Letter to the Editor. Golf as a contact sport: possible solutions

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TO THE EDITOR: I read with interest the article by Walker et al.3 (Walker CT, Uribe JS, Porter RW: Golf: a contact sport. Repetitive traumatic discopathy may be the driver of early lumbar degeneration in modern-era golfers. J Neurosurg Spine [epub ahead of print February 5, 2019. DOI: 10.3171/2018.10.SPINE181113]). I am a physician who has been a golf instructor for 8 years. Ten years ago, I started studying the biomechanics of the golf swing with the help of Mr. Jim Flick, one of the greatest instructors of all time. My goal was to simplify the golf swing and also protect the back. I applaud the authors for their attempt to identify the etiology of back problems. My opinion is that back injuries are quite rare when the spine angle, in 3 dimensions, does not change much during the swing. If the vertebrae remain parallel to each other during the swing, there is not nearly as much pressure as when a portion of the disc space is narrowed during rotation through impact. The authors are correct in identifying that the lower portion of the back on the trailing side is the most common area of injury, and this is where the disc spaces are most narrowed during torsion. When viewing videos of golf swings from face on, there is a correlation between golfers who have back problems and the amount of spine angle change from address position to post-impact position. The greater the spine angle change, the higher the likelihood of back problems.2

One should also be careful of offering possible solutions. I have found that overrotation of the trailing hip (not restriction) then requires losing vertical posture, perhaps explaining the findings of the activation of erector spinae muscles mentioned in the article.1 I am director of golf science at Jake’s Academy in Lone Tree, Colorado. In personally teaching more than 500 young students, I have never witnessed a serious back injury, and complaints of low-back pain are almost unheard of. My older students, many of them septuagenarians, are able to increase their practice times without pain. Most of these students could previously only practice a short time before they experienced back pain. Although there is much work to be done, I do feel that developing golf instruction techniques that teach 3D spine angle maintenance is the key to markedly reducing back injuries. When the spine is tilted too far toward the trailing side from the delivery position through post-impact, the disc spaces of the trailing lumbar spine are narrowed. This is when the torque is the greatest, and I feel that this narrowing plus the highest level of torque during this portion of the swing is when the majority of the damage is occurring. When the address position is maintained instead of increasing the backward tilt of the spine, I feel that most of these injuries will be prevented. I have found that my students hit the ball farther and straighter when this is accomplished. What’s good for the spine is also good for the golf swing!

Disclosures

The author reports no conflicts of interest.

References

  • 1

    Olshock R: How to Use Biomechanics to Save Your Back and Your Golf Swing: It’s All About Posture! Bryan Olshock 2016 (https://www.amazon.com/Biomechanics-Save-Your-Back-Swing-ebook/dp/B01ERG7RR6/ref=sr_1_1?ie=UTF8&qid=1549910512&sr=8-1&keywords=olshock) [Accessed July 12 2019]

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  • 2

    Olshock R: Spine movement during the golf swing. Golf Shock. February 28 2018 (https://bestgolfdrills.com/blog/golf-spine-movement/) [Accessed July 12 2019]

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  • 3

    Walker CTUribe JSPorter RW: Golf: a contact sport. Repetitive traumatic discopathy may be the driver of early lumbar degeneration in modern-era golfers. J Neurosurg Spine [epub ahead of print February 5 2019. DOI: 10.3171/2018.10.SPINE181113]

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Response

We thank Dr. Olshock for his thoughtful response and dedication to golf science from the viewpoint of a healthcare provider. A physician who is also a golf instructor brings a very unique and valuable perspective to these topics. Our interest in the golf swing and back injuries arose from experiences in our clinics while counseling patients before and after back surgeries. In Arizona, one of the top retirement states for golfers, the most common questions after back surgery are, “When can I return to golf?” and “Is there anything I can do to prevent another back injury?” As neurosurgeon scientists and golfers, we attempted to take an evidence-based approach to answer these questions. After an extensive search, sadly, we found little or no scientific literature on which to base our recommendations.

Furthermore, when discussing with our patients what other providers have counseled, we have observed that most reply with answers that are based on opinion and experience rather than on scientific fact. When counseled by nongolfing healthcare providers, enthusiasts are frequently told to quit the game. This response is not only devastating to the avid golfer but also not based on any sound scientific or physiological principle.

