Association of Chartered Physiotherapists in Sports & Exercise Medicine blog series @PhysiosinSport
By Nigel Tilley
In my 8th season as a Physiotherapist with The European Tour Performance Institute (ETPI), I have worked at over 180 golf tournaments. In this blog, I share some of my experiences, including practitioner and athlete tips for life on the road of elite sport.
The ETPI and Mobile Physio Unit provide physiotherapy, sports medicine and performance services to tour golfers across the world. We work on site at golf tournaments and have permanent facilities in France and Dubai. The original service was set up in 1990 and now has 6 full- and 8 part-time staff members across the 3 main golf tours; we travel over 30,000 miles and work in over 30 countries annually.
The blend of practitioners from various backgrounds and countries makes for a great learning environment: physiotherapists, sports therapists, chiropractors and osteopaths as well as sports medicine doctors and upper limb surgeons and radiologists. We aim to deliver a world class, integrated service, that provides a single point of access on tour for all professional golfers regarding injury, assessment, diagnosis, treatment, screening, performance enhancement, rehabilitation, strength & conditioning and biomechanics.
The road to elite sport
My first taste of working in elite sport was as a student in 1999 during a 6-week placement at Ipswich Town Football Club. I worked alongside inspiring physios, and I then knew I wanted to work in the field of physiotherapy. (See BJSM blog on career development here).
Soon after qualifying and finishing junior rotations, I travelled abroad and worked as the physio for the Bahamas FA. This built my knowledge and competencies and provided skills required to work in high level sport: strong communication, organisation, preparation, planning and dedication. After that I worked with other professional football teams, built up private practice work and started a master’s degree (see BJSM blog on MSc or not to MSc here). This created opportunities to work with amateur and professional golfers and become involved with the European Tour Physio Unit.
Life on the road
In my job, you never know who or what problem may come through the door. This really tests you daily. I enjoy the immediate, substantial effect you can have on a player, their performance and achievements. Many times we have had players about to pull out with an acute injury who have gone on to win the event that week — this is an extremely rewarding part of the job. For me, the apotheosis of my physio career was working with the triumphant European Ryder Cup Team in Medinah in 2012 when they made an incredible final day comeback. To be in the locker room listening to Jose Maria Olazabal’s team talk before, and victory speech after, was something I will never forget.
The last 5-10 years in golf physiotherapy has seen much greater emphasis on exercise and strength & conditioning work in treating injuries and maximizing performance. The new breed of much stronger, fitter golfers can generate higher forces and swing speeds and hit the ball further. We have a well equipped gym in the Mobile Physio Unit and are able to spend a good amount of our time with players, working on both general fitness and conditioning, as well as golf specific exercises.
Life on tour means long hours. In summer we regularly start at 5 am and finish at 9 pm. We open an hour before first tee and stay until every player has finished playing. Early parts of the week often involve dealing with more acute injuries and working on strength and conditioning and rehab programmes. Moving through the week, we do more preparation, recovery and maintenance work with the players and less strength & conditioning.
Practitioners and players share some similar problems: having to perform week after week when moving across large time zones and taking multiple long flights. I manage this by getting sufficient sleep, eating & drinking well and staying fit. This year I will travel to over 25 events across the world – it’s lucky I have got my packing and travel logistics down to a fine art! (This part was sponsored by TARDIS*)
Biomechanics and injuries
Golf is very demanding. It requires strength, explosive power, flexibility and athletic ability to perform a movement which produces some of the fastest club head and ball speeds of any sport.
The effect of repeated large forces, often over decades, can lead to numerous injuries, particularly in the lower back, wrist, shoulder and elbow. The biomechanical requirements of an asymmetrical swing is a risk factor for injury. For instance, right handed golfers, who lead with the left side, are more likely to suffer from Extensor Carpi Ulnaris (ECU) injuries on the left wrist and Dorsal Rim Impaction Syndrome (DRIS) injuries on the right wrist. Open Access BJSM paper on wrist injuries here.
The physical requirements to execute these most complex athletic skills are enormous. Human anatomy and biomechanics are poorly suited to perform the high-torque rotational movement of the golf swing, which creates and must resist many high forces. The modern swing uses a large shoulder turn but restricts the hip turn to build torque in the muscles of the lower back and shoulders. This places larger stresses on the back and shoulder complexes, leaving them susceptible to injury.
From the pro circuit to your clinic
When working with golfers and sportspeople in general, my plan is to make them strong, robust (resilient, strong over repeated events) and stable. When working with golfers in clinic, a good strength and conditioning programme is vital to helping them perform better and reducing injury potential. Try to get them to always perform a warm up before swinging a club and structure their practice and play so they start to build up tolerance and ability to withstand the relevant forces through vulnerable structures.
Poor technique is a massive contributor to injury in amateur golfers. Going with a golfer to their golf coach or golf specialist is a great way to understand problems with their swing and the effect that could be having on their injury. Settle in to watch the 2015 Masters in Augusta this April to see great technique and watch how it is done by the pros.
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Nigel Tilley is a Consultant Physiotherapist on the European Golf Tour & ETPI.
@nigel_tilley @ETPI_Physiounit
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