Golf Medicine – PediaCast 498
- Dr Drew Duerson and Shaun Coffman visit the studio as we consider golf medicine. The precise, repetitive, high-energy nature of the golf swing translates to a sport that is difficult and prone to injury. We explore golf medicine and its impact on game performance, injury prevention and rehabilitation. We hope you can join us!
- Golf Medicine
- Swing Analyisis
- Improving Performance
- Preventing and Treating Injuries
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.
It's Episode 498 for August 11th, 2021. We're calling this one "Golf Medicine". I want to welcome all of you to the program.
So today, we are covering an interesting field within sports medicine, one that focuses on the evaluation and care of athletes who play golf. And I have to tell you, it's a particularly interesting episode this week as we explore the ins and outs of golf medicine, but it has to begin with this disclaimer: I am not and have never been much of a golfer.
Okay, I played putt-putt a time or two and I've taken some very bad swings at golf balls at the driving range on occasion. I played a couple of par three short golf courses a very long time ago. And I was not a good golfer then, and without lots and lots of help, I would probably not be a good golfer now. I might even be a dangerous one.
And if I'm honest about it, I haven't really watched much golf either. So, as I approach the task of organizing content for today's episode, I weighted into it, into this topic of golf medicine, as a non-golfer. I was not particularly excited about recording and producing this episode, to be honest.
But like many of our topics on PediaCast, people around the hospital pitch ideas to me frequently. And when the Sports Medicine team approached me about doing the show on golf medicine, of course, I said yes because they're good friends of the show and provide parents with terrific content whenever they stop by.
But this time, I thought it might be a little boring. Again, if I'm being honest, which I am. However, and hear me out, because there is a reason I'm traveling down this road, having studied the references and resources provided by our hospital's golf medicine team and really delving into the details of caring for athletes who play golf, I have to tell you, it's really interesting stuff.
So, if you're listening now and you're thinking, "I don't play golf. My kids don't play golf. Shall I really stick around and listen?" The answer is yes. Yes, you should stick around as we consider the golf swing and makes it extremely difficult and prone to injuring athletes who do it over and over again.
So, we're going to explore golf injuries in detail, including why they occur and how they are treated and prevented. And we'll consider the analysis of an individual's golf swing, which if they had analyzed my golf swing way back then, maybe they could have corrected it. And I would be a different person today, a frequently golf-playing and golf-loving person, which who knows, maybe there's hope for me in the future. I don't know.
But the analysis of a golf swing really does use some cool technology to help golfers improve the quality of their swing and to prevent injuries from occurring.
So, stick around. And trust me, when we arrive at the finish line, I think you will agree that golf medicine is a really fascinating and interesting field.
In fact, I have a brand-new appreciation for the game of golf. Maybe not enough to get out there and really hit the links. But definitely to watch the Masters or the Memorial down the road. I'll be looking out for those big 12 swing characteristics, which you'll learn about in just a few minutes.
In our usual PediaCast fashion, we have a couple of terrific guests joining us this week. Dr. Drew Duerson is a sports medicine physician at Nationwide Children's Hospital. And Shaun Coffman is a sports and orthopedic physical therapist, also with Nationwide Children's.
It turns out they are both certified with the Titleist Performance Institute, also known as TPI. If you're a golfer, you probably know what that means. If not, stick around and we will fill you in shortly.
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So, let's take a quick break. We'll get Dr. Drew Duerson and Shaun Coffman connected to the studio. And then, we will be back to talk about golf medicine. It's coming up right after this.
Dr. Mike Patrick: Dr. Drew Duerson is a sports medicine physician at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University College of Medicine. Shaun Coffman is a physical therapist at Nationwide Children's with our Sports and Orthopedic Therapies Program.
Both Dr. Drew and Shaun serve student athletes at our hospital's Golf Medicine Program. And they're particularly qualified for this role as evidenced by their certification with the Titleist Performance Institute, which is recognized as a world leader in the evaluation and care of golf athletes.
That's what they're here to talk about, golf medicine. But let's give a warm PediaCast welcome to our guests first. Dr. Drew Duerson and Shaun Coffman, thank you both for stopping by today.
Dr. Drew Duerson: No problem. Thank you for having us.
Shaun Coffman: Yeah, thank you.
Dr. Mike Patrick: Yeah, really appreciate both of you stopping by and taking time out of your busy schedules. Drew let's start with you. First, what is golf medicine? And then I mentioned this Titleist Performance Institute, also known as TPI. Tell us about that and how it relates to golf medicine.
Dr. Drew Duerson: Sure. So, golf medicine really falls under the bigger umbrella of sports medicine. Similar to some of the other unique groups of athletes we take care of like baseball pitchers, runners, golf medicine is a way of bringing together multidisciplinary group of experts that really specialize in diagnosis, treatment, and rehabilitation of the golfer.
