Although I have been treating golf-related injuries for over 15 years, it is within the last two years that I have seen dramatic results in recovery and improved performance without pain, using Integrative Dry Needling (IDN) in my physical therapy practice. Before using dry needling, I would rely on the traditional physical therapy tool box of manual and therapeutic skills including joint mobilization, trigger point massage, active release stretching, cupping, foam rolling, etc. However, by incorporating IDN’s neurologic dry needling techniques into my treatment regime, I have found golfers are responding faster to treatment, having less recovery time from overuse injuries, and are back out on the course faster.
This modality has been a great adjunct to the golf program I have helped to develop at Cape Cod Healthcare, where I practice as a certified medical golf expert through the Titleist Performance Institute. This certification through TPI has taught me the skills to effectively evaluate, diagnose, and treat golf injuries and prescribe performance-based golf exercise programs.
To use dry needling effectively for golf injuries, it is imperative to understand the mechanics of the golf swing and to know what muscles and joints are being used. The golf swing is a complicated movement of spinal twisting, loading, and compression, and most joints in the body are affected by the swing. It’s a repetitive motion by nature and lasts about 1.8 seconds, in which time, can produce a tremendous amount of torque and pressure on the spine. Even elite tour players, who have a more efficient swing and are, on average, in better shape than most amateurs, suffer from repetitive strain injuries. Currently, over 25 PGA golf pros are on the disabled list due to injuries.
This means amateur players who have a less efficient swing and who are not as committed to a fit golf body are suffering from these repetitive strain injuries as well. The most common amateur golf injuries I see in the clinic are back injuries.
I find that the neurologic dry needling that the IDN Institute teaches really fits into my current clinical framework for treating golf clients. My physical therapy training in orthopedics focuses on global functional movement and how all the moving parts work together to form a synergistic pattern, especially in the golf swing. In other words, no moving joint can operate efficiently unless it can count on another joint to stabilize properly around it. The same global philosophy goes for IDN’s neurologic dry needling treatment approach.
Using this global framework, it’s important to not just “chase the pain” when selecting dry needling points with golfers. Before treating a golfer’s back pain, I perform a series of selected functional movement tests to tease out faulty movement patterns that may have been contributing to their pain. This is an essential step in being effective with dry needling. A lot of time, the back pain is due to poor hip, thoracic, or pelvic rotation, and in the golf swing you will see the golfer “stealing” motion from the back to make a proper back swing and follow through. So, once the movement problem is identified (which may or may not be from the back), I can treat the contracted back musculature and the surrounding soft tissue restrictions with neurologic dry needling. It is also important to perform joint mobility techniques to the hip or pelvis, or wherever the dysfunction lies, to restore proper movement.
Sometimes, back pain in golfers is due to a bad swing (and we’ve all seen those in our foursomes) and then it is very important to have the patient work with their teaching golf pro to fix that mechanical fault. As a physical therapist, my job is to address body limitations that may be affecting the golfer’s ability to make a correct swing. As I tell my clients, “I fix bodies, not swings”. Once their body has the potential to meet the golf swing demands, it’s important they have a sound idea of the proper golf swing they are trying to make.
After the first treatment with dry needling, where I may only target four to six neuro-trigger points, most golf clients can immediately feel a difference in their tissue, and many notice less spasm and pain after the first session. This type of response not only makes the patient feel better, but also allows me to progress them at a quicker pace through the movement corrective exercises they need to fix the mechanical issue. My clients are then back on the golf course quicker, and I’m finding that they’re able to play four to five times a week without becoming incapacitated from muscle spasms that would normally have them missing rounds.
While dry needling is not a panacea for all golf injuries, nor is it a modality that I use in exclusion of other evidenced-based physical therapy treatments, it is a powerful tool to have in my practice.
By Catherine Hoell, PT, DPT, OCS