When we look at Tiger Woods, Ernie Els, Annika Sorenstam, and Michelle Wie swing a club, it looks fluid, natural, and harmless. All of these golfers have something in common: they have all had injuries affecting their golf swing. Tiger and Ernie both have had an anterior cruciate ligament (ACL) tear, Annika had a ruptured disc in her neck, and Michelle broke 3 bones in her wrist. The golf swing is an unnatural, explosive, and forceful action which puts us at risk for injury. Many golfers play through some of these injuries, waiting for a "better time" to deal with the injury. Tiger Woods won the US Open in 2008 with a torn ACL; after which he announced his season was done. That "better time" for golfers in Iowa is usually in the off season for most golfers from about mid-October to May. So the question becomes, "what do I do in the off season to get back to golfing?" Even for those golfers who have not injured themselves, they may be asking the same question. Golfing requires core strength, postural stability, muscle control, precise coordination, and excellent body awareness. This strength and stability can be compromised after an injury or slowly decline as we age.

Injuries among golfers are common. In fact, up to 60% of all golfers will experience some golf related injury over their playing years. Low back pain, rotator cuff tears, arthritis of the knees and hips, and medial epicondylitis (golfer’s elbow) are some of the most commonly reported injuries related to golf. For any injury, when to return to golf is a question on every golfer’s mind. My own mother’s first words in the recovery room after having surgery to repair a ruptured disc in her neck were "So, when can I swing a club?"

Returning to golf should be done in steps, like any return to sport. The speed of progression through these steps obviously depends on the injury. The progression is as follows: Putting -> Chipping -> Pitching -> Half Swing -> Full Swing Half Speed -> Full Swing. Start with putting and progress through the phases as you are able to do one without pain. For example, when chipping is not painful, start working on pitching. Keep working on putting and chipping, but progress to pitching. When this becomes pain free, move onto the next step while still working on the steps below it. Once multiple full swings are pain free, you are ready to hit the golf course. You may want to try a few balls at the driving range once you have reached the half-swing stage, but don’t overdo it! If you are used to playing 18 holes, start out with 9 to see how it feels, then progress back to 18. Golfers can do plenty of work in the off season in the off season to improve their golf swing without even stepping onto a golf course or driving range.

Building a strong core serves as a base of movement for the golf swing. Improving core strength can increase consistency, power, accuracy, and endurance. Golf is a sport that requires a lot of rotation through the trunk, placing stress on the muscles controlling it. Not only that, our trunk serves as a stable framework from which our arms and legs move. Balance and postural stability are areas which can be overlooked, but are very important to golf.

At the end of the golf swing, most of our body weight is on our front foot, which requires a lot of balance and postural stability. Improving your balance can have a drastic impact on consistency and accuracy of your golf swing. Balance includes not only knowing how much weight to put on each foot, but getting your weight centered front to back over your feet. This can be a primary cause for "topping" the ball; something even the best of us do every once in a while! Part of balance is correct body awareness.

Knowing where your body is in space is an integral part of a consistent golf swing. For golfers, this is realizing you turned your hands over too soon, your swing is too flat, you lift your front foot on the backswing, or your hips are not turning with your shoulders. All of these are examples of what golfers refer to as "feel." Training your nervous system to react to minute changes in a swing can mean the difference of a few strokes at the end of a round. To train this body system, you may want to consider using a weighted club. This makes your body more aware of where the limbs are at, which can increase consistency and improve your "feel."

Arthritis is a common problem for golfers, especially those who are beginning to advance in age. To reduce the amount of force placed on the knee and hip, try turning your front foot out when you address the ball. This reduces the amount of torque through the joints while still allowing the golfer to take a full swing. For those with total hip replacements, this can be a useful tool to help follow the hip precautions you were given after surgery.

Pre-round stretching can drastically reduce your risk for injury. This can be as simple as stretching your hamstring muscles and doing trunk rotation stretches on the first tee.

Improving your core strength, balance, and body awareness in the off season can cut strokes from your score and improve your overall health. Knowing when to return to this life-long sport can lengthen your golfing years and keep your swing comfortable throughout them. To find out more about how to improve your core strength, balance, and body awareness, contact your local physical therapist or use the American Physical Therapy Association (APTA) service called "Find a PT." By taking the time to rehabilitate properly, Ernie Els got back into playing form in six months after his ACL injury. Tiger may be out for 10 months. It took time and effort to get back to a fluid and natural swing for these pros. During this off season, you can make the effort and put in the time to get yourself back to your swing, or improve yours by what you do behind the scenes and off the golf course.