Tiger Woods out Several Months Following Back Surgery; How Did It Come to This?

Will Carroll@injuryexpertSports Injuries Lead WriterApril 1, 2014

Patrick Smith/Getty Images

As the Masters prepares to open, it will do so without Tiger Woods. Woods has undergone a microdiscectomy on the herniated disc in his lower back and will miss "several months," according to a statement posted on TigerWoods.com (h/t Yahoo Sports). 

Woods had the surgery, which removes the impingement around the nerve coming out of his spine, in Park City, Utah, with noted spinal surgeon Charles Rich. This is common surgery, but due to the nature of his swing, Woods is unlikely to play any of the majors this season while he rehabs and likely is forced to make more changes to his swing.

Susan Walsh

Woods will face the question about whether he can win another major and continue his chase of Jack Nicklaus' record, but the real question for Woods is whether he can be healthy enough to stay in the tournament. His back may be the talk of the gallery, but it's his knee that is likely the real problem.

Woods has been fighting back spasms for the last few months. Despite earlier denials, Woods underwent an MRI and other tests, eventually leading to surgery. It's easy to assume that the MRI showed a herniation, though Woods and his agent would not confirm.

Woods tried to deal with this problem, but there was eventually no way for him to play through it. His entire game and shotmaking skill go away, but worse than that, the swing itself has been compromised as he's aged, worn down and seen some major injuries. One of those injuries—to his knee—may be the genesis of all these problems. 

Gary Huston, host of the Golf Connection radio show and a noted golf coach in his own right, explained the changes that Woods has made to his swing.

"It all started with the knee," Huston explained. "He used to have a one-plane swing and he would post that knee, really hyperextend it to create more force. Now he's shifted to an over-the-top Sean Foley swing with a soft knee. He simply can't make the same move and get the same results."

The video above makes this change crystal clear. Key in on how Woods' front leg has changed over time. 

Woods has a swing that instructors and commentators variously describe as "forceful," "violent" and even "excessive." His long drives are certainly a trademark, but Woods has shown problems in swings where he is forced to push the club through the rough or even sand. Woods was brought to his knees by a swing last August, but it was an approach shot where he had to hold up, not a full-on drive where he could follow through normally.

Woods had been getting treatment, likely an intense combination of physical work and modalities like electrical stimulation designed to break the pain-spasm cycle.

"I've had a couple weeks off and getting treatment and just working on trying to get ready for Augusta," Woods told the media March 24. "As of right now, it's still too soon, which is, as I said, pretty frustrating."

DORAL, FL - MARCH 09:  Tiger Woods plays a bunker shot on the fifth hole during the final round of the World Golf Championships-Cadillac Championship at Trump National Doral on March 9, 2014 in Doral, Florida.  (Photo by Chris Trotman/Getty Images)
Chris Trotman/Getty Images

It is clear now that did not work.

As Huston explained, the force transfer is coming at a different point. Woods' previous post of his knee was where he would generate and transfer force into his swing. With the knee damage, he had to shift to a core swing and has very shortly created problems in his back. 

Woods has had a total of at least four knee surgeries, including an ACL repair in 2008 that could have been a non-standard variation. Woods' surgeon, Thomas Rosenberg, pioneered the use of what he calls a double-bundle ACL repair. Without getting technical, the variant uses more tendon in order to better control the motion of the patella (kneecap).

Woods may have been attracted to this due to the presence of a lack of cushioning from previous surgeries, which likely removed much, if not all, of the meniscus. There may have also been some chondromalacia, which is a roughness on the surface of the patella.

This article by Ethan Skolnick about Miami Heat star Dwyane Wade explains just how serious chondromalacia can be and the lengths necessary to get Wade ready to play physically. This is likely the same situation for Woods. 

However, the proximal problem for Woods is in his back. He has dealt with back spasms for years, which are simple if also painful. Spasm is relatively easy to control, though timing is an issue. If a swing causes spasms on the 18th, Woods can fight through it; if it happens on the sixth hole, he might not make it around. With the disc compromised and impinging on the nerve, Woods faced more permanent damage if he had continued to try to play through the injury.

After Woods' most recent issue, imaging showed a disc herniation in the lumbar spine. This is not an uncommon problem, especially for golfers. Fred Couples is probably the best-known golfer with similar problems. Couples' career was nearly derailed by a similar disc problem during his peak, but a variety of therapies have helped. 

