 Thank you for joining me today on Movement Matters. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical specialist. Let me ask you, who wants to improve their golf game and prevent pain and injury? In today's show, you'll learn why certain injuries are common in golf, what to do to prevent them from occurring and how to enhance your performance with a simple warmup. But first in the spirit of Halloween as I personify the great Jane Fonda from 1980, let's do a quick get up and move before we sit for today's show. So everybody get up, that's watching. You're going to stretch your shoulders, stretch it out, stretch your neck, turn your head, roll your shoulders back. I like to do one at a time because it really gets and loosens up the neck, gets the shoulder moving, stretch your arms and then you're gonna sit back down, take a nice deep breath, raise your arms up over your head, bend, breathe, press your shoulders back, open up your chest, you're about to sit for 28 minutes. Lean the other way, look up to the opposite direction, breathe, lift your chest, squeeze your shoulders back and let's get into golf. So golf is an extremely technical and highly skilled sport that requires a precise amount of range of motion between your shoulders, your hips, your back and your torso as well as your neck so that you can swing the club. And when the golfer sets up to swing the club, that backswing like a pitcher on a mound winding up to pitch the ball, that backswing is where the golfer is storing all the potential energy to be unleashed when he or she contacts the ball. So where golfers can get injuries is not having the proper range of motion or amounts of motion in the backswing so that when they contact the ball, the timing is not proper. And say the hips aren't going early enough and the chest is going early enough or they're swinging more with their shoulders, that's where injuries will occur. And on the follow through, a lot of the injuries that occur are the body's inability to decelerate the motion after you've contacted the ball. So you're contacted the ball, you're following through, your rotator cuff is decelerating motion, your hip is decelerating motion. And if you don't have enough range of motion on that front leg in your follow through, which is your left leg, if you're a right-handed golfer in your right leg, if you're a left-handed golfer, you can get injuries to your knee, to your shoulder, you can get injuries to your neck. So one very popular physical therapist, he's very functional is Gary Gray. And he always says with everything, you need to bring your butt to the party. And with golf, that is so true. So much of having a good golf swing and preventing injury is having adequate hip range of motion and also having adequate hip strength. Now I'm gonna show you video number one where we will see how precise the golf swing is. And also how effortless it looks when you do it correctly. Let's go to video number one. So you can see how effortless this is. There's not a whole lot of bend in his knees. There's not a whole lot of knee diving in one way. He's not shifting his weight very far left or right in his windup. His arms are relatively straight. Everything looks so fluid about this stroke. So I advise you to have yourself videotaped, go see a golf pro and make some changes to how you hit the ball when you're driving because it can make all the difference in the world. And what I've been hearing for the past several months is during the pandemic, I'm in Hawaii, my friends are in Connecticut, California. So many people are golfing because that's one of the few things that you can do and stay socially distanced away from everyone. So there's a few things that you can change about your address. So let's go to video number two, image two. So you can see in the picture on your left how more bent forward, that's improper. And this person was telling me, oh my gosh, yeah, I was hitting the green a little bit. And when you hit the green, you can cause elbow and wrist injuries because that's impacting into your upper extremity. But she straightened out her address just a little bit more and all of a sudden she's not hitting the green. So it's just a quick little change in how you stand to hit the ball. So in order to prevent injury to your back, one of the important things, like I'm gonna be stressing this whole show is having adequate hip rotation range of motion. The number one reason for recurring back injuries or a first time back injury in golf is a previous history of back pain or back injury in the past. And that's because you've got a vulnerability from something, whether you didn't have enough trunk rotation above during your normal daily tasks before you started to golf or you didn't have enough hip rotation or your hamstrings are tight or your calves are tight, those are things that put strain on the lower back. Now, when you swing a golf club, that's a big rotation in this plane of movement. Your low back was not designed to move this way. It was designed to move forward and backward by the plane of the joints that are called facets. Your thoracic