Here at Nationwide Children's, we put together a team like you mentioned, the Titleist Performance Institute or TPI Certified Professionals. We all speak the same language. We think about the golfer and their body and their swing the same way. And we really share the same goals, so that we can best take care of this unique group of athletes.
Like you mentioned, TPI is the world's leading educational organization. It's been around since 2003. It really dedicated the group to the study of how the human body functions in relation to the golf swing. You'll find it home out in California, inside the Cushnet Company's Oceanside Test Facility.
It's the most technologically advanced golf evaluation and education facility on the planet. It's really a golfer's dream. It's a frequent stop for some of the game's best athletes. And over the years, TPI has really studied thousands and thousands of golfers of all different ages, skill levels, fitness levels, and really provide us data on how to assess the golf swing and how a properly functioning body allows a player to swing a golf club in the most efficient manner.
Also, with that, we'd figure out how physical limitations in that player's body can negatively affect the golf swing and potentially cause injury. That's where we come in. TPI offers several pathways and levels of certification and really is the gold standard for golf medicine program across the country.
Dr. Mike Patrick: We talked about programs being multidisciplinary often on this podcast because so many of our programs at Nationwide Children's Hospital are multidisciplinary.
And TPI is actually that as well. I mean, you have golf professionals. You have medical professionals, fitness professionals, that all really come together to help the golfer. And not just professional golfers but really student athletes, amateur golfers. There's really something for everyone.
And I love how they embrace technology. We're going to talk more about this as we move forward. But with swing analysis in golf, both two-dimensional and three-dimensional. It's really kind of a cool way to evaluate the golf swing and not only improve the game but also help prevent injuries as well, which we're going to talk about.
So, Drew, this field of golf medicine, a lot of folks may not have heard this phrase before. Sports medicine has always been there for any athlete, including golfers. But why is in particular, golf medicine an important thing to distinguish even apart from sports medicine?
Dr. Drew Duerson: Yes, it's a good question. We feel that having a Golf Medicine Program here is going to be the most efficient way to take care of these unique athletes. We all have a passion for this sport and this group of athletes. And I think with our team approach, we'll really help accurately diagnose the golf-specific injury that might be preventing these athletes from participating.
And with the proper diagnosis, then we can really target our treatment and rehabilitation appropriately so we can get them back on the course quickly and safely, with the goal to perform in a higher level and more consistently. And then really looking for longevity with the athletes to stay healthy in their entire high school, college, and maybe even a professional career.
And for most people, golf becomes a life-long sport. It's an excellent way to reach our exercise and healthy lifestyle goals. And so, we are all in the same team trying to serve the same purpose.
Dr. Mike Patrick: As I was researching this material, one thing that really stuck out to me is there are lots of different mechanisms of injury that the golfer can be prone to. When you really think about the golf swing, it's repetitive motion over and over and over again. And we know that excessive motion can cause muscle strains and soft tissue strains which we're going to talk about.
But also, when you think about golf practice, there's not usually a big exercise program associated with golfing. You don't think of golfers going out and running a mile before they start taking their swings. And so, perhaps there are also some relative unfitness with other muscle groups that they can be prone to.
And the biomechanics of the swing, it's just so complicated that if you're not doing it exactly right, or you're not using the right fit of club, there's just so many ways in which a golfer can become injured, right?
Dr. Drew Duerson: Yeah, totally agree. I think for years and years, we've maybe considered golfers, not athletes, but with groups like TPI and where the game is going nowadays, I think that has definitely been put to rest. And our golfers, our athletes, just like our football players and our basketball players, are prone to some of the same injuries. Like you mentioned, there is a lot of overuse that plays a role in the golf injuries that we see.
And while maybe doing that three-mile run or that big warmup is not typically there. These elite golfers, especially, they're in the gym putting in a lot of work and really working on their body, so they can, and again we'll talk about it later, but really swing the golf club the most efficient way they can.
Dr. Mike Patrick: As we consider what makes golf difficult in an injury prone game, there are some concepts that will be new to a lot of people. But they're really important to understand as we consider the game of golf. One of these is the body alternating mobility stability pattern which is a mouthful.
Shaun, kind of demystify that for us. What is body alternating mobility stability pattern? What is that?
Shaun Coffman: Yeah, this is one of primary reasons why the game is so difficult and why some are prone to injury because you have to have a combination of both. So, some joints have to stay very stable, some are very mobile. And if you don't have both, then you're going to either create compensatory motions or patterns that are going to result in injury. Or you're just not going to play well.
