Wednesday, November 10, 2010

Golfers Elbow and The Kinetic Chain

There is a much bigger picture that needs to be addressed in resolving elbow injuries, which is commonly missed. For example what symptomatically appears as an elbow injury can start as a lack of core stability, which involves a much larger kinetic chain.
The game of golf only emphasizes one side of the body; either you are a right-handed golfer or a left-hander golfer. This unilateral focus is the cause of numerous injuries. Because the game of golf emphasizes just one side of the body most golfers develop muscle imbalances and a wide array of myofascial restrictions.

Golf, in the ideal form, is all about efficiently storing and releasing energy from your core to your extremities. It involves your entire kinetic chain: from your feet forming a solid stance, up through your hips, your core and the release of energy through your shoulders, and arms right into the club head; much like a coiled spring, storing energy then suddenly releasing it.
Unfortunately, for most golfers, the spring is either broken or minimally functioning. To these golfers, the game of golf is more about learning to compensate for muscle imbalances, poor posture, and a multitude of myofascial restrictions.

Consider these common examination findings on a patient who comes in for a golfer’s elbow problem. Examination findings:
  • Rounded shoulders (anterior posture).
  • Neck and low back restrictions (hypertonic muscle, trigger points).
  • Tight restricted hips (hypertonic muscles, restricted motion).
  • Poor Balance
A tight muscle on one side of your body will always create a muscle imbalance. Muscle imbalances always create a cascade of events. Physically these imbalances create friction, this friction creates micro tears in your muscles, and then micro tears create inflammation and the formation of scar tissue. This scar tissue inhibits motion which causes numerous compensations throughout the body and an ongoing cycle of dysfunction. Each restriction that forms also creates abnormal motor patterns in the body, altering the orders in which energy is transfers from your core to your extremities. This is often referred to as the Kinematic Sequence.

In the case of a golfer, a hip restriction often causes the golfer to over-compensate with their shoulders, which in time creates restrictions in that shoulder and a corresponding alteration of their posture.

Most of these patients have developed what is called an anterior posture (C-posture). Anterior posture refers to the rounded shoulders or hunched position we so commonly see in our society. This anterior postural position can be a major factor in the formation and perpetuation of Golfers Elbow.

To see just how much shoulder position affects elbow function try this little test. Stand up with your arms down by your side in a relaxed position. Your shoulders should be back and down with the palms of your hands facing forward. Now hunch your shoulders forward, exaggerate a little, and notice how your thumbs turn inward.

Now hold this position and try to perform a golf swing with your shoulders in this anterior position, very difficult isn’t it. You are literally working against yourself, having to compensate for your position. It is very easy to see how staying in this position would create tension at the elbow. Not to mention that your swing in this position totally lacks power and control.

Yet, this anterior posture syndrome is one of the most common types of posture we see in our modern society. Just think of all the activities that you do every day to reinforce this anterior position: working on the computer, writing bent over at a desk, driving, even just standing around wait for the bus.

From this anterior shoulder position you are setting yourself up for wrist and elbow injuries. It does not matter what sport we are talking about: you will have a decrease in performance. Whatever power you are trying to release from your core will be lost in this position.

So here is the key point. What appears on the surface to be just an elbow injury could be a symptom of a much larger problem. Even if you are not aware of imbalances or restrictions they are affecting you. A strong, balanced, mobile core which also involves unrestricted hips and mobile shoulders in the right postural position is essential. Not only will you prevent injuries from occurring but you will have a much better chance of permanently resolving them. Best of all, you will excel at your golf game or what ever sport you are playing.

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