Literature Review

The lumbar spine and low back pain in golf: A literature review of swing biomechanics and injury prevention

Article· Literature ReviewinThe Spine Journal 8(5):778-88 · November 2007with 2,913 Reads
Abstract
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.
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    This paper proposes a new idea of an analysis of golf swing patterns. The body movement data are collected from upper back and lower back muscles using Razor IMUs. The data are then classified in two steps according to the similarity of the changing ratio: the deviation reduction from sensors and the changing ratio at each period of time. The experimental results show the modified data in the form of Linear equation which consists of many straight lines. Each line represents each player's swing which can be compared to one another or defined the golf swing pattern among golf players and coaches and can also be adapted to the similar golf swing pattern data classification which can help golf trainers or doctors for physical therapy. This proposed method can be applied to use with other sports with certain patterns such as baseball, tennis, and ping pong.
  • Article
    In golf, the trunk and pelvis kinematic variables are often related to measures of performance due to the highly complex and multi-joint movements involved in swings. However, it is unclear how specific body segments or joints contributed to the golf performance parameters. Therefore, the purpose of this study was to identify the key joints, including those of the upper and lower trunk, that are associated with golf performance parameters, such as X-Factor and pelvis motion. A motion capture system was used to obtain three-dimensional kinematics of golf swings performed by 10 low handicap male golfers. Based on regression analysis, right knee adduction, right shoulder external rotation and left elbow extension in ball address to top of the backswing and left knee adduction and lower trunk right bending with left rotation in top of the backswing to end of follow-through were presented as predictor variables for the X-Factor. For pelvis movement, a greater number of joint angles were associated with pelvis posterior tilt during backswing and pelvis motion to target with right rotation during downswing/follow-through. This study provides fundamental details of the movement mechanisms of major joints, as well as their relationships with performance parameters. Such understanding can be combined with training to improve the golfing skill and prevent possible injuries.
  • Article
    Full-text available
    The number of injuries that force golfers to quit is also increasing. In particular, the upper body injuries are concerns for amateur golfers. This study was conducted not only to investigate muscular balance, such as ipsilateral and bilateral ratios of the upper body, but to also evaluate the possible problems of muscular joints in amateur golfers. Male golfers (n=10) and a healthy control group (n=10) were recruited for the assessment of muscular function in the upper body, which was measured by an isokinetic dynamometer at 60°/sec. The tested parts were trunk, wrist, forearm, elbow, and shoulder joints. Mann-Whitney U-test was used to evaluate the significance of the differences between groups. The ipsilateral ratios of peak torque or work per repetition (WR) of trunk flexor and extensor in the golfers were not significantly different compared to those of the control group. These results were similar to the shoulder horizontal abductor and adductor. However, there were significant differences in the ipsilateral and bilateral ratios of the wrist, forearm, and elbow joints. Especially, the WR of the wrist flexor, forearm pronator, and elbow flexor on the left side of amateur golfers showed imbalances in bilateral ratios. Moreover, the WR of the wrist and elbow flexors on the left side of amateur golfers were lower than those of the wrist and elbow extensors. Therefore, amateur golfers should strive to prevent injuries of the wrist, forearm, and elbow joints and to reinforce the endurance on those parts of the left side.
  • Article
    This research looks at health issues and injuries affecting the motion apparatus of professional and amateur golfers. Significant differences have been observed between the groups in terms of both the mechanics and localization of injuries. Golfers suffer most frequently from lumbar spine issues, and other problems include the areas of the shoulder girdle, the elbow, wrist and hand, vertebral compression fractures and rib stress fractures. The most important preventive measure to avoid risk of injury is the drill practice of the right swing and sufficient warmup before the practice session and the game.
  • Article
    The strain on the lower back during the golf swing has been studied extensively through biomechanical models. An increased primary spinal angle (angle between a line from C7 to L4 through the spine and a line perpendicular to the floor) has been suggested as a risk factor for LBP in golfers. The aim of this study is to compare the PSA between golfers with and golfers without low back pain. Methods: Fifty-five players were evaluated based on a questionnaire on low back pain and a measurement of their primary spinal angle in the starting position. Results: Twenty-eight and twenty-seven players were categorized as players with and without LBP respectively. The mean primary spinal angle for players with low back pain (45.47°) was significantly higher than for players without low back pain (41.62°) (p = 0.017). ROC-analysis indicated a primary spinal angle of 44° as the best cut-off value. 69% of golfers with a primary spinal angle → 44° never had low back pain, while only 26% of players with a primary spinal angle 7144° never had low back pain. Conclusions: This study shows a difference in PSA between golfers with and without low back pain, 45° and 41° respectively. Furthermore this study shows an angle (44°) where the incidence of low back pain increases. De methods used in this study are not standardized and the inter observer variability was not tested. Therefore final conclusions can not yet be drawn.
  • Article
    The purpose of this study was conducted to make a comparative biomechanical analysis of X-factor and X-factor stretch during driver and iron swing. The subjects were composed of 10 professional golfers with more than 10 years career. The result was as follows: First, the analysis of the back swing with driver and iron swing showed no differences statistically between both the timing in horizontal rotating of shoulder and hip, the time required for X-factor stretch also showed no differences statistically. Second, the back swing with a driver swing showed more maximum horizontal rotation of shoulder and hip joint than the back swing with an iron swing, but the twist of shoulder and hip that was X-factor stretch angle showed no difference. Third, the GRF of the max value for the left and right foot during shoulder and hip horizontal rotation of back swing showed no differences statistically in the movement of driver and iron swing during the back swing, and the GRF of X-factor stretch for the left and right foot showed no differences statistically in driver and iron swing. Therefore the result of this research showed that the operation of torso(X-factor stretch) and weight shifting were similar although the horizontal rotation of body was different during the driver and iron swing.
  • Article
    Purpose : Recently, many researchers and golf coachers demonstrated that X-factor and X-factor stretch had a co-relationship with driving distance. However, its relationship is still controversial and ambiguous. Thus, the aim of this study was to examine the relationship among X-factor, X-factor stretch and swing-related factors, including driving distance in elite golfers. Method : Seventeen male elite golfers (handicap: {\leq}4) with no history of musculo-skeletal injuries participated in the study. Thirty spherical retro-reflective markers were placed on including the middle point of PSIS, the right/left ASIS, the right/left lateral acromion of the scapula, driver head and shaft grip. All motion capture data was collected at 100Hz using 6 infrared cameras. Carry distance, club speed, ball speed, smash factor, launch angle, and spin rate were collected from radar-based device, TrackMan. Results : Pearson`s correlation coefficient method was used to find the correlations among X-factor, X-factor stretch and swing-related factors. Positive correlations between driving distance and other swing-related factors which include club speed(r
  • Chapter
    Sports activities have become a part of the modern lifestyle and the number of related injuries has therefore increased dramatically. This chapter provides a brief review of injury prevention in the light of scientific evidence focusing on the knee, ankle, shoulder, and spinal joints as well as the associated muscles. The results obtained through prevention programs in reducing anterior cruciate ligament and hamstring injuries are highlighted as a model of sports-related injury prevention. The role of brace and proprioception is investigated for both the knee and the ankle joints and aging is analyzed as a factor predisposing to injury. The prevention of running injuries is discussed based on biomechanical and clinical analysis.
