1. DANIEL B. LEONARD, D.C. ART® FARABAUGH CHIROPRACTIC OFFICE 2879 E. DUBLIN GRANVILLE RD. Low Back Pain and Golf Mechanics Wedgewood Country Club

2. Dr. Daniel Leonard Graduate of Miami University (Exercise Science Major) Doctorate in Chiropractic and Sports Rehabilitation Active Release Technique® Dynamic Neuromusclouar Rehabilitation (DNS)  Only physician in Columbus utilizing this technique

3. Back Pain in the general population Affects 50-80% of population 40% have back pain in any one year 15-33% have point incidence at any given time Adams, et. Al (1999)

4. Causation: Internal vs. External Forces Internal Causes  Joint Fixations forcing motion into hyper-mobile segments  Improper usage of muscles for stability (imbalance) External Causes  Posture  Repetitive bending  Prolonged flexion  Poor workout regimes  Trauma WINCHESTER: MOTION PALPATION SEMINAR 2010 “THE DISC”

5. Back pain and Golf Golf injuries originate from an overuse or from a traumatic origin (Theriault, Lachance) Amateur golfers were prevented from playing golf for an average of 5.2 weeks per year due to chronic injuries sustained while golfing (US, McCarroll et al)

6. Overuse Injuries in Golf Amateurs desire to hit the ball as vigorously as the professionals but with out the same technical refinement Most common area affected in the lumbar region  Paraspinal muscles, intervertebral disks, vertebral ligaments, facet joints and posterior arc (spondylolysis) (THERIAULT, LACHANCE- GOLF INJURIES)

7. Kinetic Chain (system of links) Specific motions at certain segments of the kinetic chain have a dramatic effect in movement of other joints (or lack there of), and the turning on or off of certain muscles (Gray seminar 2005)

8. Golf Injuries Main Causes of Golf Injuries Overuse Technical errors during the swing Physical fitness deficiencies Aerobic, muscular strength, flexibility No pre-game warm up Natural environmental conditions (uneven course surface, wet grass, thunderstorms) Sports Med 1998 Jul; 26 (1)

9. Technical Errors during the swing C Posture S Posture Sway Slide

10. C Posture Slumped shoulders at address and roundness to your thoracic spine Limited thoracic extension Upper cross syndrome-muscle imbalance, tight pecs, lats, upper traps, levator scap and weakness in mid scapular muscles, lower traps, and deep neck flexors Instability of core muscles causing poor posture and a slouched forward position at address Lack of thoracic spine extension relates to increased lumbar and cervical spine motion

11. C Posture Functional ScreensExercise Examples Thoracic Extension/ Wall AngleFoam Roller/ Swiss ball extension

12. S Posture Too much arch in the low back as a result of sticking your tail bone out too far (“j-lo booty”) Lower cross syndrome- tighness in the hip flexors and lower back and weakness in the abdominals and glutes Lack of abdominal endurance/ strength This excessive curvature in the low back puts abnormally high stress on the lumbar joints, disks, and musculature You can successfully stick your butt out at address and keep your spine in a neutral position if you hinge from your hips. This requires good core strength and proper stabilization, the problem arises when this isn’t true and the force is generated in to the lumbar spine.

13. S Posture Functional ScreensExercise Examples Core endurance test Thomas test Side bridge Tri planar psoas stretch

14. Sway Excessive lower body movement away from the target during your back swing that forces your weight to the outside of your back foot Very difficult to attain proper weight shift during the transition and the downswing Proper rotation around the back hip is only possible if adequate amount of internal rotation exists. If the body is unable to rotate around this hip then lateral movements will dominate the pattern Secondly the ability to separate your upper body from lower body allows the lower body to laterally stabilize while rotating during a large shoulder turn. Limited trunk to pelvis is usually caused by reduced spinal mobility Finally, the ability to laterally stabilize your right leg during the downswing is directly dependant on the strength and stability of your gluteal musculature

15. Sway Functional ScreensExercise Examples Hip rotation test Thoracic Rotation test Glute stability test Hip mobility/ stretching Foam roller/ Swiss ball Glute bridge

