Injuries In Golf (End)

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SLIDE EXPERT 3 FIGURES

The wrist set refers to the angle between the club shaft and a line drawn from the shoulder to the wrist/hand. The effect of the wrist set in golf to increase club head velocity at impact to make the ball travel faster and further is exactly the same as the wrist snap that occurs when a person cracks a whip. The wrist is maintained in its position and then released suddenly to generate a rapid increase in angular velocity. You can see that the angle between the club shaft and the arm at horizontal is less than 90°. Let’s see what a graph of this will look like.

SLIDE EXPERT WRIST SET

This graph shows the wrist set angle of an expert player vs. time. Between the top of the back swing and impact is the area of interest. Notice how the curve is flat for more than half of the down swing. The wrist angle then decreases slightly and rises rapidly to impact. The sharp rise indicates a sudden, aggressive release of the wrist angle. This is known as the wrist snap and results in a very high club head speed at impact with the golf ball.

SLIDE NOVICE 3 FIGURES

Rather than “cracking the whip”, the novice is “waving a wet noodle” or “casting the club” as if casting a fishing line. The novice shows a much larger angle compared to the expert golfer when the arm is parallel and “open up” early in the downswing.

SLIDE: NOVICE WRIST SET

The novice golfer often does not demonstrate the rapid release of the wrist set. The wrist angle begins opening immediately from the top of the downswing and continues to open until impact. You can see this as the novice curve increases steadily from the top of the back swing until impact. No flat spot followed by a sharp rise is seen as with the expert. The novice is “casting” the club from the beginning of the down swing and will not generate much power.

SLIDE CASTING THE CLUB “GONE FISHING”

When a golfer “casts” the club as if casting a fishing line, they may also complain of these problems with their golf swing: slice to the right, pull left, over-the-top, or elbow and wrist pain. In addition to torso and pelvic stability problems (which are beyond today’s discussion), the golfer has an outside-in swing path visible on the 3-D motion analysis ― I’ll show you this in the next set of pictures. The angle between the left arm and the club shaft should be less than 90°, and should decrease early in the downswing. Casting occurs when this angle increases early in the downswing. The club head is released too soon and causes a decrease in the angular velocity of the club. If you consider the graphs I showed you earlier, you can visualize this decrease in angular velocity at impact. Although wrist problems may occur with this swing fault, the problem is NOT ONLY with the wrist, but also with an unstable lower body. Both problems must be corrected.

SLIDE SWING FAULTS RELATED TO CASTING

In this picture, the golfer’s hand comes down over the plane that it went up in. The black and green arrows show this “over the top” swing fault. This illustrates the path of the club as it travels from the outside to the inside ― you can see this path along the top of the curve. The ball will not go straight when it is hit! In this case, the ball will go to the left in a “pull” because the club made ball contact with a closed (or even straight) face.

SLIDE HAND AND KINESIOTAPE APPLICATION

Wrist injuries, particularly stenosing tenosynovitis of the extensor pollicis brevis and abductor pollicis longus, occur because of the “too much” syndrome: too much practice, too much play. The second cause of tenosynovitis is due to the poor mechanics and the chronic ulnar deviation as seen in the “casting” swing fault. The left wrist should also remain in neutral throught the backswing and impact but often goes into extension or flexion. Overuse combined with faulty biomechanics cause the tensile overload on the extensor pollicis brevis and the abductor pollicis longus. A final cause of wrist and hand pain is the “death grip” that golfers use to compensate for losing the grip at the top of the backswing. This picture shows the anatomical structures involved in stenosing tenosynovitis and the orthopedic surgeon’s solution to the problem. A more conservative treatment approach is the DeQuervain’s Kinesiotape application shown here. The tape starts at the IP joint with the thumb extended and abducted. Direct the tape toward the lateral epicondyle while the patient flexes the wrist and adducts and flexes the thumb. The central portion of the x piece is slightly stretched as it is laid down at the base of the wrist. Successful treatment of the problem also includes applied kinesiology methods, soft tissue/scar tissue release techniques, flexibility, eccentric strengthening, core stabilization, and correction of the faulty motor pattern.

SLIDE CONCLUDING PHOTOGRAPHS

In today’s example of 3D motion analysis of the causes of wrist injuries in golf you can see the enormous amount of information available for correct interpretation. It is important to combine the data obtained by physical examination, video analysis, functional performance testing, and 3 dimensional motion analysis into a complete picture of the golfer. For those of you in clinical practice and research, I hope I have given you some ideas to measure the results of Kinesiotaping. This is a picture of the port of Savannah. On another trip to Japan I saw this statue of the little girl with the red shoes in the harbor of Yokohama. In Savannah we have the waving girl to greet every ship and visitor that arrives in our port city. I leave you with another image of the marshes of Cumberland Island off the coast of Georgia. Thank you very much for your kind attention. I would be happy to answer any questions you might have.

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