So as Drew mentioned, these players of the game today, especially the elite ones, they definitely have a combination of both. And just really work on it. You don't see John Daly who's now on the TOUR that just kind of shop and play. These guys on the gym at 4:30 in the morning before and after the rounds on top of all the practice. So, having the combination of both is a key component there.
And as you kind of alludes to earlier, we see a lot of muscle imbalances because it is so repetitive. You're rotating both directions with the force. It's primarily going in one direction. So, we'll definitely see a lot of imbalances in both flexibility and strength. And that's where we address those in the clinic.
Dr. Mike Patrick: It's really quite unnatural for the brain, right, to have a certain group of muscles moving in a specific way and having other groups of muscle really needing to stay completely still. And when you're trying to do that on wet grass or on sand or on a hillside, it can really become quite difficult and almost requires changes in the way that the brain fires in order to do that successfully. So that really does take some training. It's not something that you're just necessarily born with the ability to do.
Dr. Drew Duerson: Absolutely.
Shaun Coffman: In addition, to that, so you're also leaning forward and rotating. So now, typically, if you're playing a sport, you're more upright. So, you're playing defense on someone or you're running. You're not leaning forward in a stationary position hitting a stationary ball. But also, it makes it seem like it'd be easy, but if anybody who's tried to make their first whip and completely missed the ball, they realize "Oh, it's not as hard." And you'll see lead athletes who play other sports try this game and make fools of themselves because of that reason.
Dr. Drew Duerson: And I would just add too really quick, I think this alternating mobility pattern becomes really important in the diagnosis of different golf-specific injuries. Because a lot people come in, and we'll talk about this later, but their back hurts, but their back is really not the problem.
It might be a hip problem or breast or spine problem. Those joints that are supposed to be mobile aren't mobile and now, like Shaun's saying, were compensating and asking the low back to do more than it's typically supposed to. And that's when they run into problems.
Dr. Mike Patrick: Absolutely. What about the body swing connection? Tell us about that concept, Drew.
Dr. Drew Duerson: I think the best way to summarize this philosophy is that this really comes from TPI, and we believe the same thing, but there's not one way to swing a golf club, but rather an infinite number of swing styles.
So, we do feel like there is one efficient way for every golfer to swing, based on what that player can physically do. There is a number of ways to get to the top of the back swing. And we see that in today's game with all the different swing styles from the PGA TOUR. But most importantly, for speed and distance and consistent ball striking is that down swing sequence, which we'll talk about shortly.
Dr. Mike Patrick: I guess another thing that makes it difficult is it's sort of counterintuitive at times, right? You mean swing to the left to make the ball curve right. You have to swing to the right to make the ball curve left. You hit down on the ball to make it go up.
And so, you do have to sort of think spatially and that can take some adjustment of the brain too, as you're learning to become good at this, correct?
Dr. Drew Duerson: That is correct, yeah. I think a lot goes into the golf swing and there's a definite mental component, physical component. I'm biased but I think it's the hardest sport out there and that's why I enjoy it.
Dr. Mike Patrick: As I mentioned in the intro to the episode today, I definitely have a new appreciation for the game of golf after having studied what's involved with this.
Another characteristic of the golf swing is, tell me if I'm pronouncing correctly, the kinematic sequence. What is that?
Dr. Drew Duerson: That's correct. So, I think for the golfers listening, they'll recognize some of these names. But if you think about swings like Jim Furyk and like, Shaun mentioned, John Daly. And you think how did they have such successful careers with these unorthodox swings?
Fortunately, with the aid of 3D motion capture systems, we'd really been able to identify the true measurement of the golf swing. It's not necessarily how it looks. This is something that goes beyond the two-dimensional camera where we're looking at what does it swing look like? We're really getting down the efficiency of that golf swing and how does it compare to the world's best.
Here at NCH, we believe that the most efficient sequence to generating speed and transferring that energy, which is the most important of these is through your body and eventually down to the golf club in a specific sequence. And that's the kinematic sequence.
When you look at all the top golfers in the world with 3D motion capture analysis graphs and these kinematic sequences that TPI has provided for us, despite their vastly different appearing swings, all the great ball strikers begin to generate the speed from their lower body. And then, they transfer that speed to their torso, into their arms, and finally the golf club.
And really, each body segment builds upon the previous segment and increase speed up the chain. As one segment slows down, the next one speeds up. And this sequence is the key to repeatability and consistency, again, that energy transfer which is key to power.
Dr. Mike Patrick: I had read that the club head reaches a speed of up to 100 miles an hour and like a fifth of a second. So, it's really an enormous amount of energy in a very short period of time. And then you can see what that does, repetitively starts to really wear and tear on muscles and soft tissues.
But the other thing is it really leaves little room for air, right? If you're off by just a few degrees or millimeters, it will have a drastic impact on the direction, the distance, the quality of the shot. And so, you really need perfection in that swing. And that's where we're going to get at in terms of evaluating swings and making those micro-adjustments.
But that can pretty tough on players and particularly student athletes, right, as they're learning this? I'm sure it can be frustrating.
Dr. Drew Duerson: You're exactly right, it's another one of the big reasons why this is I think the most difficult sport. The kinematic sequence and 3D motion, it really just shows you how you're transferring energy and in what sequence. But that doesn't tell you what the club face looks like when it hits the golf ball in that split second.
And that's what we'll talk about later as far as launch monitors and things, where's that ball going to end up going after the energy's transferred? So little room for air.
Shaun Coffman: Along those same lines, I have a couple of baseball guys who are always debating, what's harder. And they're like "Oh, hitting a fast ball at 100 miles an hour." But one of my supporting arguments is we don't get to get foul balls. They can hit multiple foul balls offline and keep on hitting. We're adding strokes and counting strokes over and over again. So, another reason why it's so challenging and frustrating.
Dr. Mike Patrick: Absolutely. Another key concept that golfers would have heard about are the big 12 swing characteristics. And we don't need to go into detail on all 12, but what is that? What are the big 12 swing characteristics and why are they important?
Shaun Coffman: Yes, this is another TPI concept. And some of this may be, others are considered swing falls, but they're not actually swing falls because there's some top-level pros that always have one of these. They're more just little characteristics of your swing that if they get exaggerated, then they create issues.
An example would be a reverse spine angle. This is something that I see a lot when I do swing analysis on a golfer in the clinic. It's when you rotate your body on back swings, you actually lean towards the target, which is not correct. Because what it does, it ends up putting pressure on your spine and also makes your swing inefficient because you can't use your lower body as well.
So that's something that I'll see. If we do see that, then I have to kind of go on there and look and see okay, why are they doing this? Is it the physical issue that I need to address with either manual therapy or exercise, stretching, or strengthening?
Or is it just like a psychomotor situation with really just technique? They have plenty of strength and mobility to do the correct move, which is a technique issue. In that case, I'd refer to them to a teaching professional. There'd be lessons to work on that. So that would be an example of one of those 12.
Dr. Mike Patrick: Yeah, so this is something where if you just handed someone a golf club and said, "Hey, take a swing at this," and they really didn't know what they were doing and they hadn't had lessons before, you're likely that they're going to do one or more of this specific swing characteristics that you're going to be on the lookout for to help them correct.
Shaun Coffman: Absolutely. It'd be several of those likely.
Dr. Mike Patrick: Combined. It gets really complicated to sort out which ones. Yeah, Drew?
Dr. Drew Duerson: I was going to add. I think with the big 12, it also helps you predict injuries. So when Shaun's doing his swing analysis and he sees a consistent pattern, whether it's reverse spine angle over the top, casting, a number of these swing characteristics, then that helps us predict "Okay, yeah, that might be the reason why you have that specific injury." Or we haven't identified it yet. It may even actually help diagnosis, too. So, it tends to point you in the right direction.
And all those back to what can they physically do? Maybe that's all they can do. And then, that's why folks like Shaun and other members of our team can work around that. You might not be able to fix that mobility issue. Maybe it's a carcinogenical thing or a congenital thing. And that's what you got to work with. And luckily, we know how to work around those issues.
Dr. Mike Patrick: Let's transition to golf-related injuries. And as you practice golf medicine and you're seeing student athletes who are playing the games and then they're coming in with injuries, just some of the more common things that we see and then how you treat and prevent those as well.
So, Shaun, you had mentioned injuries of the spine and hips are pretty common. Tell us more about those.
Shaun Coffman: Yeah, I'd say by far, number one is back pain, so low back pains, specifically. I think it's most prevalent among our population we see, at least I see in sports, sports physical therapy, that kind of adolescent athlete. Up in the college, we see a lot but also older individuals, too. Typically, the back is the number one.
The most common of the back injuries would just be your classical functional back pains. There's no specific pathology. It's just kind of overuse, strains, sprain type of situation where they more than likely don't have the strength and flexibility to handle the demands they're placing on their body in the swing. And we mentioned before how repetitive it is. That's the primary one I see.
Otherwise, the spine, we see quite a few with spondylolysis, which is just a fancy word for stress fracture in the back. We see that in the growing spines, so that same younger population we see. It's usually caused by repetitive extension and rotation.
So back then, again, twisting which the golf swing is that over and over again. So, we see a lot of that in our golfers. That reverse spine angle I mentioned, I see that quite a bit with those as well. So once again, exactly now deciding, "Okay, is it physical issue we got to work on? Is it more lessons? Is it both?" and then kind of go one from there.
