Tag Archives: Injury

Stretching is a waste of time

I spend most of my time working with clients who want more mobility, be it the ability to get a greater shoulder turn in the backswing or to turn more to ‘load the hips’ in the downswing. The flip side of this is that I spend most of my time working with golfers who spend far to long sitting, either at a desk 8-10 hours a day or on a plane/train/car traveling to the next tournament 2-3 days a week. Unsurprisingly, a fair few of them arrive on my client roster with the mobility of a clam, meaning even basic human movement patterns, such as the squat or hinge are challenging endeavours.

Seeing that part of my job is centred on optimising movement patterns and mobility, these clients expect me to help them improve in this area. However, what isn’t expected, indeed even resisted by some, is when I break down my ‘mobility’ methods, It’s often not what people expect. For most clients, there is very little to no static stretching whatsoever.

The response is pretty predictable – “how am I going to improve my mobility/flexibility if I don’t stretch?” Or “But I’m stretching everyday at the moment; surely I need to do more if I’m going to get better?” My response is to ask whether there religious stretching routine to date has actually improved their mobility. The answer is always No.

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No matter how much time a client spends stretching, they typically see only transient improvements in flexibility and negligible improvement in motor control when performing any movement using that new range of motion. Static stretching alone is not the answer. In fact, it barely provides any benefit at all.

As a result, I’ve dropped almost all static stretching from my programs in favour of some more advanced mobility methods I’ll discuss here.

Why stretching doesn’t work?

Well first off, muscles can’t actually be lengthened – There are various research studies that have looked at this exact topic. Secondly a single 20 second static stretch has been shown to noticeably reduce force output – hardly ideal if your about to go and do a strength training session or complete a high power output activity such as golf.

Most importantly however, tightness in the muscle is often just a symptom not the cause of the problem and therefore stretching is just a band aid for the symptoms and will not fix the cause in the long term. A muscle is tight because it’s protecting a perceived instability, compensating for another area, or is guarding against a perceived threat. So if your tight first you need to ask why said muscle is tight?

For most of us with tightness one or all of the factors above are also at play in limiting range of motion.  Stretching doesn’t address the cause of the muscle being tense in the first place. If the muscle is actually ‘tight’, static stretching should allow the muscle to become less tight, and those gains should be permanent if they are appropriate to the restriction. However, particularly in an area like the hips, that are designed to have a large range of motion before actual end range due to a bony block or capsular ending, the muscles are most likely hanging on to give stability to some other part of the body. Static stretching won’t fix the issue on a permanent basis, as you’ll simply return to being tight as a drum again to give you the stability to move.

You need to fix the stability issue, which is the cause. Not attack the tight muscle, which is just the symptom with static stretching.

As a quick aside: The hip joint can get to 170 degrees of flexion, and in some angles outside of the sagittal plane it can get to more than 200 degrees flexion. It can also extend to between 40-60 degrees, which adds up to way more than the necessary 180 degrees to do a split. This leaves soft tissue restrictions as the reason most people can’t hit the splits. Sure, some have structural issues with the shape of their hip joints, but that can’t be something that could account for the entire population.

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Bodybuilder, Flex Wheeler, used to hit the splits on stage, carb depleted and dehydrated while packing more muscle than 95% of the population, proving the concept of “muscle bound” reducing flexibility to be completely and utterly false.

Let’s look at the hip flexors as a specific example, a tight hip flexor is often the result of femur sliding forward (anterior glide), resulting in the glutes becoming stretched and weak (this is what’s meant by a capsular issue). Additionally, if a segment is unstable, so other areas become tense to try to provide the stability needed to move. In the case of the hip flexors, they attach to the spine, so If you core musculature responsible for stabilising the spine is weak, your hip flexors will try to stabilise your spine and they’ll stay tight to give stability.

There is huge interplay between the core and the hip. It’s not enough just to look at the hip in addressing your poor mobility. To echo the message of smart people such as Gray Cook, Charlie Weingroff , and Mike Robertson who have really made this stuff mainstream, we need proximal stability to have distal mobility. In other words, we need relative stability through the trunk to make full use of the range of motion available in joints such as the hips and shoulders.

