Latest / The Driven Athlete / Golf Mobility, Diagnosis, & Treatment Strategies | Ep 48

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Golf Mobility, Diagnosis, & Treatment Strategies | Ep 48 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up y'all?
• 0:12
  Speaker 1: It's your man, dr Kyle.
• 0:13
  Speaker 1: We're going to talk about golfer requirements.
• 0:17
  Speaker 1: Okay, movement requirements and what we find in our golfers that we work with, because we do see a lot of golfers in this area, like golf is super popular, one of my favorite things to do, mainly when I actually play good.
• 0:28
  Speaker 1: You know, I really enjoy playing golf if I'm like actually playing good and not just uh being frustrated all the time.
• 0:34
  Speaker 1: But that's another story and not my profession on how to fix uh golf swings and get people better at skills at golfing.
• 0:42
  Speaker 1: But what I am, what I do, what we do do, is movement, mobility, mobility, compensation patterns, joint mobility, compensation patterns from an orthopedic standpoint, and then also muscle recruitment, muscle strength and activation requirements for compensation patterns that can develop Right.
• 1:01
  Speaker 1: But for golfer movement requirements, the first thing we had to talk about mobility and range of motion, like flexibility, totally right, the range of motion and mobility to actually get into the positions to be in an effective posture or spot during the golf swing at the backswing and all the way in the follow through right, all the way through impact.
• 1:22
  Speaker 1: So that's the first thing we look at right.
• 1:24
  Speaker 1: And people come see us because they have pain right All the way through impact.
• 1:25
  Speaker 1: So that's the first thing we look at right.
• 1:25
  Speaker 1: If somebody is having and people come see us because they have pain right Back pain, shoulder pain, neck pain, ankle, hip, hip pinching in the front of the hip really common one, sij, sacroiliac joint pain those are the real they come see us as sports physios to fix that pain so that they can get back to playing golf at a high level and a swing at a high level with full power and not have any issues Right.
• 1:47
  Speaker 1: So that's where they're coming to see us in the first place.
• 1:49
  Speaker 1: So, with our thinking caps on and our lens as a sports physio of analyzing this we're not golf pros, of fixing golf swings or developing skills as a golfer, but what we do do is we check out mobility requirements, joint mobility disparities, strength and stability disparity and recruitment pattern disparities that ultimately cause compensation patterns over time.
• 2:11
  Speaker 1: So that's what we're checking out, that's what we're analyzing.
• 2:13
  Speaker 1: So, from that lens that we're looking at this, the first thing we're going to check out is the range of motion and mobility requirements to get into the best posture you can to play golf.
• 2:22
  Speaker 1: And we ask like first, where does it hurt?
• 2:25
  Speaker 1: Right, like hurts in your back, the left side, the right side, whatever right, the hip, front of the hip, all those we're going to deep dive into that stuff and we have to figure that out right.
• 2:34
  Speaker 1: And then another really important question that I feel like is missed a lot is when in your swing does it cause pain.
• 2:41
  Speaker 1: So we know where in your body the pain is located.
• 2:44
  Speaker 1: Cool, when does it come about?
• 2:47
  Speaker 1: When in your swing do you feel it?
• 2:48
  Speaker 1: Right?
• 2:49
  Speaker 1: Because only just saying it hurts when I golf, it hurts when I swing my golf club or when I'm hitting balls, that doesn't really tell us enough of a story to have a clear differential diagnosis of what's going on.
• 2:59
  Speaker 1: Does that make sense?
• 3:00
  Speaker 1: So we have to figure out when in your swing is it causing a problem?
• 3:04
  Speaker 1: When do your symptoms come about and you feel it?
• 3:10
  Speaker 1: Another common thing might be like I don't feel it at the beginning, but then I feel it towards the end.
• 3:11
  Speaker 1: All right, that's more of an endurance, stability issue.
• 3:13
  Speaker 1: And we would still ask where, what does it feel like?
• 3:16
  Speaker 1: And then, when in your swing do you feel these symptoms?
