Tiger Woods’ Rehabilitation and Prognosis

Tiger Woods’ March 2014 microdiscectomy (back surgery), what it was, what could have cause it, what next?

The thick long, vertical strap muscles which keep our spines erect against the forward pull of gravity, and which have given homo sapiens the ability to evolve to an upright bipedal posture, are the erector spinae (ES) group, which have a direction of action which pulls the posterior spine downwards.
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Certain positions of the spine, such as when one bends forward, require the ES group of muscles to contract even more forcefully to keep one upright. As they do so, they put compressive loads on the spongy ‘discs’ which lie between the bony vertebrae of the spine. Maximum loads are imposed lower down in the spine – the lumbar spine – which must bear the weight of the entire upper body.

The discs are ‘shock absorbers’, and are made up of a softer inner portion – the ‘nucleus pulposus’ and a tougher outer area – the ‘annulus fibrosus’. Healthy disc pictured below:
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The long-term effect of bending or bending-plus-twisting – especially at great speed – such as during the golf downswing, is that sometimes the tough ‘annulus’ layer can get weakened and have tears/fissures in it, into which the inner gel-like ‘nucleus’ can ooze – ‘protrude’.

When material from the nucleus leaks into the annulus, there is said to be a disc ‘herniation’ (in lay, but incorrect terms, a ‘slipped disc’) which can range from the minimal version (‘protrusion’) to an ‘extrusion’ or even ‘sequestration’. (See pic. below)
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The typical direction of forces acting on a disc result in a backwardly directed herniation, that is, one which extends into the already small spinal canal which is 1 cm to 1.5 cm in diameter. As the spinal canal is so small and everything inside it a snug fit, even a small protrusion can pinch a nerve or a nerve root, causing pain not only in the area of the ‘pinch’ but also, sometimes, radiating down the entire leg.

One of the last options (after conservative physiotherapy and injections) is a microdiscectomy, in which a small part of the bulging disc is removed to ease the pressure on the nerve being ‘pinched’.

A very informative youtube video on the subject, by Dr. P. R Jeffords, states that outcome prognosis post-operation is very good. However, 15-20% people continue to have back pain and 5-10% can have re-herniation.
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So, has Tiger’s coach Sean Foley had him make any swing changes, post-surgery, to prevent future injury to the currently well-healed back?

 It is very obvious the backswing has been shortened, and been made even more compact (no side-to-side movement). The hands, as a result, seem rather ‘blocked’, coming across the ball much as a ping-pong bat would be moved when one intends to put right-side-spin on the ball!

An anatomical perspective of Tiger’s new motion(s) post his first event post-surgery below.

[Sir Nick Faldo got in a small dig by commenting that Tiger himself had said his swings might be rusty but that he’d got in a lot of short-game practice so why should that have failed too!]

The Full Swing:
The set-up: This amount of forward flexion at address, excessive though it is, might not cause disc herniation, but certainly does not help relieve low-back pain. Moreover, it is so redundant. Forward flexion of the spine prevents the abdominal muscles from rotating and  forward flexion of the knees prevents the gluteal muscles of the hips from rotating, and both are required during the downswing to aid both the production of swing speed and straight direction.
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The backswing: This new Nike shirt is perfect to see spinal movement. One can see clearly that the cervical, thoracic and lumbar parts of the spine are working at cross purposes, putting much greater stress and strain on the vertebrae, besides making it difficult to re-align them all for a good downswing.
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The new full-swing sequence: Other than a very slight ‘lag’ of the left wrist during early takeaway (which merely serves to keep the left arm making a low movement (adduction), which, in turn, reduces ‘combined-arm’ width at the top), the entire backswing is a pure left-trunk lateral flexion. The arm movement to the top is short, and combined with the totally ‘close-packed’ position of the right hip, all Tiger can do to start his downswing (as his arms cannot drop down with gravity nor his hips start with an unwinding rotation) is make a squat-like movement, lowering body level, then raising it up again in time      for impact.

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Although much has been written about a squat-jump type movement during the downswing being beneficial, it truly is NOT because all Tiger’s downswing serves to do it minimize the time span within which the club can connect the ball. When the right shoulder is ‘back’, it is able to present the club to the ball on an inside path, and thus increase the time-margin within which the club can reach the ball from the inside. With Tiger’s too-compact backswing, there is no time for his right shoulder to fall back (ie. become more ‘closed’), and, in fact, his right shoulder and thigh drop down and forward steeply, ‘blocking’ his hands at impact, and requiring split-second hand-timing if he wishes to draw the ball. No golf swing should ever reply on last-minute small-muscle changes to alter ball-slight as that is too unreliable, too last-minute, and too many small joints must all move in correct sequence to pull it off.

The Chip Shot: For this small shot too, Tiger is making the same basic moves as for his full-swing. He makes a long club and arms arc, back-and-through, when all one needs for such a shot, (with the ball just a few yards from a green and not much slope) is a small, low-trajectory swing! His body at address has too much spine and hip flexion, and once again, the trunk flexes laterally for the backswing. Is there enough time for all those big muscles of the shoulders to undo the backswing-movements in the short distance the club travels during an approach shot?
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To add insult to injury, he makes a stand-and-turn type follow-through. As one stands one reduces the time-span within which one can connect the ball below its equator, and as one turns, one reduces the time-span within which one can connect the ball on its inside-right quadrant. With a stand-and-turn follow-through motion, only a part of the force intended for the ball actually goes into it (the cosine of the total amount!), the rest going into the ground or the air!
Screen shot 2014-06-29 at 9.39.06 AMHis follow-through from what should be a putting-stroke-like chip shot is very complex too. His hips have rotated (why?), his shoulders laterally flexed (dropped down) on the right side, his left arm is in the beginnings of a chicken-wing (internal rotation) and his right arm excessively stiff, altogether resulting in blocked hands and an unreliable ball-motion.

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To make the same full-swing style for a chip shot is bad enough, but to do so from a slope and expect good results is truly asking a lot, unless one practices tons of just such shots all the time, and even then, under conditions of arousal or fatigue, the brain will not as easily co-ordinate all the joint-movements required for such an unnecessarily complex movement.

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The Putt: lots of pros suddenly seem to be using this style of putting – one always wonders who’s idea it originally was! How such subjective ideas get passed around in golf is truly amazing. Once again, the Nike stripes are in perfect position to aid an anatomical analysis!
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The intended concept is obvious – to make the swing a right-arm-only movement. How is it obvious? The shoulders are open at address, the right fore-arm is on the putter plane, and the right arm moves straight down the target line.

How it would work with different golfers would depend on how active their right shoulders are. In Tiger’s case, as his right shoulder and trunk drop, his left (LEAD, and should-be-radius-of-swing) arm gets pushed back, and will surely exert some influence on club direction, as, after all, the arms both hold the club. Also, his right shoulder’s range of motion becomes reduced because of the right side lateral flexion, and might be a factor in longer putts.

A prognosis? One website lists all of Tiger’s injuries to date, and given his tight left arm and tight neck, one cannot rule out left shoulder and left wrist injury, he truly needs the Minimalist Golf Swing System URGENTLY and for all his shots from full-swing to short-game.

Try out all the described motions for yourself (without a ball, don’t get his injuries!) and feel the restrictions of Tiger’s various swing positions. Write in any questions/comments.

Stacy Lewis’ Golf Swing 2014 – An Anatomical Analysis

Stacy Lewis’ Golf Swing 2014 – An Anatomical Analysis

A look at Stacy Lewis’ statistics, score-cards and golf swing will show why she can collect a ton of birdies and have a very cool-blue score card one day (as on Day 4 of the 2014 US Women’s Open) and an orange/red card (with high/heat inducing scores) another (Day 3)!

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During the event, (see ‘statistics’ above) her ‘fairways hit’ ranged from a high of 13/14 to a low of 9/14, while her greens-for-regulation went from 11/18 to 17/18. Her average driving distance ranged from about 244 to 257, a difference of 13 yards (of course a few outliers alone can cause this difference, but in a mere 18 holes, each outlier is expensive).

How often can she rely on a mere 26 putts to save the day, as she did on Day 4? (Score card below)

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Compare Day 4’s score card with that of Day 3 (below)

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See her video

Lexi Thompson Swing 2014 – Analysis of Joint Positions and Anatomy

Lexi Thompson Swing 2014 – Analysis of Joint Positions and Anatomy

Even the most talented professional golfers do not make ‘ideal’ swings in terms of how their joints can work best, simply because prior to this no-one has ever thought to consider that aspect.

So, an athlete such as Lexi Thompson can improve too, by positioning, at the top of her backswing, her entire spine (head to tail bone), right shoulder and right thigh closer to the positions of her impact, rather than diametrically opposite of what they are!

For instance, if she needs her spine to be tilted away from target at impact, it should be so at the top of the backswing. If her right shoulder is to be externally rotated at impact it should be so at the top. her right hip should not be so extended backwards at the top, as the ‘close-packed’ position requires some aggressive repositioning to get it into its desired downswing position.

US Women’s Open 2014 – Day 2

US Women’s Open 2014 – Day 2

See the top-of-backswing position of Stacy Lewis (leading after Day 1) from the front and rear, Lexi Thompson, Karrie Webb and Cheyenne Woods.

Any comments about how their positions are? With respect to joint positions, that is? How many joint positions will each of them have to undo to get to impact?

Videos of all four with joint-placement comments to follow.

