Adaptive Golf as Therapy

Adaptive Golf as Therapy Ross Brakeville, PT, DPT, STC, TPI-MP No Disclosures GOAL Enhancing Lives Through Golf Objectives Understand basic biomechanical principles of golf swing Understand neuromuscular strategies used to improve golf mechanics Understand how common pathologies pose barriers to participation including amputations, TBI, Spinal

cord injuries, neuromuscular deficits, visually impaired, chronic pain etc. Understand adaptive techniques and equipment used to overcome pathology Understand importance of team approach to enhancing lives through golf Possess the knowledge, skills and tools to implement programs catering to those with special needs Why are we here? PGA/PT! Disabled According to the 2010 Census Bureau Survey, there are approximately 57 million Americans with some form of disability. Golfers with Disabilities In a study conducted by the National Center on Accessibility at Indiana University in cooperation with Clemson University, 5.7 million disabled persons play golf and another 19.95 million

individuals with disabilities are interested in learning. Golfers with Disabilities Of those interested but not playing, 36% percent felt they needed a better understanding of the fundamentals and 38% stated a need for lessons specific to their disability. Disabled Golf Programs The earliest record of disabled golf in the US was 1925 with a blind golfer, Clint Russell of Duluth, Minnesota. Mr. Russell,

who lost his sight when a tire exploded in his face, began playing blind golf in 1925. Toward the close of World War II, Clint contacted several people in the Veterans Administration and suggested golf as therapy for those who had lost their sight. The Veterans Administration agreed and have continued to offer golf as therapy to this day for those who are blind or visually impaired. As the number of blind golfers grew, Bob Allman, a blind golfer and lawyer from Philadelphia, in 1953 formed the United States Blind Golf Association (USBGA). Disabled Golf Programs NAGA (National Amputee Golf Association) Established in 1954, had its beginnings with World War II veteran Dale Bourisseau who organized other amputees to play golf as a means of recreation and to reinforce pride. Eventually, the group grew friendly games into tournament play.

Disabled Golf Programs The PGA of America/Disabled Sports USA Military Golf Program Initiated in 2007, as a joint effort with DS/USA, PGA professionals are working with Wounded Warriors teaching golf as a sport for rehabilitation and a fulfilling recreational pursuit. Disabled Golf Programs The European Disabled Golf Association (EDGA) was formed in Wiesbaden in the year 2000 by organizations representing

golfers with disability from seven countries. Today the association is made-up of the National Governing Bodies from 23 countries. Adaptive Golf Academy Founded by PGA Teaching Professional David Windsor, Adaptive Golf Academy has been teaching adaptive golf lessons and conducting clinics "every week" for 17 years. David was first introduced to the "adaptive golf" concept in 1999 by Paul Goodlander, a physical therapist (trained by Adaptive Golf Association founder, Sonny Ackerman in 1997) who was utilizing golf as a rehabilitative tool with stroke survivors, brain and spinal cord injured and others with physical/sensory issues. After 6 years of weekly clinics and individual lessons, gaining extensive knowledge and documenting experiences, the Adaptive Golf Academy was created as the education platform to train coaches to serve individuals through the game in their communities.

Growth of Golf in Disabled Community United States Adaptive Golf Alliance 2021 USGA hosting national disabled golfer championship Quiz Who is known for the quote: Well the world needs ditch diggers too! Biomechanics Cause of injuries Professionals - Overuse Amateurs - Poor Mechanics

Mobility/Stability Biomechanics Setup Backswing Transition Down swing Impact Follow through Set Up Preparation for swing that ends at start of motion into backswing. Objective is to position the body so the golf swing can be carried out in an efficient manner. Items to address Alignment

Posture Grip Motor control/understanding Set Up Alignment - Shoulders, hips and feet aligned parallel to target line Set Up Alignment Problems Non parallel position Shoulders, hips and feet not aligned Set Up

Posture open packed positioned to allow ease of movement to begin backswing Problems S posture C posture Set Up S posture Causes Lower crossed syndrome Tight hip flexors Tight low back Weak abdominals Weak glutes Misunderstanding of an athletic setup position Set Up C Posture Causes Upper crossed syndrome Tight pec major and minor Tight upper traps and levator scapula

