Transcript Document
Spine in Sports Tennis Golf and Elite Athletes Walter Taylor MD Matthew Serlo MPT Stephan Esser MD, USPTA 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 80% 10% 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) Tennis Injury • Abrams et al BJSM 2012 – LE>UE – LE: ankle sprains, thigh strains, GS strain, Achilles – UE: lateral epicondylitis, rotator cuff – Back 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 of the pars Kjaerstress et al.reactions Spine, 2005: 13 y/o MRI 33% with disc dessication 13 with disc dessication, disc bulging (39%) Golf and the Spine • A One-Year Prospective Study on Back Pain Among Novice Golfers • 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%). J Sports Med September 1996 vol. 24 no. 5 659-664 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. • Golf: – The Epidemiology of Injury – Investigating the cause • Pro vs Amateur A good swing starts with a good set-up Neutral Spine • The least stressful position where a vertical force extended through the spine allows equal weight transfer to the weight bearing surface. Hosea, T et al In Feeling 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 Maximum Velocity During Swing (Degrees Per Second) Hip turn LPGA 536 PGA 451 Shoulder turn 692 713 Arm velocity 1082 1151 Club velocity 1688 2102 Injuries Rates in Golfers • Professional Golfers85% • Hand and Wrist • Back • Elbow • Shoulder • • • • • Amateur golfers-62% Back Hand/Wrist Elbow Shoulder Professional Golfers Injuries • 27% Left wrist • 24% Low Back • 7% Left hand, left shoulder, left elbow • 3% Right wrist, right shoulder • 3% Left thumb Amateur Golfers Injuries • 35% Low Back • 33% Elbow • 18% Left Wrist/Hand • 12% Shoulder • 6 % Knee 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) 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 Causes of Injuries • • • • • Limited Flexibility Decreased Strength Poor Posture Balance Inappropriate Warmup • Inconsistent Swing • Swings Too Hard!! 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 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 Tennis Injuries http://2.bp.blogspot.com/-VuCL0SXN-Rs/T58nY7UYTYI/AAAAAAAAAHY/BAn1vaVu_JA/s1600/Andy+Roddick+Serve.jpg www.tennisforyou.com • Tennis: – The Epidemiology of Injury – Investigating the cause • Pro vs Amateur • Taylor Slides REHABILITATION OF THE GOLFER/TENNIS PLAYER Swing 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 Patient Evaluation • • • • Physician Diagnosis Medical History Diagnostic Test Results Physical Evaluation • Malalignments…MUST be addressed first! Treatment Techniques • • • • • • ASTYM Graston Dry Needling ART Mobilization Muscle Energy • • • • • • • • Posture Flexibility “Core” Isotonics Proprioception Plyometrics Yoga Pilates Most Valuable Tools Rehabiliation…Specific Rehabilitation…Functional Rehab…Sport Specific Sport Specific 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 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 Thank You!