Nashville Golf and Athletic Club: Case study part 2, the treatment plan
Welcome back to part two of our Nashville Golf and Athletic Club case study! This week, we continue the journey of Doug, an avid golfer and dedicated club member, who came to us seeking relief from mid-back stiffness, shoulder pain, and low back discomfort that disrupted his golf swing, workout routine, and overall mobility.
Doug’s initial assessment uncovered significant limitations in thoracic spine and hip rotation, poor motor control, and compensatory movement patterns—all of which affected his swing mechanics and increased his risk of injury. Using a thorough approach that included the Selective Functional Movement Assessment (SFMA), TPI Physical Screen, biomechanics testing, orthopedic evaluations, and a detailed swing analysis, we identified key challenges: a C-posture, an over-the-top swing, and restricted global rotation.
Armed with these insights, we designed a 12-session personalized treatment plan focused on chiropractic care, hands-on therapy, and targeted corrective exercises to rebuild mobility, strength, and performance. Doug’s ultimate goal? To play golf pain-free, enhance his overall health, and maintain long-term mobility on and off the course.
If you missed part one, be sure to check it out for a closer look at what a comprehensive golfer’s exam entails. Let’s dive into how Doug is making strides toward his goals!
Building the treatment plan
We planned Doug out for a 12-session plan over 8 weeks, seeing him twice a week for 5 weeks and once a week for the remaining 2 weeks. With our treatment plan, we include not only 1-on-1 hands on rehab and performance care, but also out of clinic programming tailored to you and what you have available at home. This is how we build volume with affective rehab and performance drills to achieve the outcomes were looking for!
Phase 1: Mobility and orientation
Let’s look at what we did to improve on key findings during phase 1 of the treatment plan. We will focus on treatments given to improve his lumbar locked test (thoracic spine rotation), his lat test (overhead mobility), and his hip internal rotation.
To begin, we used breath and positioning work to help address pelvic and rib cage orientation, giving us the groundwork to begin improving hip mobility, thoracic spine mobility, and shoulder mobility. This breath work included drills like the hip 90/90 lift and hold, kettlebell assisted rotation with pelvic stabilization, and hip 90/90 swivels.
The 90/90 hip lift and hold position
This drill creates an environment with a neutral pelvis and tucked, neutral rib cage stacked on top. We then use the diaphragm and oblique muscles to pull the rib cage down and in as we breath with cues “breath in through the mouth, out through the mouth like you’re fogging a mirror”. The exhale done this way helps us isolate the oblique muscles instead of the rectus abdominis (6-pack muscles). The importance of this is we can begin pulling the rib cage down and into internal rotation without simply crunching through the thoracic spine and rib cage, opening this crucial rib cage motion. The hamstrings control the pelvis, with this position helping us learn to use the hamstrings not just for knee flexion, but also posterior tilt of the pelvis.
This is a great early-stage drill for golfers needing to open up space for thoracic rotation. We can build on the breath work and positioning from the previous drill to help incorporate more motion in rotation into the spine and rib cage. Further, we can begin improving our ability to separate our trunk and pelvis (critical for the kinematic sequence, creating lag and more…) by keeping our top side knee firmly planted on the foam block, not letting the pelvis and hips rotate with the spine.
More on the kinematic sequence and creating lag…
A progression to the 90/90 lifts, we are now incorporating hip rotation on a relatively stable pelvis. This further emphasis positioning but also starts teaching us to create relative rotation of the hips ON the pelvis. This is phenomenal for beginning to create stimulus into the hip capsule to begin opening space and movement.
Phase 2: Asymmetry, strength, and motor control
After 3-4 sessions, we began to enter phase 2 of treatment. This means we were able to start integrating strength and motor control drills and exercises into our sessions and at home programming while continuing to address singular joint mobility where needed. In Doug’s case, we had to continue improving internal rotation of his right hip specifically, thoracic rotation in both directions, and left shoulder flexion. Here are some example drills and exercises we did in phase 2, though this is by no means a comprehensive list…
Phase 2 addressing hip range of motion
Here we continued to work on internal rotation mobility of the right hip, while beginning to integrate strength into the pelvis and hip.
This drill does a great job forcing the golfer to use his adductor or groin muscles to create a pull on the hip, creating internal rotation and a shift to that same side. We are pulling the top side hip back and down while holding the position. While golfing, the trail side leg needs to be able to accept a shift and experience internal rotation WITHOUT compensating, which means we need to address and improve TRUE hip internal rotation and shift into that side.
This exercise is a fantastic steppingstone from our mobility and muscle activation drills to true strength exercises. Again, we want to continue building mobility into this hip while also strengthening the muscles of the hip that control this motion. Last, we again get a slight weight shift into this side, continuing to help us progress the integration of mobility and strength into our swing.
Phase 2 improving the lumbar locked test
For phase 2, we still needed to clean up about 10 degrees of rotation in both direction through the thoracic spine. We cannot have a compensation free and efficient swing without adequate spine mobility…
Here we are building on our rib cage and spine mobility from our breath work and kettlebell drill in phase 1. To begin integrating some motor control and strength in this motion, we can use this banded rotation drill.
This is a must for all shoulder and spine restriction cases. This drill, when done correctly, will change the orientation of the muscles of the upper back to a more relaxed, eccentric (or lengthened) state while building on our rib cage, scap, and shoulder mobility. The idea here is to think about pulling the block apart while reaching your shoulder blades and elbows as far away from you as you can. Then perform this dragging or scraping motion. I included the instructional video of this drill here so you can better understand how to do it.
