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TherapyXperts Maynooth

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Tiger’s Knee

Watching the great Tiger playing golf in the last few months has been just like watching a noble wild animal doggedly hunting while injured. Seeing Tiger Woods wince as he turned on his injured knee was a sorry sight indeed.

You would think that golf, that apparently most sedentary sport; no running, no kicking, no contact, would be injury free. The reality is that for many, especially aged sportspeople, golf is a great way to channel a competitive spirit long after the body can no longer withstand the rigours of football and such sports.

For the leisure golfer…

Professional tour golfers are a breed apart. To start, they had to have an innate talent, most likely discovered in early teens. Then this talent was honed by practice, practice and more practice: 18 or 36 holes a day, hours practicing each type of stroke over and over to achieve a level of consistency that is far beyond the challenge for the regular once or twice a week player. Imagine how many times a pro such as Tiger or our own Padraig Harrington has teed off, chipped and putted in their career to date: probably hundreds of thousands of times.

The repetition of golf is both its beauty and downfall. It is joyous to observe the rhythm and power of a natural golf swing. However even the pros don’t get the swing perfect every time. It they did every shot would land in the centre of the fairway every time. In reality it is slight imperfections in the golfer’s stance, their wind-up, the address to the ball or the backswing that pull the ball to the left or right. These imperfections change the mechanics of how the clubface meets the ball and have implications both for where the ball goes and how the golfer’s body absorbs the shot.

Repeated less than perfect shots have an impact on the body. In golf, too much or too little rotation at the knee, the lower neck, the head and neck or the shoulders will over time lead to pain, as tissues become overloaded. Overload gradually becomes injury as the tissues become less able to absorb extra shock from cumulative imperfections. In the backswing phase of golf, for example, the long bone of the leg, the femur, acts as a pestle in a mortar within the knee joint. The femur rotates on the shinbone (tibia), causing a grating or grinding action to the cartilage within the knee, which irritates and inflames the knee. This is what ahs happened in Tiger’s knee. He has now had four sets of surgery to clean out the gritty knee, but as we could see from the wincing on his face, the knee hasn’t fully recovered and remains sore, especially on less than perfect shots.

As a Chartered Physiotherapist, I was surprised that he was back on the course only days after arthroscopic (keyhole) surgery. Post surgical rehabilitation of a joint and its surrounding muscles is essential for full recovery. In his case the muscles of the thigh would need to be 110% fit to prevent pain and re-injury. I suspect that this must be the focus of Tiger and his team in coming weeks.

The accumulation of this repetitive action is ultimately what leads to injury. The most common injuries in professional golf are back, neck, shoulder and knee injuries, in that order.

For lesser mortals, it is more common to hear leisure golfers complain of a sore back or a pinch of shoulder pain after a round of golf. In both cases, spinal stiffness is likely to be the underlying cause of dysfunction. Specific to the sport of golf, full range of trunk motion is necessary to achieve the full golf swing. The spine is meant to coil and uncoil by rotating one vertebra on another. If this spinal rotation is caught or stiff at any one level within the spine, it can negatively affect the mechanics of the swing. The outcome is either back stiffness and pain, or pinching around the shoulder, as the shoulder region tries to compensate for reduced spinal movement.

If this rings a bell or you have noticed specific problems with a part of your golf game, it is worth undertaking a physiotherapy assessment. During clinical examination the causes of movement dysfunction and actual tissues or joints in question will be identified. Treatment can then address the problems: restore motion at every level of the spine and stretch or strengthen appropriate muscles throughout the body. This process needs to be thorough and graduated to ensure that the underlying reasons for the movement dysfunction are each resolved.

Once the body is moving freely again, we normally recommend a couple of sessions with a local golf club professional to address why the dysfunction occurred in the first place. It is particularly helpful to video the golf swing before and after. The trained eye of the golf pros will pick up personal bad habits, little things that have developed gradually over time, but cumulatively if left uncorrected impact both on golf scores and golfers bodies.

Golf is a wonderful sport suitable from ages 8 to 80. In these days of emphasis on fitness, golf is one of the rare sports that can be played by all ages, at all levels of competition and all year round. If you are hesitating about playing because of pain or stiffness, don’t just stop playing. Make an appointment with a Chartered Physiotherapist today and get back on course now!
Mairead O’Riordan, MSc, MISCP is a senior Chartered Physiotherapist & CEO of TherapyXperts, an allied health network dedicated to clinical excellence.
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TherapyXperts: Registered business address: Kandoy House, 2 Fairview Strand, Fairview, Dublin 3, Ireland|Phone: +353 818 333 611|Email: info@therapyxperts.ie
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