Another example would be tight hamstrings – many people have hamstrings that feel permanently tight and couldn’t touch their toes if their life depends on it. Many of these golfers still cling to the idea that static stretching of the hamstrings is the answer, down this road lies nothing but frustration and wasted time!

These individuals typically display a pelvis that is anteriorly tilted, placing the hamstrings in a stretched position to start with, coupled with an inability to posteriorly shift weight back into the hips. If we can improve the lumbo-pelvic position and alignment, both statically and dynamically, we’ll improve that feeling of hamstring ‘tightness’.

If not stretching, then what should I do?

As I said earlier muscle, or any soft tissue for that matter, doesn’t have the physiological properties to permanently deform and lengthen. That leaves us with optimising adjacent players in gross movement patterns to improve the pattern itself, and create an illusion of muscles gaining length or suppleness. True mobility, therefore, is dependent on an athlete’s ability to create proper movement strategies.

Below is the plan of attack we use with our clients to get their mobility restrictions in the right direction:

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While many people think foam rolling or other SMR techniques are a method of stretching, they’re not. The muscle isn’t undergoing any kind of length change, but rather a neural down-regulation that reduces resting tone in prime movers, meaning you can move more easily and with a better chance of having balanced tension around the joint. It’s a testament to how resetting the neural tone of a tissue can help increase range of motion faster than simply stretching. Picking up that tight hamstrings example again, foam rolling/ SMR techniques hitting the glute, glute med, and adductors are often useful to reduce tension in these muscles and allow a more posterior pelvic tilt. Here’s a tact and floss SMR technique that I’ve found particularly effective:

But again, un-gluing a chronically tight area without restoring stability to the tissues it’s trying to help stabilise will only result in it getting tight again.

Dynamic mobilisation comes into play with the newly unlocked joints and tissues. The role of active mobility is to train the body to use the range of motion in the most effective way possible so that the likelihood of maintaining this new range is higher.

When doing any active mobility, focus on keeping the spine tense and the core active while sinking deep into the stretches, hold each for a single breath per rep, and continue on to the next one. Continuing our hamstring tightness example, modified quadruped rock backs, kneeling adductor mobilisations or kneeling posterior hip/glue mobilisations work well.

Lastly, we need to ensure this new range of motion sticks and is usable within functional movement patterns. This is where motor control and movement pattern correctives come into play.

For the those with tight hip flexors this is where exercises teaching core control and separation of hip extension from lumbar extension are really useful. For those with tight hamstrings we will now utilise toe touch correctives, to address the poor pattern. As shown in the video below elevating the toes and squeezing an airex pad placed between the legs is a good option as it encourages posterior weight shift and engages the glutes to encourage posterior pelvic tilt respectively. As with dynamic mobility be sure to keep the core tense and focus on breathing.

Closing thoughts

If you happen to be the individual with tight hamstrings and a poor toe touch pattern, used as an example here, you’re in luck as all you need to do is follow along with the exercises in these videos and let me know how much better your hamstrings feel and your toe touch is after a month or so. However, the point of this article really was to highlight the limitations of static stretching and show the system we use in our programs to develop mobility instead of stretching. For any mobility restriction you have targeted foam rolling/SMR, followed by dynamic mobilisation work and finally pattern correctives will do much more for you than mindlessly static stretching ever did.

If you would like to see more articles like this, covering how to deal with other specific mobility restrictions such as tight hip flexors, t-spine or shoulder mobility, let me know in the comments and if enough people ask for it we’ll get it written.

Elbow Pain in Golfers: What to do

Today’s article is something a bit special! It’s a guest post from Sports Chiropractor and author Tom Feeney. Tom is a Sports Chiro specialising in myofascial release in Newcastle upon Tyne. He has treated Premiership, Olympic, NHL, and WWE athletes and the general public since 1997. His work has featured in The Telegraph, Athletics Weekly, Train Magazine, and 220 Triathlon, with his article on performance therapy for golfers being published on Stack and TPI.

In this article Tom takes a look at the research on Elbow pain in golfers and offers some practical solutions to get you pain free, back to the course and back to full training in the gym. I think you’ll really enjoy it so without further ado!

Tendon pain at the elbow is common in golfers. When on the inside it is called Golfer’s Elbow and when on the outside it is called Tennis Elbow. Some tips:

  1. Research shows Myofascial Release is better than standard therapies.
  2. Exercises help- try isometric (no movement) and eccentric (negatives) exercises.
  3. There is some inflammation in some tendon problems, ice may help after heavy use.
  4. MRI may be better than diagnostic ultrasound in identifying LE.
  5. Steroid injections don’t provide long-term benefit.

Should I ice it? The inflammation debate!  There may  be some swelling but in most cases ice is not needed.

Over the last few decades, LE stopped being considered a tendinitis because little evidence of inflammatory markers were found.  Tendinopathy became the new term of choice, but recent research found convincing evidence that the inflammatory response is a key component of chronic tendinopathies like LE.   My take: some inflammation is there, but it may be an important part of healing.  Only ice after heavy use.

What causes the pain?

In a nutshell, tendinosis involves too much tendon breakdown and not enough repair. When repetitive micro trauma damages cells, they create new collagen which is structurally different.

Is exercise the answer?

Exercises helped relieve pain in the short-term compared to no intervention 2011 study.

Exercises should progress from isometrics to eccentrics:

Isometric exercises involve putting a muscle and tendon under tension, but no movement. In some cases I give this exercise with the wrist and finger in varied positions.

Eccentric exercises with a band for LE are often helpful and easy to do.

Will it go away on its own?

2002 study found in 83% of cases of LE resolved at 52 weeks with no intervention.

Does manual therapy help?

Researchers compared Active Release Techniques (ART) and Myofascial Release to a control  group receiving therapeutic ultrasound, the release techniques were found to be much more effective. Two case reports  also found them effective. A recent study found myofascial release effective in treating plantar fasciitis, which is similar to tennis elbow.

What about injections?

Steroid injections were found to provide worse outcomes than placebo in a 2013 study.  “There may be a short-term pain relief advantage found with the application of corticosteroids, but no demonstrable long-term pain relief” – 2014 review.

Are MRIs or ultrasound scans needed?

2014 review concluded, “power doppler ultrasonography and real-time sonoelastography (is) expensive, and …this technology did not significantly add to the sensitivity and specificity of Gray-scale Ultrasonography”.

There is evidence of MRI signs of oedema on the asymptomatic side of many LE patients. Thickening or partial tearing was not found on the asymptomatic side. Therefore if the non-painful side shows swelling, it may not be important for an MRI to find the sore side has swelling!

Conclusion

Combine manual therapy with an exercise program, before getting an injection.

 

You can find more from Tom at his website www.whitleybaychiropractic.co.uk

3 training methods for the unstable golfer

Injury prone?

Can’t seem to get stronger and more powerful in the gym?

No amounts of stretching or mobilisations seem to help your mobility?

Your fitness program doesn’t seem to carryover to the golf course?

As a coach I’ve had a fair few clients who would answer yes to most if not all of these questions (I’m sure all of us coaches have) so what’s the deal?

You could be trying to add functional adaptations and sports skills to an unstable base.

The goal of this article is to give you some ideas for developing that stable base. If you can learn (or teach your clients) to effectively stabilise, the answer to those questions above should start to change for the better. But first:

A Quick Look at Performance Model’s

I am a big fan of Gray Cook’s performance model. In case you haven’t seen it before, here it is:

FMS-Performance-Pyramid

As you can see, the foundation of the pyramid is quality movement. Movement quality is the base you want to build athletic development on top of.

Without high-quality movement, you’re simply laying strength, power or sport-specific development on top of a cracked foundation.

But let’s break that foundation down a bit further (and hopefully guys like Gray and Charlie Weingroff would agree here).

Within that bottom tier, you have at the very least two primary goals:

  • Mobility
  • Reflex stabilization/motor control

Many factors will affect mobility, the least of which is muscle length. There are 3 reasons why a muscle shortens:

  • You tell it too
  • It feels there is a need to protect something in the body
  • It’s hanging on for dear life, to keep you balanced

Note those last two. They mean that the mobility you can display will be effected by the ability to stabilise (simply put, if the joint is stable at a particular range of motion the the brain will allow you to go to that range of motion).

For those with stability issues static stretching is on par with having someone with a headache bang their head against a wall.

