 physical therapy for a better life. I'm your host, Christine Linder's physical therapy specialist. Today, let's improve your golf game and eliminate pain at the same time. Golf is an incredibly technical sport that requires precision of movement, technical skill, and focus. However, if adequate motion doesn't exist in your middle back and hips, you're likely to suffer pain, injury, and decreased performance. Today, golf instructor, Ryan Negata, and I will teach you simple tips that do at home to decrease pain, prevent injury, and improve your game. Welcome, Ryan. Hi, good morning. Thank you for having me. I am so excited for this show. I overheard you talking a little bit about biomechanics of golf, and I was thrilled. It's straight up my alley, and I am excited. So tell me, like, as a golf instructor, tell me maybe how golf has changed and how you teach it and what you do with your students. Yeah, so golf instruction within the last 10, 15 years or so has really evolved dramatically. Now, we incorporate things like body mechanics, range of motion into our instruction so that we can kind of better assess and quickly fix what's going on in your golf swing. In the past, you know, a lot of things that we used to think was correct about the golf swing. We now know to be almost completely false, and in some cases, we physically can't do the things that we used to ask our students to do. And this kind of came about about 20 years ago, when a couple of instructors were trying to figure out why their students weren't improving, why they can't do what they're being asked to do. So beyond just the basic instruction of what we knew as far as mechanics, there had to be something with the body that wasn't performing in the way that we think it should. So those golf instructors kind of met up with, you know, physical therapists or trainers like yourself, and they kind of went into a deep dive as to how the body works and why certain things can be done. And basically, they found out that obviously we all have different body types. We all have different things that we can and can't do. So us asking us kind of giving a one blanket instruction and one thing fits all is not going to work. If I have limited mobility or range of motion in my hip rotation, I can't ask, I can't have myself try to increase my hip rotation in the golf swing if I physically can do it. Another common thing would be with the range of motion in our wrists. One of the most common themes in golf instruction is the ability to hinge and unhinge your wrist in the golf swing. If me as an instructor is asking you that, or I'm telling you, you need to increase your wrist hinge in your golf swing, that may be obvious. But if you physically can't do it, then we're just being a dead horse and we're never going to get anywhere. So now with the golf instruction, what we can kind of implement is ways that we can either work around the limitations or golf instructors like myself will send our students to trainers like yourself and basically will tell you, hey, my student is kind of having trouble with their hip mobility, range of motion with their wrists. Is there any way you can kind of get the student to increase this or can they get better at this? Or is this something they're just stuck with and we're going to have to work around it? So that way we're, you know, we can kind of get the student to do what we want. And if they can't do it, then we got to figure out a different way. And so it's making our jobs as golf instructors a little bit easier. And it's also giving us a better understanding of how the actual body works. When we look at a golf swing, we're only looking at the golf swing from basically the outside of our body, right? So when we watch golf on TV, whether it's Tiger Woods over in Mackler, we only see what goes on from the outside. We don't see what goes on on the inside of our body. So things like Gears Video, where you've probably seen it before where you put all kinds of dots and markers on your body and you make a few golf swings. And basically, you're able to see how the insides of the body kind of moves in the golf swing. So those kinds of things help us understand how the golf swing actually works. So something kind of basic that I think everyone has heard of in general golf instruction is your spine angle or maintaining your posture. In the past, myself and other teachers before me, we always thought that you need to basically maintain your spine angle and keep it in one place in the golf swing. And we just want to kind of rotate around that. But now we understand that the spine is not just one single piece. It's a bunch of little individual vertebrae that kind of move on each other. So it's physically impossible for us to ask our student to stay in one position and rotate around it. Now we know that the spine actually flexes and flexes and tilts at the same time as it's rotating. So just understanding something like that really helps us with being able to help our students a little bit easier. I think that's fascinating. And for everybody listening, that's like if you're a golfer and you don't know that, that's amazing to think about what your golf instructor is thinking about while they're teaching you whether it's beginner golf or someone tweaking something small in your swing because your drive isn't going quite straight and you're not sure what's happening, you know, those little fine tuning precision things. But that is, that's amazing. I've actually never, I haven't seen it recently, the biomechanical videos with the spine showing. I've just seen lots of golf videos. I used to take them of my clients as well outside and watch them draw the angle so I could see and show them this is where it's not enough, this is where it's too much. And so we need to back it off because I think seeing is believing and you don't believe you don't believe that there's anything wrong with your stroke sometimes until you see it. And you're like, Oh, my gosh, I can see that doesn't feel that way. Absolutely. That's that's called feel versus real. So whatever what we think we do in the golf swing might be completely opposite in reality. Oh my gosh, that's great. So what's the most common golf injury that you see or complaint? Well, the most common injury it accounts for somewhere between 20 to 35% of all golf injuries is back injury and