Better Golf (and Less Injuries) with a Balanced Body

By Ada Wells, MPT
As seen in the Fall 2009 Balanced Body Pilates COREterly

As Pilates instructors, we possess a unique set of tools that can help golfers decrease their chances of injury and improve sports performance. To have a successful golfing experience, the individual must not only possess the proper skills to know how to properly swing a club, but they must also possess the range of motion, strength, and neuromuscular control to allow their body to actually execute the swing. While it is helpful to understand the complex biomechanics of the golf swing motion, focusing on just a few key critical areas will help most golfers.
Why golf is so difficult and why all the injuries?
Having a consistent golf swing with good form is a difficult task because of the complexity of its biomechanics. Without going into too much detail, there are a few aspects of the golf swing that are helpful to understand. First, the spine is subject to a very rapid and complex loading pattern. In less than 1.5 seconds, the spine and extremities are taken to their end ranges of motion, making the extensibility of soft tissues dictate the path of the swing. Lacking flexibility in the mid-back and hips may cause the lumbar spine to bend and rotate in ways that increase spinal stress. The golf swing also involves a combination of non-functional movement patterns and rotational movements around multiple axes. Since these are not typical motions, i.e. the head moves opposite the body through most of the swing, there are different neuromuscular firing patterns that must occur. Individuals may be prone to upper body injuries if they don’t possess the strength to control their flexibility in these atypical positions. Regardless of age, gender, or experience, muscle strength and flexibility imbalances can impair one’s ability to play effectively, especially when combined with poor instruction or form.

Critical Areas:
Many swing faults and injuries are the result of lacking range of motion or motor control in a few key areas. Below are some suggestions that are helpful when working with your golf client.
Spine Range of Motion and Control: Optimal spinal mobility at all levels is critical since limitations at one area will increase compressional forces on another. This is particularly important during the end ranges of the swing when control of thoracic extension and rotation need to be maximal. The pelvis should also stay relatively neutral throughout the swing to allow the body to rotate around a neutral spine axis. Note that the pelvis stays neutral despite changes in hip position and its directional orientation throughout the swing.

Mat exercises such as the mermaid and saw are helpful for encouraging spinal rotation and pelvic control, whereas the swan and swimming are helpful in working with spine control in extension.
Hip Range of Motion and Control: Good hip range of motion, particularly hip internal rotation and hip extension, is very important. A tight iliotibial band combined with weak hip abductors can be a culprit for many swing faults. What is often overlooked is the importance of also working on hip and lower extremity control in weight bearing positions.
The reformer is the obvious place to work on hip flexibility, whether performing the supine legs in straps series or the standing lunge/hip flexor stretch. Performing hip work on the reformer with the client standing in their golf address position is helpful for training muscular control with the hips in flexion and spine in neutral think speed skater or the standing splits series.
Cervical Mobility and Scapular Control: Integrating postural exercises is necessary for any sport, but with golf, the added complexity of the head moving in an opposite direction of the arms and thoracic spine makes it critical. Also, the potential for repetitive upper extremity injuries exists if the golfer doesn’t have good scapular control.
Lying supine, parallel to the foam roller is a great place to start with most golfers, as it allows them to engage their core stabilizers while mobilizing their mid-back and stretching out their pectorals. Prone exercises on the combo chair are helpful to encourage scapular stabilization while the spine moves into spinal extension and rotation positions. On the mat, the spine twist is excellent for working on good spinal mobility in neutral. Performing variations with neck and arm position can make it very functional for the golfer. Arm springs on the trapeze table can be used in standing or kneeling to work on scapular control in a variety of directions.
In general, a non-specific, but balanced Pilates session with good form and cues, will be of benefit to golfers, whether or not you even mention golf or have ever played yourself. However, if you choose to specifically target golfers or if you frequently have golfers as clients, it is helpful if you have a deeper understanding of the complexity of the golf swing. Take lessons, talk to a pro, take golf-specific fitness courses, and try it yourself so that you understand what is physically required to have a good golf swing and to maximize results with your golfing clients.
Ada Wells, MPT, owner of Rebalance, Inc., graduated from UC Davis with a B.S. in Physiology. She received her MPT from Chapman University. She is Polestar certified and a member of APTA and PMA. Ada specializes in combining manual therapy with Pilates-based exercise for sport-specific rehabilitation and performance programs with a special interest in golf. For the past 7 years, she has provided Pilates services to the celebrity golfers at the American Century Golf Championship.



