[Physioguy]

Hello all!

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