specifically lower back. That is caused by a combination of things. One of them being with previous golf instruction, we would be asking our students to get into positions or move their body in such a way that generally now we know to be incorrect. So one of the things we think about, we can think about now is I was always taught and I used to actually have my students try to keep their back as straight as possible and kind of stick out your butt at your address position or starting position and kind of rotate around that. We now know that that kind of puts actually puts your body in a bit of a compromising position. So something like that can contribute to your lower back pain. Other things is the golf swing itself is just naturally a pretty violent motion. We're standing on the side of we're standing on the side of the ball and we're kind of tilted over a bent over a little bit. We're trying to rotate and swing our arms as fast as we can around our body. And something also that affects it greatly is actually the impact with the ground. We're basically swinging that golf club and hopefully not with the driver, but with our irons and wedges. We're basically swinging that club right into the ground. The ground offers pretty good resistance as it turns out. So all those things put together really contribute to lower back. Next on the list would be like elbow, then wrist, then shoulder. All that again is basically related to just the natural motion of the golf swing in and of itself and the impact with the ground. Something like an example would be one of my students. She's a 17-year-old senior and we just started kind of working a little bit harder on the golf swing at the beginning of the year and she's very flexible as most 17-year-olds are but she can kind of rotate her arms and shoulders in behind her and she was actually her background when she was younger. She was a swimmer so she's very strong with the upper body, very strong with her arms. She can kind of get her good and bad. She can get her golf swing into positions that most of us can't. And earlier this year she was kind of starting to complain about her back getting a little bit sore. So I kind of looked at the her swing on video kind of and I also kind of reached out to a few of my colleagues and what can we do to kind of eliminate or alleviate some of the pain she's experiencing and she's one of those where as she's going through her downswing she tends to bend over, bend a lot downward towards the golf ball while rotating this way so there's a lot of flexing and bending in her spine. So we worked a little bit to initially improve that and kind of eliminate a lot of the flexing and the side bend going through her golf swing but still yet she was still kind of experiencing a little discomfort. So I reached out again to one of my colleagues and said she still kind of looks like we're getting her into a better position but she's still you know not quite comfortable and basically he said yeah so at that point then we need to figure out a way to strengthen the muscles around her back her spine specifically and see how we can better support her golf swing. So basically from that point I would need to send her to someone like yourself or someone who's we call them a TPI certified title is for Cannons Institute. Yeah so they've been trained on the how the biomechanics work in the golf swing and how to either improve it or how we can work around it. Whether or not she's gone and seeing the the therapist yet is questionable but at some point the instruction is not it's not going to be enough to alleviate the pain you also kind of need to figure out how you can strengthen those muscles and be able to support the golf swing which again is a very violent motion. I think that's great the TPI I'm glad you brought that up because I learned so much from a colleague of mine in San Diego in 2006 maybe he did the full certification and every week at this clinic we were a bunch of knowledge hungry high-level physical therapists we treated professional throwers we treated professional golfers so everybody and so we just wanted to learn and so he gave us three in-services on the TPI and I learned mind-blowing stuff from him about the golf swing and the biomechanics that I didn't even know as a physical therapist you're not learning that in PT school and I think some of the things you said about like a rotation the rotation with the low back being the highest injured the low back was not designed to rotate but the the middle back and the neck definitely are built that way and they're designed the upper and the middle back are designed to rotate by design of the joints the low back by design of the plane the way the joints are shaped is bent for forward and backward motion with little rotation and yeah and the hip again was designed for rotation however the knee wasn't and there's all these rotations that happened in this violent golf swing which involves this huge rotational load right you're coiling like a spring and then this violent fast rapid unload of that spring to send the power through the ball like say on the drive and I see so many low back injuries and knee injuries actually it's funny I didn't realize shoulder wrists and elbow were the most common because the most common I see are back hip and knee so that really enlightened me and maybe it's because people aren't going they're not coming like I'm not getting that group of people that are having this shoulder and from golf but I think it's amazing that you send people in just for like some core strength and you corrected her swing she's still having pain and teenage girls teenage boys they boys grow a little bit longer like into an higher age and so there's a there's a mismatch athlete instead I've seen an athlete's insides like one side one leg when hip will be weak and they'll stand on one leg and wobble and the other leg will be perfectly strong without any injury and I think as that's interesting because both bones are growing at the same time but interestingly enough the muscle support of somebody growing and I know because I was injured so much as a teenager that's why I became a PT but I didn't know that's why I didn't see physical therapist and so I will see one side that's so often wobbly and the other side that's solid and and with golf like any other sport you need to have that