Pilates and the Compromised Spinal Cord

By Allison Cabot, PT; Dawn-Marie Ickes, MPT; and Gabrielle Shier, MPT
As seen in the Summer 2008 Balanced Body Pilates COREterly
When an individual is afflicted with a spinal cord injury, there generally will be a loss of motor function and/or sensation at and below the level of injury. Where along the spine and how the injury took place will dictate the severity of the loss. The most common spinal cord injuries occur from motor vehicle accidents, gunshot wounds, and sports related accidents or falls. Non-traumatic occurrences are classified as spinal cord dysfunction.
Establishing a wellness program is extremely beneficial for maintaining and improving functional abilities and emotional well-being for patients with spinal cord injuries or dysfunction. A well-rounded program should include elements which enhance functional independence in addition to promoting fitness, balance, core strength and spinal stability.
Staying well despite injury or dysfunction involves commitment to a healthy lifestyle. Exercise is one step which, if properly executed, can enhance the functional ability of an individual afflicted with a spinal cord dysfunction. It also promotes general well-being and improved self-esteem. But with any exercise programming, precautions must be adhered to. Prior to initiating any exercise, you must learn the indications and contraindications of this population. It is imperative to consult with a trained health care professional who specializes in spinal cord injury/dysfunction.
Pilates when used in a rehabilitative capacity is an excellent choice of exercise for those individuals with a neurological impairment of the spine. It incorporates modern biomechanical principles focusing on posture, body alignment and proper muscle recruitment. It challenges the proprioceptive system so that in a spinal cord injury client – you can strengthen the nerve to muscle message, so that even if the muscle cannot be further strengthened, you can maintain or even strengthen the nerve message from the central nervous system. In addition, it facilitates the mind-body connection and breath for overall relaxation and one’s own awareness of body and self.
Pilates is ideal for persons with disabilities, because the repertoire is all encompassing with over 500 exercises. In addition, every exercise can be modified according to the mobility and ability of the participant. Because Pilates uses spring resistance instead of weight bearing exercises, spinal cord injury patients who have partial involvement can effectively strengthen the legs. Each exercise focuses on concentration, control, precision, and the fluidity of the movement. In addition, breath and core stability are key components to each exercise. It also is different from conventional weight training in that its focus is on facilitating the smaller stabilizing muscles and core musculature. These muscles are imperative in order to maximize normal function and restore trunk control.
The benefits of Pilates for a spinal cord client include, but are not limited to, improved stability, flexibility, core strength, shoulder, spinal and pelvic stability, a more balanced musculature, improved motivation and self-confidence/esteem. Postural integrity is found and maintained. Best of all it is safe and effective.


