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Comment surmonter les blessures dans le golf amateur ?

Bien que le golf ne soit pas un sport de contact, des blessures traumatiques peuvent tout de même survenir.

Les blessures dans le golf amateur sont très courantes.

Chaque année, entre 15 et 41% des golfeurs amateurs signalent une blessure. 31 à 90% des golfeurs professionnels signalent une blessure chaque année. Les nombres professionnels sont plus élevés en raison de leur volume d’entraînement et de jeu beaucoup plus élevé. Le site de blessure le plus courant est le bas du dos, qui représente 18 à 36% des blessures. Le coude, le poignet, la main et l’épaule sont également des zones de blessures courantes. 1

(Les nombres varient selon les études que vous lisez, celles ci-dessus sont tirées d’une revue d’un certain nombre d’articles).

La grande majorité de ces problèmes sont de nature abusive. Cela se produit lorsqu’une zone est exposée à un stress qu’elle ne peut tolérer, sur une période de temps. Une grande description de cela a été décrite dans l’article de Scott Dye sur «l’enveloppe de la fonction» et l’homéostasie tissulaire. 2

Beaucoup de ces blessures courantes au golf ne sont pas particulièrement compliquées et peuvent être entièrement réadaptées si certains principes de base sont appliqués de manière cohérente. Avant d’entrer dans ce que j’ai trouvé est un cadre utile à suivre pour les maux et les douleurs «au fil du temps», examinons quelques raisons pour lesquelles ces blessures négatives peuvent traîner plus longtemps que nécessaire.

D’après mes observations communiquant avec des milliers de golfeurs, il existe un certain nombre de raisons pour lesquelles les blessures simples ne sont pas bien gérées, ce qui affecte énormément la durée et la qualité de la récupération pour le cas moyen.

  1. Se fier uniquement aux médecins pour obtenir des conseils sur les blessures:  votre médecin de famille est une excellente ressource pour gérer les maladies aiguës et chroniques, mais ce n’est probablement pas le meilleur choix pour évaluer, diagnostiquer et prescrire un plan pour surmonter une blessure et retourner au sport ou à une activité sportive de haut niveau . Ce n’est pas un coup dur pour les médecins, ce n’est tout simplement pas l’expertise d’un médecin généraliste. Le meilleur scénario est qu’ils vous réfèrent à un professionnel médical certifié TPI, à qui vous auriez pu aller en premier lieu (je comprends que l’assurance entre en jeu pour certaines personnes). Trop souvent, les conseils d’un médecin sont extrêmement conservateurs, tels que le «repos» de toute activité pendant un certain nombre de jours / semaines, de la glace, des anti-inflammatoires et de ne rien soulever au-dessus d’un poids arbitraire comme 5/10/20 livres. Aller chez un médecin pour des conseils sur les blessures, c’est comme aller chez un physiothérapeute pour de la fièvre. Il existe de bien meilleures options pour obtenir des conseils sur le diagnostic et la réadaptation d’une blessure liée au sport. Ce n’est pas une attaque contre les médecins, ce n’est tout simplement pas un domaine d’expertise pour votre médecin généraliste. (Bien sûr, certains médecins ont d’excellentes connaissances dans ces domaines. Ce sont probablement des consultants spécialisés et extrêmement coûteux.)
  2. Se concentrer sur le symptôme plutôt que d’améliorer la situation qui en est la cause: les anti-inflammatoires, la glace, la chaleur, de nombreux traitements passifs et le fait d’éviter de charger ou de stresser la zone (souvent appelé repos) aideront probablement à soulager à court terme, mais font peu pour éviter que le problème ne se reproduise lorsque vous reprenez une activité normale. Pour éviter que le problème ne se reproduise lorsque nous reprenons nos activités, nous devons établir une tolérance et un niveau de conditionnement supérieurs à ceux qui étaient présents lorsque la blessure a initialement élevé la tête.