• 3:21
  Speaker 1: Right, the pain.
• 3:21
  Speaker 1: It's going to tell us a different story and it allows us to intervene and pinpoint and hone in on, like our working hypotheses of what the problem is.
• 3:28
  Speaker 1: So when anybody comes in, we always have hypotheses of, like, this person has back pain on the right side and he's a left-handed golfer.
• 3:34
  Speaker 1: When does it hurt?
• 3:36
  Speaker 1: We got to figure that out and deep dive into that.
• 3:39
  Speaker 1: It allows us to hone in on our hypotheses of what the problem is.
• 3:42
  Speaker 1: So once we have an idea of like when in your swing it hurts, it gives us an idea of like, are the mobility requirements there enough?
• 3:51
  Speaker 1: Are they sufficient to get to that position in the backswing?
• 3:54
  Speaker 1: Or the follow through during the swing pattern?
• 3:56
  Speaker 1: And then, where are they lacking?
• 3:58
  Speaker 1: Right, ultimately.
• 4:00
  Speaker 1: With that being said, athletes and active people right, active athletic people are the best compensators.
• 4:06
  Speaker 1: They compensate really well to make things happen right and they don't know that they're compensating otherwise until something comes about right, like until pain happens.
• 4:14
  Speaker 1: And that's when they started investigating and like, why is my shoulder hurting the way it is?
• 4:18
  Speaker 1: This whole time didn't really realize that I had learned to move in these patterns that were ultimately a compensation pattern to begin with, because I'm lacking internal hip rotation on my lead side for the follow-through, right During the follow-through and that makes me compensate elsewhere in my back or my lumbothoracic junction, my TLJ, my thoracolumbar junction or my sacroiliac joint or my T-spine is limited in rotation mobility or my neck is limited in rotation and making me have to compensate through my hips to rotate further because my neck can't rotate far enough.
• 4:54
  Speaker 1: So I'm like limited in my mobility requirements to make the shot happen or make the swing happen.
• 4:58
  Speaker 1: So that's the first thing we look at Do they have the mobility requirements to actually get there?
• 5:02
  Speaker 1: This next question is if they're battling issues and we're checking it out and investigating and are working hypotheses of what their problem is and why it came about in the first place, because we had to check out the stability and the strength do they have the stability to move through those positions at end range, at full end range of your rotation, your turn can backswing and then also all the way through the follow-through and then really very commonly if they're, if they have pain at impact during the impact component of the swing.
• 5:29
  Speaker 1: That's a stability problem usually and we have to find out where's the disparity?
• 5:34
  Speaker 1: Where are they lacking that strength and recruitment?
• 5:38
  Speaker 1: What muscles aren't being recruited enough to help contribute to the stability through that rotational movement and the impact?
• 5:43
  Speaker 1: Or, at end range, if they're just collapsing and resting on their bony architecture and their spine, at the follow through and full extension, the stability around the vertebrae or your hips, your SIGA, your sacroiliac joint.
• 5:58
  Speaker 1: If there's not enough of a stability component to wrap around all those structures, then those bones are just going to.
• 6:05
  Speaker 1: The joints are going to rest on their own bony architecture, which are built for congruency totally.
• 6:11
  Speaker 1: But that creates shear and that shearing component between your joints is what ultimately breaks things down and causes, over time, degenerative changes.
• 6:18
  Speaker 1: Degenerative changes being like arthritic changes, osteophytes, bone spurs, decreased disc height space, narrowing of the disc space, degenerative disc disease and just general stenotic changes over a long period of time.
• 6:34
  Speaker 1: That's where we find that it's from shearing, which is like excessive amounts of translation against forces through your joints.
• 6:41
  Speaker 1: So there's a lack of stability requirements to stabilize.
• 6:44
  Speaker 1: Through that, then the bones are going to shear each other a little more aggressively and that causes problems over time.
• 6:49
  Speaker 1: Or if they're lacking mobility, then other joints that are hypermobile and too mobile are going to be shearing excessively as well.