Dr. Mike Patrick: And then, as we move up the spine into the neck, sometimes you see some neck pain as well, right?
Shaun Coffman: You do. Not quite as much, but a lot of times, with neck, honestly, if you've ever played golf and you play with somebody that he's trying to show you the ropes, they always tell you to keep you head down. "Oh, you lifted your head up. That's why you missed it, that's why you topped it."
So, they get down and completely crunch their neck down, their chin under their chest, keeping that down. When you do that, that takes up motion in your neck and then you're trying to rotate because your head is staring at the ball. So, when you're rotating your body, your neck is actually turning.
So then if you completely take up all that motion and try to rotate, it creates a lot of stress. And then a lot of times, it's a simple thing as just bring up your chin up a little bit, just changing your setup or your starting posture. That's a big one, because it's all a chain reaction from there.
So, a lot of times, we'll just start off with just looking at how they address the ball in their starting position. And a lot of times, you can just right from the get-go like, "Well, you just change that." They change one thing, they're like, "Oh, it doesn't hurt anymore." So that's what I see a lot with the neck, honestly.
Dr. Mike Patrick: That must be satisfying. One little piece of advice and it makes all the difference. You got to love that.
What about the knees? Is golf hard on the knees?
Shaun Coffman: I don't see as much with the knees, Honestly, more knees, it's either coming back from an injury from another sports. Like they tore their ACL, football or basketball or something. Or it's more like the walk in the course.
So not as hilly in the Columbus area, but where I grow up in Marietta, there's lots of hills, uneven terrain. So, they're logging, especially high school kids, they have to carry their bag. They have to walk. They're not allowed to ride in the cart. So, they’ll get some overuse injuries from there. Some tendonitis, some what we call patellofemoral pain, just kind of kneecap, generalized pain.
We see that more so with the knee with golf swing, not necessarily from the swing itself. Just more aggravated from other injuries.
Dr. Mike Patrick: Not much ankle issues right, in golfers?
Shaun Coffman: Not as much. Just something where they misstep a root or sand graft or something.
Dr. Mike Patrick: But not with the swing?
Shaun Coffman: Not really.
Dr. Mike Patrick: Let's move to the upper extremity. Drew, what about the shoulders?
Dr. Drew Duerson: If you look at the shoulder from research that is out there from TPI and even looking at our data, shoulders are going to be usually second or third most common body part injured. It's usually the left shoulder in our right-handed golfers.
And for professionals, higher level athletes, that's usually just an overuse issue. And then most of the amateurs that we're dealing with, it typically goes back to the body mechanics or the swing body mechanics. That's the culprit.
Some common injuries, tendonitis, rotator cuff, biceps, tendon. We see impingement of the rotator cuff, shoulder instability where the joint is moving too much. Usually, this goes back to some type of swing characteristic that the athlete has. Just to name a few could be casting, swing plain, limited follow through, bad pivots. There's a number of reasons why the shoulder can hurt.
And usually, with our screening and our assessment, we can identify some type of mobility or stability dysfunction that's contributing to this issue.
Dr. Mike Patrick: And as we move down, elbows and wrists, I mean, they're also involved with the golf swing. Do you see injuries there?
Dr. Drew Duerson: Yeah, and I think classically a lot of people focus on the elbows and wrists. When you look at professional athletes, this is a very common reason why some of our PGA TOUR members get injured and out of tournaments. When you look at our numbers in children, it's not as much common. But when it does happen, it typically is the left wrist and elbow for the right-handed golfers.
And again, we see common things like tendonitis. And we'll see wrist sprains. Occasional fractures, especially if there's a bad pivot involved, hitting some type of unexpected rock or hard group. And I think a lot of people may be familiar with golfers elbow which is going to be pain at the inside of the elbow.
And this typically occurs less often in golfer. It's somewhat of a misnomer. We actually see more tennis elbow at the lateral side or the outside part of the elbow more so in that lead arm of the golfer. Again, it goes back to those mechanical issues. A lot of the same reasons why your shoulder could be in pain. And it definitely could cause the same issues in the wrist and in the elbow.
Sometimes, it's just hitting too many golf balls, especially on the practice range. We are hitting off a hard surface like a mat, a very unnatural way to hit off on. If you're doing that repetitively, it can definitely lead to issues.
Sometimes, it's just something as simple as alteration in the grip. You're going from a weak grip to a strong grip or vice versa, and that can put a lot of extra stress on wrist and forms and even the elbow. I think this might be a place where we can talk a little bit about, just custom golf-fitting.
So that's a very big thing in our game. And sometimes, it's just as simple as that, going to get a custom set a golf clubs where they have grip that is appropriate size, a club weight that's appropriate, a shaft flex that's appropriate. Because I think that's where we see a lot of injuries to the wrist and the hands, it's just because their equipment's not appropriate to fit in.
