After identifying the most common golf injuries last month, Optimal Fitness osteopath Russell Hill is now focused on ensuring you don’t fall into a perpetual injury cycle.

By Russell Hill
Injuries are sadly common in amateur golf. Data highlights that 28 percent of all players have back pain after every round, 35 percent will have sustained an injury in the last 12 months and 70 percent of these will result in the amateur missing play or practising due to the niggle. 

It all equates to frustration and unnecessary cost. Your leisure time is precious enough without injury robbing you of a chance to play and those expensive membership fees are exempt from lost-time deductions. 

It is even more annoying to keep re-injuring the same area of our body which leaves you pulling your hair out as it takes longer and longer each time to return to the game we all love. 

So, how did you get into an injury cycle and how do we get out of it? The primary goal should be prevention which I will outline later. First off, we need to understand how and why common injuries occur.

An underappreciated scenario is when amateurs are trying to implement swing changes. The Titleist Performance Institute (TPI) has identified 12 suboptimal swing characteristics that are commonly occurring among golfers. These can be as a result of being self-taught and/or poor programming of our body. Each one of them can also be linked to poor movement patterns.

It is these poor movement patterns that makes us susceptible to injury which makes seeking the advice of a qualified golf coach vital before implementing swing changes. The TPI have developed a physical screen which can be easily conducted on a driving range to detect poor movement patterns and identify if you have the movement capacity to adopt these swing changes successfully. If you cannot adapt appropriately there are two options:
1. A good coach will be able to advise safe swing adaptions that counter these dysfunctions. This is a short term fix and not a long term solution for improving your golf or long term health.
2. Seek the appropriate physical advice from a qualified golf trainer (if there is no pain involved) or see an appropriate specialised osteopath or physiotherapist.

LOWER BACK PAIN
Lower back pain accounts for 36 percent of all injuries in amateur golfers. As I discussed in last month’s article, the golf swing is a chain reaction that requires a sequential integration of each body part and if there is dysfunction in one area, this might cause an overload in an adjacent area that has no ability to absorb this load. The lower back absorbs a large amount of rotational stresses in the swing and the lack of mobility or stability in the shoulders, hips, thoracic spine and ankles can overload the lower back and cause these breakdowns. Most golf injuries happen at the lambro-sacral joint as it absorbs a far greater rotational force than the rest of the lumbar spine. Injuries can occur in the disc, the facet joints, ligaments, or local musculature.

ELBOW, WRIST AND SHOULDER
The shoulder represents up to 19 percent, the hand and wrist 32 percent and the elbow 33 percent of all golfing injuries. The arm up into the thoracic spine is a continuum of an interdependent joint that is designed to allow the hand to be utilised in any space it needs to and inversely absorb any stress coming up from the hand into the shoulder and upper back. Any disruption in range of motion or strength will overload above and below causing a breakdown into pain. The most common injury is tendonitis in the elbow, either golfer’s elbow on the inside or tennis elbow, which is bizarrely more common in golfers, on the outside of the elbow. The other common injuries in these areas are shoulder slap tear, rotator cuff dysfunction, shoulder impingement and the hand and wrist are commonly affected by tendonitis.

KNEE
Knee injuries represent nine percent of all golf injuries and, according to leading U.S. orthopaedic MD Dr Timothy. Bollom, the lead leg absorbs 4½ to 5 times the body weight in the golf swing. Therefore, “it would be less stress overall on the knee to jog 18 holes than to play golf for 18 holes,” says Dr Bollom. This stress would be significantly more if the ankles and hips were functioning sub optimally.

HIPS
Hip issues are less common in golfers but can be devastating to a fluid and powerful swing. Hip dysfunction can be a predisposing factor to lower back, knee and ankle pain.

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Conventional Approach

Conventionally, if we feel pain, we tend to reach for the medicine cabinet and take pain killers, anti-inflammatories, muscle relaxants or use ice or heat depending on past advice and past success. Is this really what is needed? This response is necessary at times and is not to be overlooked but the mindset is changing and being questioned. Inflammation is a natural body response to tissue damage and is vital in the repair and recovery of tissue and therefore reducing inflammation does not always help a speedy recovery. The same can be said for pain killers as pain is a response which warns your body of impending danger and prompts one to take the appropriate action or avoid a certain movement. By taking pain killers to cover up pain so you feel you can play golf might be prolonging your recovery and, at worst, increasing the tissue damage.

