Here you can find Boundless’ Golf Training Articles and Tips.

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Golfer’s Elbow- More than meets the eye

Elbow injuries are one of the most common injuries in golf. They are so common, in fact, that there is even a term called “Golfer’s Elbow” referring to an injury of the medial or inside part of the elbow. The only problem with that nomenclature is that “Tennis Elbow,” an injury to the lateral or outside part of the elbow, is also a common injury in golf. Though the terminology can be misleading, we can make some general assumptions as to why you have your pain depending on where it is.

 

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  • Golfer’s elbow or medial epicondilitis: This is an injury of the flexor tendons of your elbow, which connect your elbow to the muscles that flex your wrist (make your hand go down when your arm is extended in front of you with the palm facing down). Most amateur golfers get this injury in their trail arm (right elbow for a right handed golfer) because at impact their wrist tends to flex, or bend forward, as we see in the classic “Chicken Wing” “Casting” and “Scooping” swing patterns.

Low handicappers, on the other hand, tend to do the opposite since their lead wrist is flexed at impact (a more “proper” impact position). So by knowing where your discomfort is and on which arm, we can already guess what type of swing patterns we may see, and we can start to think about how to correct it.

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  • Tennis elbow, on the other hand, is the opposite of golfers elbow and involves the lateral aspect of your elbow. Amateurs tend to get it in their lead elbow as they extend their wrist, or bend the back of your hand toward the target, through impact. Low handicappers extend their trail wrist at impact, thus potentially causing pain in the lateral aspect of the right arm for right-handed golfers.

Here comes the twist. For most amateur golfers, your pain is in your elbow, but the elbow is almost never the inciting problem! Instead, the causative mechanism frequently starts in your hips and pelvis. That’s right. Your lower body causes your elbow injury. If your hips are not leading the downswing, or you are not rotating enough with your lower body, or you don’t have a proper weight shift in your lower body, or if you come over the top by starting your down-swing with your arms; all of these tendencies will force your upper body to compensate by “Chicken winging” “Scooping” or “Casting.” This leads to excessive extension of the lead wrist and flexion of the trail wrist, putting you at much greater risk for elbow injuries.

 

Since the elbow pain is the result of a mechanical compensation, a qualified professional should never focus only on your area of pain. Instead, they need to perform a thorough evaluation of how your body moves from top to bottom and how that impacts your golf swing mechanics. Only then can they indentify the true cause of your elbow pain and correct it. “Put an elbow brace on and go hit more balls” is never the best answer. It may feel better for a while, but it is a matter of time until the injury returns if you haven’t addressed the underlying mechanism. Likewise, directed therapy at your elbow is important to help speed recovery, but will not address the underlying cause.

 

A couple more tips:

  • It is OK to bend your lead arm. We are frequently told to “keep you elbow straight!” But that can increase the pressure on our lead arm. Bending it a few degrees will frequently help the problem without hurting your swing.
  • Pay attention to your work ergonomics. Your sitting position at your desk and computer can prevent an elbow injury from healing or possibly even make it worse.
  • Keep you arm down when you sleep. This can be a tough one, but if you can sleep with your hand below your chest with your elbow bent at less than 90 degrees, you can provide valuable healing time for your elbow as you sleep.
  • Watch your grip pressure. Holding the club too tightly increased the work and pressure placed on your elbows
  • Try to avoid “fat” contact as this increases the impact forces through your elbow. Hitting it “thin” is a better miss for those with chronic elbow problems.

 

Hopefully this gives you a solid basic understanding about elbow injury mechanisms and potential corrections. By knowing where the injury is and on which arm, we can already guess what may be the cause. However, we can only know the cause for sure with a full body and swing evaluation. We usually find that the elbow is the innocent bystander making compensations for improper lower body motion and sequencing. We also have to make sure other parts of your life (i.e. work, sleep etc.) aren’t making it worse or preventing it from healing. Although directed elbow therapy and an elbow brace may be helpful in the short term, a long-term fix requires a more thorough evaluation by a trained professional.

 

To learn more about how we can help you with injury prevention and overall golf performance, contact us today at info@myboundlesshealth.com

 

Fitness. Health. Life

Boundless Health

 

Bret Scher, MD FACC

President, Boundless Health

www.myboundlesshealth.com

858-799-0980

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Pelvic Tilt

A proper pelvic tilt is crucial for correct posture. Whether that applies to your golf set up posture, or your general posture as you go through your day, having a slight posterior pelvic tilt (tilting the top of your pelvic bones back and your lower pelvis forward while engaging your lower abdominal muscles) gets your core engaged and aligns your body for maximal movement efficiency with reduced risk of injury. Here is our lead trainer, Dustin Schaeffer, showing how to engage your lower abdominals in the pelvic tilt.

