It had been a week since I saw Carl and I was keen to get a little deeper in this session so we can start making headway in his realignment. Our priority in today’s session is to continue work on correcting the upper and lower cross syndrome we identified but firstly I will start with reassessing Carl to get a clear picture of where his body is following a week of rehabilitation. In addition to reassessment there were a couple of other tests I wanted to perform:
1) Glute Firing Pattern
Given the degree of anterior tilt in Carl’s pelvis and also the fact that it is likely to have been in this position for a long time there is a risk that the Glute muscles have been inhibited – in simpler terms ‘turned off’. This is due to the process within the body which involves the muscles working in antagonistic pairs i.e. when the muscles on one side of joint contract, the muscles on the opposite side relax to allow ease of movement. Given Carl’s hip flexors have been contracting hard for so long it is possible that the Glutes have been constantly receiving messages to relax which over a sustained period of time have left them lethargic and lazy letting the hamstrings do all the work.
2) Thoracic Rotation
This is a key movement in the golf swing. In order to get the amount of torso rotation required in the golf swing it is not enough to simply rotate at the lumbar spine as this only gives you about 40 degrees on average. The thoracic spine can rotate up to 30 degrees so it is vital that we have good range of motion in this part of the spine to get maximum rotation and therefore power into the golf swing. Given Carl’s lack of movement in the thoracic region in our tests last week I am keen to test the rotational aspect today.
Firstly I started with reassessment of Carl’s hips which showed a real change, both hips are now aligned relative to each other, i.e. no rotation and in addition the degree of anterior tilt has reduced by about 30%. On discussion with Carl he described how he can physically feel this change, his abs feel like they are ‘on’ and he feels them engaging in his day to day activities where he had not felt them before. I then moved on to test Carl’s Glute firing pattern. On both the right and left side it was evident that the Glutes are not acting as the main hip extensor – something we need to correct as soon as possible.
Next we moved on to the upper body where on assessment of Carl’s cervical spine/neck there is still a level of restriction and his head is still sitting slightly forward although Carl has reported some improvement in his neck stiffness which is a start.
Carl’s shoulder girdle is still of concern and this is something I plan to work more deeply on today. In addition to his Pectoralis (Pec) Major and Minor being overly short and tight his Biceps are so contracted that his elbows are slightly flexed when in a relaxed position. Although not a primary function of the Biceps Brachii muscle, it can impact on the Shoulders range of movement given its attachment to the scapula. In Carl’s case I see this as an additional layer of dysfunction causing the rounding of his shoulders and the lack of scapula control we have seen so this is something we need to address to fully balance out his upper body.
Finally, I move on to assess the amount of rotation in Carl’s Thoracic Spine. What I see is that Carl’s does appear to rotate to quite a degree, but on closer inspection what I see is that his shoulder blades are responsible for most of this rotation, by bringing his shoulders forward on the side he is rotating it appears he has rotated fully, but while focusing on the thoracic vertebrae themselves you can see that the movement is quite restricted. I found a simple but interesting article on why stiffness in this region may cause lower back and neck pain both of which Carl experiences:
Treatment Plan Session 2
Today I will continue to work on releasing Carl’s Hip flexors & lower back using a variety of soft tissue and neuromuscular techniques. In addition I have also included some proprioceptive/retraining work on the Glute muscle group to help kick start Carl’s training and homecare to get more stability in his hips.
Moving on to the upper body we will open up Carl’s chest and release his neck to restore normal range of motion. Today we will also focus on some retraining techniques on his lower and mid trapezius to start getting more control into his scapula. Thoracic rotation is something we will address in a later session as until we get more balance through the chest, neck and back I think we will make little headway.
Finally I ended today’s session by applying a functional Kinesio taping to Carl’s shoulder to bring it into a neutral position. This is not a therapeutic taping but will give Carl a sense of where his shoulders should be, and will also help over the next 3-4 days as he starts his homecare. I don’t want Carl to rely on this taping but I think it will be interesting to see how it feels to him and also how it felt while hitting balls given he is going straight to a coaching session today.
I want Carl to continue with his three exercises from session 1 as they are clearly yielding good results. In addition there are three aspects to work on over the next 4 weeks until our next session:
· New Exercises:
- Glute strengthening/hip stabilisation exercises
- Rhomboid & mid/lower Trapezius strengthening
- Pectoral & Bicep stretching
· Previous Exercises to Continue:
- Hip flexor stretching, in particular Rectus Femoris
- Lower back stretching
- Breathing rehabilitation exercises
Given Carl can already feel physical changes within his body we discussed what this means for his golf game. It is important that Carl continues to train through these changes as there is a risk that his game will appear to get worse as his body starts to react to these changes. The compensating actions that he has been doing to make his swing work we will no longer be required but he will have to relearn how to hit the ball with his more balanced, stronger body. Carl agreed that he would be continuing to work on his swing with Andy Traynor through our period of body work.
Our next session is in January, in the meantime Carl is going to continue to progress with the homecare and I am hoping to see a marked difference in the new year.
Read Andy and Carls Blogs here: