Will Tiger Woods Return?
Tiger Woods injury update
On February 23, 2021 golf made national news after Tiger Woods got into a single car accident while driving to the golf tournament that he was hosting in Pacific Palisades, California. He was extracted from the car and headed straight into surgery sending the golf world into a frenzy. Would the superstar return to golf? How long until we get the “Big Cat” back on tour? Will he even come back after recovery? Although most of those questions are up in the air, lets take a dive into the injuries that Tiger sustained to get a better understanding of the tough road ahead.
Tiger Wood’s ANATOMY AND PROCEDUREs Performed
**Warning there are surgical images of stabilization of the distal fibula in this video.
Dr. Anish Mahajan reported to CNBC that Tiger suffered “comminuted open fractures to both the upper and lower portions of the [right] tibia and fibula,” and “multiple fractures of the [right] foot.”1 Our lower leg is made up of the tibia, or shin bone, and fibula which runs along the outside of the tibia and helps to create the ankle joint near the foot. Tiger fractured both bones right below the knee joint and right above the ankle joint. These fractures were comminuted meaning multiple fractures, and open (AKA compound) meaning that the fractured pieces of bone broke the skin. With this type of fracture risk of immediate infection is high due to the openings in the skin. Another complication is the displacement of bone fragments and the need for surgery to realign the bone to promote healthy union. Surgery consists of placing a combination of rods and screws to internally fixate the ends of the bone. High impact to the shin can also cause a condition called acute compartment syndrome causing dangerous amounts of fluid to put pressure on the structures in the lower leg. In the lower leg there are four compartments that are separated by fascia and house different muscles, nerves and blood vessels. With pressure building, blood vessels can be closed off causing tissue death. Nerves can also be damaged or ruptured causing difficulties innervating the muscles that these nerves supply. To alleviate this pressure a procedure called a fasciotomy was performed on Tiger where the surgeon cut open the fascia to allow pressure release in the injured compartments. In addition to the lower leg injuries, he also sustained fractures to the forefoot bones called the metatarsals. These bones form the base of all five toes and help to make up the arches of the foot supplying stability for ambulation and sporting activities.
““Even with the best care and optimized recovery he has sustained trauma that will make even returning to walking a difficult task. I would never bet against Tiger, but he has a heck of a challenge ahead of him.””
Tiger Wood’s Golf Rehabilitation
““The tibia and fibula long bone fracture typically heal without issue after internal fixation in healthy individuals. Infection is the most immediate concern given the open nature of the fractures. The potential compartment syndrome is also of concern, but by performing fasciotomies they should have preserved the muscle function in his lower leg.””
Looking at the surgical repair of tibial fractures using internal fixation, Tiger can expect approximately 25 weeks until the bones will fully unite barring any complications.2 For this portion, rehab will focus primarily on maintaining muscle strength and range of motion of both the knee and ankle joints. He will begin with non-weight bearing exercises for the hip musculature, quads, hamstrings, and calf muscles. Limited weight-bearing will most likely begin after 3 weeks using crutches or a walker to increase ambulation ability. This timeline may be altered due to metatarsal fractures as these bones need about 6 weeks to fully heal as well. Added time may also occur due to the fasciotomy procedure and the need for healing of the skin and muscles surrounding the tibia. Long term, Tiger will most likely be fighting muscle pain, weakness, and stiffness for the next few years according to articles reporting on outcomes of fasciotomy procedures. For reference, NFL quarterback Alex Smith suffered similar injuries with complications of infection during surgery. His E60 (https://www.espn.com/watch/player/_/id/3621876/bucketId/6200) special highlights the struggles of rehabilitation of this injury and documents an experience similar to what Tiger may have ahead of him.
Tiger Wood’s PRIOR INJURIES
Tiger has not had it easy with injuries throughout his career. Playing golf at the level that he has for that long has taken its toll on his body and shows that this “leisure” sport is not a walk in the park like some may think. His early career was plagued with knee injuries and a lingering neck injury resulting from a car accident in 2009. Back injuries have been the highlight of Tiger’s career as of late, with four surgeries coming in the last 6 years. Throw in some forearm and ankle injuries and you have quite the mix of obstacles for Tiger to overcome.
Full list of Tiger Wood’s Injury History
December 1994 – Surgery left knee to remove two benign tumors
December 2002 – Surgery left knee to remove fluid and benign cysts
August 2007 – Left ACL rupture
May 2008 – Arthroscopic surgery left knee
June 2008 – Surgery L knee to repair ACL
December 2008 – Right Achilles injury
November 2009 – Car accident with neck pain and stiffness
May 2010 – Cervical spine disc herniation
April 2011 – Left Achilles injury
May 2011 – Left MCL sprain and left Achilles injury
March 2010 – Lingering left Achilles pain
August 2012 – Low back muscle strain
June 2013 – Left elbow injury
August 2013 – Low back muscle strain
March 2014 – Micro-discectomy surgery #1 to alleviate pinched nerve in low back
September 2015 - Micro-discectomy surgery #2 to alleviate pinched nerve in low back
October 2015 – Surgery on lumbar spine
April 2017 – Spinal fusion surgery in lumbar spine
EFFECTS ON HIS GOLF SWING
What do these injuries mean for Tiger’s golf swing?
