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Opinion & Analysis

Preventing injuries on the LPGA Tour: A case study with Madelene Sagstrom

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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.

You can follow Anne-Lise and her life / work on tour – Instagram and Facebook

Anne-Lise Bidou – Physio 4 Golf

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

Madelene

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.

Exercise Examples

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.

Nick Randall is a Strength and Conditioning Coach, Presenter and Rehab Expert contracted by PGA Tour Players, Division 1 colleges and national teams to deliver golf fitness services. Via his Golf Fit Pro website, app, articles and online training services, Nick offers the opportunity to the golfing world to access his unique knowledge and service offerings. www.golffitpro.net

4 Comments

4 Comments

  1. Trevor Montgomery

    Aug 16, 2019 at 5:38 pm

    Having worked with tour players and winners on the USPGA and European tours for the last 20 years I find that scapula stability is a key component that needs to be assessed and addressed appropriately to reduce injury risk and improve performance and consistency. Addressing scapula control issues can lead to increases in trunk rotational range by upward of 20% and certainly decreases injury risk to segments above and below. Kibbler reported that 68-100% of people with should joint problems had concurrent scapula dyskinesia. It is my experience that scapula stability is often unaddressed with athletes – great article for highlighting this important segment.

  2. ZQ

    Aug 1, 2019 at 12:15 pm

    Shoulder girdle main issue for injuries LOL!

    Back, hips, and elbow/wrist = way more prominent. Terrible article.

    • MhtLion

      Aug 1, 2019 at 6:15 pm

      How I’m reading the article is that because typical females have week shoulder girdles which provide the stability, they tend to overuse back, hips, elbow, and writs, and end up injuring those.

  3. North Hinkle

    Jul 31, 2019 at 10:28 pm

    I find this article limited in its discussion, specifically to the upper body and shoulder. Almost all of my injuries are knee and ankle and are due to core weakness creating stress on the lead leg joints. It is typical for men to have leg injuries when their core is weak (note Steph Curry his first 2 seasons in the NBA until he fixed his core).

    When I had good core, my strain was always the lead shoulder infraspinatinus – it would get worn out mid season and I just had to deal with it.

    Overall, I just think this article lacks depth and general applicability. A bunch of talk about LPGA players (women) having weak upper bodies, and then one story about a player the author helped.

    I find no unique insight or advancement preventing golf injury other than LPGA players pay the author money. Then again, LPGA players have believed in KT tape and I remember seeing a stupid number of PGA players wearing copper bracelets.

    Enough said.

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Opinion & Analysis

The 2 primary challenges golf equipment companies face

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As the editor-in-chief of this website and an observer of the GolfWRX forums and other online golf equipment discourse for over a decade, I’m pretty well attuned to the grunts and grumbles of a significant portion of the golf equipment purchasing spectrum. And before you accuse me of lording above all in some digital ivory tower, I’d like to offer that I worked at golf courses (public and private) for years prior to picking up my pen, so I’m well-versed in the non-degenerate golf equipment consumers out there. I touched (green)grass (retail)!

Complaints about the ills of and related to the OEMs usually follow some version of: Product cycles are too short for real innovation, tour equipment isn’t the same as retail (which is largely not true, by the way), too much is invested in marketing and not enough in R&D, top staffer X hasn’t even put the new driver in play, so it’s obviously not superior to the previous generation, prices are too high, and on and on.

Without digging into the merits of any of these claims, which I believe are mostly red herrings, I’d like to bring into view of our rangefinder what I believe to be the two primary difficulties golf equipment companies face.

One: As Terry Koehler, back when he was the CEO of Ben Hogan, told me at the time of the Ft Worth irons launch, if you can’t regularly hit the golf ball in a coin-sized area in the middle of the face, there’s not a ton that iron technology can do for you. Now, this is less true now with respect to irons than when he said it, and is less and less true by degrees as the clubs get larger (utilities, fairways, hybrids, drivers), but there remains a great deal of golf equipment truth in that statement. Think about it — which is to say, in TL;DR fashion, get lessons from a qualified instructor who will teach you about the fundamentals of repeatable impact and how the golf swing works, not just offer band-aid fixes. If you can’t repeatably deliver the golf club to the golf ball in something resembling the manner it was designed for, how can you expect to be getting the most out of the club — put another way, the maximum value from your investment?

