Spine in Sports Tennis Golf and Elite Athletes

1. Spine in Sports Tennis Golf and Elite Athletes Walter Taylor MD Matthew Serlo MPT Stephan Esser MD, USPTA

2. Goals • Review Spinal Anatomy • Engage the stats • Epidemiology of Injury: • Visit the Links: Pro vs Amateur • Courtside: Pro vs Amateur • Concepts in Rehabilitation • Take Homes

5. 80% 10%

6. Tennis Injury • BJSM 2006: Pluim et al • Injury incidence 0.05- to 2.9 per player per year • Per hour of play 0.04- 3.0 injuries/1000 hours • Junior Rugby 56.8/1000hrs JSMS Gabbett 2008 • Gender: slight inc in men > women • Age: as age increases, risk of injury increases • Volume: Unclear risk (tennis elbow)

7. Tennis Injury • Abrams et al BJSM 2012 • LE>UE • LE: ankle sprains, thigh strains, GS strain, Achilles • UE: lateral epicondylitis, rotator cuff • Back

8. Tennis and the Spine • Is tennis a risk factor for back pain or spondylosis? • Hutchinson et al 1995:LBP #1 injury over 6 yrs in adol. elite • Guilodo et al 1999: 633 subjects, No difference in rates of low back pain between recreational players and non players or in recreational players based on volume of play • Marks et al: 38% of 143 ATP players missed at least 1 tournament due to back pain • Alyas et al 2007: MRI LS 33 asymptomatic elite juniors • 5 normal MRI’s 28 Abnormal (84%) • 23 with early facet arthrosis L5/S1 L4/L5 • 9 Spondys (L5), 2 with G1 and G2 –listhesis • 2 acute/5 chronic stress reactions of the pars • 13 with disc dessication, disc bulging (39%) Kjaer et al. Spine, 2005: 13 y/o MRI 33% with disc dessication

9. Golf and the Spine • A One-Year Prospective Study on Back Pain Among Novice Golfers J Sports Med September 1996 vol. 24 no. 5 659-664 • 8% 1st time back pain, 45% had recurrent back pain • One-Year Follow-up Study on Golf Injuries in Australian Amateur Golfers Am J Sports Med August 2007 vol. 35 no. 8 1354-1360 • 15.8 injuries per 100 golfers, which equates to a range of 0.36 to 0.60 injuries/1000 hours/person • 18.3% lower back, elbow/forearm (17.2%), foot/ankle (12.9%), and shoulder/upper arm (11.8%). • 46.2% injuries during the golf swing • At ball impact (23.7%), follow-through (21.5%).

10. Back Pain Stats • > 80 % of Americans in a lifetime • ≈ 30 % at any given time • 2nd leading reason to see a doctor • Spending ≈ $85.9 billion • Among Athletes highest rates: • Football, gymnastics, wrestling etc.

11. Golf: • The Epidemiology of Injury • Investigating the cause • Pro vs Amateur

12. A good swing starts with a good set-up

13. Neutral Spine • The least stressful position where a vertical force extended through the spine allows equal weight transfer to the weight bearing surface.

16. Hosea, T et al InFeeling up to Par: Medicine from Tee to Green, 1994 • Amateur golfers generate significantly greater peak shear and lateral bending forces and greater torque than professionals • Pros use 50 % less muscle activity, yet generate 34 % more clubhead speed

17. Maximum Velocity During Swing(Degrees Per Second) LPGA PGA Hip turn 536 451 Shoulder turn 692 713 Arm velocity 1082 1151 Club velocity 1688 2102

18. Injuries Rates in Golfers • Professional Golfers- 85% • Hand and Wrist • Back • Elbow • Shoulder • Amateur golfers-62% • Back • Hand/Wrist • Elbow • Shoulder

19. Professional Golfers Injuries 27% Left wrist 24% Low Back 7% Left hand, left shoulder, left elbow 3% Right wrist, right shoulder 3% Left thumb

20. Amateur Golfers Injuries • 35% Low Back • 33% Elbow • 18% Left Wrist/Hand • 12% Shoulder • 6 % Knee

21. SWING PHASES AND INJURY RATES • Downswing / Impact responsible for 50% of injuries. • Follow-through responsible for 30% of injuries. • Take-away / backswing responsible for 20% of injuries. • Nearly 70% of injuries caused by repetitive practice swings (only 7% during competition)

22. Most Common Golfing Injuries Back • Muscular strains/spasms - erector spinae muscle group • Ligament sprains • Vertebral disc damage/displacement -Herniated disc – disc protrudes out from back -Ruptured disc - disc nucleus ruptures

23. Causes of Injuries • Limited Flexibility • Decreased Strength • Poor Posture • Balance • Inappropriate Warm-up • Inconsistent Swing • Swings Too Hard!!

24. THE GOLF SWING • Only necessary element required to hit good shot • Proper swing path • Only thing that can impede the swing path • The golfer’s body

25. Keys to Preventing Injuries • Physical conditioning before play !! • Condition body to play • Professionals practice 10-12 X more than they play • Warm-up before playing • 10 minute golf /tennis warm-up • Improve flexibility & strength prior to season

26. Tennis Injuries http://2.bp.blogspot.com/-VuCL0SXN-Rs/T58nY7UYTYI/AAAAAAAAAHY/BAn1vaVu_JA/s1600/Andy+Roddick+Serve.jpg www.tennisforyou.com

27. Tennis: • The Epidemiology of Injury • Investigating the cause • Pro vs Amateur

28. Taylor Slides

32. REHABILITATION OF THE GOLFER/TENNIS PLAYERSwing Analysis • Consultation with a Professional Instructor • Analyze swing • Identify imperfections • Develop drills to correct • Practice, practice & practice For Swing correction to be effective must properly condition

33. Patient Evaluation • Physician Diagnosis • Medical History • Diagnostic Test Results • Physical Evaluation • Malalignments…MUST be addressed first!

34. Treatment Techniques • ASTYM • Graston • Dry Needling • ART • Mobilization • Muscle Energy

35. Posture Flexibility “Core” Isotonics Proprioception Plyometrics Yoga Pilates

36. Most Valuable Tools

37. Rehabiliation…Specific

38. Rehabilitation…Functional

39. Rehab…Sport Specific • Sport Specific

40. Structure Governs Function • Structure…posture, strength, flexibility, balance. • Function…set-up, grip, planes of movement, club/racquet path, angles, club/racquet speed, power, game skills, consistency

41. Conclusion • Back pain is common • Tennis and Golf may increase the risk • Essential Prevention: • Technique, Conditioning, Volume • Rehabilitation: • Sport Specific, Functionally based, Multi-modal, Hands on

42. Thank You!