  3. La mentalité «je suis fragile»: 

Les professionnels de S&C ont entendu toutes les excuses:

« Avec mon mauvais dos, je ne peux pas soulever ça »

« Je dois faire attention à mes genoux »

« On dirait que c’est beaucoup de stress sur le _____________ »

 « On m’a dit que je ne pouvais plus faire ça » 

« À mon âge…………. » 

Lorsque vous avez une zone blessée, vous avez deux choix.

Option 1: Entraînez progressivement la zone et les zones environnantes pour améliorer la fonction (force de mobilité, puissance, endurance, etc.)

Option 2: Évitez d’entraîner la zone, ce qui la rendrait plus faible, plus déconditionnée et perdrait sa fonction.

Selon vous, lequel est le mieux pour votre résultat à long terme?

J’espère que vous avez choisi l’option

1. Donc, souvent, les gens choisissent de faire exactement le contraire. Un scénario extrêmement courant que je rencontre est que quelqu’un me dit que son dos ou son genou lui fait mal pendant ou après avoir joué au golf et que cela affecte sa performance, son plaisir ou la fréquence à laquelle il peut jouer ou s’entraîner. Je leur demande ce qu’ils font pour rectifier la situation. Ils me disent la liste habituelle du glaçage ou du chauffage, des analgésiques, du port d’un corset / soutien, du repos et peut-être d’étirements ou de massages non dirigés. Ce qui précède peut être utile pour gérer les symptômes, mais il est très peu susceptible de conduire à une réadaptation réussie car ils ne font rien ou presque pour améliorer la fonction à long terme.

Si vous souhaitez en savoir plus sur les raisons pour lesquelles le stress mécanique est essentiel à la santé des tissus, l’article «Chargement optimal: Variables et mécanismes clés» Glasgow et al (2015) peut vous intéresser. 3

Est-ce que ce cycle de son est familier? 

Les golfeurs m’expliquent régulièrement le cycle suivant. Prenons l’épaule comme exemple.

  • Le golfeur développe une douleur à l’épaule due au golf (peut remplacer n’importe quelle activité).
  • Le golfeur prend des analgésiques et utilise de la glace pour engourdir la douleur.
  • Essaie de «sucer» et continue de jouer la même quantité. La douleur aux épaules s’aggrave.
  • Le golfeur est obligé de prendre une pause complète du golf et décide que l’épaule doit se «reposer», donc arrête toute activité qui charge l’épaule.
  • La douleur à l’épaule semble diminuer et semble «OK», le golfeur saute directement dans le niveau d’activité précédent en pensant / en espérant que l’épaule est «fixe»
  • La douleur à l’épaule revient.
  • Le cycle continue.

Le diagramme ci-dessous en montre une illustration. Connaissez-vous ce cycle?

Cycle de Blessures Récurrentes chez les Golfeurs

Pourquoi Ne Vous Améliorez-Vous Pas?

Une erreur cruciale que de nombreuses personnes commettent en retournant au golf après une mise à pied en raison d’une blessure (cela s’applique à toute activité) est qu’elles ramènent immédiatement le corps / la partie du corps précédemment blessé et déconditionné à la même quantité d’entraînement et de jeu qui conduisent à la question en premier lieu. C’est complètement insensé. Si votre tolérance aux contraintes de la pratique et du jeu était inférieure au niveau requis pour votre quantité de pratique et de jeu avant la blessure, comment diable vous attendez-vous à ce que la zone maintenant plus faible et plus déconditionnée tolère les mêmes exigences qui lui sont imposées?

Bien qu’après votre période de repos, la zone ne soit plus endolorie, cela ne signifie nullement qu’elle est prête à revenir à votre volume précédent d’entraînement et de jeu.

Vous avez besoin d’un plan de rééducation structuré et progressif qui améliore la capacité de charge que votre corps peut tolérer. En termes simples, cela signifie que vous devez probablement améliorer votre mobilité, devenir plus fort et plus puissant et améliorer votre endurance musculaire. Cela ne signifie pas qu’un plan de réadaptation ne comprendra pas de glace, de chaleur, d’analgésiques, de massage, de ventouses, d’acupuncture, d’ajustements, d’aiguilletage, etc. pour aider à traiter la douleur aiguë, mais ces outils sont peu susceptibles d’améliorer la durabilité à long terme d’un athlète sur les leurs. Comme TPI aime à le dire, traitez la cause de la douleur, pas seulement le site de la douleur.