The Injury Cycle

The one known fact about injury is that the most common risk factor to sustaining an injury is past injury. I see people coming into the clinic time and again presenting with the same issues and the time between each visit can vary from several days/weeks to a few years. Often in these cases, the time between representing gradually shortens and unfortunately reoccurring issues can become more difficult to treat each time.

What I see so often is a golfer who comes in with mid-back pain. Here’s how it happens:
1. Onset of pain whilst trying to over-swing, or they use a highly compensated swing
2. Initially they use pain killers and either ice or heat to take the pain away
3. It reduces slightly and they think it’s ok so they go out and play golf again
4. The pain increases
5. A visit to their doctor where they are given stronger pain killers and they are told to rest. Occasionally they will be treated manually by an osteopath or physiotherapist but will fall into the 80 percentile who do not follow the appropriate exercise advice given
6. The pain reduces again to pain-free, but they then go back to their golf thinking they are fixed.
7. The pain reoccurs

Breaking The Pain Cycle

The most important first step to understanding that something needs to change is that pain is associated with dysfunction and without changing this dysfunction appropriately, you are unlikely to break the pain cycle.

The next action is to seek a certified osteopath, sports doctor, or appropriate physical therapist with experience in golf injuries and appropriate rehabilitation. It is important not only to get an accurate diagnosis but an accurate functional assessment to identify all predisposing factors. The first objective of treatment is to reduce the pain levels followed by a structured and progressive rehabilitation plan devised to help and improve the loading capacity of your body. It is important that the patient understands and respects that injuries take time to heal. As your body recovers, effective ‘back to play’ strategies should be implemented:
1. Chipping and half swings as opposed to long game work
2. Reducing the number of balls hit on the range
3. Shorter range sessions
4. More time putting. We all know we drive for show and putt for dough and most of us can still improve in that area of the game!

To conclude, the best way to avoid pain is to have a specific golf movement screening from one of the few qualified golf specialists in the Middle East who will devise a program to address any dysfunctions that might be either stopping you from improving or keeping you in a pain cycle that is only likely to get worse.

As I jest with patients, you have two choices. 1, you can do your exercise or 2, make your therapist rich”.

A former professional squash player and coach, Russell Hill qualified from the British School of Osteopathy at the age of 27. With his MENA Tour playing son Josh Hill, the world record holder as the youngest winner of an official WAGR event, developing into one of the hottest prospects in English golf, Russell has spent the past decade furthering his education to specialise in golf injury prevention, treatment, movement assessments, rehab and golf fitness. Hill Snr not only treats local golf enthusiasts but is the official provider to the MENA tour and treats European and LET players when they’re passing through the UAE.

The post Pain Gains Part II: How to avoid falling into a perpetual injury cycle appeared first on Golf Digest Middle East.

We’ve studied the 12 former winners spanning 14 Opens and 127 years at Royal St George’s and drawn an extremely long bow to select our long-shot winner for ‘Sandwich’ (golf is hard and picking winners of majors even harder!). We’ve even dug up a James Bond link to the famous Kent coast linksland.

Elsewhere, we get the inside oil on the Emirates Amateur Golf League’s Mini-Series at Jumeirah Golf Estates, visit the José María Olazábal-inspired golf resort in the Maldives and bring you all the shenanigans from Golf Digest Middle East’s inaugural Play & Stay at Trump Dubai and Radisson Hotels Dubai DAMAC Hills.

Russell Hill, the osteopath father of Middle East amateur No.1 Josh Hill, explains how to avoid falling into a perpetual injury cycle (and how to get out if you’ve already fallen) while Dubai Creek teaching professional Matthew Brookes shows you a simple way to nail your set-up for every full-swing shot.

Don’t miss our Playing Through feature which offers a fascinating insight into the future of the royal and ancient game and pick your next fairway wood weapon in the latest instalment of our Hot List equipment guide.

All this and much more in the July 2021 edition of Golf Digest Middle East.

The issue is again free to our loyal audience. You can scroll through the ISSUU link provided or download the bumper July 2021 issue FREE to your favourite device for later. Alternatively, pick up a copy at your favourite club. Whatever option you take, we hope you enjoy the read.

The post Get the July 2021 issue of Golf Digest Middle East FREE today! appeared first on Golf Digest Middle East.

