IMPROVE MY GAME
When to Come Back?
Fri Apr 4, 2014 by Dr. Peter Mackay
To get back in the game, ramp it up slowly!
In our last article, we looked at when common sense would dictate the need to "shut it down" with an injury. Now we will consider when it’s appropriate to return to action. There are many different issues to consider such as age, prior injuries, the type of injury and the significance of the pending competition. In the golf industry, we speak of the “money parts.” These are key areas which when injured, can change careers. They include the spine, the wrist, the shoulder, the knee, the hip and the ankle.
The majority of problems in golf are related to the repetitive nature of the game. Besides hours of practicing, there are many mundane activities such as climbing in and out of bunkers, carrying bags, and placing tees in the ground, that take a toll on a golfer’s body.
Another issue is the unfortunate result of the elaborate conditioning programs now being utilized by players. With the great benefits of training comes the inherent risk of certain cross training techniques. A short list of our red flag exercises would include the inclined leg press, the overhead shoulder press, any sustained lumbar flexion as in a prolonged posterior pelvic tilt and any unsupervised Olympic lifts such as the dead lift! The reason a certified trainer is such an integral part of a golfer’s team is the attention to detail and understanding of safe, efficient technique.
Faulty alignment and postural patterns certainly predispose all of us to strains and sprains. These patterns are shaped by the things we perform every day as a routine part of our lives like sitting, driving, and using a computer. We develop habitual movements and we adapt accordingly to the ever-present effects of gravity. If we then take these abnormal postural patterns to the golf course, potential problems may arise.
It is important to never use the presence or absence of pain as the only determining factor in whether or not to return to action. In the clinical setting, we see pain arise as a final warning and often see it disappear before all is truly well. Of course, some injuries are acute and traumatic in nature. The solution is to observe functional movements and assess an individual's ability to tolerate a level of stress consistent with the golf swing and, more importantly, 18 holes of golf.
Rules of engagement
The following outline would be appropriate for a simple disc bulge of the lower back or significant sprain/strain of the spine. We must always customize our approach based on each individual’s reactions and tolerance.
It should be noted that injury recovery is often described in three phases:
- Inflammation (first week)
- Proliferation or repair phase (day three through 3 weeks)
- Remodeling (beyond 10 days)
The duration of each phase varies between individuals and the phases may have some overlap. This is where traditional exercise therapies and training techniques along with manual therapies need to accommodate the individual’s response. Disc injuries may be aggravated by inappropriate therapies and premature aggressive motion! There is no cookie cutter approach to this area of rehab. In the hands of skilled professionals, progress will be made but setbacks can be anticipated. There is an art to being able to make these decisions and the player is best to comply at all times.
Under the guidance of your doctors and trainers, it is prudent that the following basic screens are performed pain-free before allowing a player to think about swinging a club:
Pelvic Tilt Test
Pelvic Rotation Test
Multi Segmental Rotation
Multi Segmental Extension
Single Leg Balance
Bridge with leg Extension
In addition to these screens, a player should be able to perform the following:
- The player must be able to “static hold” all positions of swing (set up, top of backswing, impact and follow through) as well as perform super slow swings without pain.
- The player must be able to maintain putting and chipping postures without pain for twenty to thirty seconds at a time for a minimum of three sets.
If the player is able to pass the physical screens without pain, he can now resume chipping. If the following day is without consequences, we begin full shots with a 7 iron. If no adverse reaction, the following day the player moves through the bag with caution. Pay close attention to the player’s physical response to the first practice session and be aware of any sense of aggravation. Always ice first and rest in a stable back position after initial return. Following a round, always perform a cool down routine involving dynamic stretching and recovery positions to relax the back.
This is meant to be a generic guideline, which needs to be customized and monitored at each step. Returning to competition brings with it more complex issues than merely being free of pain. More severe cases will be adjusted for the progression to full swings based on a 48-hour recovery period. Remember that the full affects of some injuries take up to 72 hours to be fully realized and any aggravation of an injury further worsens long-term prognosis.
One of the most common reasons for an injury is the improper handling of an initial problem!
Dr. Peter Mackay
As a board-certified chiropractor in the State of California, a Qualified Medical Evaluator, and founding member of the Titleist Performance Institute (TPI) Advisory Board, Dr. Peter Mackay has an extensive career in sports injuries, industrial medicine, and physical rehabilitation.
@ anonymous user with the total hip replacement. Find a TPI certified PT near you, or at least an orthopedic specialist PT. If your PT doesn't know golf ask him or her to help you find someone who does.
Mike Rymer 7/24/2014 4:52 PM
Just had total right hip replacement which exercises will me get back on the course quicker and safely once I have completed out patient p/t ? thank you
Anonymous User 7/13/2014 1:13 AM
none of the test video's played so i was not able to watch them, i really need to.
Anonymous User 5/29/2014 1:47 PM
Never forget to stay relaxed in wrists, shoulders and back. This been taken me 10 years to learn a relaxed golf swing !
Anonymous User 5/9/2014 12:46 PM
I had a herniated disc that first occurred in 2011, and went through PT for a long time. Then I waited a year until golfing again. The next time out I herniated the same disc again and the disc above it (L4& L5). I have had problems with sciatic nerve pain as a result of these injuries. So I waited until 2014 to try golfing again. The first time out everything was fine, but the next time my nerve pain came back. I also played baseball for 15 years. Is it possible that the swinging motion will never be achievable for my disc to withstand without injury? I’m 32 years old. The only thing that seems to help while injured is rest. PT makes it worse. The spinal doctors haven’t really been any help. Injections in my back have helped. The only other option is surgery. Can anyone HELP?
Anonymous User 4/28/2014 3:53 PM
Please excuse the delay , I did not get this request ; at 32 your prognosis should be very good ; specific things have to happen to get you back on track and that means team work; no one will have all the answers but one doc should be able to quarterback your recovery. Surgery is not a last resort but rather a timely one. That being said most disc injuries will heal with the right process . Check our professional site for a TPI certified doc who can get you started.
Dr. Peter Mackay 8/20/2014 2:59 PM
Have you tried chiropractic?
Mike Stanley 5/21/2014 11:08 AM
To the gentleman with the recurrent disk herniations... I agree with Kevin above. You need to be seen by a therapist who is TPI certified and they will help you progress toward playing golf again without injury. This will give you the best chance of return to golf in my opinion. You may have physical limitations in other areas (hips, thoracic spine) that facilitate re-injury.
Mark Elkin 5/20/2014 9:57 AM
Peter, Great article, my son is just coming out of an injury as you know, you have been really good at handling the process and planning the return, Roberto
Anonymous User 4/13/2014 12:45 PM
Peter Good article. Thanks for telling Amy to let me know about it. Bill
Anonymous User 4/11/2014 12:33 PM