The golf swing is one of the most complex movements in sport, with rotational demands from the entire body that exceed most other movements. Values of 45.5 degrees of lumbar rotation and approximately 25 degrees of hip external rotation and 5 degrees of hip internal rotation.4 Tiger’s spinal fusion procedure in 2017 causes decreased lumbar rotation range of motion putting more demand on the hip and thoracic spine rotation to compensate for this lack of range of motion. His current injuries will have drastic influences on his golf swing as well. The fractures to his lower extremity were on his trail leg that will cause issues mostly in the acceleration and impact phases. In an article looking at muscle activity through different parts of the golf swing these muscles were most active in initiating downswing and through impact.5 Injuries to bones surrounding the ankle will most likely cause a decrease in ankle dorsiflexion (pulling foot upward). Although this is not a rotational component of the swing it will decrease the ability of Tiger to avoid early extension on the downswing. To get a better understanding of this concept, Dr. Rose of Titleist Performance Institute has an amazing twitter post that highlights this in more detail.6 Tiger has been dealing with numerous injuries throughout his career, but the current injuries present new challenges that he will have to overcome.
CAREER ACCOMPLISHMENTS
Despite all his injuries Tiger has had an amazing career so far. Starting in 1996, Tiger has 82 career wins on tour, 12 internationally, and 14 additional victories. Out of the 368 events that he has participated in he has made it to the weekend 334 times, finished second 31 times, finished third 19 times, and finished top ten 199 times. Tiger is in the PGA record books as second all-time major wins with 15, and second and fourth all time for consecutive tour wins with 7 and 6. His 82 career wins puts him tied with Sam Snead for the most in history. Amazingly, he has 20 hole-in-ones and his lowest career score was a 61 in 2013. Regardless of whether Tiger decides to come back after his accident this athlete has had one of the greatest golf careers of all time and has been the face of golf since he began. [PGA Tour]
““He’s a human being at the end of the day, And he’s already been through so much. At this stage I think everyone should just be grateful that he’s here, that he’s alive, that his kids haven’t lost their dad.””
CONCLUSION
Although most of us would love to see Tiger back wearing red on Sundays, we would agree that his health is the focus at this point. He has a long road to recovery, but he has shown throughout his career that he has what it takes to overcome most obstacles. Whether or not he returns to golf through all of this, he will continue to be the face of golf. LWPT wishes Tiger all the best and hopes he has a speedy recovery.
AUTHOR:
CONTRIBUTORS:
Dr. Bob Adams, DO,
Ret. Head Medical Physician USA Track & Field
Dr. Jonathan Hall, MD
Head Foot & Ankle Physician at ProOrtho
Dr. Peter Lallas, DPM
Podiatrist Evergreen Sport & Spine
Dr. Brandon Messerli, DO
Physiatrist Evergreen Sport & Spine
Dr. Larry Maurer, DPM
Owner and Founder of Washington Foot & Ankle
Dr. Dayne Mickelson, MD
Proliance Orthopaedics & Sports Medicine
Matt Sato, PT, DPT, SFMA, TPIc
Ben Wobker, PT, MSPT, CSCS, CFSC, SFMA
REFERENCES
1. DeCiccio E. Tiger Woods suffered ‘a high energy fracture’ that makes his injuries ‘more difficult to heal,’ says orthopedic surgeon. CNBC. Published February 25, 2021. Accessed March 1, 2021. https://www.cnbc.com/2021/02/24/tiger-woods-injuries-are-more-difficult-to-heal-says-surgeon-.html
2. Surendra K, Shashank T, Chaudhary S, Anil Y. Evaluation of functional result in different grades of compound tibial fractures by intramedullary nail. Int J Orthop Sci. 2018;4(4):449-453. doi:10.22271/ortho.2018.v4.i4e.43
3. Complete list of Tiger Woods’ injuries. Accessed March 1, 2021. https://www.pga.com/archive/news/pga-tour/complete-list-tiger-woods-injuries
4. Mun F, Suh SW, Park H-J, Choi A. Kinematic relationship between rotation of lumbar spine and hip joints during golf swing in professional golfers. Biomed Eng Online. 2015;14. doi:10.1186/s12938-015-0041-5
5. Marta S, Silva L, Castro MA, Pezarat-Correia P, Cabri J. Electromyography variables during the golf swing: A literature review. Journal of Electromyography and Kinesiology. 2012;22(6):803-813. doi:10.1016/j.jelekin.2012.04.002
6. TPI on Twitter. Twitter. Accessed March 3, 2021. https://twitter.com/MyTPI/status/1248381089757843456
7. Rory McIlroy on a Tiger Woods comeback: “Golf is so far from the equation right now.” Golfweek. Published February 24, 2021. Accessed March 3, 2021. https://golfweek.usatoday.com/2021/02/24/rory-mcilroy-tiger-woods-comeback-golf-far-equation-right-now/