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The Good Life

The Golf Injury Epidemic

Sports physiologists suggest the modern golf swing may be triggering more and more professional golfers’ injuries
By Jeff Williams | From Rob Lowe, July/August 2014
The Golf Injury Epidemic
Photo/Charlie Riedel, File/AP Photo
When Tiger Woods was young, all golf records seemed within his reach. But by 2008, left leg stress fractures and a torn ACL in his left knee hobbled him.

For nearly two decades we’ve watched Tiger Woods climb to the top of golf’s Mount Everest, reaching the pinnacle of success. We’ve watched him smash drives and caress putts, that combination of power and skill adding up to 14 major championships and more than $100 million in PGA Tour earnings.

But doesn’t it seem that over the last decade we have also watched a limping Tiger, a cringing Tiger, a flinching Tiger? He won his last major, the 2008 U.S. Open, hobbling with two stress fractures in his left leg and a torn ACL in his left knee (and had a subsequent fourth surgery on that knee). And this season was significantly interrupted when he had back surgery at the end of March, forcing him to miss the Masters and the U.S. Open, and seriously calling into question his ability to ever overtake Jack Nicklaus’ record 18 major championships.

Since he burst onto the scene with two victories his rookie year on tour in 1996, followed by his 1997 Masters win, Woods has been the Tour’s epitome of achievement, it’s shining example of athletic professionalism. Yet he is now also the perfect example of what the modern golf swing can do to the body. Woods’ injuries didn’t come from being repeatedly crunched by 260-pound linebackers, or checked into the boards by flying defensemen, or hammered in the paint by 6' 10" power forwards.

No, Woods’ injuries, like all golf injuries, are self-inflicted. They are the product of a singular athletic movement repeated millions of times by the game’s professional elite over the thousands of hours of practice the sport requires to reach the promised land of Tour golf. Woods is notoriously secretive about his injuries, and in Hank Haney’s book about his time coaching Tiger, Haney cites sources as saying that Woods’ left knee was re-injured in Navy SEAL training in 2007. But there also was no question that Woods’ violent downforce move against his left knee ultimately wore it out, and part of Haney’s brief was to
develop a swing that took some of that downforce away from it.

As a golfer, Woods really wanted to be considered an athlete, and the core of his injuries stem from the endless athletic strains that golf put on his body.

Ben Shearer is a golf fitness expert who has worked with PGA Tour players for years (Luke Donald, Webb Simpson and Jason Day are among his clientele). He has a business in New Jersey, Ben Shearer Golf, works with the Titleist Performance Institute and is director of performance for Golf & Body, a golf teaching and wellness facility in New York City. Injured players are part of his portfolio and he isn’t the least bit surprised that the noncontact game produces significant implosion.

“At the highest level, most of the tour players have been hitting millions of balls, hitting massive amounts of balls starting at 5, 6, 7 years old,” says Shearer. “The biggest problem with golf is that it is a single-side rotational sport. You are just winding up, then crunching everything down. As a right-handed golfer there is this buildup on the back swing, then this whipping down and through-action getting to your left side. You are coupling that with what we call flexation rotation. That means I have forward bending, side bending and rotation coupled together. I’ve pressed down on a lot of stuff going on in my spine, a lot of compressive force.

“It’s a game from where you are going from not moving at all, zero miles per hour, to 110, 120 miles per hour in 1.5 seconds for a typical tour player, back down to zero. That’s a lot of force, a lot of torque, a lot of stresses put through the body. Multiply that by millions of swings. It’s a miracle to me that more guys aren’t injured.”

Self-inflicted wounds have trashed the careers of several top players. The late, great Seve Ballesteros developed severe back problems in the late 1980s that corrupted his sublime game. His trials and tribulations of playing while trying to compensate for the shooting pains in his back were hurtful to his millions of fans around the globe. David Duval, the 2001 winner of the British Open and a former No. 1 player in the world, lost the handle on his game when his back started giving him fits more than 10 years ago.

South African Trevor Immelman, an up-and-comer when he won the 2008 Masters, virtually disappeared after developing a problem in his left wrist that required surgery. Fellow countryman Retief Goosen, twice a U.S. Open champion, nearly had to give up the game before disk-replacement surgery seemed to salvage his career.

Then you have the ongoing back difficulties of the ever-popular Fred Couples. Couples won only one major, the 1992 Masters, but was universally considered to have the potential to win many more. But on the driving range at Doral in 1994, he injured his back and from then on, his back became the central complicating issue of his game. He credits a German doctor who uses a blood-infusion technique known as Orthokine for repairing some of the damage, and allowing him to get on with his career. Vijay Singh has also traveled to Germany for the procedure.

Jeff Poplarski is a Long Island chiropractor who has been running the U.S. Open Wellness Center for players, caddies and volunteers since 2002. He’s particularly attuned to golfers in his practice and greatly admires Tiger Woods’ accomplishments while also attributing to him a rash of injuries in the sport.

