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