Case Study – Patient with spina bifida – incomplete
Mark* was ambulatory and functional, but was unable to run and walked with a limp, one leg being much weaker than the other. He was highly motivated to strengthen “what he had” by doing lower body strengthening exercises at the gym. However, he experienced chronic knee and lower back pain. During the first year of his physical therapy, which included Pilates, his pain decreased by 90%! He showed remarkable improvements in strength and function. Now after 2 years, Mark has shown signs of increased strength in both legs, particularly in his weaker leg. Now his knees are pain-free and his limp has disappeared. However, when he attempts to strength train on his own at the gym, the pain returns. Not only is Mark an example of how Pilates can change the way a person moves, it illustrates how one must continue the practice to get the full benefit Pilates can offer. 20150703_132532
The inherit nature of the equipment which includes the Reformer, Cadillac, and Wunda chair encompasses versatility and improves effectiveness of exercises because of the springs. The springs come in various tensions and therefore can be utilized to produce different levels of tension. Utilization of the Pilates equipment should be performed only by those individuals who have been adequately trained. A trained instructor should be spotting their client at all times and if working with this population type should have adequate knowledge of how to work with a neurological client.
For more information on spinal cord injury and dysfunction please refer to NCPAD’s fact sheet on Spinal Cord Injury.
Allyson Cabot, PT, is a partner at Core Conditioning, integrated Wellness centers offering Pilates-based rehabilitation in Burbank and Studio City, CA. She holds a B.S. in Kinesiology from UCLA and graduated from CSULB in 1991 in Physical Therapy. She is certified in Pilates and Gyrotonic®.
Dawn-Marie Ickes, MPT, is a partner at Core Conditioning, integrated Wellness centers offering Pilates-based rehabilitation in Burbank and Studio City, CA. She holds a B.S. in Biology from Loyola Marymount University and graduated with a Masters in Physical Therapy from Mount Saint Mary’s College in 1996. She sits on the national Board of Directors for the Pilates Method Alliance. She is certified in Pilates.
Gabrielle Shrier, MPT, is a partner at Core Conditioning, integrated Wellness centers offering Pilates-based rehabilitation in Burbank and Studio City, CA. She holds a B.S. in Kinesiology from UCLA and graduated with a Masters in Physical Therapy from USC in 1994. She is certified in Pilates and Gyrotonic®.

IMPROVE MY GAME How To Improve Rotation While Protecting Your Lower Back

Tue Jun 2, 2015 by Mike Boyle

The thoracic spine is often a neglected section of twelve vertebrae stuck between the much more talked about lumbar spine and the forever-painful cervical spine. 

 Thoracic Spine

By definition, the thoracic spine is the twelve vertebrae that connect with the rib cage and is located between the lumbar spine and the cervical spine. Because we rarely get thoracic pain we tend to overlook this critical area. Neck and low back pain are rampant so the thoracic spine is often completely overlooked. Unfortunately a big key to avoiding both lower back pain and neck pain may lie in the mobility of your thoracic spine.

In the simplest terms, the body does what is easy, not what is best. As we age the thoracic spine stiffens. As a result we tend to turn the head at the neck (cervical spine) or rotate at the lower back (lumbar spine). A mobile thoracic spine can help to avoid or relieve both low back and neck pain by allowing rotation in this key area.

In the simplest terms, the body does what is easy, not what is best.

For years we have been warming up the wrong area with the wrong exercises. Lots of “experts” recommended exercises like hip crossovers and scorpions to “warm-up” the low back.

Here’s a video I put together for Golf Digest discussing common “rotational” exercises that are probably doing more harm than good.

The video was essentially a spin-off of an article I wrote a few years ago titled “Is Rotation Training Hurting Your Performance?”  In the article I recommended that athletes, particularly golfers, avoid most exercises that rotate the lumbar spine and instead focus on developing motion at the hips and thoracic spine.  The truth is that good motion in golf comes from turning the hips and the shoulders not from rotating the lumbar spine. In her book, The Diagnosis and Treatment of Movement Impairment Syndromes, author Shirley Sahrmann notes a key fact that I believe has been overlooked in the performance field: 

“The overall range of lumbar rotation is …approx 13 degrees. The rotation between each segment from T10 to L5 is 2 degrees. The greatest rotational range is between L5 and S1, which is 5 degrees…The thoracic spine, not the lumbar spine should be the site of greatest amount of rotation of the trunk… when an individual practices rotational exercises, he or she should be instructed to “think about the motion occurring in the area of the chest”
(Sahrmann, p61-62)

Therefore, a way to get good hip motion and good shoulder turn is to focus on the hips and thoracic spine, not the low back. Bottom line, bad golfers turn at the low back. Good golfers turn at the hips and shoulders.

Additionally, the ability to resist or to prevent rotation may in fact be more important than the ability to create it. Clients or athletes must be able to prevent rotation before we should allow them to produce it.