• 6:56
  Speaker 1: So there's a component of the joint hyper mobility and joint hypo mobility, too much movement or not enough movement in certain joints as they play the interplay together through this functional rotational sport activity like golf, and then also the strength requirements and stability through those movements as equally and as dispersed evenly as possible for recruitment of those muscles that can all work in concert together for the best stability.
• 7:20
  Speaker 1: Once that's figured out and we have a good, clear diagnosis through our working hypotheses of like, I think this is what's going on and here are the compensation patterns and here are the disparities and mobility and strength that we can work and close the gap to make it better.
• 7:31
  Speaker 1: Then we can crush core stability, crush glute strength, crush leg and hip stability and power generation, rotational strength and rotational power generation, with a lot of cool, fun variations of exercises, working and piggybacking off of what we've already been working on right.
• 7:48
  Speaker 1: We don't want to cause a problem trying to fix something else, right.
• 7:51
  Speaker 1: We don't want to cause another problem trying to solve the original thing, and that gets tricky.
• 7:55
  Speaker 1: But that's what we do right as professionals in biomechanics and pain.
• 7:57
  Speaker 1: That's what we thing and that's.
• 7:57
  Speaker 1: It's tricky, but that's what we do right as professionals.
• 7:58
  Speaker 1: And biomechanics and pain, that's what we do and that's what we ultimately have to figure out.
• 8:01
  Speaker 1: But how can we be creative and work around these issues to improve the ultimate outcome at the end without making things worse in the meantime?
• 8:09
  Speaker 1: And actually oftentimes, what we find it turns out to be a blessing in disguise, because we're unearthing and uncovering things and disparities that they wouldn't normally find anyway, and now they're a better athlete on the outcome of this at the end than they were otherwise.
• 8:23
  Speaker 1: Great, right, that's a high five.
• 8:25
  Speaker 1: So we can work on that stuff, which is really cool.
• 8:28
  Speaker 1: The next thing is with rotational strength and power generation.
• 8:33
  Speaker 1: What I was going to say is the power, rotational stability, the power generate, power, rotational strength comes from the pelvis and the trunk.
• 8:42
  Speaker 1: Rotation and the sequencing.
• 8:44
  Speaker 1: So I know in TPI and we talked a lot about this too is the in the golf swing.
• 8:49
  Speaker 1: Like I said, I'm not a golf pro, but I am a biomechanics and pain person.
• 8:53
  Speaker 1: That's what I do.
• 8:54
  Speaker 1: Biomechanics and mobility and pain expert that's what we do right.
• 8:56
  Speaker 1: And pain person that's what I do.
• 8:57
  Speaker 1: Biomechanics and mobility and pain expert that's what we do right.
• 8:59
  Speaker 1: But sequencing is really important, as in what move from the backswing and the turn, transitioning into the downswing, for the impact all the way through.
• 9:07
  Speaker 1: Follow through what moves first.
• 9:08
  Speaker 1: And the ideal situation for sequencing is the pelvis should rotate first.
• 9:13
  Speaker 1: The hips right, the pelvis it's really the pelvis.
• 9:25
  Speaker 1: All the core musculature and the glutes attach from your hips and your spine to your pelvis.
• 9:27
  Speaker 1: So the pelvic structure has to rotate and turn first and that, ultimately, is what starts and initiates the rotational power component, all right, followed by the trunk, followed by your shoulders and arms and then passively, the hands come through.
• 9:36
  Speaker 1: So we're not like slapping or cutting or tomahawking the ball, but rather sequencing our pelvis, our trunk, shoulders, arms and then hands in like a race.
• 9:46
  Speaker 1: And what sequence can they activate sequentially for the best rotational power?
• 9:51
  Speaker 1: So we can isolate certain components of that with corrective exercises if they're already having an issue.
• 9:57
  Speaker 1: To begin with and part of that is the pelvic rotation, we have to initiate the movement and separate the pelvis from the spine so the pelvis gets to separate.
