How your Hips cause wrist pain

Golf, a game of idleness?

(and how your hips cause wrist pain)

Karen Doyle, Physical Therapist

‘Golf is a day spent in a round of strenuous idleness.’ So said Williams Wordsworth, a man better known for his lonely cloudlike wanderings.

Despite Wordsworth’s thoughts on the matter, golf is quite an athletic activity.  The level of exertion and muscular activation can equate golf with football, hockey and marital arts. The average golfer can swing the golf club up to 90 miles per hour, with pros reaching 115 miles per hour. Amateur players can achieve 90 percent of their peak muscular activity when driving a ball – this the equivalent of lifting a weight that can only be lifted four times before total fatigue. Over an 18 hole golf course, a golfer may need up to 100 strokes, and up to half of these are strong intensity strokes. If the golfer does not warm up beforehand, or cools down between strokes it is no surprise that injury can occur. However the main difference between golf and these sports is that golfers do not condition themselves before playing and it this lack of proper preparation for the game that can result in nearly 50 percent of golfers suffering from a golf related injury at some stage.

There are three main causes of golf injuries: postural instability, lack of flexibility, and poor swing mechanics. Here I am going to review postural instability and lack of flexibility.

Postural Instability

Golf requires full rotational capacity of nearly very joint involved.  If your normal day to day posture is inadequately aligned, you will not be able to rotate fully when you go on the golf course. Try sitting down in a hunched position with your arms across your chest. Rotate to the left and then the right. Now sit up straight and repeat. You should have found you could rotate further when you were straight. The ideal posture is one that when adopted, a plumbline would pass through the ear lobes , the tip of the shoulder, the hip joint, the knees and the ankles.

When the body is aligned in a correct posture, it is in a position in which minimal muscle contraction is necessary to prevent the body from falling over. When we are out of alignment, there are imbalances in muscle tone – some are tight, others are weak - and the incidence of joint and pain increases.

Common postural deviations observed in people day to day include a forward head, that is where the ear lobe is in front of the tip of the shoulder, and rounded shoulders, that is where the shoulders are forward and not lined over the hip. We adopt these postures when we work with items that are in front of us, for example on a PC or studying at a desk, working at a counter or even washing dishes.

The other common postural deviation is a forward tilt of the pelvis which affects the size of the curve in the lower back and can be a contributor to back pain. Place your hands on your hips and pretend that your hips and pelvis are a bucket of water. If you tip your hips forward it is like pouring water out of the front of a bucket. If you tip your hips and pelvis backwards, it is like pouring water out of the back of the bucket. The ideal alignment is where the hips are level and no water is poured from the bucket. If we spend a lot of our time seated, at work, at home, or driving, we can develop a forward tilt of the pelvis, which leads tight muscles on the front of the hips, and a deeper curve in the lower back.

Changes in posture will affect your alignment and flexibility when playing golf and can lead to injury and pain.

Flexibility

Flexibility is the amount of unrestricted movement you have needed to achieve an action. When muscles or joint capsules shorten, biomechanics are altered which interrupts the swing mechanics, and leads to compensations elsewhere in the body, injury and pain. I will go through a few examples:

The shoulder blade has an important function in shoulder movement. In order for the arm to move at the shoulder, the shoulder blade also has to move to create space for the arm to move around the shoulder joint. If through weakened muscles it does not work correctly, compensation can occur at the shoulder, which increases the chance of hooking or slicing the ball.

If there is restricted range of motion at the shoulder joint, the golfer compensates with excessive spinal rotation. This can lead to back pain particularly if the golfer already has restricted spinal motion. When the spine cannot compensate enough, the golfer can have problems with excessive head motion or optimal swing plane and hit fat or thin.

If rotation at the hip is restricted, excessive rotational demands will be placed on the spine or shoulders possibly leading to injury here. If the golfer does not have the capacity in the shoulder or spine to compensate, he or she may be forced to overuse the wrist to drive and decelerate the golf club leading to wrist injury.

Another compensation for decreased range of movement at the hip and spine is excessive raising onto the toes of the left foot during back swing. This can lead to fat shots due to a chopping action on the down swing.

Posture and flexibility are interlinked and will affect the way you swing the golf club. In addition poor technique can also lead to injury and pain. Stretching and warming up are important to maintain flexibility and prevent injury. If you do get injured get a full assessment to find out the root cause of the problem, for example, the root of your wrist problem may be lack of flexibility in the hips or spine. Hands on physical therapy treatment of the tight muscles, advice on posture, and a homecare programme of golf specific stretches may help prevent recurrence of the injury in the long term.

The final word goes to Tommy Armour ‘Golf is an awkward set of bodily contortions designed to produce a graceful result. ‘