“Golf has changed drastically and it’s because of Tiger Woods,” says Poplarski. “Prior to 1990, there was something called the triangle of development of golf, how a golfer was built. They hit balls when they played; playing the game was part of their development, they were fitted for clubs, for grips, and there was the mental aspect of the game. Gary Player and a couple of other players were into the fitness aspect.

“Tiger Woods comes along and is doing the triangle of development of golf, but also doing a hell of a lot more than that. He’s dealing with a fitness coach, a strength coach, a chiropractor, a nutritionist. A lot of people didn’t think you needed that, then he won the Masters by 12 strokes and U.S. Open by 15 strokes, so the game has changed. That leads into, what are the mechanical forces of the golf swing and the effect on the body? This sport has more injuries than any other sport.”

Both Shearer and Poplarski believe the modern golf swing is more violent and potentially self-destructive than in generations past. The swing is the thing in golf injuries, but Poplarski uses an interesting term, disassociation, in talking about those injuries.
“The modern swing is more violent than the older swing. I would agree with that,” says Poplarski. “There is a word in golf called disassociation. What that means is moving one body part and leaving the other body part completely still. From your belt buckle to your feet, not move them at all, and take your upper body and rotate it on that bottom part that is completely stationary—that’s called torque.

“Most modern golfers are taking that upper body and torquing it in relation to the lower body that’s not moving. That creates the whip. That’s why they are driving it 330. Pro golfers are pushing the body to extremes that you wouldn’t associate with golf.”

Shearer, in his work with tour players, sees this all the time. “The modern golf swing is way more stressful than the swing of the past,” says Shearer. “Older days, a lot of the speed came from a whippier shaft. Guys would pick up that left heel, release a lot of torque in the backswing. A lot of them would have their front foot flared out some, not so square to the target line. That took out a lot of stress from the hip and the knee. That created less pressure on the body in the backswing. The modern professional golf swing is this really ‘stiff-metal-shafted.’ That means you are going to have to create more torque to flex that stiff shaft. Modern golfers have the front foot planted and way more square to the target line, stabilizing the lower body and turning the upper body more.

“The ‘reverse C’ [the old description for the arched back on the follow through] put pressure on the body differently. They could be banging the bones together with that swing and creating stress that way. The modern swing is a tension, torque-driven stress as opposed to a positional stress, if that makes any sense.”

Jeff Hendra sees the consequences of the modern golf swing on a daily basis. He is the lead fitness director for the PGA Tour and you can find him in the Visionworks physical therapy trailer at PGA Tour stops (there is also a fitness trailer). Plenty of players visit him every week.

“The nature of the golf swing, being as repetitive as it is, the rotational torque it puts on the lumbar spine being as much as it is, puts a huge toll on the body,” says Hendra. “Even if you are doing the right things physically, it’s still going to break down. It’s the nature of the game.

“What we see in the truck is 50 percent low back pain. A lot of it is muscle related, a lot of it is facet-joint related, [facet joints allow the spine to articulate]. A lot of it is just muscle imbalance. A lot these guys, they are doing the same thing over and over, they wear themselves out using the same muscle over and over. The golf swing has gotten more physical over the years.”
Hendra wasn’t a golf fitness guy until a company he worked for got involved in the game. He was a hockey player and trainer for a while, tending to wounds in the sport that could be acute, even frightening.

“When I first came out here from a hockey background, people are asking me what am I doing,” says Hendra. “My hockey friends are saying, ‘What are you doing with those guys? They don’t get beat up.’

“The biggest thing is the repetitive nature of the game, overuse injuries. In hockey, football you see things that are more acute, broken bones, torn ligaments, joint dislocation. We seldom see that kind of thing out here. We see repetitive wear and tear. They break down, get beat up almost as much as other athletes do. We do have herniated disks, joint degradations that can become career-threatening injuries.”

So much of the stress of the golf swing comes from having to contain so much of its energy. Other athletes release the energy from their bodies when they make their athletic motions. Golfers stand still, pose.

“In most sports the decelerating, the slowing down of the muscle movement—we call it E-centric contraction—you don’t get hurt jumping, you get hurt when you hit the ground,” says Shearer. “People get hurt running when they want to cut back, jam that foot into the ground, that ankle, that knee, that hip—pop, there it goes—that deceleration of all that force.

“In golf everybody wants to have this beautiful, balanced looking finish to the swing. You only have a third of the total body motion to stop that swing and hopefully you are delivering the clubhead to the ball with optimal speed through the ball. So I might have a half second to stop the club, hold in balance and look really pretty for the TV camera. That is a very stressful containment that the body has to absorb.”

