Back in the game in the wake of Tiger's miracle

Back in the game in the wake of Tiger's miracle
Tiger Woods

Tiger Woods

Tiger Woods amazed the golfing world again when he won his fifth Masters title and 15th major just two years after undergoing spinal fusion surgery.

It will go down as one of the most remarkable comebacks in the history of sport, but it has also left medical professionals to tell the millions who suffer varying degrees of back pain that they are not Tiger Woods.

Weekend golfing warriors who find it difficult to get out of the car after 18 holes or senior golfers wondering if spinal fusion surgery is the answer to their aches and pains can rest at ease.

Consultant spinal surgeon Ashley Poynton,  a specialist at the Mater Private Hospital and The Poynton SpineCare Clinic, is adamant that the majority of people can get back to their golfing best by doing some simple exercises every morning.

Q. What did you make of Tiger's victory, just two years after spinal fusion surgery?
It's remarkable. What Tiger has achieved in general, with or without a spinal fusion, is fairly amazing.  To come back from the pain and disability he was suffering after two previous surgeries for disc ruptures, the word to describe what he's achieved is "unbelievable".

Q Have you had many queries about spinal fusion since the Masters?
I see people with back problems every day of the week, and everyone is talking about Tiger and asking, 'Should I have a spinal fusion? If Tiger can do that, what can't I?'  So it's important to get it across to people that it's not that simple.

Q So what is a spinal fusion?
It is an operation done to bond bones together in the back. In most cases, you get a degenerative process in the joints in the back or the discs, and they wear out. So a spinal fusion is a surgical procedure to bond the bones together. You take the disc out, replace it with an implant or with bone and put in screws and rods, or blocks and plates, to allow the bone to grow across that disc from one bone to another so that the two bones become one and are bonded together permanently.  The theory is that if the two bones are bonded and the disc is gone, it can't move any more and it can't hurt you. 

Mr Ashley Poynton

Mr Ashley Poynton

Q Was Tiger's procedure complex?
There are different ways to do a spinal fusion — some are done through the back, some through the abdomen. What Tiger had was an anterior lumbar interbody fusion, and that's done through the abdomen. It doesn't interfere with the back muscles, doesn't damage them, and so the recovery can be quicker, and the function afterwards can be better.

Q Are spinal fusions often a success?
A spinal fusion is really an operation of last resort. It has a very high failure rate, and some people can be worse after it. That's important to get across. The good news is that vast majority of back pain does not need surgical intervention. 

Q So what does your average person need to alleviate their back pain?
For people who want to play some golf, it can generally be addressed by exercise, weight reduction and building up the muscles. With severe pathologies —people that get out of bed, can't work, can't function, can't do anything — then you resort to a spinal fusion. And it can salvage the situation in the majority of patients. But it is very important to select people properly, and the selection process is very rigorous. Even with that, you may have failure and ongoing pain.

Q You work with international rugby players and even helped Pádraig Harrington with his neck issues. Was Tiger's mental strength and athletic ability the key here?
There is a lot of psychology involved, so very highly motivated patients tend to do better. The difference is that the professional athlete has a team of people to help them. Professional sports people are some of the easiest patients that I have. Their sole aim is to get better. They are already high achievers and already motivated. They are used to recovering from injuries. They are used to pain, and their psychology is quite different from the average person. If someone gets up on a tee, hits a ball and gets back pain, they'll go, 'Whoa, I can't do that.' Whereas an athlete will ask,  'Why am I getting pain? How do I fix it?' And they go about solving the problem. 

Q. So Tiger really is different.
Tiger Woods is an incredibly motivated individual, and that's why he's done so well. If you take the average recreational golfer and do a spinal fusion on them, that's their golf career over, generally. They will never hit a ball again. But only a very small percentage of people with back pain actually need a spinal fusion. Most people don't need any surgery on their backs at all. If you look at the quality of the back muscles of people with back pain on an MRI scan, most have deficient muscles. They are simply not using them. If you can address that, you will help an awful lot of people.

Q. What's your advice for people with back problems?
We have lots of people in their 60s, 70s, and 80s who want to play golf, but they have backache and are sore afterwards and are wondering should they give it up. My advice is no. Get properly assessed. Get a back-specific exercise programme, and keep doing what you enjoy doing because if you stop, you get even worse. Get correctly assessed, get your fitness up and most people will be okay. 

Q Do you need to hit the gym?
I believe that the simple exercises you can do on the bedroom floor when you get out of bed are great. Most golfers are competitive, and there is no doubt that you will get more distance on a drive if your core muscles are strong and your spine is flexible. Instead of doing their 10-minute stretching programme, people go out to buy new clubs or see a coach. You may need to improve your swing but you can do that with better trunk rotation, and flexibility is crucial to that. Doing a simple exercise programme for 10 or 15 minutes every day is enough for most people. If you haven't played for a while, consider taking up something like pilates, which is very good for core stability and flexibility. If you are concerned about back pain or worried you might injure yourself, you can have a Spine Check. It doesn't necessarily mean you need an MRI scan. You just need to look at your muscle function and see what areas need to be worked on with a simple exercise programme. That's what the vast majority of people need. If everyone did that, you wouldn't see as much back pain in the population.

Q. In other words, we don't need spinal fusion surgery any time soon.
It's a last resort. If you look at where Tiger came from at his lowest point—not being able to move, addicted to narcotics— simply getting back to being able to work without medication after spinal fusion surgery is a massive achievement.

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This feature first appeared in the Irish Independent’s Tee to Green golf supplement on April 25