So now lets look in a little more detail what stability actually is. As Gray is famous for saying:

“stability doesn’t mean strength.”

Stability can be even further broken down into static stability and dynamic stability. An example of static stability would be training someone in half-kneeling, whereas a lunge or split-squat would be training dynamic stability.

Once you have good mobility and stability, you’ve earned the right to load those patterns. There are many many ways of going about adding load, and this is another area where a good coach can be vital in determine what is appropriate. I believe that, as well as creating physical adaptations and increases in strength and power, once you have adequate mobility and stability, loading those squats, deadlifts, etc, helps cement these quality movement patterns.

Now that we have a baseline understanding, let’s look at some of the ways I try to improve stability with unstable clients. We’re also going to assume (just to make things simple), there are no obvious mobility deficits or asymmetries – as always a movement screen such as FMS or TPI is recommended to determine this.

Method #1 – Utilise Continuums

We all know that trying to fit a round peg into a square hole doesn’t work.

So why would we train athletes with a “one-size-fits-all” approach? Or list of exercises?

This is exercise progressions and regressions. Without it, you’re really just throwing random exercises and hoping they will stick.

For example, If someone has trouble demonstrating stability in a hinge or bend pattern, you probably wouldn’t want to start them off with a kettlebell swing. It’s a fantastic exercise, but the speed of movement may make it difficult to dial-in the technique. A conventional or Sumo-style deadlift may also not be appropriate due to the integrated nature of the movement.

Another option could be if someone simply can’t figure out to hinge in a standing position, you may want to give them a more isolated regression of that same pattern, without the weight bearing demands. As far as the hinge pattern goes, hip thrusts fit the bill here:

This will allow the athlete to perform and develop the movement pattern without too many inefficiencies in movement, re-learn the movement with proper reflexive stability and progress from there.

Here are just a few factors to consider when developing progressions and regressions for any movement pattern:

  • Low to High Speed
  • Isolated to Integrated Movements
  • Low Complexity to High Complexity
  • Small to Big Ranges of Motion
  • Single to Multi-Joint Movements
  • More External Stability to Less

Method #2 – Slow down rep speed

For those who are unstable, I like to use times of slow concentrics, as well as a ton of slow eccentrics.

Slow eccentrics provide several benefits for unstable clients:

  • They improves proprioception and body awareness
  • They shift the focus on active stability versus passive (it’s harder to hang on joints when you’re moving slow!)
  • The develop strength in the muscle
  • They develop connective tissue strength (tendons, ligaments, and joints)

Too often, people who are floppy and/or unstable get overuse injuries. Various studies have shown the effectiveness of eccentric exercises in dealing with/ managing tendonitis.

In my experience, when movement patterns are dialed in, and slowed tempos made a dedicated component of a training program, stability and performance increase dramatically.

Finally, isometrics and paused reps are an excellent choice as well. When you force someone to pause and control a motion at the midpoint, they really have no choice but to learn how to stabilize more effectively.

Method #3 – Add External Stability Initially

This is my go to option to begin with. Too often, we assume that just because our clients/athlete walk around every day, that they have earned the right to exercise on their feet.

Nothing could be further from the truth!

If an athlete can’t even stand on one leg without falling over during an assessment (incidentally the single-leg balance is probably one of the most commonly failed assessments we use, particularly in a sedentary population), then we need to dial someone back as far as necessary for them to get some traction. Again, you have to earn the right to exercise standing up!

The progression may look something like this…

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These positions are in reference to the methods in which baby humans learn to explore movement. Yes, infants are basically made of rubber and their hip joints look more like shoulder joints, that possess ridiculous mobility.  However, those little guys learn to control that mobility by putting in months of work and progressing from position to position – supine/prone, sidelying, quadruped, half/tall kneeling; until they have developed the necessary stability to stand, squat, walk, run, jump, etc.

As adults, it’s beneficial to revisit these positions to hone and refine our movement -especially since today’s more sedentary lifestyle seems to cause some loss of mobility and reflexive motor control.

The half kneeling position, for example, is a fantastic tool to improve these attributes.  By lowering the centre of mass (compared to standing), the athlete can practice moving through the hips and shoulders with less compensation and unnecessary motion through the pelvis and lumbar spine – which is common and more difficult to overcome in a standing position.

