Incorporating a golf fitness program as an adjunct service gives your practice a competitive edge.

Golf is riding a popularity wave primarily due to "Tigermania," which started a few years ago. As participation increases, so do injuries. This is a definite opportunity for many chiropractors to assist the physical challenges of both professional and amateur golfers in a traditional treatment setting or in a specific golf fitness training center.

Within the past few years, there have been several golf fitness programs offered at chiropractic colleges, as well as several independent groups. Chiropractic has recognized the huge market potential with so many golfers looking for an edge to improve their game.

Fits DCs to a Tee
How does the average DC attract the golf athlete? Most of us have had our share of current and former patients who seek us for low back pain aggravated on the links, driving range, or even pulling the clubs out of the car trunk. I am often asked, "Is golf bad for the back?" Most golfers bring their bad backs to the course. A biomechanically unsound golf swing does cause an increase in the shear, torsion, and compressive forces on the spine. However, a smooth or quiet swing, as used by most professionals and low-handicap amateurs, causes no more incidences of spine injury or trauma than other sporting activities.

Golf-specific conditioning exercise

The primary problem is that most amateur golfers are deconditioned relative to the back and core musculature. Low back pain remains the number one complaint on all professional tours, as well as in the amateur ranks. The sports-oriented DC is well positioned to care for these acute and repetitive stress back injuries. Specific treatment for these spinal conditions can be as simple as an adjustment or two on certain spinal segments with specific golf stretches or as complex as going to the driving range with patients and their trainers/coaches to analyze biomechanical swing faults.

After acute issues have been addressed, chiropractors can encourage patients to consider the conditioning and fitness side of their game. Most serious golfers usually agree to this if the goal is to improve their game, increase overall fitness level, and to minimize reoccurrence of injury. It is a good idea to have a separate "low-tech" training room with mirrors and high ceilings for the golfer to swing freely and receive appropriate feedback. I try to schedule these patients at specific times of the week set aside for personal training. Patients are aware that this is a separate service from their usual chiropractic treatment and are financially responsible for these golf treatments.

The Core Philosophy
My physical training/rehabilitation philosophy for all patients/athletes is: 1) train the body from the core (the body excluding the arms, legs, and head) outward and 2) whenever possible, train in this sequence—stability/balance followed by flexibility/strength, and ending with power/endurance, always emphasizing movements over muscles. There will be a training overlap in these different areas, but always have at least a base level of core stability before moving into specific strength and power training.

For the stability/balance portion of the program, incorporate simple exercises such as balancing on one leg with eyes open and then eyes closed for 30 seconds. You will be amazed at the high percentage of patients and athletes who cannot perform this simple task, especially if they have had a previous ankle injury. Wobble boards and walking on a 4x4-beam are also tools to use. Remember, the upper cervical spine as well as the ankle joints are the two most highly innervated areas of the body relative to proprioceptive input.

Core stabilization exercise

Gym ball training is the best way to train the core for stability and balance. However, ball training requires a clinician’s expertise and assistance early in the program. Do not forget to evaluate the feet for pronation, as a balanced foundation is critical for proper footwork in the weight shift of the golf swing. Later in the program, patients can swing a club with the feet together, then one-leg standing swings with emphasis always on maintaining athletic balance, proper golf posture, and a constant spine angle. Liebensons’ text¹ is an excellent reference for core stability training.

After golf patients have demonstrated that they can perform certain stability/balance tests (which can take a few days to several weeks), then they are ready for flexibility and general strength training protocols. The lower crossed syndrome and associated muscle imbalances are one of the first areas evaluated. A good reference for these common muscular imbalances in the golf athlete is Seaman’s seminar workbook.² The very nature of the golf swing tends to bring on some imbalances as opposed to other more bilateral sporting activities, such as running or swimming. I recommend incorporating dynamic flexibility/strength training. Gym ball stretching, especially for the core, is where I start most of my golf athletes.

Next, introduce various forms of golf-specific static stretching, as well as advanced dynamic principles. Examples of dynamic flexibility training for the lower extremities are lunge-walking—forward, backward, and then lateral motions. With emphasis on strict form and complete range of motion, a high degree of flexibility as well as significant strength gain can be attained.

Balance and coordination exercise

Golf is rotation—therefore various forms of proprioceptive neuro-facilitation (PNF) are directed to the hips and thoraco-lumbar spine, which can create a tremendous increase in overall rotation in the average golfer. Access to a fully equipped gym is not necessary for a thorough workout. Athletes should be able to first push, pull, and lift their own body weight before beginning a more traditional free-weight or machine resistance program, such as push-ups, dips, pull-ups, and crunches.

Form Follows Function
The two critical factors with any strength-training program are intensity and form. There has been far too much emphasis on strength training in the body-building sense, which usually does not incorporate integrated, multiple joint exercises that mirror daily body movements or, in this case, the golf swing. Remind your patients to build the "body functional," not necessarily the "body beautiful." Most golfers I have seen tend to be weak and out of balance at the rotator cuff and interscapular muscle groups, relative to the upper extremity.

The primary reason to strength-train is to achieve muscular balance, which, in turn, decreases the incidence of injury. Improved physical performance is a secondary benefit of functional strength training. Hitting the golf ball farther will occur only if all physical training factors are integrated to allow the body to work as a fully functional unit.

The core is the critical area where most athletic movements originate and training normally begins. Again, emphasize the spinal stabilizers, such as the transverse abdomens, quadratus lumborum, and multifidus muscle groups. Correcting static and dynamic posture as well as maintenance of the spine angle throughout the entire golf swing is paramount and only possible if the spinal stabilizers are well conditioned.

More Power to You
After attaining an acceptable level of flexibility and overall strength, the power/endurance stage of training begins—a carefully supervised program of plyometrics, medicine ball, and other forms of power training, which generally includes increased weight and decreased repetitions with quick, explosive movements. The abdominal obliques are known to provide the primary power in spinal rotation of the downswing. Chek³ offers some innovative concepts for functional power training.

Golfers need a reasonable amount of aerobic endurance to walk 18 or more holes on a hot and humid day, yet golf itself will not build significant endurance. A quality cardio/aerobic routine should be incorporated in all golf fitness programs. Also, some degree of muscular endurance is necessary to improve. The best overall training for any sport is the sport itself—in this case, the golf swing. Simple drills, such as swinging a weighted club or choking down 4 to 6 inches on a broom and swinging 20 to 30 times a day, will build specific muscle groups and neurologically integrate the body into proper sequencing of the golf motion.

Golf is an extremely difficult game to master, therefore chiropractors must always consider other factors making a positive impact, such as properly fitted clubs, mental attitude, and professional instruction. For the DC breaking into the highly competitive golf market, the late Joseph Santiago, DC, a pioneer in the American Chiropractic Association Sports Council, advised, "The first and most important concept for the sports chiropractor is to know your sport." CP

About the Author
Paul Davis, DC, DABCO, CCSP, CSCS, has a private practice in Monument, Colo, and is a certified instructor through the US Golf Teachers Federation. He can be reached via email: pdfitgolf @aol.com.

References
1. Liebeson C, ed. Rehabilitation of the Spine. Baltimore: Williams & Wilkins; 1996:13–43.
2. Seaman D. Low Back Pain in Golfers: Seminar Workbook. BackSwing Dynamics: 2000:12.
3. Chek P. The Golf Biomechanic’s Manual. Encinitas, Calif: CHEK Institute Publications; 1999:185–201.

Photographs: Courtesy of Paul Davis, DC, DABCO, CCSP, CSCS