We believe that the time has come to look deeper into the etiology of back pain and injury among golfers, develop evidence-based guidelines for return to play, and coordinate better care among healthcare providers, golf instructors, and personal trainers. Currently, the chasm between these disciplines is broad. Golf instructors and trainers work with the goal of increasing swing speeds, which may not necessarily align with the healthcare provider’s intention to reduce spinal strain. One of our trusted advisors, Jim McLean, who is widely regarded as one of the best golf instructors of all time, identified the “X factor” as one metric that is observed in some of the golfers who have hit the ball the farthest in PGA (Professional Golfers’ Association) tournaments.2 Mr. McLean was the first to observe that John Daly, when he was young and on the PGA tour, reached a separation of the upper and lower torso of 48°. However, this separation is not achieved by all tour players, and many with smaller separations have seen success.1 The use of this metric as the only way to achieve distance, especially in an older, less flexible golfer, would be a mistake.

Mr. McLean emphasizes, and we agree, that all instruction must be tailored to the individual. Pushing someone to the maximum separation, whether it be during a golf lesson or yoga class, without proper training and assessment could be harmful and may result in an injury. It is essential to look at these observations in the context that these are measurements in young professional athletes, and although there is something significant to learn, a middle-aged amateur should not attempt to emulate these techniques exactly. The description of these techniques serves to make a point of what professionals achieve. These techniques should be attempted only in the context of a golfer’s age, physical fitness, handicap, swing footprint, and flexibility.

We believe that golf instruction should be taught on the basis of age, prior injuries, prior surgeries, handicap, and goals. The technique described by Dr. Olshock,3 in which the discs stay parallel in 3 dimensions throughout the swing, makes perfect sense to us. Decreasing the crunch during the downswing, increasing hip rotation, standing more upright, and other swing changes have been suggested to improve back pain. An analysis in a spine biomechanics laboratory would be the next logical step.

Finally, we advocate that serious golfers seek treatment and counseling from healthcare providers, whether physical therapists, sports medicine professionals, or surgeons, who appreciate and understand the biomechanics of the golf swing and the passion the golfers have for the game. These partnerships will maximize the chance of returning the golfer pain-free to the golf course.

Acknowledgments

We thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation.

References

  • 1

    Mann J: Jim McLean’s triple X-factor: a critical review. Perfectgolfswingreview.net2008 (http://perfectgolfswingreview.net/xfactor.htm) [Accessed July 12 2019]

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  • 2

    McLean J: The X Factor Swing and Other Secrets to Power and Distance. New York: Harper Collins1996

  • 3

    Olshock R: How to Use Biomechanics to Save Your Back and Your Golf Swing: It’s All About Posture! Bryan Olshock 2016 (https://www.amazon.com/Biomechanics-Save-Your-Back-Swing-ebook/dp/B01ERG7RR6/ref=sr_1_1?ie=UTF8&qid=1549910512&sr=8-1&keywords=olshock) [Accessed July 12 2019]

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Article Information

Contributor Notes

Correspondence Richard C. Olshock: rolshock@yahoo.com.INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.3.SPINE19170.Disclosures The author reports no conflicts of interest.
Headings
References
  • 1

    Olshock R: How to Use Biomechanics to Save Your Back and Your Golf Swing: It’s All About Posture! Bryan Olshock 2016 (https://www.amazon.com/Biomechanics-Save-Your-Back-Swing-ebook/dp/B01ERG7RR6/ref=sr_1_1?ie=UTF8&qid=1549910512&sr=8-1&keywords=olshock) [Accessed July 12 2019]

    • Search Google Scholar
    • Export Citation
  • 2

    Olshock R: Spine movement during the golf swing. Golf Shock. February 28 2018 (https://bestgolfdrills.com/blog/golf-spine-movement/) [Accessed July 12 2019]

    • Search Google Scholar
    • Export Citation
  • 3

    Walker CTUribe JSPorter RW: Golf: a contact sport. Repetitive traumatic discopathy may be the driver of early lumbar degeneration in modern-era golfers. J Neurosurg Spine [epub ahead of print February 5 2019. DOI: 10.3171/2018.10.SPINE181113]

    • Search Google Scholar
    • Export Citation
  • 1

    Mann J: Jim McLean’s triple X-factor: a critical review. Perfectgolfswingreview.net2008 (http://perfectgolfswingreview.net/xfactor.htm) [Accessed July 12 2019]

    • Search Google Scholar
    • Export Citation
  • 2

    McLean J: The X Factor Swing and Other Secrets to Power and Distance. New York: Harper Collins1996

  • 3

    Olshock R: How to Use Biomechanics to Save Your Back and Your Golf Swing: It’s All About Posture! Bryan Olshock 2016 (https://www.amazon.com/Biomechanics-Save-Your-Back-Swing-ebook/dp/B01ERG7RR6/ref=sr_1_1?ie=UTF8&qid=1549910512&sr=8-1&keywords=olshock) [Accessed July 12 2019]

    • Search Google Scholar
    • Export Citation
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