Summary

If you’re more prone to injuries, and/or the progress you do see isn’t as significant as you would like then instability could be the issue. Get you movement assessed, then try incorporating some of the options outlined above, and let me know how they work out!

If you’re interested in having us conduct a movement screen or develop a program individualised for your needs, that will absolutely get you more resilient, improve your athleticism and see carryover to your golf game get in contact via our online coaching page.

How to golf forever: 5 key exercises

Want to play the game we all love for as long as possible? Of course you do!

The golf swing is not an easy motion on the body and your posture likely sucks – You sit a lot and you stare at a lot of screens.

In order to play for as long as possible, you need to make caring for your body a priority in order to prevent injury and insure lifelong orthopedic health.

The first step is to get your training program rebalanced. Generally speaking most gym goers push more than they pull, leading to a host of potential problems down the road. Take a look at your current program and make sure to get a 2:1 ratio of pulling to pushing exercises.

Once that’s taken into account use these exercises to straighten out your posture and keep you on the course for the long haul.

No. 1 – Face Pulls

The face pull may be the most versatile loaded training tool in our arsenal for remediating poor shoulder and thoracic positioning. It provides the exact opposite movements to the ones we’re continuously pulled into on a daily basis.

This movement incorporates humeral horizontal abduction and external rotation of the shoulder and retracts the shoulder blades – all helping combat the hunched over, constantly adducted, internally rotated and protracted posture.

Slouching over a phone or computer reading this? that’s the poor position I’m talking about!

Don’t be fooled into thinking the face pull is just another dainty corrective exercise either. Sure, it can be programmed into any successful dynamic warm-up or activation technique for prepping the shoulders and rotator cuff, but you can also load this pattern up for a results-producing training effect.

No. 2 – Rear Foot Elevated Split-squats

To me the rear-foot elevated split squat might offer the biggest bang for you buck of any squat or single-leg exercise. You get the stability requirements of standing on one-leg, ycan load some heavy ass weight up with it, and it also provides some direct dynamic mobility work for the hip flexors of the leg which is placed in the elevated position (achieving an extended hip position with a flexed knee puts a nice stretch through the superficial and deep hip flexor groups while challenging this position under stability and strength requisites). All this adds up to you getting a downright brutal training effect when executed properly.

And there’s more! Not only does this movement have the ability to be loaded up, but done so in a safe manner. It actually protects the lower spine.

The single leg nature of the movement incorporates a reciprocal pelvic position that deloads the lower spinal segments and helps protect notoriously vulnerable segments from unwanted shear stress. When done with the weight loaded in a front racked manner the greater core activation will help to prevent anterior pelvic tilt during the movement (a particular problem in exercises like back squats) and hold the spine in neutral.

Basically RFESS’s mean you can strengthen the lower body without putting the spine under as much load.

No. 3 – 1-leg rotational med-ball taps

The relationship between a loss of balance and ageing has been long established. Put simply the longer you are able to maintain your level of balance ability, the more likely you are to stay active, healthy and without the need for rehab. Additionally, static balance proficiency has been associated with improved performance in baseball pitching, a movement that usually exhibits pretty good carryover to the golf swing.

The 1-leg rotational med-ball tap is a nice exercise to develop static balance whilst beginning to learn to disassociate the upper and lower body, and correct rotation mechanics.

No. 4 – Loaded carries

The loaded carry is another class of movement that is absolutely pivotal for every single person on earth to practice and master.

World class experts have been passionately teaching the loaded carry for years to tap into both a prehab model of the spine and synergistic neuromuscular stability patterns that link up the shoulders, core, and hips.

When executed properly, loaded carries are pretty much the ultimate form of core training. Indeed, low back and core health expert Dr. Stuart McGill, considers the programming of loaded carries absolutely essential.

So why does the loaded carry keep you healthy and functioning above all other core specific movements? The phenomenon of what Dr. McGill has coined “super-stiffness,” this can be explained as a rhythmic and timely firing pattern around a region of joints to maintain an optimal position.

