Injuries in Golf (P1)

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Good afternoon ladies and gentlemen. I would like to take this opportunity to thank the Kinesio Taping Association for the kind invitation to be with you today and for the hard work that has been done on our behalf in organizing this symposium in every detail. Thank you very much for your kind hospitality. I am very much looking forward to the exchange of good ideas for both clinical practice and research. These first pictures are of Savannah Georgia, where I make my home along the southeastern coast of the United States. The golf swing one of the most complex to correctly analyze, particularly with regard to the cause of many golf injuries. The topic is far too broad to discuss the injury mechanism, management, and analysis of all the injuries in this short talk. Today I would like to show you how three dimensional (I will refer to this as “3D”) motion analysis can be used to detect the underlying biomechanical problem in the golf swing that contributes to wrist injuries in the golfer. This kinematic analysis method is used to understand characteristics of movement including static and dynamic joint position, movement direction, amount and type of movement, kinematic sequence, velocity, and acceleration. A discussion of the forces acting on the body, the kinetics of motion, is beyond the focus of today’s presentation. 3D motion analysis can be a very powerful clinical and research tool in documenting the effects of Kinesiotape. In the case of golf and other sports, 3D analysis is used to analyze a sport movement to correct the cause of an injury, prevent it from occurring in the first place, and most importantly improving performance.

SLIDE: GOLF INJURIES AND BLACK MULTIPLE

Wrist injuries, especially stenosing tenosynoitis (DeQuervain’s Disease) occur frequently in golfers. These injuries are often caused by faulty golf swing mechanics which can be clearly seen on 3D motion analysis. I will also show you how other subtle factors contribute to stenosing tenosynovitis in golfers. Although the Kinesiotaping application for DeQuervain’s Disease is not difficult, the abnormal swing mechanics, musculoskeletal dysfunction, and faulty motor patterns must be corrected in order to solve the problem. Successful management of injuries, prevention, and performance enhancement are all based on a comprehensive evaluation, including physical examination, golf-specific functional performance evaluation, 2D and 3D motion analysis, and dynamic force plate analysis of balance.

SLIDE: 3-D MOTION ANALYSIS RESEARCH AND CLINICAL PRACTICE

I know many of you do not work in a sport environment. The effects of Kinesio Taping on motion can be easily and objectively measured using 3D technology. In addition to sports such as golf and baseball batting and pitching, for which we already have databases of normative values, “Real time” 3D data can be used to quantify movement characteristics following work injuries such as this firefighter, spine injuries, gait analysis, and movement as shown by this image of the lower limb and pelvis relationship during walking. These graphs of good and poor kinematic sequence (also known as the kinetic link) for baseball batting provide the sports scientist, coach, or sports health care professional with information that is invisible on video analysis.

SLIDE OUTDOOR SET UP:

This picture shows the motion analysis set up to analyze the golf swing. The SkillTech system consists of a four sensor Polhemus FastTrack System. The arrows show the location of the four motion sensors placed on the forehead, 2nd to 3rd thoracic vertebra, sacrum, and the proximal shaft of a graphite club or the dorsum (back) of the left hand. The subject stands with his heels against the white line. The electromagnetic field covers approximately 2 square meters. The transmitter is visible behind the athlete. You can ignore the globe to the right as we no longer use it in today’s data collection methods. Before the athlete assumes the starting “address” position, the system is calibrated with him in a relaxed standing position so the transmitter will know the exact orientation of the sensors space.

SLIDE SENSOR LOCATIONS:

The sensors detect motion in any direction along the red x, green y, and blue z axes once the four sensors are calibrated to the transmitter. The eight locations shown on the skeoeton are used in the full body and research systems. The data collected is analyzed and the motion is shown in “real time” using artificial intelligence. The first image shows the body from the front and you can see the position of the axes in the address position. Now you see the address position from a side view showing the orientation of the four sensors. This image shows you the top of the backsweing, just  before reversing the motion into the downswing. The final view is from the top, looking down, just impact and at the beginning of the follow-through.

SLIDE: CLUB PATH OVERLAYS

Here is an example of the multiple overlay mode of a novice, or inexperienced, golfer on the left and an expert golfer on the right. The red, green, and blue lines trace the motion path in the multiple overlay image. Let’s compare the qualitative differences between these two people. The inexperienced golfer demonstrates more side to side movement of the head and a greater excursion of the club while the head of the experienced golfer remains relatively stationary.

SLIDE KINEMATIC SEQUENCE EXPERT

SLIDE KINEMATIC SEQUENCE EXPERT

The kinematic sequence graph is very important because it gives us an idea of how the rotational speed of the body is transferred from the pelvis (shown by the red line) to the upper torso (green line) to the wrist and hands (blue line) and finally to the club (the yellow line). The “A” on the left side of the graph represents the “address” position. Between A and T is the time for the backswing. “T” represents the top of the backswing where all the lines return to zero for an instant. In an expert you can see that the pelvis and hips are the first to rotate with a sharp rate of increase. The velocities of the other segments are also increasing during this time. When the pelvis reaches its peak velocity, the energy is transferred to the upper torso, which, in turn, transfers the peak velocity to the wrist and hands. In order for the proper sequencing to occur, each segment must slow down immediately after it peaks. Ideally, peak club head velocity should occur at the time of impact, shown by the “I”. An analogy to demonstrate this is the towel snap. The followthrough occurs from “I” to “F”.

SLIDE KINEMATIC SEQUENCE NOVICE

This graph represents the kinematic sequence of a novice, or inexperienced golfer. You can see that the timing sequence is “out of synch” and there is no definite transfer of energy between the pelvis and the upper torso. Peak pelvis velocity occurs after impact. The upper torso and wrist/hand velocities appear to peak at the same time, suggesting that this golfer is using the upper body to generate all the speed. The club head velocity steadily increases to peak near the point of ball impact. The segments don’t decelerate as quickly or as smoothly as in the expert golfer. This is similar to snapping a towel with a “wimpy” wrist. Poor core strength of the pelvis and torso is often responsible for this type of kinematic sequence. The pelvis is unable to act as a stable base for the rest of the body. This is similar to attempting to stand upright on a boat in rough seas: there is no stable base for the rest of the movement to occur. At this moment you are wondering why this is important for the wrist injury I promised I would talk about. Improper timing, as evidenced by the kinematic sequence, is one causative factor for wrist injuries. The next factor is the “wrist set”.

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