Wednesday, July 8, 2015

McIlroy's Ankle Woes

Unfortunate news from Rory McIlroy's camp.  He has torn his ATFL, a ligament on the outside of his ankle, playing soccer with friends.  Depending on the extent of the injury, he will most likely spend the next several months rehabilitating his ankle to get it back into PGA shape.  Here is a look at the foot and ankle and the vital role it plays in the game of golf!
 
The feet and ankles play an extremely important part in not only the stability of the golfer during his/her swing, but also help turn on the other generators of torque higher up the chain (i.e. the hips and core).  During the back swing, the back foot needs to stay planted in order to allow the R gluteal to load, creating potential energy that will be converted to kinetic energy (power) during the downswing.  The front foot also needs to stay planted, but allow the ankle to flex so that we can get adequate hip turn.  If we lack the ankle flexion here, it may lead to insufficient hip loading and increased lower back stress, increasing our chance for lower back injury.  It can also lead to front knee collapse inward and a horde of problems (related to both health and performance) that come along with that movement. 
 
How do we keep our feet and ankles healthy and supple? 
 
Triplanar Calf Stretch
 
This stretch should help to create ankle flexion while moving through all 3 planes of movement that are going to be utilized during the golf swing. 
 
 
 
video
 

Sunday, April 19, 2015

Case Example

Got a new client in the door the other day and I thought I would share some of the findings and our thought process.

Client is a 40 year old male with a 5 handicap.  He came in for work on flexibility, balance, and strength to hit the ball farther.

This is what his swing looks like at the top of his backswing:





Observations and Findings: 

1) Decreased control observed and mild weakness reported with left lower extremity lunges. 
2) Decreased control and balance on left lower extremity noted with balance tests.
3) Limited internal rotation motion left hip due to hip joint stiffness and tight hip muscles.
4) Tight and stiff left foot.
Assessment:

Decreased balance, strength and control of left lower extremity compromises stable foundation for backswing and ability to maximize load of muscles in lower extremity to maximize load of backswing for club speed, ball speed, power, distance, control and accuracy. Left lower extremity motion restrictions may be influencing upper half of body to compensate in backswing (overswing tendency).

Objective measures from Evaluation Session:



Ball Speed: 109.8 MPH


Carry Distance: 151.66 Yards


The client was given an exercise program which he performed for 1 week, underwent his first training session after 1 week of independent exercise, and then was measured again.


Ball Speed: 120.0 MPH

Carry Distance: 171.05 Yards

After 1 week, this client gained 10.2 MPH on his swing and 19.39 yards of carry distance!! Can you say incredible?

We will continue on and report as we go.

As always, hit 'em long, hit 'em straight, and optimize your body to optimize your game!



Saturday, February 21, 2015

Why do some people hit the ball farther than others?

Here are the leaders in driving distance in 2014


RANKLEADERAVG.
1Morgan Hoffmann 318.5
2Brooks Koepka 317.3
3Peter Uihlein 315.9
T4Charlie Beljan312.4
T4Jimmy Walker 312.4
TOUR AVERAGE
290.0

Morgan Hoffman: 6'0", 180lbs
Brooks Koepka: 6'0", 186 lbs
Peter Uihlein: 6'1", 190 lbs
Charlie Beljan: 6'4", 215 lbs
Jimmy Walker: 6'2", 180lbs

Aside from Beljan, these are not huge guys.  

2014 Mr. Olympia Winners
Branch Warren: 5' 7", 250 lbs
Victor Martinez: 5' 9", 245 lbs
Fred Smalls: 5'7", 245 lbs
Shawn Rhoden: 5'10", 240 lbs

I see some stark differences in body type here.  The longest hitting golfers on tour are tall, slim guys.  But if they aren't powering the ball with muscle, then how do they do it?  Furthermore, how can we modify our training to help we normal people hit the ball as far as we can?  It seems fairly clear that training like a body builder is not the way to get long off the tee.

I believe one answer is FASCIA.  If you don't know what fascia is, don't worry.  Most folks don't.  Up until very recently, even scientists pretty much wrote fascia off as an inert covering of the more important muscular tissue and hacked it off in cadaveric dissections to get really clean looking musculature.

Fascia is a connective tissue made up of densely packed collagen fibers, water, and proteins that covers and invests inside all tissues.  Here is a really well written article about fascia and why it is important: http://breakingmuscle.com/mobility-recovery/the-top-5-ways-fascia-matters-to-athletes

This can all be a bit dense.  So let's do something a bit more active.  Take your hand and place it on your chest.  Now without lifting your palm off of your chest, hit yourself as hard as you can with your index finger.  Now, use your other hand to pull your index finger back and then let it go and hit yourself with it.  Which one created more force?

Easy.  The second one.  By a huge margin.  You were able to create an audible thump!  Why is this?  Did we somehow develop a massively stronger index finger in 5 seconds?

No.  You were able to create more range of motion when you used your other hand to pull your finger back.  Force = mass x acceleration.  Acceleration = velocity/time.  More range of motion allowed for more change in velocity (increased acceleration), and thereby increased the amount of force produced.  This explains why being a muscle bound weight lifter would be detrimental to playing the game of golf well.

However!  The increase in range of motion was pretty dang small.  How do we account for the very large increase in force production?

The answer is:  we loaded our fascia.  By stretching the finger back, the fascia was stretched, creating potential energy.  We do this in the golf swing as we wind up into the back swing.  

If you watch a slow motion clip of a Tour Pro and you look closely, you can see the hips start the downswing while the hands are still loading up into the backswing.


This stretches the fascia even further, creating an incredible amount of potential energy that is translated into acceleration and therefore massive amounts of force.  

Well how do I get ball mashing fascia?  We need to train the sensory receptors in our fascia, the proprioceptors.  Prioprioceptors basically tell the brain what is happening in the body.  If we train specific movements over time, the body creates motor patterns and can effortlessly repeat these patterns when called upon to do so.  How does Ray Charles play a piano he can't see?  He has rockin' proprioception.  His brain knows where the keys are in relation to his fingers: no sight necessary.  

This means we need to train specifically.  If we bench press or squat or curl or do rows, we aren't loading our fascia in a way that it will remember when we go to hit the ball.  We need to prepare and then repetitively load the fascia in a way that will translate to the golf swing.  
 
Here are some examples of Fascial Mobilization:

Fascial Mobilization

Having trouble with upper and lower body dissociation?  This exercise is a great way to mobilize your abdominal fascia and increase your spinal range of motion.

Place a firm ball under your torso to one side of your belly button.  Roll your abdominals over the ball, looking for tension 















Open up your lats and improve your torso rotation by rolling side to side on a foam roller.


 
 

 


 
 



 
After some fascial mobilization, now we need to create memory!

In half kneeling, reach across your chest to actively stimulate your fascia.
 



We can stabilize our upper body and drive our lower body to the left to create lower body acceleration.


 
As always, hit 'em long, hit 'em straight, and optimize your body to optimize your game!

Tuesday, July 22, 2014

Quick Hitter For Neck Pain And Hook Tendency

Written by: Dr. Benjamin D. Turner, PT, DPT, CSCS, FAFS, FMR, NG360 Golf Performance Specialist 

I had a client come in the other day with complaints of left neck pain during the backswing and problems missing left and occasionally hitting a hook.  He was going on a golfing trip and wanted some quick hitters that he could do to decrease his pain and increase his performance.

After an assessment, we found that his posterior (back) left shoulder soft tissue (muscle and connective tissue) and his upper trapezius (neck muscle) were restricted and limiting his left arm and neck from moving fully in the backswing.  Because this motion was limited, he began to unconsciously compensate by bending his left elbow, causing him to cast out during his down swing and the resulting pain and left ball flight tendency.
He has several other limitations including thoracic spine (mid-back) stiffness and shoulder joint malpositioning that are contributing to his mechanical flaws, but because he was looking for a quick improvement, we picked something that we felt we could make a change in quickly and easily.  Our hope was that it would decrease his pain and improve his performance for his upcoming golf adventure.