  • Article
    Résumé Introduction Le golf est un sport pourvoyeur de blessures chroniques et aiguës. Mieux connaître l’incidence et la localisation des blessures ainsi que leurs facteurs de risque et leurs facteurs protecteurs permettrait de mettre en place des mesures de prévention primaire et secondaire adaptées chez les golfeurs français de haut niveau. Méthode Il s’agit d’une étude rétrospective nationale réalisée par diffusion d’un questionnaire à l’ensemble des licenciés de golf français de moins de dix de handicap. Le questionnaire a collecté des informations concernant les caractéristiques du joueur, sa pratique du golf, son matériel et la survenue ou non d’une blessure au cours de la saison 2015. Une analyse descriptive puis une comparaison entre les golfeurs blessés et non blessés ont été faites, suivies d’une analyse monovariée, puis multivariée pour étudier les facteurs de risque potentiels. Résultats Mille trois cent quatre-vingt-deux golfeurs ont renvoyé un questionnaire complet et ont donc été inclus dans l’étude. On retrouvait 712 blessés (52 %) et une incidence de 1,99 blessures par 1000 heures de pratique du golf. Les blessures les plus fréquentes se situaient au niveau du rachis lombaire (21,2 %), de l’épaule dominante (7,8 %) puis du rachis dorsal (7,4 %). Une analyse a également été réalisée en fonction du sexe ne retrouvant pas de différence concernant le risque lésionnel entre les femmes et les hommes. La blessure principale chez les hommes était localisée au rachis lombaire (23,1 %) et chez les femmes à l’épaule dominante (11 %) et au rachis lombaire (11 %). On notait une récidive dans 37 % des blessures chez la femme et 44,8 % chez l’homme. Les facteurs protecteurs mis en évidence étaient l’absence d’hypersollicitation des membres supérieurs ou le port de charges lourdes au travail, l’absence de suivi par un professionnel du golf (p = 0,026). Les facteurs favorisants étaient un nombre de mois de jeu par an élevé (p = 0,0127) et des clubs d’utilisation récente (p = 0,0034). La blessure entraînait dans 53 % des cas chez l’homme et 56,1 % chez la femme un arrêt du golf et un arrêt de travail chez 9,4 % des hommes et 8,7 % des femmes. Conclusion Le golf est pourvoyeur de blessures avec un golfeur de haut niveau sur deux blessés lors d’une saison. Cependant, elles sont pour la plupart bénignes n’entraînant pas de longue convalescence. Le rachis et le membre supérieur semblent tout particulièrement touchés que ce soit chez les hommes et les femmes. La prévention (primaire et secondaire) doit être au cœur de la prise en charge du golfeur en tenant compte des facteurs protecteurs et facteurs de risque au vu du nombre de récidives.
  • Chapter
    Der Einfluss körperlicher Aktivität auf die Entstehung und den Verlauf von Rücken- und Nackenbeschwerden wird in der aktuellen wissenschaftlichen Literatur ambivalent beurteilt. Die Betrachtung der derzeitigen Literatur weist auf einen komplexen Zusammenhang zwischen sportlicher Aktivität und dem Auftreten von Rücken- und Nackenschmerzen hin. So stehen die ausgeübte Sportart, der zeitliche Umfang und die technische Ausführung des Sports im Zusammenhang mit Rücken- und Nackenschmerzen. Auch das Alter und die psychische Belastung der Leistungssportler konnten in Studien als relevante Faktoren identifiziert werden. In diesem Kapitel werden die Erkenntnisse zu diesen und weiteren Faktoren zusammengefasst und diskutiert.
  • Article
    The transition phase of a golf swing is considered to be a decisive instant required for a powerful swing. However, at the same time, the low back torsional loads during this phase can have a considerable effect on golf-related low back pain (LBP). Previous efforts to quantify the transition phase were hampered by problems with accuracy due to methodological limitations. In this study, vector-coding technique (VCT) method was proposed as a comprehensive methodology to quantify the precise transition phase and examine low back torsional load. Towards this end, transition phases were assessed using three different methods (VCT, lead hand speed and X-factor stretch) and compared; then, low back torsional load during the transition phase was examined. As a result, the importance of accurate transition phase quantification has been documented. The largest torsional loads were observed in healthy professional golfers (10.23 ± 1.69 N · kg(-1)), followed by professional golfers with a history of LBP (7.93 ± 1.79 N · kg(-1)), healthy amateur golfers (1.79 ± 1.05 N · kg(-1)) and amateur golfers with a history of LBP (0.99 ± 0.87 N · kg(-1)), which order was equal to that of the transition phase magnitudes of each group. These results indicate the relationship between the transition phase and LBP history and the dependency of the torsional load magnitude on the transition phase.
  • Article
    The aim of this research was to quantify the coordination pattern between thorax and pelvis during a golf swing. The coordination patterns were calculated using vector coding technique, which had been applied to quantify the coordination changes in coupling angle (γ) between two different segments. For this, fifteen professional and fifteen amateur golfers who had no significant history of musculoskeletal injuries. There was no significant difference in coordination patterns between the two groups for rotation motion during backswing (p = 0.333). On the other hand, during the downswing phase, there were significant differences between professional and amateur groups in all motions (flexion/extension: professional [γ] = 187.8°, amateur [γ] = 167.4°; side bending: professional [γ] = 288.4°, amateur [γ] = 245.7°; rotation: professional [γ] = 232.0°, amateur [γ] = 229.5°). These results are expected to be a discriminating measure to assess complex coordination of golfers' trunk movements and preliminary study for interesting comparison by golf skilled levels.
  • Article
    The purpose of this study was to investigate effect of golf shoe design on kinematic variables during golf swing. Five professional male golfers with shoe size 270mm were recruited for the study. Swing motion was collected using 8 high speed camera motion analysis at a sampling of 180Hz. Kinematic variables were calculated by EVaRT 4.2 software. Driver swing was divided into four events; El(adress), E2(top), E3(impact) and E4(finish). Time, peak velocity, velocity of center of mass, velocity of the foot and ankle angle during Phase 1(El-E2), Phase 2(E2-E3), and Phase 3(E3-E4) were analyzed in order to investigate the relationship between golf shoe design and swing performance. The findings indicated that type C golf shoes would be beneficial for stability and control of movement during address and swing performance. Furthermore, faster speed of golf shoes, center of mass, and both feet were observed with Type C golf shoes. It is expected that golfers with Type C golf Shoes provide greater force as they control the center of mass faster and increase rotational force during impact compared to other golf shoes.
