Physiotherapy intervention to the golf population previously consisted of mostly rehabilitation of golf specific injuries. Today’s educated therapist will place greater emphasis on performance enhancement strategies, including musculoskeletal screening and range drills aimed at accelerating technique change. The increasing popularity of golf and the substantial prize money on offer at many professional tournaments, has increased the demands on the physiotherapist. Players and coaches now expect the physiotherapist to be an integral part of a team that supports them through both “off-course” and “on range” exercises. Furthermore, continuing advances in technology are ensuring that the clinician’s role will increase in concert with the PGA

Teaching Professional in the future.

 

As the questions asked by coaches and their players increases the challenge for the physiotherapist, and the biomechanist, is to provide measurable and research supported intervention strategies.

 

In 2008, biomechanics, through three-dimensional, real-time, kinematic measurement, holds the key to long-term validation of physiotherapy interventions. It is now possible to accurately quantify the range of motion in three planes instantaneously to less than 0.16 degree of rotation and less than one millimetre of translation (see Polhemus website for electromagnetic measurement system). In addition, data can be provided on speeds and accelerations of the body segments, providing insight into the relative sequencing of body segments at any part of the swing – address, top of backswing, transition, impact or follow through. The future for the golf physiotherapist will be in clinics with this equipment available to support the Coach and accelerate technical developments for all golfing clients.

 

The modern physiotherapist now pursues evidenced based research to underpin clinical interventions. The golf-interested physiotherapist is no different. Much of the previous research that described relative muscle activity, range of motion and centre of pressure has involved cohorts that have had less than ‘ideal’ swings. The groups involved swings that would be largely categorised as ‘outliers’ in a normal distribution of modern athletic swings, thus biasing any conclusions drawn from the data. The so-called ‘model swing’ has evolved significantly over the last twenty-five years. In fact, the emergence of what we would term ‘the golf athlete’, for example Tiger Woods, has lead to certain immutable criteria being isolated regarding the kinematics of the modern, competitive swing. 

 

Biomechanists, like Dr Rob Neal, have created a definitive swing model through optimization modelling performed on the data from significant sample numbers and utilising fundamental knowledge on the function and form of anatomical structures (e.g. stretch-shorten cycles and muscle force-velocity relationships).

 

It is well-documented that the most frequently injured body segment in both amateurs and professional golfers is the spine (Batt 1992 McCarroll & Gioe 1982, McCarroll et al 1990, McCarroll 1996, Thierault and Lachance 1998). In comparison to cricket fast bowling where mixed actions at the point of delivery (difference in the frontal plane orientation of the pelvis and the torso) are discouraged, the golf swing aims to maximise the difference between the pelvis (“hip turn” in golfing vernacular) and the upper torso (“shoulder turn”). 

 

It is now well established that the best tour players and high level amateurs achieve between 40 and 45 degrees of pelvis rotation by the top of the back swing and between 90 and 95 degrees of upper torso rotation – a difference of about 50 degrees (Cheetham et al 2001 and Neal 2003).   The term X-Factor has been popularised by an American PGA Coach – Jim McLean. The transition phase of the swing follows the backswing and is characterised by a significant stretch-shortening cycle. At this time the pelvis re-rotates back toward the target while the shoulders are simultaneously rotating away from the ball. This is the key power source of the golf swing. Our best athletes will achieve stretches of 25? or more - we have termed this figure the X-Factor stretch (see Figure 1).

 

Ideally this rotation should occur around a neutral spine. Previous research (Sugaya et al 1998) has shown that increased axial rotation with compression through lateral flexion (known as the “crunch factor”) is associated with increased incidence of L4-5 and L5-S1 disc degeneration. For many golfers who lack torso rotation, increased hip slide is the most common strategy employed to generate body speed of the large, powerful body segments. The increased right lateral flexion that results (in right handed golfers) is deleterious to lumbar spine health.

Figure 2 exhibits one permutation of a static torso rotation test. The end of range is achieved when the club lifts from the posterior chest wall. An ideal result would be close to 50?. As the club is placed most commonly at between T6 and T8, the “score” obtained under-estimates the total torso rotation by 15 to 25º. Measurement within the clinic can be completed using a goniometer until the therapist is sufficiently skilled at estimating the range. Simple protractor-type measures using tape affixed to the bed increase reliability of the test results. This static test could be made more specific by quantifying the torso rotation in a golf specific posture; that is with slight hip and trunk flexion of approximately 10º or perhaps further with the arms more elevated.

 

Evidence suggests that the range of available lumbar spine rotation is minimal, perhaps as small as 5 degrees. It is imperative that for a golf swing to generate significant club head speed that the physiotherapist focuses on maximising thoracic rotation. We have developed a series of muscular, fascial and joint mobility exercises to assist the golfer gain the necessary range of motion. One such technique appears below in Figure 3. A number of other permutations appear on The Golf Athlete range of CDs and the New Players Series DVD – Flexibility for Golf.

 

The challenge for the golf-interested physiotherapist is to access measurement systems that enable informed decisions to be made regarding the most appropriate testing and exercise interventions. The integration with a biomechanist has accelerated our understanding of what movements actually occur compared to the perception inherent in two dimensional video analysis. Biomechanical “Smart System” development is progressing (a system that actually interprets the data that emerges from the 3D measurement system) and it will soon be possible for clinicians to avail themselves of this type of technology in their own clinics – please let us know if it interests you!

 

To emphasise again, you cannot measure it with the naked eye or video, so the only accurate method of measurement is with a true 6 degrees of freedom electromagnetic system or university based research equipment (eg Vicon). To find your nearest Golf Biodynamics licensee, direct your browser to www.golfbiodynamics.com website or for more information go to the About Us – Biomechanics Section of the www.thegolfathlete.com website.

 

Good luck and good golfing!

 

Michael Dalgleish

APA Sports Physiotherapist & Sports Scientist

Director – The Golf Athlete

Licensee – Golf Biodynamics for Queensland

Work:  +61 7 3354 8666 

Mobile:  +61 438 678467