Millions of Americans play golf, with 25 million of us hitting the golf course at least once a year, according to a report from the National Golf Foundation—and with the PGA season culminating in the Tour Championship on Sept. 27, golf will be on many Americans’ TV screens.
How Massage for Golfers Can Help
With golf holding steady as a popular recreational pastime, it would benefit massage therapists—and their golfing clients—to understand how sports massage for golfers can help:
- enhance performance in an activity;
- facilitate faster, more efficient recovery from an activity;
- reduce the risk of injury; and
- accelerate recovery from an injury.
In order to effectively help your golfing massage clients with any of these goals, you need to have a thorough comprehension of anatomy, and you should also have an understanding of the biomechanics of golf and how massage can impact movement, mobility and positioning in a positive way.
The golf swing is one of the most complex and multifaceted movements in all of sports. There are various types of golf swing and varying theories on how to approach it, the intricacies of which can be overwhelming for golfers. They will spend years modifying and fine-tuning their swing. Your objective as a sports massage therapist should not necessarily be to become an expert on the biomechanics of the golf swing, but it is important to have at least a basic understanding.
On the Golf Course: Biomechanics of the Golf Swing
The golf swing can be broken down into four fundamental phases: the address, the backswing, the downswing and the follow-through. Talk to your golfer client before the session to understand her goals and what restrictions she may be feeling related to her swing. If possible, you should watch your client perform a swing in a video or in person prior to administering a massage.
Conduct a few range-of-motion tests before and after the massage to help determine quality and quantity of movement, and how these may have changed over the course of the session (see below). Have your client take a few swings at the end of the session, as well, to test for changes and improvements in the swing. It can also be useful to have your client hit a few balls after the session to reinforce any new or improved movement patterns.
(Note: The following descriptions apply to right-handed golfers.)
Golf Swing, Phase 1: The Address
The address establishes the foundation and sets the stage for the rest of the swing. Legs should be spread shoulder-width apart, with weight evenly balanced between the right and left foot. Hips, knees and ankles should be slightly bent and the low and mid-back should remain straight and in the neutral position. Arms should be straight and the grip on the club should be firm but not overly tight, as a too-tight grip creates excess tension on the wrists, forearms and shoulders.
The main thing to look for in the address is tightness down the posterior chain of the hips and legs, as well as tightness in both psoai. Restriction in the gluteus maximus, hamstrings, adductor magnus, and to a lesser extent the gastrocnemius and soleus may prevent the golfer from bending effectively at the waist and maintaining a neutral spine.
Golf Swing, Phase 2: The Backswing
During the backswing phase, the aim is to get the golf club into the proper position to most effectively transfer power from the golfer’s body to the ball. As the golfer reaches the extreme limit of the backstroke, the club should be parallel with the ground and pointing in the direction of the intended line of flight.
The primary things to look for are limitation in trunk rotation and limitations in the shoulders. Trunk rotation can be restricted because of tightness in both the right and left quadratus lumborum, internal and external obliques, paraspinals, psoai and intercostals. Limitation of external rotation of the right shoulder can be caused by tightness in the subscapularis, pectoralis major and minor, serratus anterior and intercostals; whereas limitation of the left shoulder into internal rotation and/or horizontal adduction can be caused by restrictions of the infraspinatus, teres minor, rhomboids and deltoids.
Golf Swing, Phase 3: The Downswing
The downswing generates the power to hit the ball and can be a fairly fierce motion. The chain of movements through the body from the legs to the hips, torso and then arms are often described as whip-like.
Because of the transfer of weight from the right leg to the left, the left foot and ankle need to provide a stable platform for the rest of the body. You should be aware of any tightness or restriction in the left leg peroneals, tibials posterior and intrinsic foot muscles. The pelvis needs to shift, or kick, to the left, while quickly rotating from external rotation to internal rotation. The gluteus medius, gluteus minimus, tensor fasciae latae and iliotibial band can restrict the shift of the pelvis to the left and reduce the amount of power the golfer can generate. The left piriformis, deep external rotators, tensor fasciae latae, posterior gluteus medius and posterior gluteus minimus can restrict internal rotation of the left hip.
