Paul N. Grimshaw

Case report: reduction of low back pain in a professional golfer

Previous research agrees that the majority of injuries that affect male golfers are located in the lower back and that they are related to improper swing mechanics and/or the repetitive nature of the swing. This study describes the trunk motion and paraspinal muscle activity during the swing of a golfer with related low back pain (LBP) and assesses the effect of a 3-month period of muscle conditioning and coaching on these variables. Motion of the trunk was measured using three-dimensional video analysis and electromyograms (EMGs) were recorded from the same six sites of the erector spinae at the start and end of the 3-month period. At the end of the period, the golfer was able to play and practice without LBP. Coaching resulted in an increase in the range of hip turn and a decrease in the amount of shoulder turn, which occurred during the swing. In addition, a reduction in the amount of trunk flexion/lateral flexion during the downswing occurred in conjunction with less activity in the left erector spinae. These changes may serve to reduce the torsional and compressive loads acting on the thoracic and lumbar spine, which in turn may have contributed to the cessation of the LBP and would reduce the risk of reoccurrence in the future. In conclusion, further research with more subjects would now be warranted in order to test the findings of this program for the prevention of low back in golfers as piloted in this case report.

Obesity: the new childhood disability?

This review addresses the impact of obesity on paediatric physical functioning utilizing the World Health Organization International Classification of Functioning, Disability and Health Framework (ICF). The ICF encompasses functioning (as it relates to all body functions and structures), activities (undertaking a particular task) and participation (in a life situation) with disability referring to impairments in body functions/structures, activity restrictions or participation limitations. Electronic databases were searched for peer‐reviewed studies published in English prior to May 2009 that examined aspects of physical functioning in children (≤18 years). Eligible studies (N = 104) were ranked by design and synthesized descriptively. Childhood obesity was found to be associated with deficits in function, including impaired cardiorespiratory fitness and performance of motor tasks; and there was some limited evidence of increased musculoskeletal pain and decrements in muscle strength, gait and balance. Health‐related quality of life and the subset of physical functioning was inversely related to weight status. However, studies investigating impacts of obesity on wider activity and participation were lacking. Further research utilizing the ICF is required to identify and better characterize the effects of paediatric obesity on physical function, activity and participation, thereby improving targets for intervention to reduce disability in this population.

Lower Back and Elbow Injuries in Golf

AbstractGolf injuries to the lower back and elbow are common problems in both the professional and amateur player, and any information regarding the successful treatment of these injuries has important implications for the medical practitioner. This paper presents the successful management and outcome of two case studies associated with low back pain and lateral epicondylitis in golf.Exercise therapy and conditioning has been shown to be an effective treatment modality for these two types of injury. In particular, a dynamic exercise programme which incorporates golf functional rehabilitation, is a modern and accepted method by both the patient and the clinician.Effective programmes need to be golf-specific to maintain the interest of the participant and yet at the same time they need to be able to accommodate other factors such as age, gender and the level of the golfer. Furthermore, it is critical that the clinical practitioner has a fundamental knowledge of normal swing mechanics and a working knowledge of the musculoskeletal requirements needed to swing a golf club.In the case of the lower back injury, evaluationwas based on detailed computer tomography and centred on the conditioning of the transversus abdominis muscle. Although this muscle is not considered to be paraspinal, it has particularly important implications in the maintenance of spinal stability so that other more specific golf functioning exercises and rehabilitation can be performed. For the case study of lateral epicondylitis detailed evaluation and consideration of neuropathywas an important factor in the diagnostic process. In part, it was necessary to deviate from conventional treatment to produce an effective outcome. A comprehensive resistance-strength-training programme and golf functional ‘hitting’ programme was used to treat the problem.The conformity by the patient to complete the exercise regimen has been an issue of concern for clinicians managing and treating golf-related problems. Many golfers are ‘fanatical’ and unless they can see that by continuing the programme their injury will be overcome, it is difficult trying to restrict their time on the golf course. The two case studies described in this article highlight how an extensive and dynamic golf functional programme could be used as an effective method for managing and preventing golf injuries.

Biomechanical assessment of the effects of significant hamstring injury: an isokinetic study

Soccer players may develop recurrent hamstring injuries. This may be due to inadequate rehabilitation or to recurrent injury. In addition, following injury, the hamstring muscular complex may be permanently damaged, resulting in decreased strength, and increased likelihood of recurrent injury. Fourteen professional soccer players were assessed by clinical examination and by isokinetic testing with a Cybex II machine. Seven had suffered moderate or major hamstring injuries in the past year. There were seven controls. None of the hamstring group were currently suffering from an acute hamstring injury. The results of the two groups were compared. There were no differences in the mean results. This pilot study suggests that no permanent functional damage occurs to the muscular complex after moderate or major hamstring injuries after correct treatment. However, further research is required to confirm this.

The effects of acute creatine supplementation on multiple sprint cycling and running performance in rugby players

The benefits of creatine (CR) supplementation are well documented, particularly during repeated bouts of high-intensity muscular activity. Most published experiments use mass-supported (cycle ergometry) activities as a means of evaluating creatines efficacy, therefore minimizing any possible adverse effects of increased body mass associated with CR supplementation. This study aims to use both mass-supported and mass-dependent activities to assess the effectiveness of acute CR supplementation on a group of highly trained rugby players. A randomized, double-blind, crossover research design was utilized, with subjects receiving 20 g·d-1 3 5dof both CR and a glucose placebo (PL). Subjects were assessed via 10 3 6-second Wingate test and a 10 X 40-m sprint test on separate days, presupplementation and postsupplementation. A 28-d washout period separated the two treatments. No significant treatment (p > 0.05) or treatment by test interaction effects (p > 0.05) were observed for peak or minimum power output (W), peak or minimum running velocity (m·s1), or fatigue index (%). No significant differences (p > 0.05) were found postsupplementation for body mass and percentage body fat. Although statistical significance was not achieved for any of the measured parameters, there were small improvements in performance that may be of benefit to rugby players.

