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Opinion & Analysis

Preventing injuries on the LPGA Tour: A case study with Madelene Sagstrom

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This article is co-authored with Anne-Lise Bidou.

Anne-Lise is a French physiotherapist (trained in France and Australia), currently working on the LPGA Tour. Her current stable of players includes Hannah Green, Lizette Salas, Morgan Pressel, Paula Creamer, Mel Reid, Maria Fassi, Madelene Sagstrom, Mariah Stackhouse, Alena Sharp, Ashleigh Buhai, Laura Gonzalez Escallon and Tiffany Chan.

You can follow Anne-Lise and her life / work on tour – Instagram and Facebook

Anne-Lise Bidou – Physio 4 Golf

Source of Injuries

My primary role as a physiotherapist working on tour, is to keep my players injury free. I’m obsessed with prevention over cure, and really want to avoid “treating” my players for constant niggles and issues. There are, of course, several factors that contribute to injury risk, but the one that is most important and often neglected or misunderstood, is stability. Creating stable joints and spinal segments is all about activating and strengthening deep muscles, whilst holding good posture or position.

In my experience working with elite female players, a lack of stability in the spine and especially around the shoulder girdle, combined with poor upper body strength, is the cause of many of the common injuries that occur in the upper body (wrist, shoulder, neck and upper back/ribs). 

All golfers, but especially highly skilled players, will do anything to try and make great contact with the ball. If that means they have to contort their body into an unnatural position, then they will! Now if they repeat that contortion thousands of times, without having great strength and stability around the shoulder girdle, those common injury sites are going to take a beating!

Michelle Wie has recently undergone season-ending wrist surgery

Key for Prevention

One of the key stabilizers for the shoulder girdle is actually located on our back: the shoulder blade (scapula) has a huge influence on the shoulder joint and its mechanics, which has a ripple effect up and down the chain (neck, elbow, wrist). Gaining control and stability of the shoulder blade will contribute hugely to removing strain from these common injury sites, and usually results in better movement and swing mechanics also.

This is why a key focus for my approach to creating more robust players, is to really increase the activation and strength of the deep muscle system surrounding the shoulder blade. Usually, Trapezius, Serratus Anterior and Rhomboids get a lot of attention—they are often weak and not controlled very well.

 

The muscles that attach to the shoulder blade

Madelene

A good example of how I aim to address this problem with my players is the work I have done with Madelene Sagstrom in 2019. You may recognise Madelene from her incredible rookie year as a pro, when she dominated the Symetra Tour, smashing the tour’s performance records on her way to the LPGA Tour.

Last year Madelene suffered from right shoulder pain (shoulder impingement), and when we started working together in February this year,  she presented with reduced shoulder range of motion, due to a combination of poor tissue extensibility and altered motor control. These are often the result of common movement compensations seen when a player lacks strength in their rotator cuff muscles and scapular stabilizers.

For Madelene, this resulted in severe scapular dyskinesia (lack of control of the shoulder blade) and certainly wasn’t helped by significant general upper body weakness.

Sagstrom racked up 11 top 5 finishes in 15 starts on the Symetra Tour

Lots of reps combined with that weakness and instability was a significant factor for Madelene and her shoulder issues; she is very dedicated with her practice and spends a lot of time at the range (pretty common for a Swede!). She also moves the club very fast (11th on LPGA Tour in driving distance), and adding speed to any unstable system only aggravates issues.

On the plus side, her high work high ethic also applies to her gym work and guided rehab exercises; Madelene really enjoys training and working out with intensity. All I needed to do was introduce some key principles and equipment in order to make sure she was able to focus on building strength and stability around that all-important shoulder, upper spine and scapula.

Exercise Examples

Our sessions usually include some mobility exercises, cardio, movement prep including activation exercises with the GravityFit TPro and then strength/power exercises, during which we also use the GravityFit TPro, mainly for postural feedback and axial loading.

With so much else going on during a tournament week, workout time is limited and precious on tour. So I find exercises that kill two or even three birds with one stone really effective. The example below is part core stability (narrow base of support), part shoulder stability (row movement and bracing), part postural awareness (GravityFit TPro on Madelene’s back).