The old adage warns to beware the injured golfer. Sure, but wouldn’t you much prefer to play on injury-free? If so, lend Russell Hill, the proud father of Middle East amateur No.1 Josh Hill, your attention. In the first of a two-part series, the osteopath specialising in golf at Optimal Fitness identifies the most common golf injuries, why and how they happen and how to prevent frustrating time on the sidelines.

Arnold Palmer once famously described golf as “…deceptively simple and endlessly complicated.” The same can be said for writing an article on golf injuries and trying to succinctly explain why they happen, what to do if you do get injured, how to prevent recurrence and importantly how best to avoid them altogether. My passion for keeping golfers on the fairways of the UAE means I’ll do my best to honour The King by summing up this complicated subject and offering simple solutions to playing on injury-free.

Perceived by outsiders as a gentle pursuit, golf is not a sport that many people associate with sports injuries. However, a study from the Centre for Injury Research and Policy in Columbus, Ohio shows that in the U.S. alone, the game is responsible for more than 30,000 emergency room visits every year. Research has also found that 35.2% of all golfers will have sustained an injury within the last 12 months and 69.7% of the injured golfers miss games and practice sessions due to the injury. Many injuries resulted in a forced absence of a least a month.

The game is still in the early stages of understanding injuries, strength and conditioning and injury prevention. It has come a long way in a short time, however, and continues to grow at a rate that is a challenging and fun to keep up with.

Amateur Aches

The spine, and particularly the lower back, account for the greatest overall incidence of injury (up to 36.4%) for amateur golfers. The elbow (up to 33%), the wrist and hand (up to 32%), and the shoulder (up to 18.6%) are the other most frequently injured sites for weekend warriors. Injuries to the lead side (left side for right-handed golfers) are five times more frequent than the trail side (84.5%)

A number of factors contribute to the common golf swing injuries:
• Over-swinging
• Poor body mechanics and suboptimal swing mechanics
• Poor conditioning
• Lack of flexibility
• Poor ground reaction forces
• Age
• Sitting in buggies
• Overuse and over-practice
• Not warming up the muscle/joints for the required movements properly
• Rotational stress placed on the spine, ankle, knees, hips and neck
• Incorrect grip and setup
• Traumatic force to the body resulting in a poorly executed swing
• Making swing changes that the body does not have the capacity to adapt to
• Intermittent Play

Published research concerning risk factor is of relative low quality but most golf injuries generally occur as a result of a joint, cartilage, muscle, ligament, fascia, tendon, bone or disc having to absorb more stress/strain than it can cope with at that particular moment in time.

To understand golf injuries and how to avoid them we first have to understand the mechanisms that predispose someone to these injuries. The golf swing is a highly explosive athletic movement that relies on the whole body moving in a powerful, fast and sequentially integrated fashion.

Movement occurs from the ground, to the feet and up into the knees, pelvis and spine and from the club head into the hands, through the arms, elbows, shoulders and into the spine. To allow this highly complex movement integration to occur effectively, each joint along the chain has to maintain its own mobility, flexibility, stability, and local/ global muscle strengths to sustain its individual integrity and function. If a joint in the chain is missing any one of these vital elements, the stress load will have to be absorbed by another structure. This structure might not have the ability to absorb this load effectively and this invariably leads to a breakdown into injury and pain.

Modern Curse

Lets look at a commonly occurring example of a sedentary worker who does not create much opportunity to exercise during the week, plays golf once or twice at the weekend and has the occasional back pain that stops him playing golf for a month or so a year. Long periods of sitting have a tendency to reduce range of motion in the ankles, hips and upper back and reduce strength and stability in those muscles that support the posture and stabilise movement. 

If we compare this to the diagram (above) illustrating the Mike Boyle and Gary Cook mobility and stability continuum, you should notice as we work through the body the joints alternate between those joints that are mobile and those that are stable. By appreciating this we start to understand that the vital areas of movement in our example are starting to diminish. As golf is a rotational sport, if we have lost this movement in these areas we actually start to ask the lower back to absorb these additional stresses which it is not designed to do. In addition to movement/mobility dysfunctions with our sedentary lifestyle, we have the de-conditioning of the local and global musculature. This is important as muscles not only contract to provide the power to move but also work hard to decelerate movement and absorb much of the mechanical stress before it gets to the ligaments and joints. So if you have a joint under stress due to absorbing more movement than it is designed to, and an increased stress on all the local, ligaments, tendons, joint capsule, cartilage, fascia and bone as a result of the muscle unable to effectively distribute these stresses, it is only a matter of time before the body breaks down into pain.

