Working with the Retired Golfer: Can an Old Dog Learn New Tricks? Joe Eischen PT, SCS, ATC, CSCS Mayo Clinic Sports Medicine Center 2013 MFMER slide-1
Take Home Points for the Talk: Become aware of some the MSK issues that older golfers face. Be able to recognize common swing faults experienced by older golfers. Understand the concept of Regional Interdependence and how it influences injuries/compensations/corrective exercise planning in golfers. 2013 MFMER slide-2
Physical Parameters of the Senior Golfer Training and rehabilitating the senior golfer gives the Physical Therapist a chance to promote overall health and increased physical activity. Senior golfers are susceptible to various age-related changes: Decreased strength: Sarcopenia (Decreased muscle mass). 40-50% decrease in muscle mass between the ages of 25-80. Lose more type II fast twitch muscle fibers. Decreased power output? Decreased flexibility: Increasingly lost after the age of 65. Increased crosshatching and decreased elasticity of collagen. Increased proportion of connective tissue to lean muscle mass. Decreased coordination. Increased body fat. 2013 MFMER slide-3
Golfer Injuries Injury rate: Amateurs are injured at a rate of 16-40% (depending on the study). Increased exposure (play and practice) increase injury risk. Amateurs experience more acute injuries and professionals more overuse or volume injuries. Older golfers experience injury due to overuse and a lack of physical conditioning. Two things cause injuries in golfers: The swing: Most injuries are due to the swing. Acceleration, impact, and follow-through phases of the swing are the biggest culprits. Everything in between the swing: Carrying a bag. Walking to the ball. Bending over. Getting into and out of bunkers. 2013 MFMER slide-4
Common Areas of Injury. Low back pain: 18-36% of golfers both amateur and professionals. Amateurs had decreases in lead hip IR. Decreased hip rotation in athletes who play rotational sports resulted in low back pain. Lateral elbow pain. Medial elbow pain. Lead shoulder impingement. 2013 MFMER slide-5
Regional Interdependence We are made up of alternating areas of mobility and stability. If a body segment is lacking in mobility or stability, a body segment above or below may try and make up for this deficit. Mobility is typically addressed prior to stability. This makes the Physical Therapist s MSK evaluation very important. Head to toe assessment. Focus corrective exercise program at these deficient areas. 2013 MFMER slide-6
Important Physical Characteristics of Golfers Hip strength: Purpose: Is there any difference in hip strength among golfers with different proficiency levels? What is the relationship between hip strength and golf handicap? What is the relationship between hip strength and self-reported driving distance? 82 golfers: 10-19 handicap. 0-9 handicap. Scratch or better. Measured isometric hip abduction and adduction in side lying with a hand-held dynamometer. Scratch or better group was found to be significantly stronger in left hip strength as well as all hip movements tested. 2013 MFMER slide-7
Physical Faults and Swing Faults Phases of the Golf Swing: Address. Take away. Top of the back swing. Down swing/acceleration. Impact. Follow-through 2013 MFMER slide-8
Common Swing Faults with the Older Golfer C-posture: Increased thoracic kyphosis. Results in limited thoracic rotation. Early extension: Hips move forward during the downswing/acceleration portions of the swing from the position they started in at address. Results in extension of the spine and limited pelvic rotation. Slide: Excessive lateral movement of the lower body towards the target. This makes performing a proper weight shift very difficult. Lack of Pelvic Rotation (Result of all of above?): Limited or improper weight shift. Golfer will attempt to use sagittal or frontal plane movement instead of rotation. 2013 MFMER slide-9
Dartfish Video Analysis Let s look at 4 examples.. 2013 MFMER slide-10
2013 MFMER slide-11
Let s look at these top 4 swing faults C-posture 2013 MFMER slide-12
Top 4 Swing Faults Early Extension: 2013 MFMER slide-13
Top 4 Swing Faults Slide: 2013 MFMER slide-14
Top 4 Swing Faults Lack of Pelvic Rotation: 2013 MFMER slide-15
Training the faults we find. Pick the top 6-8 MSK/Swing issues found in your evaluation. That s the fun of it. You won t know what they are until you look at the client/patient. Instruct and practice the exercises with the patient. Educate on why they are doing it. Relate back to evaluation. Make sure form is correct. Develop a workout plan. Order of training. Sets, reps, hold times, times per day and/or week. 2013 MFMER slide-16
2013 MFMER slide-17
References Murray, E. Birley, E. Twycross-Lewis, R. Morrissey, D. The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: An observational study. Physical Therapy in Sport 10 (2009) 131 135 Van Dillen, L. Bloom, N. Gombatto, S. Susco, T. Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports. Physical Therapy in Sport 9 (2008) 72 81 Read, P. Lloyd, R. De Ste Croix, M. Oliver, J. Relationships between field-based measures of strength and power and golf club head speed. Journal of Strength and Conditioning Research. 2013 27(10)/2708-2713 Sell, T. Yung-Shen, T. Smoliga, J. Myers, J. Lephart, S. Strength, flexibility, and balance characteristics of highly proficient golfers. Journal of Strength and Conditioning Research. 2007, 21(4), 1166-1171 2013 MFMER slide-18
References Harris-Hayes, M. Sahrmann, S. Van Dillen, L. Relationship between hip and low back pain in athletes who participate in rotation-related sports. J Sport Rehabil. 2009 February; 18(1):60-75 Vad, V. Bhat, A. Basrai, D. Gebeh, A. Aspergren, D. Andrews, J. Low back pain in professional golfers: The role of associated hip and low back range of motion deficits. The American Journal of Sports Medicine, Vol. 32, No. 2. 2004 Becker, L. Manske, R. Management of the golfing athlete throughout the lifespan. A home study course from the Sports Physical therapy Section. 2013 MFMER slide-19