symmetry of stability so that's that's great yeah so yeah like like we said before like before we wouldn't even think twice as to what you know the alternative explanations are as to why we can and can't do things so now we're you know instead of spending six months on trying to fix something in the golf swing understanding how the the golf swing and the body work together you can kind of cut that down by a lot so either we're going to work our way around how to get someone to do something or we can send them to someone like you to help us with either increasing the range of motion or just letting us know hey this person I don't think it's not going to happen no matter what we do so we got to figure out something else this is fantastic so that that cues me up I did about a three minute video for everyone to show the importance of getting rotation one of the most common things I find in golfers it's funny actually I had two gentlemen come in recently that I didn't even know were golfers that had a complaint of back pain and I was going through their range of motion and one hip didn't internally rotate you know this that the other thing their thoracic spine was stiff which you'll see in a minute when I show the video and as we went through the evaluation I asked him you know is there any other activities that you're going to be getting back to I know you said you like to walk and that and he's like oh yeah night golf every of the week and I was like oh my gosh wait a minute I got to look back at what I found because are you a right-handed golfer because if you are then you're not getting enough rotation on that hip and and does your knee hurt like and all these things start coming off in the wash with someone that's coming in that loves to golf and as a PT I mean me especially I am an athlete I've been injured with everything and I want people to be able to do what they love to their greatest capacity if they can do it right and so I want to make sure they have success so if we can go to that video and show everyone some just range of motion things to make sure you have the proper rotation in your hip and in your middle back let's go to that video if you want to prevent injury or eliminate pain and enjoy your golf game you need to make sure you have enough thoracic rotation which is this middle part of your spine and you need to make sure you have enough hip rotation in order to not hurt your back or hurt your knee or your shoulder or your neck so before golf you need to make sure you do all these stretches and you need to make sure you have enough range of motion so the first one I'm going to show you from here is you want to put your feet wide on a table or the floor and then you're going to drop both of your knees over to the side to stretch this side now if you have knee pain or injury just go very slow on this side you want to make sure you can stretch out you stretch and breathe a lot of people if they're tight your back will come up and you're going to suck your stomach in flip the other side and stretch back and forth the key is getting your feet wide dropping this helps to disassociate your hips from your back if you come up here your hips are too tight and your back is going to give up some motion during your golf swing the second exercise is what they call a figure four stretch you just cross one ankle on your knee and you stretch up here you might notice that you have a difference side to side or you might notice that your knees up here you want to stretch out and if you notice I'm kind of using my elbow to push down on my thigh here to give me a deep hit stretch you want to make sure you have enough motion side to side with this figure four stretch and also we can do what I call the knee to opposite chest stretch so you have one leg straight one knee lines up with the opposite shoulder and the foot falls outside the other leg and you just hug your knee toward your opposite shoulder and stretch out all that glute muscle this will help if you're already suffering low back pain from your golf game the other side I'm a little bit tighter on this side I don't play golf anyway so then you want to make sure you have enough thoracic rotation so you don't hurt your back so to do a rotation stretch there every golfer I've seen has not had enough of this motion and they've had one hip that didn't move as well as the other you're going to line yourself up in like a 90 degree angle here between your thigh and your waist and you're going to keep these right here and you're going to rotate your chest back like this you can if you don't have shoulder pain you can use your arm you can also put your hand behind your head and then fall back like that it's okay to let your knees come apart here because I don't want you to hurt your back if you're very stiff but what you want to do in this position is breathe and try to bring this part of your rib cage back you can also do a movement and do like a bow and arrow and bring your rib cage back bring your rib cage back and how that would translate into golf is you have your golf club and you're going to warm up before your game ideally you should be able to put this right behind your shoulders not behind your neck because you don't want to hurt your neck right behind your shoulders here you are going to be on some sort of a platform and you are going to hip hinge at your hips here so your back is nice and straight I don't know if we could look at that from the side so it takes your low back out of it and then you're just going to turn and turn you don't want to be rounded here when you turn because you're going to hurt your low back you want to take your low back out of the game and rotate and then rotate if you cannot get it behind your back because you're too stiff or you're been rounded from working on your desk you can cross your arms here and try to keep it up here you can put it up on your chest lift your chest up and rotate here or you can put it behind your shoulders to really lift up your chest and rotate there so make sure you can do this thing so you don't hurt yourself and you can get rid of your pain and enjoy your golf game aloha I want to make one comment about that video where I say like when you keep a flat back to take your low back out of it and that goes to me talking about the rotations and how we don't want your low back to rotate this