• 10:06
  Speaker 1: Imagine like if two blocks are on top, like a building blocks are on top of each other.
• 10:09
  Speaker 1: The bottom block can rotate independently of the top block versus both moving as one unit.
• 10:14
  Speaker 1: We have to separate those rotational components and we can isolate that with a lot of cool, fun, creative corrective exercise techniques that we do Ultimately, and then we can work on trunk rotation and then we can work on upper body power and then arm upper body power and strength and plyometrics, lower body, totally like glutes, quads, hamstring.
• 10:33
  Speaker 1: We get to use all that stuff for sure and a big thing in literature, at least within the studies that are talking about where golf is using the ground for ground reaction force.
• 10:42
  Speaker 1: I totally agree with that too.
• 10:42
  Speaker 1: We're definitely going to leverage the pelvic rotation component and that comes from your core and your glutes.
• 10:48
  Speaker 1: So the glutes are the king and the core is also the king.
• 10:51
  Speaker 1: Those two things work in concert together and they mainly influence the pelvis.
• 10:55
  Speaker 1: So it's a very influential component that.
• 10:59
  Speaker 1: That's what we're focusing rotation generated from the core, the abdominals, obliques, internal obliques, external obliques, transverse abdominis, erectus abdominis, and then, of course, all the back musculature, all the erector spinae groups.
• 11:14
  Speaker 1: Your QL needs to be used too, but what we find is the erector and the QL, the quadratus lumborum.
• 11:20
  Speaker 1: Those back muscles are usually overused chronically and they're constantly on guard and the way that we answer that, or to shed light on that a little bit more, is for anybody that has back pain.
• 11:33
  Speaker 1: What does it feel like?
• 11:35
  Speaker 1: Right, your back is tight.
• 11:37
  Speaker 1: It feels like the back is constantly on high alert and guarded and then, to the extreme end of that, it's spasms, right?
• 11:45
  Speaker 1: So the muscles that are in spasm or constantly guarded and tight and hanging on for dear life, do you think those muscles are overly active or underly active?
• 11:55
  Speaker 1: They're overly active chronically, they're chronically on high alert and they're chronically hanging on for dear life.
• 12:01
  Speaker 1: So what muscles do you think are usually more re-recruited easily, more easily and more readily ready to turn on and strength and be used to stabilize the back?
• 12:13
  Speaker 1: The muscles that are chronically always on, those are always abdominant.
• 12:17
  Speaker 1: You never really hear about ab spasms like an oblique spasm or like a rectus, like your abdominal spasm, like an ab spasm or a diaphragm spasm, right For, like back pain.
• 12:28
  Speaker 1: So that would indicate to me, then, the core musculature of, like the anterior core and the lateral core, like your obliques and your rectus, those muscles are actually inactive.
• 12:37
  Speaker 1: Comparative to the back muscles like the erector spinae and your QL, those muscles are always usually more hyperactive and guarded and the spasms are a clear indication of that.
• 12:46
  Speaker 1: So we need to get everything recruited well.
• 12:50
  Speaker 1: But we can really strengthen stuff once things feel better and we're getting good progress and making good strides.
• 12:55
  Speaker 1: Then we can strengthen the heck out of everything and we can't neglect the glutes.
• 12:58
  Speaker 1: Dynamic hip stability, balance plays a role too, and those are all fun, creative touch points that we need to work on for the golfer.
• 13:05
  Speaker 1: And the last thing I was gonna say is the best way and the recipe that we found with fixing these disparities in joint mobility and range of motion.
• 13:16
  Speaker 1: Some things move too much and other things don't move enough.
• 13:18
  Speaker 1: Right Is interplay, like hip internal rotation on the lead hip for the follow through doesn't doesn't move well enough compared to the middle lumbar spine.
• 13:28
  Speaker 1: Where does that usually cause pain?
• 13:31
  Speaker 1: It's either going to be low back pain right and full extension at the follow through and rotation, which is putting a lot of torque on it, or anterior hip pinching.
• 13:41
  Speaker 1: So either one can definitely play a role right.
• 13:43
  Speaker 1: But usually the lumbar spine is going to be hypermobile because it's rotating too much to compensate for a lack of hip internal rotation.
• 13:50
  Speaker 1: So the lumbar spine is compensating too much, hips not moving enough.
• 13:55
  Speaker 1: Solution let's mobilize the hip and then strengthen the heck out of the glutes to stabilize it through that end range of motion.
• 14:00
  Speaker 1: Then we can crush core stability to help create more lumbar spine stability and then work on sequencing and then translate all that information with the golf pro so that y'all can work on that together and more of a purposeful professional way with them.
• 14:13
  Speaker 1: That's not what we do.
• 14:13
  Speaker 1: We're staying in our lane.
• 14:14
  Speaker 1: We're paying biomechanics for sure and we're not going to like implement things that might be conflicting with what the golf pro is going to say for their swing right, but for pain and mobility and orthopedics, that's what we do, right.
• 14:26
  Speaker 1: So what we find is that the manual therapy, joint mobility or joint manipulations, and then the soft tissue, like dry needling and cupping and other soft tissue modalities there's a plethora of options.
• 14:39
  Speaker 1: So everyone's different in what they need, but we set it up for success, the joint mobility and available mobility requirements, range of motion and also pain.
• 14:47
  Speaker 1: We set things up for success to tolerate and move better and more equally right, more symmetrically, more congruently, and now that things are moving more symmetrically and better, less disparities, now we can strengthen and do the corrective exercises and it really seems to solidify the changes, the corrective exercises and changing those movement and recruitment patterns is ultimately what creates the long lasting changes that we need.
• 15:11
  Speaker 1: And the question that we ask the fellowship trained clinicians that we mentor and work with for treatment is we ask them the athletes you're working with, when they're feeling good and you're there back to sport and you say, hey, practice 100% full, go hit balls, get after it.
• 15:29
  Speaker 1: How well can it last for their pain to not return?
• 15:33
  Speaker 1: And if their pain comes back after you worked on a bunch of stuff and their pain returns, then that means you didn't fix the actual underlying cause of the problem.
• 15:41
  Speaker 1: And that's what we need to tackle and that's our main focus as our high level sports clinicians that are within our practice.
• 15:48
  Speaker 1: That's what we have to focus on and really target purposefully but anyway.
• 15:54
  Speaker 1: So if you have any questions, don't hesitate to reach out.
• 15:57
  Speaker 1: We see a lot of golfers.
• 15:58
  Speaker 1: It's one of the niches that we get a lot of fulfillment and excitement over and we love treating and working with them.
• 16:04
  Speaker 1: But definitely reach out if you have any questions and if you're battling issues as a golfer or back pain in general or shoulder anything, right, we work with a lot of a plethora of people, this one specifically for golfers.
• 16:13
  Speaker 1: But if you know anybody or you yourself are suffering from golf issues and pain, don't hesitate to reach out.
• 16:19
  Speaker 1: We love to at least chat and get an idea of where you're at and what you're looking for and then we can move forward together if you feel like we're a good fit.
• 16:24
  Speaker 1: But anyway, other than that for our podcast, feel free to share this, send it to somebody.
• 16:30
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• 16:32
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• 16:36
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• 16:38
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• 16:43
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• 16:45
  Speaker 1: We have to deliver results and that's what ultimately people want.
• 16:48
  Speaker 1: We need to solve a problem for them and we need to deliver the results.
• 16:52
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• 17:01
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• 17:05
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• 17:07
  Speaker 1: It could change their insights and lens on maybe helping them and then also share some cool insights on, maybe golf.
• 17:13
  Speaker 1: You know for their swing and biomechanics, so feel free to share this.
• 17:17
  Speaker 1: I would encourage you to, and we love helping people in the community, so don't hesitate to reach out and we'll catch y'all next time.