The Golf Physio

11/13/2020

🏌️‍♂️Hip Pain: Exercises/Management ⛳️

If you happened to have some difficulty with the hip movement screens we reviewed, let’s try some exercises that target these shortcomings.

1. Limited hip internal and/or external rotation: Hip 90/90 stretch

2. Limited pelvic tilt: Cat – Camel Spinal Segmentation

3. Restriction in adductors/groin: Spiderman stretch

Full disclaimer – There can be multiple causes for the limitations experienced in the movement screens, which is why you should always be assessed by a health care practitioner to get to the root cause of the limitation! These exercises serve as a general guide to improving movement quality, but may not be specific to your limitation.

11/11/2020

Hip Pain: The Movement Screen

Following up on my previous post about hip pain, we identified 3 major contributors to hip injury in the golf swing: excessive hip internal rotation (and a possible lack of external rotation ROM), too much hip adduction, and an overly anteriorly tilted pelvis. Let’s breakout some movement screens to assess our movement quality with relation to these problematic patterns. As always, monitor for any pain or symptoms with these screens!

1. Active Prone Internal and External Hip Rotation Test

2. Pelvic Tilt Test

3. Adductor Quadruped Rockback

10/20/2020

Hip Pain: Hiding in Plain Sight

In 60% of people who seek treatment for lower back pain, the hip hasn’t been identified as the primary cause of their pain.

On average, these people get treated for up to 7 months and the issue wasn’t even the lower back

Why? Most hip injuries aren’t disabling for people. They can continue with their daily activities and not even recognize the hip is the issue (a classic case of treating the symptom versus the cause!).

Commonly, the pattern of hip pain follows what’s called a “C-sign” (see attached photo below). What is this exactly? Start by making a letter “C” with your thumb and index finger. Place your thumb over the greater trochanter (the prominent, pointy part of bone on the outside of your hip) and wrap the hand over so the tip of your index finger touches the inguinal ligament (just inside your groin). This is the area where most hip pain refers to. Even injuries to the back side of the hip will refer pain towards the front.

What are the most commonly occurring hip injuries in golfers? Labral tears, FAI (impingement of the hip), loose bodies, trochanteric bursitis, and IT band problems.

So, how can these hip injuries happen in the golf swing?

1. In the backswing, the back leg is internally rotating (IR), and if the golfer has already set up with that foot pointing inwards into IR, they are closing down the space in the hip joint even further. The same issue presents for the lead hip in the downswing – if the foot is already internally rotated, the golfer will have to create even more IR at the hip to generate the appropriate ROM

2. Too much hip adduction – There shouldn’t be any sway in the backswing; as the right hip gets too high and hikes up, you increase the adduction angle and risk of impingement in the trail hip. A similar issue exists in the lead hip if the golfer slides – the lead hip gets too high, and too much of a weight shift increases their adduction angle at the hip.

3. An overly anteriorly tilted pelvis will decrease joint space in the hip (i.e. S-posture and reverse spinal angle) and will be injury-inducing for the hip.

10/02/2020

Elbow Pain: 💪Exercises/Management🏌️‍♂️

For the purposes of this post, let’s assume your movement screen revealed the source of your elbow pain to be coming directly from the elbow itself. As previously mentioned, lateral elbow pain happens more commonly in amateur golfers. This pain originates in the what is known as the common extensor origin, where multiple muscles in your forearm attach to the outside of your elbow. The injured tendons are undergoing changes to their structure, as well as changes in pain, sensory, and motor functioning. These changes happen because the tendons are irritated and unable to handle the forces placed on them. Here are 3 things you can do to help manage it yourself:

1. Strengthen the tendons of the wrist extensors and supinator muscles 🏋️‍♀️ Depending on the level of irritability, try isometric exercises first, progressing into eccentric and then concentric exercises once the pain levels have decreased. Isometrics produce what is called an analgesic effect that can reduce the pain you feel by altering the nociceptive/pain pathways in your brain. A pain level of 3/10 or less is ok during these exercises, as long as it doesn’t result in increased pain the next morning. Aim for 3 sets of 20.

2. Gentle stretching 🧘‍♀️ The tendon is stretched by moving into wrist flexion, both with the elbow straight and flexed (because there are 2 muscles in the elbow that attach above and below the elbow). Follow the same principles as above for monitoring pain during the exercises, as well as number of reps and sets.

