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Opinion & Analysis

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



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


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 and Rehab Expert contracted by PGA Tour Players, Division 1 colleges and national teams to deliver golf fitness services. Via his Golf Fit Pro website, app, articles and online training services, Nick offers the opportunity to the golfing world to access his unique knowledge and service offerings.



  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

Watch for players lofting up at altitude at the WGC-Mexico Championship



This week, at the PGA Tour’s WGC-Mexico Championship, we are going to watch some of the best and longest players on the planet play what will effectively be one of the shortest courses on tour.

Now, 7,341 yards is by no means a cakewalk, and there are shorter courses from a pure yardage perspective played on tour—Harbour Town, as an example, only plays at 7,099 yards from the very back. The difference is Harbour Town is played at sea level while Club de Golf Chapultepec is at over 7,500 feet of elevation, and when you factor in the altitude difference between the two courses, they play very differently—more on the math in a moment.

The altitude will also factor in how some players will be setting up their equipment and we could see some adjustments. The most obvious is lofting up the driver or fairways woods to increase carry, which is something Tiger Woods specifically mentioned last year.

The biggest misconception when talking about playing golf at altitude is that the ball doesn’t spin the same in thinner air and players “loft up” to maintain spin. Let’s get into the physics to bust this “spinning less” myth and simplify the science behind playing at altitude,

The golf ball is an inanimate object, and it has no idea it’s at altitude; the air will not have an impact on how much the ball will actually spin. Yes, increasing loft should, by almost every imaginable measure, increase spin but the air it travels through will not change the spin rate.

However, playing at altitude has an effect, Let’s break down what happens

  • Thinner air exerts less drag force (resistance/friction) on the ball. The ball moves more easily through this less dense air and won’t decelerate as quickly as it flies. But note that the faster an object moves the more drag force will occur
  • Less resistance also means that it is harder to shape shots. So you when you see Shot Tracer, the pros are going to be hitting it even straighter (this makes Tiger’s fairway bunker shot last year even more unbelievable)
  • Less force = less lift, the ball will fly lower and on a flatter trajectory

Time for some math from Steve Aoyama, a Principal Scientist at Titleist Golf Ball R&D (full piece here: The Effect of Altitude on Golf Ball Performance)

“You can calculate the distance gain you will experience (compared to sea level) by multiplying the elevation (in feet) by .00116. For example, if you’re playing in Reno, at 1 mile elevation (5,280 ft.) the increase is about 6% (5,280 x .00116 = 6.1248). If you normally drive the ball 250 yards at sea level, you will likely drive it 265 yards in Reno.”

Not every player will be making changes to their bag, and some will instead focus on the types of shots they are hitting instead. When speaking to Adam Scott earlier this week, I was able to ask if he planned on making any changes heading into Mexico the week after his win at the Genesis Invitational.

“It’s very rare for me to make club changes week-to-week beyond playing in the Open Championship and adding a longer iron. The one thing I focus on when playing at altitude is avoiding partial shots where I’m trying to reduce the spin because as spin goes down the ball doesn’t want to stay in the air. I’ve experienced partial shots with longer clubs that end up 25 yards short, and because of that I want to hit as many full shots as possible”

With Club de Golf Chapultepec sitting just over 7,800 feet above sea level, we’re looking at 9.048 or an increase of just over 9 percent. That makes this 7,341-yard course play 6,677 yards (+/- where the tees are placed).


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The Gear Dive: Urban Golf Performance owner Mac Todd



In this episode of The Gear Dive brought to you by Fujikura, Johnny chats again with his old pal Mac Todd Owner and Operator of Urban Golf Performance in Los Angeles. They cover the growth of the business, what the new Club member experience may look like and much much more.

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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The Gear Dive WITB Edition: Adam Scott



In this WITB edition of The Gear Dive, Johnny chats with JJ VanWezenbeeck and Aaron Dill of Titleist Golf on the ins and outs of Genesis Invitational Champion Adam Scott’s setup.

Adam Scott WITB details below

Driver: Titleist TS4 (10.5 degrees, A1 SureFit setting, 2-gram weight)
Shaft: Mitsubishi Kuro Kage XTS 80 X

  • Scott put the Kuro Kage in play this week. Per Titleist’s J.J. VanWezenbeeck, “Adam Scott switched to the TS4 driver at the ZoZo Championship due to head size, shape, and improved launch to spin ratios. This week, after discussions with Adam, he went to a shaft he had previously played for increased stability. He felt the shaft went a little far and he lost head feel. We went on course with lead tape to get the feels to match up then weighted the head to preferred swing weight after testing.”

3-wood: Titleist TS2 (16.5 degrees, A1 SureFit setting)
Shaft: Fujikura Rombax P95 X

Irons: Titleist 716 T-MB (3-iron), Titleist 680 (4-9 irons)
Shafts: KBS Tour 130 X

Wedges: Titleist Vokey Design SM8 (48.08F, 52.08F, 56.10S), Vokey Design SM8 WedgeWorks (60.06K)
Shafts: True Temper Dynamic Gold AMT Tour Issue X100

Putter: Scotty Cameron Xperimental Prototype Rev X11 (long)

Ball: Titleist Pro V1

Scott marks his ball with dots in the pattern of the Southern Cross, which is featured on the Australian flag.

Grips: Golf Pride Tour Velvet

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