The loaded carry does just that, and then some. Not only are the four layers of the abdominal wall being activated, but also the hip and shoulder complexes that can have the ability manipulate the position of the spine, especially when they become dynamic in nature.

Don’t dismiss the carry as just an optional metabolic finisher. When programmed with parameters of progressive overload, the carry can be advanced to match increasing levels of your skill and strength.

No. 5 – Glute bridge

If you haven’t got the idea from this post already, spinal health is a big deal if you plan on playing golf or moving in general for the rest of your life. Glute strength is a vital component spinal health.

You can prevent spinal injury through training the lower pillar of your spine in a more concentrated dynamic nature.

From the simplistic supine bodyweight glute bridge to the loaded hip thrust, the popularization of glute training has never been more mainstream.

The glute max forms a highly influential structure, with specific attachment points throughout the posterior pelvic structure, that plays a major role in enhancing both posture and stability throughout the lower lumbar segments. The glute medius may be equally as important to long-term function, responsible for both lateral hip stability and alignment.

From athletic performance to avoiding hip fractures later on in life, targeting the glutes directly translates into function. Manipulate range of motion, rhythm, and loading variables in training, and the glutes will enhance global function in every step of your life and undo the poor postural stresses of daily sitting while also firing up the posterior chain.

3 ways to increase force production in the golf swing – strength, speed and stability

While strength alone isn’t enough, strength is probably the first factor you should focus on to improve velocity. To develop more power, you need to be stronger. Put plainly, the more force you can exert, the further you’ll hit it.

Studies demonstrate, lower body strengthening is an area that deserves a lot of attention. The legs are are essential in creating ground reaction force and the first stage in transferring that force from the ground through the body and into the club.

Take a look at pro’s these days. A lot of the guys that have big legs, hips, and butts are some of the longest hitters, and the ones who look like they do it most effortlessly. Jason Day is a great example:

Jason Day a.ka. Quadzilla

Jason Day a.ka. Quadzilla

The stronger your legs, the more force you can generate. This has been shown in numerous studies to correlate to velocity in all most all rotational sports including golf.

Whilst a base of strength is incredibly important and something I see many golfers still overlook, strength alone is not enough and could even be detrimental. Research in the strength and conditioning world has shown that training certain qualities, like strength and speed, results in velocity specific adaptations to the body.

Better stated – train slow and you’ll swing slow.

Once a baseline of strength is established, I tend to focus on evolving the ability to ‘explode’. What I mean by this is you want to move with intent – fast, quick and crisp. This is area many golfers are lacking, they don’t know how to explode.

Once an athlete understands how to move a heavy weight slowly, you want to transition to moving a moderate weight fast, and a lighter weight even faster.

Speed trap bar deadlifts against bands (the band tension makes it harder at the top so momentum means the faster you pull the easier it is) are probably my very favourite exercise at the moving moderate weight fast end of the spectrum. Exercises like plyometric jumps, med-ball throws and kettle bell swings are effective for the lighter weight even faster part.

On the golf training side of the equation, this is where underweight clubs, hand speed drills and simply practicing swinging faster come in to play.

Lastly, and probably the least well implemented, is training for stability. To improve clubhead velocity, you need the proper motor control and dynamic stability to stabilize both the arms, the core and the legs.

To properly transfer force that is developed from the ground, you need a strong AND stable legs.

You need front leg stability to efficiently transfer force in the downswing, also don’t forget the body has internal regulations to avoid injury. If the lead leg can’t stabilize the force, the theory goes, your body won’t allow you to develop maximum force in order to protect you from potential injury.

Incidentally, this is one of the reasons why I believe using weighted clubs is ineffective and can be harmful, especially for young golfers. You need the strength to be able to withstand the force to produce the force, your body will down-regulate force development to prevent injury otherwise.

To maximize velocity, you need to train the body to develop and withstand force. Too many programs focus on developing force alone. This can result in ineffective training programs as well as injury by pushing past your physiological limits. Whilst we use a lot of exercises to help develop force, we also use exercises such as reactive lateral jumps and lateral jumps with external rotation stick, which have a high deceleration component too.

Video credit: Eric Cressey

To recap; get strong so you can create more force, learn how to ‘explode’ and generate that force quickly, and develop stability so you can control and decelerate that force. Next, sit back and watch how far into the distance your drives now go flying!

