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.
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.
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.