3. Rest 💤 This is often an overuse injury, so we have to stop doing the things that irritate it. This means that golf may have to be stopped in the short term (bummer I know!). Sleep is also an important factor, as many people unknowingly put the wrist and elbow in compromising positions when they sleep, leading to aggravation of already sensitized tissues. Before going to sleep, remember to “keep the arm below the ni**le line” so as not to put the wrist behind your head or underneath your pillow, minimizing stress put on the wrist and elbow. Also try tucking your arm along the inside of your shirt (like a straightjacket!), pinning it to your side and minimizing movement at the wrist and elbow as you sleep.

10/02/2020

Elbow Strengthening

09/30/2020

Elbow Pain: The Movement Screen

When we’re dealing with pain in a peripheral joint like the 💪, it’s possible the cause of that pain may be referred from structures that lie higher up the limb.

While we always start our clinical exam at the elbow, if pain provocation tests are negative here, it’s important we check the cervical spine, the shoulder girdle, and the shoulder. For instance, an injury to the C5 nerve root in the neck can cause pain referral that is felt in the lateral aspect of the elbow (remember tennis elbow from our last post?).

If you happen to be dealing with elbow pain, try this sequence of screens and see if they reproduce your symptoms.

1. Wrist mobility tests (see "Wrist Hinge and Forearm Rotation Test" and "Wrist Flexion/Extension Test" videos)

2. Neck range of motion (see "Cervical CARs" video)

3. Reach, Roll, and Lift Test

09/30/2020

Cervical CARs

09/30/2020

Reach, Roll, and Lift

09/14/2020

💪Elbow Pain💪

The two most commonly occurring elbow injuries in golfers are golfer’s elbow (pain on the inside of the elbow) and tennis elbow (pain on the outside of the elbow). Common sense would dictate that golfer’s elbow would happen most often, right? Well, this is 2020 so don’t be surprised by anything anymore 😳

Tennis elbow happens to occur more frequently in amateur golfers. So, how does it happen? Well, this injury is brought on by anything that forces the wrist into extension (such as cupping the golf club), causing stress on the lateral elbow muscles and their attachment to the bone (the “epicondyle”).

Amateurs tend to extend their lead wrist while flexing the trail wrist (the opposite of a Tour Pro) at impact. In contrast, a Pro will extend their trail wrist at impact, and pain in the lead arm is usually medially (golfer’s elbow) because the wrist is slightly flexed at impact.

As mentioned during the discussion about wrist pain, if the lower body isn’t working properly, this can lead to casting, scooping, and chicken winging, all contributing factors to elbow injury 🤬

09/11/2020

Have a great weekend everyone! 🤣

Caddyshack - The Bishop's Final Round: The Bishop (Henry Wilcoxon) has Carl (Bill Murray) caddy for him during a thunderstorm in which he plays his best and ...

09/09/2020

Wrist Pain: The Exercises 🤛🏻🏋🏽‍♀️

So, how did those tests go? Do you need some work in certain areas? Although I didn’t provide a specific test for it, grip strength is usually an area with big discrepancies between amateurs and PGA Tour pros. For example, an amateur squeezing during a grip test at 100% of their maximal effort is still only about 50% of a PGA Tour player’s maximum effort! Try the following 3 drills to address your mobility and strength (including for the grip!), and compare your progress to the previous tests as you practice (see videos in Exercises section)!

1. Wrist extension PAILs and RAILs 🤛🏾: Place the palm of your hand on the floor behind you, with your wrist in an extended position. Lean back until you can feel a stretch in the front of your forearm, and hold for 2 minutes. Gradually push your palm into the floor, like you're trying to flex your wrist, and hold for 10 seconds. Now lean back further and imagine like you're trying to lift your palm up from the floor - you should feel a slight cramp or burn in the front of your forearm. Hold for 10 seconds. Re-examine your wrist extension ROM.

2. Glute bridge 🍑🌉: Laying on your back, tilt your pelvis as far forward and backward as you can, until you reach neutral. Squeeze your glutes to feel the muscles engaging, then drive your hips up towards the ceiling. About 70% of the effort should be coming from your glutes - if it feels less than this, you're likely compensating from elsewhere (likely your lower back or hamstrings). Master this movement and you can apply it to more complex exercises such as deadlifting and kettlebell swings.

3. Walking bottoms up kettlebell carries🚶‍♂️: This is a great drill for building grip strength and rotator cuff stability, as well as cueing your core. Hold a kettlebell with the bell end facing up towards the ceiling, while keeping your arm forward with your elbow bent to 90 degrees. Make sure your shoulder blade feels "packed" or engaged (create tension in it by pulling it towards your spine). Go for a walk while keeping the arm stable and making sure your rib cage remains over your pelvis (don't arch your lower back).