That picture-perfect swing of the modern pro is a devil in disguise. “You look at Ernie Els, the Big Easy, he looks like he’s not even swinging,” says Shearer. “Well the guy is swinging about 118 miles per hour. The guy is flying. You can hear a pro tell some amateur on the range you are swinging out of your shoes, slow down, and that guy is swinging at 80. What you visually see and the reality are two different things. It’s the relationship of the body parts and the mechanics that can make a swing look smooth and flowing, versus fast and herky jerky. The reality is that Ernie is swinging 40 miles an hour faster than that guy at the country club who is being told to slow down.”

Pro golfers can’t slow down. In a sense, their careers are on the line in every tournament they play in. Winners have more certainty in their careers, but they know that those careers can be on tenterhooks (and slices).

“Being healthy is No. 1 for a golfer,” said Shearer. “At the end of the day, this is not baseball or basketball where you have a $10 or $20 million contract where even if you sit on the IR you are getting paid anyway. “I’ve with worked a lot of other athletes, Olympians, pretty much every professional major sport I’ve trained people in, and I’m asked why am I fascinated with golf. Golf is the ultimate sport in which you have the ballistic rotary power of a shot putter combined with the fine motor control of a marksman. And you are training both of those at the same time.”

Shearer is trying to strengthen some muscles, provide flexibility throughout the body, doing what he can to mitigate the explosive force the body is subjecting itself to in the swing. Poplarski expresses that force this way: “I work with a lot of runners. When you run, that’s about five times your body weight into the lower back. If you are a 200-pound person running, the compression of hitting the ground from the feet through the ankles and knees and into the back is 1,000 pounds every time you hit the pavement.

“From some of the studies I’ve seen, it could be eight to 14 times your body weight with a golf swing, with a drive. I had a hard time understanding that at first. I did a little probing into that. You get three patterns of movement in the back in a golf swing. You get a rotation, blocks of bones rotating on each other; you are getting a compressional force in the body because you go up and come back down; you also get a lateral shearing on the vertebrae. You are actually getting three vectors into the lower back that increases the pressure on the lower back to 10 to 14 times your body weight.”

To try to counteract all this force to the joints and muscles, Hendra and his associates in the Tour’s therapy trailer try to strengthen core muscles and keep those rotational muscles flexible.

“What our guys really focus on are the big muscles, the glutes,” says Hendra. “We kind of joke in the business that it’s all butt and gut. Glutes and abs [abdominals], butt and gut. You want to keep the glutes firing, and you want to keep them very flexible because you need the hips to be mobile. You need to keep the left hip joint really mobile because if that doesn’t happen, if one part of the body tightens up, another part has to compensate for it, and that can be in the lower back. If the hip joint tightens up, the lower back takes the brunt of the force.”

There are a range of exercises that can strengthen muscles and also keep them flexible, but every body is different and every swing is different. Shearer knows he has to be careful in training his elite players.

“If I make you more ballistic and explosive, and you lose your touch and feel, I’ve made you worse,” says Shearer. “If I work on the fine motor control so that you lose some of your power, I’ve made you worse. Very few sports take you through such extreme ranges of motion. Golf has massive range of motion of the spine, the hips, the arms, the shoulders; the combination of flexibility and stability, meaning I have a big enough range of motion to have a good technical golf swing, but I have enough stability to control the motion. [That] is where the magic lies.”

Tiger Woods has produced his extraordinary magic, all the while fighting through his litany of injuries. The back surgery is his latest episode, his left knee his most chronic problem, his right Achilles tendon an off-and-on bother. His left elbow gives him a zing every once in awhile.

Woods was chipping and putting by the end of April, though unlikely to make any rushed return. Retief Goosen knows that the pain of back injury is difficult to overcome. He knows how it erodes the physical talent and the mental confidence needed to play at the highest level. Even with disk-replacement and the subsequent lessening of pain, Goosen has trouble standing over a shot with the full confidence of a PGA Tour player.

“Your nerves go and your sense of self-confidence goes,” says Goosen. “It’s hard to get down and bust a shot. You start steering it and not trusting the clubs . . . It’s a difficult road back.”

“If anybody could come back from this close to 100 percent and come back in a quick fashion, you know it’s going to be Tiger Woods,” says Poplarski. “Knowing what he’s about, his dedication to his body and the game, his drive is second to none.”
Yes, but is it that very drive that has ultimately worn out the ultimate golf body?

Hendra says that a golfer needs to be fit, though probably only as fit as his body can stand. “I think sometimes with personal trainers, these [players] get after it so much they sap their energy in the workout,” says Hendra. “Some have gotten a little too intense with it. I think there is a limit with the pro golfer as to what they should do . . . Not to pick on him, but the Kevin Stadlers of the world, people look at him, at his build, and he can do very well in the golf world and win. That’s a true golf mentality. This is still a game where the fittest do not always do the best.”

Jeff Williams is a Cigar Aficionado contributing editor.


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