Christopher Thurston, PT, DPT, CSCS, TPI Certified Physical Therapist
Although it’s said jokingly at times, there is some reality to the quote, “Back pain will bring the strongest of men to his knees!” Prior to his surgery, professional golf phenomenon, Tiger Woods, endured this reality while playing in the final round of a major tournament in August of 2013. Tiger, the number one golfer in the world, is so well-respected for his physical talents on the golf course that he is often seen as the Michael Jordan of golf.1,2
“The ankle bone is connected to the leg bone, the leg bone is connected to the knee bone”
With a playing style such as Tiger’s, which epitomizes the optimal combination of power and technique being applied to a golf swing, any disturbance to one part of the body can easily affect the other. Having to withdraw from a PGA tournament three years ago, Tiger was quoted saying, "The knee acted up and then the Achilles followed after that, and then the calf started cramping up." Woods says, "Everything started getting tight, so it's just a whole chain reaction." It was inevitable that problems in other parts of his body led to back problems. Recently, he was forced to decide on surgical intervention for treatment.3,4
Microdiscectomy? Sounds complicated!
Contrary to how it may sound, a microdiscectomy is a minimally invasive procedure aimed at removing a disc from the painful area of the spine where a nerve is being pinched. As described by internationally renowned spine surgeon, Dr. Chetan Patel, there is no fusion of the bones and almost all of the joints, muscles and ligaments are left preserved. Dr. Patel mentions that as soon as anesthesia wears off, patients will be able to get back on their feet with almost immediate pain relief in most cases. Having provided physical therapy for his patients firsthand, I can attest to his portrayal of this relief in patients after choosing the route of surgical intervention.5,6
Tiger’s anticipated return to the top through aggressive rehab
Strong evidence supports the idea that intensive exercise programs are more effective for improvement of functional status and a quicker return to work as compared with mild exercise after a lumbar discectomy. Of course, intensive is a relative term. At the Spine Health Institute, our efforts are not only focused on our patients’ return to work, but also on preventative care to reduce chances of future injury. An elite athlete such as Tiger Woods would need to be challenged in a way that will prepare him for a safe “return to work.” After two months post-surgery, patients who had a traditional lumbar discectomy were shown to have trunk strength deficits of 44% with trunk flexors (muscles that allow you to perform sit ups) and 36% with trunk extensors (muscles that allow you stand up tall). As with any athlete or patient, it takes a team to follow through on this concept of preventative care and education about lifestyle changes, activity modification and strengthening. The physical therapist working alongside the athlete’s golf coach and surgeon in the re-building process is essential to ensure success. 7
We must ... ANALYZE
As with any physical injury relating to movement, having a skilled physical therapist assessing your joint mobility and body mechanics is imperative. Generic sequences of movements, such as a functional squat, combined with sport-specific patterns of movement, such as a golf swing, can be analyzed to find movement impairments. By using a Titleist Performance Institute (TPI) video golf swing analysis and a hands-on physical assessment, the skilled therapist can design a rehabilitation program based on very detailed findings. As the movement specialist in the continuum of care, the physical therapist must determine which exercises and manual techniques are going to prove most effective based on these detailed findings. 8
1. Greenberg, Chris. "Tiger Woods' Back Injury Flares Up, Pain Drops Him To His Knees On 13th Hole At Barclays (VIDEO) [UPDATED]." The Huffington Post. TheHuffingtonPost.com, 25 Aug. 2013. Web. 20 Apr. 2014.
2. "Official World Golf Ranking." Official World Golf Ranking. N.p., n.d. Web. 20 Apr. 2014. <http://www.owgr.com/>.
3. "Tiger Woods, Stanford, 1995." Golf.com. N.p., n.d. Web. 20 Apr. 2014. <http://www.golf.com/photos/tiger-woods-injuries-chronology/tiger-woods-s....
4. "Homepage." TigerWoods.com. N.p., n.d. Web. 20 Apr. 2014. <http://www.tigerwoods.com/home>.
5. "Lumbar Microdiscectomy." Spine Health Institute. N.p., n.d. Web. 20 Apr. 2014. <http://www.thespinehealthinstitute.com/services-and-specialties/treatmen....
6. Patel, Chaten. "Lumbar Microdiscectomy." Personal interview. 22 Apr. 2014.
7. Placzek, Jeffrey D., and David A. Boyce. Orthopaedic Physical Therapy Secrets. St. Louis, MO: Mosby Elsevier, 2006. 450. Print.
8. Thurston, Christopher, Jr. "Expert - Christopher Thurston Jr." Titleist Performance Institute. N.p., n.d. Web. 20 Apr. 2014. <http://www.mytpi.com/experts/Christopher.ThurstonJr%40AHSS.org>.