In order to improve his motion, we chose some easy exercises shown below that he could perform before, during, and after his trip to start producing a better, safer golf swing.



Hit the soft tissue around your shoulder blade with a lacrosse ball. This should allow your shoulder blade to move more freely when  you swing. 



Put the lacrosse ball into the thick muscle of your lower neck, upper back.  Then:


Lower your arm toward the ground slowly, keeping your elbow straight. Don't force it; use the motion you have available.   Return to the starting position and repeat. You should be able to slowly increase your motion. 


Hold on to a wall or a door frame with one hand. With your other hand, reach under your armpit to create a shoulder turn.  You can hold and stretch or reach and repeat.  You can perform this on both sides.

After creating more motion, you need to use it to create proper motor patterns. 


Squat and reach over your head. 


Squat and reach across your body. 


Squat and reach over your head (to the side). 
 
 
As always, work within your available resources and slowly increase your mobility as your body will comfortably allow. 
 
Hit 'em long, hit 'em straight, and transform your body to optimize your game!

Thursday, June 26, 2014

Flying Right Elbow!

Written by: Dr. Benjamin D. Turner, PT, DPT, CSCS, FAFS, FMR, NG360 Golf Performance Specialist 

Middle aged male golfer came in to see me awhile back complaining of consistent problems hitting a “banana” slice.  His ball flight started out to the left and came all the way back across the fairway to the right, almost to the point of rolling perpendicular to the intended path.  


After assessment, we identified a clear problem.  He looked a lot like this:
 
 
 

It’s pretty obvious that something is going on with this guy’s right arm during the backswing.  From this position, the swing plane is going to be much too steep and while our golfer is working so hard to keep the clubface closed, the real problem is an outside in swing path, creating the banana slice.  

But why has he chosen to swing this way?  Excellent question!!

In the case of my client, we found that his right shoulder was very limited in the motion of external rotation.  
 



Because he could not achieve the above motion, his body chose to compensate by bringing the elbow away from the trunk into the funky position you see in the first picture.  

Well, how do we fix it?

We could concentrate really hard on trying to keep out elbow tight to our trunk, even pinching a headcover or glove there.  But does this fix our problem?  It’s inauthentic and may cause us to compensate elsewhere.  Ever feel like you are constantly fixing one issue, only to have another come popping up?  Perfect example.  

What we need to do is obvious:
 
1.) INCREASE THE SHOULDER EXTERNAL ROTATION!!  We need to do this in an authentic way
 
2.) Create motor memory so that when we hit the course, we don’t have to think about it.  It just happens naturally.
 
The deltoid is a common restrictor of external rotation.  Lets hit this piece with our lacrosse ball to free up the tissue.
 

Roll the ball through the deltoid tissue, hunting for the tight spots.  Tenderness is OK, sharp pains need to be avoided. 2 minutes.
 
Now lets perform a functional soft tissue mobilization. 
 
 
Start lying on your back with the lacrosse ball in the posterior shoulder musculature.  You can put the ball wherever you want, but we are looking for tight, sticky, restricted tissue here.


Allow your hand to drop back toward the ground.  Keep your elbow at a 90 degree bend!!  If you straighten your elbow, you are losing the position we are trying to mobilize.  You can also gradually bring your elbow closer to your body to put it closer to the position we are actually going to be using during our swing.  You know the drill: 2 minutes.
 
Now that we have mobilized our tissue, lets stretch it.
 
 
In the above starting position, keep the elbows together and spread the hands apart as far as comfortably possible.
 
 

Bring your body down, stretching the posterior (back) part of the shoulder.


Return to the starting position, then push your right hand out to the side.


 
Return to the starting position, then push your hands forward and down.  Spend 2 minutes performing this series of exercises.

Next, lets create a more authentic stretch.