Phase 2 improving the lat test
To address the lat test in phase 2, we began with an overhead position combined with shoulder internal and external rotation mobilization/ activation. This helps create space in the shoulder capsule and motor control in the overhead position. Then, we worked on shoulder complex strength in our end range…
This drill helps us mobilize into the shoulder capsule while in an overhead position. Further, we do through active muscle contraction to help integrate motor control in these ranges.
In this exercise, we rotate down into the foam block as while building up force over 45 seconds. We want to finish with the 45 seconds at about a 9/10 or 10/10 max effort. Then, we can try to lift the PVC pipe off the floor without changing the angle of our torso, holding for 5 seconds, then dropping back down and repeating for 5 reps.
Phase 3: Golf integration and power development
In this phase, we have access to full mobility in the key joints AND have built up strength and motor control through these joints. We want to continue building strength in phase 3 while also integrating power development and swing mechanics…
Phase 3 addressing hip mobility
To continue integrating our mobility improvements into a functional pattern, like the golf swing, we used drills that forces us to use our range of motion and create power quickly…
This kettlebell swing is a fantastic exercise to begin working on strength in lateral or side-to-side weight shifting while producing force in a closed kinetic chain.
This drill is especially good at highlighting the motor control needed over the pelvis and hips to create separation from the trunk and lower extremity. This again forces use our complete range of motion at the hips, pelvis, and trunk while specifically creating motion at the pelvis relative to the trunk.
Phase 3 addressing the lumbar locked test
In this phase, we again want to integrate our trunk rotation and strength into the explosiveness of the swing. To prepare for this, we can use drills med ball throws and 3d band rotations in a hinged forward position…
This drill create stability in the lower extremity and pelvis with our foot position, helping to emphasize the trunk for creating rotation and power.
This drill helps us build strength throughout trunk rotation while maintaining hinged or forward bent position, limiting the compensations we can use to achieve the rotation at the trunk. We also integrate lower extremity stability and strength as we balance and push through the hip and foot.
Phase 3 addressing the lat test
To address the components of the lat test while in phase 3, we can begin with banded separation work between the trunk and pelvis, but while at the top of the backswing when the arms are elevated.
Swing drills
Phase 3 care also includes the integration of swing drills into our care. We can program in swing drills at the range with small rep ranges of 5-10 swings, 2x at the beginning of the session to help integrate our mobility, strength, power and golf swing patterning we are doing in the clinic into the actual swing. Again, the goal of these drills are to create an environment where the golfer is forced to move into or “feel” what it is like to use his or her improved attributes during the actual swing. Then, they have full potential to make the detailed changes they are looking to make, whether it’s from swing instructor or their YouTube playlist… Here are some examples swing drills we can use to help integrate hip and pelvic mobility and strength into the swing…
1. Lift lead heel
This drill creates sequencing to encourage a full and powerful weight shift from the back side to the front into the downswing. As the heal lands, it also encourages a vertical or upward force that stops you from sliding and instead rotating through the pelvis and trunk.
2. Single leg swings
This drill creates an environment that forces the golfer to use full range of motion from the working side leg. Further, there is a high demand of strength and stability into that hip to control the motion, balance, and create power into the swing. This is a fantastic way to integrate the changes we made and get the golfer feeling their improvements in upper extremity, trunk, pelvis, and lower extremity mobility, strength, and motor control.
Before and after
1. Hip mobility
At the start, Doug came in with hip internal rotation range at 10 degrees on the right and 12 degrees on the left. The goal is to get to 30 degrees of compensation-free true hip internal rotation. At the start of his 11th session, we had him walking in at 29 degrees on the left and 32 degrees on the right. This gives him more than enough “space” for rotation at the hip to create an efficient and powerful golf swing that is capable of creating the proper kinematic sequence.
2. Thoracic spine mobility
Feeling limited in his ability to turn through the thoracic spine was a pronounced reason for Doug seeking care in the first place. We found during the initial eval that Doug had about 20-25 degrees of active thoracic rotation to either side. What we are looking for from the lumbar locked test is 45 degrees of rotation, 20-25 degrees more than what Doug was presenting with. At the 11th session, Doug walked in with 42 degrees of thoracic rotation on the left and 43 degrees on the right!
3. Lat Test
To get overhead with the arm, we need access to internal and external rotation at the shoulder joint, access to flexion, scapular mobility and rotator cuff stability, and good thoracic spine extension. These components of this test are all individually important to the golf swing and are tested functionally with this overhead test. When we started with Doug, his left arm showed a major restriction in shoulder flexion and was unable to come close to passing this test. When we finished, we see a major improvement in his ability to get his arm overhead, showing the individual or component improvements integrated back into getting to a passing position in this test and almost even getting the thumb to come in contact with the wall.
Conclusion
Doug quickly recognized how his limited trunk mobility was restricting his golf swing, creating unnecessary tension and discomfort. Compounding this were recurring bouts of shoulder and low back pain. A comprehensive evaluation revealed three key areas of restricted mobility—hips, thoracic spine, and shoulders (especially in flexion)—all of which contributed to compensatory patterns in his swing and exercise movements.
To address these issues, we started with targeted mobility interventions, including soft tissue mobilization, chiropractic adjustments, and corrective exercises. As Doug's mobility improved, we introduced strength training to stabilize his newfound range of motion. This was followed by power integration, swing-specific transfer drills, and practice with actual golf swings.
The results have been transformational. Doug has significantly improved his swing mechanics, enhanced his ability to collaborate with a swing coach, and increased his longevity in the sport. Nashville Golf and Athletic Club won’t know what hit them when Doug steps onto the course this spring!
-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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P.S. if you have mobility deficits, joint restrictions, pain, or injury that is limiting or holding you back in golf and fitness, consider how regional interdependence is at play and impacting your ability to recover, create swing faults, and lead to continued pain and injury.
