1. Are you getting the best from your golf game?
Chiropractic and Golf
By: Dr. Nicholas Wall
Wall Chiropractic

2. The Golf Swing Setup Backswing = Loading mechanism Top
Posture
Training
Backswing = Loading mechanism
Top
Downswing = Explode
Impact = Sequence
Follow through = mimic takeaway
Finish = Deceleration

3. Mechanism of a swing Arm Abduction and Adduction
Shoulder Rotation – Internal/External
Flexion
Knees
Back
Arms
Extension
Legs
Abdominal Core

4. Swing Styles
Two main styles
Classic
Modern

5. Modern Swing Large shoulder rotation Minimal hip rotation
Supposed to increase chance of striking ball with a square club face
↑ Power
↑ Distance
Increased separation angle – shoulder/hip separation
Causes increased lateral bend (crunching)
Overextension of spine

6. Classic Swing Balanced hip and shoulder rotation
Decreased separation angle
Decreases lateral bending (↓ crunching)
Lowers amount of torque on lumbar spine
Balanced, upright form on finish
Studies have shown this swing can reduce incidence of low back pain

7. Posture Neutral spine Hip flexed Knees slightly bent
T/S extended with chin tucked
Arms hanging straight down, relaxed

8. Posture
Mobility
Feet
Hips
Thoracic Spine
These three are the key areas of the body that must be mobile and controlled, or problems arise
Many injuries can be traced back to poor posture
Training the body
Rehabilitation

9. Stabilization Internal/External Obliques Quadratus Lumborum
Erector Spinae
Multifidi
Rectus Abdominus
Hip
Gluteus maximus
These muscles have been shown through EMG to be involved in most athletic tasks for stabilization of the lumbar spine and low back.

10. The Feet Dorsiflexion- 8 inch step down
Pronation- Talus must adduct and internally rotate
Calcaneal (Heel) eversion
Golf is one of the only sports that generates an explosive force with both feet on the ground at all times
This requires very mobile feet since they are locked onto the ground
Albert Pujols

11. The Hips During the Back Swing, both hips internally rotate
The Femur moves faster than the pelvis on the front leg, giving relative internal rotation
Hip internal rotation turns on our most powerful force producers, our anterior and posterior muscle slings
Internal rotation of the hips loads our gluteal and abdominal muscles
This activates the anterior and posterior oblique sling muscles, producing a concentric moment of force, the explosion or downswing.
If the calcaneus doesn’t evert, we will not be able to internally rotate our hips, causing a slide or sway, which makes it near impossible to get back to our original setup position.

12. Thoracic Spine
To end range load our Anterior sling muscles, we must EXTEND and rotate through our T/S.
T/S extension is necessary to retract our scapula, stabilizing it
This “sets” the club at the top of the back swing
At this point, the T/S is extended, rotated and laterally flexed
Separate our arms from our body, POWER!

13. Swing and Impact Counternutation of Sacrum and hip extension
Supination of both feet
Abdominals eccentrically controlling lumbar spine extension

14. Follow Through Abdominal Eccentric control of lumbar extension
Hip extension
Hip internal rotation
Feet Supination
Thoracic spine extension and rotation
Left scapula retraction
Right scapula protraction
Scapula retraction depends on whether you are swinging right or left-handed. When swinging right-handed, the left scapula retracts and right scapula protracts on the follow through.

15. Injury What areas are most commonly injured when playing golf?
- Low Back
- Elbows
- Wrists
- Shoulders
- Neck
- Knees (Tiger Woods)

16. Why? Why do we get injured? Improper biomechanics* Repetition Overuse*
Bad luck
Most golf injuries are repetitive microtrauma injuries, joints and muscles become overloaded by excessive forces and motions and symptoms present
Look for the areas not moving enough and find out why they are not moving.
The most common locations for these dysfunctions are the HIPS, FEET, and T/S!
The body must work together as a whole to avoid injury.
Chiropractic!!!
Acute trauma can occur, as in the classic “fat” shot and wrist injury