 

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Optimal Golf Nutrition

We have our clubs, our shoes, and even our large buckled white golf belt. Now we are ready for our round. Or are we? We need to warm up of course (please see our previous post about our 5 minute golf warm up). But we also need to prepare for our round before we even leave the house. This time I am talking about your nutrition. You may (or may not) be surprised to learn that very few golfers realize the impact their nutritional choices can have on their golf performance. If you get nothing else out of this post, please walk away with the concept that we should put food and nutrients in our body with a purpose, with the ultimate purpose being improving our golf performance. Grabbing a quick bowl of cereal (or even worse…. a doughnut!!) on the way out the door hardly qualifies as eating with a purpose. Grabbing a quick bar at the turn may seem like it serves a purpose, but in the end, it may hurt more than it helps.

 

What do I mean by “eating with a purpose?” Nutrition for golf (and for most of life) should have 4 main goals:

  • Maintain a stable blood sugar level (i.e. avoid the rapid highs and rapid lows or “crashes” that can happen with many foods)
  • Prevent hunger and promote satiety without feeling full
  • Help you feel energized
  • Keep you hydrated

 

Let’s start with your breakfast. What is the most common pre-golf breakfast? Cereal. Why? It is quick, it is easy, and it is what we are accustomed to. To be fair, manufacturers have attempted to improve nutritional value of cereals by adding protein and fiber, but most cereals still remain highly processed simple carbs that put you at risk of a quick rise and fall of your blood sugar. If you insist on having cereal, you can help minimize the blood sugar swings by adding higher quality fats and protein such as nuts, flax seeds, or even cottage cheese to your bowl. If you are open to a change, consider higher quality foods like eggs (cooked is great, but even 2 hard boiled eggs on your way out the door adds great benefits quickly), Greek yogurt with fruit and nuts, or even whole grain toast with peanut butter. All of these tend to provide better satiety with stable energy for hours compared with cereal, muffins, doughnuts etc.

 

A breakfast with a good mix of protein, fiber and fats will get you fueled and ready for your round. After that, most people won’t need further nutrition for the 1st nine holes. But as you finish the front nine, you may notice that your energy is waning a little bit, or that you are feeling a little hungry. You shouldn’t be ready for lunch yet, but you may be ready for something. What do we find greeting us at most “half way houses?” Cookies, candy bars, Gatorade, and the “healthy choices” of energy bars, trail mix and bananas. All of these choices may give you energy for 3 or 4 holes, but then comes the inevitable sugar swing and potential crash. This brings us back to eating with a purpose. At the turn, our purpose is once again to 1- level our blood sugar, 2 keep us from feeling hungry, 3 energize us for the next 9 holes, and 4- keep us hydrated. If we aren’t prepared and aren’t making mindful choices, it is easy to fall prey to what we have immediately available, and we may grab the first junk snack we see on our way to the back nine (we have to keep up the pace of play!).

 

What are some better choices? Make your own trail mix and bring it with you. Commercial trail mixes have become more raisins and M&Ms and less nuts. Instead, pack it full of almonds, cashews, walnuts, and add a few raisins or dark chocolate chips. You should feel like you hit the jackpot when you get a “sweet”, not with every bite. Or even better, try high quality beef jerky. They even make turkey jerky and Ahi jerky (its amazing what you can find at Whole Foods nowadays). Need more choices? Try apples or celery with peanut butter. Remember, you are not having a meal. You do not want to feel full. You are just snacking to keep you going for the next 9 holes.

 

Notice that all the above listed options combine proteins, fats and low glycemic index carbs, while limiting the simple sugars that will cause the blood sugar swings.

 

1 small apple & 1tbsp peanut butter155 cal8g fat4.5g protein17g carbs
3 pieces Beef jerky240 cal15g fat20g protein6g carbs
2 hard boiled eggs145cal10g fat12g protein1g carbs
1 cup low fat cottage cheese163 cal2g fat28g protein6 g carbs
1 cup cheerios115 cal2g fat3g protein22g carbs

 

 

If you eat with a purpose as outlined above, you should be set for the full 18 holes. If you find that even with these good choices you are dragging again come hole 16, then you can decide to get the quick fix with a sugary snack (like an energy bar or fruit) to give you the quick boost for the last 3 holes. Then once you finish, you can focus on properly refueling after your round.