Place your forearm against a door frame.  Keeping your elbow nice and tight to your body, step through the door and create a stretch.  You can turn your body away from your hand, shift your pelvis in different directions, and really do whatever you want to create more motion in this position.  2 minutes.

Lastly, lets create a movement pattern that we will use during our golf game.

 


Starting in the above position, rotate your trunk to the right, keeping your elbow flexed and tight to the trunk.  Perform 10-20x.



 
BOOM!  Freed up right shoulder external rotation.  Obviously, I did not start with a large limitation here, but this is somewhat close to the desired result.  Notice how this allows me to turn my body better as well as load up the right hip more.  Not only will this create more power, but also more consistency because the club stays on plane.  
 
 
AFTER:                                                            BEFORE:
     
 
This mobility program should make it much easier for the golfer to avoid many of the common pitfalls associated with a flying right elbow.

As always, hit 'em long, hit 'em straight, and transform your body to optimize your game!


Sunday, June 15, 2014

Fuel for the Golf Fitness Industry from the Pros

We love this video!! Straight from the professionals' mouths that a good fitness program can make the difference between frustration and success.  One thing we would like to see more of is flexibility and mobility training in this clip.  There are many examples of strength and endurance training, but what about the incredible amounts of mobility required to play golf?  Maybe more posts from us are required ;)



Saturday, June 7, 2014

Tiger Woods withdraws from 2014 US Open: How not to destroy your back playing golf

Written by: Dr. Benjamin D. Turner, PT, DPT, CSCS, FAFS, FMR, NG360 Golf Performance Specialist 

According to USA Today on May 29, 2014, Tiger Woods is still not playing golf.

After microdiscectomy surgery March 31st that was performed to alleviate pain caused by a pinched nerve in his lower back, Tiger has been restricted to chipping and putting and there is no timetable for his return. 

The biggest question for me here is not about when he can return to playing competitive golf, but was this a preventable problem?

Now I have no idea what Tiger’s physical condition looks like. I have never been able to look closely at his biomechanics or put my hands on and examine him. BUT...it never hurts to speculate. This is also a problem I see with many of my golfers, and I will speak to my experience with them.

We know that lumbar spine (lower back) nerve impingements often occur because of excessive motion at a vertebral segment. This excessive mobility demand can cause arthritis, things like bone spurring and narrowing of bony holes (foramen), and lead to pressure on a nerve.

We can attempt to treat this excessive movement in the lumbar spine with adjacent vertebral level joint mobilizations, muscle and connective tissue mobilization, and muscular stabilization, but these treatments alone would be ignoring a glaring question. Where does this excessive mobility demand come from?

Where does the extra motion demand come from?

If we look closely at the bony anatomy of the lumbar spine, it is clear that these bones are very good at flexing forward, i.e. making a bending over motion. It is also clear that lumbar extension (bending backward or standing up very straight), as well as bending and rotating to either side are not the strong suits of the lumbar spine. These motions primarily need to take place in other parts of the body.

There are many body parts that contribute to these motions, but for the sake of this article, we will focus on the parts that are directly above and below the lumbar spine: the hip and the thoracic spine (mid-back).

The hip is a very mobile ball and socket joint that has 3 degrees of freedom meaning it can move well in all 3 dimensions. Fortunately, this motion is controlled by the massive amount of muscle and connective tissue that surround the hip and pelvis. Unfortunately, these muscular and connective tissue structures have a nasty tendency to get glued together and restrict motion.  If we can’t move properly in one place, the motion will take place somewhere else and it is usually a place that is not designed for more motion.

 Let’s think specifically about the golf swing and the left hip, and then let’s examine the gluteals.

gluteals.png
Take a look at the muscle fiber orientation, the direction the fibers run through the muscle. The fibers on the left run obliquely from top right to bottom left. If this muscle starts to get tight, we lose the ability to turn our toes in. OR, if our left foot is planted, as it is in the golf swing, we would lose the ability to turn our pelvis to the left, which is EXACTLY the motion that we utilize in the downswing and follow through. Because of the massive amount of momentum that we create with our swing, a restricted hip is not going to stop us from making this motion. Unfortunately however, the tight soft tissue will create excessive motion demands above and below the hip: the knee and the lumbar spine.