Khan et Scott (2009), «Comment la prescription par les physiothérapeutes de l’exercice favorise la réparation des tissus» fournit un cadre pour l’importance de la mécanothérapie, le processus par lequel la charge peut être utilisée en thérapeutique pour «stimuler la réparation et le remodelage des tissus des tendons, des muscles, du cartilage et OS ». 4

Une Meilleure Approche :

Une blessure de surutilisation est un signe que quelque chose doit changer. «Aspirer» et prendre des pilules n’est pas la solution à long terme, surtout si vous vous souciez de votre corps et de vos performances de golf.

La puberté est une étape majeure du développement physique de l’enfant. Au cours de cette période, les os s’allongent et se solidifient, les muscles augmentent de volume et de force, et une poussée de croissance s’en suit souvent. Tous ces changements amènent des débalancements musculosquelettiques normaux, comme une diminution de la densité osseuse et une hypermobilité articulaire. Le cartilage articulaire possède alors moins de résistance aux forces de traction, aux forces de cisaillement et aux forces de compression. Par conséquent, l’athlète, en phase de croissance, est plus vulnérable aux blessures de surutilisation.

Premièrement, qu’est-ce qu’une blessure de surutilisation?

Il s’agit d’une blessure occasionnée par une charge sous-maximale répétitive sur le corps, avec un repos insuffisant entre les charges pour que le corps puisse s’y adapter. Cette charge répétée mène à des microtraumatismes ou des microlésions causant un affaiblissement et des dommages aux structures du corps. Un débalancement entre les entraînements et les périodes de repos est un facteur important pouvant mener à une blessure de surutilisation, surtout chez les jeunes athlètes dont l’appareil musculosquelettique est encore immature.

Facteurs de risque

Ils sont regroupés en deux grandes catégories : les facteurs intrinsèques et les facteurs extrinsèques. Le tableau qui suit les résume bien :

Facteurs de risques intrinsèques Facteurs de risque extrinsèques
  • Facteurs reliés à la croissance
  • Susceptibilité du cartilage en croissance par rapport au stress répétitif
  • Poussée de croissance
  • Blessure antérieure
  • Niveau de conditionnement antérieur
  • Facteurs anatomiques
  • Dysfonction menstruelle
  • Facteurs psychologiques et développementaux reliés à l’athlète
  • Charge d’entraînement (taux, intensité, progression)
  • Calendrier d’entraînement et de compétitions (ex. : entraînement 5 fois/semaine plus compétition la fin de semaine)
  • Équipement
  • Environnement
  • Technique de sport
  • Facteurs psychologiques (influence des adultes et des pairs)

*Les facteurs en gras sont les plus importants prédicteurs de blessure de surutilisation

Les blessures de sur-utilisation les plus fréquentes chez le jeune athlète sont :

    • Osgood-Schlatter : Blessure au niveau du tubercule médial du genou, tout juste sous la rotule. Elle apparaît surtout tôt à l’adolescence.

  • Maladie de Sever : Blessure au niveau de l’apophyse calcanéenne du talon, à la base du tendon d’Achille.
  • Elle aussi survient tôt à l’adolescence.
  • « Little Leaguer’s Elbow » : Blessure à l’apophyse épicondylienne médiale, au niveau du coude. Surtout présente chez les joueurs de baseball, elle survient tôt à l’adolescence.Blessures à la physe osseuse (plaque de croissance) : Ces blessures apparaissent souvent entre le début et le milieu de l’adolescence. Elles atteignent souvent l’humérus proximal chez les lanceurs et le radius distal chez les gymnastes.

Lorsque l’athlète présente une blessure de surutilisation, il se plaindra souvent de douleur, de limitation de mouvement, d’enflure, de rougeur ou de chaleur. Ses performances sportives seront aussi altérées et les limitations peuvent aller jusqu’à l’incapacité de faire certains mouvements ou certaines tâches du sport. La reconnaissance rapide de ces signes et symptômes est très importante pour éviter qu’une blessure sérieuse ou permanente ne survienne. Une consultation avec un professionnel de la santé comme le physiothérapeute est également recommandée afin d’évaluer et de traiter efficacement ce type de blessure.

