POSTURE IMPORTANCE AND IMPACT OF POSTURE IN GOLF THE EUROPEAN TOUR PHYSIOTHERAPY UNIT

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1 POSTURE IMPORTANCE AND IMPACT OF POSTURE IN GOLF THE EUROPEAN TOUR PHYSIOTHERAPY UNIT Mr Nigel Tilley Specialist Musculoskeletal Physiotherapist BSc (HONS,) MSc, MMACP, MAACP

2 INTRODUCTION 3

3 WHAT IS POSTURE? Posture can be defined as: The manner in which the body is held upright against gravity as it's sitting, lying down or standing up A state of musculoskeletal balance that protects the supporting structures of the body against injury or progressive deformity The most important function of a neutral posture is to maintain the body in an upright position, supporting the body against gravity, in an efficient manner Static posture is the position/s we adopt when not moving, Dynamic posture is how our body is positioned during movement. Static posture usually dictates your dynamic posture and subsequent movement patterns

4 GOOD POSTURE: Refers to a body in muscular and skeletal balance where each joint is bearing an appropriate load and each muscle is working at its appropriate capacity. As one muscle group fires and shortens there is always a counteracting muscle that lengthens, these are known as agonist and antagonist muscles. Antagonist and agonist need to work synergistically to maintain balance and good posture and normal movement. An optimal postural relationship will enable the body to achieve its maximal physiological and biomechanical efficiency. In addition, good posture: * minimises the stress and strain on joints, connective and neural tissues * provides shock absorption * promotes the transfer of energy during movement.

5 IMPAIRED POSTURE: Leads to muscular imbalances where there is persistent use of certain muscles/groups without adequate activity of the opposing muscles. This leads to over stretching/under use of one muscle and excessive activity and tightening /shortening of another. Over time if specific activities, habitual postures, under use and misuse of structures are not altered the posture and neuromuscular systems begins to adapt and work within the confines of its limits. This alters the normal biomechanics of the spine, pelvis, peripheral joints and structures and their complex interactions and can result in a wide range of musculoskeletal and biomechanical issues Modifiable and Non-modifiable contributors i.e. Pathology This can drive postural impairment or prevent development of or return to normal posture/movement e.g Osteoporosis, AS, Trauma, neurological conditions

6 COMMON CAUSES OF IMPAIRED POSTURE Modifiable contributors (physical) SEDENTARY LIFESTYLES FIXED POSITIONS (DESK JOBS, DRIVING, COMPUTORS) POOR CONDITIONING (NO / WRONG EXERCISE) LACK OF BODY AWARENESS PROLONGED PRACTICE WITHOUT BREAKS GROWTH SPURTS IN ADOLESCENCE GOLFERS LACK OF DIFFERENTATION OF ACTIVITY (I.E ONLY GOLF) INAPPROPRIATE EXERCISE REGIMES

7 OTHER CONTRIBUTORS It is important to remember that Posture is also more than the positions our musculoskeletal structures adopt and move in, it is more than just a collection of righting and stabilizing reflexes. It is the way you live, the shape of your flexible container, its the physical manifestation of your comfort zone. We habitually hold ourselves and move in ways that serve social and emotional needs, or avoid clashing with them: posture can be submissive or dominant, happy or sad, brave or fearful, apathetic or uptight. REMEMBER THE CHALLENGES AND REWARDS OF TRYING TO CHANGE POSTURE ARE NOT JUST MUSCULOSKELETAL AND CAN BE PERSONALLY PROFOUND PATTERNS IN PEOPLE LIVES AND BEHAVIOUR THAT LEAD TO TROUBLE ARE USUALLY STRONG.

8 IMPORTANCE OF UNDERSTANDING POSTURE EFFECTIVE ASSESSMENT AND DIAGNOSIS (UNDERSTANDING MECHANISM OF INJURY) RESTORATION/MAINTENANCE OF NORMAL MOVEMENT PATTERNS OPTIMISING MOVEMENT EFFICIENCY INJURY PREVENTION PERFORMANCE ENHANCEMENT TO BE AWARE OF THE MULTIFACTORIAL INFLUENCES AND CONTRIBUTORS ON POSTURE FORMULATING AND CARRYING OUT MANAGEMENT AND TRAINING PLANS

9 MUSCLE BALANCE & MOVEMENT EFFICIENCY * Good posture facilitates normal joint mechanics * When joints and body structures are in good alignment, the length-tension and force coupling relationships function efficiently * Enables optimum movement efficiency & reduces injury potential Muscle Balance Normal length tension relationships Normal force coupling relationships Proper Joint Mechanics (Arthrokinematics) Efficient Force acceptance & generation Movement Efficiency Promotes Joint stability and Joint Mobiity

10 ANATOMY AND POSTURE

ASSESSING POSTURE SAGITTAL (Flex/Ext movement) FRONTAL AXIS OF ROTATION FRONTAL (abd/add/latflex) SAGITAL AXIS OF ROTATION) TRANSVERSE (int/ext rot) VERTICAL AXIS OF

11 ASSESSING POSTURE SAGITTAL (Flex/Ext movement) FRONTAL AXIS OF ROTATION FRONTAL (abd/add/latflex) SAGITAL AXIS OF ROTATION) TRANSVERSE (int/ext rot) VERTICAL AXIS OF ROTATION UNDERSTANDING PLANES & AXES OF MOVEMENT IS IMPORTANT WHEN ASSESSING POSTURE & MOVEMENT. DURING ACTIVITY MOVEMENT USUALLY OCCURS IN MORE THAN ONE PLANE AT A GIVEN JOINT.

12 COG / LOG COG the theotretical point where the weight force of the object can be considered to act, the point where the 3 planes interesect LOG imaginary line passing through the COG helps define body alignment & posture using landmarks.

13 THE SPINE AND PELVIS

14 POSTURE TYPES THINK ABOUT POSITION OF PELVIS, SHOULDER GIRDLE, HEAD AND HANDS AND THE CONSEQUENCES OF THESE POSITIONS IN RELATION TO MOVEMENT AND INJURY POTENTIAL

15 EFFECTS OF ALTERED POSTURE

16 EFFECTS OF CERVICAL PROTRACTION Muscle Shortening/overactive: Upper fibres trapezius Levator scapulae Pectorals Sub-Occipitals Muscle weakness/lengthening: Deep neck Flexors Lower trapezius Rhomboids

17 EFFECTS OF HYPERLORDOTIC POSTURE Muscle Shortening/overactive: Thoracolumbar erectors Psoas major Iliacus Muscle weakness: Abdominals Gluteals

18 EFFECTS OF HYPERKYPHOTIC POSTURE Muscle Shortening/overactive: Pectorals Trapezius Levator scapulae Muscle weakness: Deep neck flexors Rhomboids Serratus anterior Gluts LOSS OF END RANGE THORACIC EXTENSION & ROTATION IMPORTANT IN GOLF SWING FOR NORMAL BIOMECHANICS

19 POSTURE AND THE GOLF SWING

20 WHY IS POSTURE IMPORTANT IN GOLF PERFORMANCE / EFFECT ON GOLF SWING MECHANICS BALANCE THROUGH SWING /FORCE GENERATION NORMAL MOVEMENT/MOVEMENT EFFICENCY HEALTH INJURY POTENTIAL INJURY PREVENTION BREATHING PSYCHOLOGICAL (CAUSES AND IMPLICATIONS)

21 HAVING CORRECT POSTURE AND SUBSEQUENT MOBILITY AT SPINAL AND PERIPHERAL JOINTS AND NORMAL MUSCLE BALANCE ARE VITAL TO ACHIEVE ALL SEQUENCES OF THE GOLF SWING WITH OPTIMAL MOVEMENT EFFICIENCY AND REDUCE INJURY POTENTIAL.

22 Does this posture look like it can perform a highly coordinated, multi-segment, rotational activity that requires strength, explosive power, flexibility, speed & balance?

23 THINK ABOUT THE KINETIC CHAIN AND THE RELATIONSHIP BETWEEN EACH MUSCLE & JOINT IN RELATION TO THE WHOLE SYSTEM & MOVEMENT TRYING TO BE PERFOMED DIFFERENT PARTS OF THE BODY ACT AS A SYSTEM OF CHAIN LINKS, WHEREBY THE ENERGY OR FORCE GENERATED BY ONE PART CAN BE TRANSFERRED SUCCESSSIVELY TO THE NEXT THE OPTIMAL COORDINATION OF THE BODY SEGMENTS & THEIR MOVEMENTS ALLOWS EFFICIENT TRANSFER OF ENERGY AND POWER THROUGH THE BODY A WEAKNESS/LIMITATION/INJURY IN ONE AREA OF THE BODY IMPEDES THIS TRANSFER & MOVEMENT EFFICIENCY. AS A RESULT THE BODY MAKES COMPENSATIONS TO OVERCOME THESE DEFICITS AND AREAS BECOME OVERSTRESSED, OVERWORKED, & RESULT IN REDUCED PERFORMANCE & INJURY.

24 SET UP NEUTRAL SPINE POSITION ARMS HANGING FREELY FROM THE SHOULDERS WEIGHT DISTRIBUTED EVENLY BETWEEN RIGHT AND LEFT WEIGHT OVER FRONT OF ANKLES

26 KEY AREAS FOR MOBILITY IN GOLF SWING SHOULDER Non lead shoulder full ext rotation (backswing) Lead Shoulder Full adduction (backswing) TRUNK/THORACIC SPINE Rotation (backswing and follow through) HIPS Lead hip Internal rotation (follow through) Non lead hip internal rotation (back swing) THINK ABOUT THE INFLUENCE OF POSTURE ON JOINT BIOMECHANICS, MOVEMENT EFFICIENCY & MUSCLE BALANCE.

28 KEY MUSCLES WORKING IN GOLF SWING UPPER BODY How do the postures we adopt affect the way our muscles function & our body moves?

29 LOWER BODY

30 POSTURAL IMPAIRMENTS AND THERE CONSEQUENCES ON THE GOLF SWING

31 S POSTURE

EFFECTS WEAK ABDOMINALS Important in spinal stability and force

GLUTEALS Key group of muscles in golf for generating stable base and

Restriction in hip mobility and increased lumbar lordosis (inc facet

32 EFFECTS WEAK ABDOMINALS Important in spinal stability and force generation especially in transition from backswing to impact WEAK GLUTEALS Key group of muscles in golf for generating stable base and power in several phases of the swing TIGHT HIP FLEXORS / ILIOPSOAS Restriction in hip mobility and increased lumbar lordosis (inc facet pressure spondylosis, disc degeneration) increase potential for hip pathology and altered swing mechanics

33 Reduced abdominal and oblique strength important for force generation, control and spinal stability Leads to increase Lumbar spine extension and compressive and shear forces. Leads to Reverse spin and Reverse C and technique faults (huge increase in Lumbar stresses and injuries). Reduced Gluteal strength and hip stability leads to reduced ground reaction force. Newton s third law of motion states that for every force applied by one object onto another, an equal & opposite force is applied from the second object back onto the first. As such, using the legs to drive forcefully into the ground results in the ground pushing back up into the golfer s body with an equal magnitude of force. The force the ground transmits into the golfer is known as the ground reaction force (GRF). GRF is then transferred up through the legs and into the pelvis. From the pelvis the force is transferred into the golfer s core, shoulder complex, arms, & finally, the Golf club, club head & ball.

34 TYPES OF POSTURE FAULTS IN GOLF C POSTURE

35 EFFECTS TIGHT PECTORALS Reduced shoulder external rotation affecting backswing and follow through Reduced scapulothoracic movement. WEAK SERRATUS Important in several sections of swing, reduced power/ acceleration in clubhead. WEAK GLUTEALS Key group of muscles in swing for generating stable base and power in several phases of the swing

36 Normal scapular and thoracic spine motion allows optimal mechanics for athletic shoulder motions. Increased thoracic kyphosis, reduced thoracic mobility, or scapular protraction (multifactoral) can contribute to impaired normal shoulder biomechanics and altered motor patterns and movements and subsequent injury. SHOULDER INJURY COMMONLY ASSOCIATED WITH REDUCED THORACIC EXTENSION ABILITY & KYPHOTIC POSTURES THORACIC SPINE KYPHOSIS HAS BEEN LINKED WITH LOW BACK PAIN (Harrison et al 2002) REDUCED THORACIC EXTENSION REDUCES THORACIC ROTATION AND SHOULDER ELEVATION (Lewis et al 2005) Remember Restriction of a thoracic functional spinal unit can involve the facet joints, the intervertebral disc articulation, the costotransverse & costovertebral joints, associated muscular, neural, fascial and ligamentous structures. Causes of restriction & postural impairment are often multifactoral. Treatment needs to address this.

37 CERVICAL PROTRACTION POSTURE

trunk and thoracolumbar fascia, resulting in subsequent swing faults WEAK GLUTS / POOR BALANCE Difficulty with

38 EFFECTS CERVICAL PROTRACTION Tight sub-occipitals and UFT Secondary knee extension Often associated with Thoracic kyphosis (Quek et al 2013) Cervical pain and reduced ROM REDUCED SEPERATION Often restriction through thoracic spine, trunk and thoracolumbar fascia, resulting in subsequent swing faults WEAK GLUTS / POOR BALANCE Difficulty with maintaining balance Difficulty with weight transfer Poor loading and force generation from gluts & quads Reduced ground reaction forces

Often rely on generating force from wrists/ forearms (gripping harder/grip issues) rather than pelvis trunk which they are unable to generate from, due to lack of spinal ROM and force generation from

39 Often rely on generating force from wrists/ forearms (gripping harder/grip issues) rather than pelvis trunk which they are unable to generate from, due to lack of spinal ROM and force generation from pelvis and core. Leads to increase injury in wrist/elbow. Issues with technique faults, poor consistency of shot, poor power development. Technique faults such as Over the top, sway and slide are common with this type of posture THINK ABOUT HOW POSTURE AFFECTS: BALANCE CO-ORDINATION MOVEMENT EFFICIENCY STRENGTH + POWER THINK ABOUT THE AFFECT OF STATIC POSTURES ON DYNAMIC MOVEMENTS

40 ROLE OF PHYSIOTHERAPISTS MDT & HEALTHCARE PROFESSIONALS

41 HOW CAN WE HELP? ASSESSMENT ORTHOPAEDIC AND FUNCTIONAL MOVEMENT SCREENING VIDEO ANALYSIS ASSESSMENT OF SWING (WITH GOLF COACH IF NECESSARY) IDENTIFY MODIFIABLE & NON-MODIFIABLE CONTRIBUTORS (NB multi-dimensional physical, emotional, psychological)

42 TREATMENT / MANAGEMENT ADVICE/EDUCATION/AWARENESS MANUAL THERAPY SOFT TISSUE TECHNIQUES CORRECTIVE EXERCISE (MUSCLE IMBALANCE) TAPING SWING / PRACTICE ADAPTATIONS EFFECTIVE WARM UP AND STRETCHING PROTOCOLS MDT MANAGEMENT (Psychologist, coach, physio)

43 CONCLUSIONS

44 THE GOLF SWING IS A COMPLEX AND HIGHLY DEMANDING MOVEMENT ON THE BODY FLEXIBILITY IS VITAL TO ENSURE NORMAL MOVEMENT & PERFORMANCE OF THE GOLF SWING POSTURE CAN AFFECT FLEXIBILITY, MOVEMENT EFFICIENCY & SUBSEQUENTLY AFFECT PERFORMANCE & INJURY POTENTIAL EFFECTIVE ASSESSMENT AND SCREENING CAN IDENTIFY AREAS OF RESTRICTION AND WEAKNESS TO HELP FORMULATE CORRECTIVE EXERCISE & TREATMENT PLANS. FACTORS INVOLVED IN POSTURE CAN BE VARIABLE AND MULTI-DIMENSIONAL THE CHALLENGES AND REWARDS OF TRYING TO CHANGE POSTURE ARE NOT JUST MUSCULOSKELETAL AND CAN BE PERSONALLY PROFOUND APPROPRIATE PREPERATION FOR PLAY & CONDITIONING IS KEY FOR HEALTHY AND EFFICIENT GOLFERS

PHYSICAL PROFILING FOR GOLF. PAUL DARBY Chartered Physiotherapist And Golf Conditioning Consultant

PHYSICAL PROFILING FOR GOLF. PAUL DARBY Chartered Physiotherapist And Golf Conditioning Consultant PHYSICAL PROFILING FOR GOLF PAUL DARBY Chartered Physiotherapist And Golf Conditioning Consultant Components of the Elite Athlete Physiological Flexibility, Strength & Power Control of Movement Technical