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US Women’s Open 2014 – Day 1

US Women’s Open 2014 – Day 1

Comments on the ANATOMY of this and that….

Had the honor of speaking with Dr Tom Boers, physiotherapist to the LPGA and PGA Tours. A wonderful quotable quote from him, “The golf swing should be designed around the spine, not the spine around the golf swing”. If only more people in golf understood that.

He has worked with very many injured golfers’ backs, including that of Suzann Pettersen. Scroll down to the previous post to see the video analysis of the anatomy of her swing and understand what might have exacerbated her disc irritation a few months ago. Also, a golfer’s standing posture is rarely analyzed in golf, look at hers below:

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Then there is the question of swing efficiency. It seems to be very popular (and this is true for all skill-levels of golfers, all over the world) to make long back- and through-swings for small ‘chip’ shots. Did these originate from the ‘dog must wag the tail’ phrase, requiring shoulder involvement even for short shots such as chipping? Did it originate from people believing the wrists are essential for all shots [see the note at the end of this post regarding wrist involvement]? Whatever its antecedents, the ‘modern’ chip shot involves too many joints being bent/twisted during the backswing for there ever to be enough time to undo it all, in this tiniest of swings.

Look at this big dog. If he had a tiny fly sitting at the end of his tail, should he ‘wag’ his entire body to get rid of it? Would simply wagging his tail not be sufficient? That would be the equivalent to a chip shot being made with the arms acting as two sticks, with no in-swing knee bending, no hip rotation and no shoulder rotation. A simple pendulum-like motion (with a shallower arc than a true pendulum would have), picking the ball off the ground with no dramatic divots.

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Look at the size of back- and down-swings of this golfer making a small shot from 15 yards off the green, with 5 yards of green to the pin, OFF an UPHILL LIE! Do not all professional golfers attend ‘Chipping 101’, the basic class that tells one not to have a big arc of swing from an uphill lie, as it reduces the margin within which they can err?

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In the above situation, the golfer has to undo all of: 1. neck forward flexion 2. left arm adduction (the ideal lead-arm movement should be more like a flexion – post a question in the forum here if interested in how/why) 3. right shoulder elevation 4. right shoulder internal rotation 5. right wrist extension (backward bending) 6. left trunk lateral flexion

Another golfer made 6-7 practice shots from the same position with a highly lofted club which had lots of bounce, and brushed the grass at different spots each time, to get the feel of what to do. Better sense finally prevailed and she chose to go with her putter. However, even then she made a long swing arc back and through, with the putter-head moving steeply up then down and then up again. Both chip and pitch shots should have a low, shallow arc, especially on an uphill lie, to increase the margin within which to err!

As regards bunker shots. See this green-side bunker top-of-backswing and past-impact positions. At the top there has been wrist bend, right elbow bend, left trunk bend and a lot of spinal rotation – different at each of the spinal levels – the cervical or neck region has remained in place, and the thoracic spine (where the ribs are) has rotated. The lumbar and sacral areas (hip area) are probably being kept in place, if the amount of knee flexion is any indication (players are often told to have a ‘solid base’).

In the downswing she chokes –  as can be seen by her hands, which stop moving during early and late follow-through. Her brain probably makes hers arms decelerate in reaction to feeling either that there will be more-than-required acceleration from the body’s involvement OR that as her shoulders spin open, over-the-top, the club will come too close to the ball (not stay behind the ball as would be the case with an ‘inside’ approach). Another reason for the cessation of her hand and arm movement could be that her head turns during early follow-through.

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The Minimalist Golf Swing System works not only for the full-swing, but has excellent heaven-sent solutions for the basic pitch, chip and putt strokes too. [An example of MGSS simplicity – create any steepness required for a slightly high chip shot or what might be termed a pitch-and-run shot, from elbow, NOT wrist, bend, as there is more time for the trail elbow to straighten than for the trail wrist to do so].

Suzann Pettersen’s Golf Swing 2014 – An anatomical analysis

Suzann Pettersen

What a phenomenal athlete! Can just imagine how pure her ball striking could be with an anatomically efficient golf swing, where every joint is positioned according to its design-based capabilities.

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See her golf swing assessed for where her body is during address, backswing and downswing. Also a picture which shows what could have caused/exacerbated, with overuse, her back injury of a few months ago.

The Common Factor in six MORE top Women’s Backswings

The Common Factor in six MORE top Women’s Backswings

Muscles of downswing rotation:

The abdominal obliques rotate the spine and the gluteal muscles (along with 6 other ‘ladder’ muscles) rotate the hips. They can rotate best when the spine is as upright as possible and rotate less and less efficiently as the spine and hips get more and more flexed forwards.