The exercise below is significantly harder than Madelene is making it look, and one of my favorite ways to train the elements that I see as critical to preventing upper-body injuries.

Below is another of my favorite multi-purpose gym moves; here Madelene performs a reverse lunge with cable wood chop. This time we are hitting those areas in a different way: core strength (rotational movement under load, using shifting and narrow base of support: the lunge), shoulder stability (bracing against wide grip on the bar), postural awareness via the GravityFit TPro. We also get additional lower body balance and stability work via the lunge component.

Since we started working together, incorporating the GravityFit TPro into exercises such as those demonstrated above, Madelene has improved her scapular stability significantly. This has helped to eliminate her shoulder pain, improved her movement quality and even contributed to an increase in clubhead speed of 2 mph!

If you suffer from upper extremity injury, or simply want to move a little better in your golf swing, then I highly recommend addressing the stability around your shoulder blade and upper back, along with improving overall upper body strength and posture.

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Nick Randall is a Strength and Conditioning Coach, Presenter, Rehab Expert and Massage Therapist contracted by PGA Tour Players. Nick is also a GravityFit Brand Ambassador. He is working with them to help spread their innovative message throughout the golf world and into other sports.

4 Comments

4 Comments

  1. Trevor Montgomery

    Aug 16, 2019 at 5:38 pm

    Having worked with tour players and winners on the USPGA and European tours for the last 20 years I find that scapula stability is a key component that needs to be assessed and addressed appropriately to reduce injury risk and improve performance and consistency. Addressing scapula control issues can lead to increases in trunk rotational range by upward of 20% and certainly decreases injury risk to segments above and below. Kibbler reported that 68-100% of people with should joint problems had concurrent scapula dyskinesia. It is my experience that scapula stability is often unaddressed with athletes – great article for highlighting this important segment.

  2. ZQ

    Aug 1, 2019 at 12:15 pm

    Shoulder girdle main issue for injuries LOL!

    Back, hips, and elbow/wrist = way more prominent. Terrible article.

    • MhtLion

      Aug 1, 2019 at 6:15 pm

      How I’m reading the article is that because typical females have week shoulder girdles which provide the stability, they tend to overuse back, hips, elbow, and writs, and end up injuring those.

  3. North Hinkle

    Jul 31, 2019 at 10:28 pm

    I find this article limited in its discussion, specifically to the upper body and shoulder. Almost all of my injuries are knee and ankle and are due to core weakness creating stress on the lead leg joints. It is typical for men to have leg injuries when their core is weak (note Steph Curry his first 2 seasons in the NBA until he fixed his core).

    When I had good core, my strain was always the lead shoulder infraspinatinus – it would get worn out mid season and I just had to deal with it.

    Overall, I just think this article lacks depth and general applicability. A bunch of talk about LPGA players (women) having weak upper bodies, and then one story about a player the author helped.

    I find no unique insight or advancement preventing golf injury other than LPGA players pay the author money. Then again, LPGA players have believed in KT tape and I remember seeing a stupid number of PGA players wearing copper bracelets.

    Enough said.

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Opinion & Analysis

Getting to know Payne Stewart

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Ever since that final putt fell in Pinehurst in 1999, Payne Stewart’s memory has enjoyed mythical qualities. A man of complex charm, but many of us who grew up without him recognize only his Knickerbocker pants, his flat cap, and his W.W.J.D. covered wrist wrapped around that United States Open trophy.

I had a wonderful opportunity to play a round of golf with two men that know a lot about Payne. One through friendship and the other through journalistic research.

Lamar Haynes was Payne Stewart’s close friend and teammate on the SMU golf team. He’s full of stories about Payne from the good old days. Kevin Robbins is an author who just finished a new book on Stewart’s final year of life, set to release to the public for purchase this October. He works as a professor of journalism at the University of Texas but has also enjoyed an impressive career as a reporter and golf writer for over 20 years.

