Teeing off: Chiropractic and its role in professional golf
The Open Golf Championship 2021, at the Royal St George’s Golf Club took place in July. Nick Metcalfe, BCA Member and Chair of the Royal College of Chiropractors Sports Faculty, discusses his experience working at The Open in 2015 as well as some quick tips for the next golfer in your clinic.
I’m not a golfer. I have swung a golf club a few times as a teenager and one of my favourite films is Happy Gilmore, but that’s about the limit of my personal experience!
Like many chiropractors though, I have seen my fair share of amateur golfers in clinic. I enjoy seeing them and really believe chiropractic can have a positive impact. A big stepping stone in my career as a sports chiropractor a few years ago followed a referral from Royal College of Chiropractors (RCC) Sports Faculty Fellow and BCA Member, Jesper Dahl, who has experience on both the PGA Tour and Ryder Cup. Sir Nick Faldo, Britain’s most decorated golfer and winner of six major championships, was flying in from the USA and looking for a chiropractor whilst in the UK. My clinic was in the right location and Jesper suggested my name.
From then on, each time Sir Nick was flying into the UK, I would receive a text a few weeks ahead of time to arrange some appointments in clinic. In 2015, he announced he was due to play at The Open for a final time. It was at St Andrews, 25 years on from his win there in 1990 and a perfect time for him to bow out. I casually mentioned that I would be happy to help him out for the week, he agreed and invited me up to Scotland. In the days before and during the Championships, I would assess him from top-to-toe twice a day, addressing any minor mobility, strength, or control issues that I could find. All in an attempt to keep him functioning and as injury free as well as possible.
A few years on, Sir Nick is due to appear at The Senior Open in July and myself and our clinic sports therapist, Naomi Wallen, will put a combined package of care together for him. A multidisciplinary approach this time.
Having the opportunity to work at The Open 2015 was a real privilege. This experience, combined with some others, allowed me to secure an interview with Fulham FC, where I’ve now been working for four seasons. Despite very little personal experience in golf at the time I made it my mission to understand more about the sport as I knew that one opportunity in sport can lead to another. Below are some of the things I have learnt and I hope they may help you with the next golfer at your clinic:
Injury risks in golf:
A summary from Edwards et al (2020)
- Regardless of skill level, golfers more frequently experience overuse injuries than acute injuries.
- Professional golfers tend to experience overuse injuries because of increased frequency of practice with reduced golf swing variance. Essentially, they are loading the same musculoskeletal tissues repetitively.
- Amateur golfers are more likely to get injured from flaws in their swing combined with large peaks and troughs in playing frequency.
- Most golf-induced overuse injuries affect the back, shoulder, knee, or elbow, with the lower back being the most common. The lead side (the left arm and leg in a right-handed golfer) is more often injured than the trail (right side in a right-handed golfer).
- The ‘classic’ golf swing is common amongst older golfers. The pelvis freely rotates away from the target during the backswing often causing the left heel to raise off the ground. The golfer also finishes the swing in an erect “I” position in the follow-through.
- The ‘modern’ golf swing is characterised by restricted pelvic motion during the backswing, lateral bending at impact, and lumbar extension during the followthrough. The modern golf swing emphasises force production through the increasing degrees of pelvic and shoulder separation. This results in larger compressive loads after impact.
Health benefits of golf
The research is indisputable; the overall health benefits of golf far outweigh any risks! We need to be doing everything in our power as chiropractors to support our golfing patients.
6 Tips for treating golfers with back pain:
- Address lead hip rotation: The lead hip acts a pivot point for the body to rotate around. If a golfer lacks lead hip rotation, then they may compensate with more spinal rotation. In both professional and amateur golfers with chronic LBP, lead hip internal rotation was limited when compared to non-lead leg internal rotation (Murray et al, 2009), and when compared to golfers without LBP (Vad et al, 2004).
- Beware IA-L5: The combination of torso lateral bending and pelvic rotation as the golfer approaches impact of the ball, is thought to contribute to LBP in golfers. Over time the right side IA-L5 vertebrae of right-handed golfers is thought to be under particular strain (Sugaya et al, 1999).
- Advise they reduce their back swing; Excessive trunk rotation may be an attempt to generate more power in the shot but may also overload spinal structures and result in back pain. In one study, shortening the backswing decreased spinal loads yet reported no significant changes in club head speed nor shot accuracy (Bulbulian et al, 2001).
- Strength training: Specific and progressive loading of the lumbar erectors, gluteus maximus, gluteus medius and abdominal muscles can improve trunk stability throughout the swing and may reduce lower back pain.
More recent evidence supports the use of increasing general lower body strength through squatting and deadlifting to increase clubhead speed and strengthen anterior and posterior trunk muscles (Oranchuk et al, 2018).
- Warming-up: Beyond a few swings of the golf club, no amateur golfer wants to warm up! Try focusing on the performance gains they may get from a proper warm up. Research suggests rotational-based warm-ups may elicit significant increases in clubhead speed (Fradkin et al, 2004).
- Keep it simple: Don’t forget all the usual stressors from the golfer’s daily activities and lifestyles that may also be contributing to their lower back pain. It might not be their golf that is causing their pain!
If you are interested in progressing your own career in sport, the Royal College of Chiropractors Sports Faculty provides a great framework for you to follow and a network of experienced sports chiropractors. Members will hear about opportunities to work at events like the Commonwealth Games 2022, receive free membership to FICS and a discount on the ICSC sports chiropractic qualification. You will also receive a free copy of UK Chiropractors Guide to Working in Sport, a 70-page manual written by the Fellows of the Sports Faculty; some of the most experienced sports chiropractors in the UK.