Random golf fitness thoughts: Instalment 4

1. The ‘modern’ golf swing may be more conducive to low back pain.

Research has suggested that players using a more classic style of golf swing experience less low back pain. If we break it down this makes perfect sense; the ‘modern’ golf swing involves turning the shoulders whilst keeping the hips relatively square and stable with the lead heel planted to create the mythical ‘x-factor’.  This means greater hip and especially t-spine mobility demands relative to a more classic style swing, where the hips are allowed to turn a lot more relative to the shoulders even to the extent of the lead heel lifting, and we already know not having appropriate t-spine and hip mobility to perform the golf swing is a contributing factor in golfers experiencing low back pain.

2. Stabilise the lumbar spine, then stabilise it some more.

I’ve talked previously about the need to develop adequate t-spine and hip mobility as when your body doesn’t have it, it will attempt to get movement elsewhere in order to make up for it, namely the lumbar spine. The lumbar spine isn’t really designed to move a great deal and requiring motion from the lumbar spine to perform the golf swing is a recipe for injury. However, we haven’t looked much at this from the other angle. Namely the need to be really really stable in the lumbar spine to prevent those excess motions in the golf swing. Core exercises, such as barbell rollouts, trx fallouts and pallof presses, as well as hip extension exercises and simply paying better attention to pelvic and rib cage positioning during movement (think neutral position, rib cage turned down and abs engaged) can have a great affect on improving lumbar stability.

3. Agnostic supersets are great, but consider spinal compression when planning them.

The agnostic method of organising supersets is one of the most popular ways of programming in total body workout set-up. The problem is, while the muscles being targeted may indeed oppose each other, you could be doubling up on the stress imposed on the skeletal frame. Here’s an example:

A1. Barbell Deadlift or RDL

A2. Barbell Standing Press or Push Press

We’ve got a pulling movement followed by a pushing movement, even though the directions of force are opposite one another both exercises place compressive load on the spine. This means the low back doesn’t get a break, often meaning that your skeletal system will become a limiting factor, not good in your pursuit of improving muscular strength. It’s important to think of the effects supersets have not only on muscles, but the bones in question, too.overhead-press

A superior alternative involving both of these exercises in a total body workout may look something like this:

A1. Barbell Deadlift or RDL

A2. Bodyweight Dip

Or

A1. Barbell Standing Press or Push Press

A2. Wide Grip Pull-Up or Lat Pulldown

In both cases, we have an example of an exercise that provides a decompression of the vertebrae after the compression imposed by the first exercise. This is a subtle change in thinking your body will thank you for.

low-back-pain

Injury proof your golf game

Research conducted into injuries amongst golfers has shown that almost 80% of injuries in professionals occur through overuse, with injuries primarily to the hips, wrists, back and shoulders. Injuries in amateurs can be caused by overuse, but in most cases occur due to low-back-painfaulty swing patterns developed around physical limitations. As a result, they over stress areas of the body and create injury, or further pre-existing injury. Injuries in the lower back and elbows due to poor technique and dysfunctional movement patterns are common in amateurs.

Injury inducing swing mechanics

Low back injuries

S-posture: Excessive anterior tilt in the lumbar spine causes inhibition of the abs and glutes. This position can lead to loss of posture, reverse spine angle, early extension and ultimately low back pain. Normal anterior tilt of the pelvis should be about 15-25 degrees. Golfers may have been told to stick their butt out when getting into golf posture, many do this by going into excessive anterior tilt. This immediately inhibits the abs and glutes. Or they exhibit lower-crossed syndrome and the same inhibition occurs.

Reverse spine angle: The golfer overly recruits the musculature of the back and lats, to go into too much extension in the back swing -this will directly increase the amount of sheer forces that the lumbar spine will be subjected too at impact. Reverse spine is can also be caused by a lack of mobility, particularly external rotation, in the shoulder.

Early extension: Golfer goes into rapid hip extension during the downswing – this inhibits the abdominals ability to stabilise through impact and increases the forces on the lumbar spine as a result. The players lower body can often be seen getting closer to the ball during the swing.

