PROLOTHERAPY Prolo Your Golf Injuries Away
From Chapter 33 of Prolo Your Sports Injuries Away.
 

The most common physical regions of injury for golfers include the following:

-Lower back strain and injury

-Left shoulder strain and injury for right-handed players

-Left lateral or strain (epicondylitis) of left elbow for right-handed players (analogous to tennis elbow)

-Right shoulder strain and injury from overuse

-Right hip and knee injury from aggressive driving motion of downswing
 

Although local treatment with Prolotherapy is effective in alleviating pain and initiating the healing repair process, the practice of preventive medicine should have the priority for all medical and therapeutic practitioners for more long-lasting results. This can only be achieved by treating the patients with chronic painful conditions with remedies that will correct the underlying problem (Prolotherapy), but then to educate the patients in the most efficient biomechanical movements in the golf swing and correcting any musculoskeletal imbalances with exercise. The doctor must also consider that as an athlete ages, there is usually less flexibility in the joints and more susceptibility to injuries especially for the "weekend warriors." All the above injuries of the athlete can be minimized by routine "proper" stretching prior to playing and the proper use of the proximal large muscles (large muscles nearest to the heart, navel, and the hips) in the golf swing.
 

The Large Muscles

The major large muscles of the upper body used are the "pecs" or pectoralis, the muscles connecting to the shoulder blade, such as the rotator cuff muscles, including the supraspinatus and infraspinatus, the muscles covering the shoulder, including the deltoids, as well as the "lats" or latissimus dorsi, and serratus posterior.
 

The large muscles of the lower body used in the golf swing are the large pelvic muscles, the "glutes," or gluteus muscles of the rear end, "hamstrings," or semitendinosus muscles in the back of the thigh connecting the power to the "glutes," for the downswing, and the "quads," or quadriceps muscles for initiating and finishing the upswing.
 

The use of proximal muscles for power, consistency, and "repeatability without strains" can make the difference between a well-controlled powerful stroke and a weaker "wimpy" hit.
 

The golfer must discipline themselves to use the shoulder/chest muscles and the trunk/leg muscles connected and coordinated with the smaller muscles of the arms for the execution of the swing. Remember that the muscles closer to the hands and feet are for fine movements and not for power, and are highly susceptible to injury when used to generate power. I have seen men with "black and blue marks" (ecchymoses or hematomas) on their forearms from the tension of gripping their clubs so tightly, with their distal muscles, to force a powerful swing.

Golf injuries, when corrected by Prolotherapy without simultaneous correction of the poor biomechanical habits are doomed to only temporary relief, especially for the professional athletes.
 

Back and sacroiliac problems: Usually, the person with this problem finishes their downswing and follow-through ending with a typical Reverse "C" position, thus straining the vertebrae and sacroiliac joints, leading to chronic injury.
 

Prolotherapy to the ligaments of the lumbar vertebrae and sacroiliac joints are effective. People receiving them will note that they cannot only swing the golf club pain-free, but that they can also sit in a car for an extended period of time without discomfort. Three treatments generally give 80 to 90 percent improvement.
 

Left shoulder: The abuse of the left shoulder from the age-old teaching of pulling the left arm on the downswing has led to not only ligamentous injuries but also rotator cuff injuries. Rotator cuff simply means injury to the four muscles adjoining the shoulder, but most frequently the supraspinatus muscle. After Prolotherapy to the shoulder joint and ligaments, the golfer must learn a new method of hitting. The advice by Ben Hogan to hold a handkerchief in the right armpit and keep the left elbow close to the chest is simply a way to keep the large muscles connected to the arm muscles in the downswing.
 

Left elbow: This injury results when those golfers who cannot rotate their body towards the direction of the intended shot are overly zealous with the use of the left arm. They fail to flex and externally rotate their left elbow, as they come into, and through, the zone of impact. These individuals often have arm straps, worn below the elbow, while playing tennis or golf. This problem is difficult to treat using conventional methods because, over time, the tissues become degenerated, including the tendinous part of the brachialradialis muscle, as well as the wrist extensor muscles.
 

These golfers need to learn how to strike the ball with maximum use of their body, and to externally rotate their left elbow, while keeping the left wrist stiff and rolling the right hand/wrist, as in a topspin stroke in tennis, during the impact.
 

Right shoulder: This overuse problem occurs more in professional players and instructors. Ligamentous injections with Prolotherapy are sufficient for pain relief and repair. After Prolotherapy, the golfer typically notices an increased ability to practice and play without pain.
 

Right and left pelvic and gluteus muscle injury: The overzealous player who plays 36 holes for each day of the weekend may feel the strain of repeated contractions of these large muscles on the downswing. This problem is more pronounced in those who end with the Reverse "C" posture after completion of the swing. Again, Prolotherapy to the sacroiliac joints is needed, as well as a more appropriate follow-through, aimed directly at the target not the sky.
 

Right Knee Injury: For those who have had previous surgery, such as an ACL (anterior cruciate ligament) repair, the overuse of driving the right knee and foot towards the ball on the downswing may cause injury and strain. After injecting the joint and ligaments with Prolotherapy, the golfer must use the larger gluteal muscles and less of the leg muscles below the knee on the downswing.
 

The importance of using the CORE or big proximal muscles in sports is the only way to lessen the visits to the doctor and chiropractor. Even the best Prolotherapist cannot cure some of the treated problems without the re-education of the athlete golfer.
 

Case Studies on Golf Injuries Treated by Prolotherapy:

J.M. is a 55 year old white male professional golf instructor who noted severe back pain from his daily work that he could not sit in a car for more than 20 minutes. Physical therapy and chiropractic manipulations only temporarily relieved his symptoms. His lower lumbar ligaments and sacroiliac joints were injected with 15 percent dextrose in three sessions, two weeks apart. His symptoms were relieved by 90 percent, and his awareness and correction of his swing, by avoiding the Reverse "C" at the finish of his downswing helped prevent the recurrence of the problem. These types of professional athletes are commonly prone to this problem because of overuse, yet the relief of symptoms after Prolotherapy treatment is most impressive.
 

J.C., a 58 year old white male executive "weekend warrior," developed a sore left shoulder after a week of golf camp and noted a clicking sound when pressing down with his left arm. His examination revealed tender coracoacromial and trapezoid ligaments in the shoulder. The MRI was negative for rotator cuff tear. He was treated with five sessions of Prolotherapy, injecting the shoulder joint and the involved ligaments. He recovered and can now play pain-free. Before his injury, he was taught to use the body to "pull the left arm" on the downswing and use as little of the right arm as possible. We advised him to use the "handkerchief" technique of keeping his left shoulder close to his chest, so that the handkerchief is trapped between his left arm and the chest wall on the downswing. This promoted the use of the large muscles of the shoulder such as the pectoralis, deltoid, latissimus, and the serratus muscles to work together with the left arm muscles. The equal use of the left and right arm swing, with proper left elbow external rotation and right wrist pronation, prevented recurrent injury.

P.R., a 49 year old male collegiate football coach, developed left elbow pain after excessive playing during the summer months. The pain was severe and he used a forearm compression brace on the tendinous portion of the lower arm muscles (brachialradialis), as commonly used by tennis players. The lateral epicondyle and lateral collateral ligament were injected. He received a total of six injection sessions with "near" complete relief of symptoms. He was taught to use proper external rotation of his left elbow on the point of impact and follow-through on the downswing. The complete resolution of his problem was possible only after he took four to five private lessons to correct his body rotation to lessen the strain on his left forearm.