MUSCULOSKELETAL PROFILING IN GOLF

out by Batt in 1992 (3), wrist and back injuries accounted for 53% of all injuries reported by 193 amateur golfers, average age 38.5 years and average handicap of 10.2. There are no studies available on younger and/or more proficient golfers.

Studies from the biomechanics laboratory at Centinela Hospital Medical Centre (6-9) provide an analysis of the muscle work required around the shoulder complex during the golf swing. Jobe and his colleagues (6) suggested that there might be more errat- ic firing of the rotator cuff muscles in amateur golfers compared to professional golfers. Even though maximum shoulder elevation is usually only 110-120 degrees, movements and stability of the gleno-humeral joints are profiled to help prevent shoulder impingement injuries.

Research led by Pink in 1990 (8), suggested that as golfers use both sides of the body in synchrony, right-handed golfers should strengthen the left rotator cuff muscles. Thus an exercise pro- gramme for junior elite golfers requires strengthening exercises for the rotator cuff muscles to provide a coordinated and protect- ed movement during the rapid, but not necessarily strenuous, arm activity.

Electromyographic analysis of the trunk in golfers (9), demon- strated that trunk posture and the control and strength of the abdominals should be assessed. Pink (9) suggested that the high and constant level of activity in the abdominal muscles requires an aggressive exercise programme to avoid injury through fatigue.

Reviewing more recent literature (10-15) and applying the knowl- edge gained from working directly with golfers and PGA coaches, it became apparent that an effective and efficient golf swing that reduced the propensity for injury required the spine-hip angle to remain constant. PGA coaches use the term “spine-hip angle” to refer to a combination of spine/pelvis and pelvis/thigh angles. Good trunk and hip rotation is required to retain the spine-hip angle throughout the swing (16).

In a right-handed golfer, limited trunk rotation to the right, lack of medial rotation of the right hip and/or a tendency to extend the right knee, results in extension of the spine and/or a right lat- eral shift of the hips. This produces an inconsistent back-swing and is frequently a cause of poor golf posture and/or mechanical low back pain in golfers.

Similar restrictions on the left may result in an inconsistent fol- low-through in a right-handed golfer. In order to enhance perfor- mance and reduce the likelihood of low back pain, it is to the golfer’s benefit to try to attain 90 degree shoulder turn (trunk rotation) in both directions in sitting, rather than in standing (the position frequently used by golfers), which allows contribu- tion from the joints of the lower limb (16).

PRACTICAL APPLICATION As common themes became evident during the musculoskeletal profiling, the areas to concentrate on during subsequent profiling, and to stress in the exercise programmes, became apparent:

In a right-handed player: ■ At the address position, the right hand is lower than the left

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on the shaft of the club resulting in the right shoulder being lower than the left. This habitual posture results in some play- ers demonstrating a scoliosis concave to the right in standing. The physiotherapist’s experience allows them to differentiate between a scoliosis associated with golf, which tends to occur between T10 - L2 and be postural in nature, and an idiopathic scoliosis that tends to occur at mid-thoracic level with more serious underlying skeletal pathology.

■ Golfers with poor posterior pelvic tilt often complain of low back pain during prolonged putting practice. This tends not to occur during a round of golf when the putting posture is not maintained for prolonged periods. Good putting posture demands neutral, if not slight posterior, pelvic tilt to allow the arms to hang relaxed in a straight line from the shoulders, without developing a kyphotic posture.

■ Restricted hamstring flexibility may reduce pelvic mobility and prevents a golfer from attaining the correct spine-hip angle at address and during the golf swing. Exercises to improve hamstring flexibility have been incorporated into the golfers’ exercise programme.