DANIEL B. LEONARD, D.C. ART® FARABAUGH CHIROPRACTIC OFFICE 2879 E. DUBLIN GRANVILLE RD. Low Back...
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Transcript of DANIEL B. LEONARD, D.C. ART® FARABAUGH CHIROPRACTIC OFFICE 2879 E. DUBLIN GRANVILLE RD. Low Back...
DANIEL B. LEONARD, D.C. ART®FARABAUGH CHIROPRACTIC OFFICE
2879 E. DUBLIN GRANVILLE RD.
Low Back Pain and Golf Mechanics
Wedgewood Country Club
Dr. Daniel Leonard
Graduate of Miami University (Exercise Science Major)
Doctorate in Chiropractic and Sports Rehabilitation
Active Release Technique®Dynamic Neuromusclouar Rehabilitation
(DNS) Only physician in Columbus utilizing this technique
Back Pain in the general population
Affects 50-80% of population 40% have back pain in any one year15-33% have point incidence at any given
time
Adams, et. Al (1999)
Causation: Internal vs. External Forces
Back pain and Golf
Golf injuries originate from an overuse or from a traumatic origin (Theriault, Lachance)
Amateur golfers were prevented from playing
golf for an average of 5.2 weeks per year due to chronic injuries sustained while golfing
(US, McCarroll et al)
Overuse Injuries in Golf
Kinetic Chain (system of links)
Specific motions at certain segments of the kinetic chain have a dramatic effect in movement of other joints (or lack there of), and the turning on or off of certain muscles
(Gray seminar 2005)
Golf Injuries
Main Causes of Golf Injuries
Overuse Technical errors during the swingPhysical fitness deficiencies Aerobic, muscular strength, flexibilityNo pre-game warm upNatural environmental conditions (uneven course surface, wet grass, thunderstorms)
Sports Med 1998 Jul; 26 (1)
Technical Errors during the swing
C PostureS PostureSwaySlide
C Posture
Slumped shoulders at address and roundness to your thoracic spine
Limited thoracic extension Upper cross syndrome-
muscle imbalance, tight pecs, lats, upper traps, levator scap and weakness in mid scapular muscles, lower traps, and deep neck flexors
Instability of core muscles causing poor posture and a slouched forward position at address
Lack of thoracic spine extension relates to increased lumbar and cervical spine motion
C Posture
Functional Screens Exercise Examples
Thoracic Extension/ Wall Angle Foam Roller/ Swiss ball extension
S Posture
Too much arch in the low back as a result of sticking your tail bone out too far (“j-lo booty”)
Lower cross syndrome- tighness in the hip flexors and lower back and weakness in the abdominals and glutes
Lack of abdominal endurance/ strength
This excessive curvature in the low back puts abnormally high stress on the lumbar joints, disks, and musculature
You can successfully stick your butt out at address and keep your spine in a neutral position if you hinge from your hips. This requires good core strength and proper stabilization, the problem arises when this isn’t true and the force is generated in to the lumbar spine.
S Posture
Functional Screens Exercise Examples
Core endurance testThomas test
Side bridge Tri planar psoas stretch
Sway
Excessive lower body movement away from the target during your back swing that forces your weight to the outside of your back foot
Very difficult to attain proper weight shift during the transition and the downswing
Proper rotation around the back hip is only possible if adequate amount of internal rotation exists. If the body is unable to rotate around this hip then lateral movements will dominate the pattern
Secondly the ability to separate your upper body from lower body allows the lower body to laterally stabilize while rotating during a large shoulder turn. Limited trunk to pelvis is usually caused by reduced spinal mobility
Finally, the ability to laterally stabilize your right leg during the downswing is directly dependant on the strength and stability of your gluteal musculature
Sway
Functional Screens Exercise Examples
Hip rotation testThoracic Rotation testGlute stability test
Hip mobility/ stretchingFoam roller/ Swiss ballGlute bridge
Slide
Excessive lower body lateral movement towards the target during your downswing
Stability on the lower body is crucial in order to accelerate during the downswing
Once the lower body starts its forward shift into the downswing its job is to transfer energy to the upper body and stabilize the extreme rotary forces that are created in the upper body. If there is no stable platform to rotate around, players will lose power and try to develop speed in an inefficient sequence
Proper rotation around the front hip is only possible if adequate amount of internal rotation exists. If the body is unable to rotate around this hip then lateral movements will dominate the pattern
Secondly the ability to separate your upper body from lower body allows the lower body to laterally stabilize while rotating during a large shoulder turn. Limited trunk to pelvis is usually caused by reduced spinal mobility
Finally, the ability to laterally stabilize your right leg during the downswing is directly dependant on the strength and stability of your gluteal musculature
Slide
Functional Screens Exercise examples
Hip rotation testThoracic Rotation testGlute stability test
Hip mobility/ stretchingFoam roller/ Swiss ballGlute bridge
Functional Screens
Core Endurance TestSide Bridge >70 seconds linked to less injury
(McGill 2010)
Functional Screens
Thoracic Mobility
Thoracic Extension (Wall Angle)
Functional Screens
Hip Mobility (internal/external rotation) Ideal hip rotation 45º internal 45º external rotation Artifically increasing hip stiffness in normal subjects caused
profound changes in the profile of trunk movements and balance control (Gruneberg, 2004)
“I am continually surprised at the number of people with back troubles who also have hip troubles” (McGill, 2005)
Functional Screens
Glute Stability testProper activation of the posterior
chain is initiated by glute activationWeak/Inhibited glutes will be
evident by over action of the lumbarextensor muscles or hamstrings
Functional Screens
Thomas Test (hip extension) Hip extension is directly related to lumbar spine function If tightness is present in the hip flexors (psoas muscle) in
order to get extension, the lumbar spine has to continually over extend to compensate= excessive wear on the posterior elements of the lumbar spine
Treating functional findings
Lumbar aliments commonly seen in golfers will be clinically improved by rest, manipulation, traction, and a good lower back rehabilitation program designed to regain maximal flexibility and strength
(Sports Med 1998 Jul; 26 (1)
Exercise
Thoracic Mobility and Thoracic Extension
Exercise
Core Endurance
Exercise
Hip Mobility
Not what we are looking for
Exercise
Tri-planar psoas stretch
Tri planar stretching allows the muscle to be stretch in all planes where as static stretching only accounts for one plane
Exercise
Glute Bridge
Poor Pattern Over-activation of lumbar muscles
and hamstrings Poor control
Ideal Pattern Core activation and Glute
activation simultaneously Good control
Chiropractic and Golf
Less than 2% of golfers visit a chiropractorGolfers suffer mainly with mechanical back
pain, making golf and chiropractic a perfect match
Spinal adjustments are known to be effective in reducing pain and increasing spinal mobility
An aggressive lumbar spine rehabilitation program should be institute as both a therapeutic and preventative measure
Dyn. Chiropractic Aug 1999; 17 (17)
Chiropractic and Golf
Three fundamental causes of golf injuries: poor posture, lack of flexibility, and poor swing mechanics All of which are often a direct result of physical restrictions or
mechanical dysfunctions which can be restored with spinal manipulation and exercise
Dyn. Chiropractic 2001; 19 (26)
“Amateur golfers achieve approximately 90 percent of their peak muscle activity when driving a golf ball. This is the same intensity as picking up a weight that can only be lifted four times before total fatigue. This level of exertion and muscular activation equates golf with such sports as football, hockey, and martial arts. The difference is that other athletes outside of golf include conditioning as part of their preparation before play.”
Paul Check-Golf Biomechanics Manual
Exercise
“Exercise programs should be started until joints have a normal end feel”
(Mennel)
The EndTHANK YOU!
Dr. Daniel B. Leonard
Farabaugh Chiropractic Office 2879 E. Dublin Granville Rd.
Columbus, Ohio 43231(614)898-0787
Copyright © 2012 Dr. Ronald J. Farabaugh