POSTURE IMPORTANCE AND IMPACT OF POSTURE IN GOLF THE EUROPEAN TOUR PHYSIOTHERAPY UNIT Mr Nigel Tilley Specialist Musculoskeletal Physiotherapist BSc (HONS,) MSc, MMACP, MAACP
INTRODUCTION 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
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.
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
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
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.
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
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
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 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.
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.
THE SPINE AND PELVIS
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
EFFECTS OF ALTERED POSTURE
EFFECTS OF CERVICAL PROTRACTION Muscle Shortening/overactive: Upper fibres trapezius Levator scapulae Pectorals Sub-Occipitals Muscle weakness/lengthening: Deep neck Flexors Lower trapezius Rhomboids
EFFECTS OF HYPERLORDOTIC POSTURE Muscle Shortening/overactive: Thoracolumbar erectors Psoas major Iliacus Muscle weakness: Abdominals Gluteals
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
POSTURE AND THE GOLF SWING
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)
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.
Does this posture look like it can perform a highly coordinated, multi-segment, rotational activity that requires strength, explosive power, flexibility, speed & balance?
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.
SET UP NEUTRAL SPINE POSITION ARMS HANGING FREELY FROM THE SHOULDERS WEIGHT DISTRIBUTED EVENLY BETWEEN RIGHT AND LEFT WEIGHT OVER FRONT OF ANKLES
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.
KEY MUSCLES WORKING IN GOLF SWING UPPER BODY How do the postures we adopt affect the way our muscles function & our body moves?
LOWER BODY
POSTURAL IMPAIRMENTS AND THERE CONSEQUENCES ON THE GOLF SWING
S POSTURE
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
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.
TYPES OF POSTURE FAULTS IN GOLF C POSTURE
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
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.
CERVICAL PROTRACTION POSTURE
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 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
ROLE OF PHYSIOTHERAPISTS MDT & HEALTHCARE PROFESSIONALS
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)
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)
CONCLUSIONS
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