Dr. Dante Implicito (Section Chief of Spine Surgery at Hackensack University Medical Center)
and Ozzie Carlson (Head Professional and Director of Golf) Help Those Golfers with Chronic Back and Neck Pain.

For most of the 25 million golfers in America, playing 18 holes is probably one of the most relaxing ways to spend a day (until you miss that 6 foot putt for birdie). However, for many of those with chronic back and neck pain, it not only hinders their ability to enjoy the game but may prevent them from playing altogether. The key for most golfers is learning how to avoid this pain without compromising the power and accuracy of their swing.

Golf is what is known as a "unilateral" sport. This means that the biomechanics of the golf swing puts asymmetrically stress one side of the body versus the other. Because the golf swing is performed on a tilted plane, it is one of the most involved complex body stressing movements of any sport and requires the use of several different muscle systems throughout the entire length of the body working in perfect harmony. The club head speed on a drive reaches speeds in excess of 100mph during a swing that occurs in approximately 1.2 seconds. Obviously, considerable muscle force is needed to exert this kind of power.

The Role of Your Spine In Your Swing

For many years, it was thought that power was generated from the arms and shoulders. However, recent advances in swing motion have added power from the ground up, thus increasing club head speed, which in turn, places more stress on the spine. For this reason, the area most prone to injury among golfers is the lower back. A recent study showed that 75% of professional PGA golfers experienced a spinal issue. Another study of 193 amateur golfers showed 53% complained of a chronic issue with the most prevalent issue being related to the spine. Some, like PGA staple Peter Jacobsen, have undergone spinal surgery to correct their spinal issue.

During a proper swing the muscles surrounding the spine play an integral role in generating power and accuracy due to the considerable amount of torque generated in the backswing and subsequently increase even further with the first move of the downswing.

Traditionally, golfers were taught a single axis swing. This swing consisted of a forceful shoulder and hip turn on the backswing followed by an arched lower back on the follow through, commonly referred to as the "reverse or inverted C". Many professional and amateur golfers who employed this technique experienced frequent low back problems. The most common of these problems were herniated discs as a result of these rapid non-fluid movements placing excessive loads on the spine. Also, this technique emphasised quick jerking movements which produced considerable pressure on the intervertebral discs of the spine which lead to herniations of the discs.

The one axis swing was subsequently replaced by the more naturally athletic two axis swing. The two axis swing permitted the golfer to load or coil against his rear axis during his backswing and then to transfer his coil to his lead axis to start his downswing. This modified swing emphasises the proper biomechanics of to alleviate excessive forces on muscles and joints and focuses on reducing the load on the spine during a swing.

World renowned golf instructor David Leadbetter described the athletic swing as "the efficient coiling and uncoiling (generating and releasing power) of one's torso in a rotary or circular motion which maximizes centripetal force. Centripetal force is the force created away from the center of one's swing, transmitting from your body (trunk and hips) out through your arms and hands. This creates clubhead speed and maintains the club on a steady orbit or arc."

The most recent swing advancement springs from the research completed by Thomas J. Meyers and his medical staff as presented in his book Anatomy Trains and via his lecture series. Meyers research defines for us the natural motion/power diagonals of the human body.

These motion/power diagonals consist of a combination of muscles, tendons and ligaments extending the entire length of the body from foot to opposite shoulder blade and wrapping around to the chest.

Through their understanding of the functional relationship between these two diagonals, trainers and coaches have recently begun improving performance in the context of improving our "KQ" - our Kinesthetic Quotient, or body intelligence, with athletes competing as pitchers, slalom skiers, martial artists, gymnasts, etc. By tapping into the natural athletic motion of these motion/power diagonals, athletes are able to generate increased power while actually reducing stress on the spine.

Applying the benefits of Meyers research to the golf swing, we find that when we generate motion using these motion/power diagonals, we can very naturally transfer weight from foot to foot as the trunk and hips rotate horizontally. In this manner we can generate an even more naturally athletic and powerful swing motion around a fixed center of gravity - located precisely at the intersection of these two motion/power diagonals - further reducing the load on the spine during the golf swing.