Similarly, game improvement equipment can only improve your game if you game it. In other words, get fit for the clubs you ought to be playing rather than filling the bag with the ones you wish you could hit or used to be able to hit. Of course, don’t do this if you don’t care about performance and just want to hit a forged blade while playing off an 18 handicap. That’s absolutely fine. There were plenty of members in clubs back in the day playing Hogan Apex or Mizuno MP-32 irons who had no business doing so from a ballstriking standpoint, but they enjoyed their look, feel, and complementary qualities to their Gatsby hats and cashmere sweaters. Do what brings you a measure of joy in this maddening game.

Now, the second issue. This is not a plea for non-conforming equipment; rather, it is a statement of fact. USGA/R&A limits on every facet of golf equipment are detrimental to golf equipment manufacturers. Sure, you know this, but do you think about it as it applies to almost every element of equipment? A 500cc driver would be inherently more forgiving than a 460cc, as one with a COR measurement in excess of 0.83. 50-inch shafts. Box grooves. And on and on.

Would fewer regulations be objectively bad for the game? Would this erode its soul? Fortunately, that’s beside the point of this exercise, which is merely to point out the facts. The fact, in this case, is that equipment restrictions and regulations are the slaughterbench of an abundance of innovation in the golf equipment space. Is this for the best? Well, now I’ve asked the question twice and might as well give a partial response, I guess my answer to that would be, “It depends on what type of golf you’re playing and who you’re playing it with.”

For my part, I don’t mind embarrassing myself with vintage blades and persimmons chasing after the quasi-spiritual elevation of a well-struck shot, but that’s just me. Plenty of folks don’t give a damn if their grooves are conforming. Plenty of folks think the folks in Liberty Corner ought to add a prison to the museum for such offences. And those are just a few of the considerations for the amateur game — which doesn’t get inside the gallery ropes of the pro game…

Different strokes in the game of golf, in my humble opinion.

Anyway, I believe equipment company engineers are genuinely trying to build better equipment year over year. The marketing departments are trying to find ways to make this equipment appeal to the broadest segment of the golf market possible. All of this against (1) the backdrop of — at least for now — firm product cycles. And golfers who, with their ~15 average handicap (men), for the most part, are not striping the golf ball like Tiger in his prime and seem to have less and less time year over year to practice and improve. (2) Regulations that massively restrict what they’re able to do…

That’s the landscape as I see it and the real headwinds for golf equipment companies. No doubt, there’s more I haven’t considered, but I think the previous is a better — and better faith — point of departure when formulating any serious commentary on the golf equipment world than some of the more cynical and conspiratorial takes I hear.

Agree? Disagree? Think I’m worthy of an Adam Hadwin-esque security guard tackle? Let me know in the comments.

@golfoncbs The infamous Adam Hadwin tackle ? #golf #fyp #canada #pgatour #adamhadwin ? Ghibli-style nostalgic waltz – MaSssuguMusic

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Podcasts

Fore Love of Golf: Introducing a new club concept

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Episode #16 brings us Cliff McKinney. Cliff is the founder of Old Charlie Golf Club, a new club, and concept, to be built in the Florida panhandle. The model is quite interesting and aims to make great, private golf more affordable. We hope you enjoy the show!

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Opinion & Analysis

On Scottie Scheffler wondering ‘What’s the point of winning?’

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Last week, I came across a reel from BBC Sport on Instagram featuring Scottie Scheffler speaking to the media ahead of The Open at Royal Portrush. In it, he shared that he often wonders what the point is of wanting to win tournaments so badly — especially when he knows, deep down, that it doesn’t lead to a truly fulfilling life.

 

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A post shared by BBC SPORT (@bbcsport)

“Is it great to be able to win tournaments and to accomplish the things I have in the game of golf? Yeah, it brings tears to my eyes just to think about it because I’ve literally worked my entire life to be good at this sport,” Scheffler said. “To have that kind of sense of accomplishment, I think, is a pretty cool feeling. To get to live out your dreams is very special, but at the end of the day, I’m not out here to inspire the next generation of golfers. I’m not out here to inspire someone to be the best player in the world, because what’s the point?”

