Up to this point, Tiger Woods has suffered an extensive amount of pain and injury. He has repeated pain and injury to his left knee, following a surgery in the left knee to remove two benign tumors in 1996. Since, the left knee and ankle has been a constantly recurring source of dysfunction and pain. Eventually, he also had right achilles and left shoulder injuries until finally, substantial low back pain in 2014.

Are the recurring injuries in the left knee and ankle a product of the initial insult from the 1996 surgery? There’s no way to know for sure, but our understanding of regional interdependence, compensation, and proprioception tells us there is likely a link. The same factors will now play a role in the development of Tigers low back pain. Years of pain, surgery, and dysfunction in the left knee and both achilles WILL impact the creation and absorption of forces in different joints in the golf swing. As we avoid force production in certain joints, we alter our motor patterns and forces us to use regions of the body sub-optimally. We will explore this more in part 3…

At the start of Tigers Woods professional career, he underwent a knee surgery to remove two benign tumors. He went on the dominate in his early professional years, again getting surgery on the same knee for a benign cyst. There is more surgery and trauma to come to this left knee that we will cover in follow up articles, but I believe these were the beginnings of compensations leading to tissue overload that will eventually cripple Tiger late in his career. We’ll continue to discuss Tigers injury history as we move along his professional career accomplishments.

Improving slide requires we improve our mobility and stability around the hip joint. We need to be able to turn into that hip fully and control the full force of the swing and the forces around the hip. When a plan of care addresses these components and we integrate it into the swing, it is then left to the swing coach to sequence these abilities fully and the trainer to help maintain and continue to improve total power output. Beyond the hip, the low back, thoracic spine, knee, and ankle are all required to be doing their job so that extra load is not taken up by the surrounding joints. A full evaluation is vital to make sure we are not just making improvements at the hip, but everywhere along the kinetic chain that needs it.

Low back pain in golfers has many physical causes. The pain can come from the lumbar facet joints, the intrinsic lumbar spine muscles, lumbar discs bulges, and lumbar discs protrusions with spinal nerve encroachment. Beyond the pain generators, the true causes of low back pain often come from joint restrictions or joint motor control deficits Addressing both the pain generators AND the functional limitations leading to the pain and inflammatory responses is critical for long term and effective treatment in golfers.

 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…

So, the general flow of all golf specific day 1 comprehensive exams, is as follows.

1.        SFMA top tier global movement screen

2.        TPI golf specific physical screen

3.        Joint-by-joint mobility and stability testing

4.        Special and orthopedic testing

5.        Golf swing analysis

For different patients, the emphasis on different areas will be apparent. For any golfer with significant acute or chronic pain, there will be significantly more time spent working on orthopedic testing and diagnostic procedures. For pain free patients, more time is spent on the global movement screening and mobility/ motor control. That being said, we will always hit on both the functional components and pain components. Check out the part two article to see examples of how we work through a treatment plan based of a day-one comprehensive exam!

Specific and individualized passive AND active care are both critical for low back pain lifters. We need to be able to use both, with changing emphasis, throughout a treatment plan. Missing one component can result in getting stuck or stagnant in your improvement. Even worse, you might start to feel better without addressing the long-term, root cause issues that will result in a future injury, potentially worse than before. If you have recurring or on and off low back pain, getting comprehensive examination AND treatment is vital to stopping the pattern.

Power is the end-all be-all for the golf swing. It’s what we train for. Mostly. When we drive the ball 10-20 yards farther then we did 12 weeks ago, it is because of the power we gained. I say mostly because the mobility and strength we gained to get to the improved power production also plays a role in injury prevention, injury rehab, and longevity in the game of golf. Besides that, the translation of the hard work you put in for mobility, strength, and power training in the weight room is to translate to power production on the golf course.

This week, we are continuing the discussion on the significance of fitness training for golfers. Today, we are specifically talking about strength. Strength is indeed vital for creating and improving club head speed in the golf swing. It is also critical for increasing how long we can effectively practice and play without increasing the risk of injury and decreasing our longevity in the game. Let’s discuss a little further how strength training can be missed by so many yet be so critical to the game.

This week, we are starting a series addressing overall health and physical ability for golf. It is, as the title says, essential to address general fitness if we are to peak our golf skills. At integrated Rehab And Performance Center, we address, in hyper-specificity, certain aspects of fitness. This includes mobility, strength, and power. Further, we work to integrate these components into the golf swing. What we don’t do (surprise at the end of this article…) in our sessions is train overall fitness. Fitness is the long game, and critical to maintaining positive changes while chipping away at performance limiters. Fitness is broadly made up of mobility, strength, power, agility, and aerobic conditioning. Today we are going to address the mobility component of overall fitness.

