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The Relationship Between Lead Hip Rotation and Low Back Pain in Golfers—A Pilot Investigation
The back is subjected to a great deal of strain in many sports. Up to 20% of all sports injuries involve an injury to the lower back or neck. Repetitive or high impact loads (e.g., running, gymnastics, skiing) and weight loading (e.g., weightlifting) affect the lower back. Rotation of the torso (e.g., golf, tennis) causes damage to both, the lumbar and thoracic spine. The cervical spine is most commonly injured in contact sports (e.g., boxing, football). One of the factors that increases the odds of injuries in athletes is excessive and rapid increases in training loads. In spite of currently emerging evidence on this issue, little is known about the balance between physiological loading on the spine and athletic performance, versus overloading and back pain and/or injury in athletes. This scoping review aims (i) to map the literature that addresses the association between the training load and the occurrence of back pain and/or injury, especially between the Acute:Chronic Workload Ratio (ACWR) and back problems in athletes of individual and team sports, and (ii) to identify gaps in existing literature and propose future research on this topic. A literature search of six electronic databases (i.e., MEDLINE, PubMed, Web of Science, SCOPUS, SportDiscus, and CINAHL) was conducted. A total of 48 research articles met the inclusion criteria. Findings identified that fatigue of the trunk muscles induced by excessive loading of the spine is one of the sources of back problems in athletes. In particular, high training volume and repetitive motions are responsible for the high prevalence rates. The most influential are biomechanical and physiological variations underlying the spine, though stress-related psychological factors should also be considered. However, limited evidence exists on the relationship between the ACWR and back pain or non-contact back injuries in athletes from individual and team sports. This may be due to insufficiently specified the acute and chronic time window that varies according to sport-specific schedule of competition and training. More research is therefore warranted to elucidate whether ACWR, among other factors, is able to identify workloads that could increase the risk of back problems in athletes.
Low back pain is a common musculoskeletal disorder affecting golfers, yet little is known of the specific mechanisms responsible for this injury. The aim of this study was to compare golf swing spinal motion in three movement planes between six male professional golfers with low back pain (age 29.2+/-6.4 years; height 1.79+/-0.04 m; body mass 78.2+/-12.2 kg; mean +/- s) and six without low back pain (age 32.7+/-4.8 years; height 1.75+/-0.03 m; body mass 85.8+/-10.9 kg) using a lightweight triaxial electrogoniometer. We found that golfers with low back pain tended to flex their spines more when addressing the ball and used significantly greater left side bending on the backswing. Golfers with low back pain also had less trunk rotation(obtained from a neutral posture), which resulted in a relative 'supramaximal' rotation of their spines when swinging. Pain-free golfers demonstrated over twice as much trunk flexion velocity on the downswing, which could relate to increased abdominal muscle activity in this group. This study is the first to show distinct differences in the swing mechanics between golfers with and without low back pain and provides valuable guidance for clinicians and teachers to improve technique to facilitate recovery from golf-related low back pain.
Background:
Hip rotation range-of-motion (ROM) impairment has been proposed as a contributing mechanical factor in the development of low back pain (LBP) symptoms. There is a hypothesis which suggests that a limited range of hip rotation results in compensatory lumbar spine rotation. Hence, LBP may develop as the result. This article reviews studies assessing hip rotation ROM impairment in the LBP population.
Material and methods:
The MEDLINE and EMBASE databases were searched without time restriction. Two authors independently selected related articles using the same search strategy and key words.
Results:
Among 124 articles 12 met the review inclusion criteria. The results of the studies are assessed in three sections, investigating the relationship between low back pain and 1) hip internal rotation ROM, 2) hip external rotation ROM and 3) hip total rotation ROM. Asymmetrical (right versus left, lead versus non-lead) and limited hip internal rotation ROM were common findings in patients with LBP. Reduced and asymmetrical total hip rotation was also observed in patients with LBP. However, none of the studies explicitly reported limited hip external rotation ROM.
Conclusion:
The precise assessment of hip rotation ROM, especially hip internal rotation ROM, must be included in the examination of patients with LBP symptoms.
Background:
While the biomechanical characteristics of the golf swing are well established, the lumbopelvic kinematic characteristics of professional golfers with limited hip internal rotation warrant further investigation.
Purpose:
The specific aim was to ascertain mechanical differences in lumbopelvic-hip movement of asymptomatic professional golfers with and without limited hip internal rotation during the golf swing.