For these this reasons, spine surgeon and avid golfer, Dr. Dante Implicito has emphasized the benefits of these far more naturally athletic and powerful swing techniques to many of his patients who are golfers.

Other Factors That Can Lead to Injury

Although golf is one of the few sports that is played avidly by almost all age ranges, retirees seem to have a specific interest in the game. For the more elder golfer, certain precautions should be factored in to avoid injury. Osteoporosis and arthritis are two of the more common conditions that plague the older golfer and can lead to a much higher rate of spine injury. As osteoporosis progresses, the joints and vertebrae within the spine become weaker and more porous. This weakening, coupled with improper golf swing, can lead to a high rate of spinal fracture and disc degeneration as a result of increased forces on the spine. Elder golfers with either of these conditions can learn to modify their swings to incorporate a slower backswing and a more fluid foreswing and acceleration in the delivery of their swing speed to avoid injury. If this is executed properly they should see no loss of drive distance.

Another specific factor that contributes to injuries of the back or neck is the lack of proper warm up prior to playing or practicing. All too many golfers rush to the 1st tee and start the game with the most powerful drive they can on the first hole. Without proper stretching or warm up, this this level of exertion is a recipe for injury. Large amounts of stress on these muscles that are not properly warmed up and thoroughly stretched prior to play will cause strains, sprains and herniations.

About Dr. Dante Implicito

Dr. Dante Implicito is a Board Certified and Fellowship Trained Orthopedic Spine Surgeon with a focus on Minimally Invasive Spine Surgery. Dr. Implicito is the section Chief of Spine Surgery in the Department of Orthopedic Surgery at Hackensack University Medical Center.

Dr. Implicito completed his General Surgery internship and Orthopedic Surgery Residency in the University of Medicine and Dentistry of New Jersey and its affiliated hospitals throughout Northern New Jersey. Upon completion of his Orthopedic Surgery Residency he completed his Spinal Fellowship Training at the San Francisco Combined Orthopedic Spine Surgical Fellowship at St. Mary's Spine Center in San Francisco under the direction of Dr. James Zucherman and Dr. Ken Hsu.

Dr. Implicito's practice consists of the full gamut of conservative and surgical treatments of cervical, thoracic and lumbar spine problems including diagnostic and therapeutic spinal injections, minimally invasive spinal surgery, disc arthroplasty and spine fusion surgery.

Dr. Implicito is also a 30 year veteran golfer. He has a special interest in spinal conditions among athletes and has treated athletes from all forms of sport.

About Ozzie Carlson

As a PGA Apprentice, Head Professional and Director of Golf, Ozzie served at some of America's finest clubs including Ridgewood CC site of the US Amateur, Senior Open, Senior PGA and the 2008 & 2010 Barclay's; The Everglades Club in Palm Beach, The Pittsburgh Field Club, Pine Tree, Quail Ridge Golf & Tennis Club in Delray Beach, FL and the Royal Palm Yacht & CC in Boca Raton.

Gaining recognition as a marvelous teacher wherever he went, Ozzie was selected to instruct at both the National and Florida PGA Junior Academies and was subsequently recruited by Golf Digest to be a member of their select teaching team. The greatest influence on Ozzie's maturing growth as a player/teacher came from the incomparable Sam Snead, who played almost daily as a member at Pine Tree (Boynton Beach, FL) during his tenure there.

"I was extremely fortunate to have Sam Snead take an interest in me, answering my daily questions about how to play most every type of shot in the game and reviewing my progress. Sam seemed to enjoy being my mentor, I guess because he'd found in me that rarest of students; a player who wanted to learn well enough to be able to teach others. I can never thank Sam enough for all the time and wisdom he invested in my understanding of the process of shot making for each facet of the game. Perhaps more than any other, I have benefited from his knowledge and understanding of how the game is learned and played. I can pay no greater tribute to Mr. Samuel Jackson Snead, and to my many mentors than to pass along to others what they taught me."