Golf, Prolotherapy, 
and Weak Ankles
Parts of this newsletter were drawn from Chapter 33 of
Prolo Your Sports Injuries Away

The goals are simple for the average golfer. Hit the ball far and hit it straight. Golfing could be defined, in a mechanical sense, as a coordinated movement between the upper body (torso, arms, and shoulders) and the lower body (feet, legs, and lower back). The most basic objective in this sport is control. Control the body segments, and you can control the physical impact and the end trajectory of the spherical object with dimples (the ball).

The Golf Swing

The most important part of the game is the golf swing. This requires a synergistic movement between the lumbar spine, the upper shoulder, and the feet. The feet are often neglected when there is any discussion about the swing. Nevertheless, if you think about the parts above the feet, the knees, back, neck, and shoulders, you will understand that none of these parts can be efficient if the feet are impaired.

I spoke at a medical seminar on the golf swing in early 1998. Dr. Hauser attended this seminar and he learned so much about the golf swing and the importance of the feet, that immediately after the talk, he changed his swing. On a recent trip to Chicago, Dr. Hauser and I had the opportunity to put that knowledge to practical use. We practiced hitting golf balls together for about two hours. Using this new information on how to balance his feet and lower his trunk at takeaway, his accuracy improved. It improved so much so, that I had to pay for the activities of the day for having the high score of the game.

Transition

During the transition from the take-away to the downswing, both the upper and lower halves of the body are moving in opposite directions. A dramatic weight shift occurs with the left foot carrying less weight and the right foot carrying more weight during the backswing. This weight shift must occur in a controlled manner to maintain a stable platform. The right lower limb will rotate around an axis in the middle of the leg, creating torque.

The right leg movement depends on the stability and inherent tension that will be created by the lower right ankle joint. It is the ligament between the tibia and fibula and behind the ankle (namely the talonavicular and calcaneolcuboid ligaments) that help compress the heel, ankle, and lower leg to maintain the stability.

If a person has ankle ligament laxity, again there will be excessive foot/ankle movement, which will cause excessive right leg movement, and errant shots will result. Palpation of the weak ligaments confirms the diagnosis of ligament laxity. Prolotherapy to the outside and rear ankle ligaments will help strengthen the ankle joint. This will allow the golfer to have a more controlled and powerful swing, not only improving distance, but also accuracy.

If the left foot and ankle are weakened during take-away, the golfer will create a sway movement causing a poor weight shift instead of torque. The sway weight shift is the main reason that people hit golf shots to the right with no power. Stabilizing the left ankle and midfoot ligaments with Prolotherapy is one avenue to correct this problem. A few golf lessons would not hurt either. The proper weight shift is vital to hitting a golf ball with power.

Impact

To hit the ball solidly requires not only steady nerves but also steady feet. If the foot is unbalanced, especially the left one (because most of the weight shifts to the left side upon impact with the ball), then the entire upper torso will over compensate with an exaggerated swing that often results in a hook. The ball will fly wildly as the body tries to recover its balance. To stabilize the left ankle, Prolotherapy is given to the ankle ligaments, especially to the outside (lateral) complex and inside, or deltoid ligaments. This will help the golfer maintain balance at impact.

Orthotics

Because of age and heredity not every foot can stand alone. Some feet are going to need help in the form of an arch support. In these instances, a specially constructed arch support, or orthotic, to promote better stance and foot efficiency may be recommended. Ideally, an orthotic placed in a golf shoe should not restrict the necessary motions of the foot during the golf swing. The orthotic should allow for adequate movement of the heel while simultaneously providing a stable base to support the rolling movements of the feet. In the past, golfers would be treated with an arch support that supported the longitudinal arch and did nothing for the heel and ankle. Support of the longitudinal arch is not critical for the golfer because this arch needs to both supinate and pronate to provide a powerful and accurate golf swing.

During the follow-through of the golf swing, the left foot goes into supination but the right foot pronates. Remember that during take-away the left foot goes into pronation. Pronation helps keep the feet stable during the golf swing, so it is more important to enhance pronation than restrict it, at least for the golfer. Allowing adequate foot pronation helps increase the torque during the golf swing and this can be accomplished by increasing the degree of pronation. To improve stability of the left foot, which is crucial during the follow-through, a left lateral wedge is placed on the left arch support. This enhances pronation in the left foot and thus improves stability upon follow-through. This gives the golfer a fluid follow-through as they watch their shot soar in the air directly at the target. If not, they smash their club on the ground.