Conseils pour prévenir les blessures de surutilisation :

  1. Prévoir un repos complet d’activités de 1 à 2 journées par semaine pour permettre au corps de récupérer et de s’adapter.
  2. Ne pas augmenter la charge d’entraînement de plus de 10 % chaque semaine.
  3. Encourager le jeune athlète à prendre chaque année 2 à 3 mois consécutifs de pause de son sport spécifique. L’athlète ne devrait pas s’entraîner 12 mois consécutifs, car son risque de blessure de surutilisation est alors grandement augmenté.
  4. Encourager la participation au sport et la bonne application des techniques et des mouvements enseignés.
  5. Encourager l’athlète à ne faire partie que d’une équipe sportive durant la saison.
  6. Connaître les signes et symptômes des blessures de surutilisation et les enseigner aux athlètes.

La première étape est quelque chose que la plupart des golfeurs n’aiment pas entendre. Vous devrez réduire votre pratique et jouer à un niveau que vous pouvez tolérer. Cela ne signifie pas que vous devez arrêter complètement de jouer au golf (bien que cela puisse durer un certain temps), mais vous devrez apporter quelques modifications. Il est impossible de dire exactement quelles sont ces modifications et à quel point elles doivent être graves. De nombreuses variables et nuances individuelles entrent en jeu. En termes simples, nous devons réduire le type et la quantité de stress (par exemple, frapper des balles de golf) qui sont les principaux facteurs aggravants. Voici quelques exemples de procédures à suivre:

  • Jouer 9 trous plutôt que 18.

  • Obtenir un petit seau de balles plutôt que grand.

  • Changer la surface que vous frappez lors de la pratique.

  • Faire 2 séances d’entraînement de 30 minutes avec quelques jours entre elles, au lieu de 1 séance de 60 minutes à la fois.

  • Travailler plus sur le jeu court ou moins que les balançoires à pleine vitesse, par opposition au travail régulier sur le long jeu.

Si nous revenons au cycle commun que j’ai souligné ci-dessus, voici une meilleure approche:

  • Le golfeur effectue une force et un conditionnement tout au long de l’année, ce qui réduit considérablement les risques de blessure. Quelque chose d’aussi peu que 20-30 minutes 2-3 fois par semaine ferait une grande différence. Cela peut être planifié en fonction de vos quantités de jeu à différents moments de l’année.
  • Si un golfeur développe un problème en jouant au golf, il arrête de «cueillir la croûte» et d’appliquer le même stress à la zone qui provoque l’aggravation.
  • Ils font évaluer la zone par une personne expérimentée dans le traitement des blessures liées au sport ET compétente pour créer un plan de réadaptation structuré et progressif. Un plan complet devrait inclure des exercices basés sur leur évaluation et une discussion sur la façon de revenir progressivement au golf. Il est très peu probable que vous obteniez cela d’un médecin généraliste. Un professionnel médical TPI sera probablement la meilleure option pour le diagnostic. Assurez-vous qu’ils ont de l’expérience dans le traitement des blessures liées au sport. Soit eux ou un entraîneur de force et de conditionnement seront les meilleurs pour prescrire un plan de réadaptation. Une fois que vous êtes sorti des premiers stades de la réadaptation, un entraîneur de force et de conditionnement sera la meilleure option pour créer un programme d’entraînement à long terme. Les professionnels de la santé et les entraîneurs de force et de conditionnement travaillent souvent ensemble, le professionnel de la santé étant le chef de file dans les premiers stades des blessures et de la réadaptation, tandis que l’entraîneur de force et de conditionnement a plus d’expertise pour guider le client vers des performances de haut niveau. L’entraîneur de golf est applicable devrait également être impliqué dans ce processus.
  • À mesure que vos symptômes et votre fonction s’améliorent, le plan de réadaptation devrait progressivement progresser. Il est important de ne pas se précipiter à ce stade. C’est à ce stade que de nombreux golfeurs s’impatientent et font simplement sauter des analgésiques, récupèrent la banquise et reprennent leur routine normale, et les mêmes symptômes réapparaissent. Après quelques séances de rééducation et un court laps de temps, ils jettent l’éponge et déclarent «ça ne marche pas». Ce qu’ils ne respectent pas, c’est que le problème a été créé sur une longue période de temps, et il est stupide de penser que les améliorations seront instantanées.
  • À mesure que les symptômes et la fonction s’améliorent, revenez progressivement à la pratique normale et jouez des volumes. Ne pensez pas que vous êtes «fixe» et abandonnez vos exercices. Il est important de se rappeler que vous devez atteindre un niveau de conditionnement supérieur à celui auquel vous étiez lorsque la blessure s’est présentée en premier lieu. Utilisez l’aggravation comme guide. Il faut s’attendre à une certaine sensibilité / douleur / symptômes, mais ils devraient être légers. Si vous avez besoin de le rappeler un peu, faites-le. Encore une fois, la clé ici est que vous ne revenez pas à l’inactivité complète, mais au stade de la réadaptation et de la pratique / du jeu qui est votre «sweet spot». C’est un niveau qui est suffisant pour stimuler la récupération et l’amélioration, mais pas tellement qu’il provoque des pas en arrière.
  • Finalement, vous devriez être de retour à mieux que ce que vous considérez précédemment comme «normal», et capable de résister à plus d’entraînement et de jeu que vous n’en auriez auparavant sans avoir de problème.
  • Je vous encourage fortement à effectuer une formation de base sur la force et le conditionnement tout au long de l’année pour aider à prévenir ces problèmes en premier lieu. Il améliore également considérablement la fonction physique générale et le potentiel de performance du golf.