Reliability of variables in the kinematic analysis of sprint hurdles

The purpose of this study was to investigate the reliability of kinematic variables in spring hurdles and to find out how many trials are needed to achieve reliable data. Seven British National level athletes in sprint hurdles were videotaped and all eight trials of each athlete were digitized from two camera views to produce three dimensional coordinates. The reliability of 28 kinematic variables across eight trials ranged from 0.54 to 1.00 for females and from 0.00 to 0.99 for males. The number of trials needed to reach a certain reliability level was evaluated using Spearman-Brown prophecy formula, and in the worst case (horizontal velocity lost for males) 78 trials would be needed to reach 0.90 reliability. The results showed reasonably high reliability, and the values for the female trials were generally higher than the male trials. The relative height of the hurdles enforces a more demanding clearance for males that can lead to increased variation within the subjects and thus lowered reliability. Subsequently, the results indicate that often more than one trial is needed to provide accurate quantitative results of the technique.

The crunch factor's role in golf-related low back pain

BACKGROUND CONTEXT The golf swing exposes the spine to complex torsional, compressive, and shearing loads that increase a players risk of injury. The crunch factor (CF) has been described as a measure to evaluate the risk of low back injuries in golfers and is based on the notion that lateral flexion and axial trunk rotation jointly contribute to spinal degeneration. However, few studies have evaluated the appropriateness of this measure in golfers with low back pain (LBP). PURPOSE To objectively examine the usefulness of the CF as a measure for assessing the risk of low back injury in golfers. STUDY DESIGN Field-based research using a cross-sectional design. METHODS This research used three-dimensional motion analysis to assess the golf swings of 12 golfers with LBP and 15 asymptomatic controls. Three-dimensional kinematics were derived using Vicon Motus, and the CF was calculated as the instantaneous product of axial trunk rotation velocity and lateral trunk flexion angle. RESULTS Maximum CFs and their timings were not significantly different between the symptomatic and asymptomatic groups. Furthermore, for those golfers who produced higher CFs (irrespective of the group), the increased magnitude could not be attributed to an increased axial angular trunk velocity or lateral flexion angle, but rather to a concomitant increase in both of these variables. CONCLUSIONS The findings suggested that although the fundamental concepts that underpin the CF seem sensible, this measure does not appear to be sensitive enough to distinguish golfers with LBP from the asymptomatic players.

Musculoskeletal Lower Limb Injury Risk in Army Populations

Injuries are common within military populations, with high incidence rates well established in the literature. Injuries cause a substantial number of working days lost, a significant cost through compensation claims and an increased risk of attrition. In an effort to address this, a considerable amount of research has gone into identifying the most prevalent types of injury and their associated risk factors. Collective evidence suggests that training and equipment contribute to a large proportion of the injuries sustained. In particular, the large loads borne by soldiers, the high intensity training programs and the influence of footwear have been identified as significant causative factors of lower limb injury in military populations. A number of preventative strategies have been developed within military bodies around the world to address these issues. The relative success of these strategies is highly variable; however, with advancements in technology, new approaches will become available and existing strategies may become more effective.

3–Dimensional Kinematics of Overarm Throwing Action of Children Age 15 to 30 Months

7 children 15 to 30 mo. old participated in a study of 3–dimensional kinematics of overarm throwing. Children of different ages were considered to be at different developmental stages of motor development. Video recordings were digitised and 3-dimensional coordinates established using the DLT algorithm. Qualitative analysis indicated that the children executed either a ‘static’ or ‘dynamic’ throwing action. Either could further be classified as ‘arm dominated’ or ‘sequentially linked.’ Maximum elbow extension was no more than 163° for any child; release velocity was higher for older subjects; and the angle of ball release was large in ‘arm-dominated throws’ (M = 49°) and comparatively smaller in ‘sequentially linked’ throws (M = 15°).

VARIABILITY IN DEVELOPMENT OF OVERARM THROWING: A LONGITUDINAL CASE STUDY OVER THE FIRST 6 MONTHS OF THROWING

One female subject of 15 months of age,-at the onset of overarm-throwing behaviour, was tested on a longitudinal study of throwing development. Data were collected at the onset of throwing and monthly thereafter, producing 6 sets of data. Kinematic variables were obtained using 3-dimensional video analysis and digitization. Qualitative observations showed that both arm-dominated and sequentially linked throws, right- and left-handed throws, and homolateral and contralateral forward steps were generated in an array of inconsistent throwing. Sequentially linked throws were generally ‘interrupted’, whereby the child paused briefly after the Back swing to focus externally, then the child executed the propulsion. The throwing elbow remained flexed at ball release. Angles of ball release (referred to the horizontal) fluctuated from 2.17° to 28.03° for all 6 months of throwing development, and the speed of ball release varied from 2.08 m/sec. to 4.32 m/sec. Height of ball release oscillated between 91.5% and 103.3% of the childs height. Horizontal and vertical components of the velocity of the ball while in the hand differed amongst both arm-dominated and sequentially linked throws. The time of the Push up phase in arm-dominated throws varied from 0.14 sec. to 0.50 sec. In sequentially linked throws the time of the Back swing ranged from 0.18 sec. to 0.22 sec., and the Propulsion varied from 0.06 sec. to 0.14 sec. This work in identifying such variability is important, therefore, in the understanding of the motor skill of throwing.