1: Golfers with an amputation – (amputees)

1: Amputees

An amputee is unable to generate a muscular force to cause the prosthetic joint to rotate, other joints (most frequently the hips in golf) will be required to work significantly harder to enable the motion of a golf swing. For instance, a lower-limb amputee will not be able to push the leg from the ankle; rather, they will pull the leg from the hip. This change in harnessing ‘Ground Reaction Force’ can influence impact factors and subsequent ball flight patterns. Be aware of the positioning of the amputation, above or below knee and above or below elbow as this can have a huge influence on mobility and ability to elicit changes in movement patterns for golf.

• Prosthetic limbs mimic real limbs in a more simplistic way. The coaching techniques you normally use are a good place to start, but you might have to make adaptations.
• Ask the player if they played golf prior to the amputation, as this will assist in modifying their golf DNA to adapt to the amputation.
• Note in the two videos above the difference in the two movement patterns between the player with and without a prothesis. Juan has a congenital amputation and James played golf prior to his amputation.
• If the participant is limited by their prosthesis, work with them on alternative exercises – keep the approach simple and seek advice from the prothesis manufacturer to advise on ‘golf specific’ adjustments which may assist the player.
• Participants may use stump socks or liners to help with the fit of the residual limb into the socket (like wearing socks in shoes). Participants will sweat in the socket, which can become swollen and uncomfortable, so give them time out to change them or remove their prosthesis during the session if necessary.
• Provide seating and introduce regular rest intervals.
• Some athletes may wish to participate without prothesis and support – let your golfer explore this option if requested as sometimes more sequenced golf motion patterns can be developed without prosthetics.
• To develop particular ball flight and to ‘match up’ motion patterns – don’t be afraid to turn the player from playing from the trail leg to playing from the lead leg – simply by giving them the opportunity to experiment with right – and left-handed play.
• Find out what the participant can do, or what may be preventing them from taking part (eg self-confidence, socket fit, pain, technology).
• Consider the individual’s physique, mobility and application. Speak to the participant to understand their personal abilities and desires and how this could affect their ability and timeframe in achieving their goals in the game.
• Check the participant’s range of movement as this can vary greatly.
• Constant and continual repetition and reinforcement can improve coordination and mastery, but it can cause skin breakdown. Talk to the participant about finding a good balance between repetition and changing the nature of the loading.
• Participants may have a slower response time when initiating movement on command, due to their prosthesis.
• The participant may have limb movement restrictions. Therefore, they need to improve their basic movement skills, through drills.
• Be aware of any balance and coordination problems, and take these into consideration with any relevant drills or game play.
• Consider their balance, coordination and strength as a starting point before introducing any sport-specific technical modelling.
• Lay down solid foundations first to build on, and keep it simple.
• Discuss pain threshold and tolerance with the player in order to have a better understanding of specific issues and concerns, such as their pain management routine (eg use of medication). This should be established and monitored regularly to prevent/reduce the risk of any aggravated or potential future injuries. Where appropriate, adjustments should be made to reflect this.

Levels of amputation

Mobility, range of movement, coordination, balance and comfort vary greatly depending on the level of amputation. As a general rule, the more residual limb (stump length) an amputee has, the more mobile they will be.

• Partial foot or toe(s)
• Syme’s (through the ankle)
• Trans-tibial amputation (below the knee)
• Knee disarticulation (through the knee)
• Transfemoral amputation (above the knee)
• Hip disarticulation or hemipelvectomy
• Bilateral lower-limb loss
• Partial hand or finger(s)
• Wrist disarticulation
• Below elbow
• Elbow disarticulation
• Above elbow
• Shoulder disarticulation or fore-quarter
• Bilateral upper-limb loss
• Multiple amputation. 
   

Note the differences in swing direction and energy loading between the next two videos – Player 1; playing with the lead arm – Player 2; playing with the trail arm: