Many of you may know that for many years I struggled with pain and instability in my low back and 2 ½ years ago I had a spinal fusion. One of the largest parts of that struggle was my inability to participate in many activities that I loved because of the pain and instability, both during and after participation. Frankly, the joy of most things was sucked right out of me.
Now, fast forward 2 ½ years. I can now say that my back and leg pain is essentially gone, and I barely ever recognize that I had a problem. As a physical therapist, I know that part of aging is the degenerative processes that occur in our body, and in this case, the joint surfaces and the discs, specifically. This is a result of both genetic predisposition as well as good old-fashioned wear and tear from the things we do on a day-to-day basis.
I, unfortunately, have some not-so-good genetics, and I have lived a very active life that included sports as a child and numerous home improvement activities from construction to yard work and everything in between, as I grew up. Nothing never seemed out of the realm of possibilities with me, except if it involved rodents, reptiles, or insects. Those, I do not do! However, build a stone wall…yes. Paint the house…yes. Lay down patio stones…yes. Build a deck…yes. Rototill for a new garden…yes, yes, and yes again. I was my own worst enemy. Yes, I did NOT practice what I preached. Now, fortunately I do. I can empathize with how hard that can be at times.
This is where golf comes in. Although I didn’t golf as a child, it is an activity that this old body can both enjoy and get some much-needed physical exercise. The result for me has been profound, both mentally and physically, and I am committed to finding and maintaining a balance that will allow me to participate in as many activities that I love to do.
I now realize that to continue doing them, I must prepare my body and I must moderate the activities so that my body will tolerate them and not rebel against me. With the PGA US Open (June 14-17) being played this month, I feel that providing you with some of the tools that have helped me return to the game would be apropos. The most common injuries in golf are back pain, shoulder pain from rotator cuff injuries, tendonitis at the elbow and wrist, and knee pain. Because I’ve been referring to my issues with back pain, I’ll highlight some specific pointers relative to the back in this article, but will refer you to some earlier posts for some great golf tips dealing with the other injuries.
Personally, I like to walk the course when possible, so having appropriate support in the form of footwear with a supportive footbed or orthotic is vital. When the foot hits the ground everything else follows, which means that when incorrect, additional force is placed on the ankles, knees, hips, and ultimately the low back, which can lead to further degeneration and inflammation (i.e., degenerative or osteoarthritis).
Conditioning for cardiovascular health is helpful as well. An average distance for 18 holes of golf is approximately 4 miles if you walk a straight line. Because I’m only a beginner golfer, I can assure you I walk more than that! In fact, by the time I’m done (which includes getting to and from the car) I’m typically putting in 6-7,000 steps for 9 holes and averaging 11-12,000 for 18.
If you think about the golf swing itself, it is important that you develop both flexibility as well as core strength, so that the back is both stabilized and has enough movement. This helps disperse the forces throughout the spine and minimizes increased stress both above and below a fusion, which is what I, and many others like me (Tiger included) deal with. A simple core exercise, and one that is a basic building block for all other core exercises, called Hollowing is learning how to isometrically contract the deep abdominal muscles. Here is a description of how to do this lying down (supine), but you really want to learn how to do this in every position possible, including just standing around. Basically, it is what most of us do to pull in our belly’s when buttoning our pants:
Supine Hollowing – Lie on your back with your knees bent and in a neutral spine, meaning a comfortable position for you and without arching your low back. Tighten your lower abdominals as if you were pulling your belly away from the front of your pants.
From a flexibility standpoint, there are hundreds of examples out there for stretching, and a zillion more opinions about which ones are best and how to do them. With nearly 40 years as a PT, I have my own favorites based upon experience in the clinic as well as having done them myself. I believe technique is key:
- Don’t bounce – Avoid abrupt or bouncy movements
- Don’t be aggressive – Mild to moderate pulling at most
- Don’t be too quick – Maintain stretch for at least 30 seconds
The following 4 exercises come straight from our clinic and can be found in our library.
Hamstring Stretching (Sitting In Chair) – Sit at the edge of a chair and straighten one leg out keeping the knee as straight as you can. Bend at the hips bringing your belly button toward your knee (keep your back straight).
Gastroc & Soleus Stretching – Also known as the calf muscles. There are 2 separate muscles, one that ends above the knee and one below. To target the gastroc(nemius) muscle, you must keep your knee straight. To target the soleus muscle, you will bend your knee and will feel the stretch lower in the leg towards your Achilles, or heel cord.
To stretch these, stand facing a wall. With your hands on the wall for balance, to stretch the muscle in the left leg, keep your right foot forward and move your left foot back. Keeping your heel on the ground, slowly slide your left foot further from the wall until you feel the pulling in your left calf. For the gastroc, keep the knee straight. You will feel the pulling higher up on your calf, just below your knee. To stretch the other muscle in your left calf (soleus), with your right leg forward and left leg slightly back, allow your left knee to slowly bend towards the floor until you feel the pulling towards your heel cord.
Reverse the legs to stretch the muscles in your right calf.
Psoas Stretch-Standing – Stand facing a chair placing your left foot on top of the chair with your right leg on the floor behind you. Lean forward slightly making sure to keep your belly and butt tight (contracted). You should feel a stretch in the front of your right hip.
Rectus Femoris Stretch – (Standing with chair) – Stand with a chair behind you. Place your right foot on the back of the chair and then your right knee on the seat of the chair. Then lean back until you feel a stretch in the front of your thigh. The closer your knee is to the back of the chair the more of a stretch you will feel. Repeat on the left to stretch that leg.
Because we are constantly researching, learning, and trying to find great resources for our patients, occasionally we come across some great examples and self-help tips produced by other organizations. In 2015 the Mayo Clinic came out with a publication which we cited and excerpted from. In our excerpt the first 4 exercises address hip and buttock, low back, and trunk flexibility (including the upper back and shoulder girdle area). This addresses the much-needed trunk rotation and flexibility that is required to put some power into your swing, without overstressing the arms and subjecting them to rotator cuff or elbow tendonitis issues.
To further help protect the back, leg strength and body mechanics are a must, as well. Think about how many times you are bending over to Tee up a ball, retrieve and errant shot, and pluck your ball from the often-elusive cup. My two favorite exercises to address these issues are sit squats and hip hinges which are described below.
Sit Squats (I call them “sit” squats because it is the same motion you use when sitting in a chair.)
Begin in a standing position with your feet hip-width apart. Bend your knees and hips as far as you feel safe, until your knees are just shy of a 90-degree angle. Your rear end should shift back as if to “hover” over a chair. Make sure that your knees do not go forward past your toes; your hips, knees and feet are aligned; and your chest stays up so your low back does not round forward. Your weight should be felt in your heels more than your toes. The goal is to lower your bottom closer to the chair with each repetition.
Bending Forward Using Your Hips (Hip Hinge) – Beginning in an upright standing position, slowly bend forward at your hips, bending your knees only if you must, making sure you keep your back straight. This may feel very foreign to you and initially it may be helpful to hold a broomstick with one hand at the back of your head and the other behind your rear end. This will keep your spine straight while you bend forward from the hips. I often think of the butler or waiter bow or the bobbing chicken toy when describing this exercise.
Please be aware that there are numerous sources out there for some great warm up activities and helpful hints to avoid injuries when participating in golf, or any other recreation or activity that you enjoy. The suggestions that I have outlined above will certainly help, but to address your individual needs, you should have an assessment to identify your specific areas of imbalance so that a program can be tailored to you. A physical therapist is an expert in this area and can help you prepare your body to carry out the directives of your golf professional or instructor.
I don’t know about you, but when I am on the course, I am a much happier person when I am a better golfer, and preparing your body is step number 1 in achieving that goal.