Print and Go Back ESPN.com: Golf [Print without images]

Wednesday, June 2, 2010
Updated: June 3, 11:16 AM ET
Uncertainty abounds with Tiger's injury

By Stephania Bell
ESPN.com

DUBLIN, Ohio -- For a guy who seems to be anything but average in most ways, Tiger Woods has been dealing with one very average problem: neck pain. The nature of his condition, the treatment of it, his recovery thus far and his expectations going forward are much what you would expect for anyone with a similar condition.

After withdrawing suddenly from The Players Championship in May due to neck pain, there was much concern about the severity of what Woods might be dealing with and how it might affect the remainder of his season. Tiger himself said he had concerns about a bulging disc, which could potentially have meant an early and abrupt end to his golf hopes for the year.

Several days later, the following information was posted on Woods' website:

"After an MRI … it was determined that Tiger Woods has an inflamed facet joint in his neck."

The message appeared to be one of relief, as the posting went on to say.

"The prognosis for Woods is a full recovery, although a return date to competitive golf is contingent on how quickly the condition heals. The layoff is not expected to be extensive but can vary."

It appears that the layoff, as predicted, was not extensive, given that Woods is back in competition this week at the Memorial Tournament, where he is the defending champion. But there are still numerous questions surrounding this latest ailment, clearly predicated on the fact that everything associated with Tiger of late has been replete with drama.

What exactly is this "inflamed facet joint"? Can he really be ready to compete less than a month after withdrawing (so rare for him) from a tournament? Is it truly healed? And what caused it? Could it have been, perhaps, the result of that now-infamous car accident?

As it turns out, the answers to these questions might ultimately reveal, well, nothing much.

This might disappoint some, but Woods' neck pain is an example of an affliction so common that it borders on dreary. Neck and low back pain are so common in the United States, yet so disabling, that they are considered public health problems.

According to a study published by the Centers for Disease Control in 2007, 70 percent of all adults experience back or neck pain at some point in their lives. Back and neck problems are the leading cause of job-related disability and cost Americans more than $50 billion each year.

In other words, there is a good chance that many Americans will, at some point in their adult lives, have something in common with Tiger Woods: an episode of neck or back pain that will lead to missed time from work.

That noted, it's worth taking a look at the specifics of Woods' latest injury and trying to answer some of those nagging questions.

Tiger Woods
Did Tiger Woods' infamous car accident cause the neck injury, as many presume? According to Stephania Bell, there are just too many other possibilities to make that assumption.

What exactly is this "inflamed facet joint?"

Facet joints are small joints on the sides of the spinal vertebrae -- running from the neck all the way through the lower back -- that help interlink the stacked bones. Specifically, the facet joints are important contributors to normal spinal motion.

If there is dysfunction of a facet joint, movement at that particular vertebral segment can become limited and painful, ultimately compromising movement above and below the injured area.

These joints are much like other joints in the body: They have fibrous tissue surrounding them called a capsule. The joint bears weight and there is lubricant fluid around it.

There are nerves that supply feeling to the area, which is why facet joints can be painful. Inflammation of a facet joint in the neck can lead to pain in the area, headaches and difficulty turning the head. Occasionally, symptoms will travel into the shoulder or arm as well.

At his news conference Wednesday, Woods referenced some of these exact symptoms. When asked how much the neck impacted his performance, Woods said, "Quite a bit. … I had a hard time turning back. I had a hard time turning through. And the headaches were just unreal at times."

Treatment for this type of condition is very ordinary. No magic. No bells and whistles. Woods' website indicated a plan of physical therapy, rest and anti-inflammatory medication.

Yawn. Important for recovery? Yes. State secrets? No.

Woods also talked about the exercises he was doing to help "get the proper muscles to activate." In fact, he referred to his exercises as "tedious little exercises" but added, "you have to do them." He was the perfect patient, clearly repeating -- just as every health care professional dreams -- the concepts he had been taught about how to manage his condition, including the need to actually follow the prescribed advice.

This leads to the next question of whether he has truly recovered.

It's hard to say with any certainty whether an athlete returning from any injury is 100 percent healed. Just take a look at baseball. Players might return from the disabled list after progressing through extensive rehab, even minor league games, only to land on the DL shortly after rejoining their team because of re-injury. It's happened several times this year alone, and the season is only two months old.

There is no guarantee upon return. The medical staff and the athletes work together to get to a point of symptom-free performance. The athlete is often put on a maintenance program to help ensure he stays healthy. And there's still no such thing as a sure thing.

Spinal conditions in particular are known for being recurrent in nature. Perhaps one of the most frustrating things for patients who suffer a setback with a spinal injury is that it can be brought on by something relatively minor: sleeping in a bad position, driving too long, reaching or bending awkwardly, just to name a few.

How can Tiger be sure he is fully recovered? He can't. But if he is able to perform his work duties -- which in his case just happen to be hitting a small object with a club over and over again -- then isn't it time for him to return to work?

Woods admitted to not quite being where he wants to be, but pointed out that he can "recover for the next day" which bodes well for tournament play. In preparation for the Memorial, Woods indicated that he had played full rounds of golf. He even said the other day he played 54 holes, albeit "[in a] cart, in shorts and fast."

Tiger sure looked like he was in midseason form on the course Wednesday, cruising to a victory in the pretournament skins game that saw him card a birdie and an eagle on his first two holes. Not bad after nearly a month off.

Will it last? That remains to be seen, but the early signs were certainly encouraging. Not a wince. Not a grimace. We even saw a relaxed Woods bouncing the golf ball up and down on the end of his club at one point, all of which suggest he's feeling good to start the week.

And as to what caused it? There's no way to know for sure. It's natural for there to be a question about the role of Woods' November single-vehicle car accident.

The body absorbs the stress and strain of everything it is subjected to every single day. Facet injuries are often caused by trauma, including whiplash. But they are also caused by postural disorders and repetitive strain, both equally arguably present in a lifelong golfer.

Put it this way: If the average person were in a car accident and did not report symptoms of this nature until several months post-accident, but was then seeking compensation suggesting that the accident was the definitive cause, how clear-cut would that case be? Not very. One could likely make arguments either in favor or opposition as to the cause, but the delay in onset of symptoms would be problematic.

The focus for Woods, then, is on what's ahead. He made that clear Wednesday when he talked about "life moving forward." And while his recent bout of neck pain might relegate him to the common majority, the last thing Tiger ever wants to be on the golf course is average.

Stephania Bell is a physical therapist who is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist. She is a clinician, author and teacher with extensive experience in the area of orthopedic manual therapy and sports medicine.