Tiger Woods Case Study Part 5: Building a treatment plan

Tiger Woods, one of the greatest professional golfers in history, faced relentless battles with chronic low back pain and injuries. Between 2014 and 2024, he underwent six lumbar spine surgeries. These setbacks undeniably hindered his career, yet his legacy as one of the all-time greats remains unshakable. Still, the question lingers: What could have been?

Tiger Woods: Parts 1–4 Recap

In Parts 1 through 4 of this series, we traced the timeline of Tiger's injuries, surgeries, and pain. His journey began in 1994, two years before turning professional, with surgery to remove two benign tumors from his left knee. Fast forward to 2014, when he had his first lumbar spine surgery, and eventually to 2024, when he underwent his sixth back surgery.

Throughout this series, we explored the concepts of regional interdependence and compensation, emphasizing how these factors created an environment ripe for low back pain and subsequent injuries. Tiger’s left knee endured consistent trauma early in his career, and without proper rehabilitation to restore proprioception, strength, and mobility, the surrounding joints—like his low back—likely bore the brunt of increased forces and stress.

So, what if we could go back to 2012? What if we had the chance to craft a treatment plan that addressed Tiger’s lower body mechanics, mobility, strength, and power? How could we integrate these rehab goals into his swing, restoring his movement variability and motor control to 100%?

Let’s dive into what that plan might have looked like and explore how it could have changed the trajectory of his career…

Left knee and rehab

First, we would need to make sure we have full range of motion, strength, and reactivity in that injured left knee. Remember, up to this point in 2012, Tiger has had 3 surgeries to the left knee alone, with additional ACL tear and repair, MCL strain, and cartilage damage. With this much trauma and having the structures around the knee repeatedly opened up, there is undoubtably loss of range of motion, strength, and motor control/ inhibition to the joint and therefore the joints around it (minimize forces through this joint, don’t let the joint be put in vulnerable positions).

We would need to assess knee flexion, extension (straightening), and access to internal and external range of motion. Here is what some of these tests look like..

To make improvements to these ranges, we would do passive hands-on work through the quads, hamstrings, and calf muscles while mobilizing the knee for rotation. We could also use chiropractic techniques to adjust into the knee and surrounding joints as needed. Further, we need to use corrective exercises to begin improving and using these ranges under load. Here is an example of progressing from hands on work to corrective movement for knee (tibia on femur) internal rotation.

For regaining knee flexion and extension, we can use a variety of progressions from foam roller hamstring eccentric drills to banded knee flexion and bodyweight squatting with assistance.

We can progress these exercises to shift from range of motion focused to strength focused. We need to address single leg strength specifically, which limits how much the other extremity can compensate for the other, previously injured leg. We want to eventually progress to a single leg (pistol) squat, which demands adequate range of motion at the surrounding joints, like the ankle and hip. Further, the motor control demands at the hip and knee are staggering, while forcing Tiger to also rely on and improve proprioception again at the foot, ankle, knee, and hip to balance while producing high force. Here is an example of improvements to the pistol squats…

The list of strength and mobility correctives and exercises we could do here are endless. We just need to make sure we are improving/ progressing and working towards our specific goals, improving 100% strength and mobility back into the knee without allowing for compensation.

Performance and golf swing rehab

Now, to go beyond the basics, we need to not only make sure we have full strength and mobility in a controlled environment, but that the strength of the knee will be used to create and transfer forces through the lower extremity without compensation. This is how we avoid pain, injury, and eventually surgery to the surrounding joints.

To begin, we can start with light plyometrics. This could include double leg pogo hops, which decrease the load on the shared joints while beginning to incorporate fast and powerful contractions. From here, we could work into integrating the full body and swing mechanics into out rehab program. An example of this includes the banded knees to center drill. This drill helps to incorporate foot and ankle stability, knee and hip mobility, pelvic mobility, and trunk stability while getting Tiger to push out of his backside leg into his front side leg and knee WHILE maintaining strong and controlled contractions in the lower extremity.

Other drills include the PVC pelvic separation, step and throw, and kettlebell swing variations like the side-to-side kettlebell swing and single leg in front kettlebell swing. These swing drills are perfect variations at this stage in the rehab process because the force unilateral (single leg) work to be done, preventing compensation patterns from taking over and forcing the foot, knee, hip, and pelvis to work together to create and absorb immense forces. This reinforces our mobility and strength we created earlier while using them to create speed and power.

Swing drills for Tiger

To get as much transfer as possible to limit the extent of compensation and to avoid the overuse of surrounding joints, like the low back, we need to give Tiger swing drills. Now, I am not a PGA professional or by any means qualified to be working on Tigers swing mechanics, nobodies in fact, but I do want him to incorporate a few drills to do on the range that will help reinforce what we have done on the clinic and gym floor. These drills will force tiger to create high speeds and power with his lead side leg and use the full extent of that lead side extremity mobility. This will help re-integrate our rehab into his full swing, allowing a compensation free golfer.

Here are the two drills I would want Tiger to do to help integrate his lead side leg fully…

1. Single leg swings

This drill helps (forces) the golfer to use the mobility we worked on and improved on the lead or backside leg, whichever is the extremity being used. It also forces all the speed and power development to come through that side. This means any inhibition around the use of that knee can be worked through and improved in the golf swing specifically by using this drill.

2. Lift lead hill

This drill helps emphasize the force transfer from the back leg into the front leg. Again, we want to help eliminate all of Tigers inhibitions to create and transmit force through that lead knee.

Putting it all together

Incorporating targeted swing drills is essential to translate the work done in the rehab setting into Tiger’s full swing. By integrating the mobility, strength, and power we’ve rebuilt into his lead-side knee and hip, these drills not only reinforce proper mechanics but also compel his body to rely on that side effectively. This approach can help him generate more power from his lead side while restoring his body’s confidence to utilize it during his swing.

This crucial step combats the lingering effects of compensating for past pain, injuries, and surgeries—effects that often lead to excessive stress and forces being placed on the lower back. If left unaddressed, these factors could have contributed to or even laid the foundation for Tiger’s chronic low back injuries. Addressing these elements holistically could make all the difference in preventing such issues and optimizing performance.

Conclusion

At Integrated Rehab and Performance Center, we pride ourselves on taking a comprehensive approach to treatment. Our plans go beyond simply addressing pain—they’re designed to uncover and treat the true root cause through the lens of regional interdependence. Furthermore, we focus on the full continuum from pain to performance, ensuring that every aspect of rehabilitation is seamlessly integrated back into the golf swing and the activities you love. This critical step is often overlooked in traditional rehab and pain-centered treatment plans, but it’s one we never miss.

While we can’t say with absolute certainty that Tiger’s low back pain and injuries could have been avoided if regional interdependence had been fully addressed, we know that his history of extensive lower extremity trauma would have played a role regardless. However, at IRPC, we make it our mission to leave no stone unturned. By addressing every restriction, imbalance, and compensation, we give our patients the best chance to move pain-free and perform at their peak.

-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.