 

Glycemic Index Fruits:

BestStrawberries, pear, plum, apple, peach, orange
MediumBanana, grapes
WorstDates, figs, raisins

 

Now lets turn our focus to purpose #4- hydration. Many of us only think about hydrating when it is an excessively hot day, or we don’t start drinking until we feel thirsty. Studies have shown that even mild dehydration can adversely affect athletic performance, and that once we are thirsty, it is too late as we have already become dehydrated. But the crazy part is that it is so easy to hydrate! Some experts in the field recommend that we drink half our body weight in ounces of water (i.e. a 200 pound man should drink 100oz of water in a day). That is significantly more than most of us get, but it highlights how relatively dehydrated we tend to be. We are almost guaranteed to wake up dehydrated since we haven’t had anything to drink for over 8 hours. If we grab a cup of coffee on the way to the course, we actually make ourselves even more dehydrated! First thing in the morning is the most important time to hydrate. The only real side effect from hydrating is having to “visit mother nature” more when you are on the course. I think that is a fair trade for improved performance, don’t you? So grab a BPA free reusable bottle of water, fill it up, and drink it on your way to the course. And then keep drinking. A good rule of thumb is that you should start the round hydrated, and then drink a minimum of one bottle of water each 9 holes.

 

Remember that sugary sports drinks get us into the same problem as the junk food with the rapid rise and fall of blood sugar. With proper nutrition, we should not need a sports drink. Water will suffice as the best source of hydration. If you really want to get specific with your hydration, it is important to note that most bottled water is highly purified tap water with minimal minerals or “solutes” in it. If you have the choice, higher quality spring waters like Fiji, Evian and other pure spring waters can give you added benefit with natural minerals and solutes. Or if needed, you can always add a sugar free electrolyte replacement to your bottled water.

 

At Boundless Health, we work with you to find your ideal approach to nutrition and hydration. We emphasize that you should eat with a purpose, and drink with a purpose. Together, we help you learn to make conscious decisions about what you put in your body. We make sure you are improving your performance by maintaining a stable blood sugar level, preventing hunger, feeling energized and staying hydrated.

 

To learn more, please contact us today to learn how we can work together to help improve your health and performance on and off the course.

 

Bret Scher, MD FACC

President, Boundless Health

TPI Fitness Level 2, NASM CPT FNS

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5-minute Golf Warmup

I have heard all the jokes, “I stretch before golf….I bend over to tie my shoes!” or “I slam the trunk and run to the first tee, that’s a warm up, right?” Although it may sound funny, it could be that you are missing the most important part of your round. The golf swing is a very powerful and dynamic motion and a proper warm up prepares your body not only to play well, but to play safely, thus reducing your risk of injury.  But don’t worry, you don’t need fancy equipment and you don’t need to get to the course an hour before your round. Please see the following video for a simple yet very effective 5 minute warm up with no equipment required.

Happy and Healthy Golfing!

Bret Scher, MD FACC
President, Boundless Health
TPI Fitness Level 2, NASM CPT
www.myboundlesshealth.com

https://www.youtube.com/watch?v=KMuvF883IXs.

 

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Are you Flexible or Mobile? Is there a difference??

Far too often when I ask someone what type of exercise they do to prepare themselves physically for golf, they say, “I do lots of stretching to make sure I’m very flexible.” Does this sound familiar? If so, this blog’s for YOU!

First off, I do not intend to write a diatribe against stretching. I’ve been working on flexibility and stretching ever since I was 10 years old and started doing taekwondo. I take pride in being flexible. I have seen the rollercoaster of flexibility popularity. First it helps you and is crucial to preventing injuries, then it is dangerous and can actually cause injuries, and then it temporarily decreases strength output of muscles and should be avoided. Of course, the “truth” lies somewhere in between.

There is no question that an absence or lack of flexibility limits proper movement, especially a proper dynamic motion like a golf swing. However the point I want to make today is that working on flexibility alone, while important in itself, is woefully insufficient training to prepare your body for golfing or any physical challenge in life. In addition to flexibility, we need to consider the concepts of mobility and stability. Let’s start with some definitions. I would define flexibility as the ability to move a specific body part around a specific joint. It’s simply a measure of how far the body part can move. For example, thoracic spine flexibility is measured by how far you can rotate the upper torso in the transverse plane. When you talk about mobility, however you talk about the ability to do this under control and you introduce strength into the equation. Can you rotate your thoracic spine in a controlled fashion so that you can rotate it back with strength and power? This is critical for rotational sports and for the golf swing. Adequate flexibility without mobility can actually put you at a higher risk of injury by placing your body in a position it cannot control. In addition, flexibility without mobility will greatly limit your potential power output.