Dr. Mike Patrick: So really lots of opportunity of the spine, the lower extremities, the upper extremities, really the whole body in terms of being a possible injured with repetitive golf swings. And to bring this all kind of home, we talked about the TPI way of analyzing a golf swing. And that's not only going to help improve technique and improve the quality of the game that's being played, but also can identify which injuries a person may be more prone to with how their swinging and how we might be able to prevent injuries by adjust swings that are there, habits that they in their swing.
And that whole TPI analysis really begins with something called the TPI Physical Screen, which is a group of like 16 tests, I believe.
Shaun, tell us more about that. What is the TPI Physical Screen and how is that useful in guiding the golfer?
Shaun Coffman: Yes, as you mentioned, it's 16 movements that are very kind of quick assessment that they can either do on the course or on the clinic. And what it does is assesses each joint that golf swing needs and looks at motion and strength. So, it helps kind of guide the decision making as far as like, "Okay, we may be need to work on spinal mobility."
And then, once you do the swing analysis, "Okay, this correlates with what I'm seeing. One of these swing characteristics will match up to my findings in that screen. We got to work on that and here." So just kind of quick that you can thoroughly look at the entire body and kind of break up each little section there and I guess guide your decision making there.
Dr. Drew Duerson: And I was going to say, it goes back to speaking the same language. So, Shaun and I, we noticed the screening test and that's a way we can monitor our athletes, too. So, if I do a quick screen in the clinic, I can email Shaun or give him a call and say, "Hey, I think this guy's got a shoulder problem. He's 90/90 test is off. Can you keep an eye on that?" And then Shaun can objectively keep track of that as we move through the rehabilitation process.
Dr. Mike Patrick: So, this is a set of 16 tests that you really evaluates different joints, correct? Different movement areas, so then you're looking to see where maybe you need to increase flexibility, where someone maybe, they don't have the flexibility or maybe they have too much flexibility, I don't know. How do you then use the results of the tests to kind of conditioning?
Shaun Coffman: So, example would be, like one of them is just looking how much they can rotate. Can they rotate their upper their body on a fixed lower body? So, say they are limited on that, I need to look. Okay, get them on the table and see, is it because they're actually tight? So, I'll actually see physically how much they can move.
Or is it just a strength issue? They don't know how to engage their muscles in that range or something like that. It's more like a neural re-education or something.
So, it's more of kind of guide you to really delve in specific areas of body to find out why they cannot get in that position. And then how it correlates with what I'm seeing on the swing analysis.
Dr. Mike Patrick: And then, you may be able to prescribe exercises or conditioning program to help them improve in that particular joint area?
Shaun Coffman: Absolutely, yep. That's why we try to make it specific to that athlete, not just kind of like a cookbook, "Well, you have pain with golf and here's a bunch of exercises." As busy as student athletes are with school and athletics, honestly, we try to really hone in what are the main things that this person needs to do because it's a little time crunch to try to get them to be compliant with their home programs. So, I make sure I make sure I'm not giving them a bunch of extraneous things they don't need to work on. Try to really to hone in what they need to work on.
Dr. Mike Patrick: Absolutely. When we think of the golf swing, it happens so quickly. And so, you're trying to analyze exactly what's happening during that golf swing. We do have some cool technology to slow down the visuals of that swing and find out exactly what's happening.
The first of those would be the video to the swing analysis. Tell us more about that Shaun.
Shaun Coffman: Yes, well, primarily right now in the clinic, so when I get a golfer to where they're able to get back to swinging or they've been playing, then I'll get them at our clinic here and actually video them. We have an iPad. We'd video and I can slow it down, draw some lines, because there's certain parameters you should fall within.
And I can slowly do that and actually takes screenshots and explain to the patient, the family, kind of show where some of this swing characteristic we mentioned before. Where some of these might creep up, what are the implications on the consistency of the golf or particular injury they're in there for.
It's also something you can use to kind of compare previous. Because still if it's something they have been working on with their swing coach trying to change, you can actually look at it objectively and see if it has changed. So, like I mentioned before, if I see something on there that correlates with their injury, then I can break it down and see if it's a physical issue or a technique issue. And I kind of go from there.
Dr. Mike Patrick: Really helps to individualize the plan for sure. And then, Drew, there's also three-dimensional motion capture. That sounds really cool. Tell us about that.
Dr. Drew Duerson: Yes, so we mentioned it with the kinematic sequence. That's really how you're able to capture that. And there's different types of 3D motion capture systems. The most common are going to be. There's really three. There's inertial sensors, electromagnetic, and optical.