17. Study Source of data No. of respondents Most common injuries
Mechanisms/comment
McCarroll et al.
Amateur (942 males, 202 females)
1144 (942 males, 202 females)
Males: low back, elbow, wrist/hand
Females: elbow, low back, shoulder
Excessive play, poor swing mechanics, hitting the ground, 50% of all injuries occurred at impact
Batt
Amateur
193 (164 males, 29 females)
Males: wrist, back
Females: elbow
Incorrect swing/miss-hit (affecting wrist), overuse type injuries
Nicholas et al.
368
47.6% had been struck by a golf ball in lower extremity, followed by trunk and upper extremity injury sites
Most serious injury being struck by a golf ball, contusion followed by concussion and fracture were most common
Theriault et al.
528 (347 males, 181 females)
Upper limb (42.4%), spine (39.7%), lower limb (17.9%)
Technical injury (53.9%), overextertion of trunk during swing (30.8), overuse (14.1%)
Burdorf et al.
Back pain in beginner males
196
Baseline survey: life-long cumulative incidence of back pain was 63%, 28% had a history or back pain within 1 month prior to answering the survey
Those that were athletes had increased odds ratio of 2.1:1 to previous back pain compared with non-athletes
Gosheger et al
Amateur and professionals
643 amateurs (70.9% males), 60 professionals (90% males)
Professionals: back, wrist, shoulder
Amateurs: elbow, back, shoulder
More than 80% of injuries were attributed to overuse in the back, shoulder, knee and elbow
McCarroll and Gioe
Professional
226 (127 males, 99 females)
Male: low back, wrist, shoulder
Females: wrist, low back, hand
Sugaya et al.
Low back pain among elite/professional
283 (115 regular tour males, 55 senior tour males, 113 tour females
Low back, followed by neck/high back and elbow and shoulder equaly
72% experienced injuries that caused them to miss a tournament or perform at a lower level, mostly due to back and upper extremity injuries
McNicholas et al.
Sports medicine clinics data collection
286
Most common site was reported as upper limb, followed by trunk and knee
Nearly 90% were recreational golfers. Of the upper limb injuries, lateral epicondylitis was most common, followed by shoulder impingement and medial epicondylitis
Finch et al.
Sports medicine clinics and emergency depts 34
Lower back, elbow and knee
Overuse, a twist or rotational component of the swing, poor swing mechanics, aggravation of previous injury. Elbow injury due to overuse (2/3) and missed hits (1/3)

18. Incidence of Injury Area Amateur % Professional % Male % Female %
Low back
15-34
22-24
25-36
22-27
Wrist
13-20
20-27
18-28
12-36
Elbow
25-33
7-10
8-33
6-50

19. Professionals Wrist Low Back Mechanism Repetition
Hitting something other than golf ball

20. Amateurs Elbows **** Low back Wrist Shoulders Mechanism
Poor mechanics ****
Overuse
Hitting the ground

21. Low Back Most common injured area Mechanism of injury:
Setup: Extension or flexion? Too much rotation? Combination?
Reverse pivot swing fault
Early extension swing fault
Sedentary lifestyle

22. Low Back Why is it getting injured? Compensations: Muscle Imbalance
Tight hips: poor loading during backswing, poor glut max and med function
Tight t/s: must be able to extend and rotate
Stiff ankles: poor dorsiflexion and subtalar joint eversion
Muscle Imbalance
Abdominals: stabilize the spine, rotate around a stable L/S
Gluts Max: control weight shift to back leg, control femur internal rotation, proper loading for power and control
Scapular stabilizers: serratus anterior, middle and lower trap
ADLs and function

23. Elbows Amateurs/Professionals Mechanism of Injury:
Golfer’s elbow (medial epicondylitis)
Tennis elbow (lateral epicondylitis)
Mechanism of Injury:
Overuse of the wrist extensors eccentrically slowing down wrist flexion and pronation.
Casting swing fault.
Scooping motion at impact.
Slicing shot pattern.
Amateurs have elbow problems a lot more than professionals, due to time put into practice and honing of skills. Amateurs are all about improper biomechanics.

24. Wrists Cartilage weakness/Hook of Hamate fx
Swing faults of Casting or Over the Top (compression of cartilage during ulnar deviation)
Hitting a fat shot, causing fx
Lack of:
Spine extension
Hip internal rotation
Hip extension
Tight pecs/lats.

25. How do you prevent injury?
Know your weakness areas
Golf swing
Loss of function
Correcting weaknesses
Lessons
Chiropractor
Exercise/Rehabilitation
Keys to successful rehab:
Are you working on the key link?
Does your rehab mimic golf?
You must know golf biomechanics to understand how injuries occur!

26. Injury Prevention Go see your chiropractor!!!! Education
Pre-game Stretching
Training

27. Low Back Chiropractic adjusting Core Musculature Glut Musculature
Exercises
Bridge
Side Bridge
Cat-Camel
Bird Dog
Glut Musculature
Glut Bridge
Wobble Board

28. Thoracic Spine Adjust for extension Exercise ball mobilization
Bruegger’s posture
Stretch tight muscles - Pecs, lats

29. Elbow/Shoulder Elbow Shoulder Chiropractic Adjustments
Exercise ball throws
Thera-band
Hip and T/S mobility
Shoulder
Lawnmower pulls

30. Wrist Chiropractic Adjustments Strengthening Stabilization
Thera-band
Broccoli stretching
All ROM
Stabilization
Wood chops
Bracing
Training hips and T/S

31. References
McHardy A, Pollard H, Luo K. Golf Injuries – A Review of the Literature. Sports Med 2006; 36 (2):
Lehman G. Resistance training for performance
and injury prevention in golf. JCCA 2006; 50(1):27–42.
Gluck GS, Bendo JA, Spivak JM. The Lumbar Spine and Low Back Pain in Golf: A Literature Review of Swing Mechanics and Injury Prevention. The Spine Journal 2008; 8 (5):