Ironically — or perhaps perfectly — he went on to win the claret jug.

That question — what’s the point of winning? — cuts straight to the heart of the human journey.

As someone who’s spent over two decades in the trenches of professional golf, and in deep study of the mental, emotional, and spiritual dimensions of the game, I see Scottie’s inner conflict as a sign of soul evolution in motion.

I came to golf late. I wasn’t a junior standout or college All-American. At 27, I left a steady corporate job to see if I could be on the PGA Tour starting as a 14-handicap, average-length hitter. Over the years, my journey has been defined less by trophies and more by the relentless effort to navigate the deeply inequitable and gated system of professional golf — an effort that ultimately turned inward and helped me evolve as both a golfer and a person.

One perspective that helped me make sense of this inner dissonance around competition and our culture’s tendency to overvalue winning is the idea of soul evolution.

The University of Virginia’s Division of Perceptual Studies has done extensive research on reincarnation, and Netflix’s Surviving Death (Episode 6) explores the topic, too. Whether you take it literally or metaphorically, the idea that we’re on a long arc of growth — from beginner to sage elder — offers a profound perspective.

If you accept the premise literally, then terms like “young soul” and “old soul” start to hold meaning. However, even if we set the word “soul” aside, it’s easy to see that different levels of life experience produce different worldviews.

Newer souls — or people in earlier stages of their development — may be curious and kind but still lack discernment or depth. There is a naivety, and they don’t yet question as deeply, tending to see things in black and white, partly because certainty feels safer than confronting the unknown.

As we gain more experience, we begin to experiment. We test limits. We chase extreme external goals — sometimes at the expense of health, relationships, or inner peace — still operating from hunger, ambition, and the fragility of the ego.

It’s a necessary stage, but often a turbulent and unfulfilling one.

David Duval fell off the map after reaching World No. 1. Bubba Watson had his own “Is this it?” moment with his caddie, Ted Scott, after winning the Masters.

In Aaron Rodgers: Enigma, reflecting on his 2011 Super Bowl win, Rodgers said:

“Now I’ve accomplished the only thing that I really, really wanted to do in my life. Now what? I was like, ‘Did I aim at the wrong thing? Did I spend too much time thinking about stuff that ultimately doesn’t give you true happiness?’”

Jim Carrey once said, “I think everybody should get rich and famous and do everything they ever dreamed of so they can see that it’s not the answer.”

Eventually, though, something shifts.

We begin to see in shades of gray. Winning, dominating, accumulating—these pursuits lose their shine. The rewards feel more fleeting. Living in a constant state of fight-or-flight makes us feel alive, yes, but not happy and joyful.

Compassion begins to replace ambition. Love, presence, and gratitude become more fulfilling than status, profits, or trophies. We crave balance over burnout. Collaboration over competition. Meaning over metrics.

Interestingly, if we zoom out, we can apply this same model to nations and cultures. Countries, like people, have a collective “soul stage” made up of the individuals within them.

Take the United States, for example. I’d place it as a mid-level soul: highly competitive and deeply driven, but still learning emotional maturity. Still uncomfortable with nuance. Still believing that more is always better. Despite its global wins, the U.S. currently ranks just 23rd in happiness (as of 2025). You might liken it to a gifted teenager—bold, eager, and ambitious, but angsty and still figuring out how to live well and in balance. As much as a parent wants to protect their child, sometimes the child has to make their own mistakes to truly grow.

So when Scottie Scheffler wonders what the point of winning is, I don’t see someone losing strength.

I see someone evolving.

He’s beginning to look beyond the leaderboard. Beyond metrics of success that carry a lower vibration. And yet, in a poetic twist, Scheffler did go on to win The Open. But that only reinforces the point: even at the pinnacle, the question remains. And if more of us in the golf and sports world — and in U.S. culture at large — started asking similar questions, we might discover that the more meaningful trophy isn’t about accumulating or beating others at all costs.

It’s about awakening and evolving to something more than winning could ever promise.

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