You may have seen over the last few days the news about how Tiger Woods sacrum ‘popped out’ during the Bridgestone Championships and how it was ‘popped’ back into place, and how this quick ‘fix’ had Tiger ready for the US PGA tournament five days later, only to see him grimace and wince his way around the first two rounds looking uncomfortable and off form and eventually not making the cut.
Now in a game like golf I’m well aware there are a myriad of other reasons why a golfer doesn’t make the cut, but to me it looked like Tigers back pain was a major factor.
So was Tigers sacrum to blame and was this miracle cure of ‘putting the bone back in’ that miraculous?
Well lets not sugar coat it, of course it bloody wasn’t.
The notion of anyone’s sacrum (a key bone in your pelvis) can just ‘pop out’ is complete and utter nonsense, let alone the sacrum of a fit athletic professional male golfer without any history of trauma, previous pelvic issues or any other risk factors such as joint hypermobility, to put it simply…
SACRUMS DON’T JUST POP IN AND OUT…
I’m not alone in thinking this is nonsense and pseudo science at its worse, many have voiced their concern and dismay at this debacle, including the British Journal Of Sports Medicine, who voice their concerns extremely eloquently here.
So lets look at why this ‘story’ of Tigers sacrum popping out has happened. But first lets look at why the sacrum simply can not pop out!
For starters the pelvis is an incredibly strong and stable structure with many, many strong ligaments and muscles across it. The sacroiliac joint does have some small amount of movement, no question about that, and yes some have more or less than others, but the variation is minimal and the belief that many have in thinking that they can 1) feel this joint move 2) decide if it’s in the right or wrong position and 3) adjust it with manipulations is just complete and utter tosh based in cloud cuckoo land and is nothing more than palpation pareidolia, a phenomenon I have discussed before in a previous blog here and on the assessment of the painful SIJ here and its management here.
Now that’s not to say the SIJ doesn’t cause some people pain, or more accurately can be a source of nociception which can produce pain, and yes there are pathologies and conditions that can cause this such as sacroiliitis etc.
But despite the common belief there is no evidence that instability or lack of it, or mal alignments cause issues around the SIJ, rather it is usually simply irritated due to overload.
So next question is why did Tiger think his sacrum had ‘popped out’ well there are two possible reasons
- He got the wrong end of the stick from his medical team
- He was given the wrong information from his medical team
So did Tiger get the wrong end of the stick? Did he misinterpret what his doctors told him?
Well its very possible! It is well known and documented that patients often misinterpret what medical professionals tell them. There are many stories of miscommunication and misunderstandings that unfortunately happen, like the one Kieran O’Sullivan talks about in this podcast about a patient who was concerned that her back pain was caused by some things called ‘vertebrae’ in her back after her doctor showed them to her on an xray!
Miscommunication like this does happen often, I had a patient who was convinced she had an extra bone in her shoulder after a doctor told her she had some calcification in her rotator cuff!
So yes its very possible Tiger got the wrong end of the stick. However, this is inexcusable in my opinion, that the medical team of one of the worlds most influential and recognised sports personalities do not FULLY brief and inform him about his condition simply, honestly and correctly, they will be well aware that he will be interviewed and asked questions about his injury and so must prepare him for such.
Now it may also be possible that Tiger didn’t get the wrong end of the stick and that maybe he was actually informed by his medical team that his sacrum had ‘popped out’! It seems that there are some doctors in the US that work with professional golfers that unbelievably think that this nonsense can happen.
For example a specialist golf MD called Dr Ara was seen discussing Tigers sacrum here on TV shortly after the incident and he seems to concur that the sacrum can dislocate and a quick 20 minute fix of popping it back in, together with some anti inflammatory’s equals ‘job done’.
He also goes on to offer some other rather dubious advice on hydration during the interview as well but that’s by the by!
Now when you look at Dr Ara’s website here we can see that he is a MD who has worked hard to rise to his current position as a golf specialist and this all sounds highly admirable, but the question still begs, why would a doctor who works with professional golfers choose to believe in some pseudo science such as dislocating sacrum’s?
Well in my opinion the answer is either pressure or ego!
The pressure can be from having to be seen to be doing something! Something proactive, something advanced or high tech or cutting edge by the player, or their management and even the public when really there isn’t anything more to do with a professional athlete than there is with any other patient in the early stages of injury. That is simply to give good, clear, sensible, well reasoned and evidenced based advice and education on the injury, recommend the most appropriate management, loading and if suitable, and maybe, just maybe a little bit of light manual therapy as well.
In my experience the best physios/doctors I know simply don’t offer or promise quick fixes or miraculous cures as they know they don’t exist!
I come across this a lot in professional sport, a desire by physios and medical professionals to promise things they simply cant do or that can be done just to be seen to be ‘doing’ something, whether its prolotherapy or PRP injections, horse placenta or stem cell massages, silly electrotherapy machines, manipulations, quacupuncture, stretchy tape etc etc the list can be endless, all in an effort to be seen as getting the athlete better, quicker, faster, sooner, I have a saying when I worked in professional football that I still use today….
the hardest thing for a physio or doctor to do at times is…. NOTHING!
Now, when I say ‘nothing’ I mean apart from giving good, honest, advice, education and optimal loading/movement stratagies for the essentail mechanotherapy effects, which really isn’t nothing, in fact it can be a bloody lot more hard work for a physio to do this, taking more gumption and guts to apply this than taking the easy pseudo scientific route and giving a muscle rub, joint pop or a bit of sticky tape!
Now, if it’s not pressure making medical professionals believe in pseudo science then its thier ego!
Ego to be seen as the smartest, cleverist or most cutting edge clinican! To be seen as being able to detect and cure things that other mere mortals cannot! Again I have seen this a lot, a hell of a lot in my time in both professional sport and day to day practice, guru’s, specialists or experts and thier influential charismatic personas who believe they have some extra skill or ability that no other in their field has, that only they can fix this athlete based on some mumbo jumbo clap trap that usually costs a lot of money!
Anyway, what now for Tiger? Well I wish him all the best for his recovery, but I do sincerely hope he hasn’t been affected by this episode of terrible, shockingly bad medical advice, and I hope he hasn’t been left with any negative thoughts or beliefs that his sacrum is now vulnerable to ‘popping out’ and that he doesn’t rely on the use of regular manipulations in a belief that it is putting it back in.
Instead I would suggest Tigers needs some simple, good, honest advice from a medical professional that his back pain isnt due to popping sacrums, that in fact its more than likley due to his recent disc surgey and the true cause of the structure to blame can really never be found, and that to manage this episode, it needs some time, regular movement and perhaps some good strength and conditioning from the many excellent golf specialist physios I know!
So Tiger if you need any recommendations, I know you’re a subscriber to ‘The Sports Physio’, drop me a line and I’ll hook you up with a sports physio who doesn’t feed you bull shit about sacrums popping out!
As always thanks for reading