I have been extremely busy in the clinic, and have been devoting the rest of my time to the family, and trying to actually play this great game when I get the chance.
I have recently been exposed to a few golfer clients - one with shoulder pain, one with chronic lower back pain, and a college golfer who simply wants to improve his game and hopefully prevent injuries.
If there is interest, I may describe the other two, but I thought I would start with the shoulder problem.
This lady is in her late fifties, loves to play 3-4 times per week. She said she is slightly worse than a bogey golfer. She had developed right shoulder pain last season, which continued as this year's season started (RH golfer).
On examination, I noted several physical restrictions/deficits that are found commonly in the "weekend" or recreational athlete. Postural analysis demonstrated a head-forward position, with rounded forward shoulders. The curve in her upper back was increased, as was the curve in her lower back. She is overweight, carrying her weight primarily in the hips and thighs. In relaxed standing, her arms are held such that the palms are facing behind her (internal rotation). Physical examination demonstrated painful limitation of shoulder movement above shoulder level. She was stiff into internal rotation of the shoulder. She was generally weak, with pain on testing the muscles that abduct and externally rotate the shoulder. Her shoulder blade was restricted into upward rotation and retraction - her shoulder blade "wanted" to stay in a forward position. She was tender to touch to the rotator cuff tendons, and all over the shoulder girdle - the neck muscles, the lats/armpit, and the chest muscles. Clinical tests for shoulder impingement were positive. The shoulder joint itself was stable, but there was significant restriction of the posterior shoulder capsule.
She had other problems, such as functionally poor leg strength, and stiffness of her lower back and hip girdles, but I won't go into them here.
Treatment included soft tissue releases to virtually everything around the shoulder blade (basically an uncomfortable, very intense, DEEP TISSUE mobilization of the soft tissues around the shoulder), and also including the rear shoulder capsule. Following one treatment, pain-free shoulder range of motion was significantly increased, to about 90% of "normal." The difference in the shoulder posture was also significant, but now very asymmetric compared to the left (non-involved) side. So, I treated that shoulder, too.
I gave her stretches, and "movement" exercises, to hopefully retain the improvements in range of motion. I gave her a couple of "golf-specific" exercises, and some basic shoulder girdle/rotator cuff exercises I use.
In short, I treated her 4 times. She tells me her pain is now gone, and she said she is hitting the ball farther than ever before in her life!
Unfortunately, she seems to have developed some achilles tendinitis in her right calf. (I should have mentioned that she has some of the tightest calves I have ever witnessed)
Now, I didn't write this post to pat myself on the back, but rather to illustrate what I believe happens in most shoulder problems. I believe that the shoulder blade stops "getting along" with the upper arm. This happens for a number of reasons, most notably the relative lack of full mobility of the chest and shoulder girdle, and poor posture. I think posture is a key one. The shoulder blade depends almost entirely on the muscular support, and it seems prone to getting "gummed up." When it stops moving properly, bad things happen. The sequencing of the movements of the shoulder blade and the arm gets out of whack, and there is stress at the ball and socket joint (the shoulder joint proper). This is where we run into shoulder impingement problems, and rotator cuff irritation, and eventually a partial or full-thickness tear of the rotator cuff in the long run.
Whew! Anyways, if anyone has read this far and has any questions about this particular problem/subject, feel free to ask!
Physioguy
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After this, there is no turning back. You take the blue pill - the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill - you stay in Wonderland and I show you how deep the rabbit-hole goes.
Thank you for another wonderful post, Physioguy. Throughout the forty years of my quest for the Perfect Golf Stroke, I concerned myself little with the physical aspects of the body. Not surprisingly, when my body rebelled vehemiously in my early forties, I was at a loss as to what to do. And so for a number of years, I did nothing. Said another way, I quit. I mean...when you can't get the club past waist high without falling to your knees, you've got a problem, right? Well, I had one, but I refused to admit it.
To make a long story short, somewhere in my late 40s, I learned to swing the Club correctly, with far less strain on my lower back than in my previous incarnation. Now, with the help of Vickie Lake and your own interactions on this Forum, I'm learning to reverse the effects of a misspent youth.
Thank you for your detailed postings on our site. I respect your knowledge and read every post. Hopefully, I'll be shooting my age sometime in the next ten years. If I do, it will happen because I'm finally paying attention to the basics long espoused by Vickie and you.
I know it is difficult to send your 'best stuff' out into cyberspace, knowing there is very little chance it will be correctly implemented without your own personal attention and oversight. But please, keep it coming: Even doing it wrong is better than doing nothing, and we need your help.
Thank you, Yoda, I appreciate your comments. And thank you also for this forum, which is about the most well-behaved golf forum I have ever been on!
You are right, it is hard to communicate much of the meaning behind all this biomechanical mumbo-jumbo, but I get a kick out of throwing my input in when I feel I have something to say.
I actually feel that the future lies in preventative rehabilitation, or what I like to refer to as "PREhabilitation." Many of my clients have longstanding physical deficits, where I become less optimistic regarding the outcomes expected. I often wish I could have gotten my hands on them years, or even decades earlier.
It is actually something that I am looking to develop - the idea that you go in for an annual biomechanical exam, just as most people go for their annual physical.
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After this, there is no turning back. You take the blue pill - the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill - you stay in Wonderland and I show you how deep the rabbit-hole goes.
That's a great story to help illustrate that you can't just treat the pain location but have to look at the 'rest' of the body and it's relationship to the symptom. Since most people don't know anatomy and the fact that the arm muscles attach to the shoulder blade they would not automatically see arm pain being treated thru shoulder blade mobilization. Ofcourse everyone knows how complicated our shoulder joints are but have very little experience thinking of controlling them. I am glad you talked about deep tissue work. Martee started a great thread about this very symptom and I didn't address massage at all. I suppose I was making an assumption that he would seek that out. Thanks for filling in the blank. Good manipulation of the joint can be invaluable as can good chiropractic to move you more rapidly and painlessly to a better joint alignment and consequent elimination of the precursor to the pain.
We teach our children to manage thei money, we teach them work ethics, we train their minds and we teach them the fun of athletic competition. But parents can only teach what they know and most people have never considered that their bodies need daily attention just like the other necessary areas of their existence. I too see this changing as the population is better educated in the real benefits of diet and exercise.
People are always amazed at the how quickly they are able to turn their painful symptoms around. But they are usually equally surprised that they hadn't realized how slump shouldered they'd become or how weak they were getting. Exercise is the great exposer of personal physical condition. I love it when I know a client has really started to 'feel' the benefits and the enticement of regular attention to his/her body. Staying in a routine is so much easier when you have an understanding of 'what' you are doing and 'why' you are doing it and 'how' it's supposed to benefit your life. So I consider myself a fitness tutor instead of a personal trainer because I want to teach people to become knowledgeable and the master of their own physicality and health.
I really started training professionally when I went back to school at the age of 33 to finish my finance degree. But I fell in love with the work and have never looked back. I so appreciate your contributions. I had a CEO tell me early in my career that while he liked that I know medical detail about his issues he couldn't understand a thing I was saying. From that day forward I have been committed to saying everything in the most familiar language possible. But it's still very difficult to put things down in print and make sure the whole picture is painted. I really appreciate you.
We're glad you're busy and glad you appreciate the importance of family time but I know everyone would agree that we are glad you had time for this contribution. Glad to read you again Physioguy.
Hybrid Mode
