A club golfer was cured of nagging consistent shoulder pain. Shoulder injury chiropractor, Dr. Alexander Jimenez evaluates the case study.
Here’s a pertinent quote from the late lamented author of Letter From America, Alistair Cooke: ‘To get an elementary grasp of the game of golf, you must learn, by endless practice, a continuous and subtle series of highly unnatural movements, involving about 64 muscles, that result in a seemingly “natural” swing, taking all of two seconds from beginning to end.’
An avid club golfer with a handicap of 4 and a right-handed stroke asked for assistance with his nagging L shoulder pain that had recently become markedly worse and finally was threatening to stop him playing. He explained he must have asked for help sooner, but he believed it would just go away (one of the most commonly heard statements by treating practitioners!) and it had now been hanging around for about six months in total, despite routine training.
He explained that initially it only used to damage when he caught his chipper from the grass and disrupted his follow-through, but now if he used an iron he’d feel a sharp pain unless he happened to stroke the ball flawlessly. It would also ache when he slept on the side, and after playing a full round, it ached for some days. He had tried a million stretches and even appeared quite flexible with specific movements around the shoulder. Also, for some years he had battled with R low- back pain and anterior hip pain which, when bad, would render him limping a couple of days after an 18-hole round.
An evaluation showed all the signs of rotator-cuff tendinitis (inflammation and microscopic breakdown of the tendon), together with accompanying weakness of the muscle itself, leading, over time, to the excessive anterior translation of the head of his humerus (extra shearing of the ball in his socket joint) on the follow-through. This would likely cause impingement of his already thickened tendon beneath the acromial rectal arch of the shoulder, giving him the sharp stabs of pain he complained of more lately.
His standing posture gave us the most explicit clues as to why this had evolved, without ever needing to video his stroke biomechanics: rounded shoulders and a very noticeable low- rear arch (lumbar lordosis) are classic signs of poor postural control resulting in wrong movement patterns within his stroke. Gradually over time something needed to give often it’s the non-dominant arm.
Had he had been middle-aged, we may have X-rayed his shoulder to search for any calcification of his tendon (he’d just turned 30), and only if progress wasn’t going well would we believe doing an ultrasound scan to find out the size of scarring and limb breakdown.
Rehabilitation could have a month or two if all went according to plan the critical unknown factor is how well he’d take on the challenge of holding his shoulders and pelvis differently; this re-education procedure is frequently the most difficult. The general treatment procedure will first entail improving flexibility so that appropriate posture positions can be held most of us get stiffness in a number of our joints because of gravity wrecking our great posture.
Recent improvements in sports physiotherapy have enhanced the speed of the process significantly. Aside from a regular stretching regime from the patient, we ‘release’ muscle tightness by deep-tissue massage and trigger-point treatment, heat, a home program of self-pressure massage with a tennis ball, and mobilizing of the tight parts of the capsule of the shoulder with seat-belts. Tightness in the posterior rotator-cuff muscles of this specific patient took a lot of effort to work out, and lat dorsi and pec major/minor were also big players.
Additionally, he had considerable stiffness in his thoracic spine, particularly with L rotation, worked loose, as were specific gluteal and hip-flexor muscles.
The Next Two Phases
Secondly, postural muscles needed to be ‘turned on,’ i.e., recruited correctly, and a schedule of the gradual strengthening of their ability to restrain the joints to which they’re responsible began. The crucial ones were the lower and mid trapezius and transverses abdominus muscles. We also taped up them sometimes to help remember to continue using them until it became more habitual.
Around this time, pain has gotten less, and less of a problem along with his postural control was growing nicely. He was able to come back to his coach and start utilizing the positional changes in his stroke, slowly increasing the stroke distance and frequency and all the while maintaining his flexibility with the tennis ball. This third phase, which entails integrating the right posture into the stroke, has to do with the coach and requires substantial discipline on the part of the athlete to ensure he remains inside the realms of what his brand new system can tolerate without being overloaded. Because he can still overdo it!
All went well, with all the golfer reaching one of his best-ever scores in the Queensland Open Tournament three months later. However, two weeks after that he dived badly in a game of rugby and twisted the exact same L shoulder and ripped the exact same rotator-cuff tendon he’d worked so hard to fix. Back to the chiropractor.