Study design:
Controlled laboratory study.
Methods:
Thirty professional male golfers (aged 25-35 years and 0 handicap matched) were classified into either the limited hip internal motion (LHIM) group (range of motion<20°) or the normal hip internal motion (NHIM) group (range of motion≥30°). All participants underwent clinical tests (muscle strength, muscle length, and range of motion) and a biomechanical assessment using 8 infrared optic cameras in a motion analysis system. Independent t tests were performed to determine potential mean differences in muscle strength, length, and range of motion and lumbopelvic kinematics at P<.05.
Results:
Kinematic analysis revealed that the LHIM group showed significantly greater lumbar flexion (P<.001), right and left axial rotation (P<.025), and right-side lateral bending (P=.003) than the NHIM group. A greater pelvic posterior tilt was observed in the LHIM group when compared with the NHIM group (P=.021). Clinical tests showed reduced internal rotator muscle strength and shorter muscle length in the iliopsoas (P=.017) and hamstring (P<.001) among those in the LHIM group when compared with the NHIM group.
Clinical relevance:
The study data suggest that constraints to hip joint internal rotation, along with muscle strength imbalances between the agonist and antagonist muscles and muscle tightness, are associated with substantially greater lumbopelvic movement during the golf swing.
Effect size information is essential for the scientific enterprise and plays an increasingly central role in the scientific process. We extracted 147,328 correlations and developed a hierarchical taxonomy of variables reported in Journal of Applied Psychology and Personnel Psychology from 1980-2010 to produce empirical effect size benchmarks at the omnibus level, for 20 common research domains, and for an even finer-grained level of generality. Results indicate that the usual interpretation and classification of effect sizes as “small,” “medium,” and “large” bear almost no resemblance to findings in the field because distributions of effect sizes exhibit tertile partitions at values approximately one-half to one-third those intuited by Cohen (1988). Our results offer information that can be used for research planning and design purposes such as producing better informed non-nil hypotheses and estimating statistical power and planning sample size accordingly. We also offer information useful for understanding the relative importance of the effect sizes found in a particular study in relationship to others and which research domains have advanced more or less given that larger effect sizes indicate a better understanding of a phenomenon. Also, our study offers information about research domains for which the investigation of moderating effects may be more fruitful and provide information that is likely to facilitate the implementation of Bayesian analysis. Finally, our study offers information that practitioners can use to evaluate the relative effectiveness of various types of interventions.
Many sports involve movements during which the lower extremity functions as a closed kinetic chain, requiring weight-bearing (WB) range of motion (ROM). Assessment of the capacity for internal and external rotation motion at the hip is typically performed with the individual in a prone, supine, or seated position. Such measurements represent ROM in a non-weight bearing (NWB) position, and, as a result, may not appropriately assess the capacity of the joint to meet the demands of the athlete's sport. To date, no research exists which documents WB hip ROM in golfers relative to the ROM demands of the golf swing or the symmetry of weight-bearing hip rotation ROM in female golfers.
Weight-bearing hip rotation ROM was measured in female golfers and compared to the actual hip rotation ROM that occurred during a full golf swing.
Fifteen right-handed, female collegiate golfers participated in the study. The WB hip rotation ROM was measured during three different stance conditions and during full golf swings using a custom-built testing device. These actions were captured using a 3-D motion analysis system.
The golfers WB ROM was symmetrical for external rotation and internal rotation, p = 0.648 and p = 0.078, respectively. During the backswing, the golfers used approximately 20-25% of their available WB right internal rotation, and 50-75% of their available WB left external rotation. For the downswing, the golfers used approximately 34-37% of their available WB right external rotation and 84-131% of their available WB left internal rotation. The golfers used significantly more external and internal hip rotation ROM on the left (lead) hip during both phases of the full golf swing (p < 0.001), demonstrating an asymmetrical movement pattern.
In general, golfers did not exceed the measured WB ROM limits during the golf swing but did demonstrate decreased WB internal rotation on the lead hip.
Clinicians need to pay special attention to functional (WB) hip rotation ROM in female golfers in order to assess injury risk related to the rotational hip asymmetry present during the golf swing.
To investigate whether amateur golfers with self-reported low back pain have reduced hip rotation compared to asymptomatic controls.
Observational case-control study.
Data collection took place at 2 amateur golf clubs in southern England.
