Early Hip Extension Research Data Collection Procedure and Worksheet
Each year Body Balance for Performance commits time and other resources to better understand the body and golf swing relationships. In 2010 we have committed to study the physical causes of early hip extension in golf. Early hip extension is when the lower body moves closer to the golf ball as the golfer takes the club back to the top or on the way down to impact.
Our hypothesis is that there are several physical contributions to early hip extension and the presence of these physical deficits will cause early hip extension. The Titleist Performance Institute asserts that a failed overhead deep squat is nearly 100 percent correlated to early hip extension. However, they assert that if you have early hip extension you will not necessarily fail the overhead deep squat test. We believe we have observed other causes of early hip extension, and that even when an overhead deep squat is done correctly there can still be early hip extension in the swing.
Our hypothesis for this research is that when a golfer fails any of Leg Lowering, Toe Touch, Overhead Deep Squat, or Seated Shoulder Rotation tests we will see early extension in the golf swing.
Procedure:
Subjects are greeted at reception in the Body Balance for Performance centers. They will be required to complete a Client Registration form fully and sign a standard liability release. The subjects will be escorted to a clinical area to meet with the researcher. During that meeting the researcher will ask the following questions of the subject:
- Tell me about your golf?
- What is your handicap or average score?
- What are the challenges you face in golf?
- What have you done to improve your golf?
- How often do you play golf?
- How often do you practice golf?
- How much time do you spend when you practice golf?
- Do you exercise regularly?
- If so, what do you do?
- What are your physical issues or challenges?
Other conversation about their golf is encouraged to get a better understanding of the golfer.
PLEASE DO NOT TELL THE SUBJECT WHAT WE ARE LOOKING FOR UNTIL AFTER THE TESTING as that could invalidate the results.
Then the researcher will explain the procedure to the subject. The researcher will tell that subject that we are studying body and golf swing relationships. Say some thing like “We will be performing 4 physical tests and capturing video of the golf swing.” Also we need to tell the subjects that we cannot go into the details of the research until after we have collected the data. After we have done the data collection we will tell them exactly what we are looking at and why. We will also tell them how the findings of their testing is relevant to their golf issues.
Testing Procedure:
Complete Overhead Deep Squat:
How to Perform the Overhead Deep Squat Test
To perform this test, begin by standing with feet shoulder width apart and toes pointing forward. Next grasp a club approximately shoulder width apart and extend the arms directly overhead, keeping the shaft in-line with your head and over your foot print. Next, simply squat down as far as you can go, while keeping the club as high above your head as possible. The test will stop if any of the following conditions are seen or felt; 1) pain or discomfort, 2) heels coming off the ground, 3) club falling forward past the feet, 4) loss of balance.
To be considered a complete full deep squat you must see the following at the bottom of the squat:
- Upper torso is parallel with tibia or toward vertical
- Femur is below horizontal
- Knees are aligned over feet
- Feet are pointing forward (not flared out)
- Dowel is aligned over feet
This test is graded as a pass/fail.
Seated Trunk Rotation Test
Test Objective for Seated Trunk Rotation Test
The Seated Trunk Rotation Test is designed to identify how much rotational mobility is present in the thoraco-lumbar spine. Good separation between the upper and lower body is important to help generate speed and maintain a stable posture during your golf swing.
How to Perform the Seated Trunk Rotation Test
To perform this test, begin by asking the client to get into a seated position with knees and feet together, body in upright and erect posture, and arms crossed across their chest (optional: have them hold a bar across their shoulders). Next you will simply ask the client to rotate the trunk both to the right and to the left as far as possible. Once the farthest point is reached, you will take a measurement with a Goniometer.
What to look for in the Seated Trunk Rotation Test
In this test we are going to determine how much range of motion is present in trunk rotation both to the right and to the left, First begin the test by asking the client to rotate his/her trunk as far to the right as they can without moving the feet, knees, or head. At this point, you will take a measurement of their range of motion with a Goniometer. Standing behind the client, place the Goniometer axis of rotation at the outside of the shoulder blade in the direction they are turning (if turning right, outside of the right shoulder blade is the axis).
One of the lever arms will be placed along the surface of the back, between the shoulder blades, while the other lever arm will be rotated to a position that is perpendicular to the knees to hip position, It can also be placed parallel to the position of the seat that the client is sitting on, as long as the client is positioned originally in a perpendicular fashion to the back edge of the bench/chair. Typical measurements range from 40-70 degrees in both directions. Repeat on opposite side.
Watch for the client’s knees or hips to rotate with the trunk. It is imperative that the knees and pelvis stay completely still and pointing forward during the test.
