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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 85 "This is not good," Mr. L. said, taking a seat in my treatment room. "I'm worried about being able to play in my club's golf tournament in three weeks. I've been practicing like crazy." "The pain started about two months ago," he continued. "I made it a goal at the beginning of the summer to hit longer drives and I was making progress, plateaued, and then the pain started." "Can you show me again where you feel the pain?" I asked. "Right here," he said, pointing to his lower ribs on the left side. "At one point, I wondered if I might have cracked a rib or something, but there was no fall or impact. It just surfaced one day, and that makes no sense." "My job isn't just to treat what you feel, it's to understand the process that may have created it," I said. "Can you demonstrate your swing pattern for me?" His golf swing followed the typical biomechanics for a right-handed golfer. Then he added a particularly relevant piece of information: "When I get to the height of my backswing, I have been adding an extra kick, by forcefully turning my shoulders a bit more at the end of the backswing. That should help me drive the ball farther because it can create a bigger whip-like motion." In a right-handed golfer, a full backswing requires substantial right thoracic rotation, stretching muscles like the left internal oblique. Once at full rotation, that lengthened left internal oblique massively contracts to bring the torso, and thus, the club, in a whip-like motion toward the golf ball. All signs pointed to his left internal oblique as the source of his pain. His additional rotation at the end of the backswing only made the problem worse. Shifting Burdens Understanding the Context of Injury By Douglas Nelson I asked him to sit in a chair so I could measure his thoracic rotation, expecting to find a substantial deficit. Instead, it was 45 degrees—not perfect, but certainly not substantially restricted. That wasn't the problem. What else would explain his need to add extra rotation if his range was quite adequate? "Could you bring your left arm across your chest?" I asked. Watching him do this, it was obvious that this movement was restricted. I asked him to lie supine on the table and measured his left humeral internal rotation, which was also restricted. "Your back is overcompensating because of your limited arm motion," I said. "Like any work group, when one component does too little, another is forced to do too much." "How's my arm connected to this?" he asked. Demonstrating the swing, I showed him how the left elbow comes across the chest during the backswing. "The muscle limiting that motion is called the infraspinatus," I explained. "It is stretched when you pull your arm across the chest, and then fires to help create the downswing. In your case, it's too tight and doesn't have full length." "It contracts when I pull the club down to the ball?" he asked, demonstrating by swinging the club with his left hand only. "Huh." I gave him a quizzical look. "I spent a lot of time doing left-handed- only swings this summer, trying to get stronger on the downswing," he said. "Maybe I should have added some stretching to the infraspinatus as well! But how is that related to my back?" "When the left arm does not have full range, your backswing will be limited," I explained. "Where can you make up the difference?" "By trying to rotate even farther with the upper back," he answered. "Plus, I added that kick at the end, stressing the back even more." "Exactly," I agreed. "I can treat your back, but to solve the problem we also need to address your shoulder as well. You can't solve a problem until you understand and change the context that created it." Table lessons. Life lessons. Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 20-therapist clinic BodyWork Associates in Champaign, Illinois, and past president of the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit or email him at essential skills | TABLE LESSONS MAT T AYLWARD/UNSPL ASH TAKEAWAY: When you understand the context that created a problem, then you can work to solve it.

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