On initial contact, all participants completed a screening questionnaire used to allocate participants into LBP (n=28) and control groups (n=36). LBP group were found to be heavier than controls (t=2.242, 95% CI 0.763-13.332) but were matched for age, height, handedness, handicap, rounds played per week and years of play.
Primary outcome measures were lead and non-lead hip medial and lateral rotation in 0 degrees of flexion as measured by inclinometer. Secondary measures included inter and intra-rater reliability.
The LBP group had significantly reduced lead hip passive (LBP 21.14+/-10.17 degrees; controls 31.06+/-8.06 degrees, t=-4.228, 95% CI -14.621--5.205) and lead hip active medial rotation (LBP 21.46+/-10.01; controls 28.06+/-7.49 degrees, t=-2.908, 95% CI -11.147--2.036) compared to controls. No between group differences were found in non-lead hips or any passive or active lateral rotation measures.
Although there is lack of causality between LBP and hip rotation, the deficit in lead leg medial hip rotation in amateur golfers who suffer LBP may be relevant for screening or treatment selection.
Considering its popularity, little epidemiologic literature exists on golf injuries.
The low back is the most common injury location for golf-related injury. Most golf injuries occur as a result of the golf swing, and occur mostly at impact. The variables age, handicap, practice habits, and warm-up habits are associated with injury.
A prospective survey over 1 year was used to study golf injuries among 588 golfers at 8 Australian golf clubs. Information collected included golfers' injuries sustained during the year, location of injury, onset, mechanism of injury, and whether injury occurred during the golf swing or at another time. Additional information was sought on the type of treatment received after injury. Logistic regression was used to examine the epidemiologic patterns of golf-related injury and any possible risk factors for the injury.
The overall 1-year incidence rate of golf injury was 15.8 injuries per 100 golfers, which equates to a range of 0.36 to 0.60 injuries/1000 hours/person. Recurrent injuries were most common, while injuries were more likely to occur over time as opposed to an acute onset. The lower back was the most common injury site (18.3%), closely followed by the elbow/forearm (17.2%), foot/ankle (12.9%), and shoulder/upper arm (11.8%). A total of 46.2% of all injuries were reportedly sustained during the golf swing, and injury was most likely to occur at the point of ball impact (23.7%), followed by the follow-through (21.5%). Multivariate analysis revealed that the amount of game play (odds ratio [OR] = 3.73, 95% confidence interval [CI] 1.29-10.75) and the last time clubs were changed (OR = 0.32, 95% CI 0.12-0.86) were significantly associated with the risk of golf injury (P < .05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significantly associated with golf injury.
Nearly 16% of Australian amateur golfers may expect to sustain a golf-related injury per year. The injuries in golf are most likely sustained in the lower back region as a result of the golf swing. Based on statistical analysis, only game play and a changing of clubs seem to be significantly associated with risk of injury after adjusting for other risk factors (P < .05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significant.
Background
Low back pain is fairly prevalent among golfers; however, its precise biomechanical mechanism is often debated.
Hypothesis
There is a positive correlation between decreased lead hip rotation and lumbar range of motion with a prior history of low back pain in professional golfers.
Study Design
A cross-sectional study.
Methods
Forty-two consecutive professional male golfers were categorized as group 1 (history of low back pain greater than 2 weeks affecting quality of play within past 1 year) and group 2 (no previous such history). All underwent measurements of hip and lumbar range of motion, FABERE's distance, and finger-to-floor distance. Differences in measurements were analyzed using the Wilcoxon signed rank test.
Results
33% of golfers had previously experienced low back pain. A statistically significant correlation (P < .05) was observed between a history of low back pain with decreased lead hip internal rotation, FABERE's distance, and lumbar extension. No statistically significant difference was noted in nonlead hip range of motion or finger-to-floor distance with history of low back pain.
Conclusions
Range-of-motion deficits in the lead hip rotation and lumbar spine extension correlated with a history of low back pain in golfers.
The Standardization and Terminology Committee (STC) of the International Society of Biomechanics (ISB) proposes a general reporting standard for joint kinematics based on the Joint Coordinate System (JCS), first proposed by Grood and Suntay for the knee joint in 1983 (J. Biomech. Eng. 105 (1983) 136). There is currently a lack of standard for reporting joint motion in the field of biomechanics for human movement, and the JCS as proposed by Grood and Suntay has the advantage of reporting joint motions in clinically relevant terms.In this communication, the STC proposes definitions of JCS for the ankle, hip, and spine. Definitions for other joints (such as shoulder, elbow, hand and wrist, temporomandibular joint (TMJ), and whole body) will be reported in later parts of the series. The STC is publishing these recommendations so as to encourage their use, to stimulate feedback and discussion, and to facilitate further revisions.For each joint, a standard for the local axis system in each articulating bone is generated. These axes then standardize the JCS. Adopting these standards will lead to better communication among researchers and clinicians.
Background Low back pain (LBP) is highly prevalent in cricketers, particularly in adolescent fast bowlers. Numerous modifiable risk factors for and interventions to address LBP in cricketers have been proposed in the literature.
Aim Summarise and critique studies evaluating LBP risk factors in cricketers, and evaluate the effectiveness of interventions designed to prevent or treat such LBP.
Study design Systematic literature review.
Methods MEDLINE, ISI Web of Knowledge, CINAHL, SportDiscus and the Cochrane Library were searched from inception using key terms relating to risk factors and interventions in LBP in cricketers. Quality of included studies was assessed using the Downs and Black Quality Index, data were extracted to complete the effect size and OR calculations and evidence levels were established using van Tulder's criteria.
Results 12 studies (6 of high quality) investigating the factors associated with LBP in cricketers and 5 low-quality studies evaluating the interventions for the treatment/prevention of LBP in cricketers were identified. Moderate evidence indicates the presence of acute MRI bone stress as a risk factor for developing lumbar stress fractures. Additionally, moderate evidence indicates increased shoulder counter rotation (associated with mixed bowling actions) and decreased anterior abdominal fascial slide may be associated with LBP in cricketers.
Conclusions Screening for bone stress on MRI should be considered by clinicians managing developing cricketers to identify the risk of lumbar stress fracture development. Numerous associative factors were outlined, although causality needs establishing to further guide interventions in cricketers with LBP. Intervention studies were of insufficient quality to generate concrete conclusions and these research failings require rapid attention.
The accuracy and processing time of 11 commercially available 3D camera systems were tested to evaluate their performance in clinical gait evaluation. The systems tested were Ariel APAS, Dynas 3D/h, Elite Plus, ExpertVision, PEAK5, PRIMAS, Quick MAG, VICON 140, VICON 370, color Video Locus and reflective Video Locus. The 3D locations of markers on both ends of a rigid bar were determined. The distance between these markers was calculated from these data and compared with the true value, which was measured with a slide caliper prior to the measurement. For the estimation of noise, 3D coordinates of the markers were measured while the same rigid bar was placed on the floor, and the standard deviations were calculated. The processing time for calculating 3D coordinates from data obtained during normal gait was measured.
Field tests were conducted to assess the clinical performance characteristics of seven optical-based and one electromagnetic-based biomechanical measurement system. A device placed in the center of the calibrated volume enabled the analysis of four optical system properties: (1) the ability to measure the distance between two constantly visible markers rotating in the volume, (2) the ability to measure motion associated with a static marker, (3) the ability to reconstruct position-time histories of markers that were visible to alternating sets of two or three cameras, and (4) the ability to measure the motion of a marker that moved in close proximity to a second marker. Results indicated that five of the seven optical systems produced less than 2.0 mm RMS errors when measuring fully visible moving markers, and typically less that 1.0 mm RMS error when measuring the stationary marker. All passive optical systems confused marker identifications when markers moved within 2 mm of each other in a 3 m long volume. The electromagnetic device was tested by mounting two sensors at a fixed distance and orientation, and measuring their variability as they moved in various patterns within a pre-defined volume. The electromagnetic system produced real-time results, but was clearly susceptible to repeatable interference from metal in the volume.
Controlled laboratory study using a cross-sectional design.
To examine the kinematics and kinetics of the trunk and the physical characteristics of trunk and hip in golfers with and without a history of low back pain (LBP).
Modified swing patterns and general exercises have been suggested for golfers with back pain. Yet we do not know what contributes to LBP in golfers. To create and validate a low back-specific exercise program to help prevent and improve back injuries in golfers, it may be valuable to understand the differences in biomechanical and physical characteristics of golfers with and without a history of LBP.
Sixteen male golfers with a history of LBP were matched by age and handicap with 16 male golfers without a history of LBP. All golfers underwent a biomechanical swing analysis, trunk and hip strength and flexibility assessment, spinal proprioception testing, and postural stability testing.
The group with a history of LBP demonstrated significantly less trunk extension strength at 60 degrees/s and left hip adduction strength, as well as limited trunk rotation angle toward the nonlead side. No significant differences were found in postural stability, trunk kinematics, and maximum spinal moments during the golf swing.
Deficits observed in this study may affect a golfer's ability to overcome the spinal loads generated during the golf swing over time. Exercises for improving these physical deficits can be considered, although the cause-effect of LBP in golfers still cannot be determined.
Cadaveric lumbar intervertebral joints were loaded simultaneously in torsion and compression, and load-deformation curves were obtained. These were repeated after each of the following structures were cut through in turn: the supra/interspinous ligaments, the apophyseal joint in compression, and the apophyseal joint in tension. From the differences in the curves, it was possible to deduce the role of each structure and of the intervertebral disc in resisting and limiting torsion. The results show that torsion of the lumbar spine is resisted primarily by the apophyseal joint that is in compression, although the intervertebral disc does play a major role. The capsular ligaments of the tension facet and the supra/interspinous ligaments are unimportant. The compression facet is the first of rotation in joints with nondegenerated intervertebral discs. Much greater angles are required to damage the intervertebral disc, so torsion seems unimportant in the etiology of disc degeneration and prolapse.
One way to ensure adequate sensitivity for analgesic trials is to test the intervention on patients who have established pain of moderate to severe intensity. The usual criterion is at least moderate pain on a categorical pain intensity scale. When visual analogue scales (VAS) are the only pain measure in trials we need to know what point on a VAS represents moderate pain, so that these trials can be included in meta-analysis when baseline pain of at least moderate intensity is an inclusion criterion. To investigate this we used individual patient data from 1080 patients from randomised controlled trials of various analgesics. Baseline pain was measured using a 4-point categorical pain intensity scale and a pain intensity VAS under identical conditions. The distribution of the VAS scores was examined for 736 patients reporting moderate pain and for 344 reporting severe pain. The VAS scores corresponding to moderate or severe pain were also examined by gender. Baseline VAS scores recorded by patients reporting moderate pain were significantly different from those of patients reporting severe pain. Of the patients reporting moderate pain 85% scored over 30 mm on the corresponding VAS, with a mean score of 49 mm. For those reporting severe pain 85% scored over 54 mm with a mean score of 75 mm. There was no difference between the corresponding VAS scores of men and women. Our results indicate that if a patient records a baseline VAS score in excess of 30 mm they would probably have recorded at least moderate pain on a 4-point categorical scale.
Previous research agrees that the majority of injuries that affect male golfers are located in the lower back and that they are related to improper swing mechanics and/or the repetitive nature of the swing. This study describes the trunk motion and paraspinal muscle activity during the swing of a golfer with related low back pain (LBP) and assesses the effect of a 3-month period of muscle conditioning and coaching on these variables. Motion of the trunk was measured using three-dimensional video analysis and electromyograms (EMGs) were recorded from the same six sites of the erector spinae at the start and end of the 3-month period. At the end of the period, the golfer was able to play and practice without LBP. Coaching resulted in an increase in the range of hip turn and a decrease in the amount of shoulder turn, which occurred during the swing. In addition, a reduction in the amount of trunk flexion/lateral flexion during the downswing occurred in conjunction with less activity in the left erector spinae. These changes may serve to reduce the torsional and compressive loads acting on the thoracic and lumbar spine, which in turn may have contributed to the cessation of the LBP and would reduce the risk of reoccurrence in the future. In conclusion, further research with more subjects would now be warranted in order to test the findings of this program for the prevention of low back in golfers as piloted in this case report.
There is increasing demand for evidence-based health care. Back pain is one of the most common and difficult occupational health problems, but there has been no readily available evidence base or guidance on management. There are well-established clinical guidelines for the management of low back pain, but these provide limited guidance on the occupational aspects. Occupational Health Guidelines for the Management of Low Back Pain at Work were launched by the Faculty of Occupational Medicine in March 2000. These are the first national occupational health guidelines in the UK and, as far as we are aware, the first truly evidence-linked occupational health guidelines for back pain in the world. They were based on an extensive, systematic review of the scientific literature predominantly from occupational settings or concerning occupational outcomes. The full evidence review is on the Faculty web site (www.facoccmed.ac.uk), but an abridged version is presented here to aid its dissemination.
Biomechanics and motor control researchers measure how the body moves and interacts with its environment. The aim of this review paper is to consider some key issues in research methods in biomechanics and motor control. The review is organized into four sections: proposing, conducting, analysing and reporting research. In the first of these, we emphasize the importance of defining a worthy research question and of planning the study before its implementation to prevent later difficulties in the analysis and interpretation of data. In the second section, we cover selection of trial sizes and suggest that using three trials or more may be beneficial to provide more 'representative' and valid data. The third section on analysis of data concentrates on effect size statistics, qualitative and numerical trend analysis and cross-correlations. As sample sizes are often small, the use of effect size is recommended to support the results of statistical significance testing. In using cross-correlations, we recommend that scatterplots of one variable against the other, with the identified time lag included, be inspected to confirm that the linear relationship assumption underpinning this statistic is met and, if appropriate, that a linearity transformation be applied. Finally, we consider important information related to the issues above that should be included when reporting research. We recommend reporting checks or corrections for violations of underpinning assumptions, and the effect of these checks or corrections, to assist in advancing knowledge in biomechanics and motor control.
Full recoil golf swings have been implicated in back pain and injury in golfers. Evidence suggests that a restricted backswing may reduce the potential for injury without compromising performance.
To examine both golf swing performance and selected muscular actions of the trunk and shoulder during a full recoil swing as compared with a modified short backswing.
Electromyographic (EMG) recordings were taken bilaterally from the lumbar, external oblique, latissimus dorsi, and right pectoral muscles in 7 golfers during a full recoil swing and a modified short backswing. High-speed videotape was used to measure back swing angle reduction. Clubhead velocity (CHV) and ball-contact accuracy were quantified by using a swing speed indicator and clubface contact tape, respectively.
Shortening of the backswing by 46.5 degrees +/- 24.7 degrees had no effect on stroke accuracy as measured by mean deviation from the target spot on the club (19.0 +/- 7.8 mm vs 19.3 +/- 9.2 mm). CHV was not significantly reduced (33.9 +/- 2.5 m/s vs 31.2 +/- 2.2 m/s). However, EMG root-mean-square was decreased 19% in the right oblique muscle from 750 to 250 ms before impact (P < .05). During the acceleration phase, activation of left lumbar muscle decreased by 12%, whereas activation of right latissimus muscle increased by 21%. Although left lumbar muscle activity during the follow-through increased 14%, there was a substantial (17%) but nonsignificant decrease of activation of trunk muscles (P = .11). There was a general trend toward an increased activation of the shoulder musculature from 250 ms before impact to 500 ms after impact.
These data support the idea that short backswings in golf may reduce trunk muscle activation and possibly reduce back injury and pain without negatively impacting swing accuracy or CHV. However, the short swing increases shoulder muscle activation and may, in turn, promote risk for shoulder injury.
Although golf is becoming more popular, there is a lack of reliable epidemiologic data on golf injuries and overuse syndromes, especially regarding their severity.
To perform an epidemiologic study of the variety of different musculoskeletal problems in professional and amateur golfers and to find associations of age, sex, physical stature (body mass index), warm-up routine, and playing level with the occurrence of reported injuries.
Retrospective cohort study.
We analyzed the injury data from a total of 703 golfers who were randomly selected over two golfing seasons and interviewed with the use of a six-page questionnaire.
Overall, 82.6% (N = 526) of reported injuries involved overuse and 17.4% (N = 111) were single trauma events. Professional golfers were injured more often, typically in the back, wrist, and shoulder. Amateurs reported many elbow, back, and shoulder injuries. Severity of reported injuries was minor in 51.5%, moderate in 26.8%, and major in 21.7% of cases. Carrying one's bag proved to be hazardous to the lower back, shoulder, and ankle. Warm-up routines were found to have a positive effect if they were at least 10 minutes long.
Overall, golf may be considered a rather benign activity, if overuse can be avoided. If not, golf can result in serious, chronic musculoskeletal problems.
One hundred tennis players were recruited from the professional men's tennis tour to investigate the correlation between hip internal rotation deficits and low back pain (LBP), as well as shoulder internal rotation deficits and shoulder pain. A statistically significant correlation was observed between dominant shoulder internal rotation deficits and shoulder pain. Also observed was a statistically significant correlation between lead hip internal rotation deficits and lumbar extension deficits with LBP. We conclude that due to repetitive demands on the dominant shoulder and repetitive pivoting at the lead hip, the cycle of microtrauma and scar formation leads to capsular contracture and subsequent reduction in internal range of motion. It is likely that the limitation in lumbar extension in the symptomatic group is not only due to decreased flexibility from an increased load on the spine, but also due to a protective mechanism to prevent further exacerbation of the LBP. Physical conditioning that includes shoulder as well as hip internal rotation stretching programs should therefore be essential aspects in the treatment of tennis players with shoulder pain and LBP respectively.
Repeatability of traditional kinematic and kinetic models is affected by the ability to accurately locate anatomical landmarks (ALs) to define joint centres and anatomical coordinate systems. Numerical methods that define joint centres and axes of rotation independent of ALs may also improve the repeatability of kinematic and kinetic data. The purpose of this paper was to compare the repeatability of gait data obtained from two models, one based on ALs (AL model), and the other incorporating a functional method to define hip joint centres and a mean helical axis to define knee joint flexion/extension axes (FUN model). A foot calibration rig was also developed to define the foot segment independent of ALs. The FUN model produced slightly more repeatable hip and knee joint kinematic and kinetic data than the AL model, with the advantage of not having to accurately locate ALs. Repeatability of the models was similar comparing within-tester sessions to between-tester sessions. The FUN model may also produce more repeatable data than the AL model in subject populations where location of ALs is difficult. The foot calibration rig employed in both the AL and FUN model provided an easy alternative to define the foot segment and obtain repeatable data, without accurately locating ALs on the foot.
Injuries sustained during golf rarely receive the recognition given to injuries from sports perceived as more violent or strenuous. However, golfing injuries are believed to occur frequently. The aim of this study was to explore the injury profile of female golfers, including treatment sought and the impact of the injury on performance and participation. Forty-one team captains were given questionnaires to distribute to their players. A total of 522 golfers participating in the Victorian Women's Pennant Competition in Victoria, Australia, from both the Metropolitan and Country competitions, completed the study. Over one-third (35.2%) of the golfers reported having sustained a golfing injury within the previous 12 months, with the lower back being the most commonly injured body region. Strains were the most frequent type of injury (67.9%). Of the 184 injuries reported, 154 sought treatment from a health professional. Physiotherapists were the most common health professional consulted. Performance was affected in 78.9% of cases, with 69.7% of the injured golfers missing games or practice sessions due to injury. Golfing injuries appear common and have a substantial impact upon the injured golfer. As lower back strains are the most common injury, strategies such as performing an appropriate warm-up could be investigated to determine the possible injury prevention benefits for golfers. This study has also highlighted that the majority of treatments are from allied health professionals, suggesting that a complete epidemiological description of golf injuries requires information from broader settings than general practice clinics and hospitals.
The golf swing imparts significant stress on the lumbar spine. Not surprisingly, low back pain (LBP) is one of the most common musculoskeletal complaints among golfers.
This article provides a review of lumbar spine forces during the golf swing and other research available on swing biomechanics and muscle activity during trunk rotation.
The role of "modern" and "classic" swing styles in golf-associated LBP, as well as LBP causation theories, treatment, and prevention strategies, are reviewed.
A PubMed literature search was performed using various permutations of the following keywords: lumbar, spine, low, back, therapy, pain, prevention, injuries, golf, swing, trunk, rotation, and biomechanics. Articles were screened and selected for relevance to injuries in golf, swing mechanics, and biomechanics of the trunk and lumbar spine. Articles addressing treatment of LBP with discussions on trunk rotation or golf were also selected. Primary references were included from the initial selection of articles where appropriate. General web searches were performed to identify articles for background information on the sport of golf and postsurgical return to play.
Prospective, randomized studies have shown that focus on the transversus abdominus (TA) and multifidi (MF) muscles is a necessary part of physical therapy for LBP. Some studies also suggest that the coaching of a "classic" golf swing and increasing trunk flexibility may provide additional benefit.
There is a notable lack of studies separating the effects of swing modification from physical rehabilitation, and controlled trials are necessary to identify the true effectiveness of specific swing modifications for reducing LBP in golf. Although the establishment of a commonly used regimen to address all golf-associated LBP would be ideal, it may be more practical to apply basic principles mentioned in this article to the tailoring of a unique regimen for the patient. Guidelines for returning to golf after spine surgery are also discussed.
A Fortran package for generalized, cross-validatory spline smoothing and differentiation
- H J Woltring
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