The efficacy of injury screening for lower back pain in elite golfers.

Background: Injury prevention is a growing focus for golfers in general and for elite golfers in particular. Movement screening has been proposed as a possible cost-effective means of identifying underlying risk factors and is widely utilised by therapists, trainers and coaches. Objectives: Our study aimed to establish whether results from movement screening were associated with subsequent lower back injury in elite golfers. Methods: Our prospective longitudinal cohort study with one baseline time point included 41 injury-free young elite male golfers who underwent movement screening. After this, the golfers were monitored for 6 months for lower back pain. Results: Seventeen golfers developed lower back pain (41%). Screening tests that were able to differentiate golfers who developed and those who did not develop lower back pain, included: rotational stability test on the non-dominant side (p = 0.01, effect size = 0.27), rotational stability test on the dominant side (p = 0.03; effect size = 0.29) and plank score (p = 0.03; effect size = 0.24). There were no differences observed in any other screening tests. Conclusion: Out of 30 screening tests, only three tests were able to identify golfers not at risk of developing lower back pain. All three of these tests had weak effect sizes. Clinical implications: Movement screening was not effective in identifying elite golfers at risk of lower back pain in our study.

Lower Quadrant Swing Biomechanics Identifies Golfers With Increased Risk of Low Back Pain: A Prospective Longitudinal Cohort Study.

CONTEXT: Elite golfers have a high incidence of low back pain. Recent reviews have emphasized the need for investigation into how to prevent low back pain in golfers, prompting the current study. DESIGN: Prospective longitudinal cohort study. METHODS: Forty-one injury-free golfers were included in this study. At baseline, lower quadrant joint angles and club and ball performance were measured while each golfer performed 10 drives. The golfers were then monitored for 6 months and were allocated into 2 groups depending on whether or not they developed low back pain. The initial, baseline kinematic variables of the low back pain group and the uninjured group were then compared. RESULTS: Over the 6-month monitoring period, 17 (41%) of the golfers developed low back pain. At baseline assessment, the low back pain group had 4° less lead ankle dorsiflexion at setup (P = .01; effect size = 0.82), 6° less lead knee flexion at the top of the backswing (P = .05; effect size = 0.64), 6° less lead ankle dorsiflexion at the top of the backswing (P = .01; effect size = 0.82), 6° more trail hip adduction at the top of the backswing (P = .02; effect size = 0.79), 9° more trail knee flexion at impact (P = .05; effect size = -0.64), and 6° more trail hip adduction at the end of follow through (P < .00; effect size = 1.00). CONCLUSION: Golfers who developed low back pain during the 6-month monitoring period displayed distinct differences in biomechanics at baseline when all golfers were injury free. These biomechanical differences may be considered a precursor to injury. Three-dimensional motion analysis may indicate whether elite golfers are at risk of developing low back pain. Research is needed to assess whether targeted exercise and sports drills aimed at addressing the biomechanical risk factors identified may prevent low back pain in elite golfers.

Increased trunk muscle recruitment during the golf swing is linked to developing lower back pain: A prospective longitudinal cohort study.

BACKGROUND: This is the first study that presents electromyographic measurements prior to the development of lower back pain in young elite golfers. STUDY DESIGN: Prospective longitudinal cohort study. METHODS: Thirty-three injury free elite golfers were included. Muscle activity from latissimus dorsi, rectus abdominis, external oblique and erector spinae muscles were recorded during 10 drive golf swings. Lower back pain, training and performance were monitored over a six-month period. Muscle activation comparisons were made between the baseline results of those who went on to develop lower back pain versus those who did not go on to develop lower back pain. RESULTS: After the six-month monitoring period 17 participants developed lower back pain. The group that developed lower back pain had increased dominant rectus abdominis and dominant latissimus dorsi activation at various time points throughout the swing. DISCUSSION: The increased dominant rectus abdominis and dominant latissimus dorsi during the golf swing is linked with developing lower back pain. Training strategies aimed at reducing these muscles activation during the swing may reduce the incidence of lower back pain in young elite male golfers.

Single-Leg Squat Delicacies-The Position of the Nonstance Limb is an Important Consideration.

Context: The single-leg squat task is often used as a rehabilitative exercise or as a screening tool for the functional movement of the lower limb. Objective: To establish the effect of 3 different positions of the nonstance leg on 3-dimensional kinematics, muscle activity, and center of mass displacement during a single-leg squat. Design: Within-subjects, repeated-measures design. Setting: Movement analysis laboratory. Participants: A total of 10 participants, aged 28.2 (4.42) years performed 3 squats to 60° of knee flexion with the nonstance (1) hip at 90° flexion and knee at 90° flexion, (2) hip at 30° flexion with the knee fully extended, or (3) hip in neutral/0° and the knee flexed to 90°. Main Outcome Measures: Trunk, hip, knee and ankle joint angles, and center of mass displacement were recorded with inertial sensors while muscle activity was captured through wireless electromyography. Results: Most trunk flexion (21.38° [18.43°]) occurred with the nonstance hip at 90° and most flexion of the stance hip (23.10° [6.60°]) occurred with the nonstance hip at 0°. Biceps femoris activity in the 90° squat was 40% more than in the 0° squat, whereas rectus femoris activity in the 0° squat was 29% more than in the 90° squat. Conclusion: The position of the nonstance limb should be standardized when the single-leg squat is used for assessment and be adapted to the aim when used in rehabilitation.

The association between hip dysfunction and lower quarter injuries in long distance runners: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to establish the association between hip dysfunction and lower quarter (low back and lower limb) injuries in long distance runners. Specifically the review question is: Are long distance runners with hip dysfunction at risk of lower quarter (low back and lower limb) injuries?

The short-term effects of trigger point therapy, stretching and medicine ball exercises on accuracy and back swing hip turn in elite, male golfers - A randomised controlled trial.

OBJECTIVES: This study aimed to compare the effect of myofascial trigger point therapy (MTPT) and stretching, MTPT and medicine ball exercises, and no intervention, on hip flexor length (HFL), golf swing biomechanics and performance in elite, male golfers. DESIGN: Single blind, randomised controlled trial with two experimental groups (stretch group: MTPT and stretching; and the ball group: MTPT, a single stretch and medicine ball exercises) and one control group (no intervention). SETTING: Professional golf academy. PARTICIPANTS: One hundred, elite, male golfers aged 16-25 years. MAIN OUTCOME MEASURES: HFL, 3D biomechanical analysis of the golf swing, club head speed (CHS), smash ratio, accuracy and distance at baseline and after the interventions. RESULTS: Backswing hip turn (BSHT) improved in the ball group relative to the control group (p = 0.0248). Accuracy in the ball group and the stretch group improved relative to the control group (Fisher's exact = 0.016). CONCLUSIONS: Other performance parameters such as: smash ratio, distance and CHS were not compromised by either intervention. This study advocates the use of MTPT combined with medicine ball exercises over MTPT combined with stretching in the treatment of golfers with shortened hip flexors - even immediately preceding a tournament.