spine, however, which is your middle back, basically from the base of your neck to about your waistline, that was designed to rotate, to twist. So you need to have a lot of rotation in your thoracic spine when you're walking. For men and women that I saw in New York City, they were carrying a briefcase, they're not rotating their torso while they're walking. They're not rotating their torso while they're sitting at their desk. They're carrying a briefcase when they're walking around New York City which stops that rotation. Then they sit at their desk and they go out for business meetings and they need to do what? They need to rotate and their thoracic spine isn't doing it. So other areas have to, one of them being your low back. So at the end of the show today, I show a great video on how to get this middle part working, but let's get your hips working. So let's go to video number three to bring your butt to the party. In golf, it's very important to have hip rotation independent of your low back spinal rotation. One way to disassociate the two is to lay on your back, put your feet right up near your butt and as wide as they can go. And then you're gonna drop one knee in and one knee out and stretch and repeat. You might feel a stretch on this side here. Make sure the hip goes all the way down, rotate over, breathe and stretch. You wanna make sure that your leg can get all the way down. Your quad has the flexibility, your hip has the flexibility. Because if you don't, you don't wanna hurt your low back while you're swinging your golf club because your hip doesn't move. Enjoy that. So muscles load to explode. That's something I learned from Gary Gray. And when you're walking and you land, that's loading so you can explode into the next step. When you're landing from running or jumping, you're loading so that you can explode. And golf is the same thing. When you're winding up, you're loading. You're putting a stretch reflex on those muscles that will send messages to your brain via proprioceptors to fire these muscles and explode into your swing. But you need to have the proper hip rotation. So here's another way to get your hip muscles to load and explode. Let's go to video number four. During golf, it's very important to generate the power from your hips. So for that reason, you need to be able to just associate your hips and your pelvis from your upper trunk. So another great way to stretch is to do the walking lunge twist or a standing lunge twist. So here you do it. You take a step forward with your left leg and then you turn towards the front leg. You can walk and do it. Or if you're just doing a pre-golf warmup, you put your right leg forward, turn and stick your arms out wide to the right. Come back, put your left leg forward and lunge. Turn your arms and spread them wide to the left. Repeat. Step, turn and stretch. Step, turn and stretch. And be sure you suck your stomach in to protect your low back and enjoy golf. That's a great dynamic warmup because you're loading and coming out of the position, loading and coming out of the position. It's a great thing to do before you play golf. Let's go to video number five, which is another way to stretch your hips. Let's say if you're sitting in a chair. Because it's so important to have adequate hip rotation during golf to prevent a low back or a knee injury, there's many ways you can do it. So if you don't wanna lay down and do the wide-footed knee rotation stretch, you could do it in the chair. I don't have a chair here, but I can sit on this stuff. So you wanna rotate your hips in and out to get the rotation. It's very important to have enough rotation. You can put them both together. You'll feel the stretch here in your outer hips. You can drop one in a little bit more. Be careful of your knee. You don't wanna put a lot of torque on your knee so you can see me kind of lifting up a little bit. So you don't wanna feel any pain, twist, twist. This is all about your hip rotation. So if you get enough to save your back and your knee during golf. So all of this will not only improve your performance when you're golfing, but will also decrease your risk for injury. A common injuries that I see are neck injuries or that kink in your neck from turning your head. And I'll show you a bit why that is in a minute, but also shoulder injuries from not being able to decelerate the motion. If your hip doesn't have enough range of motion on your follow-through, your rotator cuff has to do more work to decelerate and your rotator cuff muscles in your shoulder are a lot, not as strong as the rotator cuff muscles, the rotator muscles in your hip. So these injuries can be prevented with a pre-golf warmup and with a strengthening routine. So let's go to video number six where I show you the pre-golf warmup. Before you get ready to tee off that first hole of the golf game, it's really important that you warm up not only to prevent injury, but also to enhance your performance. So rather than pulling in quickly and grabbing those clubs and running with your shoes to the first tee, be sure to suck your stomach in and get the clubs out of your trunk