Physical Causes for limitations in the Seated Trunk Rotation Test
When a client presents with a limitation in trunk rotation either right or left, the following issues are usually present:
Thoracic spine mobility
Any restriction in thoracic spinal mobility is going to make this test difficult to perform. Degenerative joint disease, facet subluxations, or rib cage restrictions are the usual suspects! Another possible cause for limited spinal mobility is the amount of kyphosis curvature in their T-spine. If the thoracic spine has too much kyphosis (“C” Posture), their mobility will be greatly reduced since the spine is poor at flexion combined with rotation.
Muscular and myofascial restrictions in the trunk and spinal muscles
Any tightness or fascial restrictions of the Latissimus Dorsi, Erector Spinae, Multifidus, Deep Spinal Rotators, Quadratus Lumborum, etc. will definitely reduce the player’s ability to disassociate the lower body from the upper body.
Cervical spine mobility
Any restriction in rotation in the cervical spine can limit the player’s ability to rotate their trunk. The cervical spine goes through 70 degrees of rotation in the average player.
SEATED TRUNK ROTATION TEST
Seated Trunk Rotation Test Pitfalls
When taking a client through this exam, be aware of the following:
Make sure to monitor the knees and feet during the test as the client will tend to shift the knees apart while attempting to rotate the trunk
Make sure the client does not rotate the head and neck along with the trunk since this is a very common movement and they should be separate and distinct.
Make sure the client is in a full and upright seated posture.
Never rotate the trunk into a position of pain or discomfort.
Leg Lowering Test
Test Objective for the Leg Lowering Test
The Leg Lowering Test is used to assess how the golfer uses their abdominals and the overall stability of their core. Any weakness in the abdominal area can be disastrous for the golfer. The abdominals are the key muscles used to stabilize the spine and pelvis, rotate the torso, and maintain posture throughout the golf swing. In this test, any loss of lumbar curvature is a sign of abdominal weakness.
How to Perform the Leg Lowering Test
Start by having the golfer lay flat on their back with their knees bent and feet flat on the ground. Have them lift their pelvis off the ground and slide a blood pressure cuff under the small of their back (make sure it is centered). Tell them to relax and inflate the cuff to 40 lbs of pressure. Now, tell them to contract their abdominals and hold the brace. Record what happens to the needle of the blood pressure cuff when they brace (up, down, no movement). Now, keeping their abs braced have them slowly slide their left leg down to the ground noting what happens to the needle on the cuff
LEG LOWERING TEST
What to look for in the Leg Lowering Test
In this test we want to know three things:
How do they engage their abdominals?
The first part of the test determines what muscles they recruit when asked to brace their abdominals, You want to see minimal recruitment of anything but the abdominals. The blood pressure cuff needle should elevate between 40 and 50 lbs if they perform a great abdominal brace without modifying the curvature of their lower back. If accessory recruitment occurs you may see the following:
1. The blood pressure cuff needle drops below 40 lbs. This is the worst possible recruitment since it means the hip flexors and lower back engaged instead of the abdominals. Therefore, the lumbar spine increases its lordosis and the result is less pressure on the cuff.
2. The blood pressure needle increases over 50 lbs. This is due to the player performing a posterior tilt with the pelvis when engaging their abdominals. This is a better fault in our book, but the player must be trained to isolate abdominals without modifying their spinal curvatures.
Can their abdominals work independent of hip extension?
The second part of the test determines if the player can maintain a good abdominal brace with movement of the lower extremities. When you ask the player to slide their leg all the way down, hip extension should occur. Normally, hip extension should not affect pelvic or lumbar spine motion, especially if the abdominals are actively bracing the pelvis and spine. If the musculature of the hip is shortened and pulls on the lumbar spine and pelvis, the abdominals must resist this tension. If the blood pressure cuff drops during hip extension, then either the lack of mobility in the hip musculature or lack of strength (or neurological control) of the abdominals is evident.
Is there an asymmetry between the left and right hip?
The last portion of the test determines if there is an asymmetry between the leff and right hip and core. In other words, if the blood pressure cuff needle drops during right hip extension, but does not move during left hip extension, then an asymmetry exists.
Physical Causes of Limitations in the Leg Lowering Test
When a client presents with a limitation in the Leg Lowering Test either right or left, the following issues are usually present:
Poor Abdominal Strength
Weak abdominals can be the main reason for loss of stability in this test. The abdominals are not strong enough to handle the load of the legs when they slide down to the ground, so the legs pull the pelvis anterior.
Abnormal Sequence of Recruitment
- Muscle imbalances can also be the root cause. Many players will substitute hip flexors and erector spinae to try to make up for inhibition in the abdominals. This will absolutely force the pelvis to anterior tilt and thus drop the pressure!
Limited Hip Mobility
- Any restriction in hip mobility will make extension of the hip difficult to isolate without movement of the pelvis and lumbar spine. This just adds more stress and requires more effort from the abdominals.
Leg Lowering Test Pitfalls
When taking a client through this exam, be aware of the following:
- Make sure the blood pressure cuff is centered in the small of their lower back.