We also need to introduce the concept of stability. When you rotate your thoracic spine, will your supporting structures in your core (your glutes, abdominals, etc.) engage to keep the rest your body stable so that you can return your body to the proper impact position? If you have a great turn with adequate flexibility and mobility, but your lower body fails to stabilize you, you will sway back when you turn and thus be unable to consistently return to impact.

You can see how in the swing sequence, each concept (flexibility, mobility, and stability) is dependent on the other for a proper chain of events. Any weakness in the chain; be it flexibility, mobility, or stability, can cause the whole sequence to break down and result in inconsistent swing faults or even worse, a significant injury. Only by working on all 3 of these qualities, and making sure each segment in the chain of motions is working properly, can we develop stronger, more efficient, and more injury prone movements that translate not just to sports, but to all aspects of life.

Therefore when I hear someone say their golf training consists solely of stretching, I respond by saying, “That is a great start, and it is a very important component to your golf training. Now let’s test your mobility and stability and work on putting that flexibility to good functional use.”

At Boundless Health we strive to provide the most thorough assessments and the most detailed individualized treatment plans to help you achieve your goals, whether it is to develop a stronger and more consistent golf swing, or just to move better in your daily activities. Please contact us today to see how we can help you on your journey to health and fitness without boundaries.

Bret Scher, MD FACC
TPI level 1 Certified
NASM Certified Personal Trainer

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Golf and Back Pain

Unfortunately I learned first-hand that golf can be a painful game when you are injured. Shortly after the birth of my second son, I hurt my back from carrying my kids around too much. This was the first time I had ever had a back injury, and I quickly found that my golf swing was only making it worse. Fortunately for me it was just a muscle strain/ligament sprain, and through my rehab and my work with the Titleist Performance Institute (TPI), I was able to find the proper training and rehab program that helped me restore my health and strength. That made me one of the lucky ones.

The experts at TPI quote that 28% of golfers have some sort of pain in their lower back after every single round. Unfortunately, many of these golfers will have to take extended breaks from the game because of their injury. To some it may sound simple. The lower back is injured; therefore the all-too-common thought is that you need to strengthen your lower back. But it’s important to note that the low back is almost always an “innocent bystander” in the injury cycle, and although it is where the pain shows up, it is rarely the root cause of the problem. Far more often a faulty movement pattern forces the lower back to compensate and bear more of the load than it was meant to do. That’s why it is crucial not to just look at the injured body part, but rather do a full body assessment to find all the potential contributing factors.

The assessment and treatment of low back pain and golf injuries is practically a dissertation unto itself. However I do want to give you one little picture of our thought process at Boundless Health, and our approach to diagnosing and treating the problem.

One of the most common swing characteristics that we look for someone with low back pain is “Reverse Spine Angle.” This is where there is excess backward bending of the upper body during the back swing. This makes it almost impossible to initiate the downswing with the lower body and forces the upper body to dominate the downswing, which causes multiple swing faults and inconsistency with ball contact. However more importantly, it also puts excessive tension on the lower back at the top of the back swing, and since the abdominal muscles are inhibited in this posture, it forces the lower back to carry a heavier load on the downswing with excess flexion and right side bending.

When we see the reverse spine angle, we know that it can frequently be caused by lack of mobility in the hips and thoracic spine, and by too much anterior pelvic tilt at address. Therefore we screen the client with that in mind, and perform a full 16-point assessment to see what other physical characteristics they have which may predispose to these problematic movement patterns. The initial treatment is of course treating the acute injury, reducing inflammation and scar tissue build up, and helping the tissue recover back to its baseline. After that, we frequently emphasize pelvic strength and stability, and helping the client learn to maintain a neutral pelvis at address and maintain it throughout the golf swing. Once the strengthening and motor control is accomplished, then we can work on hip and thoracic spine mobility, thus relieving the pressure on the lower back and allowing for a much more efficient swing with a dramatically decreased risk of injury. However, each phase is dependent on the previous phase. Therefore trying to do too much at once, or doing things out of sequence can be a setup for failure and future injury. Only by a thorough screening, and then the systematic approach to strengthening and improving movements, do you give yourself the best chance of recovering completely and preventing further injuries.

This barely scratches the surface of the topic of golf injuries and back pain. Please contact us to learn more and find out how we can help you on your path to optimal health, fitness and performance.

Bret Scher, MD FACC

TPI Level 1 Certified

NASM Certified Personal trainer