We met at Mira Vista Country Club in Fort Worth, Texas, to talk about Payne. Robbins is a solid golfer who spends time working on his game, which tells me a lot about his personality. He is one of us.  As for Haynes, the guy hasn’t lost much since those SMU golf team days. He can still swing it. Fantastic iron player. And both men are wonderful conversationalists. They offered a unique perspective on Stewart—the golfer I grew up idolizing but never really knew. There’s a good chance you don’t really know him, either. At least not the whole story.

“Most golf fans now know the story of his ’99 U.S. Open win,” Robbins said.  “What they don’t know is where he came from.”

Robbins’ book, The Last Stand of Payne Stewart: The Year Golf Changed Foreverchronicles Payne’s last year on earth with dramatic detail, covering his triumph at Pinehurst and the Ryder Cup at Brookline. And, of course, it tells the story of that tragic plane crash that took our champion from us. What the book doesn’t do is hide any of the blemishes about Payne’s life that have either been forgotten or pushed aside by brighter moments and memories.

“I thought that the other Payne Stewart books, while they have a place, they didn’t tell the whole story,” Robbins said.

The whole story, from what I read, was Payne being brash. A poor winner and sometimes a poor sport when he lost. He often said things he shouldn’t have said and then made those mistakes again and again.

“He had no filter,” remembered Haynes.  “Several close friends on tour had a hard time with him when he won his first Open. He didn’t take into account any of the consequences his words could create. He had a huge heart. Huge heart. But at times there was just no filter. But he grew a great deal over the last 2 or three years.”

It’s most certainly is a book about a change. A change in a man that was better late than never. But also a change in golf that began at the turn of the century and hasn’t really slowed down since.

“The 20 years since his death, to see the way golf has moved, what the tour looks like now,” Robins said.  “There was an evolution that was taking place in 1999 and we didn’t know how it would manifest itself. But now we do. So when you see Brooks Koepka hit a 3-wood in the US Open 370 yards, well that all really had its beginnings in 1998 and 1999. The Pro-V1 ball was being tested in 1999 and being rolled out in 2000. Fitness and equipment, sports psychology, nutrition. All of those things that a guy like Payne Stewart really didn’t have to pay attention to.”

But that change that occurred in Payne, culminating in his final year of life, is something worth learning. It’s a lesson for all of us. A guy on top of the world with still so much to fix. And he was fixing it, little by little.

“He was authentic,” Haynes said. “And he learned a lot later in life from his children. With their Bible studies. You saw a change in him. Very much. He had a peace with himself but he still would revert to his DNA. The fun-loving Payne. Raising children and being a father helped him tremendously.”

Payne was passionate about so many things in life but his children became a primary focus. According to Haynes, he would be so loud at his daughter’s volleyball games…yelling intensely at the referees…that they gave him an option: Either he wouldn’t be allowed to watch the games anymore or he needed to become a line judge and help out with the games. So, Payne Stewart became a volleyball line judge.

Lamar brought the head of an old Ram 7-iron along with him to show me. Damaged and bent from the crash, the club was with Payne on his final flight. He had it with him to show his guys at Mizuno as a model for a new set of irons. That Ram 7-iron belonged to Haynes and Payne had always adored the way it looked at address.

“Payne also used my old Mizunos the last year of his life,” Haynes said.  I had received the MS-4s 10 years earlier from Payne in 1989. They were like playing with a shaft on a knife. The sweet spot was so tiny on the MS-4. They made the MP29 and 14s look like game improvement irons. Payne used those. Then Harry Taylor at Mizuno designed him an iron, which later became the MP33. The 29 and 14s were very sharp and flat-soled. Well, Payne loved this old Ram iron set that I had.. He asked for my Ram 7-iron for Harry Taylor to model his new set. He liked the way it went through the turf. He had it with him on the plane. This is the club that started the MP33.”

It was Lamar Haynes, the man who seems to know just about everyone in the golf community, that set Robbins on this writing journey. Robbins had written one book previously: The story of the life of legendary golf coach Harvey Penick. But this book came a bit easier for Robbins, partly due to his experience, partly due to the subject matter, and partly because of Lamar.

“There’s a story here,” Robbins said. “With any book, you hope to encounter surprises along the way, big and little. And I did. I got great cooperation a long the way. Anybody I wanted to talk to, talked to me thanks to this guy Lamar Haynes.”

“Lamar said the first guy you need to talk to is Peter Jacobsen,” Robins said. “And I said ‘great can you put me in touch with him’ which became a common question to Lamar throughout the process.” Robbins chuckled.  “Literally 2 minutes later my phone rings. ‘Kevin, this is Peter Jacobsen here.'”

“Peter told me the story about the ’89 PGA championship in our first conversation. So literally in the first 10 minutes of my reporting effort, I had the first set piece of the book. I had something. Lamar made a lot happen.”

Lamar Haynes and Kevin Robbins

The book is not a biography, though it certainly has biographical elements to it. It is simply the story of Payne’s final year, with a look back at Payne’s not so simple career mixed in. The author’s real talent lives in the research and honesty. The story reads like you’re back in 1999 again, with quotes pulled from media articles or press conferences. Anecdotes are sprinkled here and there from all of Payne’s contemporaries. The storytelling is seamless and captivating.

“I was pleasantly surprised how much Colin Montgomerie remembered about the concession at the 1999 Ryder Cup,” Robbins said. “Colin can be a tough interview. He is generally mistrustful of the media. His agent gave me 15 minutes during the Pro-Am in Houston. This was in the spring of 2018. I met Colin on the 17th hole and he had started his round on 10. Just organically the conversation carried us to the fifth green. Just because he kept remembering things. He kept talking, you know. It was incredible. Tom Lehman was the same way. He said “I’ll give you 20 minutes” and it ended up being an hour and a half at Starbucks.”

The research took Robbins to Massachusetts, Florida, and Missouri—and of course, to Pinehurst. He met with Mike Hicks, Payne’s former caddie, there to discuss that final round. The two ended up out on Pinehurst No. 2, walking the last three holes and reliving the victory. It gives life to the story and fills it with detail.

“Part of what I hoped for this book is that it would be more than just a sports story,” Robbins said.  “More than just a golf story. The more I started thinking about where Payne began and where he ended, it seemed to me…and I’m not going to call it a redemption story although I bet some people do. People when they are younger, they have regrets and they make mistakes. They do things they wish they could take back but they can’t. So, what can they do? Well, they can improve. They can get better. That’s what Payne was doing with his life. He was improving himself. It was too late to change what he had done already. So what could he do with the future? He could be different.”

“It was accurate,” Haynes said.  “I had a tear when I finished it. I texted Kevin right afterward. I told him I couldn’t call him because I’m choked up so I texted him.”

So here’s two men who knew Payne Stewart, albeit in very different ways. They knew he was flawed in life but he got better. Was Payne Stewart that hero at Pinehurst, grabbing Phil Mickelson’s face and telling him the important thing is he’s going to be a father? Yes. But he was so much more than that. He was so much more than I knew before I read this book. Most importantly, Payne Stewart was always improving. A lesson for all of us, indeed.

If you want to hear more about my experience, tweet at me here @FWTXGolfer or message me on Instagram here! I look forward to hearing from you!

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The Gear Dive: Sam Bettinardi

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In this episode of The Gear Dive brought to you by Titleist, Johnny chats with EVP of Bettinardi Golf, Sam Bettinardi. They discuss coming up as Bob’s son, the growth of the company, and why Bettinardi continues to be at the top of the putter conversations.

Check out the full podcast on SoundCloud below, or click here to listen on iTunes or here to listen on Spotify.

Want more GolfWRX Radio? Check out our other shows (and the full archives for this show) below. 

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Mondays Off

Mondays Off: Sounding off on your favorite golf pet peeves!

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Steve and Knudson weigh in on your favorite golf pet peeves. From not fixing ball marks, to slow play, to guys telling you “good shot” when you make a quad! Knudson shot a 33 in his league and still thinks he isn’t a sandbagger.

Check out the full podcast on SoundCloud below, or click here to listen on iTunes or here to listen on Spotify.

Want more GolfWRX Radio? Check out our other shows (and the full archives for this show) below. 

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