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.

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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.
Summary
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.

 

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Pilates and the Compromised Spinal Cord

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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®.