The consequences of no backswing hip rotation, along with steep trunk lateral flexion:

A lot of muscles have to hustle to position several joints into positions from which they can deliver the club to the ball from the inside. Women do not have as much fast-twitch muscle as men, and also have larger hip areas to rotate during the downswing, so will not always be able to time (ie sequence or co-ordinate) all movements in an efficient manner.

See six more top golfers with negligible to no hip rotation during the backswing, and too much trunk lateral flexion. All the various parts of the spine having to torque at different rates and in different directions! OUCH.

Left to right top row: Julie Inkster, Jessica Korda, Caroline Hedwall

Left to right bottom row: Ally McDonald (A), Karrie Webb, Marta Silva

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The Common Factor in six top Women’s Backswings

The Common Factor in six top Women’s Backswings

If you were asked, “What is the single most common swing position seen during the top of these backswings?’, what would your response be?

The answer is in the ‘backside’. NONE of theirs have rotated!

L to R: Stacy Lewis, Michelle Wie, Paula Creamer, Jessica Korda, Se Ri Pak, Lexi Thompson.

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So now, power must come from only an unwinding trunk, when women have so much more in the hip and gluteal-muscle area.  A lot of women are then excessively torquing their spines, and so having to unwind lumbar, thoracic and cervical areas of the spine at different paces and times, as they all have different sizes and roles and the spine is not in position to unwind as a single column.

The result? In-efficiency of ball-striking, potential for injury.

The ENTIRE SPINE – from neck to tail-bone NEEDS to be rotated back as a single column!

US Women’s Open 2014 – Anatomy of Participants’ Swings

Anatomy of the swings of some participants –

similar or different to what the male pros of last week were doing?

Anyone care to comment on these backswings – in terms of how many separate joints are being moved and potential consequences to both ball-striking efficiency and injury potential?

What seem to be the common factors?

Please post your comments here.

From left to right:

Stacy Lewis, Michelle Wie, Paula Creamer, and (lower row) Jessica Korda, Se Ri Pak, Lexi Thompson.

[On the subject of anatomically efficient positions and injury  – look at Wie’s kinesio-tape on quadriceps, hamstrings and around the knees, any guesses what swing-factor might exacerbate pain in the area?]

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Anatomy of new Golf Swing Trends from US Open 2014, Pinehurst No. 2

Anatomy of new Golf Swing Trends from US Open 2014, Pinehurst No. 2

The new trends that all the pros seem to be following are:

1. Full swing: a big spine forward flexion and a steep lead shoulder tilt during backswing and an equally steep shoulder tilt during downswing.

The result? A huge, deep divot.(see Martin Kaymer below)

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Effect of ball-striking efficiency – with such a deep divot, a lot of the intended power goes into the ground – a simple vector summation of forces drawing will show that. Its great when the players are young and supremely athletic and they have so much force production to spare that they do not even realize that they could get much more distance with a shallower divot.

However, the main problem is direction. The ‘upright pendulum’ which seems to be the latest version of the golf swing,  means that there is a very narrow margin within which direction can be good. Also, as the club rides inside such a deep divot, it could be prone to being twisted in the hands, as it digs through a large quantity of our planet!

All this excessive effort for not enough result probably comes from the new concept of making a squat-jump type move during the downswing to enhance ground-reaction-force (GRF). As the lead upper body ‘jumps up’, it apparently allows the golfer to decelerate correctly. No-one, however, has quantified how much ‘jumping-up’ to create GRF is optimal. The Minimalist Golf Swing creates ‘just enough’ GRF, by not requiring any up-and-down motion, but simply from the natural straightening of the trail arm! Does the full-swing need, and can it afford, all this excessive movement?

2. Chipping: What a big back-and-through motion (see Rory McIlroy below). Why are chip shots involving so much shoulder rock, ever since some famous pro told the world ‘The dog must wag the tail”. All it needs is an arms back-and-through movement, a much lower clubhead trajectory in both directions, and a ball which has the bare minimum air-time for it to just carry the lip of the green, then roll, like a putt (the simplest, least error-prone stroke) the rest of the way home. With a lower trajectory, the extra joint-movements of the shoulders gets reduced, and intentional shoulder-movement is a much more complex movement than that of just the arms.

Does the chip shot need, and can it afford, all this excessive movement? [And, on that subject, did Martin Kaymer win because he always used his putter from off the green, making a much simpler stroke?]

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3. Putting: Open shoulders and a right (trail)-arm-back-and-through movement (see Martin Kaymer below). This makes both elbows bend to differing amounts during back-and-through swings and differing amounts of shoulder rotation too, resulting in inconsistency. Does the putting stroke need, and can it afford, all this movement?

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Consider the human joints, folks, they are sadly (so far) not designed to move in all directions with equal ease, and require everything that’s done to them during the backswing to be un-done – in correct sequence – in the fraction of a second that the downswing lasts!

(All pics from NBC Sports live streaming)

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