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REHABILITATION GOLF INJURIES

to cause the injury. Comprehensive characterisation questionnaires are required to determine this and other such confounding variables (2). It is speculated that an increased

load on the lumbar spine is a major factor that contributes to lower back pain in professional golfers; these forces may be then transmitted to the lumbar spine when lead hip rotation range is decreased (18). No studies to date have been performed on amateur golfers, where an alternative symptom mechanism may indeed exist.

COMPENSATED/ SUPRAMAXIMAL JOINT RANGE A study found that golfers with lower back pain tended to use considerably more thoracic rotation in their swings than the maximum rotation range they were able to obtain from a neutral posture and controlled speed (13). Maximum thoracic rotation range

of motion was found to be more restricted in the group with lower back pain. This resulted in players using a ‘supramaximal’ range of spinal motion when swinging. This compensated range may result in an overloading and consequential failure of structures. Once again one cannot conclude whether the position or velocity differences between the professionals with and without low back pain were a cause of, or a result of pain. This reiterates the lack of causality inference in the study, which is a common theme in the published literature (18, 13, 5).

Due to a Type II error this ‘supramaximal’ range was not found to be significant due to insufficient numbers recruited for the study (13). With such low recruitment numbers it is not possible to randomly select the subject population. This would therefore limit any generalisability of the study, if in fact it was found to be significant. The study (13) also made no attempt to diagnose or categorise the nature of the low back pain, a common theme found throughout the literature. As in other literature concerning low back pain, subclassification may result in improved results and findings, avoiding the “washout” effect often created by the use of heterogeneous groupings. This compensated or supramaximal

range was also found in a retrospective cohort study involving

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ballet dancers; those with a self reported history of injury had a greater ‘compensated’ turnout than dancers with no history of self reported injury. It was found that 70% of subjects had a functional turnout that exceeded their passive hip external rotation range (4). As a consequence of hip rotation deficits, it is suggested that compensated rotational stress proximal or distal to the hip joint can lead to high joint stresses that increase the risk of damaging forces at the lower back (4).

CONCLUSION The review found little evidence of reliable high quality investigations into the role of associated hip rotation range of movement deficits and low back pain in golfers or even the wider demographic as a whole. The preliminary evidence does suggest that hip rotational deficits have been found to be significantly correlated with low back pain in professional golfers, tennis players and also the non-sporting population.

The causes of the low back pain and the range of movement deficit still remain unclear, with capsular shortening and muscular hypertonicity hypothesized. There are a few studies emerging on the role of compensated and supramaximal ranges in overloading structures as a potential mechanism and cause of low back injury. Future prospective studies that demonstrate a decrease in low back pain after addressing such range of movement deficits and compensations are required to validate these theories. Low back pain is prevalent among amateur golfers, but the mechanism still remains unclear. No studies have been performed in amateur golfers, where an alternative symptom mechanism may exist to those of professionals. Future studies are

Figure 2: The stages of a golf swing

required to investigate whether there is a relationship between hip rotation range and back pain in amateur golfers

References 1. Carroll MC, Rettig AC, Shelbourne KD. Injuries in the amateur golfer. The Physician and Sportsmedicine 1990;18;122-126 2. Gosheger G, Liem D, Ludwig K, et al. Injuries and overuse syndromes in golf. American Journal of Sports Medicine 2003;31;438-443

3. McHardy A, Pollard H, Luo K. Golf injuries a review of the literature. Sports Medicine 2006;36;171-187

4. Coplan JA. Ballet dancer’s turnout and its relationship to self reported injury. Journal of Orthopaedic and Sports Physical Therapy 2002;32;579-584 5. Vad VB, Gebeh A, Dines D, et al. Hip and shoulder internal rotation range of motion deficits in professional tennis players. Journal of Science and Medicine in Sport 2003;6;71-75 6. Ellison JB, Rose SJ, Sahrmann SA. Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain. Physical Therapy 1990;70;537-541 7. Cibulka MT, Sinacore DR, Cromer G. Unilateral hip rotation range of movement asymmetry in patients with sacro-iliac joint region pain. Spine 1998;23;1009-1015 8. Mellin D. Hip rotation and lower back pain. Spine 1998;12;134-139 9. Parziale JR. Healthy swing: a golf rehabilitation model. American Journal of Physical Medicine and Medical Rehabilitation 2002;81;498-501 10. Batt ME. Golf injuries an overview. Sports Medicine 1993;16:64-71 11. Fradkin AJ, Cameron PA, Gabbe BJ. Golf injuries common and potentially avoidable. Journal of Science and Medicine in Sport 2005;2:163-170 12. Sugaya H, Tschiya A, Moriya H, et al. Low

INJURY IS IDENTIFYING THAT THE INJURY CAN BE ATTRIBUTABLE TO GOLF

THE MOST IMPORTANT ASPECT OF DEFINING AN

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