Murray E, Birley E, Twycross-Lewis R, Morrissey D. The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: An observational study. Physical Therapy in Sport, 2009, 10: 131-135.
The purpose of this study was to compare hip rotation in amateur golfers with and without low back pain (LBP). Passive and active medial (internal) and lateral (external) rotation were measured (using an inclinometer) with subjects lying prone on a table with the knee flexed 90 degrees. Passive was measured before active. Comparisons were performed between the groups, as well as between lead hip and trail hip within the groups.
The findings, consistent with other studies, documented a statistical difference in internal rotation between the lead and trail hip of the LBP group. The lead hip had 10 degrees less passive internal rotation, and 7 degrees less active internal rotation. When comparing between groups, the LPB golfers had an average of 7 degrees less internal rotation in the lead hip than the group without pain.
If restricted internal rotation of the lead hip is present in golfers with LBP, is this one of the causes of this pain? The Chain Reaction® Biomechanics of the follow-through / finish of the golf swing requires excellent motion in the lead hip, thoracic spine, and shoulders. Lack of transverse plane motion in any of these regions will require more motion in the lumbar spine. Because the lumbar spine joints have very little transverse plane motion, tissue stress levels will increase. Symptoms will develop if the tissue stress exceeds the symptomatic threshold. If restricted hip internal rotation is high on the list of causes, then what does an Applied Functional Science® approach to restoring the body’s motion resources, and eliminating the symptoms entail?
The Functional Golf System (https://www.grayinstitute.com/courses/golf) from Gray Institute® is a specialization for people who train and rehabilitate golfers. The system is an organized program that “arms” movement practitioners with golf-specific movements to improve mobility, balance, strength, and power. For a client with limited lead hip internal rotation, the System would take advantage of the Performance System in 3DMAPS® (3D Movement Analysis & Performance System) to use multiple movements, performed in a weight-bearing position, to increase hip internal rotation. It is important to choose movements that increase rotation without putting stress into the lumbar spine. One Strategy is to use successful motions in the sagittal and frontal planes to improve the transverse plane internal rotation. (Find out more here: https://www.grayinstitute.com/courses/maps.)
Once the internal rotation improves, it is essential to teach the client to control that motion with balance / stability movements. As control improves, load can be added and speed increased to develop strength and power. The Strategy of progressing from mobility to stability, then to strength and power is logical but not the only sequence that can work. The progressions in 3DMAPS® and the Functional Golf System provide practitioners with multiple options that allow for creativity and adjustments to meet the needs of each individual patient / client, all based on the Truths of human movement.
Regardless of the sport our patients / clients want to do, activity-specific movements must be selected that increase the physical resources of the body, and then integrate these local joint / muscle resources into global movements.