  • Article
    Full-text available
    Substantial experiential research into x-factor, and to a lesser extent crunch-factor has been undertaken with the aim of increasing clubhead speed. However, a direct comparison of the golf swing kinematics associated with each ‘factor’ has not, and possible differences when using a driver compared to an iron. Fifteen low handicap male golfers who displayed a modern swing had their golf swing kinematic data measured when hitting their own driver and five-iron, using a 10-camera motion analysis system operating at 250 Hz. Clubhead speed was collected using a validated launch monitor. No between-club differences in x-factor and crunch-factor existed. Correlation analyses revealed within-club segment (trunk and lower trunk) interaction was different for the five-iron, compared to the driver, and that a greater number of kinematic variables associated with x-factor, compared to crunch-factor were shown to be correlated with faster clubhead speeds. This was further explained in the five-iron regression model, where a significant amount of variance in clubhead speed was associated with increased lower trunk x-factor stretch, and reduced trunk lateral bending. Given that greens in regulation was shown to be the strongest correlated variable with PGA Tour earnings (1990-2004), the findings suggests a link to player performance for approach shots. These findings support other empiric research into the importance of x-factor as well as anecdotal evidence on how crunch-factor can negatively affect clubhead speed.
  • Article
    Context: Low back pain is common in golfers. The risk factors for golf-related low back pain are unclear but may include individual demographic, anthropometric, and practice factors as well as movement characteristics of the golf swing. Objective: The aims of this systematic review were to summarize and synthesize evidence for factors associated with low back pain in recreational and professional golfers. Data sources: A systematic literature search was conducted using the PubMed, CINAHL, and SPORTDiscus electronic databases through September 2017. Study selection: Studies were included if they quantified demographic, anthropometric, biomechanical, or practice variables in individuals with and without golf-related low back pain. Study design: Systematic review and meta-analysis. Level of evidence: Level 3. Data extraction: Studies were independently reviewed for inclusion by 2 authors, and the following data were extracted: characterization of low back pain, participant demographics, anthropometrics, biomechanics, strength/flexibility, and practice characteristics. The methodological quality of studies was appraised by 3 authors using a previously published checklist. Where possible, individual and pooled effect sizes of select variables of interest were calculated for differences between golfers with and without pain. Results: The search retrieved 73 articles, 19 of which met the inclusion criteria (12 case-control studies, 5 cross-sectional studies, and 2 prospective longitudinal studies). Methodological quality scores ranged from 12.5% to 100.0%. Pooled analyses demonstrated a significant association between increased age and body mass and golf-related low back pain in cross-sectional/case-control studies. Prospective data indicated that previous history of back pain predicts future episodes of pain. Conclusion: Individual demographic and anthropometric characteristics may be associated with low back pain, but this does not support a relationship between swing characteristics and the development of golf-related pain. Additional high-quality prospective studies are needed to clarify risk factors for back pain in golfers.
  • Article
    Full-text available
    The University of Western Ontario Questionnaire for Musculoskeletal Conditions in Senior Golfers (MSK Golfers) was developed in Canada because of a lack of knowledge concerning musculoskeletal conditions directly related to golf play and warm-up, although the high injury incidence in golf practice. This lack of epidemiological measures also exists for the Portuguese golf population. The purpose of this study was to translate and cross-culturally adapt the MSK Golfers questionnaire into Portuguese and to test its construct validity and reproducibility.METHODS: The MSK Golfers was translated from English to Portuguese and tested for psychometric properties. Sixty-one golfers, aged between 14 and 70 years and with at least 1 year of practice in golf, were recruited. The validity of the MSK Golfers was assessed by evaluating data quality (missing, floor and ceiling effects). Reproducibility analysis included intra-class correlation coefficients (ICC) (2,1) and Cohen's Kappa coefficient.RESULTS: The ICC values for continuous items ranged from 0.634 to 0.998 with the exception of one item on golf activity. Kappa statistics for the categorical items ranged between 0.714 and 1.00. The Portuguese version of the MSK Golfers, including playing characteristics and warm-up patterns of golfers, showed a high reliability for a golfing population with an age range of 14 to 70 years.
Literature Review
  • Article
    Golf is a different sport from all others discussed in this issue in one important aspect: Almost all of its practitioners play more, rather than less, as they mature. A great many of them play better, too. This additional play and skill can be highly satisfying to the participants; however, it puts them at risk for a number of overuse syndromes directly caused by the motion requirements of golf. In addition, the repetitive nature of the activity can exacerbate pre-existing and age-related orthopedic pathology as well. There is no substitute for attention to the preplay aspects of golf (warm-up, flexibility, and strengthening).
  • Article
    Full-text available
    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.
  • Article
    The thoracolumbar spine was examined by magnetic resonance imaging (MRI) and the history of back pain was analyzed in 24 male elite gymnasts (age range, 19-29 years) and in 16 male nonathletes (age range, 23-36 years). Disc degeneration, defined as reduced disc signal intensity, was significantly more common in athletes (75%) than in nonathletes (31%). The gymnasts also had a higher incidence of other abnormalities of the thoracolumbar spine, and there was a significant correlation between reduced disc signal intensity and the other abnormalities among the gymnasts. There were also significant correlations between back pain and reduced disc signal intensity and abnormal vertebral configuration when the gymnasts and the nonathletes were pooled. Male elite gymnasts run a high risk of developing severe abnormalities of the thoracolumbar spine, and they often have a history of back pain.
  • Article
    Professional golfers' injuries are usually related to their swings. A wide variety of acute and chronic injuries have been reported, including carpal fractures, ulnar and median nerve neuropathies, tendinitis, skin rashes, and eye injuries. There have been two deaths. In this study questionnaires were mailed to 500 professional golfers, and 226 were returned. During their careers 103 men and 87 women were injured, an average of two injuries per player. The left wrist, lower back, and left hand were most commonly injured. Repetitive practice swings caused the most injuries in both men and women.
