Legends Golfer Case Study, Part 2: Comprehensive Care
This week we are furthering our discussion from the exam process described last week. Check out the key exam findings from the previous article and come back to learn a little bit more about our treatment plan and progressions from session one to session 15.
Overall, treatment at IRPC follows 3 phases. Phase 1 is the orientation and general mobility phase. We must make sure we are beginning to address the lowest hanging fruit of movement and mobility. This usually means we are spending time working on improving the positioning of the pelvis and rib cage. Often times, simply by improving the movement and positioning at the pelvis and rib cage, we open up mobility at the hip joints, shoulders, and thoracic spine! At the very least, we begin to identify with clarity the asymmetry in mobility at hips and shoulders (key for phase 2).
In phase 2, we directly attack asymmetry in range of motion and strength while beginning to build back in motor control where it is needed. This phase builds on phase 1 by re-integrating the new mobility with strength and movement patterns, while cleaning up the remaining mobility losses. This sets the foundation for phase 3, where we begin to challenge the mobility and strength with power drills and end range strength. Here we use med ball throws, swing aids, bands, and the golf club to encourage the golfer to integrate his or her new physical capacities specifically into the swing. Keep reading to see some highlight of the progressions from phase 1 to phase 3 treatment…
Phase 1 Treatment Highlights: Mobility and biomechanic orientation
Here, I will walk you through some of the early-stage drills and work we did to address the Lat Test (overhead mobility), Lower quarter rotation (hip and pelvis rotation), and trunk rotation (lumbar locked/ thoracic rotation tests). First, the overhead mobility…
Improving the lat test
Addressing the lat test requires us to address the extensibility or lengthening ability of the lat muscles, the mobility of the shoulder joint, and the ability to create extension in the thoracic spine. To improve these measures, we used hands on care like soft tissue release and chiropractic adjustments through the thoracic spine. Further, we used a variety of drills to open-up this overhead position. An example of two drills we used was a 90/90 hip lift, which helps teach us and puts us in a position to pull the anterior or front of the ribs down while breathing to create “space” in the upper and middle back. This is an essential early step to creating expansion or the ability for expansion in the upper back so the scapula and shoulders can move into the overhead position. Similarly, we used a quadruped breathing position with the right side (the worse side) slightly raised to help encourage further upper back expansion.
Improving the lower quarter rotation test
While working to improve the lower quarter rotation test, we used drills like the ones above, specifically the 90/90 hip lift not only to help address the open or flared rib cage position, but to also create change to the anterior or forward tilted position at the pelvis. We also used hands on techniques and chiropractic adjustments at the pelvis and hip. Here are a few more early stage drills we used to address pelvic and hip mobility…
Improving the trunk rotation test
Working on thoracic spine mobility is always an essential part of the early phases of golfer rehab or performance treatment plans. It is a common area of restriction, yet vital to a compensation and pain free swing. In phase 1, breathing drills that help bring the rib cage down out of the open scissor position and enhance rib cage mobility are helpful, as well as chiropractic adjustments and passive mobility exercises. Here are a few passive mobility drills we used early in the treatment plan…
Phase 2 treatment highlights: Asymmetry, strength, and motor control
In phase 2, we can begin focusing more time on improving specific asymmetry in mobility, areas missing stability and strength, and begin working to integrate these qualities into our bigger patterns (think day 1 exam SFMA and TPI global movement tests).
Improving the lat test
In this phase, we were able to make the level of change we needed to improve the lat test completely. Again, this means we created adequate shoulder capsule mobility, lat extensibility, and thoracic spine extension. We continued to use chiropractic adjustments and lat soft tissue work. Further, we began using other drills to help drive motor control over this shoulder flexion motion, such as the FRC shoulder flexion PAILs and RAILs. PAILs stands for progressive angular isometric loading while RAILs stands for regressive angular isometric loading. This drill starts with us using and creating mobility to reach the full overhead shoulder flexion position with thoracic extension. It progresses by getting the golfer to now use isometric (non-moving) end-range contractions to create stability and control over that end-rage position. Check it out below…
Here is the before and after with a voice over of the lat length test improvement.
Improving the lower quarter rotation test
In phase 2, we homed in on the left hip internal rotation. In our day 1 exam, we found both hips missing internal rotation mobility (less than 5 degrees on both sides!!). As we transitioned to phase 2, we began to see that the left hip was lagging behind the right, as our mobility numbers began creeping up towards 20 degrees on the right and 15 degrees on the left. This is normal and expected, even hoped for, to have one side present itself as the more limited one. Now, as we begin working more in phase 2, we can really target the left hip for internal rotation. We are not neglecting the right hip (remember, we need to get to 30 degrees on both hips to improve that lower quarter rotation test) but focusing a few more specific drills on the left side. Here are a few examples of the exercises and drills we use in phase two to improve mobility, strength, and stability in the hips and pelvis…
Improving the trunk rotation test
In phase 2, we wanted to emphasize continued mobility improvements as well as strength and control over spinal rotation. We started at thoracic spine rotation measurements at about 35 degrees in both directions, 10 degrees off from our target of 45 degrees for golfers. Starting phase 2, we had the golfer walking in closer to 40 degrees of rotation on both sides. To continue improving this active mobility and begin integrating it, we used passive techniques like chiropractic adjusting. We combined this with drills that forces active stability around the trunk while creating rotation at the spine, like quadruped banded thoracic spine rotations, FRC trunk rotation, and side-to-side kettlebell swings…
Phase 3 Treatment Highlights: Golf integration and power development
In phase 3, we had already made great progress on the lat test (check out the before and after above) and we’re getting close on our mobility goals for the hips and trunk. We also began incorporating stability and motor control back into these areas. The last thing we need to do continue to improve motor control and strength while integrating these individual segments back into the golf swing while creating power (adding speed as a variable now).
Improving the lower quarter rotation test
Starting into phase 3, we are working with internal rotation numbers at just under 30 degrees to begin each session. This is right where we want to be, as just a quick warm up and movement routine are able to create the last bit of mobility we need to get the 30 degrees on both sides (a long way from the start of <5 degrees!). Besides the last bit of mobility, we wanted to really focuses on integrating this passive mobility into weight bearing and force producing positions. This allows the golfer to actually use these mobility changes in the swing. Here are some drills we used to help integrate these goals.
Improving the trunk rotation test
In phase 3, the primary goal was to get to that 45-degree mark and begin integrating that rotation back into a weight bearing position. It is essential not only to have access to this spine rotation but be able to create separation between the pelvis and trunk to create stretch or the “X-factor” for speed and power in the swing. Here are some drills and exercises we used to create trunk and pelvis separation along with power in trunk rotation…
Before and After:
We got some incredible results with this golfer. Again, the day 1 exam and treatment was extensive, and we had many goals and test’s we were working on. Here are the before and after of a few of the tests we ran for this golfer…
Other notable improvements not videos include the trunk rotation test & trunk rotation test (both of these are tested in the multi-segmental rotation improvements). Further cervical rotation measurements were improved as well as cervical extension.
Swing Drills
Another important aspect of care is the integration of swing drills into the treatment. These swing drills specifically work on integrating mobility, strength, and power into the golf swing. They are not designed to address swing mechanics specifically. Reach out if your are looking for swing instruction here in the Nashville area and Dr. Nick can get you in touch with a professional who’s right for you. Here are two example drills sent to this golfer to help integrate his treatment…
Conclusion
The progression from phase 1 treatment to phase 2 and 3 is fluid. There is always overlap between the type of exercises, drills, and hands on treatment being done as we begin moving from one phase into the other. By the end of treatment, the golfer is pain free, reaching their own personal maximum mobility at key joints, and able to integrate that mobility into a powerful, efficient, and repeatable swing without compensation!
-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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