Golf Swing, Phase 4: The Follow-Through
The follow-through is a fairly passive part of the swing. The body is essentially slowing down after contact has been made with the ball. As with the downswing, left hip internal rotation, trunk rotation to the left and shoulder mobility remain extremely important.
One additional movement to be aware of is the extension that occurs at the anterior hips, especially the left side, and spine at the very end of the follow-through. Be aware of tightness in the left tensor fasciae latae, anterior gluteus medius and gluteus minimus, as well as both the right and left abdominals, external obliques and psoai.
Off the Golf Course: Assessment and Treatment
As previously mentioned, it can be useful to perform a series of range-of-motion tests, shown below, before the massage to gain a better understanding of your client’s restrictions. Test both the right and left sides to assess any asymmetries—and test before and after the massage so you and the client have a better understanding of how the massage impacted any restrictions or limitations.
Two very common injury sites for golfers are the low back and elbow. These are not the only injuries golfers sustain, but since they are so prevalent and are also issues a sports massage therapist can positively impact, we will focus on them. Golfers who carry their own bag experience twice the rate of injury in the low back and shoulder compared to golfers who do not carry a bag, according to the American Orthopaedic Society for Sports Medicine.
In order to help prevent the occurrence of low-back injuries, trunk rotation and left hip flexibility should be your primary areas of focus. You should work the quadratus lumborum, internal and external obliques, psoai and intercostals, as well as left hip piriformis, deep external rotators, gluteus medius, gluteus minimus and tensor fasciae latae.
Golfer’s elbow occurs on the inside area—the medial epicondyle—of the right elbow for a right-handed golfer and left elbow for a left-handed golfer. It can be characterized by pain, tenderness, weakness or tingling at the inside of the elbow, and is generally caused by overuse, holding the club too tightly, repetitively hitting divots, or trunk or shoulder restrictions that cause compensation in the forearms. You should work on releasing the forearm flexors and pronator teres muscles and then perform friction massage on the tendinous attachments at the medial epicondyle itself.
Between Massage Sessions: Home Treatment
A key part of our responsibility as sports massage therapists and healers is empowering clients with knowledge and the ability to treat themselves as effectively as possible. Use of a foam roller and other home self-massage devices can be a tremendous supplement to the work we perform in the clinic and make our sessions even more successful. Below are a few key self-massage techniques that are particularly effective for golfers.
With hands clasped behind the head, roll up and down the paraspinals as shown below. You can also generate additional thoracic spine mobility by incorporating rotation as shown.
Place the foam roller under the low back as shown below. It helps to use a roller with raised bumps in order to penetrate the quadratus lumborum muscles more effectively. Keeping your feet on the floor, drop your knees from side to side as shown in the next picture. For an additional variation, keep one foot on the ground and bring the other knee up to your chest.
Gluteus medius/Gluteus minimus
Lie on your side as shown in the picture below. You can adjust the roller using your left hand as shown. For an additional stretch on the lateral hip, you can straighten the arms as shown in the next picture.
Position your body on the roller as shown below.
In order to effectively foam-roll, it is extremely helpful to have a foam roller with a lip on the outside edge as shown below. Lie facedown on top of the roller with one hip off the roller and the other just on the edge so that the iliopsoas is pressing into the edge of the lip. You can increase the intensity by straightening your arms and adding a stretch as shown.
Use a tool like the one shown below to massage the forearm flexors.
Back on the Golf Course: Game On
By understanding the unique concerns of your golfing clients and providing them targeted treatment and appropriate self-care suggestions, you can help decrease their chances of injury, accelerate their recovery—and enhance their performance on the golf course.
About the Author
Mark Fadil is the co-founder of Sports Medicine Institute, a performance center which focuses on sports and orthopedic massage, in Palo Alto, California. He is also the founder of PHLX, a comprehensive foam roller system that empowers the user to recreate hands-on techniques utilized by skilled massage therapists.