Inertial sensors such as the K-Vest, is what we planned to use here at Nationwide Children's Hospital. It's a portable device. It's an accurate device that can provide us with information about that kinematic sequence. And again, going back to how efficient is their golf swing.
Gives you some objective data to monitor and really approve upon as we're golfers back out into the course. And then, there are some very neat bio feedback things that it can help folks like Shaun in the rehabilitation part and really monitor exercise. Yeah, it's awesome technology. And we're fortunate to possibly have this here at Nationwide Children's.
Dr. Mike Patrick: So, this vest has sensors on it that are detecting motion. And then a computer uses that motion to basically make a three-dimensional cartoon character, so to speak on the screen. And then you're able to view from any angle, from any dimension what exactly is happening in that swing based on that little avatar that's mimicking what you just did on the screen. Is that right? Is that how that works?
Dr. Drew Duerson: Yeah, that's right. The inertial sensors use like a Bluetooth technology. Just like anything, there's different levels and different cost. Some folks, in the video game, we're all probably familiar with EA sports, in the optical systems where they have the little balls on them and use this on an optical system to capture that.
Actually, at TPI, they used a lot of electromagnetic 3D motion capture where there's a lot of wires involved. But they feel like that's where they get the best information.
Dr. Mike Patrick: Really interesting. And then there's something called a launch monitor. What is that?
Dr. Drew Duerson: Yeah, so even a larger variety of these devices on the market. And again, as you'd expect, there's a range of cost and capabilities.
So, for the golfers listening, if you ever watched in a PGA TOUR event and you see a funny box next to them in the driving range, that's most likely a launch monitor. This technology truly has changed the way new golfers practice and also helps our golf professionals at fitting golf clubs.
And for us, it gives us data, such as golf head speed, ball speed, spin rate and those are some objective finding that we can track and hopefully approve upon. And then, also, it gives the golfer hitting a golf ball something to look at. If we project that information up on the screen, it's a simulation. Effectively, you essentially looks like you're on out on a golf course. It makes hitting into a net a lot more fun. And there's different types of devices.
And again, this is a little bit different than the previously mentioned 3D motion capture. But I think when you combine the two, you really can get some good objective data to analyze.
Dr. Mike Patrick: One of the popular models uses Doppler radar. So instead of looking at storm clouds, we just watch the golf ball and it's able to recreate its trajectory because it's got radar waves bouncing off of the ball and then can animate what that looks like.
And with the portable systems, you can make spot adjustments right there at that time and then actually see what your adjustments do to the trajectory of the ball.
Dr. Drew Duerson: Correct, yeah. It gives you real-time data and it's surprisingly very accurate. Those portable devices, a lot of them use photo monitors where it's taking a bunch of pictures at the time of impact and is able to analyze that. That impact the face angle which the golf doing as it reacts. It's kind of mind blowing, but it definitely is some very unique technology that we fortunately have to be able to use.
Dr. Mike Patrick: Yeah, it's really great that the technical wizards like golf enough to make this stuff. Because I'm sure really changing the nature the game and maybe even allowing more people to enjoy it because they can figure out what they're doing wrong and correct those and have a better game and not be as frustrated with it.
Dr. Drew Duerson: It really brings golf to be a year-round sport. So, when it's snowing here in Columbus, we can be inside using our launch monitor and go play Pebble Beach and get some pretty accurate ball flights and golf shots.
Dr. Mike Patrick: Yeah, that is great. So, all of these muscular skeletal injuries, Shaun, as a physical therapist, talk to us about how those are treated and rehabilitated.
Shaun Coffman: Yes, usually, Drew would see them in the clinic, diagnose, see what's going on with them, send to me. Then, I'm going to kind of way I look it, Drew is determining what's wrong. I'm trying to determine why they're having it. Is it strength issue, is it swing issue, flexibility?
So always the first thing is getting in the root, really detailed subjective history. So just really asking a bunch of questions because a lot of times, there are a lot of things that we do, kind of guide, almost make your formal hypothesis of what's going on.
So, I ask how long they've been playing. Have they been taking lessons before? Where do they usually shoot? So how good they are because that actually can improve it quite a bit. Better players are typically going to be more prone to overuse injuries versus if it's a newer person of the game. Then they're more likely going to have an issue with swing mechanics that can be possibly resulting in the injury.
So, I ask them about that. As Drew mentioned, getting fitted for clubs. That's a big one, too. So, if I had a kid from me that's 6'6 but Grandpa Joe is the one that hand down his clubs, it was never fitted for him, then they could be short for him. And that could actually finally cause wrist and elbow and back issues.
He has to lean forward. So, if he does that, it throws off the rest of his swing. So, I definitely had kids in the past that had too, and they have to get fitted for clubs. So, I ask them about that.
