MANUAL OSTEOPATHY
FOR GOLFERS
Introduction
The practice of golf requires optimal mobility. Think of mobility as the fusion between soft tissue flexibility, joint movement and the ability to actively utilise them, which at its turn requires stability, strength and motor control. A quick postural assessment and an active assessment of the client’s patterns of movement are a must. The Selective Functional Movement Assessment (SFMA) is a great tool to assess the client's condition. I highly recommend the use of this assessment followed by passive motion, resisted testing and/or special tests to narrow the results and determine the possible reason(s) for pain or dysfunction.
As a health practitioner, it is crucial to know that what we take for average values of range of motion are simply not good enough for the practice of golf. Remember, if a joint lacks optimal mobility, the body will always find a way to "obtain it" from somewhere else, even from joints that are designed to create stability. Here is one golden rule: "the body will always sacrifice stability for mobility". And when that happens, you can bet it will become the source of musculoskeletal and motor control issues.
Limitations or restrictions in mobility can come from different structures, from muscular, capsular, fascial or from any component of what I will call the “motor control complex”, involving the input-processing-output mobility sector in our bodies (e.g. any PNS and CNS dysfunction, such as proprioceptors damaged during or following an injury). So, treatment seeking to improve mobility should be adapted to each scenario.
Every joint is important to golf, however, you will not always have the chance to address, in a single session, all the restrictions in mobility that you will encounter. For that reason, I will describe the areas that are most relevant to golf. In case you want to start there.
In terms of mobility, the Acetabulofemoral Joint, the Glenohumeral Joint and the T-Spine are crucial to golfers. Restricted mobility at those specific areas are amongst the most common source of dysfunctional swing biomechanics, the leading cause of Golf-related injuries (Meister et al., 2013). As an example, limited mobility at the T-Spine or Acetabulofemoral Joint will be compensated by rotation of the lumbar spine. During the swing, the lumbar spine should flex-extend, but not so much rotate. The addition of rotational forces coming from a compensatory pattern caused by a lack of mobility in T-Spine or Hip is at the origin of a dysfunctional swing and lumbar acute and chronic conditions. Shoulder mobility is also paramount to golf. That's why those three, are good areas to start with.
The Acetabulofemoral Joint
When treating a golfer, it would be crucial to address any limitation in both, internal and external rotation as well as extension of the Acetabulofemoral joint.
N.B.
The golf swing requires the golfers to internally rotate their Acetabulofemoral Joint past 40˚. However, sometimes the clients exhibit a range of motion that is shifted towards external rotation. In that case it is going to be almost impossible to internally rotate past 40˚, even if they have a full range of motion. I have encountered this mostly in male clients and/or in clients with hip replacements. In those “not that rare cases” of full range of motion shifted towards external rotation of the hip, it is better NOT to try to “improve” the internal rotation. You don’t want to contribute to the creation of hypermobility in that joint. Fortunately, the swing can be adapted to these types of structural conditions, and thus repetitive strain injuries at the affected Acetabulofemoral joint can be avoided. Adjusting the swing of our clients is out of our scope of practice, however sending a note to the client's Golf Professional with your findings, suggesting to adjust the swing to the client's condition is within our scope of practice. Furthermore, once a Golf Professional realises you are knowledgeable, he/she will start referring other golfers to you. You can always offer the Golf Pro a treatment (free or discounted), in that way he/she will more likely promote your services within his students.
The Glenohumeral Joint
When treating a golfer, it is essential to address any limitation in internal and external rotation, horizontal adduction of the left limb for right handed golfer, abduction and full flexion combined with internal rotation (to check for Latissimus flexibility) of the Glenohumeral joint.
N.B.
The golf swing requires the golfers to externally rotate the Glenohumeral Joint past 100˚. It is also common to find golfers with a full range of motion shifted towards external rotation. The same considerations that were discussed for the Acetabulofemoral joint referring to the full range of motion shifted towards external rotation applies to this joint.
The T-Spine
When treating a golfer, don't forget to address any limitation in extension and rotation of the T-Spine. According to TPI, "golfers should be able to rotate past the 45- degrees mark. Typical measurements range from 45-70 degrees in both directions." (TPI, 2013)
N.B.
Make sure your client does not move the hips when testing the Thoracolumbar rotation. If possible, take the lumbar rotation out of the equation (as much as possible) by flexing the hip past 90˚, otherwise results will be altered by a possible over involvement of the lumbar spine in the thoracolumbar rotation, which is what we are trying to avoid.
Limitation in T-Spine frequently comes from improper posture (hyper kyphosis). Awareness and instruction in this matter help the golfers understand the importance of taking self-responsibility. Many will feel motivated enough to start playing an active role in the process of regaining a sounder posture. If hitting the ball farther is the motivating factor, use it!