  • Article
    Study Design. Electromyographic responses from the lumbar multifidus muscle of the cat were recorded in vivo during 50 minutes of cyclic loading followed by 2 hours of rest. Objective. To determine the rate of recovery of reflexive muscular stabilizing activity resulting from rest after viscoelastic laxity induced by 50 minutes of cyclic loading. Summary of Background Data. Muscular forces from agonists and antagonists were repeatedly shown to be the most significant stabilizing structures of the lumbar spine. Reflexive muscular coactivation force from the multifidus muscle elicited by mechanoreceptors in the spinal viscoelastic structures were, however, shown to diminish drastically with the onset of laxity in the viscoelastic structures. Data describing the rate of recovery of reflexive muscular coactivation forces resulting from rest after cyclic loading were not found. Methods. Cyclic loading of the lumbar spine at 0.25 Hz was applied to L4–L5 for 50 minutes while electromyograms from the multifidus muscles of L1–L2 to L6–L7 were recorded. A rest period of up to 2 hours was given, during which electromyographic responses and load were measured every 10 minutes to sample recovery of laxity and reflexive muscular activity. Results. Load and electromyographic response demonstrated an exponential decrease during the 50 minutes of cyclic loading. The first 10 minutes of rest allowed a significant recovery in laxity and muscle activity, with additional slow recovery over the next 20 to 30 minutes. The electromyographic response and load were increasing at an extremely slow rate thereafter. Overall, 2 hours of rest yielded only a 20% to 30% recovery in electromyographic response. Full recovery was never observed. A biexponential model was developed to predict loss and recovery of reflexive muscular activity and viscoelastic tension with laxity. Conclusions. Laxity in the viscoelastic structures of the lumbar spine desensitizes the mechanoreceptors within and causes loss of reflexive stabilizing forces from the multifidus muscles. The first 10 minutes of rest after cyclic loading results in fast partial recovery of muscular activity. However, full recovery is not possible even with rest periods twice as long as the loading period, placing the spine at an increased risk of instability, injury, and pain.
  • Article
    Parziale JR: Healthy swing: A golf rehabilitation model. Am J Phys Med Rehabil 2002;81:498–501. Objective: To describe a rehabilitation model using a multidisciplinary team approach for the diagnosis and treatment of individuals with golf injuries or physically challenged persons desiring to play golf. Design: A retrospective, descriptive study of a multidisciplinary golf rehabilitation program that included evaluation by a physiatrist, a physical therapist, and a Professional Golf Association golf professional. Results: A total of 145 individuals were treated in this program between 1994 and 1997. The majority of subjects were amateur (95%), male golfers (80%), with a mean age of 55.7 yr (range, 14–80 yr). Golfing injuries of the lower back were the most common diagnosis and had a higher frequency in men than women (49%vs. 28%); women were more likely to have shoulder (28%vs. 10%) and elbow (13%vs. 9%) injuries than men. Interventions used included medical or surgical treatment (89%), physical rehabilitation, including exercises or diathermy (92%), and modification of golf swing technique (83%). Outcomes included a return to sports participation in 98% of subjects. All subjects with golf-induced injuries returned to sports participation, and one male and one female subject won state amateur golf championships. Conclusion: A comprehensive, multidisciplinary model for the evaluation and rehabilitation of golf injuries has been developed, using a team of healthcare professionals and a golf teaching professional. This approach may play a role in facilitating recovery and sports participation in injured golfers.
  • Article
    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.
  • Article
    The forces acting across the pars interarticularis of the fifth lumbar vertebra while in the fully flexed and partially flexed postures are calculated. These values are compared with the strength of the neural arch obtained experimentally. This comparison shows the neural arch to be a relatively strong structure. However, results are presented which indicate that a spondylolytic type fracture can be initiated by fatigue loading. The mechanics of spondylolysis and spondylolisthesis are shown to be related through the shearing properties of the intervertebral disc. (C) Lippincott-Raven Publishers.
  • Article
    A clinical trial comparing a back pain group with a pain-free group. To investigate whether proprioceptive deficits existed in a group of individuals reporting low back pain. Little work has so far been conducted on the measurement of proprioception in the spine. Those studies that have been carried out, however, have failed to identify proprioceptive deficits in individuals with back pain. Previous work on peripheral joints has revealed that proprioception is affected with muscular or joint injury or degeneration. Forty individuals took part in the study, 20 with back pain and 20 with no pain. Participants were required to reproduce a predetermined target position, in standing and four-point kneeling, 10 times in 30 seconds. A computer screen was used to provide visual feedback on position. A mean deviation from the target position was obtained for each individual. A measurement of left elbow position sense was conducted in five individuals from each group to establish differences in short-term motor memory between the groups. There were no differences between the subject groups in terms of short-term motor memory (P > 0.05). A two-way analysis of variance between subject groups and position to identify differences in accuracy (deviation from the target) found that there were differences between subject groups in either position (P < 0.05). There was no significant difference in accuracy between the positions used (P > 0.05). Differences in proprioception do exist between individuals with back pain and those free from back pain. Further research needs to be undertaken on proprioceptive exercise programs and their effect on back pain.
  • Article
    The inferior articular facets of lumbar vertebrae were subjected to a loading pattern calculated to simulate walking with a heavy pack on the back. The results indicate that the lumbar neural arch, at the partes interarticulares, is vulnerable to mechanical fatigue.
  • Article
    Removal of the posterior elements will allow increased correction of axial deformity, in scoliosis. The clinician may take advantage of the creep and relaxation characteristic of the tissues to improve efficiency of correction. Axial loading has been shown theoretically to be more efficient for the more severe curves, (greater than 53 degrees) and transverse loading more efficient for the less severe curves (less than 53 degrees). Combined loading is always more efficient than either type alone. The Milwaukee brace can be just as effective as a cast in resisting deforming forces in scoliosis. Removal of axillary supports or thoracic pads or not wearing the brace when recumbent reduces the effectiveness of the Milwaukee brace. The strength of the thoracid lamina is a limiting factor in the amount of forces that may be applied to correct the deformity; 30 kilopond (65.8 lb) is the upper limit of this force. Coughing or buckling can apply dangerously high forces with the Harrington rod. Greater surgace contact of the hook to the lamina and small increments between notches on the rod may increase the tolerance limits of the system. Compression rods on the convex side probably add little or no correctional value. The Dwyer technique is biomechanically sound and effective and has the additional advantage of applying asymmetrical loads to the epiphyseal plates.
  • Article
    The defect in the pars interarticularis in spondylolysis and spondylolisthesis is most often the result of repeated trauma, stress, and factors other than acute fracture. These fatigue fractures develop early in life, may have a strong hereditary basis, and most often represent incidental roentgenographic findings. Attention should be given to the youngster or adolescent with low-back pain and paraspinal muscle spasm. If these patients are followed closely, the incidence of pars interarticularis defect is higher than appreciated. The lesion in some of these individuals may progress to significant vertebral slipping. If the developing defect is recognized early, treatment can be quite satisfactory.
  • Article
    Full-text available
    The neutral zone is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. Several studies--in vitro cadaveric, in vivo animal, and mathematical simulations--have shown that the neutral zone is a parameter that correlates well with other parameters indicative of instability of the spinal system. It has been found to increase with injury, and possibly with degeneration, to decrease with muscle force increase across the spanned level, and also to decrease with instrumented spinal fixation. In most of these studies, the change in the neutral zone was found to be more sensitive than the change in the corresponding range of motion. The neutral zone appears to be a clinically important measure of spinal stability function. It may increase with injury to the spinal column or with weakness of the muscles, which in turn may result in spinal instability or a low-back problem. It may decrease, and may be brought within the physiological limits, by osteophyte formation, surgical fixation/fusion, and muscle strengthening. The spinal stabilizing system adjusts so that the neutral zone remains within certain physiological thresholds to avoid clinical instability.