one that exercise I was showing was to get the middle back to rotate and so I'm teaching people okay get the range of motion in your thoracic spine in that middle of back without your low back getting into it for that warm up because if you round your low back your low back is going to be in the unstable mobile position but if you extend your low back it will be in the more locked and stable position so that's why I mentioned that in that video nice I really liked everything you went through there and yeah one of the things that's really trendy now with the golf instruction and incorporating in the golf swing is increasing the hip rotation both on the back swing and on the through swing and not just making more hip rotation in general but doing it correctly so also for you guys out there talking to and visiting with a physical therapist or a trainer like yourself is going to help them understand how the body should work in the golf swing another one of those things in golf instructions that we used to sort of teach our students and what we thought was correct would be on the back swing to sort of restrict our hip rotation and then kind of coil up and around against our hip and our right knee now we kind of we definitely try to stay away from that we now know we want to actually sort of incorporate and enhance that hip rotation but for right-handed golfer getting that right hip turned and rotated behind us and slightly upwards for someone who may have difficulty with that you probably want to do something like a hip flexor stretch on our website uh hawaiestategolf.org we have a nice video that was put together by one of my colleagues Corey Kozuma who's out at the mid-pacific country club he's one of the assistant professionals out there and his his tpi trainer Bryce Amoy from dna sports and they kind of demonstrate an easy to do you can do it at home you don't need anything just a nice hip flexor stretch basically what it is is you just kind of take a knee on the ground as if you're here proposing or popping the question and while keeping your back straight and extending kind of lean forward or push into that front leg and kind of hold that position try to feel the stretch up your of your glutes and into your lower back that's going to help you with your hip rotation that's a great stretch what was that website again our website is hawaiestategolf.org okay it'll be under the learn to play tab oh that's excellent that's a great resource for people to go to thank you for that yeah and then you know just a few other maybe pre-round stretches you can do the first thing I would suggest would be the assisted deep squat there is a nice video on this on youtube from the my tpi page basically with your golf cart or if you're using a golf cart for the day you can kind of grab on to one of the cross or the support beams on the cart be careful try not to try not to break it as you're doing it but basically you're going to hold on to it and you're just going to kind of keep your back straight and then kind of go into a deep squat try to go as far as you comfortably can you should feel you should feel this stretching up in your glutes and kind of into your lower back some one of the things I actually really learned doing physical therapy at your office was that you know when we're trying to recover and rehabilitate parts of her body so in my case it was my knee that I injured we needed support the muscles not we need to not just rehabilitate me but all the muscles in and around it including our glutes and our calves and our quads and things like that so lower back pain isn't just you know rehabilitating or strengthening the lower back it's strengthening everything around it so that it can support that lower back and everything the other thing you can do real quick is kind of a glute stretch a few years ago Tiger Woods famously said in an interview after he played his round I couldn't I couldn't activate my glutes and that's why I couldn't rotate in my swing so basically you're just going to lean up against something either a wall or even the golf cart again just kind of get into a sitting position while leaning up against the wall and you're just going to hold that position for about 30 seconds or so you should feel the stretch or their pressure kind of going up through your glutes and that's basically basically when you're warming up you just want to warm up the body obviously and just get the blood flowing so that everything in our golf swing can kind of start I'm glad you said that the warm-up and that I couldn't fire my glutes because I think it's important to do that dynamic warm-up and get those muscles firing so that they're ready to perform and also I'm Gary Gray he's a physical therapist brilliant always says bring your butt to the party everywhere you go you need to bring your butt to the party and I loved it because it's so much about our even daily life getting out from a chair walking down the street having strong glutes prevents back pain knee pain hip pain foot and ankle pain bunions the whole gamut so and now Ryan was talking about when he saw me at East Oahu physical therapy in I know I know is where I work right now so Ryan I think we have about a minute left is there anything else you want to tell those current golfers future golfers about the sport yeah if you're if you're either just getting into into golf or even for my colleagues out there if they're if you're struggling with your golf swing and you're taking instruction you know it may it may not necessarily be that you're getting incorrect in instruction but maybe your body just can't do it so your next step from there would be to see someone like yourself and see what she can do to help help you do what your instructor is asking you to do I think that's great this has been so awesome I've loved listening to everything you said and I so appreciate your time thank you so much Ryan for coming on the show and thanks everyone for joining us here at physical therapy for a better life remember life is better when you listen to your physical therapist aloha everyone thank you so much for watching think tech hawaii if you like what we do please like us and click the subscribe button on youtube and the follow button on vimeo you can also follow us on facebook instagram twitter and linked in and donate to us at think tech hawaii dot com mahalo