REHABILITATION GOLF INJURIES

for increased torque to the lower back. This has long been suspected as a major source of injury. The modern swing or ‘reverse C’ position of the follow through produces a hyperextension and right lateral flexion moment to the lumbar spine in the right handed golfer, having the potential to result in facet joint irritation if consistently repeated (3, 16, 18). It is thought that the twisting motion of the lumbar spine at the top of the back swing and subsequent derotation and hyperextension through the downswing and follow-through is the basis to such lower back complaints in golf (18). The modern swing has been shown to be associated with increased lumbar torque, which can increase low back pain in susceptible golfers (9, 15). This distinct asymmetric trunk motion during the golf swing, a combination of counter-clockwise axial rotation and right lateral flexion, is referred to as the crunch factor (12). The axial velocity and right lateral flexion angle increases during the forward swing through to the follow through (12). A high crunch factor is damaging to the lumbar spine and may result in injury and pain (13). The asymmetric mechanics of the

golf swing subjects the lumbar spine to large amplitudes of movement and force, with peak compressive loads measured during the golf swing of up to eight times one’s bodyweight at the finish or terminal swing position (3, 12). It has been found that back problems most frequently occur during this follow through phase, with 29% of injury occurring during the terminal finish phase of the golf swing (1). It is apparent from the literature

that low back injuries in golf are related to poor swing mechanics and/ or repetition of the swing, though the exact causes of low back pain have not yet been fully addressed or determined.

REVIEW OF RELEVANT LITERATURE The literature contains very little reliable research on golf injuries. The relationship between hip mobility and lower back pain has been examined in only a few reports. Studies undertaken in non-athletes have shown that patients who had a Type III pattern of total hip rotation, less medial hip rotation than lateral rotation, were more likely to develop low back pain (6-8).

www.sportEX.net These studies showed that

asymmetry of medial and lateral rotation range of movement is prevalent in patients with low back dysfunction. However, in one study 27% of the healthy subjects also demonstrated this hip rotation pattern, as opposed to 48% in the low back pain group (6). The patient group did have a high proportion of Type III rotation pattern, but was also generally older than the healthy subject group. It has been suggested that age can be a determinant of hip rotation (6). In another study the methodology is questionable (7); a goniometer was used instead of an inclinometer which has been shown to be more reliable (6).

It is thought that this range of

movement pattern (Type III) may lead to deleterious cumulative stress or strain to the soft tissue and bone of the lumbar spine (6). It has been theorised that any loss of rotation at the hip may place excessive mechanical stress on the lumbar spine (6). Normal values for medial and lateral hip rotation range of movement vary among different reports, with no real consensus determined. The American Academy of Orthopaedic Surgeons report medial and lateral hip range of movement to be equal (15) and the Committee on Medical Rating of Physical Impairment describe more lateral than medial hip range of movement in their report on normal ranges (19). Without a normal standard measure, it is questionable whether one can determine if there is a deficit. In studies such as these, using subjects from the non-golfing population, there are issues of generalisability to be raised, as this cohort will not necessarily be representative of the golfing population. A lack of a specific diagnosis may also limit the generalisability of the studies (7). It is certainly questionable whether the findings can be applicable to subjects outside the studies. It has been found that unilateral hip range asymmetry is prevalent in patients

Figure 1: The modern swing or ‘reverse C’ position of the follow through

with low back dysfunction (6-8). In the majority of studies there is only speculation with regard to the various diagnoses and cause for the back pain as well as for the limitations of range of motion (5, 6, 7, 18), with only one study (6) providing a specific diagnosis for each subject. Range of movement deficits have

also been implicated in repetitive injuries in various sports. It has been observed in professional tennis players that internal rotation range of movement deficits in the dominant lead shoulder and lead hip correlated to the presence of respective shoulder and low back pain (5). The lead hip had a 7.6o

deficit compared to the non

lead leg in the symptomatic low back pain group whereas there was only a 3.2o

difference for the asymptomatic group (5). It is thought that similar mechanisms may exist in golf, although study numbers are small (18). An anecdotal case report (14)

hypothesised that an increase in hip rotation reduced torsional load on the lumbar spine of a professional golfer who was unable to complete a round of golf or a practice session without severe pain. Consequently an increased range of hip turn resulted in a cessation of his back pain. A case study alone does not present a picture of injury patterns from which conclusions can be generalised, but does allow a hypothesis to be

CORRELATED WITH LOW BACK PAIN IN GOLFERS, TENNIS PLAYERS AND THE NON-SPORTING POPULATION

PRELIMINARY EVIDENCE SUGGESTS THAT HIP ROTATIONAL DEFICITS ARE SIGNIFICANTLY

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