  • Article
    Full-text available
    Presented here is the conceptual basis for the assertion that the spinal stabilizing system consists of three subsystems. The vertebrae, discs, and ligaments constitute the passive subsystem. All muscles and tendons surrounding the spinal column that can apply forces to the spinal column constitute the active subsystem. The nerves and central nervous system comprise the neural subsystem, which determines the requirements for spinal stability by monitoring the various transducer signals, and directs the active subsystem to provide the needed stability. A dysfunction of a component of any one of the subsystems may lead to one or more of the following three possibilities: (a) an immediate response from other subsystems to successfully compensate, (b) a long-term adaptation response of one or more subsystems, and (c) an injury to one or more components of any subsystem. It is conceptualized that the first response results in normal function, the second results in normal function but with an altered spinal stabilizing system, and the third leads to overall system dysfunction, producing, for example, low back pain. In situations where additional loads or complex postures are anticipated, the neural control unit may alter the muscle recruitment strategy, with the temporary goal of enhancing the spine stability beyond the normal requirements.
  • Article
    In order to evaluate the to potential hazards related to athletic functional overload on the intervertebral disk we studied with MRI the incidence of intervertebral disk abnormalities in a group of 45 volunteers who had been playing professional volleyball for 3-7 years. As a control group we examined with MRI 30 professional swimmers as well. Among the volley-ball players the incidence of intervertebral disk alterations was 44.4%; they were represented by 8 cases of disk degeneration, 11 cases of bulging and 9 disk herniations (in 8 patients the simultaneous presence of more than one lesion was observed). In the control group the incidence of such lesions was 20%. The obtained results were correlated with the clinical findings and the age of the athletes. Among the 26 athletes with back pain only 13 had positive findings at MRI, while among the 19 asymptomatic athletes 7 showed lesions detectable with MRI. As for age, we observed that the younger athletes (17-19 years) had positive MRI findings in 38.5% of cases, while the players in the age group ranging from 23 to 26 years, had positive MRI findings in 56.2% of cases. The analysis of the different types of training of the volley-ball players and the control group, showed that 19 volley-ball players who followed appropriate training procedures had positive MRI findings in 21.1% of cases (in the control group the percentage was 20%). Among the 26 athletes who were trained with exercises that caused significant functional overload, 16 had intervertebral disk lesions at MRI (61.5%). Moreover, our data showed that the correlation of the incidence of disk lesions with the type of training (and relative varying degree of overload) is definitely more important than the one existing with the age of volley-ball players and the overall period of their athletic activity. MRI proved to be a useful technique for the early assessment of the intervertebral disk damage caused by an incorrect training in young athletes, even when asymptomatic.
  • Article
    In order to evaluate the to potential hazards related to athletic functional overload on the intervertebral disk we studied with MRI the incidence of intervertebral disk abnormalities in a group of 45 volunteers who had been playing professional volleyball for 3-7 years. As a control group we examined with MRI 30 professional swimmers as well. Among the volley-ball players the incidence of intervertebral disk alterations was 44.4%; they were represented by 8 cases of disk degeneration, 11 cases of bulging and 9 disk herniations (in 8 patients the simultaneous presence of more than one lesion was observed). In the control group the incidence of such lesions was 20%. The obtained results were correlated with the clinical findings and the age of the athletes. Among the 26 athletes with back pain only 13 had positive findings at MRI, while among the 19 asymptomatic athletes 7 showed lesions detectable with MRI. As for age, we observed that the younger athletes (17-19 years) had positive MRI findings in 38.5% of cases, while the players in the age group ranging from 23 to 26 years, had positive MRI findings in 56.2% of cases. The analysis of the different types of training of the volley-ball players and the control group, showed that 19 volley-ball players who followed appropriate training procedures had positive MRI findings in 21.1% of cases (in the control group the percentage was 20%). Among the 26 athletes who were trained with exercises that caused significant functional overload, 16 had intervertebral disk lesions at MRI (61.5%). Moreover, our data showed that the correlation of the incidence of disk lesions with the type of training (and relative varying degree of overload) is definitely more important than the one existing with the age of volley-ball players and the overall period of their athletic activity. MRI proved to be a useful technique for the early assessment of the intervertebral disk damage caused by an incorrect training in young athletes, even when asymptomatic.
  • Article
    Rationale for the use of exercise in the treatment and prevention of LBP and injury has been discussed. Current knowledge supports the use of individualized exercise programs that emphasize the restoration and maintenance of adequate lumbar-spinal function. When indicated, aerobic exercises to develop overall fitness and prevent deconditioning should be included in the exercise prescription. Several commonly used exercises for strengthening the lumbar extensor muscles have been reviewed. Lumbar extension exercises that stabilize the pelvis, provide a means for progressively increasing the resistance, and allow the exerciser to move through a full range of lumbar movement appear to offer the greatest benefit to the patient with LBP.
  • Article
    The thoracolumbar spine was examined by magnetic resonance imaging (MRI) and the history of back pain was analyzed in 24 male elite gymnasts (age range, 19-29 years) and in 16 male nonathletes (age range, 23-36 years). Disc degeneration, defined as reduced disc signal intensity, was significantly more common in athletes (75%) than in nonathletes (31%). The gymnasts also had a higher incidence of other abnormalities of the thoracolumbar spine, and there was a significant correlation between reduced disc signal intensity and the other abnormalities among the gymnasts. There were also significant correlations between back pain and reduced disc signal intensity and abnormal vertebral configuration when the gymnasts run a high risk of developing severe abnormalities of the thoracolumbar spine, and they often have a history of back pain.
  • Article
    Back pain and radiological changes of the thoraco-lumbar spine were investigated in 142 top athletes, representing wrestling, gymnastics, soccer and tennis (age range 14-25 years). All groups of athletes reported back pain at high frequencies (50-85%). Male gymnasts had significantly increased incidence and severity of back pain as compared to the rest of the athletes. Radiological abnormalities occurred in 36-55% of the athletes. Reduced disc height, Schmorl's nodes and change of configuration of vertebral bodies correlated with back pain (P less than 0.05, P less than 0.01 and P less than 0.05). Significant covariation between these types of abnormalities was found. Athletes with great demands on the back are thus subjected to an increased risk of symptomatic damage of the spine.