As I mentioned in the video above, golfers should seek to improve internal and external rotation of the hips.  Exercises like the Comerford Hip Complex, a progression developed by Australian physio Mark Comerford, strengthens the rotators of the hips and improves lateral stability in your golf swing.

Comerford Hip Complex

Comerford Hip Complex – Video

Mobility at the thoracic spine is actually simpler to develop than you think. It doesn’t even involve rotation. What you are going to do to mobilize the thoracic spine is to perform a series of simple crunch type exercises while lying on two tennis balls taped together with masking tape or your can even put them in a sock.  It’s a simple exercise that you can do at the gym or even in front of the TV.  Dr. Rose demonstrates in the following video:

Tennis Ball Thoracic Spine Mobility

Tennis Ball Thoracic Spine Mobility – Video Link

Place the tennis balls under your back with one ball on either side of the spine. Begin at just above bellybutton level. With the balls in position do five crunches. You should feel the balls pushing into your spinal erectors (the big muscles on either side of the spine). The balls are actually pushing the vertebrae slightly forward, in effect creating motion (mobility) at the level of that segment. A series of these crunches can be done all the way to the top of the shoulder blades. The end result is often a large increase in shoulder turn. Another possibility is to foam roll the thoracic spine. Make sure the elbows are together to separate the shoulder blades and get pressure on the thoracic spine.

If you are bothered by low back pain, neck pain or want more shoulder turn try the attached mobility exercises. Just remember, it’s not always where it hurts that needs the attention. Often times it’s the joint above or below.


Dopamine – The Secret to Motivation


Dopamine is a neurotransmitter in your brain.  It’s associated with motivation, concentration and pleasure.  In fact, it’s often referred to as the “motivation molecule”.
It plays a broad range of roles in the brain, but the one it’s most famous for is its role in our pleasure-reward system.
A release of dopamine makes us feel enjoyment and pleasure, while a deficiency of dopamine is associated with lack of motivation and depression.

There’s a number of ways you can increase the release of dopamine.  Exercise, plus foods high in tyrosine can help (animal products, almonds, bananas, green tea, chocolate and many others).

But one key way is to set yourself small goals.  When you achieve a goal, your brain releases dopamine.  So if you only have long-term goals, you won’t get that regular surge of dopamine.
When you achieve a small goal, and dopamine is released, it gives you the motivation to set another goal, and another.

So break your big goals into smaller, achievable goals.  You can also set yourself clear and easy goals, such as cleaning the kitchen, or replying to emails.

Let  yourself feel good about achieving this goal  –  as minor as it may seem  – as this sense of reward will release dopamine and give you the motivation to take on more challenges.


1. Schedule regular pit stops
All brains need regular refueling and servicing.  Check in to ensure you are taking meal breaks, refueling with those foods that boost energy, cognition and memory and schedule a mental self-check-up.   Ask yourself simple questions like: Is your memory up to scratch, are you forgetting too many things, and are you clear in your thinking when approaching a difficult challenge? If not, it may be time to stop & reset.
2. Check your attitude
How we operate under stress compared to eustress (meaning good stress or beneficial stress) can manifest itself in different ways.  Notice your language; if it’s predominantly negative, what is your mindset?  Attitude evolves as a consequence of whom we hang around and our experience, and it can change with a conscious decision to reframe how we see the world.
3. Stretch your mental muscle
No matter how varied our work, much of our daily activity is repetitive and performed out of habit.  Engaging in new activities, especially those we may not expect to excel in, such as learning to speak a new language or taking up a new hobby or sport, is a great way to give our brains a workout and sharpen our thoughts.
4. Stretch those other muscles
Yes, some good old fashioned exercise is a great way to burn off a few stress hormones, boost our mood and stimulate cognition.  Regular exercise has been shown to prime performance through stimulating cerebral blood flow and releasing neuro-hormones including BDNF which is essential to good neuronal health and neurogenesis (the production, survival and maturation of new neurons).
Many people are on their feet all day, and it’s important to remember that taking 20-30 minutes out for a run, bike ride or gym class is a great way to unwind, relax and feel good.
5. Still Your mind
This can be one of the hardest things to do.  We rush around all day, and it can be difficult to remember how to switch off and slow our thoughts down.  Daily reflection time is a wonderful thinking space that allows us to pause and be grateful for what we have, to consider our achievements, what’s important to us, and ponder our goals.  Whether you take 20 minutes out for a meditation practice, listen to some beautiful music or do some ‘adult colouring in’, finding that mental space is crucial to your wellbeing.
If fatigue, brain fog and frustration have been getting in your way or preventing you from working at your best or allowing you to enjoy what you do, find the time to check in and take that first step to building a fitter, healthier brain.
– DR Jenny Brockis