properly so you don't start your low back off on the wrong foot. Then what you wanna do is a dynamic warmup. You wanna warm up your shoulders, your chest, your thoracic spine, your hips, your back, your calves, your thighs, your hamstrings. So I'll show you a brief warmup for the neck. When you golf, the body is moving on the head, not the head on the body. So you're not turning your head this way. You're rotating around your neck. So you wanna warm up the neck muscles so you don't end up with one of those kinks because you can't rotate your neck. You wanna stretch your upper traps out, lengthen. Stretch your upper traps out and lengthen. And then you wanna warm up your shoulders. So you wanna clasp your hands up over, open up your chest, lift, bend and stretch and turn a little bit, open up that thorax, your torso. Bend and twist, breathe, let your eyes follow. Loosen up your shoulders, you can stretch them behind your back. You wanna make sure you have good posture and then you wanna work on your thoracic spine. When the thoracic spine, the middle part of your back doesn't move, it puts more strain on our shoulders, our neck and our low back. So you wanna grab one of your clubs, put it behind your back to extend, keep your pelvis still and rotate your chest. It's important not to move your knees and not to turn your pelvis. You wanna keep your pelvis in one spot and move your torso. If you don't trust yourself to do that, sit in a chair so that your hips can't move, turn, turn, loosen that up. Get ready to go, get ready to go in good posture and then you can also do it sitting this way and just rotate, rotate. You can go fast. Make sure your knees aren't bending, make sure your hips are not turning. You wanna keep that still while you twist your torso and also you wanna stretch your wrists. So you stretch it with your elbows straight, elbows bent, stretch elbows straight, elbows bent. I'll show you how to do a few more in the next video. That's just some of my favorites to get your body prepared for the sport of golf. Now we have a question. What are good stretches to do beforehand to prevent cramping in the hamstrings and the calf? And what are good stretches to do if you cramp up on the green? And also, what are good stretches to strengthen your lower back? Oh, strengthen the exercises for your lower back. So for the first one, I was talking with a gentleman this weekend who said that all the push carts got sold out on golf greens. So he's been pushing his golf golf, golf cart with his clubs in all over the green. He said when he goes up a hill after walking green, his hamstrings and his calf cramp up and then his lower back gets sore. And that's a big problem. That's a pandemic problem, right? Because now everybody's doing the same thing because we have to be distanced. So it's very important to stretch your calves and your hamstrings. So let's go to video number seven to see how to do that. A lower body stretching program often gets overlooked in golf, especially in the golfers who I've treated in the past. It's really important if you're walking green or going up and down hills to hit the ball, that you stretch out your hamstrings and your calf. So to stretch your hamstrings, I like keeping the back safe. You can hug your knee to your chest if you're very tight or your knee to your opposite chest. But I love to stretch the hamstrings this way where your spine is safe. You clasp your hands behind your knee and then you straighten your knee. It's just easy. You lay down and relax, straighten your knee. 10 to 15 times. Now I'm pretty flexible. You may be only going this far. And then you're tight. You can also pull your toes up towards your face to get a calf stretch. Your calf crosses your knee joint and so does your hamstrings. Always repeat on both sides, knee to chest, knee to opposite chest. That gets those glutes, those hip rotators. And then you stretch your hamstring. Another stretch that's actually very good doesn't feel like you're doing much is what I call a modified version of Shirley Simon's Quad Rocket. You suck your stomach in, point your tailbone to the sky and you sit back. My back is not rounding. I'm allowing my hips to open up. So that's another nice stretch that you can do. And then of course, stretching those calves. Usually you just get in the runners position here. One foot in front of the other and you bend the front leg to stretch this back leg. It's very important to keep that foot straight and not letting it turn out. Keep your knee locked, stretch your calf. If this is before golf, you want to do dynamic stretching. If it's during golf and you're tightening up, you stretch it on the green just like that and you could also bend your knee. There's two different calf muscles we're stretching here. And you want to keep your hamstrings and your calves flexible so they don't tighten up on you leading to back pain. Please do those stretches. You do not want to hurt your back in golf with this rotational sport that it is. We don't want to hurt our backs at all, but definitely not in golf because we want to be able to enjoy golf. So another joint that