This week, we're diving into how you can become the club champion at your course. Whether you're targeting your club's championship, a member-member, or a member-guest flight, this guide will cover the key concepts every Nashville golfer should know. We've gathered insights from local Nashville golf pros and drawn from Dr. Nick's extensive experience in rehabbing and enhancing golfers' physical capabilities to help them reach their peak potential. We'll explore what swing coaches are seeing in Nashville golfers, critical fundamentals that can’t be overlooked, and Dr. Nick's approach to supporting golfers—whether they're recovering from injury or aiming to elevate their game pain-free and performance-focused.

We have three tests when it comes to wrist and forearm mobility in the golf swing. In reality, wrist and forearm action melds together to create triplanar motion and positioning, a combination of all three tests in either wrist. Both wrists go through a combination of flexion/ extension, radial/ ulnar deviation, and wrist supination/ pronation at varying degrees. Having complete access to these listed motions prevents compensations to achieve positions and create intense and explosive power. We also limit the potential for injury at the wrist and forearm by maintain the mobility AND strength in that mobility. Try these tests at home and see if you are lacking in either one. If so, don’t hesitate to reach out to Integrated Rehab And Performance Center for consultation and a FREE discovery visit.

Whether it is a CrossFit gym, Orange Theory, Crunch, or private gym with personal training, you can take steps to take full advantage of your membership to achieve your goals. Taking an intentional approach to your training can pay dividends in the speed and depth of your gains early on. Follow along to learn how to systematically evaluate and train your deficiencies on the gym floor.

The initial evaluation is key for understanding what we need to do to achieve the golfers’ goals. We need to find areas of missing mobility, missing stability, altered motor control, areas of limited strength, painful and positive orthopedic testing, and examine what the golfers’ swing looks like and how that is associated with the previous findings. In other words, we search to understand their movement capabilities AND how they swing. With this, we can then determine how the issues in their swing relate to the limitations in how they move. We can also then understand how this might be creating pain now and into the future. The depth and detail of this initial exam is truly unique and one of a kind in the Nashville area.

The cervical rotation test is an important screen to show us if we need to take a closer look at neck mobility and stability. If the screen shows we have limitations, we need to figure out why, requiring a comprehensive physical exam that should also include the entirety of the body. The aim is to figure out and establish its ability to achieve golf positions with speed, consistency, and efficiency. Once we understand better what the body is capable of and what it is producing in the golf swing, we can then go about creating a plan to fix the different components impacting the swing, including cervical rotation.

We focused here mostly on what I find to be the biggest limiter in the downswing, the front side hip. Using hands on soft tissue technique, chiropractic technique, and precise movement therapy are the first steps to creating a hip that is optimal for the golf swing. After that, modified and specific exercises help to create more mobility and build back stability into that joint as we progress towards more dynamic and golf specific activities

There are many components to the backswing that need be assessed and addressed. If one component is missing mobility or motor control, the body will need to compensate to make up the difference, leading to inconsistent and less than impressive swings. Further, we increase our chances of injury and lower our longevity in the game by forcing other joints to take up the slack.

Overall, we must fully address the back side hip for internal rotation, the back side shoulder for external rotation, and the trunk for rotation to the backside. Without these regions showing enough mobility, you and your swing coach will have a tough time making consistent changes in your swing.

Outlined is a simple description of how we can take the findings of the bridge with leg extension test and start the process of improving on it. It is by no means comprehensive, but you can at least see the reasoning behind the different phases of addressing poor glute activity in the golf swing. Keep in mind, the glute muscles are vitally important at controlling the pelvis in extension and flexion as well as rotation and tilt. A comprehensive exam tells us much more about the golfer in front of us, but the bridge test does the best at looking directly at the pelvis and glutes. Check out other podcast episodes and articles on similar concepts around the pelvis and hips in the golf swing.

Determining the true anatomical source of shoulder pain is important, but a clear understanding how everything else in the shoulder complex is moving and performing is equally important. We must be able to decipher where mobility is needed, where stability is needed, and how well the patient creates proper movement patterns with the entirety of the shoulder complex under load. With these understandings, we can build a plan to address the damaged tissue AND all the issues which were the root cause of the pain and dysfunction in the first place.

This week we are discussing the phases of power training for golfers (and other rotational athletes for that matter) regardless of whether we are starting in rehab phases or directly from a performance perspective. Either way, the same system needs to be followed. First, we must address mobility and asymmetries. Even for the golfer in pain we always will address this, even if the site of the mobility loss is distant from the actual pain. It is often the case that these asymmetries and mobility issues are causal mechanisms in the generation of pain, while also being major performance limiters. Next steps include looking at motor control and stability throughout key regions and joints in the body, baseline strength, and then re-integrating movement quality and power training. Let’s take a closer look at these components to a powerful swing.