LOW BACK PAIN IN GOLFERS

1a+b: Dynamic calf stretch for flexibility

ty shifts during the golf swing, the body’s muscles, most importantly those located in the low back, must respond in order for balance to be maintained and for coordi- nated efforts to continue (1). If problems with these muscles occur, inefficient body mechanics will result and overall stress will be transferred to the skeletal struc- ture, thus increasing potential for serious injury (1).

NEUROANATOMY AND NEUROPHYSIOLOGY A golfer’s ability to maintain balance and equilibrium is controlled by the somatosensory, vestibular and visual sys- tems. These three motor control centres are subsystems of the central nervous sys- tem (4). The somatosensory system is the faculty of bodily perception. It includes multiple types of sensation from the body - light touch, pain, pressure, temperature, and joint proprioception. This controls how we move the different segments of our body and our centre of gravity in relation to our environment to maintain postural equilibrium (5,6).

REHABILITATION The necessary components of any golf fit- ness programme are flexibility, motor con- trol/movement pat- terns, balance/stabil- ity, strength, power and cardiovascular endurance. It is the combination of all of these components which allows profes- sional golfers on the PGA Tour to remain at the top of their game. Although there will be an overlap, these main components should be addressed in the order in which they are listed. It would not do a golfer much good to focus on increasing power if they do not have the needed ranges of motion or proper movement patterns to utilise this power. As a golfer progresses

www.sportex.net

2a+b: Dynamic hamstring stretch for flexibility

through these stages, a functional approach should be taken to prepare the body for golf-specific activities.

Most of the components listed above are addressed when treating athletes for sport. However, what gets lost many times is the application of sport-specific train- ing. The scope of this article is to address functional, golf-specific rehabilitation techniques for each of these components when treating low back pain, the most common golf injury.

FUNCTIONAL REHABILITATION The different causes of low back pain can all create a functional instability to this region. This includes damage to the liga- ments, muscles, joints or discs in the low back (7). Activity-specific exercises need to be used to enhance the joint stability and help re-educate movement patterns. The muscles used for stabilisation need to be retrained in specific movement pat- terns to help enhance function and decrease the risk of further injury (8,9).

MOST COMMON GOLF INJURIES

1. Trail side of the low back 2. Cervical 3. Lead elbow 4. Lead shoulder 5. Wrists

1) Flexibility Golf is a very dynamic activity and stretching for it should be dynamic. This does not mean applying a ballistic stretch, rather putting a static stretch on a muscle and then dynamically moving it through a range it will travel during the golf swing. Examples of dynamic stretching include the calf

stretch (figure 1) and the hamstring stretch (figure 2). For a description of each stretch see page 20. When focusing on flexibility, just those muscle groups with limited ranges of motion should be addressed. Too often, golfers stretch all of the muscle groups that are “used” in the golf swing. This may create or increase an

3a: Assisted backswing

existing mus- cle imbalance (10). When possible, golf- ers should per- form stretches in a standing, upright posture to mimic the closed chain, anti-gravity position of the body in the golf swing.

3b: Assisted backswing

2) Motor control and movement patterns One integral component of a golf condi- tioning programme that is often over- looked is the enhancement of functional movement patterns. This is important since one of the common causes of low back pain, as mentioned earlier, is faulty body mechanics (1,2). A golfer “loads” their trail leg on the backswing, initiates the down swing by forward translation and rotation of the hips and then transfers their weight onto the lead leg through the forward swing, acceleration and follow- through phases. This timed weight shift requires balance and coordination.

Resistive tubing can be used to train the loading of the legs during the different golf-specific movement patterns as weight shifts are progressively trained. This will result in massive sensorimotor input (11,12) and raise the level of excitability and contractility of the nervous system so that muscle contractions can become quicker and more responsive (13). This will rapidly enhance the input from the somatosensory components mentioned above, allowing golfers to move in repet- itive patterns of the highly coordinated, sequenced movements of the golf swing (14). Ideally, the golfer will achieve cognitive programming. This occurs when a when a precise movement pattern is learned and is able to be repeated often

15