You’re injured. What now?

If you do injure yourself, the best course of action is to consult a medical practitioner as soon as possible as the quicker these things are dealt with, the shorter the recovery will be. Far too often I see patients where the injury happened a few weeks earlier and they had left it to calm down because they thought it would get better on its own. That rarely transpires. In fact, the delay often makes it harder for the practitioner to help get you back out on the golf course quickly.

Like any medical consultation, the practitioner will go through a full case history covering the pain, the onset, the nature of the pain and past medical history. Then, if appropriate, they’ll run through the necessary medical and orthopaedic tests to come to a diagnosis, prognosis and treatment plan. The primary goal of treatment is to reduce pain and achieve full recovery of the injury. In addition, the practitioner has to fully assess and treat the mobility, flexibility, stability, and local/ global muscle strengths and weaknesses. Usually, the practitioner will demonstrate a number of exercises to help reduce the pain further and to start addressing the dysfunctions found.

Post treatment continuum that will help to reduce the reoccurrence of such issues include resolution exercises, rehab and restorative exercises before moving into strength and conditioning and the implementation of an effective pre-round warmup routine.

Warm-up

Research shows that 65 percent of all golfers do not perform a pre-round warm up. While the influence of a warm-up on injury prevention is unclear, the evidence suggests a positive effect.

The ‘RAMP’ approach can guide an effective warm-up:
RAISE body temperature, heart rate, respiration rate, blood flow and joint fluid viscosity
ACTIVATE key muscle groups
MOBILISE key joints and range of motion specific to the sport
POTENTIATE high-intensity dynamic exercises to mimic performance

Photo by Masam Ali

I would also highly recommend a golf movement assessment that breaks down and exposes the functions and dysfunctions in mobility, flexibility, stability and muscular strengths / weakness. Having identified these, an appropriate exercise program can be implemented and if you regularly exercise already, it can run in conjunction with any existing program if implemented skillfully. It is also important to have these reassessed at regular intervals to make sure that the desired results are being achieved and to reset a new program with new goals once the initial outcomes have been achieved.

Next month I’ll run through common injuries and how best to deal with them. Before then, a parting thought. One of the most common injuries in the  UAE is sunburn. Please use suncream as manual therapy is not possible with sunburns.

A former professional squash player and coach, Russell Hill qualified from the British School of Osteopathy at the age of 27. With his MENA Tour playing son Josh Hill, the world record holder as the youngest winner of an official WAGR event, developing into one of the hottest prospects in English golf, Russell has spent the past decade furthering his education to specialise in golf injury prevention, treatment, movement assessments, rehab and golf fitness. Hill Snr not only treats local golf enthusiasts but is the official provider to the MENA tour and treats European and LET players when they’re passing through the UAE.

The post Pain Gains: The most common golf injuries, why they happen and how to avoid them appeared first on Golf Digest Middle East.

American golf’s clean-cut poster boy shares the clever way he rediscovered his swing after his lengthly slump in this month’s edition of Golf Digest Middle East and it could be a model for you, too. Spieth’s simple tips on the three key scoring shots – driving, bunker escapes and putting – is a useful insurance policy even if your game is in reasonable shape.

Spieth’s timely return to form will make him one of the players to watch in this month’s U.S. Open. We explore Torrey Pines and the last stand of Rees Jones as a designer of major championship layouts.

Elsewhere, we preview the Emirates Amateur Golf League’s Mini-Series at Jumeirah Golf Estates, discover how to negotiate the tough 18th hole at Dubai Creek Golf & Yacht Club and ask Russell Hill, the osteopath father of Middle East amateur No.1 Josh Hill, to examine the main golf injuries and how to avoid them. A good start is a decent pre-round warm-up; we have that covered too thanks to Dubai Creek teaching professional Matthew Brookes.

We also unveil Golf Digest Middle East’s inaugural Play & Stay at Trump Dubai and Radisson Hotels Dubai DAMAC Hills and reveal the game improvement and super game improvement iron medal winners in our ongoing Hot List equipment feature.

All this and much more in the June 2021 edition of Golf Digest Middle East.

The issue is again free to our loyal audience. You can scroll through the ISSUU link provided or download the bumper June 2021 issue FREE to your favourite device for later. Alternatively, pick up a copy at your favourite club. Whatever option you take, we hope you enjoy the read.

The post Get the June 2021 issue of Golf Digest Middle East FREE today! appeared first on Golf Digest Middle East.