Despite being considered a low-impact, non-strenuous activity that can be enjoyed by players of all ages and abilities, golf also has a down side: injuries. In fact, each year hundreds of thousands of golfers develop some form of pain or injury that interferes with their ability to play their best or to play at all.

When aches and pains develop, many golfers ignore the problem, hoping it will just go away. This usually leads to more pronounced pain and further injury, rather than resolving the problem, and when a golfer does eventually seek treatment, the injury is often slow to respond to traditional types of care.

Fortunately, a new treatment technique known as Active Release Techniques® (ART®) is proving to be a very successful method to treat many common golf-related injuries, helping golfers get back in the game quickly. But before we explain how ART® works so effectively, first we want to talk about how and why golf injuries occur.

There are two types of sports injuries: acute and repetitive. An acute injury occurs following a single event, such as a fall or collision. This type of injury is rare in golf. Repetitive strain injuries make up a vast majority of golf injuries. Repetitive injuries occur slowly over time as a result of performing the same motions repeatedly, the golf swing fits into the category of a repetitive motion. During a round of golf or a practice session at the range, a player takes anywhere from sixty to more than a hundred swings. This number may be higher if practice swings are taken into account. Depending on how often a golfer plays or practices, the number of swings can quickly add up to tens of thousands. The highly repetitive nature of the golf swing puts a tremendous amount of strain on the body.

The high level of repetition requires the production of a tremendous amount of muscle force. Generating and transferring this force through the body and applying it to the golf ball requires a significant amount of strength, flexibility, and coordination from virtually every muscle and joint in the body. As long as the muscles and joints are working properly, the chance of injury is low, but because of the repetitive nature of the muscular forces associated with the golf swing, even minor problems greatly increase the chances of pain and injury.

Muscles and joints are connected so a golf swing requires muscles and joints function properly and work in an integrated manner. This concept of integration called the kinetic chain. A minor problem, such as excessive tightness, weakness, joint restriction, poor muscle balance, or bad posture, can cause a problem not only in one area of the body, but it also have an impact on the entire kinetic chain, because it causes the body to move in an unwanted, inefficient manner in an effort to compensate for the problem area. In golf, this alteration in body movement is referred to as a swing fault or a swing compensation.

Swing compensation occurs when altered or excessive motion in one area is caused by a movement problem in another area. Because of the large amount of flexibility and coordination required for a proper swing, even minor problems are greatly magnified and can result in excessive strain and eventual injury. For example, a proper swing requires a considerable amount of strength and flexibility from the hips, trunk, and shoulders. If the hip is tight and its full range of motion is limited, it will force the trunk or shoulders to move more than usual to compensate for the loss of motion at the hip. When this happens, the mechanics of the golf swing become altered, creating a swing compensation characterized by restricted motion in one area (the hip) and excessive motion in another area (the back or shoulder). This situation not only compromises the power, accuracy, and consistency of your golf swing, but it also leads to excessive strain and eventual injury to the involved muscles and joints of the hip, trunk, or shoulder.

This is just one example of the many swing compensations commonly seen in the golfer. Because of a swing compensation’s impact on the golf swing and its close association with injury, it is critical that the entire kinetic chain be evaluated to ensure all areas are functioning properly. Failure to identify and correct the true cause of a swing compensations can not only prolong the injury process, but also lead to the recurrence of injury.

Golf is a highly repetitive activity that subjects the body to a significant amount of force with each swing. Over time, these repetitive forces can accumulate in the body, leading to muscle, tendon, and joint strain. This process is greatly magnified when movement restrictions and swing compensations are present. As time goes on, this strain can lead to small-scale damage being imposed on the body.

This damage is referred to as micro-trauma. Initially it is not painful, but instead may be perceived as a mild ache or tightness in the muscles or joints. Although small, this damage needs to be repaired, and the body responds by laying down small amounts of scar tissue in and around the injured area. The scar tissue itself is not a problem; in fact, it is a normal and necessary part of healing. The problem occurs as the body is subjected to the same high-impact forces of the golf swing over and over. This causes the same muscles to become strained and subsequently repaired again and again. Over time this scar tissue builds up and accumulates into adhesions. As these adhesions form, they start to affect the normal health and function of the muscles. In fact, they often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.

As scar-tissue adhesions accumulate, they place more and more strain on the muscles and joints as they must now stretch and contract against these adhesions with each swing. This places even further strain on the kinetic chain, which in turn leads to more micro-trauma. A repetitive-injury cycle is set up, causing continued adhesion formation and progressive movement problems. As the cycle progresses, the ability of the muscles to contract properly is affected and the health and stability of the affected regions become compromised. At this point it is not uncommon for the muscles to give way and for more severe pain to occur. Many golfers come into our office saying that they have had an injury, but have not done anything different that might have caused the pain, but almost always describe some mild pain or tightness that has been building over time. This type of injury builds up over time, and the more acute injury is often just the straw that broke the camels back.

In an attempt to treat golf injuries, a variety of treatment methods are used, either alone or in combination with other methods. Some of the more common approaches include anti-inflammatory medication, rest, ice, ultrasound (US), muscle stimulation (E-Stim), steroid injections, stretching, exercise, and when all else fails, surgery. Most of these traditional techniques require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.

The main reason that these approaches are often ineffective is that they fail to address the underlying scar-tissue adhesions that develop within the rotator cuff and shoulder-blade muscles. It is these adhesions that are binding the tissues together, restricting normal movement, and interfering with the normal flexibility and contraction of the muscles, tendons, and ligaments in the kinetic chain.

Passive approaches such as medication, rest, ice, and steroid injections focus on symptomatic relief and do nothing to address the muscle restrictions and swing compensations. More active approaches such as stretching and exercise are often needed for full correction of the condition and to restore full strength and function of the muscles; however, they do not treat the underlying adhesions. In fact, without first addressing the scar-tissue adhesions, stretches and exercise are often less effective and much slower to produce pain relief or recovery from golf injuries.

ART® stands for Active Release Techniques®. It is a new and highly successful hands-on treatment method to address problems in the soft tissue of the body, including the muscles, ligaments, fascia, and nerves. ART® treatment is highly successful in dealing with golf injuries because it is specifically designed to locate and treat scar-tissue adhesions that accumulate in the muscles and surrounding soft tissue. Locating and treating the soft-tissue adhesions with ART® it allows the practitioner to:

break up restrictive adhesions
reinstate normal tissue flexibility and movement
more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain
You can think of an ART® treatment as a type of active massage. The practitioner first shortens the muscle, tendon, or ligament, and then applies a very specific pressure with the hands as you actively stretch and lengthen the tissues. As the tissue lengthens, the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar-tissue adhesions are felt, the amount and direction of tension can be modified to treat the problem area. In this sense, each treatment is also an assessment of the health of the area, as we are able to feel specifically where the problem is occurring.

An additional benefit of ART® is that it allows us to further assess and correct problems not only at the site, but also in other areas of the kinetic chain which that are associated with movement compensations, and are often contributing factors to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.

One of the best things about ART® is how quickly it provides results. In our experience, the majority of golf injuries respond very well to ART® treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and several factors can determine the length of time required to fully resolve each condition, we usually find that significant improvement can be gained in four to six treatments. These results are the main reason that many elite athletes and professional sports teams have ART® practitioners on staff, and why ART® is an integral part of the Ironman triathlon series.

To book an appointment to see if ART® can help with your golf injury, call our office at (248) 477- 2100.