  • Article
    We performed magnetic resonance imaging on sixty-seven individuals who had never had low-back pain, sciatica, or neurogenic claudication. The scans were interpreted independently by three neuro-radiologists who had no knowledge about the presence or absence of clinical symptoms in the subjects. About one-third of the subjects were found to have a substantial abnormality. Of those who were less than sixty years old, 20 per cent had a herniated nucleus pulposus and one had spinal stenosis. In the group that was sixty years old or older, the findings were abnormal on about 57 per cent of the scans: 36 per cent of the subjects had a herniated nucleus pulposus and 21 per cent had spinal stenosis. There was degeneration or bulging of a disc at at least one lumbar level in 35 per cent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old subjects. In view of these findings in asymptomatic subjects, we concluded that abnormalities on magnetic resonance images must be strictly correlated with age and any clinical signs and symptoms before operative treatment is contemplated.
  • Article
    Previous investigations with plain radiography, myelography, and computed tomography have shown that degenerative disease of the cervical spine frequently occurs in the absence of clinical symptoms. We studied the magnetic resonance-imaging scans of sixty-three volunteers who had no history of symptoms indicative of cervical disease. The scans were mixed randomly with thirty-seven scans of patients who had a symptomatic lesion of the cervical spine, and all of the scans were interpreted independently by three neuroradiologists. The scans were interpreted as demonstrating an abnormality in 19 per cent of the asymptomatic subjects: 14 per cent of those who were less than forty years old and 28 per cent of those who were older than forty. Of the subjects who were less than forty, 10 per cent had a herniated nucleus pulposus and 4 per cent had foraminal stenosis. Of the subjects who were older than forty, 5 per cent had a herniated nucleus pulposus; 3 per cent, bulging of the disc; and 20 per cent, foraminal stenosis. Narrowing of a disc space, degeneration of a disc, spurs, or compression of the cord were also recorded. The disc was degenerated or narrowed at one level or more in 25 per cent of the subjects who were less than forty years old and in almost 60 per cent of those who were older than forty. The prevalence of abnormal magnetic-resonance images of the cervical spine as related to age in asymptomatic individuals emphasizes the dangers of predicating operative decisions on diagnostic tests without precisely matching those findings with clinical signs and symptoms.
  • Article
    The purpose of this study was to investigate the healing of surgically created defects in the anulus fibrosus in an effort to determine the healing potential of this structure. Four identical lesions were made in the anulus fibrosus of ten dogs at levels L2-L5. Two dogs were killed at 3, 6, and 9 weeks. Four dogs were killed at 12 weeks. The spines were harvested during a 3- to 12-week period and evaluated grossly and microscopically. Our study demonstrated that a stab wound of the anulus has a limited healing potential and the persisting defect could provide a pathway for irritating nuclear fluid escape onto perineural tissue, possibly resulting in persistent low-back pain.
  • Article
    The abdominal mechanism, utilizing intraabdominal pressure, has been described and numericized. Simulations show that the lumbodorsal fascia under control of the abdominal muscles contributes to reduce the stress at the intervertebral joint. The musculature of the lumbar spine is of primary importance in the control of the efficiency of the spinal mechanism. The system of loading, which results in observable physiologic response, maintains the compressive load at virtually 90 degrees at the bisector of the disc for all weights and all angles of forward flexion.
  • Article
    Intradiscal pressure and volume measurements were made in 84 fresh cadaveric lumbar spine disc spaces. The nucleus was injected with a roentgenographic contrast agent under fluoroscopic examination. The intrinsic pressure, the pressure at which the agent entered the disc, and the maximum pressure that the disc could hold were measured. The discs were graded for degeneration. The intrinsic and maximum pressures were found to be inversely related to disc degeneration grade, and directly related to each other. Relatively greater degeneration was found at lower levels of the lumbar spine as compared to the upper levels. The intrinsic disc pressure may prove to be a useful clinical tool in the evaluation of spinal integrity.
  • Article
    Previous studies have shown that reduction of precise motor control accompanies local muscular fatigue. The effects of isodynamic fatiguing of flexion and extension trunk movements on the movement patterns and the motor output of the trunk were investigated. Twenty male subjects with no history of low-back pain for the past 6 months volunteered for the study. A triaxial dynamometer was used that simultaneously provided measurement of torque, angular position and velocity of each axis. Resistances were set independently for each axis by an interfaced computer. The subjects performed trunk flexion and extension movement against a sagittal plane resistance equal to 70% of their maximum isometric extension strength in the upright position. The minimum resistances in the coronal and transverse planes were set up at 7 Newton meters. The subjects were asked to perform trunk movement as quickly and as accurately as possible while exerting the maximum efforts until exhaustion. Analysis of variance, the MANOVA procedure with a repeated measure design, was performed among the selected parameters of the first, middle and last three repetition cycles. The selected parameters are the trunk motor output and movement patterns; the total angular excursion, range of motion, maximum and average torque and angular velocity of the trunk. All the selected parameters were significantly reduced in the sagittal plane. Subjects displayed significantly less motor control and greater range of motion in the coronal and transverse planes in performing the primary task of flexion and extension. The reduction in the functional capacity of the primary muscles performing the required task is compensated by secondary muscle groups and the spinal structure is loaded in a more injury prone pattern, as identified by finite element models. In addition it is suggested that the fatigued muscles would be less able to compensate any perturbation in the load or position of the trunk. The repetitive loading results in a weakening of the viscoelastic passive elements of the spineless structure. The loss of ability to protect these weakened passive elements makes the spine susceptible to industrial and recreational injuries.
  • Article
    Reports of back discomfort and even back injuries during isometric strength testing in specific lifting positions indicated an analysis of the loads on the lumbar spine during this type of testing. A biomechanical analysis, which has been validated against EMG and intravital disc pressure measurements, was used for the calculations of the loads in four test persons. The calculations indicated compressive loads on L3 ranging from 5000-11,000 N during squat and torso lifting. Such loads in vitro have been found to cause structural failures of the vertebral endplates. Similar loads also may result in damage to the spine in vivo.
  • Article
    The longitudinal compressive load acting on the L3-L4 spinal motion segment was investigated during normal level walking for a range of speeds of progression. Forces were predicted using experimental data from photogrammetric measurements of upper body segmental motion and inertial properties, along with a biomechanical model of the trunk. A partial validation of the results was obtained using records of the electrical activity of the trunk muscles and intradiscal pressure information available in the literature. Experiments were carried out in five normal young male subjects. Results showed that the L3-L4 motion segment is subjected to cyclic compressive loads. The maximum and minimum values of this load vary with walking speed from approximately 1.0 to 2.5 and from 0.8 to 0.2 times body weight, respectively. Relevant peaks occur with a frequency ranging approximately from 1.3 to 2.5 Hz. Muscular action is mostly concentrated in the trunk extensors, which show a burst of activity at the time of ipsilateral toe-off.