The number of hours they practice and how much they're playing. Do they do warm up before they play? All those questions before we even start looking the physical stuff. So, doing that, and then after that I do that, that's when we go through all the screenings, the movement screens, and kind of really to fine tune where we need to work on.
We give them a home program. They come in here and we kind of build on that. And then when they start hitting, that's when we get them on there to do the swing analysis and kind of go from there.
Dr. Mike Patrick: When someone comes in with acute injury, so they have a muscle strain and they have that low back pain, I assume that you treat that like you would any other muscle strain, with rest, ice, if it's an extremity, elevation, non-steroidal, anti-inflammatory drugs like ibuprofen. Is that true in golf too? You treat those strains basically the same way in the first few days of after an injury?
Shaun Coffman: Well, Drew would handle the medication aspect of it first, right before they come to me. If Drew wants to…
Dr. Drew Duerson: Yeah, I think so. I think you would go with your basics, your rest, ice, compression, elevation, when appropriate. And then really, the uniqueness of the golfer comes down to the rehabilitation part and that might be a little different once when they get to Shaun's stage.
Dr. Mike Patrick: How do you know when it's okay to transition then to the rehab stage? Because I know if you do that too soon, you may risk just exacerbating the injury. How do you know when someone's ready then to start conditioning after an acute muscle injury?
Shaun Coffman: Well, on my end, when I get them, kind of depending on how irritable their condition is. If they're just really pretty flared up, a lot of times, we might say okay, yes, I have to shut it down altogether right now and not play. Just do the basic exercises, use modalities to try to get their pain under control. And then, once they are able to get past their initial acute phase, then we start to kind of push a little bit more in the clinic.
And once we can normalize their strength and flexibility, they're able to do normal data activities without pain, and that's when we start have them get back into a swing progression, which we have laid out. You start off with just like your shorter clubs, which are less force going to the body, kind of working your way up to the longer club, up to the driver and then actually playing around with the… The nice thing at least with golfers, you can kind of modify things in the beginning, so you're not completely sidelining them.
Usually, you could say, okay, only short games. And like we'll just work on their putting or like chippings. They're still part of the team, they're still at least practicing something that's actually probably one of the more important parts of the games that actually score and do well as a short game.
So sometimes, you might be able to do that initially. And then while they're healing and working on all that strength and flexibility, then progress to actual full swings.
Dr. Mike Patrick: That makes sense. So, Drew, tell us more about Golf Medicine at Nationwide Children's Hospital. Do you only see folks who have been injured or do you also do evaluations of golf swings to help with technique?
Dr. Drew Duerson: Hopefully, Shaun and I had done a good job giving you guys an idea of what we had to offer to Nationwide Children's Hospital. Most of what we'll see is the golf-related injury at this point. We do have plans to branch off and do more of sports performance type of service which we have for other of our specific athletes. But yeah, it's mostly dealing with those golf-specific injuries, diagnosing, and treating and rehabilitating and trying to get them back on the course.
I do want to mention, also part of our team, a newer member, Ryan Ingleby, who's not with us on the call today. But he's a certified athletic trainer. He also is TPI certified. He specializes in injury rehabilitation and sports performance.
And then, also, we do have plans to partner with other TPI certified golf teaching professionals in the area, like Shaun has mentioned. Sometimes, it's a swing mechanic thing, and we're not golf swing coaches. We have an idea of some of the common characteristics. But when we really need get down to the nitty gritty, that's when we're going to get the golf teaching professionals involved.
Because we truly believe that if a golfer surrounds themselves with the right group of people who are all speaking that same language, who are all focused on this TPI philosophies that we've talked about today, I mean, that's her best chance to stay healthy and perform out in the course.
So, we do specialize in the younger golfer, too. And we're definitely well-equipped to take care of those athletes but I also wanted to mention we will take care of any age golfer in locations across the city. You can find more information about our program on the website. But also, if you go to mytpi.com, and look under there, find a TPI Certified Expert section, you'll definitely find more information about us, too.
Dr. Mike Patrick: Yeah, great. And we will put a link to the Golf Medicine Program at Nationwide Children's Hospital in the show notes for this episode over at pediacast.org, Episode 498. And we'll also put a link to the TPI, Titleist Performance Institute, website there as well, so you can find both of them really easily.
Well, Dr. Drew Duerson, sports medicine physician, and Shaun Coffman, sports, and orthopedic therapist, thank you both so much for stopping by today.
Dr. Drew Duerson: Thank you. That was awesome.
Shaun Coffman: Thank you.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks to our guests this week, Dr. Drew Duerson, sports medicine physician, and Shaun Coffman, sports, and orthopedic physical therapist, both with Nationwide Children's Hospital.
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