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"The golfer's knee"
from golf-physiotherapeutic and sports medical examination
Introduction:
The analysis of a golf swing from functional anatomical and biomechanical point of view: Over the
years, Tiger Woods (TW hereafter) golf swing analyzed by "specialists" (Tiger Woods, for over a
decade, was the number one professional golfer). During this time, some concern about the socalled momentum levels in the different phases of his golf swing, ball flight distance and an
admiring wonder at his most dynamic golf swing.
Fig. 1: The “disaster” points already present. Tiger Woods complaints
about the left knee already show up walking.
In 2002, we turned our attention to an analysis that reflects
functional anatomical and biomechanical movements of his golf
swing, especially teeing off2 with the driver1. Usually a driver is
used to tee off, or start each hole on up to 18 holes per round.
The driver is the club that hits the ball the furthest due to the club
shaft length, weight and loft4 of the club head. During this first hit
with the driver the most dynamic body rotation and body
translation is generated.
Analysis of a full golf swing with a driver using a functional anatomical and
biomechanical point of view.
(Sample video clip, YouTube: http://www.youtube.com/watch?v=zGu1o-cL024)
In a golf swing analysis basic guidelines are used. Due to the complexity of the movement
sequence, using an isolated analysis of a joint is not advisable. The joints and body parts should
only be examined as part of a complete golf swing. The approach should be done starting from the
feet, the knees, hips, torso, head posture, arms and hands.
Analysis:
In the address position of the ball, the feet are aligned in parallel, thus the shear forces are
increased on the left ankle, knee and hip (see Fig. 2).
Fig. 2: The parallel stance causes high axial torques in the leg axis
and is therefore from a preventive sports medicine biomechanical
point of view is not recommended.
At the start of the golf swing an up and down movement of his body is particularly striking. This
extremely fast and dynamic body rotation can only performed by TW due to strong abdominal
muscles and core muscles which stabilize the pelvic.
The down swing begins with a translation (shifting) of the pelvis toward the target. Through the
volitional rapid dynamic pelvic rotation of TW, a large angular momentum is produced. The dive
(down movement) in the down swing till the impact hampered the body rotation, it thereby
(certainly) causes increased reactive forces on the joint, ligament and tendon structures. Through
the power development of the pelvic rotation and the downward vertical changes in posture, he
causes his body weight to create a lot of pressure on the right forefoot; possible consequences are
an overload of the transverse and longitudinal arch, the sesamoid bones and the
metatarsophalangeal joint of the foot as pressure distribution measurements have shown on several
patients. Due to the large tensile stress of the Achilles tendon (right) complaints are inevitable. He
has no choice but, in fractions of a second, to push through the left leg quickly, to bring his body
out of the way, in time (Fig. 4). As a result of the dynamics of TW swing he lifts his left leg off the
ground, and rotates the pelvis to the target (Fig. 3).
The left knee is stretched very quickly and is hyper extended which causes a lot of shear stress.
During each shot the boundary movement of the left knee is exceeded, and thus given an overload
of both cruciate ligaments and the patellar cartilage. At the end of the swing the left foot is no
longer parallel, but has rotated approximately 40 degrees to the target (see Fig. 4).
This is the only way that a free swing with torso, arms and club is possible!
Fig. 3: Swing sequence impact: TW left
foot loses contact with the ground
Fig. 4: Swing sequence follow through:
TW hyperextension in left knee
f
l
ih h
d
Resulting physical discomfort and damage due to TW unfavorable biomechanical motion
sequence in the full golf swing.
Left: capsule and ligament irritation, damage to the meniscus, torn ACL / chronic strain, overload
fracture
Right: cross-bands irritation in the foot arch and Achilles tendon
Consequences of golf physiotherapy and sports medicine perspective.
In TW modified golf swing, the address position changed from a parallel stance to an opened,
somewhat narrower open stance (slightly left of the target line with left toes pointing to target).
(see Fig. 2 and 5)
Fig. 5: The opened, somewhat narrower stance left of the
target; with left toes pointing to target facilitates the swing
through and relieves ankle-, hip- and knee joint.
Particular attention must be placed on the condition of
the musculus biceps femoris, which works as part of
the antagonist of the anterior cruciate ligament, and
the other so-called hamstrings muscles. This standing
position reduces the shear forces on the left side of
ankle, knee and hip. The fact that TW tries to keep his
right knee bent during the back swing, the up and
down movement (Vertical) has decreased. The beginning of the down swing is equally dynamic,
rather than uncontrolled explosive. Pelvic and trunk have room to rotate toward the target. Thereby
enough time remains on his right side to release his right foot on the inner edge at the beginning of
the down swing. The unnecessary stress situation for the right transverse arch of the foot and
Achilles tendon is defused. Because of the controlled dynamics at the beginning of the down swing
until impact, time remains for a more optimal biomechanical movement and weight shift to the left
towards the target. The left knee should remain slightly bent in this case, to reduce the shear
forces. The axial rotation is reduced and it will reach a chain reaction of biomechanically optimized
motion in the joints and lower back, hips and left knee. It should be noted that the mass of golf club
and the arms is shifted close to the axial center of rotation. The lateral flexion of the trunk is greatly
reduced and reaches a reduced compression of the lower back and the intervertebral discs of the
lumbar spine. In this context it is worth noting that even his manner, as long as possible „to keep
the head down" after the impact, has changed dramatically, by turning harmoniously the head
together with shoulder girdle towards the target. Who says there's "Keep your head still"? Thus
these positive biomechanical chain reactions, the final position of his feet is stable.
In addition, the rotation of the thoracic spine in the final position of the golf swing has been reduced
significantly. At the end of the golf swing (Finish) the torso is more upright.
A chronology of Tiger Woods' injuries:
December 1994:
Surgery to remove two benign tumors and scar tissue in his left knee.
December 2002:
Knee surgery to remove fluid around the anterior cruciate ligament.
July 2007:
Ruptures the ACL in his left knee while running on a golf course
April 2008:
Arthroscopic surgery on his left knee to repair cartilage damage.
June 2008:
Two stress fractures in his left tibia.
July 2008:
Reconstructive surgery on the ACL in his left knee, also repairs cartilage
damage.
December 2008:
Ruptures right Achilles tendon while rehabbing from knee surgery.
May 2010:
Joint inflammation in his neck.
December 2010:
Cortisone shot in his right ankle because of lingering soreness in his
Achilles.
April 2011:
Hurts his left knee .Minor sprain of the medial collateral ligament in left
knee and minor strain of his left Achilles tendon.
(Source: The Associated Press, 2012)
Remarkable citations Tiger Woods:
Tiger Woods 2005: “I snap my left leg for more yards.” (Source: Golfchannel)
Tiger Woods 2011: "My goal is to synchronize hip and leg in order to consistently produce accurate
shots." (Source: Golfchannel)
This realization would be consistent with the preventive, biomechanically optimized golf swing from
the perspective of golf-physiotherapy, so an "en block" rotation of the body to the target.
Note: As often as Tiger Woods chose the next best thing by damage ...
Physiotherapy treatment approach in practice for the golfer / patient - this in reference
to the swing analysis from TW.
The vast population is right handed and thus likely also the muscles on the right side of the body to
be slightly more developed than the left. For a right-handed though the left side of the body is more
stressed in the golf swing. The body dynamics developed in the golf swing, which begins shortly
before the end of the back swing, with the weight shift to the left, must be slowed in its power peak
at the moment of impact and follow through of the golf swing with the left side of the body.
In our survey findings, therefore, always a first focus is on the condition of the muscles to throw.
We begin, as in the analysis of the golf swing, from bottom to top. Of great interest due to the
stabilizing function on the left side of the body are musculus tibialis anterior, musculus peroneus
longus and previs, musculus gastrocnemius lateral head, musculus popliteus, lateral head of
musculus quadriceps, musculus biceps femoris and the iliotibial band with musculus gluteus medius.
Reasons:
The musculus popliteus together with the musculus biceps femoris the most important postlaterale
stabilizer of the knee, the musculus biceps femoris works as well as a partial antagonist of the
anterior cruciate ligament. The two collateral ligaments are tight in extension of the knee joint and
contribute to the stabilization, at which the lateral ligament is much stronger under tensile loading.