If we look back to Tiger’s freshman year at Stanford in 1994, he had his first left knee surgery to remove scar tissue. He had subsequent left knee surgeries in ‘02, ‘07, and 3 in ‘08. He has also had left tibial stress fractures (‘08) and left Achilles tendon problems (‘12).

The exact same problem can be identified above the lumbar spine in the thoracic spine. Limitation in motion here will lead to a lumbar spine that has to excessively rotate and sidebend, and can also result in problems in the neck, shoulder, elbow and beyond.

In May 2010, Tiger withdraws on the seventh hole of the final round at The Players Championship with what he fears is a bulging disk. He later says it was inflammation of a joint in his neck.

In June 2013, Tiger injured his left elbow and had to skip the AT&T national.

Finally, in 2014, his lumbar spine has had enough. The disc between 2 vertebrae has been so severely damaged from excessive stress that it has to be partially surgically removed. He will spend many arduous months rehabilitating after surgery and patiently (or impatiently) waiting for his body to repair itself. The key question is this:

Can we prevent it from happening in the first place?

Preventing the problem

Everyone is different and there are many things that can cause lower back problems while playing golf. For the purpose of this article, we will focus on the left hip problem described above (for a right handed golfer).

After the thorough examination of the hip restriction problem, the answer seems somewhat obvious. We must restore left hip mobility to remove the excessive demand on the lumbar spine. If the hip can move freely, we restore movement balance and efficiency to the system and stop grinding our vertebrae into bone dust.

This same concept actually applies to Tiger’s rehab. If he does not do this, it is just a matter of time before this same problem returns, and probably as a much more severe manifestation.

Well what can we do about it?

In order to create soft tissue mobility, we basically need to unglue our tissues. This means hydrating our tissue and restoring sliding movement inside the tissue-between the muscle fibers, the muscle and surrounding connective tissue, and the muscles themselves. A great way to do this for the gluteal tissue is illustrated below.
image (2).jpeg

With your left leg straight, place a lacrosse ball under the gluteal muscle and roll over the ball. This may be tender, uncomfortable, and bumpy, but this is OK as long as there are no sharp pains or pain that lasts after you stop rolling.

image (1).jpeg

Then take your left leg and put it over your right leg to increase the rotational tension and roll over the ball. Perform each exercise for 1 minute.

After we have unglued or melted our tissue, we need to stretch or mold it. This will help to create the hip motion that we want during our swing. We need to create stretch in all of the three dimensions that the hip moves - back, to the left, and left rotation. Below is a gluteal stretch that accomplishes this task.

lat hip stretch.jpeg

On your hands and knees, drive your pelvis to the left to create tension on the hip soft tissue. While holding the lateral position, drive the pelvis down and back to add another plane of tension.

lat hip stretch with rotation.jpeg

Then take your left leg and cross it over the right to create rotational tension. Perform each exercise 1 minute.

Finally, we need to move through our new motion so that we build motor patterns and movement that the brain will learn so that we will subconsciously move well when we swing instead of reverting back to our previously tight-hip swing.

photo.JPG

Step forward with your right foot, keeping your left foot planted.

opposite lateral.jpeg

Then step forward and across with your right foot, crossing the midline with your left foot planted and your right toes pointed forward.

image.jpeg

Finally, step forward and across with your right foot, crossing the midline with your left foot forward and your right toes pointed toward the left.

Perform these mobility exercises 3-5x/week and enjoy your new mobility and effortless, pain-free follow through!

References:
1.) Tiger Woods withdraws from US Open http://www.usatoday.com/story/sports/golf/2014/05/28/tiger-woods-withdraws-from-us-open/9690415/

2.)Chronology of Tiger Woods Injuries http://www.golf.com/photos/tiger-woods-injuries-chronology/tiger-woods-stanford-1995#340347