Beaucoup de gens n’ont pas ce niveau de patience, mais c’est ce qui est généralement requis. C’est une différence clé que j’ai vue dans l’attitude des athlètes de haut niveau qui respectent leur corps, le processus de récupération et veulent être meilleurs à long terme, par rapport à ceux qui recherchent une solution rapide et un masquage des symptômes.

(PS Si quelqu’un promet une «solution miracle» ou ne préconise pas une réadaptation progressive structurée, méfiez-vous)

Comme le dit Charlie Weingroff « Formation = Réhabilitation, Réhabilitation = Formation »

Une approche judicieuse consiste à démarrer un programme d’entraînement à un niveau approprié, en tenant compte de l’état actuel de votre blessure, de votre fonction et de votre niveau de tolérance, ainsi que du niveau de conditionnement général. Vous pouvez définir un niveau de performance pour un objectif futur et y progresser progressivement.

De nombreux golfeurs considèrent les blessures comme des problèmes isolés. Ils ont mal au coude, au dos ou à l’épaule et ne réalisent pas qu’un meilleur niveau global de conditionnement fera probablement une énorme différence dans leur capacité à jouer et à s’entraîner sans avoir à faire face à ces maux et douleurs.

Il est important que les personnes confrontées à des problèmes à long terme comprennent qu’elles ne sont pas brisées, et il est parfaitement correct et extrêmement important de traiter et même de former les zones problématiques. Nous ne sommes pas aussi fragiles que nous le pensons, et exposer le corps à un niveau de stress approprié est crucial pour les améliorations psychologiques et physiologiques. Habituellement, cela est mieux accompli sous la direction d’un professionnel médical ou de fitness qualifié.

Si vous êtes un golfeur passionné qui n’a actuellement pas de blessures, c’est une bonne idée d’adopter une approche proactive. Les principes de base de la force et du conditionnement contribuent grandement à réduire la probabilité que vous ayez à passer du temps sur la touche ou à jouer avec la douleur. Bien sûr, il existe également d’énormes avantages en termes de performances. Des oscillations plus mobiles et puissantes entraînant une augmentation de la vitesse de la tête du club et plus d’énergie pendant les rondes étant les plus évidentes.

Un grand merci à Patrick Carroll MSc, BSc (Hons) MISCP de Old Quarter Physiotherapy, Cork, Irlande pour son aide avec cet article.

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