- Do not give the player instructions on how to brace their abs, just tell them to brace them.
- Make sure the cuff starts at 40 lbs of pressure.
Toe Touch Test
The Toe Touch Test is a great test for overall mobility in the lower back and hamstrings, plus it can help us identify a hip problem versus a lower back/core limitation.
How to Perform a Toe Touch Test
To perform this test, begin by having the player stand with feet together and toes pointing forward. Next, have them bend from the hips forward and try to touch the ends of the fingers to the tips
of the toes, without bending the knees.
If the client presents with a limitation in the toe touch, then it is imperative to go a step further to differentiate the cause. At this point we will simply ask the client to perform the same test however this time we will elevate one of the feet slightly with a lift of some sort (phone book, mat etc.). This will cause a slight bend in one knee while the other is straight. Ask the client to bend over and touch the toes. Repeat in the opposite direction.
If this test is tough on one side but easy on the other side, they have a unilateral hip limitation, not a lower back or hamstring flexibility issue. Make sure you only go as far as possible without pain and try to keep your knees straight throughout the entire test.
Bilateral Toe Touch Test Unilateral Toe Touch Test
What to look for with the Toe Touch Test
In this test we are looking for the ability of the client to demonstrate a good hip hinge or forward bend. This is important for golfers since any restriction in hip hinge mechanics can lead to poor address and dynamic-Posture. Players will tend to get too rounded from the spine or excessive knee bend to make up for limited hip bend.
During the second portion of the test we are looking for whether or not the client can get fully down into a toe touch with one foot slightly elevated as compared to both feet being flat. Oftentimes a client who presents with a hip joint issue will show a limitation in one of the sides while performing the unilateral toe touch test.
Physical Causes of a limited Toe Touch Test
This test can indicate several physical flaws:
The first is an inflexibility of the hamstring muscle group, which will prevent the client from keeping the knees straight, and the second being an improper forward flexion pattern. Oftentimes clients will try to bend forward from their backs (upper, mid and low) instead of flexing forward from the hip sockets.
Hamstring Flexibility
The most common cause is inflexibility of the hamstring muscle group, which will prevent the client from keeping the knees straight and completing the forward bend. This is very common in males.
Hip Joint Mobility
Sometimes the limitation comes from immobility in the hip joints. Arthritic hips, cartilage or capsular tears, or hip joint musculature restrictions can all cause a failed Toe Touch Test.
Toe Touch Test Pitfalls
When taking a client through this exam, be aware of the following:
The client is oftentimes unaware of bending their knees. You have to be very conscious of how straight their legs are during the full range of motion.
Facial expressions will indicate if this test is causing pain or not. Many clients will try to work through the pain, but there is no need to elicit any pain as you already have your answer at that point.
Pants can be very deceptive when conducting this test. Be aware of the false positive as the pants may appear perfectly straight but the knees may be very bent in reality.
Bouncing!!! Do not allow the client to bounce in order to get down further. The use of momentum in this test is highly discouraged and is highly associated with injury.
Video Analysis:
We will be using video analysis to test for early hip extension. The capture will be of a down the line view of the subject. The test will be graded as pass or fail.
You will need to ensure consistent camera set up on each and every testing. The angle of the camera to the subject needs to be identical for every subject. If the camera angle changes even a degree it will result in variance in the results and render the test data invalid.
Camera Setup:
- The camera must be on a tripod to limit movement.
- The camera lens must be set to the height of the top of the greater trochanter.
- The camera should be aligned parallel to the target and directly behind the player’s hands. INSERT PICTURE HERE(See page 23 of TPI level 1 manual.)
- To do this project a piece of string on the floor and create a parallel target line. The string needs to run from in front of the golfer’s hands, under the hands and straight back from the golfer’s hands.
- Alternatively, if you wish to purchase an inexpensive laser level you can attach the level to the camera and make sure the red line from the laser level bisects the golfer’s hands.
- Video golfer’s full swing with an 8 iron.
Analysis of video:
- Once golfer is set up in address position, draw a vertical line on the posterior most aspect of their buttocks.
- Make sure to draw the line at the very outer edge of the pants at set-up. Make sure there is no daylight between the player’s buttocks and the line.
- Forward the video to the top of their backswing as evidenced by the stopping of upward motion of the golf club and pause the video.
- Verify if there is space between the buttocks and the line you drew. If so, then there is early extension on the backswing.
- If not forward the video to impact.
- Verify that the golfer’s buttock is still in contact with the initial line you drew or if not.
- If the buttocks are not in contact with the line then, the player has early extended. This golfer has failed to maintain their posture, and failed the test.
- If they maintain the buttocks on the line, then they have passed the test.
VIEW THE VIDEO BELOW FOR AN EXAMPLE OF A FAIL
VIEW THE VIDEO BELOW FOR AN EXAMPLE OF A PASS
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