Tight Lats and SCM Weak Serratus Anterior Weak deep neck flexors and lower traps Limited anterior pelvic tilt mobility Misunderstanding of set up position Set Up Grip goal is to assist in developing club head speed and proper club head position at impact Problems Grip position Grip strength V alignment

Set Up Grip Hands, wrist and arms not working together Difficult to square clubface Leads to early release of wrists (extended lead wrist, flexed trail wrist) Pressure of grip Backswing Begins at start of movement in windup, ending when lower body transitions forward. Objective is to coil the body in an effort to maximize potential energy so that kinetic energy can be transferred to the ball efficiently Backswing Plane Outside Inside Backswing Problems Loss of posture Sway Reverse spine angle Backswing

Loss of Posture - a substantial change in set up posture such as a flat shoulder plane Causes Limited hip rotation Extending trail knee Poor pelvic to spine mobility Limited spine rotation Limited lat flexibility Poor scapulothoracic rhythm Motor control/understanding Backswing Sway an excessive lateral movement away from the target Causes Limited trail hip internal rotation Limited pelvic to spine mobility Poor stability of back hip (glutes esp. medius) Motor control/understanding Backswing

Reverse spine angle when the trunk and upper body laterally tilt toward target at top of backswing Not a matter of if there will be a back problem but when! Causes Limited trail hip mobility/stability Knee extension Limited pelvic to spine mobility Poor spine stability (core) Motor control/understanding What is/are difference(s)? Difference(s)? Transition Phase between backswing and downswing when the legs and hips are

moving forward toward target while the arms are still moving backward. Objective is to efficiently transfer potential energy into kinetic energy Key to Swing Transition Creates eccentric load of torso Necessary for balance through the downswing (feedforward) Transition is where control in the downswing is lost Transition

Amateurs produce 50% more trunk muscle activity and 50 80% greater spinal forces yet generated 34% less club head speed. Hosea TM, Gatt CJ, Gertner E. Feeling Up To Par: Medicine From Tee to Green, Philadelphia, FA Davis, 1994 Downswing Acceleration of club Downswing

Issues to address Kinetic sequence Plane of motion esp. over the top/outside/casting Early extension Early release Slide Kinetic Sequence Downswing Plane Downswing

Plane of motion goal is to get to impact in same plane as address position efficiently Over the top/early casting Causes Over aggressive pelvic rotation Under active pelvic rotation Over aggressive shoulder rotation Thought process as to how power is generated Poor pelvic to spine mobility Reverse spine angle Motor control/understanding Downswing Early extension goal is to have buttocks on same line throughout downswing Causes Weak glutes Limited lead hip internal rotation/ankle inversion Limited mobility to posterior pelvic tilt Thought process as to how power is generated Poor pelvic to spine mobility Reverse spine angle

Downswing Early release - Goal is to maintain wrist hinge for lag Causes Over aggressive pelvic rotation Under active pelvic rotation Limited lead hip internal rotation/ankle inversion Weak forearms Lack of understanding of impact position Downswing Slide excessive lower body movement toward the target. Lack of stability as it slides toward target, wastes energy versus transferring into chest rotation. Causes Limited lead hip internal rotation/ankle inversion Poor pelvic to spine mobility Weak glutes on lead leg Impact

Impact is a zone for which the energy of the body and golf club, generated in the downswing, is actively released into the ball toward the target. Impact Items to address Stable lead leg Club face pointing to target Lead wrist/hand - at or in front of ball (flipping club). Stable Lead Leg I.e. Slide Limited lead hip internal rotation/ankle inversion Poor pelvic to spine mobility Weak glutes on lead leg Impact Clubface position - Impact Flip the club a premature loss of wrist angle. Energy is therefore released early as the club head passes the hands at impact

Causes Limited forearm/wrist/hand mobility Poor wrist hand strength (grip strength of power hitters > 60% body weight) Limited lead hip internal rotation Inability to get to a stable lead leg Limited trunk rotation Understanding of target Follow through Follow through is a eccentric action designed to absorb the energy not released into the ball. It is a reflection of actions in the first five phases and provides information about efficiency of motion &/or faults Summary Mobility ROM needed to maintain posture through the swing Ankle Hip T-spine with lats Shoulder Wrist/hand If not mobile in one area then compensations occur above or below with increased risk for injury Summary