Do you have a Pelvic Tilt?

Have a look at your posture in the mirror. What do you see?
Do you have a pronounced lower back arch? Do your tummy and bottom stick out a little bit? This posture indicates an anterior pelvic tilt, meaning your pelvis tips forward more than it should.
As in the above picture, everybody’s pelvis will naturally tilt slightly forward, but when the angle of the pelvis tips sharply forward, it is out of position.
To give yourself a better idea of the depth of your pelvic tilt, find the pointy bone at the front of your hip, and the corresponding pointy bone on your back.

Look side-on in the mirror. If you have an anterior pelvic tilt, the front bone will be significantly lower than the back.
So why is this a problem?
Well, if your pelvis is in the wrong position, it can put everything else out of position too! As well as your lower back and hips, it can cause pain and tightness in your upper back, neck and throughout the rest of your body.

An anterior pelvic tilt is often the result of sitting too much, sitting incorrectly, or most often from a combination of the two.
Excessive sitting causes an imbalance in the muscles controlling the pelvis. While some of these muscles become weak and inhibited, others become tight and overactive.
To fix an anterior pelvic tilt, you will need to stretch the tight/overactive muscles (hip flexors, tensor fascia lata, quadriceps, lower back erectors and thoracolumbar fascia), and strengthen and activate the weak/inhibited muscles (gluteal group, hamstring, abdominals and oblique’s).

Do you have carpal tunnel syndrome?

You may first notice it as tingling or pins and needles in your thumb, index, middle and ring fingers. Your hand may feel weaker than usual, and you may even drop objects.

Perhaps you’re woken at night with pain in your hand that’s relieved by shaking, hanging or massaging the hand. The pain may even involve your arm and shoulder, and you can experience darting pains from the wrist.

These are all common symptoms of carpal tunnel syndrome.

The Carpal Tunnel Ligament

 What’s a carpal tunnel?

The carpal tunnel is a space in the wrist surrounded by wrist bones and by a rigid ligament that links the bones together. The median nerve runs through the narrow carpal tunnel. If any swelling occurs, the large median nerve can easily be compressed, causing symptoms of CTS.

Swelling in the wrist can occur during pregnancy, with medical conditions including diabetes, rheumatoid arthritis and thyroid imbalance, and as a result of repetitive hand movements common in many occupations. The tendons in the carpal tunnel can become irritated and inflamed by awkward postures, strong gripping, mechanical stress on the palm, vibration, or repetitive hand movements.

What about keyboard work?

A possible link between CTS and keyboard or computer use is now considered doubtful, with most reviews finding no consistent evidence to support that extensive computer use is a risk factor.

However, keyboards can cause any pain or strain in the hand and wrist, and symptoms can come from elsewhere along the median nerve. Its not to say that computer keyboard use doesn’t cause disorders of the arm, but is doesn’t cause carpal tunnel syndrome.

How to treat CTS.

You can’t work through carpal tunnel syndrome.

Despite pain and stiffness being initially mild, they can increase until your hand hurts all the time, and you can suffer permanent damage if the cause is not addressed.

Treatment includes rest, anti-inflammatory drugs, cold packs or a splint. Certain medications can also help to reduce the swelling.

If symptoms are severe, surgery may be necessary, but should not be the first choice of treatment.

Source: safetyandhealthmagazine