Spine Surgery and Work Ethic Fueled Tiger Woods’ Masters Win

May 1, 2019May 1, 2019 / Thomas Cohn, MD

Tiger Woods coming back to win a major tournament in golf after multiple spinal surgeries appears to be a sports miracle. Most physicians wrote Tiger off once he developed low back problems. Performing at the level of a professional athlete with any physical dysfunction, especially with lumbar disc problems, is extremely difficult.

To compete at the highest level of any sport usually requires excellent physical and mental fitness. Anything that is less than perfect usually generates only average results and not the level necessary to be at the top of a sport, especially in golf, where even tiny issues with your swing can cause the ball to end up far away from your intended target. Aside from the physical aspects, there are also significant mental components, and one must not have any distractions like pain.

Tiger’s Journey

News reports with regards to Tiger Woods have clarified his struggle over the last several years. Tiger has had a single L5-S1 disc problem for several years. This is the bottom disc in the lower back and often takes the most force from activities. It is also the disc that most likely will go bad over time and degenerate or have a disc protrusion. For the last several years, Tiger has struggled with treatment, doing extensive conservative options to no avail. Additionally, he has had multiple surgical decompression operations with removal of parts of the herniated disc. Despite all the work, he still had pain and difficulties related to the L5-S1 disc. Ongoing symptoms impaired his ability to mentally and physically play golf.

The last option for Woods was for a lumbar fusion at L5-S1. He underwent that surgery with an extensive anterior interbody fusion type intervention. After removing the offending disc, the L5-S1 disc space was restored with a spacer device and packed with bone so the L5 vertebral body becomes fused to the sacrum. Once healed, the hard work of rehabilitation began with extensive strengthening and conditioning. Fortunately, everything went well and his strength as well as his coordination returned. The fusion healed and his pain improved.

So far for Tiger Woods, everything has gone well after his surgery. Unfortunately, this probably isn’t the last we’ve heard about his spine. The lumbar spine is incredibly well balanced, and every single level is important to control motion properly. Golf requires a lot of twisting of the back with some bending. These motions put an extreme amount of force through all of the segments in the lumbar spine. Now that one segment does not move in the normal way, forces that once went through the bottom level now are transitioned to the next level, as well as the forces that naturally occur at the L4/5 level.

This level will likely have a degree of premature degeneration and could easily start causing problems within a few years. Having good body mechanics, range of motion and strength is key to a good outcome. Tiger has spent a year rehabilitating his back and strengthening it in order to play golf. If he is lucky, the stress of golf will not cause further back problems. Avoiding overstressing a surgically repaired area is often key to avoiding re-injuring, but Tiger will be testing that theory every time he tees it up from here on out.

Tiger Woods Undergoes Second Microdiscectomy on Back

September 23, 2015September 23, 2015 / Thomas Cohn, MD

Tiger Woods went under the knife again recently, opting to have a second microdiscectomy operation preformed on his ailing back.

The surgery means that Woods will withdraw from the final three scheduled events he had on his calendar, and it brings another disappointing season to a close. Woods failed to contend in any of the year’s four majors and he missed five cuts in 2015. Woods announced on Friday that he hopes to return to competitive golf in “early 2016.”

“This is certainly disappointing, but I’m a fighter,” Woods said. “I’ve been told I can make a full recovery, and I have no doubt that I will.”

This is the second time Woods has undergone the intricate operation on his back. His first microdiscectomy was back in March of 2014, and he only competed in seven events that season.

Surgery and Looking Ahead

Woods said on his personal website that he pursued a second back surgery after feeling pain and discomfort in his back and hips in recent weeks. Woods is used to playing through some discomfort after undergoing a host of operations throughout the course of his career, but the spinal compression came as surprise, as he had recently committed to playing in three tournaments to round out the year.

“He committed, thinking it was going to be a regular checkup,” said Woods’ agent, Mark Steinberg. “Obviously, that area where he had the microdiscectomy had to be treated again. And it leads us to where we are now.”

The microdiscectomy operation removed a small disk fragment in his back that was compressing a nerve, which was the source of his pain. Woods announced that he “will begin intensive rehabilitation and soft tissue treatment within a week,” adding that “healing and recovery times differ for each individual based on many physiological factors, but Tiger is encouraged he can return early in 2016.”

Dr. Cohn Comments

Here’s the deal with Tiger Woods. At this stage in his career, the only thing on his mind is chasing Jack Nicklaus on the career major’s list. Jack finished with 18, and Tiger currently sits at 14.

Tiger said he hopes to return to competitive golf by early 2016, but let’s be honest, he doesn’t care about the Sony Open of the Farmers Insurance Open. Tiger Woods wants to be back and healthy for The Masters, golf’s first major in 2016, which takes place in April. Obviously Tiger would like to get some rounds in before April, but I don’t expect to see him playing in minor tournaments in January or even early February. He’s always stuck to his schedule, and I believe his ultimate goal is to have his body and his short game in their best form at Augusta National.

That’s easier said than done, however. Tiger Woods will turn 40 in December, and unlike a fine wine, athletes don’t typically get better with age. Tiger has been playing golf professionally for more than half of his life, and although it’s less physical than football, it still takes a big toll on your body. What’s more, the smallest imperfections in your body can cause you to hit the ball a long distance from where you’re aiming, so pain and discomfort is less than ideal for an athlete who depends on precision. When you consider his age, his health and the formidable foes he has in young players like Rory McIlroy, Jordan Speith and Jason Day, I think it will be incredibly difficult for Tiger to win one more major, let alone catch Jack.

I wish him the best in his recovery, and I hope we can once again catch a glimpse of the golfer that took the world by storm back in the late 90’s and early 2000’s.

Tiger Woods is Great, But…

April 13, 2015 / Thomas Cohn, MD

The Masters is over, and for first time in a long period Tiger made the cut and finished a tournament. To no one’s surprise, Tiger did not make a run for the leaderboard on Sunday, but he certainly opened some eyes by finishing tied for 17th. At 38 years of age, he is no longer in his prime and now appears fortunate when he makes the cut and finishes. In the future he may have a few more outstanding tournaments, but they will likely be few and far between, and it is likely he will only win a few more tournaments throughout the remainder of his career.

Tiger has now had lumbar back surgery, knee surgery, and may have hip problems besides the above, not to mention he injured his wrist in Sunday’s final round. He pulled out of a tournament earlier this year when he aggravated his back. Most likely, for him to play well, the conditions must be perfect, and he has to have a good day when his pain is controlled. To play at a high enough level routinely is unlikely since either his back or joints will cause just a slight issue such that he will not be good enough to play against the younger and healthier players.

Gold is a Young Man’s Game

To win at a professional level, one must be a top athlete in perfect physical and mental health. All sports at this level require one to be in the best physical shape to master the skill necessary to play a perfect game. After having the physical skill, one needs to have absolute mental concentration for the game. If one has physical pain, the concentration for the perfect game is not present. If one has had back and knee surgery, one also does not have the perfect physical balance to be at the top of one’s game.

As we age, there are many changes that occur in the body, and after age 25, for most sports, we are slightly past our prime for physical ability. By the late 30’s we are definitely past our prime for almost all intense sports, especially individual events. There are a few older athletes who are competitive later in life, but this is generally a rare event. The best athletes perform as well as they do because their bodies and minds are in perfect condition for their sport.

For professional golf, a new leader is likely to emerge in the future, and that leader could easily be 21-year-old Jordan Spieth, who ran away from the competition at Augusta this weekend. Tiger was the first very young winner to take the stage. Now, it will likely be someone who is in the young twenties and has great mental strength to deal with the pressure of winning, which sounds a lot like Spieth or Rory McIlroy. I think they’ll be the face of professional golf for the next 5-10 years.

Back Pain Can’t Keep Tiger Woods From The Masters

April 8, 2015 / Thomas Cohn, MD

Tiger Woods will end his nine week hiatus from professional golf this week as he prepares to tee up for the Masters.

Tiger’s 2015 season got off to a rough start when he missed the cut in his first event and withdrew from his second event with back pain. After withdrawing in his second tournament, Tiger decided to take some time off to get his head and health in the right position to complete for a major championship.

I actually predicted that Tiger would take some time off after withdrawing from a tournament in early February. After that tournament, Tiger had withdrawn from 7 of his last 9 tournaments, which is unheard of in today’s game. Instead of continuing to play through the pain and just hoping things got better, Tiger decided to step away from the game and focus on getting his body right.

When asked about his rehab and strength conditioning leading up to the Masters, Woods said that he “worked his ass off. That’s the easiest way to kind of describe it. I worked hard.”

The Importance of Exercise As We Age

Exercise is important at any age, but it’s even more important as we get older. Tiger Woods turns 40-years-old this year, and he can no longer get by on his talent alone, especially when his body is breaking down from years of strenuous twisting and torquing. He’s had documented problems with his back, knees and shoulder, and although he would ideally take more than nine weeks off, he made the right choice to leave the tour and re-work his health and his game.

As I always tell my patients, there is no magical pill or injection that will completely cure you of your condition. Many options provide short-term or temporary relief, but patients also need to put in work in the form of exercise, physical therapy and rehabilitation. It’s not going to be easy, but it’s going to be worth it. This quote from Woods perfectly exemplifies that notion.

“People would never understand how much work I put into it to come back and do this again,” Woods said. “But it was sunup to sundown, and whenever I had free time; if the kids were asleep, I’d still be doing it, and then when they were in school, I’d still be doing it. So it was a lot of work.”

Despite his return to the course, I stand by my prediction from back in February. I believe Woods is more likely to withdraw or miss the cut than to be in serious contention in Sunday. Based on his quotes, it truly sounds like his health and his game are in their best forms of the year, but he’s still not 100%. I believe the tournament means a lot to Tiger, and barring significant back pain, I think he’ll go without withdrawing at Augusta, but the competition is fierce, and I just think Tiger will be fighting to make the cut instead of trying to get in Sunday’s final grouping. I wish him and the rest of the field the best of luck at the Masters this weekend.

Related source: Bloomberg

Tiger Woods Dealing With Back Spasms

March 10, 2014June 24, 2014 / Thomas Cohn, MD

Back pain affects 80% of the population at some point in their life. Tiger Woods has joined the rest of us normal people and now has back pain. Unfortunately, Tiger needs his back to be working correctly to in order to play golf at the highest level. He withdrew from a tournament last weekend, and this past tournament he struggled on Sunday after re-injuring his back. Woods spoke about the pain after the tournament.

“It is back spasms, so we’ve done all the protocols and it’s just a matter of keeping everything aligned so I don’t go into that,” said Woods. “If I feel good, I can actually make a pretty decent swing. You saw it (Saturday). I actually can make some good swings and shoot a good score, but if I’m feeling like this, it’s a little tough. It’s the same thing … it flares up. It’s just a matter of keeping it calm, and we had a quick turnaround from last week. … It will be nice to take this week off and get everything ready for Bay Hill.”

Most likely, Tiger strained some muscles, or possibly irritated a disc or joints in the low back. An irritated back will develop muscle spasms, and these spasms are painful and reduce the ability to move. All of us who have strained our back and have had this problem know how hard it is to move. Walking is difficult, and bending, lifting, and twisting is even harder. Add in the fact that he has to walk the length of the course and swing a golf club – it’s no wonder he had troubles.

Tiger Woods is likely getting the most aggressive treatment to resolve the low back strain causing muscle spasms. Treatment choices are numerous, but most likely include medications that reduce muscle spasms and aggressively influence healing. Likely he is receiving prednisone, a very powerful anti-inflammatory medication that may facilitate more rapid healing. Additionally, medications for muscle spasms and traditional anti-inflammatory medications like Ibuprofen or naproxen may be used. Intense physical therapy is also likely being used to improve movement and decrease the muscle spasms.

Professional golf requires Tiger Woods to be in perfect physical and mental shape to hit the ball adequately. Unless he is at 100%, it is unlikely that he can play at a competitive level. He needs to be mentally alert to judge all variables to make any shot and to concentrate, and many of the medications for spasms have some decrease in mental awareness. Physically, any muscle spasms in his back will change his swing slightly and prevent him from making the shot he wants.

Muscle strains and sprains in the back can resolve quickly if treated correctly and aggressively. Unfortunately, many times it takes a lot of work to control back spasms. Hopefully, Tiger will be lucky and he will heal quickly. He needs to be 100%, especially with The Masters looming next month. Golf’s first major is Tiger’s biggest priority at this point, so I wouldn’t be surprised if he withdrew or skipped other tournaments leading up to The Master in order to put his back in the best possible shape in his quest for another green jacket.

Related source: USA Today