Stability Main muscles needed for efficient production of power Glutes maximus and medius Hip adductors Quads Hamstrings Abdominals Pec major Subscapularis Traps/levator/rhomboids Global wrist muscles Summary Motor control/understanding Neuromuscular control to produce efficient motion with focus on transition

Swing plane Impact position Quiz Bill Murray is well known for threatening a female MP with this The Aunt Jemima Treatment Neuromuscular Principles Balance Regulation of upright stance is fundamental to the safe and efficient performance of many of our voluntary movements J.S. Frank, M. Earl

Rotational Athletics Rotational sports utilize centrifugal forces to manipulate the end segment (club, bat, racquet, ball etc.). FORCES Centrifugal Force - The force which impels a thing, or parts of it, outward from the center of rotation. FORCES

Force used to counter centrifugal force: Centripetal force - The component of force that is directed toward the center of curvature or axis of rotation Balance If too much centrifugal force is generated, throwing the body out of balance, excess centripetal force will be needed to regain balance. Therefore, energy is used inefficiently with a resultant loss of velocity on the end segment. Brakeville et al 1998 Wilk et al 2002 Meister 2000

Efficient Achieving desired result with the minimum of waste, energy, or expense. Productive Achieving desired results but at an expense

Centrifugal force When in the golf swing is the greatest amount of centrifugal force initiated? Power Traditional teaching is to generate power from the legs. Kinetic chain of movements to transfer energy from the ground, up through the legs, trunk and into the arm.

Amateurs produce 50% more trunk muscle activity and 50-80% greater spinal force, yet generated 34% less clubhead speed. Hosea et al Power In a study by Fleisig et al 1999 on biomechanics of highly skilled baseball pitchers of different ages the main difference was in velocity. However, there was an interesting difference Pelvic Rotation

Youth - 650º/sec High School - 640º/sec College - 670º/sec Professional - 620º/sec All amateur pitchers rotated through hips faster than professionals yet velocity of ball is slower. Appears to be contradictory to traditional thought in that power comes from the legs and hips. Power Gary Wiren, PGA Master Professional, Ph.D. In his book The PGA Manual of Golf studied UE/LE contributions to power and found 70 80% produced by UE s with 20 30% in LE s. The Role of Biomechanics in Maximizing Distance and Accuracy of Golf Shots Patria A. Hume, 1 Justin Keogh1 and Duncan Reid2, Sports Med 2005; 35 (5): 429-449 The hips and torso produce approximately

10% of the total linear velocity in the downswing in skilled golfers Think An efficient motion uses the lower extremities, core, upper extremities and centrifugal force to produce maximum velocity. The question is how we think it is generated? Feedforward

Anticipatory postural adjustments consist of postural activity that begins IMMEDIATELY PRIOR to onset of voluntary movement and serves to prevent or minimize displacement of the body s center of gravity associated with that movement. Corso PJ, Nasher LM, Frank JS, Earl M How

Drivers determine neuromuscular reaction to include feedforward Transition Neurologically, we prepare before we move! How should we transition? It is AUTOMATIC! Target How many dimples are on a golf ball? TESTING

Understanding circumstances may have effected general goals, please rate current life satisfaction: 0 5 10 0 = Very unsatisfied 10 = Very satisfied Vision CN #II Peripheral L: Lateral: >80*: Y/N Medial: >45*: Y/N Up: > 60*: Y/N Down: >75*: Y/N Peripheral R: Lateral: >80*: Y/N Medial: >45*: Y/N Up: > 60*: Y/N Down: >75*: Y/N CN #VI Ability to follow objects with eyes w/o moving head: Y/N Ability to follow objects moving head and eyes: Y/N Ability to keep eyes fixed while moving head: Y/N Ability to follow object to nose: Y/N

Cervical Spine Cervical flexion: /3 (> 2 fingers chin to chest: 1/3), (1-2 fingers chin to chest: 2/3), (can touch chin to chest: 3/3) Cervical extension: /3 (< 75*: 1/3), (75 85*: 2/3), (>85*: 3/3) ***Cervical rotation: R: /3 L: /3 (< 75*: 1/3), (75 85*: 2/3), (>85* & can touch chin to shoulder: 3/3) Lumbopelvic Pelvic Function: A/P: /3 Trunk on Pelvis: /3 Pelvis on Trunk: /3

(Limited Mobility: 1/3), (Limited Stability: 2/3), (Normal: 3/3) Mobility/stability Toe Touch: /3 (-3 or >: 1/3), (-3 to toes: 2/3), (> toes: 3/3) Hands up/down Spine: L R : /3, R L : /3 (> 1 hand apart: 1/3), (< 1 hand touch: 2/3), (fingers overlap: 3/3) Hip and Trunk Extension (Hand reach down back of opposite leg): L: /3 R: /3 (Popliteal space or <: 1/3), (Within 1 hand past popliteal space: 2/3), (> 1 hand: 3/3)

mobility/stability Ankle Mobility: L: /3 R: /3 (Knee < 4 past toes: 1/3) (Knee > 4 past toes: 2/3) (Knee > 4 & IR to see all toes: 3/3) Seated Trunk Rotation: L: /3, R: /3 (< 75*: 1/3), (75*-90*: 2/3), (>90*: 3/3) mobility/stability Trunk Rotation in prone on elbows: L: /3, R: /3 (< 55*: 1/3), (55*-65*: 2/3), (>65*: 3/3) Hip IR/ER: L: IR /3, ER /3 R: IR /3, ER /3 Hip IR: (<35*: 1/3), (35-55*: 2/3), (>55*: 3/3) Hip ER: (< 55*: 1/3), (55-75*: 2/3), (>75*: 3/3)

Mobility/stability Thomas: L: /3 R: /3 (Thigh above level of table: 1/3), (Thigh to table with knee flexion < 60*: 2/3 (Thigh in midline, lower than table and knee flexion > 60*: 3/3) Latissimus Dorsi Flexibility: L: /3 R: /3 (Supine hips extended position elbows straight Thumbs unable to touch table: 1/3) (Supine hips extended position elbows straight Thumbs touch table: 2/3) (Supine hips flexed position elbows straight Thumbs touch table: 3/3) Mobility/stability

Grip: L: R: Body weight = % L: /3 R: /3 (>60% BW: 3/3), (50 60% BW: 2/3), (< 50%BW: 1/3) Mobility/stability Squat: /3 (3/3 = Heels on floor, Thighs below parallel, Knees over feet, Arms and trunk parallel with tibia or greater, Symmetrical fluid motion (2/3 = Heels on 2x6. Thighs below parallel, Knees over feet,

Arms and trunk parallel with tibia or greater, Symmetrical fluid motion) (1/3 = Heels on 2x6. Fails to perform motion as described in 2/3) Mobility/stability Modified Push-up: /3 (3/3: Male Thumbs in line with head, body moves as one, no sag in spine) (Female Thumbs in line with chin) (2/3: Male Thumbs in line with chin, body moves as one, no sag in spine) (Female Thumbs in line with clavicle) (1/3: Unable to perform one repetition)

Mobility/stability Quadruped (on hands and knees with 2 x6 board between knees/hands): /3 (3/3 = Same side elbow to knee: On raising arm and leg: Back stays flat; the elbow, hand and knee remain in line with board; When bringing elbow and knee to touch, back stays level) (2/3 = Opposite elbow to knee. On raising arm and leg: Back stays flat; the elbow, hand and knee remain in line with board; When bringing elbow and knee to touch, back stays level) (1/3 = Unable to perform level 2/3)

Mobility/stability Single Leg Bridge (8 sec): L: /3 R: /3 (Hip drop w/rotation: 1/3), (Hip drop or hip rotation: 2/3), Hip without drop or rotation: 3/3) neuromuscular Log Rolling: (Start on back, arms overhead and legs out straight. Using Right arm only, without assist of legs, reach over to Left allowing rest of body to follow, rolling to stomach. From stomach, using same technique reaching back, Right arm again leads, rolling Right onto back. Repeat with Left arm then each leg.) /3 (3/3 = Smooth symmetrical movements all quadrants) (2/3 = Able to transition but substitutes or lacks smoothness of movement) (1/3 = Unable to roll over in 1 or more of the quadrants)

How Do I get involved Learn more about biomechanics/pathomechan ics of golf swing Understand Neuromuscular aspects of golf swing This provides vocabulary Contact Adaptive Golf Alliance to find PGA Professionals in your area and set a meeting

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