PACIFIC PALISADES, CA - FEBRUARY 13:  Fred Couples hits a tee shot on the 9th hole in the first round of the Northern Trust Open at the Riviera Country Club on February 13, 2014 in Pacific Palisades, California.  (Photo by Stephen Dunn/Getty Images)
Stephen Dunn/Getty Images

Couples has used Regenokine, a therapy that is not approved for use in the United States, on his back. Woods has used similar therapies on his knee, so it is possible this is a path he could go down in regards to his back issues. It is more likely that he stayed conservative, given his choice of surgeon. 

Most golfers will do anything they can to avoid surgery, but by taking this path, Woods hopes to minimize things. A microdiscectomy is done through a small incision and does as little inside the spine as possible to remove the impingement.

Many will remember that Peyton Manning went through two microdiscectomies before eventually needing a fusion. For some, the microdiscectomy will work in a more permanent sense, but Manning may offer an example for how Woods' situation will play out.

A fusion of any sort will almost always end a competitive career, as it changes the ability of the spine to twist and exert rotational force. Even a microdiscectomy has a mixed record when it comes to golfers. The same is true for other rotational athletes, like hockey players and baseball hitters.

"It would take three to six months to make sure that everything worked well with a micro," said an orthopaedic surgeon who did not wish to speak on the record due to his work with golfers. "If [Woods] seizes up at the Masters, maybe he gets more motivated to do something, but right now, he'll do whatever he can to avoid missing another set of majors."

One question is why the underlying disc problem wasn't detected earlier. The fact is, it may be new.

While disc issues often cause spasms as the muscles attempt to guard the damaged spine, spasms happen for many reasons. The spine was obviously under pressure from Woods' swing, but the swing may have finally transferred enough force into the spine itself to cause issues.

This makes sense, due largely to Woods' conditioning. While many golfers look unathletic, to put it kindly, Woods has always been focused on his physique. A strong core, especially his abdominals and obliques, were once able to both apply force and protect the spine. That may not have been enough after the changes his knee injuries brought, along with that application over time.

It is clear that what Woods is dealing with is a cascade effect, a term borrowed from network science to describe when one injury leads to other changes and often other injuries. For Woods, his knee problems skewed his biomechanics enough to cause problems up the kinetic chain that have now focused in his back.

There is always a "weak link," and it appears that the adjustments Woods has made have led to the weak link being in his spine.

Nam Y. Huh

One major issue is that Woods has changed his swing. Lee Trevino said that Woods was playing "mechanically" in 2012 as he was in process of learning the new swing mechanics, but the worry there is that the changes never became automatic. 

Biomechanics have been a bit part of golf for years, with many of the top golfers using cameras, radar and other devices to tweak and analyze their swings. Even the best golfers are willing to make changes, sometimes significant ones, as they adjust to new conditions.

Woods has been at the forefront of this, changing coaches, custom-designing clubs and rebuilding his swing. However, he hasn't been able to take the immense torque off his knee and back.

The other issue in question is whether Woods has a stable-enough platform to have a repeatable swing. If there's a shift or even grinding inside the knee, Woods will feel different on every swing, causing unconscious changes to his swing. That inconsistency will give him complex signals that will register as "this feels wrong" without him having a stable platform from which to work. 

Another major factor is that Tiger is older. As the human body ages, especially with the demands that Woods has placed on his body, there are going to be changes. While Woods remains in top physical condition, there are things that can be seen beyond his hairline.

His core is thicker; he carries a bit more body fat; he's likely lost some flexibility. These are natural, but they necessitate adjustments. The same swing and forces will act on a changed body in ways that his body may not be able to handle. Add in insidious damage over time to cartilage and other soft tissue. 


With all these challenges, is it even possible for Woods to have a consistent and powerful swing anymore? Has the damage been done? Other players are certainly questioning that, while the surgery will give the media more puns than it needs next time someone asks if Tiger is back. 

Woods has struggled with things on and off the course over the last few years. Even so, he's remained a dominant force in the game, chasing one of the greatest records in all of sports. The question now is, in the end, can pure will and medical technology can bring him back to the top?

Surgery may be Tiger Woods' biggest challenge as he chases history.