  • Article
    Forty-one cadaveric lumbar intervertebral joints from 18 spines were flexed and fatigue loaded to simulate a vigorous day's activity. The joints were then bisected and the discs examined. Twenty-three out of 41 of the discs showed distortions in the lamellae of the annulus fibrosus and, in a few of these, complete radial fissures were found in the posterior annulus.
  • Article
    The intersegmental force and couple exchanged between upper and lower body across a transverse section passing through the fourth lumbar vertebra were estimated during level walking on a straight line at speeds ranging from 0.99 to 2.23 ms-1. This was done using 3-D kinematic information relative to the head, upper limbs, and upper torso, obtained through a stereophotogrammetric technique, and the relevant inertial parameters obtained using anthropometric measurements and estimation techniques provided in the literature. Twenty walking cycles of five normal adult male subjects were analysed. The intersegmental force and couple components are presented as referenced to both a laboratory and pelvic set of axes. Using these results some considerations are made concerning the variations which the overall trunk muscles effort undergoes because of mean walking speed changes. The muscular action on the trunk is inferred from the intersegmental couple components. The various factors that contribute to the build-up of the intersegmental force and couple are analysed and their relative importance assessed.
  • Article
    The purpose of this presentation is to provide basic biomechanical information concerning the spine, its components, and the spinal cord. It is shown that this information is helpful in understanding the fundamental functions of the spinal column. The experimentally determined physical properties of the vertebra, various spinal ligaments, the disc, and the spinal cord under many different loading conditions are described. The role of the special characteristics of the spine ligaments in allowing physiological motions of the spine, preventing excessive motions between vertebrae, and protecting the spinal cord during trauma are discussed. Movements of the spinal cord within the spinal canal and associated changes of its section during physiological movements of the spine are also described. The kinematics of the various regions of the spine are discussed and their clinical significance is presented. The problems of spinal trauma and is associated spinal instability are analyzed. Guidelines are recommended to assess spinal stability. The proper application of such guidelines will provide the basis for sound clinical judgments.
  • Article
    Historical cohort, including selected subgroups. To understand the long-term effects of exercise on back-related outcomes, back pain, sciatica, back-related hospitalizations, pensions, and magnetic resonance imaging findings were studied among former elite athletes. Exercise and sports participation have become increasingly popular, as have recommendations of exercises for back problems, but little is known about their long-term effects. Questionnaires were returned by 937 former elite athletes and 620 control subjects (83% response rate). Identification codes allowed record linkage to hospital discharge and pension registers. Magnetic resonance images were obtained of selected subgroups with contrasting physical loading patterns. Odds ratios for back pain were lower among athletes than among control subjects, with significant differences in endurance, sprinting and game sports, and wrestling and boxing. No differences in the occurrence of sciatica or in back-related pensions and hospitalizations were seen. When comparing lumbar magnetic resonance images of 24 runners, 26 soccer players, 19 weight lifters, and 25 shooters, disc degeneration and bulging were most common among weight lifters; soccer players had similar changes in the L4-S1 discs. No significant differences were seen in the magnetic resonance images of runners and shooters. Maximal weight lifting was associated with greater degeneration throughout the entire lumbar spine, and soccer with degeneration in the lower lumbar region. No signs of accelerated disc degeneration were found in competitive runners. However, back pain was less common among athletes than control subjects and there were no significant differences in hospitalizations or pensions. No benefits were shown for vigorous exercise compared with lighter exercise with respect to back findings.
  • Article
    The effect of low back pain on the size of the lumbar multifidus muscle was examined using real-time ultrasound imaging. Bilateral scans were performed in 26 patients with acute unilateral low back pain (LBP) symptoms (aged 17-46 years) and 51 normal subjects (aged 19-32 years). In all patients, multifidus cross-sectional area (CSA) was measured from the 2nd to the 5th lumbar vertebrae (L2-5) and in six patients, that of S1 was also measured. In all normal subjects, CSA was measured at L4 and in 10 subjects measurements were made from L2-5. Marked asymmetry of multifidus CSA was seen in patients with the smaller muscle being on the side ipsilateral to symptoms (between-side difference 31 +/- 8%), but this was confined to one vertebral level. Above and below this level of wasting, mean CSA differences were < 6%. In normal subjects, the mean differences were < 5% at all vertebral levels. The site of wasting in patients corresponded to the clinically determined level of symptoms in 24 of the 26 patients, but there was no correlation between the degree of asymmetry and severity of symptoms. Patients had rounder muscles than normal subjects (measured by a shape ratio index), perhaps indicating muscle spasm. Linear measurements of multifidus cross-section were highly correlated with CSA in normal muscles but less so in wasted muscles, so CSA measurements are more accurate than linear dimensions. The fact that reduced CSA, i.e., wasting, was unilateral and isolated to one level suggests that the mechanism of wasting was not generalized disuse atrophy or spinal reflex inhibition.(ABSTRACT TRUNCATED AT 250 WORDS)
  • Article
    Golf is a popular sport for both men and women. The trunk is the most common area of injury during the golf swing. The purpose of this study was to describe and compare the muscle firing patterns in the trunk during the golf swing. Twenty-three golfers with handicaps of five or below volunteered for this study. Surface electromyographic electrodes were placed on the abdominal oblique and erector spinae muscles bilaterally. High-speed cinematography was used in conjunction with the electromyographic electrodes. The results demonstrated relatively low activity in all muscles during takeaway (below 30% of maximal muscle test), and relatively high and constant activity throughout the rest of the swing (above 30% maximal muscle test, with the exception of the contralateral erector spinae during late follow-through, which was 28% maximal muscle test). This high and constant activity demonstrated the importance of the trunk muscles during a golf swing. These results indicate the need for an effective preventive and rehabilitative exercise program for the golfer.
  • Article
    A literature review of proven scientific treatment modalities for acute low back pain is integrated into an aggressive sports medicine model for the noninvasive management of acute athletic back injuries.
  • Article
    The relative importance of an elderly individual's chosen athletic endeavor should not be underestimated. These athletes have high expectations of their physical abilities. A lumbar spine syndrome can be a severe physical and psychologic setback. The ideal goal in the treatment of this population is to make an accurate diagnosis and provide expeditious treatment that allows the athlete to return to a satisfactory level of competition. The described algorithm is useful in attaining this goal. In addition, patient education is particularly important in preventing reinjury.
  • Article
    An understanding of spinal mechanics is necessary for the treatment of athletic injuries. Recognizing and isolating the mechanism of injury through noninvasive techniques will lead to specific treatment for that injury. Because the prevention of physical injury is the goal of all health care professionals, the authors hope that the information will be helpful.