(HOCHSCHILD J.)
By 1000-times repetition the knee is heavily loaded of the extended position of the left knee during
TW golf swing. The consequences are often irritating to capsular ligaments with additional cartilage
damage. Due to the constant tension of the musculus gastrocnemius, the back buffer / Bursa is
pressed. Tears of the inner meniscus are the result.
To the anterior cruciate ligament prevent hyperextension of the knee and is tense in the stretch.
With extension in the knee an axial rotation is almost impossible. Collateral ligaments and cruciate
ligaments are strained. Through fast, dynamic, powerful movement that will exceed locking of the
knee joint and certainly leads to damage of the knee in the long term. (KAPANDJI)
Conclusion:
In the earlier analysis of the golf swing from TW, though the technical side of golf was assessed and
his golf swing to the "swing pattern" highly praised, but was left to the health aspect in mind and
has underestimated this. By 1000-times repetition from the perspective of functional anatomy and
biomechanical dubious movements of TW golf swing, manifest the physical discomfort and
consecutive damage.
There is an erroneous belief that the consideration to the health of the golfer in the golf swing at
the expense of the striking distance and dynamics of the golf swing. This raises the question of
what makes a reduced ball flight distance of 10 - 20 yards at a ball flight distance from over 300
yards, teeing off with a driver? Instead, the golfer wins by a preventive, biomechanically optimized
golf swing a joint-gentle swing, reduction or prevention of physical noticeable problems, disorders
and injuries. The injury-related training and play breaks almost leave off and the shout is probably
more often on the fairway3.
Every golfer, regardless of skill level, has to confront a future with new knowledge of biomechanics
and golf physical therapy to
- prevent injuring yourself as a teenager
- practice the beloved sport of golf as an amateur as long as possible
- play successfully as long as possible in professional golf, without risking serious signs of
wear in the human body.
Sample clip for this scientific article „The Golfers Knee“can be watched at:
http://www.youtube.com/watch?v=zGu1o-cL024
1
Driver = Longest club with the lowest loft, used to hit the ball farther than any other golf club.
Teeing off = First shot on each hole, played from a tee box
3
Fairway = The area between the tee box and the putting green where the grass is cut even and
short.
4
Loft = The angle of the face of a golf club
2
Authors:
Dieter Hochmuth, GolfPhysio-Trainer, Senior Head-Instructor
DOSB Sportphysiotherapie (Lic. since 1980)
D-92245 Kümmersbruck
www.sprotmed-prof.eu
Oskar A. Schmid, Profesor visitante Universidad de Buenos Aires, Dr. med.
Orthopädie und Unfallchirurg, Sportmedizin
Golfklinik und Praxisklinik Nittenau
Chairman of the scientific commitee of the European Association GolfPhysioTherapy &
GolfMedicalTherapy e.V.
D-93149 Nittenau
[email protected]
with:
Markus M. Ernst, GolfPhysio-Trainer & GolfPhysio Therapist, Head-Instructor USA
Physical Therapist (BoA the Netherland)
Director of G-PT.us - First institute in golf specific education for health care professionals
80907 Colorado Springs
www.g-pt.us
References:
List of illustrations:
Fig. 1: sf-gate.com
Fig. 2 and 5: G-PT.us, Education USA: Golf-Physio-Trainer lecture notes, 2012
Fig. 3 and 4: G-PT.us, after screens Video clip YOUTUBE
List of literature:
GOLFCHANEL 2005 und 2011
HOCHMUTH D., HAID CH.; Der präventive, biomechanisch optimierte Golfschwung, 2005
HOCHMUTH D.: TopGolf, SportMed-Prof Marketing e.K., 2010-2012
HOCHSCHILD J.: Strukturen und Funktionen begreifen, 2. Auflage Thieme, 2002
KABANDJI: Funktionelle Anatomie der Gelenke
KENDALL F. und KENDALL E.: Muskelfunktionen und Test, 1988
G-PT.us, Education USA: Golf-Physio-Trainer lecture notes, 2012
THE ASSOCIATED PRESS 2012
YOUTUBE: http://www.youtube.com/watch?v=zGu1o-cL024