16. Slide Excessive lower body lateral movement towards the target during your downswing Stability on the lower body is crucial in order to accelerate during the downswing Once the lower body starts its forward shift into the downswing its job is to transfer energy to the upper body and stabilize the extreme rotary forces that are created in the upper body. If there is no stable platform to rotate around, players will lose power and try to develop speed in an inefficient sequence Proper rotation around the front hip is only possible if adequate amount of internal rotation exists. If the body is unable to rotate around this hip then lateral movements will dominate the pattern Secondly the ability to separate your upper body from lower body allows the lower body to laterally stabilize while rotating during a large shoulder turn. Limited trunk to pelvis is usually caused by reduced spinal mobility Finally, the ability to laterally stabilize your right leg during the downswing is directly dependant on the strength and stability of your gluteal musculature

17. Slide Functional ScreensExercise examples Hip rotation test Thoracic Rotation test Glute stability test Hip mobility/ stretching Foam roller/ Swiss ball Glute bridge

18. Functional Screens Core Endurance Test Side Bridge >70 seconds linked to less injury (McGill 2010)

19. Functional Screens Thoracic Mobility Thoracic Extension (Wall Angle)

20. Functional Screens Hip Mobility (internal/external rotation) Ideal hip rotation 45º internal 45º external rotation Artifically increasing hip stiffness in normal subjects caused profound changes in the profile of trunk movements and balance control (Gruneberg, 2004) “I am continually surprised at the number of people with back troubles who also have hip troubles” (McGill, 2005)

21. Functional Screens Glute Stability test Proper activation of the posterior chain is initiated by glute activation Weak/Inhibited glutes will be evident by over action of the lumbar extensor muscles or hamstrings

22. Functional Screens Thomas Test (hip extension) Hip extension is directly related to lumbar spine function If tightness is present in the hip flexors (psoas muscle) in order to get extension, the lumbar spine has to continually over extend to compensate= excessive wear on the posterior elements of the lumbar spine

23. Treating functional findings Lumbar aliments commonly seen in golfers will be clinically improved by rest, manipulation, traction, and a good lower back rehabilitation program designed to regain maximal flexibility and strength (Sports Med 1998 Jul; 26 (1)

24. Exercise Thoracic Mobility and Thoracic Extension

25. Exercise Core Endurance

26. Exercise Hip Mobility Not what we are looking for

27. Exercise Tri-planar psoas stretch Tri planar stretching allows the muscle to be stretch in all planes where as static stretching only accounts for one plane

28. Exercise Glute Bridge Poor Pattern  Over-activation of lumbar muscles and hamstrings  Poor control Ideal Pattern  Core activation and Glute activation simultaneously  Good control

29. Chiropractic and Golf Less than 2% of golfers visit a chiropractor Golfers suffer mainly with mechanical back pain, making golf and chiropractic a perfect match Spinal adjustments are known to be effective in reducing pain and increasing spinal mobility An aggressive lumbar spine rehabilitation program should be institute as both a therapeutic and preventative measure Dyn. Chiropractic Aug 1999; 17 (17)

30. Chiropractic and Golf Three fundamental causes of golf injuries: poor posture, lack of flexibility, and poor swing mechanics  All of which are often a direct result of physical restrictions or mechanical dysfunctions which can be restored with spinal manipulation and exercise Dyn. Chiropractic 2001; 19 (26) “Amateur golfers achieve approximately 90 percent of their peak muscle activity when driving a golf ball. This is the same intensity as picking up a weight that can only be lifted four times before total fatigue. This level of exertion and muscular activation equates golf with such sports as football, hockey, and martial arts. The difference is that other athletes outside of golf include conditioning as part of their preparation before play.” Paul Check-Golf Biomechanics Manual

31. Exercise “Exercise programs should be started until joints have a normal end feel” (Mennel)

32. The End THANK YOU!

33. Dr. Daniel B. Leonard Farabaugh Chiropractic Office 2879 E. Dublin Granville Rd. Columbus, Ohio 43231 (614)898-0787

34. Copyright © 2012 Dr. Ronald J. Farabaugh