  • Article
    Review of previous epidemiologic studies, involving both contact and noncontact sports at all levels of competition ranging from the high school level to the professional level, reveals that the overwhelming majority of sports injuries related to the spine are soft-tissue injuries and self-limiting. The spectrum of injury is related to the mechanism, the force involved, and the point of application of the force. The immediate consequence of a soft-tissue injury is decreased immobilization with result in deconditioning. Most athletes have a strong desire to compete both at the amateur and professional levels. The inability to compete can have both psychologic and emotional consequences. The professional athlete is potentially burdened with financial consequences as well. The mainstay of prevention and treatment is maintaining good strength and flexibility through conditioning. Injuries can occur at the level of the disc, resulting in disc herniation, disc degeneration, and ultimately developmental stenosis. The biochemistry and biomechanics of the disc are age related, and thus, the adolescent and older athlete may have different concerns with regards to the diagnosis, treatment, and prognosis after injury to the spine. Remember, not only injuries cause back pain in the athlete. Athletes, too, can have tumors, infection, rheumatologic disorders, and other nontraumatic etiologies of back pain. Rarely athletic injuries to the spine do result in significant neurologic compromise. These injuries have been brought to national attention with the tragic recent injuries of well-known professional football and hockey athletes.(ABSTRACT TRUNCATED AT 250 WORDS)
  • Article
    Considerable concern has been expressed about the type and level of exercise that are safe for women with osteopenia and osteoporosis; however, published information on the effect of golfing on the osteoporotic spine is meager. We describe three postmenopausal patients with acute compression fractures of the vertebrae that occurred during midswing while golfing. These healthy, active women were long-term golfers; their ages at the time of the trauma were 63, 58, and 66 years. In one patient (case 1), osteoporosis was diagnosed before the golf-related injury. The two other patients (cases 2 and 3) sought medical attention after the trauma and were found to have osteoporosis. The bone mineral density of the lumbar vertebrae (L2-4) in the three patients at the time of or shortly after the trauma was as follows: case 1, 0.77 g/cm2 (3rd percentile of normal, corrected for age); case 2, 0.63 g/cm2 (less than 1st percentile of normal, corrected for age); and case 3, 0.69 g/cm2 (2nd percentile of normal, corrected for age). These findings raise the issue of the safety of golfing for women with previously diagnosed osteoporosis and for those with predisposing risk factors for the disease. Research studies of the kinematics and kinetics of the spine during the golf swing should be conducted. In the interim, a rigid back support for golfers with osteoporosis may be helpful until more conclusive evidence is available from controlled trials.
  • Article
    Fourteen normal male subjects with mean age 23 (range 20-32) years and mean body weight of 69.6 kg underwent right and left axial rotation in a special machine--axial rotation tester (AROT). The AROT was designed and fabricated such as to allow uninhibited coupled axial rotation and lateral flexion while preventing flexion and extension. The range of rotation (ROR) and neutral zone (NZ) were recorded during active rotation (.A), active rotation with blindfold (.B), and passive rotation with blindfold (.P). Finally, bilateral axial rotation was tested with 6, 12, 18, 24, 30, and 36 Nm rotary torque (.T). There was no significant difference between ROR.A and ROR.B, both being approximately 140 degrees. However, there was a significant difference between NZ.A and NZ.B (p < 0.01). ROR.P was approximately 30 degrees greater than ROR.A. The trunk structures showed a nonlinear viscoelastic behavior with progressive rotary torque application. The neutral zone in axial rotation did not show significant difference between different loads. It is reported that the rotary neutral zone varies between subjects, and it is suggested to be contributory to spinal laxity.
  • Article
    Measured trunk kinematics, applied moments, and trunk muscle activities were employed in a biomechanical model to determine load experiences by the spine during dynamic torsional exertions. The purpose of this investigation was to examine the influence of dynamic twisting parameters on spinal load. Axial twisting of the torso has been identified as a significant risk factor for occupationally related low back disorders. However, previous studies have had difficulty describing how twisting is accomplished biomechanically, or how the spine is loaded during twisting motions. Electromyograph activity of 10 trunk muscles was monitored while 12 subjects performed twisting exertions under various conditions of force, velocity, position, and direction. An electromyograph-assisted biomechanical model was developed to interpret the effects of those twisting parameters on spine loading. Significant flexion-extension and lateral moments were generated during the twisting exertions. Muscle co-activity associated with twisting exertions was significantly greater than that associated with lifting exertions. Employing electromyograph data to represent muscle co-activity, the model accurately predicted trunk moments and hence was assumed to reasonably reflect spine loading. Under the conditions tested, the results indicated that relative spinal compression during dynamic twisting exertions was twice that of static exertions. Spine loading also varied as a function of whether the trunk was twisted to the left or right and according to the direction of applied torsion--i.e., clockwise or counterclockwise. The results may help explain, biomechanically, why epidemiologic findings have repeatedly identified twisting as a risk factor for low back disorder.
  • Article
    An axial rotation tester was designed and fabricated for the study. This allowed stabilization of seated subjects (hip down) and coupling of shoulders, permitting axial rotation and coupled lateral flexion. Using this device, a "flexion-extension free" axial rotation was executed for studying its characteristics. To determine the mechanism of initiation, sustenance, and execution of axial rotation. This was planned to be done by determining the phasic relationship of various torso muscles in the initiation, execution, and termination of axial rotation. Another objective was to determine the total and relative contribution of torso muscles in axial rotation and the small segments of these activities. There only are a few studies conducted on axial rotation. Generally, these have investigated isometric maximal voluntary contraction in neutral or prerotated postures. The two studies that have reported isokinetic axial rotation have investigated maximal efforts. No study in literature has reported initiation, termination, and execution of unresisted normal velocity axial rotation. Fifty healthy young subjects executed a full cycle of axial rotation, starting from neutral position to their extreme left, continuing to their extreme right, and finally moving to the neutral posture in one smooth motion without stopping anywhere. The electromyographic results of external obliques, internal obliques, rectus abdominis, pectoralis major, erectores spinae at T10 and L3, and latissimus dorsi were measured bilaterally simultaneously during this trunk rotation. The timing and relative magnitude analyses were done to determine the global and individual muscle contributions in axial rotation. The correlation between electromyographic and angular displacement, and nonlinear curve fitting regression analyses were performed to decipher individual muscles behavior. The pattern of muscle activation was variable. However, contralateral external obliques, ipsilateral erector spinae, and latissimus dorsi became active before other muscles. These were agonists and the others were antagonists or stabilizers. The agonists contributed 65% of the total electromyographic output, whereas antagonists and stabilizers contributed 35%. The muscle activities during onset and offset periods were biphasic with significantly different slopes. It was concluded that the axial rotation is achieved through the activities of agonists, and return to neutral position is because of elastic recoil controlled by agonistic muscles. A range of approximately 10-15 degrees on either side of the anatomical midsagittal plane involves little muscle effort, but beyond this region, the osteoligamentous structures become stiff and require increasing effort to execute axial rotation.