Invariably when old myths are proven not to be true, we simply replace old myths with new ones with this typically perpetuating through life. This approach applies to almost all areas of life and golf and in the current climate we are in, one area that this is most relevant to is pain and the associated movements we make within our swing that can create pain. Now, for the purpose of this article we are discussing anatomical pain rather than emotional or financial as there are many definitions of pain!!
For as long as medicine has been researched, two divides that have existed between some are allopathic medicine vs. homeopathy. Allopathic medicine is science and evidence based medicine with almost all known treatments and medicines prescribes by health professionals falling into the allopathic approach. Subsequently, there is a culture and way of life amongst some that look towards homeopathy and as it’s known throughout India as Ayurveda. Employing intellectual honestly, robust/critical thinking alongside our own experiences of what works/what doesn’t work we can start to apply this to pain and how we move through the golf swing through using an evidence based mathematical approach alongside a global often pragmatic one.
Therefore some questions we can explore are why do some players make movements and are exposed to pain and other’s make the exact same movement and never experience pain? There is a long answer which we’ll discuss shortly as well as a succinct one within human movement and learning which suggests you have two types of people - responders and non-responders. Some people respond to certain movements and stimuli, other less so.
Ok, now for the more detailed answer…
When attempting to understand pain, one issue with biomechanics is historically mathematical models have been used to understand and diagnose pain however this is approach is extremely erroneous as its invariably based on multiple assumptions alongside many of the most significant influences on pain being invisible to mathematics (although very experienced biomechanists can make fairly accurate predictions of pain through good understanding of calculus however even then it’s more about the end user than the data). Biomechanics is best used in human performance, correlations to their strength & conditioning program, enchaining how players move and I believe crucially locating and understanding why players move the way they do which subsequently allows coaches to map out the players movement priorities. Can it be used accurately to locate and establish why a player experiences pain? Possibly, possibly not, however as a caveat to this in an attempt to provide balance, having a large sample of data and case study history one can use this to make fairly informed and accurate diagnostics as to why a player is symptomatic.
Reverting back to a comment in the above paragraph around the invisible influences on pain, some significant contributors include:
• Hydration. Tissues are visco-elastic therefore reduced hydration can reduce their ability to deform
elastically.
• Nutrition. Each human responds differently to food with many creating inflammation at joints therefore certain food types and preparation can inflame these structures.
• Sleep. Our bodies perform most of their recoveries whilst asleep therefore if we are sleep deprived then it reduces time for the body to fully provide the recovery needed.
• Perception. Pain scientists have shown that perception is of huge influence on pain. As an example studies using humans with prosthetic limbs have shown that if a hot object is placed on the prosthetic then the human can often perceive and respond in such a way that they feel immediate pain when exposed to the heat based on memory and perception. Expanding on this, nociceptors in the skin are what send main messages to the brain however even in absence of these in prosthetics the brain may still see the danger attached to a hot object and creates a pain response.
• Our perceived relevance to task. As an example, a player at The Open championship could have wrist pain on Monday morning however because the event is three days away, the scale and significance is not perceived as important to them, however if the same pain is experienced on the Thursday morning they can perceive pain very differently based on its significance to the event and scaling of what it means to them.
• Mood. Invariably how you have chosen to see the world at the point in time you experience pain. As an example, some days you can be stuck in traffic and you approach the delay with a relaxed, philosophical approach, however the following day you could be stuck in the exact same jam however respond in a volcanic, irrational way simply because of the mood you are in.
What can we extract from this? There are many invisible influences on pain which biomechanical models simply cannot allow for however an establish biomechanist will (or at least should) be able to apply all of the above to the data they have to then start to see behaviour patterns emerge that connect back to and relate to historical case study data. In short, whenever we are unwell or experience pain typically something had changed in our environment that elicits a response in our system.
Let’s return to one of the original questions in this article, why do some players experience pain and others who make identical movement remain pain free? In short, there are four main reasons why a joint/issue will experience pain:
• Tolerance. Depending on how much a player can tolerate will determine how much they can absorb and resist. Pain occurs when the loads on the body exceed the tissue/joints ability to tolerate. Hence movement preparation helps prevent pain by best preparing the body to be tolerant of certain movements and loads.
• Resilience. Anatomically humans are born more/less resilient than others therefore how resilient the tissues/joints are will control how much they can tolerate. It’s not just mental resilience we are born with/acquire through life, it’s also anatomical resilience….
• Sensitivity. How sensitive we are to certain movements. If someone has moved in a way for long periods of time the nervous system can adapt and adjust by de-sensitising (and equally become more sensitive). A very divisive discussion amongst manual therapists is the use of devices such as foam rollers as many like and see significant benefit in using them as part of an athletes movement preparation/recovery whereas other see them as simply de-sensitising the localised areas therefore removing the humans awareness of and sensitivity to pain producing movement. This is one for another day…!
• Volume and frequency. Often the movement which isn’t the issue it’s the volume and frequency.
Joints and tissues aren’t infinitely strong as they can erode and deteriorate over time regardless of how well you train, it’s just the delights of age…
Interestingly one area which is typically looked at when attempting to locate and understand pain In players are the joint ranges they move through, however the issue with this independent approach is player A can move through a significant range for example wrist extension and never experience pain whereas player B can move through significantly less wrist extension than player A and experience chronic pain. Why? Because of all of the visible and non-visible influences listed above. Perhaps it just down to how well we choose our parents….
Let’s looks at sensitively and in particular the influence of the nervous system (NS) on pain. Almost all humans have a movement directional preference, essentially certain movement they make can sooth the NS whereas others can irritate it. Using me as an example, my right hip does not like lateral rotation, therefore if I attempted lateral rotation as part of my warm up it would simply respond in an irritated way, therefore before I warm up and move the hip through lateral rotation, I go through a series of movements that I know my NS enjoys, mainly hip flexion which serves as and provides a soothing influence on my NS, in essence a warm up before we warm up. The pre warm up takes me through a series of movements that soothes my NS, prepare the NS for more expansive and extensive movement therefore providing time for my NS and hip to prepare. Once soothed, taking my hip through large ranges of lateral rotation is typically fine however without going through the directional preferences in advance of warm up would only reinforce deeper into my belief system how much I dislike lateral rotation as well as creating a response and greater demand on other joints to move because of the reluctant of my hip.In addition, one advantage to exploring our directional preferences is it then allows us to become more adaptable over time to movement, typically more plastic which is vital as movement adaptability is for many more important than movement quality.Attempting to understand pain and why we experience it in golf is an exceptionally complex and often very divisive and emotive discussion, however empirically when working with players using an evidence based pragmatic approach to pain avoidance is perhaps still the most realistic choice rather than ideological approaches. However, even where this becomes challenging and open to provocation is unfortunately for some, coaching these days is controlled by how much you perceive you know, frequent referencing of complex theories, how you want to be perceived as an intellect/academic amongst your contemporaries and peers, however with this approach the reality is what it invariably reveals is actually what you don't know, how simple you are and the lack of intellect you really have.