can be vulnerable during your swing is your knee. I do see lots of knee injuries. I see minuscule tears, knee pain in all ages of people, usually on the front leg but not 100% of the time. And the reason why is because the rotational stresses that can occur between your thigh bone and your shin bone need to happen in the right amount of timing. Now if your foot and ankle are not moving properly or your hip bone is not rotating inward properly, you can get a twisting at your knee but also you can just be moving aberrantly or suboptimally during your swing. So let's look at video number 7.1 where we can see how the knee can move in a faulty way. Now right now you can see that front leg the knee is coming in a bit too much compared to the first video where I showed of the gentleman swinging. He's been doing it for a long time. And so this is just a video of some movements that you may not know that are occurring that can be affecting your drive and your golf swing. So I want to call that to your attention because again, see a golf pro to take a video of yourself, learn what you're supposed to be doing because I play sports and I have coaches telling me all the time you're doing this you're dropping your elbow why are you looking this way? Why don't you get your feet there? And so I don't know it because I'm just doing it. And so somebody we need a coach we need someone to point out to us that what we're doing naturally is an optimal for the sport we're trying to perform. So let's look at video number eight to explain this a little bit more. One of the reason that golfers get knee pain on that front leg let's call it the left leg here when you're going through the follow through is because it needs to be a coordinated sequence of foot and ankle motion, knee and then hip motion. So what happens as the body here is pivoting that way this femur bone the hip needs to internally rotate because your body is turning on it. If you don't have enough of this internal rotation as your body is moving this way this femur goes that way and then your foot is stuck this way and over and over again you get this twisting at the knee. It's also important to have the proper foot range of motion because again, if the foot doesn't have the right range of motion it can be taking the tibia too much in and then the femur is not rotating in enough because you don't have enough hip range of motion. And again, you get this twisting of the knee over and over and over again. So in that follow through this leg if I'm a right-handed golfer this leg that foot is fixed on the ground. And so when you are swinging through just to explain it a little bit more this hip is relatively internally rotating as my pelvis is moving forward over it and my foot is fixed on the ground. So if my foot isn't able to invert they call it or move or my hip bone is not able to have that internal rotation range of motion ability as my pelvis is moving over there you can get this bone moving outward more than it needs to inward which puts that twisting on your knee and that's what happens with wear and tear minuscule degeneration. So I wanted to hammer that home it's very complicated biomechanics to understand but have someone look at you or go see a therapist or email me so that I can help you to find out if you have the proper hip rotation range of motion for your golf swing. So let's go to video number nine where we talk a little bit more about that thoracic spine that middle part from your neck to your waistline. Last but not least in order to save your low back from trying to rotate which it's not designed to do you wanna make sure that you have not only the rotation in your hips but also the rotation in your thoracic spine here. So this is a great way to get it you gotta do it before you play. So you lay on your side, bend your knees and hips about 90 degrees directly on your shoulder and you're gonna rotate back. So you wanna twist your upper trunk not your low back. So you don't wanna see your knees go with you you wanna keep that safe. If you have shoulder problem you can leave your arm here and help yourself pull the rib cage I used to call it a bow and arrow. You can go back and forth, you can go over here you wanna try to aim for getting your shoulder blade back on the table and if you wanna see it from the back bend your hips and knees 90 degrees so they're lined up and you rotate your chest back bow and arrow, bow and arrow there should be no pain in your back you can hold there and breathe you wanna get that rotation. That was one of the first exercises that I was giving some people back in San Diego and they came back and told me that their drive improved so enjoy that one. That was great I was so excited I was treating some golfers who were in their 60s and 70s late 70s even who had very stiff hunched up for back from their jobs over the years. They're retired they're playing golf when they're having back pain or having hip pain and I was new to treating golfers and I would have them lay on their side and try to stretch them out and they would move about an inch or two. I mean, I go all the way over because I