Reverse ‘C’ finish: Finishing the swing in full hyperextension (big arch in back) puts the lumbar spine under more compressive forces, increasing the chance of injury.

Restricted right leg follow through: This is a bigger deal than most people think due to the large deceleration torque created in the spine. You should be able to count all the spikes on the bottom of the right shoe from down the line after impact.

Elbow injuries

Chicken wing/Flying elbow/limited backswing: Limited shoulder range of motion, particularly external rotation, on either side increases the potential for tendonitis and other injury in the elbow joint.

Limited shoulder mobility on the target side often results in chicken winging. Chicken winging is characterised by the elbow bending and remaining close to the body as it slides aroundthe back to the follow through. If shoulder mobility is limited in the trail arm, you could have a flying elbow in your backswing, a limited backswing or it may force the golfer into a reverse spine angle.

Overuse injuries

Playing a repeitive sport, such as golf, can lead to imbalances and overuse injuries. Mobility work, improving soft tissue and muscle fascia quality, and a balanced program of resistance exercises, will help iron out imbalances and prevent overuse injuries. Having balanced chest and upper back musculature, plus strengthening the rotator cuff, can help avoid shoulder injuries. As well as helping to keep a neutral spine at address and adding power to your golf swing.

Developing adequate extension and rotation in the t-spine and mid-back to allow a full shoulder turn and negate the necessity for excessive lumbar movement.

Imbalances in forearm musculature can occur as a result of the numerous gripping and re-gripping required in golf, these imbalances can also lead to elbow pain. Soft tissue work for the forearms will improve tissue quality and help alleviate these pains.

The truth about unstable surface training.

One of the most important things in training is to questions. To ask, for example, what are my goals? Is this helping me achieve my goals? Is this the best method I have to get the job done?

Unstable surface training (UST) has become an integral and expected part of many strength and conditioning programs, particularly in golf. Indeed magazine covers and articles are abundant promising a better swing, longer drives and lower scores from a few simple exercises performed on a swiss ball.

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Claims have been made for the effectiveness of UST for injury prehab, rehab, increasing power in the golf swing, increasing balance in the swing and improving swing mechanics. What follows is a brief synopsis of research into UST in performance settings, examining these claims and asking weather the use of UST in golf strength and conditioning programs is really appropriate.

Beginning in rehab circles, UST has been shown to be effective in aiding recovery, improving balance and enhancing performance in injured athletes. So when dealing with injured golfers there is little doubt as to the effectiveness of UST as long as the difficulty  level of the exercises used is also appropriate.

However, there is no evidence that UST reduces the likelyhood of injury or improves performance in healthy, trained athletes. Indeed a study by Cressey et al in the Journal of Strength and Conditioning found that replacing 2-3% of overall training volume with UST didn’t improve performance. More importantly, UST minimised improvements in plyometric and agility tests. In other words, the subjects who weren’t doing UST made bigger gains in power and speed.

The other issue highlighted by the  UST research is the specific nature of improvements made by trainees. Put bluntly, classic core work on unstable surfaces, such as swiss ball crunches, doesn’t really  carry over to anything at all.

A study from Stanton et al (2004) found that measure of core stability improved in athletes after 6 weeks of stability ball training, but it did not favourably effect running economy, posture, or favourably modify EMG activity of abdominal or erector spinae musculature, in other words it didn’t carry over. A comparable result was found by Tse et al (2005). After 8 weeks of stability ball training in collegiate rowers, while core stability, as they tested it, improved, no performance increases were shown over several key measures of athletic performance, including vertical jump, broad jump, overhead med ball throw, and 2000 metre row.

There is considerable opinion amongst strength and conditioning professionals that balance is best trained in the parameters it is to be used. Golf is a game played with both feet, on a stable surface and should be trained this way. Additionally, significant anecdotal evidence is beginning to emerge that attempting to replicate sporting tasks on unstable surfaces actually impairs the learning of the actual skill, through competing motor demands. In a technical sport like golf, this is absolutely unacceptable.

In short, do your mobility/ activation work to improvement movement efficiency and stability, then apply that efficiency and stability throughout a full range of motion to a solid strength training program that develops reactive ability, rate of force development, maximal strength and speed strength. If your a healthy, injury free athlete why waste your time with UST?