Athletes these days, including golfers, face unique problems that previous generations didn’t have. All athletes are asked to be more powerful, more accurate, and more consistent than ever while our environments fight relentlessly against us. We, and especially children, don’t play, climb trees, carry heavy objects, or move like we used to. We’ve traded these activities for riding in cars, sitting at desks, and carrying backpacks slung over our shoulders. Our basic modern training techniques aren’t helping either, with heavy doses of machines that stabilize the weights and an emphasis on “magazine muscles” like the pecs, abs and arms.
A unique pattern of issues has arisen from these factors, and it is so prevalent that therapists have classified it as a syndrome. Dr. Vladimir Janda first coined the term Upper Crossed Syndrome to describe a recurring pattern of muscular imbalances in the modern human – weak deep neck flexors, tight upper traps, tight pecs, and weak rhomboids and lower traps. This will generally result in forward rounded shoulders and forward head posture, where the chin rides far head of our neck. While the terms “tight” and “weak” might be debated in terms of semantics, one thing can’t be argued, and that is these issues feed into improper scapular movement. In Functional Stability Training of the Upper Extremity, noted physical therapist Mike Reinold and strength coach Eric Cressey show the profound effects poor scapular positioning and movement have on everything from grip strength to the ability to reach overhead. The scapula is the keystone to the arm, and without proper movement, you can’t expect to produce 100+ mph club head speeds, or do anything powerful involving the shoulders, without creating issues somewhere else.
The shoulder can have a profound effect on almost every joint in the body, including the wrist, elbow, neck, and even the low back. Especially with a power-based, multi-planar sport like golf, lack of mobility or stability in one joint can manifest itself almost anywhere. This is, right off the bat, the first issue with traditional physical therapy that works at managing and treating symptoms – elbow pain isn’t always simply elbow pain, and that is why it’s so important to see a therapist who is skilled at addressing and fixing more than just your symptoms.
Furthermore, in a symptom-based approach, you end up with standing banded external rotation exercises that you do until you get bored or the band breaks and you leave them behind. When four things go wrong and feed off each other, you can’t simply fix one thing and have it naturally reintegrate into the body. Isolating a single muscle group to make it stronger has no carryover to functional activity because our body, and especially a joint as complex as the shoulder, moves in patterns, not muscles. With regards to using proper cues and good coaching, it can be easy to teach someone how to isolate a muscle when it only has one motion. Bodybuilders do it all the time via the mind-muscle connection, which has been shown in studies to increase EMG activity. However, when performing a functional activity like reaching overhead, it’s impossible to think about firing three muscles and relaxing three more, all at the same time, while moving, especially when you’ve been doing it incorrectly or causing you pain for weeks, months, or even years.
So, what approach should be taken? First, as is always the case, make sure the requisite mobility is there. And no, that doesn’t mean static stretching! Classic stretches like the Sleeper Stretch can put unnecessary torque on the arm and make things worse, especially if done incorrectly. Foam rolling, lacrosse-balling, dry needling, IASTM’ing – these are all options. Choose whichever you know as a therapist or client or, better yet, what’s worked in the past. However, you can mobilize all you want, but without re-teaching your brain how to use those muscles, the mobility you gained from those techniques won’t stick around for very long, and the issues you tried to fix will rear their ugly heads sooner than later.
Steps need to be taken to integrate the improved mobility into the movements your shoulder needs to perform on a daily basis. However, what makes the shoulder so complicated is how many planes of motion need to be stable while others need to be mobile. As was mentioned earlier with regards to coaching and cueing, telling someone to think about each individual muscle is practically impossible. This is where proprioceptive feedback shines, and where Gray Cook’s idea of self-limiting and self-correcting exercises can work wonders. Using manual facilitation is a wonderful option and can allow a therapist to reinforce proper movement patterns, but at some point, an athlete and client will need to move independently. Kettlebells are a wonderful and unique option to progress, and such a simple device can have so many different uses. By using drills such as farmer’s carries, rack holds, waiter’s walks, and arms bars, an athlete and a coach can guarantee that the right muscles are being used to stabilize the shoulder and that the correct muscles are being strengthened in their optimal positions.
There are tons of different drills to do, but if you’re not assessing, you’re guessing as to what effect these drills are having. Have a checklist of movements you should be able to perform in order to exercise safely and effectively. Make sure before every session that you can do those movements. If not, have a set of drills that will get you to be able to. This is where working with a therapist that knows screening and movement can take your training or rehabilitation to the next level. However, don’t assume that once something is “fixed” that it will stay that way. Keep yourself and your patients/clients accountable by rechecking those same movements regularly, even after every set if they’re still works-in-progress. If things have gone south, you know the drills that will get you back those movements.
Smart training and knowing your body, how it works, and what it responds both positively and negatively to will take your game, whatever it is, to the next level. Understanding how your body should move, knowing your own personal limitations and compensations, and finally knowing how to reset and fix those compensations is the key to consistent progress and injury prevention.
Par4Success Intern, Summer 2016
Class of 2017
Duke University School of Medicine
Doctor of Physical Therapy Division