stretch I'm flexible I need to for my job but these gentlemen, they were gentlemen didn't have the flexibility their spines had gotten so stiff from not moving and now they wanna retire and enjoy their sports so I remember I had him working on it for a few weeks and he got back on the golf course said his back didn't hurt which I was very excited about but also he said his drive improved so much that his buddies didn't they wanted to know what he was doing and if he was really injured so I was pretty excited I remember that that was probably around 2004 or five I don't remember how much his drive improved but do that it will definitely help you and also help you prevent your injuries. Let's look at video number 10 where I talk more about how to strengthen your hip to get the most out of your golf game. So we've learned that one of the key components to golf is to have adequate hip internal and external rotation but you also need to have adequate power in those muscles to help with force generation so this is what you need to do here are some of my favorites you can use a band, put it around your knees lay on your side and there's four different ones you're gonna bend your hips and knees and open up 10 or so times after that you keep your knees open and you tap your foot then you're gonna straighten out your body in a straight line so your knees are bent and you're gonna open again this gets a different group of rotators 10 or so times, do you feel a burn? Hold your knees open and then tap your foot also you need to work the powerful abductors so you're gonna raise up and I like to come down and tap behind what you don't wanna do is you don't wanna use your waist here you wanna keep your waist long and just use your hip muscle it's a great way to strengthen now without the band a great way to strengthen is to use your legs off the end of a bench or a table to work on your rotations so you can drop the bottom leg and then you work your rotators to fatigue if you have an ankle weight you can use that if not you could just go to fatigue trust me after 20 times or so you'll feel the burn in the bottom butt and then the same thing you keep your knees together lined up here 90 degree angle at your hip and then drop it down and up there should be no pain with these you're working your deep hip rotator group after you've already stretched them so you know you have enough rotation now you strengthen to help generate the power in your swing, enjoy. I know I'm throwing a lot at everyone here and so please when the link comes out watch the video again and again to pick what you need for your golf game or your various body part ailments that you're having during this pandemic and the last video video number 11 we're gonna talk a little bit about spinal exercises for back and upper back endurance let's go to video 11. Golf like most other sports causes us to be forward and the way you swing the golf club and the way you hold yourself in your address uses a lot of the front muscles but also we need the back muscles to stabilize and a lot of people end up suffering with upper and lower back pain so you wanna have strong enough upper and lower back muscles that have enough endurance so that you can swing the club over and over and over again in that position so here's a couple of great exercises to do you can get on your hands and knees suck your stomach in a stable eye just fine you don't wanna be swayed, you don't wanna be rounded you come right in that flatter neutral position one leg back, one arm forward hold for a few seconds you can make it dynamic you can bring your leg in and out, up, and out you can do the same thing here in and out, up and out to try to get some endurance in your back muscles you can also lay face down and do what we call the Superman so you can do opposite arm and leg suck your stomach in suck your stomach in you can do the same thing you can do the same thing you can do the same thing you can do the same thing you can just do your legs alternating to work your glutes and your back muscles and you can also do what I call the W suck your stomach in and lift your arms suck your stomach in lift your arms you can lift your arms raise them up here to the ceiling arms you should have no back pain you can even put a pillow under your stomach especially if you're on a hard floor or your bed to make sure your spine doesn't sway too much but it's so important to have endurance from all of your posterior muscles your glutes your hamstrings so that you can swing the glove without back pain so that's it there you have it there's some great tips for how to do a warm up to improve the performance of your golf game what body parts you need to improve the range of motion how to improve the range of motion so you don't get injured while you're out there enjoying golf what to do if you get hamstring or calf tightness while you're golfing and I hope that helps you enjoy your golf game I'm Christine Lenders thank you so much thank Tecawaii and our sponsors and donors for joining us and thank you for joining us remember life is better when you listen to your physical therapist Aloha