Hello, my name is Tyler Van Wingerden an outpatient orthopedic physical therapist here at Fyzical Therapy and Balance Centers. I also have a certification in medical treatment for golfers through the Titleist Performance Institute (also known as TPI). Golf is a complex sport that involves very specific movements from the human body. Therefore, physical therapy for these types of injuries requires a professional who is educated and familiar with the golf swing. In today’s post, I would like to outline the general philosophy for assessing and treating golf related injuries.
The first thing we need to look at in assessing the injury is the golfer’s swing. There are 12 swing characteristics that I look for: S posture, C posture, loss of posture, flat shoulder plane, early extension, over the top, sway, slide, reverse spine angle, hanging back, chicken winging, and casting/scooping. These swing characteristics cause stress on different structures in the body, which makes them critical in assessing how a golfer’s swing can be causing, or at least contributing to, their injury. It should be noted that these are called swing characteristics and not swing flaws. This is an important distinction which I will explain in the following paragraph.
You may personally believe or have had golf instructors who have told you, that there is one proper way to swing a golf club. This perfect swing is usually patterned after one of the premier PGA golfers of our time. The instructor may watch, or even videotape, your swing and then compare it with the professional golfer pointing out the differences. For me, learning to golf in the late 90’s it was Tiger Woods, of course. They would freeze frame at the top of my back swing and say, “we need you to get your right forearm perpendicular to the ground just like Tiger!”
While there is some truth to be found in this philosophy, there are some significant flaws in applying this ideology to all individual golfers. One of these flaws is that not all professional golfers have the same swing. There are significant differences in swing characteristics amongst the best golfers in the world, and it does not affect their success on the golf course. The other issue with this mindset is that it assumes that all golfers have the same movement capabilities. Not everyone is physically capable of swinging a golf club the way that Brooks Koepka does, and trying to force somebody to do something they’re not physically capable of is ineffective, can cause injuries, and is also very frustrating.
TPI’s philosophy is that there are an infinite number of ways to swing a golf club and the best way to swing a golf club depends on the individual person’s movement capabilities. The goal is, therefore, not to start with a specific golf swing and try to adapt the person to the swing, but the reverse. We want to first assess the person’s movement capabilities and then try to adapt a swing that suits that person’s ability to move. Not only should this lead to more success on the golf course, but it should also prevent injuries from occurring.
This philosophy is why the second portion of a golf evaluation with a TPI certified professional also includes a movement evaluation that assesses the range of motion, strength, and motor control across the entire body. Here we start with global movements, such as a squat, and see if the person can complete the movement correctly and without pain. If the person has either difficulty or pain with this movement, we then need to find out what the cause is. In the case of a squat this could be a range of motion, strength, or motor control issue in the hip, knee, or ankle. We then isolate each joint and measure its strength, range of motion, and motor control. If we find an issue with one or more of these, we have the cause of the problem, but then we must answer yet another question is this something we can change, or not?
Going back to the former paragraph, our goal is not to make everybody move the same, but this does not mean that our goal is to not to improve golfer’s movement deficits, as this is the central goal of any physical therapist. We can only achieve the goal of improving a golfer’s movement if we’ve done the assessment and critical thinking required to figure out what we can change and what we cannot change. For example, if a patient has a severely arthritic shoulder, it’s probably not a helpful goal to try to change their shoulder mobility to match Tiger Woods in his prime, and in trying to achieve this goal, it’s a strong possibility that we may cause an injury to the person’s elbow or neck. Our goal is to help golfers move in the best way that they as an individual possibly can.
So, before we treat a golfer, we need to assess their movement capabilities, diagnose those movement limitations as changeable or not, and assessing their swing characteristics. The next part is trying to put these things together to figure out the cause of the injury and how to prevent further injury. This of course, can only be properly done on a person-by-person basis and therefore, is impossible to accurately explain in a blog post. However, for the purposes of giving you an insight to what this process can look like, I will try to provide a general example.
Let’s take a right-handed golfer who has low back pain. I assess their swing and find that they have the characteristic of reverse spine angle. This means that at the top of their back swing, the angle of the spine running from their pelvis to the top of their head is pointing towards the target as opposed to the “normal spine angle”, where the angle of the spine would be pointing away from the target at the top of their back swing.
Reverse Spine Angle Normal Spine Angle
I then do a movement assessment and see that they have limited hip internal rotation on their trail hip and weakness of their abdominal muscles that stabilize their spine. I find out in their medical history that they have a history of a hip replacement on their trail hip…this will lead me to the conclusion that it is probably unlikely that we can improve their internal rotation on that side. I then focus the treatment on improving the strength of their abdominal and trunk muscles to help stabilize and control the movement of their spine in their swing. Additionally, I tell them to turn their right foot away from the target after they set up for their swing to put the trail hip in a starting position that provides more available movement into internal rotation. I also instruct them to shorten up their backswing to limit the spine from bending towards the target.
Trail leg External Rotation
Another key feature of TPI’s comprehensive philosophy is using a team approach to treatment. While, as a physical therapist, I have knowledge of how the human body moves and how to improve movement, I am not a certified golf instructor. Similarly, while a golf instructor has knowledge of how to get you to improve your effectiveness and consistency in striking a golf ball, they likely do not have expert knowledge on how to accomplish this in golfers with injuries. Therefore, the best way to treat you is for the two of us to work together. The golf instructor will tell me what you two are trying to accomplish with your swing, and I can provide input on how we can accomplish this while considering your injury and movement capabilities.
I hope that this has provided a small window into the philosophy of assessment and treatment that I use to assist my patients with golf related injuries. As I have stressed a great many times in this post each patient requires a unique and individual assessment, so please give us a call and I would be happy to start this process with you and get you to Love Your Life and continue enjoying your golf game.
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