Tiger Woods Case Study Part 2: ACLs and Navy Seals

Last week, we kicked off Part 1 of the Tiger Woods series, where we covered the early stages of his career, including the benign tumor and cyst removals, as well as the fluid drainage procedure on his left knee. Today, we'll continue exploring the key moments in Tiger's career—both achievements and injuries—leading up to the unforgettable display of pain he showed on the 13th hole during the final round of the Barclays in 2013. In this article, we’ll focus on his wins and injuries from 2003 to 2014.

Between 2003 and 2014, Tiger racked up 45 tournament wins and amassed around $81.9 million in prize money. During this period, he reached his peak driving average of 316 yards in 2005, earning $10.6 million that year—close to his highest-earning season. However, this success was coupled with several physical setbacks, including a shoulder injury, a ruptured ACL, multiple knee surgeries (including ACL reconstruction), a torn Achilles, a neck injury, MCL sprains, and recurring knee and Achilles issues, which ultimately led to his infamous back pain by 2014.

2006, left shoulder pain

Tiger appeared to avoid any major pain, injury, and surgery from 2003 to 2006. It was in 2006 he finally experienced left shoulder pain with enough severity to make us aware of it. This was after winning 5 CONSECUTIVE tournaments. Despite this left shoulder blade muscle strain, he carried himself to victory in the World Golf Championship-American Express.

2007, ruptured ACL

It was reported that Tiger ruptured his ACL while “running”. This is highly unlikely. In fact, Hank Haney’s book reported the truth on this matter. Tiger Woods was doing training with Navy Seals in a shoot house training exercise. The story goes, Tiger refused to be marked as a known entity so he wouldn’t receive special treatment. During the training session, his knee was kicked in while he was rounding the corner in the training exercise.

This resulted in his ACL rupture and continued trauma to that left knee… That being said, Tiger opted out of surgery and proceeded to win 5 of his next 6 tournaments that year.

2008; knee surgery, ACL repair, tibia stress fracture

Tiger underwent arthroscopic knee surgery in 2008 to clear out damaged cartilage from his left knee. Later that year, he also finally went under the knife to repair the torn ACL in his left knee from 2007. Last, Tiger reported he had two stress fractures in his left tibia. Tiger missed the remaining 5 month of the season after the left ACL surgery.

Compensation, proprioception, and regional interdependence

In retrospect of the 2008 season, we at this point have a tremendous amount of scar tissue, muscle damage, and joint proprioception dysfunction. Major surgeries, and especially a history of repeated surgeries into the same joint, do not just rely on the healing of the tissue operated on, but all the tissues effected by the pain and inactivity. These muscles, ligaments, and proprioceptive joint capsules need to be retrained to not only regain their range of motion, but also their ability to create and absorb dynamic forces. The key here is to avoid compensations due to the damaged proprioceptive receptors. Golfers will begin relying on other surrounding joints and joint complexes to create and absorb forces to avoid the troubled and previously injured joint. Further, pain in the previously injured joint often return due to the lack of proprioceptive information returning to the brain from this joint. This discussion becomes complicated, so we will leave it at that for now. The key is to see how injuries and repeated surgeries to the same joint can create disruption of that joints function that effects SURROUNDING joints! Compensation, proprioception, and regional interdependence (see part 1) are the story of Tiger’s downfall…

2008, right achilles torn

Tiger also suffered a torn achilles, now in the right leg. The first major symptoms of compensation? Possibly. What forces where being routed into the right lower leg to avoid the left foot and knee? It’s hard to say, but it is certainly worth pointing out.

Tiger ended his 2008 season early, but still maintained the #1 World Golf Ranking spot…

2010, neck injury

Within a year of Tigers famous SUV car accident, he withdrew from the final round of the Player’s Championship due to a neck injury. Tiger says, at the time, that the neck injury had nothing to do with the recent car accident. MRI reports diagnosed Tiger with cervical facet inflammation. The facet joints in the spine are small bony articulations on the posterior or most back part of the spine where one vertebra will connect to the other. On the most front side of the spine, or the anterior portion, the vertebrate articulates above and below with other vertebrae through the intervertebral disc.

When the facets get irritated, this is often due to restrictions in the small joint capsules around the facet joints themselves. These can also get irritated from arthritis, or extra bony growth on the facets themselves. Last, repeated and poor motor patterns or excessive overload to the joints can create irritation of these joints.

Exhibit of the cervical facet and facet joint.

Chiropractic adjustments are fantastic at addressing facet joint dysfunctions. That being said, the addition of motor control, stability, and motor pattern retraining is the key component to enforcing or making sure irritating factors don’t remain, creating the problem again down the line. At Integrated Rehab and Performance center, we specialize in addressing both components.

2011, left MCL sprain and achilles tendon strain

In 2011, Tiger suffered an in-round injury to his left MCL and achilles while attempting to hit a shot from the pine straw at Augustas 17th hole. The awkward shot did not stop him from finishing the round, tying for 4th.

2011, left knee and achilles

Half-way through Tigers first round at the Players Championship, he withdrew due to pain and tightness in his left knee and achilles. He sat out the next three months of play. Most likely, Tiger was dealing with tendinopathy in the achilles tendon.

What is tendinopathy?

Tendinopathy is a blanket term for tendonitis or tendinosis. Tendinitis is short term swelling and damage to the tendon that creates a healing and sometimes inflammatory response. Tendinosis, what Tiger was likely dealing with at this time, has long term damage to the tendon with swelling of the tendon. The damage done to the tendon is likely permanent, and treatment relies on creating improved health of the surrounding tendon tissue while decreasing swelling of the tendon as a whole. Without direct and precise loading strategies to the tendon itself, tendon issues have a high incidence of returning. In Tigers case, he needed specific and progressed rehab training to the injured achilles. Further, surrounding joint dysfunctions and motor control strategies needed to be addressed to help decrease the extra stress being put through the achilles which was not equipped to handle it…the compensations needed to be addressed.

2012, left achilles tendon

As I mentioned, the tendinopathy would not improve without a direct and specific treatment plan with proper loading. Further, compensations around the joint needed to be addressed. As a result, Tiger withdrew from the final round of the WGC-Cadillac tournament in 2012 due to the left achilles tendon pain.

Finally, in 2014, Tiger Woods withdrew from the final round of the Honda Classic…. More on this in part 3!

Pain, injury, and compensation

Up to this point, Tiger Woods has suffered an extensive amount of pain and injury. He has repeated pain and injury to his left knee, following a surgery in the left knee to remove two benign tumors in 1996. Since, the left knee and ankle has been a constantly recurring source of dysfunction and pain. Eventually, he also had right achilles and left shoulder injuries until finally, substantial low back pain in 2014.

Are the recurring injuries in the left knee and ankle a product of the initial insult from the 1996 surgery? There’s no way to know for sure, but our understanding of regional interdependence, compensation, and proprioception tells us there is likely a link. The same factors will now play a role in the development of Tigers low back pain. Years of pain, surgery, and dysfunction in the left knee and both achilles WILL impact the creation and absorption of forces in different joints in the golf swing. As we avoid force production in certain joints, we alter our motor patterns and forces us to use regions of the body sub-optimally. We will explore this more in part 3…

-Dr. Nick DC, MS, TPI, CSCS

If you would like to learn more about your body, pain, and performance, send Dr. Nick an email at contact@integratedrpc.com or call at (585)478-4379, or schedule a FREE discovery visit at Contact.

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P.S. if you have mobility deficits, joint restrictions, pain, or injury that is limiting or holding you back in golf and fitness, consider how regional interdependence is at play and impacting your ability to recover, create swing faults, and lead to continued pain and injury.