes eight to twelve years of training for a talented athlete to reach elite levels This is called the ten-year or 10,000 hour rule. For athletes, coaches and parents, this translates as slightly more than three hours of practice daily for ten years Source: Balyi,

15 Long Term Athletic Development (LTAD) 5 Stage Model for Late Specialization 1. The Fundamental Stage 6-10 year old Males and Females 2. The Training to Train Stage Males 10-14; Females Training to Compete Stage Males 14-18; Females Training to Win Stage Males 18+; Female The Retirement/Retraining Stage Source: Balyi, 1998 Deficits Across the Lifespan The Senior Golfer This is the typical golfer Because this may be the activity to motivate your patient, it is an avenue to incorporate activity into their life 44 Physical Changes for the Senior Golfer Declining Strength Flexibility Coordination Balance How much of this is inevitable and how much can be slowed/stopped 45 15

16 Strength in the Senior Golfer Loss of strength due to loss of Size (atrophy) Number (hypoplasia) Strength loss may be inevitable, but it can be slowed Aerobic and resistance training Also consider the neuromuscular impact 46 Balance in the Senior Golfer Decreased average SLS as people age By decade of life 60 s Male: 28.7 sec, Female: 25.1 sec 70 s Male: 18.3 sec, Female: 11.3 sec 80 s Male: 5.6 sec, Female: 7.4 sec Clear for vertigo, falls, dizziness, other vestibular disorders 47 Flexibility in the Senior Golfer Loss of flexibility due to physiologic factors Decreased elasticity of collagen Increase connective tissue to lean muscle mass Due to lifestyle changes Decreased activity levels Consider the hips, spine, ankles and shoulders 48 16

17 Cardiovascular decline in the Senior Golfer Decreased maximal HR, HR response Results in decreased exercise capacity Golf is a power sport built on endurance Must address both 49 Implications for age-related losses Typical postural deficits Forward Head Rounded Shoulders Increased Kyphosis 50 So what? Repetitive swings with a loss of posture, decreased flexibility, decreased physical condition, decreased balance Lead to increased use of compensations and swing faults Increasing the chances of developing overuse injuries Creates a domino effect increased pain, decreased activity 51 17

18 Exercise focus for the Senior Golfer Flexibility/Mobility Hip joint mobility int rot, ext rot Hip flexor tightness Trunk T-spine extension and rotation Shoulder capsular tightness, pec tightness Cervical extension, retraction, rotation mobility Motivation is key to compliance Get some early wins to show the value 52 Exercise focus for the Senior Golfer Strengthening and Stability Focus on golf specific movements Rotational stability exercises Core control and isolation Scapular strength and control Golf is a repeated unilateral sport Make sure to train in both directions to avoid muscle imbalances and asymmetries 53 Special Considerations for the Senior Golfer Total Joint Replacement THA and TKA Be aware of surgical precautions and surgeon precautions Return to golf estimates THA typically 3-6 months post-op TKA More variable due to rotational forces through the knee Incorporate trunk and hip rotation ex s early and progress intensity and weight bearing as appropriate TSA/RTSA Variable 2-8+ months (longer, if at all, for RTSA) 54 18

19 Special Considerations for the Senior Golfer Osteoporosis Common in hips, spine and wrists Be cautious with high velocity rotational activities May need to modify swing Consider vertebral compression fractures in the thoracic spine with postural correction or high stress positions 55 Special Considerations for the Senior Golfer Need for a high quality warm up Focus on short, efficient warm up to improve compliance Use of off season to prepare for next year Increased chance of co-morbidities 56 Evaluation of the Golfer 57 19

20 Evaluation Golfer most likely will not be ready day 1 for golf evaluation/screening Need to clear initial/underlying injury first!! 58 Subjective General History Gives PT a good idea on which other health care professions may need to be consulted ie: nutritionist, sports psychologist, physician, swing coach Any pertinent medical history Injury/Surgical History Helps PT identify possible areas of impairment Can also predict swing faults/characteristics 59 Subjective Golf Ability History Allows PT to determine level of skill Could predict overuse vs deconditioning as cause Areas of strength and weakness ie: ball striking, distance, pain at end of round, pain with certain swing or shot Pain provocation where during the round/swing is there pain Goal Development What does the golfer want to get out of treatment? Play pain-free? Distance? Consistency? Lower scoring? 60 20

21 Recommended equipment Mid iron (5-7) Alignment or doll rods ½ foam roll Airex Mat Evaluation algorithms you choose! 61 Based on Mobility/Stability Model The body works in an alternating pattern of stable segments connected by mobile joints. If this pattern is altered dysfunction and compensation will occur. Gray Cook 62 Mobility/Stability Model Mobility The ability to produce a desired movement Stability The ability to resist an undesired movement 63 21

22 Postural assessment Down the line Quiet posture and golf posture Lower extremity positioning, pelvic positioning, spinal alignment, shoulder positioning, head positioning, hand positioning, distance from golf ball 64 S Posture Lower Crossed Syndrome Tight Muscles- hip flexors, back (erector spinae), TFL, and quadratus lumborum Weak Muscles- gluteus maximus, rectus abdominis, and gluteus medius 65 C Posture Upper Crossed Syndrome Tight Muscles- upper trapezius, levator scapulae, suboccipitals, SCM, and pectoralis major/minor Weak Muscles- lower/mid trapezius, deep neck flexors, serratus anterior 66 22

23 Postural Assessment Frontal/Coronal View Looking for body symmetry, hand position, lower extremity alignment 67 Foot (stability) Single leg balance Compare bilaterally Stable and unstable surface 68 Ankle (mobility) Overhead Deep Squat 69 23

24 Ankle (mobility) Arms Down Full Deep Squat If patient fails overhead deep squat 70 Ankle (mobility) Half Kneeling Dorsiflexion test or Anterior Tibial Translation test If patient fails the arms down deep full squat 71 Knee (stability) Squat (double leg and single leg) Lateral lunge looking at hip/knee mechanics and ability 72 24

25 Hip (mobility) Overhead Deep Squat Lower Quarter rotation Looking at total lower extremity internal/external rotation 73 Pelvis/Lumbar Spine (stability) Front Plank- abdominals Side Plan- oblique and hip abductors Bridging- double and single leg Pelvic tilting in golf posture 74 Thoracic Spine (mobility) Seated trunk mobility test 75 25

26 Scapula (stability) Lift reach and roll test Push-up plus test 76 Cervical Spine (mobility) Cervical Rotation (looking for >70dgs) 77 Shoulder (mobility) Shoulder 90/90 ER in standing position Shoulder 90/90 ER in golf posture Looking for greater than 90 degrees in both postures Lat Length 78 26

27 Elbow (stability), Wrist (mobility), Hand (stability) Active Radial/Ulnar Deviation Active Wrist Extension/Flexion Active wrist Pronation/Supination 79 Disassociation from lower body to upper body Golfer should be able to independently move hips/pelvis while keeping upper body quite If golfer is unable to do so, provide manual stabilization at the golfer s shoulders to assess if it can be done 80 Disassociation from upper body to lower body While keeping the lower body quiet, turn the shoulders and thoracic spine If golfer cannot do this, provide manual stabilization at the hips to asses if golfer is able to improve ease of disassociation 81 27

28 Treating the Injured Golfer Be the PT first General Treatment Concepts Focus on the Mobility-Stability Model Give the golfer ownership in what he/she desires from the golf swing Include any swing coach/instructor as needed Consider change if the body can t physically meet the swing needs Fully understand when/where the pain occurs within the context of golf During the round During the swing With specific clubs General Session Flow Active Warm-up Manual Interventions Active ROM Muscle activation as needed Strengthening in newly-gained ROM Functional exercise/multi-segmental exercises Sport-specific exercises and drills 84 28

29 General Treatment Concepts In golf medicine, the gluteals are the priority. Core/lumbopelvic stability is a must. The ability to dissociate the upper and lower bodies is integral. 85 Non-Negotiables Gluteal/bridge progression Hip Hinge Golf posture exercises Other dissociation exercises 86 Comprehensive Golf Medicine and Performance Programs 87 29

30 It IS a Team Game Medical Nutrition Golfer Mental Technical Fitness Additional References Balyi I. Sport System Building and Long-term Athlete Development in British Columbia. Canada: SportsMed BC; Becker L, Manske R (Eds.). Management of the Golfing Athlete Throughout the Lifespan. Zionsville, Indiana. Sports Physical Therapy Section. Cole MH, Grisham PN. The biomechanics of the modern golf swing: implications for lower back injuries. Sports Med (2016) 46: Cook G. Movement. Lotus Publisher; Gosheger G, Liem D, Ludwig K, et al. Injuries and overuse syndromes in golf. Am J Sports Med. 2003;31(3): Hume P, et al. The Role of Biomechanics in Maximizing Distance and Accuracy of Golf Shots. Sports Med (2005) 35: Rose G. Titleist Performance Institute Level 1 Manual. Oceanside, CA: Titleist Performance Institute; Rose G, Voight M. Titleist Performance Institute Level 2 Medical Manual. Oceanside, CA: Titleist Performance Institute;